Objective To investigate the correlations between eosinophil counts in induced sputum and lung function (FENO) and evaluate these parameters in medication adjustment in patients with asthma.Methods Sixty-five outpatients with mild to moderate persistent asthma ( mild,32 ; moderate,33 ) from January to August 2008 were enrolled in the study.All were treated with combined medications comprising inhaled corticosteroids plus long-acting β2 agonists for 1 year.Lung function (FEV1％ and PEF％ ),eosinophil counts in induced sputum,FENO,and Asthma Control Test (ACT) scores were obtained at regular follow-up intervals.Twenty-one healthy volunteers served as controls,and lung function,eosinophil counts in induced sputum,and FENO were also obtained.Results Sixty-three subjects completed 1-year or longer follow-up.Lung function of 63 subjects recovered quickly in the early days and improved slowly during the following 6 months.FENO decreased from (61 ± 25 ) nmol/L at baseline to ( 32 ± 19 ) nmol/L by the third month (q =7.32,P＜0.05) and to (22 ± 12) nmol/L by the sixth month,which showed significant difference from normal controls [ ( 13 ± 8) nmol/L; q =6.63,P ＜ 0.05 ].Eosinophil counts in induced sputum of the asthma group at baseline were (0.093 ±0.023) × 109/L and decreased to (0.032 ±0.011)× 109/L by the third month,which was significantly different from baseline and normal controls [ (0.005 ±0.003) × 106/ml; q =5.49,P ＜0.05 and q =5.87,P ＜0.05,respectively].FENO showed a significantly positive correlation with eosinophil counts in induced sputum in the first 6 months (r1 =0.612,r2 =0.558,r3 =0.675; all P＜0.05) and a negative correlation with FEV1 (r1 =-0.537,r3 =-0.658,r6 ＝ -0.623,r9 =-0.537,r12 =-0.597 ; all P ＜0.05 ) at any time point of the study.The ACT score of 63 subjects at baseline was 14 ±3,and the scores after treatment for 1,3,6,9,and 12 months were 18 ±5,19 ±7,23 ±2,24 ± 1,and 24 ± 1,respectively; at the same time,significant difference was found ( F =5.72,P ＜ 0.05).Effectiveness was found according to the ACT score only 1 month after treatment.Conclusion The parameters of FENO and eosinophil counts in induced sputum were sensitive in the detection of airway inflammation and may be useful in evaluation of the efficacy of treatment and adjustment of medication regimens.

Objective To evaluate the effects of clinical center-based health management on quality of life (QOL) of patients with asthma. Methods A total of 642 patients who had received standard antiasthma treatment over 3 years in our clinical center from September 2005 up to now were randomly assigned to the good compliance group ( group A, n = 326 ) and bad compliance group ( group B, n = 316 ). A questionnaire was used to estimate the awareness about asthma,medical therapy and disease control. Levels of QOL were compared at 6 months and 1 and 3 years after health education. Results In group A,uncontrolled,partly controlled, and completely controlled asthma were found in 21%, 47%, and 32% participants, respectively. Significant difference of QOL was shown between the 2 groups after the intervention ( P ＜ 0. 05 ). At 6 months, forced expiratory volume in one second ( FEV1 ), percentage of predicted FEV1 ( FEV1 % pre) ,and peak expiratory flow rate ( PEF)were significantly improved in group A ( all P ＜0. 05 ),although acute attack and hospitalization were largely reduced. In comparison with baseline,6 months and 1 year,self-reported QOL, limitation of motion, stimulus avoidance and response, and disease concerns were significantly changed at 3 years. Conclusions Clinic center-based health management could benefit disease control and QOL of patients with asthma.

