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Sun B.,Beijing Institute of Respiratory Medicine
Zhonghua jie he he hu xi za zhi = Zhonghua jiehe he huxi zazhi = Chinese journal of tuberculosis and respiratory diseases

To analyze the clinical, radiological, and pathological characteristics of tracheobronchomegaly (TBM, Mounier-Kuhn syndrome). The clinical, radiological and pathological characteristics of 3 cases of TBM were analyzed, and the literatures were reviewed. All 3 patients were men, between the age of 58 - 71 years old. From the onset to diagnosis, the shortest time was 2 months, and the longest 43 years. The most usual presentations included recurrent cough and sputum, and occasional haemoptysis. In the advanced stage of the disease, patients would present shortness of breath and the symptoms associated with respiratory failure because of the reduction in pulmonary function. All the diagnoses were confirmed by X-ray and CT of the chest finding that the trachea and the main bronchi dilated markedly. After anti-infection treatment, all patients recovered. Mounier-Kuhn syndrome was a rare congenital abnormality characterized by atrophy or absence of elastic fibers and thinning of smooth muscle layer in the trachea and main bronchi. These airways were thus flaccid and markedly dilated on inspiration and collapsed on expiration. The usual presentation was recurrent respiratory tract infections with a broad spectrum of functional impairment ranging from minimal disease with preservation of lung function to severe disease in the form of bronchiectasis, emphysema and pulmonary fibrosis, ultimately culminating in respiratory failure and death. Computed tomography scan of the chest was used for the diagnosis. Treatment was mainly supportive with chest physiotherapy and antibiotics. Mounier-Kunh syndrome should be suspected in patient with recurrent respiratory infections and chronic sputum production. A careful analysis of the central airways at the chest radiograph of these patients is required. Source

Luo Z.,Capital Medical University | Zhan Q.,Capital Medical University | Wang C.,Beijing Institute of Respiratory Medicine
Clinical Respiratory Journal

Introduction: Timely extubation and sequential invasive to noninvasive positive pressure ventilation (NPPV) at the pulmonary infection control (PIC) window is beneficial for patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). However, it remains unclear whether patients can breathe independently at the PIC window and if NPPV is indeed necessary after extubation. Objectives: To assess whether AECOPD patients can breathe independently at the PIC window and thus whether NPPV is necessary after extubation. Methods: We performed a prospective observational study at a university hospital during a 9-month period. We used the spontaneous breathing trial (SBT) to assess whether each patient could breathe independently at the PIC window, then performed extubation. Patients who passed the SBT received venturi oxygen therapy only, whereas those that failed received NPPV. However, if the former showed respiratory distress, they too received NPPV. The primary outcome variables were SBT pass/fail, the demand for NPPV and rate of reintubation within 72h following extubation. Results: In all, 23 patients were enrolled, 15 (65%) of which passed the SBT. Of these, 12 (80%) developed respiratory distress after extubation and required NPPV (one of whom required reintubation). Of the eight patients that failed, one received reintubation after NPPV. The reintubation rates within 72h following extubation of SBT-pass (7%) and SBT-fail (13%) patients were comparable. Conclusion: Our results provide experimental evidence that most AECOPD patients can breathe independently at the PIC window, but nonetheless develop respiratory distress and thus require NPPV following extubation. © 2013 John Wiley and Sons Ltd. Source

Li Y.,Chinese Academy of Meteorological Sciences | Wang W.,Beijing Institute of Respiratory Medicine | Kan H.,Fudan University | Xu X.,University of Florida | Chen B.,Fudan University
Science of the Total Environment

To fulfill its commitment to a successful 2008 Olympic and Paralympic Games, the Chinese government made unprecedented efforts to improve the air quality in Beijing. We report findings on air quality and outpatient visits for asthma among adults in Beijing during the 2008 Summer Olympic Games. Three study periods were defined: summer baseline (June 1-June 30: before any air pollution controls), pre-Olympics (July 1-August 7: transportation restrictions in effect), and Olympics (August 8-September 20: further restrictions on industrial emissions). Daily data on outpatient asthma visits were obtained from the asthma registry of Beijing Chaoyang Hospital. We used time-series Poisson regression models to estimate the relative risk (RR) for asthma visits associated with pollution levels. The average numbers of outpatient visit for asthma were 12.5 per day at baseline and 7.3 per day during the Olympics. Compared with baseline, the Games were associated with a significant reduction in asthma visits (RR 0.54, 95%CI: 0.39-0.75). Our analysis showed that even in a heavily-polluted city, decreased concentrations of small particles were associated with some reduction in asthma visits in adults. © 2009 Elsevier B.V. All rights reserved. Source

Wang W.,Capital Medical University | Wang W.,Beijing Institute of Respiratory Medicine
Journal of Thoracic Disease

It has been revealed by many studies that air pollution is one of the important inducements of asthma exacerbations. In addition, meteorological conditions such as high atmospheric pressure, low temperature, low humidity and large diurnal amplitude can directly induce asthma. Meanwhile, meteorological conditions play an important role in the diffusion, dilution and accumulation of air pollution. This article reviewed research progress in the impact of polluted meteorological conditions on the incidence of asthma. © Journal of Thoracic Disease. All rights reserved. Source

Kakkar A.K.,University College London | Cimminiello C.,Ospedale Civile di Vimercate | Goldhaber S.Z.,Harvard University | Parakh R.,Medicity | And 2 more authors.
New England Journal of Medicine

BACKGROUND: Although thromboprophylaxis reduces the incidence of venous thromboembolism in acutely ill medical patients, an associated reduction in the rate of death from any cause has not been shown. METHODS: We conducted a double-blind, placebo-controlled, randomized trial to assess the effect of subcutaneous enoxaparin (40 mg daily) as compared with placebo - both administered for 10±4 days in patients who were wearing elastic stockings with graduated compression - on the rate of death from any cause among hospitalized, acutely ill medical patients at participating sites in China, India, Korea, Malaysia, Mexico, the Philippines, and Tunisia. Inclusion criteria were an age of at least 40 years and hospitalization for acute decompensated heart failure, severe systemic infection with at least one risk factor for venous thromboembolism, or active cancer. The primary efficacy outcome was the rate of death from any cause at 30 days after randomization. The primary safety outcome was the rate of major bleeding during and up to 48 hours after the treatment period. RESULTS: A total of 8307 patients were randomly assigned to receive enoxaparin plus elastic stockings with graduated compression (4171 patients) or placebo plus elastic stockings with graduated compression (4136 patients) and were included in the intentionto-treat population. The rate of death from any cause at day 30 was 4.9% in the enoxaparin group as compared with 4.8% in the placebo group (risk ratio, 1.0; 95% confidence interval [CI], 0.8 to 1.2; P = 0.83). The rate of major bleeding was 0.4% in the enoxaparin group and 0.3% in the placebo group (risk ratio, 1.4; 95% CI, 0.7 to 3.1; P = 0.35). CONCLUSIONS: The use of enoxaparin plus elastic stockings with graduated compression, as compared with elastic stockings with graduated compression alone, was not associated with a reduction in the rate of death from any cause among hospitalized, acutely ill medical patients. (Funded by Sanofi; LIFENOX ClinicalTrials.gov number, NCT00622648.) Copyright © 2011 Massachusetts Medical Society. All rights reserved. Source

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