The Effect of Respiratory Care on the Treatment of Asthma Patients

Objective:To analyze the intervention effect of respiratory care on asthma patients.Methods:49 asthma patients admitted to the hospital between December 1,2018 and November 30,2022 were selected for this study.The patients were divided into Group A(25 cases)and Group B(24 cases).The patients in Group A received respiratory care,while the patients in Group B received routine care,and the nursing effects of both groups were compared.Results:Group A demonstrated a better nursing effect compared to Group B;the patients in Group A were generally more satisfied with the care given compared to those of Group B.Furthermore,Group A showed better improvements in respiratory function compared to Group B(P<0.05).Before care,there was no difference in quality-of-life scores between the two groups(P>0.05).After care,Group A’s quality of life score was lower than Group B’s(P<0.05).Conclusion:Respiratory care for asthma patients can improve the quality of care and patient satisfaction.Besides,it also leads to a better improvement in respiratory function and the quality of life of the patients.

Uridine diphosphate glucuronosyltransferase 1A1 prevents the progression of liver injury

BACKGROUND Uridine diphosphate glucuronosyltransferase 1A1(UGT1A1)plays a crucial role in metabolizing and detoxifying endogenous and exogenous substances.However,its contribution to the progression of liver damage remains unclear.AIM To determine the role and mechanism of UGT1A1 in liver damage progression.METHODS We investigated the relationship between UGT1A1 expression and liver injury through clinical research.Additionally,the impact and mechanism of UGT1A1 on the progression of liver injury was analyzed through a mouse model study.RESULTS Patients with UGT1A1 gene mutations showed varying degrees of liver damage,while patients with acute-onchronic liver failure(ACLF)exhibited relatively reduced levels of UGT1A1 protein in the liver as compared to patients with chronic hepatitis.This suggests that low UGT1A1 levels may be associated with the progression of liver damage.In mouse models of liver injury induced by carbon tetrachloride(CCl_(4))and concanavalin A(ConA),the hepatic levels of UGT1A1 protein were found to be increased.In mice with lipopolysaccharide or liver steatosis-mediated liver-injury progression,the hepatic protein levels of UGT1A1 were decreased,which is consistent with the observations in patients with ACLF.UGT1A1 knockout exacerbated CCl_(4)-and ConA-induced liver injury,hepatocyte apoptosis and necroptosis in mice,intensified hepatocyte endoplasmic reticulum(ER)stress and oxidative stress,and disrupted lipid metabolism.CONCLUSION UGT1A1 is upregulated as a compensatory response during liver injury,and interference with this upregulation process may worsen liver injury.UGT1A1 reduces ER stress,oxidative stress,and lipid metabolism disorder,thereby mitigating hepatocyte apoptosis and necroptosis.

Current status and prospects of basic research and clinical application of mesenchymal stem cells in acute respiratory distress syndrome

Acute respiratory distress syndrome(ARDS)is a common and clinically devastating disease that causes respiratory failure.Morbidity and mortality of patients in intensive care units are stubbornly high,and various complications severely affect the quality of life of survivors.The pathophysiology of ARDS includes increased alveolar–capillary membrane permeability,an influx of protein-rich pulmonary edema fluid,and surfactant dysfunction leading to severe hypoxemia.At present,the main treatment for ARDS is mechanical treatment combined with diuretics to reduce pulmonary edema,which primarily improves symptoms,but the prognosis of patients with ARDS is still very poor.Mesenchymal stem cells(MSCs)are stromal cells that possess the capacity to self-renew and also exhibit multilineage differentiation.MSCs can be isolated from a variety of tissues,such as the umbilical cord,endometrial polyps,menstrual blood,bone marrow,and adipose tissues.Studies have confirmed the critical healing and immunomodulatory properties of MSCs in the treatment of a variety of diseases.Recently,the potential of stem cells in treating ARDS has been explored via basic research and clinical trials.The efficacy of MSCs has been shown in a variety of in vivo models of ARDS,reducing bacterial pneumonia and ischemia-reperfusion injury while promoting the repair of ventilator-induced lung injury.This article reviews the current basic research findings and clinical applications of MSCs in the treatment of ARDS in order to emphasize the clinical prospects of MSCs.

