Rapid on-site evaluation of routine biochemical parameters to predict right ventricular dysfunction in and the prognosis of patients with acute pulmonary embolism upon admission to the emergency room.

INTRODUCTION: Patients with acute pulmonary embolism(APE)who present with right ventricular dysfunction (RVD) have a worse prognosis. This study aimed to evaluate the value of routine biochemical parameters in predicting RVD and 30-day mortality in patients with APE. METHODS: We retrospectively collected the clinical data for 154 enrolled patients, including the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), D-dimer, cardiac troponin I (cTnI), and N-terminal pro-brain natriuretic peptide (NT-proBNP). We analyzed the correlation between RVD and the parameters and conducted a receiver operating characteristic (ROC) curve to confirm the cut-off values for predicting RVD and 30-day mortality. Formulas were built with relevant parameters to predict RVD and 30-day mortality. RESULTS: Age, NLR, PLR, D-dimer, the ratio of cTnI (+), and NT-proBNP (+) were significantly higher in RVD (+) patients. The ratio of cTnI (+) and NT-proBNP (+) in 30-day mortality (+) patients was significantly higher than that in 30-day mortality (-) patients. According to the logistic regression analysis, NLR, cTnI (+), and NT-proBNP (+) correlated with RVD. The formula for the RVD risk score is 0.072 × NLR+1.460 × NT-proBNP (+)+2.113 × cTnI (+), and the area under the curve (AUC) = 0.890 (95% CI: 0.839-0.941, P = .001). The formula for the 30-day mortality risk score is 0.115 × NLR + 2.046 × NT-proBNP (+) + 1.946 × cTnI (+) -0.016 × PLR, and the AUC = 0.903 (95% CI: 0.829-0.976, P = .001). CONCLUSIONS: The rapid on-site evaluation of routine biochemical parameters, including NLR, cTnI, and NT-proBNP levels, and the formula developed using these parameters are valuable for predicting RVD and 30-day mortality in patients with APE.

Hybrid video-assisted thoracic surgery with segmental-main bronchial sleeve resection for non-small cell lung cancer.

BACKGROUND: The purpose of the current study is to present the clinical and surgical results in patients who underwent hybrid video-assisted thoracic surgery with segmental-main bronchial sleeve resection. METHODS: Thirty-one patients, 27 men and 4 women, underwent segmental-main bronchial sleeve anastomoses for non-small cell lung cancer between May 2004 and May 2011. RESULTS: Twenty-six (83.9%) patients had squamous cell carcinoma, and 5 patients had adenocarcinoma. Six patients were at stage IIB, 24 patients at stage IIIA, and 1 patient at stage IIIB. Secondary sleeve anastomosis was performed in 18 patients, and Y-shaped multiple sleeve anastomosis was performed in 8 patients. Single segmental bronchiole anastomosis was performed in 5 cases. The average time for chest tube removal was 5.6 days. The average length of hospital stay was 11.8 days. No anastomosis fistula developed in any of the patients. The 1-, 2-, and 3-year survival rates were 83.9%, 71.0%, and 41.9%, respectively. CONCLUSION: Hybrid video-assisted thoracic surgery with segmental-main bronchial sleeve resection is a complex technique that requires training and experience, but it is an effective and safe operation for selected patients.

Expression and significance of miRNA-21 and BTG2 in lung cancer.

