Mechanism of Qingfei Huatan Zhuyu Decoction in Treatment of COPD Based on "Lung and Intestinal Co-treatment" / 中国实验方剂学杂志

ObjectiveTo observe the effect of Qingfei Huatan Zhuyu decoction on the lung and intestinal function of rats with chronic obstructive pulmonary diseases （COPD） and explore the deep-seated mechanism of its embodiment of lung and intestinal co-treatment. MethodA total of 60 Wistar rats were randomly divided into six groups， with 10 rats in each group， and the groups were control group， model group， acute syrup group （10 g·kg-1·d-1）， and low， medium， and high-dose groups （10， 15， 20 g·kg-1·d-1） of Qingfei Huatan Zhuyu decoction. The COPD rat model was established by lipopolysaccharide tracheal drip combined with the smoke inhalation method， and the acute syrup group and the Qingfei Huatan Zhuyu decoction group were administered by gavage with corresponding dose concentrations respectively， while the rest groups were controlled by saline gavage， and the lung function and blood gas indexes of rats were monitored after the last administration. The histopathological changes in the lung and intestine were observed microscopically. The expression of serum interleukin-6 （IL-6）， tumor necrosis factor-α （TNF-α）， and secretory immunoglobulin A （IgA） in colon tissue were measured by enzyme-linked immunosorbent assay （ELISA）. The biochemical indexes such as serum diamine oxidase （DAO）， D-lactic acid， and malondialdehyde （MDA） were measured. Immunohistochemistry was used to detect the expression of tight junction protein （Occludin） in rat colon tissue. The expression of F4/80 positive alveolar macrophages in rat lung tissue， and the expression of α-actin （α-SMA） and colonic atresia small band protein-1 （ZO-1） were determined by immunofluorescence. The protein expression of p-NF-κB p65， NF-κB p65， p-p38 MAPK， and p-p38 MAPK and the expression of Occludin and ZO-1 in colon tissue were detected in rat lung tissue by Western blot. ResultCompared with the normal group， the model group had pulmonary dysfunction， reduced forced vital capacity （FVC）， arterial partial oxygen pressure （PaO2）， arterial oxygen saturation （SaO2）， and dynamic lung compliance （Cdyn） （P<0.01）， and the pathological changes in the lung and intestine were obvious. The expressions of IL-6， TNF-α， DAO， D-lactic acid， and MDA in serum were increased （P<0.05，P<0.01）， and the protein expression ratio of p-NF-κB p65/NF-κB p65 and p-p38 MAPK/p38 MAPK in lung tissue was increased. The expression of F4/80 positive macrophages in lung tissue was enhanced. The expression of IgA， Occludin， and ZO-1 in colon tissue decreased （P<0.05，P<0.01）. Compared with the model group， the pulmonary function of the rats in the acute syrup group and groups of Qingfei Huatan Zhuyu decoction was significantly improved， and the FVC， PaO2， SaO2， and Cdyn were increased （P<0.05， P<0.01）. The pathological changes in the lung and intestine were significant. The expressions of IL-6， TNF-α， DAO， D-lactic acid， and MDA in serum were decreased （P<0.05，P<0.01）， and the expressions of F4/80 positive macrophages in lung tissue were decreased （P<0.01）. The protein expression ratio of p-NF-κB p65/NF-κB p65 and p-p38 MAPK/p38 MAPK in lung tissue decreased （P<0.01）， and the expression of IgA， Occludin， and ZO-1 in colon tissue increased （P<0.01）. ConclusionQingfei Huatan Zhuyu decoction can effectively reduce the symptoms of COPD rats， and its mechanism of action is related to inhibiting the inflammatory response of lung tissue and improving the barrier function of the intestinal mucosa.

A study to monitor adverse drug reactions in patients of chronic obstructive pulmonary disease, asthma and bronchiectasis

Background: These Diseases are chronic and often have complex pathologies which lead to polypharmacy and causes unwanted adverse drug reaction (ADRs). We conducted this study at Respiratory Medicine Department of Gandhi Medical College and associated Hamidia Hospitals, Bhopal. Aim and Objective: The objectives of the study were (i) to monitor and assess ADRs in patients of chronic obstructive pulmonary disease (COPD), Asthma, Bronchiectasis; and (ii) to assess causality of the ADR using WHO-UMC causality assessment system and Naranjo’s ADR probability scale. Materials and Methods: The present study indicates the pattern and spectrum of ADRs due to drugs used in the treatment of COPD, Asthma, Bronchiectasis. 159 patients from Respiratory Medicine, Gandhi Medical College receiving chemotherapy were enrolled in study after written informed consent of patients. Approval was obtained from institutional ethics committee. It was cross-sectional, observational study. Prescriptions were analyzed for number of drugs prescribed using a predesigned format. Any ADR observed by patient or treating physician was noted and causality was assessed by Naranjo’s algorithm and WHO-UMC scale. Results: In our study, most important causative drug was Budesonide (12.3%). Causality assessment of ADR by Naranjo’s algorithm showed 22% probable and 78% possible reactions. According to WHO-UMC scale, 81% reactions are possible, 17% are probable, and 2% are unlikely. Conclusion: To minimize this high incidence of ADRs dose individualization and therapeutic monitoring of medicine is important. In clinical practice, special precautions while prescribing these drugs with well-known potential for causing ADRs, early detection and appropriate intervention are required. This may greatly contribute to reduce the incidence, frequency, severity, morbidity, and possible mortality.

