In recent years, the incidence of Mycoplasma pneumoniae pneumonia in children has continued to rise, with a corresponding increase in the number of severe Mycoplasma pneumoniae pneumonia, attracting widespread attention from clinical physicians. Understanding the risk factors associated with severe Mycoplasma pneumoniae pneumonia with the aim to determine the severity of the condition in affected children, prevent the occurrence of severe cases, and reduce sequelae has been a focal point in research. Although numerous studies have been conducted on the risk factors of severe Mycoplasma pneumoniae pneumonia, variations in time and geographical regions of the studies necessitate a systematic review and analysis for a comprehensive understanding.

To systematically review the risk factors for severe Mycoplasma pneumoniae pneumonia.

CNKI, Wanfang Data, VIP, CBM, Duxiu, Yiigle, Cochrane Library, PubMed, Embase, Web of Science, Science Direct, and BioMed Central were searched for studies related to risk factors of severe Mycoplasma pneumoniae pneumonia in children from inception to August 2023. Two investigators independently screened literature, extracted data, and assessed the bias risk of included studies. Meta-analysis was performed using Stata 14.0 and RevMan 5.4 software.

A total of 22 retrospective case-control studies involving 4 531 childre were included. Meta-analysis showed that C-reactive protein (CRP) (OR=1.92, 95%CI=1.72-2.15, P<0.000 01), erythrocyte sedimentation rate (ESR) (OR=2.61, 95%CI=2.12-3.22), P<0.000 01), procalcitonin (PCT) (OR=2.60, 95%CI =1.43-4.75, P=0.002), D-dimer (OR=4.36, 95%CI=2.93-6.50, P<0.000 01), white blood cell count (WBC) (OR=1.98, 95%CI=1.66-2.36, P<0.000 01), lower lobe lesions (OR=5.70, 95%CI=3.48-9.35, P<0.000 01), large patchy lesions (OR=6.37, 95%CI=4.09-9.92, P<0.000 01), high Mycoplasma pneumoniae antibody titers (OR=2.83, 95%CI=1.78-4.49, P<0.000 1), lactate dehydrogenase (LDH) (OR=1.03, 95%CI=1.00-1.05, P=0.05), and duration of fever (OR=8.33, 95%CI=3.38-20.56, P<0.000 01) were positively correlated with severe Mycoplasma pneumoniae pneumonia in children.

Elevated inflammatory markers (CRP, ESR, PCT, LDH, WBC), the presence of characteristic imaging changes (large patchy consolidation, lower lobe lesions), high Mycoplasma pneumoniae antibody titer, elevated D-dimer, and prolonged fever duration may be risk factors for severe Mycoplasma pneumoniae pneumonia in children. Future high-quality studies are needed to further explore the relationship of other clinical, radiographic, and laboratory findings with severe Mycoplasma pneumoniae pneumonia in children, and develop prognostic models based on identified risk factors.

Chronic obstructive pulmonary disease (COPD) is a heterogeneous disease. Asthma-COPD overlap (ACO) has clinical features both related to asthma and COPD. Some patients are unable to cooperate with pulmonary function tests, so it is difficult to determine the degree of airflow limitation.

To compare the clinical characteristics of different low attenuation area (LAA) grades in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) and asthma-chronic obstructive pulmonary disease overlap (ACO), and analyze the correlation between forced expiratory volume in 1 second as a percentage of predicted value (FEV₁%pred) and LAA grades, so as to provide a reference index for patients who are unable to receive pulmonary function tests.

The clinical data of AECOPD and ACO patients hospitalized in the Department of Pulmonary and Critical Care Medicine of the Second Hospital of Hebei Medical University from March 2020 to May 2022 were collected. The participants were divided into the four groups including the emphysema AECOPD group (150 cases), bronchitis AECOPD group (84 cases), emphysema ACO group (47 cases) and bronchitis ACO group (59 cases) according to the LAA grade, LAA≥2 as emphysema groups, LAA<2 as bronchitis groups. The clinical characteristics of the AECOPD and ACO groups and the patients with different LAA grades within the group were compared. Multiple linear regression analysis was used to analyze the influencing factors of FEV₁%pred in ACO and AECOPD patients.

Compared with the bronchitis AECOPD group, BMI, PaO₂/FiO₂ and FEV₁%pred of the bronchitis AECOPD group were lower, and the amount of cigarette smoking, proportions of males and smokers were higher (P<0.05). In the bronchitis AECOPD group, BMI, FEV₁%pred, PaO₂/FiO₂, and albumin (ALB) were lower in patients with LAA grade 1 than those with LAA grade 0 (P<0.05) ; Neutrophil/lymphocyte ratio (NLR), high-sensitivity C-reactive protein (hs-CRP), fibrinogen degradation product (FDP) and interleukin-6 (IL-6) were higher (P<0.05). In the emphysema AECOPD group, compared with patients with LAA grade 4, patients with LAA grade 3 were elder, with higher BMI and FEV₁%pred (P<0.05), patients with LAA grade 2 had higher BMI and FEV₁%pred, and shorter hospital stay (P<0.05) ; NLR, hs-CRP, and FEV₁%pred in patients with LAA grade 3 were higher than those with LAA grade 2 (P<0.05). Compared with the bronchitis ACO group, the emphysema ACO group had higher amount of cigarette smoking, proportions of males and smokers, and lower BMI and FEV₁%pred (P<0.05). In the bronchitis ACO patients, patients with LAA grade 0 had higher proportion and total amount of systemic steroids and lower FEV₁%pred than those with LAA grade 1 (P<0.05). In the emphysema ACO patients, FEV₁%pred was lower in patients with LAA grade 4 than those with LAA grade 3 and LAA grade 2, and FEV₁%pred in patients with LAA grade 3 was lower than patients with LAA grade 2. Multiple linear regression analysis showed that LAA grades were negatively correlated with FEV₁%pred in AECOPD and ACO patients.

In AECOPD and ACO patients, different LAA grades are manifested as various clinical characteristics. ACO patients with LAA grade 1 were less sensitive to corticosteroids than those with LAA grade 0. There is a negative correlation between LAA grades and FEV₁%pred. LAA grades can provide a reference for evaluating the degree of airflow limitation in AECOPD and ACO patients who are unable to receive pulmonary function tests.

As emerging economies, the BRICS countries (Brazil, Russia, India, China and South Africa) face similar challenges of a significant increase in the burden of chronic obstructive pulmonary disease (COPD) .

To understand the current situation, past trends and attributable risk factors of the burden of disease caused by COPD in the BRICS countries, and provide a basis for evaluating and developing prevention and control strategies of COPD and strengthening health cooperation among the BRICS countries.

The trends in prevalence, mortality and disability life-adjusted year (DALY) rates of COPD in the BRICS countries from 1990 to 2019 was characterized by using the Global Burden of Disease 2019 Database (GBD 2019) . Annual percentage change (APC) and average annual percentage change (AAPC) were calculated using Joinpoint software, and population attributable fraction (PAF) was used to estimate the proportion of COPD disease burden attributable to different risk factors.

The disease burden in the BRICS countries showed an increasing trend with age in 2019, and increased rapidly above 45 years of age with a certain gender difference. From 1990 to 2019, the prevalence of COPD was on the rise in all BRICS countries, while the mortality and DALY rates were on the decline in all BRICS countries except India. The standardized prevalence rate, standardized mortality rate and standardized DALY rate in the BRICS countries showed a decreasing trend, and the decrease was the largest in China, with the AAPC value of -1.14, -4.22 and -4.17, respectively (P<0.05) . Tobacco use was the top risk factor for COPD disease burden in Brazil, Russia, China and South Africa, with a PAF of more than 50%, while the top risk factor in India was air pollution.

The burden of COPD disease remains high in the BRICS countries, with differences within countries. Positive results have been achieved in the prevention and treatment of COPD in BRICS countries, but the overall improvement is less than that in the high-income countries in Asia-Pacific. The total burden of COPD in China has decreased significantly, but the prevention and control situation is still serious. The BRICS countries should pay more attention to the prevention and treatment of COPD in the middle-aged and elderly population, and continue to pay attention to the health effects caused by tobacco use and environmental pollution at the same time.

Community-acquired pneumonia (CAP) is one of the common infectious diseases, especially in elderly patients, with atypical clinical symptoms, which is susceptibility to serious complications, lacks effective treatment measures, and often has a poor prognosis.

To investigate the effect of traditional Chinese medicine (TCM) syndrome differentiation therapy on the quality of life and efficacy satisfaction of elderly patients with CAP discharged from hospital (within 1 week) .

This study was designed as a multicentre, randomized double-blind placebo clinical study. Elderly CAP post-discharge patients admitted to the respiratory departments of the First Affiliated Hospital of Henan University of Traditional Chinese Medicine, Henan Chest Hospital, Henan People's Hospital, Zhengzhou Hospital of Traditional Chinese Medicine and Zhengzhou People's Hospital from April 2018 to January 2020 were selected as the study subjects and divided into the experimental group and control group by using a central randomized group enrolment model. The patients in the experimental group were treated with corresponding TCM granules based on syndrome differentiation, and the lung-tonifying spleen-invigorating phlegm-reducing formula was given for syndrome of phlegm-dampness due to qi deficiency, and the qi-supplementing yin-nourishing lung-clearing formula was given for qi and yin deficiency and phlegm-heat syndrome. The control group was given a placebo with the same appearance, weight, color, and smell as the Chinese medicine granules. The treatment course was 2 months, and the follow-up was up to 6 months. The quality of life evaluated by the Chinese version of the Quality of Life Rating Scale (SF-36) and efficacy satisfaction evaluated by the Efficacy Satisfaction Questionnaire for CAP (ESQ-CAP) were compared between the two groups before the treatment, 1 month after the treatment, 2 months after the treatment, 3 months after the follow-up, and 6 months after the follow-up.

