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.

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.

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

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.

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.

The clinical efficacy of non-invasive bilevel positive airway pressure ventilator combined with oxygen atomization in the treatment of chronic obstructive pulmonary disease complicated with type Ⅱ respiratory failure / 中国医师进修杂志

Objective:To investigate the clinical efficacy and safety of non-invasive bilevel positive airway pressure (BiPAP) ventilator combined with oxygen atomization in the treatment of chronic obstructive pulmonary disease (COPD) complicated with type Ⅱ respiratory failure.Methods:A total of 80 patients with COPD complicated with type Ⅱ respiratory failure admitted to Haiyan County People′s Hospital from June 2019 to July 2021 were selected, and they were divided into the observation group and the control group by the random number table method, with 40 cases in each group. Patients in both groups received conventional treatment, while patients in the control group were connected with BiPAP non-invasive ventilator and received non-invasive mechanical ventilation in S/T mode; the observation group was given aerosol inhalation drugs during ventilation, and both groups were treated for 7 d. Blood gas indicators and vital signs were collected before treatment and 7 d after treatment. Clinical symptoms were investigated by COPD patient Caring Assessment Tool (CAT) and Dyspnea Scale (DECAF). Serum levels of interleukin (IL)-10, tumor necrosis factor (TNF-α) and CD 4+/CD 8+ were determined, and treatment outcomes and adverse reactions were compared between the two groups. Results:After treatment, the partial pressure of oxygen (PaO 2) and the oxygen saturation (SaO 2) in the observation group were higher than those in the control group: (73.41 ± 5.26) mmHg(1 mmHg = 0.133 kPa) vs. (65.11 ± 4.33) mmHg, 0.921 ± 0.052 vs. 0.884 ± 0.039; the arterial partial pressure of carbon dioxide (PaCO 2), heart rate (HR), respiratory rate (RR) were lower than those in the control group: (45.20 ± 5.33) mmHg vs. (50.52 ± 5.96) mmHg, (90.12 ± 8.56) times/min vs. (98.52 ± 9.63) times/min, (17.41 ± 2.26) times/min vs. (22.10 ± 3.05) times/min, there were statistical differences ( P<0.05). After treatment, CAT scores and DECAF scores in the observation group were lower than those in the control group: (8.45 ± 1.63) scores vs. (12.77 ± 2.36) scores, (0.89 ± 0.15) scores vs. (1.15 ± 0.19) scores, there were statistical differences ( P<0.05). After treatment, the levels of IL-10 and CD 4+/CD 8+ in the observation group were higher than those in the control group: (15.28 ± 3.12) ng/L vs. (13.41 ± 2.96) ng/L, 1.71 ± 0.38 vs. 1.54 ± 0.30; while the level of TNF-α was lower than that in the control group: (215.27 ± 33.96) ng/L vs. (251.11 ± 50.95) ng/L, there were statistical differences ( P<0.05). The hospitalization time in the observation group was shorter than that in the control group: (13.52 ± 3.96) d vs. (15.22 ± 2.74) d, there was statistical difference ( P<0.05). The rates of tracheal intubation and the incidence of adverse reactions between the two groups had no significant differences ( P>0.05). Conclusions:Non-invasive BiPAP ventilator combined with oxygen atomization can improve blood gas index, vital signs and clinical symptoms of COPD patients complicated with type Ⅱ respiratory failure and reduce inflammatory response.

Effects of budegforo combined with doxofylline on inflammatory indexes, monocyte chemotactic protein 1 and serum amyloid A protein levels in patients with moderate and severe chronic obstructive pulmonary disease during acute exacerbation period / 中国医师进修杂志

