The sit-to-stand test (STST) has been used to evaluate the exercise tolerance of patients with COPD. However, mutual comparisons to predict poor exercise tolerance have been hindered by the variety ...of STST modes used in previous studies, which also did not consider patients' subjective perceptions of different STST modes. Our aim was to compare the five-repetition sit-to-stand test (5STS) with the 30-second sit-to-stand test (30STS) for predicting poor performance in the six-minute walking test and to evaluate patients' subjective perceptions to determine the optimal mode for clinical practice.
Patients with stable COPD performed 5STS, 30STS and the 6MWT and then evaluated their feelings about the two STST modes by Borg dyspnea score and a questionnaire. Moreover, we collected data through the pulmonary function test, mMRC dyspnea score, COPD assessment test and quadriceps muscle strength (QMS). A receiver operating characteristic curve analysis of the 5STS and 30STS results was used to predict 6-minute walk distance (6MWD) <350 m.
The final analysis included 128 patients. Similar moderate correlations were observed between 6MWT and 5STS (
=-0.508,
<0.001) and between 6MWT and 30STS (
=0.528,
<0.001), and there were similar correlations between QMS and 5STS (
=-0.401,
<0.001) and between QMS and 30STS (
=0.398,
<0.001). The 5STS and 30STS score cutoffs produced sensitivity, specificity and positive and negative predictive values of 76.0%, 62.8%, 56.7% and 80.3% (5STS) and 62.0%, 75.0%, 62.0% and 75.0% (30STS), respectively, for predicting poor 6MWT performance. The 5STS exhibited obvious superiority in terms of the completion rate and the subjective feelings of the participants.
As a primary screening test for predicting poor 6MWD, the 5STS is similar to the 30STS in terms of sensitivity and specificity, but the 5STS has a better patient experience.
Introduction
Patients with acute pulmonary embolism(APE)who present with right ventricular dysfunction (RVD) have a worse prognosis. This study aimed to evaluate the value of routine biochemical ...parameters in predicting RVD and 30‐day mortality in patients with APE.
Methods
We retrospectively collected the clinical data for 154 enrolled patients, including the neutrophil‐to‐lymphocyte ratio (NLR), platelet‐to‐lymphocyte ratio (PLR), D‐dimer, cardiac troponin I (cTnI), and N‐terminal pro‐brain natriuretic peptide (NT‐proBNP). We analyzed the correlation between RVD and the parameters and conducted a receiver operating characteristic (ROC) curve to confirm the cut‐off values for predicting RVD and 30‐day mortality. Formulas were built with relevant parameters to predict RVD and 30‐day mortality.
Results
Age, NLR, PLR, D‐dimer, the ratio of cTnI (+), and NT‐proBNP (+) were significantly higher in RVD (+) patients. The ratio of cTnI (+) and NT‐proBNP (+) in 30‐day mortality (+) patients was significantly higher than that in 30‐day mortality (−) patients. According to the logistic regression analysis, NLR, cTnI (+), and NT‐proBNP (+) correlated with RVD. The formula for the RVD risk score is 0.072 × NLR+1.460 × NT‐proBNP (+)+2.113 × cTnI (+), and the area under the curve (AUC) = 0.890 (95% CI: 0.839‐0.941, P = .001). The formula for the 30‐day mortality risk score is 0.115 × NLR + 2.046 × NT‐proBNP (+) + 1.946 × cTnI (+) −0.016 × PLR, and the AUC = 0.903 (95% CI: 0.829‐0.976, P = .001).
Conclusions
The rapid on‐site evaluation of routine biochemical parameters, including NLR, cTnI, and NT‐proBNP levels, and the formula developed using these parameters are valuable for predicting RVD and 30‐day mortality in patients with APE.
Background
After the low quality of Chinese clinical practice guidelines (CPGs) for respiratory diseases published from 1979 to 2013 was reported, some handbooks were published to standardize ...guidelines’ development recently. There was a great increase in the production and dissemination of CPGs annually in China, whose quality and potential impact were unknown.
Methods
A systematic search of four literature databases was performed for the period January 2013 to December 2018 to identify Chinese CPGs for respiratory diseases. Eligible CPGs were evaluated using the appraisal of guidelines for research and evaluation II (AGREE II) instrument.
