Prevalence and causes of chronic cough in Japan

BACKGROUND

Chronic cough is one of the most common symptoms of respiratory diseases and can adversely affect patients' quality of life and interfere with social activities, resulting in a significant social burden. A survey is required to elucidate the frequency and treatment effect of chronic cough. However, clinical studies that cover all of Japan have not yet been conducted.

METHODS

Patients who presented with a cough that lasted longer than 8 weeks and visited the respiratory clinics or hospitals affiliated with the Japan Cough Society during the 2-year study period were registered.

RESULTS

A total of 379 patients were enrolled, and those who did not meet the definition of chronic cough were excluded. A total of 334 patients were analyzed: 201 patients had a single cause, and 113 patients had two or more causes. The main causative diseases were cough variant asthma in 92 patients, sinobronchial syndrome (SBS) in 36 patients, atopic cough in 31 patients, and gastroesophageal reflux (GER)-associated cough in 10 patients. The time required to treat undiagnosed patients and those with SBS was significantly longer and the treatment success rate for GER-associated cough was considerably poor.

CONCLUSIONS

We confirmed that the main causes of chronic cough were cough variant asthma, SBS, atopic cough, and their complications. We also showed that complicated GER-associated cough was more likely to become refractory. This is the first nationwide study in Japan of the causes and treatment effects of chronic cough.

Changes in sleep profile on exposure to sodium chloride and artificially carbonated springs: a pilot study

[Purpose] Herein, we aimed to investigate the effects of bathing in a sodium chloride spring and an artificially carbonated spring on core body temperature and electroencephalograms, to assess whether the springs facilitate sleep. [Participants and Methods] This randomized, controlled, crossover study evaluated the effects of a sodium chloride spring, an artificially carbonated spring, a plain hot bath, and no bath on sleep. The subjective evaluations and recording of temperature were performed before/after bathing at 40 °C for 15 min at 22:00 h, before nocturnal sleep (0:00-7:00 h), and after the participants (n=8) woke up in the morning. [Results] Bathing significantly increased the core body temperature, with significant subsequent declines observed until bedtime. Participants in the sodium chloride spring group had the highest average core body temperature, while participants in the no-bath group had the lowest average core body temperature before bedtime (23:00-0:00 h). During bedtime (1:00-2:00 h), the participants in the no bath group had the highest average core body temperature, while participants in the artificially carbonated spring group had the lowest average core body temperature. The amount of delta power/min in the first sleep cycle significantly increased in the bathing groups, with the highest value during bedtime being recorded in the artificially carbonated spring group, followed by the sodium chloride spring, plain hot bath, and no-bath groups. These sleep changes were associated with significant declines in the elevated core body temperature. Increased heat dissipation and decreased core body temperature were observed in the artificially carbonated spring and sodium chloride spring groups, which increased the delta power during the first sleep cycle compared with that observed in the plain hot bath group, followed by the no-bath group. [Conclusion] An artificially carbonated spring would be the most appropriate given each circumstance because it did not cause fatigue, as observed with the sodium chloride spring.

Residual effects of low dose of suvorexant, zolpidem, and ramelteon in healthy elderly subjects: A randomized double‐blind study

Introduction

Methods

Result

Conclusion

Objective physical activity level is associated with rectus femoris muscle echo‐intensity in patients with chronic obstructive pulmonary disease

Introduction

Skeletal muscle dysfunction is one of the major extrapulmonary complications of chronic obstructive pulmonary disease (COPD). Some studies have reported a relationship between physical activity (PA) level and skeletal muscle quality assessed by echo‐intensity (EI) in healthy individuals but not in patients with COPD.

Objectives

The aim of this study is to investigate the relationships between PA level and both skeletal muscle EI and skeletal muscle mass in patients with COPD.

Methods

We employed a cross‐sectional design. Forty male outpatients with stable COPD were enrolled. Using B‐mode ultrasonography, we measured the rectus femoris muscle cross‐sectional area (RF‐CSA) and EI (RF‐EI). The RF‐CSA and RF‐EI were measured on frozen images using an electronic caliper and 8‐bit gray‐scale analysis, respectively. The objective PA level was determined by monitoring daily step counts and moderate‐to‐vigorous physical activity time (MVPA) with an activity monitor. A general regression model was used to assess the relationships between PA level and both RF‐CSA and RF‐EI. Age and body mass index (BMI) were adopted as confounding variables.

Results

Twenty‐five outpatients with stable COPD (age, 70 ± 7 years old; forced expiratory volume in 1 s, 55.0 ± 24.9% of predicted values) were finally enrolled in the present study. Even after adjusting for age and BMI, the daily step counts and MVPA were significantly associated with RF‐EI, and knee extensor force was associated with RF‐CSA.

Conclusion

The present study showed that PA level was associated with RF‐EI in patients with COPD. In addition, RF‐CSA was associated with knee extensor force. When assessing skeletal muscle using ultrasonography in patients with COPD, we should also assess EI.

Probing Gluon Spin-Momentum Correlations in Transversely Polarized Protons through Midrapidity Isolated Direct Photons in p^{↑}+p Collisions at sqrt[s]=200 GeV

Studying spin-momentum correlations in hadronic collisions offers a glimpse into a three-dimensional picture of proton structure. The transverse single-spin asymmetry for midrapidity isolated direct photons in p^{↑}+p collisions at sqrt[s]=200  GeV is measured with the PHENIX detector at the Relativistic Heavy Ion Collider (RHIC). Because direct photons in particular are produced from the hard scattering and do not interact via the strong force, this measurement is a clean probe of initial-state spin-momentum correlations inside the proton and is in particular sensitive to gluon interference effects within the proton. This is the first time direct photons have been used as a probe of spin-momentum correlations at RHIC. The uncertainties on the results are a 50-fold improvement with respect to those of the one prior measurement for the same observable, from the Fermilab E704 experiment. These results constrain gluon spin-momentum correlations in transversely polarized protons.

