Add-on Tiotropium in Chinese Patients With Moderate Asthma: A Pooled Subgroup Analysis of MezzoTinA-Asthma 1 and 2

PURPOSE: Asthma affects approximately 30 million patients in China; however, tiotropium data for Chinese patients is limited. This study aimed to assess the efficacy and safety of tiotropium in Chinese patients with moderate symptomatic asthma. METHODS: A post hoc subgroup analysis was conducted on 430 Chinese patients pooled from two 24-week, replicate phase 3 trials (NCT01172808 and NCT01172821), in which they received once-daily tiotropium 2.5 µg (Tio R2.5) or 5 µg (Tio R5) (n = 106 or 109, respectively), twice-daily salmeterol 50 µg (Sal 50) (n = 110), or placebo (n = 105), while maintaining inhaled corticosteroids (ICS). The co-primary endpoints assessed in week 24 were forced expiratory volume in 1 second (FEV1) peak0–3h response, trough FEV1 response, and responder rate as assessed using the Asthma Control Questionnaire (ACQ). RESULTS: For both FEV1 peak0–3h responses and trough FEV1 responses, the mean treatment differences were greater for Tio R2.5, Tio R5, and Sal 50 compared with placebo at 0.249 L, 0.234 L, and 0.284 L, and 0.172 L, 0.180 L, and 0.164 L, respectively (P< 0.001). The ACQ responder rate in placebo, Tio R2.5, Tio R5, and Sal 50 was 58.7%, 62.3%, 59.3%, and 69.1%, respectively. Furthermore, 11 (2.6%) of 430 patients had serious adverse events (Tio R5, n = 4; Tio R2.5, n = 1; Sal 50, n = 1; and placebo, n = 5). CONCLUSIONS: Once-daily tiotropium, as add-on to medium-dose ICS, was effective and well tolerated for Chinese patients with moderate symptomatic asthma, consistent with the main analysis.

Chinese expert consensus for non-antiinfective effects and clinical use of macrolides / 中华内科杂志

Important/potential value of macrolides has been proved in the management of chronic respiratory diseases by increasing basic and clinical trials.Through three face-to-face discussions,10 experts examined important data and drafted this consensus related to macrolides:(1) mechanism of nonantiinfective effects;(2) clinical use in chronic respiratory diseases;(3) cautions of long-term use.The mechanism out of non-antiinfective effects includes anti-inflammatory effect,modifying airway secretion,immune-regulation related to antibacterial effect,corticoid saving effect and anti-viral effect.The efficacy of long-term use of low-dose macrolides is definitely confirmed in diffuse panbronchiolitis,chronic rhinosinusitis.It is considerably used in bronchiectasia,cystic fibrosis,severe asthma and chronic obstructive pulmonary disease.Further studies should be conducted in cryptogenic organizing pneumonia and respiratory viral infection.It should be paid attention to its possible adverse effects (including drug interactions,cardiac toxicity,ototoxicity and disturbance of intestinal flora) and drug resistance in long-term use.A Chinese consensus for non-antiinfective effects and clinical use of macrolides is developed for the first time,which aims to expand their rational use and the further research.

The relationship between smoking status and epidermiology of asthma in people aged over 14 years in China / 中华内科杂志

Objective To study the relationship between bronchial asthma and smoking status in Chinese people.Methods Asthma epidemiological survey and stratified-cluster-random method survey were performed in residents over 14 years in 8 provinces (cities) of China from February 2010 to August 2012.Asthma was diagnosed based upon case history,clinical signs and lung function test.Smoking status was investigated by questionnaire.Results Sampling population was 180 099 and 164 215 were valid.A total of 2 034 subjects were diagnosed as asthma including 79 692 men and 84 523 women.The overall prevalence rate of asthma was 1.24％ (2 034/164 215).Smokers were 23.8％ (39 137/164 215) in the whole population.Smokers were 34.5％ (702/2 034) in asthmatic patients,compared with 23.7％ (38 435/ 162 181) in no-asthmatic population.The incidence of asthma was 1.79％ and 1.06％ in smokers and nonsmokers respectively (P ＜0.001),suggesting that OR of smoking was 1.70 (95％ CI 1.55-1.86,P ＜ 0.001).According to asthma control test (ACT) score,the level of asthma control in non smoking group was higher than that in smoking group(43.2％ vs 35.3％).The times of hospitalization due to acute exacerbations (0.51 vs 0.41 events/person/year),total hospitalization rate (27.35 ％ vs 20.12％),annual emergency room visits (0.80 vs 0.60 events/person/year) and emergency room visit rate (31.77％ vs 24.47％) were all much higher in smoking asthmatic patients than those in non smoking asthmatic patients,indicating that the level of asthma control in smoking patients was significantly worse than in non smoking patients.Conclusions The smoking rate in Chinese people over 14 years is still high.The prevalence rate of asthma in smokers is significantly higher than that of non-smokers.The level of asthma control in smokers is significantly worse than that in non smokers.

