Efficacy and safety of antagonists for chemoattractant receptor-homologous molecule expressed on Th2 cells in adult patients with asthma: a meta-analysis and systematic review

Background

Chemoattractant receptor-homologous molecule expressed on Th2 cells (CRTH2) antagonists are novel agents for asthma but with controversial efficacies in clinical trials. Therefore, we conducted a meta-analysis to determine the roles of CRTH2 antagonists in asthma.

Methods

We searched in major databases for RCTs comparing CRTH2 antagonists with placebo in asthma. Fixed- or random-effects model was performed to calculate mean differences (MD), risk ratio (RR) or risk difference (RD) and 95% confidence interval (CI).

Results

A total of 14 trails with 4671 participants were included in our final analysis. Instead of add-on treatment of CRTH2 antagonists to corticosteroids, CRTH2 antagonist monotherapy significantly improved pre-bronchodilator FEV₁ (MD = 0.09, 95% CI 0.04 to 0.15, P = 0.0005), FEV₁% predicted (MD = 3.65, 95% CI 1.15 to 6.14, P = 0.004), and AQLQ (MD = 0.25, 95% CI 0.09 to 0.41, P = 0.002), and reduced asthma exacerbations (RR = 0.45, 95% CI 0.23 to 0.85, P = 0.01). Rescue use of SABA was significantly decreased in both CRTH2 antagonist monotherapy (MD = − 0.04, 95% CI -0.05 to − 0.03, P < 0.00001) and as add-on to corticosteroids (MD = − 0.78, 95% CI -1.47 to − 0.09, P = 0.03). Adverse events were similar between the intervention and placebo groups.

Conclusions

CRTH2 antagonist monotherapy can safely improve lung function and quality of life, and reduce asthma exacerbations and SABA use in asthmatics.

Electronic supplementary material

The online version of this article (10.1186/s12931-018-0912-y) contains supplementary material, which is available to authorized users.

Nanoscale Structural Evolution and Anomalous Mechanical Response of Nanoglasses by Cryogenic Thermal Cycling

One of the central themes in the amorphous materials research is to understand the nanoscale structural responses to mechanical and thermal agitations, the decoding of which is expected to provide new insights into the complex amorphous structural-property relationship. For common metallic glasses, their inherent atomic structural inhomogeneities can be rejuvenated and amplified by cryogenic thermal cycling, thus can be decoded from their responses to mechanical and thermal agitations. Here, we reported an anomalous mechanical response of a new kind of metallic glass (nanoglass) with nanoscale interface structures to cryogenic thermal cycling. As compared to those metallic glasses by liquid quenching, the Sc₇₅Fe₂₅ (at. %) nanoglass exhibits a decrease in the Young's modulus but a significant increase in the yield strength after cryogenic cycling treatments. The abnormal mechanical property change can be attributed to the complex atomic rearrangements at the short- and medium- range orders due to the intrinsic nonuniformity of the nanoglass architecture. The present work gives a new route for designing high-performance metallic glassy materials by manipulating their atomic structures and helps for understanding the complex atomic structure-property relationship in amorphous materials.

[A multi-center study for the association between the perception and control of disease among asthmatic patients in Chinese urban areas]

Objective: To investigate the current perception of disease among asthmatic patients in Chinese urban areas, and to address its association with asthma control. Methods: This was a nationwide, multi-center, cross-sectional study covering 30 third-level, grade A hospitals in 30 provinces, municipalities and autonomous regions (not including Tibet) across Chinese mainland. The survey was carried out from October 2015 to May 2016. Asthmatic outpatients were selected to receive face-to-face questionnaire survey on asthma control including Asthma Control Test (ACT) score, classification of asthma control level[according to the Global Initiative for Asthma (GINA) 2015 classification system, as assessed by the physician completing the survey], perception of asthma (including question 1: nature of asthma as a disease; question 2: selection of first-line therapeutic agents to be regularly used daily for asthma; question 3: appropriate timing of the use of short-acting aerosols of β(2) receptor agonists; and question 4: therapeutic goals for asthma). Results: A total of 3 875 asthmatic outpatients were included; among them, 69.0% (2 660/3 857) were aware that asthma is "an airway inflammatory disorder resulting from the combined effects of heredity and environment" ; 60.2% (2 321/3 857) considered "inhaled glucocorticoids or their compound preparations" to be the first-line therapeutic agents to be regularly used daily for patients with persistent chronic asthma; 85.7% (3 277/3 823) considered it appropriate to use short-acting aerosols of β(2) receptor agonists "as needed in the event of disease aggravation or acute exacerbation" ; and 75.4% (2 761/3 661) were aware that asthma "can be adequately or completely controlled in the long term" . The ACT score[20 (16, 23) vs 19 (16, 22) points; Z=-3.928, P<0.001]and asthma control rate (29.92% vs 25.31%; χ(2)=8.616, P=0.003) were significantly higher, and the rate of uncontrolled asthma (19.92% vs 23.48%; χ(2)=6.267, P=0.012) was significantly lower among the 2 660 (69.0%) patients correctly answering question 1 than among the 1 197 (31.0%) patients giving incorrect answer. The ACT score[21 (17, 23) vs 19 (15, 22) points; Z=-9.190, P<0.001] and asthma control rate (32.66% vs 22.20%; χ(2)=49.614, P<0.001) were significantly higher, and the rate of uncontrolled asthma (18.40% vs 25.00%; χ(2)=24.267, P<0.001) was significantly lower among the 2 321 (60.2%) patient correctly answering question 2 than among the 1 536 (39.8%) patients giving incorrect answer. Conclusions: Compared to previous surveys, there has been improved perception of disease among asthmatic patients in Chinese urban areas. Correct perception of disease is favorable for improving asthma control level.

UFD1 contributes to MYC-mediated leukemia aggressiveness through suppression of the proapoptotic unfolded protein response

Despite the pivotal role of MYC in tumorigenesis, the mechanisms by which it promotes cancer aggressiveness remain incompletely understood. Here we show that MYC transcriptionally upregulates the ubiquitin fusion degradation 1 (UFD1) gene in T-cell acute lymphoblastic leukemia (T-ALL). Allelic loss of ufd1 in zebrafish induces tumor-cell apoptosis and impairs MYC-driven T-ALL progression but does not affect general health. As the E2 component of an endoplasmic reticulum (ER)-associated degradation (ERAD) complex, UFD1 facilitates the elimination of misfolded/unfolded proteins from the ER. We found that UFD1 inactivation in human T-ALL cells impairs ERAD, exacerbates ER stress, and induces apoptosis. Moreover, we show that UFD1 inactivation promotes the proapoptotic unfolded protein response (UPR) mediated by protein kinase RNA-like ER kinase (PERK). This effect is demonstrated by an upregulation of PERK and its downstream effector C/EBP homologous protein (CHOP), as well as a downregulation of BCL2 and BCLxL. Indeed, CHOP inactivation or BCL2 overexpression is sufficient to rescue tumor-cell apoptosis induced by UFD1 knockdown. Together, our studies identify UFD1 as a critical regulator of the ER stress response and a novel contributor to MYC-mediated leukemia aggressiveness, with implications for targeted therapy in T-ALL and likely other MYC-driven cancers.