Functionally relevant threshold of inspiratory muscle strength in patients with chronic obstructive pulmonary disease

OBJECTIVES

We aimed to identify the inspiratory muscle strength thresholds below which exercise capacity is compromised in men with chronic obstructive pulmonary disease (COPD).

METHODS

We measured the maximum static inspiratory mouth pressure (PImax) and the percentage of predicted values (%PImax) in 113 patients with COPD. Six-minute walk distance (6-MWD) was measured as an indicator of functional exercise capacity, and a 6-MWD of <350 m was defined as functional exercise intolerance. Thresholds were determined as values with high specificity (>0.90) and maximal sensitivity. Statistical significance was set at P < 0.01.

RESULTS

The data of 96 patients (74 ± 6 years old; forced expiratory volume in 1-s [FEV₁], 56.5 ± 26.2% predicted) were analyzed; three women and 14 participants with missing data were excluded. Multivariate logistic regression models identified significant associations of PImax (odds ratio at 99% confidence interval [CI]: 0.95 [0.92-0.98]) and %PImax (odds ratio at 99% CI: 0.97 [0.95-0.99]) with 6-MWD, after adjustments for height and FEV₁. C-statistics showed that the area under the curves (99% CI) of PImax and %PImax were comparable (0.87 [0.77-0.96] and 0.83 [0.72-0.94]). The thresholds of PImax and %PImax were 45.1 cmH₂O and 66%; PImax and %PImax also had moderate positive likelihood ratios of 4.44 and 5.00.

CONCLUSIONS

Thresholds of inspiratory muscle strength in men with COPD could help clinicians evaluate whether their patient's inspiratory muscle strength is inadequate to achieve a 6-MWD of ≥350 m, and identify patients who should be targeted for inspiratory muscle training.

Functionally Relevant Threshold of Quadriceps Muscle Strength in Patients with Chronic Obstructive Pulmonary Disease

Objectives

We aimed to identify the quadriceps muscle strength (QMS) thresholds below which exercise capacity is compromised in men with chronic obstructive pulmonary disease (COPD).

Methods

We measured the quadriceps isometric maximum voluntary contraction (QMVC) and calculated the QMVC values normalized to weight (QMVC-BW), height squared (QMVC-H²), and body mass index (QMVC-BMI) in 113 patients with COPD. The functional exercise capacity was evaluated using the 6-minute walk distance (6MWD), and 6MWD <350 m was defined as functional exercise intolerance. Thresholds were determined for QMVC and its normalized values to achieve high specificity (>0.90) with maximal sensitivity. P-values <0.01 were considered statistically significant.

Results

Data from 99 male patients (age, 74 ± 6 years; percentages of predicted forced expiratory volume in 1-s, 56.9 ± 26.4%) were analyzed; 3 women and 11 participants with the missing data were excluded. Multivariate logistic regression models identified significant associations of QMVC and QMVC-H² with 6MWD, after adjustment for age and dyspnea. C-statistics showed that the area under the curves of all QMVC parameters were comparable. The thresholds of QMVC and QMVC-H² for predicting compromised exercise capacity were 26.2 kg and 9.6 kg/m², respectively.

Conclusions

QMS thresholds in men with COPD could help clinicians evaluate whether QMS is insufficient to achieve 6MWD ≥350 m and thereby identify patients who should be specifically targeted for muscle strengthening training during their pulmonary rehabilitation program.

The association between systemic inflammation and the time spent in posture and movement during daytime in patients with chronic obstructive pulmonary disease and lower weight

[Purpose] The effect of physical activity on systemic inflammation remains unclear and might be negative in patients with chronic obstructive pulmonary disease (COPD) and lower weight. We investigated the amount of physical activity as the time spent in posture and movement and its association with systemic inflammation. [Participants and Methods] In this retrospective cross-sectional pilot study, we evaluated 11 patients with COPD (age, 73 ± 7 years; body mass index, 18.9 ± 2.9 kg/m²). A recently developed triaxial accelerometer was used to measure the time spent in posture and movement. We also evaluated body composition, physiological indexes, and serum levels of inflammatory cytokines. Single correlation coefficients were calculated as the association between physical activity and other outcomes. [Results] The walking time was 36 ± 32 min/d, and the standing time was 151 ± 118 min/d. The time spent walking significantly correlated with the fat-free mass index (r=0.73) and interleukin (IL)-8 level (r=0.76). The time spent standing significantly correlated with the C-reactive protein (r=0.80) and IL-6 levels (r=0.74). [Conclusion] These data indicate that increased physical activity is associated with higher systematic inflammation. We should consider that the systemic inflammation may have been affected by the increased physical activity of the patients with COPD and lower weight in this study.

Estimation of minimal clinically important difference for quadriceps and inspiratory muscle strength in older outpatients with chronic obstructive pulmonary disease: a prospective cohort study

OBJECTIVE

To estimate the minimal clinically important difference (MCID) of quadriceps and inspiratory muscle strength after a home-based pulmonary rehabilitation program (PRP) in chronic obstructive pulmonary disease (COPD).