Objective:To investigate the effects of budegforo combined with doxofylline on inflammatory indexes, monocyte chemotactic protein 1 (MCP-1) and serum amyloid A protein (SAA) levels in patients with moderate and severe chronic obstructive pulmonary disease (COPD) during exacerbation period.Methods:The method of prospective study was adopted, 80 patients with moderate and severe COPD during exacerbation period who were treated in Gongan County People′s Hospital from January 2020 to December 2021 were selected as the research objects, and they were divided into the combined group and the budegforo group by random number table method, with 40 cases in each group. The budegforo group was treated with budegforo inhalation and the conventional maintenance therapy, the combined group was treated with doxofylline on the basis treatment of the budegforo group. The patients of the two groups were treated for 12 weeks. The clinical total effective rate and pulmonary function, inflammatory indexes and MCP-1, SAA levels before and after treatment and adverse reactions of the two groups were compared.Results:The clinical total effective rate in the combined group was higher than that in the budegforo group: 95.00%(38/40) vs. 75.00%(30/40), there was statistical difference ( χ2 = 4.80, P<0.05). After 12 weeks of treatment, the forced expiratory volume in one second (FEV 1), FEV 1 and forced vital capacity (FVC) ratio (FEV 1/FVC), percentage of FEV 1 in predicted value (FEV 1% pred), maximum voluntary ventilation (MVV), percentage of predicted value of diffusing capacity of the lung for carbon monoxide (DLCO% pred) in the combined group were higher than those in the budegforo group: (2.80 ± 0.56) L vs. (2.41 ± 0.27) L, (66.35 ± 8.20)% vs. (61.84 ± 9.77)%, (72.73 ± 7.57)% vs. (65.39 ± 5.41)%, (73.56 ± 7.06) L/min vs. (68.53 ± 6.25) L/min, (71.03 ± 5.85)% vs. (66.37 ± 7.08)%; residual volume (RV) to total lung capacity (TLC) ratio (RV/TLC) level was lower than that in the budegforo group: (45.32 ± 6.64)% vs. (51.73 ± 8.45)%, there were statistical differences ( P<0.05). After 12 weeks of treatment, the levels of interleukin(IL)-17, IL-22, MCP-1, SAA in the combined group were lower than those in the budegforo group: (21.46 ± 5.86) ng/L vs. (30.55 ± 8.74) ng/L, (155.62 ± 14.39) ng/L vs. (170.81 ± 16.70) ng/L, (89.57 ± 7.41) ng/L vs. (105.25 ± 8.70) ng/L, (45.21 ± 8.86) ng/L vs. (57.67 ± 7.16) ng/L, there were statistical differences ( P<0.05). There was no statistical difference in adverse reactions between the two groups ( P>0.05). Conclusions:The application of budegforo combined with doxofylline can improve the pulmonary function and clinical efficacy of patients with moderate and severe COPD during exacerbation period, and also play a positive role in reducing MCP-1 and SAA levels.

Based on CiteSpace Visualization Analysis of TCM Treatment of Chronic Obstructive Pulmonary Disease / 医学研究杂志

Objective To explore the hot topics and the research trend of traditional Chinese medicine treatment of chronic obstruc-tive pulmonary disease in 2017-2021,and to aware the cooperation among authors and institutions in the field.Methods Literature on TCM treatment of chronic obstructive pulmonary disease published in CNKI and PubMed in 2017-2021 was searched,and CiteSpace 5.8 R3 was used to visualize the authors,research institutions and keywords of the included literatures.Results A total of 3082 Chinese literatures and 1093 English literatures were included.In 2017-2021,the trend of publication has always shown a steady growth,and there was a lack of communication and cooperation among authors and teams.Keywords visualization map showed 18 clusters and 20 emer-gent words.Conclusion Traditional Chinese medicine treatment of chronic obstructive pulmonary disease is mainly focused on syndrome type,treatment methods,disease mechanism and related curative effect indicators,and the syndrome differentiation analysis and clinical curative effect evaluation of traditional Chinese medicine compounds are still the main forces at present.As the patients quality of life is becoming more and more attention,how to strengthen pulmonary rehabilitation education,improve patient compliance,and expand the lo-cation and area of pulmonary rehabilitation is one of the current research trends.

Construction and evaluation of a multifactor prediction model for the risk of pneumothorax in patients with chronic obstructive pulmonary disease / 中国基层医药

