Trend of age of menarche among Chinese Han girls aged 9 to 18 years from 2010 to 2019 / 中华预防医学杂志

Objective: To analyze the trends of the age of menarche among Chinese Han girls aged 9 to 18 years from 2010 to 2019. Methods: Data were extracted from the Chinese National Surveys on Students' Constitution and Health in 2010, 2014 and 2019. A total of 253 037 Han girls aged 9 to 18 years with complete data on menarche were selected in this study. They were asked one-on-one about their menstrual status, age and residence information. The median age of menarche was estimated by probability regression. U tests were used to compare the difference in median age at menarche in different years. Results: The median age at menarche (95%CI) among Chinese Han girls was 12.47 (12.09-12.83) years in 2010, 12.17 (11.95-12.38) years in 2014 and 12.05 (10.82-13.08) years in 2019, respectively. Compared with that in 2010, the median age at menarche in 2019 decreased by 0.42 years (U=-77.27, P<0.001). The annual average changes were -0.076 years from 2010 to 2014 (U=-57.19, P<0.001) and -0.023 years from 2014 to 2019 (U=-21.41, P<0.001), respectively. The average annual changes in urban areas in the periods of 2010 to 2014 and 2014 to 2019 were -0.071 years and 0.006 years, respectively, while those in rural areas were -0.082 years and -0.053 years, respectively. The average annual changes in the regions of north, northeast, east, south central, southwest and northwest were -0.064, -0.099, -0.091, -0.080, -0.096 and -0.041 years in the period of 2010 to 2014 and 0.001, -0.040, -0.002, -0.005, -0.043 and -0.081 years in the period of 2014 to 2019. Conclusion: The age of menarche among Chinese Han girls aged 9 to 18 years shows an advanced trend from 2010 to 2019, and the trends in urban and rural areas and different regions have different characteristics.

Related factors of acute exacerbation of chronic obstructive pulmonary disease and the value of inhaled glucocorticoid guided by eosinophil in peripheral blood / 中国医师杂志

Objective:To explore the risk factors of acute exacerbation (AE) of chronic obstructive pulmonary disease (COPD) and whether Eosinophil (EOS) in peripheral blood can guide the treatment of inhaled corticosteroids (ICS).Methods:This study was a single center, Prospective cohort study. The subjects of this study were from stable COPD patients who were treated in the Department of Respiratory Medicine of the Xiangya Second Hospital of Central South University from January 2020 to December 2021. Patient general information, past year AE status, exposure risk factors, modified version of the British Medical Research Council Respiratory Difficulty Questionnaire (mMRC) score, Chronic Obstructive Pulmonary Disease Assessment Questionnaire (CAT) score, ICS usage, lung function, blood routine, etc. were collected. We followed up the patient for one year. During the follow-up period, the clinical characteristics of patients with and without AE were compared to analyze the correlation between blood EOS and ICS use.Results:The median blood EOS of 617 stable COPD patients was 0.13×10 9/L, 289 patients (46.8%) with chronic obstructive pulmonary disease had a history of AE, and 207 patients (33.5%) experienced AE during 1-year follow-up. The results of univariate analysis showed that the future occurrence of AE in COPD was correlated with body mass index (BMI), AE history, Global Initiative for Chronic Obstructive Lung Disease (GOLD) grading, GOLD grouping, mMRC score, and CAT score (all P<0.05). The results of logistic multiple factor regression analysis showed that patients with BMI<24 kg/m 2, AE in the past year, severe AE in the past year, smoking history and other exposure factors, GOLD level 2 or above, GOLD C and D groups, and mMRC score≥ 2 had a higher risk of future AE (all P<0.05). There was no statistically significant difference in the incidence of AE between patients with COPD with different levels of EOS and those without ICS during a 1-year follow-up period (all P>0.05). Conclusions:The past 1-year AE history, BMI, exposure risk factors, degree of airflow restriction, and respiratory symptoms of patients with chronic obstructive pulmonary disease can predict future AE risk. There is no significant difference in future AE risk among patients with different levels of EOS, and EOS cannot guide ICS treatment to reduce AE risk.

