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BACKGROUND@#Although intensively studied in patients with cardiovascular diseases (CVDs), the prognostic value of diastolic blood pressure (DBP) has little been elucidated in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). This study aimed to reveal the prognostic value of DBP in AECOPD patients.@*METHODS@#Inpatients with AECOPD were prospectively enrolled from 10 medical centers in China between September 2017 and July 2021. DBP was measured on admission. The primary outcome was all-cause in-hospital mortality; invasive mechanical ventilation and intensive care unit (ICU) admission were secondary outcomes. Least absolute shrinkage and selection operator (LASSO) and multivariable Cox regressions were used to identify independent prognostic factors and calculate the hazard ratio (HR) and 95% confidence interval (CI) for adverse outcomes.@*RESULTS@#Among 13,633 included patients with AECOPD, 197 (1.45%) died during their hospital stay. Multivariable Cox regression analysis showed that low DBP on admission (<70 mmHg) was associated with increased risk of in-hospital mortality (HR = 2.16, 95% CI: 1.53-3.05, Z = 4.37, P <0.01), invasive mechanical ventilation (HR = 1.65, 95% CI: 1.32-2.05, Z = 19.67, P <0.01), and ICU admission (HR = 1.45, 95% CI: 1.24-1.69, Z = 22.08, P <0.01) in the overall cohort. Similar findings were observed in subgroups with or without CVDs, except for invasive mechanical ventilation in the subgroup with CVDs. When DBP was further categorized in 5-mmHg increments from <50 mmHg to ≥100 mmHg, and 75 to <80 mmHg was taken as reference, HRs for in-hospital mortality increased almost linearly with decreased DBP in the overall cohort and subgroups of patients with CVDs; higher DBP was not associated with the risk of in-hospital mortality.@*CONCLUSION@#Low on-admission DBP, particularly <70 mmHg, was associated with an increased risk of adverse outcomes among inpatients with AECOPD, with or without CVDs, which may serve as a convenient predictor of poor prognosis in these patients.@*CLINICAL TRIAL REGISTRATION@#Chinese Clinical Trail Registry, No. ChiCTR2100044625.
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Humans , Blood Pressure , Pulmonary Disease, Chronic Obstructive/therapy , Cohort Studies , Respiration, Artificial , Inpatients , Hospital MortalityABSTRACT
PURPOSE: Details of patients hospitalized for asthma exacerbation in mainland China are lacking. To improve disease control and reduce economic burden, a large sample survey among this patient population is indispensable. This study aimed to investigate the clinical characteristics and outcomes of such patients.METHODS: A retrospective study was conducted on patients hospitalized for asthma exacerbation in 29 hospitals of 29 regions in mainland China during the period 2013 to 2014. Demographic features, pre-admission conditions, exacerbation details, and outcomes were summarized. Risk factors for exacerbation severity were analyzed.RESULTS: There were 3,240 asthmatic patients included in this study (57.7% females, 42.3% males). Only 28.0% used daily controller medications; 1,287 (39.7%) patients were not currently on inhaled corticosteroids. Acute upper airway infection was the most common trigger of exacerbation (42.3%). Patients with severe to life-threatening exacerbation tended to have a longer disease course, a smoking history, and had comorbidities such as hypertension, chronic obstructive pulmonary disease (COPD), and food allergy. The multivariate analysis showed that smoking history, comorbidities of hypertension, COPD, and food allergy were independent risk factors for more severe exacerbation. The number of patients hospitalized for asthma exacerbation varied with seasons, peaking in March and September. Eight patients died during the study period (mortality 0.25%).CONCLUSIONS: Despite enhanced education on asthma self-management in China during recent years, few patients were using daily controller medications before the onset of their exacerbation, indicating that more educational efforts and considerations are needed. The findings of this study may improve our understanding of hospital admission for asthma exacerbation in mainland China and provide evidence for decision-making.