Prevalence and risk factors of asthma in mainland China: The CARE study

BACKGROUND

There are limited population based data on the prevalence of asthma in China. The China Asthma and Risk factors Epidemiologic (CARE) survey was designed to understand the prevalence and risk factors for asthma in mainland China.

OBJECTIVES

The CARE survey aims to demonstrate the prevalence and risk factors of asthma in mainland China among adolescents (age >14 years) and adults.

METHODS

The survey was performed between February 2010 and August 2012 in eight provinces/cities of seven areas in mainland China. The inhabitants (age, >14 years) recruited in this survey were through multi-stage cluster random sampling. Asthma diagnosis was based on medical history and lung function tests. Multivariable logistic regression was used to analyzed the risk factors for asthma.

RESULTS

The study included 164 215 subjects (men, 79 692 [48.53%]; women, 84 523 [51.47%]). 2034 (1.24%) were asthmatic patients. Among all asthmatic patients, 521 (25.61%) were newly diagnosed. Univariable regression analysis showed that risk factors for asthma included smoking, first-degree relatives with asthma, allergic rhinitis, chronic bronchitis, COPD, pollinosis, allergic pneumonia, concomitant allergic diseases, BMI and raising pets. Multivariable logistic regression indicated that asthma risk factors included women, age stratification, smoking, first-degree relatives suffering from asthma or pollinosis, combined with allergic rhinitis, eczema or GERD.

CONCLUSIONS

We speculated that the prevalence of asthma is increasing in mainland China among individuals aged >14 years in the past 10 years. A number of risk factors were identified. The risk factors of asthma would be further elucidated in our future work.

CLINICAL IMPLICATIONS

Our CARE study highlights that asthma epidemic in mainland China should be paid more attention.

WITHDRAWN: Research progress of cGAS-STING pathway in infectious diseases

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Symbicort® Maintenance and Reliever Therapy (SMART) and the evolution of asthma management within the GINA guidelines

INTRODUCTION

The Global Initiative for Asthma (GINA) annual report summarizes the latest evidence for asthma management. GINA recommends stepwise pharmacological treatment, advocating inhaled corticosteroids (ICS) plus rapid, long-acting β₂-agonists (LABA) delivered in a single inhaler for maintenance and relief at Steps 3 (moderate persistent asthma requiring 1-2 controllers plus as-needed reliever), 4 (severe persistent asthma requiring ≥2 controllers plus as-needed reliever), and 5 (higher level care and/or add-on treatment). Areas covered: Randomized controlled trials and real-world evidence demonstrate that flexibly dosed budesonide/formoterol for maintenance and relief (Symbicort® Maintenance And Reliever Therapy [SMART]) is associated with reductions in severe exacerbations, prolongs time to first exacerbation, and provides fast symptom relief. Expert commentary: SMART provides greater or equal levels of sustained asthma control than similar or higher fixed doses of ICS/LABA plus short-acting β₂-agonist (SABA) as needed or higher ICS plus SABA as needed, with lower overall ICS doses and cost. The simplified dosing strategy may improve adherence and overall asthma control but relies on patient education. Budesonide/formoterol as needed in mild asthma (patients qualifying for regular low-dose ICS) is currently under investigation in two double-blind randomized studies, SYGMA1/2 (NCT02149199/NCT02224157), comparing budesonide/formoterol as needed with budesonide plus SABA and SABA alone.

Development of a data-processing method based on Bayesian k-means clustering to discriminate aneugens and clastogens in a high-content micronucleus assay

Genotoxicants can be identified as aneugens and clastogens through a micronucleus (MN) assay. The current high-content screening-based MN assays usually discriminate an aneugen from a clastogen based on only one parameter, such as the MN size, intensity, or morphology, which yields low accuracies (70-84%) because each of these parameters may contribute to the results. Therefore, the development of an algorithm that can synthesize high-dimensionality data to attain comparative results is important. To improve the automation and accuracy of detection using the current parameter-based mode of action (MoA), the MN MoA signatures of 20 chemicals were systematically recruited in this study to develop an algorithm. The results of the algorithm showed very good agreement (93.58%) between the prediction and reality, indicating that the proposed algorithm is a validated analytical platform for the rapid and objective acquisition of genotoxic MoA messages.

Direct separation of arsenic and antimony oxides by high-temperature filtration with porous FeAl intermetallic

A temperature-controlled selective filtration technology for synchronous removal of arsenic and recovery of antimony from the fume produced from reduction smelting process of lead anode slimes was proposed. The chromium (Cr) alloyed FeAl intermetallic with an asymmetric pore structure was developed as the high-temperature filter material after evaluating its corrosive resistance, structural stability and mechanical properties. The results showed that porous FeAl alloyed with 20wt.% Cr had a long term stability in a high-temperature sulfide-bearing environment. The separation of arsenic and antimony trioxides was realized principally based on their disparate saturated vapor pressures at specific temperature ranges and the asymmetric membrane of FeAl filter elements with a mean pore size of 1.8μm. Pilot-scale filtration tests showed that the direct separation of arsenic and antimony can be achieved by a one-step or two-step filtration process. A higher removal percentage of arsenic can reach 92.24% at the expense of 6∼7% loss of antimony in the two-step filtration process at 500∼550°C and 300∼400°C. The FeAl filters had still good permeable and mechanical properties with 1041h of uninterrupted service, which indicates the feasibility of this high-temperature filtration technology.

[The relationship between smoking status and epidermiology of asthma in people aged over 14 years in China]

Objective: To study the relationship between bronchial asthma and smoking status in Chinese people. Methods: Asthma epidemiological survey and stratified-cluster-random method survey were performed in residents over 14 years in 8 provinces (cities) of China from February 2010 to August 2012. Asthma was diagnosed based upon case history, clinical signs and lung function test. Smoking status was investigated by questionnaire. Results: Sampling population was 180 099 and 164 215 were valid. A total of 2 034 subjects were diagnosed as asthma including 79 692 men and 84 523 women. The overall prevalence rate of asthma was 1.24% (2 034/164 215). Smokers were 23.8% (39 137/164 215) in the whole population. Smokers were 34.5% (702/2 034) in asthmatic patients, compared with 23.7% (38 435/162 181) in no-asthmatic population. The incidence of asthma was 1.79% and 1.06% in smokers and non-smokers respectively (P<0.001), suggesting that OR of smoking was 1.70 (95% CI 1.55-1.86, P<0.001). According to asthma control test (ACT) score, the level of asthma control in non smoking group was higher than that in smoking group(43.2% vs 35.3%). The times of hospitalization due to acute exacerbations(0.51 vs 0.41 events/person/year), total hospitalization rate(27.35% vs 20.12%), annual emergency room visits (0.80 vs 0.60 events/person/year) and emergency room visit rate (31.77% vs 24.47%) were all much higher in smoking asthmatic patients than those in non smoking asthmatic patients, indicating that the level of asthma control in smoking patients was significantly worse than in non smoking patients. Conclusions: The smoking rate in Chinese people over 14 years is still high. The prevalence rate of asthma in smokers is significantly higher than that of non-smokers. The level of asthma control in smokers is significantly worse than that in non smokers.

