Anti-Ehrlichia properties of the dichloromethane fraction of Ageratum conyzoides associated with doxycycline: In vitro study / Propriedades anti-Ehrlichia da fração diclorometânica de Ageratum conyzoides associada com doxiciclina: estudo in vitro

ABSTRACT: The increasing number of cases of canine ehrlichiosis caused by Ehrlichia canis in hospitals and veterinary clinics has demonstrated the need for a new drug protocol for this disease. Doxycycline is used to treat ehrlichiosis, but the resistance of the microorganism to this treatment protocol, as well as the various side effects to the animals, has become a concern. Several studies have shown a positive interaction with extracts of plants and drugs, which allow for the reduction of the concentration necessary to produce the desired effect, minimizing adverse effects. This study determined the efficiency of the combination of the dichloromethane (DCM) fraction of Ageratum conyzoides L. with anti-Ehrlichia activity and doxycycline by using the checkerboard assay. Plant material was collected in São Luís, northeastern Brazil, followed by extraction in MeOH: H2O (8:2) and partitioning of the DCM fraction. After determining the Minimum Inhibitory Concentration (MIC) of the fraction under study against DH82 cells infected with Ehrlichia canis, it was combined with doxycycline to derive the Fractional Inhibitory Concentration Index (CIF Index). A reduction of 5.83 times the doxycycline minimum inhibitory concentration was observed, showing that this fraction of A. conyzoides composed predominantly by the class of lignans, identified by mass spectrometry notably intensified the activity of doxycycline against E. canis, resulting in a synergistic effect.

RESUMO: O crescente número de casos de erliquiose canina por Ehrlichia canis em hospitais e clínicas veterinárias tem demonstrado a necessidade de um novo protocolo de medicamentos para essa doença. A doxiciclina é usada para tratar a erliquiose, mas a resistência do microrganismo a esse protocolo de tratamento, bem como os diversos efeitos colaterais para os animais, tornou-se uma preocupação. Vários estudos têm demonstrado interação positiva com extratos de plantas e fármacos, que permitem a redução da concentração necessária para produzir o efeito desejado, minimizando os efeitos adversos. Este estudo determinou a eficiência da combinação da fração diclorometânica (DCM) de Ageratum conyzoides L. com atividade anti-Ehrlichia canis associada com doxiciclina por meio do ensaio de Checkerboard. O material vegetal foi coletado em São Luís, Maranhão, nordeste do Brasil, seguido pela extração em MeOH:H2O (8:2) e partição da fração diclorometânica. Após a determinação da Concentração Inibitória Mínima (CIM) da fração em estudo frente às células DH82 infectadas com Ehrlichia canis, a mesma foi combinada com a doxiciclina para derivação do Índice de Concentração Inibitória da Fração (Índice CIF). Observou-se uma redução de 5,83 vezes a concentração inibitória mínima da doxiciclina mostrando que esta fração de A. conyzoides, composta predominantemente por lignanas identificadas por espectrometria de massas, notavelmente intensificou a atividade desse fármaco contra E. canis, resultando em um efeito sinérgico.

Diluente Tris suplementado com óleo de Mauritia flexuoxa sobre a qualidade do sêmen caprino após a criopreservação / Tris diluent supplemented with Mauritia flexuoxa oil on the quality of goat semen after cryopreservation

Objetivou-se verificar os efeitos, nos parâmetros espermáticos, na integridade mitocondrial, acrossomal e de membrana em células espermáticas, desencadeados pelo uso do Tris (Tris hidroximetil aminometano) suplementado com óleo de Mauritia flexuoxa como diluente para criopreservação de sêmen caprino. Quatro caprinos clinicamente saudáveis foram utilizados. Os animais eram alimentados diariamente com volumoso (Pennisetum purpureum, Schum.), concentrado (ração peletizada com teor de 20% proteína, 300 g/animal/dia) e sal mineral específico para Caprinos (Caprinofós®), à vontade. Dois ensaios foram realizados: I – Teste de toxicidade; II – Criopreservação do sêmen com concentrações ideais. No teste de toxicidade as concentrações avaliadas foram: 5%, 10%, 15% e 20% de diluente a base de óleo de Mauritia flexuoxa. Após o teste de toxicidade, foi escolhido a concentração que apresentou o melhor resultado (5%). Logo após, foram realizadas mais 32 coletas, que foram diluídas em Tris-gema-glicerol (grupo controle) ou diluente contendo óleo vegetal (Mauritia flexuoxa). As amostras foram criopreservadas com auxílio do aparelho Tk3000®. Após o período mínimo de uma semana as palhetas foram descongeladas em banho-maria a 37 °C por 30 segundos, acondicionadas em microtubos de centrifugação e homogeneizadas para a análise imediata de motilidade, vigor espermático e morfologia. Em seguida, por meio de sondas fluorescentes foram avaliadas a integridade de acrossomo, membrana plasmática (Diacetato de Carboxifluresceína e Iodeto de Propídeo) e função mitocondrial sob microscopia de epifluorescência. Quanto a motilidade e vigor, integridade mitocondrial e acrossomal, o grupo buriti foi inferior ao grupo controle. O Tris suplementado com óleo de Mauritia flexuoxa na concentração de 5% não influenciou significativamente a qualidade espermática, porém, observouse morfologia e integridade de membrana favoráveis. Dessa forma, sendo uma alternativa para substituição de diluentes a base de produtos de origem animal.

