ObjectiveTo explore the predictive value of fractional exhaled nitric oxide (FeNO) in the treatment response of adult asthmatic patients. Methods64 adult outpatients with asthma from Peking Union Hospital between March and September 2013 were recruited in the study. All patients completed asthma control test (ACT) together with exhaled nitric oxide (FeNO) and pulmonary function test. Then the patients were classified into a higher FeNO group (n=33) and a normal FeNO group (n=31) according to FeNO level. All patients accepted regular inhaled ICS/LABA treatment (salmeterol and fluticasone 50/250). Three months later all patients reaccepted ACT,FeNO and pulmonary function test. ResultsThe ACT score increased in all patients,and was significantly higher in the higher FeNO group than that in the normal FeNO group[22.07±5.49 vs. 19.23±5.48,t=2.893,P<0.05]. The complete control rate of the higher FeNO group was higher than that in the normal FeNO group (42.42% vs. 19.35%,χ2=3.960,P<0.05). The FEV1 and FEV1%pred of two groups both increased significantly (P<0.05),but there was no significant difference between two groups (P>0.05). Correlation analysis showed that FeNO and the declined rate of FeNO was negatively correlated with the ACT score(r=-0.302,P<0.05;r=0.674,P<0.01) and positively correlated with the improvement of ACT score (r=0.514,P<0.01;r=0.674,P<0.01). No significant correlation was found between FeNO and FEV1 or FEV1%pred. ConclusionThe effect of ICS/LABA therapy is better for asthma patients with higher FeNO. FeNO can be used for predicting the response to ICS/LABA therapy in patients with asthma and guiding the treatment.
Objective Using nerve growth factor ( NGF) and anti-NGF microspheres injected directly into the asthmatic rat adrenal gland, to explore the possible role of anti-NGF microsphere treatment in asthma.Methods 32 male SD rats were randomly divided into a normal control group, an asthma group, a NGF microspheres group, and an anti-NGF microspheres group. The behavior of rats, lung function testing, light microscopy of lung biopsy, electron microscopy of adrenal medulla cell ultrastructure changes, NGF and phenylethanolamine N-methyltransferase ( PNMT) expressions in the adrenal gland were assayed by immunohistochemistry method, and serum NGF, cortisol, corticosterone, epinephrine and norepinephrine concentrations were detected by ELISA. Results Behavior in the asthma rats showed varying degrees of sneezing, runny nose, wheezing, scratching the head and face, irritability holes, incontinence, increased aggression and other acts, while in the anti-NGF rats showed relatively slighter symptoms. The rats in the asthma, anti-NGF and NGF groups showed significant airway hyperresponsiveness, while RL value reduced and Cdyn value increased in the anti-NGF group compared with the asthma group. HE staining of lung tissue revealed obvious bronchoconstriction, inflammatory cell infiltration around small vessels and alveolar spaces and in interstitum, bronchial epithelial cells desquamation in the asthma group. In anti-NGF group, tracheal epithelium was relatively complete, inflammatory exudation, bronchoconstriction and inflammatory cell infiltration were milder compared to the asthma group. Electron microscopy showed vacuolated changes of adrenal medulla cells, uneven distribution of chromaffin granules in the asthma group and the NGFgroup, and the quantity and concentration of chromaffin granules were significantly lower than normal. There were villous clubbing processes on the adrenal medulla cell membrane in the NGF group. While the anti-NGF group had no significant vacuolar changes in chromaffin granules and the concentration was close to normal. Image analysis showed that mean gray values of PNMT and NGF in the anti-NGF group were significantly different fromthe asthma group. The ELISA results showed that: ( 1) The average concentrations of epinephrine in each group were as follows, ie. the control group gt; anti-NGF group gt; asthma group gt; NGF group. ( 2) The average concentrations of norepinephrine in each group were as follows, ie. the NGF group gt; asthma group gt; anti-NGF group gt; control group. ( 3) There was no significant difference among the groups in the average concentration of cortisol. ( 4) The average concentrations of norepinephrine in each group were as follows, ie. , the control group gt; anti-NGF group gt; asthma group gt; NGF group. Conclusions Local embedding of anti-NGF microspheres can alleviate inflammatory infiltration in lung tissue and improve lung function of rat model with asthma. The mechanismmay be the anti-NGF antagonists the NGF receptor and reverse adrenal medulla cell transdifferentiation process primined by NGF.