Objective To compare the clinical effect of different doses of methylprednisolone in the treatment of children with severe hand foot mouth disease research and analysis. Methods 100 patients in our hospital from January 2014 to August 2016 were selected and randomly divided into the control group and the experimental group, with 50 patients in each group. The control group were treated with small doses of methylprednisolone, 2 mg/ (kg?d), intravenous injection. The experimental group was treated with large dose of methylprednisolone, 10～15 mg/(kg?d) intravenous infusion. The therapeutic effects of the experimental group and the control group were compared and analyzed. Results after the corresponding treatment, the number of adverse reactions in the experimental group was 31, the adverse reaction rate was 62.0％, and the adverse reaction rate in the control group was 60.0％. There was no significant difference in the incidence of adverse reactions between the two groups. The upper respiratory rate and critical illness in the experimental group were 26.0％ and 32.0％, significantly lower than that of the control group (P<0.05). The average remission time of the patients in the experimental group was (2.19±1.01) days. The symptomatic remission time in the control group was (4.19±1.89) days. The remission time of the control group was significantly longer than that of the experimental group, with statistical difference (P<0.05). Conclusion The short term large dose of methylprednisolone in treatment of children with severe HFMD clinical effect is ideal, can be reduced to critical illness rate, less symptom remission time, with the further promotion of the clinical significance.

Objective To investigate the immunoregulatory effects of propofol on airway hyperresponsiveness,airway inflammation and Thl/Th2 ratio in the asthmatic mice.Methods One hundred female BALB/c mice,aged 6-8 weeks,weighing 18-20 g,were randomly divided into 5 groups (n =20,each):control group (normal saline i.p.,group C),asthma group (group A),low-dose propofol (50 mg/kg i.p.,group LP),medium-dose propofol (100 mg/kg i.p.,group MP) and high-dose propofol (150 mg/kg i.p.,group HP).Mice of groups A,LP,MP and HP were sensitized with ovalbumin (OVA),mice of group C were sensitized with normal saline.24 h after the last challenge,animals were sacrificed by lethal dose of pentobarbital sodium.Blood and bronchoalveolar lavage fluid (BALF) were collected for determination of serum OVA-specific IgE and the levels of cytokines (IL-4,IL-5 and IFN-γ) in the BALF.Airway responsiveness was measured by the forced-oscillation technique and histological inflammation scores were measured by staining with hematoxylin and eosin.Results Propofol (group LP and group MP) attenuated airway hyperresposiveness to the muscarinic agonist methacholine in OVA-induced asthma.Different doses of propofol (group LP,group MP and group HP) decreased eosinoplils influx in lungs.In addition,propofol treatment reduced expression of IL-4,IL-5 and serum OVA-specific IgE and increased the ratio of IFN-γ/IL-4.Conclusion The study demonstrates a potential protective value of propofol in alleviating airway inflammation,up-regulating Th1/Th2 ratio and attenuating airway hyperresposiveness in the asthmatic mice.

Objective To evaluate the role and technical advantages of CT in 125Ⅰseed implantation in the treatment of tumors. Methods CT-guided 125Ⅰ seed implantation in 45 cases of cancer patients treated 57 times in 51 lesions,CT were used to evaluate the progress of lesions after 125Ⅰ seed implantation 1,2,6 months. Results All procedures were once successful and the total effective rate was 74.5% without any serious complications. Fifty CT examinations immediately after implantation showed satisfactorily seeds distribution but seven cases less satisfactorily that include particles overlap,the location is too close to the lesion edge,the larger the radiation cold spots,etc. Follow-up CT reexamination in 1,2 and 6 months demonstrated that CT examinations showed satisfactorily seeds distribution but accurate seeds number,which could be solved by combined with MPR images and the positioning piece. Conclusions CT-guided 125Ⅰ seed implantation treatment of tumors was a safe,reliable and effective minimally invasive treatment. CT in the preoperative treatment of seed implants planning,precise intraoperative guidance,quality assurance and efficacy of postoperative assessment had a greater role and application advantages.

