[Chinese literature review of etiology distribution of adult patients with fever of unknown origin from 1979 to 2012].

OBJECTIVE: To review the etiology of 10 201 adult patients with fever of unknown origin (FUO) in China from 1979 to 2012, and to compare the reasons between the South and the North of China, and to illustrate the change in different periods. METHODS: Literatures containing key word "fever of unknown origin" were selected in China National Knowledge Infrastructure (CNKI) database from 1979 to 2012. Articles were excluded if patient population were less than 100. Diagnostic criteria of FUO were confirmed by the standard of Petersdorf and Beeson in 1961. Totally 43 literatures including 10 201 patients were enrolled in this study. The period of the literatures were divided into the early, middle and later period, and the regions were partitioned into the South and the North. RESULTS: A total of 42 articles (including 9787 patients) provided the gender information with 5063 men and 4724 women. The etiologies of 10 201 FUO patients included infectious diseases (53.5%), rheumatic diseases (20.1%) and tumor (12.0%). The positive diagnostic rate was 91.8%. Tuberculosis (23.8%) was the most common reason in infectious diseases. Adult Still's disease (7.0%) was the most common cause of FUO among rheumatic diseases. Lymphoma (3.4%) was the most common tumor in FUO patients. Besides, drug-induced fever (1.7%) should also be considered. In the recent 30 years, the proportion of FUO caused by infectious diseases had decreased, rheumatic diseases and other reason had increased (P < 0.05). The proportion of tumor in middle period was significantly higher than that in the early and later period (P < 0.05). The negative diagnostic rate had increased (all P < 0.05). The proportion of infectious diseases in North China was significantly lower than that in the South (P < 0.05). The proportion of other reason was significantly higher in the North (P < 0.05). CONCLUSION: In the recent 30 years, the most common cause of FUO was still infectious diseases, especially tuberculosis.

[Survey on the prevalence rate of bronchial asthma in Beijing area among the residents aged over 14 years from 2010 to 2011].

OBJECTIVE: To survey the prevalence rate of bronchial asthma in Beijing area among residents aged over 14 years. METHODS: In accordance with stratified cluster random sampling, epidemiological questionnaires were performed in Beijing residents aged over 14 years during household visits from February 2010 to August 2011. Asthma was diagnosed on the basis of case history, clinical signs and lung function test. The statistical software SAS 9.2 was employed to analyze the epidemiological status of asthma. RESULTS: In a sampling population of 61 107, 57 647 questionnaires were effective. Among 687 asthmatics, there were 296 males and 391 females. The overall prevalence rate of asthma was 1.19% (687/57 647). The asthma prevalence rates were 1.09% (418/38 468) and 1.40% (269/19 179) in urban and suburb Beijing respectively and the prevalence rate of asthma in suburb area was significantly higher than that of urban area (χ(2) = 10.850, P = 0.001). The prevalence rates of males and females were 1.06% (296/27 947) and 1.32% (391/29 700) respectively and the prevalence rate of asthma in females was much higher than that of males (χ(2) = 8.098,P = 0.004). Significant differences existed among different age groups (χ(2) = 404.874, P = 0.000) and residents aged at or over 71 years had the highest prevalence rate. The prevalence rates in urban and suburb Beijing area increased by 1.12 and 2.26 folds respectively than that of 2002. And 198 asthmatics were first diagnosed in this survey and accounted for 28.8% (198/687) in all asthma diagnosed asthmatics. CONCLUSIONS: The prevalence rate of asthma in Beijing area among residents aged over 14 years increased greatly from 2010 to 2011. And the epidemiological data may reflect the current distribution status of asthma in Beijing area.

Epworth Sleepiness Scale may be an indicator for blood pressure profile and prevalence of coronary artery disease and cerebrovascular disease in patients with obstructive sleep apnea.