The objective was to verify the effects, sperm parameters, mitochondrial, acrosomal and membrane integrity in sperm cells, triggered by the use of Tris (Tris hydroxymethyl aminomethane) supplemented with Mauritia flexuoxa oil as a diluent for cryopreservation of goat semen. Four goats clinically healthy were used. The animals were fed daily with bulky (Pennisetum purpureum, Schum.), concentrate (pelleted feed with 20% protein content, 300 g / animal / day) and mineral salt Specific for Goats (Caprinofós®), ad libitum. Two tests were carried out: I - Toxicity test; II - Semen cryopreservation with ideal concentrations. In the toxicity test as selected were: 5%, 10%, 15% and 20% of Mauritia flexuoxa oil-based diluent. After the toxicity test, the concentration that showed the best result (5%) was chosen. Soon after, a further 32 samples were obtained, which were diluted in Tris-glycerol (control group) or diluent containing vegetable oil (Mauritia flexuoxa). The samples were cryopreserved using the Tk3000® machine. After a minimum of one week, the samples were thawed in a 37 ° C water bath for 30 seconds, packed in centrifugation microtubes and homogenized for immediate analysis of motility, sperm vigor and morphology. Then, by means of fluorescent probes, the integrity of the acrosome, plasma membrane (Carboxyflurescein diacetate and Propidium Iodide) and mitochondrial function under epifluorescence microscopy were evaluated. As for motility and vigor, mitochondrial and acrosomal integrity, the buriti group was inferior to the control group. Tris supplemented with Mauritia flexuoxa oil at a concentration of 5% did not significantly influence sperm quality, however, favorable motility, morphology and membrane integrity were observed. Thus, being an alternative to replace diluents based on products of animal origin.

Diluente Tris suplementado com óleo de Mauritia flexuoxa sobre a qualidade do sêmen caprino após a criopreservação / Tris diluent supplemented with Mauritia flexuoxa oil on the quality of goat semen after cryopreservation

Objetivou-se verificar os efeitos, nos parâmetros espermáticos, na integridade mitocondrial, acrossomal e de membrana em células espermáticas, desencadeados pelo uso do Tris (Tris hidroximetil aminometano) suplementado com óleo de Mauritia flexuoxacomo diluente para criopreservação de sêmen caprino. Quatro caprinos clinicamente saudáveis foram utilizados. Os animais eram alimentados diariamente com volumoso (Pennisetum purpureum, Schum.), concentrado (ração peletizada com teor de 20% proteína, 300 g/animal/dia) e sal mineral específico para Caprinos (Caprinofós®), à vontade. Dois ensaios foram realizados: I ­ Teste de toxicidade; II ­ Criopreservação do sêmen com concentrações ideais. No teste de toxicidade as concentrações avaliadas foram: 5%, 10%, 15% e 20% de diluente a base de óleo de Mauritia flexuoxa. Após o teste de toxicidade, foi escolhido a concentraçãoque apresentou o melhor resultado (5%). Logo após, foram realizadas mais 32 coletas, que foram diluídas em Tris-gema-glicerol (grupo controle) ou diluente contendo óleo vegetal (Mauritia flexuoxa). As amostras foram criopreservadas com auxílio do aparelho Tk3000®. Após o período mínimo de uma semana as palhetas foram descongeladas em banho-maria a 37 °C por 30 segundos, acondicionadas em microtubos de centrifugação e homogeneizadas para a análise imediata de motilidade, vigor espermático e morfologia. Em seguida, por meio de sondas fluorescentes foram avaliadas a integridade de acrossomo, membrana plasmática (Diacetato de Carboxifluresceína e Iodeto de Propídeo) e função mitocondrial sob microscopia de epifluorescência. Quanto a motilidade e vigor, integridade mitocondrial e acrossomal, o grupo buriti foi inferior ao grupo controle. O Tris suplementado com óleo de Mauritia flexuoxa na concentração de 5% não influenciou significativamente a qualidade espermática, porém, observou-se morfologia e integridade de membrana favoráveis. Dessa forma, sendo uma alternativa para substituição de diluentes a base de produtos de origem animal.

The objective was to verify the effects, sperm parameters, mitochondrial, acrosomal and membrane integrity in sperm cells, triggered by the use of Tris (Tris hydroxymethyl aminomethane) supplemented with Mauritia flexuoxa oil as a diluent for cryopreservation of goat semen. Four goats clinically healthy were used. The animals were fed daily with bulky (Pennisetum purpureum, Schum.), concentrate (pelleted feed with 20% protein content, 300 g / animal / day) and mineral salt Specific for Goats (Caprinofós®), ad libitum. Two tests were carried out: I - Toxicity test; II - Semen cryopreservation with ideal concentrations. In the toxicity test as selected were: 5%, 10%, 15% and 20% of Mauritia flexuoxa oil-based diluent. After the toxicity test, the concentration that showed the best result (5%) was chosen. Soon after, a further 32 samples were obtained, which were diluted in Tris-glycerol (control group) or diluent containing vegetable oil (Mauritia flexuoxa). The samples were cryopreserved using the Tk3000® machine. After a minimum of one week, the samples were thawed in a 37 ° C water bath for 30 seconds, packed in centrifugation microtubes and homogenized for immediate analysis of motility, sperm vigor and morphology. Then, by means of fluorescent probes, the integrity of the acrosome, plasma membrane (Carboxyflurescein diacetate and Propidium Iodide) and mitochondrial function under epifluorescence microscopy were evaluated. As for motility and vigor, mitochondrial and acrosomal integrity, the buriti group was inferior to the control group. Tris supplemented with Mauritia flexuoxa oil at a concentration of 5% did not significantly influence sperm quality, however, favorable motility, morphology and membrane integrity were observed. Thus, being an alternative to replace diluents based on products of animal origin.

