[An epidemiological survey on management and insights of asthma in China in 2009 to 2010].

OBJECTIVE: Through the analysis of relevant data of China Asthma and Risk factors Epidemiologic investigation (CARE study), we understand the status quo of management and insights of asthma patients in our country. METHODS: Using multi-stage random cluster sampling method, epidemiological survey was performed on the prevalence rate in 8 provinces (cities) of China residents who aged over 14 years from 2009 to 2010. Detailed epidemiological data was collected via face-to-face home visit interview among 2 034 asthmatics who were diagnosed in the last epidemiology survey. Asthma was diagnosed based upon case history, clinical signs and lung function test. The SPSS12.0 software was conducted for statistical analysis and the status of asthma control was investigated. RESULTS: This survey has shown that 22.71% (462/2 034) asthmatics had ever taken a lung functional test in the past year. A total of 294 (14.45%) people had peak flow meters but only 1.62% (33/2 034) regularly used it daily. There were 22.42% (456/2 034) asthmatics aware that bronchial asthma is characterized by chronic airway inflammation. 14.85% (302/2 034) asthmatics understood that the treatment goal of this disease is long-term good control or complete control. This survey has found that 59.64% (1 213/2 034) patients complained that asthma has affected their work, life and entertainment, including 8.90% (181/2 034) asthmatics dependent on instruments in daily life and 4.57% attempting to suicide. This suggested that allergic asthma has seriously decreased the quality of life. CONCLUSION: Therefore it is necessary to educate the asthmatics, guide the patients to the long-term management and standardized therapy and raise the level of disease understanding, thus reducing the burden of disease to society. Gaining better insight of patient's attitude about self-care is critical to the improvement of asthma management.

Deubiquitination and stabilization of T-bet by USP10.

The T-box transcriptional factor T-bet is crucial in the development, differentiation and function of Th1 cells. It drives Th1 immune response primarily through promoting expression of Th1 hallmark cytokine IFN-γ. Although T-bet was found associated with many immune-mediated diseases such as asthma and systemic sclerosis, little is known about the regulation of T-bet stability and function. Here we identified USP10, a carboxyl-terminal ubiquitin-processing protease, could interact with T-bet in the nucleus. Overexpression of USP10 directly inhibited T-bet ubiquitination and increased the expression of T-bet. We further confirmed Quercetin, a reported inhibitor of T-bet, could target USP10. Quercetin treatment downregulated USP10 and promoted T-bet degradation in a proteasome dependent way. Moreover, we found USP10 expression was upregulated in asthmatic patient PBMC, suggesting USP10 may maintain high level of T-bet and IFN-γ to fight against Th2-dominated inflammation.

[An epidemiological survey of current asthma control status in China].

OBJECTIVE: Base on the China asthma and risk factors epidemiologic investigation (CARE study), we analyzed the current status of asthma control in China. METHODS: With the multi-stage random cluster sampling method, epidemiological survey was performed among Chinese residents who aged over 14 years in 8 provinces (cities) from 2010 to 2011. Detailed clinic data of 2 034 asthma patients were collected via face-to-face home visit . Asthma was diagnosed based upon the history, clinical signs and lung function tests. The SPSS 12.0 was conducted for statistics analysis. RESULTS: This survey found that the prevalence rate of asthma in China was 1.24% (2 034/164 215), including 973 male and 1 061 female patients, with a mean age of (56 ± 18) years old. Consistent with the Global Initiative for Asthma (GINA) guidelines, 40.51% (824/2 034) and 42.58% (866/2 034) of our patients achieved control and partial control, respectively. According to the asthma control test (ACT) estimates, 15.63% (318/2 034) and 49.46% (1 006/2 034) of patients achieved full control (ACT 25) and well control(ACT 20-24), respectively. In the past year, 22.62% (460/2 034) of patients reported hospitalized and 26.99% (549/2 034) of patients reported emergency room visit at least one time due to asthma exacerbation. 61.80% (1 257/2 034) of patients were on daily us of medication. Inhaled corticosteroids (ICS) plus a long-acting ß2 agonist (LABA) or solely ICS were used in 6.39% and 14.75% of patients, respectively. Theophylline treatment accounted for 29.11% (592/2 034). Oral glucocorticoid and oral leukotriene modifier (LTRA) treatment accounted for 9.49% (193/2 034) and 3.10% (63/2 034), respectively. According to the survey, 34.51% (702/2 034) of asthma patients reported a history of smoking . The percentage of asthma control in non smoking patients was higher than in smoking patients [43.24% (576/1 332) and 35.33% (248/702), respectively]. Meanwhile, the rates of both hospitalization and emergency due to asthma exacerbation in smoking asthma patients were significantly higher than nonsmoking asthma patients (27.35% and 31.77%, 20.12% and 24.47%, respectively). CONCLUSIONS: The situation of asthma control has been improved in China. However, compared with GINA guidelines, there is still a considerable gap. Smoking is one of the crucial factors that affect asthma control.

