Artificial Intelligence-Based Diagnosis of Obstructive Sleep Apnea Syndrome: A Scoping Review

SUMMARY: To diagnose obstructive sleep apnea syndrome (OSAS), polysomnography is used, an expensive and extensive study requiring the patient to sleep in a laboratory. OSAS has been associated with features of facial morphology, and a preliminary diagnosis could be made using an artificial intelligence (AI) predictive model. This study aimed to analyze, using a scoping review, the AI-based technological options applied to diagnosing OSAS and the parameters evaluated in such analyses on craniofacial structures. A systematic search of the literature was carried out up to February 2024, and, using inclusion and exclusion criteria, the studies to be analyzed were determined. Titles and abstracts were independently selected by two researchers. Fourteen studies were selected, including a total of 13,293 subjects analyzed. The age of the sample ranged from 18 to 90 years. 9,912 (74.56 %) subjects were male, and 3,381 (25.43 %) were female. The included studies presented a diagnosis of OSAS by polysomnography; seven presented a control group of subjects without OSAS and another group with OSAS. The remaining studies presented OSAS groups in relation to their severity. All studies had a mean accuracy of 80 % in predicting OSAS using variables such as age, gender, measurements, and/or imaging measurements. There are no tests before diagnosis by polysomnography to guide the user in the likely presence of OSAS. In this sense, there are risk factors for developing OSA linked to facial shape, obesity, age, and other conditions, which, together with the advances in AI for diagnosis and guidance in OSAS, could be used for early detection.

Para diagnosticar el Síndrome Apnea Obstructiva del Sueño (SAOS) se utiliza la polisomnografía, el cual es un costoso y extenso estudio que exige que el paciente duerma en un laboratorio. El SAOS ha sido asociado con características de la morfología facial y mediante un modelo predictivo de la Inteligencia Artificial (IA), se podría realizar un diagnóstico preliminar. El objetivo de este estudio fue analizar por medio de una revisión de alcance, las opciones tecnológicas basadas en IA aplicadas al diagnóstico del SAOS, y los parámetros evaluados en dichos análisis en las estructuras craneofaciales. Se realizó una búsqueda sistemática de la literatura hasta febrero del 2024 y mediante criterios de inclusión y exclusión se determino los estudios a analizar. Los títulos y resúmenes fueron seleccionados de forma independiente por dos investigadores. Se seleccionaron 14 estudios, incluyeron un total de 13.293 sujetos analizados. El rango edad de la muestra oscilo entre 18 y 90 años. 9.912 (74.56 %) sujetos eran de sexo masculino y 3.381 (25,43 %) eran de sexo femenino. Los estudios incluidos presentaron diagnóstico de SAOS mediante polisomnografía, siete estudios presentaron un grupo control de sujetos con ausencia de SAOS y otro grupo con presencia de SAOS. Mientras que los demás estudios, presentaron grupos de SAOS en relación con su severidad. Todos los estudios tuvieron una precisión media del 80 % en la predicción de SAOS utilizando variables como la edad, el género, mediciones y/o mediciones imagenológicas. no existen exámenes previos al diagnóstico por polisomnografía que permitan orientar al usuario en la probable presencia de SAOS. En este sentido, existen factores de riesgo para desarrollar SAOS vinculados a la forma facial, la obesidad, la edad y otras condiciones, que sumados a los avances con IA para diagnóstico y orientación en SAOS podrían ser utilizados para la detección precoz del mismo.

Apnea obstructiva del sueño en la práctica clínica cardiológica. Epidemiología, diagnóstico y tratamiento. Estudio observacional, retrospectivo y transversal / Obstructive sleep apnea in cardiology clinical practice. Epidemiology, diagnosis, and treatment. Observational, cross-sectional, and retrospective study

Resumen Objetivo: Determinar las características clínico-epidemiológicas, viabilidad diagnóstica de la poligrafía respiratoria domiciliaria y el tratamiento de pacientes con sospecha de apnea obstructiva del sueño (AOS) en riesgo cardiovascular. Métodos: Se realizó estudio observacional, transversal, descriptivo en pacientes atendidos en un servicio de consulta externa de cardiología con sospecha de AOS, de enero de 2015 a diciembre de 2019. La información se obtuvo de los expedientes médicos, se aplicó análisis estadístico descriptivo. Resultados: Se examinaron 138 expedientes, de las poligrafías respiratorias domiciliarias fueron descartadas solo el 8% por no cumplir con los estándares de calidad requeridos. Se demostró que el 89% padecían AOS, un 60% moderada a severa; predominó en hombres después de los 50 años. El principal ractores de riesgo cardiovascular fue hipertensión (89%). La cardiopatía más prevalente fue la hipertensiva (52%). Se optimizó tratamiento farmacológico cardiovascular en el 82% de los casos. Rehabilitación cardiaca en el 30%, ventilación mecánica no invasiva 41%, modalidad fija 33% y autoajustable 9%, todos con telemetría. Conclusiones: La prevalencia y severidad de la AOS es mayor en presencia de riesgo o enfermedad cardiovascular establecida. Ante la sospecha clínica es factible confirmar el diagnóstico con poligrafía respiratoria domiciliaria por el nivel de precisión y la menor infraestructura requerida. Es necesaria una mayor participación del cardiólogo en el diagnóstico y tratamiento de este trastorno por el riesgo significativo de enfermedad cardiovascular que representa.

Abstract Objective: To determine the clinical-epidemiological characteristics, diagnostic feasibility of home respiratory polygraphy and treatment of patients with suspected obstructive sleep apnea (OSA) at cardiovascular risk. Methods: An observational, cross-sectional, descriptive study was conducted in patients seen in a cardiology outpatient service with suspected OSA, from January 2015 to December 2019. The information was obtained from medical records, and a descriptive statistical analysis was applied to this information. Results: 138 files were reviewed; only 8% of the home respiratory polygraphs were discarded, because they did not meet the required quality standards. It was demonstrated that 89% suffered from OSA, 60% moderate to severe; in men after 50 years of age. The main cardiovascular risk factors was hypertension (89%). The most prevalent heart disease was hypertension (52%). Cardiovascular pharmacological treatment was improved in 82% of the cases. Cardiac rehabilitation in 30%, noninvasive mechanical ventilation 41%, fixed modality 33%, and self-adjustable 9%, all with telemetry. Conclusions: The prevalence and severity of OSA is higher in the presence of risk or established cardiovascular disease. In the presence of clinical suspicion, it is feasible to confirm the diagnosis with home respiratory poligrafy due to the level of precision and the lower infrastructure required. Greater involvement of the cardiologist in the diagnosis and treatment of this disorder is necessary due to the significant risk of cardiovascular disease it represents.

