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Objective:To investigate the effects of aerobic exercise on blood glucose and insulin levels in chronic intermittent hypoxic(CIH)rats and the underlying mechanisms, and to provide new insights for the prevention and treatment of diabetes caused by CIH.Methods:SD rats were randomly divided into the blank control group, CIH control group and CIH exercise group.After adaptive feeding, a rat model of CIH was established.The CIH exercise group received non-weight bearing exercise training through swimming.After 4 weeks, all rats were sacrificed and levels of total antioxidant capacity(T-AOC), reactive oxygen species(ROS), malondialdehyde(MDA), fasting blood glucose(FPG)and fasting insulin(FINS)were measured.Results:Compared with the blank control group and CIH control group, levels of ROS, MDA, FPG, T-AOC, FINS and FPG were significantly different in the CIH exercise group( F=4.60, 5.03, 4.87, 4.52 and 6.42, P=0.021, 0.015, 0.017, 0.022 and 0.006). Compared with the blank control group, levels of ROS, MDA, FPG and FINS increased and levels of T-AOC declined in the CIH control and exercise groups(all P<0.05). Compared with the CIH control group, levels of ROS, MDA, FPG and FINS decreased and T-AOC levels increased in the CIH exercise group(all P<0.05). Conclusions:CIH increases blood glucose and insulin levels by activating the oxidative stress response.Aerobic exercise can reduce the impact of oxidative stress on blood glucose and insulin levels.
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Objective:To investigate the effects of microRNA(miR)-133b on epithelial-mesenchymal transition(EM)of human small airway epithelial cells induced by cigarette smoke extracts(CSE)and its regulatory mechanisms.Methods:The miR-expression profiles with microarray in airway epithelial cells of patients with chronic obstructive pulmonary disease were searched in the Gene Expression Omnibus(GEO)database, and the differentially expressed miRs were searched and verified by a real-time fluorescence quantitative method(qRT-PCR). Human small airway epithelial cells(HSAEpiC)were divided into the control group, the CSE group, the CSE+ miR-133b inhibitor transfection group(inhibitor group)and the CSE+ miR-133b inhibitor negative control transfection group(inhibitor control group)according to different intervention methods.Levels of miR-133b and mRNA levels of transforming growth factor(TGF)-β1, Smad2, E-cadherin and vimentin were detected by RT-PCR; Protein levels of E-cadherin and vimentin were detected by enzyme-linked immunosorbent assays(ELISA)and Western blotting.Results:Nine differentially expressed miRs were found in GSE53519, with miR-133b showing the most significant differential in thee HSAEpiC cell model after verification.CSE induced morphological changes in HSAEpiC cells, and miR-133b inhibitors could partially reverse the morphological changes in cell mode.mRNA and protein expressions of E-cadherin were decreased and expression of Vimentin mRNA and protein were increared in CSE induced HSAEpiC cells( F=9.09、12.35、7.57、101.87, P=0.015、0.007、0.023、0.000); miR-133b inhibitors partally reversed the mRNA and protein expressions of E-cadherin and Vimentin( F=40.59、27.74、15.87、20.42, P=0.000、0.001、0.004、0.002). CSE induced incresed expression of TGF-β1 mRNA and Smad mRNA in HSAEpiC cells, and miR-133b inhibitors partially reversed the changes in TGF-β1 mRNA and Smad mRNA( F=17.25、64.15, P=0.003、0.000). Conclusions:miR-133b may regulate CSE-related HSAEpiC cell EMT through the TGF-β1/Smad pathway.
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PURPOSE: Details of patients hospitalized for asthma exacerbation in mainland China are lacking. To improve disease control and reduce economic burden, a large sample survey among this patient population is indispensable. This study aimed to investigate the clinical characteristics and outcomes of such patients.METHODS: A retrospective study was conducted on patients hospitalized for asthma exacerbation in 29 hospitals of 29 regions in mainland China during the period 2013 to 2014. Demographic features, pre-admission conditions, exacerbation details, and outcomes were summarized. Risk factors for exacerbation severity were analyzed.RESULTS: There were 3,240 asthmatic patients included in this study (57.7% females, 42.3% males). Only 28.0% used daily controller medications; 1,287 (39.7%) patients were not currently on inhaled corticosteroids. Acute upper airway infection was the most common trigger of exacerbation (42.3%). Patients with severe to life-threatening exacerbation tended to have a longer disease course, a smoking history, and had comorbidities such as hypertension, chronic obstructive pulmonary disease (COPD), and food allergy. The multivariate analysis showed that smoking history, comorbidities of hypertension, COPD, and food allergy were independent risk factors for more severe exacerbation. The number of patients hospitalized for asthma exacerbation varied with seasons, peaking in March and September. Eight patients died during the study period (mortality 0.25%).CONCLUSIONS: Despite enhanced education on asthma self-management in China during recent years, few patients were using daily controller medications before the onset of their exacerbation, indicating that more educational efforts and considerations are needed. The findings of this study may improve our understanding of hospital admission for asthma exacerbation in mainland China and provide evidence for decision-making.