This study investigates the expression of micro-ribonucleic acid-21 (miRNA-21) and B cell translocation gene 2 (BTG2) in lung cancer cells. We examined the impact of miRNA-21 on biological characteristics of lung cancer cells, such as growth, proliferation, apoptosis, and invasion. The expression of miRNA-21 and BTG2 protein in lung cancer cell lines (A549, HCC827, NCI-H292, and 95-D) was examined using quantitative reverse transcription-polymerase chain reaction and Western blot analysis, respectively. Subsequently, the regulatory role of miRNA-21 on BTG2 was explored by inhibiting miRNA-21 expression in 95-D cells using miRNA-21-antisense oligonucleotides (miRNA-21 ASO). The impact of miRNA-21 on the biological characteristics of 95-D cells was further studied using methylthiazol tetrazolium assays, flow cytometry, and Transwell invasion chamber assays. The impact of miRNA-21 on the expression of cyclin D1, caspase-3, and matrix metalloprotease-9 (MMP9) was also studied. miRNA-21 expression was significantly higher in lung cancer cell lines (A549, HCC827, NCI-H282, and 95-D) than that in normal human bronchial epithelial cells (HBE; p < 0.05). The pattern of BTG2 protein expression was exactly the opposite of miRNA-21 expression in lung cancer cells. BTG2 was highly expressed in HBE cells and was expressed at very low levels in lung cancer cell lines (A549, HCC827, NCI-H292, and 95-D). High miRNA-21 expression may inhibit BTG2 protein expression, whereas the inhibition of miRNA-21 expression may promote BTG2 protein expression in 95-D cells. Cell viability and invasion of 95-D cells were significantly lower in the miRNA-21 ASO-transfected group than that in the control ASO-transfected group and untransfected group (p < 0.05). The number of apoptotic cells was significantly higher in the miRNA-21 ASO-transfected group than that in the control ASO-transfected and untransfected groups (p < 0.05). The expression level of cyclin D1 and MMP9 in 95-D cells was significantly lower in the miRNA-21 ASO-transfected group than in the control ASO-transfected and untransfected groups (p < 0.05). Meanwhile, caspase-3 expression was significantly higher in the miRNA-21 ASO-transfected group than that in the control ASO-transfected and untransfected groups (p < 0.05). miRNA-21 overexpression may inhibit the BTG2 gene in lung cancer cells. miRNA-21 may promote cell proliferation and invasion and inhibit cell apoptosis in 95-D cells.

Local atopy is more relevant than serum sIgE in reflecting allergy in childhood adenotonsillar hypertrophy.

BACKGROUND: There was a lack of convincing evidence supporting the influence of allergy on the adenotonsillar hypertrophy (ATH). We investigated the presence of specific IgE (sIgE) in the serum and adenotonsillar tissues in children with ATH. METHODS: A Pharmacia ImmunoCAP system was used to test sIgE against 31 allergens in the serum in 83 children with ATH before adenotonsillectomy. sIgE against 15 representative allergens were detected in adenotonsillar tissues from 20 of those children. RESULTS: A total of 51 (61.45%) children had positive serum sIgE. 20 children with ATH had positive sIgE to more than two allergens at both tonsils and adenoids, although half of them were serum sIgE negative. The percentage of subjects with positive sIgE expression in adenoids and tonsils was 50.0% and 42.9%, respectively, among the subjects with positive serum sIgE expression. Of subjects with negative serum sIgE expression, local sIgE was detected in 36.0% of adenoids and 43.8% of tonsils, respectively. The rate of sIgE presence in local tissue (adenoids or tonsils) was significantly higher than that seen in the serum. CONCLUSION: This study provided evidence that there was an important role for allergic inflammation in the ATH. The inconsistency in sIgE expression between adenotonsillar and serum suggests a role of local atopy in childhood ATH.

Effects of nebulized high-dose budesonide on moderate-to-severe acute exacerbation of asthma in children: a randomized, double-blind, placebo-controlled study.

