The preserved ratio impaired spirometry (PRISm) population is a high-risk group for chronic obstructive pulmonary disease, with different clinical characteristics and development trajectories, closely related to various systemic comorbidities and poor prognosis. Currently, researches on PRISm are still in the exploratory stage both domestically and internationally. Due to insufficient understanding of PRISm, such as the lack of standardized clinical classification, imaging evaluation, accurate diagnosis, and prevention and treatment strategies, it is easily overlooked or confused with other common respiratory and comorbidities, resulting in many patients missing the opportunity for early intervention. General practitioners should not only pay attention to the patients with PRISm, but also fully consider their clinical heterogeneity, mechanism relationship with comorbidities, early imaging features, and potential detection targets. They should also focus on community screening of PRISm population and management of comorbidities. This article provides an overview of the current status, challenges, and response strategies of PRISm.

Patients with interstitial lung disease (ILD) are prone to acute exacerbation (AE-ILD), with infection being a significant trigger. AE-ILD patients exhibit high mortality rates and poor prognoses, yet domestic research on this population remains limited.

To investigate the clinical predictive value of dynamic changes in peripheral blood lymphocyte count (LYM) for 28-day prognosis in AE-ILD patients with pulmonary infection and to establish a corresponding prognostic prediction model.

A retrospective cohort study included AE-ILD patients with pulmonary infection hospitalized in the Department of Respiratory and Critical Care Medicine at the Affiliated Hospital of Xuzhou Medical University from January 2022 to June 2024. Patients were stratified into survival (n=37) and non-survival (n=65) groups based on 28-day outcomes. Data collected included demographics (sex, age, diagnosis, ILD subtype, comorbidities), disease severity scores (APACHEⅡ, SOFA), and laboratory parameters: white blood cell count (WBC), neutrophil count (NEU), lymphocyte count on days 1, 3, and 5 (d1 LYM, d3 LYM, d5 LYM), hemoglobin (Hb), platelet count (PLT), procalcitonin (PCT), C-reactive protein (CRP), albumin (ALB), total bilirubin (Tbil), lactate dehydrogenase (LDH), Serum creatinine (Scr), activated partial thromboplastin time (APTT), partial pressure of oxygen (PaO₂), partial pressure of carbon dioxide (PaCO₂), fraction of inspired oxygen (FiO₂), PaO₂/FiO₂ ratio (P/F), and lactate (Lac). Intergroup differences were analyzed, and statistically significant variables were identified. Receiver operating characteristic (ROC) curves evaluated prognostic predictive capacity. Univariate and multivariate Cox proportional hazards regression analyses were conducted using R software. Scores were assigned to each indicator based on the hazard ratio (HR). A nomogram prediction model was constructed. After calculating the total score of each indicator, risk stratification was established. The ROC curve of the prediction model was drawn to evaluate its predictive value. The survival curves of 28-day prognosis of patients with different risk stratifications were plotted using R software, and the 28-day survival rates of patients in different groups were compared.

The non-survival group exhibited higher APACHEⅡ scores, SOFA scores, PCT, CRP, and LDH than survival group, but lower d3 LYM, d5 LYM, ALB, and P/F than survival group (P<0.05). The results of the ROC curve showed that the AUCs of d3 LYM, d5 LYM, APACHEⅡ score, and SOFA score in predicting the 28-day prognosis of AE-ILD patients with pulmonary infectionwere 0.723, 0.764, 0.733, and 0.704, respectively. Multivariate Cox regression identified P/F (HR=2.01, 95%CI=1.08-3.75), PCT (HR=2.14, 95%CI=1.02-4.49), Hb (HR=2.34, 95%CI=1.22-4.48), d5 LYM (HR=2.40, 95%CI=1.01-5.70) as independent predictors of 28-day mortality (P<0.05). The nomogram model was constructed based on d5 LYM, P/F, PCT and Hb. The AUC value of this model for predicting 28-day mortality in AE-ILD patients with pulmonary infection was 0.853 (95%CI=0.781-0.925), with the optimal cut-off value being 2. The sensitivity and specificity were 88.24% and 82.35%, respectively. According to the results of the optimal risk stratification, 0-2 was classified as the low-risk group (n=39), and 3-6 was classified as the high-risk group (n=63). There were significant differences on the 28-day survival rates between the two groups of patients (χ²=51.00, P<0.001).

Lymphopenia is associated with increased 28-day mortality in AE-ILD patients with pulmonary infection. The nomogram model incorporating d5 LYM, P/F, PCT, and Hb provides a clinically practical tool for risk stratification and prognostic assessment.

