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Cyclic adenosine monophosphate(cAMP)is a “second messenger” that regulates cell signal transduction. Adenylyl cyclases(ACs)and phosphodiesterases(PDEs)can directly regulate cAMP level in cells and then regulate the downstream signaling pathways. Increasing intracellular cAMP level can inhibit inflammation and enhance smooth muscle relaxation, which is an effective strategy for the prevention and treatment of chronic obstructive pulmonary disease(COPD). This paper briefly summarizes the signaling pathways regulating cAMP and their mechanisms and related drugs in COPD therapy, hoping to provide references for further research and development of new target drugs which regulate cAMP for the prevention and treatment of COPD.
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OBJECTIVE：To systematically evaluate therapeutic efficacy and safety of Breviscapine injection combined with routine treatment of acute exacerbation of chronic obstructive pulmonary disease （AECOPD），and to provide evidence-based reference for clinical drug use. METHODS ：Retrieved from Cochrane Library ，PubMed，Embase，CBMdisc，CNKI，VIP and Wanfang database ，randomized controlled trials （RCTs）about Breviscapine injection combined with routine treatment （trial group ） versus routine treatment （control group ）in the treatment of AECOPD were collected. After literature screening and data extraction ， the qualities of literatures were evaluated with modified Jadad scale ；Meta-analysis was performed by using Rev Man 5.2 statistical software. RESULTS ：A total of 19 RCTs were included ，involving 1 930 patients. Results of Meta-analysis showed that total response rate [OR ＝2.80，95％ CI （1.96，4.01），P＜0.000 01]，FEV1[MD＝0.65，95％ CI（0.57，0.72），P＜0.000 01]， FEV1％[MD＝5.33，95％CI（0.31，10.35），P＝0.04]，FVC[MD＝0.69，95％CI（0.23，1.16），P＝0.004]， FEV1/FVC [MD ＝ 4.83，95％CI（0.98，8.67），P＝0.01]，PEF [M D＝0.95，95％CI （0.57，1.33），P＜0.001]，PaO2 [MD＝4.70，95％CI（2.02， No.81402991） + 7.37），P＜0.001]，CD3 level [MD ＝5.11，95％ CI（3.04， 7.18），P＜0.001] and CD 4+ level [MD ＝2.62，95％CI（1.78， qq.com 3.47），P＜0.001] of trial group were significantly higher than those of control group ；PaCO2 [MD＝－3.33，95％CI（－5.02， －1.65），P＜0.001]，CD8+ level [MD ＝－2.55，95％CI（－4.28，－0.82），P＜0.004]，cough relief time [MD ＝－1.93，95％CI （－2.24，－1.63），P＜0.001]，sputum remission time [MD ＝－2.19，95％CI（－2.48，－1.89），P＜0.001]，wheezing remission time [MD ＝－1.59，95％CI（－1.86，－1.32），P＜0.001] and hospital stay [MD ＝－1.73，95％CI（－2.06，－1.39），P＜0.001] of trial groups were significantly lower or shorter than those of control group ；there was no statistical significance in CD 4+/CD8+ between 2 groups [MD ＝－0.11，95％CI（－0.23，0.01），P＝0.06]. In terms of safety ，3 studies reported the occurrence of ADR ， and no serious ADR occurred. CONCLUSIONS ：Breviscapine injection can improve clinical efficacy and lung function ，enhance immunity in patients with AECOPD with good safety.
