Quantitative detection of the KRAS gene mutation in circulating tumor DNA for patients with colorectal cancer / 基础医学与临床

Objective To establish a liquid biopsy technique of KRAS gene G12D mutation and to assess its diagnostic value. Methods KRAS G12D mutation was analyzed by ddPCR in plasma DNA from 52 colorectal cancer patients and compared that of to 80 healthy subjects. KRAS gene sequencing in cancerous tissue of colorectal cancer patient being set as a golden standard, we evaluated the accuracy of ddPCR and analyzed the correlation between G12D mutation rate, plasma concentration;and their clinical manifestations in CRC. Results ddPCR indicated that KRAS G12D mutation rate and concentration(26.92％, 81.5 copies/mL) in the plasma samples of colorectal cancer patients were significantly higher than that of healthy subjects (8.75％, 16 copies/mL). Colorectal cancer patients with highly differentiated adenocarcinoma showed a significantly higher number of mutant copies than medium and low differentiated adenocarcinoma(P＜0.05);M2 patients had a significantly higher number of mutant copies than N1 and NO patients (P＜0.05);The concordance rate of KRAS gene mutation between cancerous tissue and plasma ctDNA was 87.50％ in CRC.Conclusions ddPCR is a fast, noninvasive and accurate method for plasma testing of ctDNA, and the test results could be used to monitor the course of the disease and as clinical guidelines.

Chronic obstructive pulmonary disease assessment test score correlated with dyspnea score in a large sample of Chinese patients.

BACKGROUND: The chronic obstructive pulmonary disease assessment test (CAT) is an easy to use health-related quality of life questionnaire, the modified Medical Research Council (mMRC) dyspnea scale is a classic dyspnea scale which is widely used, while the correlation between them is still not clear. This study investigated the use of the Chinese translation of CAT in chronic obstructive pulmonary disease patients and its correlation with the mMRC dyspnea scale. METHODS: The multicenter cross-sectional study was conducted in 329 hospitals throughout China from March 1 to April 30, 2010. Chronic obstructive pulmonary disease patients completed both the assessment test and the dyspnea scale during a single study visit. RESULTS: Six thousand, four hundred and thirty-seven patients were evaluated; 74.9% were male and the mean age was (64.9 ± 10.0) years. Median test scores in dyspnea grades 0 to 4 were 14, 16, 22, 26 and 32, respectively; these differences were statistically significant. The CAT score was moderately correlated with mMRC dyspnea grade (r = 0.579, P < 0.001). There was no significant difference in mean CAT score between males and females, and patients of high and low socioeconomic status. Primary analysis suggested that CAT scores were higher in older patients (>65 years) than in younger patients (≤ 65 years) and increased with duration of formal education, but these findings were repudiated by further analysis of subgroups according to mMRC dyspnea grade. CONCLUSIONS: There was no obvious confounding factor influencing use of the CAT in Chinese patients. CAT scores were moderately correlated with the mMRC dyspnea scale.

Current situation of the project of water improvement to reduce arsenic in endemic arsenism area in Shanxi province / 中国地方病学杂志

Objective To investigate the actual situation of implementation of the project to reduce water arsenic in endemic arsenic poisoning areas in Shanxi province,and to provide a scientific basis for prevention and control of the disease.Methods In June 2011,a questionnaire survey of 151 arsenic endemic villages was carried out in Shanxi province.The actual situation of implementation of the project to reduce water arsenic was investigated.Water samples were collected and arsenic level was determined by atomic fluorescence spectrometry.Results In the 151 arsenic poisoning villages 126 villages had changed the water,and the rate was 83.44％.In these villages,22 villages did not use the water improvement utilities properly.Of the 33 water improvement projects to reduce arsenic,23 operated normally.The projects covered 110 villages,beneficiary population of 97 920 people,accounting for 46.9％(97 920/208 736) of the total population.Water arsenic exceeded the national standards(≤0.05 mg/L) in 10 of the water improvement projects which covered 31 villages,including 15 nonendemic villages and 16 diseased villages.There were a population of 24 764 people in the diseased villages.Conclusions In Shanxi endemic arsenic poisoning areas,water improvement efforts need to be strengthened; the quality of water improvement project needs to be improved,and the project's later management and maintenance also need to be further strengthened.