Association of IGF-1 and IGF-2 genotypes with respiratory muscle strength in individuals with COPD: A cross-sectional study / Asociación de los genotipos de IGF-1 e IGF-2 con la fuerza muscular respiratoria en individuos con EPOC: estudio transversal

Introduction Chronic obstructive pulmonary disease is a systemic disease characterized not only by respiratory symptoms but also by physical deconditioning and muscle weakness. One prominent manifestation of this disease is the decline in respiratory muscle strength. Previous studies have linked the genotypes of insulin-like growth factor 1 and 2 (IGF-1 and IGF-2) to muscle weakness in other populations without this disease. However, there is a notable knowledge gap regarding the biological mechanisms underlying respiratory muscle weakness, particularly the role of IGF-1 and IGF-2 genotypes in this pulmonary disease. Therefore, this study aimed to investigate, for the first time, the association between IGF-1 and IGF-2 genotypes with respiratory muscle strength in individuals with chronic obstructive pulmonary disease. In addition, we analyzed the relationship between oxidative stress, chronic inflammation, and vitamin D with respiratory muscle strength. Methods A cross sectional study with 61 individuals with chronic obstructive pulmonary disease. Polymerase chain reaction of gene polymorphisms IGF-1 (rs35767) and IGF-2 (rs3213221) was analyzed. Other variables, related to oxidative stress, inflammation and Vitamin D were dosed from peripheral blood. Maximal inspiratory and expiratory pressure were measured. Results The genetic polymorphisms were associated with respiratory muscle strength ( 3.0 and 3.5; = 0.57). Specific genotypes of IGF-1 and IGF-2 presented lower maximal inspiratory and expiratory pressure (<0.05 for all). Oxidative stress, inflammatory biomarkers, and vitamin D were not associated with respiratory muscle strength. Conclusion The polymorphisms of IGF-1 and IGF-2 displayed stronger correlations with respiratory muscle strength compared to blood biomarkers in patients with chronic obstructive pulmonary disease. Specific genotypes of IGF-1 and IGF-2 were associated with reduced respiratory muscle strength in this population.

Introducción La enfermedad pulmonar obstructiva crónica es una enfermedad sistémica caracterizada no solo por síntomas respiratorios, sino también por el deterioro físico y la debilidad muscular. Una manifestación destacada de esta enfermedad es el declive en la fuerza de los músculos respiratorios. Estudios previos han vinculado los genotipos de factor de crecimiento insulínico 1 y 2 (IGF-1 e IGF-2) con la debilidad muscular en poblaciones sin esta enfermedad. Sin embargo, existe un vacío de conocimiento con respecto a los mecanismos biológicos subyacentes a la debilidad de los músculos respiratorios, en particular el papel de los genotipos IGF-1 e IGF-2 en esta enfermedad pulmonar. Por lo tanto, este estudio tuvo como objetivo investigar, por primera vez, la asociación de los genotipos IGF-1 e IGF-2 con la fuerza de los músculos respiratorios en individuos con enfermedad pulmonar obstructiva crónica. Además, analizamos la relación entre el estrés oxidativo, la inflamación crónica y la vitamina D con la fuerza de los músculos respiratorios. Métodos Un estudio transversal con 61 individuos con enfermedad pulmonar obstructiva crónica. Se analizó la reacción en cadena de la polimerasa de los polimorfismos genéticos IGF-1 (rs35767) e IGF-2 (rs3213221). Otras variables relacionadas con el estrés oxidativo, la inflamación y la vitamina D se dosificaron a partir de muestras de sangre periférica. Se midieron las presiones inspiratorias y espiratorias máximas. Resultados Los polimorfismos genéticos están asociados con la fuerza de los músculos respiratorios (F: 3.0 y 3.5; R2= 0.57). Genotipos específicos de IGF-1 e IGF-2 presentaron bajos valores en las presiones inspiratorias y espiratorias (p<0.05 en todos los casos). El estrés oxidativo, los biomarcadores inflamatorios y la vitamina D no se asociaron con la fuerza de los músculos respiratorios. Conclusión Los polimorfismos de IGF-1 e IGF-2 mostraron correlaciones más sólidas con la fuerza de los músculos respiratorios en pacientes con enfermedad pulmonar obstructiva crónica en comparación con los biomarcadores sanguíneos. Genotipos específicos de IGF-1 e IGF-2 se asociaron con una disminución de la fuerza de los músculos respiratorios en esta población

Ineficiência Ventilatória Comparável no Desempenho Máximo e Submáximo em Indivíduos com DPOC e ICC: Uma Abordagem Inovadora / Comparable Ventilatory Inefficiency at Maximal and Submaximal Performance in COPD vs. CHF subjects: An Innovative Approach

Resumo Fundamento: Atualmente, o excesso de ventilação tem sido fundamentado na relação entre ventilação-minuto/produção de dióxido de carbono ( V ˙ E − V ˙ CO 2). Alternativamente, uma nova abordagem para eficiência ventilatória ( η E V ˙) tem sido publicada. Objetivo: Nossa hipótese principal é que níveis comparativamente baixos de η E V ˙ entre insuficiência cardíaca crônica (ICC) e doença pulmonar obstrutiva crônica (DPOC) são atingíveis para um nível semelhante de desempenho aeróbico máximo e submáximo, inversamente aos métodos estabelecidos há muito tempo (inclinação V ˙ E − V ˙ CO 2 e intercepto). Métodos: Ambos os grupos realizaram testes de função pulmonar, ecocardiografia e teste de exercício cardiopulmonar. O nível de significância adotada na análise estatística foi 5%. Assim, dezenove indivíduos elegíveis para DPOC e dezenove indivíduos elegíveis para ICC completaram o estudo. Com o objetivo de contrastar valores completos de V ˙ E − V ˙ CO 2 e η E V ˙ para o período de exercício (100%), correlações foram feitas com frações menores, como 90% e 75% dos valores máximos. Resultados: Os dois grupos tiveram características correspondentes para a idade (62±6 vs 59±9 anos, p>.05), sexo (10/9 vs 14/5, p>0,05), IMC (26±4 vs 27±3 Kg m2, p>0,05), e pico V ˙ O 2 (72±19 vs 74±20 % pred, p>0,05), respectivamente. A inclinação V ˙ E − V ˙ CO 2 e intercepto foram significativamente diferentes para DPOC e ICC (207,2±1,4 vs 33,1±5,7 e 5,3±1,9 vs 1,7±3,6, p<0,05 para ambas), mas os valores médios da η E V ˙ foram semelhantes entre os grupos (10,2±3,4 vs 10,9±2,3%, p=0,462). As correlações entre 100% do período do exercício com 90% e 75% dele foram mais fortes para η E V ˙ (r>0,850 para ambos). Conclusão: A η E V ˙ é um método valioso para comparação entre doenças cardiopulmonares, com mecanismos fisiopatológicos até agora distintos, incluindo restrições ventilatórias na DPOC.