[Risk factors of bronchial asthma among people aged over 14 years in China].

OBJECTIVE: To survey the risk factors of asthma among the people aged over 14 years in China. METHODS: Home visits for completing epidemiological questionnaires in accordance with stratified cluster random sampling survey were conducted in 8 provinces (cities) of China residents aged over 14 years from February 2010 to August 2011. Asthma was diagnosed based upon case history, clinical signs and lung function test. The SPSS 12.0 software was used for statistic analyses for the epidemiological status of asthma. RESULTS: Sampling population was composed of 180 099 subjects. Among 164 215 valid questionnaires, there were 79 692 males and 84 523 females, 2 034 had asthma. The overall prevalence rate was 1.2% (2 034/164 215). Correlation analyses showed that the risk factors were smoking (OR = 1.697, 95%CI: 1.547-1.861), breast feeding (OR = 0.801, 95%CI: 0.670-0.959), genetics (OR & 95%CI >1, asthma (OR = 10.440, 95%CI: 8.991-12.112)), complications (OR & 95%CI >1), body mass index (compared with normal weight, overweight (OR = 1.360, 95%CI: 1.212-1.531), obesity (OR = 10.631, 95%CI: 9.570-11.801)) and petting (OR & 95%CI >1). CONCLUSION: Among Chinese asthmatics aged over 14, their risk factors include host (genetics & obesity) and environmental (smoking, breastfeeding, complications & pets) factors.

High-dose N-acetylcysteine in the prevention of COPD exacerbations: rationale and design of the PANTHEON Study.

Chronic obstructive pulmonary disease (COPD) is characterized by persistent airflow limitation; from a pathophysiological point of view it involves many components, including mucus hypersecretion, oxidative stress and inflammation. N-acetylcysteine (NAC) is a mucolytic agent with antioxidant and anti-inflammatory properties. Long-term efficacy of NAC 600mg/d in COPD is controversial; a dose-effect relationship has been demonstrated, but at present it is not known whether a higher dose provides clinical benefits. The PANTHEON Study is a prospective, ICS stratified, randomized, double-blind, placebo-controlled, parallel-group, multi-center trial designed to assess the efficacy and safety of high-dose (1200 mg/daily) NAC treatment for one year in moderate-to-severe COPD patients. The primary endpoint is the annual exacerbation rate. Secondary endpoints include recurrent exacerbations hazard ratio, time to first exacerbation, as well as quality of life and pulmonary function. The hypothesis, design and methodology are described and baseline characteristics of recruited patients are presented. 1006 COPD patients (444 treated with maintenance ICS, 562 ICS naive, aged 66.27±8.76 yrs, average post-bronchodilator FEV1 48.95±11.80 of predicted) have been randomized at 34 hospitals in China. Final results of this study will provide objective data on the effects of high-dose (1200 mg/daily) long-term NAC treatment in the prevention of COPD exacerbations and other outcome variables.

Low-dose theophylline restores corticosteroid responsiveness in rats with smoke-induced airway inflammation.