BACKGROUND AND OBJECTIVE: The efficacy of inhaled corticosteroids (ICS) in asthma exacerbation are yet to be clarified. The aim of this study was to investigate the efficacy of nebulized ICS in children with moderate-to-severe acute exacerbation of asthma in an emergency room setting in order to elucidate the potential use of ICS as the first-line therapy in the management of acute exacerbation of asthma. METHODS: This was a prospective, randomized, double-blind, placebo-controlled study. Paediatric patients with moderate-to-severe acute exacerbation of asthma in emergency room were randomized to receive nebulized salbutamol and ipratropium bromide, with the addition of nebulized high-dose budesonide (BUD group, n = 60) or normal saline (control group, n = 58), three doses in the first hour. RESULTS: The improvement in forced expiratory volume in 1 s was similar in both groups at 0 h after three doses of nebulization, but there was significantly further improvement at 1 and 2 h in the BUD group (0.095 ± 0.062 L and 0.100 ± 0.120 L, respectively) compared with the control group (0.059 ± 0.082 L and 0.021 ± 0.128 L, respectively), P = 0.013 and 0.001, respectively. Complete remission rate was significantly higher (84.7% vs 46.3%, P = 0.004) and need for oral corticosteroids was significantly lower (16.9% vs 46.3%, P = 0.011) in BUD group than in control group. CONCLUSION: On the basis of nebulized short-acting bronchodilators, addition of nebulized high-dose budesonide resulted in clinical improvement in children with moderate-to-severe acute exacerbation of asthma, suggesting that nebulized high-dose ICS can be used as first-line therapy for non-life-threatening acute exacerbation of asthma in children.

Effect of early enteral nutrition on postoperative nutritional status and immune function in elderly patients with esophageal cancer or cardiac cancer.

OBJECTIVE: To explore the effect of early enteral nutrition (EN) on postoperative nutritional status, intestinal permeability, and immune function in elderly patients with esophageal cancer or cardiac cancer. METHODS: A total of 96 patients with esophageal cancer or cardiac cancer who underwent surgical treatment in our hospital from June 2007 to December 2010 were enrolled in this study. They were divided into EN group (n=50) and parenteral nutrition (PN) group (n=46) based on the nutrition support modes. The body weight, time to first flatus/defecation, average hospital stay, complications and mortality after the surgery as well as the liver function indicators were recorded and analyzed. Peripheral blood samples were collected on the days 1, 4 and 7 after surgery. The plasma diamine oxidase (DAO) activity and D-lactate level were determined to assess the intestinal permeability. The plasma endotoxin levels were determined using dynamic turbidimetric assay to assess the protective effect of EN on intestinal mucosal barrier. The postoperative blood levels of inflammatory cytokines and immunoglobulins were determined using enzyme-linked immunosorbent assay (ELISA). RESULTS: After the surgery, the time to first flatus/defecation, average hospital stay, and complications were significantly less in the EN group than those in the PN group (P<0.05), whereas the EN group had significantly higher albumin levels than the PN group (P<0.05). On the 7th postoperative day, the DAO activity, D-lactate level and endotoxin contents were significantly lower in the EN group than those in the PN group (all P<0.05). In addition, the EN group had significantly higher IgA, IgG, IgM, and CD4 levels than the PN group (P<0.05) but significantly lower IL-2, IL-6, and TNF-α levels (P<0.05). CONCLUSIONS: In elderly patients with esophageal cancer or cardiac cancer, early EN after surgery can effectively improve the nutritional status, protect intestinal mucosal barrier (by reducing plasma endoxins), and enhance the immune function.

Infrared thermal imaging as a novel evaluation method for deep vein thrombosis in lower limbs.