Quality of life survey of inhabitants living in endemic arsenism areas after drinking-water improvement / 中国地方病学杂志

ObjectiveTo find out the quality of life of inhabitants living in endemic arsenism areas after drinking-water improvement and related influencing factors.MethodsCase group ( 118 people) of arsenicosis,and control group (237 people ) of nearby residents without arsenicosis in endemic arsenic areas after drinking-water improvement in Shanxi and Inner Mongolia and outside control group(116 people) not exposed to arsenic in nearby non-arsenic areas were selected to be interviewed using homogeneous validity and reliability of the World Health Organization quality of life(WHOQOL-BREF,Chinese Version) in 2010,and physical health,psychological,social relationships,environment scores and total score were calculated,respectively.Covariance analysis was used to find out the real difference in the three groups and multiple linear regression analysis was used to explore the influencing factors on quality of life.Results The scores of physical health,psychological,social relationships,environment and total score of case group were ( 12.14 ± 2.68),( 12.18 ± 2.22),( 14.81 ± 2.24),(11.33 ± 1.92),(69.27 ± 16.23) points,respectively,and those of internal control group were ( 13.39 ± 2.67),( 12.80 ± 1.88 ),( 15.16 ± 1.80),( 11.72 ± 1.62),(75.49 ± 14.50) points,respectively,those of control group were (13.91 ± 254),(13.67 ± 2.14),(15.07 ± 1.36),(12.64 ± 1.68),(78.41 ± 12.03) points,respectively.Them was significant difference in physical health,psychological,environment scores and total score among the three groups(F =7.57,10.74,13.44,10.77,all P ＜ 0.05),of which case group was significantly lower than those of the inside and outside control group(all P ＜0.01 ),while in the control group the psychological and environment scores were lower than those of the external control group(all P ＜ 0.01 ).Health,whether-or-not arsenicosis patient,annual per capita income,age and sex were influential factors of quality of life among inhabitants living in endemic arsenism areas after drinking-water improvement (all P ＜ 0.05 ).Conclusions Quality of life among inhabitants living in endemic arsenism areas after drinking-water improvement is lower than residents of non-arsenic areas.

[Clinical analysis of diffusive interstitial lung diseases with positive anti-neutrophil cytoplasmic antibody].

OBJECTIVE: To explore the features of pulmonary interstitial pathological changes in diffuse interstitial lung disease (DILD) patients with positive anti-neutrophil cytoplasmic antibody (ANCA), and the similarities as well as differences between ANCA positive patients with non-primary vasculitis and primary systematic vasculitis. METHODS: Clinical data of 122 patients with DILD having ANCA examined from October 1995 to September 2008, were reviewed. Among the ANCA positive patients with non-primary vasculitis (Group A), those with primary systematic vasculitis (Group B), and the ANCA negative patients (Group C), the results of syndromes, signs, radiological manifestations, pulmonary function tests, bronchoscope examinations, bronchoalveolar lavage fluid (BALF) cytology and other laboratory examinations were compared. RESULTS: In the 122 DILD patients with ANCA results, 36 patients' ANCA (29.51%) were positive. The numbers of patients in Groups A, B, and C were 7, 29, and 86. Total lung capacity (TLC) decreased less and pleural pathological changes were more seen in Groups A and B than in Group C. Oliguria, haematuria, proteinuria, anaemia, and renal inadequacy in Group A, which were similar in Group C, appeared less than in Group B. Results of bronchoscope examination, BALF cytology, anti-nuclear antibody (ANA), and etc. were not significantly different among the three groups. CONCLUSION: In DILD patients, pulmonary interstitial changes of those with positive ANCA accompany with more pleural pathological changes and TLC decreased less than those with negative ANCA. In patients with positive ANCA, non-primary vasculitis had some similar clinical manifestations as primary systematic vasculitis, however, anaemia and renal damages were less seen in the non-primary vasculitis patients.

Long-term effect of endemic arsenism on oxidative stress and immune function / 中国地方病学杂志

