Objective To assess the effectiveness and safety of moxifloxacin versus levofloxacin for the treatment of acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Methods Such databases as PubMed, EMbase, The Cochrane Library, CBM, CNKI and VIP were electronically searched, and the relevant conference proceedings were also hand-searched. The search time was up to July, 2011. Randomized controlled trials (RCTs) on moxifloxacin versus levofloxacin for AECOPD were included. Literature was screened according to inclusive and exclusive criteria, data were extracted, quality was assessed, and then meta-analysis was performed using RevMan 5.0. Results A total of 6 RCTs involving 482 patients with AECOPD were included. The results of meta-analysis showed that moxifloxacin group was significantly superior to levofloxacin group in the effective rate (OR=3.15, 95%CI 1.80 to 5.49, Plt;0.000 1). The bacterial clearance rate in moxifloxacin group was also higher than that in the levofloxacin group (OR=2.79, 95%CI 1.30 to 5.97, P=0.008). In addition, adverse effects of moxifloxacin group were less than levofloxacin (OR=0.48, 95%CI 0.24 to 0.98, P=0.04). Conclusion Based on current studies, moxifloxacin is superior to levofloxacin in improving effective rate and bacterial clearance rate, and in lowering side effects when treating AECOPD. Hence it is considerable to use moxifloxacin instead of levofloxacin in the treatment of AECOPD if necessary. Due to the limitation of both quantity and quality of included studies, this conclusion should be further confirmed with more high quality and large sample studies.
ObjectivesTo assess the efficacy and safety of 3 dosages (75, 150, and 300 μg) of indacaterol in patients with moderate-to-severe chronic obstructive pulmonary disease (COPD) by network meta-analysis.MethodsPubMed, EMbase, The Cochrane Library, CBM, CNKI, WanFang Data and VIP databases were electronically searched to collect randomized controlled trials (RCTs) of indacaterol for treating stable COPD patients from inception to December 31st, 2018. Two reviewers independently screened literature, extracted data and assessed the risk bias of included studies, and then ADDIS 1.16.8 and Stata 15.1 softwares were used to perform network meta-analysis.ResultsA total of 13 RCTs involving 5 476 patients were included. The results of network meta-analysis showed that: compared to placebo, 3 dosages of indacaterol could improve trough forced expiratory volume in 1 second (trough FEV1), lower St George respiratory questionnaire (SGRQ), and improve transitional dyspnea index (TDI). 150 μg and 300 μg groups were better than placebo group in reducing COPD exacerbation rate. There were no statistically differences between groups in incidence of all adverse effects. Ranking probability table showed that 300 μg group was most likely to be the most effective treatment in improving trough FEV1, SGRQ and TDI, and it ranked second in reducing COPD exacerbation rate.ConclusionsConsidering the network meta-analysis and rankings, 300 μg indacaterol is superior to the other 2 dosages in treating the patients with moderate-to-severe COPD.
Objective To explore the correlation between different ultrasound pulmonary artery systolic pressure (PASP) and high-resolution CT (HRCT) pulmonary artery width (PAD) in patients with chronic obstructive pulmonary disease (COPD). Methods A retrospective analysis was conducted on 473 patients with acute exacerbation of chronic obstructive pulmonary disease who were hospitalized in the First Hospital of Lanzhou University from January 2016 to December 2020. They were divided into four groups according to the degree of PASP elevation: PASP normal group: PASP≤36 mm Hg, 182 cases; mildly elevated group: PASP 37 to 50 mm Hg, 164 cases; moderately elevated group: PASP 51 to 70 mm Hg, 89 cases; severely elevated group: PASP>70 mm Hg, 38 cases. The PAD of chest HRCT and the width of the ascending aorta (AAD) on the same plane were measured, and the ratio of PAD to AAD (PAD/AAD) was calculated. The differences of PAD, AAD, PAD/AAD in different PASP groups of COPD were compared. The correlations between PASP, lung function, blood gas analysis and PAD, PAD/AAD were analyzed. Results With the decrease of FEV1%pred, FVC%pred, FEV1/FVC, PaO2 and SaO2 in the patients, PaCO2 increased, PASP gradually increased, PAD and PAD/AAD gradually increased. PAD and PAD/AAD were significantly different between the severely elevated PASP group and the other three groups, and there were significant differences between the moderately elevated group and the normal group, and between the moderately elevated group and the mildly elevated group. PASP and PaCO2 were positively correlated with PAD and PAD/AAD, and FEV1%pred, FVC%pred, FEV1/FVC, PaO2, SaO2 were negatively correlated with PAD and PAD/AAD. Multivariate logistic regression analysis showed that after adjusting for confounding factors, decreased FEV1%pred was an independent risk factor for PAD/AAD>1 in COPD patients. The receiver operating characteristic curve showed that the width of PAD and PAD/AAD had certain predictive value for PASP. Conclusions There is a significant positive correlation between different degrees of ultrasound PASP and PAD and PAD/AAD in patients with COPD. HRCT PAD has certain predictive value for PASP. The heavier the hypoxia and carbon dioxide retention, the worse the pulmonary ventilation function, the higher the pulmonary artery pressure, the greater the possibility of PAD and PAD/AAD.
