Point application combined with catgut implantation at acupoint for lung-distention：a clinical study of 122 cases / 国际中医中药杂志

Objective To evaluate the efficacy of point application combined with catgut implantation at acupoint for lung-distention. Methods A total of 122 patients with lung-distension were randomized into a treatment group (62 patients) and a control group (60 patients). The patients in the control group received conventional treatment, and those in the treatment group were additionally treated with point application combined with catgut implantation at acupoint on the basis of the control group for 4 weeks. At 6 months follow-up, pulmonary function including the forced expiratory volume in first second (FEV1) and the percentage of FEV1 to forced vital capacity (FEV1/FVC), the total effective rate and acute exacerbation rate were compared in both groups. Results The total effective rate in the treatment group was significantly higher than that in the control group (98.4%vs. 85.0%;χ2=5.592, P0.05).The FEV1 (treatment group: 71.58% ± 2.23% vs. 59.98% ± 2.19%, t=29.223, P<0.01; control group: 66.99% ± 2.25% vs. 61.03% ± 2.50%, t=13.726, P<0.01) and the FEV1/FVC (treatment group:68.99%± 1.33%vs. 50.77%± 1.45%, t=72.914, P<0.01; control group: 62.67% ± 1.47% vs. 51.89% ± 1.88%, t=34.989, P<0.01) after the treatment were significantly increased compared with before the treatment in both groups and such improvement in the treatment group was greater in the treatment group than that in the control group (FEV1: t=13.726, P<0.01;FEV1/FVC:t=34.989, P<0.01). Conclusion Point application combined with catgut implantation at acupoint can improve lung function and clinical effects in patients with lung-distention.

Terapia celular em doenças pulmonares: existem perspectivas? / Cell therapy in pulmonary diseases: are there perspectives?

A terapia celular poderia ser conceituada de forma ampla e genérica como o emprego de células para tratamento de doenças. Apesar de um número não tão expressivo de relatos tendo o pulmão como objeto de estudo na terapia celular em pacientes humanos, há dados consistentes da literatura, tanto em humanos, quanto em modelos animais,que evidenciam a migração de células-tronco da medula óssea para o pulmão,em diferentes situações experimentais. Esses resultados forneceram o embasamento experimental para o emprego de células-tronco na regeneração do tecido pulmonar em modelos animais. Em nosso laboratório, vários projetos de pesquisa têm sido conduzidos com a finalidade de avaliar a resposta pulmonar (morfológica e funcional) ao tratamento com células-tronco adultas em camundongos com doença pulmonar obstrutiva crônica (DPOC) induzida experimentalmente. Os resultados obtidos, aliados àqueles de outros grupos de pesquisa, permitem aventar a possibilidade de aplicação, a curto prazo, da terapia celular em pacientes com DPOC. Em outra patologia pulmonar, fibrose cística (FC), cuja abordagem terapêutica com células-tronco apresenta aspectos particulares em relação às patologias pulmonares crônico-degenerativas, há avanços promissores e potencialmente interessantes; no entanto, os resultados podem ser considerados incipientes e deve-se assinalar, portanto, que a associação da terapia gênica e celular apresenta-se como uma alternativa possível, mas ainda muito distante quanto à sua consolidação e incorporação como opção terapêutica segura e eficaz em FC. Por outro lado, tendo por embasamento os resultados obtidos em modelos experimentais, é possível postular que a terapia celular com células-tronco hematopoéticas (ou de outras fontes) encerra perspectivas consistentes de aplicação em diversas outras patologias pulmonares humanas, especialmente em DPOC.

Cell therapy can be briefly described as the use of cells in the treatment of diseases. Although the number of scientific reports involving lung and cell therapy in humans is not expressive, there are consistent data, both in humans and animal models. Experiments show the migration of bone marrow stem cells to the lung, in different situations. These results provide the experimental basis for the use of stem cells in the regeneration of the lung tissue in animal models. In our laboratory, several projects have been conducted aiming to evaluate the pulmonary response (morphological and functional) to treatment with adult stem cells in mice with experimentally induced chronic obstructive pulmonary disease. The results obtained, together with those from other research groups, allow us to consider the possibility of application, in the near future, of cell therapy in chronic obstructive pulmonary disease patients. For another disease, cystic fibrosis, cell therapy shows particular aspects in relation to other chronic degenerative pulmonary diseases. In this pathology, there are interesting and promising advances, however, the results are incipient and, thus, it must be said that the association between genetic and cell therapy appears to be a possibility, but still far from being consolidated and incorporated as a safe and effective therapeutic alternative in cystic fibrosis. On the other hand, based on the results obtained in experimental models, it is possible to postulate that cell therapy with hematopoietic stem cells (or from other sources) brings consistent application perspectives in several other human pulmonary diseases, especially in chronic obstructive pulmonary disease.

Programa de trasplante pulmonar en Uruguay: Nuestra experiencia con un centro regional de referencia / Lung transplant program in Uruguay: our experience with a regional reference center

El Uruguay es un país con 3 millones de habitantes que no cuenta con un programa de trasplante pulmonar propio. En este contexto se ha optado por generar un acuerdo para su realización en un centro de referencia regional como la Fundación Favaloro de la República Argentina. En este trabajo se muestra la experiencia de este programa durante 4 años. Hasta el momento se han trasplantado 20% de los pacientes alistados y la mortalidaden lista de espera ha sido elevada. La principal limitante ha sido la dificultad para obtener donantes pulmonares óptimos para el implante. La flexibilización en la selección, con la utilización de donantes marginales o la utilización de donantes en asistolia pueden en el futuro mejorar esta situación.

