Predictors of health status do not change over three-year periods and exacerbation makes difference in chronic obstructive pulmonary disease

<p>Abstract</p> <p>Background</p> <p>The association between disease markers and health status (HS) overtime is unclear. The aim of this study was to verify the predictors of HS at baseline and after three years in Chronic Obstructive Pulmonary Disease (COPD) patients.</p> <p>Methods</p> <p>Ninety-five consecutive COPD patients (66% male, age = 67 ± 9 y, FEV₁= 58 ± 23%) underwent the following evaluations at baseline and after three years: body composition, pulse oximetry (SpO₂), six-minute walk distance (6MWD), Modified edical Research Council dyspnea scale (MMRC) and Saint George's Respiratory Questionnaire (SGRQ). The Charlson comorbidity index and BODE index were calculated. COPD exacerbations during the follow-up were evaluated. At baseline, age, gender, smoking, SpO₂, BODE index or its components (BMI, MMRC, FEV₁and 6MWD), and Charlson index were included in a multiple linear regression analysis with the baseline SGRQ total score as the dependent variable. After three years, we included the final values of the variables plus the number of exacerbations and the final SGRQ total score as the dependent variable.</p> <p>Results</p> <p>SGRQ total score (42 ± 19% <it>vs </it>44 ± 19%; p = 0.041) and activity domain (52 ± 21% <it>vs </it>60 ± 22%; p < 0.001) deteriorated during follow-up. At baseline, BODE index was selected as a predictor of SGRQ total score (R²= 0.46; p < 0.001); after three years, BODE index and age were the predictors (R²= 0.49; p < 0.001). When the BODE index was replaced by its variables, MMRC was selected as the only variable associated with the SGRQ total score (R²= 0.58; p < 0.001). After three years, MMRC, FEV₁and number of exacerbations were selected as predictors of SGRQ total score (R²= 0.63; p < 0.001).</p> <p>Conclusion</p> <p>HS deteriorated significantly over the three-year period and the predictors of HS do not change over time. BODE index and dyspnea were predictors at baseline and after three years. Exacerbation was also a predictor of HS after three years.</p> <p>Trial Registration</p> <p>ClinicalTrials.gov: <a href="http://www.clinicaltrials.gov/ct2/show/NCT00605540">NCT00605540</a></p

Heterostructures for High Performance Devices

Contains an introduction, reports on thirteen research projects and a list of publications.Charles S. Draper Laboratory Contract DL-H-418483DARPA/NCIPT Subcontract 542383Joint Services Electronics Program Contract DAAL03-89-C-0001IBM Corporation FellowshipNational Science Foundation FellowshipVitesse SemiconductorAT&T Bell LaboratoriesHertz Foundation FellowshipNational Science FoundationTRWBelgian American Education Foundation (BAEF) FellowshipNational Science Foundation Grant ECS 90-08485Harvard University. Division of Applied PhysicsAT&T Bell Laboratories FellowshipNational Science Foundation Grant ECS 90-0774

Responses of yield and N use of spring sown crops to N fertilization, with special reference to the use of plant growth regulators