Results
A total of 197 CPGs were identified for review. Compared with the result of previous study, the increased scores of the six AGREE II domains were screened: Scope and purpose (57.3% vs. 57.8%), Stakeholder involvement (17.6% vs. 25.0%), Rigor of development (10.2% vs. 13.2%), Clarity and presentation (55.2% vs. 58.4%), Applicability (9.3% vs. 25.9%), and Editorial independence (1.1% vs. 6.3%). The improved overall assessment for included CPGs were: Recommended (4, 2.0% vs. 0, 0%) and Recommended with modifications (26, 13.2% vs. 3, 2.8%). The improved level of evidence used to make recommendations were 59, 11.9% versus 168, 22.4% and 88, 17.7% versus 195, 26.0%, A and B, respectively.
Conclusions
The overall quality of CPGs for respiratory diseases published from 2013 to 2018 in China was slightly improved, but had a big gap with the optimum level, especially in Rigor of development and Editorial independence. Increased efforts are required to enable the development of high‐quality evidence‐based CPGs for respiratory diseases.
Classical conditioning plays a critical role in the learning process of biological brains, and many computational models have been built to reproduce the related classical experiments. However, these ...models can reproduce and explain only a limited range of typical phenomena in classical conditioning. Based on existing biological findings concerning classical conditioning, we build a brain-inspired classical conditioning (BICC) model. Compared with other computational models, our BICC model can reproduce as many as 15 classical experiments, explaining a broader set of findings than other models have, and offers better computational explainability for both the experimental phenomena and the biological mechanisms of classical conditioning. Finally, we validate our theoretical model on a humanoid robot in three classical conditioning experiments (acquisition, extinction, and reacquisition) and a speed generalization experiment, and the results show that our model is computationally feasible as a foundation for brain-inspired robot classical conditioning.
Display omitted
•Classical conditioning (CC) is crucial in biological and embodied robot learning•A spiking neural network incorporates existing biological findings of CC in one model•BICC can explain a broader set of findings than other existing computational models•BICC ensures a robot gets similar biological behavior and speed generalization capability
Neuroscience; cognitive neuroscience; artifical intelligence; robotics
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.
Background and objective
The efficacy of inhaled corticosteroids (ICS) in asthma exacerbation are yet to be clarified. The aim of this study was to investigate the efficacy of nebulized ICS in ...children with moderate‐to‐severe acute exacerbation of asthma in an emergency room setting in order to elucidate the potential use of ICS as the first‐line therapy in the management of acute exacerbation of asthma.
Methods
This was a prospective, randomized, double‐blind, placebo‐controlled study. Paediatric patients with moderate‐to‐severe acute exacerbation of asthma in emergency room were randomized to receive nebulized salbutamol and ipratropium bromide, with the addition of nebulized high‐dose budesonide (BUD group, n = 60) or normal saline (control group, n = 58), three doses in the first hour.
Results
The improvement in forced expiratory volume in 1 s was similar in both groups at 0 h after three doses of nebulization, but there was significantly further improvement at 1 and 2 h in the BUD group (0.095 ± 0.062 L and 0.100 ± 0.120 L, respectively) compared with the control group (0.059 ± 0.082 L and 0.021 ± 0.128 L, respectively), P = 0.013 and 0.001, respectively. Complete remission rate was significantly higher (84.7% vs 46.3%, P = 0.004) and need for oral corticosteroids was significantly lower (16.9% vs 46.3%, P = 0.011) in BUD group than in control group.
Conclusion
On the basis of nebulized short‐acting bronchodilators, addition of nebulized high‐dose budesonide resulted in clinical improvement in children with moderate‐to‐severe acute exacerbation of asthma, suggesting that nebulized high‐dose ICS can be used as first‐line therapy for non‐life‐threatening acute exacerbation of asthma in children.
This prospective, randomized, double‐blind, placebo‐controlled study showed that on the basis of nebulized salbutamol and ipratropium bromide, nebulized high‐dose budesonide as the first‐line therapy for paediatric patients with moderate‐to‐severe acute exacerbation of asthma is effective in improving symptoms and reducing the need of systemic corticosteroid and hospitalization.
Cycle ergometer training (CET) has been shown to improve exercise performance of the quadriceps muscles in patients with COPD, and inspiratory muscle training (IMT) may improve the ...pressure-generating capacity of the inspiratory muscles. However, the effects of combined CET and IMT remain unclear and there is a lack of comprehensive assessment.
Eighty-one patients with COPD were randomly allocated to three groups: 28 received 8 weeks of CET + IMT (combined training group), 27 received 8 weeks of CET alone (CET group), and 26 only received 8 weeks of free walking (control group). Comprehensive assessment including respiratory muscle strength, exercise capacity, pulmonary function, dyspnea, quality of life, emotional status, nutritional status, and body mass index, airflow obstruction, and exercise capacity index were measured before and after the pulmonary rehabilitation program.