Recent progress of respiratory inhalation drug delivery systems

With the influence of many factors such as the aging of the population,the younger smokers,and the serious air pollution,the incidence of chronic respiratory diseases is increasing year by year.In the treatment of respiratory diseases,clinical intervention is still mainly based on drug control of pulmonary symptoms.However,systemic drugs have disadvantages such as many adverse reactions and severe systemic side effects.In recent years,the research and development of local drug delivery systems for the respiratory tract has brought new changes to the treatment of respiratory diseases.Locally delivered drugs can directly act on the airways and have the characteristics of fast onset,good curative effect and small side effects.It is a simple,efficient and safe treatment method,which has a very significant effect,and has become a hot topic of current research and promotion.This paper briefly reviews the development track and latest research progress of respiratory local drug delivery systems at home and abroad,in order to provide reference for clinical workers in drug selection and application.

Effect of early stepwise cardiopulmonary rehabilitation on function and quality of life in sepsis patients

BACKGROUND Sepsis,as a non-limiting host infection disease,can be accompanied by serious complications such as organ failure,which seriously threatens patient quality of life.AIM To investigate the effect of early stepwise cardiopulmonary rehabilitation on cardiopulmonary function and quality of life in patients evacuated from mechanical ventilation with sepsis.METHODS A total of 80 patients with sepsis who were hospitalized in our hospital from January 2021 to January 2022 were selected and divided into the observation group(n=40)and the control group(n=40)according to the random number table method.The observation group was treated with early stepwise cardiopulmonary rehabilitation,and the control group was treated with a conventional treatment regimen.Cardiac function indexes(central venous pressure,cardiac troponin I,B-type brain natriuretic peptide),lung function indicators(diaphragmatic mobility,changes in central venous oxygen saturation,oxygenation index),and quality of life(Quality of Life Evaluation Scale)were compared between the two groups after treatment.RESULTS After treatment,the central venous pressure,diaphragm mobility,central venous oxygen saturation,oxygenation index,and Quality of Life Evaluation Scale scores in the observation group were higher than those in the control group,and the differences were statistically significant(P<0.05).The observation group was less than that of the control group for other parameters,and the differences were statistically significant(P<0.05).CONCLUSION Early stepwise cardiopulmonary rehabilitation can effectively enhance cardiac and pulmonary function and improve the quality of life in patients evacuated from mechanical ventilation with sepsis.

Impact of minimally invasive surgery on immune function and stress response in gastric cancer patients

BACKGROUND Gastric cancer remains a leading cause of cancer-related mortality globally.Traditional open surgery for gastric cancer is often associated with significant morbidity and prolonged recovery.AIM To evaluate the effectiveness of laparoscopic minimally invasive surgery as an alternative to traditional open surgery for gastric cancer,focusing on its potential to reduce trauma,accelerate recovery,and achieve comparable oncological out-comes.METHODS This study retrospectively analyzed 203 patients with gastric cancer who underwent surgery at the Shanghai Health Medical College Affiliated Chongming Hospital from January 2020 to December 2023.The patients were divided into two groups:Minimally invasive surgery group(n=102),who underwent laparoscopic gastrectomy,and open surgery group(n=101),who underwent traditional open gastrectomy.We compared surgical indicators(surgical incision size,intraop-erative blood loss,surgical duration,and number of lymph nodes dissected),recovery parameters(time to first flatus,time to start eating,time to ambulation,and length of hospital stay),immune function(levels of IgA,IgG,and IgM),intestinal barrier function(levels of D-lactic acid and diamine oxidase),and stress response(levels of C-reactive protein,interleukin-6,and procalcitonin).RESULTS The minimally invasive surgery group demonstrated significantly better outcomes in terms of surgical indicators,including smaller incisions,less blood loss,shorter surgery time,and more lymph nodes dissected(P<0.05 for all).Recovery was also faster in the minimally invasive surgery group,with earlier return of bowel function,earlier initiation of diet,quicker mobilization,and shorter hospital stays(P<0.05 for all).Furthermore,patients in the minimally invasive surgery group had better preserved immune function,superior intestinal barrier function,and a less pronounced stress response postoperatively(P<0.05 for all).CONCLUSION Laparoscopic minimally invasive surgery for gastric cancer not only provides superior surgical indicators and faster recovery but also offers advantages in preserving immune function,protecting intestinal barrier function,and mitigating the stress response compared to traditional open surgery.These findings support the broader adoption of laparoscopic techniques in the management of gastric cancer.