Among the 120 subjects included, 8 were dislodged and 112 were finally included that met the protocol set, including 54 cases in the experimental group and 58 cases in the control group. There was no significant difference in gender, age, time after discharge, TCM syndrome differentiation, CUBR-65 score, and underlying diseases between the two groups before treatment (P>0.05) . The main effects of the group were significant on SF-36 physiological function domain score (F_group=5.057, P_group=0.027) , general health domain score (F_group=7.286, P_group=0.008) , and role limitations due to emotional problems domain score (F_group=6.858, P_group=0.010) . Comparison between the two groups showed that SF-36 physical function domain score of the experimental group was higher than that of the control group at 2 months of treatment, 3 months of follow-up, and 6 months of follow-up (P<0.05) ; SF-36 general health status domain and role limitations due to emotional problems domain scores of the experimental group were higher than those of the control group at 1 and 2 months of treatment, 3 and 6 months of follow-up (P<0.05) ; the SF-36 domain score for role limitations due to mental health was higher than that of the control group (P<0.05) at 3 and 6 months of follow-up. The main effect of group on ESQ-CAP daily living and ability domain score (F_group=16.218, P_group<0.001) , convenience domain score (F_group=25.013, P_group<0.001) , and ESQ-CAP total score (F_group=13.843, P_group<0.001) was significant. The ESQ-CAP daily living and ability domain scores were higher in the experimental group than the control group at 2 months of treatment, 3 and 6 months of follow-up (P<0.05) . At 1 and 2 months of treatment and 3 and 6 months of follow-up, ESQ-CAP convenience domain score and ESQ-CAP total score were higher in the experimental group than in the control group (P<0.05) . At 3 months of follow-up, the ESQ-CAP overall efficacy domain score was higher in the experimental group than the control group (P<0.05) .

The TCM syndrome differentiation therapy scheme can improve the quality of life and efficacy satisfaction of elderly patients with CAP after discharge.

The number of chronic obstructive pulmonary disease (COPD) patients in China is huge, and respiratory rehabilitation training, as an important part of the management of COPD patients in the stabilization period, can effectively improve their lung function and quality of life, as well as reduce the burden on their families and society. Current data from Europe and the United States have shown that the implementation of respiratory rehabilitation under telemedicine management can improve the lung function and QOL of patients, however, there is a lack of relevant practice in China, especially in the west.

To assess the impact of respiratory rehabilitation training via telemedicine management in combination with conventional therapy on improving ventilatory capacity and lung function in elderly patients with moderate-to-severe COPD.

This study was a prospective randomized controlled study, enrolling consecutive COPD patients who attended the Fourth People's Hospital of Sichuan Province and five joint community clinics from June 2021 to June 2022. The included patients were randomly divided into the experimental group and control group by simple randomized grouping method using random number table. The control group received traditional long-term regular inhalation bronchodilator and oral medication, and the experimental group was guided by telemedicine on the basis of the treatment plan of the control group. A six-month study was conducted on two groups of patients, lung function, Borg score, 6MWT, and quality of life score (QOL score) were recorded at 1 month before and 1, 3, 6 months after intervention.

The study subjects were divided into 72 cases in the control group and 73 cases in the experimental group, and there was no significant difference in gender, age and lung function at baseline [the forced expiratory volume in one second/predicted value ratio (FEV₁%pred) , and the ratio of the forced expiratory volume in one second to the forced vital capacity (FEV₁/FVC) ] between the two groups (P>0.05) . There was an interaction between time and group for dyspnea and mood in FEV₁%pred, FEV₁/FVC, 6MWT level and QOL score (P<0.05) . After 1, 3, and 6 months of intervention, FEV₁%pred, FEV₁/FVC, 6MWT, Borg score, and QOL score of the experimental group were better than those of the control group (P<0.05) ; FEV₁%pred, FEV₁/FVC, Borg score, 6MWT, and QOL scores at 3 and 6 months post-intervention were better than those at 1 month post-intervention in the experimental group (P<0.05) .

The use of telemedicine technology for respiratory rehabilitation of elderly moderate-to-severe COPD patients in the stable stage can effectively improve the pulmonary function, quality of life and the quality of survival of this group of patients after 3, 6-months intervention.

Oral traditional Chinese medicine (TCM) has been widely used in the treatment of acute exacerbation of chronic obstructive pulmonary disease (AECOPD), but the outcome measures of relevant clinical trials have not been standardized and regulated.

To screen the published randomized controlled trials (RCTs) of oral TCM in the treatment of AECOPD, summarize the literature characteristics and outcome measures, so as to provide reference for the design of clinical trials and the selection of outcome measures for the treatment of AECOPD with TCM.

CNKI, Wanfang Data, VIP, SinoMed, PubMed, Embase, Web of Science, Cochrane Library, ClinicalTrials.gov and Chinese Clinical Trial Registry were systematically searched by computer to obtain RCTs and clinical trial registration protocols for the treatment of AECOPD with oral TCM from January 2018 to October 2022. After independent screening of the literature and extraction of data by 2 researchers, qualitative analysis was used to describe the selection of outcome measures in the enrolled studies.

A total of 578 studies were enrolled, including 574 RCTs with reported trial results and 4 clinical trial registration protocols. A total of 51 508 patients were involved in 574 RCTs. In the inclusion criteria, 88 studies limited the classification of disease, and 361 studies limited the TCM syndrome type, 6 studies reported the blinding method, and 6 studies mentioned the follow-up. A total of 4 030 outcome measures were covered and the number of outcome measures in a single article ranged from 1 to 24. According to the functional attributes, the outcome measures were classified into 8 measure domains: TCM symptoms/syndromes, symptoms/signs, physical and chemical tests, quality of life, long-term prognosis, economic evaluation, safety evaluation and others. The measure domain with the highest reporting rate was physical and chemical tests, and the top 5 outcome measure items reported in terms of frequency were: response rate (11.5%), forced expiratory volume in 1 s (FEV₁) (7.5%), TCM symptom/syndrome score (7.0%), FEV₁/Forced Vital Capacity (FVC) (6.8%), FVC (4.6%). Four hundred and forty-five studies reported the composition of response rate, and the top 5 measures with reporting rate were symptoms (423), signs (281), TCM syndrome score (203), laboratory tests (89), and pulmonary function (71) .

The RCTs of oral TCM in the treatment of AECOPD involved a large number and a wide range of outcome measures. The included literature focused on the effects of oral TCM on the symptoms and signs, physical and chemical test indicators, quality of life, long-term prognosis, economic evaluation and safety outcomes of patients with AECOPD in varying degrees. However, the selection of outcome measures remains problematic in multiple ways: unclear prioritization of outcome measures; focusing on clinical endpoints with insufficient attention to clinical endpoints; insufficient attention to health economics indicators; different sources and judgment criterias of reference of response. In the future studies, researchers can design the rational outcome measures by refering to the published core outcome set (COS) to improve the quality of TCM clinical research.

Chronic obstructive pulmonary disease (COPD) is one of the major chronic disease seriously affecting the health of Chinese residents. There are national and international guidelines and consensus on the diagnosis, treatment and management of COPD. However, there is no expert consensus on integrated traditional Chinese and western medicine management for COPD by now. Therefore, Chinese and western medicine experts with rich experience in the diagnosis and treatment of COPD in China were invited to formulate this consensus based on relevant domestic and foreign guidelines, consensus and personal experience, which includes early recognition and diagnosis of COPD, disease assessment, integrated traditional Chinese and western medicine treatment for stable COPD, evaluation, intervention measures of traditional Chinese and modern medicine, follow-up and management of acute exacerbation of COPD, so as to further improve the level of diagnosis, treatment and management of COPD in China.

During the COVID-19 pandemic, wearing masks and maintaining social distancing have become common personal protective measures. However, there is little research on alterations in cardiopulmonary function of patients with chronic obstructive pulmonary disease (COPD) after wearing different masks.

To study the effect of wearing a surgical mask versus an N95 respirator on cardiopulmonary function in patients with COPD.

Thirty patients diagnosed with COPD in General Hospital of Xinjiang Military Region were recruited from 30th June to 10th August, 2022, and randomly assigned to either an N95 respirator group (n=15) or a surgical mask group (n=15) . Both groups underwent two bouts of walking on a treadmill at a speed of 4 km/h for 20 min with an interval of 24 h (washout period) , with the difference that N95 respirator group wore an N95 respirator in the first bout and a surgical mask in the second bout, and surgical mask group did the opposite. Arterial blood gas analysis was performed, and heart rate, blood pressure and respiratory rate were measured immediately after each bout of walking, and the overall pre- and post-experiment alterations of these indicators were calculated. The lowest percutaneous arterial oxygen saturation (SpO₂) and the maximum respiration rate during the experiment were monitored, and adverse events were recorded as well.