The Relation of COPD Assessment Test (CAT) and BODE Index in Assessing Patients with COPD: Is Cat Alone Simple and Good Enough?

Chronic obstructive pulmonary disease (COPD) is a significant cause of disability and death worldwide. It is often evaluated with outcome measures like lung function test (LFT), health status and BODE (Body mass, Obstruction, Dyspnoea and Exercise capacity) index, to initiate appropriate treatment. Objectives: To determine the association between the BODE index and COPD assessment test (CAT) in COPD patients. To ascertain the utility of CAT alone as an assessment tool for COPD patients in primary care setting and low resource countries. Methods: A cross-sectional study of sixty (60) patients with clinical and lung function test diagnosis of COPD were recruited consecutively from the outpatient clinic. The body mass index (BMI) of the patients, CAT scores, modified medical research council dyspnoea scale and sixminute walk distance test (6MWDT) was assessed and recorded. The individual score was summed up to obtain the BODE index score for the particular patients. Results: The mean age was 68.8years (± 10.3). There was a strong correlation between the BODE index and CAT scores (r= 0.77 P <0.0001). Inter-rater agreement between the tools (CAT and BODE index) was moderate (k=0.46). The CAT questionnaire also correlated well with the modified medical research council dyspnea scale, the six-minute walk test and the forced expiratory volume in the first second. Conclusion: CAT can serve as a simple, easy to administer tool for the assessment of patients with COPD especially in low resource countries and primary care setting.

Body mass index, obstruction of the airflow, dyspnea, and exercise capacity index as predictor of the severity of exacerbations and systemic involvement in patients with COPD

Background: Allocation of the limited resources to the needed patients and decision making regarding timely interventions demand development of a reliable, cost effective, simple assessment tool. Several studies propose body-mass index, airflow obstruction, dyspnea, and exercise (BODE) index for this purpose in patients with Chronic obstructive pulmonary disease (COPD). The objective of this study was to assess the utility of BODE index to predict the severity of exacerbations and systemic involvement in COPD.Methods: A Present hospital based cross sectional study was carried out among 100 COPD patients. BODE index was used to assess the patients and its association was studied with various variables. The data was analyzed using one-way analysis of variance (ANOVA) test.Results: As the body index class of severity increases, the number of hospitalizations required in the past also increases and this association is statistically significant. As the severity of the disease increased as indicated by the class the mean number of exacerbations in the past increased and this association was found out to be statistically significant. As the severity of the disease increased as indicated by the class level, the mean number of days of hospitalization increased. But this increase was of small difference and hence on one-way ANOVA test was not found out to be statistically significant. As the pack years increases, the BODE index increases significantly (p value <0.001). As the severity of the disease increased, the mean body mass index decreased. Haemoglobin level was found to decrease with increase in BODE index class of severity. This association was statistically significant.Conclusions: The BODE index has been found to be a very good tool to assess the prognosis of COPD as well as severity of acute exacerbations.

A Descriptive Study of Chronic Obstructive Pulmonary Disease in Tertiary Care Clinics of a Caribbean Island / Estudio descriptivo de la enfermedad pulmonar obstructiva crónica en clínicas de atención terciaria de una isla caribeña

ABSTRACT Objective: To determine the relationship between severity of chronic obstructive pulmonary disease (COPD) and quality of life as well as COPD's correlation with depressive symptoms in West Indian subjects. Methods: This is a cross-sectional, observational study of outpatients with COPD in tertiary care. The severity of COPD was determined by the Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage, GOLD group, and body mass index, airflow obstruction, dyspnoea and exercise capacity (BODE) index. Quality of life was assessed by the St George Respiratory Questionnaire (SGRQ) and COPD Assessment Test (CAT), and depression was assessed by the Center for Epidemiologic Studies Depression Scale (CES-D). Results: A total of 105 patients (85.7% male, 37.1% Indo-Trinidadian, 42.9% Afro-Trinidadian, 64.8% primary level education) were recruited with a mean age of 66.9 years (standard deviation: 9.60 years). The median body mass index was 25 kg/m2; 26.7% were underweight. Risk factors identified were: ever-smokers (27.6%), marijuana (20%), biomass (81.9%), passive smoke (70.5%), occupational exposures (80%). The CES-D of 25% of the patients was ≥16. Co-morbidities included diabetes (22%), hypertension (29%), gastro-oesophageal reflux disease (10%) and previous myocardial infarction (15%). A total of 59% of the patients reported a monthly household income of less than US$800. Lower level of education was associated with worse SGRQ (total and impact), lower forced expiratory volume in one second, modified Medical Research Council scale (mMRC) of ≥ 2 and higher BODE index. Higher GOLD group correlated with worse SGRQ, CAT and CES-D. Higher CES-D was associated with shorter six-minute walk distance, worse SGRQ, CAT and mMRC scores, higher GOLD group and increased COPD admissions per year. Patients with a CES-D of ≥ 16 walked shorter distances. Higher BODE quartile was associated with worse SGRQ, CAT and CES-D scores. Conclusion: Higher GOLD group and higher BODE quartile were associated with worse quality of life scores and higher depression scores. Patients in higher GOLD groups should be screened for depression. Education on COPD should be targeted at those of lower socioeconomic status.