Association of outdoor artificial light at night exposure with overweight and obesity among children and adolescents aged 9 to 18 years in China / 北京大学学报(医学版)

OBJECTIVE@#To analyze the association between outdoor artificial light-at-night (ALAN) exposure and overweight and obesity among children and adolescents aged 9 to 18 years in China.@*METHODS@#Using follow-up data of 5 540 children and adolescents aged 9 to 18 years conducted from November 2019 to November 2020 in eight provinces of China, latitude and longitude were determined based on school addresses, and the mean monthly average nighttime irradiance at the location of 116 schools was extracted by the nearest neighbor method to obtain the mean outdoor ALAN exposure [unit: nW/(cm2·sr)] for each school. Four indicators of overweight and obesity outcomes were included: Baseline overweight and obesity, persistent overweight and obesity, overweight and obesity progression and overweight and obesity incidence. Mixed effects Logistic regression was used to explore the association between ALAN exposure levels (divided into quintiles Q1-Q5) and baseline overweight and obesity, persistent overweight and obesity, overweight and obesity progression and overweight and obesity incidence. In addition, a natural cubic spline function was used to explore the exposure response association between ALAN exposure (a continuous variable) and the outcomes.@*RESULTS@#The prevalence of baseline overweight and obesity, persistent overweight and obesity, overweight and obesity progression and overweight and obesity incidence among the children and adolescents in this study were 21.6%, 16.3%, 2.9% and 12.8%, respectively. The OR value for the association between ALAN exposure and baseline overweight and obesity was statistically significant when ALAN exposure levels reached Q4 or Q5, 1.90 (95%CI: 1.26-2.86) and 1.77 (95%CI: 1.11-2.83), respectively, compared with the children and adolescents in the Q1 group of ALAN exposure. Similar to the results for baseline overweight and obesity, the OR values for the association with persistent overweight and obesity were 1.89 (95%CI: 1.20-2.99) and 1.82 (95%CI: 1.08-3.06) when ALAN exposure levels reached Q4 or Q5, respectively, but none of the OR values for the association between ALAN and overweight and obesity progression and overweight and obesity incidence were statistically significant. Fitting a natural cubic spline function showed a non-linear trend between ALAN exposure and persistent overweight and obesity.@*CONCLUSION@#There is a positive association between ALAN exposure and overweight and obesity in children and adolescents, and the promotion of overweight obesity in children and adolescents by ALAN tends to have a cumulative effect rather than an immediate effect. In the future, while focusing on the common risk factors for overweight and obesity in children and adolescents, there is a need to improve the overweight and obesity-causing nighttime light exposure environment.

Perceived exercise benefits and barriers and their association with physical activity time in Chinese Han children and adolescents aged 9 to 18 years / 中华流行病学杂志

Objective: To analyze the perceived exercise benefits and barriers and their association with physical activity time in Chinese Han children and adolescents aged 9-18 years. Methods: Data were extracted from the 2019 Chinese National Survey on Students' Constitution and Health and a total of 163 656 children and adolescents aged 9-18 years in Han ethnic group were included in the analysis. Mann-Whitney U test and Kruskal-Wallis test were used to compare the perceived exercise benefits score, perceived exercise barriers score and perceived exercise benefits to barriers ratio in the children and adolescents with different demographic characteristics and physical activity time. The differences in physical activity time in subgroups were compared with χ2 tests. log-binomial regression model was used to evaluate the association between physical activity time and perceived exercise benefits and barriers. Results: The M (Q1,Q3) of the perceived exercise benefits score, perceived exercise barriers score, and perceived exercise benefits to barriers ratio in the children and adolescents were 4.11 (3.78, 4.78), 2.70 (2.10, 3.20) and 1.55 (1.22, 2.07), respectively. Children and adolescents living in urban area, boys, those at younger age and those with physical activity time ≥1 hour had higher perceived exercise benefits score and perceived exercise benefits to barriers ratio, but lower perceived exercise barriers score (all P<0.001). The prevalence of physical activity time ≥1 hour was 41.4% in the children and adolescents. In the log-binomial model with two variables of perceived exercise benefits score and perceived exercise barriers score, for each 1-point increase in the perceived exercise benefits, the possibility of physical activity time ≥1 hour increased by 11% (OR=1.11, 95%CI: 1.10-1.12), and for each 1-point increase in the perceived exercise barriers, the possibility of physical activity time ≥1 hour decreased by 15% (OR=0.85, 95%CI: 0.84-0.85). In the log-binomial model with variable of perceived exercise benefits to barriers ratio, for each 1-point increase in the perceived exercise benefits to barriers ratio, the possibility of physical activity time ≥1 hour increased by 12% (OR=1.12, 95%CI: 1.11-1.12). Conclusion: The perceived exercise benefits and barriers are significantly associated with physical activity time in children and adolescents in China.