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Female , Humans , Adrenal Cortex Hormones , Asthma , China , Comorbidity , Disease Progression , Education , Food Hypersensitivity , Hospitalization , Hypertension , Inpatients , Medication Adherence , Mortality , Multivariate Analysis , Pulmonary Disease, Chronic Obstructive , Retrospective Studies , Risk Factors , Seasons , Self Care , Smoke , SmokingABSTRACT
Objective To understand the seasonal distribution of patient hospitalization due to asthma exacerbation in 7 geographic areas in China.Methods This was a retrospective study which involved patients hospitalized for asthma exacerbation in 29 hospitals throughout 7 geographic areas in the mainland of China (northeast,north,central,east,south,northwest and southwest).The numbers of asthmatic patients and total inpatients of the respiratory department of each hospital were recorded.The monthly ratio of asthmatic patients to the total inpatients in every area was calculated and compared.Results During the study period,6 480 patients were admitted for asthma exacerbation,accounting for 3.14％ of all the 206 135 patients admitted to the respiratory departments in the 29 hospitals.The ratio of asthmatic patients to total inpatients in the northeast area (5.61％) was highest,and the ratio in east area was lowest (1.97％).Statistical analysis showed that the difference among different areas was significant (P＜0.000 1).In most areas,both the number and proportion of hospitalized asthmatic patients peaked in spring (February-April) and autumn (September-October).In the northeast area,east area and south area,the peaks in spring were more obvious,while in the north area and southwest area,the peaks in autumn were more obvious.In the northwest area the peaks occurred in winter (December-January) and summer (June-August),respectively.The differences in hospitalization due to asthma among different months were significant in the northeast,north,and southwest areas (P＜0.005).Conclusion The number of patients hospitalized for asthma exacerbation fluctuated with season in different areas in China.In most areas,more asthmatic patients were admitted to hospitals in spring and autumn.
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Objective To understand the seasonal distribution of patient hospitalization due to asthma exacerbation in 7 geographic areas in China.Methods This was a retrospective study which involved patients hospitalized for asthma exacerbation in 29 hospitals throughout 7 geographic areas in the mainland of China (northeast,north,central,east,south,northwest and southwest).The numbers of asthmatic patients and total inpatients of the respiratory department of each hospital were recorded.The monthly ratio of asthmatic patients to the total inpatients in every area was calculated and compared.Results During the study period,6 480 patients were admitted for asthma exacerbation,accounting for 3.14％ of all the 206 135 patients admitted to the respiratory departments in the 29 hospitals.The ratio of asthmatic patients to total inpatients in the northeast area (5.61％) was highest,and the ratio in east area was lowest (1.97％).Statistical analysis showed that the difference among different areas was significant (P＜0.000 1).In most areas,both the number and proportion of hospitalized asthmatic patients peaked in spring (February-April) and autumn (September-October).In the northeast area,east area and south area,the peaks in spring were more obvious,while in the north area and southwest area,the peaks in autumn were more obvious.In the northwest area the peaks occurred in winter (December-January) and summer (June-August),respectively.The differences in hospitalization due to asthma among different months were significant in the northeast,north,and southwest areas (P＜0.005).Conclusion The number of patients hospitalized for asthma exacerbation fluctuated with season in different areas in China.In most areas,more asthmatic patients were admitted to hospitals in spring and autumn.
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Objective To investigate the effects of Genistein (GEN) acting on human lung adenocarcinoma A549 cells induced by LPS;To discuss its action of mechanism for improving injuries of lung. Methods The activity of cell treated with different concentrations of Genistein was detected by CCK-8 method and/or LPS intervention for 12 h. The expressions of inflammatory cytokines IL-1β, IL-6, and TNF-α induced by LPS were detected by RT-PCR. TUNEL was used to detect apoptosis, and Western blot was used to detect the changes of signal pathway. Results GEN (1, 5, 10μmol/L) alone had no effects on cell activity;LPS (1μg/mL) reduced cell viability significantly, while co-treated the A549 cells with GEN and LPS could reverse this condition in a concentration-dependent manner;RT-PCR results showed that LPS could significantly increase the level of gene expression of inflammatory factors, while GEN could inhibited this phenomenon in both concentration-and time-dependent manner;the results of TUNEL staining showed that GEN (10μmol/L) combined with LPS for 12 h could significantly decrease the apoptosis rate;the results of Western blot showed that GEN possibly inhibited the inflammation and apoptosis through inhibiting the phosphorylation of IκBα, p65 signaling pathways. Conclusion GEN has anti-inflammation and anti-apoptosis effects on A549 cells induced by LPS, so as to play a protective rate.
