Objective To investigate the application value of pan-immune-inflammation value(PIV),hypersensitive C-reactive protein(hs-CRP)/albumin(ALB)ratio(HCAR)and procalcitonin/platelet count ratio(PCT/PLT)in pulmonary infection in elderly patients with chronic obstructive pulmonary disease(COPD).Methods A total of 143 elderly patients with COPD and pulmonary bacterial infection were selected as the infected group.Meanwhile,143 elderly patients with COPD and without pulmonary infection were selected as the uninfected group.Patients in the infected group were furthrer divided into the mild group(47 cases),the moderate group(51 cases)and the severe group(45 cases)according to the degree of pulmonary infection.They were divided into the favorable prognosis group(112 cases)and the poor prognosis group(31 cases)according to the prognosis.Blood biochemical indicators,PIV,HCAR and PCT/PLT were compared between groups.The relationship between above indicators and pulmonary infection,infection degree and the prognosis was analyzed.Results Compared with the uninfected group,neutrophil(NEU),monocyte(MON),hs-CRP and PCT levels were higher,while lymphocyte(LYM)and ALB levels were lower in the infected group(P＜0.05).PIV,HCAR and PCT/PLT were higher in the infected group and the poor prognosis group than those in the uninfected group and the favorable prognosis group,respectively(P＜0.05).PIV,HCAR and PCT/PLT in the mild group,the moderate group and the severe group increased in sequence(P＜0.05).Spearman correlation analysis showed that PIV,HCAR and PCT/PLT were positively correlated with the degree of pulmonary infection(P＜0.05).Multivariate Logistic regression analysis showed that high levels of PIV,HCAR and PCT/PLT were independent risk factors for pulmonary infection in elderly patients with COPD(P＜0.05),and also independent risk factors for poor prognosis in patients with pulmonary infection(P＜0.05).The areas under the curve(AUC)of PIV combined with HCAR and PCT/PLT for diagnosing pulmonary infection in elderly patients with COPD and predicting poor prognosis in patients with pulmonary infection were 0.980 and 0.910(P＜0.05).Conclusion PIV,HCAR and PCT/PLT are related to COPD with pulmonary infection in the elderly.They can help to identify pulmonary infection,judge the condition of pulmonary infection and evaluate the prognosis in patients with pulmonary infection.

Objective To investigate the application value of pan-immune-inflammation value(PIV),hypersensitive C-reactive protein(hs-CRP)/albumin(ALB)ratio(HCAR)and procalcitonin/platelet count ratio(PCT/PLT)in pulmonary infection in elderly patients with chronic obstructive pulmonary disease(COPD).Methods A total of 143 elderly patients with COPD and pulmonary bacterial infection were selected as the infected group.Meanwhile,143 elderly patients with COPD and without pulmonary infection were selected as the uninfected group.Patients in the infected group were furthrer divided into the mild group(47 cases),the moderate group(51 cases)and the severe group(45 cases)according to the degree of pulmonary infection.They were divided into the favorable prognosis group(112 cases)and the poor prognosis group(31 cases)according to the prognosis.Blood biochemical indicators,PIV,HCAR and PCT/PLT were compared between groups.The relationship between above indicators and pulmonary infection,infection degree and the prognosis was analyzed.Results Compared with the uninfected group,neutrophil(NEU),monocyte(MON),hs-CRP and PCT levels were higher,while lymphocyte(LYM)and ALB levels were lower in the infected group(P＜0.05).PIV,HCAR and PCT/PLT were higher in the infected group and the poor prognosis group than those in the uninfected group and the favorable prognosis group,respectively(P＜0.05).PIV,HCAR and PCT/PLT in the mild group,the moderate group and the severe group increased in sequence(P＜0.05).Spearman correlation analysis showed that PIV,HCAR and PCT/PLT were positively correlated with the degree of pulmonary infection(P＜0.05).Multivariate Logistic regression analysis showed that high levels of PIV,HCAR and PCT/PLT were independent risk factors for pulmonary infection in elderly patients with COPD(P＜0.05),and also independent risk factors for poor prognosis in patients with pulmonary infection(P＜0.05).The areas under the curve(AUC)of PIV combined with HCAR and PCT/PLT for diagnosing pulmonary infection in elderly patients with COPD and predicting poor prognosis in patients with pulmonary infection were 0.980 and 0.910(P＜0.05).Conclusion PIV,HCAR and PCT/PLT are related to COPD with pulmonary infection in the elderly.They can help to identify pulmonary infection,judge the condition of pulmonary infection and evaluate the prognosis in patients with pulmonary infection.