Trend of the detection rate of myopia among Chinese Han children and adolescents aged 7-18 years from 2010 to 2019 / 中华预防医学杂志

Objective: To analyze the trend of the detection rate of myopia among Chinese Han children and adolescents aged 7-18 years from 2010 to 2019. Methods: Data from the Chinese National Survey on Students' Constitution and Health in 2010, 2014 and 2019 were used, and about 213 833, 212 742 and 209 942 Han students aged 7-18 years were included in this study. The χ² test was used to compare the differences in the prevalence of myopia among the subgroups in the survey year, and logistic regression was used to compare the differences in the prevalence of myopia between different years. A curve-fitting method was used to obtain the growth rate of myopia among Han Chinese students from 2010 to 2019, and the differences in the change of myopia between different age groups were analyzed. Results: In 2019, the overall detection rate of myopia among Chinese Han children and adolescents aged 7-18 was 60.1%. The detection rate of urban students (62.7%) was higher than that of rural students (57.4%) and the detection rate of girls (63.5%) was higher than that of boys (56.7%). In 2019, the regional disparities were large in the detection rate of myopia in various provinces, with the lowest in Guizhou (49.6%) and the highest in Zhejiang (71.3%). The detection rate of myopia showed an upward trend from 2010 to 2019, from 55.5% in 2010 to 57.1% in 2014, and finally to 60.1% in 2019. The gap in the detection rate of myopia between urban and rural children and adolescents gradually shrank. The average annual growth rate of myopia detection rate from 2014 to 2019 was 0.6 percentage points per year, higher than that from 2010 to 2014 about 0.4 percentage points per year. The peak age of the growth rate of myopia detection rate decreased from 12 years in 2010 to 10 years in 2014, and finally to 7 years in 2019. Conclusions: The detection rate of myopia among Chinese Han children and adolescents is still at a high level, and the peak age of the growth rate of myopia detection rate continues to advance.

Long-term trend of the age of spermarche and its association with nutritional status among Chinese Han boys aged 11-18 from 2010 to 2019 / 中华预防医学杂志

Objective: To analyze the long-term trend of the age of spermarche among Chinese Han boys aged 11 to 18 from 2010 to 2019 and its association with nutritional status. Methods: The data from Chinese National Surveys on Students' Constitution and Health in 2010, 2014 and 2019 were used. The age, residence and spermarche of the participants were collected by questionnaire, and their height and weight were measured. A total of 184 633 Han boys aged 11‒18 years with complete data on spermarche, height, and weight were included in this study. The probability regression method was used to calculate the median age (95%CI) at spermarche in different areas, and the trend of age at spermarche in different groups was compared. The multivariate logistic regression model was used to analyze the association between nutritional status and spermarche of Chinese Han boys aged 11‒18 years. Results: The median age of spermarche (95%CI) was 13.85 (13.45-14.22) years old among Chinese Han boys aged 11‒18 years in 2019, with 0.18 years earlier than that in 2010. The median age at spermarche in urban and rural boys was 13.89 and 13.81 years, respectively. Compared with that in 2010, the age at spermarche in urban and rural boys was 0.08 and 0.27 years earlier, respectively. After adjusting for age, province and urban/rural areas, compared with normal weight, spermarche was negatively associated with wasting and positively associated with overweight and obesity, with OR (95%CI) about 0.73 (0.67-0.80), 1.09 (1.02-1.17) and 1.09 (1.01-1.18), respectively. Conclusion: The age of spermarche generally shows an advanced trend among Chinese Han boys and is associated with nutritional status.