METHOD

Eighty-five COPD patients were included. Quadriceps maximal voluntary contraction (QMVC) was measured. We measured maximal inspiratory mouth pressure (PImax), the 6-minute walk distance (6MWD), the chronic respiratory questionnaire (CRQ) and the modified Medical Research Council dyspnoea score (mMRC). All measurements were conducted at baseline and at the end of the PRP. The MCID was calculated using anchor-based (using 6MWD, CRQ, and mMRC as possible anchor variables) and distribution-based (half standard deviation and 1.96 standard error of measurement) approaches. Changes in the five variables were compared in patients with and without changes in QMVC or PImax >MCID for each variable.

RESULTS

Sixty-nine COPD patients (age 75±6 years) were analysed. QMVC improved by 2.4 (95%CI 1.1-3.7) kgf, PImax by 5.8 (2.7-8.8) cmH₂O, 6MWD by 21 (11-32) meters and CRQ by 3.9 (1.6-6.3) points. The MCID of QMVC and PImax was 3.3-7.5 kgf and 17.2-17.6 cmH₂O, respectively. The MCID of QMVC (3.3 kgf) could differentiate individuals with significant improvement in 6MWD and PImax from those without.

CONCLUSION

The MCID of QMVC (3.3 kgf) can identify a meaningful change in quadriceps muscle strength after a PRP. The MCID of PImax (17.2 cmH₂O) should be used with careful consideration, because the value is estimated using distributionbased method.

0518 Sleep Facilitation by Artificial Carbonated Bathing in Healthy Elderly; EEG, Core, Proximal, and Distal Temperature Evaluations

Introduction

Bathing, especially with hot spring with various mineral compositions, is known to facilitate / improve sleep by warming the body. Artificial carbonated bathing (ACB) is known to keep the body warm too. Previous our study examined that ACB before sleep more specifically affected body temperature and sleep on healthy young subjects. In this study, we evaluated the effects of usual (plain hot water; PH) and artificial carbonated bathing, on sleep using clinical thermometers and EEG in healthy elderly subjects.

Methods

Nine healthy elderly women (average age 71.3 years old) were divided into 2 groups ACB (858 ppm, Awacomachi, Danrei Co.) and PH with a week interval. Subjects soaked in the bath (38 C degree) deep enough their chests touched the water for 10 min. From the time they finished bathing to the next morning, we measured their distal skin temperature (top side of the foot), proximal skin temperature (lower part of the clavicle) and EEG using a single channel portable device (Brain wave sensor, Proassist Co.). Subjects were told to sleep from 23:00-6:00. As the same time, subjects were examined with visual analog scale (VAS) and clinical flicker fusion test (CFF).

Results

There was no significant difference in body temperature (proximal, distal, distal-proximal temperature gradient: DPG) before and during sleep between ACB and PH. The condition of the ACB tended to have less light sleep compared to PH (150min vs 201min, p=0.08), but there was no significant difference in the SWS (44.1min vs 39.1min, ns), EEG delta power analysis, VAS and CFF.

In the previous study, bathing was performed for 15 min at a water temperature of 40 C degree, but this condition was considered to be a high risk for the elderly. The reason why there was no significant difference in body temperature. The effects of ACB were not fully demonstrated due to changes in hot water temperature and bathing time.

Conclusion

The effect of ACB on the body temperature of healthy elderly people could not be confirmed. However, a tendency to reduce light sleep was observed.

Support

This work was supported by JSPS KAKENHI Grant Number JP19K11294

Diaphragm thickening assessed by ultrasonography is lower than healthy adults in patients with chronic obstructive pulmonary disease

BACKGROUND

Ultrasound imaging has been widely used for imaging of the diaphragm thickness (Tdi) and thickening. Few studies assessed the Tdi using ultrasonography in patients with chronic obstructive pulmonary disease (COPD). We measured the Tdi and thickening in patients with COPD compared with healthy younger and healthy older adults to reveal the influence of ageing and/or COPD.

METHODS

Thirty-eight male patients with COPD (age 72 ± 8 years), 15 healthy younger (age 22 ± 1 years) and 15 healthy older (age 72 ± 5 years) male volunteers were recruited. We measured Tdi at total lung capacity (Tdi_TLC ), functional residual capacity (Tdi_FRC ) and residual volume (Tdi_RV ) using B-mode ultrasonography. We calculated the change ratio of Tdi_TLC and Tdi_RV (ΔTdi%). We used a one-way analysis of variance and multiple comparison test for the comparison analysis.

RESULTS

The Tdi_TLC and the ΔTdi% were significantly lower in patients with COPD compared to the healthy adults. There was no significant difference in these values with age. There was no between group difference in the Tdi_FRC or Tdi_RV .

CONCLUSIONS

Our results indicate significant differences in Tdi_TLC and ΔTdi% between patients with COPD and healthy adults. Therefore, diaphragm ultrasonography can assess diaphragm dysfunction associated with COPD. We suggest that it is better to use Tdi_TLC and ΔTdi% (not only Tdi at rest) to assess diaphragm function.

Nuclear Dependence of the Transverse Single-Spin Asymmetry in the Production of Charged Hadrons at Forward Rapidity in Polarized p+p, p+Al, and p+Au Collisions at sqrt[s_{NN}]=200 GeV

We report on the nuclear dependence of transverse single-spin asymmetries (TSSAs) in the production of positively charged hadrons in polarized p^{↑}+p, p^{↑}+Al, and p^{↑}+Au collisions at sqrt[s_{NN}]=200  GeV. The measurements have been performed at forward rapidity (1.4<η<2.4) over the range of transverse momentum (1.8<p_{T}<7.0  GeV/c) and Feynman x (0.1<x_{F}<0.2). We observed positive asymmetries for positively charged hadrons in p^{↑}+p collisions, and significantly reduced asymmetries in p^{↑}+A collisions. These results reveal a nuclear dependence of TSSAs for charged-hadron production in a regime where perturbative techniques are applicable. These results provide new opportunities to use p^{↑}+A collisions as a tool to investigate the rich phenomena behind TSSAs in hadronic collisions and to use TSSAs as a new handle in studying small-system collisions.