Objective To observe the effects of fine particulate matter (PM2.5) on airway remodeling and Notch signaling pathway in mice with bronchial asthma, and explore the possible mechanism of its influence on airway remodeling in asthmatic mice. Methods Forty eight-week-old SPF female BALB/c mice were divided into a healthy control group, a healthy PM2.5 group, an asthma group and an asthma PM2.5 group by random number table, with 10 mice in each group. The asthma group and the asthma PM2.5 group were sensitized with ovalbumin to establish asthma mouse model, and the healthy PM2.5 group and the asthma PM2.5 group received aerosol inhalation of PM2.5 (510 μg/m3) after each provocation. After modeling, lung function was measured in each group. Hematoxylin and eosin staining and Masson staining were performed on the lung tissue sections of mice. Image analysis software was used to determine the circumference of the bronchial basement membrane, the total area of the bronchial wall, the area of bronchial smooth muscle and the area of collagen deposition. The expressions of Notch1, Hes1, α-smooth muscle actin (α-SMA), transforming growth factor-β1 (TGF-β1) and type Ⅰ collagen (Col-Ⅰ) were detected by immunohistochemistry and western blotting. The content of hydroxyproline (HYP) in lung tissue was determined by alkaline water method. Results The total airway wall area, airway smooth muscle area and collagen deposition area in the asthma group [(365.81±46.10), (132.80±20.14), (221.82±25.20) μm2/μm] were significantly higher than those in the healthy control group [(187.70±14.80), (89.73±8.49), (123.91±16.88) μm2/μm] (P<0.01). The healthy PM2.5 group [(244.62±42.86), (116.40±20.40), (174.91±57.41) μm2/μm] and the asthma PM2.5 group [(447.70±76.14), (236.14±36.35), (294.89±75.96) μm2/μm] were higher than those in the control group (all P<0.01). The expressions of Notch1, Hes1, α-SMA, TGF-β1 and Col-Ⅰ were strongly positive in the lung tissues of the asthmatic mice, but weak in the healthy control group. After PM2.5 intervention, compared with the control group, the expression intensity of the above molecules increased. Notch1 receptor and downstream Hes1 protein in the asthma group (0.86±0.10, 1.02±0.06) were significantly higher than those in the healthy control group (0.26±0.07, 0.56±0.09) (all P<0.01). The healthy PM2.5 group (0.44±0.06, 0.77±0.07) and asthma PM2.5 group (1.33±0.23, 1.25±0.18) were higher than the control group (all P<0.01). Airway remodeling related molecules α-SMA, TGF-β1 and Col-Ⅰ protein in the asthma group (0.60±0.04, 0.52±0.09, 0.36±0.04) were significantly higher than those in the healthy control group (0.31±0.03, 0.22±0.04, 0.23±0.04) (all P<0.01). The health PM2.5 group (0.49±0.02, 0.30±0.03, 0.28±0.03) and the asthma PM2.5 group (0.88±0.09, 0.62±0.03, 0.49±0.07) were higher than the control group (P<0.05 or P<0.01), respectively. The content of HYP in lung tissue of the asthma group (57.71±7.60) μg/100mg was significantly higher than that of healthy control group (40.53±5.73) μg/100mg. The healthy PM2.5 group (53.92±6.82) μg/100mg and asthma PM2.5 group (70.96±4.44) μg/100mg were higher than the control group (P<0.01), respectively. In asthma group and asthma PM2.5 group, the expression of Notch1 and Hes1 protein was positively correlated with the total airway wall area, airway smooth muscle area, collagen deposition area, α-SMA, TGF-β1, Col-Ⅰ and HYP (all P<0.01). Conclusion PM2.5 can promote early airway remodeling in asthma, and the activation of Notch signaling pathway may be involved in the promoting effect of PM2.5 on early airway remodeling.