Pulmonary function testing, regarded as the "gold standard" for the classification and evaluation of therapeutic efficacy in chronic obstructive pulmonary disease (COPD), is a core method for its diagnosis and management. Among these tests, pulmonary ventilation parameters can effectively reflect the degree of airway obstruction; however, they are limited in detecting early lung parenchymal damage and microvascular lesions. In contrast, the diffusing capacity of the lung for carbon monoxide (DLCO) is an important indicator of pulmonary gas exchange function, which responds sensitively in the early stages of COPD and provides valuable clues for early disease detection. This article systematically discussed the role of DLCO in the early identification of COPD, assessment of disease severity, risk of acute exacerbations, long-term prognosis, and summarized its unique clinical value in COPD and related comorbidities. DLCO might serve as an alternative indicator for disease evaluation or prognostic assessment in patients with poor lung function or advanced age who were unable to complete pulmonary ventilation testing. Furthermore, in patients with COPD complicated by pulmonary hypertension, heart failure, or lung cancer, DLCO could effectively reflect the severity of comorbidities and assist in prognostic evaluation. This review provided a useful reference for future studies on DLCO in patients with COPD and its comorbid conditions.

Chronic obstructive pulmonary disease (COPD) is the third leading cause of death worldwide. Pulmonary rehabilitation (PR) is an integral nonpharmacological component of chronic disease management, but global participation in PR is low (<3%). Pulmonary telerehabilitation (TPR) delivered via video or mobile applications can overcome barriers of travel, distance, and cost and may increase access to home-based PR.

To comprehensively evaluate the effects of a WeChat mini-program-based PTR program on exercise capacity, health-related quality of life, lung function, psychological status, sleep quality, and adherence in patients with stable COPD.

From October 2022 to October 2024, 82 stable COPD patients attending the Respiratory Department of the Affiliated Hospital of Inner Mongolia Medical University were enrolled in this randomized study. Patients were assigned by random number table to either: the intervention group (home-based PTR through a WeChat mini-program, n=42) or the control group (outpatient face-to-face PR, n=40). Both groups received rehabilitation three times weekly for 12 weeks. Assessments were performed at baseline (T1), week 8 (T2), and week 12 (T3). Primary and secondary outcomes included: 6-minute walk distance (6MWD) for exercise capacity; modified Medical Research Council dyspnea scale (mMRC); St. George's Respiratory Questionnaire (SGRQ) for health-related quality of life; Hospital Anxiety and Depression Scale (HADS); Pittsburgh Sleep Quality Index (PSQI); and spirometry measured at T1 and T3. Adherence and safety were evaluated after 12 weeks.

Exercise capacity: there was a significant group × time interaction for 6MWD (P_interaction<0.05); the main effect of time was significant (P_time<0.05), while the main effect of group was not significant (P_group>0.05). Dyspnea (mMRC): no significant group × time interaction, and no significant main effects of group or time on mMRC scores (P>0.05). Quality of life (SGRQ): no significant interaction between group and time for SGRQ symptom, activity, impact domains, or total score (P_interaction>0.05); group main effects were not significant (P_group>0.05), whereas time main effects were significant (P_time<0.001). Psychological status: both groups showed significant reductions in HADS anxiety and depression scores over the study period (P<0.05). Sleep quality and lung function: no significant group×time interactions or main effects of group were observed for PSQI scores (P>0.05). The main effect of time was significant for the total PSQI score (P_time<0.05), but not for the other subscale scores (P_time>0.05). Comparisons of spirometric indices [forced expiratory volume in 1 second (FEV₁), forced vital capacity (FVC), forced expiratory volume in 1 second as a percentage of the predicted value (FEV₁%pred), FEV₁/FVC] between groups at T1 and T3 showed no significant differences (P>0.05); within-group comparisons between T1 and T3 were also not significant (P>0.05). Adherence: the intervention group demonstrated significantly better adherence than the outpatient control group (χ²=5.00, P<0.05).

A WeChat mini-program-based PTR program is at least comparable to outpatient face-to-face PR in improving exercise capacity, health-related quality of life, and psychological status in stable COPD patients, and it achieves higher patient adherence. It represents a feasible alternative to conventional outpatient PR.

Idiopathic pulmonary fibrosis (IPF) is characterized by increasing incidence and mortality in the context of global population aging, with poor prognosis and substantial economic burden. In traditional Chinese medicine (TCM), accurate syndrome differentiation is essential for effective treatment. However, the heterogeneity of IPF syndromes, shaped by both temporal evolution and regional differences, has not been systematically investigated from a long-term, macroscopic perspective.