RESUMEN Objetivo: Determinar la relación entre la severidad de la enfermedad pulmonar obstructiva crónica (EPOC) y la calidad de vida, así como la correlación de la EPOC con síntomas depresivos en sujetos antillanos. Métodos: Se realizó un estudio observacional transversal de pacientes ambulatorios con EPOC en cuidados terciarios. La severidad de la EPOC fue determinada por la etapa de la Iniciativa Global para la Enfermedad Pulmonar Obstructiva Crónica (GOLD, en inglés), el grupo GOLD, así como el índice de masa corporal, la obstrucción del flujo de aire, la disnea y la capacidad de ejercicio (índice BODE). La calidad de vida fue evaluada mediante el Cuestionario Respiratorio de Saint George (CRSG) y la prueba de evaluación de la EPOC (CAT, en inglés), en tanto que la depresión fue evaluada por la Escala de Depresión del Centro de Estudios Epidemiológicos (CES-D). Resultados: Un total de 105 pacientes (85.7% varones, 37.1% indotrinitenses, 42.9% afrotrinitenses, 64.8% nivel de educación primaria) fueron reclutados con una edad promedio de 66.9 años (desviación estándar: 9.60 años). El índice de masa corporal promedio fue de 25 kg/m2; 26.7% por debajo del peso normal. Los factores de riesgo identificados fueron: fumar ocasionalmente (27.6%), marihuana (20%), biomasa (81.9%), humo pasivo (70.5%), exposición ocupacional (80%). El CES-D del 25% de los pacientes fue ≥ 16. Las comorbilidades incluyeron diabetes (22%), hipertensión (29%), enfermedad por reflujo gastroesofágico (10%), y previo infarto del miocardio (15%). Un total de 59% de los pacientes reportaron un ingreso mensual familiar de menos de $800 USD. El nivel más bajo de educación se asoció con un peor (CRSG) (total e impacto), menor volumen espiratorio forzado en un segundo, Escala del Consejo de Investigaciones Médicas modificada (mMRC) de ≥ 2, y más alto índice de BODE. Un grupo más alto de GOLD se correlacionó con peores resultados de CRSG, CAT y CES-D. El CES-D más alto se asoció con una caminata de una distancia más corta en seis minutos, peores puntuaciones de CRSG, CAT y mMRC, un grupo más alto de GOLD, y mayores ingresos de EPOC por año. Los pacientes con CES-D de ≥ 16 caminaron distancias más cortas. El cuartil más alto de BODE estuvo asociado con las puntuaciones peores de CRSG, CAT y CES-D. Conclusión: El grupo GOLD más alto y el cuartil más alto de BODE se asociaron con peores puntuaciones de calidad de vida y puntuaciones de depresión más altas. Los pacientes en los grupos de GOLD más altos deben ser tamizados para detectar si padecen depresión. La educación sobre la EPOC debe estar dirigida a aquellos que tienen una situación socioeconómica inferior.

Effects of smoking cessation on pulmonary function and quality of life

Background: Cigarette smoking is a major public health problem and is the most important cause of chronic obstructive pulmonary disease (COPD). This study shows the importance of smoking cessation for improvement in respiratory function and quality of life and brings out the potential usage of pharmacological and behavioural therapy for the same.Methods: This prospective study was conducted on 50 male smokers at Kilpauk Medical College, Chennai. During the treatment only 43 patients were continued till the end of follow up. During the period, varenicline treatment was given for three months as per schedule, regular periodic counselling was given to these patients and followed up for a period of 1 year. Forced expiratory volume at one second (FEV1), COPD assessment test (CAT) scoring, 6 min walk test (6MWD), BODE index, was taken before starting therapy and on 3rd month and at the end of one year of follow-up. All the values obtained were analysed statistically.Results: The mean age of the 43 patients was 44.7±7.34, mean BMI was 22.27±4.24. The mean difference between pre and post treatment scores of CAT, 6MWD and BODE index were found to be statistically significant (p<0.0001).Conclusions: Combined behavioural counseling and pharmacotherapy with varenicline significantly improved the odds of achieving tobacco abstinence in the participants by the end of one year of treatment.

Effect of Fufei Gushen Decoction on BODE Index of Patients with Chronic Obstructive Pulmonary Disease at Stable Stage / 广州中医药大学学报

Objective To observe the effect of Fufei Gushen Decoction on the BODE index, an index for body mass index(BMI), airflow obstruction, dyspnea, and exercise capacity, in severe and extremely severe chronic obstructive pulmonary disease (COPD) patients with lung-kidney deficiency interweaved with phlegm and blood stasis at stable stage. Methods Eighty qualified COPD patients were randomly divided into treatment group and control group, 40 cases in each group. Both groups were given inhalation of Seretide (Salmeterol Xinafoate and Fluticasone Propionate Powder for inhalation) , and the treatment group was given oral use of Fufei Gushen Decoction additionally. The treatment for the two groups lasted for 3 months. Before and after treatment, BMI, the percentage of forced expiratory volume in one second of the predicted value (FEV1%) , dyspnea index of modified British Medical Research Council (MMRC), and exercise performance index of 6-min walking test (6MWT) in the two groups were observed. Results (1) After treatment, FEV1%, MMRC dyspnea index, 6MWT scores and BODE index overall scores of severe and extremely severe patients in the treatment group were much improved(P 0.05). MMRC dyspnea index, 6MWT scores and BODE index overall scores of severe and extremely severe patients inthe control group were much improved (P 0.05).(2) Except for BMI, the parameters of FEV1%, MMRC dyspnea index, 6MWT scores and BODE index overall scores of the treatment group were much improved as compared with those of the control group after treatment(P < 0.05). Conclusion Fufei Gushen Decoction combined with inhalation of Seretide exerts certain effects on decreasing the BODE index scores, relieving symptoms, and improving pulmonary function, exercise performance and the quality of life of COPD patients with lung-kidney deficiency interweaved with phlegm and blood stasis at stable stage.

