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Patients with COPD have a higher risk of type 2 diabetes compared with control subjects after adjusting for confounding factors such as sex, age, residential area, insurance premium, steroid use, hypertriglycemia, hypertension, CAD and cerebrovascular disease. Continuous surveillance of signals of dysglycemia may be incorporated into care programmes for patients with COPD.

Purpose: To compared the clinical efficacy of tramadol and morphine using a patient-controlled analgesia (PCA) delivery system. Methods: In a prospective, randomized, double blind study, we evaluated 80 adult patients scheduled for elective hip or knee arthroplasty with general inhalational anesthesia. When patients complained of pain in the recovery room, patients were randomized to receive either tramadol or morphine by titration in 30 min to achieve analgesia (VAS ~ 4). Equivalent volumes containing either 30 mg-ml -I tramadol or I mgml -I morphine were used for PCA with a lockout interval of 10 min. The patients were followed six-hourly for 48 hr for VAS, satisfaction rate, analgesic dose, and side effects. Results: Patients obtained adequate analgesia with either drug. More patients had very good satisfaction scores in the morphine group in the recovery room (43% vs 23%, P < 0.05) and at 24 hr (40% vs 20%, P < 0.05) than those in the tramadol group. More nausea was evident in the tramadol group (48% vs I I% in recovery room and 28% vs 12% in 24 hr, P < 0.05) than in the morphine group. Vomiting was also more (28% vs 5% in recovery room, 15% vs 3% in 24 hr, P < 0..05). Morphine produced more sleepiness (45% vs 23% in recovery room, P < 0.05 and 35% vs 15% in 24 hr, P < 0.05). Conclusion: Tramadol PCA can provide effective analgesia following major orthopedic surgery provided sufficiently high doses are given for loading and by patient demand. However, the incidence of nausea/vomiting is also higher causing decreased satisfaction.Objectif : Comparer I'efficacit~ clinique du tramadol et de la morphine en utilisant un syst~me d'analg&ie contr61~e par le patient (ACP). M~.thode : Lors d'une &ude prospective, randomis~e et en double aveugle, nous avons ~valu~ 80 adultes dont rarthroplastie de la hanche ou du genou avait ~t~ pr~vue avec une anesth&ie g~n&ale d'inhalation./~ la salle de r~veil, les patients r~partis au hasard ont re,u, quand ils ~prouvaient de ta douleur, du tramadol ou de la morphine selon un dosage permettant d'atteindre I'analg&ie (EVA ~ 4) en 30 min. Des volumes ~quivalents contenant 30 mg.ml -~ de tramadol ou I mg-ml -~ de morphine ont ~t~ utilis& pour I'ACP, qui comprenait une p&iode r~ffac-taire de 10 min. Les patients ont ~t~ revus ~ toutes les six heures pendant 48 h pour I'enregistrement des scores de I'EVA, de la satisfaction, de la dose d'analg&ique et des effets secondaires. l~-'ultats : Les patients ont obtenu une analg&ie suffisante avec I'un ou ['autre m~dicament. Un plus grand nombre de patients a &~ tr~s satisfait darts le groupe ayant re~u de la morphine ~ la salle de r~veil (43 % vs 23 %, P < 0,05) et ~ 24 h (40 % vs 20 %, P < 0,05) que ceux du groupe ayant re~u le tramadol. II y a eu davantage de naus~es dans le groupe du tramadol (48 % vs I 1% dans la salle de r~veil et 28 % vs 12 % ~ pendant les 24 premi&es heures, P < 0,05) que dans le groupe de la morphine. Les vomissements ont ~t~ ~galement plus frequents (28 % vs 5 % en salle de r~veil, 15 % vs 3 % pendant les 24 premi&es...

Matrix metalloproteinase 9 (MMP-9) has been implicated in airway injury in chronic obstructive pulmonary disease (COPD), lung inflammation, and lung cancer and plays a major role in tumor necrosis factor-α (TNF-α)-stimulated tumor invasion and lung inflammation. MMP-9 activity is promoted by the pro-inflammatory cytokine TNF-α. GMI, cloned from Ganoderma microsporum and purified, is one of the recombinant fungal immunomodulatory proteins. To understand the molecular mechanisms involved in the suppression of TNF-α-mediated tumor invasion and inflammation, GMI modulation of this pathway was investigated in human alveolar epithelial A549 cells in this study. GMI exhibited an inhibitory effect on TNF-α-induced invasion, with GMI treatment and TNF-α exposure presenting the most anti-invasive properties on Boyden chamber assay. GMI reduced TNF-α-induced MMP-9 activities on gelatin zymography assay through inhibition of MMP-9 transcriptional activity. RT-PCR and MMP-9 promoter luciferase analysis revealed that GMI inhibits the transcription of MMP-9 mRNA. Moreover, in vitro and in vivo binding experiments, an electrophoretic mobility shift assay (EMSA), and chromatin immunoprecipitation assay (ChIP) demonstrated that GMI suppresses DNA binding of nuclear factor (NF)-κB transcription factors to MMP-9 promoter. Western blot analysis indicated that GMI blocks the phosphorylation and degradation of IκBα, which in turn leads to suppression of the phosphorylation and nuclear translocation of p65. Thus, overall, our results indicated that GMI mediates antitumor invasion and anti-inflammatory effects through modulation of NF-κB/MMP-9 pathways.

The results of this study underlined the importance of developing nasogastric tube-related nursing interventions and educational strategies for clinical nurses, home care nurses and caregivers. The research tool used here may serve as a reference for assessing the technical operations of healthcare professionals and the knowledge and skills of caregivers.

P Pu ur rp po os se e: : To evaluate the clinical benefits and disadvantages of adding metoclopramide to tramadol for patient-controlled analgesia (PCA).M Me et th ho od ds s: : Forty adult patients, undergoing elective arthroplasties, were recruited into this prospective, randomized, double-blind study. During general anesthesia all patients received 2.5 mg·kg -1

Patients with chronic obstructive pulmonary disease (COPD) have chronic, irreversible airway inflammation; currently, there is no effective or curative treatment and the main goals of COPD management are to mitigate symptoms and improve patients' quality of life. Stem cell based therapy offers a promising therapeutic approach that has shown potential in diverse degenerative lung diseases. Preclinical studies have demonstrated encouraging outcomes of mesenchymal stem/stromal cells (MSCs) therapy for lung disorders including emphysema, bronchopulmonary dysplasia, fibrosis, and acute respiratory distress syndrome. This review summarizes available data on 15 studies currently registered by the ClinicalTrials.gov repository, which used different stem cell therapy protocols for COPD; these included bone marrow mononuclear cells (BMMCs), bone marrow-derived MSCs, adipose-derived stem/stromal cells (ADSCs), and adipose-derived MSCs. Published results of three trials indicate that administering BMMCs or MSCs in the setting of degenerative lung disease is safe and may improve patients' condition and quality of life; however, larger-scale studies are needed to evaluate efficacy. Results of another completed trial (NCT01872624) are not yet published, and eleven other studies are ongoing; these include MSCs therapy in emphysema, several studies of ADSCs in COPD, another in idiopathic pulmonary fibrosis, and plerixafor mobilization of CD117 stem cells to peripheral blood.