To investigate the spatiotemporal evolution of TCM syndromes and syndrome elements in IPF from 1997 to 2025 based on a comprehensive literature analysis.

Relevant studies on TCM interventions for IPF were retrieved from CNKI, VIP, WanFang Data, CBM, and PubMed. The search timeframe was from database inception to April 2025. After screening according to predefined criteria, data including TCM syndromes, syndrome elements, publication year, region, and author affiliations were extracted. The studies were categorized into four periods (1997-2003, 2004-2010, 2011-2017, and 2018-2025) and seven geographical regions in China. Statistical analyses, including association rule mining, hierarchical clustering, and descriptive statistics.

A total of 172 studies involving 11 680 patients were included. Publications were most frequent in North China, with Beijing University of Chinese Medicine contributing the largest number. Fifty TCM syndromes were identified, among which qi-yin deficiency, phlegm-blood stasis congealing, qi deficiency with blood stasis, and lung-kidney qi deficiency were the most prevalent. Seventeen syndrome elements were extracted, with qi deficiency, blood stasis, yin deficiency, and phlegm turbidity being the most common pathological elements, while the lung and kidney were the predominant disease-location elements. Temporal analysis showed that qi-yin deficiency and phlegm-blood stasis congealing consistently predominated across all periods. The proportions of qi-yin deficiency and lung-kidney qi deficiency increased from 1997 to 2017 but declined thereafter, whereas qi deficiency with blood stasis exhibited a continuous upward trend. Syndrome element analysis indicated that qi deficiency, yin deficiency, blood stasis, and phlegm turbidity persisted throughout the disease course, with phlegm turbidity showing a decreasing trend in recent years. Regional analysis revealed that qi-yin deficiency predominated in most regions, whereas phlegm-blood stasis congealing was more common in Northeast China, and lung-kidney qi deficiency in Southwest China. Association rule and clustering analyses consistently identified core combinations of qi deficiency, yin deficiency, blood stasis, and phlegm turbidity.

The core TCM syndromes of IPF are characterized by qi-yin deficiency and phlegm-blood stasis congealing, with qi deficiency, yin deficiency, blood stasis, and phlegm turbidity forming the fundamental pathological basis throughout disease progression. These findings, revealing the core pathological basis and its spatiotemporal evolution, support the implementation of region-specific, dynamic, and individualized treatment strategies based on syndrome patterns, providing evidence for precision TCM diagnosis and management.

Chronic obstructive pulmonary disease (COPD) is one of the three leading causes of death worldwide. Early prevention is particularly important for reducing the global healthcare burden. To enhance clinicians' awareness of high-risk populations for COPD and thereby enable early identification of such individuals, the GOLD guidelines have explicitly introduced the pre-COPD. Compared with the general population, individuals in the pre-COPD stage have a higher incidence of COPD; however, few studies have conducted a quantitative analysis of the relative validity of the various indicators.

Clarify the progression of patients with pre-COPD to COPD under different screening indicators, quantify their risk of developing COPD, and compare the clinical value of different screening indicators.

Cohort studies on the progression of pre-COPD to COPD published from the establishment of databases to November 30, 2025, were retrieved from CNKI, Wanfang Data, VIP Chinese Journal Service Platform, PubMed, Embase, and Web of Science. Two researchers independently conducted retrieval, literature eligibility screening, data extraction, and quality assessment. Meta-analysis was then performed using R 4.4.1. For the difference in COPD incidence between high-risk populations defined by different screening criteria and normal populations, Hazard Ratio (HR), Relative Risk (RR), and Odds Ratio (OR) were collected or calculated for aggregation and comparison to assess the risk.

A total of 23 studies were included, covering 6 grouping criteria: NOCB, PRISm, FEV₁/FVC<75%, DLCO, FEV₃/FEV₆<lower limit of normal (LLN), and variable airflow limitation. Among them, FEV₁/FVC<75% had the strongest correlation with COPD incidence (RR=11.98, 95%CI=3.91-36.72). The correlation strength of other indicators in descending order was as follows: variable airflow limitation (RR=4.51, 95%CI=2.37-8.57), low DLCO (RR=4.05, 95%CI=1.49-11.05), PRISm (RR=2.33, 95%CI=1.72-3.14), FEV₃/FEV₆<LLN (RR=2.11, 95%CI=1.48-3.03), and NOCB (RR=1.36, 95%CI=1.02-1.81).

