A multicenter survey on the current status of chronic cough and its impact on quality of life in Guangdong, China.

Background: Chronic cough is a troublesome clinical problem with long-term impacts at the patient level. However, the burden of chronic cough in China is largely unknown. Thus, we performed a multicenter cross-sectional survey on the current status of chronic cough and its impact on quality of life in Guangdong, south China. Methods: Using a standardized questionnaire, we extracted and analyzed the relevant data on demographics, number of visits to a doctor, previous diagnosis, previous medications used and initial diagnosis. Cough-specific quality of life was measured by the Mandarin Chinese version of the Leicester Cough Questionnaire (LCQ-MC). Results: Of 933 patients from 13 tertiary medical centers in Guangdong, 52.2% were female, the median age was 40.0 [interquartile range (IQR), 31.0-52.0] years, and the median duration of chronic cough was 6.0 (IQR, 3.0-24.0) months. Over half (n=452, 54.0%) of the patients had visited physicians ≥3 times for cough. In terms of previous diagnosis, bronchitis (n=432, 46.5%) had been most frequently diagnosed, followed by pharyngitis (n=246, 26.5%) and asthmatic cough (n=98, 10.5%). A majority of patients with chronic cough had used antitussive agents (n=539, 58.5%), antibiotics (n=374, 40.6%) and traditional Chinese medicine (TCM) (n=294, 31.9%). Among the three subscales of the LCQ-MC, we observed lower scores in the mental health domain than in the physical and social domains (both P<0.001). Additionally, lower LCQ-MC scores were found in females and patients who saw the doctor >3 times for both the total and three subscale scores (all P<0.05). Conclusions: Misdiagnosis and inappropriate treatment are prevalent in patients with chronic cough and lead to considerable antibiotic abuse. Chronic cough markedly affects suffers' quality of life, especially for women.

Clinical characteristics of patients with chronic cough in Guangdong, China: a multicenter descriptive study.

BACKGROUND: The clinical characteristics of patients with chronic cough are reported only in single-center survey in China, being significantly different from that in western countries. Here, we performed a multicenter study to describe the clinical characteristics of chronic cough patients. METHODS: A cross-sectional observational survey was conducted in thirteen tertiary hospitals of Guangdong, South China. Relevant data were recorded using a standardized questionnaire and analyzed, including demographics, educational attainment, cough features, and concomitant symptoms. RESULTS: Of 933 patients in this study, the median age was 40.0 (IQR 31.0-52.0) years with a peaked age of 30-39 years. The proportion of females (487, 52.2 %) was comparable to that of males (446, 47.8 %). Up to 81.9 % of the patients were non-smokers. More than two-thirds of the subjects with chronic cough had a low educational level. The median cough duration was 6.0 (IQR 3.0-24.0) months, and 73.0 % of chronic cough patients presented with dry cough. Laryngeal paresthesia was the most common concomitant symptom (704, 75.5 %), followed by rhinitis/sinusitis-related (350, 37.5 %) and respiratory symptoms (322, 34.5 %). Rhinitis/sinusitis-related symptoms more frequently occurred in patients with productive cough than in those with dry cough (49.0 % vs. 33.0 %, P < 0.001). Moreover, female patients displayed an older age and a higher prevalence of nocturnal cough compared to male patients (both P < 0.05). CONCLUSIONS: Our results show an equal gender, young profile and laryngeal paresthesia in patients with chronic cough, and different clinical features between females and males.

P-Gp and TOPO II Expression and Their Clinical Significance in Colon Cancer.