Enhancement of anti-PD-L1 antibody plus anlotinib efficacy due to downregulation of PD-L1 in the micro-conduit endothelium within the tumor:a randomized double-blind trial

Objective:The possible enhancing effect of anlotinib on programmed death receptor ligand(PD-L1)antibody and the efficacy-predicting power of PD-L1 in micro-conduit endothelium,including lymphatic endothelial cells(LECs)and blood endothelial cells(BECs),were determined to identify patients who would benefit from this treatment.Methods:PD-L1 positivity in LECs,BECs,and tumor cells(TCs)was assessed using paraffin sections with multicolor immunofluorescence in an investigator’s brochure clinical trial of TQB2450(PD-L1 antibody)alone or in combination with anlotinib in patients with non-small cell lung cancer.Progression-free survival(PFS)with different levels of PD-L1 expression was compared between the two groups.Results:Among 75 patients,the median PFS(mPFS)was longer in patients who received TQB2450 with anlotinib[10 and 12 mg(161 and 194 days,respectively)]than patients receiving TQB2450 alone(61 days)[hazard ratio(HR)_(10 mg)=0.390(95%confidence interval{CI},0.201–0.756),P=0.005;HR_(12 mg)=0.397(0.208–0.756),P=0.005].The results were similar among 58 patients with high PD-L1 expression in LECs and TCs[159 and 209 vs.82 days,HR_(10 mg)=0.445(0.210–0.939),P=0.034;HR_(12 mg)=0.369(0.174–0.784),P=0.009],and 53 patients with high PD-L1 expression in BECs and TCs[161 and 209 vs.41 days,HR_(10 mg)=0.340(0.156–0.742),P=0.007;HR_(12 mg)=0.340(0.159–0.727),P=0.005].No differences were detected in the mPFS between the TQB2450 and combination therapy groups in 13 low/no LEC-expressing and 18 low/no BEC-expressing PD-L1 cases.Conclusions:Mono-immunotherapy is not effective in patients with high PD-L1 expression in LECs and/or BECs.Anlotinib may increase efficacy by downregulating PD-L1 expression in LECs and/or BECs,which is presumed to be a feasible marker for screening the optimal immune patient population undergoing anti-angiogenic therapy.

Research progress on the clinical diagnosis and treatment of COPD with pulmonary embolism

Chronic obstructive pulmonary disease(COPD)is one of the most common and important diseases leading to the death of elderly patients in the world at present.It is characterized by continuous airflow restriction and irreversible chronic airway obstruction,which can easily lead to a variety of complications and accompanying symptoms,greatly affecting the quality of life of individuals and increasing the economic burden of families and society.Pulmonary embolism(PE)is one of the complications of COPD,which can lead to pulmonary blood circulation and respiratory failure,with a high risk of death.However,because its clinical symptoms overlap with the symptoms of acute exacerbation of COPD and lack of specific clinical manifestations and laboratory tests,it is easy to be misdiagnosed and ignored,thus delaying the treatment of patients and affecting the prognosis.This article will elaborate on the clinical diagnosis and treatment of chronic obstructive pulmonary disease combined with pulmonary embolism,providing certain value for early identification of COPD combined with PE patients and the severity of the condition.

Clinical Evaluation of Two Interferon-Gamma Release Assays for Diagnostic Tests of Tuberculosis Infection in a Tertiary Hospital: Clinical Evaluation of Two IGRAs for TB Infection