OBJECTIVE: This study seeks to determine whether scores of a short questionnaire assessing subjective daytime sleepiness (Epworth Sleepiness Scale [ESS]) are associated with blood pressure (BP) level, BP profile, and prevalence of related coronary artery disease (CAD) and cerebrovascular disease (CVD) in obstructive sleep apnea (OSA) patients diagnosed by polysomnography (PSG). METHODS: Twenty university hospital sleep centers in China mainland were organized by the Chinese Medical Association to participate in this study. Between January 2004 and April 2006, 2,297 consecutive patients (aged 18-85 years; 1,981 males and 316 females) referred to these centers were recruited. BP assessments were evaluated at four time points (daytime, evening, nighttime, and morning) under standardized conditions. Anthropometric measurements, medical history of hypertension, CAD, and CVD were collected. ESS score was calculated for each participant and at the night of BP assessment, nocturnal PSG was performed and subjects were classified into four groups based on the apnea-hypopnea index (AHI) from PSG as follows: control group (control, n = 213) with AHI < 5; mild sleep apnea (mild, n = 420) with AHI ≥ 5 and <15; moderate sleep apnea (moderate, n = 460) with AHI ≥ 15 and <30; and severe sleep apnea (severe, n = 1,204) with AHI ≥ 30. SPSS 11.5 software package was used for the relationships between ESS and BP profile and prevalence of CAD and CVD. RESULTS: ESS is correlated positively with average daytime, nighttime, evening, and morning BP before and even after controlling for confounding effects of age, sex, BMI, AHI, and nadir nocturnal oxygen saturation (before--r = 0.182, 0.326, 0.245, and 0.329, respectively, all P values < 0.001; after--r = 0.069, 0.212, 0.137, and 0.208, respectively, all P values < 0.001). In the severe group, nighttime, evening, morning average BPs (ABPs), the ratio of nighttime/daytime average BP (ratio of nighttime average BP to daytime average BP), and prevalence of hypertension, drug-resistant hypertension (R-HTN), isolated nighttime hypertension (IN-HTN), CAD, and CVD in excessive daytime sleepiness (EDS, ESS ≥ 11) subjects are higher than those in non-EDS (ESS 0-10; t/χ(2) = -8.388, -6.207, -8.607, -5.901, 12.742, 38.980, 16.343, 59.113, and 67.113, respectively; all P values < 0.05). For EDS subjects in the moderate group but not in the control and mild group, nighttime ABP and the ratio of nighttime/daytime average BP are higher (t = -2.086 and -3.815, respectively, all P values < 0.05). Linear fitting with ESS and the ratio of nighttime/daytime average BP shows a positive correlation (r(2) = 0.049, P < 0.001). CONCLUSIONS: In severe OSA patients with comparable AHI, EDS may identify a subset of individuals with OSA at higher risk of hypertension, R-HTN, IN-HTN, CAD, and CVD. Overall, nighttime ABP seems to be more sensitive to be influenced by EDS than other ABP parameters. Future studies should investigate the potential dose-effect relationship between EDS and hypertension and the possibility that diagnosis and treatment of EDS could aid in BP reduction and ultimately in decreased morbidity and mortality from cardiovascular and cerebrovascular complications (TMUIRB20010002 at www.clinicaltrials.gov ).

[Interventional effects of different management programs on the outcomes of stable chronic obstructive pulmonary disease patients].