The role of plant growth regulators (PGR) in nitrogen (N) fertilization of spring wheat and oats (CCC), fodder barley (etephon/mepiquat) and oilseed rape (etephone) in crop rotation was studied in 19931996 on loamy clay soil. Carry over effect of the N fertilization rates (0180 kg ha-1 ) was evaluated in 1997. N fertilization rate for the best grain/seed yield (120150 kg ha-1 ) was not affected by PGRs. The seed and N yields of oilseed rape were improved most frequently by recommended use of PGR. The yields of oats were increased in 199596. Even though PGR effectively shortened the plant height of spring wheat, the grain yield increased only in 1995. N yield of wheat grains was not increased. Response of fodder barley to PGR was insignificant or even negative in 1995. The data suggest that PGRs may decrease some N leaching at high N rates by improving N uptake by grain/seeds, if the yield is improved. The carryover study showed that in soils with no N fertilization, as well as in soils of high N rates, N uptake was higher than in soils with moderate N fertilization (6090 kg ha-1 ), independent of PGRs. According to soil mineral N contents, N leaching risk is significant (1535 kg ha-1 ) only after dry and warm late seasons. After a favourable season of high yields, the N rates did not significantly affect soil mineral N contents. ;Voidaanko typpilannoituksen hyötyä parantaa kasvunsääteidenavulla vai lisäävätkö kasvunsääteet typen käyttöä tuottamatta lisää satoa? Näitä kysymyksiä sekä typpilannoituksen jälkivaikutuksia tutkittiin edesmenneen professori Paavo Elosen hietasavimaalle perustamassa kenttäkokeessa vuosina 19931997. Koekasveja viljeltiin neljässä vierekkäisessä lohkossa viljelykierrossa, seitsemällä eri typpitasolla (0180 kg/ha). Suurin sato saatiin typpilannoituksen tasolla 120150 kg/ha. Vuoden 1993 suositusten mukaiset kasvunsäädekäsittelyt, jotka vuonna 1995 tosin viivästyivät sateiden vuoksi, eivät vaikuttaneet tähän optimitasoon. Kasvunsääteet kuitenkin saattoivat lisätä jyvä- ja typpisatoja varsinkin suurilla typpilannoitusmäärillä, tehostaen siten typen ottoa. Lisäystä ei kuitenkaan havaittu kaikilla viljelykasveilla. Ainoastaan rypsi (cv. Kulta) hyötyi kasvunsäädekäsittelystä (Cerone) kaikkina koevuosina, jopa kuivana kesänä 1994. Kasvunsääde (CCC) lisäsi myös kauran (cv. Yty) jyvä- ja typpisatoja, mutta vain sateisina kesinä, jolloin lakoutuminen selvästi väheni käsittelyn myötä. Kevätvehnällä (cv. Satu) vuosittainen vaihtelu oli suuri, ja kasvunsääteen (CCC) edullinen vaikutus jyväsatoon oli merkittävä vain vuonna 1995, jolloin alkukesä oli hyvin sateinen ja loppukesä kuiva. Tällöin kasvunsääde lyhensi selvästi vehnän korren pituutta (30 cm). Typpisadot eivät kuitenkaan kohonneet, koska kasvunsääde laski jyvän typpipitoisuutta. Kasvunsääteen (Terpal) vaikutus rehuohran (cv. Loviisa) jyvä- ja typpisatoihin vaihteli suuresti eri vuosina. Typpisadot jopa laskivat merkitsevästi viivästyneen käsittelyn vaikutuksesta vuonna 1995. Kasvunsääteet lisäsivät yleensä puintikosteutta, mutta muuten jyvän laatu heikkeni vain vähän tai käsittelyillä ei ollut vaikusta valkuaispitoisuuksiin ja 1000 jyvän painoon, paitsi vehnällä vuonna 1995. Rypsin 1000 siemenen paino kasvoi vuosina 199495 kasvunsääteen ansiosta. Typpilannoituksen ja kasvunsäädekäsittelyjen jälkivaikutusta tutkittiin vuonna 1997, jolloin koko koealueelle kylvettiin rehuohraa. Typpilannoitustaso oli kaikissa koeruuduissa 30 kg/ha. Tulosten mukaan paras sato saatiin koealueilta, jotka lannoitettiin aiempina vuosina suurimmalla typpimäärällä. Myös typpisato oli näissä ruuduissa suurin, runsaat 50 kg/ha. Koevuosien lannoitustasoilla 6090 kg/ha typpisato oli tätä 10 kg/ha pienempi. Ilman typpilannoitusta viljellyissä ruuduissa ero oli vain 5 kg/ha. Pienempi ero osoitti, että maahan kertyy typpeä, mikäli typpilannoitusta ei käytetä lainkaan. Tällöin heikoksi jäävä kasvusto ei todennäköisesti pysty tyhjentämään maan typpivaroja yhtä tehokkaasti kuin kohtuullisesti lannoitetut kasvustot. Vastaavasti korkeilla typpilannoitustasoilla (150180 kg/ha) kasvi ei pysty hyödyntämään kaikkea käytettävissä olevaa typpeä, riippumatta kasvunsääteiden käytöstä. Suuret typpilannoitusmäärät lisäsivät korjuun jälkeisiä maan mineraalityppipitoisuuksia, mutta vain kuivan kesän jälkeen. Syksyllä 1994 maan nitraatti-typpipitoisuudet olivat 1535 kg/ha suuremmat typpilannoitustasoilla 127187 kg/ha verrattuna pienempiin typpilannoitusmääriin. Keväällä 1995 mineraalityppeä oli eniten jankossa suuria typpimääriä saaneilla koeruuduilla, osoittaen mahdollista huuhtoutumista. Vuoden 1996 suotuisan, hyviä satoja tuottaneen kasvukauden jälkeen maan minaraalityppipitoisuudet olivat lähes samanlaiset eri lannoitustasoilla. Typen huuhtoutumisen välttämiseksi tulokset puoltavat typpilannoitustasoa 90100 kg/ha. Tutkimus tukee näin nykyisiä ympäristötukiehtoja. Tulosten mukaan kasvunsääteet voivat parantaa typen hyväksikäyttöä, mutta tutkituilla aineilla todennäköisimmin vain rypsin ja sateisina kesinä kauran viljelyssä