Trends of age of menarche among Chinese Han girls aged 9 to 18 years from 2010 to 2019 / 中华预防医学杂志

Objective: To analyze the trends of the age of menarche among Chinese Han girls aged 9 to 18 years from 2010 to 2019. Methods: Data were extracted from the Chinese National Surveys on Students' Constitution and Health in 2010, 2014 and 2019. A total of 253 037 Han girls aged 9 to 18 years with complete data on menarche were selected in this study. They were asked one-on-one about their menstrual status, age and residence information. The median age of menarche was estimated by probability regression. U tests were used to compare the difference in median age at menarche in different years. Results: The median age at menarche (95%CI) among Chinese Han girls was 12.47 (12.09-12.83) years in 2010, 12.17 (11.95-12.38) years in 2014 and 12.05 (10.82-13.08) years in 2019, respectively. Compared with that in 2010, the median age at menarche in 2019 decreased by 0.42 years (U=-77.27, P<0.001). The annual average changes were-0.076 years from 2010 to 2014 (U=-57.19, P<0.001) and-0.023 years from 2014 to 2019 (U=-21.41, P<0.001), respectively. The average annual changes in urban areas in the periods of 2010 to 2014 and 2014 to 2019 were-0.071 years and 0.006 years, respectively, while those in rural areas were-0.082 years and-0.053 years, respectively. The average annual changes in the regions of north, northeast, east, south central, southwest and northwest were-0.064, -0.099, -0.091, -0.080, -0.096 and-0.041 years in the period of 2010 to 2014 and 0.001, -0.040, -0.002, -0.005, -0.043 and-0.081 years in the period of 2014 to 2019. Conclusion: The age of menarche among Chinese Han girls aged 9 to 18 years shows an advanced trend from 2010 to 2019, and the trends in urban and rural areas and different regions have different characteristics.

Clinical characteristics and guideline compliance analysis of chronic obstructive pulmonary disease patients with initial triple therapy in real-life world / 中国医师杂志

Objective:To observe the clinical characteristics and guideline compliance of chronic obstructive pulmonary disease (COPD) patients with initial triple therapy in real-life world.Methods:This study is a cross-sectional study. The subjects of the study were COPD patients admitted to 13 hospitals in Hunan Province and Guangxi Zhuang Autonomous Region from December 2016 to December 2021. The initial treatment was triple inhaled drugs. The data collected included gender, age, diagnosis, body mass index (BMI), history of acute exacerbation (AE) in the past year, pulmonary function, COPD Assessment Test (CAT) score, modified British Medical Research Council Dyspnea Questionnaire (mMRC), inhaled drugs and other indicators. The characteristics and differences of COPD patients before and after 2020 were analyzed.Results:7 184 patients with COPD were enrolled in this study, including 2 409 COPD patients treated with initial triple therapy, accounting for 33.5%(2 409/7 184). Taking January 1st, 2020 as the cut-off point, 1 825 COPD patients (75.8%) received initial treatment with triple inhaled drugs before 2020 and 584 patients (24.2%) after 2020 were included in this study. Compared with COPD patients before 2020, the COPD patients after 2020 had higher FEV 1% [(40.9±15.5 )% vs (39.3±15.5)%, P=0.040], lower CAT [(15.8±6.5)point vs (17.5±6.2)point, P<0.001], less AE in the past year [1(0, 2)times vs 1(0, 2)times, P=0.001] and higher rate of non-AE [255(43.7%) vs 581(37.1%), P=0.006]. In addition, before 2020, patients with COPD were mainly treated with open triple drugs (1 825/1 825, 100%); after 2020, 306 patients (52.4%) received open triple inhaled drugs, and 278 patients (47.6%) received closed triple inhaled drugs. Conclusions:In real-life world, most of patients with COPD treated with triple therapy have severe lung function, obvious symptoms and high risk of acute exacerbation. The real-world prescribing of triple therapy in patients with COPD does not always reflect recommendations in guidelines and strategies, and overtreatment is common. After 2020, prescribing triple therapy for COPD patients is more positive and worse consistency with guideline.

