The Clinical Role of Changes of Maximum Expiratory Flow at 25%and 50%of Vital Capacity before and after Bronchodilator Reversibility Test in Diagnosing Asthma

Summary:Changes of maximum expiratory flow at 25%and 50%of vital capacity(MEF2s and MEFso,respectively),and predominant parameters indicating small airways function in asthmatics before and after bronchodilator(BD)reversibility test have been less interpreted.Our study aimed to investigate the clinical role of changes of MEF2s and MEFso before and after BD reversibility test in diagnosing asthma.Forced expiratory volume in the first second(FEV),MEF2s,and MEFso were measured before and after BD reversibility test in 207 asthmatic patients using standard process.Forty healthy individuals were enrolled as controls.Receiver operating characteristic(ROC)curve was used to assess the diagnostic accuracy of reversibility of MEF2s and MEFgo before and after BD reversibility test(OMEF 2s%and AMEF so%,respectively)in diagnosing asthma.Among these functional criteria,AMEF2;%and 0MEFs%≥25%performed the best diagnostic performance.The sensitivity,specificity,and accuracy of AMEF 25%≥25%as an objcctive diagnostic test for asthma were 63.29%,87.50%,and 67.21%,and of AMEFs0%≥25%were 79.23%,85.00%,and 80.16%,respectively.The area under the ROC curve of the indicators was 0.8203 and 0.9104,respectively.By contrast,an increase in FEV≥12%and 200 mL demonstrated a sensitivity of 62.32%,specificity of 82.50%,and accuracy of 65.59%in diagnosing asthma.The changes of MEF2s and MEFso before and after BD reversibility test may be of additional value in the clinical diagnosis of asthma,with cutoff values of 25%being the most.

Normal reference value of forced vital capacity of Chinese younger women and geographical factors

Objective To supply a scientific basis for standardizing the normal reference value of forced vital capacity(FVC)of Chinese younger women.Methods We studied the relationship between the normal reference value of 21767 samples of FVC of younger women and eight geographical factors in 157 areas in China.Results It was found that the correlation between geographical factors and the normal reference value of FVC of younger women was quite significant(F=5.884,P=0.000).By adopting the method of mathematical regression analysis,one regression equation was inferred:=3.146+0.00006919X1+0.01315X4-0.006966X6+0.09524X8±0.254.In the above equation,is the normal reference value of younger women’ FVC(L);X1 is the altitude(m);X4 is the annual mean air temperature(℃);X6 is the annual mean relative humidity(%);X8 is the annual mean wind speed(m/s);0.254 is the value of the residual standard deviation.Conclusion If geographical values are obtained in a certain area,the normal reference value of FVC of younger women in this area can be obtained by using the regression equation.Furthermore,according to the geographical factors,China can be divided into eight regions:Northeast China Region,North China Region,Shanxi-Shaanxi-Inner Mongolia Region,middle and lower reaches of the Yangzte River Region,Southeast China Region,Northwest China Region,Southwest China Region,and Qinghai-Tibet Plateau Region.

Body mass index correlated with forced expiratory volume in 1 second/forced vital capacity in a population with a relatively low prevalence of obesity

Background Obesity is the most common metabolic disease in the world. However, the relationship between obesity and lung function is not fully understood. Although several longitudinal studies have shown that increases in body weight can lead to reductions in pulmonary function, whether this is the case with the Japanese population and whether high body mass index （BMI） status alone represents an appropriate predictor of obstructive lung dysfunction remains unclear.The purpose of present study was to estimate the effect of BMI on lung function measured by spirometry of Japanese patients in general clinics. We measured BMI and performed spirometry on screening patients who had consulted general clinics.Methods Subjects comprised 1231 patients ≥40 years of age （mean age （65.0±12.0） years, 525 men, 706 women） who had consulted clinics in Nagasaki Prefecture, Japan, for non-respiratory disease. BMI was calculated and lung function was measured by spirometry.Results BMI was found to be positively correlated with forced expiratory volume in 1 second （FEV1）/forced vital capacity （FVC） in men and with maximum mid-expiratory flow （MMF） in all subjects. Following adjustment for relevant factors, a significant positive correlation between BMI and FEV1/FVC was identified for all subjects. Comparison between subjects with normal BMI （18.5-25.0） and higher BMI （25.1-30.0） also demonstrated that FEV1/FVC and percentage of predicted maximum mid-expiratory flow （%MMF） were significantly higher in the latter subjects.Conclusions In a population without marked respiratory disease, higher BMI subjects showed less obstructive pulmonary dysfunction compared to normal BMI subjects. High BMI status alone may be inappropriate as a predictor of obstructive lung dysfunction, particularly in populations with a low prevalence of obesity.