New evaluation of trunk movement and balance during walking in COPD patients by a triaxial accelerometer

Background

Individuals with COPD may experience ambulatory difficulty due to both effort intolerance arising from respiratory dysfunction and impaired balance control during walking. However, the trunk movement during walking has not been evaluated or adjusted for patients with COPD. The Lissajous index (LI) visually and numerically evaluates the left–right symmetry of the trunk movement during walking and is useful in clinical practice. In COPD patients, the LI is used as an indicator of the left–right symmetry of the trunk during walking. Here, we used the LI to evaluate the symmetry of COPD patients based on bilateral differences in mediolateral and vertical accelerations, and we investigated the correlation between the patients’ symmetry evaluation results and their physical function.

Patients and methods

Sixteen stable COPD patients (all males; age 71.3±9.2 years) and 26 healthy control subjects (15 males; age 68.2±6.9 years) participated in this study. They performed the 10-minute walk test at a comfortable gait speed wearing a triaxial accelerometer, and we measured their trunk acceleration for the evaluation of symmetry. Motor functions were also evaluated in the patients with COPD.

Results

The average mediolateral bilateral difference and LI values of the COPD patients were significantly larger than those of the healthy subjects. The COPD patients’ LI values were significantly correlated with their static balance.

Conclusion

The LI measured using a triaxial accelerometer during walking is useful in balance assessments of patients with COPD.

Pseudorapidity Dependence of Particle Production and Elliptic Flow in Asymmetric Nuclear Collisions of p+Al, p+Au, d+Au, and ^{3}He+Au at sqrt[s_{NN}]=200 GeV

Asymmetric nuclear collisions of p+Al, p+Au, d+Au, and ^{3}He+Au at sqrt[s_{NN}]=200  GeV provide an excellent laboratory for understanding particle production, as well as exploring interactions among these particles after their initial creation in the collision. We present measurements of charged hadron production dN_{ch}/dη in all such collision systems over a broad pseudorapidity range and as a function of collision multiplicity. A simple wounded quark model is remarkably successful at describing the full data set. We also measure the elliptic flow v_{2} over a similarly broad pseudorapidity range. These measurements provide key constraints on models of particle emission and their translation into flow.

Improvement of physical activity in chronic obstructive pulmonary disease by pulmonary rehabilitation and pharmacological treatment

Physical activity (PA) is defined as bodily movement produced by skeletal muscles with energy expenditure beyond resting levels. PA is closely related to reduced morbidity and mortality in chronic obstructive pulmonary disease (COPD). Self-report questionnaires are often subject to recall bias, correlating poorly with objectively qualified PA, and do not provide an accurate estimate of free-living energy expenditure. PA may be objectively evaluated by newly developed tri-axial accelerometers by quantifying steps or body movements over a period of time. Low-intensity, home-based pulmonary rehabilitation (PR) using pedometer feedback improves PA. Improvement in physiological factors correlates with increased walking time in stable elderly COPD patients. This review focuses on the effects of PR and pharmacological treatment on PA in COPD patients. We selected 32 studies from our literature search evaluating the effects of PR and 11 studies examining the effects of pharmacological treatment on PA. Findings in both categories were inconsistent. Nineteen studies showed a positive effect with PR whereas 13 showed no effect. Eight studies showed a positive effect, while three revealed no effect from pharmacological intervention. As both interventions increase exercise capacity without a consistent effect on PA, counseling with behavioral changes may be necessary to achieve a significant and lasting increase in PA. Changing PA behavior in COPD patients requires an interdisciplinary approach involving specialists in respiratory medicine, rehabilitation, social, and behavioral sciences. Future research in this area is warranted to advance our knowledge in this area, specifically with regard to the interaction of pharmacological and non-pharmacological interventions.

Evaluation of gait symmetry using a tri-axial accelerometer in stroke patients

OBJECTIVES

The purpose of this study was to confirm the intra-rater reliability and absolute reliability of Lissajous Index (LI) in evaluating the symmetry of trunk movement during gait in patients with stroke and to examine the relation between LI and body function in patients with stroke.

METHODS

Twenty-one healthy subjects (11 males and 10 females, age 63.3±2.0 yrs) and 45 patients with stroke (33 males and 12 females, age 58.7±13.4 yrs) were included in the study. The accelerometer was fixed to a belt at the level of the L3 spinous process. The 10-m walk test was performed twice to record definitive data on trunk acceleration. LI was calculated from trunk accelerations. We confirmed the intra-rater reliability and absolute reliability of LI in patients with stroke and we examined the relation between LI and body function in patients with stroke.

RESULTS

There was no fixed bias and proportional bias in the LI of patients with stroke. It was found that BBS significantly correlated with LI in stroke patients (p < 0.05, r = -0.413).

CONCLUSIONS

It was clear that LI during gait was effective at evaluating gait symmetry and balance. LI was indicated to be useful in evaluating gait in patients with stroke.

