Treatment of Connective Tissue Diseases-associated Interstitial Lung Disease by the Origin-restoring and Bi （痹）-alleviating Method / 中医杂志

It is believed that the fundamental pathogenesis of the connective tissue diseases-associated interstitial lung disease （CTD-ILD） is kidney essence deficiency， with lung collateral obstruction throughout the disease， and environmental toxin pathogen is the important causative factors for the development of CTD-ILD. This article proposed to restore origin and alleviate bi （痹） for CTD-ILD， for which restoring origin means tonifying the lungs， spleen and kidneys to bank up the roots and consolidate the original qi， with modified Erxian Decoction （二仙汤） plus Liu Junzi Decoction （六君子汤）； alleviating bi means expelling wind and dredging collaterals， and eliminating the mass to restore the smoothness of the lung collaterals， with paired medicines of Chuanshanlong （Dioscorea nipponica）-Dilong （Kalanchoe pinnata）， Vinegar-processed Sanleng （Sparganium stoloniferum）-Vinegar-processed Ezhu （Curcuma zedoaria）， and stem-type medicines， and emphasized on removing the environmental toxin pathogens to facilitate the recovery of healthy qi.

High-resolution Computed Tomography Findings and Serum Biomarker of Subclinical Interstitial Lung Disease in Moderate-to-severe Obstructive Sleep Apnea Patients

Background: Obstructive sleep apnea (OSA) has association with many comorbidities. Based on the postulated hypothesis from few studies, the primary objective of this study was to assess the occurrence of subclinical interstitial lung disease in moderate-to-severe OSA patients. Materials and methods: It was a prospective observational study, conducted at a tertiary care chest institute of India, 43 moderate-to-severe OSA patients diagnosed by level-I polysomnography were enrolled. All the patients underwent detailed clinical examination with high-resolution computed tomography (HRCT) chest, pulmonary function test (PFT), and serum markers MMP-1,7, SP-A, and Krebs von den Lungen-6 (KL-6). Subclinical interstitial lung disease (ILD) was identified based on the two validated measures: high-attenuation areas (HAA), defined as the percentage of imaged lung volume having computed tomography (CT) attenuation between ?600 and ?250 HU and interstitial lung abnormalities (ILA), defined as the presence of ground-glass, reticular abnormality, diffuse centrilobular nodularity, honeycombing, traction bronchiectasis, nonemphysematous cysts, or architectural distortion in at least 5% of nondependent portions of the lung in HRCT chest without respiratory symptoms with preserved lung function. Results: The mean age was 54.33 � 11.5 years with 22 (51%) males. The mean apnea?hypopnea index (AHI) was 42.38 � 27.6 with BMI >30 kg/m2 in 18 (42%) patients. The subclinical ILD was diagnosed in 12 patients. The HRCT finding of ILA was seen in 12 and high-attenuation areas (HAA) in 5 patients. The serum markers were higher in subclinical ILD compared with non-ILD OSA patients, however, only the level of MMP-7 was significantly higher in subclinical ILD patients. Conclusion: It was concluded that subclinical ILD is quite common among OSA patients with HRCT findings seen in nearly 30% of cases. This supports the hypothesis that OSA may be considered as a risk factor of subclinical ILD.

Clinical Trial of Buyang Huanwutang in Treatment of Connective Tissue Disease-associated Pulmonary Fibrosis with Syndrome of Qi Deficiency and Blood Stasis / 中国实验方剂学杂志

