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Biomedical subjects

David S C Hui

Publications and source records attributed to David S C Hui.

At least 19 recordsLinked to original sources
PubMed2007

A 1-year prospective study of the infectious etiology in patients hospitalized with acute exacerbations of COPD.

INTRODUCTION: Infection is a major cause of acute exacerbations of COPD (AECOPDs). We aimed to study the infectious etiology related to AECOPD. METHODS: Patients admitted to an acute care hospital in Hong Kong with an AECOPD were recruited prospectively from May 1, 2004, to April 30, 2005. Sputum samples, nasopharyngeal aspirate (NPA) samples, and paired serology specimens were collected. Spirometry was performed with patients in the stable phase 2 to 3 months after hospital discharge. RESULTS: There were 643 episodes of AECOPD among 373 patients. Their mean age was 75.3 years (SD, 7.9 years) with 307 male patients. The mean FEV(1) was 40.4% predicted (SD, 18.7% predicted), and the mean FEV(1)/FVC ratio was 58.4% (SD, 16.0%). Among sputum samples from the 530 episodes of AECOPD hospital admissions that were saved, 13.0%, 6.0%, and 5.5%, respectively, had positive growth of Haemophilus influenzae, Pseudomonas aeruginosa, and Streptococcus pneumoniae. Among the 505 hospital admissions with patients who had NPA samples saved, 5.7%, 2.3%, 0.8%, and 0.8%, respectively, had influenza A, respiratory syncytial virus (RSV), influenza B, and parainfluenza 3 isolated from viral cultures. Paired serology test results revealed a fourfold rise in viral titers in 5.2%, 2.2%, and 1.4% of patients, respectively, for influenza A, RSV, and influenza B. Very severe airflow obstruction (stable-state spirometry) was associated with a higher chance of a positive sputum culture (FEV(1) >/= 30% predicted, 28.2%; FEV(1) < 30% predicted, 40.4%; p = 0.006). CONCLUSION: H influenzae and influenza A were the most common etiologic agents in patients who were hospitalized with AECOPDs. More severe airflow obstruction was associated with a higher chance of a positive sputum culture finding.

Aged↗
PubMed2006

Aberrant expression of CC and CXC chemokines and their receptors in patients with asthma.

This study further elucidates the roles of selected chemokines (IP-10, MIG, and RANTES) and their receptors (CCR3, CCR5, and CXCR3) in asthma. We compared their profiles in six groups of participants-atopic cohort and nonatopic cohort (each including controls and asthmatic patients with or without steroid therapy). Plasma concentration of IP-10 was significantly lower while that of RANTES and the expression of CCR3 were higher in asthmatic patients (all p < 0.05). Plasma RANTES correlated positively with the GINA severity score in all asthmatic patients (r=0.27, p < 0.05), and with IL-13 in nonatopic asthmatic patients (r=0.46, p < 0.05). In asthmatic patients, the ex vivo release of IP-10 and MIG was attenuated in PBMC activated with allergen, mitogens and IL-18 (p < 0.05). In conclusion, plasma RANTES may be a surrogate marker for asthma and the diminished Th1 related CXC chemokine production may contribute to Th2 predominance in asthma.

Adult↗
PubMed2006

Anti-severe acute respiratory syndrome coronavirus immune responses: the role played by V gamma 9V delta 2 T cells.

Severe acute respiratory syndrome (SARS) is caused by a novel coronavirus (SARS-CoV) strain. Analyses of T cell repertoires in health care workers who survived SARS-CoV infection during the 2003 outbreak revealed that their effector memory V gamma 9V delta 2 T cell populations were selectively expanded ~3 months after the onset of disease. No such expansion of their alpha beta T cell pools was detected. The expansion of the V gamma 9V delta 2 T cell population was associated with higher anti-SARS-CoV immunoglobulin G titers. In addition, in vitro experiments demonstrated that stimulated V gamma 9V delta 2 T cells display an interferon- gamma -dependent anti-SARS-CoV activity and are able to directly kill SARS-CoV-infected target cells. These findings are compatible with the possibility that V gamma 9V delta 2 T cells play a protective role during SARS.