Measurements of Multiparticle Correlations in d+Au Collisions at 200, 62.4, 39, and 19.6 GeV and p+Au Collisions at 200 GeV and Implications for Collective Behavior

Recently, multiparticle-correlation measurements of relativistic p/d/^{3}He+Au, p+Pb, and even p+p collisions show surprising collective signatures. Here, we present beam-energy-scan measurements of two-, four-, and six-particle angular correlations in d+Au collisions at sqrt[s_{NN}]=200, 62.4, 39, and 19.6 GeV. We also present measurements of two- and four-particle angular correlations in p+Au collisions at sqrt[s_{NN}]=200  GeV. We find the four-particle cumulant to be real valued for d+Au collisions at all four energies. We also find that the four-particle cumulant in p+Au has the opposite sign as that in d+Au. Further, we find that the six-particle cumulant agrees with the four-particle cumulant in d+Au collisions at 200 GeV, indicating that nonflow effects are subdominant. These observations provide strong evidence that the correlations originate from the initial geometric configuration, which is then translated into the momentum distribution for all particles, commonly referred to as collectivity.

Nuclear Dependence of the Transverse-Single-Spin Asymmetry for Forward Neutron Production in Polarized p+A Collisions at sqrt[s_{NN}]=200 GeV

During 2015, the Relativistic Heavy Ion Collider (RHIC) provided collisions of transversely polarized protons with Au and Al nuclei for the first time, enabling the exploration of transverse-single-spin asymmetries with heavy nuclei. Large single-spin asymmetries in very forward neutron production have been previously observed in transversely polarized p+p collisions at RHIC, and the existing theoretical framework that was successful in describing the single-spin asymmetry in p+p collisions predicts only a moderate atomic-mass-number (A) dependence. In contrast, the asymmetries observed at RHIC in p+A collisions showed a surprisingly strong A dependence in inclusive forward neutron production. The observed asymmetry in p+Al collisions is much smaller, while the asymmetry in p+Au collisions is a factor of 3 larger in absolute value and of opposite sign. The interplay of different neutron production mechanisms is discussed as a possible explanation of the observed A dependence.

Association Between Endothelial Progenitor Cells and Treatment Response in Non-Squamous Non-small Cell Lung Cancer Treated with Bevacizumab

BACKGROUND/AIM

To investigate the association between the number of circulating endothelial progenitor cells (EPCs) in non-squamous non-small cell lung cancer (NSCLC) and disease outcome, in combination chemotherapy with and without bevacizumab.

MATERIALS AND METHODS

We retrospectively identified 25 non-squamous NSCLC cases, and divided them into high-EPC and low-EPC groups. Within each group, we compared disease outcomes, with or without the administration of bevacizumab.

RESULTS

In the high-EPC group, chemotherapy with bevacizumab produced a significantly higher tumor reduction rate and objective response rate, with significantly longer progression-free survival, compared to chemotherapy without bevacizumab (p<0.001, p=0.010, and p<0.001, respectively). However, in the low-EPC group, there were no significant differences in disease outcomes in groups with versus those without bevacizumab.

CONCLUSION

The number of EPCs may be a useful biomarker to guide decision-making in the use of bevacizumab in non-squamous NSCLC.

Contractile capability of the diaphragm assessed by ultrasonography predicts nocturnal oxygen saturation in COPD

BACKGROUND AND OBJECTIVE

Diaphragm function might be useful to predict nocturnal oxygen desaturation in COPD. Ultrasonography has been widely used for the assessment of the diaphragm. We aimed to investigate the relationship between the contractile capability of the diaphragm assessed by ultrasonography and the nocturnal percutaneous arterial oxygen saturation (NSpO₂ ) in COPD.

METHODS

Twenty-eight male patients with COPD (age, 73 ± 7 years; forced expiratory volume in 1 s (FEV₁ ), 54.2 ± 17.0% predicted) were included. The thickness of the diaphragm (Tdi) was assessed by ultrasonography. We calculated the change ratio of Tdi at the end of maximal inspiration and expiration (%ΔTdi). The mean value of NSpO₂ (NSpO_2mean ), the percentage of total sleep time (TST) with desaturation above 4% (DA4%) and the percentage of TST with saturation below 90% (SB90%) were measured by overnight oximetry. Daytime arterial oxygen pressure (PaO₂ ) and maximal inspiratory mouth pressure (PI_max ) were also measured.

RESULTS

All participants had mild or no daytime hypoxaemia (PaO₂ , 77.3 ± 8.6 mm Hg). The NSpO_2mean , DA4% and SB90% were significantly correlated with %ΔTdi, PaO₂ , %PI_max of the predicted value and the Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage. The %ΔTdi and PaO₂ were predictors of NSpO₂ mean by multiple regression analysis.

CONCLUSION

This study suggested a close relationship between the NSpO₂ and the contractile capability of the diaphragm assessed by ultrasonography in COPD. The %ΔTdi combined with PaO₂ might predict NSpO₂ in COPD patients with mild or no daytime hypoxaemia.

Relationship between balance and physical activity measured by an activity monitor in elderly COPD patients

Background

Little is known regarding the relationship between balance impairments and physical activity in COPD. There has been no study investigating the relationship between balance and objectively measured physical activity. Here we investigated the association between balance and physical activity measured by an activity monitor in elderly COPD patients.

Materials and methods

Twenty-two outpatients with COPD (mean age, 72±7 years; forced expiratory volume in 1 second, 53%±21% predicted) and 13 age-matched healthy control subjects (mean age, 72±6 years) participated in the study. We assessed all 35 subjects’ balance (one-leg standing test [OLST] times, Short Physical Performance Battery total scores, standing balance test scores, 4 m gait speed, and five-times sit-to-stand test [5STST]) and physical activity (daily steps and time spent in moderate-to-vigorous physical activity per day [MV-PA]). Possible confounders were assessed in the COPD group. The between-group differences in balance test scores and physical activity were analyzed. A correlation analysis and multivariate regression analysis were conducted in the COPD group.