Objective To systematically review the effectiveness and safety of alanyl-glutamine dipeptide for severe acute pancreatitis (SAP). Methods Such databases as MEDLINE, EMbase, CENTRAL, VIP, WanFang Data, CBM and CNKI were electronically searched from inception to October, 2012 for randomized controlled trials on alanyl-glutamine dipeptide for SAP. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data, and assessed methodological quality. Then, meta-analysis was performed using RevMan 5.2. Results Five trials were included involving a total of 227 patients. The results of meta-analysis showed that: compared with the control group, the alanyl-glutamine dipeptide group had the lower incidence of SAP complications (RR=0.41, 95%CI 0.20 to 0.82), the lower incidence of infected pancreatic necrosis (RR=0.12, 95%CI 0.02 to 0.89), less time for alleviating bellyache (MD= –0.90, 95%CI –1.72 to –0.08). There was a tendency in decreasing SAP mortality (RR=0.15, 95%CI 0.02 to 1.19) and lessening the recovery time of blood amylase (SMD=0.37, 95%CI –0.04 to 0.79). Conclusion Current evidence shows that, alanyl-glutamine dipeptide can lower the incidence of complications and the incidence of infected pancreatic necrosis, and shorten the time for alleviating bellyache in SAP patients. Due to the limited quality of the included studies, the above conclusion needs to be verified by more high quality studies.
Objective To evaluate the control status and knowledge level about disease in asthmatic patients in hospitals of different grades in Gansu province, and provide a basis for proposing a work plan forprevention and treatment of asthma in Gansu province.Methods We performed a questionnaire investigation in a face-to-face manner in asthmatic patients from hospitals of three different grades, which included a grade 3A hospital, a grade 3B hospital, and a grade 2A hospital.Results A total of 542 asthmatic patients were investigated. The percentage of complete controlled, well controlled and uncontrolled were 3. 5% , 16. 9% and 79. 5% respectively. The rate of complete controlled was low in three hospitals without significant difference ( 3. 6% , 3. 4% , and 3. 3% , respectively) . The rate of well controlled in the grade 3A and 3B hospitals was higher than that in the grade 2A hospital ( 20. 4% and 18. 3% vs. 8. 2% ,P lt;0. 05) . 41. 4% of the respondents had been hospitalized for exacerbation in the past one year, and the rate was higher in the grade 2A hospital than that in the grade 3A and 3B hospitals ( 58. 2% vs. 31. 8% and 42. 9%, P lt;0. 01) . 46. 9% of the patients had visited the emergency department, and the rate was higher in the grade 2A hospital than that in the grade 3A and 3B hospitals ( 63. 9% vs. 41. 6% and 42. 3% , P lt;0. 01) . 23. 6% of the respondents had underwent lung function test follow-up during the past one year, andthe rate in the grade 3A hospital was higher than that in the grade 3B and 2A hospitals( 79. 2% vs. 44% and 40. 2%, P lt;0. 01) . Only 2. 8% of the patients in the grade 3A hospital had used peak flowmeter regularly.There were 19. 7% of the patients received a long-term treatment plan by specialists, and the rate in the grade 3A and 3B hospitals was higher than that in the grade 2A hospital ( 22. 4% and 21. 7% vs. 11. 5% ,P lt;0. 05) . 30. 6% of the respondents insisted on using inhaled corticosteroid ( ICS) or combination of ICS and long acting β2 -agonist ( ICS/LABA) , and the rate was higher in the grade 3A and 3B hospitals than that in the grade 2A hospital ( 33. 9% and 32. 6% vs. 21. 3% , P lt;0. 05) . 27. 7% of the patients had used the theophylline drugs regularly, and there were no significant differences in three hospitals. 30. 3% of the patients did not used the drugs regularly, and most of these patients were from the grade 2A and 3B hospitals ( 54. 1% and 32. 9% respectively) . 11. 4% of the patients has used antibiotics, herbal medicine or other drugs. And most of these patients were from the grade 2A and 3B hospitals ( 50% and 30. 6% respectively) . 26. 2% of the patients believed that asthma is an inflammatory disease. 51. 3% of the patients selected ICS ( or ICS/LABA) as the first line medicine, and the rate in the grade 3A hospital was higher than that in the grade 3B and 2A hospitals ( P lt;0. 05) . Only13. 1% -14. 7% of the patients attended the lecture about asthma in hospitals in the past one year, and the rate in the grade 3A hospital was thehighest, but the difference was not significant. Conclusions The lack of the awareness, the poor control, and the non-standardized treatment and management of the disease are the main obstacles in the control of asthma in Gansu province, especially in township hospitals.