Status and compliance with the guideline of inhaled corticosteroids use in patients with chronic obstructive pulmonary disease / 中国医师杂志

Objective:To understand the use of inhaled corticosteroids (ICS) in patients with chronic obstructive pulmonary disease (COPD) in the real world and analyze its compliance with the guidelines.Methods:This study is a multicenter, cross-sectional study. 1 051 COPD patients who were treated in the Second Xiangya Hospital of Central South University, the First Affiliated Hospital of Shaoyang College and Zhuzhou Central Hospital from January 2020 to March 2022 were collected. The general information, drug use, types of exposure risk factors, acute exacerbation (AE) in the past year, the scores of the modified British Medical Research Council Dyspnea Questionnaire (mMRC), COPD Assessment Test (CAT), pulmonary function, blood routine of patients were collected. The status of ICS use in COPD patients, the clinical characteristics and guideline compliance of non-ICS users and ICS users were analyzed.Results:Among 1 051 patients with COPD, ICS was used in 490 cases (46.6%) and was not used in 561 cases (53.4%). ICS use was associated with relapse, frequent AE, severe AE, Global Initiative for Chronic Obstructive Pulmonary Disease (GOLD) grade 2 or above, GOLD D group, mMRC score, bronchial asthma, and blood eosinophils (EOS) (all P<0.05). Among 1 051 patients, 583(55.5%) were newly treated, 222(38.1%) were newly treated with ICS, and 361(61.9%) were not treated with ICS. ICS use in newly treated patients was associated with frequent AE, severe AE in the past year, GOLD grade 2 to 3, GOLD B and D group, mMRC score, bronchial asthma, and blood EOS (all P<0.05). Conclusions:Nearly half of patients with COPD are treated with ICS, and patients with ICS use had a higher risk of AE, more severe symptoms, higher blood EOS, and higher rates of asthma. However, there still exists the phenomenon of overuse of ICS.

Clinical research progress and implications of therapeutic vaccines for cervical cancer and precancerous lesions: a qualitative systematic review / 中华肿瘤杂志

Objective: To systematically summarize and analyze the clinical research progress of therapeutic vaccines for cervical cancer or precancerous lesions. Methods: English databases (PubMed, Embase, Web of Science, Cochrane library, Proquest, and ClinicalTrails.gov) and Chinese databases (SinoMed, CNKI, WanFang, and VIP Database) were systematically searched to collect literature on therapeutic vaccines for cervical cancer or precancerous lesions from inception to February 18, 2021. After screening, we evaluated the risk of bias of included studies, and combed the basic information of the literature, research designs, information of vaccines, study patients, outcome indicators and so on, qualitatively summarized the clinical research progress. Results: A total of 71 studies were included in this systematic review, including 14 random controlled trials, 15 quasi-random controlled trials, 4 cohort studies, 1 case-control study, 34 case series studies and 3 case reports. The study patients included women aged 15~79 with cervical cancer or precancerous lesions in 18 countries from 1989 to 2021. On the one hand, there were 40 studies on therapeutic vaccines for cervical precancerous lesions (22 867 participants), involving 21 kinds of vaccines in 6 categories. Results showed 3 marketed vaccines (Cervarix, Gardasil, Gardasil 9) as adjuvant immunotherapies were significant effective in preventing the recurrence of precancerous lesions compared with the conization only. In addition, MVA E2 vaccine had been in phase Ⅲ clinical trials as a specific therapeutic vaccine, with relative literature showing it could eliminate most high-grade precancerous lesions. Therapeutic vaccines for precancerous lesions all showed good safety. On the other hand, there were 31 studies on therapeutic vaccines for cervical cancer (781 participants), involving 19 kinds of vaccines in 7categories, with none had been marketed. 25 studies were with no control group, showing the vaccines could effectively eliminate solid tumors, prevent recurrence, and prolong the median survival time. However, the vaccines effectiveness couldn't be statistically calculated due to the lack of a control group. As for the safety of therapeutic vaccines for cervical cancer, 9 studies showed that patients experienced serious adverse events after treatments, where 7 studies reported that serious adverse events occurred in patients couldn't be ruled out as the results of therapeutic vaccines. Conclusions: The literature review shows that the literature evidence for the therapeutic vaccines for cervical precancerous lesions is relatively mature compared with the therapeutic vaccines for cervical cancer. The four kinds of vaccines on the market are all therapeutic vaccines for precancerous lesions, but they are generally used as vaginal infection treatments or adjuvant immunotherapies for cervical precancerous lesions, not used for the specific treatments of cervical precancerous lesions. Other specific therapeutic vaccines are in the early stage of clinical trials, mainly phase Ⅰ/Ⅱ clinical trials with small sample size. The effectiveness and safety data are limited, and further research is still needed.

