The effects of long-acting bronchodilators on total mortality in patients with stable chronic obstructive pulmonary disease

Background

Chronic obstructive pulmonary disease (COPD) is the 4^th leading cause of mortality worldwide. Long-acting bronchodilators are considered first line therapies for patients with COPD but their effects on mortality are not well known. We performed a comprehensive systematic review and meta-analysis to evaluate the effects of long-acting bronchodilators on total mortality in stable COPD.

Methods

Using MEDLINE, EMBASE and Cochrane Systematic Review databases, we identified high quality randomized controlled trials of tiotropium, formoterol, salmeterol, formoterol/budesonide or salmeterol/fluticasone in COPD that had a follow-up of 6 months or longer and reported on total mortality. Two reviewers independently abstracted data from the original trials and disagreements were resolved by iteration and consensus.

Results

Twenty-seven trials that included 30,495 patients were included in the review. Relative risk (RR) for total mortality was calculated for each of the study and pooled together using a random-effects model. The combination of inhaled corticosteroid (ICS) and long-acting beta-2 agonist (LABA) therapy was associated with reduced total mortality compared with placebo (RR, 0.80; p = 0.005). Neither tiotropium (RR, 1.08; p = 0.61) nor LABA by itself (RR, 0.90; p = 0.21) was associated with mortality.

Conclusions

A combination of ICS and LABA reduced mortality by approximately 20%. Neither tiotropium nor LABA by itself modifies all-cause mortality in COPD.     

Remote sensing of larch phenological cycle and analysis of relationships with climate in the Alpine region

This research aims at developing a remote sensing technique for monitoring the interannual variability of the European larch phenological cycle in the Alpine region of Aosta Valley (Northern Italy) and to evaluate its relationships with climatic factors. Phenological field observations were conducted in eight test sites from 2005 to 2007 to determine the dates of completion of different phenological phases. MODerate Resolution Imaging Spectrometer (MODIS) 250 m 16‐days normalized difference vegetation index (NDVI) time series were fitted with double logistic curves and the dates corresponding to different features of the curves were determined. Comparison with field data showed that the features of the fitted NDVI curve that allowed the best estimate of the start and end of the growing season were the zeroes of its third derivative (MAE of 6 and 4 days, respectively). The start and end of season were also estimated with the spring warming (SW) and growing season index (GSI) phenological models. MODIS start and end of season dates generally agreed with those obtained by the SW and GSI climate‐driven phenological models. However, phenological models provided erroneous results when applied in years with anomalous meteorological conditions. The relationships between interannual variability of the larch phenological cycle and climate were investigated by comparing the mean start and end of season yearly anomalies with air temperature anomalies. A strong linear relationship (R²=0.91) was found between mean spring temperatures and mean start of season dates, with an increase of 1 °C in mean spring temperature leading to a 7‐day anticipation of mean larch bud‐burst date. Leaf coloring dates were found to be best related with mean September temperature (R²=0.77), but with higher spring temperatures appearing to lead to earlier leaf coloring.     

百合组织培养和遗传转化的研究进展

百合是单子叶球茎类观赏花卉,具有食用和药用的作用。本文综述了国内外百合组织培养和遗传转化研究进展。包括营养器官、生殖器官和原生质体再生系统的建立。详细介绍了基因转化的方法,例如农杆菌、基因枪、电激穿孔等。浅析百合外源基因的表达,例如GUS、半夏凝集素基因、几丁质酶基因等。同时,讨论了百合遗传转化中存在的问题,以期为百合基因工程方面的研究提供依据。     

Computational fluid dynamics modeling of the upper airway of children with obstructive sleep apnea syndrome in steady flow

Computational fluid dynamic (CFD) analysis was used to model the effect of airway geometry on internal pressure in the upper airway of three children with obstructive sleep apnea syndrome (OSAS), and three controls. Model geometry was reconstructed from magnetic resonance images obtained during quiet tidal breathing, meshed with an unstructured grid, and solved at normative peak resting flow. The unsteady Reynolds-averaged Navier-Stokes equations were solved with steady flow boundary conditions in inspiration and expiration, using a two-equation low-Reynolds number turbulence model. Model results were validated using an in-vitro scale model, unsteady flow simulation, and reported nasal resistance measurements in children. Pharynx pressure drop strongly correlated to airway area restriction. Inspiratory pressure drop was primarily proportional to the square of flow, consistent with pressure losses due to convective acceleration caused by area restriction. On inspiration, in OSAS pressure drop occurred primarily between the choanae and the region where the adenoids overlap the tonsils (overlap region) due to airway narrowing, rather than in the nasal passages; in controls the majority of pressure drop was in the nasal passages. On expiration, in OSAS the majority of pressure drop occurred between the oropharynx (posterior to the tongue) and overlap region, and local minimum pressure in the overlap region was near atmospheric due to pressure recovery in the anterior nasopharynx. The results suggest that pharyngeal airway shape in children with OSAS significantly affects internal pressure distribution compared to nasal resistance. The model may also help explain regional dynamic airway narrowing during expiration.     