Adult↗
PubMed2006

12-year change in prevalence of respiratory symptoms in elderly Chinese living in Hong Kong.

Respiratory diseases may cause considerable disability in the elderly because of their limited respiratory reserve related to aging. This study aimed to assess the time trend of respiratory symptoms and common chronic respiratory diseases in the elderly Chinese living in Hong Kong. Two questionnaire surveys were conducted in 1991-1992 and 2003-2004. Subjects aged > or = 70 years were invited to complete a respiratory questionnaire. A total of 2032 (999 male) and 1524 (698 male) subjects completed the questionnaire surveys in 1991 and 2003, respectively. The response rates were 60% in 1991 and 78% in 2003. The prevalence of most respiratory symptoms increased over time after adjusting the data for age, sex, social status and smoking habits. Comparing the symptoms between 1991 and 2003, wheeze over the past 12 months increased from 7.5 to 12.1% (adjusted OR 2.00, 95% CI 1.54-2.61) and morning chest tightness from 4.2 to 8.8% (adjusted OR 2.48, 95% CI 1.79-3.43). The prevalence of self-reported physician-diagnosed emphysema increased over time (2.4-3.1%, adjusted OR 1.78, 95% CI 1.12-2.86), but there was no change for asthma (5.1% in 1991 and 5.8% in 2003) or chronic bronchitis (6.7% in 1991 and 7.7% in 2003). The prevalence of respiratory symptoms has increased over the past 12 years and this may be related to environmental factors especially increasing air pollution in Hong Kong.

Aged↗
PubMed2006

SARS: clinical presentation, transmission, pathogenesis and treatment options.

SARS (severe acute respiratory syndrome) appeared as the first emerging infectious disease of this century. It is fortunate that the culprit virus can be grown without much difficulty from a commonly used cell line, allowing an unlimited supply of isolates for further molecular studies and leading to the development of sensitive diagnostic assays. How the virus has successfully jumped the species barrier is still a mystery. The superspreading events that occurred within hospital, hotel and high-density housing estate opens a new chapter in the mechanisms and routes of virus transmission. The old practice of quarantine proved to be still useful in controlling the global outbreak. Despite all the available sophisticated tests, alertness with early recognition by healthcare workers and prompt isolation of suspected cases is still the most important step for containing the spread of the infection. Although the rapidly evolving outbreak did not allow the conducting of systematic clinical trails to evaluate treatment options, the accumulated experience on managing SARS patients will improve the clinical outcome should SARS return. Although SARS led to more than 700 deaths worldwide, the lessons learnt have prepared healthcare systems worldwide to face future emerging and re-emerging infections.

China↗
PubMed2006

Steroid-induced osteonecrosis in severe acute respiratory syndrome: a retrospective analysis of biochemical markers of bone metabolism and corticosteroid therapy.

