Study of Bone Mineral Density, Vitamin-D and Body Mass Index in Asthmatic ACOS and COPD Cases: Those who are on Prolonged (more than 3 Years) use of Inhaled Corticosteroids

Introduction: Inhaled corticosteroids are the prime choice of treatment for Asthma, ACOS, and COPD cases, but using inhaled corticosteroids with the influencing factors for a longer duration may cause cachexia, skeletal muscle abnormalities, and metabolic syndromes. Objectives: To determine whether the use of inhaled corticosteroids has a harmful effect on bone, in case of Asthma, ACOS, and COPD. To assess the correlation between low bone mineral density with low vitamin D levels and low body mass index. To assess the fracture risk with the effect of inhaled corticosteroids in asthma, ACOS and COPD cases. Methods: A total of 260 subjects (123 males and 137 females) aged ≥ 25 years attended the routine check-up for NRI Institute of Medical Sciences, Visakhapatnam. The pulmonology department was grouped into 4. Data was collected and filed by using data collection sheet, measured bone mineral density with the ultra-sonogram machine, did investigative procedures to know the blood calcium and vitamin-D levels. Results: Our study revealed that all quantitative and qualitative parameters were measured and analyzed with the SPSS software version 18, (vitamin-D, bone mineral density, body mass index, allergies, family, smoking histories and others) obtained a statistically significant p-value. Conclusion: Effect of disease and inhaled corticosteroids use respiratory diseases for a longer duration or in high doses resulting in decreased bone mineral density along with the decreased body mass index.

Clinical significance of exhaled breath condensate and serum 8-isoPG MPO,LTB4 and IL-6 in patients with bronchial asthma and chronic obstructive pulmonary disease overlap syndrome / 实用医学杂志

Objective To investigate the clinical significance of biochemical markers in EBC and serum in patients with bronchial asthma and chronic obstructive pulmonary disease overlap syndrome(ACOS). Methods We selected Patients with chronic airway inflammatory diseases in our hospital,These patients underwent clinical trial after the stable phase,including 18 ACOS patients,22 asthma patients,24 COPD patients and 20 healthy non-smokers in the same period.8-isoPG and other inflammatory factors levels in EBC and serum were measured in the selected patients. A comparative analysis was performed. Results The levels of EBC 8-isoPG in the ACOS group were significantly higher than those in the healthy control group,The levels of serum and EBC 8-isoPG in the ACOS group were significantly higher than the asthma group and the COPD group(P < 0.05). The level of 8-isoPG in EBC was not related to age,smoking index,weight,and FEV1value(P>0.05).Conclusions Inflam-matory factors including 8-isoPG,are involved in chronic inflammation in lung tissues of patients with ACOS. 8-isoPG in EBC may have potential value in identifying ACOS from COPD and asthma as biomarkers and deserve further study.

A case report on a 29-year-old male with difficult to treat bronchial asthma in exacerbation: Rediscovering asthma COPD overlap syndrome (ACOS)

@#<p style="text-align: justify;"><strong>BACKGROUND:</strong> Asthma chornic obstructive pulmonary disorder(COPD) overlap syndrome (ACOS) was formally described by the joint project of global initiative for asthma (GINA) and global Initiative for chronic obstructive lung disease (GOLD) as persistent airflow limitation with several features usually associated with both asthma and COPD. ACOS is identified by the features shared with both asthma and COPD.The underlying cause though remains unknown,hence the project did not offer current formal definition.<br /><strong>CASE:</strong> This is a case of a 29-year-old male, asthmatic with an eight-pack year smoking history who presented with chronic obstructive respiratory symptoms with non significant improvement on control of exacerbation despite standard maximal  therapy.Diagnostic tests such as pulmonary function Tests,2D Echo,chest CT scan and even assay for alpha 1 anti trypsin were done to rule out for other disease entities and prognosticate the patient's condition leading to the diagnosis of asthma COPD overlap syndrome (ACOS). <br /><strong>CONCLUSION:</strong> ACOS as a disease entity is still under debate and still has no current formal definition due to lack of specific biomarkers and lack of defining characteristics.Despite this,management should not be compromised since these patients often present with higher rates of exacerbations,hospitalization,associated co morbid illness and mortality.Treatment therefore is individualized.</p>