Evaluation of BODE index as a predictor of Pulmonary Hypertension in COPD patients.

Background: The severity of COPD is usually assessed on the basis of a single parameter – forced expiratory volume in one second (FEV1). However, the patients with COPD have systemic manifestations that are not reflected by the FEV1. The present study was undertaken to determine the predictive value of BODE index (Body-mass index (B), the degree of airflow obstruction (O) ,dyspnea (D), and exercise capacity (E) for development of pulmonary hypertension and as a predictor of severity in COPD patients. The original BODE index is a simple multidimensional grading system which is superior to FEV1 alone for prediction of mortality and hospitalization rates among COPD patients. Methods: This study was done from January 2013 to December 2014.Total one hundred male patients who attended the chest medicine department, with the symptoms suggestive of COPD were included in this study and the study was done to evaluate the BODE index and correlated with echo-cardigraphic findings suggestive of pulmonary hypertension as a predictor of severity in patients with COPD. Result: Among patients with COPD, there were (21%) patients who had mild COPD with a BODE score between 0 – 2, Moderate COPD (BODE score of 3 – 5) were (23%), Severe COPD (BODE score more than or equal to 6) groups had (56%) patients. The study results showed that as the BODE index scores severity increases the incidence of pulmonary hypertension increases as identified by echocardiography RVSP (Right ventricular systolic pressure) findings. The average RVSP was 59.6 in severe COPD patients (BODE index more than 6) 47.2 in moderate severe COPD (BODE index 3-5), while it was less than 36 in mild groups. These values were found to be significant on comparison to other groups. Conclusion: BODE index may offer superior and alternative reliable method to predict severity in patients with COPD in terms of pulmonary hypertension and for following up after medications. Since the assessment of BODE index requires only a spirometer, which is relatively inexpensive and can easily be made available, this index could be of great practical value in a primary health care setup to identify individuals who are at need for further evaluation in a higher referral center. Thus, BODE index can be used for judicious referral of patients with COPD thereby preventing the wastage of the limited resources available.

Study on the correlation between BODE and inflammatory factors in patients with chronic obstructive pulmonary disease / 中国综合临床

Objective To assess the significance and the relationship of BODE index score and inflammation factors in stable chronic obstructive pulmonary disease(COPD).Methods Sixty COPD patients in their stable condition were evaluated for BODE index score and the level of tumor necrosis factor-α(TNF-α),interleukin-8(IL-8) and C reactive protein (CRP) were determined.Results BODE index score in COPD patients was positively correlated with serum concentrations of TNF-α,IL-8 (r =0.455,P ＜ 0.01 ; r =0.303,P ＜0.05),but not with CRP (r =0.111,P =0.398).IL-8 and TNF-α were both significantly negatively correlated to body mass index(BMI),force exhale volume of the first second (FEV1) and 6 minute walking distance (6MWD) (r=-0.417,P ＜0.01;r=-0.538,P＜0.01;r =-0.419,P＜0.01 for IL-8;and r=-0.262,P＜0.05;r=-0.348,P＜0.01;r=-0.334,P＜0.01 for TNF-α).Conclusion The BODE index,as a simple multidimensional grading system for COPD,is closely related to system inflammation,which indicates that system inflammation may contribute to the systemic development of COPD.

Clinical study on Du moxibustion for stable phase of chronic obstructive pulmonary disease / 国际中医中药杂志

Objective To investigate the Du moxibustion therapy in the treatment of chronic obstructive pulmonary disease (Chronic obstructive pulmonary disease,COPD)at stable phase.Methods 60 cases of lung COPD patients in stable stage who received treatment from January to December 2010 in Taihe Hospital of Traditional Chinese Medicine outpatient were randomly divided into two groups in,according to the case of tail number,with 30 patients in each.The control group was taken oral doxofylline tablets,0.2 g/time,2 time/d and ambroxol hydrochloride,30 mg/time,3 time/d.The treatment group was treated with Du moxibustion two times on the basis of the control group.One year follow-up and pulmonary function and BODE index assessment were performed in each group.Results ① the pulmonary function of the treatment group after the treatment (65.58±7.90) ％ was significantly improved than the same group before the treatment (53.20± 7.37) ％ (P＜0.05),and had significant difference compared with the control group after the treatment (57.53 ± 7.22)％ (P＜0.05).The recurrence rate was significantly different in the treatment group (1.79±0.32) and the control group (2.09±0.38) (P＜0.05).② BMI,MMRC,6MWD,BODE index,shortness of breath,wheezing,anorexia was significantly improved after the treatment in the treatment group [after treatment were (21.98 ± 1.32)kg/m2,(2.09±0.37)％,(350.68±88.70),(3.82±2.18) meters,(0.38±0.27),(0.32±0.25)％,(0.35±0.27) respectively; before treatment were (18.21±2.49)kg/m2,(2.50±0.43)％,(324.88±70.92),(4.66±1.40) meters,(1.49±0.62) ％,(1.42±0.56)％,(1.77±0.35),P＜0.01 respecitively].Compared with the control treatment after the treatment [(18.20 ± 1.79) kg/m2,(2.36 ± 0.64) ％,(320.03 ± 68.53),(4.43 ±1.62) meters,(1.22± 0.71),(1.28±0.67)％,(1.73±0.24) respectively] (P＞0.01),the difference was statistically significant(P＜0.01).Conclusion Du moxibustion therapy was effective in treating chronic obstructive pulmonary diseases in stable phase.