PURPOSE: Early detection of deep vein thrombosis (DVT) is critical to prevent clinical pulmonary thromboembolism. However, most conventional methods for diagnosing DVT are functionally limited and complicated. The aim of this study was to evaluate the value of infrared-thermal-imaging (IRTI), a novel imaging detection or screening technique, in diagnosis of DVT in animal models. METHODS: DVT model of femoral veins was established in nine New Zealand rabbits. The right hind femoral vein was embolized and the contralateral one served as a nonembolized control. Measurements of IRTI, compression ultrasonography (CPUS), and angiography under ultrasonic observation (AGUO) were performed at three time points: T1 (baseline, 10 min prior to surgery), T2 (2 h after thrombin injection), and T3 (48 h postoperatively). Qualitative pseudocolor analysis and quantitative temperature analysis were performed based on mean area temperature (Tav) and mean curvilinear temperature (Tca) of the region of interest as shown in IRTI. Temperature differences (TD) in Tav (TD(Tav)) and Tca (TD(Tca)) between the DVT and control sides were computed. Comparative statistical analysis was carried out by paired t-test and repeated measure, while multiple comparisons were performed by using Greenhouse-Geisser and Bonferroni approach. Values of P < 0.05 and P < 0.01 were considered statistically significant and highly significant. RESULTS: Modeling of DVT was successful in all rabbits, as confirmed by CPUS and AGUO and immediately detected by IRTI. IRTI qualitative analysis of pseudocolor revealed that the bilateral temperatures were apparently asymmetrical and that there were abnormally high temperature zones on the DVT side where thrombosis formed. The results of paired t-test of Tav and Tca between DVT side and control sides did not reveal statistical difference at T1 (Tav: P = 0.817; Tca: P = 0.983) yet showed statistical differences at both T2 (Tav: P = 0.023; Tca: P = 0.021) and T3 (Tav: P = 0.016; Tca: P = 0.028). Results of repeated measure and multiple comparisons of TD(Tav) and TD(Tca) were highly different and significant differences across the T2 (TD(Tav): P = 0.009; TD(Tav): P = 0.03) and T3 (TD(Tav): P = 0.015; TD(Tav): P = 0.021). CONCLUSIONS: IRTI temperature quantitative analysis may help further detection of DVT. Additionally, IRTI could serve as a novel detection and screening tool for DVT due to its convenience, rapid response, and high sensitivity.

Non-smoking-related chronic obstructive pulmonary disease: a neglected entity?

Chronic obstructive pulmonary disease (COPD) is an increasing cause of morbidity and mortality worldwide, and it has been strongly correlated to tobacco smoking. While a number of studies have concentrated on smokers only, recent published data demonstrate that at least one fourth of patients with COPD are non-smokers, and that the burden of COPD in non-smokers is also higher than previously believed. Risk factors of COPD in non-smokers may include genetic factors, long-standing asthma, outdoor air pollution (from traffic and other sources), environmental smoke exposure (ETS), biomass smoke, occupational exposure, diet, recurrent respiratory infection in early childhood, tuberculosis and so on. In Asian region, indoor/outdoor air pollution and poor socioeconomic status may play important roles in the pathogenesis of non-smoking-related COPD. The prevalence of COPD among never smokers varies widely across nations. Such a variation may arise from several aspects, including study design, definition of COPD, diagnostic criteria, age and gender distribution of the studied population, local risk factors and socioeconomic status. More investigations and efforts are required to elucidate the involved factors and their shared contributions to non-smoking-related COPD so as to achieve better estimation and reduction of the burden of this neglected entity worldwide.

How to write research papers and grants: 2011 Asian Pacific Society for Respirology Annual Scientific Meeting Postgraduate Session.

This review article summarizes the content of a series of interrelated workshop presentations from the Annual Scientific Meeting of the Asian Pacific Society of Respirology held in Shanghai in November, 2011. The article describes tips and strategies for writing research papers and research grant applications and includes discussion of: the role of pulmonologists in research; the debates around the use of the journal impact factor; tips for writing manuscripts and publishing research in high-impact journals; how journals assess manuscripts and the most common reasons editors reject manuscripts; how to write grant applications and what grant panels look for in successful proposals; and how to undertake research in resource-limited countries.

Quality changes of clinical practice guidelines for respiratory diseases in China: A systematic review.