Abstract Background: Currently, excess ventilation has been grounded under the relationship between minute-ventilation/carbon dioxide output ( V ˙ E − V ˙ CO 2). Alternatively, a new approach for ventilatory efficiency ( η E V ˙) has been published. Objective: Our main hypothesis is that comparatively low levels of η E V ˙ between chronic heart failure (CHF) and chronic obstructive pulmonary disease (COPD) are attainable for a similar level of maximum and submaximal aerobic performance, conversely to long-established methods ( V ˙ E − V ˙ CO 2 slope and intercept). Methods: Both groups performed lung function tests, echocardiography, and cardiopulmonary exercise testing. The significance level adopted in the statistical analysis was 5%. Thus, nineteen COPD and nineteen CHF-eligible subjects completed the study. With the aim of contrasting full values of V ˙ E − V ˙ CO 2 and η V ˙ E for the exercise period (100%), correlations were made with smaller fractions, such as 90% and 75% of the maximum values. Results: The two groups attained matched characteristics for age (62±6 vs. 59±9 yrs, p>.05), sex (10/9 vs. 14/5, p>0.05), BMI (26±4 vs. 27±3 Kg m2, p>0.05), and peak V ˙ O 2 (72±19 vs. 74±20 %pred, p>0.05), respectively. The V ˙ E − V ˙ CO 2 slope and intercept were significantly different for COPD and CHF (27.2±1.4 vs. 33.1±5.7 and 5.3±1.9 vs. 1.7±3.6, p<0.05 for both), but η V ˙ E average values were similar between-groups (10.2±3.4 vs. 10.9±2.3%, p=0.462). The correlations between 100% of the exercise period with 90% and 75% of it were stronger for η V ˙ E (r>0.850 for both). Conclusion: The η V ˙ E is a valuable method for comparison between cardiopulmonary diseases, with so far distinct physiopathological mechanisms, including ventilatory constraints in COPD.

Estudio de la vía aérea superior frente a apneas obstructivas del sueño persistentes en pediatría / An approach to the upper airway evaluation in pediatric persistent obstructive sleep apnea

El síndrome de apneas obstructivas del sueño (SAOS) en pediatría constituye un trastorno asociado a múltiples consecuencias en el espectro cognitivo y comportamental. El principal factor de riesgo asociado es la hipertrofia amigdalina y las vegetaciones adenoideas. La adenoamigdalectomía es el tratamiento de primera línea. La incidencia del SAOS persistente varía entre un 15 % y un 75 % según las comorbilidades. Este se presenta como un desafío a la hora de tratarlo; requiere un abordaje integral para su diagnóstico y tratamiento adecuado. El objetivo de esta revisión bibliográfica es proponer un abordaje diagnóstico y terapéutico para el SAOS persistente.

In pediatrics, obstructive sleep apnea syndrome (OSAS) is a disorder associated with multiple consequences at the cognitive and behavioral level. The main associated risk factor is the presence of tonsillar hypertrophy and adenoids. An adenotonsillectomy is the first-line treatment. The incidence of persistent OSAS varies from 15% to 75%, depending on comorbidities. This is a challenge in terms of management; it requires a comprehensive approach for an adequate diagnosis and treatment. The objective of this bibliographic review is to propose a diagnostic and therapeutic approach for persistent OSAS.

Factores de riesgo asociados a mortalidad por COVID-19 en México / Risk factors associated with COVID-19 mortality in Mexico

Resumen Antecedentes: El 31 de diciembre de 2019, se inició una de las pandemias más graves de los últimos tiempos. Se ha descrito que ciertas condiciones de salud, como la obesidad y la diabetes mellitus, están relacionadas con desenlaces desfavorables por COVID-19. Objetivo: Identificar factores asociados a mortalidad en pacientes con COVID-19. Material y métodos: Cohorte retrospectiva de 998 639 pacientes. Se analizaron las características sociodemográficas y clínicas de los pacientes, y se compararon supervivientes con fallecidos. Se utilizó el modelo de riesgos proporcionales de Cox para la identificación de variables predictivas de defunción por COVID-19. Resultados: Entre los fallecidos, los hombres representaron 64.3 % y las mujeres 35.7 %, diferencia que resultó estadísticamente significativa. Las personas con más de 80 años presentaron un riesgo 13 veces mayor de morir por COVID-19 (IC 95 % = 12.469,13.586) y la enfermedad renal crónica, un riesgo de 1.5 (IC 95 % = 1.341, 1.798); la diabetes mellitus tuvo un riesgo de 1.25 (IC 95 % = 1.238,1.276). Conclusiones: La edad, el sexo, la diabetes mellitus y la obesidad resultaron ser entidades predictivas de muerte por COVID-19. Se sugiere más investigación relacionada con enfermedad pulmonar obstructiva crónica, enfermedades cardiovasculares, tabaquismo y embarazo.

Abstract Background: On December 31, 2019, one of the most serious pandemics in recent times made its appearance. Certain health conditions, such as obesity and diabetes mellitus, have been described to be related to COVID-19 unfavorable outcomes. Objective: To identify factors associated with mortality in patients with COVID-19. Material and methods: Retrospective cohort of 998,639 patients. Patient sociodemographic and clinical characteristics were analyzed, with survivors being compared with the deceased individuals. Cox proportional hazards model was used to identify variables predictive of COVID-19-associated mortality. Results: Among the deceased patients, men accounted for 64.3%, and women, for 35.7%, with the difference being statistically significant. Subjects older than 80 years had a 13-fold higher risk of dying from COVID-19 (95% CI = 12,469, 13,586), while chronic kidney disease entailed a risk 1.5 times higher (95% CI = 1,341, 1,798), and diabetes mellitus involved a risk 1.25 times higher (95% CI = 1.238,1.276). Conclusions: Age, sex, diabetes mellitus and obesity were found to be predictors of COVID-19 mortality. Further research related to chronic obstructive pulmonary disease, cardiovascular diseases, smoking and pregnancy is suggested.

Epidemiological characteristics of chronic obstructive pulmonary disease and influencing factors of acute exacerbation in Ma'anshan Area in 2020 - 2022 / 公共卫生与预防医学

Objective To study the epidemiological characteristics of chronic obstructive pulmonary disease (COPD) in Ma'anshan area and analyze the influencing factors of acute exacerbation. Methods The clinical data of 1 676 patients with COPD who visited the Department of Respiratory Medicine of Deyu Medical Ma'anshan General Hospital from 2020 to 2022 were retrospectively analyzed. The patients were divided into acute exacerbation group and stable group according to whether they had acute exacerbation or not，and the general information, severity of COPD, previous pulmonary infection and combined hypoproteinemia were compared between the two groups. Logistic regression was used to analyze the influencing factors of acute exacerbation. Results A total of 1 676 COPD patients were mainly male (58.17%) and ≥ 46 years old (82.58%), of which the incidence of acute exacerbation of chronic obstructive pulmonary disease (AECOPD) was 78.82%. Logistic regression analysis showed that male sex , ≥46 years of age, smoking >400 cigarettes/year, occupational exposure to dust, severe and very severe COPD, recurrent new coronavirus infections, combined cardiovascular disease, or hypoproteinemia were risk factors for acute exacerbations in COPD patients. Conclusion Nearly 80% of COPD patients in Ma'anshan area have previously experienced acute exacerbations, and prevention and treatment cannot be ignored. Strengthening the education and prevention of key populations can effectively reduce the incidence of AECOPD and improve the overall prognosis of COPD patients.

