Background Leptin is a protein mainly secreted by adipocytes, and the major function of leptin was its role in body weight regulation. It is suggested that increased levels of circulating leptin may contribute to anor...Background Leptin is a protein mainly secreted by adipocytes, and the major function of leptin was its role in body weight regulation. It is suggested that increased levels of circulating leptin may contribute to anorexia in pathologic conditions including chronic obstructive pulmonary disease （COPD）. Recent studies have provided evidence for a link between leptin and proinflammatory cytokines such as tumor necrosis factor-α （TNF-α）. This study aimed to explore the role of serum leptin in the malnutrition of COPD patients, and to observe the changes of serum leptin levels during acute exacerbation, also to investigate relationship between leptin and TNF-α. Methods Seventy-two COPD patients and 34 control subjects participated in this study. Seventy-two COPD patients were divided into 3 groups： group COPD IA （patients without malnutrition during acute exacerbation, n=25）, group COPD IB （patients without malnutrition during stable disease, n=29）, group COPD II （patients with malnutrition during stable disease, n=18）. To eliminate the effect of sex differences, all patients and controls were male. Body mass index （BMI）, percent ideal body weight （IBW%）, triceps skin-fold thickness （TSF）, mid-upper ann circumference （MAC）, mid-upper arm muscle circumference （MAMC）, serum leptin and TNF-α levels, serum prealbumin （PA）, serum transferrin （TF）, serum albumin （Alb）, total lymphocytes count （TLC）, forced expiratory volume in one second （FEV1）, maximal inspiration pressure （MIP） and maximal expiration pressure （MEP） were measured in all participants. Leptin levels were measured by radioimmunoassay. TNF-α levels were measured by ELISA. The between group difference and correlation of these parameters were analyzed. Results Serum leptin levels were significantly lower in group COPD Ⅱ[（4.07 ±3.42） ng/ml] than in group COPD IB [（9.72± 6.67） ng/ml] and controls [（8.21 ±5.41） ng/ml] （P〈0.05）. There was no statistically significant difference in serum leptin levels between group COPD IA [（10.82±6.40） ng/ml], group COPD IB [（9.72±6.67） ng/ml] and controls [（8.21 ±5.41） ng/ml]. There was no statistically significant difference in serum TNF-α levels between group COPD Ⅱ[（8.03 ±3.37） pg/ml], group COPD IA [（8.90± 1.60） pg/ml], and group COPD IB [（7.25 ±2.08） pg/ml]. There was no significant correlation between leptin and TNF-α in any group. Conclusions Leptin was not involved in anorexia and weight loss of COPD patients. There was no statistically significant difference in serum leptin levels between COPD patients during stable stage and acute exacerbation, and there was no significant correlation between TNF-α and leptin during the regulation of the energy balance in COPD patients.展开更多
Background Many studies have shown the superior efficacy of budesonide （BUD）/formoterol （FORM） maintenance and reliever therapy, but still lack evidence of its efficacy in Chinese asthma patients in a relative lar...Background Many studies have shown the superior efficacy of budesonide （BUD）/formoterol （FORM） maintenance and reliever therapy, but still lack evidence of its efficacy in Chinese asthma patients in a relative large patient-group. We finished this research to compare BUD/FORM maintenance and reliever therapy and high-dose salmeterol （SALM）/fluticasone （FP） maintenance plus an as-needed short-acting IB2-agonist in Chinese patients with persistent uncontrolled asthma. This was a post hoc analysis based on a 6-month, multicenter, randomized, double-blind study （NCT00242775）. Methods A total of 222 eligible asthma patients from nine centers in China were randomized to either BUD/FORM＋as- needed BUD/FORM （160/4.5 pg/inhalation） （640/18 pg/d; n=111 ）, or SALM/FP＋as-needed terbutaline （0.4 mg/inhalation） （100/1000 pg/d; n=111）. The primary endpoint was time to first severe exacerbation while secondary endpoints included various measures