All the participants completed the experiment. Compared with the surgical mask group, N95 respirator group had increased difference between pre- and post-experiment arterial pH〔0.013 (0.020) vs -0.004 (0.010) , P=0.001〕, arterial partial pressure of carbon dioxide (PaCO₂) 〔1.2 (1.2) mmHg vs 0.5 (1.6) mmHg, P=0.001〕 or arterial partial pressure of oxygen (PaO₂) 〔12.5 (10.5) mmHg vs 5.0 (13.2) mmHg, P=0.002〕. In the experiment, dyspnea occurred in 25 cases (83.3%) wearing an N95 respirator, and 16 cases (53.3%) wearing a surgical mask. Compared with wearing a surgical mask, the relative risk of dyspnea in COPD patients wearing an N95 respirator during the experiment was 1.563〔95%CI (1.078, 2.264) , P=0.012〕.

COPD patients wearing an N95 respirator during walking are more likely to have alterations in arterial pH, PaCO₂ and PaO₂ levels, which affect the gas exchange and may cause dyspnea.

Severe pneumonia is a common critical respiratory illness with high mortality and heavy social burden. Early and accurate assessment of the condition and prognosis of patients with severe pneumonia contributes to clinical decision-making. The Sequential Organ Failure Assessment (SOFA), CURB-65 score, and Pneumonia Severity Index (PSI) score can reflect the severity of pneumonia in different aspects, but there is no consensus on which one of them has the highest performance in predicting the prognosis of severe pneumonia.

To explore the predictive efficacy of SOFA, CURB-65 and PSI scores for short-term prognosis of patients with severe pneumonia.

This was a multicenter, prospective observational study. Inpatients with severe pneumonia were selected from the ICU and department of respiratory and critical medicine of 11 hospitals (including the First Affiliated Hospital of Henan University of Traditional Chinese Medicine and other 10 hospitals) from December 2017 to March 2022. The patients were divided into survival group and death group according to the 28-day mortality after diagnosis to compare clinical characteristics and SOFA, CURB-65 and PSI scores assessed on the day of hospitalization. The receiver operating characteristic (ROC) curve was used to assess the performance of three risk scores for predicting the 28-day mortality. The predictive efficacy of the risk scores was evaluated using the Hosmer-Lemeshow test and calibration plot. Optimal risk scores were stratified using X-tile 3.6 to determine the optimal threshold. Kaplan-Meier survival curves of the patients were plotted and compared using the Log-rank test.

A total of 240 patients were included, among whom 57 (23.8%) died within 28 days after diagnosis. Compared with the survival group, the death group had greater average age and lower average platelet count (P<0.05). And the SOFA, CURB-65 and PSI scores in the death group were higher (P<0.05). ROC analysis demonstrated that the values of AUC of SOFA score, CURB-65 score and PSI score were 0.741〔95%CI (0.663, 0.820) 〕, 0.627〔95%CI (0.544, 0.710) 〕, and 0.621〔95%CI (0.539, 0.703) 〕, respectively, all were greater than 0.6, indicating that the three scores had good predictive value for 28-day mortality in severe pneumonia (P<0.001), and the AUC of SOFA score was higher than that of CURB-65 score (Z=2.492, P=0.013) or PSI score (Z=2.775, P=0.006). Both the Hosmer-Lemeshow test and calibration plot suggested that the SOFA score was more accurate. Kaplan-Meier survival analysis showed that 28-day mortalities in low-risk (0-5), moderate-risk (6-8), and high-risk (9-18) patients stratified by SOFA score using the X-tile 3.6 were 12.0% (17/142), 28.8% (19/66), and 65.6% (21/32) respectively (χ²=37.93, P<0.001) .

SOFA, CURB-65 and PSI score are all suitable for predicting 28-day mortality of patients with severe pneumonia, with SOFA score being more valuable for clinical application.

Non-communicable disease (NCD) managers are the main force in the prevention and treatment of chronic obstructive pulmonary disease (COPD) . Understanding the perceptions of COPD among NCD managers in primary care in rural areas can provide a scientific basis for enhancing future prevention and management of COPD in primary care.

To investigate the perceptions of COPD in NCD managers in rural primary care, offering a scientific basis for the improvement of COPD prevention and management in primary care.

In June 2021, random sampling method was used to select 20 township hospitals in Zigong, Sichuan Province, and from which NCD managers〔including general practitioners (GPs) , public health workers and rural doctors〕were selected by use of cluster sampling. A survey was conducted with them using a self-developed questionnaire (consisting of two parts: general demographics and COPD-related knowledge) for understanding their perceptions of COPD.

All the cases (n=474) who participated in the survey returned responsive questionnaires, achieving a response rate of 100.0%, including 68 GPs (14.4%) , 177 public health workers (37.3%) , and 229 rural doctors (48.3%) . With regards to answering the questions of comprehensive COPD knowledge, GPs had statistically significant higher pass rate than rural doctors〔35.3% (24/68) vs 7.4% (17/229) 〕 (P<0.017) , and public health workers also had statistically notably higher pass rate than rural doctors〔31.6% (56/177) vs 7.4% (17/229) 〕 (P<0.017) . In terms of answering the questions about risk factors of COPD, GPs had statistically significant higher pass rate than rural doctors〔73.5% (50/68) vs 46.3% (106/229) 〕 (P<0.017) , and so did public health workers〔66.7% (118/177) vs 46.3% (106/229) 〕 (P<0.017) . In terms of answering the questions about diagnosis and evaluation of COPD, GPs had statistically significant higher pass rate〔38.2% (26/68) 〕than public health workers〔20.3% (36/177) 〕or rural doctors〔3.9% (9/229) 〕 (P<0.017) , and the pass rate of public health workers was statistically significant higher than that of rural doctors (P<0.017) . In terms of answering the questions about treatment strategies for COPD, GPs had statistically significant higher pass rate than rural doctors〔30.9% (21/68) vs 6.6% (15/229) 〕 (P<0.017) , and so did public health workers〔19.2% (34/177) vs 6.5% (15/229) 〕 (P<0.017) . In terms of answering the questions regarding follow-up management for COPD, public health workers had statistically significant higher pass rate than GPs〔46.9% (83/177) vs 29.4% (20/68) 〕and rural doctors〔46.9% (83/177) vs 14.4% (33/229) 〕 (P<0.017) . And GPs had statistically significant higher pass rate than rural doctors (P<0.017) .

The NCD managers in primary care in rural areas of Sichuan's Zigong have insufficient knowledge of COPD, especially its diagnosis, evaluation, treatment strategies and follow-up management. NCD managers from different positions have different perceptions of COPD, among them rural doctors have the lowest level of perception. In view of the above problems, we need to take targeted measures to improve the level of general prevention and management of COPD in rural primary care.

Chronic obstructive pulmonary disease (COPD) is a global public health problem with increasing incidence and mortality. Fatigue is a common complaint of COPD patients, which seriously impairs the quality of life.

To conduct a scoping review of current research status and tools about fatigue as well as fatigue-related factors in COPD, providing ideas for the development of relevant individualized intervention schemes.

Methodological framework was used. Studies on fatigue in COPD were searched from databases of Web of Science, PubMed, EmBase, CINAHL, ProQuest, the Cochrane Library, CNKI, WanFang, CQVIP, and SinoMed from inception to July 2022, and enrolled according to the inclusion and exclusion criteria. Relevant data were extracted, collected, summarized and reported.

A total of 52 studies were included. Taken overall, a wide variety of assessment tools for fatigue in COPD featured by lack of multidimensionality and specificity were used, among which common were the Functional Assessment of Chronic Illness Therapy and the Fatigue Severity Scale. There were certain disparities in the incidence, duration, and severity of fatigue in COPD across studies. The main influencing factors of fatigue include sociodemographic factors, COPD-related factors, somatic factors, and psychological factors.

As fatigue is a major symptom that seriously declines the quality of life in COPD patients, clinical care providers need to use specific tools to accurately assess fatigue, and to develop individualized interventions to improve fatigue according to its influencing factors.

Respiratory virus infection is an important trigger of acute exacerbation of chronic obstructive pulmonary disease (AECOPD) . China has adopted a series of containment measures assisting to curb COVID-19 transmission since the outbreak of the pandemic. Several studies showed a decrease in hospitalizations for AECOPD during the COVID-19 pandemic. However, there has been a relative lack of studies investigating the effects of preventive measures on the frequency and severity of exacerbations.

To explore the impact of the COVID-19 pandemic on the frequency of AECOPD with or without medical attention.

The subjects were from a prospective COPD cohort study conducted in the First Affiliated Hospital of Guangzhou Medical University, which began recruiting patients in early 2016, with visits every 3 months to collect demographic and clinical data, including those who were followed up during June to August 2017 (group 1) , June to August 2018 (group 2) , June to August 2019 (group 3) , and June to August 2020 (group 4) . Basic clinical data (including the frequency of AECOPD, sex, age, symptom score and so on) were collected from group 1 from October 2016 to May 2017, group 2 from October 2017 to May 2018, group 3 from October 2018 to May 2019, and group 4 from October 2019 to May 2020 (during which the periods from October 2019 to January 2020, and from February to May 2020 were defined as pre-COVID-19 period, and post-COVID-19 period, respectively) . The frequency of AECOPD during October to May next year in group 4 was compared with that of the other three groups. The changes in the frequency of AECOPD between pre- and post-COVID-19 periods were analyzed.

