Allergy-related Evidences in Relation to Serum IgE:Data from the China State Key Laboratory of Respiratory Disease,2008-2013

Objective To investigate the serum total IgE （tlgE） and specific IgE （slgE） to common allergens among allergic patients in Guangzhou, China. Methods 7 085 patients were examined for tlgE and slgE to 15 allergens, based on the protocols of reversed enzyme allergosorbent test and the sandwich enzyme-linked immunosorbent assay. Results 3 758 （53.04%） patients tested positive for tlgE, and 4 640 （65.49%） for slgE. Der pteronyssinus, Derfarinae, eggs, and cow＇s milk were the most common allergens leading to higher positive rates of slgE responses. Several peaks of sensitization were： Der pteronyssinus, Derfarinae, and Blomia tropicalis at age 10-12; cow＇s milk at age below 3; eggs at age 4-6. The mean level and positive rate of tlgE tended to increase in subjects sensitized to more allergens. Sensitization to Der pteronyssinus （OR, 1.6; P〈O.05）, Der farinae （OR, 1.5; P〈O.05）, Blomia tropicalis （OR, 1.4; P〈O.05）, Blattella germanica （OR, 1.5; P〈O.05）, cow＇s milk （OR, 1.3; P〈O.05）, and soy beans （OR, 2.0; P〈O.05） were independently correlated with allergy-related conditions in preliminary diagnosis. Conclusion The major allergens in Guangzhou include Derpteronyssinus, Derfarinae, cow＇s milk, and eggs. Sensitization to these allergens appears to be predictors of allergy-related disorder.

Early screening of lung cancers:an effort arduous but worthwhile

Cancers are a concerning health catastrophe worldwide that may become the end of lifetime for many of us--they overwhelmingly exhaust medical resources, lead to huge economic burdens, and separate people from their beloved ones. Fewer and fewer insurance agencies are willing to include primary cancers on their general health insurance plan, just because cancers have been so flummoxingly usual in our daily life that many primary cancer claims would give rise to much less profits.

Character of diaphragm compound muscle action potential and phrenic nerve conduction time in patients with obstructive sleep apnea-hypopnea syndrome

BACKGROUND： Both hypoxia and.carbon dioxide retention can damage phrenic nerve and muscle conduction, as well as diaphragm function. Diaphragm compound muscle action potential and phrenic nerve conduction time are reliable indicators for measuring phrenic nerve and diaphragm function. OBJECTIVES： To verify the hypothesis that changes of phrenic nerve conduction time （PNCT） and diaphragm compound muscle action potential （CMAP） in obstructive sleep apnea-hypopnea syndrome （OSAHS） patients might contribute to the decline of phrenic nerve and diaphragm function. PNCT and CMAP were measured with multipair esophageal electrodes combined with unilateral magnetic stimulation. DESIGN, TIME AND SETTING： Case controlled study. The experiment was carried out in Guangzhou Institute of Respiratory Disease, Guangzhou MediCal College, from June 2005 to April 2006. PARTICIPANTS： Twenty seven OSAHS patients and eight primary snoring subjects from Guangzhou Institute of Respiratory Disease, Guangzhou Medical College were recruited and all subjects were diagnosed by polysomnography （PSG）. Sixteen healthy, non-snoring subjects in the hospital for medical examination during the same time period were selected as the control group. METHODS： Esophageal electrodes, made by Guangzhou Institute of Respiratory Disease, combined with unilateral magnetic stimulation, were used to measure PNCT and CMAP of all subjects. PNCT was defined as the time from stimulation artifact to the onset of CMAP and diaphragm CMAP amplitude was measured from peak to peak. Oxygen desaturation index and apnea-hypopnea index were measured using PSG, and their relevance to PNCT and CMAP were analyzed. PNCT and CMAP in five OSAHS patients were repeatedly measured after effective nasal continuous positive airway pressure treatment for more than 2 months. MAIN OUTCOME MEASURES： （1） PNCT and diaphragm CMAP of subjects in each group. （2） Relevance of oxygen desaturation index and apnea-hypopnea index to PNCT and CMAP. （3） Changes of PNCT and CMAP of OSAHS patients before and after treatment. RESULTS： All subjects were included in the analyzed results. （1） PNCT of the OSAHS group was significantly longer compared to that of the control and primary snore groups, while CMAP of the OSAHS group was significantly lower （P 〈 0.05）. （2） PNCT and CMAP recorded from both sides correlated significantly with oxygen desaturation index and with apnea-hypopnea index （P 〈 0.01 ）. （3） PNCT shortened significantly after effective nasal continuous positive airway pressure treatment for more than 2 months （ P 〈 0.05）. CONCLUSION： Prolongation of PNCT and decrease of CMAP might contribute to the decline of phrenic nerve and diaphragm function caused by repeated nocturnal hypoxia and carbon dioxide retention. The impairment of the phrenic nerve might also decrease diaphragm function.