Objective To explore the long-term effect of endemic arsenism on oxidative stress and immune function, and to provide scientific basis for prevention and treatment of the disease in the areas. Methods In 2009, Using cluster sampling and typical investigation, the cross-sectional study was completed. The patient groups and the internal control group were selected in the arsenism areas after 5 years quality improvement of drinking water(Silizhuang village, Daying village and Gucheng village in Shanyin county, Gucheng city, Shanxi province) and they were divided into mild, moderate, severe case and internal control groups, respectively. The external control group was selected in a non-arsenism area(Yangzhuang village in Heshengbu city). The Oxidative stress indicators were determined and analyzed [serum superoxide dismutase (SOD) activity was determined with xanthine oxidase method, glutathione peroxidase(GSH-Px) activity was determined with 2-thio-2-nitrobenzoic acid method, and mmuuity malondisldohyde(MDA) levels was determined with thiobarbituric acid method]. The immune function was determined and analyzed [immunoglobulin G (IgG) was determined with radioimmunoassay method, and serum lysozyme was determined with turbidimetric method]. Results A total of 252 people were surveyed, in which the external control group, the internal control group, mild, moderate and severe patient groups were 56, 57, 49,44 and 46, respectively. Serum SOD activities were (72.19 ± 11.75), (66.96 ± 12.02), (49.79±11.07), (48.54 ±10.56) and (47.68 ± 10.68)kU/L, respectively. The difference of serum SOD activities between the groups was statistically significant(F = 52.42, P ＜ 0.01 ). Serum SOD activities in the external control group were significantly higher than other groups (all P ＜ 0.05). The value in the internal control group was significantly higher than the 3patient groups (all P ＜ 0.05). There were no significant differences between the case groups (P ＞ 0.05). Serum GSH-Px activities of the five groups were (197.41 ± 38.54), (195.02 ± 31.93), (187.26 ± 28.22), (187.24 ± 25.40),(186.88 ± 21.84)U/mg, respectively, and the difference between the groups was not significant(H = 4.21, P ＞0.05). Serum MDA levels of the five groups were (4.51 ± 2.14), (5.88 ± 2.00), (6.44 ± 2.83), (5.89 ± 2.57),(5.88 ± 2.40)μ mol/L, respectively, and the difference between the groups was statistically significant(F = 3.36,P ＜ 0.05). The external control group was significantly lower than other groups(all P ＜ 0.05). No significant difference was observed between other groups(all P ＞ 0.05). Serum IgG levels were(11.16 ± 2.08), (8.15 ± 1.44), (8.77 ±2.54), (9.19 ± 1.97), (8.44 ± 2.52)g/L, respectively, and the difference between the groups was statistically significant(H = 52.92, P ＜ 0.01 ). The external control group was significantly higher than other groups(all P ＜0.05). No significant difference was observed between other groups(all P ＞ 0.05). Serum lysozyme levels were (13.57 ± 5.16), (10.05 ± 3.96), (8.78 ± 3.35), (8.72 ± 3.76), (9.38 ± 4.26)mg/L, respectively, and the difference between the groups was statistically significant (H = 35.00, P ＜ 0.01 ). The external control group was significantly higher than other groups(all P ＜ 0.05). No significant difference was observed between other groups(all P ＞ 0.05). Conclusions The effect of arsenic on the body's oxidative stress response and immune function persists after 5 years of drinking low arsenic water. In addition to intensify arsenic removal from drinking water, it should also strengthen the monitoring of population's health in the diseased areas.

Outcome analysis on screening of drinking water source with high fluoride and the condition of the water-improving projects in Shanxi province in 2007 / 中国地方病学杂志

Objective To explore into the condition of fluoride content of the drinking water and the present status of water-improving projects in the endemic fluomsis areas in Shanxi province,and to provide the evidence for making scientific and effective tactics in prevention and control.Methods In 2007,according to "The National Technical Scheme for Endemic Disease Control",screening for drinking water fluoride content was carried out in non-improving water villages of 15 counties(cities,districts).The investigation of all water-improving projects was carried out in 10 counties(cities).The fluoride content in drinking water was determined by fluoride selective ion electrode(GB/T 8538-1995).Results Screening for drinking water fluoride content was carried out in 969 non-improving water villages in 15 counties(cities,districts).Average water fluoride content was≤1.0 mg/L in 497 villages,accounting for 51.29%(497/969).Average water fluoride content was>1.0 mg/L in 472 villages.accounting for 48.71%(472/969).The overall standard drinking water fluoride content was mainlv>1.0-4.0mg/L,and the maximum average water fluoride content was 8.96 mg/L.The investigation of 290 water-improving projects was carried out in 10 counties(cities).Among 290 water-improving projects 213 water-improving projects were running normally,accounting for 73.45%(213/290);77 water-improving projects were running abnormally,accounting for 26.55%(77/290).Water fluoride content was≤1.0 mg/L in 158 projects,accounting for 54.48%(158/290).Water fluoride content was>1.0 mg/L in 132 projects,accounting for 45.52%(132/290).The maximal water fluoride content was 5.20 mg/L.Conclusions The situation of drinking water fluoride content over the national standard is serious in Shanxi province.The qualification rate was lower for the fluoride content of water-improving projects.Therefore,we should strength water-improving projects to raise the effectiveness of prevention and treatment and assure their quality.

