ABSTRACT
<p><b>BACKGROUND</b>In our clinical practice we have been attracted by a group of patients with airway aspergillosis who have airway obstruction; we termed the condition as pseudomembranous necrotizing tracheobronchial aspergillosis (PNTA). In this study we analyzed the clinical data from patients with PNTA, so as to guide the diagnosis and treatment of the disease.</p><p><b>METHODS</b>A total of 16 PNTA patients were treated in Changhai Hospital from January 2000 to January 2009. Their clinical data, including the demographic information, clinical symptoms, imaging findings, bronchoscopy findings, treatment strategies and efficacy, and prognosis, were retrospectively analyzed.</p><p><b>RESULTS</b>All 16 patients were found to have primary systemic immunodeficiency diseases and/or damage of the focal airways. Nine patients (9/16, 56.3%) had pulmonary and tracheobronchial tumors, 5/16 (31.3%) had tracheobronchial involvement secondary to non-pulmonary tumors, and 2/16 (12.5%) had lung transplantation. The most common causes of PNTA included local radiotherapy (10/16, 62.5%), repeated chemotherapy (7/16, 43.8%) and recurrent intervention therapy by bronchoscope (4/16, 25.0%). Aspergillus fumigatus was the most frequent pathogen (62.5%, 10/16). The main clinical manifestations included progressive dyspnea (14/16, 87.5%) and irritable cough (12/16, 75.0%). The trachea was involved in 9/16 patients (56.3%), right main bronchus in 10/16 (62.5%). All 16 patients were treated with systemic anti-aspergillosis agents, local anti-aspergillosis agents with amphotericin B inhalation and direct perfusion of amphotericin B by bronchoscope, and interventional treatment by bronchoscope to ensure an unobstructed airway. The total efficiency was 31.3%.</p><p><b>CONCLUSIONS</b>PNTA is an infectious disease caused by aspergillus and it mainly involves the trachea, primary bronchus and segmental bronchus. A. fumigatus is the most common pathogen. PNTA can pose a severe clinical threat and often occurs after systemic immunodeficiency and/or local airway damage, with the main symptoms including dyspnea and irritable cough. Bronchoscopic findings supply the main evidence for diagnosis of PNTA. Treatment of PNTA is difficult and requires a long course. Systemic and local anti-aspergillosis agents plus bronchoscopy debridement can improve the prognosis of the disease.</p>
Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Amphotericin B , Therapeutic Uses , Antifungal Agents , Therapeutic Uses , Aspergillosis , Diagnosis , Drug Therapy , Bronchoscopy , Echinocandins , Therapeutic Uses , Itraconazole , Therapeutic Uses , Lipopeptides , Lung Diseases, Fungal , Diagnosis , Drug Therapy , Pyrimidines , Therapeutic Uses , Triazoles , Therapeutic Uses , VoriconazoleABSTRACT
Objective To observe the expression of YKL-40 protein in the pulmonary tissues of rats with bleomycin-induced pulmonary fibrosis (PF). Methods The PF model group was induced with intratracheal instillation of bleomycin solution (7. 5 mg/kg) and the control group was treated with normal saline. On day 7, 14, 21 after bleomycin challenge, rats were sacrificed and the pulmonary tissues were harvested. H-E staining, Masson staining and Szapiel score were employed to determine alveolitis and pulmonary fibrosis. Expressions of YKL-40 in lung tissues were detected by real-time RT-PCR, Western blotting analysis and immunohistochemistry method. Results Bleomycin instillation induced alveolitis in the lung of rats, with inflammation score being significantly higher on day 7 (2. 8 ± 0. 45, P<0. 01) and on day 21 (1. 8 ± 0. 84, P<0. 05) compared with that of control group (0. 42± 0. 25). Pulmonary fibrosis degrees in model group was significantly higher on day 14 (1.7 ± 0.73, P<0.05) and on day 21 (2.9± 0.56, P<0. 01) compared with that of control group (0.2 ± 0.45). YKL-40 mRNA (YKL-40/p-actin) expression was significantly increased on day 7 (3. 71 ± 0. 25) after bleomycin treatment compared with the control group (P<0. 05). Western blotting analysis showed that YKL-40 protein expression was significantly increased on day 14(0. 56 ±+ 0. 24,P<0. 05) and on day 21(1. 15 ± 0. 19, P<0. 01) after bleomycin treatment compared with the control group (0. 23 ± 0. 07). The results of immunohistochemistry showed that bleomycin up-regulated YKL-40 expression in a time-dependent manner, and YKL-40 expression was mainly located in the smooth muscle cells, alveolar macrophages, alveolar epithelium and fibroblasts. Conclusion YKL-40 expression may contribute to the pulmonary fibrosis, and may participate in the pathogenesis of pulmonary fibrosis.
ABSTRACT
Aspergillus tracheobronchitis is the generic term for all the diseases caused by planting and growing of Aspergillus in the airway, mainly including invasive Aspergillus tracheobronchitis, ulcerative Aspergillus tracheobronchitis, pseudomembranous necrotizing Aspergillus tracheobronchitis and tracheobronchial aspergilloma. Aspergillus tracheobronchitis is frequently seen in populations with immunodeficiency accompanied with local airway damages. This article reviews the pathogenesis, clinical symptoms, imagining findings, diagnosis, treatment and prognosis of the disease, and the clinical features of populations with impaired general immune function.
ABSTRACT
<p><b>BACKGROUND</b>Genetic variability in the renin-angiotensin-aldosterone system may modify renal responses to injury and disease progression. The angiotensin I-converting enzyme (ACE) gene insertion/deletion (I/D), the angiotensinogen (AGT) gene, M235T, the aldosterone synthase (CYP11B2) gene, C-344T, and the angiotensin II type 1 receptor (AT1R) gene, A1166C, have been shown to be associated with IgA nephropathy (IgAN) and its progression. We determined the presence of these polymorphisms in 130 Chinese patients with IgAN, including 47 patients with end-stage renal disease (ESRD) and 120 healthy Chinese subjects, to assess their impact on the susceptibility to disease and the liability of progression to ESRD.</p><p><b>METHODS</b>Genotyping was performed with DNA isolated from peripheral leucocytes using polymerase chain reaction amplification of the polymorphic sequence, restriction enzyme digestion, and separation and identification of DNA fragments. Clinical data from renal biopsies were collected.</p><p><b>RESULTS</b>ACE, AGT, CYP and AT1R genotype distributions were similar in patients with IgAN and in controls. Comparing patients with ESRD (IgAN-ESRD) and those without ESRD (IgAN-non ESRD), there was a significant increase only in the ACE DD genotype (P < 0.05) among the four gene polymorphisms. There was significant dominance of the male (P < 0.05), more marked hypertension (P < 0.01), proteinuria (P < 0.01) and increased serum creatinine during renal biopsy (P < 0.01) in the IgAN-ESRD group.</p><p><b>CONCLUSION</b>Among the ACE, AGT, AT1R and CYP gene polymorphisms, only the DD genotype may predispose the individual to increased risk of progression to ESRD in the Chinese population.</p>