Objective To investigate the prevalence and severity of malnutrition in patients with stable chronic obstructive pulmonary disease (COPD) , analyze serum levels of myostatin, tumor necrosis factor alpha (TNFα) and C reactive protein (CRP) , and investigate the relationship between serum myostatin and malnutrition in COPD. Methods Seventy-one patients with stable COPD and 60 age-matched healthy volunteers were recruited in this study. Pulmonary function was tested in all of the subjects and the severity of malnutrition was evaluated by a multiple-parameter malnutritional index (MNI). Based on the MNI scores, patients with COPD were divided into group Ⅰ (MNI≥5 score) and group Ⅱ (MNI ＜ 5 score) , the former represents the patients with severe or very severe malnutrition while the latter represents the patients with mild or without malnutrition. Serum concentration of myostatin, TNFα and CRP were measured by enzyme-linked immunosorbent assay. Results The MNI score was significantly elevated in patients with COPD [(7. 75 ±3. 86)score] compared with the controls [(1. 13 ±0. 96)score; P＜0.001],and 55 patients (77%) in COPD group Ⅰ showed MNI ≥ 5 (9. 30 ± 3. 01) score. Serum myostatin concentration was significantly elevated in COPD group Ⅰ [(12. 18 ±4. 76)μg/L] than in COPD group Ⅱ [(9. 73 ±2.85) μgL] and controls [(7.93 ±2.35) μg/L], with each P ＜ 0.001. Serum TNFα concentration was also significantly elevated in patients with COPD compared with the controls (P ＜ 0. 001).Pearson correlation analysis showed that serum myostatin levels were significantly correlated with MNI scores (r = 0. 438, P - 0. 000) and TNFa levels (r = 0. 234, P = 0. 041) in COPD group (combined group I and Ⅱ) while MNI scores were correlated inversely with BMI in COPD group (r = - 0. 530, P = 0. 000) . After stratified with subgroups, the correlation between myostatin levels and MNI scores was more significant and the correlation coefficient was higher (r =0.464, P =0.000) in COPD group I patients. Moreover,myostatin levels were inversely correlated with BMI (r = - 0. 287, P = 0. 034) and forced expiratory volume in one second of the predicted value (r = - 0. 264, P = 0. 049) in COPD group I patients. Conclusions Malnutrition commonly and substantially exists in patients with COPD; serum myostatin concentration is significantly elevated and is correlated with the severity of malnutrition in the patients. The elevation of serum myostatin may contribute to malnutrition in COPD patients.

Objective Backgrounds and Objectives Skeletal muscle dysfunction is an important systemic manifestation of several diseases such as chronic obstructive pulmonary disease and chronic heart failure.Quadriceps function assessment was used in majority of the studies for assessment of peripheral skeletal muscle function as it is readily accessible and is a primary locomotor muscle.Appropriate evaluation of the prevalence and severity of quadriceps dysfunction relies on the proper control data from the age-matched normal subject.So,the present study was aimed to measure the quadriceps function in healthy elderly,to investigate the multiple factors related to quadriceps functions,and to establish the normal ranges for quadriceps functional performance in healthy elderly.Methods Sixty healthy volunteers were recruited for the study.Quadriceps function was assessed by measurement of the following 3 items:maximum of twitch tension (TwQmax) induced by magnetic stimulation of femoral nerve,maximal volitional contraction (QMVC),and endurance time.The intensity and frequency of quadriceps exercises were quantified with physical activity (PA) scores by using a special PA questionnaire.Anthropometric measurements such as height,weight and mid-thigh muscle mass (MTMC) were measured in all of the subjects.Multiple regression models were developed by stepwise method to determine the independent factors respectively contributing to the quadriceps functional performance.Results Quadriceps functional tests results showed that the data of the three items fit normal distributions in both female and male subjects,and the gendcr-related difference was observed in quadriceps strength,with TwQmax and QMVC being significantly decreased in female than in male subjects.The mean values and normal ranges for TwQmax,QMVC,and endurance time were [13.86(10.53-17.65)] kg,[42.06(34.45-49.67)] kg,and [81.08(58.52-103.66)] second,respectively,in male subjects; and they were [7.41(6.02-9.52)] kg,and [29.40(24.66-33.82)] kg,and [83.44 (60.81-106.67)] second,respectively,in female subjects.Stepwise regression correlation analysis showed that QMVC was related with sex,PA scores and weight (R2=0.61,P＜0.01) ; endurance time was predicted by PA scores,MTMC,body weight and sex (R2 =0.58,P ＜0.01) ; and TwQmax was predicted by sex,height and PA scores (R2 =0.67,P＜0.01).Conclusions Our study results demonstrate that quadriceps functional performance fits normal distributions in healthy elderly,and that quadriceps function is related to multiple factors such as subjects' sex,muscles exercises,weight,height,muscle mass,and etc,with muscles exercises being the most significant one,except of gender.We conclude that muscles exercises take a very important role in muscles functional performance in healthy elderly.