[Chinese expert consensus for non-antiinfective effects and clinical use of macrolides]

Important/potential value of macrolides has been proved in the management of chronic respiratory diseases by increasing basic and clinical trials.Through three face-to-face discussions, 10 experts examined important data and drafted this consensus related to macrolides: (1) mechanism of non-antiinfective effects; (2) clinical use in chronic respiratory diseases; (3) cautions of long-term use.The mechanism out of non-antiinfective effects includes anti-inflammatory effect, modifying airway secretion, immune-regulation related to antibacterial effect, corticoid saving effect and anti-viral effect.The efficacy of long-term use of low-dose macrolides is definitely confirmed in diffuse panbronchiolitis, chronic rhinosinusitis. It is considerably used in bronchiectasia, cystic fibrosis, severe asthma and chronic obstructive pulmonary disease. Further studies should be conducted in cryptogenic organizing pneumonia and respiratory viral infection. It should be paid attention to its possible adverse effects (including drug interactions, cardiac toxicity, ototoxicity and disturbance of intestinal flora) and drug resistance in long-term use.A Chinese consensus for non-antiinfective effects and clinical use of macrolides is developed for the first time, which aims to expand their rational use and the further research.

[A cross-section study of severe asthma in eight provinces of China]

Objective: To analyze the prevalence of severe asthmain China. Methods: The epidemiological data was collected from 2 034 asthmatics who were diagnosed in the last epidemiological survey from 2009 to 2010 in 8 provinces. Results: According to the questionnaire survey, among the 2 034 patients, the previously diagnosed patients accounted for 72.47% (1 474/2 034) and the percentage of newly-diagnosed patients was 27.53% (560/2 034). In those 1 474 previously diagnosed asthmatics, 122 (8.28%) were classified into severe asthma, while 6.00% (122/2 034) of all asthmatics and 0.07% (122/164 215) of total respondents presented as severe cases. Statistically, there was no difference in the prevalence of severe patients between men and women. The morbidity rate of severe asthma was the lowest in the 21-30 year old group and the highest in 61-70 year old group (0.85% and 8.31% respectively). The difference among ages was statistically significant (χ²=18.791, P=0.005). In addition, the prevalence rates of severe asthma were also significantly diverged among patients with different education background(χ²=24.639, P<0.000 1). A negative relation was found between education level and the proportion of severe cases. Moreover, the morbidity of severe asthma in smoking patients and non-smoking patients were significantly different as well (χ²=7.447, P<0.05). Compared with asthma patients who do not smoke, smokers were more likely to suffer severe asthma (OR=1.663, 95% CI 1.150-2.404). Conclusions: The prevalence rate of severe asthma in China is similar to that in other countries.Elderly patients have higher risk of severe asthma. Smoking is considered as a risk factor for severe asthma.

A multicenter, cross-sectional, observational study of budesonide/formoterol maintenance and reliever therapy in real-world settings

BACKGROUND

To assess the level of asthma control achieved with budesonide/formoterol in Chinese patients with asthma, based on the Global Initiative for Asthma (GINA) definition and Asthma Control Test (ACT) score.

METHODS

This multicenter, cross-sectional study (NCT01785901) evaluated asthma control levels in Chinese patients receiving physician-prescribed budesonide/formoterol treatment. Adults with a diagnosis of asthma ≥6 months and receiving budesonide/formoterol treatment ≥3 months before screening were consecutively enrolled. Data including medical and medication history were collected using face-to-face questionnaires and physical examinations during a single visit.

RESULTS

A total of 1483 asthma out-patients from 27 medical centers were enrolled; 217 (14.6%) were treated with budesonide/formoterol using a fixed-dose strategy and 1266 (85.4%) with the SMART (Symbicort^® Maintenance And Reliever Therapy) strategy. According to GINA criteria, asthma was controlled in 58.6% (95% CI: 56.1%-61.1%) of patients and was either controlled or partly controlled in 94.1% (95% CI: 92.8%-95.3%) of patients. According to ACT score, asthma was completely controlled in 22.4% (95% CI: 20.3%-24.6%) of patients and was either completely or well controlled in 83.3% (95% CI: 81.4%-85.2%) of patients. Multivariate logistic regression analysis revealed that a >5-year history of asthma and an age of >50 years were factors associated with lower levels of asthma control.

CONCLUSIONS

This study demonstrated high levels of asthma control (GINA: controlled and partly controlled and ACT: completely and well controlled) in Chinese patients with asthma treated with budesonide/formoterol. Greater age and a longer disease history were associated with lower levels of asthma control.

TRIAL REGISTRATION

ClinicalTrials.govNCT01785901. Registered February 5, 2013.

First-principles computation of electron transfer and reaction rate at a perovskite cathode for hydrogen production

The focus of this research is on the electron transfer and its reaction rate at the perovskite cathode of a photoelectrochemical cell for hydrogen production. By employing the density functional theory (DFT), the electron density, projected density of states (PDOS), electron distribution and electron transfer path between [Fe-Fe] hydrogenase and the perovskite cathode can be obtained. Simulation results show that the perovskite cathode is better than traditional cathodes for hydrogen production. Before transmission to the [Fe-Fe] hydrogenase, electron clouds mainly aggregate at the periphery of amine molecules. Simulations also show that the key to hydrogen production at the perovskite structure lies in the organic molecules. Electrons are transferred to the hydrocarbon structural chain before reaching the Fe atoms. The Rice, Ramsperger, Kassel and Marcus (RRKM) theory was used to predict the reaction rates at different temperatures. It was found that the reaction rates are in good agreement with the experimental results. This research provides more physical insight into the electron transfer mechanism during the hydrogen production process.

Comparison of fluticasone propionate with budesonide administered via nebulizer: a randomized controlled trial in patients with severe persistent asthma

BACKGROUND

This study compared the efficacy and safety of fluticasone propionate (FP) inhalation n solution with budesonide (BUD) suspension for inhalation administered via nebulizer, in Chinese adult patients with severe, persistent asthma.

METHODS

This was a multicenter, randomized, active-controlled, single-blind, parallel-group study, conducted at 26 clinical sites in China. Participants were randomized 1:1 to FP nebules 1 mg twice daily or BUD 2 mg twice daily via nebulizer for 12 weeks.