ObjectiveTo evaluate the effect and safety of Buyang Huanwutang in treatment of connective tissue disease-associated pulmonary fibrosis in the patients with syndrome of Qi deficiency and blood stasis and explore the possible anti-fibrosis mechanism of Buyang Huanwutang. MethodSixty-six patients with connective tissue disease-associated pulmonary fibrosis with syndrome of Qi deficiency and blood stasis were randomized to receive either Buyang Huanwutang combined with routine therapy or routine therapy for 4 weeks. The primary outcome indicator was change in forced vital capacity （FVC） from the baseline， and the secondary outcome indicators included the changes in percentage of predicted forced vital capacity （FVC%pred）， percentage of forced expiratory volume in first second to predicted value （FEV1%pred）， King's Brief Interstitial Lung Disease （K-BILD） total score， 6 minute walking distance （6MWD）， hydroxyproline （HYP）， matrix metalloproteinase （MMP）， tissue inhibitor of metalloproteinase-1 （TIMP-1）， and transforming growth factor-β （TGF-β） from baseline. Patients in line with the inclusion criteria were included in the primary analysis， and sensitivity analysis was performed after multiple imputation of missing data. Safety set was adopted for safety analysis. ResultThe 66 patients （included in the sensitivity analysis） meeting the inclusion criteria included 34 in the observation group and 32 in the control group， and 60 patients finally received the whole trial intervention （included for primary analysis）. Compared with the baseline， the FVC increased in the observation group and decreased in the control group after intervention （P<0.01）， which was consistent between the sensitivity analysis and the primary analysis. The changes in FVC%pred， FEV1%pred， 6MWD， and K-BILD total score from baseline in the observation group were superior to those in the control group （P<0.01）， with consistent results between the sensitivity analysis and the primary analysis. TIMP-1 in the observation group decreased compared with baseline （P<0.05）， while TIMP-1 in the two groups showed no significant changes from the baseline The observation group outperformed the control group in the changes in HYP， MMP-9， and TGF-β from baseline （P<0.05）. The common adverse events were cough， diarrhea， nausea， rash， and upper gastrointestinal tract infection， the incidence of which showed no statistical difference between the two groups. ConclusionBuyang Huanwutang can improve lung function， motor function， and quality of life in patients with connective tissue disease-associated pulmonary fibrosis and has good safety. The mechanism may be related to the reduction of TGF-β， MMP-9， and TIMP-1 levels and maintaining of MMP-9/TIMP-1 balance.

Acute lung involvement in RA is not always ILD

Rheumatoid arthritis is a systemic inflammatory disorder with diverse extra-articular manifestations including vasculitis,lung disease, inflammatory eye disease and subcutaneous nodule formation. Among these manifestations, lung diseasehas been identified as a primary contributor of morbidity and mortality. The predominance of non-specific interstitialpneumonia pattern has been observed in most forms of connective tissue-associated ILD. Studies have demonstratedthat the usual interstitial pneumonia (UIP) pattern is more prevalent among patients with RA-associated ILD. The extraarticular manifestations have been noted in nearly 50% of the patients, and the lung involvement in majority of thecases.8, 9 This study details the occurrence of lung involvement of viral etiology in RA, which could be misdiagnosed asRA-associated ILD

Clinicoradiological Profile of Patients with Diffuse Parenchymal Lung Disease

The profile of diffuse parenchymal lung disease (DPLD) has mainly been reported from the developed countries; the prevalence and outcome of DPLD is not studied well across India. The aim of this study is to describe the clinical radiological spectrum of various DPLDs from a tertiary care centre of a developing country. Methods: An observational cross-sectional study was carried out in a single tertiary care center in northern India which included 50 consecutive subjects (age >12 years) who had diffuse parenchymal lung diseases. In this study, the clinical, radiological and histological data subjects was collected. Results: Out of the total 50 subjects, mean age was 49.04 years with females constituting 58% of the total. Most common symptoms were gradually progressing dyspnoea (100%) followed by dry cough (76%). The commonest finding on chest radiograph in our series was reticular pattern (78%).The commonest pattern on high-resolution computed tomography was traction bronchiectasis (56%), followed by honeycombing (50%), septal thickening (46%).The commonest cause of DPLD in study was Idiopathic Pulmonary Fibrosis (38) %, followed by connective tissue – interstitial lung disease (CTD-ILD)(26%) and NSIP(12%). Smoking was one of the major risk factor associated with IPF, and 52.6% of patients with IPF were smokers (P<0.001). Conclusion: IPF (38%) was the commonest DPLD seen followed by CTD- ILD and NSIP at a tertiary center in northern India similar to the spectrum reported from developed countries. More studies are required from developing countries to ascertain the spectrum of DPLDs in different geographic

Clinical efficacy of Chenshi Qingfei Decoction on rheumatoid arthritis and interstitial lung disease / 中成药