Objective:To analyze the independent risk factors for pneumothorax in older adult patients with chronic obstructive pulmonary disease (COPD), construct and validate a prediction model of pneumothorax risk in patients with COPD.Methods:A total of 500 patients with COPD who received treatment at the Department of Emergency, Wenzhou Hospital of Integrated Traditional Chinese and Western Medicine from January 2018 to December 2021 were selected using the convenience sampling method and included in this study. Chest CT scan or chest X-ray film findings were used as diagnostic criteria. These patients were divided into a pneumothorax group and a control group according to whether they developed pneumothorax. Taking whether patients develop pneumothorax as a dependent variable and predictive risk factors as independent variables, univariate and multivariate logistic regression analyses of the included risk factors were performed to identify the independent influential factors for developing pneumothorax in patients with COPD. Subsequently, a prediction model for predicting the risk of pneumothorax was constructed and evaluated. A decision curve analysis was conducted to evaluate its clinical practicality.Results:Among 500 patients with COPD, 104 developed pneumothorax, with an incidence of 20.80%. Binary logistic regression analysis showed that long duration of COPD, C-reactive protein, and mechanical ventilation were independent risk factors for the development of pneumothorax in these patients. The percentage of forced expiratory volume in one second (FEV 1%), the FEV 1/forced vital capacity ratio (FEV 1/FVC), and serum albumin are protective factors for the development of pneumothorax in patients with COPD. A prediction model for the risk of developing pneumothorax was constructed. Finally, we obtained the formula: Logit( P) = 12.427 + 2.241 × COPD duration + 0.899 × smoking + 7.715 × CRP + 0.208 × mechanical ventilation history -0.514 × albumin -0.243 × FEV 1%-0.286 FEV 1/FVC. Receiver operating characteristic curve analysis results showed that the area under the curve was 0.815 and the C-Index was 0.781 (95% CI: 0.856-0.891), indicating that the constructed prediction model can better distinguish between patients with and without pneumothorax among those with COPD. Conclusion:C-reactive protein, albumin, FEV 1%, FEV 1/FVC, smoking history, and mechanical ventilation history are all risk factors for the development of pneumothorax. A prediction model has been successfully constructed based on these risk factors, which can effectively predict the risk of pneumothorax. This constructed risk prediction model provides good guidance in taking preventive treatment and nursing measures by medical staff.

Advances in the study of mesenchymal stem cells in obstructive sleep apnea hypoventilation syndrome / 中国临床药理学与治疗学

Mesenchymal stem cells(MSCs)are self-regenerating,rapidly proliferating pluripotent stem cells that depend primarily on their derived pro-angiogenic,inflammatory regulatory,and tro-phic factors to exert beneficial effects that attenu-ate deleterious inflammatory responses,reduce vascular damage,and promote tissue repair and re-generation.Obstructive sleep apnea hypoventila-tion syndrome(OSAHS)is a chronic disorder marked by oropharyngeal collapse during sleep,re-sulting in transient reduced airflow,large fluctua-tions in intrathoracic pressure,and intermittent hy-poxia and hypercapnia.OSAHS subsequently cyto-kine-mediated inflammatory cascades,oxidative stress,and ischemia,recruit MSCs from inflamed and damaged tissues through MSCs-derived of anti-inflammatory and pro-angiogenic factor activity,re-duce hypoxia,suppress inflammation,promote re-generation,and prevent fibrosis in OSAHS-injured tissues.In this paper,we will describe the patho-genesis of inflammation,oxidative stress,fibrosis and ischemia from the perspective of OSAHS,high-lighting the current research progress on MSCs-de-pendent regulation of OSAHS-related pathology.

An Overview of Methods for Assessing the Burden of Chronic Obstructive Pulmonary Disease / 中国卫生经济

Chronic obstructive pulmonary disease(COPD)poses a serious threat to human health and carries a heavy burden of disease.The disease burden mainly includes traditional epidemiological indicators such as morbidity,disability rate,and mortality rate,as well as economic burden evaluation indicators such as direct economic burden,indirect economic burden,and intangible economic burden,as well as social/health burden evaluation indicators such as potential years of life reduction,disability adjusted life years,and quality adjusted life years.It summarized the existing methods for evaluating the burden of COPD diseases and proposed the following suggestions:(1)enriching economic burden research methods to comprehensively and accurately evaluate direct economic burden;(2)expanding the scope of economic burden research and improve the economic burden research of COPD;(3)strengthening information management and enhance the accuracy of disease burden data;(4)exploring multidimensional indicators and establish a COPD disease burden evaluation system;(5)strengthening relevant research and highlight the health economics advantages of traditional Chinese medicine intervention in COPD.It can provide references for establishing a COPD disease burden evaluation system and policy formulation.