Correlation analysis between the BODE index with fatigue symptoms on COPD patients / 中国实用护理杂志

Objective To explore the correlation between BODE index with fatigue symptoms on COPD patients,and provide new ways for clinical evaluation,prediction,symptom control and establishment of effective management mode.Methods 120 COPD patients of stable stage were selected to be investigated and analyzed by the Fatigue Scale-14(FS-14),six-minute walking distance(6MWD),pulmonary func-tion test and the body mass index (BMI).Dyspnea was measured using the Medical Research Council (MRC) dyspnea scale.Results The fatigue symptoms showed high positive linear correlation with BODE index and mMRC,and significant negative correlation with 6 MWD,FEV1％ and BMI.Conclusions The study shows that fatigue symptoms had a higher prevalence in COPD patients of stable stage.There were a high correlation between fatigue symptoms with the BODE index,mMRC,6MWD,FEV1％ and BMI.The BODE index was a good predictor and evaluation of fatigue symptoms.

Avaliação de espermatozoides caprinos congelados em meio à base de água de coco em pó (ACP-101®) ou TRIS / Evaluation of goat spermatozoa frozen in media based on powder coconut water media based (ACP-101®) or TRIS

Compararam-se as características cinéticas e morfológicas de espermatozoides caprinos congelados nos meios à base de ACP-101® e TRIS. Os diluentes utilizados foram: ACP-101® (+ 2,5 por cento gema ovo + 7 por cento glicerol) e TRIS (+ 20 por cento gema ovo + 6,8 por cento glicerol). Quarenta e oito ejaculados de quatro bodes foram coletados, avaliados, divididos em duas alíquotas e diluídos nos meios ACP-101® e TRIS, respectivamente, posteriormente congelados e, após 30 dias, descongelados. A avaliação da motilidade espermática por computador foi realizada aos 5, 60 e 120 minutos pós-descongelação. As características de motilidade espermática analisadas foram: motilidade total (MT) ( por cento) e progressiva (MP) ( por cento), velocidades média do trajeto do espermatozoide (VAP) (µm/s) e linear (VSL) (µm/s) e população de espermatozoides rápidos (ER) ( por cento). As avaliações de morfologia espermática quantificaram a porcentagem de espermatozoides normais (N) e as alterações da cabeça (AC), da peça intermediária (API) e do flagelo (AF), aos cinco e 120 minutos pós-descongelação. O diluente TRIS apresentou resultados cinéticos mais elevados que o ACP-101® aos 60 e 120 minutos pós-descongelação. As AC aos 120 minutos pós-descongelação foram mais altas nos espermatozoides congelados em ACP-101®. Conclui-se que o diluente TRIS promoveu maior viabilidade in vitro dos espermatozoides caprinos pós-descongelação.

The aim of the work was to compare kinetic and morphologic characteristics of goat sperm frozen in diluent media based on ACP-101® and TRIS. The employed diluents were: ACP-101® (+ 2.5 percent egg yolk + 7 percent glycerol) and TRIS (+ 20 percent egg yolk + 6.8 percent glycerol). Forty eight ejaculates from four bucks were collected, assessed and divided into two aliquots and diluted into the experimental treatments ACP-101® and TRIS. The samples were frozen and after 30 days, thawed. The computer assisted spermatic motility evaluations were placed into 5, 60 and 120 minutes post-thawing. The motion parameters assessed were: total motility (MT) ( percent), progressive motility (MP) ( percent), average path velocity (VAP) (µm/s), straight linear velocity (VSL) (µm/s), and population of rapid spermatozoa (ER) ( percent). The morphologic parameters: normal spermatozoa (N), head alteration (AC), intermediary piece alteration (API), tail alteration (AF) were evaluated at 5 and 120 min post-thawing. The media based on TRIS showed kinetic results significantly superior to ACP-101® at 60 and 120min. After 120min post-thawing the AC was higher in frozen sperm in media based on ACP-101®. The TRIS media promoted better goat spermatozoa in vitro viability post-thawing.

Does the BODE index reflect the level of physical activity in daily life in patients with COPD? / O índice BODE reflete o nível de atividade física na vida diária de pacientes com DPOC?

