Smoking cessation among rural populations in Beijing / 中国医学科学院学报

<p><b>OBJECTIVE</b>To survey the smoking cessation among rural populations in Beijing.</p><p><b>METHODS</b>One natural village in Beijing suburb was sampled and all the 1901 villagers were surveyed by face-to-face interview to collect information on smoking status and smoking cessation. The potential factors related with smoking prevalence and smoking cessation were analzyed.</p><p><b>RESULTS</b>The response rate was 91.2%. The ever-smoking rate was 35.8%. Among the 621 ever-smokers, 35.5% had tried or were trying to quit smoking. The vast majority (93.9%) of smoking cessation methods was self-service method. The overall rate of abstinence was 12.4%, and the success rate was higher in those groups of elder age, lower educational level, lower income level, having respiratory symptoms, and/or without nicotine dependence. There were 291 responders (46.9%) had the willingness to quit. Responders at older age, having respiratory symptoms, or with nicotine dependence had higher willingness to quit.</p><p><b>CONCLUSIONS</b>The tobacco control efforts in rural areas should be strengthened. In part of motivated intervention, the advice should be given from the family, friends, doctors to young, asymptomatic smokers.</p>

Clinical features of thymic neuroendocrine carcinoma: analysis of 21 cases / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To improve the understanding of thymic neuroendocrine carcinoma (TNC) by retrospective analysis of the clinical data of 21 cases.</p><p><b>METHODS</b>The clinical data of 21 patients with TNC treated in the Peking Union Medical College Hospital from 1998 to 2010 were retrospectively analyzed.</p><p><b>RESULTS</b>There were 12 males and 9 females, with onset age ranging from 13 to 67 years and the mean age of 43 years. The clinical manifestation was diverse, in which the malaise of chest and back accounted for 57.1% (12/21), Cushing's syndrome 33.3% (7/21), multiple endocrine neoplasia type 1 accounted for 4.8% (1/21), pharyngeal malaise 4.8%, superior vena cava syndrome 4.8% (1/21) and asymptomatic patients accounted for 4.8% (1/21). Eighteen of them demonstrated metastasis, in which 13 had metastasis to lymph nodes and local vascular invasion, 9 to lung or pleura, 5 to bone, 1 to liver and 1 was recurred in situ. Twenty of them were treated by surgical resection. Eleven of them received radiotherapy and 9 chemotherapy after surgery. One patient was too severe to endure surgery, and was a treated by chemotherapy only.</p><p><b>CONCLUSION</b>TNC is rare, and its clinical features are complex, with a high level of malignancy. The first choice of treatment is resection. Adjuvant radiotherapy and/or chemotherapy may be applied in patients with metastasis.</p>

The in-vitro effects of arbidol hydrochloride against 2009 new influenza virus A (H1N1) / 中国医学科学院学报

<p><b>OBJECTIVE</b>To detect the in-vitro effects of arbidol hydrochloride against 2009 new influenza virus A (H1N1).</p><p><b>METHODS</b>The activity of arbidol hydrochloride against 2009 new influenza virus A (H1N1) was determined in MDCK cell cultures. Hemagglutination assay, observation of cytopathic effects, RT-PCR and quantitative RT-PCR tests were performed for determination of virus titers. Inhibition concentration 50% and cytotoxic concentration 50% were calculated with Chou's Menu of Dose-Effect Program.</p><p><b>RESULTS</b>Arbidol hydrochloride showed low cytotoxicity (cytotoxic concentration 50%>100 μmol/L)and significant anti-2009 new influenza virus A (H1N1) activity in cell cultures. Inhibition concentration 50% were (5.5 ± 0.9), (3.4 ± 0.8), and (1.5 ± 0.2) μmol/L in hemagglutination assay, cytopathic effect test, and quantitative RT-PCR assay, respectively.</p><p><b>CONCLUSION</b>Arbidol has low cytotoxicity and high anti-virus activity and can effectively trigger the activities of interferon and immune response, and therefore can be a valuable anti-influenza virus drug.</p>