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Feminino , Humanos , Corticosteroides , Asma , China , Comorbidade , Progressão da Doença , Educação , Hipersensibilidade Alimentar , Hospitalização , Hipertensão , Pacientes Internados , Adesão à Medicação , Mortalidade , Análise Multivariada , Doença Pulmonar Obstrutiva Crônica , Estudos Retrospectivos , Fatores de Risco , Estações do Ano , Autocuidado , Fumaça , FumarRESUMO
Objective To investigate the protective effects of a Yiqi Huatan Quyu formulation on liver injury in chronic intermittent hypoxia rats.Methods Thirty healthy male Sprague-Dawley rats of SPF grade were randomly divided into 3 groups:Group A(normoxia and normal saline gavage),Group B(chronic intermittent hypoxia and normal saline gavage)and Group C(chronic intermittent hypoxia and Yiqi Huatan Quyu formulation gavage)(n =10 in each group).After 8 weeks of treatment,the liver tissue was extracted for protein and RNA.Western blot was used to test the protein levels of B-cellymphoma-2 associated X protein (BAX) and B-cellymphoma-2 (BCL-2),and Realtime PCR was used to test gene expression of BAX and BCL-2.Transferase-mediated dUTP nick end-labeling(TUNEL)was used to assay the apoptotic rate of liver cells.Results The expression of the BAX protein and BAX gene was higher and the expression of the BCL-2 protein and BCL-2 gene was lower in Group B than in Group A(t =13.490 and 16.480,P =0.005 and 0.002;t =5.142 and 9.776,P =0.036 and 0.001,respectively).The levels of the BAX protein and BAX gene were lower and the levels of the BCL-2 protein and BCL-2 gene were higher in Group C than in Group B(t =6.088 and 15.240,P =0.026 and 0.005;t =5.296 and 16.380,P =0.034 and 0.004,respectively).The apoptosis rate of hepatocytes was higher in Group B than in Group A(t =7.698,P =0.002),and was lower in Group C than in Group B(t=4.345,P =0.012).Conclusions The Yiqi Huatan Quyu formulation may alleviate the apoptosis of liver cells in chronic intermittent hypoxia rats by upregulating BCL-2 and down-regulating BAX levels,thus exerting protective effects on the liver.
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Objective To evaluate the general level of asthma management in urban areas of China and further promote the national asthma management plan. Methods A multi-center, cross-sectional survey was carried out in 30 provinces of China (except for Tibet) during Oct 2015 to May 2016. It's a questionnaire-based face-to-face survey which included asthma management using peak flow meter (PFM) and pulmonary function test,medication choice of maintenance therapy and asthma education.Results A total of 3 875 asthmatic outpatients were recruited including 2 347(60.6%)females and 1 528(39.4%)males. The mean age was(50.7±16.7)years ranging from 14 to 99.Only 10.1%(388/3 837)patients used PFM as monitoring, whereas 62.1%(2 405/3 874) patients underwent pulmonary function test during the past year. There were 57.4%(2 226/3 875) patients treated with inhaled cortical steroid plus long-acting β2-agonist combinations (ICS+LABA) as daily medication. 43.3%(1 661/3 836) patients were followed up by physicians. Among this population, 1 362 asthmatic outpatients were recruited, who also took part in the asthma control survey in 2007-2008 in 10 cities.In this subgroup,17.9%(244/1 360)were tested by PFM and 66.6%(907/1 362)by pulmonary function test during last year.As to the medication,63.1%(860/1 362) selected ICS+LABA for daily control. There were 50.4%(685/1 359) patients in the follow-up cohort by physicians.Compared to the similar survey conducted in 2007-2008,the proportion of patients with ICS+LABA regimen and follow-up by physicians were markedly higher,while the rate of PFM use did not have significant improvement. Conclusion Although the present level of asthma management in China is still far from ideal, asthma management has improved compared to 8 years ago. Yet the use of PFM does not significantly improve.Asthma action plan and application of PFM should be further promoted to improve the level of asthma management.