Application of exercise combined with lung rehabilitation in respiratory disease / Aplicação de exercícios combinados com reabilitação pulmonar em doenças respiratórias / Aplicación de ejercicios combinados con rehabilitación pulmonar en enfermedades respiratorias

ABSTRACT Introduction: Chronic obstructive pulmonary disease (COPD) is a respiratory disease characterized by incomplete reversibility of airflow obstruction and persistent respiratory symptoms. Objective: To explore the therapeutic effect of physical exercise on patients with chronic obstructive pulmonary disease in pulmonary rehabilitation. Methods: Forty-eight experimental subjects were divided into control group, experimental group 1, and experimental group 2 for research. The control group received normal medical-related treatment without any other means of intervention. In addition to normal medical-related treatment, experimental group 1 received breathing training and educational interventions and experimental group 2 received exercise, breathing training and educational interventions. Results: The vital capacity of female subjects before and during the experiment ranged from 2.23±0.01 to 2.26±0.04, the FVC ranged from 2.00±0.02 to 2.01±0.03, the FEV1 ranged from 1.03±0.01 to 1.03±0.01,the FEV1% ranged from 55.50±1.29 to 55.25±1.71,the FEV1/FVC ranged from 51.44±0.24 to 50.84±1.00, andthe heart rate ranges from 65.00±0.82 to 65.50±1.29. Conclusions: Exercise training can increase the exercise tolerance of patients with COPD, relieve dyspnea, and improve the quality of life. Level of evidence II; Therapeutic studies - investigation of treatment results.

RESUMO Introdução: A doença pulmonar obstrutiva crônica (DPOC) é uma patologia respiratória caracterizada pela reversibilidade incompleta da obstrução ao fluxo aéreo e sintomas respiratórios persistentes. Objetivo: Explorar o efeito terapêutico do exercício físico em pacientes com doença pulmonar obstrutiva crônica sobre a reabilitação pulmonar. Métodos: Quarenta e oito participantes foram divididos em grupo controle, grupo experimental 1 e grupo experimental 2 para a realização do estudo. O grupo controle recebeu tratamento clínico normal, sem qualquer outra intervenção. Além do tratamento clínico normal, o grupo experimental 1 recebeu treinamento respiratório e intervenções educacionais e o grupo experimental 2 recebeu exercícios, treinamento respiratório e intervenções educacionais. Resultados: A capacidade vital de mulheres antes e durante o experimento variou de 2,23 ± 0,01 a 2,26 ± 0,04, a CVF variou de 2,00 ± 0,02 a 2,01 ± 0,03, o VEF1 variou de 1,03 ± 0,01 a 1,03 ± 0,01, o VEF1% variou de 55,50 ± 1,29 a 55,25 ± 1,71, a VEF1/CVF variou de 51,44 ± 0,24 a 50,84 ± 1,00, e a frequência cardíaca variou de 65,00 ± 0,82 a 65,50 ± 1,29. Conclusões: O treinamento físico pode aumentar a tolerância ao exercício de pacientes com DPOC, atenuar a dispneia e melhorar a qualidade de vida. Nível de Evidência II; Estudos terapêuticos - Investigação dos resultados do tratamento.

RESUMEN Introducción: La enfermedad pulmonar obstructiva crónica (EPOC) es una patología respiratoria caracterizada por la reversibilidad incompleta de la obstrucción del flujo aéreo y la persistencia de síntomas respiratorios. Objetivo: Explorar el efecto terapéutico del ejercicio físico en la rehabilitación pulmonar en pacientes con enfermedad pulmonar obstructiva crónica. Métodos: Cuarenta y ocho participantes fueron divididos en grupo de control, grupo experimental 1 y grupo experimental 2 para el estudio. El grupo de control recibió tratamiento clínico normal sin ninguna otra intervención. Además del tratamiento clínico normal, el grupo experimental 1 recibió entrenamiento respiratorio e intervenciones educativas y el grupo experimental 2 recibió ejercicios, entrenamiento respiratorio e intervenciones educativas. Resultados: La capacidad vital de las mujeres antes y durante el experimento osciló entre 2,23 ± 0,01 y 2,26 ± 0,04, la FVC entre 2,00 ± 0,02 y 2,01 ± 0,03, el FEV1 entre 1,03 ± 0,01 y 1, 03 ± 0,01, el FEV1% varió de 55,50 ± 1,29 a 55,25 ± 1,71, la FEV1/FVC varió de 51,44 ± 0,24 a 50,84 ± 1,00, y la frecuencia cardíaca varió de 65,00 ± 0,82 a 65,50 ± 1,29. Conclusiones: El entrenamiento físico puede aumentar la tolerancia al ejercicio en pacientes con EPOC, atenuar la disnea y mejorar la calidad de vida. Nivel de evidencia II; Estudios terapéuticos - Investigación de los resultados del tratamiento.