Inactivation of mammalian target of rapamycin (mTOR) by rapamycin in a murine model of lipopolysaccharide-induced acute lung injury / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>The mammalian target of rapamycin (mTOR) pathway, a key cellular signaling pathway associated with various cellular functions, has distinct roles in the inflammatory process. In this study, the mTOR inhibitor rapamycin (Rapa) was used to test whether inhibition of mTOR activation attenuates lipopolysaccharide (LPS)-induced acute lung injury (ALI) in a murine model.</p><p><b>METHODS</b>Mice pretreated with Rapa or vehicle were given LPS intratracheally. Local cell numbers and inflammatory cytokines present in the bronchoalveolar lavage fluid (BAL), wet-to-dry weight ratio, histopathology of the lungs, and survival were evaluated.</p><p><b>RESULTS</b>The phosphorylation of S6, a major downstream target of mTOR, had a 3-fold increase in lung tissue after LPS stimulation, but the increase was blocked by Rapa. Rapa reduced the levels of TNF-α (LPS vs. LPS + Rapa, (1672.74 ± 193.73) vs. (539.17 ± 140.48) pg/ml, respectively; P < 0.01) and IL-6 (LPS vs. LPS + Rapa: (7790.88 ± 1170.54) vs. (1968.57 ± 474.62) pg/ml, respectively; P < 0.01) in the BAL fluid. However, Rapa had limited effects on the overall severity of ALI, as determined by the wet-to-dry weight ratio of the lungs, number of neutrophils in the BAL fluid, and changes in histopathology. In addition, Rapa failed to reduce mortality in the LPS-induced ALI model.</p><p><b>CONCLUSIONS</b>We confirmed that mTOR was activated during LPS-induced ALI and strongly inhibited by Rapa. Although Rapa reduced the levels of the mediators of inflammation, the overall severity and survival of the ALI murine model were unchanged.</p>

The St. George's Respiratory Questionnaire in lymphangioleiomyomatosis / 中国医学科学杂志(英文版)

<p><b>OBJECTIVE</b>To examine the correlation between the health-related quality of life measured by the St. George's Respiratory Questionnaire (SGRQ) and the commonly used physiological measures in lymphangioleiomyomatosis (LAM).</p><p><b>METHODS</b>This study retrospectively analyzed the SGRQ scores and other measures (the Borg scale of breathlessness at rest, 6-minute walking distance, blood oxygen levels, and pulmonary function) of patients diagnosed and confirmed with LAM. Altogether 38 patients between June 2007 and November 2009 were included.</p><p><b>RESULTS</b>The mean values of the SGRQ three components (symptoms, activity, and impacts) and total scores in the LAM patients were 46.95 +/- 28.90, 58.47 +/- 25.41, 47.89 +/- 29.66, and 51.11 +/- 26.35, respectively. The SGRQ total or component scores were correlated well with the Borg scale of breathlessness, 6-minute walking distance, partial pressure of oxygen in arterial blood, spirometry and diffusion capacity of lung. There were poor correlations between SGRQ score and residual volume or total lung capacity. In our preliminary observation, sirolimus improved the SGRQ total and three component scores and the Borg scale of breathlessness significantly after 101-200 days of treatment (n = 6).</p><p><b>CONCLUSIONS</b>The SGRQ score in LAM is correlated well with physiological measures (Borg scale of breathlessness, 6-minute walking distance, blood oxygen levels, and pulmonary function tests). The SGRQ could therefore be recommended in baseline and follow-up evaluation of patients with LAM. Treatment with sirolimus, an inhibitor of mammalian target of rapamycin, may improve the quality of life and patient's perception of breathlessness in LAM.</p>

A new health-related quality of life questionnaires-chronic obstructive pulmonary disease assessment test / 中国医学科学院学报

Chronic obstructive pulmonary disease (COPD) is a major public health problem with high prevalence and mortality. A simple and effective tool for COPD assessment is urgently needed in clinical practice. The COPD Assessment Test is a newly developed questionnaire for assessing and monitoring COPD. This simple, highly sensitive, and highly reliable in assessing the patients quality of life and providing information concerning the severity of disease, and therefore can be widely applied.