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Objective To understand the seasonal distribution of patient hospitalization due to asthma exacerbation in 7 geographic areas in China.Methods This was a retrospective study which involved patients hospitalized for asthma exacerbation in 29 hospitals throughout 7 geographic areas in the mainland of China (northeast,north,central,east,south,northwest and southwest).The numbers of asthmatic patients and total inpatients of the respiratory department of each hospital were recorded.The monthly ratio of asthmatic patients to the total inpatients in every area was calculated and compared.Results During the study period,6 480 patients were admitted for asthma exacerbation,accounting for 3.14％ of all the 206 135 patients admitted to the respiratory departments in the 29 hospitals.The ratio of asthmatic patients to total inpatients in the northeast area (5.61％) was highest,and the ratio in east area was lowest (1.97％).Statistical analysis showed that the difference among different areas was significant (P＜0.000 1).In most areas,both the number and proportion of hospitalized asthmatic patients peaked in spring (February-April) and autumn (September-October).In the northeast area,east area and south area,the peaks in spring were more obvious,while in the north area and southwest area,the peaks in autumn were more obvious.In the northwest area the peaks occurred in winter (December-January) and summer (June-August),respectively.The differences in hospitalization due to asthma among different months were significant in the northeast,north,and southwest areas (P＜0.005).Conclusion The number of patients hospitalized for asthma exacerbation fluctuated with season in different areas in China.In most areas,more asthmatic patients were admitted to hospitals in spring and autumn.
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Objective To understand the seasonal distribution of patient hospitalization due to asthma exacerbation in 7 geographic areas in China.Methods This was a retrospective study which involved patients hospitalized for asthma exacerbation in 29 hospitals throughout 7 geographic areas in the mainland of China (northeast,north,central,east,south,northwest and southwest).The numbers of asthmatic patients and total inpatients of the respiratory department of each hospital were recorded.The monthly ratio of asthmatic patients to the total inpatients in every area was calculated and compared.Results During the study period,6 480 patients were admitted for asthma exacerbation,accounting for 3.14％ of all the 206 135 patients admitted to the respiratory departments in the 29 hospitals.The ratio of asthmatic patients to total inpatients in the northeast area (5.61％) was highest,and the ratio in east area was lowest (1.97％).Statistical analysis showed that the difference among different areas was significant (P＜0.000 1).In most areas,both the number and proportion of hospitalized asthmatic patients peaked in spring (February-April) and autumn (September-October).In the northeast area,east area and south area,the peaks in spring were more obvious,while in the north area and southwest area,the peaks in autumn were more obvious.In the northwest area the peaks occurred in winter (December-January) and summer (June-August),respectively.The differences in hospitalization due to asthma among different months were significant in the northeast,north,and southwest areas (P＜0.005).Conclusion The number of patients hospitalized for asthma exacerbation fluctuated with season in different areas in China.In most areas,more asthmatic patients were admitted to hospitals in spring and autumn.
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Objective To examine whether autophagy plays a role in the development of chronic intermittent hypoxia-induced cardiac hypertrophy,whether resveratrol can reverse the process by modulating autophagy and what molecular pathways are involved.Methods Rats were randomly divided into four groups.Eight rats were treated with normoxia (control group),eight were exposed to chronic intermittent hypoxia (CIH) (CIH group),eight were exposed to CIH plus resveratrol (RSV) (CIH+RSV group) and eight were exposed to CIH,RSV and chloroquine (Cq) (CIH + RSV+ Cq group).After treatment for seven weeks,the levels of LC3,Beclin,P62,ANP,β-MHC,AMPK,P-AMPK,mTOR,P-mTOR and cleaved-caspase 3 were detected by Western blot.The area of cardiomyocytes and the ratio of brotic area to the total area were obtained by HE and Sirius Red staining.Results Rats in the CIH+RSV group were associated with an increased ratio of LC3 Ⅱ /LC3 Ⅰ,increased Beclin levels and decreased P62 levels,compared with those in the control and CIH groups (all P＜0.05).After chloroquine injection,the ratio of LC3 Ⅱ/LC3 Ⅰ was markedly increased in the CIH+RSV+Cq group,compared with that in the CIH+RSV group (all P＜0.05).Moreover,the CIH group was associated with significantly increased area of cardiomyocytes,ratio of fibrotic area to the total area,and levels of ANP,β-MHC and cleaved-caspase 3,compared with the control group (all P＜0.05).However,their values markedly decreased in the CIH +RSV group and significantly increased in the CIH+RSV+Cq group,compared with the CIH group (all P＜0.05).Furthermore,there were tendencies of progressively increased levels of P-AMPK and decreased levels of P-mTOR among the control group,CIH group and CIH+RSV group (both P ＜ 0.05).However,levels of AMPK and mTOR were similar among the three groups (P ＞ 0.05).Conclusions Chronic intermittent hypoxia and resveratrol can affect the level of cardiac hypertrophy by autophagy through activating the AMPK/mTOR pathway.