of pulmonary function, symptom control and quality-of-life. Results Time to first severe exacerbation over six months was lower with the BUD/FORM than with the SALM/FP treatment （risk ratio=0.52, 95% CI 0.22-1.22）, but the difference did not achieve statistical significance （P=-0.13）. The cumulative number of severe exacerbations in the BUD/FORM group was lower than in the SALM/FP group （7.2% vs. 13.5%; risk ratio=0.45, P=0.028）. BUD/FORM produced significantly better improvements in reliever use, cumulative mild exacerbations, symptom-free days （%）, and morning/evening peak expiratory flow （PEF） than SALM/FP （P 〈0.05 in all cases）. The two groups achieved similar improvements in their time to first mild exacerbation, forced expiratory volume in one second （FEV1）, asthma control questionnaire and asthma symptom scores, and percentage of nights with awakening（s）. Both treatments were well tolerated. Conclusions In Chinese patients with persistent asthma, BUD/FORM decreased severe and mild exacerbations, decreased reliever use, increased symptom-free days, and improved morning/evening PEF compared with SALM/FP. There were no significant differences in time to first severe exacerbation or other assessments regarding daily asthma control between BUD/FORM and SALM/FP. BUD/FORM was more effective in this Chinese sub-group than in the total cohort involved in the oriclinal study. （Clinical Trial Registry Number： NCT00242775）展开更多
Pseudomonas aeruginosa （P. aeruginosa） is one of the leading pathogens involved in nosocomial pneumonia. In addition, P. aeruginosa infection is associated with significant morbidity and mortality. A major problem i...Pseudomonas aeruginosa （P. aeruginosa） is one of the leading pathogens involved in nosocomial pneumonia. In addition, P. aeruginosa infection is associated with significant morbidity and mortality. A major problem in P. aeruginosa infection is that this organism exhibits natural and acquired resistance to many structurally and functionally diverse antibiotics.展开更多
Background The emergence of heteroresistant vancomycin-intermediate Staphylococcus aureus （hVISA） is increasingly challenging the methods for detection in diagnostic microbiology laboratories. However, the report of...Background The emergence of heteroresistant vancomycin-intermediate Staphylococcus aureus （hVISA） is increasingly challenging the methods for detection in diagnostic microbiology laboratories. However, the report of hVISA is rare in China. This study summarizes the prevalence and clinical features associated with hVISA infections at our institution and the local impact they have on clinical outcome. Methods A total of 122 methicillin-resistant Staphylococcus aureus （MRSA） isolates which were of the causative pathogens were collected. One hundred and two patients for whom we had full information of MRSA pneumonia were included. Isolates of MRSA were collected using PCR to detect the mecA gene. Both Etest and macro Etest were performed to screen for hVISA. The Staphylococcal chromosome cassette mec （SCCmec） types were determined by multiplex PCR strategy. Logistic regression analysis was used to determine the risk factors. Results Among the 122 MRSA isolates collected, 25 （20.5%） strains were identified as hVISA. There were 119 （97.5%） SCCmec III isolates, two （1.6%） SCCmec II isolates, and one （0.8%） SCCmec V isolate. The 30-day mortality of MRSA-hospital acquired pneumonia （HAP） was 37.3%, and 62.5% for hVISA-HAP. Vancomycin treatment was the independent risk factor of hVISA. Factors independently associated with 30-day mortality in all patients were acute physiology and Chronic Health Evaluation （APACHE） II score 〉20, multiple lobe lesions, and creatinine clearance rate （CCR） 〈15 ml/min. Conclusions The prevalence of hVISA is 20.5% at our institution, hVISA-HAP patients had a poor clinical outcome. Vancomycin treatment was the independent predictors for hVISA infection. Factors independently associated with 30-day mortality in all patients were APACHE II score 〉20, multiple lobe lesions and CCR 〈15 ml/min.展开更多
