Background The socio-economic burden of acute exacerbation of chronic obstructive pulmonary disease （AECOPD） in Beijing is not fully understood. The study investigated the hospitalization cost in patients with AECOP...Background The socio-economic burden of acute exacerbation of chronic obstructive pulmonary disease （AECOPD） in Beijing is not fully understood. The study investigated the hospitalization cost in patients with AECOPD and the associated factors. Methods A multi-center, retrospective study was conducted in the four hospitals in Beijing including two level III hospitals and two level II hospitals. Patients with AECOPD admitted to the hospitals between January and December in 2006 were enrolled. The hospitalization cost and its relationship with disease severity and treatment were analyzed. Results Totally 439 patients were enrolled with 294 men （67.0%） and a mean age 73.4 years. The mean hospital stay was 20.7 days. A total of 204 patients （46.5%） had respiratory failure, 153 （34.9%） with cor pulmonale, 123 （28.0%） with coronary artery disease, 231 （52.6%） with hypertension, 70 （15.9%） with cerebrovascular disease and 32 （7.3%） with renal failure. The percentage of drug cost to total cost was the highest （71.2%）, followed by laboratory cost （16.7%）, therapy cost （9.7%）, oxygen cost （7.3%）, radiology cost （4.5%）, examination cost （4.5%）, bed cost （4.1%）. Correlation analysis showed that cost was positively correlated with age, hospitalization days, co-morbidities such as respiratory failure and cor pulmonale, hypertension. Three hundred and twenty-one patients were further analyzed. The hospitalization cost increased in patients with non-invasive ventilation （P〈0.01）, invasive mechanical ventilation （P〈0.01）, ICU stay （P〈0.01）, antibiotics （P〈0.05）, systemic steroids （P〈0.01）, and poor prognosis （P〈0.05）. Correlation analysis showed that the hospitalization cost was negatively correlated with percentage forced expiratory volume in 1 second （FEV1%） （r=-0.149, P〈0.05）, pH （r=-0.258, P〈0.01）, and PaO2 （r=-0.131, P〈0.05）, positively correlated with PaCO2 （r=0.319, P〈0.01）, non-invasive positive pressure ventilation （r=0.375, P〈0.01） and duration （r=0.463, P〈0.01）, invasive mechanical ventilation （r=0.416, P〈0.01） and duration （r=0.511, P〈0.01）, ICU stay （r=0.390, P〈0.01） and duration （r=0.650, P〈0.01）, antibiotics （r=0.140, P〈0.05） and systemic steroids （r=0.202, P〈0.01）. Conclusions AECOPD had a great impact on healthcare resources utilization. Disease severity, use of non-invasive or invasive ventilation, ICU stay and usage of antibiotics and systemic steroids were the major determinants of hospitalization cost. Long-term regular treatment aimed at reducing the frequency of acute exacerbation will lower the social and economic burden of chronic obstructive pulmonary disease （COPD）.展开更多
Background The mammalian target of rapamycin （mTOR） pathway, a key cellular signaling pathway associated with various cellular functions, has distinct roles in the inflammatory process. In this study, the mTOR inhib...Background The mammalian target of rapamycin （mTOR） pathway, a key cellular signaling pathway associated with various cellular functions, has distinct roles in the inflammatory process. In this study, the mTOR inhibitor rapamycin （Rapa） was used to test whether inhibition of mTOR activation attenuates lipopolysaccharide （LPS）-induced acute lung injury （ALl） in a murine model.Methods Mice pretreated with Rapa or vehicle were given LPS intratracheally. Local cell numbers and inflammatory cytokines present in the bronchoalveolar lavage fluid （BAL）, wet-to-dry weight ratio, histopathology of the lungs, and survival were evaluated.Results The phosphorylation of S6, a major downstream target of mTOR, had a 3-fold increase in lung tissue after LPS stimulation, but the increase was blocked by Rapa. Rapa reduced the levels of TNF-α （LPS vs. LPS ＋ Rapa,（1672.74±193.73） vs. （539.17±140.48） pg/ml, respectively; P 〈0.01） and IL-6 （LPS vs. LPS ＋ Rapa： （7790.88±1170.54）vs. （1968.57±474.62） pg/ml, respectively; P 〈0.01） in the BAL fluid. However, Rapa had limited effects on the overall severity of ALI, as determined by the wet-to-dry weight ratio of the lungs, number of neutrophils in the BAL fluid, and changes in histopathology. In addition, Rapa failed to reduce mortality in the LPS-induced ALI model.Conclusions We confirmed that mTOR was activated during LPS-induced ALI and strongly inhibited by Rapa.Although Rapa reduced the levels of the mediators of inflammation, the overall severity and survival of the ALI murine model were unchanged.展开更多