Background: The aim of this study was to evaluate the usefulness of two interferon-gamma release assays (IGRAs) (QuantiFERON-TB Plus (QFT-plus) and T-SPOT.TB assay) for patients suspected of having tuberculosis (TB) infection as supportive methods for diagnosing TB. Patients and Methods: The subjects consisted of 45 patients who required clinical differentiation of TB disease from June 2019 to August 2023. The final clinical diagnoses were: 14 patients with active TB disease, 4 with latent TB infection (LTBI), 17 with old (cured) TB disease, and 10 with pulmonary nontuberculous mycobacterial (NTM) disease. We used the two IGRAs for these patients and evaluated the data according to the manufacturer’s guidelines for interpretation or FDA-approved cutoffs. Results: Among the total of 14 patients with active TB disease (mean age: 64 years old, male: 9, and female: 5), a positive response was noted in 10 patients (71%) on QFT-plus and 9 (64%) on T-SPOT.TB. Four patients with a negative response on QFT-plus and T-SPOT.TB were elderly or cancer patients with lymphocytopenia or hypoalbuminemia. All four patients with LTBI showed a positive response (100%) on both QFT-plus and T-SPOT.TB. Among the seventeen patients with old (cured) TB disease, a positive response was noted in 8 patients (47%) on QFT-plus and 9 (53%) on T-SPOT.TB. All patients with pulmonary NTM disease showed a negative response on both QFT-plus and T-SPOT.TB. Conclusions: A false-negative response on QFT-plus as well as T-SPOT.TB was recognized in elderly patients and patients with an immunosuppressed condition, and half of patients with old (cured) TB showed no negative conversion after the completion of treatment through this study. Although it was recently reported that the positive response rate on QFT-plus of patients with active TB disease was high, we consider it necessary to be careful in diagnosing TB infection using IGRAs for patients with severe underlying diseases in a tertiary hospital based on the results.

Is there a correlation between the changes in airway inflammation and the changes in respiratory mechanics after vaping in patients with asthma?

BACKGROUND Electronic cigarettes(ECs)have been promoted as alternatives to traditional cigarettes.To investigate ECs’effects on respiratory system,especially in patients with respiratory diseases.METHODS We randomly selected 25 smokers with stable moderate asthma and matched them with 25 healthy smokers.All were subjucted to pulmonary function tests(PFTs),impulse oscillometry(IOS),fraction exhaled Nitric Oxide(FeNO),exhaled breathe condensate(EBC)and biomarker measurements before and after vaping one nicotinecontaining EC.RESULTS The increase in FeNO 30 minutes after EC,reflecting airway inflammation,significantly correlated with increase of residual volume(RV),total lung capacity,respiratory impedance at 5 Hz(Z5Hz)and respiratory resistance at 5 and 20 Hz(R5Hz and R20Hz).No significant correlations were found between EBC biomarkers'changes and respiratory mechanics.CONCLUSION This is the first study demonstrating that the changes in airway inflammation caused by EC have direct effects in respiratory mechanics of asthmatic patients.

Simultaneous Detection of 13 Key Bacterial Respiratory Pathogens by Combination of Multiplex PCR and Capillary Electrophoresis

Objective Lower respiratory tract infections continue to pose a significant threat to human health. It is important to accurately and rapidly detect respiratory bacteria. To compensate for the limits of current respiratory bacteria detection methods, we developed a combination of multiplex polymerase chain reaction （PCR） and capillary electrophoresis （MPCE） assay to detect thirteen bacterial pathogens responsible for lower respiratory tract infections, including Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catorrholis, Pseudomonas aeruginosa, Klebsiella pneumoniae, Escherichia coli, Staphylococcus aureus, Mycoplasma pneumoniae, Legionella spp., Bordetella pertussis, Mycobacterium tuberculosis complex, Corynebactefium diphthefiae, and Streptococcus pyogenes. Methods Three multiplex PCR reactions were built, and the products were analyzed by capillary electrophoresis using the high-throughput DNA analyzer. The specificity of the MPCE assay was examined and the detection limit was evaluated using DNA samples from each bacterial strain and the simulative samples of each strain. This assay was further evaluated using 152 clinical specimens and compared with real-time PCR reactions. For this assay, three nested-multiplex-PCRs were used to detect these clinical specimens. Results The detection limits of the MPCE assay for the 13 pathogens were very low and ranged from 10-7 to 10-2 ng/μL. Furthermore, analysis of the 252 clinical specimens yielded a specificity ranging from 96.5%-100.0%, and a sensitivity of 100.0% for the 13 pathogens. Conclusion This study revealed that the MPCE with high specificity and sensitivity. This assay survey of respiratory pathogens. assay is a rapid, reliable, and high-throughput method has great potential in the molecular epidemiological.