Establishment of a nomogram prediction model for risk of COPD complicating pulmonary interstitial fibrosis / 重庆医学

Objective To analyze the influencing factors of chronic obstructive pulmonary disease(COPD)complicating pulmonary interstitial fibrosis,and to establish a nomogram prediction model.Methods The clinical data of 195 patients with COPD admitted and treated in this hospital from January 2019 to Feb-ruary 2021 were retrospectively analyzed.The factors possibly affecting the patients with COPD complicating pulmonary interstitial fibrosis were collected,and the patients were divided into 2 groups according to whether having pulmonary interstitial fibrosis.The independent risk factors were analyzed and screened by the multi-variate logistic regression.Then the nomogram prediction model was constructed.Results Among the includ-ed 195 cases of COPD in this study,there were 50 cases(25.64％)of complicating pulmonary interstitial fi-brosis.The univariate and multivariate logistic regression analysis results showed that the smoking history,duration of COPD,frequency of acute exacerbations onset,serum transforming growth factor β1(TGF-β1),basic fibroblast growth factor(bFGF)and angiotensin Ⅱ(AngⅡ)were the independent influencing factors of COPD complicating pulmonary interstitial fibrosis(P＜0.05).The nomogram model was constructed accord-ing to the results of multivariate analysis results,and the area under the receiver operating characteristic(ROC)curve was 0.956(95％CI:0.930-0.983),the average absolute error of internal verification by the Bootstrap method was 0.025,and the prediction model performance basically fitted the ideal model.Conclusion The nomogram model constructed by this study for predicting the pulmonary interstitial fibrosis in COPD patients has high accuracy and distinction degree.

Expression and significance of CD4+T cell subtypes and their associated inflammatory factors in NE-FE-COPD patients / 重庆医学

Objective To investigate the expression of CD4+T cell subtypes and related inflammatory factors in patients with neutrophil-predominant frequent acute exacerbation chronic obstructive pulmonary disease(NE-FE-COPD).Methods COPD patients who were treated in the hospital from March 2019 to March 2021 were selected as the research objects.According to different phenotypes,they were divided into the infrequent exacerbator COPD group(IECOPD group,n=11),the eosinophilic dominant frequent acute plus severe COPD group(Eos-FE-COPD group,n=13),and the neutrophil dominant frequent exacerbator COPD group(NE-FE-COPD group,n=15).Patients with normal lung function and smoking history＞10 packs/year were the control group(CTRL group,n=9).Bronchoalveolar lavage fluid(BALF)was collected from each group,and the expression of CD4+T cell subtypes and inflammatory factors were detected by flow cytometry.The correlation between BALF and lung function and the frequency of acute exacerbation was ana-lyzed.CD4+CD28nullT cells and CD4+CD28+T cells were co-cultured with human airway epithelial cells(hAECs)and divided into co-culture group and Control group.The damage of hAECs was observed by immu-nofluorescence staining,and the mRNA and protein expression levels of ZO-1 and occludin were detected by RT-qPCR and Western blot.Results The proportion of CD4+CD28nullT cells and IL-1β level in BALF in the NE-FE-COPD group were higher than those in the CTRL group,the IE-COPD group,and the Eos-FE-COPD group,and the difference was statistically significant(P＜0.05).The proportion of CD4+CD28nullT cells and IL-1βlevel were negatively correlated with lung function(P＜0.05),and positively correlated with acute ex-acerbation frequency(P＜0.05).Compared with the Control group,hAECs tight junctions were damaged in the co-culture group,and mRNA and protein expression levels of ZO-1 and occludin decreased,with statistical significance(P＜0.05).Conclusion CD4+CD28nullT cells and IL-1β may be involved in the occurrence and de-velopment of NE-FE-COPD.

Correlation analysis of inflammation,nutrition indexes and hypoproteinemia in patients with AECOPD / 重庆医学

Objective To analyze the correlation between inflammation,nutritional indicators and hy-poproteinemia in patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD).Meth-ods The clinical data of patients with AECOPD admitted to the Department of Respiratory and Critical Care Medicine of the First Affiliated Hospital of Xiamen University from January 2020 to September 2022 were ret-rospectively analyzed,and the patients were divided into the hypoproteinemia group(n=73)and the non-hy-poproteinemia group(n=141)according to whether the serum albumin(ALB)was lower than 35 g/L.The clinical data,inflammatory indicators and nutritional indicators of the two groups were compared,Spearman correlation analysis was performed,and binary logistic regression analysis was performed to analyze the influ-encing factors of patients with AECOPD complicated with hypoproteinemia.Results There were statistically significant differences in age,length of hospital stay,and body weight between the two groups(P＜0.05).There were no significant differences in gender,number of hospitalizations in the past 1 year,height,diabetes,hypertension and proportion of coronary heart disease(P＞0.05).Compared with the non-hypoproteinemia group,the hypoproteinemia group had longer hospital stays and higher levels of C-reactive protein,neutrophil/albumin ratio(NAR),neutrophil to lymphocyte ratio(NLR),platelet-lymphocyte ratio(PLR),and systemic immunoinflammatory index(SII).The prognostic nutritional index(PNI),body mass index(BMI),hemoglo-bin and total protein levels were lower,and the difference was statistically significant(P＜0.05).Body weight,BMI,hemoglobin,total protein,PNI and AECOPD patients with hypoproteinemia were negatively cor-related(P＜0.05),while age,length of hospital stay,C-reactive protein,NAR,NLR,PLR,SII and AECOPD patients with hypoproteinemia were positively correlated(P＜0.05).Binary logistic regression analysis showed that PNI,SII and NLR were the influencing factors of hypoproteinemia in AECOPD patients.Conclusion In clinical practice,attention should be paid to and timely correction of hypoproteinemia in pa-tients with AECOPD,improvement of inflammatory indicators and nutritional status of patients,and preven-tion of acute exacerbation.