Identification and characterization of nontuberculous mycobacteria isolated from suspected pulmonary tuberculosis patients in eastern china from 2009 to 2019 using an identification array system

Abstract Objective Nontuberculous mycobacteria (NTM) species are increasingly being isolated and have become a key factor affecting public health by causing pulmonary diseases. Most NTM species do not respond to conventional tuberculosis (TB) drugs. This study aimed to identify NTM isolated from suspected pulmonary TB patients from the Zhejiang province and analyze their distribution in the region. Methods A total of 1,113 NTM isolates from patients suspected to be suffering from acid-fast bacilli-positive tuberculosis were identified at the species level, using the CapitalBio Mycobacterium identification array and polymerase chain reaction amplification and sequencing of 16S-23S gene internal transcribed spacer (ITS), 16S rRNA, and hsp65. Results Of the 23,138 isolates, we identified 1,102 NTM (4.8%), mainly including Mycobacterium intracellulare (54.81%, 604/1,102), M. chelonae-M. abscessus (16.52%, 182/1,102), M. avium (13.16%, 145/1,102), M. kansasii (8.17%, 90/1,102), and M. gordonae (3.27%, 36/1,102). Conclusion The distribution of NTM species observed in patients with suspected pulmonary tuberculosis provides guidance for the diagnosis and treatment of NTM pulmonary diseases.

Riesgo patogénico por Aspergillus fumigatus en la producción de compost de Musa paradisiaca / Pathogenic risk by Aspergillus fumigatus in the compost production of Musa paradisiaca

Aspergillus fumigatus es un hongo con características de saprofito que crece en las partes muertas y en descomposición de la materia orgánica. La presencia de terapias inmunosupresoras o de antifúngicos pueden convertirlo en un patógeno fúngico oportunista causante de enfermedades como aspergilosis pulmonar crónica (CPA), aspergilosis invasiva aguda y síndrome de alergias. Pacientes que sufren de enfermedad pulmonar severa como la pulmonar obstructiva crónica (EPOC) tienen un mayor riesgo de desarrollar aspergilosis pulmonar crónica y aspergilosis pulmonar necrosante crónica (CNPA) que pueden causar crecimiento de hongos en los tejidos dañados. Por otro lado, una de las fuentes más comunes de estos hongos son la generación de compost. Estos fertilizantes orgánicos no dañan al medio ambiente y podrían resultar una estrategia eficaz para salvaguardar el medio ambiente. El compost orgánico promueve el suelo con mejor capacidad de retención de agua y resistencia a la sequía. Entre los residuos agrícolas postcosecha más comunes utilizados en la formación de compost, se pueden mencionar a las cáscaras de yuca, de maní, de frutas y verduras, desechos de cervecería, cascarilla de cacao, cascarilla de cola, maíz, conchas de plátano (Musa paradisiaca). Esta investigación tuvo por objetivo determinar la calidad del compost producido a partir de la cáscara de plátano con el fin de aprovechar hasta un 70% de su biomasa en la Municipalidad Provincial de Leoncio Prado, Perú. Los resultados mostraron que la la degradación aerobia de la cáscara de M. paradisiaca generó emisiones de CO2 (88,61%), así como compost (6,57 %) y lixiviados (4,82 %). Sin embargo, los efectos fitotóxicos usando el índice de germinación mostraron una inhibición completa de las semillas probadas posiblemente debido al gran contenido de minerales (alto contenido de salinidad del compost y lixiviado), presencia de metales pesados, compuestos orgánicos presentes, o la presencia de hongos tales como el A. fumigatus(AU)

Aspergillus fumigatus is a saprophytic fungus that grows on dead and decomposing parts of organic matter. The presence of immunosuppressive or antifungal therapies can make it an opportunistic fungal pathogen causing diseases such as chronic pulmonary aspergillosis (CPA), acute invasive aspergillosis, and allergy syndrome. Patients suffering from severe lung disease such as chronic obstructive pulmonary disease (COPD) are at increased risk of developing chronic pulmonary aspergillosis and chronic necrotizing pulmonary aspergillosis (CNPA) which can cause fungal growth in damaged tissues. On the other hand, one of the most common sources of these fungi is the generation of compost. These organic fertilizers do not harm the environment and could be an effective strategy to safeguard the environment. Organic compost promotes soil with better water holding capacity and drought resistance. Among the most common postharvest agricultural residues used in the formation of compost, we can mention cassava shells, peanut shells, fruit and vegetable shells, brewery waste, cocoa shells, tail shells, corn, banana shells (Musa paradisiaca). The objective of this research was to determine the quality of the compost produced from the banana peel in order to take advantage of up to 70% of its biomass in the Provincial Municipality of Leoncio Prado, Peru. The results showed that the aerobic degradation of the shell of M. paradisiaca generated CO2 emissions (88.61%), as well as compost (6.57%) and leachates (4.82%). However, the phytotoxic effects using the germination index showed a complete inhibition of the tested seeds, possibly due to the high mineral content (high salinity content of the compost and leachate), the presence of heavy metals, organic compounds present, or the presence of fungi such as A. fumigatus(AU)

Nivel de adhesión y prevalencia a inhaladores en pacientes ambulatorios con Asma y Enfermedad Pulmonar Obstructiva Crónica / Level of inhaler adhesion and prevalence in outpatients with Asthma and Chronic Obstructive Pulmonary Disease