Study on the levels and risk factors of Vitamin D from preconception to pregnancy / 中华疾病控制杂志

Objective To investigate the levels of serum Vitamin D(VD) from preconception to pregnancy in Jiading district of Shanghai, and explore the risk factors of VD concentration deficiency in the second and third trimester of pregnancy. Methods A total of 94 women who planned to have antenatal care and delivery in Maternal and Child Health Hospital of Jiading district of Shanghai from September 2016 to December 2018 were recruited as the study participants. Chemiluminescent immunoassay (CLIA) was used to examine the concentration of women’s serum VD from preconception to pregnancy. A total of 282 serum samples were detected. Results The prevalence of VD deficiency among 94 women from preconception to pregnancy were 40.4%,57.4% and 48.9% respectively. Results of the mixed linear model showed that women who had dyed or permed hair within the past 1 year had significantly lower serum VD levels during pregnancy (P<0.05), and women who often drank milk and ate deep-sea fish during pregnancy had higher VD levels during pregnancy (P<0.05). Conclusions VD deficiency was common among women in Jiading district of Shanghai, and it should be emphasized to supplement VD before and during pregnancy.

Application of pulmonary rehabilitation in elderly patients with acute exacerbation of chronic obstructive pulmonary disease / 中国医师杂志

Chronic obstructive pulmonary disease (COPD) is a common preventable disease characterized by persistent respiratory symptoms and airflow limitation, mainly manifested as chronic cough, expectoration and wheezing. With the aging of the population and the aggravation of environmental pollution, the number of elderly patients with COPD has gradually increased in recent years. Compared with young individuals, the acute exacerbation of elderly COPD patients is more frequent and often complicated with a variety of underlying diseases, even after active drug treatment, the therapeutic effect is still limited. More systematic treatment methods are needed on the basis of conventional drug therapy. The positive role of pulmonary rehabilitation in COPD patients who are in stable period has been confirmed, but in the acute exacerbation of chronic obstructive pulmonary disease (AECOPD) patients is controversial, especially in the elderly AECOPD patients. In this review, we summarized current studies of the application of pulmonary rehabilitation in elderly AECOPD patients.

Differences of clinical features between smokers and non-smokers with chronic obstructive pulmonary disease / 中国医师杂志

Objective:To evaluate the clinical differences between smokers and non-smokers with chronic obstructive pulmonary disease (COPD).Methods:The clinical data of 5 183 COPD patients, including 3 688 smoking COPD patients and 1 495 non-smoking patients, were collected from the respiratory and critical medicine clinics of 12 Grade-A hospitals in Hunan Province and Guangxi Zhuang Autonomous Prefecture from December 2016 to December 2019. The general condition, clinical symptoms, acute exacerbation history and pulmonary function of the two groups were compared.Results:⑴ Non-smokers were more likely to be female, to be younger and had a lower educational level ( P<0.05). There was no difference of body mass index (BMI) and marriage statue between two groups ( P>0.05). ⑵ Clinical features: the incidence of chest distress in non-smoking COPD patients was higher than that in smoking COPD patients (86.8% and 81.4%, respectively), and the incidence of asthma was also higher than that of smoking COPD patients (86.0% and 83.1%, respectively), with statistically significant difference ( P<0.05). There was no significant difference in the incidence of cough and expectoration between the two groups ( P>0.05). The COPD assessment test (CAT) score of non-smoking COPD patients was significantly higher than that of smoking group (16.2±6.4) and (15.7± 6.5) ( P<0.05). There was no significant difference in the score of dyspnea modified medical research council dyspnea scale (mMRC) and the risk of acute exacerbation between the two groups ( P>0.05). The first second exertional volume as a percentage of predicted value (FEV 1%) and forced vital capacity (FVC) of non-smoking COPD patients were higher than those of smoking COPD patients ( P<0.05). Conclusions:Compared to smokers with COPD, non-smokers more are more likely to be female and have more severe clinical symptoms.