Role of glucocorticoid receptor and nuclear factor-kappaB in patients with stable chronic obstructive pulmonary disease / 中国医学科学院学报

<p><b>OBJECTIVE</b>To explore the expressions of glucocorticoid receptor (GCR) and nuclear factor-kappaB (NF-kappaB) in patients with stable chronic obstructive pulmonary disease (COPD).</p><p><b>METHODS</b>Bronchial biopsies and blood specimens were obtained from 8 smokers with stable COPD (COPD group) and 8 nonsmokers with normal lung function (control group). The expressions of NF-kappaB and GCR in nucleus protein of bronchial biopsies and peripheral blood lymphocyte from these two groups were examined by Western blot.</p><p><b>RESULTS</b>The expressions of GCR in nuclear protein of peripheral blood lymphocyte and the bronchial biopsies, especially in bronchi, were significantly lower in COPD group than in control group (P<0.05, P <0.01). Also, the expressions of NF-kappaB in nuclear proteins of the bronchial biopsies and peripheral blood lymphocyte were significantly higher in COPD group than in control group (P<0.05). The expressions of NF-kappaB and GCR were significantly higher in bronchial biopsies than in peripheral blood lymphocyte in both groups (P<0.05, P<0.01).</p><p><b>CONCLUSION</b>Chronic inflammation, especially airway inflammation, still exists in patients with stable COPD, as suggested by the different expressions of GCR and NF-kappaB between COPD patients and normal controls.</p>

Characteristics of vibration response imaging in chronic obstructive pulmonary disease / 中国医学科学院学报

<p><b>OBJECTIVE</b>To explore the characteristics of vibration response imaging (VRI) in chronic obstructive pulmonary disease (COPD).</p><p><b>METHODS</b>Sixty-three COPD patients received lung function test (LFT) and VRI examination before and after inhalation of bronchodilator. As the control group, 66 healthy volunteers received LFT and VRI examinations. We defined VRI results as quantitative lung data (QLD), crack counts, and image grade.</p><p><b>RESULTS</b>The results of control group were: QLD of right lung (45.1 +/- 5.9%), mean crack counts 0.1, and mean image grade 0.9. After inhalation of bronchodilator, the VRI results of COPD group were: QLD of right lung (51.0 +/- 12.1)%, mean crack counts 2.7, and image grade 4.2 +/- 1.9. The results between control group and COPD group were significantly different (P < 0.01). The VRI results were similar before and after inhalation of bronchodilator in COPD group (P > 0.05). After inhalation of bronchodilator, there was a linear relationship between VRI image grade and FEV1% (r = 0.31, P = 0.01). The model of the linear regression was: y = 63.85 -2.95 x (y: 100 x FEV1%, x: VRI image grade).</p><p><b>CONCLUSIONS</b>The VRI results differ between COPD patients and healthy people. The VRI results are stable after inhalation of bronchodilator in COPD patients, which may be helpful in the diagnosis of COPD. The VRI image grade after inhalation of bronchodilator is useful to assess the degree of obstruction.</p>

Economic analysis in admitted patients with acute exacerbation of chronic obstructive pulmonary disease / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>The socio-economic burden of acute exacerbation of chronic obstructive pulmonary disease (AECOPD) in Beijing is not fully understood. The study investigated the hospitalization cost in patients with AECOPD and the associated factors.</p><p><b>METHODS</b>A multi-center, retrospective study was conducted in the four hospitals in Beijing including two level III hospitals and two level II hospitals. Patients with AECOPD admitted to the hospitals between January and December in 2006 were enrolled. The hospitalization cost and its relationship with disease severity and treatment were analyzed.</p><p><b>RESULTS</b>Totally 439 patients were enrolled with 294 men (67.0%) and a mean age 73.4 years. The mean hospital stay was 20.7 days. A total of 204 patients (46.5%) had respiratory failure, 153 (34.9%) with cor pulmonale, 123 (28.0%) with coronary artery disease, 231 (52.6%) with hypertension, 70 (15.9%) with cerebrovascular disease and 32 (7.3%) with renal failure. The percentage of drug cost to total cost was the highest (71.2%), followed by laboratory cost (16.7%), therapy cost (9.7%), oxygen cost (7.3%), radiology cost (4.5%), examination cost (4.5%), bed cost (4.1%). Correlation analysis showed that cost was positively correlated with age, hospitalization days, co-morbidities such as respiratory failure and cor pulmonale, hypertension. Three hundred and twenty-one patients were further analyzed. The hospitalization cost increased in patients with non-invasive ventilation (P < 0.01), invasive mechanical ventilation (P < 0.01), ICU stay (P < 0.01), antibiotics (P < 0.05), systemic steroids (P < 0.01), and poor prognosis (P < 0.05). Correlation analysis showed that the hospitalization cost was negatively correlated with percentage forced expiratory volume in 1 second (FEV(1)%) (r = -0.149, P < 0.05), pH (r = -0.258, P < 0.01), and PaO(2) (r = -0.131, P < 0.05), positively correlated with PaCO2 (r = 0.319, P < 0.01), non-invasive positive pressure ventilation (r = 0.375, P < 0.01) and duration (r = 0.463, P < 0.01), invasive mechanical ventilation (r = 0.416, P < 0.01) and duration (r = 0.511, P < 0.01), ICU stay (r = 0.390, P < 0.01) and duration (r = 0.650, P < 0.01), antibiotics (r = 0.140, P < 0.05) and systemic steroids (r = 0.202, P < 0.01).</p><p><b>CONCLUSIONS</b>AECOPD had a great impact on healthcare resources utilization. Disease severity, use of non-invasive or invasive ventilation, ICU stay and usage of antibiotics and systemic steroids were the major determinants of hospitalization cost. Long-term regular treatment aimed at reducing the frequency of acute exacerbation will lower the social and economic burden of chronic obstructive pulmonary disease (COPD).</p>

