Short-term effect of particulate matter on lung function and impulse oscillometry system (IOS) parameters of chronic obstructive pulmonary disease (COPD) in Beijing, China.

OBJECTIVE: This study aimed to evaluate the associations between particulate matter (PM), lung function and Impulse Oscillometry System (IOS) parameters in chronic obstructive pulmonary disease (COPD) patients and identity effects between different regions in Beijing, China. METHODS: In this retrospective study, we recruited 1348 outpatients who visited hospitals between January 2016 and December 2019. Ambient air pollutant data were obtained from the central monitoring stations nearest the participants' residential addresses. We analyzed the effect of particulate matter with aerodynamic diameter ≤ 2.5 µm (PM2.5) exposure on lung function and IOS parameters using a multiple linear regression model, adjusting for sex, smoking history, education level, age, body mass index (BMI), mean temperature, and relative humidity . RESULTS: The results showed a relationship between PM2.5, lung function and IOS parameters. An increase of 10 µg/m3 in PM2.5 was associated with a decline of 2.083% (95% CI: -3.047 to - 1.103) in forced expiratory volume in one second /predict (FEV1%pred), a decline of 193 ml/s (95% CI: -258 to - 43) in peak expiratory flow (PEF), a decline of 0.932% (95% CI: -1.518 to - 0.342) in maximal mid-expiratory flow (MMEF); an increase of 0.732 Hz (95% CI: 0.313 to 1.148) in resonant frequency (Fres), an increase of 36 kpa/(ml/s) (95% CI: 14 to 57) in impedance at 5 Hz (Z5) and an increase of 31 kpa/(ml/s) (95% CI: 2 to 54) in respiratory impedance at 5 Hz (R5). Compared to patients in the central district, those in the southern district had lower FEV1/FVC, FEV1%pred, PEF, FEF75%, MMEF, X5, and higher Fres, Z5 and R5 (p < 0.05). CONCLUSION: Short-term exposure to PM2.5 was associated with reductions in lung function indices and an increase in IOS results in patients with COPD. The heavier the PM2.5, the more severe of COPD.

Interaction between slow wave sleep and elevated office blood pressure in non-hypertensive obstructive sleep apnea patients: a cross-sectional study.

Purpose: Reduced slow wave sleep (SWS) has been linked to hypertension in some studies. The aim of the study is to investigate the association between SWS and office blood pressure (BP) in non-hypertensive obstructive sleep apnea (OSA).Methods: This is a retrospective study of 3350 patients who underwent polysomnography (PSG) in our hospital. Based on quartiles of percent SWS, participants were classified into four groups. BP was measured manually on the randomly chosen arm in a seated position with sphygmomanometer after PSG in the morning, and the average of the second and third measurements was used for this analysis. Elevated office BP was defined as a systolic BP≥140 mmHg or diastolic BP≥90 mmHg.Results: There were 1365 patients with OSA and 597 primary snorers included in our study. In OSA group, OSA patients with SWS <13.5% had a significant elevated risk with elevated office BP (OR,1.49[95%CI 1.05-2.10], P=0.025), compared to the highest quartile (percent SWS >39.2%). However, no significant relationship between decreased SWS and elevated office BP was found in primary snorers group.Conclusion: In non-hypertensive OSA patients, decreased SWS is associated with elevated office BP.

This is the first study to investigate the association between decreased SWS and incident elevated office BP in non-hypertensive OSA patients.Our results found that in non-hypertensive OSA patients, decreased SWS is associated with elevated office BP.The relationship between decreased SWS and elevated office BP in OSA patients was evident especially in men and in those <60 years old.

Association Between Sleep Efficiency and Hypertension in Chinese Obstructive Sleep Apnea Patients.