A case report on a 29-year-old male with difficult to treat bronchial asthma in exacerbation: Rediscovering asthma COPD overlap syndrome (ACOS)

BACKGROUND: Asthma chornic obstructive pulmonary disorder(COPD) overlap syndrome (ACOS) was formally described by the joint project of global initiative for asthma (GINA) and global Initiative for chronic obstructive lung disease (GOLD) as persistent airflow limitation with several features usually associated with both asthma and COPD. ACOS is identified by the features shared with both asthma and COPD.The underlying cause though remains unknown,hence the project did not offer current formal definition.CASE: This is a case of a 29-year-old male, asthmatic with an eight-pack year smoking history who presented with chronic obstructive respiratory symptoms with non significant improvement on control of exacerbation despite standard maximal  therapy.Diagnostic tests such as pulmonary function Tests,2D Echo,chest CT scan and even assay for alpha 1 anti trypsin were done to rule out for other disease entities and prognosticate the patient's condition leading to the diagnosis of asthma COPD overlap syndrome (ACOS). CONCLUSION: ACOS as a disease entity is still under debate and still has no current formal definition due to lack of specific biomarkers and lack of defining characteristics.Despite this,management should not be compromised since these patients often present with higher rates of exacerbations,hospitalization,associated co morbid illness and mortality.Treatment therefore is individualized.

A case report on a 29-year-old male with difficult to treat bronchial asthma in exacerbation: Rediscovering asthma COPD overlap syndrome (ACOS)

BACKGROUND: Asthma chornic obstructive pulmonary disorder(COPD) overlap syndrome (ACOS) was formally described by the joint project of global initiative for asthma (GINA) and global Initiative for chronic obstructive lung disease (GOLD) as persistent airflow limitation with several features usually associated with both asthma and COPD. ACOS is identified by the features shared with both asthma and COPD.The underlying cause though remains unknown,hence the project did not offer current formal definition.CASE: This is a case of a 29-year-old male, asthmatic with an eight-pack year smoking history who presented with chronic obstructive respiratory symptoms with non significant improvement on control of exacerbation despite standard maximal  therapy.Diagnostic tests such as pulmonary function Tests,2D Echo,chest CT scan and even assay for alpha 1 anti trypsin were done to rule out for other disease entities and prognosticate the patient's condition leading to the diagnosis of asthma COPD overlap syndrome (ACOS). CONCLUSION: ACOS as a disease entity is still under debate and still has no current formal definition due to lack of specific biomarkers and lack of defining characteristics.Despite this,management should not be compromised since these patients often present with higher rates of exacerbations,hospitalization,associated co morbid illness and mortality.Treatment therefore is individualized.

Feasibility Study on Treating Bronchial Asthma with Spleen Intervention Syndrom / 中国生化药物杂志

Objective To investigate the efficacy and safety of tiotropium bromide aerosol combined with salmeterol in the treatment of ACOS. Methods 76 patients with ACOS were enrolled in this study from October 2014 to November 2016. They were divided into experimental group and control group according to the random number table method. The test group was given tiotropium bromide combined with salmeterol Casson aerosol treatment, the control group was given salmeterol tacrolone aerosol treatment, compared the two groups of patients with clinical efficacy and adverse reactions. Results The total effective rate was 92.11% in the experimental group and 73.68% in the control group, the difference was statistically significant (Z = 4.547, P<0.05). The ACT score of the test group was higher than that of the control group, the CAT score was lower than that of the control group, the difference was statistically significant (P<0.05); The incidence of adverse reactions in the test group was 10.53%, the incidence of adverse reactions in the control group was 13.16%,the difference was not statistically significant (χ2 = 0.126). Conclusion Tiotropium powder combined with salmeterol tegon aerosol in the treatment of bronchial asthma-chronic obstructive pulmonary syndrome is reliable and worthy of clinical practice.