Effect analysis of information-guided enteral nutrition-associated diarrhea treatment process in patients with chronic obstructive pulmonary disease undergoing continuous non-invasive assisted ventilation: a mixed cohort study of pre- and post-control / 中华危重病急救医学

Objective:To clarify the application effect of information-guided enteral nutrition-associated diarrhea (ENAD) management process in patients with chronic obstructive pulmonary disease (COPD) undergoing non-invasive assisted ventilation.Methods:A mixed cohort study of pre- and post-control was conducted. Thirty-nine patients with COPD who were admitted to the emergency intensive care unit (ICU) of Huzhou First People's Hospital from July 1, 2021 to July 31, 2022 were enrolled. Taking the completion of the software development of ENAD management software for critically ill patients on January 28, 2022 as the time node, 20 patients admitted from July 1, 2021 to January 28, 2022 were set as the control group, and 19 patients admitted from January 29 to July 31, 2022 were set as the observation group. The two groups of patients received the same enteral nutrition support treatment, and the control group implemented the conventional ENAD treatment process with enteral nutrition intolerance disposal process as the core. On the basis of the control group, the observation group implemented the information-guided ENAD treatment process, and the system software actively captured the information of ENAD patients and reminded the medical team to improve the patient's diarrhea-related examination and provide alternative treatment plans. The duration of antidiarrhea, feeding interruption rate, and energy and protein intake, blood biochemical indexes, incidence of abnormal blood electrolyte metabolism, daily continuous non-invasive assisted ventilation and endotracheal intubation after 7 days of targeted diarrhea intervention were compared between the two groups.Results:Except for the basal pulse rate, there were no significant differences in gender distribution, age, and vital signs, basic nutritional status, arterial blood gas analysis and blood biochemistry at admission between the two groups, indicating comparability between the two groups. When ENAD occurred, the patients in the observation group obtained earlier cessation of diarrhea than those in the control group [days: 3.00 (2.00, 3.25) vs. 4.00 (3.00, 5.00), P < 0.01], and the feeding interruption rate was significantly lower than that in the control group [10.53% (2/19) vs. 65.00% (13/20), P < 0.01]. After 7 days of diarrhea intervention, the energy intake of the observation group was significantly higher than that of the control group [kJ·kg -1·d -1: 66.28 (43.34, 70.36) vs. 47.88 (34.60, 52.32), P < 0.01], the levels of hemoglobin (Hb), albumin (Alb) and serum prealbumin (PAB) were significantly higher than those in the control group [Hb (g/L): 119.79±10.04 vs. 110.20±7.75, Alb (g/L): 36.00 (33.75, 37.25) vs. 31.00 (30.00, 33.00), PAB (mg/L): 155.79±25.78 vs. 140.95±14.97, all P < 0.05], the daily continuous non-invasive assisted ventilation duration was significantly shorter than that of the control group [hours: 14 (12, 16) vs. 16 (14, 18), P < 0.01], and the arterial partial pressure of carbon dioxide (PaCO 2) was significantly lower than that of the control group [mmHg (1 mmHg ≈ 0.133 kPa): 66.00 (62.00, 70.00) vs. 68.00 (67.50, 70.05), P < 0.05]. However, there were no significant differences in protein intake, incidence of abnormal electrolyte metabolism, and incidence of endotracheal intubation due to acute respiratory failure between the two groups. Conclusion:The information-guided ENAD treatment process can enable the COPD patients undergoing continuous non-invasive assisted ventilation who experience ENAD to receive earlier cessation of diarrhea, and improve the protein energy metabolism and respiratory function of the patients.

Effects of conditioned medium of alveolar epithelial cells on vascular endothelial cell damage / 中华危重病急救医学