Diagnostic value of elevated serum carbohydrate antigen 125 level in sarcoidosis

BACKGROUND Sarcoidosis is a multisystem disorder with unknown etiology, and it predominantly affects the lungs and intrathoracic lymph nodes. For patients with atypical clinical manifestations, the diagnosis of sarcoidosis is difficult and specific biomarkers may play an important role in assisting diagnosis. Previous research has demonstrated a correlation between sarcoidosis and increased carbohydrate antigen 125(CA125), but remains a lack of large cohort studies to validate this observation.AIM To compare serum CA125 levels in sarcoidosis patients and healthy controls, and explore whether CA125 can be used as a biomarker for the diagnosis of sarcoidosis.METHODS In this study, the serum CA125 levels were measured by enzyme-linked immunosorbent assay in 108 consecutive sarcoidosis patients between June 2016 and December 2020(31 males, 77 females;age at diagnosis 49.69 ± 9.10 years) and 112 healthy subjects. Data on the C-reactive protein, erythrocyte sedimentation rate, and angiotensin-converting enzyme were also collected. The association of serum CA125 levels with clinical, radiological, and respiratory functional characteristics was analyzed between patient groups with CA125 ≤ 35 U/mL or CA125 >35 U/mL.RESULTS We found that serum CA125 levels were higher in sarcoidosis patients compared to healthy controls(median: 44.78 vs 19.11 U/mL, P < 0.001). The area under the receiver operator characteristic was 0.9833(95%CI: 0.9717-0.9949), and the best cutoff point was 32.33 U/mL. The elevated serum CA125 was notably associated with the percentage of predicted forced vital capacity(FVC%) and neutrophil-to-lymphocyte ratio(P =0.043 and P = 0.038, respectively) in sarcoidosis patients. Multivariate analysis revealed that FVC%was a statistically notable predictor of elevated serum CA125(P = 0.029). Also, our research revealed that compared to patients with Stage I of radiology classification, patients with Stage Ⅱ and Ⅲ showed a higher concentration of serum CA125(46.16 ± 8.32 vs 41.00 ± 6.04 U/mL, P =0.005, and 47.92 ± 10.10 vs 41.00 ± 6.04 U/mL, P = 0.002, respectively).CONCLUSION Serum CA125 was highly increased in sarcoidosis patients and showed high efficiency for noninvasive diagnosis of the disease. In addition, abnormally elevated serum CA125 was correlated with pulmonary function and radiological Scadding’s classification of sarcoidosis.

Age-associated changes in pulmonary function： a comparison of pulmonary function parameters in healthy young adults and the elderly living in Shanghai

Background The respiratory system changes with age and a better understanding of the changes contribute to detect and prevent respiratory dysfunctions in old population. The purpose of this study was to observe age-associated changes of pulmonary function parameters in healthy young adults and the elderly. Methods A cross-sectional study was conducted among 600 male and female subjects aged 19 to 92 years. The subjects were divided into three groups by age： young adult （19-39 years）, middle-aged adult （40-59 years）, and the elderly （〉60 years）. The pulmonary function was measured with routine examination methods and 13 parameters including vital capacity （VC）, residual volume （RV）, functional residual capacity （FRC）, total lung capacity （TLC）, RV/TLC, forced vital capacity （FVC）, forced expiratory volume in one second （FEV1）, FEV1/FVC, peak expiratory flow （PEF）, forced expiratory flow at 25% of FVC exhaled （FEF25）, forced expiratory flow at 50% of FVC exhaled （FEF50）, diffusion capacity of the lung for carbon monoxide （DLCO）, and specific diffusion capacity of CO （KCO） were collected and analyzed. Changes in pulmonary function parameters among the influence on FEVJFVC and RV were studied further. Results Ten pulmonary function parameters including VC, FVC, pre-elderly and elderly subjects, especially the aging FEV1, FEV1/FVC, PEF, FEF25, FEF50, TLC, DLCO and KCO decreased significantly with age in both male and female subjects （P 〈0.01）. RV and RV/TLC were increased with age （P 〈0.01）. FRC remained stable during aging. Except FRC, the linear relationship was significant between age and other pulmonary function parameters. In the pre-elderly and elderly subjects, RV had a non-significantly increasing tendency with age （P 〉0.05）, and FEV1/FVC did not change significantly with age （P 〉0.05）. Conclusion Total pulmonary function was declined tendency of RV and decreasing tendency of FEV1/FVC with advancing age, but FRC was stable, and the increasing obviously slowed down in the pre-elderly and elderly subjects.

