Exosomes are 40 - 100 nm vesicular bodies that are formed by the fusion of the multi-vesicular bodies and the plasma membrane and can be released into the extracellular space by a variety of cells through exocytosis. With rich active genetic substances such as proteins,mRNAs,and microRNAs,exosomes can exert their biological functions by transferring cargos to the recipient cells. In recent years,the roles of exosomes in oncology have been rapidly recognized. Some of them have been investigated in phase I trials. Preliminary studies have demonstrated that exosomes play important roles in the physiological and pathological processes of chronic inflammatory airway diseases such as bronchial asthma and chronic obstructive pulmonary disease. Meanwhile,exosomes may serve as useful biomarkers in the diagnosis and treatment of chronic inflammatory airway diseases.
Asthma ; physiopathology ; Biomarkers ; Exosomes ; Humans ; MicroRNAs ; Pulmonary Disease, Chronic Obstructive ; physiopathology ; RNA, Messenger

Epithelial Cells ; immunology ; Humans ; Pulmonary Disease, Chronic Obstructive ; physiopathology ; Respiratory System ; physiopathology

BACKGROUNDThe Borg scale is most commonly used to measure dyspnea in China. However, many patients that find it is difficult to distinguish the labeled numbers corresponding to different dyspnea scores. We developed a new method to rate dyspnea, which we call the count scale (CS). It includes the count scale number (CSN) and count scale time (CST). The aims of the present study were to determine the reproducibility and sensitivity of the CS during exercise in patients with chronic obstructive pulmonary disease (COPD).

METHODSFourteen male patients with COPD (aged 58.00 ± 7.72 years) participated in this study. A progressive incremental exercise and a 6-minute constant work exercise test were performed every 2 to 3 days for a total of 3 times. The CS results were evaluated at rest and at 30% and 70% of maximal workload (Wmax) and Wmax. The Borg scales were obtained during exercise.

RESULTSNo significant differences occurred across the three trials during exercise for the CS and Borg scores. The CSN and CST were more varied at Wmax (coefficient of variation (CV) = (22.28 ± 16.96)% for CSN, CV = (23.08 ± 19.11)% for CST) compared to 30% of Wmax (CV = (11.92 ± 8.78)% for CSN, CV = (11.16 ± 9.96)% for CST) and 70% of Wmax (CV = (9.08 ± 7.09)% for CSN, CV = (12.19 ± 12.32)% for CST). Dyspnea ratings with either CSN or CST tended to decrease at the higher workload compared to the lower workload. CSN and CST scores were highly correlated (r = 0.861, P < 0.001). CSN was negatively correlated with Borg scores (r = -0.363, P = 0.001). Similar results were obtained for the relationship between CST and Borg scores (r = -0.345, P = 0.003).

CONCLUSIONWe concluded that the CS is simple and reproducible when measuring dyspnea during exercise in patients with COPD.

Aged ; Dyspnea ; diagnosis ; Exercise ; Humans ; Male ; Middle Aged ; Pulmonary Disease, Chronic Obstructive ; physiopathology ; Reproducibility of Results

Acupuncture Therapy ; Aged ; Aged, 80 and over ; Female ; Humans ; Male ; Pulmonary Disease, Chronic Obstructive ; physiopathology ; therapy

OBJECTIVETo study the effects of expiratory triggering sensitivity (ETS) on patient-ventilator expiratory synchrony and work of breathing in chronic obstructive pulmonary disease (COPD) patients during pressure support ventilation (PSV).

METHODSA total of 31 COPD patients were ventilated in PSV mode, and measured by a pulmonary monitor. Meanwhile, the electromyogram of the diaphragm (EMG(diaph)) was obtained with electromyography. Five levels of ETS, 1%, 15%, 25%, 35%, and 50% of peak inspiratory flow (PIF), were studied in random order. Each ETS level lasted 30 minutes and all the data were recorded simultaneously for 3 minutes at the end of each period. The effects of ETS on patient-ventilator expiratory synchrony were analyzed by measuring the phase angle of expiration between the EMG(diaph) and the flow wave curve, and the effects of ETS on work of breathing by calculating total work of breathing (Wtot), work of inspiration by patients (Wi, P) and expiratory work of breathing (Wex).

RESULTSTen patients were excluded from the study. At the 25% PIF level of ETS, patient-ventilator expiratory synchrony was the best, theta = (8 +/- 3) degrees, 16 patients - 15 degrees < or = theta < or = 15 degrees, and the amount of Wtot, Wi, p, Wex was the smallest among all the 5 levels of ETS, which was (1.86 +/- 0.53) J/L, (0.54 +/- 0.13) J/L, and (0.16 +/- 0.08) J/L respectively. When the level of ETS decreased, the occurrence of delayed termination of inspiration and the amount of Wex increased. At the level of 1% PIF, 18 patients theta > 15 degrees, and Wex was (0.48 +/- 0.10) J/L; at this level of ETS, Wi, p also increased significantly to (0.65 +/- 0.16 ) J/L. But when the level of ETS increased, the occurrence of premature termination of inspiration and the amount of Wi, p increased: at 50% PIF level of ETS, theta < - 15 degrees and Wi, p was (1.33 +/- 0.14) J/L in 19 patients.