BACKGROUND: After the low quality of Chinese clinical practice guidelines (CPGs) for respiratory diseases published from 1979 to 2013 was reported, some handbooks were published to standardize guidelines' development recently. There was a great increase in the production and dissemination of CPGs annually in China, whose quality and potential impact were unknown. METHODS: A systematic search of four literature databases was performed for the period January 2013 to December 2018 to identify Chinese CPGs for respiratory diseases. Eligible CPGs were evaluated using the appraisal of guidelines for research and evaluation II (AGREE II) instrument. RESULTS: A total of 197 CPGs were identified for review. Compared with the result of previous study, the increased scores of the six AGREE II domains were screened: Scope and purpose (57.3% vs. 57.8%), Stakeholder involvement (17.6% vs. 25.0%), Rigor of development (10.2% vs. 13.2%), Clarity and presentation (55.2% vs. 58.4%), Applicability (9.3% vs. 25.9%), and Editorial independence (1.1% vs. 6.3%). The improved overall assessment for included CPGs were: Recommended (4, 2.0% vs. 0, 0%) and Recommended with modifications (26, 13.2% vs. 3, 2.8%). The improved level of evidence used to make recommendations were 59, 11.9% versus 168, 22.4% and 88, 17.7% versus 195, 26.0%, A and B, respectively. CONCLUSIONS: The overall quality of CPGs for respiratory diseases published from 2013 to 2018 in China was slightly improved, but had a big gap with the optimum level, especially in Rigor of development and Editorial independence. Increased efforts are required to enable the development of high-quality evidence-based CPGs for respiratory diseases.

Pandemic planning in China: applying lessons from severe acute respiratory syndrome.

There were three events of severe acute respiratory syndrome (SARS) in China from 2003 to 2004. Starting from 2002, we are also aware of the increasing alert of an avian flu pandemic. Epidemics of SARS and avian flu have posed huge threats to social stability, economic prosperity and human health in this country. What we have experienced during SARS outbreaks has great implications for the protection of people against a resurgence of SARS and potential attacks of high-pathogenic avian flu viruses. To that end, China has been preparing to contain future pandemics by applying lessons learnt from SARS.

The practical benefit of Phadiatop test as the first-line in vitro allergen-specific immunoglobulin E (sIgE) screening of aeroallergens among Chinese asthmatics: a validation study.

BACKGROUND: Phadiatop test is a variant of ImmunoCAP assay that covers a mixture of common aeroallergens. Its diagnostic efficiency in Chinese population remains so far inadequate. We validated Phadiatop testing with ImmunoCAP assays in a Chinese cohort. METHODS: Phadiatop test was performed for serum samples from 290 asthmatics and 92 healthy controls previously tested with "classic" ImmunoCAP for house dust mix (hx2), molds and yeasts mix (mx2), tree pollen mix (tx4) and weed mix (wx5). RESULTS: Phadiatop positivity was shown in 46.2% of 290 asthmatic patients. Using ImmunoCAP as the gold standard, the concordance rate was 91.7%; negative predictive value, 92.9%; and positive predictive value, 90.2%. The sensitivity of Phadiatop test was high for hx2 (98.2%), tx4 (100%) and wx5 (95.5%), but not for mx2 (78.4%). Yet the mx2 allergen-specific immunoglobulin E (sIgE) level in all missed cases was relatively low (0.35 to 0.90 kUA/L). The total Phadiatop sIgE level was correlated with the ImmunoCAP sIgE levels for all allergen mixes combined (rs =0.941, P<0.001) or each allergen mix, particularly the hx2 (rs =0.924) (all P<0.001), 0.53 kUA/L used as a cut-off would optimize the diagnostic performance of Phadiatop testing, yielding 89.4% sensitivity and 97.5% specificity in indentifying serums positive to any of these allergen mixes. CONCLUSIONS: Overall, Phadiatop test may efficiently detect sensitization to common aeroallergen mixes. In light of the currently rigorous administration on crude extracts for skin tests in China, using Phadiatop as the first-line test for suspected atopy can be cost-effective.

A comparative study of the five-repetition sit-to-stand test and the 30-second sit-to-stand test to assess exercise tolerance in COPD patients.