Survey of adult carotid atherosclerosis in drinking-water type of endemic high arsenic area in Shanxi province in 2009 / 中国地方病学杂志

Objective To investigate the relationship between drinking-water type of endemic arsenicosis and adult carotid artery atherosclerosis. Methods In 2009, 285 participants aged over 40 from drinking-water type of endemic arsenism areas and 293 residents aged over 40 from control areas were investigated in Yingxian county,Shanxi province. Portable-type B mode color ultrasound was used to examine the carotid artery of all participants.The carotid atherosclerosis were diagnosed and graded through the ultrasonograms. Content of water arsenic and hair arsenic of 10 people randomly selected in every villages were detected. Results A total of 5 villages with drinkingwater type of endemic arsenicosis as observation group and 5 villages without drinking-water type of endemic arsenicosis as control group were investigated. The prevalence rates of adult carotid atherosclerosis within observation group were 35.09%(20/57), 55.74%(34/61), 38.46%(20/52), 36.51%(23/63) and 46.15%(24/52), respectively,and standardized prevalence rates were 32.5%, 33.8%, 34.9%, 46.2% and 47.3%, respectively and the prevalence rates of adult carotid atherosclerosis within control group were 18.18%(10/55), 30.77%(16/52), 20.00%(10/50),18.67% (14/75) and 21.31% ( 13/61 ), respectively; the standardize prevalence rates were 22.4%, 17.7%, 10.7%,24.6%, 18.9%, respectively. The standardize prevalence rates were higher in observation group [39.50%(113/285) ]than that in control group[39.50%(113/285), T = 26, P ＜ 0.01 ]. The severity of adult carotid atherosclerosis (composition of 4 - 7 scores ) was compared between observation group [ 17.70%(20/113 )] and control group [ 14.06% (9/64) ], and the difference was insignificant(x2 = 0.26, P ＞ 0.05). Conclusions The prevalence rate of carotid atherosclerosis in drinking-water type of endemic arsenicosis areas is higher than that of the control areas.The study provides evidence that arsenic poisoning can cause atherosclerosis.

Investigation on the state of Kaschin-Beck disease in Shanxi province in 2008 / 中国地方病学杂志

Objective To investigate the current situation and variation in the tendency of Kaschin-Beck disease (KBD) in Shanxi province, to assess the effectiveness of prevention measures, and to provide evidence for making scientific and effective tactics in prevention and control of the disease. Methods In 2008, according to "The National Technical Scheme for Kaschin-Beck Disease Control in 2007", children aged 7 - 12 years underwent clinical and X-ray examination in two historical severe KBD areas of Shanxi province, the observed position on Xray film was finger bone and carpal bone. Adults aged 16 years and above were clinically examined in 50 villages of 13 counties of KBD areas, Shanxi province. The diagnosis was based on "Diagnostic Standard of Kashin-Beck Disease"(GB 16003-1995), the adult patients were degreed according to the state of illness and divided into different groups according to their ages. Results A total of 181 children were examined, none of them was diagnosed as clinical KBD patient. The positive cases of X-ray were 2, X-ray detectable rate of metaphysis was 1.1% for children.In the 50 villages 13 871 of adults were examined and 801 KBD patients were found and the detectable rate was 5.77%. The detectable rate increased with age. The adult patients distributed mainly in the subpopulation aged 51years and above and these patients accounted for 70.66% (566/801) of total people examined. Degrees Ⅱ and Ⅲ patients at these ages accounted for 71.78%(206/287) of total degrees Ⅱ and Ⅲ patients. Conclusions The state of child KBD in Shanxi is under the national control standards. The detectable rate of adult KBD is higher. Relevant departments should pay close attention to the treatment of adult patients.

The relationship between arsenic in drinking water and skin lesions in endemic arsenism area in Shanyin County of Shanxi Province / 中国地方病学杂志