INTRODUCCIÓN. Para el tratamiento farmacoterapéutico de enfermedades respi-ratorias, el uso de herramientas para abordar la vía inhalatoria es de elección por su mayor eficacia y menos efectos secundarios; registrar su adhesión y prevalencia es importante. OBJETIVO. Determinar el nivel y la prevalencia de adhesión al uso de inhaladores en pacientes con Asma y Enfermedad Pulmonar Obstructiva Cróni-ca. MATERIALES Y MÉTODOS. Estudio analítico transversal. Población de 215 y muestra de 121 Historias Clínicas. Se aplicó el Test de Adhesión a Inhaladores, que consistió en dos cuestionarios complementarios: el de 10 ítems, que valoró el nivel de adhesión, y el de 12 que identificó el tipo de incumplimiento en pacientes de Consulta Externa de la Unidad Técnica de Neumología del Hospital de Especialidades Carlos Andrade Marín, periodo julio 2018 - enero 2019. La tabulación y análisis de datos se realizó con el programa Excel. RESULTADOS. La prevalencia de mala adhesión en asmáticos fue de 83,33% y en Enfermedad Pulmonar Obstructiva Crónica 13,33%. En cuanto al sexo, la prevalencia de mala adhesión fue de 15,28% en hombres y de 40,82% en mujeres, con una p<0,05. No se encontró diferencia significativa respecto a los niveles de instrucción. CONCLUSIÓN. La prevalencia de mala adhesión al uso de inhaladores en pacientes con Asma y Enfermedad Pulmonar Obstructiva Crónica fue alta sobre todo en los asmáticos.

INTRODUCTION. For respiratory diseases and their pharmacotherapeutic treatment, the use of tools to address the inhalation route is chosen due to its greater efficacy and fewer secondary effects; then record the adherence and prevalence is important. OBJECTIVE. To determine both level and prevalence of adherence to the use of inhalers in patients with Asthma and Chronic Obstructive Pulmonary Disease. MATE-RIALS AND METHODS. Cross-sectional analytical study. Population of 215 and sam-ple of 121 patients. The Inhaler Adherence Test was applied, which consisted of two complementary questionnaires: a 10-item questionnaire, which assessed the level of adherence, and a 12-item questionnaire that identified the type of non-compliance in patients of the Pneumology Technical Unit of the Hospital de Especialidades Carlos Andrade Marín, period July 2018 - January 2019. The tabulation and data analysis was performed with Microsoft Excel program. RESULTS. The prevalence of poor ad-herence in asthmatics was 83.33% and in Chronic Obstructive Pulmonary Disease was 13.3%. Regarding gender, the prevalence of poor adherence was 15.28% in men and 40.82% in women, with a p <0.05. No significant differences were found regarding the levels of instruction. CONCLUSION. The prevalence of poor adherence to the use of inhalers in patients with Asthma and Chronic Obstructive Pulmonary Disease was high, especially in asthmatics

Os efeitos do método Pilates sobre a força muscular respiratória em crianças com sintomas de asma / The effects of the Pilates method on respiratory muscle strength in children with asthma symptoms

Objetivo: analisar os efeitos do método Pilates sobre a força muscular respiratória em crianças com sintomas de asma. Metodologia: nesse estudo clínico foram avaliadas 17 crianças em idade escolar (09 a 12 anos), de ambos os sexos. Inicialmente responderam ao questionário International Study of Asthma and Allergies in Childhood (ISAAC), que avalia a prevalência de asma e doenças alérgicas em crianças e adolescentes. Assim, aquelas que obtiveram uma pontuação no ISAAC, com nota de corte igual ou superior a 5, foram incluídas no estudo. Após as crianças realizarem uma avaliação através do manovacuômetro, a fim de mensurar as pressões respiratórias máximas (PImáx e PEmáx) foi realizada uma avaliação antropométrica para verificar a massa corporal e a estatura. Como intervenção, as crianças participaram de um programa de exercícios com base no método Pilates 2 vezes por semana, com duração aproximada de 50 minutos cada sessão, durante 8 meses, totalizando 32 semanas. Resultados: Em relação às pressões, tanto a PImáx quanto a PEmáx aumentaram pós-intervenção. Conclusão: o estudo encontrou contribuições significativas do método Pilates sobre a força muscular respiratória (PImáx e PEmáx) de crianças com sintomas de asma. Desta forma, sugere-se que o método representa uma ferramenta importante para melhorar a força muscular respiratória dessa população.

Objective: To analyze the effects of the Pilates method on respiratory muscle function in children with asthma symptoms. Methods: in this clinical study, a sample of school-age children (9 to 12 years old) of both sexes was included. Initially, the children answered the questionnaire International Study of Asthma and Allergies in Childhood (ISAAC). Thus, those who scored 5 or more were included in the study. Subsequent to this initial screening, the children performed an evaluation of respiratory muscle strength through the digital manovacuometer in order to measure the maximum respiratory pressures (MIP and MEP). An anthropometric assessment was also performed to verify body mass and height. The children participated in an exercise program based on the Pilates method, being performed twice a week, lasting about 50 minutes each session, for 8 months, totaling 32 weeks. Results: regarding the pressures, both inspiratory and expiratory pressure increased at the end of the intervention. Conclusion: the present study found significant contributions of the Pilates method in the inspiratory muscle strength of children with asthma symptoms. Thus, it is suggested that the method represents an important tool to improve the muscular strength of these children.

Pharmaceutical strategies to extend pulmonary exposure of inhaled medicines

Pulmonary administration route has been extensively exploited for the treatment of local lung diseases such as asthma, chronic obstructive pulmonary diseases and respiratory infections, and systemic diseases such as diabetes. Most inhaled medicines could be cleared rapidly from the lungs and their therapeutic effects are transit. The inhaled medicines with extended pulmonary exposure may not only improve the patient compliance by reducing the frequency of drug administration, but also enhance the clinical benefits to the patients with improved therapeutic outcomes. This article systematically reviews the physical and chemical strategies to extend the pulmonary exposure of the inhaled medicines. It starts with an introduction of various physiological and pathophysiological barriers for designing inhaled medicines with extended lung exposure, which is followed by recent advances in various strategies to overcome these barriers. Finally, the applications of the inhaled medicines with extended lung exposure for the treatment of various diseases and the safety concerns associated to various strategies to extend the pulmonary exposure of the inhaled medicines are summarized.