AIM: We investigated the effect of massive doses of corticosteroid therapy on bone metabolism using specific biochemical markers of bone metabolism, and the prevalence of osteonecrosis in severe acute respiratory syndrome (SARS) patients at a university teaching hospital in Hong Kong. METHODS: Seventy-one patients with a clinical diagnosis of SARS were studied according to the modified World Health Organization case definition of SARS who were involved in the SARS epidemic between 10 March and 20 June 2003. The clinical diagnosis was confirmed by serological test and/or molecular analysis. Biochemical markers of bone metabolism were analysed retrospectively using serial clotted blood samples collected from each patient during the course of hospital admission to discharge and subsequent follow-up at out-patient clinic using the arbitrary time periods: (i) Day <10; (ii) Day 28-44; (iii) Day 51-84; and (iv) Day >90 after the onset of fever. Magnetic resonance imaging of the knee and hip joints were performed post-admission to evaluate the prevalence of osteonecrosis amongst these SARS patients. Various risk factors for the development of osteonecrosis were assessed using receiver operating characteristics curve comparison with appropriate test statistics and Spearman's coefficients of rank correlation with biochemical bone markers. RESULTS: Biochemical markers of bone metabolism showed significant bone resorption as evidenced by a marked increase in serum C-terminal telopeptide concentration (CTx) from Day 28-44 after the onset of fever. With tapering down of corticosteroid dosage, CTx started to return to previous baseline level from Day 51 onwards, while other bone formation markers, serum osteocalcin and bone-specific alkaline phosphatase concentrations (OC and BALP, respectively), started to increase. The latter effect was even more marked after Day >90. Seven patients developed radiological evidence of osteonecrosis. The prevalence of osteonecrosis in this cohort was 9.9%. A total corticosteroid dosage of >1900 mg hydrocortisone, >2000 mg methylprednisolone, >13 340 mg hydrocortisone-equivalent corticosteroid therapy, and >18 days on corticosteroid therapy were found to be significant risk factors for the subsequent development of osteonecrosis. There were also significant positive correlations amongst various biochemical bone markers in this patient cohort. CONCLUSIONS: Both bone resorption and formation markers were unable to predict the subsequent development of osteonecrosis. The use of high dose of hydrocortisone or methylprednisolone for an extended duration was shown to be a significant risk factor for osteonecrosis. Its prevalence in this cohort is comparable to those reported in the literature for SARS patients with high-dose corticosteroid therapy. The Day 28-44 increase in the serum CTx coincided with the timing of corticosteroid use. The Day >51 increase in serum OC and BALP coincided with the timing of corticosteroid withdrawal.

Adult↗
PubMed2006

A community model of group therapy for the older patients with chronic obstructive pulmonary disease: a pilot study.

OBJECTIVE: A community-based programme for chronic obstructive pulmonary disease (COPD) patients in group sessions is designed, and the feasibility, acceptability and physical and psychosocial outcomes evaluated. METHODS: Patients with COPD discharged from hospital, or those attending specialist outpatient clinic, with a history of hospital admission owing to COPD in the preceding 12 months were recruited. Those who had malignancy or were housebound were excluded. Group sessions were arranged once a week in a Community Centre, and consisted of two hourly sessions. The components of each session consist of education regarding the disease, breathing techniques, use of oxygen and other medication, smoking cessation, nutrition, dyspnoea management skills, relaxation and energy conservation techniques, introduction of social and community support, and strengthening as well as aerobic exercises. Assessments before and after intervention include lung function, 6 minutes walk test (6MWT), general Health Questionnaire (GHQ), the St. George's Respiratory Questionnaire (SGRQ), and a COPD knowledge Questionnaire. A programme evaluation was carried out using questionnaire and group discussions. RESULTS: Forty-four subjects were recruited, with 75% completing the programme, and 20% with drawing for unavoidable reasons. Statistically significant improvement was noted in all domains of the GHQ, SGRQ, and knowledge test, while the mean 6MWT improved, although statistical significance was not reached. Subjects were enthusiastic about the provision of this service in helping them cope with the disease through empowerment and mutual support. CONCLUSION: A group community intervention programme for COPD patients is feasible and acceptable, with positive psychosocial outcomes. Such a model could be further developed and cost-effectiveness evaluated as a model of chronic disease management in the community.

Aged↗
PubMed2006

Sleep-disordered breathing and continuous positive airway pressure compliance in a group of commercial bus drivers in Hong Kong.