结核分枝杆菌及多重耐药性的快速检测：MTB/RIF实验及检测诊断系统(英文)

我国是结核病及耐药结核高发地区,年新发结核病例130万,新发结核病例耐药率为5.7%。痰涂片抗酸染色和临床放射影像学是结核病尤其是肺结核的主要诊断手段。但痰涂片阳性率偏低,新发肺结核病例涂阳率仅28%,而且结核病的影像学表现缺乏特异性。缺乏简单、准确、快速的诊断手段一直是我国实现结核病防控目标的瓶颈。结核分枝杆菌/利福平耐药（MTB/RIF）检测诊断系统运用半槽式（hemi-nested）RT-PCR及荧光探针报告技术（beacontechnology）,特异性扩增并检测结核分枝杆菌特有并与利福平耐药密切相关的rpoB基因片段。以PCR循环阈值反映标本中的结核分枝杆菌载量,进行半定量分析。该系统以结核杆菌培养作为标准对照,对疑诊肺结核患者痰标本的诊断总体敏感性为73.1%~90.0%,特异性99.0%~99.5%;对利福平耐药基因（MDR-TB的分子生物学标记物）诊断的敏感性为97.2%、特异性为98.3%。上样后系统可在2h内自动完成诊断及结果打印程序。由于系统特异性扩增rpoB基因片段,因此与非结核分枝杆菌及呼吸系统常见病原体无交叉反应。除外痰标本,该系统还能用于多种体液（胸腔积液、尿、脑脊液以及支气管肺泡灌洗液等）和肺组织匀浆中结核分枝杆菌的检测。该系统的诊断敏感性较抗酸染色高100倍,与结核分枝杆菌培养相近,但后者从加样至报告的平均时间为16d（平板培养基）或30d（液体培养基）。与传统结核诊断实验室诊断技术相比,本系统还具有操作简便、不产生传染性生物气溶胶等优点。

Spectrum and antimicrobial resistance of common pathogenic bacteria isolated from patients with acute exacerbation of chronic obstructive pulmonary disease in mainland of China

Background Bacteria-induced respiratory infection has been long considered to be the major cause of acute exacerbation of chronic obstructive pulmonary disease （AECOPD）.Therefore,a clear picture about the distribution and drug-resistance of pathogenic bacteria in the lower airways should be helpful for treatment of the disease.So far,data on this topic among Chinese are lacking.Methods A surveillance study was performed in consecutive patients with AECOPD at five areas in China between October 2006 and April 2008.The sputum from these patients was cultured and isolated for bacteria.Agar dilution method was used to determine the minimal inhibitory concentrations （MICs） of levofloxacin and other 15 antibiotics against these strains.Results Three hundred and fifty-nine pathogenic bacterial strains were isolated among 884 patients with AECOPD.The predominant bacteria were Pseudomonas aeruginosa （21.7%）,Klebsiella pneumoniae （12.3%）,Haemophilus influenzae （14.2%） and Streptococcus pneumoniae （11.7%）,followed by Haemophilus parainfluenzae （9.5%）,Acinetobacter baumannii （7.8%）,Moraxella catarrhalis （6.4%） and Escherichia coli （3.6%）.The majority of bacterial pathogens isolated in this study were susceptible to fluoroquinolones,ceftazidime,cefepime and imipenem.Conclusions Gram-negative bacilli are the leading pathogens in patients with AECOPD in China.Haemophilus parainfluenzae may be one of the most important pathogens in AECOPD.This study provides evidence for local surveillance of AECOPD pathogens and appropriate choice of antimicrobials in China.