Predictors of mortality in patients with COPD after 9 years

Robson Prudente,1 Estef&acirc;nia Aparecida Thom&eacute; Franco,2 Carolina Bonfanti Mesquita,1 Renata Ferrari,1 Irma de Godoy,1 Suzana Erico Tanni1 1Department of Internal Medicine, S&atilde;o Paulo State University (UNESP), Medical School, Botucatu, S&atilde;o Paulo Brazil; 2University Hospital of S&atilde;o Paulo State University (UNESP), Medical School, Botucatu, S&atilde;o Paulo, Brazil Background: COPD is one of the leading causes of morbidity and mortality in the world; however, the most varied amounts of clinical and laboratory characteristics acts in different ways in the mortality among over time. Therefore, this study aimed to evaluate the predictors of mortality in patients with COPD after 9 years.Patients and methods: One hundred and thirty-three patients with COPD were assessed at baseline by spirometry, pulse oximetry (SpO2), body composition, intensity of dyspnea, distance walked in the 6-minute walk test (6MWT), and Charlson Comorbidity Index (CCI).Results: After 9 years, it was not possible to identify the lifetime of 4 patients who died and of 19 patients who stopped follow-up; thus, 110 patients were included in the analysis of predictors of mortality (67% male, 65&plusmn;9 years old, and FEV1: 52.5 [40%&ndash;73%]). Male sex, age, SpO2, Body mass index, airway Obstruction, Dyspnea, and Exercise capacity (BODE) index, and frequency of exacerbations in the first 3 years of follow-up were considered in the model. Patients classified at baseline with BODE class 2 (HR: 2.62, 95% CI: 1.36&ndash;5.04; P=0.004), BODE class 3 (HR: 2.54, 95% CI: 1.15&ndash;5.61; P=0.02), and BODE class 4 (HR: 15.35, 95% CI: 3.11&ndash;75.75; P=0.001) showed increased risk of death compared to those with BODE class 1. The CCI (HR: 1.29, 95% CI: 1.00&ndash;1.68; P=0.04) and the number of exacerbations in the first 3 years (HR: 1.32, 95% CI: 1.00&ndash;1.76; P=0.04) also showed increased risk of death. By replacing the BODE index for the variables that compose it, those with body mass index &le;21 kg/m2 showed increased risk of death compared to those with body mass index (BMI)&gt;21 kg/m2 (HR: 2.70, 95% CI: 1.38&ndash;5.25; P=0.003).Conclusion: After 9 years, we identified that those with high BODE index, greater CCI, greater frequency of exacerbations in the first 3 years, and BMI &le;21 kg/m2 showed increased risk of death. Keywords: COPD, disease severity index, mortality&nbsp