OBJECTIVE AND BACKGROUND: Sleep-disordered breathing may predispose drivers to road traffic accidents. However, CPAP acceptance and compliance among commercial bus drivers is unknown. METHODS: We conducted a sleep questionnaire survey at a bus depot followed by random selection of bus drivers for home sleep study with the mesam iv device. Bus drivers with a respiratory disturbance index (RDI)>or=5/h were invited to have hospital-based polysomnography for confirmation followed by nasal CPAP treatment. RESULTS: Out of 1477 bus drivers, 1016 (971 men) were interviewed with mean (SD) age of 45.3 (7.5) years, BMI 24.9 (3.6) kg/m2, neck circumference 38.9 (3.1) cm and Epworth sleepiness score 4.8 (4.0). Sleepiness at work was reported by 60.9%, snoring>or=3 nights per week 23.9%, witnessed apnoea 3.7% and having fallen asleep during driving by 24%. Among 211 who underwent home sleep study, 85 (40.3%), 55 (26.1%) and 37 (17.5%) had RDI>or=5, >or=10 and >or=15/h respectively. BMI, snoring intensity and neck circumference were the positive independent factors associated with the RDI. Of the 25 drivers who attended polysomnography, nine accepted CPAP prescription with improvement of Epworth sleepiness score, trail B and digit span after 3 months with CPAP usage of 4.5 (1.3) h/night. CONCLUSION: The estimated minimum prevalence rates of sleep-disordered breathing and obstructive sleep apnoea syndrome were 8.4% and 5.4% respectively among the bus drivers. Home CPAP acceptance was low among bus drivers with sleep apnoea but there was significant improvement of subjective sleepiness and cognitive function among those on CPAP treatment.

Accidents, Traffic↗
PubMed2006

Long-term outcome of acute respiratory distress syndrome caused by severe acute respiratory syndrome (SARS): an observational study.

OBJECTIVE: We examined long-term outcome of pulmonary function, exercise capacity and health-related quality of life (HRQoL) in patients with acute respiratory distress syndrome (ARDS) caused by severe acute respiratory syndrome (SARS). METHODS: 59 critically ill patients with ARDS caused by SARS between March and July 2003 were studied prospectively and followed up for 1 year. Thirty-six underwent pulmonary function testing and a 6-minute walk test, and 35 underwent HRQoL evaluation by Short Form-36 questionnaire at 3, 6, and 12 months after illness onset. RESULTS: Mean age was 47 (SD, 15.7) years. Median APACHE II score was 10 (interquartile range [IQR], 7-12). Only 47% required invasive mechanical ventilation. Median admission and worst PaO2/FIO2 ratio were 142 (IQR, 94-177) mmHg and 86 (IQR, 66-122) mmHg, respectively. Median stay in ICU and hospital were 9 (IQR, 5-20) and 31 (IQR, 20-54) days, respectively. Mortality was 24% at hospital discharge and at 1 year. Mean lung volumes and spirometric measurements were nearly normal by 6 months. Except for diffusion capacity adjusted for haemoglobin concentration (DLCO) measured at 12 months, there was no significant difference in pulmonary function measurement between those who had mechanical ventilation and those who did not. The 6-minute walk distance (6MWD) improved from 3 to 6 months, with no further significant change. Younger patients had near normal HRQoL by 6 months. Those aged over 40 years had impaired HRQoL at multiple domains even at 12 months. At 12 months, forced expiratory volume in 1 second, forced vital capacity and 6MWD correlated significantly with multiple SF-36 domain scores. DLCO correlated significantly only with domain scores reflecting physical function. CONCLUSIONS: The mortality of SARS-related ARDS is similar to the mortality of ARDS from other causes. A substantial number of patients with SARS-related ARDS survived without receiving mechanical ventilation. Patients had good recovery of pulmonary function and HRQoL.

Adult↗
PubMed2005

Exhaled breath condensate levels of 8-isoprostane, growth related oncogene alpha and monocyte chemoattractant protein-1 in patients with chronic obstructive pulmonary disease.