Protective effect of a bacterial extract against acute exacerbation in patients with chronic bronchitis accompanied by chronic obstructive pulmonary disease

Background Immunostimulating agents made from bacterial extracts represent a class of medications that contains antigens derived from several bacterial strains and their potential ability to prevent bacterial infections results from the stimulation of the nonspecific component of the immune system. The present study investigated the effect of the oral immunostimulant Broncho-Vaxom,which includes material from eight different species of bacteria that are frequently present in the lower respiratory tract,on the frequency and severity of acute exacerbation in patients with chronic bronchitis accompanied by chronic obstructive pulmonary disease (COPD). Methods Ninety patients with chronic bronchitis complicated with COPD were randomly divided into groups A and B. Forty-nine subjects in group A received oral capsules containing 7mg Broncho-Vaxom,while 41 patients in group B received similar placebo capsules. Both groups took one capsule daily for the first 10 days of each month for 3 consecutive months. The frequency of acute exacerbation,symptom scores,and lung function were recorded for the following one year period.Results There was a significant decrease in the incidence,duration,and severity of acute exacerbation,as well as a reduction in the course of antibiotics administered and in the dosage of bronchodilator and mucolytic agent in group A,as compared to group B ( P <0.05,respectively). Symptom scores for cough,sputum,dyspnea,as well as symptoms observed upon auscultation of the chest also improved significantly in group A as compared to group B ( P <0.05,respectively). The bacterial clearance rate in sputum cultures from patients who received no antibiotics for the first 3 months was also significantly higher in group A compared to group B ( P <0.01).Conclusions Orally administered Broncho-Vaxom is associated with a decrease in the incidence of acute exacerbation and a decrease in the need for antibiotics and symptomatic relief medications in patients with chronic bronchitis accompanied by COPD. Broncho-Vaxom is also associated with a decrease in symptom scores. Without causing any apparent adverse effects,this drug may also help to eradicate pathogenic bacteria in the airways.

Asymptomatic patients of chronic obstructive pulmonary disease in China

Background Chronic obstructive pulmonary disease （COPD） has a variable natural history and not all individuals follow the same course. This study aimed to identify the prevalence and characteristics of asymptomatic COPD patients from a population-based survey in China.Methods A multistage cluster sampling strategy was used in a population from seven different provinces/cities. All residents （over 40 years old） were interviewed with a standardized questionnaire and spirometry.Post-bronchodilator forced expiratory volume in 1 second （FEV1）/forced vital capacity （FVC） of less than 70% was defined as the diagnostic criterion of COPD. All COPD patients screened were divided into symptomatic group and asymptomatic group according to the presence or absence of chronic respiratory symptoms. Socio-demographic,personal and exposure variables were collected and analyzed.Results Among the 1668 patients who were diagnosed with COPD from the 25 627 sampling subjects, 589 （35.3%）were asymptomatic. The age, sex, body mass index （BMI）,rural and urban distributions, smoking habit and education levels were similar in the two groups. A total of 64.7% of the asymptomatic patients had no comorbidities. Cardiovascular diseases and lung cancer were more common among symptomatic COPD patients than asymptomatic group.Asymptomatic COPD group were less likely to present with poor ventilation in the kitchen, a family history of respiratory disease and recurrent childhood cough. Asymptomatic COPD patients had significantly higher FEV1 （73.1% vs. 61.0%）, FVC （91.9% vs. 82.0%）, and a higher ratio of FEV1/FVC （62.9% vs.58.7%） （all P 〈0.001） than symptomatic group. More asymptomatic patients were underdiagnosed （91.9% vs.54.3%, P〈0.001） than symptomatic patients.Conclusions This large population-based survey confirmed a high prevalence of asymptomatic COPD patients in China. More use of spirometry screening test may be important to the early detection of COPD.