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OBJECTIVE： To systematically evaluate the effects of roflumilast on lung function of Asian patients with chronic obstructive pulmonary disease （COPD）， and to provide evidence-based reference for rational drug use in the clinic. METHODS： Retrieved from Cochrane library， PubMed， Embase， CBM， CNKI， VIP and Wanfang database， RCTs about roflumilast or roflumilast combined with routine treatment or placebo （trial group） versus routine treatment or placebo （control group） in the treatment of Asian COPD patients were collected. After literature screening， data extraction and quality evaluation with Cochrane bias risk evaluation tool， Meta-analysis was conducted by using Rev Man 5.2 software. RESULTS： Totally 6 RCTs were included， involving 1 494 patients. Meta-analysis showed that pre-bronchodilator FEV1 （pre-FEV1） [MD＝75.19， 95％CI（53.21， 97.17）， P＜0.000 01]， post-bronchodilator FEV1 （post-FEV1） [MD＝56.60， 95％CI（27.56， 85.63）， P＝0.000 1]， forced vital capacity （FVC） [MD＝43.67， 95％CI （15.91，71.43）， P＝0.002]， average flow rate of post-bronchodilator 25％-75％ of forced vital capacity （post-FEF25％-75％） [MD＝14.58， 95％CI （8.43， 20.73）， P＜0.001]， the incidence of diarrhea [RR＝5.06， 95％CI （1.26，20.27）， P＝0.02]， respiratory infection [RR＝1.94， 95％CI （1.30，2.90）， P＝0.001]， decreased appetite [RR＝7.43， 95％CI （2.94，18.79）， P＝0.001]， body weight decrease [RR＝5.46， 95％CI （2.12，14.03）， P＝0.001]， headache [RR＝7.73， 95％CI （1.42，42.16）， P＝0.02]， dizziness [RR＝3.44， 95％CI （1.28，9.27）， P＝0.01]， gastritis [RR＝5.09， 95％CI （1.49， 17.45）， P＝0.01] and anorexia [RR＝5.06， 95％CI （1.97， 13.00）， P＝0.001] in trial group were significantly higher than control group； St. George’s Respiratory Questionnaire （SGRQ） total score [MD＝－5.82， 95％CI（－7.77， －3.87）， P＜0.001]， respiratory symptom score [MD＝－1.67， 95％CI （－2.51， －0.84）， P＜0.001]， activity limited score [MD＝－1.55， 95％CI （－2.14， －0.97）， P＜0.001] and disease impact score [MD＝－2.59， 95％CI （－3.40，－1.79）， P＜0.001] of trial group were significantly lower than those of control group. CONCLUSIONS： Roflumilast can improve lung function and dyspnea in Asian COPD patients， but it can increase the risk of ADR.
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Objective To improve vibration resistance of conventional blood transportation kits and mitigate hemolysis during transportation.Methods The structure of a blood transportation kit was modified.We installed a suspension brac-kets within the kit,added buffer material between the brackets,and tested the vibration-suppressing effect compared with the conventional blood transportation kit.Results Rubber and plastic materials between brackets were added,and double membrane suspension brackets were installed.After 4 and 6 min of vibration,free hemoglobin(FHb)[(1559.7 ±1038.5) and(1886.2 ±1023.8)mg/L],lactic dehydrogenase levels[(135.3 ±67.7)and(195.7 ±123.6)U/L]and hemolysis rate[(0.35 ±0.34)%and(0.42 ±0.38)%]in the conventional transportation kit were significantly higher than in the vibration-suppressing kit.K+did not change significantly,and was comparable in both groups at each time point.After 4 and 6 min of vibration, FHb in the conventional transportation kit exceeded the standard.However, after 12 min of vibration,FHb[(560.1 ±342.3)mg/L]in the vibration-suppressing kit were within the standard range.No bacterial growth was detected in either group.Conclusion The vibration-suppressing kit under research shows a better 1986vibration-suppressing effect,which could improve blood support capability in case of emergency.
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Objective To study the thermal insulation properties of vacuum insulated panel(VIP)used as materials for blood transportation kits.Methods A VIP transportation kit was taken as test group,and a conventional transportation kit was taken as control.Phase change cool storage materials of the same amount and 4℃water bags were put into both kits.A recordable electronic thermometer was used to record the temperature within the two kits,and free hemoglobin(FHb)and potassium ion concentration were measured at 0, 4, and 7 days after blood storage.Results The temperature in the conventional transportation kit increased faster after 36 h, and was significantly higher than in the VIP transportation kit until 60 h.Besides,the VIP transportation kit kept the temperature under 10℃ for(60.7 ±0.6)h, compared to (54.2 ±3.0)h in the conventional transportation kit.FHb concentration was significantly lower in the VIP transportation kit[(605.26 ±74.63)mg/L]than in the conventional transportation kit[(1327.60 ±187.41)mg/L]at day 7(d 7),so was the potassium ion concentration in the VIP transportation kit[(22.7 ±0.4)mmol/L]compared to[(24.6 ±0.6) mmol/L]in the transportation kit at d 7.Conclusion The VIP transportation kit keeps the temperature under 10℃ for a longer time,and the blood quality of preservation is better than that of the conventional transportation kit.Novel heat preservation material can improve health support ability,and is of great value and significance.