Chronic obstructive pulmonary disease (COPD) patients have increased neutrophils and macrophages in their lungs, and inflammation of the airway is related to oxidative stress. This study assessed the levels of 8-isoprostane (an oxidative stress marker) and chemokines related to neutrophil and monocyte inflammation (growth-related oncogene alpha [GROalpha] and monocyte chemoattractant protein-1 [MCP-1]) in the airway of ex-smoking COPD patients by exhaled breath condensate (EBC) collection. Thirty-two (28 males) stable COPD patients (14 with FEV(1) 50% [Group 1], 18 with FEV(1) <50% predicted [Group 2]) and 18 non-smoking age and sex-matched controls were studied in this cross-sectional study. EBC was collected using the EcoScreen (Jaeger, Germany) during 10 min of tidal breathing with the nose clipped. Concentrations of 8-isoprostane, GROalpha and MCP-1 were measured by enzyme immunoassays. COPD patients had a higher concentration of 8-isoprostane than controls (COPD versus control, P<0.001; Group 1 versus Group 2, P=0.045). 8-isoprostane increased across the groups from normal, Group 1 to Group 2 (r=0.64, P<0.001). The median intraquartile range (IQR) levels in pg/ml for GROalpha were 45.3(44.5-46.5), 45.4(44.5-46.0), 46.0(45.6-47.3), whereas MCP-1 levels were 5.3(5.2-5.9), 6.2(5.4-6.9) and 5.7(5.5-6.4) in Group 1, Group 2 COPD and control subjects, respectively. GROalpha level was lower in COPD patients when compared to controls (P=0.01). MCP-1 level did not differ between COPD and the control group. 8-isoprostane level, but not GROalpha and MCP-1, in EBC was increased in COPD patients with poorer lung function. This suggests an increased oxidative stress in the airway in patients with more severe COPD.

Aged↗
PubMed2005

Absence of association between angiotensin converting enzyme polymorphism and development of adult respiratory distress syndrome in patients with severe acute respiratory syndrome: a case control study.

BACKGROUND: It has been postulated that genetic predisposition may influence the susceptibility to SARS-coronavirus infection and disease outcomes. A recent study has suggested that the deletion allele (D allele) of the angiotensin converting enzyme (ACE) gene is associated with hypoxemia in SARS patients. Moreover, the ACE D allele has been shown to be more prevalent in patients suffering from adult respiratory distress syndrome (ARDS) in a previous study. Thus, we have investigated the association between ACE insertion/deletion (I/D) polymorphism and the progression to ARDS or requirement of intensive care in SARS patients. METHOD: One hundred and forty genetically unrelated Chinese SARS patients and 326 healthy volunteers were recruited. The ACE I/D genotypes were determined by polymerase chain reaction and agarose gel electrophoresis. RESULTS: There is no significant difference in the genotypic distributions and the allelic frequencies of the ACE I/D polymorphism between the SARS patients and the healthy control subjects. Moreover, there is also no evidence that ACE I/D polymorphism is associated with the progression to ARDS or the requirement of intensive care in the SARS patients. In multivariate logistic analysis, age is the only factor associated with the development of ARDS while age and male sex are independent factors associated with the requirement of intensive care. CONCLUSION: The ACE I/D polymorphism is not directly related to increased susceptibility to SARS-coronavirus infection and is not associated with poor outcomes after SARS-coronavirus infection.

Adult↗
PubMed2005

Sputum bacteriology in patients with acute exacerbations of COPD in Hong Kong.

STUDY OBJECTIVE: To study the demographics and sputum microbiology of patients admitted to a teaching hospital with acute exacerbations of chronic obstructive pulmonary disease (AECOPD). DESIGN: A retrospective study. SETTING: A tertiary university hospital in Hong Kong. PATIENTS: All episodes of AECOPD, patient demographics, length of stay, sputum culture and radiological results admitted in the first half of the year 2000 were retrieved from hospital records. RESULTS: There were 329 patients with 418 episodes of AECOPD without concomitant pneumonia. The age of the patients was 74.4+/-8.3 years. The acute hospital length of stay for an episode of AECOPD was 7.3+/-6.5 days. Haemophilus influenzae was the commonest organism found in sputum (23.1%), followed by Pseudomonas aeruginosa (6.3%) and Streptococcus pneumoniae (4.0%). Mycobacterium tuberculosis was found in 1.1% of the admissions. Presence of organisms in sputum had no association with the hospital length of stay and intensive care unit admissions. In patients whose FEV1 was >50% of predicted values, there was a higher chance of positive sputum growth of H. influenzae than those with FEV1 <50% (16/44 vs. 31/162 episodes, respectively, P=0.02). CONCLUSIONS: H. influenzae was the commonest bacterium isolated in sputum in patients with AECOPD. In areas endemic of tuberculosis, it is advisable to use fluoroquinolones for AECOPD with caution.

