Prevalence of gastroesophageal reflux disease in patients with asthma and chronic obstructive pulmonary disease

Background and Aim: It is speculated that the prevalence of gastroesophageal reflux disease (GERD) might increase with asthma or chronic obstructive pulmonary disease (COPD). The aim of the present study was to evaluate the prevalence of GERD in patients with asthma and COPD in an area representative of developing countries. Methods: A validated GERD questionnaire was conducted face‐to‐face with 308 consecutive asthma (240 women) and 133 COPD (35 women) patients in the tertiary referral pulmonary outpatient clinic, and 694 controls from the research area. Detailed histories of patients and pulmonary function tests were also recorded. Results: The prevalence of GERD (heartburn/regurgitation once a week or more) was 25.4%, 17.0%, 19.4% and occasional symptoms (less than weekly) were 21.2%, 16.3% and 27.0% of patients with asthma, COPD and controls, respectively. The prevalence was higher in the asthma group compared with the controls and the COPD group. No significant difference was found between the COPD group and the controls. Heartburn started following pulmonary disease in 24.1% of the asthma group, and 26.4% of the COPD group. The majority of additional symptoms were significantly higher in asthmatics compared with the controls. No difference was found in the consumption of pulmonary medications in asthmatic patients in groups with different symptom frequency. Heartburn was increased 13.8% by the consumption of inhaler medications. Conclusions: These results implicate that the prevalence of GERD in asthma and COPD are lower than in published reports in a tertiary referral center. These differences might be related to the characteristics of developing countries, increased consumption of powerful medications in GERD and pulmonary diseases, or methodological flaws in earlier studies.     

Early Myocardial Functional Alterations in Patients with Obstructive Sleep Apnea Syndrome

Background: There is limited information regarding myocardial alterations in patients with obstructive sleep apnea syndrome (OSAS) in the absence of pulmonary and cardiac comorbidity. In this study, we aimed to evaluate potential myocardial alterations of these patients and investigate the possible effects of OSAS-related pathological variations on left and right ventricular functions. Methods: We studied 107 consecutive patients who were referred to our sleep laboratory for clinically suspected OSAS and 30 controls without any history or symptoms of sleep-related disorders. Severity of OSAS was quantified by polysomnography. Patients with apnea–hypopnea index (AHI) < 5 were included in the OSAS (−) group (Group 1, n = 22). Subjects with AHI ≥ 5 were considered as OSAS and classified according to their AHI as mild-to-moderate (AHI ≥ 5 and AHI < 30) (Group 2, n = 45) and severe (AHI ≥ 30) OSAS groups (Group 3, n = 40). Conventional M-mode, 2D, and Doppler mitral inflow parameters, tissue Doppler velocities, myocardial peak systolic strain, and strain rate values of various segments were measured and compared between groups. Results: Patients with OSAS displayed impairment of left ventricular diastolic function compared with controls. There were no significant differences between groups regarding parameters reflecting left ventricular systolic function. Myocardial strain analysis demonstrated significant decrement regarding apical right ventricular longitudinal peak systolic strain and strain rate values between groups in relation to the severity of OSAS. Conclusions: Patients with OSAS display a regional pattern of right ventricular dysfunction correlated with the severity of disease.     

COPD stories of complex causal ‘truths’‘Sure I’ve smoked all my life/but I also put in 37 years at the mine’

Aims and objectives. Secondary analysis was conducted to interpret the causes of illness stories told by patients living with chronic obstructive pulmonary disease. Background. Despite the abundance of quantitative evidence regarding the causal relationship between smoking and chronic obstructive pulmonary disease, there is limited research that provides a contextual emic understanding of chronic obstructive pulmonary disease aetiology. Design. Interview data from two earlier focused ethnography studies were examined by retrospective interpretation, a type of secondary qualitative research. Chronic obstructive pulmonary disease causation stories were identified in both primary study data bases, but were not previously systematically examined. Methods. The analysis was completed using an eclectic, explicit narrative approach that involved the examination of causation story elements. Results. Participants told 104 causal stories about the development of their lung disease. They situated the aetiology of their chronic illness within a psychosocial reality. Conclusions. The causal stories told by participants demonstrate that those living with chronic obstructive pulmonary disease present a broader causal explanation for their illness, an orientation not commonly presented in the literature. They demonstrate the need for further examination of the important lay accounts of causes of illness in relation to chronic obstructive pulmonary disease. Relevance to clinical practice. Clinicians’ ability to hear an alternative understanding may be impeded when they only listen for what they already know, ‘facts’ concerning the relationship between smoking and chronic obstructive pulmonary disease. Addressing vulnerable persons in such a manner may impede patients’ efforts to be responsible for the development of their chronic illness and individualised care.     

Reversibility of acute intermediate phase bilirubin encephalopathy

Aim:  To show the potential for reversing acute intermediate to advanced phase bilirubin encephalopathy.
Methods:  Case studies.
Results:  Six extremely jaundiced infants had symptoms of intermediate to advanced phase acute bilirubin encephalopathy. The infants were treated aggressively. Two patients had brain magnetic resonance imaging showing increased signals in the globus pallidus. On follow-up, all infants are neurologically normal.
Conclusions:  Intermediate-to-advanced stage acute bilirubin encephalopathy may occasionally be reversible. These cases provide a strong argument in favour of rapid and aggressive intervention in infants presenting with extreme jaundice and neurological symptoms.     