Objective To explore the significance of negative expiratory pressure technique in detecting expiratory flow limitation in chronic obstructive pulmonary disease (COPD) patients. Methods Negative expiratory pressure technique was performed in 13 special COPD patients who did not accomplish routine pulmonary function tests. Results Negative expiratory pressure technique was executed successfully in 13 special COPD patients without any side-effects. Expiratory flow limitation was detected in 12 special COPD patients. 5-point expiratory flow limitation score was significantly correlated with Medical Research Council (MRC) dyspnea score, which was a predictor of dyspnea. Conclusions Negative expiratory pressure technique provides a test which is simple, rapid, noninvasive and does not require any initiative cooperation from the patients, it can be applied in special COPD patients who can not accomplish routine pulmonary function tests.

Objective To evaluate the effects of inhaled bronchodilators on dynamic PEEPi in COPD patients.Methods Twenty moderate to severe COPD subjects were divided into three groups.Lung functions,PEEPi,dyn and Borg score were measured at baseline and 30 min after inhaled placebo,and after inhalation of salbutamol 400 ?g(or ipratropium 80 ?g),ipratropium 80 ?g(or salbutamol 400 ?g)in sequence at interval as specified in different groups.Results In comparison with placebo,PEEPi,dyn decreased after inhalied bronchodilators(P

Objective To describe the clinical features of pulmonary epithelioid hemangioendothelioma and heighten the ratio of diagnosis.Methods With a case report and review of the related literature,the etiology,clinical manifestations,pathology diagnosis,differential diagnosis,management and prognosis of pulmonary epithelioid hemangioendothelioma were described.Results The etiology of this rare disease remained unknown.Symptoms were scanty and usually mild.Chest radiograph or computed tomography usually revealed multiple bilateral pulmonary nodules.Primitive lumen formed by a single cell was the pathologic feature.Immunohistochemical stains showed that the malignant cells are of the endothelial type.There was no effective treatment for this disease and its prognosis was unpredictable.Conclusion Pulmonary epithelioid hemangioendothelioma is rare and often misdiagnosed as other pulmonary diseases.

Objective To investigate the methods of recording EMGscm and its significance in monitoring of central drive.Methods Three methods of collecting EMGscm were compared.The subjects were asked to re-breath until the highest PCO2-ET was reached and the EMGscm,Flow,VT(tidal volume),Ttot(Total time of respiratory cycle),and PCO2-ET were measured during the re-breathe.Results (1)The EMGscm did not appeared until the PCO2-ET reached the value of(48.2?2.6)mm Hg.The value of PCO2-EThighest was(81.2?6.6)mm Hg.(2)As the PETCO2 increased,the Ttot became shorter and shorter,from(2.91?0.85)s to(1.92?0.39)s,while the VT became higher and higher,from(0.68?0.27)L to(2.21?0.37)L.There was a statistical relationship between the Ttot(or VT)and the PCO2-ET,and their correlative coefficient was respectively(0.86?0.12)and(0.89?0.13)(both P

Objective To investigate the changes of SARS-IgG in serum,X-ray of lung and lung function in severe acute respiratory syndrome(SARS)patients.Methods During the period of 2003-06~2004-04,the SARS-IgG in serum,X-ray of lung and lung function tests were checked up in 103 SARS patients by Guangzhou Institute of Respiratory Disease in regularly every 3 months after their discharge from hospital and the SARS-IgG level in serum was compared with another 20 healthy medical workers.Results 1.On the third day after the onset of SARS disease,the optical density(OD)value of SARS-IgG in serum was(0.063?0.012)which was significantly higher than the normal control group. Moreover,from then on,it increased step by step and went up greatly in the third week(0.180?0.202)and attained the highest level(1.730?0.331)in the fourth month. Then it decreased step by step and in the 17th month,it dropped to(0.668?0.109).2.The chest X-ray of 32.3%of 62 cases became normal in the first 3 months after onset of SARS and that of 56.5% did in the 17th month.However,if 22 cases were taken into account,who did not have a re-check,80% of the cases became normal and the left 5 cases were severe patients. 3.The lung function of 16 of 25 cases became normal in 6 months after onset and among the other 9 cases,the lung function of 4 cases had an improvement in the following 3 to 6 months.Conclusion The OD value of SARS-IgG in serum in the third day can be used as a screening test of SARS. Its remarkable increase in the third week will support the diagnosis.The chest X-ray and lung function of SARS patients will improve gradually and become normal in the final.

