Objective To evaluate the effectiveness of oral appliance (OA) vs. continuous positive airway pressure (CPAP) in treating patients with mild to moderate obstructive sleep apnea-hypopnea syndrome (OSAHS). Methods The following databases including PubMed, EMbase, The Cochrane Library, CBM, VIP, WanFang data and CNKI were searched from inception to November 30, 2012 to collect the randomized controlled trials (RCTs) on OA vs. CPAP in treating OSAHS. The relevant conference proceedings were also retrieved without limitation of type and publication time. In accordance with the inclusion and exclusion criteria, two reviewers independently screened studies, extracted data, and evaluated quality. And then meta-analysis was performed using RevMan 5.1 software. Besides, the level of evidence was graded using GRADEpro 3.6 software. Results A total of 7 RCTs were included. The results of meta-analysis showed that: a) compared with OA, CPAP significantly reduced the degree of apnea-hypopnea index (AHI) (WMD=9.13, 95%CI 8.77 to 9.50, Plt;0.000 01); and b) there was no significant difference in the Epworth sleeping scale (ESS) between OA and CPAP (WMD=0.00, 95%CI −0.12 to 0.12, P=0.97). Conclusion Compared with OA, CPAP takes remarkable effects in improving AHI for mild to moderate OSAHS, but it shows no significant difference in improving ESS. For the quality and quantity limitation of the included studies, this conclusion still needs to be proved by conducting more high quality RCTs.
Objective To evaluate the diagnostic accuracy of Wilson score for predicating difficult intubation. Methods Such databases as PubMed, EMbase, CNKI, WanFang Data and VIP were searched to collect the studies about Wilson score for predicating difficult intubation published from inception to January 2013. Two reviewers independently screened the studies, extracted the data, and assessed the methodological quality by QUADAS. The analysis was conducted by using Meta-Disc 1.4 software, and the random effect model was chosen to calculate the pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio, and the 95%CI. The summary receiver operating characteristic (SROC) curve was drawn and the area under the curve (AUC) was calculated in order to comprehensively assess the total diagnostic accuracy of Wilson score for predicating difficult intubation. Results A total of 9 studies involving 6 506 subjects were included. The results of meta-analysis showed that: the pooled sensitivity was 0.57 (95%CI 0.53 to 0.62), specificity was 0.89 (95%CI 0.88 to 0.90), positive likelihood ratio was 6.11 (95%CI 4.63 to 8.07), negative likelihood ratio was 0.52 (95%CI 0.41 to 0.66), diagnostic odds ratio was 12.76 (95%CI 8.60 to 18.93), and the AUC of SROC was 0.84. Conclusion Wilson score plays a role in predicating difficult intubation, while some other clinical indicators also need to be taken into consideration in its application.
ObjectiveTo investigate the expressions of IL-10,tumor necrosis factor-α (TNF-α) and interferon-γ (IFN-γ) in serum and lung tissue of COPD rats in order to elucidate the potential mechanism of airway inflammation. MethodsForty-five healthy adult male SD rats were randomly divided into a COPD model group (n=30) and a normal control group (n=15). The COPD rat model was established by intratracheal instillation of lipopolysaccharide (LPS) and exposure to cigarette smoke for 28 days. The concentrations of IL-10,TNF-α and IFN-γ in serum and lung tissue were measured by ELISA. ResultsTNF-α level of serum and lung tissue in the COPD model group increased significantly compared with the control group(P<0.05),while the levels of IFN-γ and IL-10 decreased significantly[serum:(44.68±8.67) ng/L vs. (75.96±10.59) ng/L;lung tissue:(64.55±9.03) ng/L vs. (94.06±8.71) ng/L,P<0.01]. The level of IL-10 in serum and lung tissue was negatively correlated with TNF-α (serum:r=-0.67,lung tissue:r=-0.80,P<0.01). The level of IL-10 in serum and lung tissue was positively correlated with IFN-γ (serum:r=0.64,lung tissue:r=0.72,P<0.01). The level of IL-10 in serum and lung tissue was negatively correlated with the percentage of neutrophils(serum:r=-0.70,lung tissue:r=-0.67,P<0.01). ConclusionIn COPD rats,down regulation of IL-10 plays an important role in regulation of airway inflammation.