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Objective To evaluate the efficacy of eucalyptol-limonene-pinene enteric capsule on stable chronic obstructive pulmonary disease (COPD) in the elderly.Methods A total of 120 patients with stable COPD were randomized into ELP group (n=63) with conventional treatment combined ELP and control group (n=57) with conventional treatment without ELP.Primary outcome was the number of exacerbations per year, and secondly outcomes were lung function parameters and St.George's Respiratory Questionnaire (SGRQ).Results After 1 year of treatment, numbers of exacerbations per patient per year were lower in ELP group than in control group (0.70 times/y vs.1.21 times/y, Z=-3.887, P=0.000).The proportion of exacerbation-free patients were 25.4％(16/63) in ELP group and 5.3％ (3/57) in control group (x2 =9.103, P=0.003).The differences in the forced vital capacity (FVC), forced expiratory volume in one second (FEV1), and FEV1/ FVC ratio (FEV1％) between 5 different time points measurements were statistically significant in both groups (ELP group: F=15.429, 36.389, 33.278, respectively, all P=0.000;control group: F=54.238, 94.213 and 83.774, respectively, all P=0.000).Difference in FEV1/FVC ratio between 5 different time point was statistically significant in control group(F=2.766, P=0.043), but not in ELP group(F=0.861, P=0.451).After treatment, SGRQ score was decreased in both group, and difference in symptom score was statistically significant between the two groups (t=2.109, P =0.037).The adverse reactions were found in 3 cases in ELP group, and in 2 cases in control group with no statistically significant difference between the two groups [3 (4.8％) vs.2 (3.5％), x2 =0.013, P=0.732].Conclusions Long-term oral administration of eucalyptol-limonene-pinene enteric capsule can significantly decrease exacerbation frequency, improve quality of life, delay the deterioration in lung function, and have good safety in elderly patients with stable COPD.
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Objective To investigate the significance of changes in serum uric acid levels in elderly patients with obstructive sleep apnea hyponea syndrome (OSAHS).Methods The study recruited elderly patients aged 60 years and over undergoing polysomnography (PSG) at the Center for Diagnosis and Treatment of Sleep Disorders of our hospital from January 2012 to December 2014.According to the diagnostic criteria established by the Group of Sleep and Breathing Disorders,Respiratory Diseases Branch,Chinese Medical Association (2011),patients were divided into the simple snoring group,the mild OSAHS group,the moderate OSAHS group and the severe OSAHS group.Levels of serum uric acid,blood glucose,blood lipids and high-sensitive C-reactive protein (hsCRP) were compared between all groups after adjusting for age,gender and underlying diseases.Independent risk factors associated with serum uric acid were analyzed using Spearman' s rank correlation and stepwise multivariate analysis.Results A total of 129 elderly subjects including 100 males and 29 females,with a mean age of (63.6±2.25) years,were enrolled.Of these subjects,23 were grouped as simple snoring,24 as mild OSAHS,39 as moderate OSAHS and 43 as severe OSAHS.Serum uric acid and hs-CRP levels were increased in the severe OSAHS group as compared with the simple snoring group (both P＜0.05).Spearman's rank correlation analysis showed that the apnea-hypopnea index (AHI) and the oxygen desaturation index (ODD were positively correlated with the serum uric acid level (r =0.251 and 0.210,P =0.004 and 0.018,respectively).Stepwise multivariate analysis showed that,with serum uric acid level as the dependent variable,AHI was an independent risk factor for increased serum uric acid levels (β=0.354,P =0.000).Conclusions Serum uric acid levels are elevated in elderly patients with severe OSAHS,and AHI is an independent risk factor for the increased serum uric acid levels.