Brain white matter variation in patients with obstructive sleep apnea-hypopnea syndrome with diffusional kurtosis imaging / 中国耳鼻咽喉头颈外科

OBJECTIVE To explore the changes of brain white matter of the patients with obstructive sleep apnea-hypopnea syndrome(OSAHS)with magnetic resonance diffusional kurtosis imaing(DKI).METHODS There were 38 patients with OSAHS examined by polysomnogram(PSG)from November 2017 to June 2021,and 32 non-OSAHS controls matched in gender and age who were included in this study.All the subjects were scanned by DKI.The different encephalic regions through comparing kurtosis fractional anisotropy(KFA)values of all encephalic regions between the two groups were found,and the relationship between the KFA values of the different encephalic regions in OSAHS patients and the apnea-hypopnea index(AHI),lowest saturation oxygen(LSaO2)and the percent of the total record time spent below 90%oxygen saturation(TS90%)in PSG were analyzed.RESULTS The KFA values of white matter fiber tracts in corpus callosum,bilateral corona radiata,cingulate gyrus,right superior cerebellar peduncle and inferior cerebellar peduncle of OSAHS group were obviously lower than control group(P<0.05).After controlling for age and body mass index(BMI),the partial correlation between AHI and the KFA values of corpus callosum,left posterior corona radiata,right anterior corona radiata,cingulate gyrus in OSAHS group were also negative(r=-0.344,-0.380,-0.406,-0.53,P<0.05).The partial correlation between LSaO2 and the KFA values of corpus callosum,left posterior corona radiata,right anterior corona radiata,cingulate gyrus,right superior cerebellar peduncle in OSAHS group were also positive(r=0.366,0.406,0.446,0.404,0.342,P<0.05).The partial correlation between TS90%and the KFA values of corpus callosum,left posterior corona radiata,right anterior corona radiata,cingulate gyrus,right superior cerebellar peduncle and inferior cerebellar peduncle in OSAHS group were also negative(r=-0.414,-0.352,-0.355,-0.336,-0.456,-0.360,P<0.05).CONCLUSION Recurrent apnea and hypoxemia at night of OSAHS patients can cause damage to white matter fibers in parts of encephalic regions.

Correlation between serum asprosin and apropin levels and disease severity in elderly patients with obstructive sleep apnea syndrome / 中国耳鼻咽喉头颈外科

OBJECTIVE To investigate the correlation between serum levels of asprosin and adropin in elderly patients with obstructive sleep apnea syndrome(OSAS)and the disease severity.METHODS From August 2021 to August 2023,131 elderly OSAS patients admitted to Ezhou Central Hospital were collected as observation subjects(OSAS group),according to the sleep apnea hypopnea index(AHI),there were 40 cases in the mild group,52 cases in the moderate group,and 39 cases in the severe group,meantime,124 healthy individuals who came to health clinic of our hospital for physical examination were collected as the control group.Enzyme-linked immunosorbent assay(ELISA)was applied to determine the levels of asprosin and apropin in the serum of OSAS patients;Pearson method was applied to analyze the correlation between serum asprosin,apropin levels and AHI,ODI,and LSaO2.ROC curve was used to analyze the diagnostic value of serum asprosin and adropin levels in OSAS and the severity of OSAS patients.RESULTS Compared with the control group,the asprosin level in the OSAS group was obviously increased,while the adropin level was obviously reduced(P<0.05).There was no statistically obvious difference in gender,age,coronary heart disease,hypertension,TC,TG,HDL-C,LDL-C among the mild,moderate,and severe groups(P>0.05);compared with the mild group,the levels of BMI,AHI,ODI,and asprosin in the moderate and severe groups were obviously increased,while the levels of LSaO2 and apropin were obviously reduced(P<0.05);compared with the moderate group,the levels of BMI,AHI,ODI,and asprosin in the severe group were obviously increased,while the levels of LSaO2 and apropin were obviously reduced(P<0.05).The serum asprosin level in OSAS patients was positively correlated with AHI and ODI,and negatively correlated with LSaO2(P<0.05);the level of apropin was negatively correlated with AHI and ODI,and positively correlated with LSaO2(P<0.05).The AUC of serum asprosin,apropin levels,and their combination in diagnosing moderate and severe OSAS was 0.832,0.882,and 0.942,respectively,the combined diagnostic value of the two was superior to that of single diagnosis(Z=3.435,2.560,P=0.001,0.011).Serum asprosin,adropin levels and AUC of combined diagnosis of OSAS were 0.818,0.804 and 0.893,respectively.The value of combined diagnosis was better than that of single diagnosis(Z=3.886,4.126,P=0.000,0.000).CONCLUSION The serum level of asprosin is increased and the level of adropin is decreased in patients with OSAS,which is closely related to the severity of the disease,and may be used in the clinical diagnosis of OSAS and the evaluation of the severity of OSAS.

Changes in serum TIMP-1 and PTX3 levels and clinical significance in patients with obstructive sleep apnea-hypopnea syndrome / 国际检验医学杂志

Objective To explore the expression and clinical significance of tissue inhibitor of matrix metal-loproteinases(TIMP)-1 and pentraxin-3(PTX3)in the serum of patients with obstructive sleep apnea-hypop-nea syndrome(OSAHS).Methods A total of 120 patients with OSAHS admitted to the hospital from 2021 to 2022 were selected as the study group,and another 114 healthy people who underwent the physical exami-nation in the same period were selected as the control group.The severity of OSAHS was determined accord-ing to the apnea-hypopnea index(AHI)and the minimum oxygen saturation(LSpO2),and the patients were divided into mild group(66 cases)and the moderate-severe group(54 cases).Serum TIMP-1 and PTX3 levels were measured by enzyme-linked immunosorbent assay.Pearson method was used to analyze the correlation between serum TIMP-1,PTX3 and AHI,LSpO2.Receiver operating characteristic(ROC)curve was used to analyze the predictive value of serum TIMP-1 and PTX3 on the severity of disease in patients with OSAHS.Logistic regression was used to analyze the factors influencing the severity of the disease in OSAHS patients.Results Serum TIMP-1,PTX3 and AHI levels in the study group were higher than those in the control group,and LSpO2 level was lower than that in the control group(P<0.05).The body mass index(BMI),the proportion of hypertension history,the proportion of coronary heart disease history,the levels of total choles-terol,triglycerides,low-density lipoprotein cholesterol,TIMP-1,PTX3 and AHI in the moderate-severe group were significantly higher than those in the mild group,and the high density lipoprotein cholesterol,LSpO2 lev-el was significantly lower than that in the mild group(P<0.05).Pearson method results showed that serum TIMP-1,PTX3 levels were positively correlated with AHI(r=0.428,0.392,P<0.05),and serum TIMP-1,PTX3 levels were negatively correlated with LSpO2(r=-0.645,-5.836,P<0.05).The results of the ROC curve showed that the area under the curve(AUC)of serum TIMP-1 and PTX3 alone predicted the severity of the patients'disease was 0.813 and 0.777,with cut-off values were 2.47 μg/L and 7.23 ng/L,with the sensi-tivity of 70.37%and 77.78%and the specificity of 77.27%and 72.23%,respectively.The AUC for predic-ting the severity of patients'disease by combining the two was 0.866,which was significantly higher than those of serum TIMP-1(Z=2.067,P=0.039)and PTX3 alone(Z=2.331,P=0.020).Logistic regression a-nalysis showed that TIMP-1,PTX3,history of hypertension,and history of coronary artery disease,AHI and LSpO2 were influential factors for severity of disease in patients with OSAHS(P<0.05).Conclusion TIMP-1 and PTX3 are both up-regulated in the serum of OSAHS patients and closely related to the severity of the disease,and they are the influential factors in the severity of OSAHS patients.

