Benralizumab efficacy and safety in severe asthma: A randomized trial in Asia.

BACKGROUND: Benralizumab is indicated as add-on therapy in patients with uncontrolled, severe eosinophilic asthma; it has not yet been evaluated in a large Asian population with asthma in a clinical trial. OBJECTIVE: To evaluate the efficacy and safety of benralizumab in patients with severe asthma in Asia. METHODS: MIRACLE (NCT03186209) was a randomized, Phase 3 study in China, South Korea, and the Philippines. Patients aged 12-75 years with severe asthma receiving medium-to-high-dose inhaled corticosteroid/long-acting ß2-agonists, stratified (2:1) by baseline blood eosinophil count (bEOS) (≥300/µL; <300/µL), were randomized (1:1) to benralizumab 30 mg or placebo. Endpoints included annual asthma exacerbation rate (AAER; primary endpoint), change from baseline at Week 48 in pre-bronchodilator (BD) forced expiratory volume in 1 second (pre-BD FEV1) and total asthma symptom score (TASS). Safety was evaluated ≤ Week 56. RESULTS: Of 695 patients randomized, 473 had baseline bEOS ≥300/µL (benralizumab n = 236; placebo n = 237). In this population, benralizumab significantly reduced AAER by 74% (rate ratio 0.26 [95% CI 0.19, 0.36], p < 0.0001) and significantly improved pre-BD FEV1 (least squares difference [LSD] 0.25 L [95% CI 0.17, 0.34], p < 0.0001) and TASS (LSD -0.25 [-0.45, -0.05], p = 0.0126) versus placebo. In patients with baseline bEOS <300/µL, there were numerical improvements in AAER, pre-BD FEV1, and TASS with benralizumab versus placebo. The frequency of adverse events was similar for benralizumab (76%) and placebo (80%) in the overall population. CONCLUSIONS: MIRACLE data reinforces the efficacy and safety of benralizumab for severe eosinophilic asthma in an Asian population, consistent with the global Phase 3 results.

Protective Effect of Liuwei Dihuangwan on Mitochondrial Damage in AD Model of Caenorhabditis Elegans / 中国实验方剂学杂志

ObjectiveTo investigate the protective effect of the extract of Liuwei Dihuangwan （LW） on mitochondrial damage in the Alzheimer's disease （AD） model of Caenorhabditis elegans （C. elegans）. MethodC. elegans transfected with human β-amyloid protein （Aβ） 1-42 gene was used as an AD model. The rats were divided into blank group， model group， metformin group （50 mmol·L-1）， and low， medium， and high dose （1.04， 2.08， 4.16 g·kg-1） LW groups. Behavioral methods were used to observe the sensitivity of 5-hydroxytryptamine （5-HT） in nematodes. Western blot was used to detect the expression of Aβ in nematodes. Total ATP content in nematodes was detected by the adenine nucleoside triphosphate （ATP） kit， and mitochondrial membrane potential was detected by the JC-1 method. In addition， the mRNA expression of Aβ expression gene （Amy-1）， superoxide dismutase-1 （SOD-1）， mitochondrial transcription factor A homologous gene-5 （HMG-5）， mitochondrial power-associated protein 1 （DRP1）， and mitochondrial mitoprotein 1 （FIS1） was detected by real-time fluorescence quantitative polymerase chain reaction （RT-PCR）. ResultThe extract of LW could reduce the hypersensitivity of the AD model of nematodes to exogenous 5-HT （P<0.05） and delay the AD-like pathological characteristics of hypersensitivity to exogenous 5-HT caused by toxicity from overexpression of Aβ in neurons of the AD model of nematodes. Compared with the blank group， in the model group， the mRNA expression of Aβ protein and Amy-1 increased （P<0.01）， and the mRNA expression of SOD-1 and HMG-5 decreased （P<0.01）. The mRNA expression of DRP1 and FIS1 increased （P<0.01）， and the level of mitochondrial membrane potential decreased （P<0.05）. The content of ATP decreased （P<0.01）. Compared with the model group， in the positive medicine group and medium and high dose LW groups， the mRNA expression of Aβ protein and Amy-1 decreased （P<0.05，P<0.01）， and the mRNA expression of SOD-1 and HMG-5 increased （P<0.01）. The mRNA expression of DRP1 decreased （P<0.05，P<0.01）， and that of FIS1 decreased （P<0.01）. The level of mitochondrial membrane potential increased （P<0.01）， and the content of ATP increased （P<0.05，P<0.01）. ConclusionThe extract of LW may enhance the antioxidant ability of mitochondria， protect mitochondrial DNA， reduce the fragmentation of mitochondrial division， repair the damaged mitochondria， adjust the mitochondrial membrane potential， restore the level of neuronal ATP， and reduce the neuronal damage caused by Aβ deposition.