Clinical Features of Isolated Bulbar Palsy of Amyotrophic Lateral Sclerosis in Chinese Population

Background：Progressive bulbar palsy （PBP） is a classic phenotype ofbulbar onset amyotrophic lateral sclerosis （ALS） with more rapid progression and worse prognosis.However,as an often under-understood variant of ALS,isolated bulbar palsy （IBP） appears to progress more slowly and has a relatively benign prognosis.This study aimed to investigate the natural course and clinical features of IBP in Chinese population and to compare them with those of PBP.Methods：The clinical data of patients with bulbar onset ALS were collected from January 2009 to December 2013.Revised ALS Functional Rating Scale （ALSFRS-R）,forced vital capacity （FVC）,and follow-up evaluation were performed,and the differences in basic clinical features,ALSFRS-R,FVC,and primary outcome measures between IBP and PBP were analyzed.The independent t-test,Chi-square test,Mann-Whitney U-test,and Kaplan-Meier analysis were used.Results：Totally 154 patients with bulbar onset ALS were categorized into two groups,33 with IBP and 121 with PBP.In the IBP group,the male to female ratio was 0.7 to 1.0,and the mean onset age was 58.5 years.The mean duration from the onset was 16.0 months,and the mean ALSFRS-R score was 43.4 at patients＇ first visit to our hospital.In 14 IBP patients performing FVC examination,the mean FVC value was 90.5% and there were only two cases with abnormal FVC.In 26 IBP patients completing follow-up,15 （58%） suffered death or tracheotomy and the mean survival time was 40.5 months.Significant differences were noted in sex ratio,onset age,ALSFRS-R score,upper motor neuron limb signs,pure lower motor neuron （LMN） bulbar signs,FVC,and survival time between IBP and PBP.Conclusions：IBP was evidently different from PBP.which was characterized with the predominance of female,pure LMN bulbar signs,an older onset age,a relative preservation of respiratory function,and a better prognosis.

Effects of Qizhukangxian granules on idiopathic pulmonary fibrosis:a randomized,double blind,placebo-controlled and multicenter clinical pilot trial

OBJECTIVE:To evaluate the effects of Qizhukangxian granules(QG)on idiopathic pulmonary fibrosis(IPF).METHODS:This is a randomized,double blind,placebo-controlled and multicenter clinical pilot trial.Six medical centers in Tianjin,China,participated in the study.A total of 120 IPF patients were enrolled and randomized into two groups,with 60 patients in each group.The treatment group was treated with QG,while the control group received a Qizhukangxian placebo.The pharmacological treatment lasted for 48 weeks from the enrollment date.The indexes of patients were recorded on the admission day and at the end of the 24th and 48th weeks.Data were analyzed to study the effects of QG;forced vital capacity,change in forced vital capacity and maximal 6-min walk test(6MWT)distance were the primary endpoints.Secondary endpoints were percentage of patients with episodes of acute exacerbation of IPF,pulmonary function,changes in pulse oxygen saturation during the 6MWT,dyspnea score,St.George's respiratory questionnaire score,arterial blood gas analyses and the total Traditional Chinese Medicine symptom pattern score.RESULTS:After 24 weeks of treatment,QG showed greater efficacy than the placebo in certain parameters,including the dyspnea score,Traditional Chinese Medicine symptom pattern score and some indicators in the St.George's respiratory questionnaire score.Analysis of the indexes obtained from all patients at the end of the 48th week showed that the therapeutic effects in the treatment group were significantly better than those in the control group because remarkable differences were observed in most of the primary and secondary endpoints between the two groups,except for the maximal distance of the 6MWT and arterial blood gas analyses.No adverse reaction was observed in either group during the 48-week trial treatment period.CONCLUSION:QG could effectively treat IPF patients by ameliorating pulmonary function,improving the quality of life and lowering the percentage of acute exacerbations.