Acute Disease↗
PubMed2005

Chest radiograph scores as potential prognostic indicators in severe acute respiratory syndrome (SARS).

OBJECTIVE: We analyzed serial chest radiographic scores for lung opacification in patients with severe acute respiratory syndrome (SARS) for temporal changes and differences between fatal and discharged cases. We sought to establish the earliest radiographic scores sensitive as potential prognostic indicators of fatal outcomes. MATERIALS AND METHODS: Chest radiographs that had been obtained from presentation until the death or discharge of 313 patients with SARS were scored on the basis of the percentage area and location of lung opacification. Profile analysis and univariable logistic regression were performed on these radiographic scores. RESULTS: Despite the increased mortality risks of advanced age and male sex, no significant difference was seen in the percentage area of opacification (AO%) between the sexes in either the group of patients with fatal outcomes or the group of patients who were discharged. No difference existed between age groups (< 65 years vs >/= 65 years), except for the radiograph showing the peak lung opacification in the deceased group in which the lungs of older patients had less opacification than those of younger patients. The radiographic scores obtained by day 7 were the earliest ones with good performance in prognostic prediction. The model showed good discriminatory performance, indicated by high C-indexes for receiver operator characteristic curves (0.86 for AO% and 0.90 for the number of opacified zones). The predicted proportion of patients with fatal outcomes showed high agreement with percentage of patients who died (goodness-of-fit statistic p = 0.18 for AO%, 0.73 for the number of opacified zones). By day 7, crude odds ratio of death was 1.73 per 5% of AO% (p < 0.0001) or 2.93 per lung zone opacified (p < 0.0001). CONCLUSION: Chest radiographic scores (percentage of lung or the number of zones opacified) by day 7 could be used as fatal prognostic indicators.

Adolescent↗
PubMed2004

Severe acute respiratory syndrome: correlation between clinical outcome and radiologic features.

PURPOSE: To evaluate whether there is a correlation between the clinical outcomes and radiologic features of severe acute respiratory syndrome (SARS). MATERIALS AND METHODS: The clinical, laboratory, and radiologic features of 138 patients with SARS were analyzed. Three radiologists in consensus retrospectively assessed the frontal chest radiographs obtained at presentation and during treatment (n = 2045) for the distribution (each lung was divided into upper, middle, and lower zones) and extent of lung parenchymal abnormality. Clinical end points included intensive care unit (ICU) admission and death. RESULTS: Thirty-six (26.1%) patients required ICU care, and eight (5.8%) died. The patients who required ICU care and/or died had more extensive consolidation on chest radiographs obtained initially (median percentage of consolidation, 3.30%, with interquartile range [IR] of 1.70%-8.78% vs 1.70% [IR, 0%-3.30%]; P < .001) and on day 7 after fever onset (median percentage of consolidation, 15.00% [IR, 6.48%-28.73%] vs 5.00% [IR, 2.50%-7.50%]; P < .001) than did surviving patients who did not require ICU care. Patients with involvement of more than one lung zone on initial and day 7 chest radiographs were more likely to require ICU care and/or die than were those with involvement of one or fewer zones (P < .001). Patients with bilateral pneumonic changes at presentation were more likely to have an adverse outcome than were those with unilateral pneumonia (P < .001). Involvement of more than one lung zone at baseline chest radiography was an independent predictor of ICU admission and/or death (odds ratio, 3.16; 95% confidence interval: 1.07, 9.32; P = .037) after adjustments for other significant factors (ie, patient age, and baseline neutrophil count and lactate dehydrogenase level). CONCLUSION: More extensive airspace disease at presentation is an independent predictor of adverse outcome in patients with SARS.

Adult↗
PubMed2004

Factors associated with difference in prevalence of asthma in children from three cities in China: multicentre epidemiological survey.

