Sustained low diffusing capacity in hepatopulmonary syndrome after liver transplantation

AIM： To study the presence of sustained low diffusing capacity （DLco） after liver transplantation （LT） in patients with hepatopulmonary syndrome （HPS）. METHODS： Six patients with mild-to-severe HPS and 24 without HPS who underwent LT were prospectively followed before and after LT at mid-term （median, 15 mo）. HPS patients were also assessed at Iong-tem （median, 86 mo）. RESULTS： Before LT, HPS patients showed lower PaO2 （71 ± 8 mmHg）, higher AaPO2 （43 ± 10 mmHg） and lower DLco （54% ± 9% predicted）, due to a combination of moderate-to-severe ventilation-perfusion （VA/Q） imbalance, mild shunt and diffusion limitation, than non- HPS patients （94 ± 4 mmHg and 19 ± 3 mmHg, and 85% ± 3% predicted, respectively） （P 〈 0.05 each）. Seven non-HPS patients had also reduced DLco （70% ± 4% predicted）. At mid- and long-term after LT, compared to pre- LT, HPS patients normalized PaO2 （91 ± 3 mmHg and 87 ± 5 mmHg）, AaPO2 （14 ± 3 mmHg and 23 ± 5 mmHg） and all VA/Q descriptors （P 〈 0.05 each） without changes in DLco （53% ± 8% and 56% ± 7% predicted, respectively）. Post-LT DLco in non-HPS patients with pre- LT low DLco was unchanged （75% ± 6% predicted）. CONCLUSION： While complete VA/Q resolution in HPS indicates a reversible functional disturbance, sustained low DLco after LT also present in some non-HPS patients, points to persistence of sub-clinical liver-induced pulmonary vascular changes.

The effect of traditional Chinese medicine rehabilitation exercise(pulmonary Daoyin)in patients with chronic obstructive pulmonary disease:A systematic review and meta-analysis

Objective:Previous research has demonstrated that pulmonary Daoyin could be an efficacious way to ameliorate the physical and psychological state of sufferers with chronic obstructive pulmonary disease(COPD)and bolster the quality of life.However,the results are not consistent.Thus,the objective of this research is to assess the impacts of pulmonary Daoyin in individuals with COPD.Methods:Relevant articles were searched in Web of Science,Cochrane Library,PubMed,EMBASE,SinoMed,CNKI,Wanfang,and VIP from database inception to January 2024.Results:There were a total of 15 randomized controlled trials(RCTs)included in this meta-analysis involving 1732 patients,of which 864 participated in the intervention group and 868 in the control group.When comparing with the control group,the COPD patients practicing pulmonary Daoyin demonstrated a significant improvement in 6 min walking distance(mean difference[MD]=24.53,95%confidence interval[CI][18.55,30.52],P<0.00001),forced expiratory volume in the 1 s(FEV_(1))(MD=0.39,95%CI[0.18,0.59],P=0.0002),percentage of FEV_(1)to the predicted value(FEV_(1)%)(MD=5.35,95%CI[3.22,7.48],P<0.0001),the forced vital capacity(FVC)(MD=0.39,95%CI[0.06,0.73],P=0.02),percentage of FVC to the predicted value(FVC%)(MD=7.52,95%CI[4.91,10.13],P<0.00001),the ratio of FEV_(1)/FVC(MD=4.95,95%CI[0.91,8.99],P=0.02),peak expiratory flow rate(standardized MD=0.98,95%CI[0.74,1.22],P<0.00001),modified Medical Research Council(mMRC)scale(MD=-0.47,95%CI[-0.89,-0.04],P=0.03),and Borg scale(MD=-0.65,95%CI[-0.75,-0.55],P<0.00001).Conclusions:Our findings may illuminate the influence of pulmonary Daoyin on exercise ability,breathlessness,and pulmonary function in COPD patients.More rigorous RCTs with larger samples and longer-term interventions will be required moving forward.