Objective The purpose of this study was to explore the correlation between peripheral blood eosinophil (EOS) count and smoking history, some inflammatory indicators, lung function, efficacy of ICS, risk of respiratory failure and chronic pulmonary heart disease, risk of acute exacerbation within 1 year, readmission rate and mortality in patients with acute exacerbation of COPD. Methods Retrospective analysis of the baseline clinical data of 816 patients with acute exacerbation of chronic obstructive pulmonary disease in the Department of Respiratory and Critical Care Medicine of the First Affiliated Hospital of Shihezi University from January 1,2019 to December 31,2021. The patients were divided into EOS ≥ 200 cells / μL (High Eosinophi, HE) group and EOS<200 cells / μL (low Eosinophi, LE) group according to whether the peripheral blood EOS was greater than 200 cells / μL at admission. Peripheral venous blood data (including blood eosinophil count, white blood cell count, lymphocyte percentage, neutrophil percentage), blood gas analysis value, lung function index and medication regimen of all patients were collected, and the efficacy of ICS was recorded. The patients were followed up for 1 year to observe the acute exacerbation and readmission rate, and the mortality rate was followed up for 1 year and 2 years. Results Neutrophil count, lymphocyte count and peak expiratory flow (PEF) in HE group were positively correlated with EOS value (P<0.05), and smoking was more likely to increase EOS value. HE group was more sensitive to ICS. The risk of acute exacerbation in HEA group was higher than that in LE group. ICS could reduce the rate of acute exacerbation in HE group. EOS value in LE group was inversely proportional to FEV1 / FVC and MMEF values (P<0.05). The risk of chronic pulmonary heart disease in LE group was higher than that in HE group. The 2-year mortality rate in HE group was higher than that in LE group. Conclusions Peripheral blood EOS count is correlated with some inflammatory indicators, acute exacerbation risk, and lung function. ICS can improve the clinical symptoms and prognosis of patients with higher EOS count.
Lung cancer is the leading cause of cancer-related deaths worldwide. Radiation pneumonitis is a major complication in lung cancer radiotherapy. Four-dimensional computed tomography (4DCT) imaging provides dynamic ventilation information, which is valuable for lung function assessment and radiation pneumonitis prevention. Many methods have been developed to calculate lung ventilation from 4DCT, but a systematic comparison is lacking. Prediction of radiation pneumonitis using 4DCT-based ventilation is still in an early stage, and no comprehensive review exists. This paper presented the first systematic comparison of functional lung ventilation algorithms based on 4DCT over the past 15 years, highlighting their clinical value and limitations. It then reviewed multimodal approaches combining 4DCT ventilation imaging, dose metrics, and clinical data for radiation pneumonitis prediction. Finally, it summarized current research and future directions of 4DCT in lung cancer radiotherapy, offering insights for clinical practice and further studies.
Objective To explore the correlation between different ultrasound pulmonary artery systolic pressure (PASP) and high-resolution CT (HRCT) pulmonary artery width (PAD) in patients with chronic obstructive pulmonary disease (COPD). Methods A retrospective analysis was conducted on 473 patients with acute exacerbation of chronic obstructive pulmonary disease who were hospitalized in the First Hospital of Lanzhou University from January 2016 to December 2020. They were divided into four groups according to the degree of PASP elevation: PASP normal group: PASP≤36 mm Hg, 182 cases; mildly elevated group: PASP 37 to 50 mm Hg, 164 cases; moderately elevated group: PASP 51 to 70 mm Hg, 89 cases; severely elevated group: PASP>70 mm Hg, 38 cases. The PAD of chest HRCT and the width of the ascending aorta (AAD) on the same plane were measured, and the ratio of PAD to AAD (PAD/AAD) was calculated. The differences of PAD, AAD, PAD/AAD in different PASP groups of COPD were compared. The correlations between PASP, lung function, blood gas analysis and PAD, PAD/AAD were analyzed. Results With the decrease of FEV1%pred, FVC%pred, FEV1/FVC, PaO2 and SaO2 in the patients, PaCO2 increased, PASP gradually increased, PAD and PAD/AAD gradually increased. PAD and PAD/AAD were significantly different between the severely elevated PASP group and the other three groups, and there were significant differences between the moderately elevated group and the normal group, and between the moderately elevated group and the mildly elevated group. PASP and PaCO2 were positively correlated with PAD and PAD/AAD, and FEV1%pred, FVC%pred, FEV1/FVC, PaO2, SaO2 were negatively correlated with PAD and PAD/AAD. Multivariate logistic regression analysis showed that after adjusting for confounding factors, decreased FEV1%pred was an independent risk factor for PAD/AAD>1 in COPD patients. The receiver operating characteristic curve showed that the width of PAD and PAD/AAD had certain predictive value for PASP. Conclusions There is a significant positive correlation between different degrees of ultrasound PASP and PAD and PAD/AAD in patients with COPD. HRCT PAD has certain predictive value for PASP. The heavier the hypoxia and carbon dioxide retention, the worse the pulmonary ventilation function, the higher the pulmonary artery pressure, the greater the possibility of PAD and PAD/AAD.