Populations with NOCB, PRISm, low DLCO, variable airflow limitation, FEV₃/FEV₆<LLN, or FEV₁/FVC<75% have a higher risk of developing COPD than normal populations, among which the population with FEV₁/FVC < 75% has the highest risk.

Building on the established framework for the diagnosis, treatment, management, and prevention of chronic obstructive pulmonary disease (COPD), the 2026 report of the Global Initiative for Chronic Obstructive Lung Disease (GOLD) provides systematic updates to key aspects including disease burden, case finding, risk stratification, maintenance treatment, acute exacerbation management, comorbidity evaluation, and the application of emerging technologies. This revision further highlights the importance of early identification, acute exacerbation prevention, and long-term dynamic assessment in COPD care; clearly differentiates screening from case finding and underscores proactive case identification in individuals with symptoms and/or risk factor exposure; defines the occurrence of one or more moderate or severe acute exacerbations within the previous year as a criterion for Group E assignment, thereby reinforcing the central role of acute exacerbations in risk stratification and therapeutic decision-making; and introduces for the first time the concept of "disease activity", proposing a low disease activity state, defined by the absence of acute exacerbations, no symptomatic deterioration, and no accelerated decline in lung function, as a major management goal. The guideline also clarifies distinct decision pathways for initial and follow-up treatment, strengthens precise evaluation and individualized intervention during acute exacerbations, and advances comorbidity assessment from a single-disease focus to an integrated multimorbidity management paradigm. Collectively, GOLD 2026 places greater emphasis on early intervention and acute exacerbation prevention in COPD management, carrying important implications for optimizing early diagnosis and treatment as well as long-term standardized management of COPD in China.

Sleep apnea is a high incidence sleep disorder disease in clinic. With the change of lifestyle, the incidence rate continues to rise, which can cause cardiovascular, metabolic and other multiple system damage. In recent years, it has been found that female sleep apnea patients often experience reproductive dysfunction such as menstrual disorders and infertility. However, the immune regulatory mechanism of sleep apnea induced damage to the female reproductive system, especially the abnormal immune response mediated by dendritic cells (DCs), still lacks in-depth analysis.

To study the effects of sleep apnea induced immune dysfunction on the reproductive system of female rats.

The research period was from January 2023 to December 2024. Thirty 4-6 month female SD rats (SPF grade) with regular estrous cycles were randomly divided into a blank control group, a short-term group, and a long-term group, with 10 rats in each group. The blank control group was fed normally for 6 weeks, the short-term group was fed for 3 weeks on the basis of preparing a sleep apnea model, and the long-term group was fed for 6 weeks on the basis of preparing a sleep apnea model. The estrous cycle of each group of rats, the expression levels of estrogen receptor alpha (ERα) and estrogen receptor beta (ERβ) subtypes in ovarian tissue, and the number of follicles in ovarian tissue were analyzed. The migration ability of DCs, the ability of DCs to stimulate homologous T lymphocyte proliferation response (MLR), and the changes in Toll-like receptor 4 (TLR4) and RelB expression levels in DCs were observed. The fertility of each group and the growth and development of offspring mice were analyzed.

Compared with the blank control group, the long-term groups showed an increased rate of dysregulation in the estrous cycle (P<0.017). Compared with the blank control group, the expression levels of ERα and ERβ in ovarian tissues were reduced in the short-term and long-term groups (P<0.05). Compared with the short-term group, the long-term group showed a decrease in the expression levels of ER α and ERβ in ovarian tissue (P<0.05). Compared with the blank control group, the number of primordial follicles, primary follicles, and antral follicles decreased in the short-term and long-term groups, while the number of blocked follicles increased (P<0.05). Compared with the short-term group, the long-term group showed a decrease in the number of primordial follicles, primary follicles, and antral follicles, and an increase in the number of blocked follicles (P<0.05). Compared with the blank control group, the migration rate of DCs decreased and the MLR increased in the short-term and long-term groups (P<0.05). Compared with the short-term group, the long-term group showed a decrease in the migration rate of DCs and an increase in MLR (P<0.05). Compared with the blank control group, the expression levels of TLR4 and RelB in DCs in both the short-term and long-term groups increased (P<0.05). Compared with the short-term group, the long-term group showed an increase in the expression levels of TLR4 and RelB in DCs (P<0.05). Compared with the blank control group, the pregnancy rate and live birth rate of long-term groups decreased (P<0.05). Three groups of live born offspring mice showed an increase in daily weight after 21 days of birth, but compared with the blank control group, the short-term and long-term groups showed growth retardation, especially the long-term group.