【摘要】 目的 研究肺癌患者的气道高反应性和肺通气功能情况，并探讨其易感因素，为肺癌患者肺通气功能的临床评估提供依据。 方法 对2010年4月-2011年4月收治的40例肺癌患者（A组）进行术前肺功能检测及气管激发试验，选取同期的健康体检者40例做对照组（B组），并采用logistic逐步回归分析肺癌患者的气道高反应性的易感因素。 结果 ①A组患者的用力肺活量、第1秒用力呼气容积（forced expiratory volume in one second，FEV1）、最高呼气流量（peak expiratory flow，PEF）以及最大呼气中期流量均小于B组，且差异有统计学意义（P=0.000）；②A组的FEV1估计异常人数和PEF估计异常人数均多于B组（Plt;0.05）；③A组组胺气道激发试验阳性者多于B组（χ2=5.000，P=0.025），且A组PD20FEV1低于对照组[分别为（4.69±0.82）、（8.32±1.43）μmol/L；t=13.930，P=0.000]；④logistic逐步回归分析表明影响A组患者的气道高反应性的因素为年龄、分型、TNM分期、病史、吸烟。 结论 肺癌气道反应性增高，且肺功能下降，由于肺癌气道高反应性的易感因素较多，因此需对合并因素较多者进行及时的预防，防止由于气道阻力增加和气道狭窄引起的胸闷、咳嗽、喘息和呼吸困难等症状。【Abstract】 Objective To learn the condition of bronchial hyper-reactivity and pulmonary function in patients with lung cancer, and explore the risk factors for bronchial hyper-reactivity in order to provide clinical reference for pulmonary function evaluation in patients with lung cancer. Methods Forty patients with lung cancer treated in our hospital from April 2010 to April 2011 (research group) took pulmonary function and tracheal stimulation tests before operation, and in the meanwhile, 40 healthy people were chosen as controls. The logistic regression analysis was employed to analyze the risk factors for bronchial hyper-reactivity. Results The forced vital capacity, forced expiratory volume in one second (FEVl), peak expiratory flow (PEF) and maximal mid expiratory flow in the research group patients were all significantly lower than those in the control group patients (P=0.000). The number of patients with estimated FEVl and PEF abnormality in the research group was more than that in the control group (P=0.05). The number of patients positive in histamine bronchial provocation test in the research group was more than that in the control group (χ2=5.000, P=0.025), and the PD20FEV1 level of the research group was lower than that of the control group [(4.69±0.82) and (8.32±1.43) μmol/L; t=13.930, P=0.000]. Logistic regression analysis showed that the risk factors for bronchial hyper-reactivity in patients with lung cancer were age, type, TNM stage, history of lung cancer, and smoking. Conclusions The airway reactivity elevates and the lung cancer pulmonary function decreases in lung cancer patients. Because there are many risk factors, prevention should be taken for patients with combined risk factors to avoid the occurrence of chest distress, cough, gasp and dyspnea caused by increased airway resistance and stricture.