Monitoring and its clinical significance of SP-D and interleukin-8 levels in bron-choalveolar lavage fluid of ACOS patients undergoing mechanical ventilation / 中国免疫学杂志

Objective:To investigate the concentration of pulmonary surfactant-associated protein D ( SP-D) and interleukin-8 (IL-8) in the bronchoalveolar lavage fluid (BALF) of ACOS patients undergoing mechanical ventilation (MV). Methods:38 patients with ACOS undergoing MV were involved in the study. According to the APACHEⅡscore, the patients were divided into the remission group (n=20) and the aggravation group (n=18). BALF was collected on the 1st and 5th days after MV. The content of IL-8 and SP-D in BALF was measured by ELISA. The levels of IL-8 and SP-D in BALF of the patients with different severity were compared. Results:The level of SP-D was significantly higher on the 5th day than on the 1st day in the remission group,and it decreased more ob-viously in the worsening group (P<0. 05). The level of IL-8 decreased gradually in the remission group but increased gradually in the worsening group. The level of SP-D was negatively correlated with IL-8 level and APACHEⅡ score. Conclusion:The findings suggest that the levels of SP-D and IL-8 in BALF are correlated with prognosis of ACOS patients undergoing MV,and it may prove to be useful as a guidance of therapy and prognosis.

The analysis of different clinical features between asthma-COPD overlap syndrome and chronic obstructive pulmonary disease in patients / 实用医学杂志

Objective We make a retrospective analysis , to compare to COPD group and discuss the risk factors and the clinical features in acute exacerbation in patients with ACOS to follow-up the exacerbating frequency after regular treatment in both two groups in one year. Methods There were 56 patients with ACOS and 80 patients with COPD from 2013 to 2015 in our hospital in 30%≤FEV1<80% in the stable phase. The common data of the enrolled patients included the age,sex,smoking, and allergic rhinitis or other allergic diseases in family. We analyzed laboratory index including PaO2,PaCO2,CRP,white blood cells,IgE of serums and compared the proportion of antibiotics,system used of glucocorticoid and noninvasive ventilation in hospitalization of acute exacerbation and followed up exacerbating frequency after using ICS united LABA/LAMA. Results The age and smoking index in the ACOS group were lower than the COPD group (P < 0.05). The allergic rhinitis or other familial allergic diseases,lower age of 60,the high IgE in serum were risk factor, in ACOS. In acute exacerbation, the PaCO2,IgE and WBC in serum were higher than that of the COPD group(P <0.05). The midian length of stay in hosipital was 12 days in the ACOS group and 8 days in the COPD group. The proportion of antibiotics,systemic administration of glucocorticoid and noninvasive ventilation in hospitalization of acute exacerbation in the ACOS group were higher than that of the COPD group (P < 0.05). The exacerbating frequency was decreased after using ICS united LABA/LAMA(1.2±0.6 vs 3.8±1.3,P < 0.05)in both ACOS and COPD groups. Conclusions The allergic diseases may participate in ACOS, in which it has familial tendency. In acute exacerbation, ACOS patients had even more inflammation and faster course than COPD patients. Using ICS united LABA/LAMA can reduce exacerbating frequency in ACOS.

Mathematical modeling of dilatometric behavior of 420A and 440C martensitic stainless steels used in surgical tools / Modelamento matemático de ensaio dilatométrico em aços inoxidáveis martensíticos 420A e 440C utilizados em ferramental cirúrgico

This research consisted of implementing and evaluating an empirical mathematical model to reproduce analytically the dilatometric behavior of ASTM 420A and ASTM 440C martensitic stainless steels, widely used for manufacturing surgical tools. Martensitic stainless steels can be subdivided into three subgroups: low-carbon, medium-carbon and high-carbon steels. The microstructure of each group is also characteristic as needlelike martensitic; very fine martensitic; and ultra-fine martensitic containing carbides. The proposed method was based on experimental data obtained from the dilatometric testing of the steel samples applying low heating rates. It was possible to determine the formation of phase fields near the equilibrium conditions. The method, being based on empirical data, ensured a greater approximation to the experimental values, verifying that it can be applied as a useful tool in the evaluation of industrial heat treatments for surgical tools.