Sleep apnea can cause ovarian dysfunction and reduced fertility in female rats, suggesting that it may activate TLR4/RelB by altering the migration ability of DCs, leading to immune damage and reproductive system disorders.

Chronic obstructive pulmonary disease (COPD) is closely related to cardiovascular disease, but the mechanism of their interaction is still unclear. Hypertension is the most common comorbidity of COPD, and it is also an independent risk factor for cardiovascular diseases. Current studies believe that blood pressure variability is also a risk factor for cardiovascular disease, and blood pressure variability can better reflect the patient's blood pressure fluctuation than a single blood pressure value, so is blood pressure variability a bridge between COPD and cardiovascular disease. At present, there are no relevant studies in China.

To investigate the correlation study of pulmonary function and blood pressure variability in patients with COPD and hypertension.

A total of 341 COPD patients with hypertension who visited the respiratory and critical care medicine outpatient department of kailuan general hospital from september 2020 to september 2023. On the day of the patient's visit, data were collected on the patient's lung function indicators, height, weight, age, sex, use of antihypertensive medications, and lifestyle habits (whether they smoke or drink alcohol) . Multiple factor linear regression was used to analyze the correlation between lung function indicators (percentage of forced vital capacity to predicted value: FVC%pred; percentage of forced expiratory volume to predicted value in the first second: FEV₁%pred; the ratio of forced expiratory volume in one second to forced vital capacity: FEV₁/FVC) and blood pressure variability (standard deviation of systolic blood pressure: SDSBP, standard deviation of diastolic blood pressure: SDDBP) .

(1) Males had higher body mass index, smoking rate, and alcohol consumption rate than females, while females had a higher predicted forced vital capacity percentage (FVC%pred) than males (P<0.05) . (2) FEV₁%pred was negatively correlated with blood pressure variability (SDSBP, SDDBP) (r_s values were -0.149 and -0.114, respectively, P<0.05) . (3) FEV₁%pred was negatively linearly correlated with SDSBP and SDDBP, with B values (95% CI) of -0.566 (-1.078--0.054) and -0.427 (-0.761--0.093) , respectively; FVC%pred and FEV₁/FVC were not correlated with SDSBP and SDDBP.

FEV₁%pred is negatively linearly correlated with SDSBP and SDDBP.

Patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) are chronically exposed to disease uncertainty and high stress, and their psychological trait of intolerance of uncertainty is strongly associated with poor health outcomes, but existing research lacks comprehensive analyses based on multilevel ecosystems.

To analyze the current situation and influencing factors of intolerance of uncertainty in patients with AECOPD under the perspective of health ecology, and to provide reference for formulating targeted intervention strategies.

From November 2024 to June 2025, patients with AECOPD in the Respiratory and Critical Care Medicine Center of Xinjiang Uygur Autonomous Region People's Hospital were conveniently selected as the survey objects. The Intolerance of Uncertainty Scale-12, the Acceptance and Action Questionnaire-Ⅱ, the COPD Knowledge Questionnaire, and the Perceived Social Support Scale were used to conduct a cross-sectional survey. Pearson correlation analysis was used to explore the correlations among psychological flexibility, health literacy, social support and intolerance of uncertainty. Multiple linear regression analysis was adopted to investigate the influencing factors of intolerance of uncertainty in patients with AECOPD.

A total of 360 questionnaires were distributed in this study. 342 valid questionnaires were recovered, with an effective recovery rate of 95.0%. 342 patients with AECOPD had a total score of intolerance of uncertainty (32.2±7.1). The scores of psychological flexibility, health literacy and social support were (24.7±8.6), (6.9±2.4), (54.7±11.8). The results of the correlation analysis indicated that the score of intolerance of uncertainty was positively correlated with the score of psychological flexibility (r=0.648, P<0.001), and negatively correlated with the scores of health literacy and social support (r=-0.548, -0.643, P<0.001). Multiple linear regression analysis showed that the number of comorbidities (B=1.057, 95%CI=0.552-1.563), number of hospital admissions (B=1.646, 95%CI=0.409-2.882), regular exercise (B=1.670, 95%CI=0.551-2.789), average monthly medication cost (B=2.962, 95%CI=1.623-4.300), psychological flexibility (B=0.151, 95%CI=0.065-0.238), health literacy (B=-0.754, 95%CI=-0.992 to -0.517), and social support (B=-0.128, 95%CI=-0.188 to -0.068) were the main influencing factors of intolerance of uncertainty in patients with AECOPD (P<0.05).