The recent advances of asthma-chronic obstructive pulmonary disease overlap / 中国医师杂志

Asthma and chronic obstructive pulmonary disease overlap (ACO) is a hot topic in recent years. Although the precise definition of ACO is still controversial, scholars have found that the patients with overlapping features of asthma and COPD have a worse prognosis and increased medical cost than those with asthma or COPD alone. Thus, there is a big challenge to have a better understanding and to manage these patients in clinical practice. To strengthen awareness of this type of patients, the Global initiative for Chronic Obstructive Lung Disease (GOLD) and Global initiative for asthma (GINA) in 2014 named them as " Asthma Chronic Obstructive Lung Overlap Syndrome" (ACOS), which was further revised to the Asthma Chronic Obstructive Lung Overlap (ACO) in the follow-up GINA guidelines (2017). In the updated version, it emphasized that ACO was not a separate disease. However, although the research on ACO has increased significantly in recent years, there are still many controversies, which includes the definition, diagnostic criteria and treatment therapies. In this review, we provide the recent advances in the diagnosis and an overview of available treatment for of ACO.

The recent advances of asthma-chronic obstructive pulmonary disease overlap / 中国医师杂志

Asthma and chronic obstructive pulmonary disease overlap (ACO) is a hot topic in recent years.Although the precise definition of ACO is still controversial,scholars have found that the patients with overlapping features of asthma and COPD have a worse prognosis and increased medical cost than those with asthma or COPD alone.Thus,there is a big challenge to have a better understanding and to manage these patients in clinical practice.To strengthen awareness of this type of patients,the Global initiative for Chronic Obstructive Lung Disease (GOLD) and Global initiative for asthma (GINA) in 2014 named them as " Asthma Chronic Obstructive Lung Overlap Syndrome" (ACOS),which was further revised to the Asthma Chronic Obstructive Lung Overlap (ACO) in the follow-up GINA guidelines (2017).In the updated version,it emphasized that ACO was not a separate disease.However,although the research on ACO has increased significantly in recent years,there are still many controversies,which includes the definition,diagnostic criteria and treatment therapies.In this review,we provide the recent advances in the diagnosis and an overview of available treatment for of ACO.

Correlation between inspiratory muscle strength and pulmonary ventilation function in patients with chronic obstructive pulmonary disease / 中国医师杂志

Objective To analyze the correlation between inspiratory muscle strength and pulmonary ventilation function in chronic obstructive pulmonary disease (COPD) patients.Methods A total of 41 COPD patients admitted in the Second Xiangya Hospital from January to September 2018 were screened.The inspiratory muscle strength (MIP) and peak inspiratory flow (PIF) of patients were measured by using POWER breathe K-5 tester.The MIP was also calculated as a percentage of the predicted value.A pulmonary function detector was used to measure the forced vital capacity (FVC),forced expiratory volume in 1 second (FEV1 ％),FEV1 as a percentage of FVC (FEV1/FVC％),peak expiratory flow (PEF),forced expiratory flow as a percentage of the predicted value (FEF 50％) at 50％ of vital capacity and forced expiratory flow rate as a percentage of the predicted value (FEF 75％) at 75％ of vital capacity.According to the Gobal Inistiative for chronic Obstructive Lung Disease (GOLD) classification method of COPD patients,the corresponding MIP value and PIF value of the patients were divided into 4 groups and conducted the comparison between groups.Pearson correlation was used to analyze the correlation between the above-mentioned inspiratory muscle strength test values and lung ventilation function test values,and a scatter diagram was drawn for the ones that had a correlation.Results Among the 41 patients,39 (95.1％) had a decrease in inspiratory muscle strength.According to the GOLD classification,the mean MIP value has a difference among the 4 groups.The mean MIP of grade Ⅲ was [(47.09 ± 29.42) cmH2O],which was higher than that of grade Ⅳ of [(24.72 ± 7.66) cmH2 O] (P ＜ 0.05).There was no difference between PIF.The MIP was positively correlated with FVC (P ＜0.05).There was no correlation between MIP and FEV1 ％,FEV1/FVC％,PEF,FEF50％ and FEF75％ (P ＞0.05).The MIP as a percentage of the predicted value had a weak positive correlation with FVC and FEV1％ (P ＜0.05).There was no significant correlation between MIP as a percentage of the predicted value and FEV1/FVC％,PEF,FEF50％ and FEF75％ (P ＞0.05).PIF had a weak positive correlation with FVC,PEF,FEF50％ and FEF75％,with statistically significant difference (P ＜ 0.05).There was no significant correlation between PIF and FEV1 ％ and FEV1/FVC％ (P ＞0.05).Conclusions Inspiratory muscle dysfunction was common in patients with COPD.There was a difference in MIP among different GOLD lung function classification in COPD patients.Some values of the inspiratory muscle strength and lung ventilation function had a weak-moderate correlation,while some values had no correlation.Therefore,inspiratory muscle strength test cannot replace the lung ventilation function test in COPD patients.