OBJECTIVE: To evaluate the interventional effects of different management programs on the outcomes of stable chronic obstructive pulmonary disease (COPD) patients. METHODS: Systemic education, follow-up and control groups were divided according to the frequency of follow-ups and the profile of participating in education. A total of 157 patients were enrolled into the COPD database from May 2002 to May 2010. They were interviewed face-to-face at our department. The investigation contained general conditions, the frequency of acute exacerbations (AE) the previous year, COPD Assessment Test (CAT), Modified British Medical Research Council Dyspnea Scale (mMRC) and spirometric classification. A combined assessment was conducted. RESULTS: The frequency of AE and rate of AE < once the previous year in systemic education group was 0.9 ± 1.1 and 71.2%, 1.0 ± 0.8 and 68.6% in follow-up group and 1.4 ± 1.1 and 44.4% in control group. And the frequency of AE in systemic education and follow-up groups was significantly less than that in control group (P < 0.05). Rate of AE < once in systemic education and follow-up groups was significantly higher than that in control group (P < 0.01). CAT and rate of CAT ≤ 20 in systemic education, follow-up and control groups were 10.0 ± 5.0 and 96.2%, 11.1 ± 6.0 and 88.2%, 15.3 ± 6.8 and 64.8% respectively. CAT in systemic education and follow-up groups was significantly lower than that in control group (P < 0.01). Rate of CAT ≤ 20 in systemic education and follow-up groups was significantly higher than that in control group (P < 0.01). mMRC in systemic education, follow-up and control groups was 1.5 ± 0.8, 1.6 ± 0.9 and 2.1 ± 1.0 respectively. mMRC in systemic education and follow-up groups was significantly lower than that in control group (P < 0.05). Combined assessment showed that no significant difference existed in Types A and B among three groups (P > 0.05). Type C in the systemic education group was significantly higher than that of the control (P < 0.05). Type D in the systemic education and follow-up groups was significantly lower than that of the control (P < 0.01). CONCLUSION: Long-term systemic education and follow-up management program can reduce the frequency of AE of COPD effectively and improve the health status of COPD patients.

Meta-analysis: Noninvasive ventilation in acute cardiogenic pulmonary edema.

BACKGROUND: Noninvasive ventilation (NIV) is commonly used to treat patients with acute cardiogenic pulmonary edema (ACPE), but the findings of a recent large clinical trial suggest that NIV may be less effective for ACPE than previously thought. PURPOSE: To provide an estimate of the effect of NIV on clinical outcomes in patients with ACPE that incorporates recent trial evidence and explore ways to interpret that evidence in the context of preceding evidence that favors NIV. DATA SOURCES: PubMed and EMBASE from 1966 to December 2009, Cochrane Central Register of Controlled Trials and conference proceedings through December 2009, and reference lists, without language restriction. STUDY SELECTION: Randomized trials that compared continuous positive airway pressure and bilevel ventilation with standard therapy or each other. DATA EXTRACTION: Two independent reviewers extracted data. Outcomes examined were mortality, intubation rate, and incidence of new myocardial infarction (MI). DATA SYNTHESIS: Compared with standard therapy, continuous positive airway pressure reduced mortality (relative risk [RR], 0.64 [95% CI, 0.44 to 0.92]) and need for intubation (RR, 0.44 [CI, 0.32 to 0.60]) but not incidence of new MI (RR, 1.07 [CI, 0.84 to 1.37]). The effect was more prominent in trials in which myocardial ischemia or infarction caused ACPE in higher proportions of patients (RR, 0.92 [CI, 0.76 to 1.10] when 10% of patients had ischemia or MI vs. 0.43 [CI, 0.17 to 1.07] when 50% had ischemia or MI). Bilevel ventilation reduced the need for intubation (RR, 0.54 [CI, 0.33 to 0.86]) but did not reduce mortality or new MI. No differences were detected between continuous positive airway pressure and bilevel ventilation on any clinical outcomes for which they were directly compared. LIMITATIONS: The quality of the evidence base was limited. Definitions, cause, and severity of ACPE differed among the trials, as did patient characteristics and clinical settings. CONCLUSION: Although a recent large trial contradicts results from previous studies, the evidence in aggregate still supports the use of NIV for patients with ACPE. Continuous positive airway pressure reduces mortality more in patients with ACPE secondary to acute myocardial ischemia or infarction. PRIMARY FUNDING SOURCE: None.

A meta-analysis of the effects of atrial overdrive pacing on sleep apnea syndrome.