Objective:To assess the association between particulate air pollution and hospital admissions for acute exacerbation of chronic obstructive pulmonary disease (AECOPD) in Beijing, and to eva-luate the differences of association among different subgroups.Methods: Hospital admissions to intertiary hospitals for AECOPD from January 1,2014, through December 31, 2015 were obtained from the electronic hospitalization summary reports (HSRs).We obtained the data on air pollution during the study period from the national air pollution monitoring system.The data on meteorological variables were obtained from the Chinese meteorological bureau.A poison generalized additive model was used to assess the effects of particulate pollution on AECOPD with adjustment for the long term trend, day of week, holiday effect and meteorological variables.Subgroup analyses were also conducted by age and gender, which would help identify higher-risk groups.Results: A total of 7 884 hospitalizations from 15 tertiary hospitals were recorded during the study period, and 69.3% were male patients, 37.1% were ≥80 years of age, 45.5% were 65-79 years of age, and 17.4% were younger than 65.The mean (SD) daily concentrations of PM2.5, PM10 were 77.1 (66.6) μg/m3, 111.9 (75.8) μg/m3.Every 10 μg/m3 increase in particulate pollution concentration for a lag of 4 d was associated with an increase in hospital admissions for AECOPD as follows: 0.53% (95% CI: 0.01%-1.06%, P=0.0478) of PM2.5, 0.53% (95% CI: 0.07%-1.00%, P=0.0250) of PM10, respectively.We found differences in risk for AECOPD admissions among the different subgroups.For every 10 μg/m3 increase in PM2.5, PM10 exposure in the female group there was a 1.13% (95% CI: 0.19%-2.07%, P=0.018 3) increase, 1.06% (95% CI: 0.22%-1.91%, P=0.013 6) increase in admissions, respectively, while in the male group, the association was non-significant.The patients of 80 years of age and older demonstrated a hi-gher risk of AECOPD, 1.25% (95% CI: 0.40%-2.11%, P=0.004 0) increase of PM2.5, 1.18% (95% CI: 0.42%-1.95%, P=0.002 4) increase of PM10, respectively, while other subgroups didn't find significant association.Conclusion: Our findings showed that particulate air pollution was significantly associated with hospital admissions for AECOPD in Beijing.The susceptibility to particulate pollution varied by gender and age.

AIM: To establish a guinea pig asthma model and to evaluate the effect of airway remodeling on airway responsiveness. METHODS: The guinea pig asthma model was established by ovalbumin (OVA) sensitization and challenge repeatedly. Bronchial provocation tests were conducted through intravenous injection of acetylcholine. The airway morphologic parameters were measured by computer image analysis system. White blood cells and the differential count in bronchoalveolar lavage fluid (BALF) were examined. RESULTS: The resistance of airway was increased significantly after 4 weeks of OVA exposure, but the increase disappeared upon prolonged exposure. After 8 weeks of OVA exposure, fiber tissue in large airway was increased, and the thickness of smooth muscle layer of small airway was enlarged, as compared with that in control animals. CONCLUSION: Airway responsiveness has changed after prolonged OVA exposure in guinea pigs. This change is related to airway remodeling. [

OBJECTIVETo investigate the impact of proportional assist ventilation (PAV) on tolerance and breathlessness in ventilated chronic obstructive pulmonary disease (COPD), and to describe the patient-ventilator interaction, hemodynamic state, breathing pattern and work of breath during PAV and pressure support ventilation (PSV).

METHODSTen intubated COPD patients on weaning from mechanical ventilation were studied. Elastance and resistance were measured by both the inspiratory-hold technique during a brief period of volume control ventilation and runaway technique during PAV. Each assistance level of PAV (80%, 60% and 40%) and PSV was selected randomly. Patients' response, hemodynamics, blood gas and lung mechanics were monitored.

RESULTSTidal volume and respiratory rate didn't change in a consistent manner as the level of assist was decreased (P > 0.05). With the level of assist increasing, peak inspiratory pressure was increasing significantly (P < 0.05), while patients' work of breath had the tendency to decrease (P < 0.05). A significant difference in the Borg Category Scale was observed between PAV and PSV (0.50 [1.50] vs. 0.75 [2.00], P < 0.05) at the same degree of respiratory muscle unloading. PaCO(2) was significantly higher on PAV (54 [23] mm Hg) than on PSV (48 [23] mm Hg) (P < 0.05). Peak inspiratory pressure on PAV was significantly lower than on PSV (16 +/- 4 cm H(2)O vs. 21 +/- 3 cm H(2)O, respectively, P < 0.05). Hemodynamics and oxygenation remained unchanged.