OBJECTIVE: Analysis of P-Gp and TOPO II expression levels and their clinical significance in colon cancer. METHODS: A total of 300 cases of paraffin embedded specimens of primary colon cancer were collected from the Affiliated Hospital of Putian University. The levels of P-Gp and TOPO II expression in colon cancer tissues were detected by the two-step En Vison. RESULTS: P-glycoprotein (P-Gp) was mainly localized in the membrane and nucleus of colon cancer cells and the positive expression rate was 62% (186/300). The positive expression of P-Gp correlated with gender, invasion depth and lymph node metastasis and the differences were statistically significant (P<0.05). Topoisomerase II (TOPO II) was mainly expressed in the cell nucleus and the positive rate was 83.3%. A total of 250 out of 300 samples were TOPO II positive and exhibited significant correlation with invasion depth, lymph node metastasis and differentiation degree (P<0.05). Spearman correlation analysis indicated that P-Gp and TOPO II expression levels in colon cancer were positively correlated (r=0.480). CONCLUSION: P-Gp and TOPO II expression levels were associated with colon cancer progression.

Morbidity burden of respiratory diseases attributable to ambient temperature: a case study in a subtropical city in China.

BACKGROUND: There are significant associations between ambient temperature and respiratory disease mortality. However, few studies have assessed the morbidity burdens of various respiratory diseases that are attributable to different temperature ranges in subtropical regions. METHODS: Daily outpatient visits, weather variables, and air pollution data were collected from January 2013 to August 2017 in a hospital in Dongguan city. A standard time series quasi-Poisson regression with a distributed lag non-linear model (DLNM) was applied to estimate the associations between daily mean temperature and morbidity for total respiratory diseases, bronchiectasis, chronic obstructive pulmonary disease (COPD), and asthma. Attributable fractions were then calculated to quantify disease burden relative to different temperature components. Finally, we conducted stratified analysis by age group. RESULTS: Both low and high temperatures were associated with an increased risk of morbidity secondary to respiratory diseases. Compared with the optimum temperature, the accumulated relative risk (RR) during the seven lag days was 1.13 with a 95% confidence interval (CI) of 1.01-1.26 for extreme heat and 1.02 (95% CI: 0.99-1.05) for extreme cold. Heat-related respiratory morbidity risk was higher than cold-related risk for the total population, but an opposite result was observed for the elderly. About 8.4% (95% CI: 2.8-13.3%) of respiratory morbidity was attributable to non-optimal temperatures, and moderate heat was responsible for most of the excess respiratory morbidity (7.5, 95% CI: 2.4-12.2%). CONCLUSIONS: We found that exposure to non-optimal temperatures increased the risk of respiratory morbidity in subtropical region, and moderate heat contributed to most of the temperature-related respiratory morbidities. This indicates a need for further examination of moderate, rather than extreme, heat in subtropical region.

Clinical Features of Patients with Bronchiectasis with Comorbid Chronic Obstructive Pulmonary Disease in China.

BACKGROUND The prevalence of bronchiectasis with comorbid chronic obstructive pulmonary disease (COPD) is rising, which causes extremely high risk of exacerbation and mortality. We aimed to evaluate the differences in clinicopathological manifestations, immune function, and inflammation in bronchiectasis patients with comorbid COPD vs. patients who only have COPD. MATERIAL AND METHODS Clinicopathological characteristics, including common potentially pathogenic microorganisms, lung function, immune function, and inflammation were assessed in bronchiectasis patients with comorbid COPD and in patients who only had COPD. RESULTS Compared to patients who only had COPD, patients with bronchiectasis with comorbid COPD had a higher positive rate of sputum bacteria (45.27% vs. 28.03%, P<0.01). Among them, Pseudomonas aeruginosa (P. aeruginosa) accounted for 25.19% in COPD (4.37%) (P<0.01). Likewise, patients with bronchiectasis with comorbid COPD had worse lung function, worse COPD assessment test scores, and worse Modified Medical Research Council scores. Moreover, compared with COPD only cases, patients with bronchiectasis with comorbid COPD had higher levels of white blood cells (WBC), neutrophils, C-reactive protein (CRP), and procalcitonin (PCT) (all P<0.05). Interestingly, the expression levels of Treg in patients with bronchiectasis with comorbid COPD were lower than in patients with COPD only (P<0.05). Th17 and Th17/Treg levels were higher (P<0.05). Furthermore, remarkable increased level of IL17 and IL-6 and decreased level of IL-10 and TGF-ß were observed in the bronchiectasis combined COPD than in pure COPD (All P<0.05). CONCLUSIONS Our findings suggest that P. aeruginosa is the main pathogen of bacterial infection in bronchiectasis patients with comorbid COPD. These patients have more serious clinical manifestations and immune imbalance, which should be considered when providing clinical treatment.