The intolerance of uncertainty of AECOPD patients is at a moderately high level, and their intolerance of uncertainty is influenced by the multilevel factors. Comprehensive interventions should be carried out for AECOPD patients according to the patient's condition and from multiple perspectives, such as psychological, family, and social.

Mechanically ventilated patients in the intensive care unit (ICU) experience both nociception and pain-related distress, while simultaneously being at risk of ventilator-induced lung injury (VILI). Implementing individualized analgesic regimens is crucial to facilitate lung-protective ventilation strategies. Although preclinical studies suggest that oxycodone may attenuate VILI, clinical evidence supporting its use in critically ill patients remains limited, particularly in the ICU setting.

To evaluate the effects of intravenous oxycodone on respiratory mechanics and clinical outcomes in mechanically ventilated ICU patients, with a specific focus on those who have undergone abdominal surgery, thereby providing a novel theoretical basis and practical guidance for optimizing analgesic management and mitigating VILI risk.

A prospective randomized controlled trial was conducted. A total of 94 adult patients (aged≥18 years) requiring analgesic intervention, with a mechanical ventilation duration exceeding 24 hours and an Critical-care Pain Observation Tool (CPOT) score ≥3, were enrolled from the ICU of Zhoushan Hospital between August 2023 and March 2025. Participants were randomly assigned to either the sufentanil group or the oxycodone group, with 47 patients in each group. Both groups received standard treatment for underlying conditions and were managed with mechanical ventilation according to a conventional lung-protective ventilation strategy. The sufentanil group received a continuous intravenous infusion of sufentanil via micropump (loading dose: 0.5-1.0 μg/kg; maintenance dose: 0.02-0.15 μg·kg^-1·h^-1), while the oxycodone group received a continuous intravenous infusion of oxycodone injection (diluted to 1 mg/mL with 0.9% saline or 5% glucose solution; loading dose: 0.03 mg/kg; initial maintenance dose: 2 mg/h). Dosages were adjusted based on CPOT scores to maintain pain control with a target CPOT score below 3. Both groups received propofol for sedation as clinically indicated. Routine assessments included pain evaluation, respiratory mechanics monitoring, and arterial blood gas analysis. Outcome measures included demographic characteristics, airway peak pressure (Ppeak), airway plateau pressure (Pplat), driving pressure (ΔP), dynamic compliance (Cdyn), mechanical power MP), oxygenation index (P/F), and ventilation ratio (VR), recorded at baseline (0 h) and at 4 h, 12 h, and 24 h after initiation of analgesia. Additionally, cumulative analgesic consumption over 24 hours (converted to morphine equivalent), total propofol dose over 24 hours, duration of MV, and length of ICU stay (ICU-LOS) were documented. The study compared the effects of the two analgesic regimens on respiratory mechanics and clinical efficacy. A prespecified subgroup analysis was performed among 37 patients who underwent abdominal surgery (sufentanil subgroup: n=17; oxycodone subgroup: n=20).

There was no significant interaction effect between group and time on respiratory mechanics and oxygenation/ventilation parameters (P>0.05). The main effect of group on these parameters was not statistically significant (P>0.05), whereas the main effect of time was significant for Ppeak, MP, and VR (P<0.05). Subsequent intergroup comparisons were conducted for total morphine equivalent dose (24-hour analgesic requirement), total propofol dose (24-hour sedative requirement), duration of mechanical ventilation, and ICU length of stay (LOS), with no statistically significant differences observed (P>0.05). However, a subgroup analysis restricted to patients who underwent abdominal surgery demonstrated a statistically significant difference in propofol dosage between the oxycodone and sufentanil groups (P<0.05).

Both oxycodone injection and sufentanil injection can effectively improve respiratory mechanics parameters and oxygenation-ventilation indices in mechanically ventilated ICU patients, thereby facilitating the implementation of lung-protective ventilation strategies and reducing the risk of VILI. In post-abdominal surgery patients requiring mechanical ventilation, oxycodone injection demonstrates superior efficacy in pain relief, allows for reduced use of sedative agents, mitigates clinical risks associated with high-dose sedation, and exhibits a more favorable safety profile.

Chronic obstructive pulmonary disease (COPD) is one of the major diseases that severely jeopardize the health of the Chinese population. The kidneys are extremely sensitive to low oxygen levels due to their sensitivity, patients with COPD are susceptible to renal impairment. Nevertheless, there is a paucity of research on the factors associated with COPD and renal impairment both domestically and internationally.

Analyze the clinical characteristics of patients with acute exacerbation of chronic obstructive pulmonary disease complicated by renal dysfunction, identify relevant factors, and provide theoretical basis for the prevention and treatment of renal dysfunction in clinical AECOPD patients.