AIM To explore the efficacy of Chenshi Qingfei Decoction (Pseudostellariae Radix,Ophiopogonis Radix,Adenophorae Radix,etc.) against rheumatoid arthritis and interstitial lung disease (RA-ILD).METHODS Based on Prednisolone,RA-ILD patients were randomly divided into control group and observation group by random number table and randomized block design.The observation group took Chenshi Qingfei Decoction.The treatment course was three months for both groups.Before the treatment,the activity of the disease (DAS28) was assessed and ESR,CRP,RF,CCP were measured.Before and after the treatment,high resolution-CT (HRCT) was conducted and graded,and symptoms and signs were graded.RESULTS After the treatment,the effective rate of cough,expectoration and breath hard in the syndromes of Chinese traditional medicine was 71％ in the observation group and 23％ in the control group (P ＜0.01).The effective rate of improved lung imaging by HRCT was 68％ in the observation group but 13％ in the control group (P ＜0.01).CONCLUSION Based on the immunosuppressive agents therapy in RA,Chenshi Qingfei Decoction can relieve clinical symptoms of cough,expectoration and breath hard,and reduce area and degree of interstitial lung disease by HRCT.

Clinical efficacy of Chenshi Qingfei Decoction on rheumatoid arthritis and interstitial lung disease / 中成药

AIM To explore the efficacy of Chenshi Qingfei Decoction (Pseudostellariae Radix,Ophiopogonis Radix,Adenophorae Radix,etc.) against rheumatoid arthritis and interstitial lung disease (RA-ILD).METHODS Based on Prednisolone,RA-ILD patients were randomly divided into control group and observation group by random number table and randomized block design.The observation group took Chenshi Qingfei Decoction.The treatment course was three months for both groups.Before the treatment,the activity of the disease (DAS28) was assessed and ESR,CRP,RF,CCP were measured.Before and after the treatment,high resolution-CT (HRCT) was conducted and graded,and symptoms and signs were graded.RESULTS After the treatment,the effective rate of cough,expectoration and breath hard in the syndromes of Chinese traditional medicine was 71％ in the observation group and 23％ in the control group (P ＜0.01).The effective rate of improved lung imaging by HRCT was 68％ in the observation group but 13％ in the control group (P ＜0.01).CONCLUSION Based on the immunosuppressive agents therapy in RA,Chenshi Qingfei Decoction can relieve clinical symptoms of cough,expectoration and breath hard,and reduce area and degree of interstitial lung disease by HRCT.

Scleroderma: a case report.

Scleroderma is systemic multi organ autoimmune disorder characterized by hardening of skin. Also known as systemic sclerosis. Estimated annual incidences of approximately 19 cases per million persons. The limited skin disease has a 10-year survival rate of 71%, whereas those with diffuse skin disease have a 10-year survival rate of just 21%. Risk is higher in women than men and peak in individuals aged 30-50 years. It has no definitive treatment. It may be limited or diffuse depending upon manifestations of symptoms or signs affecting internal organs especially lungs, heart, or kidney. We report a case of scleroderma with pulmonary hypertension and interstitial lung disease in our hospital who presented with tightening of skin, joint pain, dysphagia, and breathlessness. On examination skin appeared dark, shiny, and tight, with loss of hair, paraesthesia and digital ulceration. Patient also has history of Raynaud's phenomenon. On investigation, Scl-70 and ANA (antinuclear antibodies) by enzyme immunoassay came positive. HRCT thorax was suggestive of interstitial fibrosis and PFT revealed moderate restriction. On 2D echocardiography, mild pulmonary hypertension was present while barium swallow showed motility disorder involving oesophagus. On view of extensive systemic involvement like skin, respiratory system, gastrointestinal system and heart, we would like to present this rare disorder.

Clinical Profile of Interstitial Lung Disease in Indian Children.