RESULTS

A total of 317 adult patients were randomized. The primary endpoint was mean change in morning peak expiratory flow (PEF) over weeks 1-12 from baseline, and analyzed in the ITT (n=315) and PP populations (n=283). Week 12 PEF increase from baseline was 26.7 L/min (14.1%) and 28.0 L/min (15.3%) in the ITT population, and 29.1 L/min (15.7%) and 30.1 L/min (16.2%) in the PP population, in the FP and BUD groups, respectively; all improvements were of clinical significance. Lower limits of the two-sided 95% CIs for the least squares (LS) mean treatment difference (FP minus BUD) were -12.19 L/min (ITT) and -12.95 L/min (PP), both above the pre-specified non-inferiority criteria -12.00 L/min and not clinically meaningful. There was no significant difference in the week 12 mean FEV₁ increase between the FP and BUD groups (0.237 L/16.79% vs. 0.236 L/17.73%). Lower limits of the 95% CIs for LS mean treatment difference in morning PEF change from baseline over weeks 1-4 in a post hoc analysis were -10.41 and -11.96 L/min in the ITT and PP populations respectively; both above -12.00 L/min. A review of safety data indicated that rates of AEs, SAEs, and drug-related AEs were similar between two groups.

CONCLUSIONS

The 12-week treatment of FP inhalation solution administered via nebulizer is safe and effectively for treating severe, persistent asthma in Chinese patients over 12 week.

Clinical Roles of Lung Volumes Detected by Body Plethysmography and Helium Dilution in Asthmatic Patients: A Correlation and Diagnosis Analysis

Roles of lung volumes in asthma remain controversial. We aimed to evaluate the efficacy of lung volumes in differentiating asthma severity levels. Consecutive outpatients with chronic persistent asthma were enrolled, and body plethysmography (BP) and helium dilution (HD) were performed simultaneously to extract RV%pred, TLC%pred, and RV/TLC. Significant negative correlations were found between FEV₁%pred and RV%pred (r = -0.557, P < 0.001), TLC%pred (r = -0.387, P < 0.001), and RV/TLC (r = -0.485, P < 0.001) measured by BP, as well as difference in volumes between these two techniques (ΔRV%pred, ΔTLC%pred and ΔRV/TLC). In mild and moderate asthma, AUC of RV%pred detected by BP and ΔTLC%pred was 0.723 (95%CI 0.571-0.874, P = 0.005) and 0.739 (95%CI 0.607-0.872, P = 0.002) with sensitivity and specificity being 79.41% and 88.24%, and 65.22% and 56.52% at cut-off of 145.40% and 14.23%, respectively. In moderate and severe asthma, AUC of RV%pred detected by BP and ΔTLC%pred was 0.782 (95%CI 0.671-0.893, P < 0.001) and 0.788 (95%CI 0.681-0.894, P < 0.002) with sensitivity and specificity being 77.78% and 97.22%, and 73.53% and 52.94% at cut-off of 179.85% and 20.22%, respectively. In conclusion, lung volumes are reliable complement of FEV₁ in identifying asthma severity levels.

The effect of Ni(i)–N active sites on the photocatalytic H2O2 production ability over nickel doped graphitic carbon nitride nanofibers

This work provides a strategy to improve the photocatalytic H₂O₂ production ability by embedding Ni(i)–N sites into the g-C₃N₄ lattice.

CeO2-modified α-MoO3 nanorods as a synergistic support for Pt nanoparticles with enhanced COads tolerance during methanol oxidation

A new type of Ce-doped α-MoO₃ (Ce_0.2Mo_0.8O_3−δ) nanorod support was synthesized using a two-step hydrothermal method.

Properties of hail storms over China and the United States from the Tropical Rainfall Measuring Mission

A 16-yr record of hail reports over the south U.S. and from weather stations in China are collocated with Precipitation Features (PF) derived from the Tropical Rainfall Measuring Mission (TRMM) radar and passive microwave observations. Differences in the way hail is reported in the two nations make it difficult to draw meaningful conclusions about storm frequency. But taking the two together yields a wide spectrum of hail sizes, suitable for comparing with remote sensing measurements. While U.S. hail reports are dominated by cases with hail size greater than 19 mm, hail reports in China mostly include diameters of 1-10 mm and mostly occur over the Tibetan Plateau. The fraction of PFs collocated with hail reports (hail PFs) reaches 3% in the plains of the U.S. In China, the fraction is higher in high elevation regions than low elevation regions. Hail PFs (as reported in the U.S.) show lower brightness temperatures, higher lightning flash rates, stronger maximum reflectivity, and higher echo tops than those with smaller hail, as reported in China. The average near surface maximum reflectivity of hail PFs at high elevations (≥ 2000 m) in China is about 5 dB smaller than those at low elevations. Larger hail is reported with PFs having stronger maximum reflectivity above 6 km, though the median of maximum reflectivity values at levels below 5 km is similar among the storms with large and small hail sizes.

Imputing rare variants in families using a two-stage approach

BACKGROUND

Recent focus on studying rare variants makes imputation accuracy of rare variants an important issue. Many approaches have been proposed to increase imputation accuracy among rare variants, from reference panel selection to combinations of existing methods to multistage analyses. We aimed to bring the strengths of these new approaches together with our proposed two-stage imputation for family data.

METHODS

Our imputation methods were tested on the region from 46.75Mb to 49.25Mb on chromosome 3. We did quality control based on the proportion of missing genotypes per variant and individual, leaving 495 individuals with 761 genome-wide association studies (GWAS) variants only, 45 with 14,077 sequence variants only, and 419 with both GWAS and sequencing data. All data were prephased using SHAPEIT2 with a duo hidden Markov model algorithm prior to performing imputation. Imputations were performed 100 times, each time masking the sequence data for 1 individual and imputing it from the GWAS data. We used well-imputed genotypes, defined as a probability of greater than 0.9, above 2 different minor allele frequency cutoffs-0.01 and 0.05-from Impute2 as input for Merlin, and compared these results to Impute2 and Merlin separately. The imputed results were evaluated using correlation measurement and the imputation quality score.

RESULTS

Our method improved imputation accuracy, measured by imputation quality score, for variants with minor allele frequency between 0.01 and 0.40, but failed to improve accuracy for variants with minor allele frequency less than 0.01 when we used a minor allele frequency cutoff of 0.01 for the Impute2 results. In contrast, our 2-stage approach with a minor allele frequency cutoff of 0.05 performed the worst of all methods for variants with minor allele frequency between 0.01 and 0.40.

CONCLUSIONS

This method gave promising results, but may be further improved by changing the inclusion criteria of Impute2 variants. More analyses are needed on a larger region with different inclusion thresholds to assess the accuracy of this approach.

Kinetic ways of tailoring phases in high entropy alloys

The comprehensive performance of high entropy alloys (HEAs) depends on the phase selection significantly. However, up to now, investigations of the phase selection in HEAs mainly focused on the thermodynamic equilibrium phase, while kinetic ways of tailoring the phases in HEAs are seldom considered. In HEAs, the kinetics of sluggish diffusion and the numerous possible phases make the kinetics of phase transformation more complex and intriguing. Here, the kinetic effect in CoCrFeNiTi_0.4 HEAs was investigated to reveal the possibility of controlling phase selection via kinetic ways for HEAs. The σ, γ′ and R phases in the CoCrFeNiTi_0.4 HEA can be controlled under different cooling rate both in solidification and solid transformation. The theoretical analyses revealed the kinetic effect on phase selection. The method proposed here, tailoring the phases with different kinetic ways, could be used to prepare promising HEAs with very rich composition design.