A total of 100 patients with acute exacerbation of chronic obstructive pulmonary disease complicated by renal dysfunction who were hospitalized in the Respiratory Department of the First Affiliated Hospital of Jinzhou Medical University from December 2020 to July 2023 were selected.At the same time, 92 patients with AECOPD who were admitted and had complete examination data during the same period were collected, totaling 192 cases. According to the glomerular filtration rate (eGFR) of patients, they were divided into a normal renal function group (92 cases), a mild impairment group (66 cases), and a severe impairment group (34 cases). Collect general data of the subjects and laboratory data: white blood cell (WBC), hemoglobin (Hb), C-reactive protein (CRP), procalcitonin (PCT), interleukin-6 (IL-6), albumin (ALB), brain natriuretic peptide (BNP), troponin I (CTnI), glucose (GLU), pH Arterial oxygen partial pressure (PaO₂), arterial carbon dioxide partial pressure (PaCO₂), lactate (cLac), creatinine (Cr), Cystatin C (Cys C), β₂-Microglobulin (β₂-MG), Urea, uric acid (UA), percentage of forced expiratory volume per second (FEV₁%), and percentage of forced vital capacity per second (FEV₁/FVC). Multivariate Logistic regression analysis of predictive factors for renal dysfunction in AECOPD patients; Pearson correlation analysis shows the correlation between eGFR, Cys C, and other indicators; Draw ROC curves and evaluate the predictive value of various factors on renal function damage in AECOPD patients.

Three inter group analysis, age, hypertension, coronary heart disease, Hb, CRP, ALB, BNP, CTnI, IL-6, Cr, UA, Urea, Cys C, β₂-MG, FEV₁% and PaO₂ were statistically significant (P<0.05) ; Cys C is negatively correlated with PaO₂ and FEV₁% (r=-0.379, -0.254, P<0.01), and positively correlated with IL-6 (r=0.641, P<0.01). eGFR is positively correlated with PaO₂ and FEV₁% (r=0.470, 0.286, P<0.01), and negatively correlated with IL-6 (r=-0.456, P<0.01). Multivariate Logistic regression analysis showed that age, hypertension, PaO₂, IL-6, UA, β₂-MG and Cys C were predictive factors for renal dysfunction in patients with acute exacerbation of COPD (P<0.05). Further ROC curve analysis showed that UA (AUC=0.646, 95%CI=0.569-0.724), Cys C (AUC=0.895, 95%CI=0.852-0.939), β₂-MG (AUC=0.822, 95%CI=0.764-0.879), IL-6 (AUC=0.743, 95%CI=0.674-0.812), and PaO₂ (AUC=0.676, 95%CI=0.601-0.751) had certain predictive value for renal function damage in AECOPD patients (P<0.05).In terms of concurrent renal dysfunction in AECOPD patients, the sensitivity, specificity, accuracy, and area under the ROC curve of Cys C were all higher than those of β₂-MG, IL-6, and PaO₂, with statistically significant differences (P<0.05).

Age, hypertension, PaO₂, IL-6, UA, β₂-MG and Cys C are related predictive factors for renal dysfunction in patients with acute exacerbation of chronic obstructive pulmonary disease.Cys C has a high diagnostic value in predicting renal function impairment in AECOPD patients, and is an indicator for predicting the risk of renal injury in AECOPD patients.

Chronic obstructive pulmonary disease(COPD) poses a serious threat to human health, making it one of the major global public health burdens. In 2023, an expert consensus group was established to address key clinical questions in the integrated Chinese and western medicine management of COPD. Based on authoritative domestic and international guidelines and adapted to China's national conditions, the Expert Consensus on Integrated Traditional Chinese and Western Medicine Management for Chronic Obstructive Pulmonary Disease (2023 Edition) was developed and published. To provide more scientific and practical guidance, a guideline development working group was formed as a project of the China Association of Chinese Medicine, with funding from multiple projects. The group integrated evidence-based medicine with expert experience and clinical realities, conducted systematic evidence retrieval and evidence grading, and ultimately developed the Guidelines for Integrated Traditional Chinese and Western Medicine in the Diagnosis and Treatment of Chronic Obstructive Pulmonary Disease (2025 Edition). This guideline introduces the selection of screening tools for COPD at primary healthcare institutions. Focusing on integrative strategies for prevention and treatment of COPD, this guideline addresses 8 core clinical questions and provides specific recommendations on various interventions, including population screening, oral Chinese medicine, external therapies, and traditional Chinese exercises. This guideline emphasizes the organic integration of Chinese and western medicine in the diagnosis and treatment of COPD, with a focus on individualized therapy, aiming to further enhance the comprehensive diagnosis, treatment, and management of COPD in China.