Results

The COPD patients exhibited significant reductions in OLST times (P=0.033), Short Physical Performance Battery scores (P=0.013), 4 m gait speed (P<0.001), five-times sit-to-stand times (P=0.002), daily steps (P=0.003), and MV-PA (P=0.022) compared to the controls; the exception was the standing balance test scores. The correlation and multivariate regression analyses revealed significant independent associations between OLST times and daily steps (P<0.001) and between OLST times and MV-PA (P=0.014) in the COPD group after adjusting for possible confounding factors.

Conclusion

Impairments in balance and reductions in physical activity were observed in the COPD group. Deficits in balance are independently associated with physical inactivity.

[Improvement of physical activity in patients with COPD]

Physical activity (PA) is defined as any bodily movement produced by skeletal muscles that results in energy expenditure beyond resting energy expenditure. Physical activity is an important clinical parameter closely related to morbidity and mortality in COPD. A self-report questionnaire is often subject to recall bias, correlates only poorly with objectively qualified PA, and does not provide an accurate estimate of free-living energy expenditure. In contrast, tri-axial accelerometers generate objective data in terms of quantifying steps or body movements performed over a period of a time. Low-intensity and home-based pulmonary rehabilitation with the feedback from using pedometer was effective in improving PA, and the improvements of physiological factors were correlated with increased walking time in stable elderly patients with COPD.

Residual effects of zolpidem, triazolam, rilmazafone and placebo in healthy elderly subjects: a randomized double-blind study

With current hypnotic agents, next-day residual effects are a common problem. The purpose of the present study was to evaluate the residual effects of the commercially available hypnotics - zolpidem, triazolam, and rilmazafone - on the physical and cognitive functions of healthy elderly people in the early morning and the day following drug administration. In this study, the next-day residual effects of zolpidem, triazolam, and rilmazafone, following bedtime dosing in elderly subjects, were evaluated. Women (n = 11) and men (n = 2) aged 60-70 years received a single dose (at 23:00) of one of these, zolpidem 5 mg, triazolam 0.125 mg, rilmazafone 1 mg and placebo in a randomized, double-blind, crossover design. Measures of objective parameters and psychomotor performances (Timed up and Go test, Functional Reach Test, body sway test, critical flicker fusion test, simple discrimination reaction test, short-term memory test) and subjective ratings were obtained at 04:00, 07:00, and the next time of the day. All hypnotics were generally well tolerated; there were no serious adverse side effects and no subjects discontinued the evaluations. Compared to placebo, zolpidem and rilmazafone had good results on the Functional Reach Test. Although subjective assessments tended to be poor in the early morning, rilmazafone significantly improved the body sway test in the other hypnotics. A single dose of zolpidem 5 mg and triazolam 0.125 mg did not have any next-day residual effects on healthy elderly subjects. Residual effects appeared to be related to the compound's half-life and the dose used. Rilmazafone 1 mg exhibited steadiness in static and dynamic balance and seemed to be more favorable for the elderly with early morning awakening.

Practical method using superposition of individual magnetic fields for initial arrangement of undulator magnets

We have developed a practical method for determining an excellent initial arrangement of magnetic arrays for a pure-magnet Halbach-type undulator. In this method, the longitudinal magnetic field distribution of each magnet is measured using a moving Hall probe system along the beam axis with a high positional resolution. The initial arrangement of magnetic arrays is optimized and selected by analyzing the superposition of all distribution data in order to achieve adequate spectral quality for the undulator. We applied this method to two elliptically polarizing undulators (EPUs), called U#16-2 and U#02-2, at the Photon Factory storage ring (PF ring) in the High Energy Accelerator Research Organization (KEK). The measured field distribution of the undulator was demonstrated to be excellent for the initial arrangement of the magnet array, and this method saved a great deal of effort in adjusting the magnetic fields of EPUs.

Effects of low-intensity exercise and home-based pulmonary rehabilitation with pedometer feedback on physical activity in elderly patients with chronic obstructive pulmonary disease

PURPOSE

We evaluated the effects of low-intensity and home-based pulmonary rehabilitation (PR) on physical activity (PA) and the feedback provided by a pedometer in stable elderly patients with chronic obstructive pulmonary disease (COPD).

METHODS

We assessed PA using a newly developed triaxial accelerometer (A-MES™, Kumamoto, Japan), which measures the time spent walking, standing, sitting and lying down. Twenty-seven elderly patients with COPD (age 74 ± 8 yrs; %FEV1 56.6 ± 18.7%) participated. They were randomly selected to undergo PR (pulmonary rehabilitation only) or PR + P (PR plus the feedback from using a pedometer). Their PA and pulmonary function, exercise capacity (6-min walking distance; 6MWD), quadriceps femoris muscle force (QF) were evaluated before the PR began (baseline) and at 1 year later. We compared the patients' changes in PA and other factors between the baseline values and those obtained 1 year later and analyzed the relationships between the changes in PA and other factors in the both groups.

RESULTS

The increase in the time spent walking in the PR + P group (51.3 ± 63.7 min/day) was significantly greater than that of PR group (12.3 ± 25.5 min/day) after the PR. The improvement rate of daily walking time after PR was significantly correlated with that of the 6MWD and QF in all subjects.