Pay attention to the pulmonary rehabilitation of chronic obstructive pulmonary disease / 中国医师杂志

Post-exercising tachypnea is the main manifestation of chronic obstructive pulmonary disease (COPD).Pulmonary rehabilitation,which is one of non-pharmacotherapy of COPD,can relieve dyspnea,improve exercise tolerance and health-related quality of life.At present,although the pulmonary rehabilitation is developing in China,there is a lack of more emphasis,recognition and unbalance development.Most grass-roots hospitals have not carried out the treatment.Now,there is no unified definition about the prescription of pulmonary rehabilitation for COPD patients.More studies are warranted to standardize the formulation and implementation of the pulmonary rehabilitation program.Therefore,we mainly demonstrate the pulmonary rehabilitation of COPD including assessments and trainings,in order to pay more attention to it.

Clinical COPD questionnaire (CCQ) in patients with COPD / 中国医师杂志

The overall impact of chronic obstructive pulmonary disease (COPD) on individuals is multifaceted and it causes impairment not only in lungs but also in other organs,and even in psychological conditions that result in multiple symptomatic effects and poorer quality of life.Therefore,it is critical to e valuate patients'quality of life in the clinical practice.Besides modified Medical British Research Council (mMRC) and COPD assessment test (CAT),the clinical COPD questionnaire (CCQ),a self-administered questionnaire was also recommended by GOLD2013 to assess patients'health status.Compared to the wide spread use of mMRC and CAT,CCQ was paid less attention in our clinical work.This study focused on the development,reliability,validity and responsiveness of the CCQ among subjects with COPD.We found that CCQ was easily understood with good reliability,validity and responsiveness and the use of the CCQ should be promoted as a health status measurement in more countries and regions.

The comprehensive assessment of chronic obstructive pulmonary disease / 中国医师杂志

Chronic obstructive pulmonary disease (COPD) is a common and frequent disease that endangers human health seriously.It has the characteristics of high morbidity and mortality and heavy social-economic burden.It has become an important public health issue.The purpose of the comprehensive assessment of COPD is to determine the level of airflow restriction,assess the impact on the patient's health status and future risk factors.At present,the pulmonary function test is still the gold standard for diagnosing COPD.However,it can not fully reflect the clinical features and risk prediction of the disease.In clinical practice,comprehensive indexes are needed to evaluate the impact of the disease on the patient's health status.The comprehensive assessment for a COPD patient is conducive to the guidance of individualized treatment,to improve the current symptoms,comprehensive prognosis,delay the disease progression and improve the quality of life of patients.

Pay attention to the assessment and pulmonary rehabilitation of chronic obstructive pulmonary disease / 中国医师杂志

The assessment runs through the diagnosis,treatment and prognosis of chronic obstructive pulmonary disease (COPD).Though there are various methods of assessments,many physicians diagnose patients and prescribe medicine homogeneously according to the lung function or clinical manifestations.Therefore,it is necessary to summarize the measurements of COPD,making it be better known to clinic physicians.On the basis of these measurements,physicians can choose the suitable therapeutic schemes to treat COPD patients.In recent years,pulmonary rehabilitation is growing up gradually,which is one of treatment methods for COPD.To popularize knowledge and form complete treatments of pulmonary rehabilitation is still a long way to go,because of unbalanced development,unpopular and monotherapy in China.In order to benefit patients and improve the patients'life quality,we need to promote actively,intensify constantly and practice the pulmonary rehabilitation one by one.