Effects of combined aerobic,resistance and inspiratory training in patients with pulmonary hypertension:A systematic review

BACKGROUND Pulmonary hypertension(PH)is a serious progressive disorder of the modern world,characterized by endothelial dysfunction and impaired vasoreactivity.Patients with PH usually present exercise intolerance from the very early stages and reduced exercise capacity.Exercise training has been shown to have beneficial effects in patients with cardiovascular comorbidities.However,data regarding the effects of combined exercise training programs in patients with PH still remains limited.AIM To investigate the effects of combined exercise training programs on exercise capacity and quality of life in patients with PH.METHODS Our search included all available randomized controlled trials(RCTs)regarding combined aerobic,resistance and inspiratory training programs in patients with PH in 4 databases(Pubmed,PEDro,Embase,CINAHL)from 2012 to 2022.Five RCTs were included in the final analysis.Functional capacity,assessed by peak VO_(2)or 6-min walking test(6MWT),as well as quality of life,assessed by the SF-36 questionnaire,were set as the primary outcomes in our study.RESULTS Peak VO_(2)was measured in 4 out of the 5 RCTs while 6MWT was measured in all RCTs.Both indices of functional capacity were significantly increased in patients with PH who underwent combined exercise training compared to the controls in all of the included RCTs(P<0.05).Quality of life was measured in 4 out of 5 RCTs.Although patients improved their quality of life in each group,however,only 2 RCTs demonstrated further improvement in patients performing combined training compared to controls.CONCLUSION By this systematic review,we have demonstrated that combined aerobic,resistance and inspiratory exercise training is safe and has beneficial effects on aerobic capacity and quality of life in patients with PH.Such exercise training regimen may be part of the therapeutic strategy of the syndrome.

Comparison of Various Parameters of DWI in Distinguishing Solitary Pulmonary Nodules

In order to prospectively assess various parameters of diffusion weighted imaging (DWI)in differential diagnosis of benign and malignant solitary pulmonary nodules (SPNs),58 patients (40 men and 18 women,and mean age of 48.1±10.4years old) with SPNs undergoing conventional MR,DWI using b=500s/mm^2 on a 1.5T MR scanner, were studied.Various DWI parameters [apparent diffusion coefficient (ADC),lesion-to-spinal cord signal intensity ratio (LSR),signal intensity (SI)score] were calculated and compared between malignant and benign SPNs groups.A receiver operating characteristic (ROC)curve analysis was employed to compare the diagnostic capabilities of all the parameters for discrimination between benign and malignant SPNs.The results showed that there were 42 malignant and 16 benign SPNs.The ADC was significantly,lower in malignant SPNs (1.40±0.44)×10^-3mm^2/s than in benign SPNs (1.81±0.58)×10^-3mm^2/ s.The LSR and SI scores were significantly increased in malignant SPNs (0.90±0.37 and 2.8±1.2)as compared with those in benign SPNs (0.68±0.39 and 2.2±1.2).The area under the ROC curves (AUC)of all parameters was not significantly different between malignant SPNs and benign SPNs.It was suggested that as three reported parameters for DWI,ADC,LSR and SI scores are all feasible for discrimination of malignant and benign SPNs.The three parameters have equal diagnostic performance.

PULMONARY VESSEL EXTRACTION BASED ON COHERENCE DIFFUSION AND FAST MARCHING

Objective To accurately extract pulmonary vessels on medical images. Methods An efficient vessel segmentation framework is presented, which includes a smoothing method and a extraction algorithm. The smoothing method is based on an improved coherence diffusion approach that integrates the second-order directional differential information. It can analyze weak edges such as narrow peak or ridge-like structures. Meanwhile, an improved extraction algorithm is proposed. It is based on a fast marching algorithm where a sorted sequence array and multi-initialization technique are applied. Results The improved coherence diffusion approach can precisely preserve important oriented patterns and remove noises on the images. Experimental results on several images show that the proposed method can effectively find the location of pulmonary vessels. Conclusion The segmentation method is accurate and fast that can be a useful tool for medical imaging applications.