Objective:To observe the effect of lipopolysaccharide (LPS) induced conditioned medium of alveolar epithelial cells on the inflammatory response and cell damage of vascular endothelial cells, and explore its mechanism.Methods:The LPS induced type Ⅱ alveolar epithelial cells (A549) conditioned medium was used as a stimulus to induce human umbilical vein endothelial cells (HUVEC) damage. The cell counting kit-8 (CCK-8) was used to detect the effect of 0% (blank group), 12.5%, 25%, 50%, 75% and 100% A549 cell conditioned medium cultured for 6, 12, 24 and 48 hours on the cell viability of HUVEC. Enzyme-linked immunosorbent assay (ELISA) was used to detect the levels of inflammatory factors [interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α)] and vasoactive substances [vascular endothelial growth factor (VEGF), endothelin-1 (ET-1)] in the supernatant. Phalloidin staining was used to observe the effects of A549 cells conditioned medium on cell morphology. The expressions of protein kinase B/nuclear factor-κB (AKT/NF-κB) pathway in HUVEC induced by conditioned medium was detected by Western blotting.Results:Compared with the blank group, A549 cells conditioned medium with concentrations of 12.5%, 25%, and 50% had no significant effects on cell viability of HUVEC after 6, 12, and 24 hours, but the activity of HUVEC decreased significantly after 48 hours. Therefore, 12.5%, 25%, 50% A549 cell conditioned medium stimulated for 24 hours was selected as the induction condition for follow-up experiments. Compared with the blank group, the level of IL-6 was significantly increased in 12.5% and 50% conditioned medium groups (ng/L: 2?438.95±64.89, 3?036.41±96.69 vs. 1?736.75±20.99, both P < 0.05), the level of TNF-α was significantly increased in 12.5% and 25% conditioned medium groups (ng/L: 174.08±11.09, 81.37±8.17 vs. 50.03±0.26, both P < 0.01), the levels of VEGF and ET-1 were significantly increased in 12.5%, 25% and 50% conditioned medium groups [VEGF (ng/L): 173.60±41.44, 192.49±12.38, 318.89±27.90 vs. 66.68±19.65; ET-1 (ng/L): 54.88±1.37, 36.69±0.29, 24.07±0.73 vs. 10.67±0.25, all P < 0.01]. Phalloidin staining showed that HUVEC induced by 25% A549 cells conditioned medium were irregular in shape, uneven in size, disordered in arrangement, widened in gap, dense and unclear in microfilament structure and serrated in cell membrane. Furthermore, the average fluorescence intensity of 25% conditioned medium group significantly increased compared to the blank group (67?205.60±3?430.40 vs. 56?272.67±7?650.95, P < 0.05). Western blotting showed that compared with the blank group, the expression of HUVEC cells phosphonated inhibitor α of NF-κB (p-IκBα) was significantly decreased in the 12.5%, 25%, and 50% conditioned medium groups (p-IκBα/IκBα: 0.38±0.08, 0.67±0.12, 0.31±0.07 vs. 1.00±0.00, all P < 0.01), the expressions of phosphonated-AKT (p-AKT) and VEGF were significantly increased (p-AKT/AKT: 1.50±0.18, 1.42±0.27, 1.61±0.14 vs. 1.00±0.00, VEGF/GAPDH: 1.37±0.10, 1.53±0.22, 1.40±0.12 vs. 1.00±0.00, all P < 0.05), the expression of phosphonated NF-κB p65 (p-P65) was significantly increased in the 25% conditioned medium group (p-P65/P65: 1.45±0.14 vs. 1.00±0.00, P < 0.05). Conclusion:LPS induced conditional culture medium of alveolar epithelial cells induced endothelial cell damage via activating AKT/NF-κB pathway.

Current research status of mesenchymal stem cell therapy for chronic obstructive pulmonary disease / 中国医师杂志

Chronic obstructive pulmonary disease (COPD) is a heterogeneous lung condition characterized by persistent airflow obstruction caused by long-term airway inflammation or alveolar abnormalities, often manifested as chronic respiratory symptoms and decreased lung function. In recent years, experimental research has shown that mesenchymal stem cells (MSC) have anti-inflammatory, immunomodulatory, and repairing properties of lung epithelial cells, which can be used to treat various diseases including COPD. This article is mainly based on the main findings of in vitro and in vivo animal model experiments and clinical studies of MSC treatment for COPD. It summarizes and discusses the possible mechanisms of action of MSC as a new therapy, and provides new ideas for clinical treatment of COPD.