CONCLUSIONS

These data suggest that low-intensity and home-based PR with the feedback from using pedometer was effective in improving PA, and the improvements of physiological factors were correlated with increased walking time in stable elderly patients with COPD.

Dynamic hyperinflation and dyspnea during the 6-minute walk test in stable chronic obstructive pulmonary disease patients

The purpose of this study was to investigate the relationship between dynamic hyperinflation and dyspnea and to clarify the characteristics of dyspnea during the 6-minute walk test (6MWT) in chronic obstructive pulmonary disease patients. Twenty-three subjects with stable moderate chronic obstructive pulmonary disease (age 73.8±5.8 years, all male) took part in this study. During the 6MWT, ventilatory and gas exchange parameters were measured using a portable respiratory gas analysis system. Dyspnea and oxygen saturation were recorded at the end of every 2 minute period during the test. There was a significant decrease in inspiratory capacity during the 6MWT. This suggested that dynamic hyperinflation had occurred. Dyspnea showed a significant linear increase, and there was a significant negative correlation with inspiratory capacity. It was suggested that one of the reasons that dyspnea developed during the 6MWT was the dynamic hyperinflation. Even though the tidal volume increased little after 2 minutes, dyspnea increased linearly to the end of the 6MWT. These results suggest that the mechanisms generating dyspnea during the 6MWT were the sense of respiratory effort at an early stage and then the mismatch between central motor command output and respiratory system movement.

Quantitative assessment of walking time and postural change in patients with COPD using a new triaxial accelerometer system

Background

The purpose of this study was to quantify the walking time and frequency of postural changes in daily life in patients with chronic obstructive pulmonary disease (COPD) using a new triaxial accelerometer system.

Methods

Twenty-six elderly patients with stable COPD (age 76.8 ± 6.2 years; percent forced expiratory volume in one second [%FEV₁] 52.9% ± 26.3%) and 20 age-matched elderly subjects (age 73.0 ± 4.2 years; %FEV₁ 124.0% ± 22.3%) participated in the study. The subjects’ time spent walking (slow, fast), standing, sitting, and lying down and the frequency of their postural changes (getting up, standing up) were assessed for 7 consecutive days using an Activity Monitoring And Evaluation System (A-MES™). We analyzed the relationships among walking times, frequency of postural changes, and physiologic factors in both COPD patients and controls.

Results

The COPD patients’ total walking time, including slow (<2 km/hour) and fast (≥2 km/hour) walking, and their frequency of standing up were significantly lower than those of the age-matched controls (P < 0.01). The fast walking time in daily life was significantly correlated with the 6-minute walking distance, quadriceps femoris muscle force, and dyspnea (P < 0.01).

Conclusion

These results suggest that both slow (<2 km/hour) and fast (≥2 km/hour) walking time and frequency of postural changes is significantly decreased in COPD patients compared with healthy elderly subjects. The data also suggest that the COPD patients’ different walking times in daily life are significantly correlated with exercise capacity and dyspnea. The 6-minute walking distance had the strongest correlation with fast walking time.

Questionnaire survey on the continuity of home oxygen therapy after a disaster with power outages

BACKGROUND

After the Great East Japan Earthquake, oxygen-dependent patients in areas experiencing power outages could not continue home oxygen therapy (HOT) without oxygen cylinders. The purpose of this study was to examine use of oxygen cylinders in areas experiencing power outages and the effects of HOT interruption on patients' health.

METHODS

Questionnaires were mailed to 1106 oxygen-dependent patients and HOT-prescribing physicians in Akita, near the disaster-stricken area. We investigated patients' actions when unable to use an oxygen concentrator and classified the patients based on oxygen cylinder use. Patients who experienced an interruption of or reduction in oxygen flow rate by their own judgment were assigned to the "interruption" and "reduction" groups, respectively; those who maintained their usual flow rate were assigned to the "continuation" group. Differences were tested using analysis of variance and the χ2 tests.

RESULTS

In total, 599 patients responded to the questionnaire. Oxygen cylinders were supplied to 574 patients (95.8%) before their oxygen cylinders were depleted. Comparison of the continuation (n=356), reduction (n=64), and interruption (n=154) groups showed significant differences in family structure (p=0.004), underlying disease (p=0.014), oxygen flow rate (p<0.001), situation regarding use (p<0.001), knowledge of HOT (p<0.001), and anxiety about oxygen supply (p<0.001). There were no differences in changes in physical condition.

CONCLUSIONS

Most patients could receive oxygen cylinders after the disaster. Some patients discontinued their usual oxygen therapy, but their overall health status was not affected.

Prevalence of pulmonary arteriovenous malformations as estimated by low-dose thoracic CT screening

BACKGROUND

Pulmonary arteriovenous malformations (PAVMs) are rarely encountered in clinical practice. The prevalence of PAVMs associated with hereditary hemorrhagic telangiectasia (HHT) has been estimated based on the rate in the family members of HHT patients, but the prevalence of PAVMs in the general population remains unknown.

METHODS

We retrospectively examined the prevalence and clinical characteristics of PAVMs as detected by a low-dose thoracic CT screening program for lung cancer at the Hitachi Medical Center and the Hitachi General Health Care Center in the northern part of Ibaraki Prefecture, Japan.