Quadriceps strength assessed by magnetic stimulation of femoral nerve in patients with chronic obstructive pulmonary disease

Background Skeletal muscle dysfunction is one of important systemic manifestations of chronic obstructive pulmonary disease （COPD） and is associated with mortality in patients with COPD, thus quantifying its strength is of great clinical interest and of particular value. Quadriceps maximal volitional contraction （MVC） is often used for the routine measurements of this muscle＇s strength; while twitch tension （TwQ） evoked by magnetic stimulation of the femoral nerve has been employed for measurement of quadriceps strength non-volitionally. We aimed to investigate the prevalence and severity of skeletal muscle dysfunction in COPD patients by measurement of quadriceps strength with volitional and non-volitional techniques, and to probe into some methodological issues. Methods We recruited 71 COPD patients and 60 control subjects. Quadriceps strength was measured with both maximality of TwQ and MVC force. The reproducibility for TwQ and MVC was investigated using within-occasion variability from three repeated maneuvers. Results Maximal TwQ was achieved in 121 participants at a mean of 90% of the stimulator＇s maximum output. The mean maxmality of TwQ was decrease by about 44%-47% in COPD patients as compared with controls （P 〈0.05）, so was MVC. There was a significant correlation between quadriceps TwQ and MVC, and the mean ratio of TwQ/MVC was 0.29 in controls and 0.33 in patients. The coefficient of variation showed that TwQ yielded lower within-occasion variability than MVC in both groups. Conclusions Quadriceps strength is commonly and substantially impaired in patients with COPD, in terms of MVC as well as TwQ. The magnetic stimulation of the femoral nerve presents a higher reproducibility and is a better technique for measurement of quadriceps strength for the general population, especially for those who are too unwell to perform a full MVC; while it may not be applied to subjects who are over-weighted.

A prospective cohort study of the presence of SARS-CoV-2 in clinical samples from multiple bodily sites:implications for transmission routes of COVID-19

Objective: The coronavirus disease 2019 (COVID-19) epidemic resulting from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has still spread globally. The occurrence of the Delta variant, which is more infectious and spreads faster than earlier forms of the virus that causes COVID-19, makes infection prevention more challenging. Therefore, this study aimed to gain a comprehensive insight into the transmission routes of SARS-CoV-2 for curbing the propagation of SARS-CoV-2 in human populations.Methods: We studied a prospective cohort of 576 patients admitted consecutively to the First Affiliated Hospital of Guangzhou Medical University from January 21 to June 8, 2020. These patients were chosen based on their similar clinical phenotypes or imaging findings. There were 21 (3.6%) laboratory-confirmed COVID-19 patients (16 severe and 5 mild cases) and 555 non-COVID-19 patients. The antibody response and routes and duration of viral shedding were systematically evaluated in serial clinical specimens. Moreover, SARS-CoV-2 RNA was also detected in a mouth rinse, urine, and tear samples. This study was approved by the Medical Ethical Committee of The First Affiliated Hospital of Guangzhou Medical University (approval No. 2020-77).Results: SARS-CoV-2 mainly existed in sputum, nasal and throat swabs, and feces samples. Virus latency was longer in sputum and feces samples than in nasopharyngeal samples. IgG antibody response in respiratory samples was related to disease severity. Although droplets and aerosols are the major transmission routes for COVID-19, covert routes of transmission from asymptomatic patients, contaminated surfaces, and wastewater are also of interest.Conclusion: Our findings provide a solid foundation for developing prophylactic measures against SARS-CoV-2.

