Risk factors for exacerbations and pneumonia in patients with chronic obstructive pulmonary disease: a pooled analysis.

BACKGROUND: Patients with chronic obstructive pulmonary disease (COPD) are at risk of exacerbations and pneumonia; how the risk factors interact is unclear. METHODS: This post-hoc, pooled analysis included studies of COPD patients treated with inhaled corticosteroid (ICS)/long-acting β2 agonist (LABA) combinations and comparator arms of ICS, LABA, and/or placebo. Backward elimination via Cox's proportional hazards regression modelling evaluated which combination of risk factors best predicts time to first (a) pneumonia, and (b) moderate/severe COPD exacerbation. RESULTS: Five studies contributed: NCT01009463, NCT01017952, NCT00144911, NCT00115492, and NCT00268216. Low body mass index (BMI), exacerbation history, worsening lung function (Global Initiative for Chronic Obstructive Lung Disease [GOLD] stage), and ICS treatment were identified as factors increasing pneumonia risk. BMI was the only pneumonia risk factor influenced by ICS treatment, with ICS further increasing risk for those with BMI <25 kg/m2. The modelled probability of pneumonia varied between 3 and 12% during the first year. Higher exacerbation risk was associated with a history of exacerbations, poorer lung function (GOLD stage), female sex and absence of ICS treatment. The influence of the other exacerbation risk factors was not modified by ICS treatment. Modelled probabilities of an exacerbation varied between 31 and 82% during the first year. CONCLUSIONS: The probability of an exacerbation was considerably higher than for pneumonia. ICS reduced exacerbations but did not influence the effect of risks associated with prior exacerbation history, GOLD stage, or female sex. The only identified risk factor for ICS-induced pneumonia was BMI <25 kg/m2. Analyses of this type may help the development of COPD risk equations

Sensitivity of lung resistance and compliance to beta-blocker induced bronchoconstriction and long acting beta-agonist withdrawal in COPD

Little is known about impulse oscillometry (IOS) in COPD. IOS is an effort independent measure of lung resistance and reactance (compliance). We assessed how frequency dependence of resistance (R) and reactance (X) changed in response to bronchoconstriction with carvedilol followed by long acting beta-agonist (LABA) withdrawal. N = 12 patients with moderate to severe COPD were analysed, who had ≥ 100 ml fall in FEV1 with carvedilol. Compared to baseline taking ICS/LABA there were 21, 59, and 135% significant changes in resistance at 5 Hz (R5), reactance at 5 Hz (X5), and reactance area (AX), respectively, with carvedilol, while after LABA withdrawal only AX showed a further significant increase to 210% (i.e. reduced compliance). Hence changes in lung compliance rather than resistance play a more important role in the beta-2 receptor-mediated responses in COPD

Linking Adult Reproduction and Larval Density of Invasive Carp in a Large River

Identifying how temporal variation in the environment affects reproductive success of invasive alien species will aid in predicting future establishment and tracking dynamics of established populations. Asian carp Hypophthalmichthys spp. have become a nuisance in recent years in the Mississippi River basin. Their populations are apparently expanding, indicating favorable conditions for reproduction. During 2004 and 2005, we quantified mean density of Asian carp larvae, mean monthly gonadosomatic index (GSI) of adult males and females, and number of eggs within mature females in the lower Illinois River, a major tributary of the Mississippi River. A flood (water velocity ≥ 0.7 m/s) and drought (\u3c0.2 m/s) occurred during apparent spawning in 2004 and 2005, respectively. During 2004, Asian carp larvae were found during 32% of sampling weeks; mean GSI and fecundity were relatively low for adults, probably reflecting partially spawned individuals and perhaps low reproductive investment. During the drought of 2005, larval stages were present during only one (5%) of the sampling weeks, whereas mean GSI and fecundity of adults were high through summer. Females resorbed their eggs instead of spawning during this year. Spawning conditions during low water periods appear to be unsuitable for Asian carps, inhibiting adult spawning and yielding few larvae. Spawning conditions during 2004 were better but still yielded low densities of larvae relative to native fishes. Reproduction in the lower Illinois River appears to be linked to river flow and its impact on adult spawning decisions, but conditions for strong year-class production (i.e., high larval densities) may be rarer than previously expected

Shear Waves in Highly Concentrated Viscoelastic Wormlike Micellar Fluid

Wormlike micellar fluids form by the self-aggregation of surfactant molecules in aqueous solution. These non-Newtonian fluids have been well studied and are used in the oil industry, hydraulics, and medical research. However, little is known regarding the structure of the three-dimensional networks in which the “worms” become entangled and possibly branched, especially at high concentrations. What is known is that this composition results in two distinctive fluid characteristics: viscoelasticity and strain-birefringence. The latter is exploited in this work in order to study the shear wave speed and attenuation in 500/300mM CTAB/NaSal fluid. Three different experiments were conducted using either a laser/diode system or a camera/backlight system. The average speed of a shear wave in wormlike micellar fluid was determined to be 63.47cm/s for this concentration at room temperature with no consistent effect from aging. Temperature, however, had a significant impact. Around 35oC, there was a dramatic drop in shear speed. The steady linear decrease in micelle length with increasing temperature does not account for this steep decline. A possible explanation is that the micelle conformation changes at this point—a topological phase transition. It is recommended that the rheology around this temperature be examined

Growth, Fecundity, and Diets of Newly Established Silver Carp in the Middle Mississippi River

The silver carp Hypophthalmichthys molitrix has spread throughout the Mississippi River drainage. During 2003, we determined its population status and potential impact in the middle Mississippi River (MMR), the conduit between the lower Mississippi River and the upper Mississippi, Missouri, and Illinois rivers. We quantified growth, age structure, fecundity, and diets of silver carp sampled with trammel nets and AC electrofishing in main-channel areas. Mean length at age in the MMR exceeded that of populations in Asia by as much as 26%. Individuals were typically more than 1 year old and 230 mm total length, suggesting that small, young fish were absent. Individuals in this population matured earlier (age 2) than in the species\u27 native range. Regardless of phytoplankton variation (using chlorophyll a as a surrogate) and zooplankton concentration at MMR sites, phytoplankton was consistently most abundant in diets. Silver carp are finding suitable resources within the MMR, allowing individuals to grow rapidly during early life, persist as adults, and successfully disperse upstream