Polysynthetic twinned TiAl single crystals for high-temperature applications

TiAl alloys are lightweight, show decent corrosion resistance and have good mechanical properties at elevated temperatures, making them appealing for high-temperature applications. However, polysynthetic twinned TiAl single crystals fabricated by crystal-seeding methods face substantial challenges, and their service temperatures cannot be raised further. Here we report that Ti-45Al-8Nb single crystals with controlled lamellar orientations can be fabricated by directional solidification without the use of complex seeding methods. Samples with 0° lamellar orientation exhibit an average room temperature tensile ductility of 6.9% and a yield strength of 708 MPa, with a failure strength of 978 MPa due to the formation of extensive nanotwins during plastic deformation. At 900 °C yield strength remains high at 637 MPa, with 8.1% ductility and superior creep resistance. Thus, this TiAl single-crystal alloy could provide expanded opportunities for higher-temperature applications, such as in aeronautics and aerospace.

A New Quantitative Method for Evaluating Dry Powder Inhalation Efficiency in Asthma Patients

PURPOSE

Many methods have been developed to evaluate dry powder inhalation techniques and their efficiency for disease control in asthma patients. However, it is difficult to apply these methods to clinical practice and research. In this study, we introduce a simple new method that can be applied to dry powder inhalation techniques to evaluate their efficiency in clinical practice.

METHODS

Twenty volunteers were recruited to evaluate the reliability of this new method. One hundred one asthma patients who met the inclusion criteria participated in this study. A dark cloth covered the outlet of the inhaler during dry powder inhalation. The image formed by the inhalation process was evaluated using analysis software and converted into integrated optical density (IOD). Inhalation techniques were scored before and after inhalation technique training, and asthma control was evaluated using the Asthma Control Questionnaire (ACQ) before inhalation technique training.

RESULTS

The relative standard deviation of IOD ranged from 3.8% to 7.8%. In patients with or without inhaler prior use, both the IOD and inhalation technique scores improved significantly after inhalation technique training (p < 0.05). Inhalation technique scores were positively correlated with IOD before (r = 0.80, p < 0.001) and after inhalation technique training (r = 0.52, p < 0.001). In patients with prior inhaler experience, ACQ results were negatively correlated with inhalation technique scores (r = -0.44; p < 0.05) and IOD (r = -0.52; p < 0.05).

CONCLUSION

The results from this study demonstrated that this quantitative method is equivalent to traditional methods for dry powder inhalation evaluation. This study also indicated that training significantly improved the inhalation technique and efficiency in asthma patients with or without prior inhaler use.

Structural Signature of Plasticity Unveiled by Nano-Scale Viscoelastic Contact in a Metallic Glass

Room-temperature plasticity in metallic glasses (MGs) is commonly associated with local structural heterogeneity; however, direct observation of the subtle structural change caused by plasticity is vitally important but the data are extremely scarce. Based on dynamic atomic force microscopy (DAFM), here we show that plasticity-induced structural evolution in a Zr-Ni MG can be revealed via nano-scale viscoelastic contacts between an AFM tip and plastically deformed MG surface layers. Our experimental results clearly show a spatial amplification of the nano-scale structural heterogeneity caused by the distributed plastic flow, which can be linked to the limited growth, reorientation and agglomeration of some nano-scale energy-absorbing regions, which are reminiscent of the behavior of the defect-like regions with non-affine deformation as conceived in many theories and models. Furthermore, we are able to experimentally extract the thermodynamic properties of these nano-scale regions, which possess an energy barrier of 0.3–0.5 eV, about half of that for a typical shear transformation event that usually occurs at the onset of plasticity. The outcome of our current work sheds quantitative insights into the correlation between plasticity and structural heterogeneity in MGs.

Shear-banding Induced Indentation Size Effect in Metallic Glasses

Shear-banding is commonly regarded as the “plasticity carrier” of metallic glasses (MGs), which usually causes severe strain localization and catastrophic failure if unhindered. However, through the use of the high-throughput dynamic nanoindentation technique, here we reveal that nano-scale shear-banding in different MGs evolves from a “distributed” fashion to a “localized” mode when the resultant plastic flow extends over a critical length scale. Consequently, a pronounced indentation size effect arises from the distributed shear-banding but vanishes when shear-banding becomes localized. Based on the critical length scales obtained for a variety of MGs, we unveil an intrinsic interplay between elasticity and fragility that governs the nanoscale plasticity transition in MGs. Our current findings provide a quantitative insight into the indentation size effect and transition mechanisms of nano-scale plasticity in MGs.

Origin of Shear Stability and Compressive Ductility Enhancement of Metallic Glasses by Metal Coating

Metallic glasses (MGs) are notorious for the poor macroscopic ductility and to overcome the weakness various intrinsic and extrinsic strategies have been proposed in past decades. Among them, the metal coating is regarded as a flexible and facile approach, yet the physical origin is poorly understood due to the complex nature of shear banding process. Here, we studied the origin of ductile enhancement in the Cu-coating both experimentally and theoretically. By examining serrated shear events and their stability of MGs, we revealed that the thin coating layer plays a key role in stopping the final catastrophic failure of MGs by slowing down shear band dynamics and thus retarding its attainment to a critical instable state. The mechanical analysis on interplay between the coating layer and shear banding process showed the enhanced shear stability mainly comes from the lateral tension of coating layer induced by the surface shear step and the bonding between the coating layer and MGs rather than the layer thickness is found to play a key role in contributing to the shear stability.

Effect of the Si/Al ratio on the performance of hierarchical ZSM-5 zeolites for methanol aromatization

A series of hierarchical ZSM-5 zeolites with different Si/Al ratios were successfully prepared using a seed-deduced method and the addition of organosilicone reagents into the medial synthesis system.

Assessment of second-line treatments for patients with uncontrolled moderate asthma

AIM

To evaluate the best second-line treatments for patients with uncontrolled moderate asthma.

METHODS

A single-center, random study was conducted in adult patients with uncontrolled moderate asthma to evaluate the effects of add-on treatments. After add-on treatments for 4 and 12 weeks, the concentration of exhaled nitric oxide (FeNO), average daily durnal peak expiratory flow (PEF) variability and asthma control test (ACT) score were measured.