Role of MR-DWI and MR-PWI in the radiotherapy of implanted pulmonary VX-2 carcinoma in rabbits

Objective： To detect the activity of tumor cells and tumor blood flow before and after the radiotherapy of implanted pulmonary VX-2 carcinoma in rabbit models by using magnetic resonance diffusion-weighted imaging（MR-DWI） and magnetic resonance perfusion weighted imaging（MR-PWI）, and to evaluate the effectiveness and safety of the radiotherapy based on the changes in the MR-DWI and MR-PWI parameters at different treatment stages.Methods： A total of 56 rabbit models with implanted pulmonary VX-2 carcinoma were established, and then equally divided into treatment group and control group. MR-DWI and MR-PWI were separately performed using a Philips Acheiva 1.5T MRI machine（Philips, Netherland）. MRI image processing was performed using special perfusion software and the WORKSPACE advanced workstation for MRI. MRDWI was applied for the observation of tumor signals and the measurement of apparent diffusion coefficient（ADC） values; whereas MR-PWI was used for the measurement of wash in rate（WIR）, wash out rate（WOR）, and maximum enhancement rate（MER）. The radiation treatment was performed using Siemens PRIMUS linear accelerator. In the treatment group, the radiotherapy was performed 21 days later on a once weekly dosage of 1,000 c Gy to yield a total dosage of 5,000 c Gy.Results： The ADC parameters in the region of interest on DWI were as follows： on the treatment day for the implanted pulmonary VX-2 carcinoma, the t values at the center and the edge of the lesions were 1.352 and 1.461 in the treatment group and control group（P〉0.05）. During weeks 0-1 after treatment, the t values at the center and the edge of the lesions were 1.336 and 1.137（P〉0.05）. During weeks 1-2, the t values were 1.731 and 1.736（P〈0.05）. During weeks 2-3, the t values were 1.742 and 1.749（P〈0.05）. During weeks 3-4, the t values were 2.050 and 2.127（P〈0.05）. During weeks 4-5, the t values were 2.764 and 2.985（P〈0.05）. The ADC values in the treatment group were significantly higher than in the control group. After the radiotherapy（5,000 c Gy）, the tumors remarkably shrank, along with low signal on DWI, decreased signal on ADC map, and remarkably increased ADC values. As shown on PWI, on the treatment day for the implanted pulmonary VX-2 carcinoma, the t values of the WIR, WOR, and MER at the center of the lesions were 1.05, 1.31, and 1.33 in the treatment group and control group（P〉0.05）; in addition, the t values of the WIR, WOR, and MER at the edge of the lesions were 1.35, 1.07, and 1.51（P〉0.05）. During weeks 0-1 after treatment, the t values of the WIR, WOR, and MER at the center of the lesions were 1.821, 1.856, and 1.931（P〈0.05）; in addition, the t values of the WIR, WOR, and MER at the edge of the lesions were 1.799, 2.016, and 2.137（P〈0.05）. During weeks 1-1 after treatment, the t values of the WIR, WOR, and MER at the center of the lesions were 2.574, 2.156, and 2.059（P〈0.05） and the t values of the WIR, WOR, and MER at the edge of the lesions were 1.869, 2.058, and 2.057（P〈0.05）. During weeks 2-3 after treatment, the t values of the WIR, WOR, and MER at the center of the lesions were 2.461, 2.098, and 2.739（P〈0.05） and the t values of the WIR, WOR, and MER at the edge of the lesions were 2.951, 2.625, and 2.154（P〈0.05）. During weeks 3-4 after treatment, the t values of the WIR, WOR, and MER at the center of the lesions were 2.584, 2.107, and 2.869（P〈0.05） and the t values of the WIR, WOR, and MER at the edge of the lesions were 2.057, 2.637, and 2.951（P〈0.05）. During weeks 4-5 after treatment, the t values of the WIR, WOR, and MER at the center of the lesions were 2.894, 2.827, and 3.285（P〈0.05） and the t values of the WIR, WOR, andMER at the edge of the lesions were 3.45, 3.246, and 3.614（P〈0.05）. After the radiotherapy（500 c Gy）, the tumors shrank on the T1 WI, WIR, WOR, and MER; meanwhile, the PWI parameter gradually decreased and reached its minimum value.Conclusions： MR-DWI and MR-PWI can accurately and directly reflect the inactivation of tumor cells and the tumor hemodynamics in rabbit models with implanted pulmonary VX-2 carcinoma, and thus provide theoretical evidences for judging the clinical effectiveness of radiotherapy for the squamous cell carcinoma of the lung.