BACKGROUND: Atrial overdrive pacing is a novel method that has been used to treat patients with sleep apnea syndrome (SAS) in many trials. However, the effects of atrial overdrive pacing on SAS are unclear. METHODS: Studies were retrieved from the PubMed and EMBASE databases (1966 to January 2008), the Central Cochrane Controlled Trials Register (January 2008), and reference lists. Randomized controlled trials were selected that compared atrial overdrive pacing with nonpacing in SAS. Information on study design, patient characteristics, the apnea hypopnea index (AHI), and minimum arterial oxygen saturation (SaO2) was extracted. RESULTS: Eight trials that included a total of 129 patients were identified. The analysis showed that atrial overdrive pacing, as compared to nonpacing, reduced the AHI and increased the minimum SaO2 significantly in the subgroup of patients who presented predominantly with central sleep apnea syndrome (CSAS) (for AHI, mean difference [MD]=-17.08, 95% confidence interval [CI]: -23.25 to -10.91; for minimum SaO2, MD=4.00, 95% CI: 2.48 to 5.52, respectively). The AHI (MD=-2.94, 95% CI: -5.33 to -0.54) was also significantly reduced in the subgroup of patients who showed predominant obstructive sleep apnea syndrome (OSAS), but the result of the analysis of AHI in OSAS-predominant trials was not robust to the exclusion of some trials. There was weak evidence of an increase in minimum SaO2 in the subgroup in which OSAS was predominant (MD=0.13, 95% CI: -1.18 to 1.45). CONCLUSIONS: Atrial overdrive pacing appears to be effective in patients with CSAS. The role of atrial overdrive pacing in OSAS remains unclear.

[Evaluation of chronic obstructive pulmonary disease screening in a high risk population].

OBJECTIVE: To investigate the results of spirometry testing used in the screening of COPD from at risk populations. METHODS: A survey of the population aged over 40 years with any of chronic cough and sputum, dyspnea, heavy tobacco smoke was performed, using a questionnaire on clinical characteristics of COPD. Spirometry and chest X ray examination were performed. Different screening methods were compared for sensitivity and specificity for COPD diagnosis. RESULTS: Of 241 surveyed persons, 156 were diagnosed as having COPD, among whom 126 cases were firstly diagnosed. Among all surveyed persons, 87 (36. 1%) cases had mild and moderate COPD, while 69 (28. 6%) had severe and very severe disease. The sensitivity and specificity for diagnosis of COPD of shortness of breath were 61.5% and 61.2% respectively. Combination of respiratory symptoms and risk factors improved the screening power. More than 40 years of age combined with any of heavy smoking, chronic cough and sputum, or shortness of breath, improved the sensitivity to more than 90 percent. CONCLUSIONS: Spirometry test screening of the at risk population can effectively improve early diagnosis of COPD.

[Impact of chronic obstructive pulmonary disease on quality of life and economic burden in Chinese urban areas].

OBJECTIVE: To assess the impact of chronic obstructive pulmonary disease (COPD) on the quality of life and economic burden in Chinese urban areas. METHODS: COPD patients (n = 723) were interviewed face-to-face in outpatient departments in 6 large cities in China. The questionnaire included social and demographic information, current health status, quality of life (SGRQ), and medical expenditure on outpatient visit, hospitalization, medicine purchasing in medicine stores in the last 12 months, and other expenditures related with COPD were also collected. All the data were analyzed using descriptive method. RESULTS: Of the 723 COPD patients interviewed, 73% were male and the average age was 67 years old. The average symptom score of SGRQ was 49 +/- 24, activity score 57 +/- 23, impact score 46 +/- 23 and total score 50 +/- 21, which were all higher than scores of the healthy populations. The average direct medical cost (including outpatient cost, inpatient cost, and medicine purchasing cost) was 11 744 RMB yuan annually. The direct non-medical cost (including transportation fee, nutrition fee, and nursing fee) was 1570 RMB yuan. 36% of the patients in work had an average of 17 working days lost in the last 12 months because of COPD, while 17% of their relatives had an average of 14 working days lost for caring the patients. CONCLUSIONS: COPD has a serious impact on the quality of life of Chinese urban patients and places a heavy economic burden on their family and the society. Management of COPD should be improved for patients at stable conditions, so as to reduce the incidence and exacerbation of COPD.