Expression of suppressor of cytokine signaling 1 in the peripheral blood of patients with idiopathic pulmonary fibrosis / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Idiopathic pulmonary fibrosis (IPF) is a progressive diffuse parenchymal disease with a poor prognosis. A variety of cytokines and chemokines are involved in its pathophysiology. The aim of this study was to evaluate the clinical features in IPF patients with the expression of suppressor of cytokine signaling 1 (SOCS-1), which acts as a negative regulator of cytokine signaling.</p><p><b>METHODS</b>IPF patients (n = 20) and healthy controls (n = 16) were included in this study. The expression of SOCS-1 was analyzed in peripheral blood mononuclear cells (PBMC) of subjects using RT-PCR. Interleukin 4 (IL-4), transforming growth factor β1 (TGF-β1) and type I collagen expression were also analyzed in each individual using enzyme-linked immunosorbent assay (ELISA). The clinical characteristics of IPF patients were delineated. These results were analyzed by SPSS13.0 statistics software.</p><p><b>RESULTS</b>SOCS-1 mRNA expression was significantly decreased in the PBMC of IPF patients compared with healthy controls; serum levels of IL-4 and TGF-β1 were higher in IPF patients. The patients with lower expression of SOCS-1 developed lower percentage of forced vital capacity (FVC%) and DLCO/VA. A patients' SOCS-1 mRNA level was negatively correlated with serum levels of IL-4, and negatively correlated with their high-resolution computed tomography (HRCT) scores.</p><p><b>CONCLUSIONS</b>SOCS-1 mRNA can be detected in PBMC, and it is down-regulated in IPF patients. The expression of SOCS-1 is associated with the severity of IPF patients' symptoms, so it might be the predictor of disease severity. SOCS-1 might play an important role in IPF by reducing the expression of the T helper type 2 (Th2) cell-related cytokine IL-4.</p>

Clinical research of individualized therapy in advanced non-small cell lung cancer guiding by & nbsp;detection of ERCC1 protein / 中国癌症杂志

10.3969/j.issn.1007-3969.2013.05.002

Study of obstructive sleep apnea-hypopnea syndrome and metabolic syndrome in females / 上海交通大学学报（医学版）

Objective To analyse the changes of metabolic parameters and condition of metabolic syndrome(MS)in females with obstructive sleep apnea-hypopnea syndrome(OSAHS),and explore the interaction between OSAHS and MS.Methods Sixty females undergoing polysomnography were included,and were divided into simple snorer group(n=19),mild OSAHS group(n=21)and moderate to severe OSAHS group(n=20).Epworth sleepiness scale(ESS)scores and metabolic parameters were compared among groups.Forty-one patients with OSAHS were subdivided into group with MS(MS group,n=15)and group without MS(non-MS group,n=26).ESS scores,apnea hypopnea index(AHI),oxygen desaturation index(ODI)and lowest pulse oxygen saturation(LSpO_2)were compared between MS group and non-MS group.Results There was no significant difference in age,body mass index(BMI),total cholesterol(TC),triglyceride(TG),low density cholesterol(LDL),high density cholesterol(HDL),apolipoprotein A-I(apoA-I)and apolipoprotein B(apoB) among simple snorer group,mild OSAHS group and moderate to severe OSAHS group(P>0.05).Correlation analysis revealed ESS was positively related to AHI(r=0.327,P=0.011).ESS scores and proportions of hypertension,fasting plasma glucose(FPG)and MS were significantly higher in moderate to severe OSAHS group than those in simple snorer group(P<0.05).BMI,FPG,TG,proportion of hypertension,ODI and ESS score in MS group were significantly higher than those in non-MS group(P<0.05),while there was no significant difference in AHI and LspO_2 between these two groups(P>0.05). Conclusion ESS score may reflect the severity of OSAHS in females.Females with OSAHS matched for age and BMI have no difference in blood fat.With the increase of severity of OSAHS,glycometabolism can be impaired,the prevalences of hypertension and MS increase.MS can exacerbate the severity of OSAHS,indicating that MS and OSAHS interact with each other.

Risk Factors for Infection and Colonization of Community-acquired MRSA / 中华医院感染学杂志

OBJECTIVE To comprehensively analyze the risk factors for infection and colonization of community-acquired MRSA.METHODS The results of 12 studies were analyzed by meta-analysis and the OR value of every factor was calculated.RESULTS All eight risk factors were evaluated:prior hospitalization(OR=2.46,CI1.25-4.85),antibiotics exposure recently(OR=2.77,CI1.34-5.74),contact with healthcare system and medical workers frequently(OR=6.48,CI2.38-17.63),surgery or invasive procedure(OR=2.53,CI1.90-3.36),age(OR=-1.99,CI-9.21-5.23),gender(OR=1.04,CI0.71-1.51),intravenous drug use(OR=1.49,CI0.34-6.54),and underlying diseases(OR=1.12,CI0.55-2.28).CONCLUSIONS Prior hospitalization,antibiotics exposure recently,contact with healthcare system and medical workers frequently and surgery or invasive procedure are risk factors of community-acquired MRSA.The effects of age,gender,intravenous drug use and underlying diseases need further investigation.