Diffuse alveolar hemorrhage with histopathologic manifestations of pulmonary capillaritis:Three case reports

BACKGROUND Diffuse alveolar hemorrhage(DAH)is a multicause pulmonary capillary hemorrhage or pulmonary vascular small vessel injury(mainly capillaries,including arteries and veins),causing pulmonary microcirculation blood to accumulate in the alveolar space.DAH is classified by the histological absence or presence of pulmonary capillaritis(PC)and is rarely reported in the literature.CASE SUMMARY This is a report of three girls aged 6-11 years with DAH and PC.Two patients had decreased hemoglobin and one had increased erythrocyte sedimentation rate.High-resolution computed tomography showed bilateral diffuse pulmonary infiltrate,and diagnosis of PC was confirmed by lung biopsy.Immunofluorescence test in one case showed granular IgG and a small amount of granular IgA deposit on the alveolar walls,and was negative in the other two cases,describing isolated pauci-immune PC.Treatment was with glucocorticoid alone or combination with immunosuppressants,and the symptoms resolved in all patients.CONCLUSION PC is classified as isolated and immune-mediated PC associated with systemic disease.It can be controlled in most children with glucocorticoid alone or combined with immunosuppressants.

Relation of Indices of Lung Hyperinflation to Dyspnea in Patients with Chronic Obstructive Pulmonary Disease: A Physiologic Assessment and Discussion

Background: The severity of COPD is commonly assessed by the reduction in forced expiratory volume at one second (FEV1), although more recently prognostic factors influencing survival have also incorporated functional capacity, degree of breathlessness on exertion, and body mass index. Increasingly, the reliability of physiological parameters such as FEV1 to predict patient-centered outcomes has been brought into question. Objectives: To evaluate the relationship between dyspnea as assessed by the Modified Medical Council Dyspnea (MMRC) scale, the Global Initiative for Chronic Obstructive Lung Disease (GOLD 2014) staging and indices of lung hyperinflation and spirometry. Methods: Data were retrospectively analyzed at a 600-bed tertiary care center including spirometry, plethysmographic lung volumes, single breath carbon monoxide diffusion capacity and dyspnea graded according to MMRC, and GOLD staging. Results: Data for 331 patients were analyzed. Differences amongst FEV1, IC, IC/TLC, FRC and RV/TLC were significant between GOLD I/II and GOLD III/IV groups. The closest relationship to GOLD staging was seen with FEV1, FVC and slow vital capacity (SVC). FEV1/FVC, IC, and IC/TLC were inversely associated with MMRC score, while RV/TLC exhibited a positive relation with MMRC score. Conclusions: Indices of lung hyperinflation are closely associated, with dyspnea as assessed by MMRC grading with TLC, RV/TLC and IC exhibiting the closest relations, more so than FEV1. GOLD staging also shows strong correlations with lung volume subdivisions (weakly with TLC), more so than with FEV1. That TLC changed little between GOLD stages can be explained by the presence of collateral interalveolar channels and population characteristics different from those of other studies. These findings further support the concept that more than a reduction in FEV1, lung hyperinflation contributes to the sensation of dyspnea in airflow limitation.