Transbronchial needle aspiration in the diagnosis of bronchogenic carcinoma with enlarged mediastinal and /or hilar lymph nodes / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To evaluate the role of transbronchial needle aspiraion (TBNA) in the diagnosis of bronchogenic carcinoma with enlarged mediastinal and/or hilar lymph node.</p><p><b>METHODS</b>Patients with mediastinal and/or hilar lymphoadenopathy proven by CT scan were eligible for TBNA as reported by WANG. All specimen was directly and instantly smeared for cytological examination.</p><p><b>RESULTS</b>From June 2004 to May 2006, 77 such patients were examined: including 38 lung cancers, 35 lung benign diseases and 4 without definite diagnosis. All TBNA procedures were successfully carried out in 222/225 ( 98.7%). Positive TBNA rate was 81.6% (31/38) in patients who had been proven to suffer from bronchogenic carcinoma. The diagnosis of lung cancer was confirmed via TBNA only in 9 patients. A total of 63 lymph nodes in the 38 lung cancer patients were aspirated by TBNA with a positive rate of 65.1% (41/63). The sensitivity of TBNA was significantly correlated with pathology type, lymph node size and experience of the cytologist. Severe complications were rare except small amount of bleeding at the TBNA site (52/77, 67.5%).</p><p><b>CONCLUSION</b>TBNA is quite safe and helpful in diagnosis and staging of bronchogenic carcinoma, yet it is not helpful in diagnosis of benign lung diseases.</p>

Respiratory manifestations in amyloidosis / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Amyloidosis is a collection of diseases in which different proteins are deposited. Amyloid deposits occur in systemic and organ-limited forms. In both systemic and localized forms of the disease, lung can be involved. The aim of this study was to explore the different respiratory manifestations of amyloidosis.</p><p><b>METHODS</b>Chest radiology, clinical presentations, bronchoscopic/laryngoscopic findings and lung function data of 59 patients with amyloidosis involving respiratory tract collected during January 1986 to March 2005, were analysed.</p><p><b>RESULTS</b>Of the 16 cases with localized respiratory tract amyloidosis, 8 had the lesions in the trachea and the bronchi, 2 in the larynx and the trachea, 5 in the larynx and/or the pharynx, and 1 in the lung parenchyma. Of 43 systemic amyloidosis with respiratory tract involvement, 3 had the lesions in bronchi, 13 in lung parenchyma, 33 in pleura, 8 in mediastina, 1 in nose and 1 in pharynx. Chest X-rays were normal in most cases of tracheobronchial amyloidosis. CT, unlike chest X-rays, showed irregular luminal narrowing, airway wall thickening with calcifications and soft tissue shadows in airway lumen. Localized lung parenchymal amyloidosis presented as multiple nodules. Multiple nodular opacities, patch shadows and reticular opacities were the main radiological findings in systemic amyloidosis with lung parenchymal involvement. In pleural amyloidosis, pleural effusions and pleural thickening were detected. Mediastinal and/or hilar adenopathy were also a form of lung involvement in systemic amyloidosis. The major bronchoscopic findings of tracheobronchial amyloidosis were narrowing of airway lumen, while nodular, 'tumour like' or 'bubble like' masses, with missing or vague cartilaginous rings, were detected in about half of the patients.</p><p><b>CONCLUSIONS</b>Localized respiratory tract amyloidosis mostly affects the trachea and the bronchi. Chest X-rays are not sensitive to detect these lesions. Systemic amyloidosis often involves lung parenchyma and the pleura. Open lung biopsy or pleural biopsy should be performed for the diagnosis.</p>