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Objective To investigate the effects of genistein on the epithelium-mesenchyme transition of alveolar type II cells; To discuss its mechanism of improving pulmonary fibrosis. Methods The activity of genistein with different concentrations and TGF-β1 intervention cells after 72 h were determined by CCK-8 method; epithelial and mesenchymal markers as well as the key regulatory factors in the transformation process were determined by RT-PCR; changes of p38 and JNK signaling pathways were determined by Western blot. Results The A549 cells were transformed into fibroblast phenotype stimulated by TGF-β1 for 72 h; mesenchymal markers increased and endothelial marker decreased. The results of RT-PCR indicated that genistein inhibited this phenomenon in a concentration-dependent manner. The results of Western blot showed that, genistein possibly inhibited the epithelial-mesenchymal transition through inhibiting the phosphorylation of p38 and JNK signaling pathways and its downstream transcription factors. Conclusion Genistein has anti-fibrosis effects through inhibiting A549 cells undergoing epithelial-mesenchymal transition.
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Objective To examine the relationship between quetiapine serum concentration,dose,therapeu-tic efficacy and side effects in male patients with schizophrenia.Methods Sixty-three male patients with schizo-phrenia were collected.They were treated openly for 8 weeks with quetiapine,the dose was adjusted according to clini-cal improvement and tolerance.The plasma quetiapine concentrations,therapeutic efficacy and adverse drug reactions were observed after the 4 -week treatment period,and at the end of the 8 weeks of the treatment.Results After 4 weeks,the serum concentration had significant correlation with age,the disease duration and education level.After 8 weeks,there was significant correlation between serum concentration and age.We found a correlation between dose and serum concentration of quetiapine,and no relationship between serum concentration and PANSS scores.Side effects were correlated with 4 weeks′serum concentrations.Conclusion Quetiapine is effective for male patients with schizophrenia.Age,quetiapine dose and side effects have significant correlations with the serum concentration.It appears that plasma quetiapine concentration has no effects on therapeutic efficacy.
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To investigate the neuroprotective effect of melatonin against chronic intermittent hypoxia [CIH], the major pathophysiologic feature of obstructive sleep apnea syndrome. This study was conducted between January 2011 and September 2012 in Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China. Thirty 8-week Wistar rats were randomly divided into 3 groups [10 each]: a control group, a vehicle-treated CIH group; and a melatonin-treated [10 mg/kg] CIH group. Rats were exposed to either intermittent hypoxia [IH] [oxygen concentration changing periodically from 21.78 +/- 0.65 to 6.57 +/- 0.57%], or air-air cycling at a rate of 30 cycles/hour, 8 hour/day for 4 weeks. The CIH exposure led to a significant decrease in superoxide dismutase [SOD] activity and anti-apoptotic protein B-cell lymphoma-2 [BCL-2] expression in the hippocampus of CIH group rats compared with that of the control group and melatonin-treated CIH group. In contrast, hippocampal neuronal apoptosis increased significantly in parallel to an augment in 3, 4-methylenedioxyamphetamine [MDA] content and pro-apoptotic protein Bcl-2-associated X protein [BAX] expression in CIH group than the other 2 groups. Melatonin administration abrogated the increase in MDA activity, as well as BAX expression, and restored SOD activity and BCL-2 expression to nearly their normal levels. These results indicate melatonin can inhibit hippocampal neuron apoptosis following CIH by scavenging reactive oxygen species, up-regulating anti-apoptotic protein BCL-2 and down-regulating pro-apoptotic protein BAX, and thus, alleviate CIH-induced oxidative stress injury and produce neuroprotection effect
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To explore the relationship between the serum vascular endothelial growth factor (VEGF) level and the severity of obstructive sleep apnea hypopnea syndrome (OSAHS), the concentrations of serum VEGF in 40 OSAHS patients and 9 healthy controls were measured by using ELISA method. Meanwhile the correlation between the concentration of VEGF and parameters of polysomnography (PSG) was examined. Our results showed that the concentrations of VEGF were significantly higher in OSAHS patients with severe hypoxia (536.8+/-334.7 pg/mL) than in those with mild hypoxia (329.2+/-174.7 pg/mL) and healthy controls (272. 8+/-211.0 pg/mL) (P<0.05 for both). The concentrations of VEGF were also significantly higher in OSAHS patients with hypertension (484.5+/-261.4 pg/mL) than in those without hypertension (311.0+/-158.4 pg/mL) and healthy controls (272. 8+/-211.0 pg/mL) (P<0.05 for both). There was a positive correlation between the concentration of VEGF and the apnea hypopnea index (AHI) (r=0.34, P<0.05). It is concluded that the concentration of the serum VEGF is positively related to the severity of OSAHS. The elevated serum VEGF level may be involved in the pathogenesis of the complications of obstructive sleep apnea hypopnea syndrome.