Unexpected diffuse lung lesions in a patient with pulmonary alveolar proteinosis:A case report

BACKGROUND Pulmonary alveolar proteinosis(PAP)often presents nonspecifically and can be easily confused with:(1)Idiopathic interstitial lung fibrosis;(2)alveolar carcinoma;(3)pulmonary tuberculosis;and(4)other lung diseases such as viral pneumonia,mycoplasma pneumonia,and chlamydial pneumonia.CASE SUMMARY Diagnosis:In this case,a patient was diagnosed with PAP through transbronchial cryobiopsy(TBCB)and quantitative metagenomic next-generation sequencing,which confirmed the impairment of surfactant turnover as the underlying cause of PAP.Interventions:High-volume total lung lavage was performed for this patient.Outcomes:The patient's clinical condition had improved significantly by the 6-month follow-up,with a 92%finger oxygen saturation.A repeat chest computed tomography scan revealed scattered patchy ground-glass shadows in both lungs,which was consistent with alveolar protein deposition but with a lower density than in the radiograph from October 23,2022.CONCLUSION TBCB has unique advantages in diagnosing atypical alveolar protein deposition,particularly for enabling the early detection of PAP.This information can help patients take preventive measures to prevent or halt PAP development by avoiding dusty environments and seeking treatment with total lung lavage and inhaled granulocyte macrophage colony-stimulating factor.

Study on the Application Effects of the Teach-Back Method Combined with WeChat Tutorials on Chronic Disease Self-Management in Patients with Chronic Obstructive Pulmonary Disease(COPD)

Objective:To study the application effects of teach-back method combined with WeChat education in patients with chronic obstructive pulmonary disease(COPD).Methods:Convenience sampling was used to select 103 patients with COPD hospitalized in the department of respiratory medicine of a tertiary-level hospital from March to June 2021 as study subjects.Randomized grouping was carried out using the random number table method.The routine care was given in the control group,and the teach-back method combined with WeChat tutorials on the basis of routine care was applied in the intervention group.In the follow-up three months after discharge,the changes in pulmonary function,self-care ability,and quality of life of patients in the two groups were observed and compared.Results:After the intervention,the pulmonary function indexes of both groups improved significantly,and the improvement effect was more significant in the intervention group(P<0.05);after the intervention,the self-care ability scores of the patients in the intervention group were significantly higher than those of the control group(P<0.05);the quality-of-life scores of the patients in the two groups decreased at 3 months after discharge,and the scores of the patients in the intervention group were significantly lower than those of the patients in the control group(P<0.05).Conclusion:The teach-back method combined with WeChat education can effectively improve the pulmonary function,self-care ability,and quality of life of patients with COPD.

Decision-tree analysis for cost-effective management of solitary pulmonary nodules in China

AIM: To analyze the cost-effectiveness of the diagnosis of solitary pulmonary nodule(SPN) in China. METHODS: Decision analysis models were constructed to assess the cost-effectiveness of four strategies for the management of SPN: computed tomography(CT) alone, CT plus CT-guided automated cutting needle biopsy(ACNB), CT plus positron emission tomography/computed tomography(PET/CT), CT plus diffusionweighted magnetic resonance imaging(DWI) plus PET/CT. RESULTS: The prevalence of lung cancer among SPN discovered in the clinical setting was approximately 50%. The CT plus ACNB strategy had higher diagnostic accuracies(87% vs 81%), with a cost saving of $1945 RMB per patient, and reducing unnecessary thoracotomy by 16.5%; this was associated with a 4.5% missed diagnosis rate. CT plus DWI plus PET/CT strategy also had higher accuracies(95% vs 81%), with a cost saving of $590 RMB per patient, and reducing unneces-sary thoracotomy by 13.5%; this was accompanied by 0.3% missed diagnosis rate. CT plus PET strategy is cost effective at a prevalence rate of 0-34%, but there was a larger prevalence range of lung cancer for CT plus ACNB strategy(from 0 to 0.6) and CT plus DWI plus PET/CT strategy(from 0 to 0.64). CONCLUSION: CT plus DWI plus PET/CT strategy was cost-effective, and had a higher accuracy accompanied by a lower missed diagnosis rate than CT plus ACNB strategy.