Clinical characteristics of patients >65 years old with acute exacerbation of chronic obstructive pulmonary disease and COVID-19 infection / 中国医师杂志

Objective:To investigate the clinical characteristics of patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) and corona virus disease 2019 (COVID-19) infection.Methods:Clinical data of AECOPD patients over 65 years old who were diagnosed in the Respiratory and Emergency Departments of the Dongzhimen Hospital, Beijing University of Chinese Medicine from September 2022 to September 2023 were collected. AECOPD patients were divided into a COVID-19 group ( n=29) and a non COVID-19 group ( n=31). The platelet count, white blood cell count, lymphocyte count, neutrophil count, neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), C-reactive protein (CRP), procalcitonin (PCT), partial pressure of oxygen (PO 2), partial pressure of carbon dioxide (PCO 2), D-dimer (D-D), and interleukin-6 (IL-6) were compared between two groups of patients upon admission Confusion, Uremia, Respiratory, BP, Age 65 Years (CURB-65) was used to compare length of hospital stay, AECOPD grading, and mortality endpoint days. Results:There was no statistically significant difference in platelet count, white blood cell count, lymphocyte count, neutrophil count, NLR, and PLR between the COVID-19 group and the non COVID-19 group (all P>0.05). The proportion of males, CRP, PCO 2, D-D, IL-6, and CURB-65 scores in the COVID-19 group were higher than those in the non COVID-19 group, while PCT and PO 2 were lower than those in the non COVID-19 group, with statistically significant difference (all P<0.05). The proportion of AECOPD grade Ⅲ in the COVID-19 group was significantly higher than that in the non COVID-19 group, and the progression rate of the disease was higher in the COVID-19 group (37.9% vs 22.6%, P<0.05). COVID-19 was an independent influencing factor for the progression of AECOPD. Conclusions:Patients over 65 years old with AECOPD infected with COVID-19 have a more pronounced inflammatory response, and CRP, IL-6, and CURB-65 scores can be used as indicators to evaluate the degree of inflammation. AECOPD infected with COVID-19 are more prone to coagulation disorders, hypoxemia, more severe illness, and easier progression, suggesting that COVID-19 infection is an independent influencing factor for the progression of AECOPD.

Changes of quantitative CT indexes in chronic obstructive pulmonary disease patients and correlations with pulmonary function indicators / 中国医学影像技术

Objective To observe changes of CT quantitative indexes in patients with untreated chronic obstructive pulmonary disease(COPD)and relationships with pulmonary function indicators.Methods Totally 99 patients with untreated COPD were retrospectively enrolled.According to the degrees of airflow obstruction,the patients were divided into group A(GOLD grade 1 with mild obstruction,n=36),group B(GOLD 2 with moderate obstruction,n=37)and group C(GOLD 3 or 4 with obvious obstruction,n=26).The results of chest CT and pulmonary function tests conducted at the first diagnosis and the follow-up,as well as their correlations were analyzed.CT quantitative indicators included the whole lung volume,low-attenuation areas less than-950 percentage(LAA％),total number of vessels per 1 cm2 of lung surface area(Ntotal/LSA),total number of vessels with area less than 5 mm2 per 1 cm2 of lung surface area(N＜5mm2/LSA),the square root of the wall area of a hypothetical airway with a 10 mm internal perimeter(Pi10),the entire volume,wall thickness and wall area percentage(WA％)of airway wall,etc.,while results of pulmonary function tests included the forced expiratory volume in one second(FEV1)after administration of a bronchodilator,forced vital capacity(FVC),the ratio FEV1/FVC and FEV1 expressed as percent predicted(FEV1％).Results Compared with those at the first diagnosis,the follow-up results of FVC,FEV1,FEV1/FVC,Ntotal/LSA and N＜5mm2/LSA were lower,whereas LAA％,Pi10 and entire volume of airway were all higher in each group(all P＜0.05).Compared with those in group A,group B and C had decreased LAA％and increased Pi10,and the magnitude increased with the severity of airflow obstruction(all P＜0.05).LAA％,Pi1o and entire volume of airway wall were negatively correlated with pulmonary function indicators(all P＜0.05),while Ntotal/LSA and N＜5 mm2/LSA were positively correlated with pulmonary function indicators(all P＜0.05).Conclusion CT quantitative parameters,including LAA％,Ntotal/LSA,N＜5mm2/LSA,Pi10 and entire volume of airway wall were related to pulmonary function,which might reflect the longitudinal changes of airways and blood vessels in COPD patients.