锁阳多糖提取工艺的研究

以浸膏得率和浸膏中多糖质量分数综合评价,利用L9(34)正交实验从水提和醇沉两方面优选锁阳中水溶性多糖最佳提取工艺条件,为锁阳活性多糖的开发提供科学依据和实验基础。最佳水提工艺条件为:m(锁阳):v(水)=1:12,回流提取0.5 h,提取2次;最佳醇沉工艺条件为:在m(生药):v(水提液)=1 g:2 mL溶液中加入乙醇,使φ(乙醇)=70%,静置6 h。     

中国木层孔菌属三个新记录种

报道了木层孔菌属Phellinus 3个中国新记录种。赤杨木层孔菌Phellinus alni典型特征为菌盖具有较宽的同心环带和清晰的密集环纹菌核;黑木层孔菌P. nigricans具有较大的担孢子;东方木层孔菌P. orienticus具有平伏的子实体,担孢子相对较小。对这3个种进行了详细的描述和显微结构绘图。     

平地无风条件下蒙古栎阔叶床层的火行为Ⅱ.火焰长度和驻留时间影响因子分析与预测模型

以帽儿山地区蒙古栎凋落叶的含水率、载量和床层高度为控制变量,模拟野外凋落叶床层状态,进行了100次平地无风条件下的室内点烧试验,分析含水率、载量和床层高度对火焰长度和驻留时间的影响,并建立了多元线性预测模型.结果表明： 含水率与火焰长度呈极显著线性负相关(P<0.01),与驻留时间的线性关系并不显著(P>0.05);载量、床层高度与火焰长度和驻留时间均呈极显著线性正相关(P<0.01).床层高度与含水率、载量的交互作用对火焰长度有显著影响;含水率与载量、床层高度的交互作用对驻留时间有显著影响.火焰长度预测模型的预测效果较好,能解释火焰长度83.3%的变异,平均绝对误差为7.8 cm,平均相对误差为16.2%;驻留时间预测模型的效果略差,仅能解释驻留时间54%的变异,平均绝对误差为9.2 s,平均相对误差为18.6%.     

Endotoxin-induced cardiovascular dysfunction in mice: effect of simvastatin

Lung infections are associated with acute lung injury (ALI), systemic inflammation, and vascular events. Clinical studies suggest that statins improve health outcomes of patients with pneumonia and ALI. The mechanisms by which this occurs are unknown. The aim of this study was to determine whether statins attenuate systemic inflammation and cardiovascular dysfunction related to ALI in mice. Simvastatin (SS; 20 mg/kg) or vehicle solution was instilled intraperitoneally into mice 24 h before and again just prior to intratracheal LPS instillation (1 μg/g). These mice were then anesthetized with 2.0% isoflurane and underwent a short surgical procedure to instill LPS. Four hours later, IL-6 levels in bronchoalveolar lavage fluid and in arterial and venous serum were measured. Cardiac function was evaluated using 2-D echocardiography, and endothelial function was determined using wire myography on aortic sections. LPS induced a significant increase in serum IL-6 levels. SS reduced venous (P = 0.040) but not arterial concentrations of IL-6 (P = 0.112). SS improved the maximal vasodilatory response of the aorta to ACh (P = 0.004) but not to sodium nitroprusside (P = 1.000). SS also improved cardiac output (P = 0.023). Vasodilatory response to ACh was impaired when aorta from untreated mice was incubated with ex vivo IL-6 (P = 0.004), whereas in the aorta from mice pretreated with SS, the vasodilatory response did not change with IL-6 incubation (P = 0.387). SS significantly improved LPS-induced cardiovascular dysfunction possibly by reducing systemic expression of IL-6 and its downstream signaling pathways. These findings may explain how statins improve health outcomes in patients with ALI.