Effect of dyspnea and clinical variables on the quality of life and functional capacity in patients with chronic obstructive pulmonary disease and congestive heart failure

Background Chronic obstructive pulmonary disease （COPD） and congestive heart failure （CHF） are two chronic diseases that affect negatively the functional condition and quality of life of patients. We assessed the effect of symptoms and clinical variables on the functional capacity and quality of life in COPD and CHF patients. Methods The study included 42 COPD and 39 CHF patients. In both patient groups, dyspnea was assessed using Borg scale; functional capacity by shuttle-walk and cardiopulmonary exercise test and quality of life by short form-36 （SF36）. Results No statistically significant difference was found in neither of the two disease groups regarding the dyspnea score, shuttle-walk test and the majority of subgroup scores of SF36 （P〉0.05）. A statistically significant difference was observed in peak VO2 in favor of COPD group （P〈0.05）. No significant relationship was established between dyspnea score and forced expiratory volume in one second （FEV1） in COPD patients, and left ventricular ejection fraction （LVEF） in CHF patients （P〉0.05）. A significant negative correlation was observed between dyspnea score and functional capacity tests in both disease groups （P〈0.05）. On the other hand, no relationship was found between LVEF and FEV1 and quality of life and functional capacity （P〉0.05）. Conclusions It was revealed that symptoms have an impact on functional capacity and quality of life in both disease groups, however, objective indicators of disease severity do not show a similar relationship. Therefore, in addition to the objective data related to the disease, we recommend that symptoms should also be taken into consideration to assess cardiopulmonary rehabilitation program and during following-up.

Whole Lung Lavage Treatment of Chinese Patients with Autoimmune Pulmonary Alveolar Proteinosis： A Retrospective Long-term Follow-up Study

Background： Pulmonary alveolar proteinosis （PAP） is a rare lung disease, the most common type of which is autoimmune PAP. The gold standard therapy for PAP is whole lung lavage （WLL）. Few studies have reported the optimal technique with which to evaluate the response to WLL. In this study, we aimed to identify parameters with which to assess the need for repeat WLL during a long-term 8-year follow-up. Methods： We conducted a retrospective analysis of 120 patients with autoimmune PAP with 80 of whom underwent WLL. Physiologic, serologic, and radiologic features of the patients were analyzed during an 8-year follow-up after the first WLL treatment. Results： Of the 40 patients without any intervention, 39 patients either achieved remission or remained stable and only one died of pulmonary infection. Of the 56 patients who underwent WLL for 1 time, 55 remained free from a second WLL and 1 patient died of cancer. Twenty-four required additional treatments after their first WLL. The baseline PaO2, （P = 0.000）, PA-aO2 （P = 0.000）, shunt fraction rate （P = 0.001）, percent of predicted normal diffusing capacity of the lung for carbon monoxide （DLCO%Pred） （P = 0.016）, 6-rain walk test （P = 0.013）, carcinoembryonic antigen （CEA） （P = 0.007）, and neuron-specific enolase （NSE） （P = 0.003） showed significant differences among the three groups. The need for a second WLL was significantly associated with PaO2 （P = 0.000）, CEA （P= 0.050）, the 6-minute walk test （P= 0.026）, and DLCO%Pred （P = 0.041 ）. The DLCO%Pred on admission with a cut-off value of42.1% （P = 0.001） may help to distinguish whether patients with PAP require a second WLL. Conclusions： WLL is the optimal treatment method for PAP and provides remarkable improvements for affected patients. The DLCO%Pred on admission with a cut-offvalue of 42.1% may distinguish whether patients with PAP require a second WLL.