CONCLUSIONThe proper adjustment of ETS during PSV improves patient-ventilator synchrony and decreases work of breathing in COPD patients.

Humans ; Intermittent Positive-Pressure Ventilation ; methods ; Pulmonary Disease, Chronic Obstructive ; physiopathology ; therapy ; Respiration

OBJECTIVETo observe the difference between the therapeutic effect of Du-moxibustion (Moxibustion on the Governor Vessel) combined with western medicine and that of simple western medication for the remission stage of chronic obstructive pulmonary disease.

METHODSTwo hundred and ten cases were randomly divided into an observation group (108 cases)and a control group (102 cases). The observation group was treated by routine treatment of western medicine combined with herb-partitioned spread moxibustion on the Governor Vessel between Dazhui (GV 14)and Yaoshu (GV 2). Simple western medicine was used in control group. The therapeutic effects of two groups were compared with the changes of symptom scores and pulmonary function before and after treatment.

RESULTSThe total effective rate of observation group (90.7%, 98/108) was higher than that of control group (74.5%, 76/102) (P < 0.01). The symptom scores and some pulmonary function indices such as forced vital capacity (FVC), forced expiratory volume in one second (FEV1), the percentage of force expiratory volume in one second in predicted value(FEV1%) and maximal expiratory flow(PEF) after treatment were improved obviously than those before treatment in observation group (P < 0.05, P < 0.01), and the improvement degree was better than that of control group (all P < 0.01).

CONCLUSIONMoxibustion on the Governor Vessel combined with western medicine can improve the clinical symptoms and pulmonary function of chronic obstructive pulmonary disease of lung and kidney qi deficiency type effectively,and the effect is better than that of simple western medication.

Adult ; Aged ; Cyclobutanes ; Female ; Humans ; Kidney ; physiopathology ; Lung ; physiopathology ; Male ; Middle Aged ; Moxibustion ; Pulmonary Disease, Chronic Obstructive ; physiopathology ; therapy ; Qi

OBJECTIVETo investigate the imaging and hemodynamical features of pulmonary artery branches in chronic obstructive pulmonary disease (COPD) with pulmonary artery hypertension (PAH).

METHODSCT pulmonary angiography (CTPA) with ECG-gating was performed in 13 patients with clinical diagnosed COPD and 25 normal subjects. The thin-slice multiple plane reconstruction in systole and diastole phase was conducted, which in turn was used to generate the InSpace reconstructed images with reference frame of the main pulmonary artery and the first two grades branches, the contour of the branches was depicted. On the base of coordinates, the GAMBIT was used to generate nodes and furthermore meshes, then the software Fluent was used for numerical calculation and flow simulation. The velocity and pressure changes in the main pulmonary artery and the first two grades branches during different periods of cardiac cycle were observed in both groups.

RESULTCTPA showed that the diameter of the main pulmonary before bifurcate and proximal of the first two branches was larger in systole period than that in diastole period. The diameter of the second segmental artery of right upper lobe was larger during diastole period. The length of the main pulmonary and the first two branches showed no significant difference in both diastole and systole periods. There was no significant difference in length of pulmonary arteries between COPD and normal groups. The main pulmonary to distal right pulmonary artery appeared larger in diastole period. Compared with normal, in COPD group several arteries increased in diameter including proximal and distal of the proximal right pulmonary artery and the proximal right pulmonary artery during systole and diastole periods. In systole period only the diameter of the main pulmonary before bifurcate got larger and the back basic segmental artery of both lower lobe show smaller than normal. The flow condition analysis in COPD and normal groups suggested higher pressure in pulmonary arteries during systole period than that in diastole period, both groups showed high pressure area below the branching point. In COPD patients the right lower lobe artery endured the most significant pressure fall during the two periods and high pressure distributed larger area than normal. Flow velocity in main branch was faster than lower grade branches and that in systole period was faster than that in diastole period. The trend of diffusion of high pressure area was more prominent in diastole period than normal and the influence more prominent.

CONCLUSIONThe distal part of right pulmonary artery to lower lobe artery may be affected earlier when the pulmonary pressure increased. It is feasible to study the changes of flow condition in pulmonary artery branches though the combination of CTPA image and relevant software.

Adult ; Angiography ; methods ; Case-Control Studies ; Humans ; Hypertension, Pulmonary ; etiology ; physiopathology ; Middle Aged ; Pulmonary Artery ; diagnostic imaging ; physiopathology ; Pulmonary Disease, Chronic Obstructive ; complications ; physiopathology ; Tomography, Spiral Computed

OBJECTIVETo assess the risk factors correlating to the likelihood for airflow obstruction among first-degree children of chronic obstructive pulmonary disease (COPD) patients and whether familial aggregation of pulmonary function abnormality exists.