Changes in intestinal microflora in rats with acute respiratory distress syndrome

AIM: To implement high-throughput 16S rDNA sequencing to study microbial diversity in the fecal matter of rats with acute lung injury/acute respiratory distress syndrome (ALI/ARDS).

Acute exacerbation of chronic obstructive pulmonary disease was associated with respiratory syncytial virus infection and the upregulation of TLR3

Respiratory syncytial virus(RSV)infection is known as a risk factor for chronic obstructive pulmonary disease(COPD).RSV infection induces the upregulation of Toll-like receptor 3(TLR3).This study aimed to investigate the association of TLR3 with RSV induced acute exacerbations of chronic obstructive pulmonary disease(AECOPD).Serum/sputum samples from AECOPD patients,stable chronic obstructive pulmonary disease(SCOPD)patients,and healthy controls were collected.Nested PCR was used to detect RSV.The lung function parameters were assessed by blood gas and lung function analysis.The expression levels of inflammatory factors in sputum and serum samples were determined by enzyme-linked immunosorbent assay.BEAS-2B cell lines were infected with RSV,and the expression of TLR3 mRNA was determined by PCR and the levels of inflammatory factors were also investigated.The presence of RSV was detected in 3 SCOPD and 8 AECOPD patients,but not in healthy patients.The expression levels of TNF-αand IRF-3 in both sputum and serum samples of RSV-positive group were significantly higher than in RSV-negative group.TLR3 mRNA levels in RSV-positive group were significantly higher than those in RSVnegative group.Interestingly,the level of TLR3 mRNA expression was negatively correlated with oxygenation index and lung function parameters.Furthermore,BEAS-2B cells infected with RSV led to significant increase of the expression of TLR3 mRNA and inflammatory factors IFN-β,IL-13,IL-32,and TNF-α.Our observations indicate that AECOPD is associated with RSV infection and the upregulation of TLR3.

Clinical evaluation of prone position ventilation in the treatment of acute respiratory distress syndrome induced by sepsis

BACKGROUND Acute respiratory distress syndrome(ARDS)is an acute,diffuse,inflammatory lung injury.Previous studies have shown prone position ventilation(PPV)to be associated with improvement in oxygenation.However,its role in patients with ARDS caused by sepsis remains unknown.AIM To analyze the clinical effects of PPV in patients with ARDS caused by sepsis.METHODS One hundred and two patients with ARDS were identified and divided into a control group(n=55)and a PPV treatment group(n=47).Outcomes included oxygenation index,lung compliance(Cst)and platform pressure(Pplat),which were compared between the two groups after ventilation.Other outcomes included heart rate(HR),mean arterial pressure(MAP),central venous pressure(CVP),left ventricular ejection fraction(LVEF),the length of mechanical ventilation time and intensive care unit(ICU)stay,and levels of C-reactive protein(CRP),procalcitonin(PCT),and interleukin-6(IL-6)after ventilation.Finally,mortality rate was also compared between the two groups.RESULTS On the first day after ventilation,the oxygenation index and Cst were higher and Pplat level was lower in the PPV group than in the conventional treatment group(P<0.05).There were no significant differences in oxygenation index,Cst,and Pplat levels between the two groups on the 2^(nd),4^(th),and 7^(th) day after ventilation(P>0.05).There were no significant differences in HR,MAP,CVP,LVEF,duration of mechanical ventilation and ICU stay,and the levels of CRP,PCT,and IL-6 between the two groups on the first day after ventilation(all P>0.05).The mortality rates on days 28 and 90 in the PPV and control groups were 12.77% and 29.09%,and 25.53% and 45.45%,respectively(P<0.05).CONCLUSION PPV may improve respiratory mechanics indices and may also have mortality benefit in patients with ARDS caused by sepsis.Finally,PPV was not shown to cause any adverse effects on hemodynamics and inflammation indices.