Patients with chronic obstructive pulmonary disease (COPD) respond poorly to corticosteroids. Histone deacetylase-2 (HDAC-2) plays a pivotal role in many cases of steroid insensitivity. The main aim of this study was to restore the smoking-induced reduction in corticosteroid sensitivity by increasing HDAC-2 activity using low-dose theophylline. Rats were exposed to cigarette smoke (CS) and treated with budesonide and two doses of theophylline. Besides the pathologic examination and cell counting in the bronchoalveolar lavage fluid (BALF), the expression of HDAC-2 and CXC chemokine ligand-8 (CXCL-8) were measured. Airway inflammation induced by CS was demonstrated by pathologic changes of lung tissue and increased level of CXCL-8. CS exposure also markedly decreased HDAC-2 expression. Moreover, a negative correlation was found between HDAC-2 activity and a lung destruction index. The index was restored to control levels with inhaled corticosteroid treatment in combination with a low, not a high, dose of theophylline. These results indicate that low-dose theophylline might provide protection from smoke damage and improve the anti-inflammatory effects of steroids by increasing HDAC-2 activity.

[Characteristics of histone deacetylase 9 in peripheral blood of patients with bronchial asthma].

OBJECTIVE: To investigate the expression pattern of histone deacetylase 9 (HDAC9) in peripheral blood of asthmatics and its effect on immune cells (Th2, Th17, Tregs) involved in the pathogenesis of asthma. METHODS: Forty-seven asthmatics from Ruijin Hospital were recruited and assigned to intermittent, mild and moderate-severe groups. Lung function test and Asthma Control Questionnaire were performed to evaluate asthma control and severity. Twenty healthy donors were enrolled as controls. GATA3, IL-4, and HDAC9 mRNA expression levels were measured by SYRB Green Real-time PCR. The cytokine IL-17-mainly produced by Th17 cells and TGF-ß-mainly produced by Treg cells, were measured by ELISA. RESULTS: The GATA3 and IL-4 mRNA expression levels (28.12 ± 7.57 and 743.6 ± 312.8) were up-regulated in asthmatics as compared to the healthy controls [0.56 ± 0.22, 0.7 ± 0.8 (U = 16.00, 37.00, P < 0.01)]. The HDAC9 mRNA expression levels of intermittent, mild and moderate-severe groups were 3.20 ± 0.50, 89.6 ± 18.0, 323.0 ± 65.3, respectively, which were associated with the severity of disease (H = 11.32, P < 0.05). The level of IL-17 in asthmatic group was (83 ± 55) ng/L, which was up-regulated as compared to the healthy control [(34 ± 22) ng/L (U = 153.50, P < 0.01)]. The level of TGF-ß was decreased in the asthmatic groups as compared to the healthy control, but the difference did not reach significance. HDAC9 mRNA expression level was positively correlated with GATA3 mRNA expression level (r = 0.482, P < 0.05), and also with IL-4 mRNA expression (r = 0.432, P < 0.05) and IL-17 (r = 0.538, P < 0.05), but negatively correlated with TGF-ß (r = -0.417, P < 0.05). In patients with moderate-severe asthma, HDAC9 mRNA expression level was negatively correlated with FEV(1)% (r = -0.657, P < 0.05). CONCLUSION: HDAC9 mRNA expression was up-regulated in peripheral blood of asthmatics, which was not only associate with the Th2 master transcriptional factors GATA3, cytokine IL-4 mRNA, Th17 and Treg cell-related cytokines, but also with FEV(1)% in moderate-severe asthma.

Lack of association between the TGF-ß(1) gene and development of COPD in Asians: a case-control study and meta-analysis.

Abnormalities in the transforming growth factor-ß(1) (TGF-ß(1)) gene are thought to be linked to chronic obstructive pulmonary disease (COPD). We investigated the association between the single nuclear polymorphisms (SNPs) of TGF-ß(1) and the risk of COPD in a case-control study and meta-analysis. We genotyped 160 cases and 177 control subjects in a local hospital using the Mass-Array(TM) Technology Platform and then tested the association of four SNPs in TGF-ß(1) (rs6957, rs1800469, rs2241712, and rs2241718) with COPD. Plasma TGF-ß(1) level measurement was performed later. A database covering all papers published up to October 30, 2010, was then reviewed. Statistical analysis was performed using Revman 5.0 and STATA 11.0 software. No association was found between TGF-ß(1) gene SNPs and an increased risk of COPD in Asians. By meta-analysis, the link of two polymorphisms, rs1800469 and rs1982073, was investigated in seven and eight studies, respectively, involving 1,508 COPD patients and 2,608 control subjects. The results showed that there was no significant association between an increased risk of COPD in carriers of the T allele (TT+TC) versus the CC genotype in rs1800469 and rs1982073. In ethnic subgroup analysis, the risk of COPD associated with the rs1800469 T allele was not significantly elevated among Asians. TGF-ß(1) gene polymorphisms are not associated with an increased risk of COPD in the Asian population.