There were 162 patients in group 1, 157 in group 2, 167 in group 3, and 159 in group 4. Group 1 had a higher frequency of AECOPD in February to May than in October to January next year (P=0.013) , so did group 2 (P=0.016) . In contrast, group 4 had a higher frequency of AECOPD in October to January next year than in February to May (P=0.001) . The frequency of AECOPD during October to December in group 4 was similar to that of the other three groups (P>0.05) . But the frequency of AECOPD from February to April in group 4 was lower than that in groups 1-3 (P<0.05) . There was no significant difference in the monthly frequency of AECOPD without medical attention in group 4 compared with that of groups 1-3 (P>0.05) . The frequency of AECOPD with medical attention from October to December in group 4 was similar to that of groups 1-3 (P>0.05) . but it from February to April in group 4 was lower than that in groups 1-3 (P<0.05) .

Prevention and control measures targeting COVID-19 may be contributive to reducing the frequency of AECOPD. It is suggested that COPD patients should reduce gathering activities, maintain social distance, wear masks when going out, and wash hands frequently even after the COVID-19.

Ginkgo biloba extract (GBE) has been found to be effective in inhibiting the airway and systemic inflammatory response and improve airway remodeling in rat models of chronic obstructive pulmonary disease (COPD) , but the mechanism remains unclear.

To discuss the mechanism of GBE regulating alveolar macrophage autophagy through phosphatidylinositol 3-kinase (PI3K) /protein kinase B (Akt) /mammalian target of rapamycin (mTOR) signaling pathways to prevent and treat COPD.

A total of 90 SPF male Wistar rats were equally randomized into normal control group, COPD model group, GBE group, bicalutamide group, rapamycin group, and Taselisib group. The normal control group were normally fed except that normal saline was injected into their trachea on the 1st and 14th days of intervention, the other 5 groups were treated with exposure to cigarette smoking combined with intratracheal injection of lipopolysaccharide (LPS) to establish rat models of COPD. The GBE group received intraperitoneal injection of Shuxuening injection from the 15th day to the 28th day of the experiment, while bicalutamide, rapamycin, and Taselisib groups were given bicalutamide, rapamycin, and taselisib, respectively, from the 29th day to the 42nd day of the experiment. HE staining was used to observe alveolar pathological changes and airway remodeling. ELISA was used to detect the levels of interleukin -6 (IL-6) and interleukin -8 (IL-8) in alveolar lavage fluid (BALF) and the serum. The number of alveolar macrophages was counted under microscope. The ultrastructure of alveolar macrophages was observed by transmission electron microscope. Western blotting was used to measure the expression levels of autophagy-related proteins in alveolar macrophages. The ratio of microtubule-associated protein light chain 3 (LC3) -Ⅱ/LC3-Ⅰwas calculated subsequently.

As of the models being successfully established, the rats in normal control, COPD model, GBE, bicalutamide, rapamycin, and Taselisib groups numbered 12, 11, 12, 12, 12, and 11, respectively. H&E staining showed that the degree of alveolar injury in COPD model group was more severe than that of GBE, bicalutamide, rapamycin, or Taselisib group (P<0.05) . COPD model group had larger mean linear intercept and mean alveolar area as well as less mean alveolar number than GBE, bicalutamide, rapamycin, or Taselisib group (P<0.05) . Moreover, COPD model group had less complete bronchial wall structure than GBE, bicalutamide, rapamycin, or Taselisib group. The levels of BALF and serum IL-6 and IL-8 in COPD model group were higher than those of each of other five groups (P<0.05) . Among all groups, the number of macrophages in the normal control group was the lowest, while that of COPD model group was the highest (P<0.05) .Transmission electron microscopy showed that COPD model group had less autophagolysosomes in alveolar macrophages than GBE, bicalutamide, rapamycin, or Taselisib group. The normal control group had higher expression levels of PI3Kp110α, Akt, p-Ak, mTOR and p-mTOR and lower ratio of LC3-II/LC3-I than each of other five groups (P<0.05) . COPD model group had higher expression levels of PI3Kp110α, Akt, p-Akt, mTOR and p-mTOR, and lower ratio of LC3-Ⅱ/LC3-Ⅰ compared with GBE, bicalutamide, rapamycin or Taselisib group (P<0.05) .

GBE maintained the autophagy function of alveolar macrophages, reduced macrophage infiltration, inhibited the inflammatory response and alveolar damage, and improved airway remodeling in model rats of COPD through regulating the PI3K/Akt/mTOR signaling pathway.

The incidence of mucocutaneous lymph node syndrome (MCLS), also known as Kawasaki disease (KD), has been increasing year by year. Coronary artery lesions (CAL) induced by KD has become the main cause of acquired heart disease in children. Many clinical studies show that mycoplasma pneumoniae (MP) is associated with CAL in KD, but the strength of association between them differs across original research on different individuals.

To systematically evaluate the correlation between MP infection and CAL in KD, providing evidence for early and timely delivery of effective clinical treatment to improve the quality of life and to prevent adverse outcomes in children with KD.

Observational studies on KD〔KD patients with MP infection (MP-IgM positive) (exposed group) compared with those with simple KD (control group), with CAL as the outcome measure〕 were retrieved from databases of CNKI, Wanfang Data, VIP, SinoMed, PubMed, Embase, Cochrane Library and Web of Science from inception to April 3, 2022. Two researchers independently performed literature screening and data exaction. The Newcastle-Ottawa Scale (NOS) was used to evaluate the quality of included studies. Stata 15.0 and RevMan 5.4 were used for data analysis.

A total of 31 studies involving 6 131 subjects were included. The average quality score of the studies rated using the NOS was 7, indicating a high overall quality. Meta-analysis showed that the risk of CAL in the exposed group was higher than that in the control group〔RR=1.65, 95%CI (1.40, 1.94), P<0.000 01〕. Subgroup analysis based on baseline data revealed that, the risk of CAL in exposed group was higher in studies on exposed and control groups with matched baseline data〔RR=1.92, 95%CI (1.71, 2.16), P<0.000 01〕, but was similar in studies on two groups with unmatched baseline data〔RR=0.98, 95%CI (0.91, 1.06), P=0.65〕. Furthermore, the risk of CAL was found to be higher in the exposed group in subgroup analysis based on MP infection diagnosed serologically with IgM>1∶160, or by quantitative PCR, or undescribed method (P<0.05). And in subgroup analysis based on age, C-creactive protein/procalcitonin ratio, or undescribed method, the risk of CAL was still higher in the exposed group (P<0.05). Egger's and Begg's tests showed that all the studies had publication bias (P<0.05). However, the comparison of the pooled effect size using the random effects model〔RR=1.32, 95%CI (1.13, 1.54), P<0.000 01〕 showed that the results before and after trimming and filling were not reversed, indicating that the results of this study were relatively stable.

MP infection increased the risk of CAL in children with KD. Early detection of MP and timely delivery of effective intervention are very important.

Chronic obstructive pulmonary disease (COPD) is a common respiratory disease that is associated with high risk of disability and mortality. Although evidence suggests that fatigue may induce acute exacerbation in COPD, it needs to be further tested.

To explore the relationship between fatigue and the acute exacerbation in COPD.

By use of convenient sampling, a total of 597 COPD patients were selected from the First Affiliated Hospital of Bengbu Medical College, the Second Affiliated Hospital of Bengbu Medical College and the Third People's Hospital of Bengbu to establish a cohort study population between March 2019 and October 2020. During the hospitalization, general information such as gender, age, educational level, marital status, living style, comorbidities, smoking history, and monthly family income were collected from patients. Fatigue Scale-14 was used to measure the fatigue status, BODE index was used to predict the severity and prognosis, Anxiety and depression were assessed by the Anxiety Scale (HADS-A) and the Depression Scale (HADS-D) in the Hospital Anxiety and Depression Scale (HADS) . The patients were followed up for 1 year after discharge, recorded the occurrence of acute exacerbation in COPD, and assessed the quality of life with COPD Assessment Test (CAT) . Univariate analysis and multivariate Cox regression analysis were performed to identity factors possibly associated with the acute exacerbation in COPD. ROC curve analysis was used to measure the performance of fatigue in predicting acute exacerbation in COPD.

The lost cases were screened and eliminated according to the corresponding inclusion criteria and exclusion criteria, five hundred and fifty cases were finally included for analysis, 416 of them had fatigue, and other 134 did not. Patients with and without fatigue had significant differences in smoking prevalence, mean number of acute exacerbations in a year, BODE index, HADS-A score, and CAT score (P<0.05) . Multivariate Cox regression analysis showed that FS-14 score, BODE index and CAT score are risk factors for acute exacerbation in COPD (P<0.05) . ROC curve analysis showed that the area under the curve of fatigue in predicting the acute exacerbation in COPD was 0.826, with 85.2% sensitivity, 65.4% specificity, and 0.506 Youden's index.

Fatigue increases the risk of acute exacerbation in COPD to a certain extent. So clinical delivery of targeted preventive interventions may be beneficial to the reduction of acute exacerbation in COPD.

Inexpensive and convenient early screening for chronic obstructive pulmonary disease (COPD) is of great significance to identify individuals at high risk of COPD. There are many kinds of COPD screening tools with various diagnostic accuracies, but which one is superior to others has not been identified by evidence-based studies.

To evaluate the diagnostic accuracies of common COPD screening tools using a network meta-analysis.

PubMed, the Cochrane Library, Embase, Web of Science, CNKI, Wanfang Data and VIP databases were searched for diagnostic studies related to COPD screening and tools for early diagnosis COPD included from database establishment to December 31, 2021. Two researchers independently conducted literature screening, quality evaluation and data extraction. Meta-disc 1.4 and Stata 15.0 were used for network meta-analysis.