Prevalence characteristics and influencing factors of COPD in Chengdu, 2019-2020 / 公共卫生与预防医学

Objective To explore the characteristics of chronic obstructive pulmonary diseases (COPD) in Chengdu from 2019 to 2020 and analyze its influencing factors. Methods A total of 362 patients with COPD from January 2019 to January 2020 in Chengdu Fifth People's Hospital were collected, and the patients’ medical records were analyzed. The patients’ gender, age, number of hospitalizations, days of hospitalization, disease classification and other information were extracted and analyzed. Results A total of 362 COPD patients were included in this study, including 293 males, accounting for 80.94% of the total. The number of COPD patients over 60 years old was significantly higher than that of patients under 59 years old, with the largest age group being 60 to 79 years old and a median age of 72 years old. The average hospitalization times and days were (8.22±8.75) times and (11.03±5.47) days, respectively. Most patients had COPD of grade II or grade III, accounting for 62.83% of the total. In this study, there were 490 cases of complications occurring in 362 patients, with 1.35 complications per capita. There were 394 cases of respiratory diseases, 74 cases of cardiovascular diseases, and 22 cases of other diseases. The incidence of pulmonary infection was the highest (204 cases, 56.35%), followed by bullae and asthma (83 cases and 64 cases, 22.93% and 17.68%, respectively). The proportion of antiasthmatic drug use was the highest and the use time was the longest, which was 220 times (60.77%) and (10.50±6.23) days, respectively. There were 119 cases (32.87%) treated with antibiotics for (7.85±5.21) days. The anticoagulants were used for 105 times (29.01%) and (7.54±3.18) days. Logistic regression analysis showed that smoking history, passive smoking history, age over 50 years old, family history of respiratory disease and respiratory disease history were independent risk factors for COPD. Conclusion The majority of COPD patients in Chengdu from 2019 to 2020 were male, with the highest incidence in the age group of 60-79 years. Pulmonary infection and other respiratory diseases were the most common complications. Antibiotic use met the guidelines.

Research progress of CC10 protein in chronic obstructive pulmonary disease and asthma / 解放军医学杂志

Clara cell 10-kD protein (CC10) is one of the most abundant proteins in the respiratory secretions, and plays an important role in immune response, anti-infection and lung injury repair. Chronic obstructive pulmonary disease and bronchial asthma are common chronic lower respiratory tract inflammatory diseases, the pathogenesis of which are intimately related to the abnormal expression of CC10. Therefore, an in-depth research of the biological characteristics of CC10 are helpful for exploring for the important targets for the treatment of chronic respiratory inflammatory diseases in the future. This review summarizes the current research progress in this field.

Advances in inflammasome and pulmonary disease and its intervention / 中华实用儿科临床杂志

Nucleotide-binding oligomerization domain like receptors (NLRs) can recognize conserved sequences of microorganisms and initiate inflammation, nucleotide-binding oligomerization domain-like receptor family pyrin domain-containing 3 (NLRP3) is one of the most representative members of the NLRs family.Activated by a variety of endogenous or exogenous dangerous signals, NLRP3 combines with apoptosis-associated speck-like protein(ASC) and caspase-1 to form inflammasome.And then it acts on downstream inflammatory factors such as inter-leukin-1β (IL-1β) and interleukin-18 (IL-18) to promote their maturation and secretion.At the same time, it can interact with gasdermin D(GSDMD)and eventually lead to pyroptosis.It was found that, NLRP3 was closely related to the occurrence and development of pulmonary diseases.Finding inhibitors of key proteins in NLRP3 inflammasome pathway may provide a new way to treat related diseases.This article reviews the composition of NLRP3 inflammasome, the relationship between NLRP3 inflammasome and the occurrence of pulmonary diseases, and the advances in intervention research.

Advances in inflammasome and pulmonary disease and its intervention / 中华实用儿科临床杂志

Nucleotide-binding oligomerization domain like receptors (NLRs) can recognize conserved sequences of microorganisms and initiate inflammation,nucleotide-binding oligomerization domain-like receptor family pyrin domain-containing 3 (NLRP3) is one of the most representative members of the NLRs family.Activated by a variety of endogenous or exogenous dangerous signals,NLRP3 combines with apoptosis-associated speck-like protein (ASC) and caspase-1 to form inflammasome.And then it acts on downstream inflammatory factors such as interleukin-1β (IL-1β) and interleukin-18 (IL-18) to promote their maturation and secretion.At the same time,it can interact with gasdermin D(GSDMD) and eventually lead to pyroptosis.It was found that,NLRP3 was closely related to the occurrence and development of pulmonary diseases.Finding inhibitors of key proteins in NLRP3 inflammasome pathway may provide a new way to treat related diseases.This article reviews the composition of NLRP3 inflammasome,the relationship between NLRP3 inflammasome and the occurrence of pulmonary diseases,and the advances in intervention research.