Application Design for Child Obesity Management Based on Users' Preferences and Needs.

This study aimed to investigate the constructive preferences and needs of children and guardians in a child obesity management application, and to suggest and visualize the key features of its design. To reflect users' preferences and needs, the questionnaires used in this study were developed in four stages: draft, validity test, review, and final version. The survey was conducted with fifth and sixth grade children who are overweight or obese and their guardians. Differences were observed by gender and between children and guardians with respect to children's perceived body shape, technology experience and preferences, preferred obesity management method, application design, exercise and diet-related features, preferred partner for obesity management, and preferred reward after mission completion. Our study suggests and visualizes the key features of a child obesity management application for both children and guardians based on their preferences and needs, which can be utilized by both application developers and researchers.

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.

House Dust Mite Sensitization Is Inversely Associated with Plasma 25-Hydroxyvitamin D3 Levels in Patients with Severe Atopic Dermatitis

BACKGROUND: The relationship between atopic dermatitis (AD) and low vitamin D levels has been studied. Emerging evidence has implicated vitamin D as a critical regulator of immunity, playing a role in both the innate and cell-mediated immune systems. However, the effect of vitamin D on house dust mite (HDM) sensitization in patients with AD has not been established. OBJECTIVE: We investigated the association between vitamin D levels and HDM sensitization according to AD severity. METHODS: In total, 80 patients (43 men and 37 women) with AD were included. We classified AD severity using Rajka and Langeland scores. Laboratory tests included serum 25-hydroxyvitamin D3, total immunoglobulin E (IgE), and specific IgE antibody titer against Dermatophagoides farinae and D. pteronyssinus. RESULTS: There were no differences in vitamin D levels between the mild or moderate AD and severe AD groups. In the severe AD group, high HDM sensitization group had lower serum vitamin D levels compared to low HDM sensitization group with statistical significance. In addition, a significant negative correlation was found between vitamin D levels and HDM sensitization in the severe AD group. CONCLUSION: Our results demonstrate that low vitamin D levels may link to high HDM sensitization in patients with the severe AD. Further elucidation of the role of vitamin D in HDM sensitization may hold profound implications for the prevention and treatment of AD.

Teaching exploration of standardized training of pulmonary function test for respiratory medicine specialists from a certain hospital / 中华医学教育探索杂志

It is an important teaching task how to make respiratory disease specialists to accept the standardization training of pulmonary function. However, the theory of pulmonary function is comparatively abstract and the training time is short, but the task is heavy. In order to explore a set of feasible training mode, the pulmonary function laboratory of Zhongshan Hospital affiliated to Fudan University carries out various forms of training, such as compiling textbooks, establishing case database, using multimedia teach-ing, arranging one-to-one guided teaching, and training the ability of doctor-patient communication.