A total of 46 studies were enrolled, involving seven screening tools: the Lung Function Questionnaire (IFQ) , COPD Diagnostic Questionnaire (CDQ) , COPD Screening Questionnaire (COPD-SQ) , Self-Scored COPD Population Screener Questionnaire (COPD-PS) , spirometer, peak flow meter, questionnaire+peak flow meter. The results of meta-analysis demonstrated combined sensitivity values of the aforementioned seven screening tools for COPD were as follows: 0.79〔95%CI (0.75, 0.83) 〕, 0.85〔95%CI (0.83, 0.86) 〕, 0.68〔95%CI (0.65, 0.70) 〕, 0.60〔95%CI (0.56, 0.63) 〕, 0.58〔95%CI (0.54, 0.61) 〕, 0.86〔95%CI (0.84, 0.88) 〕, and 0.68〔95%CI (0.65, 0.71) 〕. And combined specificity values of them were: 0.67〔95%CI (0.65, 0.68) 〕, 0.59〔95%CI (0.58, 0.59) 〕, 0.81〔95%CI (0.80, 0.82) 〕, 0.84〔95%CI (0.83, 0.85) 〕, 0.88〔95%CI (0.87, 0.89) 〕, 0.86〔95%CI (0.84, 0.88) 〕, and 0.85〔95%CI (0.84, 0.86) 〕. The surface under the cumulative ranking curve (SUCRA) values of the tools ranked in terms of combined sensitivity from highest to lowest were: peak flow meter (72.7%) >CDQ (70.1%) >LFQ (61.8%) >questionnaire+peak flow meter (45.3%) >COPD-SQ (28.5%) >COPD-PS (13.2%) >spirometer (9.1%) . And the SUCRA values of these tools ranked in terms of combined specificity from highest to lowest were: spirometer (76.8%) >questionnaire+peak flow meter (66.7%) >COPD-SQ (46.7%) >peak flow meter (45.8%) >COPD-PS (39.2%) >LFQ (11.9%) >CDQ (8.2%) .

Among the seven commonly used tools, peak flow meter has higher sensitivity, and spirometer has higher specificity. But this conclusion still needs to be further confirmed by more multicenter, large-sample studies.

Our previous study showed that Yifei moxibustion has good effect on chronic obstructive pulmonary disease (COPD) in stable stage, but the effect could be enhanced according to the suggestions of an expert questionnaire survey. It is of great significance to carry out clinical research on the relationship of moxibustion duration with clinical efficacy and suitability in COPD.

To study and optimize the appropriate duration of moxibustion treatment in COPD, and to evaluate its clinical efficacy and suitability.

One hundred and twenty patients with stable COPD were recruited from the First Affiliated Hospital of Henan University of Chinese Medicine from June to July 2017, and randomly divided into groups A and B with SAS software. Both groups received routine western medicine treatment and one course of Yifei moxibustion treatment (1.5 h each time for group A, and 2 h each time for group B, once every 15 days, for a total of six times in three months) . The primary outcome index was the number of colds during treatment, and the secondary outcome indices included clinical symptoms and signs scores, COPD Assessment Test (CAT) , pulmonary function, suitability evaluation〔using the Visual Analogue Scale (VAS) 〕, and the safety was evaluated.

Except 29 dropouts, 91 cases (47 in group A and 44 in group B) were included in the Per Protocol Set and analyzed with full data set analysis. The results of repeated measures ANOVA showed that the main effects on the number of colds, score of chest tightness, CAT score and VAS score were significant between groups (P<0.05) . There were significant intergroup differences in the number of colds, the total score of clinical symptoms and signs, the score of each of the clinical symptoms and signs, the score of each of the clinical symptoms and signs, CAT score and VAS score at different time points (P<0.05) . No adverse events occurred in both groups.

Both types of Yifei moxibustion could reduce the number of colds, improve the cough, chest tightness and other clinical symptoms as well as the quality of life in stable COPD patients. But the efficacy of Yifei moxibustion lasting for 1.5 h each time was better, and was more applicable.

Chronic obstructive pulmonary disease (COPD) is a common chronic respiratory disease that greatly threatens human health. Studies have found that compared with the healthy population, the mucosal barrier function and immune homeostasis in COPD patients are impaired due to significantly changed composition and structure of both lung and gut microbiota, which further aggravate the disease progression. Taking measures to actively improve the microbial balance in lung and gut microbiota is very important for the prevention and delaying of the development of COPD. However, the summary and understanding of the role of lung and gut microbiota and their cross-talk mechanism in COPD still have much room for development. We reviewed the latest developments in the composition characteristics of lung and gut microbiota and the possible cross-talk mechanism between them in healthy people and COPD patients, as well as the prevention and treatment of COPD based on lung and gut microbiota and their cross-talk, providing new ideas for pathogenesis exploration, early diagnosis, prevention and treatment of COPD.

In the diagnosis of neonatal pneumonia, the possibility of iatrogenic injury caused by magnetic resonance imaging (MRI) may be lower than that by widely used X-ray and even computed tomography scan. However, there are few studies on the application of MRI in the diagnosis of neonatal pneumonia.

To explore the feasibility of using MRI for the diagnosis of neonatal pneumonia in primary care based analyzing the application of SS_TSE and modified abdominal T2WI sequences at 1.5 Tesla for the diagnosis of this illness.

Nineteen neonates diagnosed with pneumonia by MRI were selected from Wuchuan People's Hospital from January to November 2020. Six parameters under SS_TSE and modified abdominal T2WI sequences including subjective MR score, signal intensity of the lesion (SI lesion) , lung signal intensity (SI lung) , lung noise (SD lung) , calculated image signal-to-noise ratio (SNR) and lesion signal intensity ratio (SIR) were statistically analyzed.

The values of these six parameters of SS_TSE sequence were 2.2 (2.0, 2.8) , (505.0±102.5) , (243.5±32.0) , (21.8±6.7) , (12.0±3.1) , and 2.1 (2.0, 2.2) , respectively. And The values of subjective score, SI lesion, SI lung, SD lung, SNR and SIR of T2WI sequence were 2.7 (2.0, 3.3) , (293.1±129.6) , (99.7±40.3) , (19.0±7.6) , (5.6±2.3) , and 3.1 (2.6, 3.2) , respectively. Based on the combination of SS_TSE and T2WI images, the diagnoses for all cases were made.

The brightness of the lesions in SS_TSE sequence is higher, with better objective definition of the images. T2WI sequence has higher subjective definition, and the signal of the lesions was markedly different from the background, which is helpful to observe the border of the lesions. SS_TSE and T2WI sequences are complementary in the diagnosis of neonatal pneumonia. In a word, it is feasible to apply MRI for the diagnosis of neonatal pneumonia at 1.5 Tesla to reduce the possibility of iatrogenic injury.

The spreading epidemic of novel coronavirus (corona virus disease 2019, COVID-19) pneumonia poses a serious challenge to global life health and disease control, with significantly higher mortality rates among individuals infected with COVID-19 comorbid underlying disease. Inhibitors of the rennin-angiotensin-aldosterone system (RAASi) , an important class of anti-hypertensive drugs, have been found to increase the morbidity and mortality of COVID-19. This study aimed to clarify the efficacy and safety of RAASi treatment in COVID-19 patients with hypertension.

To systematically evaluate the efficacy and safety of RAASi therapy in COVID-19 patients with hypertension.

PubMed, Embase, Cochrane Library and China National Knowledge Infrastructure (CNKI) were searched from inception to January 2022. A publicly available case-control studies of COVID-19 patients with hypertension treated with RAASi versus non RAASi therapy were included, and outcome measures were overall mortality, incidence of critical illness, incidence of acute respiratory distress syndrome (ARDS) , incidence of myocardial injury, and incidence of renal injury, with meta-analysis performed using Revman 5.3.

Seventeen studies with a total of 5 689 patients were included, of whom 2 168 received RAASi therapy and 3 521 did not. Meta analysis showed that overall mortality was lower in COVID-19 comorbid hypertensive patients treated with RAASi compared with non RAASi treated patients 〔OR=0.54, 95%CI (0.41, 0.72) , P<0.000 1〕; Between RAASi treated and non RAASi treated COVID-19 patients associated with hypertension, the incidence of critical illness 〔OR=0. 92, 95%CI (0.79, 1.08) , P=0.30〕, the incidence of ARDS 〔OR=0.81, 95%CI (0.57, 1.13, P=0.22〕, the incidence of myocardial injury 〔OR=1.03, 95%CI (0.83, 1.27) , P=0.82〕, and the incidence of kidney injury 〔OR=1.13, 95%CI (0.78, 1.66) , P=0.52〕, differences were not statistically significant.

Treatment with RAASi in COVID-19 patients with hypertension reduced the overall mortality rate, and did not increase the incidence of critical illness, ARDS, myocardial injury, and renal injury in COVID-19 patients with hypertension. RAASi therapy is effective and safe in treating patients with COVID-19 combined with hypertension.

The Effectiveness Satisfaction Questionnaire for COPD (ESQ-COPD) previously developed by us based on classical test theory has proven to have some limitations. The combination use of classical test theory and item response theory may achieve complementary advantages, which may be a theoretical basis and methodological support for the development or revision of instruments.

To develop a modified ESQ-COPD (mESQ-COPD) based on the combination of disease and syndrome, and to evaluate its psychometric properties.