文摘Background The socio-economic burden of acute exacerbation of chronic obstructive pulmonary disease （AECOPD） in Beijing is not fully understood. The study investigated the hospitalization cost in patients with AECOPD and the associated factors. Methods A multi-center, retrospective study was conducted in the four hospitals in Beijing including two level III hospitals and two level II hospitals. Patients with AECOPD admitted to the hospitals between January and December in 2006 were enrolled. The hospitalization cost and its relationship with disease severity and treatment were analyzed. Results Totally 439 patients were enrolled with 294 men （67.0%） and a mean age 73.4 years. The mean hospital stay was 20.7 days. A total of 204 patients （46.5%） had respiratory failure, 153 （34.9%） with cor pulmonale, 123 （28.0%） with coronary artery disease, 231 （52.6%） with hypertension, 70 （15.9%） with cerebrovascular disease and 32 （7.3%） with renal failure. The percentage of drug cost to total cost was the highest （71.2%）, followed by laboratory cost （16.7%）, therapy cost （9.7%）, oxygen cost （7.3%）, radiology cost （4.5%）, examination cost （4.5%）, bed cost （4.1%）. Correlation analysis showed that cost was positively correlated with age, hospitalization days, co-morbidities such as respiratory failure and cor pulmonale, hypertension. Three hundred and twenty-one patients were further analyzed. The hospitalization cost increased in patients with non-invasive ventilation （P〈0.01）, invasive mechanical ventilation （P〈0.01）, ICU stay （P〈0.01）, antibiotics （P〈0.05）, systemic steroids （P〈0.01）, and poor prognosis （P〈0.05）. Correlation analysis showed that the hospitalization cost was negatively correlated with percentage forced expiratory volume in 1 second （FEV1%） （r=-0.149, P〈0.05）, pH （r=-0.258, P〈0.01）, and PaO2 （r=-0.131, P〈0.05）, positively correlated with PaCO2 （r=0.319, P〈0.01）, non-invasive positive pressure ventilation （r=0.375, P〈0.01） and duration （r=0.463, P〈0.01）, invasive mechanical ventilation （r=0.416, P〈0.01） and duration （r=0.511, P〈0.01）, ICU stay （r=0.390, P〈0.01） and duration （r=0.650, P〈0.01）, antibiotics （r=0.140, P〈0.05） and systemic steroids （r=0.202, P〈0.01）. Conclusions AECOPD had a great impact on healthcare resources utilization. Disease severity, use of non-invasive or invasive ventilation, ICU stay and usage of antibiotics and systemic steroids were the major determinants of hospitalization cost. Long-term regular treatment aimed at reducing the frequency of acute exacerbation will lower the social and economic burden of chronic obstructive pulmonary disease （COPD）.
文摘Background The mammalian target of rapamycin （mTOR） pathway, a key cellular signaling pathway associated with various cellular functions, has distinct roles in the inflammatory process. In this study, the mTOR inhibitor rapamycin （Rapa） was used to test whether inhibition of mTOR activation attenuates lipopolysaccharide （LPS）-induced acute lung injury （ALl） in a murine model.Methods Mice pretreated with Rapa or vehicle were given LPS intratracheally. Local cell numbers and inflammatory cytokines present in the bronchoalveolar lavage fluid （BAL）, wet-to-dry weight ratio, histopathology of the lungs, and survival were evaluated.Results The phosphorylation of S6, a major downstream target of mTOR, had a 3-fold increase in lung tissue after LPS stimulation, but the increase was blocked by Rapa. Rapa reduced the levels of TNF-α （LPS vs. LPS ＋ Rapa,（1672.74±193.73） vs. （539.17±140.48） pg/ml, respectively; P 〈0.01） and IL-6 （LPS vs. LPS ＋ Rapa： （7790.88±1170.54）vs. （1968.57±474.62） pg/ml, respectively; P 〈0.01） in the BAL fluid. However, Rapa had limited effects on the overall severity of ALI, as determined by the wet-to-dry weight ratio of the lungs, number of neutrophils in the BAL fluid, and changes in histopathology. In addition, Rapa failed to reduce mortality in the LPS-induced ALI model.Conclusions We confirmed that mTOR was activated during LPS-induced ALI and strongly inhibited by Rapa.Although Rapa reduced the levels of the mediators of inflammation, the overall severity and survival of the ALI murine model were unchanged.