OBJECTIVES: To study the relationship between the level of physical activity in daily life and disease severity assessed by the BODE index in patients with chronic obstructive pulmonary disease (COPD). METHODS: Sixty-seven patients with COPD (36 men) with forced expiratory volume in the first second (FEV1) of 39 (27-47) percent predicted and age of 66 (61-72) years old were evaluated by spirometry, dyspnea levels (measured by the Medical Research Council scale, MRC) and by the 6-minute walking test (6MWT). The BODE index was calculated based on the body mass index (weight/height²), FEV1, MRC and 6MWT, and then the patients were divided in four quartiles according to their scores (Quartile I: 0 to 2 points, n=15; Quartile II: 3 to 4 points, n=20; Quartile III: 5 to 6 points, n=23; Quartile IV: 7 to 10 points, n=9). Two activity monitors (DynaPort® and SenseWear®) were used to evaluate the level of physical activity in daily life. The Kruskal-Wallis test (Dunns's post-hoc test), the Mann-Whitney test and the Spearman Correlation Coefficient were used for statistical analysis. RESULTS: There were modest correlation between the BODE index and the time spent walking per day, the total daily energy expenditure and the time spent in moderate and vigorous activities per day (-0.32 < r <- 0.47; p<0.01 for all variables). When comparing the pooled quartiles I+II with III+IV, there were significant difference between the time spent walking per day, the total daily energy expenditure and the time spent in moderate activities per day (p<0.05). CONCLUSION: The level of physical activity in daily life has a modest correlation with the classification of COPD severity assessed by the BODE index, reflecting only differences between patients with classified as mild-moderate and severe-very severe COPD.

OBJETIVOS: Estudar a relação entre nível de atividade física na vida diária (AFVD) e gravidade da Doença Pulmonar Obstrutiva Crônica (DPOC) avaliada pelo índice BODE. MÉTODOS: Sessenta e sete pacientes com DPOC (36 homens), com volume expiratório forçado no primeiro segundo (VEF1) 39(27-47) por centoprevisto, e 66(61-72)anos foram submetidos a avaliações de espirometria, grau de dispneia (Medical Research Council scale, MRC) e teste de caminhada de 6 minutos (TC6). O índice BODE foi calculado com base no índice de massa corpórea (peso/estatura²), VEF1, MRC e TC6, e os pacientes foram subdivididos em quatro quartis de acordo com sua pontuação no BODE (quartil I: 0 a 2 pontos, n=15; quartil II: 3 a 4 pontos, n=20; quartil III: 5 a 6 pontos, n=23; quartil IV: 7 a 10 pontos, n=9). O nível de AFVD foi avaliado por dois monitores de atividade física (DynaPort® e SenseWear®). Os testes de Kruskal-Wallis (pós-teste Dunns), Mann-Whitney e Coeficiente de Correlação de Spearman foram utilizados na análise estatística. RESULTADOS: Houve correlação modesta entre os escores do índice BODE e o tempo gasto andando/dia, gasto energético total e tempo gasto/dia em atividades moderadas e vigorosas (-0,32< r <-0,47; p<0.01 para todos). Quando comparados os quartis agrupados I+II com III+IV, houve diferença significante entre o tempo gasto andando/dia, gasto energético total e tempo gasto em atividades moderadas (p<0,05). CONCLUSÃO: O nível de AFVD apresenta correlação modesta com a classificação da gravidade da DPOC dada pelo índice BODE, refletindo apenas diferenças entre pacientes com doença leve-moderada e grave-muito grave.

Three-year follow-up study of respiratory and systemic manifestations of chronic obstructive pulmonary disease

Few studies show patient outcomes over time in chronic obstructive pulmonary disease (COPD). In the present study, we monitored forced expiratory volume in the first second (FEV1) and other manifestations of the disease over 3 years in 133 COPD patients (69 percent males, age = 65 ± 9 years, FEV1 = 59 ± 25 percent) evaluated at baseline. During follow-up, 15 patients (11 percent) died and 23 (17 percent) dropped out. Measurements for 95 (72 percent) COPD patients alive after 3 years were analyzed. FEV1, body mass index (BMI), 6-min walking distance (6MWD), Medical Research Council scale (MRC), Saint George’s Respiratory Questionnaire (SGRQ), Charlson Comorbidity index, and BODE index were obtained at baseline and after 3 years. At baseline, 17 patients (18 percent) presented mild, 39 percent moderate, 19 percent severe, and 24 percent very severe COPD. Predicted FEV1 percent and BMI did not change over the period (P > 0.05). FEV1 in liters [1.25 (0.96-1.72) vs 1.26 (0.88-1.60) L; P < 0.001], 6MWD (438 ± 86 vs 412 ± 100 m; P < 0.001), MRC [1 (1-2) vs 2 (1-3); P = 0.002], Charlson index [3 (3-4) vs4 (3-5); P = 0.009], BODE index (2.2 ± 1.8 vs 2.6 ± 2.3; P = 0.008), and total SGRQ (42 ± 19 vs 44 ± 19 percent; P = 0.041) worsened after 3 years compared to baseline measurements. These data show that COPD patients deteriorated during the 3-year follow-up despite the fact that they had only minor modifications in airway obstruction and body composition. They support the need for comprehensive patient assessment to better identify disease progression.