By predefining basic characteristics of the instrument, normalizing the essential concepts and terminologies, revising the conceptual framework, generating an item pool, and reviewing the items, the draft of the mESQ-COPD was developed by our revision group. Then the draft was improved to be a mESQ-COPD by screening items based on the results of a pretest conducted during October 2017 to February 2018 with a convenience sample of 265 stable COPD patients from the respiratory clinic of 10 grade A tertiary hospitals in China, in combination with item screening using the classical test theory and item response theory. After that, the psychometric properties of the mESQ-COPD were tested using an onsite investigation carried out in a convenience sample of 365 stable COPD patients from the respiratory clinic of six grade A tertiary hospitals in China from November 2018 to February 2019.

The final mESQ-COPD includes four domains (clinical symptoms, capabilities for work and life, ability of environmental adaptation, and therapeutic effect) and 19 items. The Cronbach's α of the questionnaire was 0.949, and that of the four domains was 0.943, 0.869, 0.829, and 0.767, respectively. The correlation coefficient between the domain of clinical symptoms, capabilities for work and life, ability of environmental adaptation, or therapeutic effect and its component items ranged from 0.667 to 0.798, 0.855 to 0.882, 0.795 to 0.907, or 0.857 to 0.934, respectively. Confirmatory factor analysis showed that the comparative fit index, incremental fit index, non-normed fit index, standardized root mean square residual, and root mean square error of approximation measuring the construct validity of the mESQ-COPD were 0.94, 0.94, 0.93, 0.07, and 0.16, respectively. The correlation coefficients of the mESQ-COPD and its domains with COPD assessment test ranged from 0.371 to 0.538, while those of the mESQ-COPD and its domains with the modified Medical Research Council scale ranged from 0.329 to 0.564. The differences in the total score and domain scores of the mESQ-COPD between mild/moderate and severe/extremely severe COPD patients were both statistically significant (P<0.01). The acceptance rate of the mESQ-COPD was 99.5%, and the completion rate was 99.2%, with a mean completion time of (6.13±4.59) min.

The 19-item mESQ-COPD (consists of four domains: clinical symptoms, ability of work and life, capability for environmental adaptation, and therapeutic effect) has good reliability, validity, and applicability, which could be used to support the efficacy evaluation in COPD.

Low attenuation area ratio (LAA%) and pectoral major parameters are in elderly patients with COPD related to pulmonary ventilation function, but there are few studies at home and abroad.

To analyze the correlation of LAA% and pectoral major parameters with impaired pulmonary ventilation function in elderly patients with COPD, and to explore the predictive value of LAA% and PMcsa in the severity of airflow restriction, in order to provide clinical basis for the early detection and diagnosis of COPD.

A total of 270 elderly patients with stable COPD who underwent chest CT and lung function examination in North Jiangsu People's Hospital affiliated to Yangzhou University from December 2019 to June 2021 were selected and divided into GOLDⅠgroup (FEV_l%pred≥80%, n=47) , GOLD Ⅱgroup (50%≤FEV_l%pred<80%, n=88) , GOLD Ⅲ group (30%≤FEV_l%pred<50%, n=84) and GOLD Ⅳ group (FEV_l%pred<30%, n=51) according to GOLD classification with their general information and CT quantitative indexes recorded. Pearson correlation analysis and multiple linear regression analysis were used to explore the relationship between LAA%, pectoralis major areas (PMcsa) and lung function. The receiver operating characteristic curve (ROC curve) was used to evaluate the predictive value of LAA% and PMcsa for FEV₁%pred<50% and FEV₁%pred<80%.

BMI and PMD in GOLDⅠgroup were higher than those in GOLD Ⅲ group and GOLD Ⅳ group (P<0.05) , and the BMI in GOLD Ⅱgroup and GOLD Ⅲ group was higher than that in GOLD Ⅳ group (P<0.05) . PMcsa, PMI, FEV₁%pred, FEV₁ and FVC in GOLD Ⅰgroup were higher than those in GOLD Ⅱ group, GOLD Ⅲ group and GOLD Ⅳ group (P<0.05) . PMcsa, PMI, FEV₁%pred, FEV₁ and FVC in GOLD Ⅱ group were higher than those in GOLD Ⅲ group and GOLD Ⅳ group (P<0.05) . PMcsa, PMI , FEV₁%pred, FEV₁ and FVC in GOLD Ⅲ group were higher than those in GOLD Ⅳ group (P<0.05) . Left lung LAA%, right lung LAA% and total lung LAA% in GOLD Ⅰ group were lower than those in GOLD Ⅱ group, GOLD Ⅲ group and GOLD Ⅳ group (P<0.05) . Left lung LAA%, right lung LAA% and total lung LAA% in GOLD Ⅱ group were lower than those in GOLDⅢ group and GOLD Ⅳ group (P<0.05) . Left lung LAA%, right lung LAA% and total lung LAA% in GOLD Ⅲ group were lower than those in GOLD Ⅳ group (P<0.05) . FEV₁%pred, FEV₁ and FVC were positively correlated with PMcsa, PMI and PMD (P<0.05) . Both FEV₁%pred and FEV₁ were negatively correlated with low attenuation area ratio (right LAA%, left LAA%, total LAA%) (P<0.05) . Multiple linear regression analysis show that gender, total LAA% and PMcsa were independent influencing factors of FEV₁%pred. The area under ROC curve of right lung LAA%, left lung LAA%, total lung LAA% and PMcsa predicting FEV₁%pred<50% in male patients were 0.832, 0.827, 0.834, 0.809, respectively. The area under ROC curve of right lung LAA%, left lung LAA%, total lung LAA% and PMcsa predicting FEV₁%pred<50% in female patientswere 0.844, 0.801, 0.845, 0.839, respectively. The area under ROC curve of right lung LAA%, Left lung LAA%, total lung LAA% and PMcsa predicting FEV₁%pred<80% in male patients were 0.830, 0.815, 0.831, 0.844, respectively. The area under ROC curve of right lung LAA%, left lung LAA%, total lung LAA% and PMcsa predicting FEV₁%pred<80% in female patients were 0.805, 0.817, 0.807, 0.846, respectively.

The low attenuation area ratio and PMcsa can assess the severity of airflow restriction in elderly patients with COPD, and can be used as an important tool for early screening and severity assessment of COPD.

Themucosal structure of the respiratory tract is similar to that of the gastrointestinal tract in humans, which is the body's first line of defense against the invasion of pathogens through the function of mucosal barrier. When the respiratory tract infection stimulates the airway mucosa to produce a local immune response, it affects the intestinal tract through migration and homing, resulting in the weakening of the local mucosal anti-infection ability, inducing mucosal barrier damage, and further aggravating chronic obstructive pulmonary disease (COPD) .

To explore the effects of Bufei Jianpi Formula on the expression levels of inflammatory factors in lung tissue, and the content of lung-gut related peptides in lung and colon tissues in a rat model of stable COPD based on a typical viscera theory of Traditional Chinese Medicine, namely "the lungs and large intestines are interior-exteriorly related" .

This experiment was carried out from September 2019 to December 2020. Fifty SPF SD rats were selected, and equally and randomly divided into control, model, Bufei Jianpi, aminophylline and probiotics groups. Except for the control group, the rats in other groups received cigarette smoke exposure combined with intranasal instillation of lipopolysaccharide (LPS) in the first eight weeks of intervention for establishing a COPD model. From the ninth week of intervention, rats in the control and model groups received intragastric administration of 0.9% sodium chloride solution, and those in Bufei Jianpi, aminophylline and probiotics groups received intragastric administration of Bufei Jianpi Formula, aminophylline and probiotics, respectively. The rats were sacrificed after 12 weeks of intervention. The pathological changes of lung and colon tissues were observed under an optical microscope, the expression levels of tumor necrosis factor-α (TNF-α) and interleukin-10 (IL-10) in lung tissue were detected by immunohistochemistry. The contents of secretory immunoglobulin A (SIgA) in bronchoalveolar lavage fluid (BALF) , substance P (SP) and vasoactive intestinal peptide (VIP) in lung and colon tissues were detected by enzyme-linked immunosorbent assay (ELISA) .

In terms of morphology, the lung and colon tissue structures of rats in the control group were basically intact. In the model group, the trachea was narrowed and surrounded by a lot of inflammatory cells with thickened bronchial wall. The improvement in histopathology of the lung tissues was the most obvious in Bufei Jianpi group. The colon tissue of rats in the model group was damaged, which was manifested by numerous shed epithelial cells, and crypts in different shapes and sizes. Bufei Jianpi group demonstrated better improvement in histopathology of the colon tissue. There were statistically significant differences in the expression levels of TNF-α, IL-10, SP and VIP in the lung tissue of the five groups of rats (F_TNF-α=70.640, F_IL-10=8.444, F_SP=108.700, F_VIP=4.665, P<0.05) . The expression level of SIgA in BALF differed significantly across five groups of rats (F=26.370, P<0.05) . The expression levels of SP and VIP in colon tissue also varied significantly across five groups of rats (F_SP=136.600, F_VIP=13.980, P<0.05) . Compared with the control group, the expression levels of TNF-α and SP in the lung tissue and those of SP and VIP in the colon tissue of the model group were increased (P<0.05) ; the expression levels of IL-10 and VIP in the lung tissue, and expression level of SIgA in the BALF of the model group were decreased (P<0.05) . Compared with the model group, the expression levels of TNF-α and SP in the lung tissue and those of SP and VIP in the colon tissue of the Bufei Jianpi group were decreased (P<0.05) ; the expression levels of IL-10 and VIP in the lung tissue, and expression level of SIgA in the BALF of the Bufei Jianpi group were increased (P<0.05) .