Objective To investigate the relationship between arsenic in drinking water and skin lesions in endemic arsenism area in Shanyin County of Shanxi Province,in order to provide epidemiologic data for further arsenism research.Methods One hundred and eighty-nine endemic arsenism patients and 59 controls were randomly selected in 17 endemic amenism countries in Shanyin County of Shanxi Province.The content of arsenic in drinking water which wa8 collected indoom was half-quantitatively screened by a kit made by Chinese Center for Disease Control and Prevention,then quantitatively determined by HPLC-ICP-MS.Patients of endemic arsenism were diagnosed by "The Standard of Diagnosis for Endemic Amenism"(WS/T 211-2001).Results There were 64.9% (87/134)samples above the arsenic level(50μg/L)of drinking water and the median value of arsenic in drinking water was 91.43 μg/L in 134 water samples.The OR(95%CI)value between arsenic in drinking water and hyperkeratosis,hyperpigmentation,depigmentation was 2.46(1.22-4.94),3.34(1.50～7.44)and 2.86(1.50-5.46),respectively.The prevalence of hyperkeratosis,hyperpigmentation and depigmentation increased,as the arsenic in drinking water increased(≤10,≤50,≤200,＞200μg/L),especially in＞200μg/L group(OR=6.15,13.96,11.41,P＜0.05).The arsenic level in drinking water of Ⅲ degree of depigmentation patients(318.300μg/L)was higher(P＜0.05)than that of 0,Ⅰ and Ⅱ degree groups(86.670,131.800,1 10.590μg/L,P＜0.05).Conclusions Shanyin County is a medial arsenic pollution area. Arsenic in drinking water is considered as a risk factor of skin lesion. The degree of skin lesions increased,as the arsenic in drinking water increased.

Outcome analysis on screening of drinking water source with high fluoride in Shanxi Province / 中国地方病学杂志

Objective To become aware of the present distribution of drinking water source with high fluoride in endemic fluorosis disease areas in Shanxi Province, and to provide the evidence for making scientific and effective tactics in prevention and control. Methods According to "The National Technical Scheme for Endemic Disease Control" in the year 2004 to 2006, the investigation points were selected in 60 counties at 8 cities of Shanxi Province. The fluoride levels of water were determined by fluoride selective ion electrode. Results The fluoride content of water was determined in 2990 villages in 60 counties. Water fluorides content of 1658 villages were above 1.00 mg/L, accounted for 55.45%(1658/2990). The highest water fluoride content was 9.72 mg/L. Villages with high fluoride water in Taiyuan, Datong, Xinding, Linfen, Yuncheng basins accounted for 89.63% (1486/1658) among villages with high fluoride in Shanxi Province. In Shanxi Province the villages with high fluoride water were mainly distributed over 5 basins and scattered on the other areas. The distribution of drinking water source with high fluoride were different in 5 basins(H=316.10, P<0.05). The Water fluorides content in Datong basin(2.32 mg/L) was significantly higher than that of the other basins (P<0.05) and the ratio of drinking water fluoride levels under the national standard was 81.16%(336/414) in Datong basin. Conclusions Drinking water source with high fluoride are widespread distributed in Shanxi Province and mainly distributed in 5 basins. The situation of drinking water fluoride levels under the national standard is serious. The task of prevention and control for endemic fluorosis is still arduous. Therefore, we should strength water improving to raise the effect of prevention and treatment.

[The changing patterns and the associated factors of microbial pathogens in ventilator-associated pneumonia in a respiratory intensive care unit from 1995 to 2004].