Relação entre periodontite e doenças pulmonares: revisão de literatura / Relationship between periodontitis and pulmonary diseases: literature review

A doença periodontal é uma doença infecciosa que atinge os tecidos de sustentação e proteção do dente e tem como principal determinante o biofilme dental. Recentemente foram feitas pesquisas que indicam a doença periodontal como um provável fator de risco para doenças cardiovasculares, incluindo aterosclerose, infarto do miocárdio, acidente vascular cerebral, diabetes, partos prematuros e distúrbios respiratórios. O presente trabalho tem como objetivo revisar na literatura a partir das influências da doença periodontal no desenvolvimento e potencialização de patologias pulmonares, compreendendo o processo infeccioso no trato respiratório ocasionado por bactérias bucais. Para tanto, foi realizada uma busca eletrônica de artigos científicos indexados em bases de dados, como: Pubmed, Scielo e Lilacs. Os critérios de inclusão adotados, foram: a) Idioma: Línguas Portuguesa e Inglesa; b) Período: De 2007 a 2018; c) Método de pesquisa: Estudos observacionais e ensaios clínicos. Os estudos que buscam investigar o vínculo existente entre as doenças periodontais e patologias pulmonares, bem como os fatores facilitadores e predisponentes são fundamentais à elaboração de estratégias no que concerne aos setores da saúde, em virtude de estarem relacionados a altos índices de morbidade e mortalidade. Os achados da literatura acima apresentadas neste trabalho, demonstram que a higienização bucal é o mecanismo mais eficaz à prevenção de origem e exacerbação de patologias respiratórias, provenientes do contato com agentes patógenos oriundos do biofilme oral.(AU)

The periodontal disease isaninfectious disease that reaches the tissues of support and protection of the tooth, its main determinant is the dental biofilm. Research has recently be end one that indicate periodontal disease as a likely risk factor for cardiovascular disease, including at herosclerosis, myocardial linfarction, stroke, diabetes, preterm delivery, and respiratory disorders. The present work aim store view in the literature from the influences of periodontal disease on the development and potentiation of pulmonary pathologies, including the infectious process in the respiratory tractcaused by oral bacteria. To do so an electronic search of scientific articles indexed in data bases was performed, such as Pubmed, Scielo and Lilacs. The inclusion criteria adopted were: a) Language: Portuguese and English; b) Period: From 2007 to 2018; c) Research method: Observational studies and clinical trials. Studies that seek to investigate the link between periodontal diseases and pulmonary pathologies, as well as the facilitating and predisposing factors are fundamental to the development of strategies in the health sectors, because they are related to high morbidit yandmortality rates. The literature findings presented in this study, demonstrated that oral hygiene is the most effective mechanism for the prevention of origin and exacerbation of respiratory pathologies, arising from contact with pathogenic agents originating from oral biofilm (AU)

High flow nasal cannula oxygen therapy versus non-invasive ventilation for chronic obstructive pulmonary diseases with acute-moderate hypercapnic respiratory failure: an observational cohort study / 中华急诊医学杂志

Objective To compare the efficacy of high flow nasal cannula oxygen therapy (HFNC) and non-invasive ventilation (NIV) in the treatment of chronic obstructive pulmonary disease (COPD) with acute-moderate type Ⅱ respiratory failure,and to explore the feasibility of HFNC in the treatment of COPD with respiratory failure.Methods Patients diagnosed with COPD with acute moderate type Ⅱ respiratory failure (Arterial blood gas pH 7.25-7.35,PaCO2＞ 50 mmHg) admitted to the ICUs from April 2017 to December 2017 were retrospectively analyzed.All patients who were treated with HFNC within the first 4 hours after the admission to the ICUs,and continued for more than 2 hours and for at least 4 hours within the first 24 hours were included in the HFNC group.Those treated with NIV in the same conditions were included in the NIV group.The end point was the failure rates of treatment (changing to respiratory support method in another group or invasive ventilation) and 28-day mortality.Results Eighty-two patients (39 in the HFNC group and 43 in the NIV group) were enrolled.The HFNC group had a treatment failure rate of 28.2％,which was lower than that of the NIV group (39.5％).However,Kaplan-Meier curve analysis showed no significant difference between the two groups (Log Rank test 1.228,P=0.268).The 28-day mortality rate in HFNC group was 15.4％,which was no different from 14％ in NIV group (Log Rank test 0.049,P=0.824).The number of airway care interventions within the first 24 hours was significantly lower in the HFNC group than in the NIV group [5 (3～8) vs.11 (7～15)],whereas the duration of respiratory support within the first 24 hours was significantly longer in the HFNC group than in the NIV group [16 (9～22) hours vs.8 (4～11) hours] (all P＜0.05).The incidence of nasal facial lesions in the NIV group was 20.9％,significantly higher than that of HFNC group (5.1％,P ＜0.05).Conclusion For COPD with acute moderate type Ⅱ respiratory failure,HFNC has similar therapeutic effects as NIV.HFNC has better therapeutic tolerance and is a new potential respiratory support method for clinical treatment of COPD with respiratory failure.