[Effect of acute hypoxia and hypercapnia on arterial stiffness and blood pressure in patients with obstructive sleep apnea hypopnea syndrome].

OBJECTIVE: To investigate the effect of acute hypoxia and/or hypercapnia on cardio-ankle vascular index (CAVI) and blood pressure (BP) in patients with obstructive sleep apnea hypopnea syndrome (OSAHS). METHOD: CAVI and blood pressure were measured before and after isocapnic hypoxic, hyperoxia hypercapnic, and hypoxic and hypercapnic challenge in 28 non-hypertensive patients with OSAHS (AHI > 10/h) and 26 healthy controls (AHI < 5/h), respectively. They were matched for age and sex. Hypoxia and hypercapnia were induced by re-breathing technique. RESULTS: The 2 groups had no differences in regard to systolic (SBP) and diastolic BP(DBP) and CAVI. After hypercapnic challenge, SBP increased significantly in both groups. CAVI decreased significantly in controls, but not in OSAHS. Hypoxia induced significant increase of CAVI, but not in OSAHS. SBP and DBP maintained to the pre-challenge levels in both group. Hypercapnia and hypoxia together caused increase of SBP in both groups, and CAVI increased significantly in controls, but not in OSAHS. CONCLUSIONS: Acute hypoxia and hypercapnia exposure caused change of arterial stiffness and BP in both control and patients with sleep apnea hypopnea syndrome. However, CAVI responses to hypoxic and/or hypercapnic challenge were blunted in patients with OSAHS.

[Impact of "three-in-one" asthma education and management model on asthma control in adult patients].

OBJECTIVE: To evaluate the impact of the asthma education and management model developed by Peking University People's Hospital on the level of asthma control. METHODS: Trained respiratory physicians from 6 large teaching hospitals in the urban districts of Beijing conducted a successive questionnaire survey in the form of face-to-face interviews with adult asthma patients attending their respective clinics. The results were used to compare the levels of asthma control between patients who were administered "three-in-one" asthma education and management (education group) and those who were not (control group). RESULTS: Among the 100 patients in the education group, 85% showed asthma control test (ACT) values > or = 20 points. This was significantly higher than that in the 427 control group patients (37%, chi2 = 74.345, P < 0.01). During the past 1 year, the rate of hospitalization due to exacerbation of asthma, number of emergency treatments, and missed working days were significantly lower in the education group than in the control group (4%, 18%, 20% vs 23%, 32%, 55%, respectively; chi(2) = 19.431, 7.515 and 17.853 respectively; and P < 0.01 for all). CONCLUSION: The "three-in-one" asthma education and management model can significantly improve asthma control.

[Effects of short-term continuous positive airway pressure treatment on arterial stiffness in patients with obstructive sleep apnea hypopnea syndrome].

OBJECTIVE: To investigate the effect of short-term continuous positive airway pressure (CPAP) treatment on the arterial stiffness in patients with obstructive sleep apnea hypopnea syndrome (OSAHS). METHODS: Cardio ankle vascular index (CAVI) and blood pressure (BP) were measured before and after sleep in 60 non-hypertensive patients with OSAHS and gender and 60 age-matched healthy controls. CPAP was administrated in 22 of the 60 OSAHS patients. And on the first and third days of the CPAP treatment CAVI and BP were measured in the morning, i. e., after sleep. RESULTS: In the morning, the CAVI of the OSAHS patients was 8.0 +/- 1.2 m/s, significantly higher than that before sleep (7.3 +/- 1.0, P = 0.000), the diastolic BP (DBP) was (86 +/- 12) mm Hg, significantly higher than that before sleep (83 +/- 13 mmHg, P = 0.001), and the mean BP (MBP) was (101 +/- 12) mm Hg, significantly higher than that before sleep (98 +/- 14, P = 0.00116). However, there were no significant differences in these parameters among the controls The systolic BP (SBP) of the OSAHS patients did not changed significantly after sleep, however, there was a tendency to decrease in the controls [(123 +/- 14) vs (121 +/- 13) mm Hg, P = 0.074). After the first night treatment, the CAVI, SBP, DBP, and mean BP of the 22 severe OSAHS patients decreased significantly (all P < 0.05), and after three nights treatment, only the CAVI showed further significant decrease (P < 0.05). CONCLUSION: Sleep induces increase of artery stiffness in OSAHS patients, but not in the normal controls. Short-term CPAP may decrease CAVI without affecting the blood pressures. Early atherosclerosis in the patients with OSAHS may be reversed by CPAP therapy.