CONCLUSIONSPAV is a feasible method for supporting ventilator-dependent patients and was well tolerated. It can improve the breathing pattern and reduce inspiratory effort. At the same degree of respiratory muscle unloading, PAV can be implemented at much lower peak inspiratory pressure than PSV. It can also apply proportional pressure support according to the patients' ventilatory demand.

Aged ; Blood Gas Analysis ; Female ; Hemodynamics ; Humans ; Male ; Positive-Pressure Respiration ; Pulmonary Disease, Chronic Obstructive ; complications ; Pulmonary Gas Exchange ; Pulmonary Ventilation ; Respiration, Artificial ; methods ; Respiratory Insufficiency ; etiology ; physiopathology ; therapy

Objective　To investigate the effects of extrinsic positive end-expiratory pressure (PEEPe) on work of breathing in patients with chronic obstructive pulmonary disease (COPD) and their corresponding mechanism. Methods　Ten ventilated patients with COPD were included in the study. A Bicore CP-100 pulmonary monitor （Bicore Monitoring System, USA） was used for monitoring respiratory mechanics. First, dynamic intrinsic positive end-expiratory pressure (PEEPi,dyn) was measured when PEEPe was zero, which was called PEEPi,dynz. Then the PEEPe was set randomly at 0%, 40%, 60%, 80% and 100% of PEEPi,dynz respectively. Pulmonary mechanics and other parameters (heart rate, blood pressure and blood gas analysis) were measured 30 minutes after the level of PEEPe was changed. Results　Work of breathing patient (WOBp), pressure time product, difference of esophageal pressure and PEEPi,dyn decreased significantly when PEEPe was applied, and continued decreasing as PEEPe was increased. Work of breathing ventilator increased significantly when PEEPe was increased to 80% and 100% of PEEPi,dynz. Significantly positive linear correlation was found between the changes in WOBp and in PEEPi,dyn. Conclusions　WOBp decreases gradually as PEEPe is increased. WOBp decreases by narrowing the difference between the alveolus pressure and the central airway pressure at the end of expiration when PEEPe is applied.

OBJECTIVETo estimate the feasibility and the efficacy of early extubation and sequential non-invasive mechanical ventilation (MV) in chronic obstructive pulmonary disease (COPD) with exacerbated hypercapnic respiratory failure.

METHODSTwenty-two intubated COPD patients with severe hypercapnic respiratory failure due to pulmonary infection (pneumonia or purulent bronchitis) were involved in the study. At the time of pulmonary infection control window (PIC window) appeared, when pulmonary infection had been significantly controlled (resolution of fever and decrease in purulent sputum, radiographic infiltrations, and leukocytosis) after the antibiotic and the comprehensive therapy, the early extubation was conducted and followed by non-invasive MV via facial mask immediately in 11 cases (study group). Other 11 COPD cases with similar clinical characteristics who continuously received invasive MV after PIC window were recruited as control group.

RESULTSAll patients had similar clinical characteristics and gas exchange before treatment, as well as the initiating time and all indices at the time of the PIC window. For study group and control group, the duration of invasive MV was (7.1 +/- 2.9) vs (23.0 +/- 14.0) days, respectively, P < 0.01. The total duration of ventilatory support was (13 +/- 7) vs (23 +/- 14) days, respectively, P < 0.05. The incidence of ventilator associated pneumonia (VAP) were 0/11 vs 6/11, respectively, P < 0.01. The duration of intensive care unit (ICU) stay was (13 +/- 7) vs (26 +/- 14) days, respectively, P < 0.05.

CONCLUSIONSIn COPD patients requiring intubation and MV for pulmonary infection and hypercapnic respiratory failure, early extubation followed by non-invasive MV initiated at the point of PIC window significantly decreases the invasive and total durations of ventilatory support, the risk of VAP, and the duration of ICU stay.

Adult ; Aged ; Female ; Humans ; Hypercapnia ; therapy ; Male ; Middle Aged ; Pulmonary Disease, Chronic Obstructive ; complications ; Respiration, Artificial ; methods ; Respiratory Insufficiency ; therapy