Application of TREM-1 in peripheral blood as a switching point for sequential ventilation of patients with chronic obstructive pulmonary disease complicated with respiratory failure

Objective:To investigate the application of peripheral blood triggering receptor expressed on myeloid cells-1(TREM-1)for sequential treatment switching points in patients with chronic obstructive pulmonary disease(COPD)complicated with respiratory failure.Methods:A total of 120 cases of COPD patients with respiratory failure from June 2017 to December 2018 were randomly divided into two groups:60 cases in the control group and 60 cases in the observation group.The control group received spontaneous breathing trials for 2 h to select the time for non-invasive positive pressure ventilation,while the observation group received peripheral blood TREM-1(≤90.0 pg/mL)to select the time for non-invasive positive pressure ventilation.The stress hormones,clinical pulmonary infection score and vital signs of two groups after 24 h of mechanical ventilation were detected.The treatment time and the adverse reactions of the two groups were recorded.Results:There was no significant difference in rennin,adrenaline,noradrenaline and angiotensin II between two groups(P>0.05).Compared with the control group,the clinical pulmonary infection score was decreased in the observation group(P<0.05).There was no significant difference in heart rate,respiratory rate,pH,partial pressure of carbon dioxide and partial pressure of oxygen between two groups(P>0.05).There was no significant difference in intensive care monitoring time between two groups(P>0.05).Compared with the control group,the observation group had no significant difference in invasive ventilation time and total mechanical ventilation.The time of hospitalization and hospitalization had significantly decreased(P<0.05).There was no significant difference in mortality,ventilator-associated pneumonia and re-intubation between two groups(P>0.05).Conclusion:TREM-1 can be used as a switching point during invasive-noninvasive sequential ventilation for COPD patients with respiratory failure,which can shorten the time of invasive ventilation,total mechanical ventilation and hospitalization.

Application of next-generation sequencing technology to precision medicine in cancer: joint consensus of the Tumor Biomarker Committee of the Chinese Society of Clinical Oncology

Next-generation sequencing(NGS) technology is capable of sequencing millions or billions of DNA molecules simultaneously.Therefore, it represents a promising tool for the analysis of molecular targets for the initial diagnosis of disease, monitoring of disease progression, and identifying the mechanism of drug resistance. On behalf of the Tumor Biomarker Committee of the Chinese Society of Clinical Oncology(CSCO) and the China Actionable Genome Consortium(CAGC), the present expert group hereby proposes advisory guidelines on clinical applications of NGS technology for the analysis of cancer driver genes for precision cancer therapy. This group comprises an assembly of laboratory cancer geneticists, clinical oncologists, bioinformaticians,pathologists, and other professionals. After multiple rounds of discussions and revisions, the expert group has reached a preliminary consensus on the need of NGS in clinical diagnosis, its regulation, and compliance standards in clinical sample collection. Moreover, it has prepared NGS criteria, the sequencing standard operation procedure(SOP), data analysis, report, and NGS platform certification and validation.

Effects of Solvents on Extraction of Effective Components from Cell Wall Tissues of Chinese Traditional Medicines

The effects of different Chinese traditional medicines were solvents on the extraction of effective studied by the histochemical methods, components from the cell wall tissues of such as the bare-handed section, swelling ratio, paraffin section, IR spectrum and cell wall component analysis. The results show that the ethanol-alkali solvent could increase the swelling ratio as well as the swelling speed. The effective components of cell wall tissues extracted by ethanol-alkali solvent become loose shown by the paraffin section. According to the IR spectrum analysis and the results of cell wall tissue component analysis, it was found that the ethanol-alkali solvent could decrease the contents of pectin and hemicellulose in the cell wall to make the wall broken, and therefore the effective components can be extracted easily by the solvent and the extraction rate is increased.

Research advances concerning the mechanism of glucocorticoid resistance in relation to traditional Chinese medicine for patients with chronic obstructive pulmonary disease

Chronic obstructive pulmonary disease is a common,highly disabling,and burdensome disease.Anti-inflammatory glucocorticoid medication plays a key role in its treatment;however,glucocorticoid resistance in patients with chronic obstructive pulmonary disease considerably weakens the effects of the treatment.Despite recent advances in determining the mechanism of glucocorticoid resistance in patients with chronic obstructive pulmonary disease,the role of traditional Chinese medicine in treating such patients remains unclear.In this review,we reviewed the mechanism of chronic obstructive pulmonary disease-related glucocorticoid resistance with reference to the glucocorticoid receptor,the important signaling pathways(phosphatidylinositol-3-kinase/protein kinase B signaling pathway,p38 mitogen-activated protein kinase signaling pathway,and interferon-γ/Janus kinase/stransducer and activator of transcription signaling pathway),histone deacetylase,nuclear transcription factor-κB,exosomes,and microRNA.Moreover,the methods of establishing the glucocorticoid resistance model associated with chronic obstructive pulmonary disease and advances in therapeutic approaches including traditional Chinese medicine to restore chronic obstructive pulmonary disease glucocorticoid sensitivity have also been reviewed.This review shows that traditional Chinese medicine reverses glucocorticoid resistance mainly by regulating the expression of glucocorticoid receptor,p38 mitogen-activated protein kinase signaling,histone deacetylase 2,and nuclear transcription factor-κB in chronic obstructive pulmonary disease models.Future research is suggested to evaluate traditional Chinese medicine understanding of chronic obstructive pulmonary disease-related glucocorticoid resistance in relation to exosomes,microRNA,and other signaling pathways.