Evaluation of the Chinese versions of the Minnesota nicotine withdrawal scale and the questionnaire on smoking urges-brief.

OBJECTIVES: To evaluate the reliability and validity of the Chinese versions of Minnesota Nicotine Withdrawal Scale and Questionnaire on Smoking Urges-Brief (MNWS-C and QSU-Brief-C) in Chinese smokers. DESIGN AND METHODS: MNWS and QSU-Brief were translated into Chinese version through 10 steps. The reliability and validity of Chinese versions of the two scales were evaluated based on the data collected from 354 subjects. Cronbach's alpha coefficient was calculated to assess the reliability. Construct validity were evaluated with confirmatory factor analysis. Criteria validity was examined with correlation analysis between scale scores and patient-evaluated scores of craving and tobacco withdrawal symptoms. RESULTS: Cronbach's alpha coefficient of QSU-Brief-C was .96. Confirmatory factor analysis demonstrated that the fit indexes (adjusted goodness-of-fit index [AGFI], comparative fit index [CFI], normed fit index [NFI], and non-normed fit index [NNFI]) exceeded or approached 0.9. The correlation between QSU-Brief-C scores and patient-evaluated craving scores were statistically significant(r = .75, p < .0001). Cronbach's alpha coefficient of MNWS-C was .90. Confirmatory factor analysis demonstrated that the fit indexes (AGFI, CFI, NFI, and NNFI) exceeded 0.9. The correlation between MNWS-C scores and patient-evaluated discomfort scores were statistically significant(r = .68, p < .0001). CONCLUSION: Both QSU-Brief-C and MNWS-C have satisfactory validity and reliability and retain the two dimensions identified in their corresponding original English versions, which suggest that QSU-Brief-C and MNWS-C can be used in further research and clinical evaluation in Chinese smoking population with acceptable validity and reliability.

Quantification of circulating cell-free DNA in the serum of patients with obstructive sleep apnea-hypopnea syndrome.

Serum cell-free DNA concentrations have been reported to increase in many acute diseases as well as in some chronic conditions such as cancer and autoimmune diseases. The aim of this study was to examine whether serum DNA concentrations were elevated in patients with obstructive sleep apnea-hypopnea syndrome (OSAHS). The effects of nasal continuous positive airway pressure (nCPAP) on serum DNA were also investigated. One hundred twenty-seven people diagnosed with OSAHS by polysomnography (PSG) were admitted into the OSAHS group, and 52 subjects without OSAHS were recruited for the control group. The OSAHS group was further divided into mild, moderate, and severe OSAHS subgroups based on their apnea-hypopnea index (AHI) during sleep. Ten patients with moderate and severe OSAHS were treated with nCPAP. Serum DNA, interleukin-6 (IL-6), and malonaldehyde (MDA) concentrations were measured and were found to be significantly higher in patients with moderate and severe OSAHS groups than those in the mild OSAHS and control groups (p < 0.05). Univariate analysis showed that serum DNA correlated positively with AHI, oxygen desaturation index (ODI), IL-6, and MDA, and negatively correlated with minimal oxygen saturation (miniSaO(2)) (all p < 0.05). In stepwise multiple regression analysis, only MDA and miniSaO(2) were suggested as significant independent predictors for the serum DNA concentrations. After 6 months of nCPAP therapy, serum concentrations of DNA, IL-6, and MDA were significantly decreased (p < 0.05). The increasing concentration of serum DNA in patients with OSAHS was positively correlated with disease severity. Serum DNA may become an important parameter for monitoring the severity of OSAHS and effectiveness of therapy.