RESULTS

94 patients have been divided into three groups to take different add-on treatments, in tiotropium bromide group, montelukast sodium group and double-dose inhaled corticosteroid (ICS) group. After four weeks, most patients improved their symptoms and ACT scores, with lower concentration of FeNO and small PEF variability. In double-dose ICS group, almost all patients took the complete controls of asthma, compared to those in other two groups. After additional 12 weeks' therapy, patients in all three groups nearly achieved complete controls of asthma. There were two patients with pneumonia in double-dose ICS group. Patients in double-dose ICS group had higher ACT scores, lower concentrations of FeNO and smaller PEF variabilities, but a higher risk of pneumonia, compared to those in other two groups. The differences of PEF variabilities and ACT scores between tiotropium group and double-dose ICS group were not significant.

CONCLUSION

Tiotropium in combination with ICS plus LABA showed the similar effects with double-dose ICS plus LABA, without adverse effects, which might be the best option for optimal control of asthma.

[An epidemiological survey on management and insights of asthma in China in 2009 to 2010]

OBJECTIVE

Through the analysis of relevant data of China Asthma and Risk factors Epidemiologic investigation (CARE study), we understand the status quo of management and insights of asthma patients in our country.

METHODS

Using multi-stage random cluster sampling method, epidemiological survey was performed on the prevalence rate in 8 provinces (cities) of China residents who aged over 14 years from 2009 to 2010. Detailed epidemiological data was collected via face-to-face home visit interview among 2 034 asthmatics who were diagnosed in the last epidemiology survey. Asthma was diagnosed based upon case history, clinical signs and lung function test. The SPSS12.0 software was conducted for statistical analysis and the status of asthma control was investigated.

RESULTS

This survey has shown that 22.71% (462/2 034) asthmatics had ever taken a lung functional test in the past year. A total of 294 (14.45%) people had peak flow meters but only 1.62% (33/2 034) regularly used it daily. There were 22.42% (456/2 034) asthmatics aware that bronchial asthma is characterized by chronic airway inflammation. 14.85% (302/2 034) asthmatics understood that the treatment goal of this disease is long-term good control or complete control. This survey has found that 59.64% (1 213/2 034) patients complained that asthma has affected their work, life and entertainment, including 8.90% (181/2 034) asthmatics dependent on instruments in daily life and 4.57% attempting to suicide. This suggested that allergic asthma has seriously decreased the quality of life.

CONCLUSION

Therefore it is necessary to educate the asthmatics, guide the patients to the long-term management and standardized therapy and raise the level of disease understanding, thus reducing the burden of disease to society. Gaining better insight of patient's attitude about self-care is critical to the improvement of asthma management.

Unusual fast secondary relaxation in metallic glass

The relaxation spectrum of glassy solids has long been used to probe their dynamic structural features and the fundamental deformation mechanisms. Structurally complicated glasses, such as molecular glasses, often exhibit multiple relaxation processes. By comparison, metallic glasses have a simple atomic structure with dense atomic packing, and their relaxation spectra were commonly found to be simpler than those of molecular glasses. Here we show the compelling evidence obtained across a wide range of temperatures and frequencies from a La-based metallic glass, which clearly shows two peaks of secondary relaxations (fast versus slow) in addition to the primary relaxation peak. The discovery of the unusual fast secondary relaxation unveils the complicated relaxation dynamics in metallic glasses and, more importantly, provides us the clues which help decode the structural features serving as the ‘trigger' of inelasticity on mechanical agitations.

Mechanical relaxation processes in glasses can provide information on the structural and mechanical properties of glasses. Here, the authors observe a fast secondary relaxation process in La-based metallic glasses, providing information on the inelasticity of metallic glasses.

[Efficacy and Safety of Tiotropium Bromide in the Treatment of Chronic Obstructive Pulmonary Disease--a Multi-center Randomized Clinical Trial]

OBJECTIVE

To investigate the efficacy and safety of domestic tiotropium inhalation capsule in patients with chronic obstructive pulmonary disease (COPD) with multi-center randomized clinical trial.

METHODS

Patients with stable slight to moderate COPD were randomized into trial group (n=109) with tiotropium 18 pg Qd or control group (n =111) with ipratropium 40 µg Qid for a treatment of four weeks. The spirometry and scoring questionaire were recorded at different visits during the treatment. Rescue medication consumption and adverse events were recorded. Results Forced expiratory volume in 1 s (FEV1) of both groups increased obviously 30 min and 3 h after first dosing. After four weeks treatments, FEV, and forced vital capacity (FVC) in both groups were improved obviously, and the improvement in tiotropium group was significantly higher than that ipratropium group. COPD symptom scores were significantly reduced in both groups, and the improvement in tiotropium group was significantly better than that in ipratropium group. There was no significant difference in rescue medication consumption between the two groups. The ratios of adverse events were 22. 02% and 15. 32% in tiotropium and ipratropium group, respectively (P=0. 23).

CONCLUSION

Domestic tiotropium inhalation capsule is efficient and safe in the treatment of COPD.

Activin A is associated with asthma in underweight and overweight patients

There are limited data regarding the effects of activin A on underweight, normal weight, and overweight patients with asthma. We determined serum levels of activin A in asthmatic patients in relation to body mass index. The study protocol included questionnaires, measurement of exhaled nitric oxide, blood sampling for inflammatory biomarkers, and high-resolution computed tomography of the lungs to identify bronchial wall thickening. Serum and sputum activin A levels were measured using an enzyme-linked immunosorbent assay in 94 asthmatic patients. Mean serum levels of activin A were significantly (P = 0.001) higher in underweight (1781 ± 327.3 pg/mL) than in normal weight and overweight asthmatic patients, regardless of gender. After stratification by gender, significantly higher mean values of activin A were observed in females compared to males in the normal and underweight groups (P = 0.003 and P = 0.0002, respectively). Significant differences between groups were found in airway wall area (%) (P < 0.0001). We also observed a much higher percentage of sputum lymphocytes in the underweight group compared to the other groups (P < 0.0001). Correlations between bronchial wall thickness and activin A were found in the underweight (r = 0.67, P = 0.48) and normal weight groups (r = 0.51, P = 0.042). Correlations between fractional of exhaled nitric oxide, forced expiratory volume in 1 s, delayed treatment years, and activin A in different groups were also observed. Increased serum level of activin A indicates its role in the pathogenesis of asthma, particularly in underweight and overweight patients.

Ni2+ and Ti3+ co-doped porous black anatase TiO2 with unprecedented-high visible-light-driven photocatalytic degradation performance

A black Ni doped porous TiO₂ were fabricated via an in situ solid-state chemical reduction approach, which exhibited excellent visible-light-driven performance.

Poly(γ-glutamic acid) induced homogeneous mineralization of the poly(ethylene glycol)-co-2-hydroxyethyl methacrylate cryogel for potential application in bone tissue engineering

Homogeneous mineralization of a polymeric cryogel could be induced by poly(γ-glutamic acid) and benefit the cell response of the cryogel.