Compared with the model group, the improvement in the lung-gut related peptides indices in three treatment groups was better, and the improvement was the best in the Bufei Jianpi group. Bufei Jianpi Formula could improve symptoms of lung inflammation and pathological damage of lung and intestine tissues. The mechanism may be related to the involvement in regulating the content of SIgA, SP and VIP, and enhancing local mucosal immunity and barrier function.

Noninvasive positive pressure ventilation (NPPV) is a major respiratory support technique for patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) and carbon dioxide (CO₂) retention. However, the obvious dead space in available masks used for NPPV could easily lead to repeated CO₂ inhalation, which affects the correction of CO₂ retention.

To develop a face mask with two channel and constant leakage (TCCL) used for NPPV, and to examine its value in NPPV treatment of AECOPD patients with CO₂ retention.

Thirty patients with AECOPD and typeⅡ respiratory failure treated with NPPV were recruited from the ICU, the First Affiliated Hospital of Chongqing Medical University from 2020 to 2021, and equally randomized into an experimental group (using the TCCL mask) and an control group (using the traditional mask with an exhalation valve on the side for NPPV) . Treatment effectiveness was assessed using arterial partial pressure of oxygen (PaO₂) and partial pressure of carbon dioxide (PaCO₂) monitored at baseline, and at the end of 4, 8, 24, and 48 hours of NPPV treatment as well as 24 hours after NPPV cessation.

The two-way repeated measures ANOVA indicated that treatment time and treatment approach had no interactive effects on PaO₂ (P>0.05) . Treatment time produced significant main effects on PaO₂ (P<0.001) , while treatment approach did not (F=0.153, P=0.699) . In both groups, the level of PaO₂ at baseline was lower than that at the end of 4, 8, 24, and 48 hours of NPPV treatment and 24 hours after NPPV cessation (P<0.05) ; the level of PaO₂ at the end of 4 hours of treatment was lower than that measured at the subsequent four time points (P<0.05) ; the PaO₂ level at the end of 8 hours of treatment was lower than that at 48 hours of treatment and 24 hours after NPPV cessation (P<0.05) . The PaO₂ level at 24 hours of treatment was lower than that at 48 hours of treatment in the control group (P<0.05) . The PaO₂ level at 24 hours of treatment was lower than that at 48 hours of treatment and 24 hours after NPPV cessation in the experimental group (P<0.05) . But there was no significant difference in PaO₂ level measured at each time point between the groups (P>0.05) . Treatment time and treatment approach had no interactive effects on PaCO₂ (P>0.05) . Treatment time produced significant main effect on PaCO₂ (P<0.001) , treatment approach also exerted obvious effect on it (F=5.129, P=0.031) . Compared with the control group, the experimental group demonstrated lower PaCO₂ levels at the end of 4, 8 and 24 hours of treatment (P<0.05) . In both groups, the PaCO₂ level at baseline was higher than that at the end of 4, 8, 24, and 48 hours after NPPV treatment and 24 hours after NPPV cessation (P<0.05) . The PaCO₂ level at the end of 4 hours of treatment was higher than that measured at the subsequent four time points (P<0.05) . The PaCO₂ level at the end of 8 hours of treatment was higher than that measured at the subsequent three time points (P<0.05) . The PaCO₂ level of the control group at 24 hours of treatment was higher than that at 48 hours of treatment and 24 hours after NPPV cessation (P<0.05) . The PaCO₂ level in the experimental group at 24 or 48 hours of treatment was higher than that at 24 hours after NPPV cessation.

TCCL mask may contribute to rapid correction of CO₂ retention and effective improvement of oxygenation in AECOPD patients.

There are rare studies assessing the efficacy of inhaled glucocorticoids (ICS) , the common therapy for chronic obstructive pulmonary disease (COPD) . MicroRNAs (miRNAs) have been confirmed to be involved in the development of COPD, among which miR-210 and miR-181a are closely related to COPD. Moreover, there is lack of clinical research on changes of miR-210 and miR-181a in COPD patients treated with ICS.

To examine the changes and response predictive values of serum miR-210 and miR-181a levels in stable COPD patients treated with ICS.

Eighty-six COPD outpatients were recruited from 363 Hospital from January 2017 to June 2020. All of them received four-week budesonide and formoterol inhalation. Treatment efficacy was assessed by the results of spirometry test or COPD Assessment Test (CAT) 〔responsive to treatment was defined as the COPD stage was reduced at least one stage or CAT score was reduced at least 2 points after treatment〕. Pre- and post-treatment lung function parameters〔including forced expiratory volume in one second (FEV₁) , forced vital capacity (FVC) , and peak expiratory flow (PEF) 〕 and serum miR-210 and miR-181a levels were collected. Pearson correlation analysis was used to assess the associations of serum miR-210 and miR-181a levels with FEV₁, FVC, and PEF as well as CAT score before and after the treatment. ROC analysis was used to assess the predictive values of serum miR-210 and miR-181a levels for treatment response in stable COPD.

Compared with pre-treatment, stable COPD patients demonstrated significantly increased values of FEV₁, FVC, and PEF, and significantly decreased CAT score, serum miR-210 and miR-181a levels after treatment (P<0.05) . Serum miR-210 and miR-181a levels were positively correlated with the CAT score before the treatment (P<0.05) . Serum miR-210 and miR-181a levels were negatively correlated with FEV₁ after the treatment (P<0.05) . Patients with responses to treatment had significantly lower pre- and post-treatment serum miR-210 and miR-181a levels compared with those without (P<0.05) . In predicting the treatment response in stable COPD, the AUC of pre-treatment serum miR-210 level was 0.807, and that of pre-treatment serum miR-181a level was 0.844 (P<0.05) .

The serum levels of miR-210 and miR-181a were much lowered in stable COPD patients with responses to four-week budesonide and formoterol inhalation. Pre-treatment serum miR-210 and miR-181a levels might be effective predictors of treatment response.

Severe community-acquired pneumonia (SCAP) progresses rapidly, with high mortality, multiple complications, and heavy economic burden. Despite the continuous improvement of clinical diagnosis and treatment programs, its morbidity and mortality remain high. Traditional Chinese Medicine (TCM) has proven its significant clinical efficacy in treating SCAP, but there is still no a standardized TCM-based clinical diagnosis and treatment protocol for SCAP, and insufficient research on the distribution of clinical TCM syndromes of SCAP.

To study the characteristics and distribution of clinical TCM symptoms of SCAP, providing ideas for clinical diagnosis and treatment of SCAP.

SCAP inpatients were recruited from Department of Respiratory Medicine, the First Affiliated Hospital of Henan University of CM from December 2012 to March 2021. Their symptoms and signs were summarized. Factor analysis and cluster analysis were performed on the data using SPSS Statistics (version 26.0) .

One hundred and sixty-six patients were included, including 119 men and 47 women, the ratio is 2.53∶1, with an average age of (70.1±15.8) years old. Altogether, 13 TCM syndromes were summarized, among which phlegm-heat obstructed lung syndrome had a high prevalence〔34.33% (57 /166) 〕; cough and expectoration were prevalent in more than 50% of the patients. Twelve common factors were obtained by factor analysis of TCM symptoms, explaining 62.842% of the total variance. By cluster analysis, the common factors were clustered into four major categories: phlegm-heat obstructed lung syndrome, xiexian-zhengtuo syndrome, qi-yin deficiency syndrome, and phlegm-damp obstructed lung syndrome.

Men is accounting for a larger percentage of SCAP. Clinical TCM syndromes of SCAP mainly include phlegm-heat obstructed lung syndrome, xiexian-zhengtuo syndrome, qi-yin deficiency syndrome, and phlegm-damp obstructed lung syndrome.

In China, a country with relatively serious burden of chronic obstructive pulmonary disease (COPD) , COPD is the third leading cause of death, and ranks third among all diseases in terms of disability adjusted life years (DALYs) . Effective prediction of the burden of COPD based on its prevalence, mortality and DALYs rate will provide theoretical support for the formulation of prevention and control measures.

To describe and analyze the burden of COPD and its temporal trends from 1990 to 2019, and to forecast the COPD burden between 2020 and 2024 in China, provide a basis for scientific prevention and control of COPD in China.

In December 2021, data about indicators measuring the burden of COPD in China from 1990—2019, including COPD prevalence, mortality and DALYs rates, were extracted from the Global Burden of Disease 2019. The average annual percentage change was used to measure the temporal trend of COPD prevalence, mortality and DALYs rates over the period. Autoregressive moving average (ARIMA) and neural network autoregressive (NNAR) models for COPD prevalence, mortality and DALYs rates were constructed based on data from 1990-2016 (training set) , and their predictive performance was tested using data from 2017—2019 (test set) . The relative error, mean absolute percentage error (MAPE) , mean absolute error (MAE) and root mean square error (RMSE) between predicted and actual values of these two models were calculated for comparing their goodness of fit and predictive performance. And the better model was used to estimate the COPD disease burden from 2020 to 2024.