Objective: We aimed to explore the relationship of sleep efficiency (SE) with the prevalence of hypertension in Chinese obstructive sleep apnea (OSA) patients based on polysomnography (PSG) records. Methods: We studied 2360 patients with OSA and 764 primary snorers who underwent PSG in our hospital. SE was divided into three grades, including ≥85%, 80%~84.9%, and <80%. Hypertension was defined based either on direct blood pressure measurements, under anti-hypertensive treatments or on physician diagnosis. Multivariate logistic regression models were conducted to investigate the association between SE and hypertension. Results: After adjusting for potential confounding factors, OSA patients with <80% SE and those with 80% to 84.9% SE were significantly associated with the prevalence of hypertension (OR = 1.248, 95% CI 1.018~1.531, P=0.033; OR = 1.380, 95% CI 1.040~1.832, P=0.026). Compared to primary snorers, OSA combined with <85% SE increased the odds of hypertension. In stratified analysis by SE, risk of hypertension only in those with <80% SE was significantly different between OSA and primary snorers. Furthermore, this relationship between reduced SE and hypertension was evident especially in female, younger ages, obese, moderate and severe OSA patients. No significant relationship between reduced SE and hypertension was found in primary snores group. Conclusion: We found that poor SE was correlated with the prevalence of hypertension in Chinese OSA patients, but not in those with primary snoring. Moreover, this relationship was evident especially in female, younger ages, obese, moderate and severe OSA patients.

Remission of hepatotoxicity in chronic pulmonary aspergillosis patients after lowering trough concentration of voriconazole.

BACKGROUND: Chronic pulmonary aspergillosis (CPA) is a rare syndrome that is often accompanied by gradual lung tissue destruction. Voriconazole is usually employed as the first-line agent for CPA treatment. However, some patients can develop hepatotoxicity and often were forced to stop voriconazole treatment. AIM: To record the improving trend of liver function and the therapeutic effects in patients after lowering the trough concentration of voriconazole. METHODS: This study retrospectively analyzed 12 adult CPA patients who developed hepatotoxicity during the voriconazole treatment. In these patients, the oral dose was reduced to 3/4 or 1/2 of the standard dose (4 mg/kg, twice daily), and the lower limit of voriconazole trough concentration was maintained more than 0.5 µg/mL. The trend of remission of liver toxicity after drug reduction in 12 patients was recorded. During the same period, 25 patients who received standard doses served as the control group. Data from the two groups were collected and analyzed for different parameters such as demographic characteristics, underlying pulmonary disorders, laboratory tests, and therapeutic effect. The differences between the two groups were statistically compared. RESULTS: Hepatotoxicity occurred in 12 patients within 28-65 d after oral voriconazole treatment. Hepatotoxicity was mainly manifested by the significantly increased level of gamma-glutamyltransferase and a slight increase of alanine aminotransferase and aspartate aminotransferase. The oral dose of voriconazole was reduced to approximately 3 mg/kg in seven patients and approximately 2 mg/kg in five patients. The average trough concentrations for the 12 patients before and after voriconazole oral dose reduction were 3.17 ± 1.47 µg/mL (1.5-6.0 µg/mL) and 1.70 ± 0.78 µg/mL (0.6-3.3 µg/mL), respectively (P = 0.02). After lowering the trough concentrations, the hepatotoxicity was alleviated in all the patients. However, gamma-glutamyltransferase levels declined slowly. After 4 mo of treatment, 7 of the 12 patients were successfully treated in the low trough concentrations group (41.7%). Similarly, 8 of the 25 patients in the standard treatment dose group (32.0%) were effectively treated. There was no statistical difference between the groups (P = 0.72). CONCLUSION: Reducing the lower limit of the voriconazole trough concentration to 0.5 µg/mL can alleviate the hepatotoxicity and maintained certain clinical efficacy in CPA patients; however, patients should be closely monitored.

Relationship Between Particulate Matter (PM2.5) and Hospitalizations and Mortality of Chronic Obstructive Pulmonary Disease Patients: A Meta-Analysis.