[A study of the prevalence of obstructive sleep apnea hypopnea syndrome in drivers].

OBJECTIVE: To study the prevalence of snoring and obstructive sleep apnea hypopnea syndrome (OSAHS) in drivers in Chengde city. METHODS: The prevalence of snoring and OSAHS in drivers was investigated by a questionnaire, and some of the drivers with more severe snoring were also evaluated by polysomnographic study. RESULTS: Among the 718 investigated drivers, never snoring was reported in 68.3% (490/718), mild snoring in 31.7% (228/718), and moderate and severe snoring in 16.6% (119/718). The prevalence of snoring increased with age. The prevalence of snoring was higher in males (33.6%) than in females (15.3%). When their knowledge of snoring was evaluated, 43.2% (310/718) thought snoring was not a disease, 16.7% (120/718) considered snoring as a disease but needed no treatment, 40.1% (228/718) considered it as a disease and needed treatment but only 1 had ever received treatment. If AHI > or = 5/h was used as the diagnostic criteria, the prevalence of OSAHS in the drivers was 12.3% (28/228); and if Epworth Sleepiness Scoring (ESS > or = 9) was combined, the prevalence of OSAHS was 4.1% (9/228). CONCLUSION: The prevalence of snoring in drivers was 31.7%, and the prevalence of OSAHS was 4.1%. Drivers need to be informed of the potential harm of OSAHS on their work.

[The prevalence of snoring in male pilots].

OBJECTIVE: To investigate and analysis the prevalence and risk factors of snoring and excessive daytime sleepiness among male pilots. METHODS: 1108 subjects were derived from a random sample of pilots. They were asked to answer the questions from a questionnaire concerning their snoring and daytime sleepiness, etc. 1054 questionnaire were available for evaluation. RESULTS: The overall prevalence of snoring among male pilots was 51.04% (538/1054), while moderate and severe snorers accounted for 26.28% (227/1054). The prevalence of snoring among male pilots aged over 30 yr was 63.68% (426/669). The prevalence and severity of snoring increase with age and BMI. Age, overweight and obesity, alcohol ingestion and family history of snoring were associated with the prevalence and severity of snoring. There was significant difference in Epworth sleepiness scale scores among without snoring group and various severity of snoring groups (chi2 = 16.948, P < 0.05). CONCLUSION: The prevalence of snoring is high in male pilots. The Epworth sleepiness scale score increase with increasing degree of snoring. Doctors should pay more attention to snoring in male pilot.

[Effect of dopamine and norepinephrine on hemodynamics and tissue oxygenation of patients with septic shock].