Current Status of Nursing Informatics Education in Korea / 대한의료정보학회지

OBJECTIVES: This study presents the current status of nursing informatics education, the content covered in nursing informatics courses, the faculty efficacy, and the barriers to and additional supports for teaching nursing informatics in Korea. METHODS: A set of questionnaires consisting of an 18-item questionnaire for nursing informatics education, a 6-item questionnaire for faculty efficacy, and 2 open-ended questions for barriers and additional supports were sent to 204 nursing schools via email and the postal service. Nursing schools offering nursing informatics were further asked to send their syllabuses. The subjects taught were analyzed using nursing informatics competency categories and other responses were tailed using descriptive statistics. RESULTS: A total of 72 schools (35.3%) responded to the survey, of which 38 reported that they offered nursing informatics courses in their undergraduate nursing programs. Nursing informatics courses at 11 schools were taught by a professor with a degree majoring in nursing informatics. Computer technology was the most frequently taught subject (27 schools), followed by information systems used for practice (25 schools). The faculty efficacy was 3.76 ± 0.86 (out of 5). The most frequently reported barrier to teaching nursing informatics (n = 9) was lack of awareness of the importance of nursing informatics. Training and educational opportunities was the most requested additional support. CONCLUSIONS: Nursing informatics education has increased during the last decade in Korea. However, the proportions of faculty with degrees in nursing informatics and number of schools offering nursing informatics courses have not increased much. Thus, a greater focus is needed on training faculty and developing the courses.

Current Status of Nursing Informatics Education in Korea / 대한의료정보학회지

OBJECTIVES: This study presents the current status of nursing informatics education, the content covered in nursing informatics courses, the faculty efficacy, and the barriers to and additional supports for teaching nursing informatics in Korea. METHODS: A set of questionnaires consisting of an 18-item questionnaire for nursing informatics education, a 6-item questionnaire for faculty efficacy, and 2 open-ended questions for barriers and additional supports were sent to 204 nursing schools via email and the postal service. Nursing schools offering nursing informatics were further asked to send their syllabuses. The subjects taught were analyzed using nursing informatics competency categories and other responses were tailed using descriptive statistics. RESULTS: A total of 72 schools (35.3%) responded to the survey, of which 38 reported that they offered nursing informatics courses in their undergraduate nursing programs. Nursing informatics courses at 11 schools were taught by a professor with a degree majoring in nursing informatics. Computer technology was the most frequently taught subject (27 schools), followed by information systems used for practice (25 schools). The faculty efficacy was 3.76 ± 0.86 (out of 5). The most frequently reported barrier to teaching nursing informatics (n = 9) was lack of awareness of the importance of nursing informatics. Training and educational opportunities was the most requested additional support. CONCLUSIONS: Nursing informatics education has increased during the last decade in Korea. However, the proportions of faculty with degrees in nursing informatics and number of schools offering nursing informatics courses have not increased much. Thus, a greater focus is needed on training faculty and developing the courses.

Survey on the usage of antiasthmatic drugs in community hospitals in Shanghai / 中华全科医师杂志

Objective To observe the usage of antiasthmatic drugs and seek problems of following the guidelines of asthma and COPD prevention & treatment in community hospitals.Methods The prescribed quantity in 2013 of antiasthmatic drugs was recorded for 5 community hospitals in a district of Shanghai.Basing on the defined daily dose (DDD),the dosing frequency of drugs (DDDs) and the percentages of each category of drugs were calculated.Then comparisons were made with the data of a grade Ⅱ hospital and a grade Ⅲ hospital in the same district.Results Among three level hospitals,no significant difference existed in the percentages of oral antiasthmatic drugs.But the major category of oral drugs at grades Ⅱ-Ⅲ hospitals was leukotriene receptor antagonist whereas only oral theophylline and oral β2-receptor agonists were available at community hospitals.Among inhaled drugs,inhaled corticosteroids (ICS) dominated at grades Ⅱ-Ⅲ hospitals.But at community hospitals,inhaled short-acting beta-agonists (SABA) predominated.Among inhalants,dry powder inhaler (DPI) dominated at grades Ⅱ-Ⅲ hospitals and metered dose inhaler (MDI) at community hospitals.Conclusions The usage of antiasthmatics at community hospitals is not consistent with the guidelines.Optimizing drug purchasing at hospitals,strengthening continued medical education,modifying the medication concept of patients and boosting the production of domestic inhalants should be urgently undertaken.