Analysis of influential factors in bronchodilation test in mechanically ventilated patients with chronic obstructive pulmonary diseases / 重庆医学

Objective To explore the main influential factors of bronchodilation test positive results in mechanically ventila-ted patients with chronic obstructive pulmonary disease(COPD).Methods A total of 55 inpatients with acute exacerbation of COPD(AECOPD)receiving the invasive ventilation from June 2015 to March 2016 were collected.The accurate respiratory mechan-ics monitoring was performed before and after using the bronchodilator.The airway resistance reduction over 12% after inhaling bronchodilator served as the judgment criteria,the patients were divided into the bronchodilation test positive or negative groups, then the influential factors were compared and statistical analysis was performed.Results Twenty-nine cases(52.7%)showed the positive reaction and 26 cases(47.2%)were negative.After univariate analysis,results of heart rate,SaO2,fungal infection,horm-onotherapy,CKMB,lactic acid and BNP were brought into the multivariable Logistic regression analysis(P< 0.1).The analysis found that fungal infection was an independent factor affecting the results of the bronchodilation test(P<0.05).Conclusion Fun-gal infection is an independent influential factor of the bronchodilation test positive in COPD patients receiving invasive ventilation.

Meta-analysis of efficacy and safety of Salviae Miltiorrhizae and Ligustrazine Hydrochloride Injection in treatment of chronic obstructive pulmonary diseases / 中草药

To evaluate therapeutic efficacy and safety of Salviae Miltiorrhizae and Ligustrazine Hydrochloride Injection in the treatment of chronic obstructive pulmonary diseases (COPD). All clinical trial databases were retrieved from PubMed, EMBase, ClinicalTrials, Cochrane Library, CNKI, CBM, VIP, and Wanfang. Data were searched from inception to February 2018, randomized controlled trials (RCTs) by Salviae Miltiorrhizae and Ligustrazine Hydrochloride Injection combined with chemotherapy (experimental group) compared with conventional therapy (control group) in the treatment of COPD were included. All included studies were critically appraised by two independent reviewers according to the cochrane systematic review method and using Revman 5.3 Software and State 12.0 for Meta-analysis. There were 16 RCTs were included in the evaluation and screening of selected articles with a total of 1 259 patients. The Meta-analysis showed that the total clinical efficacy of the patients in the experimental group after treatment was significantly better than that in the control group [OR = 4.67, 95% CI (3.03, 7.19), P < 0.000 01]; The improvement of forced expiratory volume in one second (FEV1) was significantly better than control group [SMD = 1.43, 95% CI (1.14, 1.72), P < 0.000 01]; Forced vital capacity (FVC) was significantly better than control group [SMD = 1.53, 95% CI (1.17, 1.90), P < 0.000 01]; FEV1/FVC was significantly better than control group [SMD = 1.12, 95% CI (0.90, 1.34), P < 0.000 01]; FEV1 in the percentage of the predicted value forced vital capacity (FVC) was significantly better than control group [SMD = 0.62, 95% CI (0.31, 0.93), P < 0.000 1] and the blood gas index of PaO2 was significantly higher than control group [MD= 9.7, 95% CI (7.92, 11.65), P < 0.000 01]; PaCO2 was significantly lower than control group [SMD =-1.51, 95% CI (-1.90, -1.12), P < 0.000 01]; SaO2 was significantly higher than control group [SMD = 0.94, 95% CI (0.48, 1.40), P < 0.000 1]. For the treatment of chronic obstructive pulmonary disease, Salviae Miltiorrhizae and Ligustrazine Hydrochloride Injection combined with chemotherapy can significantly improve the lung function of patients, but the conclusions of the study still need to be confirmed by more high-quality clinical trials.

The risk factors for chronic obstructive pulmonary disease in Li and Han ethnic groups in Hainan, China

Objective:To investigate the risk factors of chronic obstructive pulmonary disease (COPD) in Li and Han ethnic group in Hainan, China.Methods:All subjects were randomly selected from various regions in Hainan. General characteristics were compared between COPD cases and healthy control cases in both Li and Han ethnic groups. The odds ratio (OR), the corresponding 95% confidence interval (CI) of COPD were calculated by logistic regression.Results:A total of 277 Li COPD cases, 307 Li healthy control subjects, 290 Han COPD cases and 301 Han healthy control were included in this study. In both the Li and Han groups, the average age exceeded 65 years, and the cigarette number smoked per day and the smoking duration were correlated with risk of COPD. In the Li COPD subjects, low weight, smoking, and recurrent infection of respiratory tract were mainly risk factors; while the mainly risk factor of Han COPD subjects was family history of respiratory disease.Conclusions:The risk factors are different in COPD subjects of Han and Li nationalities in Hainan of China. The age and smoking are strongly correlated with COPD risk.

The risk factors for chronic obstructive pulmonary disease in Li and Han ethnic groups in Hainan, China

Objective: To investigate the risk factors of chronic obstructive pulmonary disease (COPD) in Li and Han ethnic group in Hainan, China. Methods: All subjects were randomly selected from various regions in Hainan. General characteristics were compared between COPD cases and healthy control cases in both Li and Han ethnic groups. The odds ratio (OR), the corresponding 95% confidence interval (CI) of COPD were calculated by logistic regression. Results: A total of 277 Li COPD cases, 307 Li healthy control subjects, 290 Han COPD cases and 301 Han healthy control were included in this study. In both the Li and Han groups, the average age exceeded 65 years, and the cigarette number smoked per day and the smoking duration were correlated with risk of COPD. In the Li COPD subjects, low weight, smoking, and recurrent infection of respiratory tract were mainly risk factors; while the mainly risk factor of Han COPD subjects was family history of respiratory disease. Conclusions: The risk factors are different in COPD subjects of Han and Li nationalities in Hainan of China. The age and smoking are strongly correlated with COPD risk.