BACKGROUND: Numerous studies have reported associations between particulate matter with aerodynamic diameters of ≤2.5 µm (PM2.5) and chronic obstructive pulmonary disease (COPD) hospitalizations and mortality in cities worldwide. Nonetheless, the evidence of an association remains varied and limited. METHODS: Systematic searches were conducted in 6 common English and Chinese electronic databases (i.e., PubMed, Web of Science, EMBASE, Ovid, Google Scholar, and China National Knowledge Infrastructure [CNKI]). A meta-analysis was performed to estimate the odds ratio (OR) to evaluate the relationship between PM2.5 and COPD hospitalizations and mortality. Publication bias and heterogeneity of samples were tested using a funnel plot and the Egger's test. Studies were analyzed using either a random-effect model or a fixed-effect model. RESULTS: The search yielded 18 studies suitable for meta-analysis during the period from Jan 1, 2010 to Dec 31, 2018. A 10-µg/m³ increase in PM2.5 was associated with a 2.5% (95% confidence interval [CI]: 1.8-3.2%) increase in COPD hospitalizations, with an OR of 1.025 (95% CI: 1.018-1.032), and a 1.5% (95% CI: 0.9-2.2%) increase in COPD mortality, with an OR of 1.015 (95% CI: 1.009-1.022). Comparing different age groups, elderly people were more sensitive to the adverse effects. The estimated risk was higher in European countries than Asian countries, and in warm compared cold seasons. Various additional confounding factors also led to different results. CONCLUSIONS: PM2.5 is associated with COPD hospitalizations and mortality. Controlling ambient air pollution would provide benefits to COPD patients.

Effect of basic fibroblast growth factor on the proliferation, migration and phenotypic modulation of airway smooth muscle cells.

BACKGROUND: Proliferation, cell migration and phenotypic modulation of airway smooth muscle cells (ASMCs) are important features of airway remodelling in asthma. The precise cellular and molecular mechanisms that regulate ASMCs proliferation, migration and phenotypic modulation in the lung remain unknown. Basic fibroblast growth factor (bFGF), a highly specific chemotactic and mitogenic factor for many cell types, appears to be involved in the development of airway remodelling. Our study assessed whether bFGF directly stimulates the proliferation, migration and phenotypic modulation of ASMCs. METHODS: Confluent and growth arrested human ASMCs were treated with human recombinant FGF. Proliferation was measured by BrdU incorporation and cell counting. Migration was examined using Boyden chamber apparatus. Expressions of smooth muscle (sm)-alpha-actin and sm-myosin heavy chain (MHC) isoform 1 were determined by RT-PCR and Western blot analysis. RESULTS: It was found that hrbFGF (10 ng/ml), when added to ASMCs, induced a significant increase in BrdU uptake and cell number by ASMCs as compared to controls and a significant increase in ASMCs migration with respect to controls. The mRNA and protein expressions of sm-alpha-actin and sm-MHC in ASMCs that were stimulated with hrbFGF decreased with respect to controls. CONCLUSION: It appears that bFGF can directly stimulate proliferation and migration of ASMCs, however, the expressions of cells' contractive phenotype decreased.

[Assessment of asthma control and insights of asthmatic outpatients in Beijing urban districts].

OBJECTIVE: To evaluate the asthma control and insights of asthmatic outpatients in Beijing urban districts and to provide the basis for drawing up a work plan for Beijing Asthma Alliance. METHODS: We performed a investigation by a questionnaire in a face-to-face method in asthmatic outpatients. A total of 6 teaching hospitals distributed in the 6 different Urban districts participated in this study. RESULTS: A total of 527 asthmatic patients completed the questionnaire. The percentage of asthmatic patients who had various social insurance was 87.1% (459/527). According to the GINA standards the disease classification was 19.2% (101/527), 26.0% (137/527), 36.8% (194/527) and 18.0% (95/527) respectively in intermittent, mild persistent, moderate persistent and severe persistent asthma. The results showed that 19.5% (103/527) of respondents had been admitted to hospital and 29.2% (154/527) had visited a hospital emergency because of exacerbation during the past year. The percentage of adults with lost workdays was 33.8% (76/225) and 4 students of 22 school-aged asthmatic patients (4/22, 18.2%) had lost school days. The rates of complete control and well control were 25.2% (133/527) and 27.7% (146/527) respectively. Only 46.1% (243/527) of respondents had undergone lung function tests during the past year. Approximately one fourth of respondents 23.1% (122/527) had owned peak flowmeter. Only 6.1% (32/527) reported regular use of peak flowmeter. The percentage of regular inhaled corticosteroids was 59.6% (314/527). The level of knowledge for asthma management had improved significantly. CONCLUSION: With the implementation of patient education program and asthma guideline, the asthma control level improved further and the knowledge for disease management also improved obviously.