OBJECTIVE: To investigate the changing patterns and associated factors of microbial pathogens which caused ventilator-associated pneumonia (VAP) in our respiratory intensive care unit (RICU) from 1995 to 2004. METHODS: Cases of VAP in our RICU from 1995 to 2004 (n = 137) were retrospectively analyzed, 47 cases from 1995 to 1999 and 90 cases from 2000 to 2004. VAP was diagnosed according to the following criteria: pneumonia occurred 48 hours after tracheal intubations; new or progressive infiltrative opacities on chest X ray film; and at least two of the following clinical features: (1) Temperature > 38.0 degrees C or < 35.5 degrees C, (2) WBC > 10 x 10(9)/L or < 4 x 10(9)/L, (3) purulent airway secretions; and positive bacterial cultures (the samples obtained through endotracheal intubations). The data were analyzed using statistical software SPSS version 11.5. Continuous data were expressed as (-x) +/- s. t-test and chi(2)-test were used for continuous and categorical data, respectively. Logistic regression analysis was used to determine the risk factors for special pathogens. RESULTS: The mean incidence of VAP was 17.9% from 1995 to 2004 (137/765), 16.2% from 1995 to 1999 (n = 47, 3.1% - 29.8%) and 19.6% from 2000 to 2004 (n = 90, 12.4% - 27.7%). From 1995 to 1999, common pathogens were Stenotrophomonas maltophilia (n = 15, 23.4%), Pseudomonas aeruginosa (n = 12, 18.8%), Aerobacter cloacae (n = 8, 12.5%) and Acinetobacter baumanii (n = 7, 10.9%). From 2000 to 2004, common pathogens were Acinetobacter baumanii (n = 40, 34.2%), Pseudomonas aeruginosa (n = 32, 27.4%), Staphylococcus aureus (n = 24, 20.5%) and Stenotrophomonas maltophilia (n = 8, 6.8%). There were 2 cases (2/64, 3.1%) caused by Staphylococcus aureus from 1995 to 1999, and both were caused by Methicillin-resistant Staphylococcus aureus (MRSA); there were 24 cases caused by Staphylococcus aureus from 2000 to 2004, and 21 cases (21/117, 17.9%) were caused by MRSA.There were 11 (11/47, 23.4%) and 45 (45/90, 50.0%) cases with central intravenous catheters in the period of 1995 to 1999 and 2000 to 2004, respectively. In the period of 1995 to 1999 and 2000 to 2004, durations of aerosolized therapy were (46 +/- 55) and (28 +/- 30) days. There were 12 patients (12/47, 25.5%) using second-generation cephalosporin before VAP occurred in the period of 1995 to 1999 and 7 patients (7/90, 7.8%) in the period of 2000 to 2004. There were 13 patients (13/47, 27.7%) using penicillin before VAP in the period of 1995 to 1999 and 10 patients (10/90, 11.1%) in the period of 2000 to 2004. There were 10 patients (10/47, 21.3%) using quinolones before VAP in the period of 1995 to 1999 and 46 patients (46/90, 51.1%)in the period of 2000 to 2004. The occurrence of Staphylococcus aureus VAP may be related to the cross-infection between inpatients (Wald = 16.690, P < 0.01, OR = 9.212). VAP caused by Stenotrophomonas maltophilia was positively related to duration of aerosolized therapy (Wald = 7.852, P < 0.01, OR = 1.021). VAP caused by Acinetobacter baumanii was positively related to third-generation cephalosporin usage (Wald = 5.553, P < 0.05, OR = 3.461). CONCLUSIONS: The incidence of VAP was not increased in the recent 10 years in our RICU, but the incidence of VAP caused by Acinetobacter baumanii. Staphylococcus aureus and MRSA increased significantly, may be related to the decrease of duration of aerosolized therapy, the usage of different kinds of antibiotics and cross-infection between inpatients.

Investigation and analysis of neonate deformity in water arsenic exposure areas / 中华预防医学杂志

<p><b>OBJECTIVE</b>To explore the level and feature of neonate deformity in water arsenic exposure areas, as to finding out an evidence for the study and prevention of the arsenic exposure.</p><p><b>METHODS</b>The birth situation of neonate was surveyed from 1998 to 2004 in water arsenic exposure areas according to cross-sectional survey. The results were classified in accordance with ICD-10 and common surveillance of china. The population of Shanyin County served as the common people and the data were analyzed by SPSS 11.5 for windows.</p><p><b>RESULTS</b>The neonates surveyed were 2467 cases. There were 49 neonates deformity found in this investigation, giving a neonate deformity rate of 198.62 per 10,000 cases, which was shown significantly higher in water arsenic exposure areas than in the normal (U = 3.23, P < 0.01), with types of nervous system deformity, limbs deformity and congenital heart disease as in system classification. There was no significant difference of deformity rate in different sex neonates (chi2 = 0.32, P > 0.05).</p><p><b>CONCLUSION</b>The drinking high-arsenic water over a long period of time should be a risk factor of neonate deformity. Prevention and treatment of endemic arsenic exposure should be urgently needed.</p>

[Pleural sarcoidosis: report of cases and review of the literature].

OBJECTIVE: To analyze the clinical features and differential diagnosis of pleural disease caused by sarcoidosis. METHODS: The clinical data of cases of sarcoidosis diagnosed with pathological evidence in this hospital were retrospectively analyzed. The clinical features and the diagnostic procedures of the cases with pleural disease as the main manifestations were reported. A review of case reports and series published in Chinese literature were carried out to study the incidence and the features of pleural effusion and pneumothorax in sarcoidosis. RESULTS: Thirty-two cases of pulmonary sarcoidosis were diagnosed with pathological evidence, of which 2 cases (2/32, 6.3%) presented as pleural effusion with one confirmed by medical thoracoscopy; one case (1/32, 3.1%) presented as recurrent pneumothorax and interstitial lung disease, and the diagnosis was confirmed by open lung biopsy. Pleural fluid analysis showed exudates with lymphocyte predominance. The fluid level of adenosine deaminase (ADA) was all less than 30 U/L and increased angiotensin converting enzyme level was demonstrated in one case. All 3 cases had been misdiagnosed as tuberculosis and received anti-tuberculous therapy for a period of 1 - 12 months. A review of the case reports and series in Chinese literature showed that the incidence of pleural disease in sarcoidosis was 3.4% - 16.7% in different series, and that pleural effusion in sarcoidosis was misdiagnosed as tuberculous in most cases. CONCLUSIONS: Pleural sarcoidosis is not rare in Chinese patients, but often misdiagnosed as tuberculous pleural disease. Recognition of this fact is of clinical importance both in the diagnosis of sarcoidosis and in the differential diagnosis of pleural diseases.