The applicable value of respiratory impedance for the stage 0 of chronic obstructive pulmonary disease

Objective ：To evaluate the applicable value of respiratory impedance for the stage 0 of chronic obstructive pulmonary disease （COPD）. Methods：Respiratory impedance was measured by impulse oscillometry （lOS） in 41 cases at stage 0 of COPD （NHLBI/WHO, 2001 Standard） and their conventional pulmonary function values were compared with 42 healthy subjects. Both groups had no significant deviation in age, stature and avoirdupois, etc. Master-Screen pulmonary function test system （Jaeger Co, Germany） were used to determine IOS parameters including viscous resistance of 5Hz, 20 Hz and 35Hz （R5, R20, R35）, reactance of 5Hz, 35 Hz （X3, X35）, resonant frequency （Fres） ,total respiratory impedance （Zrs） and routine pulmonary function values including forced expiratory volume in one second to predicted value （FEV1 % ）, forced expiratory volume in one second to forced vital capacity ratio（ FEV1/ FVC% ）, maximal mid expiratory flow （MMEF%）,V23% and V50%. Results：Both groups had no significant deviation in FEV1%, FEV1/FVC% and X35（P〉0.05）. It was increased significantly in viscous resistance of 5Hz, 20 Hz and 35Hz （R5, R20, R35） in COPD group than that in healthy group （P〈0.01）. So were Fres and Zrs （P〈0.01）. MMEF%,V25%,V50% and reactance of 5Hz （X5） in COPD group were marked lower than that in healthy group （P〈0.01）. The sensitivity of MMEF%, V25%,V50% was higher than others, but its specificity was lower. In parameters of IOS, Fres was the most sensitive index for diagnosis of the small airway function and its specificity was higher than that of MMEF%, V25% ,V50%. Conclusion：In the risk case at the stage 0 of COPD, MMEF%, V25% and V50% could be decreased, but Fres, R5 ,R5-20 could be increased in spite of FEV1% and FEV1/FVC% in normal range.

Effect of adjuvant tiotropium bromide therapy on the oxygenation function and inflammatory response in patients with COPD and type Ⅱ respiratory failure

Objective:To explore the effect of adjuvant tiotropium bromide therapy on the oxygenation function and inflammatory response in patients with COPD and type Ⅱ respiratory failure. Methods:a total of 58 patients with COPD and type II respiratory failure treated in our hospital between August 2012 and January 2016 were collected and divided into observation group (n=29) and control group (n=29) according to the single blind randomized control method. Control group of patients received clinical routine treatment, and observation group of patients received adjuvant tiotropium bromide treatment on the basis of routine treatment. Before treatment and 30d after treatment, spirometer was used to determine pulmonary ventilation function;blood gas analyzer was used to test oxygenation function indexes;enzyme-linked immunosorbent assay (ELISA) was used to detect serum inflammatory factor levels.Results: Before treatment, differences in pulmonary ventilation function, oxygenation function and serum inflammatory factor levels were not statistically significant between two groups of patients. 30 d after treatment, FEV1, FEF75%, PEF, PaO2/FiO2, DO2 and O2ER levels of observation group were significantly higher than those of control group while VO2 level was significantly lower than that of control group;serum IL-1β, IL-18, IL-27 and CRP levels were significantly lower than those of control group.Conclusion:Adjuvant tiotropium bromide treatment can optimize the pulmonary ventilation and oxygenation function and reduce systemic inflammatory response in patients with COPD and type II respiratory failure.