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Objective To investigate the effect of β-lactam antibiotics on the false positive rate of the serum Aspergillus galactomannan (GM) assay in patients with lung diseases.Methods We selectively recruited 77 lung disease patients who did not meet the diagnostic criteria of invasive pulmonary Aspergillosis (IPA) and received different β-lactam antibiotics,while 41 patients without IPA who did not receive any antibiotic treatment were recruited as the control group.Serum samples for GM detection were collected from all participants.The rate of false-positive Aspergillus galactomannan was compared between the two groups.Results False-positive serum results were found in patients who received piperacillin-tazobactam (30.8％ or 8/26) and cefoperazone sulbactamand (27.8％ or 5/18).The rate of false-positive Aspergillus galactomannan in patients who receive β-lactam antibiotics were significantly higher than that in the control group (24.7％ or 19/77vs.7.3％ or 3/41,x2 =5.315,P=0.025).Taking false-positive serum Aspergillus galactomannan as the dependent variable and β-lactam antibiotic treatment as the independent variable,univariate logistic regression analysis showed that the rate of false-positive Aspergillus galactomannan in patients who received β-lactam antibiotics were 4.149 times more than that in the control group (OR=4.149,P=0.030).Conclusions The administration of β-lactam antibiotics may increase the occurrence of false-positive serum Aspergillus galactomannan,and physicians should be aware of this possible interference.
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Objective To investigate the intervention effects of Jiawei Ditan Decoction on oxidative stress and inflammatory reaction in elderly patients with obstructive sleep apnea hypopnea syndrome (OSAHS).Methods A total of 60 OSAHS patients with deficiency of phlegm and blood stasis mutual junction were enrolled,and randomly divided into treatment group (n=30,receiving JiaweiDitan Decoction+ conventional treatment for 12 weeks) and control group (n=30,receiving conventional treatment for 12 weeks).The clinical symptoms integral,Epworth Sleepiness Scale (ESS),apnea hypopnea index (AHI),minimum oxygen saturation (SaO2),superoxide dismutase (SOD),malondialdehyde (MDA),tumor necrosis factor (TNF)-α interleukin (IL)-6,and C-reactive protein (CRP) were observed before and after treatment.Results The clinical symptoms integral,AHI value,minimum SaO2,ESS score,levels of SOD,MDA,TNF-α,IL-6 and CRP were significantly improved in treatment group after treatment as compared with pretreatment [(11.65 ± 3.82) points vs.(14.32±4.25) points,(21.18 ± 12.37) times/h vs.(29.16 ± 13.58) times/h,(83.24±7.42)％ vs.(76.92±11.91)％,(7.12±4.84)points vs.(10.01±4.16) points,(99.24± 13.15)×103 U/L vs.(87.511±14.82) ×103 U/L,(8.56 ± 3.23) μmol/L vs.(11.25±3.41) μmol/L,(50.63±10.57) ng/L vs.(58.92±11.65) ng/L,(78.12±15.92) ng/L vs.(89.13± 16.54) ng/L,(9.93±5.25) mg/L vs.(13.59±4.92) mg/L,t=2.559,2.379,2.467,2.480,3.243,3.137,2.887,2.651,2.786,respectively,all P＜0.05].All the above indicators after treatment had significant differences between the treatment group and the control group [(11.65 ± 3.82) points vs.(13.89±4.45) points,(21.18± 12.37) times/h vs.(28.03± 13.12) times/h,(83.24±7.42)％ vs.(78.26±10.15)％,(7.12±4.84) points vs.(9.56±7.12) points,(99.24± 13.15)×103 U/Lvs.(90.13±13.56)×103 U/L,(8.56±3.23) μmol/L vs.(10.86±3.65)μmol/ L,(50.63±10.57) ng/L vs.(56.52±11.04) ng/L,(78.12±15.92) ng/L vs.(87.81±15.61) ng/ L,(9.93±5.25) mg/L vs.(12.97±5.03) mg/L,t=2.092,2.018,2.169,2.009,2.642,2.585,2.111,2.380,2.290,respectively,all P＜0.05].Conclusions Jiawei Ditan Decoction could improve the clinical symptoms and has the intervention effect on oxidative stress and inflammatory reaction in elderly patients with OSAHS,which provides the experimental basis for the treatment of senile OSASH with Chinese herbal medicine.