Objectives To investigate the pathogenic characteristics and the possible relationship between pathogen and respiratory function in patients with acute exacerbations of COPD (AECOPD).Methods Sixty-four patients with AECOPD were investigated with lung function test，quantitative and qualitative sputum bacteria culture，drug sensitive test，and Mycoplasma pneumoniae and Chlamydia pneumoniae specific antibodies test.The patients were divided into three groups according to FEV1%pred，50%≤FEV1lt;80%pred for the Group One，30%pred≤FEV1lt;50%pred for the Group Two，and FEV1lt;30%pred for the Group Three.Meanwhile according to the result of sputum culture，infective bacteria were divided into four kinds： Gram-positive cocci for kind A，Gram-negtive germ except kind C for kind B，Acinetobacter，Enterobacter and Pseudomonas spp for kind C，and negative result for kind D.Results ⑴Of 64 patients who were conducted quantitative sputum culture，germs isolated were mostly Streptococcus pneumoniae，Enterobacter，Moraxella Catarrhalis，and Pseudomonas.Of 38 patients who were conducted qualitative sputum culture，most of them were found mixed infection，and germs isolated were mostly Streptococcus pneumoniae，Staphylococcus epidermidis，Acinetobacter and Enterobacter.⑵Both quantitative and qualitative sputum culture revealed that Most of Group One patients were not infected by bacteria，and the Group Three patients were mainly by resistant kind A and kind C bacteria (Plt;0.01 and 0.05 respectively).⑶The infection of Mycoplasma pneumoniae or Chlamydia pneumoniae was identified in 29.4% of the cases.Conclusions There is a close correlation between the degree of functional damage and the infected bacterial strains for patients with AECOPD，the more chance of bacteria infection such as S pneumoniae，Acinetobacter，Enterobacter and Pseudomonas，the more damage of lung function.
Objective To observe the effects of salmeterol / fluticasone combined with tiotropium in the treatment of sever to very sever COPD. Methods Eighty patients with severe to very severe stable COPD were recruited from outpatient of Central Hospital of Cangzhou between May 2008 and October 2009. The subjects were randomly divided into a salmeterol /fluticasone group and a combination group. The salmeterol / fluticasone group received salmeterol / fluticasone propionate, and the combination group received the combination therapy of tiotropium and salmeterol / fluticasone propionate. All patients had received the treatment for 12 months. At baseline and at the end of 1-month, 3-month, 6-month, 12-month, lung function ( FEV1 , IC and FVC) , six-minute walk distance and the St. George’s Respiratory Questionnaire ( SGRQ) score were assessed. The number of exacerbations and the time to the first exacerbation were also recorded. Results At every visit, lung function ( FEV1 , IC and FVC) , six-minute walk distance and the SGRQ score were improved in both groups compared with baseline ( Plt;0. 05) , especially in the combination group ( Plt;0.05) . Compared with the salmeterol /fluticason, the combination therapy with tiotropium significantly decreased the incidence of exacerbations and prolonged the time to the first exacerbation ( Plt;0.05) . And there was no significant difference between two groups in adverse effects ( Pgt;0.05) . Conclusions The combination therapy with salmeterol / fluticasone propionate and tiotropium was superior to salmeterol / fluticasone propionate in treatment of sever to very severe stable COPD patients in improving lung function, exercise tolerance, and quality of life, without additional adverse effects.