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To explore the relationship between the serum vascular endothelial growth factor (VEGF)level and the severity of obstructive sleep apnea hypopnea syndrome (OSAHS), the concentrations of serum VEGF in 40 OSAHS patients and 9 healthy controls were measured by using ELISA method.Meanwhile the correlation between the concentration of VEGF and parameters of polysomnography (PSG) was examined. Our results showed that the concentrations of VEGF were significantly higher in OSAHS patients with severe hypoxia (536.8±334.7 pg/mL) than in those with mild hypoxia (329.2±174.7 pg/mL) and healthy controls (272. 8±211.0 pg/mL) (P＜0.05 for both). The concentrations of VEGF were also significantly higher in OSAHS patients with hypertension (484.5±261.4 pg/mL) than in those without hypertension (311.0±158.4 pg/mL) and healthy controls (272. 8±211.0 pg/mL) (P＜0.05 for both). There was a positive correlation between the concentration of VEGF and the apnea hypopnea index (AHI) (γ=0.34, P＜0.05). It is concluded that the concentration of the serum VEGF is positively related to the severity of OSAHS. The elevated serum VEGF level may be involved in the pathogenesis of the complications of obstructive sleep apnea hypopnea syndrome.
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To compare the efficacy, safety, and tolerability of intravenous moxifloxacin with those of a commonly used empirical antibiotic regimen, cefoperazone and azithromycin in the treatment of community acquired pneumonia (CAP) in adult patients requiring initial parenteral therapy, 40 patients with CAP were divided into two groups, a moxifloxacin group (n=20) and a control group(n=20), which were treated for 7 to 14 days. The patients in the moxifloxacin group were intravenously given 400 mg of moxifloxacin (AveloxR) once a day. Patients in the control group were administered 2.0 g of cefoperazone twice a day and azithromycin 0.5 g once a day. Clinical, bacteriological, and laboratory examinations were performed before the treatment, and at the end of the treatment. Our results showed that there was no significant difference in the clinical efficacy rate between two treatment groups at end of therapy (90 % for moxifloxacin, 95 % for cefoperazone plus azithromycin) (P＞0.05). The bacteriologic eradication rate at the end of treatment was 90 % in the moxifloxacin group and 80 % in the cefoperazone-plus-azithromycin group, whereas there was no significant difference between the two groups (P＞0.05). In addition, both drugs were well-tolerated in this trial, with the number of drug-related adverse events being comparable. It is concluded that moxifloxacin is an effective and well-tolerated treatment for CAP and was equivalent to the commonly used empirical treatment of cefoperazone plus azithromycin. Moxifloxacin is likely to offer clinicians an alternative for reliable empirical CAP treatment in the face of increasing antibiotic resistance.
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To compare the efficacy, safety, and tolerability of intravenous moxifloxacin with those of a commonly used empirical antibiotic regimen, cefoperazone and azithromycin in the treatment of community acquired pneumonia (CAP) in adult patients requiring initial parenteral therapy, 40 patients with CAP were divided into two groups, a moxifloxacin group (n = 20) and a control group (n = 20), which were treated for 7 to 14 days. The patients in the moxifloxacin group were intravenously given 400 mg of moxifloxacin (Avelox) once a day. Patients in the control group were administered 2.0 g of cefoperazone twice a day and azithromycin 0.5 g once a day. Clinical, bacteriological, and laboratory examinations were performed before the treatment, and at the end of the treatment. Our results showed that there was no significant difference in the clinical efficacy rate between two treatment groups at end of therapy (90% for moxifloxacin, 95% for cefoperazone plus azithromycin) (P > 0.05). The bacteriologic eradication rate at the end of treatment was 90% in the moxifloxacin group and 80% in the cefoperazone-plus-azithromycin group, whereas there was no significant difference between the two groups (P > 0.05). In addition, both drugs were well-tolerated in this trial, with the number of drug-related adverse events being comparable. It is concluded that moxifloxacin is an effective and well-tolerated treatment for CAP and was equivalent to the commonly used empirical treatment of cefoperazone plus azithromycin. Moxifloxacin is likely to offer clinicians an alternative for reliable empirical CAP treatment in the face of increasing antibiotic resistance.