Expression and clinical significance of serum lncRNA SNHG16 and SMAD4 in elderly COPD patients with PI / 国际检验医学杂志

Objective To investigate the expression and clinical significance of serum long non-coding RNA small nucleolar RNA host gene 16(lncRNA SNHG16)and mothers against decapentaplegic homolog 4(SMAD4)in elderly patients with chronic obstructive pulmonary disease(COPD)and pulmonary infection(PI).Methods A total of 237 elderly COPD patients admitted to the hospital from January 2021 to January 2023 were enrolled in the study.Among them,117 patients with concomitant PI were classified as the concur-rent group,and 120 patients without concomitant PI were classified as the COPD group.Real-time fluores-cence quantitative polymerase chain reaction(qRT-PCR)was applied to detect the expression level of serum lncRNA SNHG16 in two groups.Enzyme linked immunosorbent assay(ELISA)was applied to detect the lev-el of SMAD4 in patients'serum.Simplified clinical pulmonary infection scale(sCPIS)was used to evaluate the degree of PI of patients in the concurrent group.Multivariate Logistic regression was applied to analyze the in-fluencing factors of PI in elderly COPD patients.Correlation between serum lncRNA SNHG16,SMAD4 levels and sCPIS in elderly COPD patients with PI was analyzed by using Spearman correlation analysis.Receiver op-erating characteristic(ROC)curve was applied to analyze the diagnostic value of serum lncRNA SNHG16 and SMAD4 levels in elderly COPD patients with PI.Results The serum relative expression level of lncRNA SNHG16 in the concurrent group was higher than that in the COPD group,but the serum SMAD4 level was lower than that in the COPD group(P<0.05).In addition,the proportions of patients with age≥70 years,smoking history,complicated with diabetes and COPD course≥5 years and the levels of tumor necrosis fac-tor-α(TNF-α),interferon-γ(INF-γ)in the concurrent group were higher than those in the COPD group,and FEV1/FVC and the level of interleukin-10(IL-10)in concurrent group were lower than those in COPD group(P<0.05).Multivariate Logistic analysis showed that age≥70 years old,complicated with diabetes,COPD course≥5 years,high levels of TNF-α,INF-γ and lncRNA SNHG16 were risk factors for elderly patients with COPD complicated with PI(P<0.05),but high FEV1/FVC and high levels of SMAD4 and IL-10 were protective factors(P<0.05).Spearman correlation analysis showed that serum relative expression level of ln-cRNA SNHG16 was positively correlated with sCPIS in COPD patients with PI(r=0.505,P<0.001),while SMAD4 level was negatively correlated with sCPIS(r=-0.550,P<0.001).The area under the curve(AUC)of the combined diagnosis of serum lncRNA SNHG16 and SMAD4 for PI in elderly COPD patients was higher than those of individual diagnosis(Z=2.416,P=0.016;Z=2.375,P=0.018).Conclusion The serum relative expression level of lncRNA SNHG16 increases and SMAD4 level decreases in elderly COPD pa-tients with PI,both are influencing factors for elderly COPD patients complicated with PI,and both are related to the degree of PI in patients,and both have diagnostic value for elderly COPD patients complicated with PI,and the diagnostic efficacy of combined detection is better.

Study on the Regulatory Mechanism of Xuanfei Tongluo Pingchuan Decoction on Immune Function and Inflammatory Response in Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease / 广州中医药大学学报

Objective To investigate the clinical efficacy of Xuanfei Tongluo Pingchuan Decoction in treating patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD)and to explore its regulatory mechanism on immune function and inflammatory response.Methods A retrospective study was conducted in 122 patients with AECOPD of phlegm-stasis obstructing lung type,and the patients were divided into an observation group and a control group according to the therapy,with 61 patients in each group.The control group was treated with conventional western medicine,and the observation group was treated with Xuanfei Tongluo Pingchuan Decoction on the basis of treatment for the control group.The treatment lasted for 14 days.Before and after treatment,the patients of the two groups were observed in the changes of pulmonary function indicators,6-minute walking distance(6MWD),COPD Assessment Test(CAT)scores,immune function indicators,and serum inflammatory factors.After treatment,the clinical efficacy and the overall occurrence rate of the adverse reactions were compared between the two groups.Results(1)After 14 days of treatment,the total effective rate of the observation group was 95.08%(58/61),and that of the control group was 77.05%(47/61).The intergroup comparison showed that the therapeutic effect of the observation group was significantly superior to that of the control group(P＜0.01).(2)After treatment,pulmonary function indexes such as the forced expiratory volume in one second(FEV1),forced vital capacity(FVC),and peak expiratory flow(PEF)of the two groups were significantly improved compared with those before treatment(P＜0.05),and the effect on improving all pulmonary function indexes in the observation group was significantly superior to that in the control group(P＜0.01).(3)After treatment,the 6MWD of the two groups were significantly higher(P＜0.05)and the CAT scores were significantly lower than those before treatment(P＜0.05),and the observation group was significantly superior to the control group in terms of improving the 6MWD and decreasing CAT scores(P＜0.01).(4)After treatment,the levels of immune function indicators of T lymphocyte subsets CD4+ and CD4+/CD8+ in the two groups were significantly higher than those before treatment(P＜0.05),and CD8+ level was significantly lower than that before treatment(P＜0.05),and the observation group had stronger effect on increasing T lymphocyte subsets CD4+ and CD4+/CD8+ levels and on decreasing CD8+ level than the control group(P＜0.01).(5)After treatment,the serum levels of inflammatory factors C-reactive protein(CRP)and tumor necrosis factor alpha(TNF-α)in the two groups were significantly decreased compared with those before treatment(P＜0.05),and the effect on lowering the levels of serum CRP and TNF-α in the observation group was significantly superior to that in the control group(P＜0.01).(6)During the trial,the total incidence of adverse reactions in the observation group was 3.28%(2/61)and that in the control group was 6.56%(4/61),and the intergroup comparison showed that the difference was not statistically significant between the two groups(P＞0.05).Conclusion Xuanfei Tongluo Pingchuan Decoction can effectively alleviate the symptoms of cough and expectoration in AECOPD patients,improve the lung function and immune function,and reduce the inflammatory response.During the treatment,no obvious adverse reactions occur and the therapy is safe and effective.