COPD prevalence, mortality and DALYs rates in China during 1990—2019: (1) The prevalence of COPD in the whole population increased from 2 344.40/100 000 to 3 175.37/100 000, with an average annual growth rate of 1.04%. And the average annual growth rates of COPD prevalence were 0.92% and 1.13% for men and women, respectively. (2) The mortality rate of COPD in the whole population decreased from 105.09/100 000 to 72.94/100 000, with an average annual rate of decrease of 1.29%. And the mortality rates in both men and women showed a decreasing trend, with average annual rates of decrease of 0.83% and 1.83%, respectively. (3) The rate of COPD DALYs in the whole Chinese population decreased from 2 206.55/100 000 to 1 400.71 /100 000, with an average annual rate of decrease of 1.56%. And the rates of DALYs in both men and women showed a decreasing trend, with average annual rates of decrease of 1.37% and 1.86%, respectively. The predicted values of the trends by both ARIMA and NNAR models were basically consistent with the actual values of trends, but the ARIMA model had smaller relative error, MAPE, MAE and RMSE, indicating that it may have better prediction accuracy. And by the ARIMA model, the predicted COPD prevalence in 2020—2024 was 3 229.77/100 000, 3 262.44/100 000, 3 292.38/100 000, 3 322.31/100 000, and 3 352.25/100 000, respectively; the predicted mortality rates were 74.50/100 000, 75.49/100 000, 76.11/100 000, 76.50/100 000, and 76.75/100 000, respectively; the predicted DALYs rates were 1 429.56/100 000, 1 452.07/100 000, 1 469.64/100 000, 1 483.35/100 000, and 1 494.05/100 000, respectively.

The trend of burden of COPD in China was predicted to be increased from 2020 to 2024 by the ARIMA model. Owing to the high goodness of fit and predictive accuracy demonstrated in the prediction, the ARIMA model may be used as a tool for predicting short-term burden of COPD.

Mycoplasma pneumoniae pneumonia (MPP) can cause a variety of intrapulmonary and extrapulmonary injuries, including thrombotic diseases, which seriously endanger the health of children. And for assessing the coagulation status, routine coagulation parameters has great limitations, while thromboelastography (TEG) can be comprehensively and rapidly, but there are few data on TEG used in condition evaluation in children with MPP.

To explore the value of TEG in condition assessment of children with MPP.

Two hundred and twelve MPP children were recruited from the Affiliated Changzhou No.2 People's Hospital of Nanjing Medical University from July 2019 to July 2021, including 52 with severe condition and 160 with non-severe condition. Comparisons were made between two groups in terms of demographics, platelet count, routine coagulation parameters, and TEG parameters. The association of TEG parameters with platelet count and routine coagulation parameters was assessed. Multivariate Logistic regression analysis was used to explore influence factors for the condition of MPP. ROC analysis was used for assess the value of those identified risk factors for predicting the condition of MPP.

Both groups had no significant differences in sex ratio and mean age (P>0.05) . Compared with children with non-severe condition, those with severe conditionhad shortened reaction time (R) and kinetic time (K) , and elevated maximum amplitude (MA) , α-angle, clotting index (CI) , fibrinogen (FIB) , prothrombin time (PT) , international normalized ratio (INR) , D-dimer (D-D) (P<0.05) . Correlation analysis showed that MA was moderately positively associated with PLT and FIB (P<0.001) ; R was weakly positively associated with activated partial thromboplastin time (P<0.001) ; K was weakly negatively associated with PLT and FIB (P<0.001) ; α-angle was weakly positively correlated with PLT and FIB (P<0.001) . Multivariate Logistic regression analysis showed that CI〔OR=5.698, 95%CI (3.329, 9.753) , P<0.05〕, and D-D〔OR=5.061, 95%CI (1.724, 14.859) , P<0.05〕were influence associated with MPP, and the prediction algorithm based on them for MPP is CI+D-D: Y=1.777CI+1.624D-D-5.264. ROC analysis indicated that the area under the ROC curve of CI was 0.885〔95%CI (0.830, 0.941) 〕with 0.750 sensitivity and 0.907 specificity when the cut-off value was determined as 2.05, and that of D-D was 0.716〔95%CI (0.632, 0.799) 〕with 0.615 sensitivity and 0.784 specificity when the cut-off value was determined as 0.545, and that of CI in combination with D-D was 0.901〔95%CI (0.850, 0.952) 〕with 0.769 sensitivity and 0.914 specificity when the cut-off value was determined as -0.65.

TEG could partially predict the condition of children with MPP, but could not replace the routine coagulation parameters, and the combined predictive value of the two may be higher.

Community-acquired pneumonia (CAP) is one of the common infectious diseases with high morbidity and heavy disease burden. Despite the continuous advancement of diagnostic technology and the launch of new antimicrobial drugs, the morbidity and mortality of CAP are still high. The clinical research of Shufeng Jiedu capsules in the adjuvant treatment of CAP is increasing, but there is still a lack of systematic review and meta-analysis.

To systematically evaluate the efficacy and safety of Shufeng Jiedu capsules in the treatment of CAP.

Randomized controlled trials (RCTs) about Shufeng Jiedu capsules in the treatment of CAP was retrieved in CNKI, Wanfang Data, VIP, SinoMed, PubMed, Cochrane Library and EMBase from inception to November 2021 by computer. The control group was treated with routine western medicine, and the experimental group was treated with Shufeng Jiedu capsules orally on the basis of the control group. The retrieval time was from the establishment of the database to November 2021. RevMan 5.3 software was used for data analysis, and GRADE criteria were used to evaluate the level of evidence for the outcome indicators.

A total of 13 studies with 1 355 patients were included. The results of meta-analysis showed that the cure rate of the test group〔RR=1.49, 95%CI (1.28, 1.74), P<0.000 01〕, the total effective rate〔RR=1.18, 95%CI (1.13, 1.24), P<0.000 01〕, imaging complete absorption rate〔RR=1.57, 95%CI (1.13, 1.89), P<0.000 01〕 were higher than the control group, antibiotic use time〔MD=-1.25, 95%CI (-1.90, -0.61), P=0.000 1〕, time of fever disappearance〔MD=-1.15, 95%CI (-1.93, -0.37), P=0.004〕, time of cough disappearance〔MD=-0.96, 95%CI (-1.13, -0.80), P<0.000 01〕, time of expectoration disappearance〔MD=-1.44, 95%CI (-2.40, -0.48), P=0.003〕 and time of lung rales disappearance〔MD=-1.60, 95%CI (-2.33, -0.87), P<0.000 1〕 were shorter than the control group, C-reactive protein〔MD=-4.12, 95%CI (-6.95, -1.30), P=0.004〕 and white blood cell count〔MD=-2.20, 95%CI (-3.36, -1.05), P=0.000 2〕 were lower than the control group. There was no significant difference in the incidence of adverse events between the two groups〔RR=0.84, 95%CI (0.26, 2.67), P=0.76〕. The funnel chart of the cure rate showed that the left and right sides were asymmetrical, suggesting that there may be publication bias. GRADE grading results showed that the cure rate, total effective rate, the time of cough disappearance and imaging complete absorption rate were of moderate quality, the time of fever disappearance, expectoration disappearance and lung rales disappearance, C-reactive protein and white blood cell count were of low quality, the time of antibiotic use and the incidence of adverse events were of very low quality.

Shufeng Jiedu capsule has significant curative effect and good safety in the adjuvant treatment of CAP. However, due to the low quality of the included research methodology, more high-quality, multi-center and large sample trails are still needed for verification.

Acute exacerbation is an important cause for the significant decline of lung function in patients with chronic airway disease, which seriously affects the health and quality of life of patients, and significantly increases the medical and economic burden of the disease. Early identification of different inflammatory phenotypes in acute exacerbations of chronic obstructive pulmonary disease (AECOPD) and asthma-COPD overlap (ACO) and timely and precise treatment are important in reducing the occurrence of exacerbations, controlling disease progression, and improving quality of life.

To compare the clinical characteristics of AECOPD with different inflammatory phenotypes and ACO patients and their response to glucocorticoid therapy, and to provide a reference for further guiding the application of glucocorticoids.

The basic clinical data of AECOPD and ACO patients hospitalized in respiratory and critical care Medicine Department of the Second Hospital of Hebei Medical University from January 2018 to December 2020 were collected. The basic clinical data were collected, and the peripheral blood eosinophils (EOS) percentage (2%) was used as the critical value, EOS%≥2% was defined as EOS group, EOS%<2% was defined as non-EOS group, and ACO patients were defined as ACO group. The clinical characteristics and response to glucocorticoids of the three groups were analyzed.

High-sensitivity C-reactive protein (hs-CRP) , absolute value of peripheral blood neutrophils (NE) , neutrophil/lymphocyte ratio (NLR) , fibrinogen/serum albumin (FAR) , lung and the use rate of systemic hormones, total hormone application, hormone treatment course, and hospitalization time of AECOPD patients in the EOS group were lower than those in the non-EOS group (P<0.05) . ALB of AECOPD patients in EOS group was higher than that in non-EOS group (P<0.05) . Body mass index (BMI) , FEV₁%pred, severity of pulmonary function, absolute value of NE, NLR, utilization rate of pulmonary and systemic hormones, total hormone application, and hormone treatment course of AECOPD patients in the EOS group were lower than those in ACO group (P<0.05) . The age, hospitalization time, male prevalence rate, smoking rate, and EOS%≥2% of AECOPD patients in EOS group were higher than those in ACO group (P<0.05) .

EOS may be used as an important indicator to evaluate the severity of AECOPD and guide glucocorticoid therapy. The causes of acute exacerbations of COPD patients in the EOS group were mostly considered to be caused by non-infectious factors, and the treatment of antibiotics may be more prudent. AECOPD patients in EOS group have different clinical characteristics, and it is of positive significance to grasp their unique clinical characteristics for the early identification of chronic airway disease and accurate treatment decision.