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Objective To investigate the change of serum cystatin C (CC) level and its clinical significance in elderly patients with obstructive sleep apnea hypopnea syndrome (OSAHS),and to evaluate the diagnostic value of serum CC for renal impairment in elderly OSAHS patients.Methods Elderly snoring subjects (age ≥60 years) undergoing sleep apnea monitoring in our sleep laboratory were recruited.Patients were divided into simple snoring group,mild OSAHS group,moderate OSAHS group and severe OSAHS group according to the diagnostic criteria of American academy of sleep medicine.Anthropometric characteristics,lipid profiles,blood glucose,creatinine,estimated glomerular filtration rate (eGFR) and serum CC were compared between groups after age,gender and basic diseases were adjusted.The independent risk factors associated with serum CC were analyzed by Spearman's rank correlation and stepwise linear regression.Results Totally 89 elderly patients [70males and 29 females,aged (68.4±6.3) years in average] were collected.21 subjects were grouped as simple snoring,14 subjects as mild OSAHS,21 subjects as moderate OSAHS and 33 subjects as severe OSAHS.There were no differences in age,gender,basic diseases (hypertension and diabetes),lipid profiles,creatinine and eGFR among groups.The levels of body mass index,systolic blood pressure,diastolic blood pressure and serum CC were higher in severe OSAHS group than in simple snoring group [(28.3±3.9) vs.(24.6±5.9),(136.55±16.14) mm Hgvs.(122.43±16.64) mm Hg,(89.18±11.92) mm Hgvs.(78.10±9.55) mm Hg,(0.95±0.22) mg/L vs.(0.76±0.13)mg/L,respectively,all P＜0.05].Serum CC was significantly correlated with apnea hypopnea index (AHI),oxygen desaturation index,creatinine,eGFR,high sensitive C reactive protein (r=0.397,0.347,0.275,－0.354,0.254 respectively,all P％0.05).Regression analysis showed that AHI was an independent factor for serum CC (β=0.449,P＜ 0.001).Conclusions Serum CC level is increased in elderly patients with severe OSAHS.AHI is an independent factor for the increase of serum CC.Serum CC can be as an index for the early impairment of renal function in patients with OSAHS.
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Objective To analyze the plasma procalcitonin (PCT) as a predictor of the severity of community acquired pneumonia (CAP) in elderly patients.Methods Totally 90 elderly patients hospitalized with community acquired pneumonia from 2010 to 2011 were analyzed retrospectively for the relation between plasma procalcitonin and severity of pneumonia.All cases were divided into two groups,the severe group (n=36) and the non-severe group (n=54) according to diagnostic criteria.Results The level of plasma PCT was much lower in the severe group (median 2.44 μg/L) than that in the non-severe group (median 0.11 μg/L) (U=335.50,P=0.000).Among all patients,when PCT was lower than 0.5 μg/L,the incidence of non-severe CAP was 76％,however,when PCT was equal or above 2.0 μg/L,the incidence of non-severe CAP was reduced to 9％.In Binary logistic regression analysis,PCT was a risk factor of aged person with severe community acquired pneumonia independent of age and CRUB-65 scores [OR =1.328 (95 ％ confidential interval:1.072,1.645)].PCT had a positive correlation with CRUB-65 scores (U=10.162,P=0.006).In all cases,the patients who improved well had lower PCT value than the remaining (median 0.21 μg/L,17.0μg/L; U=10.000,P=0.000),which also happened in severe cases (median 1.47 μg/L,17.0 μg/L;U=8.000,P=0.000).The area under the receiver operating characteristic curve was 0.872 (95％ confidential interval:0.741,0.914).At a PCT cut-off level of greater than or equal to 2.0 μg/L,the sensitivity and specificity to predict the severity of aged person with CAP was 55.6％ and 98.9％ respectively.Conclusions Plasma PCT may be a good predictor to evaluate the severity of CAP in elderly patients.
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Objective To explore the guiding role of serum procalcitonin (PCT) in antibiotic therapy during acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Methods Totally 72 patients with AECOPD were randomly divided into PCT group (n=40) and conventional therapy group(n=32).For patients in PCT group,the use of antibiotics was based on PCT serum levels,antibiotics were stopped when PCT＜0.25 μg/L,while in conventional treatment group,the use of antibiotics was based on clinical symptoms of patients.The main observation indexes included ratio of antibiotic usage,time of antibiotics use,hospital stay,clinical efficacy,aggravating cases and death cases. Results There were no significant difference in clinical efficacy between the two groups(82.5％ vs.75.8％,x2 =0.217,P=0.641),however,the ratio of antibiotics usage in PCT patients was significantly lower than conventional therapy group (47.5％ vs.71.9％,x2 =4.346,P=0.037),average time of antibiotics use and days of hospital stay were shorter in PCT treatment group than conventional therapy group [(6.84±3.27) d vs.(10.22±3.67)d,x2 =3.116,P=0.003; (11.7±5.2) d vs.(20.3±8.7) d,x2 =5.202,P=0.000].There were no difference in double infection incidence (2.5％ vs.18.8％,x2 =3.657,P=0.056),aggravating cases (3 cases vs.4 cases,x2 =0.097,P=0.756) and mortality (2.5％ vs.6.3％,x2 =0.039,P=0.843) between the two groups.Conclusions Serum PCT level may be an appropriate indicator to guide antibiotic therapy in patients with AECOPD in view of its effective decreases of excessive use of antibiotics,double infection opportunities and hospitalization time.