Purpose: The sit-to-stand test (STST) has been used to evaluate the exercise tolerance of patients with COPD. However, mutual comparisons to predict poor exercise tolerance have been hindered by the variety of STST modes used in previous studies, which also did not consider patients' subjective perceptions of different STST modes. Our aim was to compare the five-repetition sit-to-stand test (5STS) with the 30-second sit-to-stand test (30STS) for predicting poor performance in the six-minute walking test and to evaluate patients' subjective perceptions to determine the optimal mode for clinical practice. Patients and methods: Patients with stable COPD performed 5STS, 30STS and the 6MWT and then evaluated their feelings about the two STST modes by Borg dyspnea score and a questionnaire. Moreover, we collected data through the pulmonary function test, mMRC dyspnea score, COPD assessment test and quadriceps muscle strength (QMS). A receiver operating characteristic curve analysis of the 5STS and 30STS results was used to predict 6-minute walk distance (6MWD) <350 m. Results: The final analysis included 128 patients. Similar moderate correlations were observed between 6MWT and 5STS (r=-0.508, P<0.001) and between 6MWT and 30STS (r=0.528, P<0.001), and there were similar correlations between QMS and 5STS (r=-0.401, P<0.001) and between QMS and 30STS (r=0.398, P<0.001). The 5STS and 30STS score cutoffs produced sensitivity, specificity and positive and negative predictive values of 76.0%, 62.8%, 56.7% and 80.3% (5STS) and 62.0%, 75.0%, 62.0% and 75.0% (30STS), respectively, for predicting poor 6MWT performance. The 5STS exhibited obvious superiority in terms of the completion rate and the subjective feelings of the participants. Conclusion: As a primary screening test for predicting poor 6MWD, the 5STS is similar to the 30STS in terms of sensitivity and specificity, but the 5STS has a better patient experience.

A Component-resolved Diagnostic Approach for a Study on Grass Pollen Allergens in Chinese Southerners with Allergic Rhinitis and/or Asthma.

Sensitization to grass pollen imposes a global risk for allergic airway diseases. Although prevention relies on local investigation of the pollen allergens, data on this topic are limited in southern China. Any available data were obtained by self-report questionnaires, skin prick tests, and total or specific IgE tests using crude extracts. For many reasons, these methods are unreliable. Serum sIgE reactivity to Bermuda grass, Timothy grass, and Humulus scandens allergens in a cohort of patients from Greater Guangzhou (southern China's largest city and its outskirts) with allergic rhinitis and/or asthma were examined using a fully-automated immunoassay analyzer as a component-resolved diagnostics (CRD) tool. For the first time, a considerably high prevalence of Bermuda grass sIgE positivity was demonstrated in Chinese southerners with allergic rhinitis and/or asthma. In these patients, a subtle prevalence of sensitization to Timothy grass and Humulus scandens was also noted, which may arise from cross-reactivity, as the latter two are not common in the region. This was also supported by the detection of allergen components. Fully-automated immunoassay analyzers may offer satisfactory consistency between regions, laboratories, and institutions and over time. The automaticity of the instrument may enable a standardized detection that would not have been readily revealed before the advent of CRD. This is a study that uses a CRD approach to investigate sensitization to grass pollen allergens in southern China. It adds to current evidence in the literature. Future studies are needed to validate these findings. However, although CRD is a useful tool, the findings made with the fully-automated immunoassay analyzer should not substitute for other laboratory investigations, clinical evaluations, and physician expertise.

A cross-sectional observational study on allergen-specific IgE positivity in a southeast coastal versus a southwest inland region of China.

Few studies addressed trans-regional differences in allergen sensitization between areas within a similar latitudinal range but with distinct geomorphological features. We investigated specific IgE (sIgE) positivity to common allergens in populations from two southern China provinces. Using a uniformed protocol, serum samples were collected from 2778 subjects with suspected atopy in coastal Guangdong and inland Yunnan. The overall prevalence of sIgE positivity were 57.8% (95% CI: 56.0%, 59.6%) from Guangdong vs 60.9% (95% CI: 59.1%, 62.7%) from Yunnan. House dust mite (d1) was the most common allergen in both regions. Among d1-sensitized subjects, only 35.7% (208/583) in Guangdong and 22.9% (147/642) in Yunnan tested positive for d1 alone. Among those poly-sensitized d1-positive subjects, cockroach was the most common co-sensitizing aeroallergen. 41.9% of the d1-sensitized Guangdong subjects showed high-class sIgE reactivity (≥class 4), in contrast to a very low percentage of such reactivity in Yunnan. However, 36.3% of d1-sensitized subjects in Yunnan were concomitantly positive for tree pollen mix. Surprisingly, Yunnan subjects showed high prevalence of sIgE positivity for crabs and shrimps, either by overall or by age-group analysis, compared with their Guangdong counterparts (both P < 0.05). These findings may add to data about local allergies in China and worldwide.