Neurophysiological aspects and their relationship to clinical and functional impairment in patients with chronic obstructive pulmonary disease

OBJECTIVE: The purpose was to assess functional (balance L-L and A-P displacement, sit-to-stand test (SST) and Tinetti scale - balance and gait) and neurophysiological aspects (patellar and Achilles reflex and strength) relating these responses to the BODE Index. INTRODUCTION: The neurophysiological alterations found in patients with chronic obstructive pulmonary disease (COPD) are associated with the severity of the disease. There is also involvement of peripheral muscle which, in combination with neurophysiological impairment, may further compromise the functional activity of these patients. METHODS: A cross-sectional study design was used. Twenty-two patients with moderate to very severe COPD (>60 years) and 16 age-matched healthy volunteers served as the control group (CG). The subjects performed spirometry and several measures of static and dynamic balance, monosynaptic reflexes, peripheral muscle strength, SST and the 6-minute walk test. RESULTS: The individuals with COPD had a reduced reflex response, 36.77±3.23 (p<0.05) and 43.54±6.60 (p<0.05), achieved a lower number repetitions on the SST 19.27±3.88 (p<0.05), exhibited lesser peripheral muscle strength on the femoral quadriceps muscle, 24.98±6.88 (p<0.05) and exhibited deficits in functional balance and gait on the Tinetti scale, 26.86±1.69 (p<0.05), compared with the CG. The BODE Index demonstrated correlations with balance assessment (determined by the Tinetti scale), r = 0.59 (p<0.05) and the sit-to-stand test, r = 0.78 (p<0.05). CONCLUSIONS: The individuals with COPD had functional and neurophysiological alterations in comparison with the control group. The BODE Index was correlated with the Tinetti scale and the SST. Both are functional tests, easy to administer, low cost and feasible, especially the SST. These results suggest a worse prognosis; however, more studies are needed to identify the causes of these changes and the repercussions that could result in their activities ...

Application value of BODE index in patients with chronic obstructive pulmonary disease in rural China / 中国综合临床

Objective To evaluate the application value of BODE and the relationship between BODE index and life quality in patients with chronic obstructive pulmonary disease (COPD) in rural China. Methods A total of 26 rural patients with stable COPD were enrolled. BODE index and it's four components including body mass index ( BMI ), airflow obstruction ( FEV1 % ), dyspnea ( MMRC ) and exercise capacity ( 6MWD ) were calculated. St. Georgeps Respiratory Questionnaire (SGRQ) were used to evaluate health-related quality of life of these patients. Results The BODE index was significantly correlated with the SGRQ total score , symptom ,activity and impact score ( r = 0. 674,0. 430,0. 460,0. 495 respectively, Ps ＜ 0. 05 ). GOLD grade was only significantly correlated with the SGRQ total score and active score( r =0. 447,0. 418 ,Ps ＜0. 05 ). Stepwise liner multiple regression analysis showed that activity score of SGRRQ was an influence factor of BODE index. 6MWD of BODE index( t = - 2. 397, P = 0. 025 ) and MMRC ( t = 2. 257, P = 0. 034 ) were independently correlated with activity scores of SGRQ . Conclusion BODE index and life quality had significant relationship. 6MWD and MMRC of BODE index were the most powerful influence factors of life quality in rural COPD patients.

Application of BODE grading system in evaluating clinical prognosis of chronic obstructive pulmonary disease / 中华全科医师杂志

Objective The aim of this study is to evaluate clinical application of BODE (body mass index, airflow obstruction, dyspnea, and exercise capacity) index in patients with chronic obstructive pulmonary disease (COPD). Methods Forty patients with stable COPD in Xuanwu Hospital of Beijing during September 2003 to December 2007, were recruited in the study, including 25 men and 15 women, aged 38 to 85 years (with a mean of 62 ± 13 years). BODE index was measured for each patient, one year and three years after recruitment, respectively. Severity of COPD, including number and duration of episodes, length of each hospital stay and times of hospitalization due to acute exacerbation of COPD (AECOPD), were recorded. All data were statistically analyzed with SPSS 13.0 software for windows. Results ①There was a remarkable difference in COPD severity between patients with BODE score equal to or greater than five and these with less than five (P <0.01 ). ①BODE score inversely correlated with forced expired volume at the first second ( FEV1 ) in COPD patients (P < 0.01 for those with BODE score equal to or greater than five and P <0.05 for these with BODE score less than five, respectively). ③BODE score positively correlated with number and duration of acute exacerbation, length of hospital stay and times of hospitalization due to AECOPD (P <0. 01 for those with BODE score equal to or greater than five and P < 0. 05 for those with BODE score less than five, respectively). For patients with COPD, their BODE score in the first year positively correlated with that in the third year ( r = 0.834, P < 0.01 ). Conclusions BODE index is a better indicator to evaluate their condition severity in patients with COPD.

Short-term effect of video-thoracoscope in the treatment of chronic obstructive pulmonary diseases accompanied with pneumothorax / 中国综合临床

Objective To study the short-term(≤1 year) effect of video-thoracoscope in the treatment of chronic obstructive pulmonary diseases (COPD) accompanied with pneumothorax.Methods 52 COPD cases with pneumothorax from June 2005 to June 2007 were divided into thoracoscope group(n=28) and open heart group(n=24).The patients were followed up at 1,6 and 12 month after surgery,for determination of BODE index,including body mass index,air block,difficulty in respiratory and motor ability.Results No operative death and servere complicatins occurred.Pneumothorax did not relapse.One month after surgery,air block was[(58.62±15.73)% vs (50.12±11.38)%],difficulty in respiratory was[(1.04±0.37)s vs( 1.72±0.45)s] and motor ability was [(387.32±52.07)m vs (318.35±61.52)m] in thoracoscope group and open heart group (P<0.05).At the six month after surgery,body mass index was[(27.19±2.18)kg/m2 vs (20.90±2.35)kg/m2] in thoracoscope group and open heart group(P<0.05);At the 12 month after operation,there was no significant difierence in BODE index between the two groups(P>0.05).Conclusions Video-thoracoscope in treating COPD with pneumothorax can remarkably improve the quality of life early after surgery.