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Objective To analyze the relationship between daytime sleepiness and oxygen desaturation in the male eldcrly with obstructive sleep apnea /hyponea syndrome (OSAHS).Methods 147 male elderly (aged 60-80 years) with OSAHS in our sleep laboratory from March 2008 to February 2011 were divided into daytime sleepiness and daytime non-sleepiness groups. Epworth sleeping scale (ESS) and polysomnography (PSG) were employed to detect the degree of sleepiness.Oxygen desaturation were evaluated by oxygen desaturation index (ODI),average and minimum blood oxygen,time percentage of 90％ oxygen desaturation (CT90). Resulls There were significant differences between the two groups in body mass index (BMI) (t=4.157),ODI (t=-10.063),average (t=5.800) and minimum (U=916) blood oxygen,CT90(U=887)and apnca/hypopneaindex (AHI) (t =-11.361) (all P＜0.001).ESS scores were related with desaturation parameters of ODI,average and minimum blood oxygen and CT90 (r=0.683,-0.450,-0.583,0.507,all P＜0.001).ODI was correlated with average and minimum blood oxygen and CT00 (r=-0.628,-0.763,0.689,all P＜0.001).Among parameters of oxygen desaturation,only ODI had influence on ESS scores (odds ratio=1.11,95％CI:1.07 1.15),The sensitivity and specificity predicting daytime sleepiness at ODI ≥23 times/h were about 79.2％ and 84.3％,respectively.Conclusions Daytime sleepiness is associated with oxygen desaturaion and may be predicted by ODI through which average and minimum blood oxygen and CT00 are related with daytime sleepiness in the male elderly with OSAHS.
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Objective To explore the difference of the clinical manifestations between the elderly and non-elderly patients with non-massive pulmonary thromboembolism (PTE) and the significance of D-dimer in the diagnosis of PTE and its dynamic change after anticoagulant therapy.Methods The clinical manifestations of 83 cases with PTE were retrospectively analysed and divided into two groups:39 elderly and 44 non-elderly.The dynamic changing of D-dimer content was determined by immunoturbidimetry(ITM) method before and 3 d after anticoagulant therapy in the two groups.Results There were no significant statistical differences in the incidence of the main symptoms:dyspnea,cough,emptysis,syncope,palpitations between the elderly and the non-elderly (x2 =2.74,0.06,0.10,0.49,0.01,P＞0.05) except for the incidence of chest pain [14 cases (35.9 ％) vs.30 cases (68.2 ％),x2 =4.95,P ＜ 0.05].No differences were found in the the main signs:shortness of breath,tachycardia,accentuation or split of second pulmonary valve sound,cyanosis,and engorgement of neck veins between the two groups (x2 =2.60,0.03,0.61,0.06,0.33,0.11,P＞0.05).D-dimer content was lower in the elderly than in the non-elderly [(1.89±1.21) mg/L vs.(4.93±3.88) mg/L,Z=-2.55,P=0.01] before anticoagulant therapy.But there was no difference in D -dimer content between the two groups 3 d after anticoagulant therapy [( 1.28 ±1.11) mg/L vs.(2.09±2.22) mg/L,Z=-7.07,P=0.50].The decreasing level of D-dimer was less prominent in the elderly than in the non-elderly [(0.61±1.01) mg/Lvs.(2.84±2.95) mg/L,Z=-3.54,P=0.001].Conclusions The main clinical manifestations are similar between the elderly and non-elderly with non-massive PTE,but the incidence of chest pain is less in the elderly than in the non-elderly.The content of D-dimer is lower in the elderly than non-elderly after PTE and its decrements are less prominent in the elderly than the non-elderly after anticoagulant therapy.
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Objective To explore the relationship between obstructive sleep apnea-hypopnea syndrome (OSAHS) and metabolic syndrome (MS) in obese middle-aged and older men. Methods We selectively recruited 154 obese middle-aged and older men matched for body mass index (BMI) and age. The polysomnography was performed for diagnosing OSAHS and for discriminating disease severity. The BMI, waist circumference, blood pressure, plasma glucose and lipid profiles were measured and analyzed in all subjects. Appropriate statistical methods were used to compare the components of MS in each group. Logistic regression was taken to elucidate the relationship between OSAHS and MS. Results Compared to control group, severe OSAHS group had significantly lower high density lipoprotein cholesterol level [( 1.03 ± 0.29 ) mmol/L vs. ( 1.31 ± 0. 38) mmol/L,P＜0. 05] and higher fasting glucose [(6.61±1.76) mmol/L vs. (5.47±0.64) mmol/L, P＜0. 05]as well as higher systolic blood pressure [( 133 ± 13) mm Hg vs. ( 125 ± 12) mm Hg, P＜0. 05] and diastolic blood pressure [(99±10) mm Hg vs. (80±5) mm Hg, P＜0. 05]. The prevalence of MS was significantly higher in OSAHS group than in control group (mild OSAHS group: 25.7%,moderate OSAHS group: 46. 5%, severe OSAHS group: 84.4%, control group: 16. 1 %, all P＜0. 01). OSAHS was independently associated with an increased prevalence of MS Odds ratio, 6.16).Conclusions OSAHS is independently associated with MS in obese middle-aged and older men.