ObjectiveTo analyze the effects of time-worn ritual endotracheal suction (TRES) and on-demand invasive airway suction (OIAS) for patients.MethodsPubMed, EMBASE, Cochrane Library, Web of Science, EBSCO, CBM, CNKI, WanFang and VIP databases were searched for all randomized controlled trials (RCTs) comparing TRES with OIAS for patients. The studies were selected according to inclusion and exclusion criteria. The articles were assessed and data were extracted from them. The RevMan 5.3 software was used to analyze the data.ResultsSeventeen randomized controlled trials were included finally, and 2 029 patients were included, involving 1 028 patients in the control group and 1 001 patients in the experimental group. The results of meta-analysis showed that compared with TRES, OIAS could reduce the damage to the airway mucosa injury (RR=0.18, 95%CI 0.13 - 0.26, P<0.000 01), reduce secondary respiratory infections (RR=0.44, 95%CI 0.30 - 0.65, P<0.000 1), decrease the occurrence of phlegm blockade (RR=0.20, 95%CI 0.13 - 0.33, P<0.000 01), shorten the hospital stay (MD=5.03, 5%CI 3.17 - 6.89, P<0.000 01), but not influence the drop in oxygen saturation and the drop in blood oxygen pressure (RR=0.50, 95%CI 0.21 - 1.17, P=0.11). However there was no significant difference in mortality between two groups (P=0.46).ConclusionOIAS is preferred for patients who need suction than TRES.
ObjectiveTo investigate the disease severity and comorbidities in outpatient with asthma from urban area in China.MethodsA face-to-face, questionnaire-based survey was carried out in outpatient department in 30 general hospitals from 30 provinces in China mainland except for Tibet during October 2015 to May 2016, and asthma patients who meet the including criteria were enrolled. Data of demographic characteristics, smoking status, disease severity, and comorbidities were collected.ResultsA total of 3 875 cases were included. According to GINA criteria, the proportion of diseases severity was as following: intermittent status 52.5% (2 033/3 875), mild persistent 24.5% (951/3 875), moderate persistent 16.9% (656/3 875), and severe persistent 6.1% (235/3 875). The overweight rate was 32.9% (1 274/3 875), the rate of obesity was 10.3% (401/3 875), and the smoking rate was 20.1% (777/3 875). Obesity and smoking were related to poor asthma control. 75.9% (2 941/3 875) of the patients had comorbidities: allergic rhinitis 43.4% (1682/3 875), hypertension 16.4% (634/3 875), nasosinusitis 8.7% (338/3 875), chronic obstructive pulmonary disease 7.3% (283/3 875), bronchiectasis 3.0% (118/3 875), and rhinopolypus 2.9% (114/3 875).ConclusionsThe majority of asthma patients from outpatient department are mild asthma patients. The proportion of allergic rhinitis and bronchiectasis in asthma patients is higher than mean level. Asthma patients with comorbidities of obesity and smoking is related to poor asthma control.
ObjectiveTo analyze the relationship between medication compliance of patients with uncontrolled asthma and lung function,airway inflammation level, asthma control level and quality of life so as to obtain important references for improving patient compliance and asthma control level in the future. MethodsQuestionnaires were performed in asthma patients who did not achieve asthma control and had poor compliance in 32 third-class hospitals in 28 provinces of China mainland. All patients were tested for lung function and airway inflammation levels. So the relevant data of asthma compliance was investigated and analyzed. ResultsA total of 923 patients were investigated and the questionnaire recovery rate was 100%. Two hundred and forty-three (26.33%) answered cognitive related questions about asthma completely correctly. Treatment compliance in asthma patients was positively correlated with lung function and significantly negatively correlated with exhaled nitric oxide. Better treatment compliance in asthma has higher level of asthma control and quality of life. Poor compliance in asthma patients will lead to decreased lung function and elevated levels of airway inflammation, resulting in decreased asthma control and quality of life. ConclusionAsthma treatment compliance is related to lung function, airway inflammation, asthma control level and quality of life.