Ambient carbon monoxide and increased risk of daily hospital outpatient visits for respiratory diseases in Dongguan, China.

BACKGROUND: The toxicity of high-concentration carbon monoxide (CO) on human health has previously been documented. However, the epidemiological evidence on the association between acute exposure to ambient CO and respiratory diseases is relatively lacking and controversial. OBJECTIVES: To examine the short-term association between ambient CO and hospital outpatient visits for respiratory diseases in Dongguan, China. METHODS: The number of daily hospital outpatient visits for respiratory diseases, and air pollution and meteorological data were collected from January 2013 to August 2017. A generalized additive model with a quasi-Poisson link was used to estimate the association between ambient CO concentration and the total number of hospital outpatient visits for all respiratory diseases and those for asthma, bronchiectasis, chronic obstructive pulmonary disease (COPD) and pneumonia. We further analyzed the effect of ambient CO by gender and age. RESULTS: Over the study period, a 24-h mean concentration of ambient CO of 0.88 mg/m3 (below the limit for CO in China) and a total of 89,484 hospital outpatient visits for respiratory diseases were recorded. Ambient CO was found to increase the risk for asthma, bronchiectasis, pneumonia and the total number of respiratory diseases. The per interquartile range (IQR) increase in ambient CO at lag03 day corresponded to a 5.62% (95% confidence interval (CI): 3.24%, 8.05%), 8.86% (95% CI: 4.89%, 12.98%), 6.67% (95% CI: 0.87%, 12.81%) and 7.20% (95% CI: 2.35%, 12.29%) increased risk in outpatient visits for all respiratory diseases, asthma, bronchiectasis and pneumonia, respectively. Each association was partially weakened after adjusting for co-pollutants. The effect of ambient CO on respiratory diseases appeared to be greater for females and the elderly. CONCLUSIONS: Short-term exposure to ambient CO was associated with increased risk of outpatient visits for respiratory diseases. Our analysis may help to understand the health effects of low-levels of CO and provide evidence for the creation of air quality standards.

Ambient fine and coarse particulate matter pollution and respiratory morbidity in Dongguan, China.

We estimated the short-term effects of particulate matter (PM) pollution with aerodynamic diameters ≤2.5 µm (PM2.5) and between 2.5 and 10 µm (PMc) on hospital outpatient visits due to overall and specific respiratory diseases, as well as the associated morbidity burden in Dongguan, a subtropical city in South China. A time-series model with quasi-Poisson link was used to examine the association between PM pollution and morbidities from respiratory diseases, COPD, asthma and pneumonia in Dongguan during 2013-2015. We further estimated the morbidity burden (population attributable fraction and attributable morbidity) due to ambient PM pollution. A total of 44,801 hospital outpatient visits for respiratory diseases were recorded during the study period. Both PM2.5 and PMc were found to be significantly associated with morbidity of overall respiratory diseases, COPD, and asthma. An IQR (interquartile range) increase in PM2.5 at lag03 day was associated with 15.41% (95% CI: 10.99%, 20.01%) increase in respiratory morbidity, and each IQR increase in PMc at lag03 corresponded to 7.24% (95% CI: 4.25%, 10.32%) increase in respiratory morbidity. We did not find significant effects of PM2.5 and PMc on pneumonia. Using WHO's guideline (25 µg/m3) as reference concentration, about 8.32% (95% CI: 5.90%, 10.86%) of respiratory morbidity (3727, 95% CI: 2642, 4867, in morbidity number) were estimated to be attributed to PM2.5, and 0.86% (95% CI: 0.50%, 1.23%) of respiratory morbidity, representing 385 (95% CI: 225, 551) hospital outpatient visits, could be attributed to coarse particulate pollutant. Our study suggests that both fine and coarse particulate pollutants are an important trigger of hospital outpatient visits for respiratory diseases, and account for substantial respiratory morbidity in Dongguan, China.