[Characteristics of chronic obstructive pulmonary disease phenotypes based on high-resolution CT and the relationship with interleukin-6].

OBJECTIVE: To classify the high-resolution CT (HRCT) phenotypes of COPD, and to investigate the clinical characteristics of various phenotypes and the relationship with airway inflammation. METHODS: Chest HRCT and pulmonary function tests were performed in 84 COPD patients. The patients were classified into 3 phenotypes according to the visual HRCT findings. Exhaled breath condensate was gathered from 30 patients and the interleukin (IL)-6 level was measured by ELISA. RESULTS: The COPD patients were classified into 3 phenotypes: Phenotype A, absence of emphysema, with or without bronchial wall thickening (n = 34); Phenotype E, emphysema without bronchial wall thickening (n = 23); and Phenotype M, emphysema with bronchial wall thickening (n = 27). The 3 phenotypes of COPD showed different characteristics in several aspects. Patients with phenotype A showed a higher body mass index [(25.1 +/- 4.4) kg/m(2) vs phenotype E (22.5 +/- 4.1) kg/m(2) and phenotype M (21.3 +/- 3.4) kg/m(2), F = 6.732, P < 0.01]. The prevalence of patients with milder dyspnea was lower in phenotype A compared with others (15/34) vs phenotype E (2/23) and phenotype M (6/27), chi(2) = 9.097, P < 0.05. The patients who complained of severe expectoration in phenotype E were fewer than those in other groups (0/23) vs phenotype A (2/34) and phenotype M (4/27), chi(2) = 8.702, P < 0.05. The FEV(1)/FVC and FEV(1)% in phenotype M [(53 +/- 14)% and (51 +/- 25)%] were significantly lower as compared with those in other phenotypes [(67 +/- 11)% and (72 +/- 24)% in phenotype A, and (53 +/- 14)% and (52 +/- 26)% in phenotype E], F = 10.252, F = 6.508, P < 0.01. The ratio of inspiratory capacity to total lung capacity (IC/TLC) in phenotype A was higher [phenotype A (41 +/- 17)%, phenotype E (33 +/- 13)%, phenotype M (28 +/- 13)%, F = 5.964, P < 0.01], while the ratio of residual volume to total lung capacity (RV/TLC) was lower [phenotype A (37 +/- 9)%, phenotype E (44 +/- 10)%, phenotype M (45 +/- 8)%, F = 6.954, P < 0.01]. Patients with different phenotypes showed various levels of IL-6 in exhaled breath condensate [phenotype A (19.9 +/- 6.3) ng/L, phenotype E (16.7 +/- 2.1) ng/L, phenotype M (25.6 +/- 4.4) ng/L, F = 7.749, P < 0.01]. CONCLUSION: Various morphological phenotypes of COPD based on HRCT showed different clinical characteristics and airway inflammation.

[Atypical pathogens in adult patients admitted with community-acquired pneumonia].

OBJECTIVE: To investigate the current status of atypical pathogen associated infections in community-acquired pneumonia (CAP) in adults, and their clinical attributes. METHODS: Clinical data, sputum specimens from acute phase, and paired sera from acute- and convalescent-phases of CAP in 153 adult patients were collected from May 2005 to May 2008 in multiple medical centers. Chlamydia pneumoniae (Cpn) IgG antibody, and Legionella pneumophila (LP) mixed IgG, IgA and IgM antibodies were determined by indirect immuno-fluorescent assay. Mycoplasma pneumoniae (Mpn) mixed IgG, IgA and IgM antibodies were determined by passive agglutination assay. All the sputum specimens were routinely cultured for bacterial isolation. RESULTS: Fifty-two (34%) out of the 153 cases were diagnosed as atypical CAP per the paired serum-antibody assay. Forty-seven of the 52 atypical CAP cases were infected by one atypical pathogen, 38 with Cpn, 4 with Mpn, and 5 with LP, while 5 out of the 52 atypical CAP cases were infected by 2 pathogens, Cpn and Mpnin 2, Cpn and LP in 3 cases. Eleven cases (21.2%) out of the 52 patients with atypical pneumonia were complicated with bacterial infection. Except peripheral white blood count was significant increased in the group of typical (bacterial only) pneumonia (WBC > 10 × 109)/L, P = 0.03), all the other clinical parameters did not show statistically significant difference between the typical and the atypical pneumonia groups. CONCLUSIONS: Our data suggest that Chlamydia pneumoniae, Mycoplasma pneumoniae and Legionella pneumophila are common pathogens of adult CAP. Chlamydia pneumoniae might be the most frequent atypical pathogen associated with atypical CAP.