Objective To analyze the clinical, radiological, pathological and microbiological features of invasive pulmonary aspergillosis (IPA) to improve clinical management.Methods Retrospective analysis of 20 pathologically and/or microbiologically confirmed IPA cases in our hospital from January 2005 to August 2008. Results Group A (with underlying diseases) included 13 patients (underlying malignancy in 9 patients, including 5 cases of hematological malignancy, COPD in 2 patients, pulmonary tuberculosis and bronchiectasis in 1 each). Group B (without underlying disease) included 7 patients (2 patients with a long time of fluffy toy contact, another 1 had exposure to moldy rice, and 3 had exposure to polluted water). All these 20 patients had pulmonary invasion revealed by CT imaging. Multiple changes were identified in 16 patients. Bilateral pulmonary infiltrates and/or consolidation were revealed in 7 patients. Multiple nodules were seen in 9 patients. Four patients had solitary lesions, including isolated nodules in 2 patients and segment consolidation in the other 2 patients. Pulmonary cavity without fluid level was found in 8 patients (40.0%). Eighteen cases received antifungal therapy. The overall efficacy rate was 55.6%. The efficacy rate in group A and B was 45.5% and 5/7 respectively. The average time to symptomatic relief was (12.0±2.8) days. The time to lung lesion improvement on CT was (17.4±2.9) days. The time to significant CT improvement was (34.3±9.9) days. The time to the resolution of active lesion was (56.4±6.2) days.Conclusions IPA may occur in immunocompetent patients without underlying disease. Most IPA patients have bilateral multiple pulmonary nodules and cavities on CT. The time to the resolution of active pulmonary lesions is about 6 weeks.

BACKGROUND: In patients with obstructive sleep apnea(OSA),the degree of severity of OSA is mostly related to the sleep time spent in the supine position. According to the apnea-hypopnea index(AHI), positional and n onpositional OSA has been distinguished.OBJECTIVE: To compare the clinical characteristics of positional and nonpositional OSA and investigatethe relationship between sleep position and respiratory function of patients with OSA.DESIGN: A comparative clinica] observation based on the OSA patients.SETTING: Center of Sleep Disorders,Nanjing General Hospital of Nanjing Military Area Command of Chinese PLA.PARTICIPANTS: From October 1998 to May 2002,225 patients were examined with overnight polysomnography in the Center of Sleep Disorders,Department of Respiratory Disease, Nanjing General Hospital of Nanjing Command. According to the inclusion criteria of ① AHI≥10 times/hour;② Sleep time in supine and lateral positions≥30 minutes; ③ Over 20years of age; 225 patients were selected from the total of 415 consecutive patients,including 63 with positional and 162 with nonpositional OSA.METHODS: All patients received overnight monitoring with HMS-5500polysomnography system(Respironics Inc USA) in the sleep laboratory. Queries for a detailed case history and physical examination were performed with the pulmonary functions evaluated with body p lethysmography. The clinical data and results of polysomnographic and pulmonary function tests were compared between the two groups of patients and a multiple stepwise regression analysis was employed to evaluate the determinant factors for sleep position dependence of the patients' condition.MAIN OUTCOME MEASURES: Main outcome: Comparisons of the clinical data,polysomnographic result and pulmonary function between the two groups. Secondary outcome: Correlation between classification of OSA and the clinical data.RESULTS: Totally 63 (28%) of the 225 OSA patients were identified as the positional type,who had significantly greater body mass index (BMI)then the nonpositional type patients [(43.46 ± 16.43) kg/m2 vs (23.90 ± 12.36) kg/m2,t =3. 977,P<0.01]. Except for sleeping time in lateral and supine positions, minimal SatO2 and basic SatO2 before the matching for BMI,all the other factors in polysomnograms of the two groups were significant different(P<0.05 or P<0.01). After BMI matching,all the measurements were identical to those recorded for the primary grouping with the exception of nocturnal limb movement frequency,which differed but insignificant between the two groups. The pulmonary function in the two groups was no significant difference(P>0.05) . Multiple stepwise regression analysis indicated that AHI and BMI were the two determinant factors for positional dependence of OSA with a predictive power of 26. 2%. Linear correlation analysis showed correlation of AHI and SatO2 with BMI in the whole group and nonpositional group(P<0.05 or P<0.01),but not in the positional group (P>0.05).CONCLUSION: About one-third of the OSA patients shows sleep position dependence,who may respond favorably to sleep position training. Sufficient patency can be retained in the upper airway of these patients to relieve respiratory obstruction during sleep and improve the respiratory function.