长期应用小剂量氨茶碱对稳定期慢性阻塞性肺疾病患者、动物外周血、骨髓粒细胞增殖的影响

目的探讨长期应用小剂量氨茶碱（Aminophyllin,AP）对稳定期慢性阻塞性肺疾病（Chronic Obstructive Pulmonary Disease,COPD）患者、动物骨髓、外周血粒细胞增殖的影响。方法 （1）应用前瞻、随机分组、对照及自身对照的方法,将1252例稳定期COPD患者（Ⅱ～Ⅲ级）分为治疗组（常规治疗＋茶碱缓释片0.4g/d）和对照组（常规治疗）。治疗开始后每间隔15d复查1次血常规,对治疗前后的指标进行自身前后比较。（2）25只实验用羊采用自身对照法,在应用AP 3mg/（kg.d）后,对治疗前后的各项指标进行自身前后比较。结果 （1）长期应用小剂量AP,对稳定期COPD患者的外周血粒细胞增殖无影响（P〉0.05）;（2）长期应用小剂量AP可使动物的骨髓嗜酸性粒细胞增生活跃（P〈0.05）;（3）长期应用小剂量AP对动物的骨髓、外周血粒细胞增生无影响（P〈0.05）。结论长期应用小剂量AP可使骨髓嗜酸性粒细胞增生活跃以提高机体抗炎及调节免疫能力,而对骨髓血红系统及外周血粒细胞增殖无影响。     

超声监视宫腔镜介入治疗输卵管阻塞性不孕的应用价值

目的探讨超声监视宫腔镜下介入治疗输卵管阻塞性不孕的临床应用价值。方法对2007年5月～2009年5月的112例输卵管阻塞性不孕症患者在超声监视宫腔镜下通液联合导丝介入治疗的疗效进行分析，并采用超声评价治疗效果。结果112例患者在超声监护宫腔镜下通液联合导丝介入治疗，其中97例双侧输卵管经过治疗后完全通畅，占8839％；术后一个月复查并随访一年，34例受孕，占35．05％，与文献报道的受孕率（34．7％）相比较，P〈0．05，有统计学意义。结论超声监视宫腔镜下通液联合导丝介入治疗输卵管阻塞性不孕症，方法简便、直观、安全，疗效满意，具有较高的临床应用价值，值得推广。     

对37年来我国慢性阻塞性肺疾病研究工作的文献分析

目的评价我国慢性阻塞性肺疾病（COPD）37年的研究状况，对COPD研究工作的历程进行时代划分。方法综合手工检索、数据库检索、文献引用对中华医学杂志、中华内科杂志、中华结核和呼吸杂志（三大杂志）、中文科技期刊数据库（VIP）、PUBMED数据库上我国科技人员发表的有关COPD的文献进行统计，并经过数据转换计算后进行分析。结果1972—2008年37年中3种杂志刊登的论文数（不包括肺心病）共947篇，得到COPD各类别文献对时间的曲线图（三大杂志、VIP、PUBMED），各类别及各方向的论文数据。并通过文献学分析将我国COPD研究历史分为4个阶段。结论我国近40年的COPD研究工作取得一定成果，各个时代都有其鲜明的特征，但仍然存在的不少问题，需要在今后得以解决。     

腹腔镜治疗胆囊结石并肝外非结石性良性梗阻性黄疸

目的 研究腹腔镜治疗胆囊结石并肝外非结石性良性梗阻性黄疸的可行性.方法 对采用腹腔镜治疗的11例胆囊结石并肝外非结石性良性梗阻性黄疸病历资料进行回顾性研究.结果10例成功实施腹腔镜手术,其中腹腔镜胆囊切除术(LC)4例,腹腔镜胆囊切除、胆总管探查术(LCBDE)6例；1例因胆囊三角冰冻样粘连及胆囊动脉变异(横跨胆总管)而中转开腹；各种手术患者均治愈,随访6个月,无异常.结论 胆囊结石并肝外非结石性良性梗阻性黄疸是对腹腔镜外科医师的一种考验,术中诊断甚为重要,依靠术者的经验积累和耐心细致的操作,采用合理的手术方式,是可以成功的.     

Stable dry powder inhaler formulation of tranilast attenuated antigen-evoked airway inflammation in rats

Tranilast (TL) has been clinically used for the treatment of airway inflammatory diseases, although the clinical use of TL is limited because of its poor solubility and systemic side effects. To overcome these drawbacks, a novel respirable powder of TL (CSD/TL-RP) for inhalation therapy was developed using nanocrystal solid dispersion of TL (CSD/TL). Stability study on CSD/TL-RP was carried out with a focus on inhalation performance. Even after 6 months of storage at room temperature, there were no significant morphological changes in micronized particles on the surface of carrier particles as compared with that before storage. Cascade impactor analyses on CSD/TL-RP demonstrated high inhalation performance with emitted dose and fine particle fraction (FPF) of ca. 98% and 60%, respectively. Long-term storage of CSD/TL-RP resulted in only a slight decrease in FPF value (ca. 54%). Inhaled CSD/TL-RP could attenuate antigen-induced inflammatory events in rats, as evidenced by marked reduction of granulocytes in bronchoalveolar lavage fluid and inflammatory biomarkers such as eosinophil peroxidase, myeloperoxidase, and lactate dehydrogenase. These findings were consistent with decreased expression levels of mRNAs for nuclear factor-kappa B and cyclooxygenase-2, typical inflammatory mediators. Given these findings, inhalable TL formulation might be an interesting alternative to oral therapy for the treatment of asthma and other airway inflammatory diseases with sufficient dispersing stability.