[Cross-talk between calcineurin and protein kinases in airway remodeling in asthma].

OBJECTIVE: To determine the role of cross-talk between calcineurin-dependent signal transduction pathway and protein kinase C (PKC), mitogen-activated protein kinase (MAPK) and protein kinase A (PKA) in airway remodeling in asthma. METHODS: Male guinea pigs were sensitized with intraperitoneal injections of ovabumin (OVA), then treated with cyclosporin A (CsA, 5 mg/kg), an inhibitor of calcineurin, then inhaled OVA for 2 weeks 14 days later. Activities of calcineurin, PKC, MAPK, and PKA were was analyzed by phosphorylation and dephosphorylation. In primary cultures of rat airway smooth muscle cells (ASMC), activities of calcineurin, PKC, MAPK, and cross-talk induced by urotensin II (UII ), a recently identified strong mitogen, were measured. RESULTS: (1) The activities of calcineurin, MAPK and PKC increased by 19% (P<0.01), 28% (P<0.01) and 35% (P<0.05), respectively, in the asthmatic group compared with controls but decreased by 52% (P<0.01), 18% (P<0.05) and 52% (P<0.01), respectively, in the CsA group compared with asthmatic group. PKA activity in the asthma group decreased by 53% (P<0.01) compared with controls but increased by 2.65-fold (P<0.01) in the CsA group compared with the asthma group. (2) UII 10(-7) mol/L stimulated ASMC PKC and MAPK activities by 44% and 24% (P<0.01), respectively, after incubating for 20 min. It increased CaN activity in a time-dependent manner, being 1.67 times that of the control for 24 h (P<0.01). (3) CsA 10(-6) mol/L and H(7) 50 micromol/L, an inhibitor of PKC, inhibited UII-stimulated CaN activity by 45% (P<0.01) and 21% (P<0.05), respectively, while PD(98059) 50 micromol/L, an inhibitor of MAPK, had no effect on CaN activity (P>0.05). (4) CsA 10(-6) mol/L inhibited UII-stimulated PKC activity by 14% (P<0.05), while having no effect on MAPK activity (P>0.05). CONCLUSION: The signal transduction pathways between calcineurin and other protein kinases such as PKC, MAPK and PKA have cross-talk in airway remodeling in asthma.

[Endogenous hydrogen sulfide in patients with chronic obstructive pulmonary disease].

OBJECTIVE: To investigate the role of endogenous hydrogen sulfide (H(2)S) in patients with chronic obstructive pulmonary disease (COPD). METHODS: Levels of serum H(2)S and nitric oxide (NO), lung function and cell differential count in induced sputum were studied in 27 patients with acute exacerbation of COPD (AECOPD), 37 patients with stable COPD and 13 health subjects. Echo-Doppler assessment and arterial blood gas were measured in patients with AECOPD. RESULTS: (1) The serum H(2)S level was significantly higher in patients with stable COPD [(50.8 +/- 2.5) micromol/L] as compared to those in the controls [(39.8 +/- 1.6) micromol/L] and in patients with AECOPD [(33.5 +/- 2.2) micromol/L, P < 0.01]. (2) The level of serum H(2)S was significantly lower in smokers with AECOPD [(28.1 +/- 1.3) micromol/L] as compared to nonsmokers with AECOPD [(39.4 +/- 3.9) micromol/L, P < 0.05] and healthy nonsmokers [(39.8 +/- 1.6) micromol/L, P < 0.01]. (3) There was significant difference in the serum H(2)S level among stable COPD patients with different severity of airway obstruction (P < 0.05); being lower in patients with stage III [(45.1 +/- 4.1) micromol/L] as compared to stage I obstruction [(70.2 +/- 6.2) micromol/L, P < 0.05]. (4) AECOPD with pulmonary hypertension pulmonary artery systolic pressure (PASP) > or = 35 mm Hg (1 mm Hg = 0.133 kPa) showed a lower serum H(2)S level [(26.3 +/- 2.2), (36.2 +/- 2.5) micromol/L, P < 0.05] than that with a normal resting PASP. (5) H(2)S in serum was positively correlated with NO levels (r = 0.278, P = 0.029), FEV(1)% predicted values (r = 0.533, P = 0.000), percentage of sputum lymphocytes (r = 0.286, P = 0.028) and macrophages (r = 0.334, P = 0.01); and negatively correlated with PASP (r = -0.561, P = 0.011) and the percentage of sputum neutrophils (r = -0.422, P = 0.001) in patients with COPD. CONCLUSION: Endogenous H(2)S may be involved in the pathogenesis of airway obstruction in COPD and may be a noninvasive marker of disease activity and severity.