Respiratory muscle strength, exercise capacity, inspiratory capacity, dyspnea, quality of life, depression and anxiety, and nutritional status were all improved in the combined training and CET groups when compared with that in the control group (
<0.05) after pulmonary rehabilitation program. Inspiratory muscle strength increased significantly in the combined training group when compared with that in the CET group (ΔPI
maximal inspiratory pressure 5.20±0.89 cmH
O vs 1.32±0.91 cmH
O;
<0.05). However, there were no significant differences in the other indices between the two groups (
>0.05). Patients with weakened respiratory muscles in the combined training group derived no greater benefit than those without respiratory muscle weakness (
>0.05). There were no significant differences in these indices between the patients with malnutrition and normal nutrition after pulmonary rehabilitation program (
>0.05).
Combined training is more effective than CET alone for increasing inspiratory muscle strength. IMT may not be useful when combined with CET in patients with weakened inspiratory muscles. Nutritional status had slight impact on the effects of pulmonary rehabilitation. A comprehensive assessment approach can be more objective to evaluate the effects of combined CET and IMT.
The purpose of this study was to establish an animal model of chronic pulmonary hypertension with a single-dose intraperitoneal injection of monocrotaline (MCT) in young Tibet minipigs, so as to ...enable both invasive and noninvasive measurements and hence facilitate future studies.
Twenty-four minipigs (8-week-old) were randomized to receive single-dose injection of 12.0 mg/kg MCT (MCT group, n = 12) or placebo (control group, n = 12 each). On day 42, all animals were evaluated for pulmonary hypertension with conventional transthoracic echocardiography, right heart catheterization (RHC), and pathological changes. Findings of these studies were compared between the two groups.
At echocardiography, the MCT group showed significantly higher pulmonary arterial mean pressure (PAMP) compared with the controls (P<0.001). The pulmonary valve curve showed v-shaped signals with reduction of a-waves in minipigs treated with MCT. In addition, the MCT group had longer pulmonary artery pre-ejection phases, and shorter acceleration time and ejection time. RHC revealed higher mean pulmonary arterial pressure (mPAP) in the MCT group than in the control group (P<0.01). A significant and positive correlation between the mPAP values and the PAMP values (R = 0.974, P<0.0001), and a negative correlation between the mPAP and ejection time (R = 0.680, P<0.0001) was noted. Pathology demonstrated evidence of pulmonary vascular remodeling and higer index of right ventricular hypertrophy in MCT-treated minipigs.
A chronic pulmonary hypertension model can be successfully established in young minipigs at six weeks after MCT injection. These minipig models exhibited features of pulmonary arterial hypertension that can be evaluated by both invasive (RHC) and noninvasive (echocardiography) measurements, and may be used as an easy and stable tool for future studies on pulmonary hypertension.
To establish normal reference values of induced sputum cytology in healthy children in southern China.
During a period from January 2010 to December 2011, a total of 580 healthy children (5-16 years ...of age) were approached. A total of 266 children (137 boys and 129 girls) participated in the study. Sputum induction was carried out by using 5% hypertonic saline. Cell types in the sputum were examined by using routine methods.
Sputum induction was completed in 175 of the 266 subjects (65.79%), but 16 sputum samples were disqualified. The overall success rate was 59.77% (159/266). Macrophages and neutrophils were the predominant cell types: macrophages: median, 76.14%; interquartile range (IQR), 32.68%; and 2.5% to 97.5% percentile, 1.00% to 94.50%; neutrophils: median, 20.67%; IQR, 33.0%; and 2.5% to 97.5% percentile, 4.00% to 92.75%; eosinophils: median, 0.39%; IQR, 1.93%; and 2.5% to 97.5% percentile, 0.00% to 6.50%; and lymphocytes: median, 1.22%; IQR, 2.04%; and 2.5% to 97.5% percentile, 0.00% to 5.00%. The cell types did not differ among different age, gender, and passive smoking groups. Adverse events occurred in 4.4% (7/159) of the participants who completed the procedures but required no specific treatment to dissipate. Peak expiratory flow did not differ between those who completed the procedures compared with those who did not, suggesting that the procedure is safe and feasible in children.
The current study represents the first attempt to develop normal reference values of induced sputum cytology in Chinese children, and could be used as a control for future studies.
PDF