O presente trabalho consistiu em implementar e avaliar um modelo matemático empírico que reproduz analiticamente o comportamento dilatométrico dos aços inoxidáveis martensíticos ASTM 420A e ASTM 440C, utilizados em ferramental cirúrgico. Aços inoxidáveis martensíticos podem ser subdivididos em três subgrupos, ou seja, baixo carbono; médio carbono e alto carbono. A microestrutura de cada grupo é caracterizada por martensita em forma de agulha; martensita fina e martensita ultra-fina contendo carbetos. A elaboração do método matemático se baseou em dados extraídos de ensaios dilatométricos sob baixas taxas de aquecimento. Foi possível determinar a formação dos campos de fase próximos às condições de equilíbrio. Os resultados obtidos garantiram boa aproximação com os valores experimentais, evidenciando que o modelo aplicado é um instrumento útil na avaliação dos tratamentos térmicos industriais para ferramental cirúrgico.

Um novo fio de aço inoxidável para aplicações ortodônticas / A new stainless steel wire for orthodontic purposes

OBJETIVO: desenvolver uma metodologia para fabricação de fios ortodônticos de aço inoxidável austeno-ferrítico SEW 410 Nr. 14517 por meio dos processos convencionais de laminação e trefilação. MÉTODOS: o aço austeno-ferrítico foi elaborado em um forno elétrico de indução. A qualidade dos fios foi avaliada por ensaios de tração e medidas de microdureza. A ductilidade e a manuseabilidade foram analisadas por meio da confecção de componentes ortodônticos. RESULTADOS E CONCLUSÕES: os valores encontrados mostraram que os fios de aço inoxidável austeno-ferrítico atenderam às normas BS 3507:1976 e ISO 5832-1, e apresentaram ótima ductilidade para confecção de componentes ortodônticos com dobras complexas.

OBJECTIVE: To develop a method to manufacture austenitic-ferritic stainless steel orthodontic wires (SEW 410 Nr. 14517) using conventional rolling and wiredrawing processes. METHODS: Austenitic-ferritic steel was produced in an induction furnace. Traction trials and microhardness measurements were used to evaluate wire quality. Orthodontic parts were fabricated to assess ductility and malleability. RESULTS AND CONCLUSIONS: Austenitic-ferritic stainless steel wires meet the BS 3507:1976 and ISO 5832-1 norms and have excellent ductility for the fabrication of orthodontic parts with complex folds.

Caracterização química e metalográfica dos aços inoxidáveis de implantes removidos de pacientes / Chemical and metallographic characterization of stainless steel in implants removed from patients

OBJETIVO: Este trabalho estudou a composição química e metalográfica (microestrutura, tamanho de grão, teor de inclusões) de aços inoxidáveis austeníticos, desenvolvidos para aplicações como biomateriais, utilizados na fabricação de implantes ortopédicos. MÉTODO: Foram analisados doze implantes removidos de pacientes afetados por quadro inflamatório. As análises químicas foram desenvolvidas pelas técnicas Espectrometria de Emissão Ótica e Microanálise por Dispersão de Energia (EDS) e o tamanho de grão foi determinado por microscopia ótica e Microscopia Eletrônica de Varredura (MEV) conforme norma ASTM E 1382 97. RESULTADOS: Observou-se que, todos os implantes apresentavam tamanho de grão superior ao recomendado pela norma, constatou-se também a presença de ferrita delta em dez dos doze implantes removidos, que de acordo com a norma ASTM F138-92 não deveriam ser percebidas microscopicamente com um aumento de 100 vezes. CONCLUSÕES: Em oito casos existe forte indicação de que as inflamações foram desencadeadas pela corrosão por pite. Nivel de Evidência III, Revisão sistemática de Estudos .

OBJECTIVE: This study examines the chemical and metallographic composition (microstructure, grain size, inclusion content) of austenitic stainless steel developed as biomaterials for used in the manufacture of orthopedic implants. METHOD: An analysis was carried out of twelve implants removed from patients affected by inflammation. Chemical analyses were carried out using Optical Emission Spectrometry and Energy Dispersive Microanalysis (EDS), and the grain size was determined by optical microscopy and scanning electron microscopy (SEM) according to ASTM Standard E 1382 97. RESULTS: It was observed that all the implants had a larger grain size than is recommended by the Standard. The presence of delta ferrite was also observed in ten of the twelve implants removed, which according to ASTM Standard F138-92, should not be perceived microscopically under magnification of 100x. CONCLUSIONS: In eight cases, there is a strong indication that the inflammation was triggered by pitting corrosion. Level of Evidence: Level III, Systematic review of studies.