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The effects of Shenmai injection (SMI) and aminophylline on apoptosis of small airway smooth muscle cells (SASMC) and the Fas/FasL expression in rats with papain-induced emphysema were investigated. Rat emphysema model was established by a single intratracheal instillation of papain. Apoptosis and Fas/FasL expression of SASMC were detected by immunohistochemistry SABC and TUNEL assay at day 1, 3, 5, 7, 15, 30 after modeling, and the effect of SMI and aminophylline on them were observed. The results indicated that the Fas/FasL expression positive rate in SASMC was 2.31 +/- 0.55/1.28 +/- 0.47 respectively. After a single intratracheal instillation of papain, the expression of Fas/FasL positive rate in the placebo group was increased in a time-dependent manner. SMI could inhibit the expression of Fas/FasL, but aminophylline couldn't. The positive rate of apoptosis in the control group was 0.87 +/- 0.32. After a single intratracheal instillation of papain, the SASMC apoptosis positive rate in the placebo group was increased in a time-dependent manner. The SASMC apoptosis rate in all groups was declined after treatment with SMI, but the effect of aminophylline was not obvious. It was demonstrated that in the pathogenesis of emphysema Fas/FasL played an important role in the regulation of SASMC apoptosis. SMI influenced the expression of Fas/FasL and declined SASMC apoptosis by inhibiting the releasing of inflammatory media and played an important role in the therapy of emphysema.
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Animals , Female , Male , Rats , Aminophylline , Pharmacology , Bronchi , Metabolism , Pathology , Bronchodilator Agents , Pharmacology , Drug Combinations , Drugs, Chinese Herbal , Emphysema , Genetics , Pathology , Fas Ligand Protein , Gene Expression , Membrane Glycoproteins , Genetics , Myocytes, Smooth Muscle , Pathology , Plant Extracts , Pharmacology , Rats, Wistar , fas Receptor , GeneticsABSTRACT
In order to improve the knowledge of clinicians in hypoxia of COPD during the night,the physiological changes of arterial oxygen and carbon dioxide during sleep in healthy population were investigated at first,and the features and state of oxygen deficiency during sleep in patients with COPD were analyzed.Furthermore,the possible mechanism,effect,predictor,diagnosis and therapy were explored.
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AIM:To observe the change of insulin-like growth factor-2(IGF-2)in patients with obstructive sleep apnea-hypopnea syndrome(OSAHS),and to explore the relationship of IGF-2,OSAHS and cardiovascular disease complicated with it.METHODS:The level of serum IGF-2 in 40 OSAHS patients and 20 healthy controls was measured by enzyme-linked immunosorbent assay(ELISA).The expression of IGF-2 mRNA in peripheral blood mononuclear cells was detected by reverse transcription polymerase chain reaction(RT-PCR).RESULTS:The serum level of IGF-2 and the expression of IGF-2 mRNA in peripheral blood mononuclear cells were significantly higher in OSAHS group than those in control group(P
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AIM: To study the effect of dexamethasone (DEX) on the adrenomedullin (ADM) and its gene expression in lung tissue of asthmatic rats. METHODS: 30 healthy male SD rats were randomly divided into three groups (10 for each). The asthmatic model was established by ovalbumin inhalation and injection. The mRNA expression of ADM was examined by RT-PCR and the protein expression was detected by immunohistochemical method. The airway wall thickness, the airway smooth muscle (ASM) thickness and pulmonary tissue changes were observed under light microscope. RESULTS: The expression of ADM mRNA and protein in the asthma group A were higher than those in the control group(group C) (P