Cycle ergometer and inspiratory muscle training offer modest benefit compared with cycle ergometer alone: a comprehensive assessment in stable COPD patients.

BACKGROUND: Cycle ergometer training (CET) has been shown to improve exercise performance of the quadriceps muscles in patients with COPD, and inspiratory muscle training (IMT) may improve the pressure-generating capacity of the inspiratory muscles. However, the effects of combined CET and IMT remain unclear and there is a lack of comprehensive assessment. MATERIALS AND METHODS: Eighty-one patients with COPD were randomly allocated to three groups: 28 received 8 weeks of CET + IMT (combined training group), 27 received 8 weeks of CET alone (CET group), and 26 only received 8 weeks of free walking (control group). Comprehensive assessment including respiratory muscle strength, exercise capacity, pulmonary function, dyspnea, quality of life, emotional status, nutritional status, and body mass index, airflow obstruction, and exercise capacity index were measured before and after the pulmonary rehabilitation program. RESULTS: Respiratory muscle strength, exercise capacity, inspiratory capacity, dyspnea, quality of life, depression and anxiety, and nutritional status were all improved in the combined training and CET groups when compared with that in the control group (P<0.05) after pulmonary rehabilitation program. Inspiratory muscle strength increased significantly in the combined training group when compared with that in the CET group (ΔPImax [maximal inspiratory pressure] 5.20±0.89 cmH2O vs 1.32±0.91 cmH2O; P<0.05). However, there were no significant differences in the other indices between the two groups (P>0.05). Patients with weakened respiratory muscles in the combined training group derived no greater benefit than those without respiratory muscle weakness (P>0.05). There were no significant differences in these indices between the patients with malnutrition and normal nutrition after pulmonary rehabilitation program (P>0.05). CONCLUSION: Combined training is more effective than CET alone for increasing inspiratory muscle strength. IMT may not be useful when combined with CET in patients with weakened inspiratory muscles. Nutritional status had slight impact on the effects of pulmonary rehabilitation. A comprehensive assessment approach can be more objective to evaluate the effects of combined CET and IMT.

Longitudinal profiles of serum specific IgE and IgG4 to Dermatophagoides pteronyssinus allergen and its major components during allergen immunotherapy in a cohort of southern Chinese children.

Longitudinal data on serum specific sIgE and sIgG4 to allergen component of Dermatophagoides pteronyssinus (Der p) during allergen immunotherapy (AIT) are limited in Chinese populations. We serially followed up serum sIgE and sIgG4 to Der p and its components (Der p 1 and 2) in 51 Der p-sensitized children receiving guideline-based medications alone and additional 36-month AIT. The the Der p 1 and Der p 2 sIgE levels were elevated at 6 months and progressively declined from 12 months; the sIgG4 levels for Der p, Der p 1 and Der p 2 were increasing during the first year and reached a plateau thereafter; the sIgE/sIgG4 ratios for Der p 1 and Der p 2 decreased continuously from 6 through 24 months of AIT. Subgroup analysis showed that younger children (≤8years) experienced a greater increase in sIgG4 levels for Der p, Der p 1 and Der p 2 during AIT compared with older children (9-16 years). In summary, sIgE and sIgG4 to Der p 1 and Der p 2 may be more useful than those to Der p in reflecting the change in immunological reactivity during AIT. Earlier delivery of AIT may yield greater increase in sIgG4 after 36-month treatment than given later in life.