The exploration of the market demand of medical logistics professional undergraduates / 中华医学教育探索杂志

Analysising the Internet talents recruitment information of medical logistics professional undergraduates with content analysis,we have got to know that talent post group of medical logistics professional undergraduate mainly consists of production logistics manager,warehouse manager,transportation and delivery manager,customer service manager,purchasing manager,and logistics information center administrator.Besides,the ability requirements of medical logistics professional undergraduates are orderly work experience,communication and coordination skills,teamwork spirit,written expression ability and innovation ability.So some suggestions have been put forward that personnel training target should be proactive,curriculum system should highlight the professional characteristic,diversified teaching methods should be emphasized,and evaluation system should focus on process control.

The value of serum cystatin C and urinary microalbumin in the diagnosis of early renal function injury in patients with essential hypertension / 中国医师进修杂志

ObjectiveTo investigate the clinical value of serum cystatin C(CysC) and urinary microalbumin(MA) in the diagnosis of early renal function injury in patients with essential hypertension.MethodsOne hundred and twenty patients with essential hypertension(hypertension group) were divided into three groups by the results of blood pressure:grade 1 with 48 cases,grade 2 with 47 cases,grade 3 with 25 cases.Thirty healthy subjects were selected as control group.Serum CysC,urinary MA and serum creatinine (Cr) were detected in all subjects.ResultsThe serum CysC and urinary MA in grade 1,2 and 3 hypertension group [(1.57 ±0.48),(2.12 ±0.72),(2.91 ± 1.09) mg/L and(18.12 ±5.43),(29.01 ±8.07),(46.06 ± 13.21 ) mg/L] were obviously higher than those in control group [ (0.71 ± 0.23 ),(9.35 ±5.17)mg/L](P＜ 0.05).The serum Cr had no significant difference between grade 1,2,3 hypertension group and control group (P ＞ 0.05 ).Serum CysC was positively correlated with urinary MA in hypertension group (r =0.613,P ＜ 0.05),serum CysC and urinary MA were both negatively correlated with estimated glomenlar filtration rate (eGFR)(r=-0.635,-0.563,P＜0.05).ConclusionsSerum CysC and urinary MA are sensitive indexes of early renal function injury in patients with hypertension.The combined determination of serum CysC and urinary MA can improve the detection rate of early renal function injury.

Immune function changes of non-small cell lung cancer patients after chemotherapy / 复旦学报（医学版）

Objective To compare the proportion of CD3~+T cell and CD4~+CD25~(high) regulatory T cell (Treg cell) and the production of inferon γ ( IFN-γ) and interleukin-12 (IL-12) in peripheral blood mononuclear cells (PBMC) between patients with non-small cell lung cancer (NSCLC) and healthy people, and to analyze the changes of CD3~+T cell, CD4~+CD25~(high)Treg cell, IFN-γ and IL-12 of NSCLC patients before and after chemotherapy, so as to determine immune function changes of NSCLC patients caused by chemotherapy. Methods Twenty NSCLC patients and 20 healthy volunteers according to the including criteria were selected. Three mL of blood was drawn from NSCLC patients before chemotherapy (0 d), on the 3~(rd) day (3 d) and 7~(th) day (7 d) after chemotherapy. PBMC cells were separated from the blood samples. The proportions of CD4~+CD25~(high)Treg cell and CD3~+T cell (%) in PBMC were tested by FACS, and the IFN-γ and IL-12 (pg/mL) in the supernatants were also detected. Results The proportions of CD3~+T cell in NSCLC patients on 0, 3 and 7 d were (55.15±20.11)%,(57.73±14.08)% and (62.79±7.80)%,respectively, and there was no statistical difference between any two of these results. The proportion of CD4~+CD25~(high)Treg cell in healthy volunteers was (2.14±0.85)%, while that of NSCLC patients was (2.76±0.53)% on 0 d with statistical difference compared to the healthy volunteers (P<0.05). The CD4~+CD25~(high)Treg cell proportion (%) of NSCLC patients on 3 d and 7 d were (2.54±0.57)% and (2.72±0.29)%, respectively, which were both significantly lower than that of 0 d. On 3 d it was even much lower than that on 7 d (P<0.05). IFN-γ and IL-12 of NSCLC patients on 0 d were (34.36±4.38) pg/mL and (33.24±4.36) pg/mL, and no statistical difference was observed when compared with (34.36±4.38) pg/mL and (33.24±4.36) pg/mL in the healthy volunteers. On 3 d and 7 d, IFN-γ of NSCLC patients were (40.42±5.66) pg/mL and (39.27±6.07) pg/mL, respectively, and both were higher than that on 0 d (P<0.05); IL-12 of NSCLC patients were (35.51±5.03) pg/mL and (38.62±6.44) pg/mL, also both were higher than that on 0 d (P<0.05). Conclusions This study suggests that chemotherapy can improve immune functions of NSCLC patients, and may reinforce the anti-tumor immune response.