Basic Study on Inhibitory Effect of Sulforaphane on Inflammatory Response and Alleviation of Airway Remodeling in COPD Rats / 广州中医药大学学报

Objective To investigate the ameliorative effect of sulforaphane on inflammatory response and airway remodeling in rats with chronic obstructive pulmonary disease(COPD).Methods Seventy-five SD rats were randomly divided into the normal group,the model group,and the low-,medium-,and high-dose groups of sulforaphane,with 15 rats in each group.Except for the normal group,the COPD model was prepared in the remaining group using aroma smoke inhalation combined with intratracheal droplet lipopolysaccharide(LPS)method.After the successful modelling,the rats were administered the drug by gavage for 28 days.At the end of the administration,the general conditions of the rats in each group were observed,and the lung function[forced vital capacity(FVC),peak expiratory flow-rate(PEF),forceful expiratory volume in 1 second(FEV1)]was examined,and the pathological changes of the lung tissues were observed by hematoxylin-eosin(HE)staining method,and the indexes of airway remodeling(thickness of the bronchial wall,thickness of the smooth muscle)were measured;the enzyme-linked immunosorbent assay(ELISA)was used to examine the lung function of the rats.The levels of inflammatory factors[tumor necrosis factor α(TNF-α),interleukin 1β(IL-1β)]were detected in lung tissue by enzyme-linked immunosorbent assay(ELISA),and changes in the protein expressions of Toll-like receptor 4(TLR4),myeloid differentiation factor 88(MyD88),and nuclear transcription factor κB(NF-κB)were detected in lung tissue by Western Blot.Results(1)The rats in the model group had dry and lack of glossy fur,obvious coughing and nose scratching,shortness of breath,slow movement,and preferred to arch their backs and lie curled up;the rats in the low-,medium-and high-dose groups of sulforaphane showed significant improvement in shortness of breath,coughing,and other abnormal manifestations.(2)HE staining showed that the airway wall and smooth muscle of rats in the model group were thickened,the airway epithelium was damaged,and alveolar destruction,fusion,and massive infiltration of inflammatory cells were seen;the histopathological changes in the lungs of rats in the low-,medium-and high-dose groups of sulforaphane improved to varying degrees,with the airway wall becoming thinner,the degree of alveolar destruction being reduced,and the infiltration of inflammatory cells being reduced.(3)Compared with the normal group,FVC,PEF and FEV1 were significantly reduced in the model group(P＜0.05),and the levels of TNF-α and IL-1β,bronchial wall thickness,smooth muscle thickness,and the expression levels of TLR4,MyD88 and NF-κB were significantly increased in the model group(P＜0.05);and in comparison with the model group,the levels of FVC,PEF,and FEV1 were significantly increased in the rats in the sulforaphane low-,medium-,and high-dose groups(P＜0.05),and the levels of TNF-α,IL-1β,bronchial wall thickness,smooth muscle thickness,and the expression levels of TLR4,MyD88,and NF-κB were significantly decreased(P＜0.05)compared with the model group.Conclusion Sulforaphane helps to inhibit the inflammatory response,attenuate airway remodeling,and improve the pathological injury and lung function of lung tissue in rats with COPD,and its mechanism may be related to the inhibition of TLR4,MyD88,and NF-κB protein expressions.

Clinical Efficacy of Qiangli Pipa Syrup in Treating Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease and Its Influence on Pulmonary Function and Levels of Interleukin 6,C-reactive Protein and Procalcitonin / 广州中医药大学学报

Objective To investigate the clinical efficacy of Qiangli Pipa Syrup for the treatment of patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD),and to observe its effects on pulmonary function and interleukin 6(IL-6),C-reactive protein(CRP)and procalcitonin(PCT)levels in the patients.Methods Eighty patients with AECOPD of phlegm-heat obstructing the lung syndrome were randomly divided into the observation group and the control group,with 40 patients in each group.Patients in the control group were treated with conventional western medicine,and patients in the observation group were treated with Qiangli Pipa Syrup on the basis of treatment for the control group.Both groups were treated for 5 days.The two groups were observed in the changes of traditional Chinese medicine(TCM)syndrome scores(including cough,expectoration,shortness of breath,and wheezing),pulmonary function parameters[the forced expiratory volume in one second(FEV1)and the ratio of FEV1 to the forced vital capacity(FVC)(FEV1/FVC)],blood gas indicators[arterial partial pressure of oxygen(PaO2),blood oxygen saturation(SaO2)and arterial partial pressure of carbon dioxide(PaCO2)]and the levels of the inflammatory factors of IL-6,CRP,and PCT before and after treatment.Moreover,the clinical efficacy and safety of the patients in the two groups were evaluated.Results(1)After 5 days of treatment,the total effective rate of the observation group was 95.00%(38/40),and that of the control group was 77.50%(31/40).The intergroup comparison(tested by chi-square test)showed that the therapeutic effect of the observation group was significantly superior to that of the control group(P＜0.05).(2)After treatment,the TCM syndrome scores of cough,expectoration,shortness of breath,and wheezing in the two groups were reduced compared with those before treatment(P＜0.05),and the reduction in the observation group was significantly superior to that in the control group(P＜0.05).(3)After treatment,the pulmonary function parameters of FEV1/FVC and FEV1 in the two groups were improved compared with those before treatment(P＜0.05),and the improvement in the observation group was significantly superior to that in the control group(P＜0.05).(4)After treatment,the blood gas indicators of PaO2 and SaO2 levels in the two groups were increased compared with those before treatment(P＜0.05),and the PaCO2 level was decreased compared with that before treatment(P＜0.05).The increase of PaO2 and SaO2 levels and the decrease of PaCO2 level in the observation group were significantly superior to those in the control group(P＜0.05).(5)After treatment,the serum levels of inflammatory factors of IL-6,CRP,and PCT in the two groups were lower than those before treatment(P＜0.05),and the reduction in the observation group was significantly superior to that in the control group(P＜0.05).(6)The incidence of adverse reactions in the observation group was 10.00%(4/40),while that in the control group was 7.50%(3/40).There was no significant difference between the two groups(P＞0.05).Conclusion Qiangli Pipa Syrup exerts certain effect in treating patients with AECOPD of phlegm-heat obstructing the lung syndrome,which can effectively relieve the clinical symptoms,improve the pulmonary function and blood gas indicators,and inhibit inflammatory response of the patients,with high safety profile.

Pomalidomide improves airway inflammation and mucus hypersecretion in COPD rats by inhibiting TNF-α/NF-κB signaling pathway / 解放军医学杂志