OBJECTIVE: To evaluate the effects of dopamine (DA) and norepinephrine (NE) on hemodynamics and tissue oxygenation of patients with septic shock. METHODS: Sixteen patients with septic shock were assigned to the groups of DA and NE randomly. They were given DA or NE for 4 hours, then shifted to NE or DA. Heart rate (HR), mean artery pressure (MAP), cardiac index (CI), stroke index (SI), systemic vascular resistance index (SVRI), acceleration index (ACI), left cardiac work index (LCWI), thoracic fluid content (TFC), mixed venous oxygen saturation (SvO2), venous lactate concentration (Lac), and urine volume per hour (UV) were measured at the end of the 1st, 2nd, 3rd, and 4th hour of the treatment for each of the two drugs. Creatinine clearance rate (CCr) was measured at the end of the 4th hour of study. The differences of all parameters were compared between the two groups. RESULTS: (1)There were no differences in MAP, SI and TFC between the two groups (P>0.05), and there was significant difference in LCWI between the two groups at the end of the 2nd hour (P=0.031). HR, CI and ACI were higher while SVRI was lower in DA group than that in NE group, with significant differences between the two groups (P<0.05 or P<0.01). The results suggested that both DA and NE had good effect on raising blood pressure; DA was more effective than NE in increasing oxygen delivery (DO2), but its use was confined to certain extent due to its effect of accelerating HR. (2) There were no significant differences of SvO2 between the two groups (P>0.05),and the levels of Lac in the group of DA were significantly higher than those in the group of NE (all P<0.05). The results suggested that NE was better than DA in improving internal organ perfusion and tissue oxygenation. (3)UV in the group of DA was significantly higher than that in the group of NE at different time points (P<0.05 or P<0.01). CCr at the end of the 4th hour in DA group was significant higher than that in NE group (P=0.023). The results suggested that DA had significant effects in increasing urine and CCr, denoting that it might have an effect in protecting renal function. CONCLUSION: DA has better effect of increasing DO2 than NE, but its side effect of accelerating HR may to some degree restrict its use. NE may has better effects than DA on enhancing visceral perfusion and tissue oxygenation. DA may be a better choice for patients with septic shock accompanied by oliguria and/or renal dysfunction. NE may be a better choice for the patients of septic shock with tachycardia and/or severe tissue hypoxia.

Validity of Asthma Control Test in Chinese patients.

BACKGROUND: So far, in China, there has been no effective or easy procedure to define the control of asthma. This study assesses the validity of Asthma Control Test in Chinese patients. METHODS: Three questionnaires (Asthma Control Test, Asthma Control Questionnaire and the 30 second asthma test) were administered to 305 asthma patients from 10 teaching hospitals across China. Spirometry was also used. Asthma specialists rated the control of asthma according to patients' symptoms, medications and forced expiratory volume in first second. The patients were divided into noncontrolled group and controlled group according to the specialists' rating. Reliability, empirical validity and screening accuracy were conducted for Asthma Control Test scores. Screening accuracy was compared among 3 questionnaires. The patients' self rating and the specialists' rating were also compared. RESULTS: The internal consistency reliability of the 5-item Asthma Control Test was 0.854. The correlation coefficient between Asthma Control Test and the specialists' rating was 0.729, which was higher than other instruments. Asthma Control Test scores discriminated between groups of patients differing in the percent predicted forced expiratory volume in first second (F = 26.06, P < 0.0001), the specialists' rating of asthma control (F = 88.24, P < 0.0001) and the Asthma Control Questionnaire scores (F = 250.57, P < 0.0001). Asthma Control Test showed no significant difference with Asthma Control Questionnaire in the percent correctly classified, while the percent correctly classified by Asthma Control Test was much higher than 30 second asthma test. The patients' self rating was the same as assessment of the specialists (t = 0.65, P = 0.516). CONCLUSION: The Asthma Control Test is an effective and practicable method for assessing asthma control in China.

[The efficacy and safety of tulobuterol tape in mild and moderate persistent asthma patients].