Age-associated changes in pulmonary function： a comparison of pulmonary function parameters in healthy young adults and the elderly living in Shanghai

Background The respiratory system changes with age and a better understanding of the changes contribute to detect and prevent respiratory dysfunctions in old population. The purpose of this study was to observe age-associated changes of pulmonary function parameters in healthy young adults and the elderly. Methods A cross-sectional study was conducted among 600 male and female subjects aged 19 to 92 years. The subjects were divided into three groups by age： young adult （19-39 years）, middle-aged adult （40-59 years）, and the elderly （〉60 years）. The pulmonary function was measured with routine examination methods and 13 parameters including vital capacity （VC）, residual volume （RV）, functional residual capacity （FRC）, total lung capacity （TLC）, RV/TLC, forced vital capacity （FVC）, forced expiratory volume in one second （FEV1）, FEV1/FVC, peak expiratory flow （PEF）, forced expiratory flow at 25% of FVC exhaled （FEF25）, forced expiratory flow at 50% of FVC exhaled （FEF50）, diffusion capacity of the lung for carbon monoxide （DLCO）, and specific diffusion capacity of CO （KCO） were collected and analyzed. Changes in pulmonary function parameters among the influence on FEVJFVC and RV were studied further. Results Ten pulmonary function parameters including VC, FVC, pre-elderly and elderly subjects, especially the aging FEV1, FEV1/FVC, PEF, FEF25, FEF50, TLC, DLCO and KCO decreased significantly with age in both male and female subjects （P 〈0.01）. RV and RV/TLC were increased with age （P 〈0.01）. FRC remained stable during aging. Except FRC, the linear relationship was significant between age and other pulmonary function parameters. In the pre-elderly and elderly subjects, RV had a non-significantly increasing tendency with age （P 〉0.05）, and FEV1/FVC did not change significantly with age （P 〉0.05）. Conclusion Total pulmonary function was declined tendency of RV and decreasing tendency of FEV1/FVC with advancing age, but FRC was stable, and the increasing obviously slowed down in the pre-elderly and elderly subjects.

Diffuse pulmonary lymphangiomatosis： a case report with literature review

Diffuse pulmonary lymphangiomatosis （DPL） is a rare disease that is characterized by diffuse proliferation of abnormal pulmonary lymphatic channels. DPL occurs mostly in children and young adults and often undergoes a progressive clinical course, eventually causing deterioration of the lung. Both the clinical diagnosis and treatment of DPL remain a challenge. Here, we report a case of DPL in a 53-year-old Chinese woman with comprehensive investigations including pulmonary function tests, computer tomography （CT）, bronchoscopy and histological examination of the lung biopsy, and review the literature.

Effects of Qizhukangxian granules on idiopathic pulmonary fibrosis:a randomized,double blind,placebo-controlled and multicenter clinical pilot trial

OBJECTIVE:To evaluate the effects of Qizhukangxian granules(QG)on idiopathic pulmonary fibrosis(IPF).METHODS:This is a randomized,double blind,placebo-controlled and multicenter clinical pilot trial.Six medical centers in Tianjin,China,participated in the study.A total of 120 IPF patients were enrolled and randomized into two groups,with 60 patients in each group.The treatment group was treated with QG,while the control group received a Qizhukangxian placebo.The pharmacological treatment lasted for 48 weeks from the enrollment date.The indexes of patients were recorded on the admission day and at the end of the 24th and 48th weeks.Data were analyzed to study the effects of QG;forced vital capacity,change in forced vital capacity and maximal 6-min walk test(6MWT)distance were the primary endpoints.Secondary endpoints were percentage of patients with episodes of acute exacerbation of IPF,pulmonary function,changes in pulse oxygen saturation during the 6MWT,dyspnea score,St.George's respiratory questionnaire score,arterial blood gas analyses and the total Traditional Chinese Medicine symptom pattern score.RESULTS:After 24 weeks of treatment,QG showed greater efficacy than the placebo in certain parameters,including the dyspnea score,Traditional Chinese Medicine symptom pattern score and some indicators in the St.George's respiratory questionnaire score.Analysis of the indexes obtained from all patients at the end of the 48th week showed that the therapeutic effects in the treatment group were significantly better than those in the control group because remarkable differences were observed in most of the primary and secondary endpoints between the two groups,except for the maximal distance of the 6MWT and arterial blood gas analyses.No adverse reaction was observed in either group during the 48-week trial treatment period.CONCLUSION:QG could effectively treat IPF patients by ameliorating pulmonary function,improving the quality of life and lowering the percentage of acute exacerbations.