Association Between Rectus Abdominis Denervation and Ventilation Dysfunction in Patients with Amyotrophic Lateral Sclerosis

Background： Spontaneous potentials in electromyography （EMG） ofparaspinal muscles are associated with diaphragm denervation and, therefore, poor respiratory timction in amyotrophic lateral sclerosis （ALS） is understandable. EMG changes in the rectus abdominis （RA） display an effect similar to those in paraspinal muscles with respect to the function of lower motor neurons in the thoracic spinal cord. The RA denervation was examined to determine its association with ventilation dysfunction in ALS. Methods： We collected the clinical data of 128 patients with sporadic ALS in Department of Neurology of Peking University Third Hospital from 2009 to 2013. EMG, Revised ALS Functional Rating Scale （ALSFRS-R） and forced vital capacity （FVC） were perIbrmed in all patients and the differences in the EMG changes in RA between those with and without FVC 〉 80% were analysed. Results： The mean FVC value was 83.4% ~ 17.1% （range： 45%-I 31%） of the predicted value. A total of 79 patients displayed FVC _〉80%, and 49 patients displayed FVC 〈80%, Compared with the patients displaying a normal FVC （60/79, 75.9%）, spontaneous activity in RA was significantly different among those patients displaying an FVC 〈80% （47/49, 95.9%）. In addition, spontaneous potentials in RA were more frequently detected in patients exhibiting dyspnea （32/33, 97.0%） than in patients without dyspnea （75/95, 78.9%）. Conclusion： Spontaneous potentials in RA are associated with ventilation dysfunction and dyspnea in ALS patients.

Influence of acupuncture on pulmonary function of patients with asthma： a review

Asthma is a common disease with recurrent onset which severely affects patients＇ quality of life. Acupuncture can improve pulmonary functions in asthma patients and thus treat this disorder. To summarize the status of acupuncture treatment for asthma, we have collected clinical literatures published in the recent 20 years and analyzed the influence of acupuncture on pulmonary functions in asthma patients from the aspects of frequently used points, needling techniques, manipulation and mechanisms to provide references for treating asthma with acupuncture.

Fetal stem cells are effective in the treatment of Grade Ⅰ and Ⅱrespiratory failure in amyotrophic lateral sclerosis and muscular dystrophy

Objectives: To study the effect of fetal stem cell(FSC) therapy on Grade Ⅰ and Ⅱrespiratory failure in patients with amyotrophic lateral sclerosis(ALS) and muscular dystrophy(MD). Methods: A comparative study was conducted on 41 patients with Grade Ⅰ or Ⅱrespiratory failure(RF) resulting from ALS or MD. The patients were divided into 4 groups according to the underlying disease and the degree of RF. Patients underwent combined treatment, including the experimental application of FSC therapy, and were examined before FSC treatment, and 6 months and 12 months after treatment. Results: FSC treatment improved both subjective and objective breathing parameters as early as 6 months post‐treatment. A significant increase in the forced vital capacity(FVC) and forced expiratory volume in 1 second(FEV1) was reported by all patients with grade Ⅰ RF linked to ALS and MD compared to baseline. Patient respiratory improvement was maintained over the next 6 months. Grade Ⅱ RF patients with MD reported a significant improvement in FVC 12 months after treatment. Conclusions: Evidence for respiratory improvement was observed as early as 6 months in all patients after combined treatment including FSC therapy, and this was maintained for a further 6 months after therapy. In MD patients with Grade Ⅱ RF, treatment resulted in a significant FVC and FEV1 increase within 6 months and downgrading to Grade Ⅰ RF within a year after FSC treatment.