Objective To investigate the effect and mechanism of pomalidomide(POM)on airway inflammation and mucus hypersecretion in rats with chronic obstructive pulmonary disease(COPD).Methods Thirty-six SD rats were randomly divided into control group,model group and POM group,with 12 in each group,half male and half female.The COPD model was established by smoke exposure combined with Klebsiella pneumoniae infection in model group and POM group.The rats in POM group were treated with POM(0.5 mg/kg,once a day for 1 week).The lung function,lung tissue pathology,the proportion of inflammatory cells in bronchoalveolar lavage fluid(BALF)and the levels of serum inflammatory factors tumor necrosis factor-α(TNF-α),interleukin(IL)-1β,IL-6 and IL-13 were observed and detected in each group.AB-PAS staining and immunohistochemistry were used to analyze the proliferation of goblet cells and the secretion of mucin(MUC)5AC and MUC5B in airway epithelium of rats.The expression levels of TNF-α receptor 1(TNFR1),IκB kinase(IKK),phosphorylated IKK(p-IKK)and P65 protein in lung tissue were detected by Western blotting.Results Compared with control group,model group showed significant decreased of tidal volume(TV),minute ventilation(MV),forced expiratory vital capacity(FVC),0.1s forced expiratory volume(FEV0.1)and 0.3 s forced expiratory volume(FEV0.3)(P<0.05),increased of the mean linear intercept(MLI)of the alveoli(P<0.01),decreased of the mean alveolar number(MAN)(P<0.01),increased of the proportion of neutrophils and lymphocytes in BALF sediment(P<0.05),and decreased of the proportion of macrophages in BALF sediment(P<0.01);increased of the levels of serum inflammatory factors TNF-α,IL-1β,IL-13 and IL-6(P<0.05),the proportion of goblet cells in airway epithelium(P<0.01),the secretion of MUC5AC and MUC5B in lung tissue(P<0.01),the content of TNFR1 and the ratio of p-IKK/IKK(P<0.01),the content of P65 in nucleus(P<0.01);and decreased of the content of P65 in cytoplasm(P<0.05).Compared with model group,after one week of POM treatment,POM group showed significant improved of the TV,MV,FVC,FEV0.1,FEV0.3,MLI and MAN of rats(P<0.05);decreased of the proportion of neutrophils and lymphocytes in BALF(P<0.05);increased of the proportion of macrophages(P<0.01);decreased of the levels of serum TNF-α,IL-1β,IL-6 and IL-13(P<0.05),the proportion of goblet cells in airway(P<0.01),the secretion of MUC5AC and MUC5B(P<0.01),and the expression of TNFR1,P-IKK and P65(nucleus)(P<0.05);and increased of the level of P65(cytoplasm)(P<0.01).Conclusions POM can improve airway inflammation and mucus hypersecretion in COPD rats,which may be achieved by inhibiting TNF-α/NF-κB signaling pathway.

Mechanism of peimine improving chronic obstructive pulmonary disease induced by lipopolysaccharide combined with cigarette smoke in mice / 解剖学报

Objective To investigate the effects and mechanisms of peimine(PME)on chronic obstructive pulmonary disease(COPD)in mice.Methods The mice were randomly divided into 4 groups(20 mice in each group),control group,PME group,chronic obstructive pulmonary disease group and treatment group.Animal models of COPD were induced in mice by lipopolysaccharide combined with smoke.The effects of PME on COPD model mice was analyzed by HE staining,transmission electron microscopy and the ratio of wet/dry weight of mouse lung tissue.The effects of PME on COPD model mice were analyzed by HE staining,transmission electron microscopy and the ratio of wet/dry weight of mouse lung tissue.The effects of PME on inflammatory factor tumor necrosis factor(TNF)-α,interleukin(IL)-6 and IL-1β in lung tissue were analyzed by ELISA and Western blotting.The effects of PME on oxidative stress in lung tissue were analyzed by dihydroethidium(DHE)staining and Western blotting.The effects of PME on nuclear factor kappa-B(NF-κB)pathway and nuclear factor erythroid 2-related factor 2(Nrf2)pathway were analyzed by protein immunoblotting.Results Compared with the COPD group,PME treatment could significantly improve the lung tissue injury and the number of inflammatory cells in mice,and the wet/dry weight ratio of lung tissue was significantly reduced.Compared with the control group,the levels of TNF-α,IL-6 and IL-1β in the alveolar lavage fluid of COPD mice significantly increased,and the level of TNF-α,IL-6 and IL-1β in the alveolar lavage fluid of mice after PME treatment was significantly reduced.In addition,compared with the control group,the protein expression of TNF-α,IL-6 and IL-1β in the lung tissue of COPD mice significantly increased,and the level of TNF-α,IL-6 and IL-1β in the lung tissue of COPD mice after PME treatment were significantly reduced.Immunohistochemistry and Western blotting showed that the level of superoxide dismutase 2(SOD2)protein in COPD group was significantly lower than that in control group,while PME treatment could improve the level of superoxide dismutase protein.The analysis of MDA content in lung tissue showed that compared with the COPD group,the production of MDA in lung tissue of COPD mice was significantly inhibited after PME treatment.Protein Western blotting showed that PME treatment could prevent the phosphorylation of inhibitor of NF-κB(IκBα)and the transfer of NF-κB p65 to the cell nucleus,and the expression of Nrf2 and its main downstream target heme oxygenase-1(HO-1)in the lung tissue of mice treated with PME significantly increased.Conclusion PME is able to inhibit inflammation and oxidative stress and improve lung tissues damage in the COPD model in vivo and this protection effect might be both the Nrf2 pathway activation and NF-κB pathway inhibition.

Quality assessment of global obstructive sleep apnea guidelines / 上海交通大学学报（医学版）

Objective·To evaluate the quality of clinical practice guidelines of obstructive sleep apnea(OSA)published worldwide.Methods·The guidelines of OSA were retrieved in PubMed,Embase,China National Knowledge Infrastructure(CNKI),Wanfang Data,SinoMed,MedSci,The Cochrane Library,and the websites such as Medlive,U.S.Preventive Services Task Force(USPSTF),National Institute for Health and Care Excellence(NICE),New Zealand Guidelines Group(NZGG),Scottish Intercollegiate Guidelines Network(SIGN),and Guidelines International Network(GIN)from establishment to December 2022.Two reviewers screened the literature and extracted the main information independently,using the Appraisal of Guidelines for Research and Evaluation Ⅱ(AGREE Ⅱ)and Reporting Items for Practice Guidelines in Healthcare(RIGHT)to evaluate the quality of the included OSA guidelines.Subgroup analysis was performed according to the publication regions of guidelines.The inter-evaluator consistency test was also performed and the results were expressed as the intra-class correlation coefficient(ICC).All the included guidelines were read entirely and the clinical questions they raised were summarized.Results·A total of 35 OSA guidelines were included.The ICC value of 0.975 showed a good inter-evaluator agreement.The results of AGREE Ⅱ showed that the average score of all guidelines was(63.60±16.45)%,with a minimum of 23.40%and a maximum of 91.67%.In the six domains,the scores of"Rigor of development"[(56.07±25.89)%]and"Applicability"[(53.57±15.52)%]were relative low.The average reporting rate of RIGHT of all the included guidelines was(67.84±20.03)%,with a minimum of 14.29%and a maximum of 94.29%,and the three domains with the lowest reporting rates were"Review and quality assurance"[(31.40±45.51)%],"Funding and conflict of interest declaration and management"[(56.43±33.95)%]and"Other aspects"[(56.19±36.85)%].Subgroup analysis showed that guidelines in Asian had a lower score in"Rigor of development"and a lower overall score of AGREE Ⅱ than the guidelines in America and Europe(both P<0.05),and the reporting rates in the domains of"Evidence"and"Other information"of RIGHT of the Asian guidelines were also lower than those in the guidelines in America and Europe(P<0.05).These guidelines focused on 42 clinical questions which were classified to 3 aspects,i.e.screening and diagnosis,treatment and long-term management of OSA.Conclusion·The quality of current global OSA guidelines varies a lot,and they need to be strengthened in terms of rigor of development,applicability,review and quality assurance,funding and conflict of interest declaration and management,especially those in Asia.