ObjectiveTo assess the fatigue in patients with obstructive sleep apnea hypopnea syndrome (OSAHS), and analyze the factors caused fatigue and the relationship between quality of life (QOL) and fatigue. MethodsOne hundred and sixty-nine patients with OSAHS and 78 subjects without OSAHS diagnosed by polysomnography (PSG) between December 2010 and March 2011 in West China Hospital were recruited in the study. Fatigue was assessed by using multidimensional fatigue inventory (MFI), excessive daytime sleepiness by Epworth sleepiness scale(ESS), QOL by functional outcomes of sleep questionnaire (FOSQ). ResultsFatigue in the patients with OSAHS was more severe than that of the controls (51.06±13.39 vs. 44.82±9.81, P < 0.001), but no difference was revealed in the patients with different degree of OSAHS. Fatigue was positively correlated with ESS score(r=0.210), total sleep time intervals(r=0.156), and the ratio of time of SpO2 below 90% in total sleep time(r=0.153)(P < 0.05), and was negatively correlated with the average oxygen saturation(r=-0.171, P < 0.05) and all subscales of FOSQ(P < 0.01). ConclusionsFatigue in patients with OSAHS is more severe than that of controls. Fatigue can significantly reduce QOL, and the impact is greater than that of excessive daytime sleepiness.
抗生素在哮喘当中的应用一直备受争议。近年的研究主要集中于大环内酯类抗生素(Macrolides)的非抗菌效应，已有研究发现l4元环和l5元环的大环内酯类抗生素具有类激素样抗炎活性[1]。作为新一代大环内酯类衍生物的泰利霉素(Telithromycin)由于其独特的抗细菌耐药性，一问世便受到广泛关注，而近期公布的TELICAST试验(The Telithromycin，Chlamydophila，and Asthma Trial)中关于其在哮喘急性加重疗效方面的结果更是令人振奋。该试验发现，对已确诊的哮喘急性加重期患者，在指南推荐的常规治疗基础上加用为期10 d的泰利霉素口服(800 mg／d)，可使哮喘症状评分明显下降，肺功能指标改善，但其发挥疗效的机制尚不十分清楚[2]。
Objective To investigate the effects of immune—enhancing enteral nutritioin therapy on the inflammatory reaction and immune function in the rats of ventilation-induced lung injury．Methods Fourty rats were divided into four groups(EN1、EN2、SEN1、SEN2，n=10)．All groups were performed mechanic ventilation and fed isocaloric enteral nutrition．EN1 group：tidal Volume(VT) =8 mL／kg，traditional enteral nutrition；EN2 group：VT=40 mL／kg，traditional enteral nutrition；SEN1 group：VT：8 mL／kg，immune-enhancing enteral immunonutrition；SEN2 group：VT=40 mL／kg，immune-enhancing enteral immunonutrition．Lymphocyte subsets，TNF-α，IL-6 and contents of arachidonic acid(AA)were determined at different time point(0，4，24，72 h after ventilation)．Results The levels of CD3+，CD4+，CD4+／CD8+ in SEN2 group were lower(Plt;0.05)than in EN1，EN2 and SEN1 group after 24，72 h of ventilation．The serum concentrations of TNF-α，IL-6 and AA were significantly lower in EN2 than in other three groups(P lt;0.05)．Conclusion Immune-enhancing enteral nutrition feeding prior to machanie ventilatioin can alleriate the damage of immunological function and reduce infl ammotory responses
Objective This is a meta-analysis of the efficacy of noninvasive ventilation (NIV) with helmet compared to NIV with face mask in patients with acute respiratory failure (ARF). Methods " Helmet, face mask or facial mask” and " mechanical ventilation or noninvasive ventilation” were used as key words both in Chinese and English to search all the trials in PubMed, OVID, Embase, Scopus and Cochrane Library, websites, reference lists of articles, CNKI and Wanfang Database from inception to December 2016. Two reviewers independently assessed the methodological quality of the trials and extracted information. Revman 5.3 was used for data analysis. Results Ten randomized controlled trials (RCTs) and six case-control trials were included. NIV with a helmet reduced the intubation rate (OR=0.35, 95%CI 0.24 to 0.51, P<0.000 01), in-hospital mortality rate (OR=0.51, 95%CI 0.34 to 0.76, P=0.001), and NIV-related complications (OR=0.10, 95%CI 0.06 to 0.15, P<0.000 01) compared to NIV with face mask. There was no significant difference in gas exchange between two groups. In the subgroup analysis, types of ARF and ventilation mode did not affect the intubation rate and the complications relevant to NIV, but NIV with helmet mainly decreased the in-hospital mortality of the patients with hypoxemic ARF or pressure support ventilation. Conclusions NIV with a helmet can decrease the endotracheal intubation rate, in-hospital mortality, and NIV-related complications of the patients with ARF. And helmet is as effective as face mask in improving the gas exchange. However, larger or multicenter RCTs are needed to analyze the role of NIV with a helmet in this condition.
ObjectiveTo enhance the cognition about the clinical characteristics of diffuse panbronchiolitis (DPB). MethodsThe data of patients with DPB searched out on the computer from January 1996 to September 2013 were retrospectively studied. ResultsThe 91 patients had a male to female ratio of 2︰1, and the mean age at onset was (40.5± 18.4) years old. The median course of disease was 7 years. The main clinical profiles included chronic cough, sputum production, exertional dyspnea, and crackles. A history of sinusitis occurred in 90.1% (82/91) of the patients. Positive rate of cold hemoagglutinin and HLA-B54 were 46.1% (30/65) and 42.1% (8/19), respectively. All patients' CT scans showed bilateral, diffuse, small centrilobular nodules. Lung function assessment showed an obstructive ventilation disfunction in 60.0% (51/85) of the patients and a mixed obstructive-restrictive pattern in 36.5% (31/85) of the patients. Thirty-four patients underwent lung biopsy. A total of 65.9% (60/91) of the patients had been misdiagnosed, and 98.8% (84/85) of the patients achieved significant improvement after the macrolide therapy. ConclusionDPB is not rare in China, but tends to be misdiagnosed or underdiagnosed. Macrolides can improve the prognosis of DPB.
ObjectiveTo explore the relevance of the ratio of pulmonary arterial diameter to aortic diameter exceeding one (PA:A>1) with brain natriuretic peptide (BNP) and inflammatory factor levels in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). MethodsFrom August 2013 to December 2013,95 inpatients with AECOPD in West China Hospital were divided into two groups according to the ratio of pulmonary arterial diameter to aortic diameter. The clinical data of the patients were collected. Meanwhile,arterial blood gas,plasma levels of BNP,C-reactive protein (CRP),and interleukin-6 (IL-6) within 24 hours were measured. ResultsThe plasma BNP level was 2005(483-4582)ng/L in the group with PA:A>1,and 404(137-1224)ng/L in the group with PA:A<1. There was significant difference in plasma BNP level between two groups (P<0.01). There was no significant difference in CRP or IL-6 level between two groups (P>0.05). ConclusionThe ratio of pulmonary arterial diameter to aortic diameter is correlated with BNP level in patients with AECOPD,but is not correlated with CRP or IL-6.