Effects of parameters of BiPAP ventilator on compliances of chest and lung,and arterial blood gas indexes of AECOPD patients / 中国医学装备

Objective:To explore the effects of ventilator parameters on the compliances of chest and lung,and arterial blood gas indicators of patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD)when biphasic positive airway pressure(BiPAP)ventilation treated AECOPD patients at acute exacerbation period.Method:A total of 78 AECOPD patients who underwent non-invasive ventilation treatment by using BiPAP ventilators in Xinjiang Cardiovascular and Cerebrovascular Hospital from April 2020 to April 2021 were selected.The common range of inspiratory positive airway pressure(IPAP)was 10-25 cmH2O.Based on the specific situation and adjustment of clinical needs of patients,this study set"<15 cmH2O"as the low IPAP group(n=34),and set"≥15 cmH2O"as the high IPAP group(n=44)to analyze the correlation between IPAP of BiPAP ventilator parameters and the therapeutic effects,chest lung compliances and arterial blood gas indicators of patients.Results:The rate of therapeutic effect of patients in the high IPAP group was 93.48%,which was significantly higher than 71.88%of the low IPAP group,and the difference between the two groups was statistically significant(x2=6.766,P<0.05).Before treatment,there were no statistically significant differences in indicators included chest compliance(CTh),lung compliance(CL)and total compliance(Ct)between the two groups(P>0.05).After treatment,the Ct,CL and CTh of patients in the high IPAP group were significantly higher than those in the low IPAP group,and the differences between the two groups were statistically significant(t=2.508,2.027,2.185,P<0.05),respectively.There was no statistically significant difference in arterial oxygen partial pressure(PaO2)value between the two groups before used mechanical ventilation(P>0.05).The PaO2 values of patients at 2,4,6 and 8h of using mechanical ventilation in the high IPAP group were significantly higher than those in the low IPAP group,and the differences between different groups were statistically significant(t=8.531,5.296,3.264,4.623,P<0.05),respectively.Both two groups of patients showed a significant increase in inflammatory mediators such as matrix metalloproteinase-9(MMP-9)and interleukin-8(IL-8)during occurring disease.After treatment,the levels of the two mediators decreased,and the high IPAP group was significantly lower than that of low IPAP group(t=2.251,5.484,P<0.05),respectively.The incidence of abdominal distension in patients of high IPAP group was 20.45%,which was significantly higher than 5.88%of low IPAP group,and the difference between groups was statistically significant(x2=3.623,P<0.05).Conclusion:The IPAP of BiPAP ventilator parameters has effect on chest lung compliance,arterial blood gas analysis and inflammatory indicators in AECOPD patients.High IPAP can improve therapeutic effect,and improve chest lung compliance and arterial blood gas analysis,but can easily cause adverse reactions such as abdominal distension.

Role and new progress of AGP in pulmonary diseases and different systems diseases / 中国综合临床

Alpha1-acid glycoprotein (AGP), also known as oral mucus protein (ORM), is an acute phase positive protein. AGPs have various biological activities, such as drug transport, immune regulation, maintenance of capillary barrier, regulation of lipid metabolism, etc. AGP mainly exists in liver cells, but it is also expressed in other tissue cells, such as adipose tissue, brain tissue, endothelial cells and immune cells. This article mainly reviews the application of AGP in pulmonary diseases, and the role,significance and related new developments in different systemic diseases.

Effects of Zhoufei Pingchuan Capsules on Th17/Treg Balance and Related Inflammatory Factors in Peripheral Blood of Patients with Stable Chronic Obstructive Pulmonary Disease with Lung-kidney Qi Deficiency Syndrome / 中国中医药信息杂志