Up-regulation of two actin-associated proteins prompts pulmonary artery smooth muscle cell migration under hypoxia.

Hypoxia stimulates the migration of pulmonary artery smooth muscle cells (PASMCs), which contributes to the pathogenesis of pulmonary vessel structural remodeling in hypoxic pulmonary hypertension (HPH). In the present study, we found, using a proteomics-based method, that gelsolin-like actin-capping protein (CapG) and transgelin were preferentially expressed in human (h)PAMSCs under hypoxia compared with normoxia. These two actin-associated proteins, modulate a variety of physiologic processes, including motility of cells, by interacting differently with the actin cytoskeleton. Our study showed that these two genes were up-regulated at both mRNA and protein levels under hypoxia in hPASMCs. As a key transcriptional regulation factor under hypoxia, hypoxia-inducible factor 1alpha (HIF-1alpha) up-regulated CapG protein expression under normoxia, and knockdown of HIF-1alpha expression in hPASMCs also inhibited hypoxia induced CapG up-regulation. However, HIF-1alpha could not regulate transgelin expression. Reduction of CapG or transgelin expression in hPASMCs by RNA interference was accompanied by significantly impaired migration ability in vitro, especially under hypoxia. Our study demonstrates that CapG and transgelin were preferentially expressed in hPAMSCs under hypoxia compared with normoxia. Hypoxia stimulates expression of these two actin-associated proteins via HIF-1alpha-dependent and -independent pathways, respectively. The up-regulation of these two proteins may contribute to the increased motility of hPASMCs under hypoxia. These findings may contribute to the understanding of the pathogenesis of HPH.

Role of HIF-1alpha in the regulation ACE and ACE2 expression in hypoxic human pulmonary artery smooth muscle cells.

Angiotensin-converting enzyme (ACE) enhances the proliferation and migration of pulmonary artery smooth muscle cells (PASMCs), which contribute to the pathogenesis of hypoxic pulmonary hypertension (HPH). Previous reports have demonstrated that hypoxia upregulates ACE expression, but the underlying mechanism is unknown. Here, we found that ACE is persistently upregulated in PASMCs on the transcriptional level during hypoxia. Hypoxia-inducible factor 1alpha (HIF-1alpha), a key transcription factor activated during hypoxia, was able to upregulate ACE protein expression under normoxia, whereas knockdown of HIF-1alpha expression in PASMCs inhibited hypoxia-induced ACE upregulation. Furthermore, HIF-1alpha can bind and transactivate the ACE promoter directly. Therefore, we report that ACE is a novel target of HIF-1alpha. Recently, a homolog of ACE, ACE2, was reported to counterbalance the function of ACE. In contrast to ACE, we found that ACE2 mRNA and protein levels increased during the early stages of hypoxia and decreased to near-baseline levels at the later stages after HIF-1alpha accumulation. Thus HIF-1alpha inhibited ACE2 expression, and the accumulated ANG II catalyzed by ACE is a key mediator in the downregulation of ACE2 by HIF-1alpha. Moreover, a reduction of ACE2 expression in PASMCs by RNA interference was accompanied by significantly enhanced proliferation and migration during hypoxia. We conclude that ACE is directly regulated by HIF-1alpha, whereas ACE2 is regulated in a bidirectional way during hypoxia and may play a protective role during the development of HPH. In sum, these findings contribute to the understanding of the pathogenesis of HPH.

Different expression of mimecan as a marker for differential diagnosis between NSCLC and SCLC.