Aspirin Resistance in healthy drug-naive men versus women (from the Heredity and Phenotype Intervention Heart Study).

This study was designed to determine the factors that contribute to interindividual variation in the antiplatelet effects of aspirin. We measured platelet response to aspirin in 745 (400 men and 345 women) drug-naive asymptomatic subjects of the Heredity and Phenotype Intervention (HAPI) Heart Study. Whole blood platelet aggregometry was performed to assess response to arachidonic acid, adenosine diphosphate, and collagen at baseline and after 14 days of aspirin 81 mg/day. There was wide interindividual variation in platelet aggregation in response to aspirin, with no clear biological threshold to define aspirin resistance. Variation in platelet function before and after aspirin was heritable. Women exhibited greater platelet aggregability in response to adenosine diphosphate and collagen at baseline and after aspirin administration. The degree to which aspirin inhibited collagen-induced platelet aggregation was also significantly less in women compared with men (mean +/- SD percent inhibition of collagen-induced [1 microg/ml] platelet aggregation 49.9 +/- 30.9 vs 57.5 +/- 42.5 in women and men, respectively, p = 0.005). Using a cutoff <70% inhibition of collagen-induced platelet aggregation, 21% of the total population demonstrated aspirin resistance, which occurred in 30% of women and 16% of men (p = 0.0002). Aspirin-resistant subjects were older, had significantly higher total cholesterol and low-density lipoprotein cholesterol levels, lower hematocrit, and higher platelet count compared with aspirin-sensitive subjects. In conclusion, in this study group, platelet function is heritable. There is wide interindividual variation in platelet response to aspirin as defined by whole blood platelet aggregometry, with women having lower mean percent inhibition of platelet aggregation and greater prevalence of aspirin resistance than men.

Identification of novel candidate genes for type 2 diabetes from a genome-wide association scan in the Old Order Amish: evidence for replication from diabetes-related quantitative traits and from independent populations.

OBJECTIVE: We sought to identify type 2 diabetes susceptibility genes through a genome-wide association scan (GWAS) in the Amish. RESEARCH DESIGN AND METHODS: DNA from 124 type 2 diabetic case subjects and 295 control subjects with normal glucose tolerance were genotyped on the Affymetrix 100K single nucleotide polymorphism (SNP) array. A total of 82,485 SNPs were tested for association with type 2 diabetes. Type 2 diabetes-associated SNPs were further prioritized by the following: 1) associations with 5 oral glucose tolerance test (OGTT) traits in 427 nondiabetic Amish subjects, and 2) in silico replication from three independent 100L SNP GWASs (Framingham Heart Study Caucasians, Pima Indians, and Mexican Americans) and a 500K GWAS in Scandinavians. RESULTS: The strongest association (P = 1.07 x 10(-5)) was for rs2237457, which is located in growth factor receptor-bound protein 10 (Grb10), an adaptor protein that regulate insulin receptor signaling. rs2237457 was also strongly associated with OGTT glucose area under the curve in nondiabetic subjects (P = 0.001). Of the 1,093 SNPs associated with type 2 diabetes at P < 0.01, 67 SNPs demonstrated associations with at least one OGTT trait in nondiabetic individuals; 80 SNPs were nominally associated with type 2 diabetes in one of the three independent 100K GWASs, 3 SNPs (rs2540317 in MFSD9, rs10515353 on chromosome 5, and rs2242400 in BCAT1 were associated with type 2 diabetes in more than one population), and 11 SNPs were nominally associated with type 2 diabetes in Scandinavians. One type 2 diabetes-associated SNP (rs3845971, located in FHIT) showed replication with OGTT traits and also in another population. CONCLUSIONS: Our GWAS of type 2 diabetes identified several gene variants associated with type 2 diabetes, some of which are worthy of further study.