Long-term regualr prevention and management for asthmatic patients after exacerbation / 中国呼吸与危重监护杂志

Objective To explore the effects of long term preventive treatment and patient education on asthmatic patients after acute attack Methods Prevention,treatment,and education were underwent for two to five years in 78 asthmatic patients after acute attack Frequency of exacerbation,lung function and laboratory parameters were monitored while treatment regimen was adjusted according to above results Results Regular prevention and management resulted in improvement of lung function and symptom as well as quality of life in all the patients Mmeanwhile less frequences of acute attack,emergency department visit,and hospital stay were observed,leading to reduction of medical expenditure Conclusion Long term prevention,treatment and education for asthmatic patients after acute attack are effective for better asthma control

The role of CTLA4-Ig in a mouse model against allergic asthma / 中华医学杂志(英文版)

<p><b>OBJECTIVE</b>To investigate CTLA4-Ig's potential role in therapy for allergic asthma by blocking B7/CD28 interactions with cytotoxic T lymphocyte antigen 4-Ig (CTLA4-Ig).</p><p><b>METHODS</b>We divided BALB/C mice into the three groups: Sham/Sham (control), ovalbumin (OVA)/OVA and mCTLA4-Ig. Blood, bronchoalveolar lavage, histology and determination of cytokines were performed 24 hours after airway challenge.</p><p><b>RESULTS</b>In the OVA/OVA group, the number of cells, the percentage of inflamed cells and the level of IL-4 in BALF were increased. Airways in our murine model for allergic asthma underwent pathological changes, which were significantly reduced after treatment with mCTLA4-Ig.</p><p><b>CONCLUSION</b>Blockage of co-stimulation with mCTLA4-Ig can inhibit allergy-specific response of T cells, and asthmatic response as well.</p>

The effect of cigarette smoke extract on ICAM-1 expression as well as the influence of adenovirus E1A gene in pulmonary epithelial cells / 中国免疫学杂志

Objective:To explore the expression of intercellular adhesion molecule-1(ICAM-1 )induced by cigarette smoking extract(CSE) as well as the influence of the adenovirus E1A gene in pulmonary epithelial cells.Methods:A549 cells were transfected with a plasmid carrying the adenovirus E1A gene and stable trasfectants expressing E1A protein were selected. The cells were tested for the expression of ICAM-1 after stimulation with different concentrations of CSE.Results:ICAM-1expression was increased in A549 markedly with CSE stimulation,and the higher CSE concentration were,the more expression of ICMA-1 was observed. As compared with parental cells or cells transfected with control plasmid, ICAM-1 expression was markedly increased with stimulation of different concentrations of CSE in E1A-positive A549 cells.Conclusion:CSE exposure induces the surface expression of ICAM-1 and adenovirus E1A gene can markedly increase ICAM-1 expression induced by CSE in pulmonary epithelial cells, which suggest that latent adenovirus infection may amplify the inflammation process present in airways of smokers.

Clinical Analysis of 31 Patients With Sarcoidosis / 中国医师杂志

Objective To summarize the clinical features and therapy of sarcoidosis in the South of China.Methods A retrospective analysis was perfomed in 31 patients with sarcoidosis in past 22 years.Results The most frequent age at onset of sarcoidosis was 30～50 years old.Female patients were more than that in male patients. X-ray test of chest was the major way to diagnose the disease at early stage.The typing of lymphocytes in broncho-alveolar lavage fluid(BALF) has valuable to diagnose,but confirmed diagnosis depended on biopsy of histopathology.Conclusions Glucocorticoid is effective drug treatment for the most the patients who are at stage Ⅰ and Ⅱ. Every patient should be treated individually .If necessary,we should add immunosuppressors.

Clinical benefit of gemcitabine plus cisplatin 3-week regimen for patients with advanced non-small-cell lung cancer (NSCLC): a prospective observational study / 中国癌症杂志

Purpose:To study the effectiveness and safety o f first-line chemotherapy with GEM-Cis 3-week regimen in routine care of Chin ese patients with advanced NSCLC. Methods:Gem-Cis 3-week regimen was used as first line chemoth erapy to treat stage Ⅲb/Ⅳ NSCLC patients, measurements of effectiveness includ ed clinical benefit and significant clinical response (SCR), and side events of GEM-Cis in the treatment of stage Ⅲb/IV NSCLC. Results:221 patients with cytological or pathological confirmed stage Ⅲb or IV NSCLC were enrolled, 209 eligible for effectiveness and safety analysis. Median age 58 years (range, 29 to 79 years); males: females, 67.5%∶ 32.5%; stage Ⅳ: ⅢB, 52.5%∶47.8 %; KPS