Relation between systemic inflammatory markers, peripheral muscle mass, and strength in limb muscles in stable COPD patients

Renata Ferrari,1 Laura MO Caram,1 Marcia M Faganello,2 Fernanda F Sanchez,3 Suzana E Tanni,1 Irma Godoy1 1Botucatu Medical School, Department of Internal Medicine, Pneumology Area, Botucatu, S&atilde;o Paulo, 2Paulista State University, Department of Physiotherapy and Occupational Therapy, Marilia, S&atilde;o Paulo, 3Federal&nbsp;University of Amazonas, Department of Physiotherapy, Manaus, Amazonas, Brazil Abstract: The aim of this study was to investigate the association between systemic inflammatory mediators and peripheral muscle mass and strength in COPD patients. Fifty-five patients (69% male; age: 64&plusmn;9 years) with mild/very severe COPD (defined as forced expiratory volume in the first second [FEV1] =54%&plusmn;23%) were evaluated. We evaluated serum concentrations of IL-8, CRP, and TNF-&alpha;. Peripheral muscle mass was evaluated by computerized tomography (CT); midthigh cross-sectional muscle area (MTCSA) and midarm cross-sectional muscle area (MACSA) were obtained. Quadriceps, triceps, and biceps strength were assessed through the determination of the one-repetition maximum. The multiple regression results, adjusted for age, sex, and FEV1%, showed positive significant association between MTCSA and leg extension (0.35 [0.16, 0.55]; P=0.001), between MACSA and triceps pulley (0.45 [0.31, 0.58]; P=0.001), and between MACSA and biceps curl (0.34 [0.22, 0.47]; P=0.001). Plasma TNF-&alpha; was negatively associated with leg extension (-3.09 [-5.99, -0.18]; P=0.04) and triceps pulley (-1.31 [-2.35,&nbsp;-0.28]; P=0.01), while plasma CRP presented negative association with biceps curl (-0.06 [-0.11, -0.01]; P=0.02). Our results showed negative association between peripheral muscle mass (evaluated by CT) and muscle strength and that systemic inflammation has a negative influence in the strength of specific groups of muscles in individuals with stable COPD. This is the first study showing association between systemic inflammatory markers and strength in upper limb muscles. Keywords: Inflammation, skeletal muscle, X-Ray Computed Tomograph

Three-year follow-up study of respiratory and systemic manifestations of chronic obstructive pulmonary disease

Few studies show patient outcomes over time in chronic obstructive pulmonary disease (COPD). In the present study, we monitored forced expiratory volume in the first second (FEV1) and other manifestations of the disease over 3 years in 133 COPD patients (69% males, age = 65 ± 9 years, FEV1 = 59 ± 25%) evaluated at baseline. During follow-up, 15 patients (11%) died and 23 (17%) dropped out. Measurements for 95 (72%) COPD patients alive after 3 years were analyzed. FEV1, body mass index (BMI), 6-min walking distance (6MWD), Medical Research Council scale (MRC), Saint George’s Respiratory Questionnaire (SGRQ), Charlson Comorbidity index, and BODE index were obtained at baseline and after 3 years. At baseline, 17 patients (18%) presented mild, 39% moderate, 19% severe, and 24% very severe COPD. Predicted FEV1 % and BMI did not change over the period (P > 0.05). FEV1 in liters [1.25 (0.96-1.72) vs 1.26 (0.88-1.60) L; P < 0.001], 6MWD (438 ± 86 vs 412 ± 100 m; P < 0.001), MRC [1 (1-2) vs 2 (1-3); P = 0.002], Charlson index [3 (3-4) vs4 (3-5); P = 0.009], BODE index (2.2 ± 1.8 vs 2.6 ± 2.3; P = 0.008), and total SGRQ (42 ± 19 vs 44 ± 19%; P = 0.041) worsened after 3 years compared to baseline measurements. These data show that COPD patients deteriorated during the 3-year follow-up despite the fact that they had only minor modifications in airway obstruction and body composition. They support the need for comprehensive patient assessment to better identify disease progression