Objective To investigate the effects of Zhoufei Pingchuan Capsules on the balance of peripheral blood helper T lymphocyte 17 cell/regulatory T lymphocyte cell(Th17/Treg)and related inflammatory factors in peripheral blood of patients with stable chronic obstructive pulmonary disease(COPD)with lung-kidney qi deficiency syndrome.Methods Totally 40 COPD patients were randomly divided into the study group and the control group,with 20 cases in each group.Another 20 cases were in the healthy group.The control group was given tiotropium bromide powder inhalation,18 μg/time,1 time/d,inhalation;on the basis of the control group,the study group was given Zhoufei Pingchuan Capsules,3 pills/time,3 times/d,orally.All patients were treated for 8 weeks.The healthy group was not given any intervention.Forced expiratory volume in one second(FEV1),FEV1/forced vital capacity(FEV1/FVC),maximum mid-expiratory flow(MMEF),carbon monoxide diffusing capacity/alveolar ventilation(DLCO/VA),arterial partial pressure of oxygen(PaO2),arterial partial pressure of carbon dioxide(PaCO2),COPD assessment test(CAT)score,Th17/Treg ratio,cytokines interleukin(IL)-17,IL-22,IL-10,and transforming growth factor-β1(TGF-β1)were compared before and after treatment.Results Compared with before treatment,the lung function indexes(FEV1,FEV1/FVC,MMEF,DLCO/VA),blood gas indexes(PaO2,PaCO2)and CAT score in the study group after treatment were significantly improved(P<0.05).After treatment,the mean values of MMEF,DLCO/VA,PaCO2 and CAT score in the study group were better than those in the control group(P<0.05).Compared with before treatment,the levels of Th17,IL-17 and IL-22 in the study group were significantly lower,and the levels of Treg,IL-10 and TGF-β1 were significantly higher(P<0.05).After treatment,there were significant differences in Th17,Treg,IL-17,IL-22,IL-10 and TGF-β1 among the three groups(P<0.01).Further pairwise comparison showed that Th17 ranked in the order of high and low was control group>study group>healthy group,Treg in the order of high and low was healthy group>study group>control group,the levels of IL-17 and IL-22 in the order of high and low were control group>study group>healthy group,and the levels of IL-10 and TGF-β1 in the order of high and low were healthy group>study group>control group,with statistical significance(P<0.05).Conclusion Zhoufei Pingchuan Capsules can improve the lung function,arterial blood gas and symptom score of patients with lung-kidney qi deficiency syndrome in stable stage of COPD.Its mechanism may be related to regulating the balance of Th17/Treg,down-regulating the levels of Th17,IL-17 and IL-22,and up-regulating the levels of Treg,IL-10 and TGF-β1,in order to reduce airway inflammation and regulate immune homeostasis.

Clinical Study on Feisu Granules for the Treatment of Acute Exacerbation of COPD with Syndrome of Phlegm-heat and Blood Stasis of Lung / 中国中医药信息杂志

Objective To observe the clinical efficacy of Feisu Granules,and its effects on quality of life,coagulation and immune function in acute exacerbation of chronic obstructive pulmonary disease(AECOPD)with syndrome of phlegm-heat and blood stasis of lung.Methods Totally 120 AECOPD patients were divided into observation group and control group according to random number table method,with 60 cases in each group.The control group was given conventional Western medicine treatment,and the observation group received Feisu Granules treatment on the basis of the control group,one bag each time,three times a day,orally.The treatment for both groups lasted for 7 d.The clinical efficacy of both groups were observed.TCM symptom scores,St.George's respiratory questionnaire(SGRQ)score,coagulation function indexes(fibrinogen,D-dimer),and immune function indexes(CD4+,CD8+,CD4+/CD8+)of both groups were compared.The side effects were observed.Results The total effective rate in the observation group(93.10%)was significantly higher than that of the control group(79.66%),with statistical significance(P<0.05).Compared with before treatment,TCM symptom scores,scores of cough,wheezing,venous congestion,and SGRQ score decreased in both groups after treatment(P<0.05);after treatment,the observation group had lower above scores than the control group(P<0.05).Compared with before treatment,both groups showed a decrease in plasma fibrinogen and D-dimer levels after treatment(P<0.05);after treatment,the observation group showed lower levels of plasma fibrinogen and D-dimer compared with the control group(P<0.05).Compared with before treatment,the peripheral blood CD4+ and CD4+/CD8+ levels in both groups significantly increased after treatment,while CD8+ levels significantly decreased(P<0.05);after treatment,the peripheral blood CD4+ and CD4+/CD8+ in the observation group were higher than those in the control group,while CD8+ was lower than those in the control group(P<0.05).Neither group had any drug-related side effects.Conclusion On the basis of conventional Western medicine,the combination of Feisu Granules in the treatment of AECOPD with syndrome of phlegm-heat and blood stasis of lung can significantly improve clinical efficacy,improve patient quality of life,facilitate coagulation function recovery,and enhance cellular immune function.