METHODSFifty-nine smokers with COPD and 28 smokers without COPD as control and all their children available were recruited into the study. Their history was recorded and a binary logistic regression analysis was carried out to ascertain the effects of their relationship to a proband with COPD, when other potential risk factors were controlled.

RESULTSChildren with COPD probands showed increased risk of FEV1 below the 70% predicted (OR = 1.987) after accounting for the effects of smoking, sex and clinical symptoms. The lower the pulmonary function of the COPD proband, the higher the risk to their children for FEV1 below the 70% predicted.

CONCLUSIONSOur finding demonstrates the presence of a household aggregation inclination of COPD and pulmonary function impairment. Genetic factors might act as the basis of the familial aggregation.

Aged ; Female ; Forced Expiratory Flow Rates ; Humans ; Lung ; physiopathology ; Male ; Pulmonary Disease, Chronic Obstructive ; genetics ; physiopathology ; Regression Analysis ; Smoking

Background: Neural respiratory drive (NRD) using diaphragm electromyography through an invasive transesophageal multi-electrode catheter can be used as a feasible clinical physiological parameter in patients with chronic obstructive pulmonary disease (COPD) to provide useful information on the treatment response. However, it remains unknown whether the surface diaphragm electromyogram (EMGdi) could be used to identify the deterioration of clinical symptoms and to predict the necessity of hospitalization in acute exacerbation of COPD (AECOPD) patients. Methods: COPD patients visiting the outpatient department due to acute exacerbation were enrolled in this study. All patients who were subjected to EMGdi and classical parameters such as spirometry parameters, arterial blood gas analysis, COPD assessment test (CAT) score, and the modified early warning score (MEWS) in outpatient department, would be treated effectively in the outpatient or inpatient settings according to the Global Initiative for Chronic Obstructive Lung Disease guideline. When the acute exacerbation of the patients was managed, all the examination above would be repeated. Results: We compared the relationships of admission-to-discharge changes (Δ) in the normalized value of the EMGdi, including the change of the percentage of maximal EMGdi (ΔEMGdi%max) and the change of the ratio of minute ventilation to the percentage of maximal EMGdi (ΔVE/EMGdi%max) with the changes of classical parameters. There was a significant positive association between ΔEMGdi%max and ΔCAT, ΔPaCO, and ΔpH. The change (Δ) of EMGdi%max was negatively correlated with ΔPaO/FiOin the course of the treatment of AECOPD. Compared with the classical parameters including forced expiratory volume in 1 s, MEWS, PaO/FiO, the EMGdi%max (odds ratio 1.143, 95% confidence interval 1.004-1.300) has a higher sensitivity when detecting the early exacerbation and enables to predict the admission of hospital in the whole cohort. Conclusions The changes of surface EMGdi parameters had a direct correlation with classical measures in the whole cohort of AECOPD. The measurement of NRD by surface EMGdi represents a practical physiological biomarker, which may be helpful in detecting patients who should be hospitalized timely.
Diaphragm ; physiopathology ; Electromyography ; methods ; Forced Expiratory Volume ; physiology ; Hospitalization ; Humans ; Pulmonary Disease, Chronic Obstructive ; metabolism ; physiopathology ; Spirometry ; Vital Capacity ; physiology

OBJECTIVETo study the serum level of carbohydrate antigen 125 (CA125) in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) and its relation with pulmonary hypertension.

METHODSForty-six patients with AECOPD complicated by pulmonary hypertension, 46 with AECOPD and 38 healthy control subjects were examined for their clinical data, pulmonary function, echocardiographic findings, and serum levels of lung tumor markers and brain natriuretic peptide (BNP).

RESULTSCompared with the healthy control group, COPD patients with or without pulmonary hypertension showed significantly decreased pulmonary function (P<0.05), especially in those with AECOPD and concurrent pulmonary hypertension (P<0.05). Serum CA125 level was obviously higher in AECOPD group than in the healthy control group, and further increased in AECOPD patients with pulmonary hypertension (P<0.05). The levels of lung tumor markers (CEA, NSE, CYFRA and PROGRP) were similar among the 3 groups (P>0.05). The serum level of BNP in patients with AECOPD and concurrent pulmonary hypertension was significantly higher than that in patients with AECOPD (P<0.05). Pearson linear correlation analysis showed that serum CA125 was positively correlated with pulmonary artery systolic pressure and BNP in AECOPD patients with pulmonary hypertension (P<0.01).

CONCLUSIONSerum CA125 may serve as a serological index to identify AECOPD patients with pulmonary hypertension.

Acute Disease ; Biomarkers, Tumor ; CA-125 Antigen ; blood ; Case-Control Studies ; Disease Progression ; Humans ; Hypertension, Pulmonary ; physiopathology ; Lung ; Natriuretic Peptide, Brain ; blood ; Pulmonary Disease, Chronic Obstructive ; blood ; physiopathology