Mimecan mRNA was present in a limited number of mouse and human tissues, however, abundant mimecan mRNA was observed in the lung tissue. Therefore, we hypothesize that mimecan could serve as a biomarker for differentiating various histological types of lung cancers. In humans, the mimecan mRNA was found most abundant in ovary and less abundant in lung by using Northern blot analysis. Moreover, the mimecan was expressed strongly in the epithelial cells of the bronchial wall and weaker in the epithelial cells of the alveolar sacs by in situ hybridization and immunohistochemical analysis. Furthermore, the mimecan immunoreactivity was found in 103 (97.2%) of 106 non-small cell lung cancers (NSCLCs). Nevertheless, a large majority of small cell lung cancers (SCLCs) (50/56, 89.3%) showed negative immunoreactivity to mimecan polyclonal antibody. A significant difference of mimecan immunoreactivity was found between NSCLC and SCLC (P<0.00001). This is the first study showing that mimecan could serve as an excellent pathological biomarker to distinguish NSCLCs from SCLCs.

BMI is an independent risk factor for snoring in Chinese women aged over 30 years.

OBJECTIVE: The study was designed to analyze body mass index (BMI) as one of risk factors for snoring in Chinese women. MATERIALS AND METHODS: Totally, 2,938 women (2,423 available for evaluation of menstrual status) aged over 30 years from a population-based epidemiologic study were enrolled. RESULTS AND DISCUSSIONS: For those with regular menstrual status, BMI was the main risk factor with OR 3.906 (BMI >or=25 kg/m(2)) and 8.467 (BMI >or=30 kg/m(2)), respectively, compared with those of BMI 20-25 kg/m(2) (p < 0.001). For postmenopausal women, BMI was also indicated as a risk factor with OR 2.041 (BMI >or=25 kg/m(2)) and 2.884 (BMI >or=30 kg/m(2)) compared with those of BMI 20-25 kg/m(2) (p < 0.01). As for different BMI, menopause was the only risk factor for women with BMI < 20 kg/m(2) (OR = 10.568, p < 0.05). Whereas for those with BMI between 20 and 25 kg/m(2), the risk factors included post-menopause, family history, drinking, etc. CONCLUSION: In conclusion, the prevalence of snoring was correlated with BMI independent of menstrual status, and lower BMI is a protective factor against snoring in premenopausal women.

[Lipid frofile and hemorheology in obstructive sleep apnea-hypopnea syndrome.].

OBJECTIVE: To investigate whether there was a correlation between lipid level, hemorheology and the obstructive sleep apnea hypopnea syndrome. METHODS: Two hundred and thirty-one subjects in our sleep respiratory disease center between 2006 and 2009 were included. Eighty nine were obese OSAHS subjects, 62 were non-obese OSAHS subjects, 40 were obese subjects without OSAHS (obese group) and 40 were non-obese subjects without OSAHS (control group). We examined and compared the lipid profile and hemorheology in all subjects. RESULTS: In obese OSAHS group, the levels of triglyceride (TG) [(2.74 +/- 2.02) mmol/L], cholesterol (TC) [(5.14 +/- 0.96) mmol/L] were higher and HDL [(1.13 +/- 0.36) mmol/L], apoA-I [(1.20 +/- 0.20) mmol/L] were lower, compared to the non-obese OSAHS group (F = 7.77, 7.99, all P < 0.01). The level of the whole blood viscosity in obese OSAHS group was significantly higher than that in non-obese OSAHS group (F = 8.81-11.99, P < 0.05). There was no significant difference in blood lipid levels among the 2 study groups:non-obese OSAHS and control group, obese OSAHS and obese group (F = 6.42 - 11.99, P > 005). The levels of the whole blood viscosity and HCT were significantly higher in non-obese OSAHS group than in control group (F = 0.41 - 2.23, P < 0.05); obese OSAHS group were higher than obese group (F = 0.12 - 2.10, P < 0.05). No significant difference in blood lipid levels was noted among the 4 non-obese groups with different disease severity; similar result was also observed among obese OSAHS groups. CONCLUSIONS: Obesity is responsible for dyslipidemia in OSAHS. OSAHS has no significant correlation with lipid abnormalities, but it significantly correlates with hemorheology disorder.