Objective:Patients with obstructive sleep apnea syndrome (OSAS) often had severe cardiovascular complications. So the early detection of the cardiovascular functional abnormality was more and more thought highly of by people. We evaluated the cardiac function of the patients with (OSAS) using tissue Doppler imaging (TDI) technique. Methods:Thirty-five patients with OSAS and 35 healthy controls were enrolled in the study. TDI was applied in the pulse-Doppler mode to allow for a spectral display and recording of mitral annulus at septal,lateral corner and tricuspid lateral corner in the apical four chamber view. The peak systolic (Sm),early diastolic (Em) and late diastolic (Am) TDI velocity both of mitral and tricuspid annulus were measured by pulsed wave tissue Doppler imaging technique. Results:There were significant differences in Sm of mitral lateral corner,in Sm,Em and Em to Am ratio of mitral septal corner and in Sm,Em,Am and Em to Am ratio of tricuspid lateral corner between the OSAS group and healthy control group (P

Objectives: To identify any craniofacial morphological changes induced by a mandibular-repositioning oral appliance (MRA) and to explore the possibility of predicting the treatment response to MRA by cephalometric analysis in patients with obstructive sleep apnea (OSA). Methods: Seventy OSA patients [male/female: 63/7; age: (50.5±11.6) years; BMI: (27.6±4.6) kg/m2; AI: (34.9±21.3) episodes/hour; and oxygen saturation nadir: (66.3±16.5) %] were enrolled. MRA was fabricated individually for each patient after the consultation by a dentist. Polysomnographic (PSG) examination was repeated with MRA in place 3 months after the initiation of the MRA therapy. For cephalometric analysis, a pair of cephalograms of each patient was obtained, one with and another without MRA. Results and Conclusions: After 3 months' treatment, AI was (156±19.2) episodes/hour, significantly reduced compared with the pre-treatment average AI (34.9±21.3 episodes/hour,P<0.000 1). Oxygen saturation nadir improved from (66.3±16.5)% (pre-treatment) to (74.1±15.5)% (with MRA) (P<0.001). A reduction of AI≥50% was achieved in 42 patients. Insertion of MRA led to anterior shift of the mandible, increase in upper airway width and area and decrease in upper airway length. Those with evident retrognathia and longer anterior upper facial height were more likely to benefit from the MRA management.

Objective To evaluate the frequency, the change of sleep structure ,pulmonary function and respiratory muscle functions of overlap syndrome: a serious respiratory disease of sleep apnea syndrome (SAS) with chronic obstructive pulmonary diseases (COPD), for the further study of clinical and experimental characteristics.Methods 44 consecutive, unselected SAS patients (39 males and 5 females) were analyzed. All received continuous and overnight polysomonography monitoring with HMS-5500 polysomnography system (Respironics Inc USA) in our sleep laboratory. A thorough and detailed collection of case history, physical examination, blood gas analysis and pulmonary functions, as well as respiratory muscle functions and right ventricular functions were taken before the polysomnographic examination.Results A chronic obstructive spirographic pattern, defined by a FEV1/VC ratio (60%,was observed in 16 of 44 SAS patients (36.3%, the overlap group). The overlap patients were older (62.6±12.5 vs 54.7±11.4 years) than the simple SAS patients. The number of heavy smokers in overlap group was more than that in simple SAS group (600±210 vs 550±127 cigarette-year). There were signi-ficant difference in FEV1.0% (58.70±4.76 vs 86.42±7.50%, P<0.01), maximal expiration pressure (MEP,198.54±21.76 vs 129.3±31.9 cm H2O, P<0.01), maximal inspiration pressure (MIP, 72.75±11.4 vs 111.3±33.6 cm H2O, P<0.01) and minimal nocturnal oxyhemoglobin saturation (63.7±14.7 vs 74.8±11.4%, P<0.01) between two groups. And the total recording time (513±45.8 vs 521±48.6 min, P>0.05), however, showed no significant difference between two groups, while the percentage of total sleep time/total recorded time (73.4±9.6 vs 87.6±8.8%, P<0.01), rapid eye movement sleep time/total sleep time (6.0±4.3 vs 8.9±5.8%, P<0.01) in the overlap group were significantly decreased, and apnea plus hypopnea index (AHI) were significantly higher (54.6±20.3 vs 39.9±16.8, P<0.05) in the overlap group. Also, the incidence rate of right heart failure measured by cardiac ultrasonography was higher in the overlap group than in the simple SAS group. No differences were found in body mass index (BMI) and daytime arterial blood gas analysis between overlap group and simple SAS group.Conlusion Sleep apnea plus hypopnea index, as well as nocturnal hypoxemia, were more obviours in overlap syndrome than in the simple SAS patients. Also pulmonary function and respiratory muscle function were more significantly impaired, indicating a higher risk of developing pulmonary hypertension, cor pulmonale and respiratory failure in overlap syndrome.