Relationship between Tumor Necrosis Factor-alpha and Smoking-related Chronic Obstructive Pulmonary Disease / 中国康复理论与实践

@#Objective To investigate the relationship between tumor necrosis factor-alpha (TNF-α) and development of chronic obstructive pulmonary disease (COPD).Methods COPD patients and controls were divided into three groups: COPD group (n=66), smoker control group (n=42) and health control group (n=23). COPD group was further divided into the serious group (n=23) and non-serious group (n=43). The concentration of TNF-α of all cases was detected by human Th1/Th2 cytokine kit.Results The concentration of TNF-α in the COPD group was significantly higher than that of the smoker and healthy groups ( P<0.01). Furthermore, compared to non-serious COPD group, the concentration of TNF-α was higher in the serious COPD group ( P<0.05).Conclusion The concentration of TNF-α might be related with the pathogenesis and development of COPD.

Protective effects of alpha 1-antitrypsin on acute lung injury in rabbits induced by endotoxin / 中华医学杂志(英文版)

<p><b>OBJECTIVE</b>To investigate whether pretreatment with alpha(1)-antitrypsin (AAT) can attenuate acute lung injury (ALI) in rabbits induced with endotoxin.</p><p><b>METHODS</b>Thirty-two healthy adult New Zealand rabbits were anaesthetized, tracheotomized and mechanically ventilated. They were then randomly divided into four groups (n = 8): (1) Infusion of Escherichia coli endotoxin [Lipopolysaccharide (LPS) 500 microg/kg] without AAT (Group LPS). (2) Infusion of AAT 120 mg/kg at 15 minutes after LPS (Group LAV). (3) Infusion of AAT 120 mg/kg without endotoxin (Group AAT). (4) Infusion of saline 4 ml/kg as control (Group NS). Arterial blood gases, peripheral leukocyte counts and airway pressure were recorded every hour for eight hours. Physiologic intrapulmonary shunting (Qs/Qt) was measured every four hours. After eight hours, blood samples were collected for measurement of plasma concentration and activity of AAT. Then, the animals were sacrificed, and bronchoalveolar lavage fluid (BALF) was collected for measurement of concentrations of total protein (TP), interleukin-8 (IL-8), tumor necrosis factor (TNF alpha, the activities of NE and AAT, total phospholipids (TPL) and disaturated phosphatidylcholine (DSPC). In addition, the wet-to-dry lung weight ratio (W/D) was measured.</p><p><b>RESULTS</b>The infusion of endotoxin induced decreases in arterial oxygen pressure (PaO(2)), peripheral leukocyte counts, total respiratory compliance (TLC) and the increases in peak pressure (P(peak)), Qs/Qt compared with the baseline values (P < 0.05). The increased plasma concentration but reduced activity of AAT was also found in contrast to that in Group NS (P < 0.05). In the BALF, the activity of AAT, TPL, DSPC/TPL were lower than those in Group NS (P < 0.05), but the concentrations of albumin, IL-8, TNF alpha, the activity of NE and the ratio of W/D were higher than those in Group NS (P < 0.05). The pretreatment of AAT attenuated the deterioration of oxygenation, the reduction of compliance and the deterioration of other physiological and biochemical parameters mentioned above.</p><p><b>CONCLUSION</b>Pretreatment with AAT could attenuate endotoxin-induced lung injury in rabbits. Those beneficial effects of AAT might be due, in part, to reduction in the levels of mediators that could activate neutrophils, in addition to the direct inhibitory effect on neutrophil elastase.</p>