目的：评价电子气管镜直视下置入镍钛合金支架治疗气道狭窄的疗效及安全性。方法：对我院3年来由各种原因引起的气管或支气管狭窄的21例患者行电子气管镜直视下经鼻置入国产镍钛合金支架术，观察置入支架前后症状、狭窄段气道直径变化、动脉血气变化情况及其并发症。结果：21例患者术后呼吸困难均明显改善，气道内径扩张及动脉血氧分压改善较术前均有统计学意义，未发生严重并发症。结论：电子气管镜直视下置入气道支架准确、迅速、安全，操作较方便，有助于延长患者的生存时间和提高生活质量，为进一步治疗创造条件。
Objective To investigate the effects of FasL gene-modified dendritic cell (DC) on the airway inflammation in mice sensitized/challenged by house dust mite (HDM) allergen.Methods FasL gene-modified DC (FasL-DC) and control DC (nontransfection DC) were administrated into HDM sensitized and challenged mice by intratracheal injection respectively，then HDM sensitized and challenged mice were sacreificed two days later.Total and differentiation cell counts and levels of interleukin-4（IL-4），IL-5 and interferon-γ(IFN-) in bronchoalveolar lavage fluid (BALF) were detected and lung histological features were observed.Results After administration of FasL-DC，lung allergic inflammation was ameliorated while total cell counts，the percentage of eosinophil ,the levels of IL-4 and IL-5 in BALF decreased and the level of IFN- in BALF increased.Conclusion Administrating FasL-DC into HDM sensitized/challenged mice can inhibit Th2 cells activation and ameliorate airway allergic inflammation.
Objective To investigate the changes of small airway function and diffusing capacity in patients with mild asthma before and after bronchial provocation test (BPT).Methods BPT was performed in suspected asthma patients with chief complaints of paroxysmal wheeze,chest tightness and cough，but with normal chest X-ray and baseline pulmonary function.BPT positive group was regarded as asthma group，while BPT negative group as control group.Lung volume，ventilatory function and diffusing capacity were measured before and after BPT and compared between the asthma and control groups.Results （A）No statistical differences were found in FEV1%，FEV1/FVC，FVC%，VC%，TLC%，FRC%，RV%，RV/TLC between the asthma and control groups before BPT.FEV1/FVC and FVC% were significantly decreased (all Plt;0.01)，while FRC% (Plt;0.05)，RV% (Plt;0.01) and RV/TLC (Plt;0.01) increased significantly in the asthma group after BPT compared with the control group.The decline rate of FEV1/FVC and FVC% and the increase rate of TLC%，RV%，RV/TLC were significantly higher in the asthma group than those in the control group (all Plt;0.01).（B）Compared with the control group，FEF25%-75% (Plt;0.05)，Vmax75% (Plt;0.01) and Vmax50% (Plt;0.05) were significantly lowered before BPT，while the above parameters and Vmax25% were significantly decreased after BPT in the asthma group (all Plt;0.01).The decline rate of FEF25%-75%，Vmax75%，Vmax50% and Vmax25% was significantly higher in the asthma group than those in the control group (all Plt;0.01).（C）There was no statistical difference in DLCO in both groups before and after BPT.Conclusions Patients with mild asthma had small airways impairment before BCT which further declined after BPT.However,no impairment of diffusion capacity was found before or after BPT.
Objective To investigate the mRNA and protein expression of human β-defensin-2 (hBD-2) induced by lipopolysaccharide (LPS)，IL-1β and TNF-α in human airway primary epitheliums.Methods The bronchial primary epitheliums from human were stimulated with LPS，IL-1β and TNF-α respectively and then were harvested for hBD-2 expression detection.The mRNA expression of hBD-2 was detected by RT-PCR，and the protein expression by immunocytochemistry and western blot.Results There was a small expression of hBD-2 mRNA in human airway primary epitheliums before stimulation.The hBD-2 mRNA expression was significantly increased after 3 hours of LPS，IL-1β and TNF-α stimulation respectively and the expression increasement was in a dose dependent manner.The hBD-2 protein could be detected in cytoplasm after 4 hours of LPS (0.1 μg/mL)，IL-1β (1 ng/mL) and TNF-α (10 ng/mL) stimulation.Conclusions LPS and proinflammatory cytokines can induce the mRNA and protein expression of hBD-2 in a short time.The expression of hBD-2 may play an initial defense role against bacterial invasion.