Rulmonary function tests provide an objective means to verify ventilatory dysfunction and to estimate its severity in respiratory disorders. Measurement of forced expiratory volume in 1 second （FEV1） and forced vita...Rulmonary function tests provide an objective means to verify ventilatory dysfunction and to estimate its severity in respiratory disorders. Measurement of forced expiratory volume in 1 second （FEV1） and forced vital capacity （FVC） is considered to be the basic tests for the assessment of airway obstruction. Although they are useful diagnostically and prognostically, the results of FEV1 and FVC are strongly dependent on the cooperation of the patient. Lack of collaboration is particularly present in elderly patients because of mood alterations, fatigability or cognitive impairment. The forced oscillation technique （FOT） and the interrupter resistance technique are the two methods of measuring respiratory resistance during tidal breathing, they are of special interest because both of them are noninvasive, requires minimal cooperation, takes little time and can be easily repeated, especially in children and elderly subjects who cannot accomplish forced expiratory maneuvers in a reproducible manner.展开更多
Leukotrienes （LTs） are synthesized from membrane derived arachidonic acid.Downstream of 5-lipoxygenase in the arachidonic acid cascade, leukotriene C4 synthase （LTC4S） catalyses the conjugation of leukotriene A4 ...Leukotrienes （LTs） are synthesized from membrane derived arachidonic acid.Downstream of 5-lipoxygenase in the arachidonic acid cascade, leukotriene C4 synthase （LTC4S） catalyses the conjugation of leukotriene A4 （LTA4） with reduced glutathione to form LTC4, then LTC4 convert to active metabolites LTD4 and LTE4. LTC4, LTD4 and LTE4, which are called cysteinyl leukotrienes （CysLTs）, are potent proinflammatory mediators of asthma. LTC4S is the key enzyme involved in the formation of CysLTs. There is a polymorphism of adenine （A） to cytosine （C） transversion at -444 locus in the promoter region of the LTC4S gene, A-444C.^1 This allelic variant results in an extra recognition site for the Ap-2 transcription factor and is associated with an increased LTC4S transcription rate.^2 Some studies in other countries suggest that LTC4S A-444C polymorphism is associated with asthmatic severity and clinical response to leukotriene receptor antagonist.^3-5 Little is known about the frequency of the LTC4S gene variant in the Chinese population. In this study, we evaluated the association of LTC4S A-444C polymorphism with susceptibility to asthma, severity of asthma and clinical response to a leukotriene receptor antagonist, montelukast, in Chinese Han people in Beijing.展开更多
文摘Background Leptin is a protein mainly secreted by adipocytes, and the major function of leptin was its role in body weight regulation. It is suggested that increased levels of circulating leptin may contribute to anorexia in pathologic conditions including chronic obstructive pulmonary disease （COPD）. Recent studies have provided evidence for a link between leptin and proinflammatory cytokines such as tumor necrosis factor-α （TNF-α）. This study aimed to explore the role of serum leptin in the malnutrition of COPD patients, and to observe the changes of serum leptin levels during acute exacerbation, also to investigate relationship between leptin and TNF-α. Methods Seventy-two COPD patients and 34 control subjects participated in this study. Seventy-two COPD patients were divided into 3 groups： group COPD IA （patients without malnutrition during acute exacerbation, n=25）, group COPD IB （patients without malnutrition during stable disease, n=29）, group COPD II （patients with malnutrition during stable disease, n=18）. To eliminate the effect of sex differences, all patients and controls were male. Body mass index （BMI）, percent ideal body weight （IBW%）, triceps skin-fold thickness （TSF）, mid-upper ann circumference （MAC）, mid-upper arm muscle circumference （MAMC）, serum leptin and TNF-α levels, serum prealbumin （PA）, serum transferrin （TF）, serum