OBJECTIVE: To evaluate the efficacy and safety of tulobuterol tape in mild and moderate persistent asthma patients. METHODS: A multicenter, randomized, controlled, open label study was performed. A total of 233 adult patients with mild and moderate persistent asthma were enrolled, and 115 patients were treated with tulobuterol tape and 118 with tulobuterol tablet. RESULT: After 4 weeks of treatment, the morning peak expiratory flow (PEF) and evening PEF and the percent change in the tulobuterol tape group were increased significantly as compared to the tulobuterol tablet group (P < 0.05). The rate of improvement in morning PEF with the tape group and the tablet group were 9.1 (0.38 approximately 19.4)% and 4.2 (-6.4 approximately 18.3)%, respectively. The pulmonary function, variation rate of PEF, asthma score and usage of short-acting beta(2) agonist were improved after 4 weeks of treatment, but the differences were not significant between the two groups. The incidence of adverse reactions including palpitations and tremor in the tulobuterol tape group was significantly lower than that in the tablet group (chi(2) = 7.0919, P = 0.0077), and the incidence of local skin adverse reactions in tape group was 2.6%. CONCLUSION: Tulobuterol tape is a newly formulated, effective and safe medication for the treatment of asthma.

[Effect of long-term continuous positive airway pressure ventilation on blood pressure in patients with obstructive sleep apnea hypopnea syndrome: a meta-analysis of clinical trials].

OBJECTIVE: To explore whether long-term continuous positive airway pressure (CPAP) ventilation is effective to decrease the blood pressure in the patients with obstructive sleep apnea hypopnea syndrome (OSAHS) accompanied with hypertension. METHODS: Literatures of relevant randomized, controlled, prospective, clinical trials 2000 - 2006 in English and Chinese were retrieved from Medline and CNKI based on the criteria: the subjects being patients with OSAHS, the study lasting at least 4 weeks, and the effect on 24 hours ambulatory blood pressure in CPAP group being compared with that in no-CPAP group. The data thus collected underwent meta-analysis. RESULT: 471 cases in 7 studies were included. Three of the 7 studies indicated that CPAP ventilation could decrease the diastolic blood pressure in the patients with OSAHS and four studies showed no significant difference in the effect of CPAP on blood pressure between the two groups. From meta-analysis, the weighted mean difference (WMD) in fixed effect model of 24 h diastolic blood pressure (DBP) was -1.78 [95% CI: -3.34, -0.22]; the WMD (fixed) of 24 h systolic blood pressure (SBP) was -0.95 [95% CI: -2.85, 0.94], and the WMD (random) of 24 h mean blood pressure (MBP) was -1.25 [95% CI: -4.00, 1.49]. CONCLUSION: The long-term CPAP ventilation can decrease the 24 h DBP.

[Changes of sleep architecture in patients with narcolepsy].

OBJECTIVE: To investigate the sleep architectures of patients with narcolepsy. METHODS: 38 drug-naive narcoleptic patients, 25 males and 13 females, aged 21 +/- 6.5, and 44 age-, sex ratio-, and BMI-matched normal persons underwent polysomnography (PSG) and multiple sleep latency test (MSLT) during one night sleep. Conventional visual scoring of the polysomnograms was performed according to the international. RESULTS: The sleep latency of the patients was 5.6 min, however, 30 patients (79%) complained of fragmented nocturnal sleep and difficulty to fall asleep again. The sleep efficiency of the narcoleptics was 81.7% +/- 12.5%, significantly lower than that of the normal persons (87.1% +/- 7.9%, P = 0.029). The non-rapid eye movement (NREM) I sleep accounted for (21.5 +/- 12.2)% in the patients, a proportion significantly higher than that of the normal persons [(10.3 +/- 6.3)%, P = 0.000]). The AHI of the patients was 0.6 +/- 1.3 times/h, not significantly different from that of the normal persons (0.5 +/- 1.1 times/h). Although the rapid eye movement (REM) period and eye movement density of the narcoleptics were significantly increased, their REM period duration was not significantly different from that of the normal subjects (17.7% +/- 6.9% vs 18.9% +/- 5.5%, P = 0.23), probably due to the interruption of REM sleep by more frequent arousals in narcoleptics. PSG did not show significant periodic leg movements in these 2 groups. CONCLUSION: One of the important symptoms of narcolepsy, night sleep disturbance may contribute to the pathological sleepiness of narcolepsy during daytime.