Endogenous hydrogen sulfide in patients with COPD.

OBJECTIVES: COPD is characterized by progressive airway obstruction. Recent studies showed that besides nitric oxide (NO) and carbon monoxide (CO), endogenous hydrogen sulfide (H(2)S) might be the third signaling gasotransmitter. To clarify the role of endogenous H(2)S in the pathogenesis of COPD, we investigated the relation of serum H(2)S level to severity of COPD as defined by lung function and airway inflammation. METHODS: Levels of serum H(2)S and NO, lung function, and cell differential counts in induced sputum were studied in 27 patients with acute exacerbation of COPD (AECOPD), 37 patients with stable COPD, and 13 healthy subjects. Patients with AECOPD had arterial blood gas levels measured and underwent Doppler echocardiography. In addition, in order to clarify the effects of age and smoking status on serum H(2)S level, we recruited three groups who were age matched to the study group but had no airflow limitation (59 subjects). RESULTS: Serum H(2)S level (34.0 +/- 0.9 to 36.4 +/- 1.1 micromol/L [+/- SEM]) did not differ among healthy control subjects with different ages (56.6 to 75.0 years, respectively). Serum H(2)S level was significantly higher in patients with stable COPD than in patients with AECOPD and age-matched control subjects (p < 0.01) and correlated positively with NO level in all healthy control subjects and all patients with COPD (r = 0.352, p = 0.000). Serum H(2)S level was significantly lower in smokers than nonsmokers, both with AECOPD (p < 0.05) and healthy control subjects (p < 0.01). It was significantly lower in smokers with AECOPD than healthy smokers and smokers with stable COPD (p < 0.01). Serum H(2)S level differed and was decreased (p < 0.05) among stable COPD patients by stage of airway obstruction (p < 0.05), and it was lower in patients with stage III than stage I obstruction (p < 0.05). Serum H(2)S level in all patients with COPD and healthy control subjects correlated positively with the percentage of predicted FEV(1) value (r = 0.300, p = 0.009). It was lower in patients with AECOPD and systolic pulmonary artery pressure (PASP) > or = 35 mm Hg than those with PASP within the normal range (< 35 mm Hg) [p < 0.05] and was negatively correlated with PASP (r = - 0.561, p = 0.011). Serum H(2)S level was negatively correlated with proportion of neutrophils in sputum (r = - 0.422, p = 0.001) and positively correlated with proportion of lymphocytes (r = 0.286, p = 0.028) and macrophages (r = 0.334, p = 0.01) in all patients with COPD. CONCLUSIONS: Endogenous H(2)S is involved in the pathogenesis of airway obstruction in COPD, and its alteration in level may be connected with disease activity and severity.

[Characteristics of non-symptomatic chronic obstructive pulmonary disease patients].

OBJECTIVE: To evaluate the epidemiological characteristics of non-symptomatic chronic obstructive pulmonary disease (COPD) patients in a rural area in Beijing. METHODS: The data of 1,624 people aged more than 40 in 5 villages in Yanqing county in Beijing were collected. Information of medical history and symptom were obtained, and physical examination and lung function test were performed. RESULTS: The prevalence of COPD was 9.1% (148/1 624) in this area. In these 148 patients, 62 (42%) were non-symptomatic and 86 (58%) were symptomatic, the prevalence of non-symptomatic COPD being 3.8% (62/1 624). There was no statistical difference in the sex, age, occupation, marriage status, education level and smoking index between the symptomatic and the non-symptomatic groups (all P > 0.05). The forced expired volume in one second (FEV(1)) and FEV(1)% predicted were lower in the symptomatic group [(1.3 +/- 0.7) L, (61 +/- 23)%] than those in the non-symptomatic group [(1.5 +/- 0.6) L, (70 +/- 22)%; all P < 0.05]. CONCLUSIONS: The prevalence of COPD was high in this area with a high percentage of non-symptomatic patients. The COPD prevalence might be underestimated due to the symptom free patients.