albumin （Alb）, total lymphocytes count （TLC）, forced expiratory volume in one second （FEV1）, maximal inspiration pressure （MIP） and maximal expiration pressure （MEP） were measured in all participants. Leptin levels were measured by radioimmunoassay. TNF-α levels were measured by ELISA. The between group difference and correlation of these parameters were analyzed. Results Serum leptin levels were significantly lower in group COPD Ⅱ[（4.07 ±3.42） ng/ml] than in group COPD IB [（9.72± 6.67） ng/ml] and controls [（8.21 ±5.41） ng/ml] （P〈0.05）. There was no statistically significant difference in serum leptin levels between group COPD IA [（10.82±6.40） ng/ml], group COPD IB [（9.72±6.67） ng/ml] and controls [（8.21 ±5.41） ng/ml]. There was no statistically significant difference in serum TNF-α levels between group COPD Ⅱ[（8.03 ±3.37） pg/ml], group COPD IA [（8.90± 1.60） pg/ml], and group COPD IB [（7.25 ±2.08） pg/ml]. There was no significant correlation between leptin and TNF-α in any group. Conclusions Leptin was not involved in anorexia and weight loss of COPD patients. There was no statistically significant difference in serum leptin levels between COPD patients during stable stage and acute exacerbation, and there was no significant correlation between TNF-α and leptin during the regulation of the energy balance in COPD patients.
文摘Background Many studies have shown the superior efficacy of budesonide （BUD）/formoterol （FORM） maintenance and reliever therapy, but still lack evidence of its efficacy in Chinese asthma patients in a relative large patient-group. We finished this research to compare BUD/FORM maintenance and reliever therapy and high-dose salmeterol （SALM）/fluticasone （FP） maintenance plus an as-needed short-acting IB2-agonist in Chinese patients with persistent uncontrolled asthma. This was a post hoc analysis based on a 6-month, multicenter, randomized, double-blind study （NCT00242775）. Methods A total of 222 eligible asthma patients from nine centers in China were randomized to either BUD/FORM＋as- needed BUD/FORM （160/4.5 pg/inhalation） （640/18 pg/d; n=111 ）, or SALM/FP＋as-needed terbutaline （0.4 mg/inhalation） （100/1000 pg/d; n=111）. The primary endpoint was time to first severe exacerbation while secondary endpoints included various measures of pulmonary function, symptom control and quality-of-life. Results Time to first severe exacerbation over six months was lower with the BUD/FORM than with the SALM/FP treatment （risk ratio=0.52, 95% CI 0.22-1.22）, but the difference did not achieve statistical significance （P=-0.13）. The cumulative number of severe exacerbations in the BUD/FORM group was lower than in the SALM/FP group （7.2% vs. 13.5%; risk ratio=0.45, P=0.028）. BUD/FORM produced significantly better improvements in reliever use, cumulative mild exacerbations, symptom-free days （%）, and morning/evening peak expiratory flow （PEF） than SALM/FP （P 〈0.05 in all cases）. The two groups achieved similar improvements in their time to first mild exacerbation, forced expiratory volume in one second （FEV1）, asthma control questionnaire and asthma symptom scores, and percentage of nights with awakening（s）. Both treatments were well tolerated. Conclusions In Chinese patients with persistent asthma, BUD/FORM decreased severe and mild exacerbations, decreased reliever use, increased symptom-free days, and improved morning/evening PEF compared with SALM/FP. There were no significant differences in time to first severe exacerbation or other assessments regarding daily asthma control between BUD/FORM and SALM/FP. BUD/FORM was more effective in this Chinese sub-group than in the total cohort involved in the oriclinal study. （Clinical Trial Registry Number： NCT00242775）
文摘Pseudomonas aeruginosa （P. aeruginosa） is one of the leading pathogens involved in nosocomial pneumonia. In addition, P. aeruginosa infection is associated with significant morbidity and mortality. A major problem in P. aeruginosa infection is that this organism exhibits natural and acquired resistance to many structurally and functionally diverse antibiotics.