Diagnosis and differential diagnosis of airway-centered interstitial fibrosis / 中国医学科学院学报

<p><b>OBJECTIVE</b>To describe a form of interstitial lung disease pathologically characterized by small airway-centered interstitial fibrosis (ACIF).</p><p><b>METHODS</b>We analyzed the clinical, pulmonary functional, radiographic, and histologic characteristics of one ACIF case in Peking Union Medical College Hospital and reviewed 12 cases in literatures.</p><p><b>RESULTS</b>Clinically, patients presented with chronic cough and progressive dyspnea. Pulmonary function tests showed restrictive ventilatory pattern. Bronchoalveolar lavage showed a mild increase in lymphocytes in most cases. Chest radiography revealed diffuse reticulonodular infiltrates, with thickening of the bronchial walls and surrounding fibrosis. The key finding in histopathology was a distinctive pattern of ACIF centered on membranous and respiratory bronchioles.</p><p><b>CONCLUSIONS</b>ACIF is a disease that do not fit into any known category of interstitial lung disease. Whether it is a unique disease remains to be determined.</p>

Pathogenesis of cigarette smoke-induced chronic obstructive pulmonary disease and therapeutic effects of glucocorticoids and N-acetylcysteine in rats / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>T lymphocytes and matrix metalloproteinase (MMP) play an important role in the pathogenesis of chronic obstructive pulmonary disease (COPD). However, the details of the mechanisms involved are unclear. The aims of this study were to investigate the changes in interferon-gamma (IFN-gamma), interleukin-4 (IL-4), MMP-9, MMP-12 and tissue inhibitor of metalloproteinase-1 (TIMP-1) levels in a smoke-induced COPD rat model and the therapeutic effects of glucocorticoids and N-acetylcysteine.</p><p><b>METHODS</b>Male Wistar rats were exposed to cigarette smoke for 3.5 months. Budesonide or N-acetylcysteine was given in the last month. Lung function was measured at the end of the study. IL-4 and IFN-gamma levels were then determined in bronchoalveolar lavage fluid and lung tissue samples by enzyme-linked immunosorbent assay. The expression of MMP-9, MMP-12 and TIMP-1 mRNA in lung tissue was determined by RT-PCR.</p><p><b>RESULTS</b>In comparison with the control group, rats exposed to smoke had a significant increase in IL-4 and MMP-12 levels and a significant decrease in IFN-gamma levels. In addition, the IL-4/IFN-gamma ratio and MMP-12/TIMP-1 ratio were both higher. At the same time, the ratio of forced expiratory volume in 0.3 second to forced vital capacity (FEV(0.3)/FVC) and dynamic compliance (C(dyn)) decreased and expiratory resistance (Re) increased. By measuring pulmonary mean linear intercept and mean alveolar numbers, obvious emphysematous changes were observed in the smoke exposed group. After treatment with budesonide, IL-4 and MMP-12 decreased and IFN-gamma increased. The IL-4/IFN-gamma ratio returned to normal, though the MMP-12/TIMP-1 ratio remained unchanged. FEV(0.3)/FVC was significantly higher and Re was significantly lower than that in untreated smoke exposed rats. No significant differences were found in pulmonary mean linear intercept and mean alveolar numbers. After treatment with N-acetylcysteine, IFN-gamma increased and the IL-4/IFN-gamma ratio decreased. The MMP-12/TIMP-1 ratio remained unchanged. Re and C(dyn) both improved obviously. No significant differences were found in pulmonary mean linear intercept and mean alveolar numbers. Correlation analysis indicated that IL-4 levels in lung tissue correlated negatively with FEV(0.3)/FVC (r = -0.53, P = 0.001), IFN-gamma levels in lung tissue correlated negatively with Re (r = -0.63, P = 0.000) and positively with C(dyn) (r = 0.44, P = 0.009), and that the IL-4/IFN-gamma ratio correlated negatively with FEV(0.3)/FVC (r = -0.44, P = 0.010) and C(dyn) (r = -0.42, P = 0.015) and positively with Re (r = 0.58, P = 0.000). Finally, MMP-12 correlated negatively with FEV(0.3)/FVC (r = -0.36, P = 0.026).</p><p><b>CONCLUSIONS</b>Cigarette smoke exposure increases IL-4 levels and decreases IFN-gamma levels. This may be the result of smoke-induced changes in lung function. Budesonide can mitigate the changes in IL-4 and IFN-gamma levels induced by smoke exposure. N-acetylcysteine has no effect on IL-4, but increases IFN-gamma levels and brings the IL-4/IFN-gamma ratio back to normal. Cigarette smoke can also promote MMP-12 gene expression and elevate the MMP-12/TIMP-1 ratio. This effect may play a role in smoke-induced emphysema. Budesonide and N-acetylcysteine do not alter the MMP-12/TIMP-1 ratio in this study when given in the late phase of smoke exposure.</p>