Chemokine-like factor 1,a novel cytokine,contributes to airway damage,remodeling and pulmonary fibrosis

Background Chemokine-like factor 1 (CKLF1) was recently identified as a novel cytokine The full-length CKLF1 cDNA contains 530 bp encoding 99 amino acid residues with a CC motif similar to that of other CC family chemokines Recombinant CKLF1 exhibits chemotactic activity on leucocytes and stimulates proliferation of murine skeletal muscle cells We questioned whether CKLF1 could be involved in the pathogenesis of inflammation and proliferation in the lung Therefore we used efficient in vivo gene delivery method to investigate the biological effect of CKLF1 in the murine lung Methods CKLF1-expressing plasmid, pCDI-CKLF1, was constructed and injected into the skeletal muscles followed by electroporation Lung tissues were obtained at the end of week 1,2,3 and 4 respectively after injection The pathological changes in the lungs were observed by light microscope Results A single intramuscular injection of CKLF1 plasmid DNA into BALB/c mice caused dramatic pathological changes in the lungs of treated mice These changes included peribronchial leukocyte infiltration, epithelial shedding, collagen deposition, proliferation of bronchial smooth muscle cells and fibrosis of the lung Conclusions The sustained morphological abnormalities of the bronchial and bronchiolar wall, the acute pneumonitis and interstitial pulmonary fibrosis induced by CKLF1 were similar to phenomena observed in chronic persistent asthma, acute respiratory distress syndrome and severe acute respiratory syndrome These data suggest that CKLF1 may play an important role in the pathogenesis of these important diseases and the study also implies that gene electro-transfer in vivo could serve as a valuable approach for evaluating the function of a novel gene in animals

Links between allergic rhinitis and asthma

AIlergic diseases of the airway, which include seasonal rhinitis, chronic perennial rhinitis and asthma, are recognized as inflammatory disorders of the airway mucosa, but differ in the location of the inflammatory reaction and clinical manifestations of the disease. Asthma and allergic rhinitis frequently coexist in the same patient and are thought to share common predisposing genetic factors which interact with the environmental influences. Both diseases have increased in prevalence over recent decades particularly in westernized countries. This increase has been largely attributed to environmental factors such as exposure to aerial pollutants and early life events, including the degree of exposure to infectious agents which might affect IgE production, since there has been insufficient time for a significant change in the gene pool.

Food allergy and related risk factors in 2540 preschool children: an epidemiological survey in Guangdong Province, southern China

Background:Although the number of studies on allergic diseases in the general population of southern China is increasing,only a few have addressed food allergy(FA)in children in this region.The present study aimed to investigate the prevalence,clinical manifestations,spectrum of allergens,and related risk factors of FA in preschool children in Guangdong Province,southern China.Methods:A random cluster-sampling method was used to select 24 kindergartens from 12 cities in Guangdong Province.The parents or guardians of the children were requested to complete a questionnaire on general information and data regarding FA diagnosis and symptoms in the children and their first-degree relatives.Thereafter,the Chi-square test,multivariate regression analysis,and Spearman's rank-order correlation coefficient analysis were performed to identify statistically significant differences.Results:Analysis of 2540 valid questionnaires revealed an FA prevalence rate of 4%.Adverse food reactions were due to the consumption of shrimp(4.4%),crab(3.2%),mango(2.3%),cow's milk and dairy products(1.9%),and eggs(1.4%).Logistic regression analysis indicated that a history of FA and a history of allergic rhinitis in the first-degree relatives were the major factors leading to FA in children.Conclusions:The incidence of FA in children in Guangdong Province is higher than that commonly believed.An individual's genetic background is an important risk factor for FA.Hence,mitigation of the impact of lifestyle and environmental factors should be carefully considered to reduce the incidence of childhood FA.