Normal lung attenuation distribution and lung volume on computed tomography in a Chinese population.

Backgroud and objectives: Although lung attenuation distribution and lung volume on computed tomography (CT) have been widely used in evaluating COPD and interstitial lung disease, there are only a few studies regarding the normal range of these indices, especially in Chinese subjects. We aimed to describe the normal range of lung attenuation distribution and lung volume based on CT. Methods: Subjects with normal lung function and basically normal chest CT findings (derivation group) at Ruijin Hospital, Shanghai (from January 2010 to June 2014) were included according to inclusion and exclusion criteria. The range of the percentage of lung volume occupied by low attenuation areas (LAA%), percentile of the histogram of attenuation values (Perc n), and total lung volume were analyzed. Relationships of these measures with demographic variables were evaluated. Participants who underwent chest CT examination for disease screening and had basically normal CT findings served as an external validation group. Results: The number of subjects in the derivation group and external validation groups were 564 and 1,787, respectively. Mean total lung volumes were 4,468±1,271 mL and 4,668±1,192 mL, and median LAA%(-950 HU) was 0.19 (0.03-0.43) and 0.17 (0.01-0.41), in the derivation and external validation groups, respectively. Reference equations for lung volume and attenuation distribution (LAA% using -1,000-210 HU, Perc 1 to Perc 98) were generated: Lung volume (mL) = -1.015 *10^4+605.3*Sex (1= male, 0= female)+92.61*Height (cm) -12.99*Weight (kg) ±1766; LAA% (-950 HU)=[0.2027+0.05926*Sex (1= male, 0= female) -4.111*10^-3*Weight (kg) +4.924*10^-3*Height (cm) +8.504*10^-4*Age]^7.341-0.05; Upper limit of normal range: [0.2027+0.05926*Sex-4.111*10^-3*Weight+4.924*10^-3*Height+8.504*10^-4*Age+0.1993]^7.341-0.05. Conclusion: This large population-based retrospective study demonstrated the normal range of LAA%, Perc n, and total lung volume measured on CT scans among subjects with normal lung function and CT findings. Reference equations are provided.

Add-on Tiotropium in Chinese Patients With Moderate Asthma: A Pooled Subgroup Analysis of MezzoTinA-Asthma 1 and 2.

PURPOSE: Asthma affects approximately 30 million patients in China; however, tiotropium data for Chinese patients is limited. This study aimed to assess the efficacy and safety of tiotropium in Chinese patients with moderate symptomatic asthma. METHODS: A post hoc subgroup analysis was conducted on 430 Chinese patients pooled from two 24-week, replicate phase 3 trials (NCT01172808 and NCT01172821), in which they received once-daily tiotropium 2.5 µg (Tio R2.5) or 5 µg (Tio R5) (n = 106 or 109, respectively), twice-daily salmeterol 50 µg (Sal 50) (n = 110), or placebo (n = 105), while maintaining inhaled corticosteroids (ICS). The co-primary endpoints assessed in week 24 were forced expiratory volume in 1 second (FEV1) peak0-3h response, trough FEV1 response, and responder rate as assessed using the Asthma Control Questionnaire (ACQ). RESULTS: For both FEV1 peak0-3h responses and trough FEV1 responses, the mean treatment differences were greater for Tio R2.5, Tio R5, and Sal 50 compared with placebo at 0.249 L, 0.234 L, and 0.284 L, and 0.172 L, 0.180 L, and 0.164 L, respectively (P < 0.001). The ACQ responder rate in placebo, Tio R2.5, Tio R5, and Sal 50 was 58.7%, 62.3%, 59.3%, and 69.1%, respectively. Furthermore, 11 (2.6%) of 430 patients had serious adverse events (Tio R5, n = 4; Tio R2.5, n = 1; Sal 50, n = 1; and placebo, n = 5). CONCLUSIONS: Once-daily tiotropium, as add-on to medium-dose ICS, was effective and well tolerated for Chinese patients with moderate symptomatic asthma, consistent with the main analysis.