Clinical analysis of lymphangioleiomyomatosis / 中国医学科学院学报

<p><b>OBJECTIVE</b>To improve the diagnosis and treatment of lymphangioleiomyomatosis (LAM).</p><p><b>METHODS</b>The clinical data of four cases of lymphangioleiomyomatosis diagnosed in our hospital were analyzed and corresponding literature was reviewed.</p><p><b>RESULTS</b>Lymphangioleiomyomatosis, a rare disorder of unknown cause that occured almost exclusively in women of child bearing ages, was characterized microscopically by atypical smooth muscle proliferation. It could occur as a sporadic diseases or as a part of tuberous sclerosis complex (TSC). LAM was associated with progressive dyspnea, recurrent spontaneous pneumothoraces, chylous effusions, and hamartomas.</p><p><b>CONCLUSION</b>Clinicians should be familiar with the characteristics of LAM so that diagnosis and treatment can be made earlier to improve the prognosis.</p>

Efficacy and safety of arbidol in treatment of naturally acquired influenza / 中国医学科学院学报

<p><b>OBJECTIVE</b>To evaluate the efficacy and safety of Arbidol in the treatment of naturally acquired influenza.</p><p><b>METHODS</b>A randomized, double-blinded, placebo controlled trial was conducted. Subjects were enrolled. The inclusion criteria included: aged 18 to 65 years, presented within 36 hours of onset of influenza symptoms; and had documented temperature of 37.8 degrees C or higher during an influenza outbreak in the community. Individuals were randomly divided Arbidol group (200 mg three times daily for 5 days) or placebo group.</p><p><b>RESULTS</b>Totally 232 individuals were recruited and received medication and follow-up. All of them were qualified to be analyzed for safety as intent-to-treat population (ITT) (113 Arbidol, 109 placebo). Twenty-two (9.48%) were during follow-up or refused to continue the trial, and 210 completed as schecule and identified as PP population (102 Arbidol, 108 placebo). Totally 125 individuals were identified as influenza-infected through laboratory test, which was defined as PPi population (59 Arbidol, 66 placebo). In PPi population, the cumulative alleviation proportion of Arbidol group was significantly higher than that of placebo group. The median duration of illness was 72.0 hours (95% confident interval (CI) 66.00-78.00 hours) in Arbidol group and 96.0 hours (95% CI 87.46-104.54 hours) in placebo group. The median area under the curve (AUC) of decreased total score were significantly higher in Arbidol group than in placebo group, which were 780.00 and 684.00 score-hours respectively. For PP population, similar results were seen. Adverse events reported were similar in Arbidol group and in placebo group. The main adverse events were gastrointestial symptoms and increased transaminase.</p><p><b>CONCLUSION</b>Arbidol was effective and well tolerated in the treatment of early naturally acquired influenza.</p>