Uruguay, a country with three million- inhabitants does not have its own lung transplant program. Therefore an agreement has been reached for transplants, to be performed in the regional reference center called Favaloro Foundation in Argentine. The experience of the program for the first four years is presented in this paper. Twenty percent of the waiting list patients have been transplanted so far; the mortality of the patients on the waiting list was high. The main limitation of the program has been the difficulty to get optimal lung donors.The selection of donors who either meet marginally the transplant requirements or are in asystolic arrest will make the program more flexible and may improve current results.

The Relationship between Intraoperative Spirometry and Prognosis of Lung Volume Reduction Surgery in Patients with Severe Emphysema / 대한마취과학회지

BACKGROUND: Lung volume reduction surgery (LVRS) for severe emphysema can significantly improve maximal expiratory flow rates and ameliorate dyspnea on exertion, probably by reducing airway resistance and by reducing hyperinflation with corresponding improvement in inspiratory muscle function. We have recently experienced 12 cases of bilateral LVRS in patients with severe emphysema in an effort to improve pulmonary function. Among these patients we examined the relationship between intraoperative spirometry and prognosis of LVRS. METHODS: Intraoperative total dynamic lung compliance (CT) and % of breath exhaled in one second (V1.0%) obtained immediately pre-lung reduction was compared with immediate post-lung reduction. In addition we also compared a preoperative pulmonary function test (PFT) [FEV1, TLC, and FRC] with 3 month postoperative values. RESULTS: Six of the twelve patients demonstrated post-reduction improvement in dynamic CT and V1.0% during LVRS. These six patients demonstrated an increase in FEV1 and a decrease in TLC, and FRC 3 months after an LVRS. The other six patients without improvement in V1.0% during an LVRS had no change in the PFT three months after an LVRS. CONCLUSIONS: It appears that sidestream spirometry with immediate intraoperative measurement of dynamic CT and V1.0% could play a role in predicting the expected follow-up objective PFT; improvement in both CT and V1.0% may predict significant increases in PFT.

Intraoperative Spirometry during Reduction Pneumoplasty for Emphysema / 대한마취과학회지

BACKGROUND: Surgical resection of severely emphysematous lung tissue can significantly ameliorate shortness of breath, possibly by reducing dynamic airway compression and auto-PEEP. We utilized online spirometry to examine the intraoperative relationship between expiratory flow rate and compliance changes associated with a reduction pneumoplasty. METHODS: Eight surgical patients were anesthetized with IV propofol, isoflurane inhalation and thoracic epidural lidocaine/bupivacaine. A 37 or 39 left double lumen endobronchial tube (DLT) was placed and mechanical ventilation provided with tidal volume set at approximately 10 ml/kg. A Datex UltimaTM spirometer was placed at the proximal end of the DLT. Copies of flow/volume and pressure/volume curves (3 - 10 breaths) were obtained on a digital recorder during closed and open chest conditions, and before and after lung reduction. The mean +/- SD of expired tidal volume (VT), inspiratory plateau airway pressure (Pplat), respiratory rate, % of breath exhaled in 1 sec (V1.0%), and total dynamic compliance (CT) was measured. RESULTS: After a reduction pneumoplasty, CT decreased by an average 23% with open chest and 35% with closed chest conditions. Three subjects showed improved V1.0%, while 5 showed little change or reduced flow, hence no statistically significant change. There was no significant correlation between change in compliance and change in V1.0% (r2 = 0.24, p = 0.22). CONCLSIONS: An emphysematous reduction pneumoplasty reliably reduces lung compliance. However, reduced lung compliance did not reliably predict improved expiratory flow rates after a reduction pneumoplasty. The further reduction in CT with sternal closure may have been due to the return of dynamic airway compression.

Objective in Vivo Quantification of Emphysema by Thin-Section CT: Correlation with Physiologic Findings / 결핵

BACKGROUND: To correlate the emphysema score for quantification of the overall extent of emphysema in both lungs by CT with physiologic findings and 13 get more objective and simple method to assess the extent of em physema. METHOD: Thin-section CT and pulmonary function test(PFT) were performed in 17 patients with emphysema (all males, mean age, 62 years). Emphysema score was obtained as percentage of emphysematous lung area, dividing the total area of the emphysema(voxels with attenuation value less than -880, -900, -920HU, respectively) by the overall area of both lungs(voxels with attenuation value less than -400HU) with highlighting voxels using "Density mask" program. Emphysema score was calculated from whole lung(ESW) sod 5 representative scans(ESR) using "Density mask". Visual emphysema score(ESV) was obtained by visual assessment from 5 representative scans. Correlation of these emphysema scores(ESW, ESR, ESV) and physiologic findings were performed, comparing the ESW with ESR and ESV. RESULTS: ESW had correlation with DLCO(r=0.53-0.64) and FEVl/FVC(r=0.42-0.57) among PFT parameters. ESR had good correlation with ESW and with PFT parameters as well. ESV did not correlate with PFT parameters except DLCO. CONCLUSION: CT quantification of emphysema using "density mask" correlated well with physiologic findings. To assess the severity of emphysema, both ESW and ESR are more reliable than ESV, and ESR is recommended in routine practice as it is objective, simple and reliable.