[Relative functional changes in neutrophils in early period of acute lung injury in rabbit].

OBJECTIVE: To explore the relationship of interleukin-8 (IL-8), adherence function of neutrophil (PMN) and acute lung injury (ALI). METHODS: Eighteen male New Zealand rabbits were divided into two groups randomly: the control group (n=8) and the ALI group (n=10). The model of ALI was replicated by using intravenous lipopolysaccharide (LPS) in the rabbits of group ALI. Blood pressure, heart rate, blood gas analysis, hemogram, CD11b expression intensity on the surface of PMN, concentration of serum IL-8 and malondialdehyde (MDA) were measured at each time point. Specimens for pathology were obtained at the end of experiment. RESULTS: In group ALI, blood pressure, heart rate and pH declined obviously. PMN count was lowered obviously at 3 hours and increased at 6 hours to some extent. CD11b expression intensity on the surface of PMN, the concentration of serum IL-8 and MDA were increased progressively (all P<0.05). The main changes in the microscopic examination were inflammatory granulocyte infiltration, disseminated thickening of alveolar septa and focal hemorrhages. There were significant correlations between CD11b and IL-8 (r2=0.813, Y=26.729X), and between CD11b and the grades of pathological changes at 6 hours after intravenous LPS (r2=0.771, Y=0.011 02X+5.292). CONCLUSION: LPS could induce the release of large amount of IL-8, and it activates the expression of CD11b on the surface of PMN, which shows high degree of correlation with IL-8 and the degree of pathological changes in the lung. Therefore, both of them could serve as sensitive indexes for the diagnosis of ALI.

The cross-sectional and longitudinal association of the BODE index with quality of life in patients with chronic obstructive pulmonary disease.

BACKGROUND: The body mass index, airflow obstruction, dyspnea, and exercise capacity (BODE) index was shown at predicting the risk of death, exacerbation and disease severity among patients with COPD, but few studies verified relationship between BODE index and health related quality of life (HRQoL) among Chinese COPD patients. The objective of this study was to evaluate the relationship between BODE index and HRQoL in cross-sectional and longitudinal association analyses. METHODS: A multi-center prospective cohort study was initially conducted in 491 stable COPD patients in Beijing, China. Health status (HRQoL) was assessed by St. George's Respiratory Questionnaire (SGRQ); the BODE index was calculated for each patient; dyspnea was assessed using the 5-grade Medical Research Council dyspnea scale. Other measurements included socio-demographic, body mass index (BMI), lung function test and 6-minute-walk test (6MWT). Patients were then followed monthly for 12 months. RESULTS: Only 450 patients completed the 1-year follow up and were enrolled in our present analyses. Mean age was (65.2 +/- 10.6) years, men 309 (68.7%). The BODE index was categorized into 4 subgroups: 0 - 2, 3 - 4, 5 - 6 and 7 - 10. At baseline BODE index was gradually increased with baseline total SGRQ and SGRQ subscales (P trend < 0.001). For individual components of BODE index, with the decrease of airflow limitation, and 6MWD, and with the increase of Medical Research Council (MRC) dyspnea grade, total SGRQ and SGRQ subscales were increased correspondingly, P trend < 0.05, respectively. Similar association patterns were found between baseline BODE index and its individual components and mean SGRQ scores at the end of 1-year follow up. By multiple linear regression analyses, baseline BODE index was not only significantly associated with SGRQ score at baseline but also with SGRQ score at the end of 1-year follow up after adjustment for age, male, current smoking, betas being 0.434 and 0.378, respectively. CONCLUSIONS: BODE index is associated with SGRQ score cross-sectionally and longitudinally among stable COPD patients. BODE index might have potential to be used as a sensitive tool to assess the status of quality of life and to monitor disease progression among stable COPD patients.