Objective To explore the relationship between improved exercise endurance and inspiratory muscle strength,dyspnea and lower limb fatigue in chronic obstructive pulmonary disease(COPD)patients. Methods Twelve moderate-to-severe COPD patients were given lower limb exercise training for 12 weeks.Routine tests of pulmonary ventilation function,diffusion function,lung volume,maximal inspiratory pressure(MIP),expiratory flow limitation(EFL),cycle ergometer exercise capacity and constant work rate capacity were administered before and after the training program.Borg's scale(BS)was used to assess dyspnea and lower limb fatigue was measured during the exercise tests.Results After training,the average peak work rate(W Rpeak)and average MIP both had increased significantly,but no significant change was observed in routine pulmonary ventilation function,diffusion function or lung volume.The 5-point EFL score showed no significant change.hut Borg's scale dyspnea scores and lower limb fatigue decreased significantly.The changes in W Rpeak were positively correlated with the MIP changes,Borg scale scores and changes in Borg scores.All of these relationships were statistically significant. Conclusion The improved exercise endurance of moderate-to-severe COPD patients after lower limb exercise training is due to increased inspiratory muscle strength and decreases in the sensation of dyspnea and lower limb fatigue.

Objective To compare negative expiratory pressure (NEP)technique with conventional test in detecting expiratory flow limitation (EFL)in chronic obstructive pulmonary diseases( COPD) patients. Methods EFL was measured with NEP technique and conventional method respectively in 72 COPD patients;EFL was measured with NEP technique in 20 COPD patients who failed to perform conventional test. Results EFL was detected in 54 of the 72 COPD patients. NEP test was successfully performed on the 20 patients, and 19 of them were found with EFL. The level of forced expired volume in one second percentage( FEV_1 % ) of the patients with 2-score group (46. 92 ± 12. 74) % and 3-score group (33. 35 ± 8.96)% were significantly lower than that of the 1-score group(63. 60 ±16.65)%. Area under curve of NEP technique and conventional test in ROC is 0. 903 and 0. 761 respectively. Conclusions As compared with conventional test, EFL detected with NEP technique is more reliable in evaluating dyspnea of COPD patients. It is simple and doesn't require any cooperation of the patients. NEP technique can be applied in COPD patients who fail to receive conventional test.

Objective To explore the clinical significence of three alternative ways in assessing bronchodilator reversibility in patients with severe chronic obstructive pulmonary disease (COPD).Methods 18 clinically stable patients with severe COPD were collected. Pulmonary ventilation function and capacity of lung were measured after inhaling compound ipratropium bromide solution before and after nebulised saline, and at intervals. Expiratory flow limitation (EFL) was detected by negative expiratory pressure technique concurrently. Results Compared with placebo,bronchodilator caused a significant increase in forced expiratory volume in one second (FEV1)%Pred,forced vital capacity (FVC)%Pred and inspiratory capacity (IC)%Pred and a significant decrease in residual volume (RV)%Pred, functional residual capacity (FRC)% Pred and Borg scale. But there were no changes in total lung capacity (TLC)% Pred, 5-point EFL score and breathing pattern variables. The increase of IC was correlated with the reduction of Borg scale, but such correlation did not exist between the increase of FEV1 and the reduction of Borg scale. When ROC curve was applied to assess the significance of IC, 5-point EFL score and FEV1 in evaluating the effects of broncholilator,the area under curve (AUC) of which was 0. 868,0. 681 and 0. 557 respectively.Conclusions Compared with FEV1, IC has higher sensitivity and reliability to evaluate the clinical response of bronchodilator in patients with severe COPD. The 5-point EFL score is not an appropriate measurement of acute bronchodilator response.