Severe iron-deficiency anemia as initial manifestation of pulmonary hemosiderosis in a child / Anemia ferropriva grave como manifestaçao inicial de hemossiderose pulmonar em criança

ABSTRACT Idiopathic pulmonary hemosiderosis is a potentially fatal disease that results from episodes of alveolar hemorrhage of unknown origin. The clinical spectrum is varied, and anemia may constitute the only manifestation of illness, preceding other signs and symptoms by several months. We present the case of a 4 year-old child presenting with fever, vomiting and prostration, associated with pallor. He had microcytic and hypochromic anemia refractory to iron therapy. Gastrointestinal bleeding was ruled out after negative extensive etiological investigation. Subsequently, pulmonary infiltrates suggestive of alveolar hemorrhage were observed in the chest radiography. The cytological exam of the bronchoalveolar lavage showed hemosiderin-laden macrophages. After the etiological study, the diagnosis of idiopathic pulmonary hemosiderosis was made by exclusion. He was initiated on corticosteroid therapy, later associated to an immunosuppressive agent, with subsequent correction of anemia and of the radiological pattern. The patient is currently asymptomatic.

RESUMO A hemossiderose pulmonar idiopática é uma doença potencialmente fatal que cursa com episódios de hemorragia alveolar de etiologia desconhecida. As manifestações clínicas são variadas, e a anemia pode constituir o único sinal de doença, precedendo em vários meses os outros sinais e sintomas. Apresenta-se o caso de criança de 4 anos, com febre, vômitos e prostração, associados à palidez. Apresentava anemia microcítica e hipocrômica, refratária à terapêutica com ferro. A hipótese diagnóstica de sangramento gastrintestinal foi excluída, após investigação etiológica extensa, inconclusiva. Posteriormente, em radiografia torácica, foram observados infiltrados sugestivos de hemorragia alveolar. O exame citológico do lavado broncoalveolar mostrou macrófagos com depósitos de hemossiderina. Após estudo etiológico, assumiu-se, por exclusão, o diagnóstico de hemossiderose pulmonar idiopática. Foi iniciada terapêutica com corticoides, associada posteriormente a imunossupressor, com correção subsequente da anemia e do padrão radiológico, encontrando-se, atualmente, assintomático.

Análisis factorial exploratorio de una escala de gravedad de obstrucción bronquial evaluada en menores de tres años, Chile, 2015 / Exploratory factor analysis of a score for grading the severity of bronchial obstruction evaluated in children younger than 3 years old, Chile, 2015

Introducción. La escala de Tal modificada es utilizada en Chile para determinar la gravedad de la obstrucción bronquial. Existen informes de su validez; sin embargo, carece de antecedentes del análisis de su estructura como escala para cuantificar de forma significativa la gravedad de la obstrucción bronquial. Objetivo. Identificar el patrón de relación entre los ítems de la escala y la dimensión gravedad de la obstrucción bronquial en una muestra de menores de tres años que consultan en dos centros de salud de la provincia de Concepción, Chile. Método. Análisis factorial exploratorio. Selección no aleatoria y voluntaria de participantes, menores de 36 meses, agosto-noviembre de 2015. Evaluados de manera independiente por médico y kinesiólogo, en tiempo seguido. Se aplican medidas de tendencia central, análisis factorial exploratorio, por subgrupo de menores y mayores de 6 meses, y consistencia interna. Resultados. 204 mediciones a 102 menores. Con una varianza explicada de 39%, los ítems se dirigen a dos conceptos diferentes, un factor que agrupa frecuencia respiratoria, sibilancia y retracción, y otro que solo lo determina cianosis, con alfa de Cronbach de 0, 5. Al extraer cianosis del análisis, muestra matriz monofactorial con 38% de varianza total explicada y consistencia interna de 0, 62. Conclusiones. Por medio de sus ítems, la estructura de la escala no se ajusta adecuadamente para esta muestra. Cianosis se muestra como un ítem disociado en la estructura. Al ajustar el modelo a solo tres ítems, la estabilidad del alfa como medida de consistencia interna aumenta, pero a un valor cuestionable, lo que, sin duda, variará al ser aplicada en otra muestra.

Introduction. The modified Tal's score has been used in Chile to determine the severity of bronchial obstruction. Its validity has been reported already; however, its structure as a scale to significantly quantify the severity of bronchial obstruction has not been analyzed. Objective. To identify the relationship pattern among the score's items and the severity of bronchial obstruction in a sample of children younger than 3 years seen in two health care centers in the province of Concepción, Chile. Method. Exploratory factor analysis. Nonrandom, voluntary selection of participants youngerthan36months, August-November 2015. Participants were assessed independently and subsequently by a physician and a physical therapist. The following measurements were applied: central tendency, exploratory factor analysis, subgroups of participants younger and older than 6 months, and internal consistency. Results. A total of 204 measurements were done in 102 children. With a 39% explained variance, items incline towards to two different concepts: one factor groups respiratory rate, wheezing, and retractions, and the other determines only cyanosis, with a Cronbach's alpha of 0.5. Once cyanosis is removed from the analysis, the original one-factor matrix sample shows a 38% total explained variance and a 0.62 internal consistency. Conclusions. Based on its items, the score's structure does not fit adequately to this sample. Cyanosis appears as a dissociated item within the structure. Once the model is adjusted to only 3 items, the stability of Chronbach's alpha as a measure of internal consistency increases but at an objectionable value, which will undoubtedly vary once it is applied to a different sample.