0bjective To investigate the prevalence of gastroesophageal reflux(GER)in acute exacerbation of chronic obstructive pulmonary disease(AECOPD)and to explore the influence of GER on the acidity of airway and pulmonary ventilation function in AECOPD patients．Methods Sixty-five hospitalized AECOPD patients and 20 healthy volunteers were enrolled in this study．According to “GER survey”questionnaire，AECOPD patients were allocated into GER group and non-GER group and expired breath condensate(EBC)pH and pulmonary ventilation function were detected．Breath condensate samples were collected using a specially designed condensing chamber(EcoScreen，Germany)．Results About 30.8％ (20／65)AECOPD patients were complicated with GER．EBC pH was lowest in GER group，middle in non-GER group and highest in the control group[6.oo±0.75 VS 6.76±0.77 and 7.97±0.12，both Plt;0.05)．The pulmonary ventilation function(FEV1、FEV1％pred)in AECOPD patients with GER were lower than those without GER(both Plt;0.05)．Conclusions There iS a high prevalence of GER in AECOPD patients．And the airway pH is reduced in AECOPD patients，especially when complicated with GER，which may play an important role in the development of COPD．
ObjectiveTo explore the clinical features of atypical bronchial asthma with chief complaint of palpitations. MethodsTwelve cases with unexplained palpitations diagnosed by asthma were analyzed retrospectively. ResultsThe patients were diagnosed with asthma through bronchodilation test,skin prick tests,fractional exhaled nitric oxide (FeNO) and diagnostic treatment.The ratio of male to female cases was 1:5. The ventilation lung function of all patients was in normal range. The median time of misdiagnosis was 13.5(3-120) months. 41.6% of cases had dust mite positive skin prick test. The median value of FeNO was 32.75(18-54) ppb. The symptoms of all patients were relieved completely after standard treatment. ConclusionPalpatation may be a specific presentation of asthma characterized with eosinophilic airway inflammation which may be misdiagnosed as other diseases for a long time,especially in elder women. To improve the knowledge of this kind of atypical asthma,detailed medical history, experimental examinations and diagnostic treatment response are important to confirm the diagnosis in time.
ObjectiveTo verify the existing domestic and foreign formulas of normal predictive value indicator for adult pulmonary diffusion capacity’s applicability at current stage in Kunming.MethodsBased on the pulmonary diffusion capacity parameters determination of diffusion capacity for carbon monoxide of the lung (DLCO) collected from one-breath breathing test completed by 680 adults with healthy lung function and without any disease which may cause pulmonary diffusion dysfunctions in Kunming, the regression equation of adult DLCO normal predicted value in Kunming was initially established; the fitting degree of DLCO predicted value and measured value was verified; and the correlation between European adults (instrument-inherent ECCS93) and the normal predicted values of adult DLCO in Shanghai, Chongqing and Lhasa were calculated and contrasted.ResultsThe regression equation of adult DLCO normal predicted value in Kunming was initially established: for male, 0.483+0.063×height (cm)+0.041×weight (kg)–0.071×age (years); for female, 1.679+0.055×height (cm)+0.018×weight (kg)–0.060×age (years). The data collected from the one-breath breathing test were similar to the predicted values obtained from the normal adult male and female DLCO prediction formulas in Kunming, the difference was not statistically significant (tM=–0.167, tF=–0.436, both P>0.05), suggesting that the formula for predicting the value established in this study was valid and well fitted. The predicted value of adult DLCO in Kunming area was statistically significant compared with the adult DLCO estimates of European adults and Lhasa, Chongqing and Shanghai in China (FM=713.4, FF=1 442.2, both P<0.001). Lhasa had the highest value; Kunming was the second highest; instrument-inherent European area and Chongqing came to third and fourth; and Shanghai had the lowest predicated adult DLCO value (all P<0.001).ConclusionThe current predictive formulas for adult pulmonary diffusion capacity indicators in China and worldwide are not suitable for the populations in Kunming.