基金This research was supported by a grant from the National Natural Science Foundation of China
文摘Background The emergence of heteroresistant vancomycin-intermediate Staphylococcus aureus （hVISA） is increasingly challenging the methods for detection in diagnostic microbiology laboratories. However, the report of hVISA is rare in China. This study summarizes the prevalence and clinical features associated with hVISA infections at our institution and the local impact they have on clinical outcome. Methods A total of 122 methicillin-resistant Staphylococcus aureus （MRSA） isolates which were of the causative pathogens were collected. One hundred and two patients for whom we had full information of MRSA pneumonia were included. Isolates of MRSA were collected using PCR to detect the mecA gene. Both Etest and macro Etest were performed to screen for hVISA. The Staphylococcal chromosome cassette mec （SCCmec） types were determined by multiplex PCR strategy. Logistic regression analysis was used to determine the risk factors. Results Among the 122 MRSA isolates collected, 25 （20.5%） strains were identified as hVISA. There were 119 （97.5%） SCCmec III isolates, two （1.6%） SCCmec II isolates, and one （0.8%） SCCmec V isolate. The 30-day mortality of MRSA-hospital acquired pneumonia （HAP） was 37.3%, and 62.5% for hVISA-HAP. Vancomycin treatment was the independent risk factor of hVISA. Factors independently associated with 30-day mortality in all patients were acute physiology and Chronic Health Evaluation （APACHE） II score 〉20, multiple lobe lesions, and creatinine clearance rate （CCR） 〈15 ml/min. Conclusions The prevalence of hVISA is 20.5% at our institution, hVISA-HAP patients had a poor clinical outcome. Vancomycin treatment was the independent predictors for hVISA infection. Factors independently associated with 30-day mortality in all patients were APACHE II score 〉20, multiple lobe lesions and CCR 〈15 ml/min.
文摘Rulmonary function tests provide an objective means to verify ventilatory dysfunction and to estimate its severity in respiratory disorders. Measurement of forced expiratory volume in 1 second （FEV1） and forced vital capacity （FVC） is considered to be the basic tests for the assessment of airway obstruction. Although they are useful diagnostically and prognostically, the results of FEV1 and FVC are strongly dependent on the cooperation of the patient. Lack of collaboration is particularly present in elderly patients because of mood alterations, fatigability or cognitive impairment. The forced oscillation technique （FOT） and the interrupter resistance technique are the two methods of measuring respiratory resistance during tidal breathing, they are of special interest because both of them are noninvasive, requires minimal cooperation, takes little time and can be easily repeated, especially in children and elderly subjects who cannot accomplish forced expiratory maneuvers in a reproducible manner.
文摘Leukotrienes （LTs） are synthesized from membrane derived arachidonic acid.Downstream of 5-lipoxygenase in the arachidonic acid cascade, leukotriene C4 synthase （LTC4S） catalyses the conjugation of leukotriene A4 （LTA4） with reduced glutathione to form LTC4, then LTC4 convert to active metabolites LTD4 and LTE4. LTC4, LTD4 and LTE4, which are called cysteinyl leukotrienes （CysLTs）, are potent proinflammatory mediators of asthma. LTC4S is the key enzyme involved in the formation of CysLTs. There is a polymorphism of adenine （A） to cytosine （C） transversion at -444 locus in the promoter region of the LTC4S gene, A-444C.^1 This allelic variant results in an extra recognition site for the Ap-2 transcription factor and is associated with an increased LTC4S transcription rate.^2 Some studies in other countries suggest that LTC4S A-444C polymorphism is associated with asthmatic severity and clinical response to leukotriene receptor antagonist.^3-5 Little is known about the frequency of the LTC4S gene variant in the Chinese population. In this study, we evaluated the association of LTC4S A-444C polymorphism with susceptibility to asthma, severity of asthma and clinical response to a leukotriene receptor antagonist, montelukast, in Chinese Han people in Beijing.