Pulmonary Langerhans Cell Histiocytosis in an Adult Diagnosed with Solitary Inguinal Lymphadenopathy

We herein report an extremely rare case of pulmonary Langerhans cell histiocytosis with a solitary enlarged inguinal lymph node. A 19-year-old man presented with a non-productive cough lasting for over a five-month period and an enlarged left inguinal lymph node that had persisted for four months. A histopathological study of the lymph node specimens found Langerhans cells coupled with eosinophils. Positive immunohistochemical staining for langerin, Cluster of Differentiation 1a, S100 in the Langerhans cells confirmed the diagnosis, and a mildly impaired ventilation function in addition to multiple peripheral pulmonary cystic lesions were detected. The patient was managed with prednisone (0.5 mg/kg daily), with slow tapering over several months.

Risk factors related to persistent airflow obstruction in severe asthma in Chinese Han population

OBJECTIVE

To explore the significance of assessing persistent airway obstruction (PAO) in asthma patients by airway wall remodeling with bronchoscopy, high-resolution computed tomography (HRCT), and biological markers in the induced sputum and serum, exhaled nitric oxide (FENO), and lung function.

METHODS

The study was conducted in 119 patients with PAO and 125 patients with reversible airway obstruction (RAO). Endobronchial biopsy specimens were analyzed for airway smooth muscle (ASM) area, and reticular basement membrane (RBM) thickness. Airway thickness was also measured by HRCT scanning. Levels of matrix metalloproteases-9 (MMP-9), metalloproteinase 33 (ADAM33), and vascular endothelial growth factor (VEGF) were measured in the induced sputum and serum by enzyme linked immunosorbent assay.

RESULT

PAO was associated with longer disease duration, absence of atopy and rhinitis, and larger ASM area (SMA%) (15.83%±2.32% [n=9] vs. 8.0%±1.68% [n=7], P=0.02), thicker RBM (16.27±2.32 μm [n=9] vs. 8.71±2.41 μm [n=7], P=0.042); No differences in any of the biomarker molecules measured in airway thickness in HRCT, sputum and blood individually between groups were found.

CONCLUSION

Severe asthma patients with longer disease duration and the absence of atopy and rhinitis are more likely to develop PAO in Chines Han population. PAO patients have increased ASM area and RBM thickness appear to be valuable in the evaluation of airway remodeling in asthma patients in Chinese Han population.

New angle of view on the role of rho/rho kinase pathway in human diseases

Rho-kinase is an effector molecule of RhoA, a monomeric GTP-binding protein, and causes Ca2+ sensitization through inactivation of myosin phosphatase. The major physiological functions of Rho/Rho-kinase cascade include contraction, proliferation and migration in cells.There are some excellent reviews about Rho/Rho-kinase signal pathway, most of which focus on the specific proteins of the pathway including some upstream regulators and its final effects. But few articles cover signal pathways that can activate the signaling concerned, and/or the pathways that Rho/Rho-kinase can exactly activate. This review hence highlights the two questions after a profound survey of published literatures. Rho/Rho-kinase can exert positive feedback with just another kinase/signal transducers and activator of transcription, receptor tyrosine kinase signal pathways, even reactive oxygen species, which seem to comprise certain signal loops. The authors also presume, accordingly, that the positive feedback suggests a possible reason for exacerbation of some kind of inflammatory diseases including asthma, rheumatoid arthritis, multiple sclerosis, atherosclerosis, etc. This essay, therefore, provides a new angle of view for the therapy of these kinds of diseases.

Asthma with allergic rhinitis management in China: a nationwide survey of respiratory specialists at tertiary hospitals

BACKGROUND

Many asthmatic patients have coexisting allergic rhinitis (AR). This study aims to investigate the compliance of physicians with respiratory medicine specialty (PRMs) to Global Initiative for Asthma (GINA) and Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines during the management of their asthma-AR patients.

METHODS

This cross-sectional questionnaire study surveyed the diagnostic methods and treatment patterns for asthma-AR comorbidity by PRMs from 98 hospitals across China.

RESULTS

PRMs reported an estimated prevalence of asthma-AR comorbidity of >30% at their clinics. PRMs with greater work experience and a higher professional title estimated treating a significantly higher proportion of patients with AR within the previous month (p = 0.002 and p < 0.001, respectively); they also estimated a higher incidence of patients with AR in the autumn (p < 0.001 and p < 0.001). A higher percentage of PRMs with ≥11 years work experience prescribed nasal steroids for AR as compared to those with 1 to 10 years experience (56.9% vs 44.7%, p = 0.002). A greater proportion of chief physicians used leukotriene modifiers and a lower proportion used antihistamine H1 -receptor blockers for AR as compared to residents (resident vs assistant chief: 27.5% vs 11.6%, p = 0.002; and resident vs chief PRMs: 27.5% vs 9.5%, p = 0.001).

CONCLUSION

PRMs in China demonstrated an up-to-date comprehension of asthma management (>90%); however, knowledge gaps existed in their concepts of AR and asthma-AR comorbidity. Thus, further education is warranted for PRMs regarding the importance of AR in asthma patients, definitive diagnosis (allergy tests), classifications of AR, and treatment guidelines for the asthma-AR comorbidity.

[Role of acute kidney injury staging by KDIGO criteria in choosing the opportune time of continuous blood purification]

OBJECTIVE

To investigate the role of acute kidney injury staging in multiple organ dysfunction syndrome (MODS) patients with acute kidney injury (AKI) for deciding the opportune time of continuous blood purification (CBP).

METHODS

A retrospective study was conducted. One hundred and twenty-six MODS patients with AKI in general intensive care unit (ICU) and emergency intensive care unit (EICU) requiring continuous venous-venous hemofiltration treatment were enrolled. According to the criteria of "Kidney Disease: Improving Global Outcomes Organization (KDIGO standard)" and acute physiology and chronic health evaluation II (APACHEII) score, the patients were stratified into KDIGO 1, 2, 3 groups and APACHEII score of <15, 15-25, >25 groups. ICU survival rate and renal function outcome, CBP treatment total ultrafiltration, average ICU day and the average medical costs of survivals were compared among groups.

RESULTS

Compared with APACHEII ≤ 25, KDIGO 1, 2 hospitalized patients had significantly higher survival rate [94.1% (32/34) vs. 76.8% (43/56), P<0.05]. Renal function improvement rate in survivors of KDIGO 1, 2 patients was significantly higher than that in APACHEII ≤ 25 [90.6% (29/32) vs. 62.8 (27/43), P<0.01], and number of patients requiring CBP treatment, mean ICU day, and medical expenses were significantly reduced (CBP treatment of total ultrafiltration: 199.0±44.7 L vs. 239.0 ± 73.3 L, the mean length of stay in ICU: 12.9±3.4 days vs. 15.1±4.8 days, medical expenses: 2.6±0.4 million vs. 3.0±1.0 million, all P<0.05). There was no significant difference in above indexes between survivors in KDIGO 3 and APACHEII>25, and the indexes in KDIGO 3 and APACHEII >25 were worse than those in KDIGD 1, 2 and APACHEII>25.