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ObjectiveTo investigate changes of the cellular immune function in the elderly patients with nonsmall-cell lung cancer (NSCLC) after chemotherapy.Methods T-lymphocyte subsets and natural killer cell were detected in 29 elderly patients with NSCLC,20 adults with NSCLC and 22 healthy elderly,and their levels were compared between pre-chemotherapy and at the end of 2 cycles of chemotherapy in the elderly patients with NSCLC.ResultsThe levels of CD3,CD4,CD8,CD4/CD8andNK cell were (58.9±15.8),(32.3±12.7),(22.0±9.8),(1.3±0.7),(21.6± 7.7),respectively in the elderly patients with NSCLC,(65.9 ± 7.2),(38.5 ± 7.6),(23.1 ± 9.2),(1.5±0.7),(16.8±6.2),respectively in adults with NSCLC and (67.3±9.0),(39.0±7.8),(23.9±9.3),(2.0±1.6),(22.5±5.8),respectively in healthy elderly.The levels of CD3 and CD4 were decreased (t=2.109,2.159,P＜0.05) and NK cell was increased (t=2.273,P＜0.05) while CD8 and CD4/CD8 had no difference(t = 0.406,0.736,P＞ 0.05 ) in the elderly patients with NSCLC as compared with adults with NSCLC.The levels of CD3,CD4,and CD4/CD8 were lower (t = 2.234,2.200,2.016,all P＜ 0.05) in elderly patients with NSCLC than in healthy elderly,with no significant change in the levels of CD8 and NK cell(t= 0.700,0.474,P＞0.05) between the two groups.The levels of CD3 (51.6 ±10.3)was reduced(t=2.067,P＜0.05) and CD4 (31.7 ± 11.7),CD8(21.6 ± 6.5),CD4/CD8 (1.3 ± 0.7),NK cell (26.0 ±12.7)had no remarkable difference (t =0.186,0.180,0.289,1.570,all P＞ 0.05)after chemotherapy in elderly patients with NSCLC.ConclusionsThe cellular immune function in the elderly patients with NSCLC is lower than in adults with NSCLC and healthy elderly,and further decreases after chemotherapy.
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ObjectiveTo evaluate the role of galactomannan (GM) detection in bronchoalveolar lavage fluid (BALF) in the diagnosis of invasive pulmonary aspergillosis (IPA) in elderly patients with lung diseases.MethodsThe elderly patients with lung diseases and suspected of having IPA were enrolled. BALF for culture and GM detection, and serum samples for GM detection were obtained from all participants.According to European Organization for Research and Treatment of Cancer/Mycoses Study Group (EORTC/MSG) with host factors, clinical criteria, mycological evidence and histological or cytopathological evidence, all patients were categorized into the proven, probable,possible and no IPA patients. The IPA patients were considered as IPA group while no IPA was considered as control group. ResultsAmong 76 enrolled elderly patients, 18 cases were diagnosed with IPA (1 proven, 11 probable and 6 possible), the remained 58 patients were as control group.Based on a GM index cutoff value of ≥0. 5, the sensitivity, specificity, positive predictive value and negative predictive value for BALF were 83.3％, 82. 8％, 60.0％ and 94.1％, respectively; these variables in serum were 55.60％ , 91.4 ％, 66.7 ％ and 86.9％ , respectively. Using a GM index cutoff value of ≥1.0, the specificity and positive predictive value of both BALF GM and serum GM reached 100％, but the sensitivity and negative predictive value of BALF GM were higher than serum GM (66.7％ vs. 22.2％, 90.60％ vs. 80.60％, respectively). Receiver operating characteristic curve analysis yielded a sensitivity of 83.4％ and a specificity of 96.6％ at a BALF GM index cutoff value of ≥0.725. ConclusionsGM detection in BALF seems to be a useful tool in the diagnosis of IPA in elderly patients with lung diseases,and could be widely used in future.