The effects of Chinese Yam-Epimedium mixture on respiratory function and quality of life in patients with chronic obstructive pulmonary disease

OBJECTIVE:To examine the clinical effects of a mixture of Chinese Yam and Epimedium in patients with stable moderate or severe chronic obstructive pulmonary disease(COPD).METHODS:Forty-nine patients with COPD were randomly allocated to a group whose usual treatment was supplemented with oral Chinese Yam-Epimedium mixture,or a control group given placebo.For each patient,body mass index,airflow obstruction,dyspnea,and exercise capacity were measured and converted into the BODE index before treatment and at one and three months after initiation of treatment.Participants also completed the St George's Respiratory Questionnaire(SGRQ) at the same intervals.RESULTS:After one month,improvements were seen in the BODE index and SGRQ of participants taking Chinese Yam-Epimedium mixture compared to controls.There were statistically significant differences in the SGRQ:three of its components and the total SGRQ scores were significantly decreased(P<0.05),respiratory symptom scores had improved(P<0.01),and the dyspnea component of the BODE index had significantly decreased(P<0.05).Similar improvements were observed after three months of treatment,but exercise tolerance had also improved:the six-minute walking distance had significantly increased(P<0.05) in the treatment group when compared with controls.CONCLUSION:Chinese Yam-Epimedium mixture can significantly improve dyspnea,exercise capacity,and the quality of life of patients with stable moderate or severe COPD.

Diffusion-weighted magnetic resonance imaging with short T1 inversion recovery-echo planar imaging combined with dual-head coincidence single photon emission computed tomography for diagnosing solitary pulmonary nodule

Positron emission tomography （PET） using 18F-fluorodeoxyglucose （FDG） has not been widely used in China for expensive cost （$1200）. Dual-head coincidence single photon emission computed tomography （DHC-SPECT） can depict many of the lesions depicted with a PET scanner in the lungs, which is used in place of PET-CT for discriminating malignant from benign pulmonary nodules in many studies. However, DHC-SPECT has inevitable false-negative results because the sensitivity for small lesions less than 2.0 cm is limited, and has high false-positive rate for active inflammatory nodules. Furthermore,DHC-SPECT also has a considerably higher cost （$300 in China） than other imaging examination.

Capacity Titration Technique for Determining the Solid Diffusion Coefficient of Intercalary Species within Insertion-host Materials

In this paper, the capacity titration technique （CT technique） was developed on basis of the RPG （ratio of potentio-charge capacity to galvano-charge capacity） method to continuously determine the solid diffusion coefficient D of the intercalary species within insertion-host materials with a small voltage region. The linear equations of D vs. q （value of ratio of the potentio-charge capacity to the galvano-charge capacity） were given in different range of q. By the CT technique,the Li^＋ solid diffusion coefficients D within LiMn2O4 at different voltages were determined. The results showed that the values of D varied from 3.447×10^-9 cm^2/s to 7.60×10^-11 cm^2/s in the voltage range of charge from 3.3V to 4.3V as a function of voltage with “W” shape.

Absorptive Capacity and Knowledge Flows for Large International Finns： A Survey

The main objective of this paper is that of surveying both theoretic and econometric models exploring the existence of knowledge spillovers and quantifying firm＇s ability to identify, assimilate, and exploit existing information （absorptive capacity）. In so doing, we explore different methodologies through which we may analyze the knowledge transmission： both the production function approach and the knowledge function approach. In order to construct the spillover stocks, different dimensions are considered： geographic and technological.