RESULTS

From 2001 to 2007, we identified eight patients (seven females and one male) with PAVMs among 21,235 initial screening participants (the mean age of the patients with PAVMs and that of the screening participants was 60.6 years). The prevalence of PAVMs was estimated at 38 per 100,000 individuals [95% confidence interval (CI)=18-76]. The diameter of the PAVMs was a mean of 6.6 mm, and none of the lesions could be detected by chest X-ray. Females older than 60 years tended to have larger PAVMs than younger women did (p=0.06). Two patients (25%) were diagnosed with HHT. One patient had previously undergone surgery for a brain abscess.

CONCLUSION

PAVMs are more prevalent than previously reported, especially among females.

Endothelial progenitor cells are associated with response to chemotherapy in human non-small-cell lung cancer

PURPOSE

Bone marrow-derived endothelial progenitor cells (EPCs) play an important role in angiogenesis and tumor growth. However, the clinical relevance of EPCs in non-small-cell lung cancer (NSCLC) remains unclear. Recently, some reports suggested that EPCs correlate with clinical behavior of cancer patients. We assessed the hypothesis that EPCs correlate with efficient of therapy, prognosis, and clinicopathological factors, and EPCs may offer a possible biomarker for treatment outcome in NSCLC.

METHODS

EPCs labeled with CD34, CD133, and vascular endothelial growth factor receptor-2 (VEGFR-2) antibodies were counted by flow cytometry in the peripheral blood of 31 NSCLC patients. We categorized two groups of NSCLC patients according to circulating EPC numbers. We examined age, pathological stage, histological type, Fluoro-D: -glucose Positron emission tomography (FDG-PET), response to therapy, progression-free survival, and tumor size of NSCLC patients and investigated whether these factors correlate with EPC counts.

RESULTS

Circulating EPC numbers before antitumor therapy were increased in NSCLC patients compared with healthy controls (P < 0.05). In NSCLC patients, therapy was significantly effective in low circulating EPC group compared with that of high (P < 0.05). Furthermore, the low EPC group showed significantly longer progression-free survival times than that of high (P < 0.05). However, no significant associations with age, gender, histological type, pathological stage, or FDG-PET were detected.

CONCLUSION

Peripheral blood levels of bone marrow-derived EPCs are significantly increased in patients with NSCLC and correlate with response to chemotherapy. EPCs may offer a possible biomarker for efficient of treatment and prognosis.

Long-term effect of the beta2-receptor agonist procaterol on daily life performance and exercise capacity in patients with stable chronic obstructive pulmonary disease. Clinical study with special reference to health-related quality of life and activities of daily living

The present study was undertaken to evaluate the long-term effect of procaterol hydrochloride (CAS 62929-91-3, Meptin), a third generation beta2-receptor agonist on lung function, exercise capacity, health-related quality of life (HRQOL) and activities of daily living (ALDs) in patients with stable chronic obstructive pulmonary disease (COPD). Twenty patients were randomly assigned to the procaterol group or to the control group, who received oxitropium bromide (CAS 30286-75-0), an anticholinergic agent. Procaterol was inhaled three times a day at a dose of 20 pg, while oxitropium was inhaled three times a day at a dose of 200 microg. The subjects were evaluated based on spirometry, exercise capacity, the Borg Scale, HRQOL, and ADLs before and after 12, 24 and 52 weeks of therapy. The values of forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), total lung capacity (TLC), functional residual capacity (FRC), residual volume (RV), maximal inspiratory pressure (PImax), and maximal expiratory pressure (PEmax) were significantly improved at 12, 24 and 52 weeks compared with baseline values in the procaterol group (p < 0.05, p < 0.01), while these values did not differ from baseline values at any point in the oxitropium group (p > 0.05). Additionally, 6-min walking distances and Borg Scale values showed significant improvement at 12, 24 and 52 weeks compared with baseline values in the procaterol group (p < 0.05, p < 0.01), but did not significantly differ from baseline values in the oxitropium group at any point (p > 0.05). Likewise, the scores for dyspnea, fatigue, emotional function, mastery, total scores and ADLs were significantly higher at 12, 24 and 52 weeks compared with the baseline values in the procaterol group (p < 0.05, p < 0.01), but did not differ at any point in the oxitropium group (p > 0.05). These results suggest the effectiveness of long-term regular bronchodilator therapy with the beta2-receptor agonist procaterol in patients with stable COPD.

Antitussive effects of the H1-receptor antagonist epinastine in patients with atopic cough (eosinophilic bronchitis)

Chronic cough is the only symptom of eosinophilic bronchitis (EB). There is considerable overlap between EB and atopic cough. To investigate the antitussive effects of a histamine H1-recetor antagonist, epinastine hydrochloride (epinastine, CAS 80012-43-7, Alesion; 20 mg/day, once daily), cough scores, pulmonary function, capsaicin cough threshold, and bronchial hyperresonsiveness (BHR) to methacholine (MCh) were evaluated before and after a 4-week treatment with epinastine in patients with EB. In the epinastine group, the cough scores were decreased significantly (18.3 +/- 6.1 in week 1, 17.4 +/- 6.7 in week 2, 15.1 +/- 6.2 in week 3, 14.0 +/- 4.8 in week 4) in comparison with the value of 35.3 +/- 8.7 in week -2). The cough threshold for capsaicin improved from 1.70 +/- 3.04 micromol/l to 12.7 +/- 17.6 micromol/l in the epinastine group (p < 0.05; baseline vs. week 4) The bronchial hyperresponsiveness to MCh (Dmin) did not change significantly either in the epinastine or the placebo groups. The morning and evening peak expiratory flow rate (PEFR, L/min) did not change from the baseline period in either the epinastine or the placebo groups. These results suggested that epinastine may be useful for treating patients with EB and that histamine H1-receptor is related to the pathophysiology of coughing in EB.