Clinical diagnosis, treatment and prognosis of elderly SARS patients / 中国医学科学院学报

<p><b>OBJECTIVE</b>To discuss the clinical manifestations, therapeutic strategy and prognosis of patients with severe acute respiratory syndrome (SARS) older than 60 years.</p><p><b>METHODS</b>Elderly patients diagnosed as SARS in Peking Union Medical College Hospital were compared with younger patients.</p><p><b>RESULTS</b>Twenty-four elderly patients and 53 younger patients were analysed. Elderly patients had more coexisting conditions, such as hypertension, diabetes, coronary heart disease, and renal disease than control group (P < 0.05). Rate of respiratory failure in elderly patients was higher than that in control group (P < 0.05). Elderly patients had more respiratory symptoms, such as cough, sputum, and shortness of breath (P < 0.05). Rate of lymphocytopenia and thrombocytopenia in elderly patients was higher than that in control group. All patients were given ribavirin and antibiotics. More patients in elderly group were given 3rd generation cephalosporin and imipenem. Mortality rate in elderly group was higher than that in control group (33.3% vs 3.8%, P < 0.05). Univariate analysis showed that age, respiratory failure, and thrombocytopenia were risk factors of death, but logistic analysis did not find any independent risk factor.</p><p><b>CONCLUSIONS</b>Though the elderly patients have a lower morbidity of SARS, they have more coexisting conditions. The therapy of elderly patients is more difficult than that of control group, and the mortality in elderly patients is high.</p>

Assessment of pulmonary function in SARS patients during the convalescent period / 中国医学科学院学报

<p><b>OBJECTIVE</b>To investigate the pulmonary function in severe acute respiratory syndrome (SARS) patients during the convalescent period.</p><p><b>METHODS</b>Followup 89 outpatients of SARS. The follow-up study included interview, physical examination, and pulmonary function test.</p><p><b>RESULTS</b>The interval between hospital discharge and functional assessment was 1.75 +/- 0.53 months (0.5-3.4 months). Mild to moderate abnormalities in pulmonary function were found in 48 patients (53.9%). Diffusion capacity for carbon monoxide (DLco) was impaired in 38 patients (42.7%); in 7 patients (7.9%), lung function was restrictive defect combined DLco impairment; Other patterns of impairment were revealed in 3 patient. Dyspnea during acute phase and CT during the convalescent period were found to have significant influences on DLco and total lung capacity (TLC).</p><p><b>CONCLUSIONS</b>Diffusing capacity impairment as well as restrictive defect persist in convalescence SARS.</p>

Assessment of health-related quality of life in cured SARS patients / 中国医学科学院学报

<p><b>OBJECTIVE</b>To assess the quality of life in cured patients with severe acute respiratory syndrome (SARS).</p><p><b>METHODS</b>One hundred and nineteen SARS outpatients, including 64 men and 55 women, with mean age (34.1 +/- 11.4) years and average days of discharge from hospital (28.0 +/- 12.8) days, were assessed by the St George's respiratory questionnaire (SGRQ), and 72 patients with spirometry test.</p><p><b>RESULTS</b>The patients had a moderately degree physiological impairment and increased SGRQ score. Scores of all four part of SGRQ correlated significantly with diffuse capacity of the lung for carbon monoxide/pre (DLco%). The correlation coefficients between the activation, impaction, total score, and diffuse capacity of the lung for carbon monoxide/alveolar ventilation/pre (DLco/Va%) were resembled (r = 0.47-0.54, P < 0.01). There was a significant relationship between the score of SGRQ and patients age, and gender. The time leaving hospital only had a significant relationship with the symptom score of SGRQ.</p><p><b>CONCLUSIONS</b>SGRQ is a sensitive tool for assessing quality of life in cured SARS patients. The cured SARS patients' quality of life decrease moderately.</p>

Thoracic high resolution CT findings of 100 SARS patients in convalescent period / 中国医学科学院学报

<p><b>OBJECTIVE</b>To study thoracic high resolution CT findings of severe acute respiratory syndrome (SARS) patients in convalescent period and the relationship between the features with laboratory and pulmonary function results.</p><p><b>METHODS</b>All the 100 SARS patients who had been discharged from hospital for about 2 months underwent thoracic high resolution CT examinations. Among them, 65 also had laboratory results and 91 underwent examinations of pulmonary function.</p><p><b>RESULTS</b>Forty-nine SARS patients (49.0%, 49/100) in convalescent period still had abnormal findings in CT examination. And ground-glass opacification (95.9%, 47/49) and reticular opacification (59.2%, 29/49) were common. There was no significant difference in the level of lymphocytes and CD4 cells among groups divided according to severity of CT findings (P > 0.01). Diffusing capacity for carbon monoxide (DLco%) of level 2 and 3 were statistically lower than that of level 0 (P < 0.01).</p><p><b>CONCLUSIONS</b>The features of CT findings of SARS patients in convalescent period are not the same as those of patients in period of apparent manifestation. The high resolution CT can reflect pulmonary diffusing function to some degree.</p>