OBJECTIVE: To determine the factors associated with difference in prevalence of asthma in children in different regions of China. DESIGN: Multicentre epidemiological survey. SETTING: Three cities in China. PARTICIPANTS: 10,902 schoolchildren aged 10 years. MAIN OUTCOME MEASURES: Asthma and atopic symptoms, atopic sensitisation, and early and current exposure to environmental factors. RESULTS: Children from Hong Kong had a significantly higher prevalence of wheeze in the past year than those from Guangzhou and Beijing (odds ratio 1.64, 95% confidence interval 1.35 to 1.99). Factors during the first year of life and currently that were significantly associated with wheeze were cooking with gas (odds ratio 2.04, 1.34 to 3.13), foam pillows (2.58, 1.66 to 3.99), and damp housing (1.89, 1.26 to 2.83). Factors protecting against wheeze were cotton quilts and the consumption of fruit and raw vegetables. CONCLUSION: Environmental factors and diet may explain the differences in prevalence of asthma between children living in different regions of China.

Asthma↗
PubMed2004

Early results of endoscopic lung volume reduction for emphysema.

BACKGROUND: We determined the feasibility, safety, and short-term efficacy of bronchoscopic placement of a one-way endobronchial valve in selected bronchopulmonary segments as an alternative to surgical lung volume reduction. METHODS: A total of 21 patients with incapacitating emphysema who underwent this procedure were studied. All patients had placement of the endobronchial valves into the most emphysematous lung segments. We recorded any major complications or deaths attributed to the procedure and analyzed (1) improvements in the spirometric and functional parameters and quality of life and (2) the radiologic changes compared with the baseline data at 30 and 90 days. RESULTS: A total of 20 patients had complete follow-up data. There was no mortality in the group studied. The forced expiratory volume at 1 second, forced expiratory volume at 1 second (percentage of predicted), forced vital capacity, and forced vital capacity (percentage of predicted) all improved significantly at 90 days (0.73 +/- 0.26 L vs 0.92 +/- 0.34 L [P =.009]; 33.3% +/- 11.9% vs 42.2% +/- 15.0% [P =.006]; 1.94 +/- 0.62 L vs 2.25 +/- 0.61 L [P =.015]; and 63.3% +/- 17.6% vs 73.9% +/- 17.1% [P =.012], respectively). The 6-minute walking distance improved at 30 and 90 days (251.6 +/- 100.2 m vs 306.3 +/- 112.3 m and 322.3 +/- 129.7 m; P =.012 and P =.003). The results of the 36-Item Short-Form Health Survey and the St George Respiratory Questionnaire showed significant improvements at 90 days. The Medical Research Council dyspnea grade also improved significantly at 30 and at 90 days (P =.006 and P =.003, respectively). CONCLUSIONS: Endobronchial valve placement is a safe procedure, with significant short-term improvements in functional status, quality of life, and relief of dyspnea in selected patients with emphysema. A larger study with long-term follow-up is therefore warranted.

Adult↗
PubMed2004

Differential diagnosis of pleural effusions by fuzzy-logic-based analysis of cytokines.

Pleural effusions can be caused by highly different underlying diseases and are characterized by complex interactions of various local and circulating cells as well as numerous soluble parameters like interleukins (IL). Knowledge about this complex network could help to indicate underlying disease. Therefore, we have investigated immunoreactive concentrations of IL-4, IL-6, IL-11, IL-15, IL-17, IL-18, and tumor necrosis factor-alpha (TNF-alpha) in pleural effusions and peripheral blood from patients with tuberculosis, bronchial carcinoma and other carcinomas as well as congestive heart failure (CHF) and pneumonias. To determine the value of cytokine measurement for differential diagnosis, statistical and fuzzy-logic methods were applied. Quantitative analysis showed high concentrations of IL-6 and IL-11 only in pleural effusions. IL-15, IL-17, IL-18 and TNF-alpha could be detected also in blood plasma. Lowest amounts were detected in CHF indicating the non-inflammatory origin of effusions. Statistical analysis did not provide evidence for diagnostic relevance of singular cytokines. Fuzzy-logic analysis was able to assign patients to the correct diseases with 80% accuracy using IL-6 and IL-15 measurement. Our results confirm the pathogenetic role of these cytokines in pleural effusions. Fuzzy-logic-based procedures may help to characterize and distinguish effusions of unknown origin even in small patient groups.

Adult↗