Objective: To describe the clinical spectrum and factors associated with poor short-term outcomes in children with interstitial lung disease (ILD). Design: Retrospective chart review Setting: Pediatric Chest Clinic of a tertiary care hospital Methodology: We retrieved information regarding clinical course and laboratory features of all children diagnosed as ILD between January 1999 and February 2010. Disease severity was assessed using ILD score based on clinical features and SpO2 at the time of initial evaluation. Outcome was assessed after 3 months of initial diagnosis as improved or death/no improvement in symptoms. Results: 90 children (median age, 6.8 years; 62% boys) were diagnosed to have ILD during this period. 46 children were R E S E A R C H P A P E R classified as having ‘definite ILD’ while 44 had ‘possible ILD’. The commonest clinical features at presentation were cough (82.2%), dyspnea (80%), pallor (50%), and crackles (45.6%). 3 children (3.3%) died while 21 (23%) showed no improvement in clinical status on follow-up at 3 months. A higher ILD score (RR 3.72, 95% CI 1.4, 9.9) and lower alkaline phosphatase levels (median [IQR]: 205 [175.2] vs. 360 [245.7]; P=0.006) were found to be significantly associated with worse outcomes. Conclusion: The common clinical features of ILD in our study included breathlessness, cough and hypoxemia. A working diagnosis of ILD can be made with the help of imaging, bronchoscopy, or lung biopsy. A simple score based on clinical findings and pulse-oximetry might predict those children with poor short-term outcome.

The Role of Pharmacoethnicity in the Development of Cytotoxic and Molecular Targeted Drugs in Oncology

The effective and toxic ranges of anticancer drugs are very narrow and, in some cases, inverted. Thus determination of the most appropriate dosage and schedule of administration is crucial for optimal chemotherapy. In common arm trials conducted in Japan and by Southwest Oncology Group (SWOG) that used the same doses and schedules for the administration of carboplatin plus paclitaxel, the frequency of hematological toxicity was significantly higher in the Japanese trials than in the SWOG trial, despite demonstrating similar response rates. The frequency of epidermal growth factor receptor (EGFR) mutations in tumors was significantly higher among East Asian populations, and these populations are also reported to demonstrate a higher response rates to epidermal growth factor receptor tyrosine-kinase inhibitors (EGFR-TKIs). The prevalence of interstitial lung disease induced by treatment with EGFR-TKIs has been shown to be quite high in the Japanese population. Clinical trials of cetuximab against non-small cell lung cancer and of bevacizumab against stomach cancer have shown that these agents are only active in Caucasians. In a trial examining the use of sorafenib after transarterial chemoembolization in Korean and Japanese patients with advanced hepatocellular carcinoma, the compliance and dose intensity of the drug were quite low compared with other trials. Although not only identified pharmacogenomics differences but also differences in social environment, and regional medical care, including pharmacoeconomics strongly influence ethnic differences in treatment response, further identification and understanding of the pharmacogenomics underlying ethnic differences will be essential to timely and reliable global development of new anticancer drugs.

Study on the Expression of ILD Patients and Normal Subjects During Exercise / 医学研究杂志

Objective To study the expression of ILD patients and health men during exercise,furthermore provide the reference of application of exercise test in ILD.Methods Cycle exercise test was used in 36 patients with ILD and 20 normal subjects,The oxygen uptake per minute(VO2),Borg Scale(BS),SpO2,and other index of exercise test were detected.Results Compared with normal subjects,The VO2max in ILD patients was decrease markedly;The BS was increased,SpO2 decreased markedly during exercise.Conclusions The results indicate that the hypoxemia and dyspnea are the limited factors of exercise in the patients with ILD;The capacity of exercise in ILD decrease compare with normal subjects.

Clinical Evaluation of NIPPV in the Treatment of Interstitial Lung Disease Combined with Respiratory Failure / 医学研究杂志

Objective To discuss the effect and possibility of NIPPV in ILD combined with respiratory failure. Methods A total of 37 cases of ILD combined with respiratory failure admitted by our hospital during Feb 2004 to Oct 2007 were divided into treatment group (20 cases) and control group (17 cases). Routine pharmaceutical intervention was adopted in both groups while NIPPV was given in the patients of treatment group. The symptoms、signs and the arterial blood gases were observed and analyzed. Results Among 20 patients,3 gave up treatment , 17 patients were successfully treated with the NIPPV therapy. There were significant improvement of PaCO2、PaO2、pH and respiratory rate ,heart rate after 2h NIPPV. Conclusion NIPPV is an effective method for ILD combined with respiratory failure,which can save the patients life and decrease the complications.