CONCLUSIONS

In patients of MODS accompanied by AKI, compared using as APACHEIIscore≤25 as opportune time to start CBP, to commence the treatment in the period of KDIGO standard 1, 2 cannot only improve patient survival with recovery of renal function, but also can reduce the ICU stay and medical expenses.

[An epidemiological survey of current asthma control status in China]

OBJECTIVE

Base on the China asthma and risk factors epidemiologic investigation (CARE study), we analyzed the current status of asthma control in China.

METHODS

With the multi-stage random cluster sampling method, epidemiological survey was performed among Chinese residents who aged over 14 years in 8 provinces (cities) from 2010 to 2011. Detailed clinic data of 2 034 asthma patients were collected via face-to-face home visit . Asthma was diagnosed based upon the history, clinical signs and lung function tests. The SPSS 12.0 was conducted for statistics analysis.

RESULTS

This survey found that the prevalence rate of asthma in China was 1.24% (2 034/164 215), including 973 male and 1 061 female patients, with a mean age of (56 ± 18) years old. Consistent with the Global Initiative for Asthma (GINA) guidelines, 40.51% (824/2 034) and 42.58% (866/2 034) of our patients achieved control and partial control, respectively. According to the asthma control test (ACT) estimates, 15.63% (318/2 034) and 49.46% (1 006/2 034) of patients achieved full control (ACT 25) and well control(ACT 20-24), respectively. In the past year, 22.62% (460/2 034) of patients reported hospitalized and 26.99% (549/2 034) of patients reported emergency room visit at least one time due to asthma exacerbation. 61.80% (1 257/2 034) of patients were on daily us of medication. Inhaled corticosteroids (ICS) plus a long-acting β2 agonist (LABA) or solely ICS were used in 6.39% and 14.75% of patients, respectively. Theophylline treatment accounted for 29.11% (592/2 034). Oral glucocorticoid and oral leukotriene modifier (LTRA) treatment accounted for 9.49% (193/2 034) and 3.10% (63/2 034), respectively. According to the survey, 34.51% (702/2 034) of asthma patients reported a history of smoking . The percentage of asthma control in non smoking patients was higher than in smoking patients [43.24% (576/1 332) and 35.33% (248/702), respectively]. Meanwhile, the rates of both hospitalization and emergency due to asthma exacerbation in smoking asthma patients were significantly higher than nonsmoking asthma patients (27.35% and 31.77%, 20.12% and 24.47%, respectively).

CONCLUSIONS

The situation of asthma control has been improved in China. However, compared with GINA guidelines, there is still a considerable gap. Smoking is one of the crucial factors that affect asthma control.

[Risk factors of bronchial asthma among people aged over 14 years in China]

OBJECTIVE

To survey the risk factors of asthma among the people aged over 14 years in China.

METHODS

Home visits for completing epidemiological questionnaires in accordance with stratified cluster random sampling survey were conducted in 8 provinces (cities) of China residents aged over 14 years from February 2010 to August 2011. Asthma was diagnosed based upon case history, clinical signs and lung function test. The SPSS 12.0 software was used for statistic analyses for the epidemiological status of asthma.

RESULTS

Sampling population was composed of 180 099 subjects. Among 164 215 valid questionnaires, there were 79 692 males and 84 523 females, 2 034 had asthma. The overall prevalence rate was 1.2% (2 034/164 215). Correlation analyses showed that the risk factors were smoking (OR = 1.697, 95%CI: 1.547-1.861), breast feeding (OR = 0.801, 95%CI: 0.670-0.959), genetics (OR & 95%CI >1, asthma (OR = 10.440, 95%CI: 8.991-12.112)), complications (OR & 95%CI >1), body mass index (compared with normal weight, overweight (OR = 1.360, 95%CI: 1.212-1.531), obesity (OR = 10.631, 95%CI: 9.570-11.801)) and petting (OR & 95%CI >1).

CONCLUSION

Among Chinese asthmatics aged over 14, their risk factors include host (genetics & obesity) and environmental (smoking, breastfeeding, complications & pets) factors.

Evaluation of asthma control and patient's perception of asthma: findings and analysis of a nationwide questionnaire-based survey in China

BACKGROUND

Little is known about asthma control and perception of asthma among asthmatic patients on a national scale in China due to the difficulty of conducting a survey of the large, vastly distributed population of the country. We know that the medical insurance system may not evenly cover all patients and that socioeconomic status varies greatly across cities.

OBJECTIVE

This study marks the first survey conducted on a national scale that was aimed at obtaining baseline information on asthma control and patients' perceptions of asthma and providing a point of reference for future studies.

METHODS

This face-to-face, questionnaire-based survey was conducted from April 2007 to March 2008 in 3069 asthmatic patients from the respiratory outpatient clinics of 36 general hospitals located in 10 geographically dispersed cities.

RESULTS

Per the Global Initiative for Asthma (GINA) guidelines, 28.7% and 45.0% of our patients achieved complete or partial asthma control, respectively. Of patients in the study, only 21.8% had used a peak flow meter (PFM) and 6.6% of these patients used it daily. Inhaled corticosteroids (ICS) plus a long-acting β2 agonist and ICS were the two most common medication regimens and were used in 45.6% and 30.4% of patients, respectively. Asthma had a significant effect on patients' life and work. A considerable number of hospitalizations, emergency department visits and sick days were also observed.

CONCLUSIONS

Despite improvements in asthma control and ICS and PFM compliance compared with past literature, the current level of asthma control countrywide continues to fall short of the goals set in the GINA.

Vitamin D with asthma and COPD: not a false hope? A systematic review and meta-analysis

Vitamin D deficiency and insufficiency are increasingly being recognized in the general population over the last few decades. However, a number of other disorders have now been linked to vitamin D deficiency and insufficiency, including asthma and COPD. The aim of this study was to evaluate the evidence on the effect of vitamin D on asthma and COPD. We searched electronic databases including SCI, EMBASE, Ovid, and PubMed. Reviewers working independently and in duplicate extracted study characteristics, quality, and the outcomes. The weighted mean differences across trials and random-effect meta-analysis were used to pool the relative risks (RR). This is the first meta-analysis about the risk of vitamin D deficiency for asthma and COPD. Ten studies were available for this meta-analysis and systematic review. The prevalence of vitamin D deficiency was significantly greater among cases than control subjects [RR=1.59, 95%CI=1.07-2.36, 488/812 (60%) vs 278/875 (32%)] for asthma. However, vitamin D insufficiency was not significantly associated with asthma [RR=1.09, 95%CI=0.91-1.30, 702/996 (70%) vs 665/1016 (65%)]. Moreover, studies failed to demonstrate that COPD patients had an increased risk for vitamin D deficiency or insufficiency compared to controls (RR=0.89, 95%CI=0.63-1.25). Vitamin D deficiency was associated with a significant decrease in lung function in asthmatic children. Vitamin D deficiency was highly prevalent in asthma patients, and vitamin D status was associated with lung function. COPD cannot be considered as completely free of vitamin D deficiency.