In China, chronic obstructive pulmonary disease (COPD) is a prevalent chronic disorder. With high incidence and mortality, it burdens both individual health and socioeconomic systems. Pharmacological treatment is essential for COPD management, and personalized therapy is key. Triple therapy combining inhaled corticosteroids (ICS), long-acting muscarinic antagonist (LAMA), and long-acting beta-agonist (LABA) has become a focal point. In 2024 Italy has refined the management of COPD patients through the establishment of an expert panel focusing on the applicability of triple therapy in order to standardize the management of patients with COPD and published the "An Italian Delphi Consensus on the Triple Inhalation Therapy in Chronic Obstructive Pulmonary Disease". This article interprets the consensus' core points on triple therapy, analyzes its applications in diverse clinical scenarios, and provides evidence - based guidance for optimizing drug selection in Chinese COPD treatment. The goal is to improve treatment standardization and enhance patient outcomes.

The pathogenesis of chronic obstructive pulmonary disease (COPD) is complex. Analyzing and forecasting the epidemiological status can provide valuable insights for COPD prevention and control.

To examine COPD incidence, prevalence, and mortality in China from 1990 to 2021, and predict the incidence and mortality rates for 2022-2032 to inform COPD prevention and treatment efforts.

Based on the 2021 Global Burden of Disease (GBD) database, the incidence, prevalence, and mortality of COPD in China from 1990 to 2021 were collected. The change rate and estimated annual percentage change (EAPC) were used to describe the changing trends of COPD. The autoregressive integrated moving average model (ARIMA) was used to predict the incidence, prevalence and mortality of COPD in China from 2022 to 2032.

The standardized incidence and prevalence of COPD in the whole Chinese population from 1990 to 2021 showed an increasing trend (EAPC were 2.25% and 2.53%, respectively, t values of 71.35 and 165.91, respectively, P<0.001); whereas the standardized mortality rate showed a decreasing trend compared with that in 1990 (EAPC=-0.31%, P<0.05). In 2021, the standardized incidence rate of COPD in Chinese men was 308.68/100 000 and the prevalence rate was 3 358.06/100 000; both the incidence and prevalence rates of COPD in men showed an increasing trend compared with 1990 (EAPC were 2.32%, 2.48%, t values of 64.23 and 39.67, respectively, P<0.001); whereas the standardized mortality rate in men increased from 97.13/100 000 to 101.05/100 000, but was not statistically significant in terms of trend (EAPC=0.05%, t=0.62, P=0.54). In 2021, the standardized incidence rate of COPD in Chinese women was 320.70/100 000, and the standardized prevalence rate was 3 829.79/100 000; compared with 1990, the standardized incidence and prevalence rates of COPD in women showed an increasing trend (EAPC were 2.19% and 2.59%, t values of 25.29 and 33.19, respectively, P<0.001); the standardized mortality rate in women showed a decreasing trend (EAPC=-0.77%, t=-3.36, P<0.01), from 91.43/100 000 in 1990 to 74.18/100 000. In 2021, the standardized incidence and prevalence of COPD in Chinese females were 1.04 and 1.14 times higher than that of males, respectively; and the standardized mortality rate of COPD in males was 1.36 times higher than that of females. In the age-stratified analysis, there was a weak increasing trend in the age group of 25-29 years (EAPC=0.05%, P<0.01), and fluctuations in the incidence of standardization in the age group of 30-44 years, but there was no statistical significance (P>0.05). The standardized prevalence of the population over 50 years of age showed an increasing trend and the increase was further widened with age, with the highest rise in the ≥80 years age group (EAPC=4.46%, t=89.92, P<0.001). The age-stratified trend of COPD prevalence showed significant differentiation: a significant decline in prevalence was observed in the 25-34 year olds (25-29 year olds: EAPC=-1.52%, P<0.001; 30-34 year olds: EAPC=-0.57%, P=0.045), while the prevalence of the 35-39 year olds group showed a statistically insignificant change (EAPC=-0.40%, P=0.187), whereas the 40-44 year old group showed a turnaround increase (EAPC=0.60%, P=0.047), and the 50+ year old group showed a rapid increasing trend (EAPC>2.00%, P<0.001). COPD mortality showed a significant increasing trend in the ≥80 years age group (EAPC=0.95%, P<0.001); COPD mortality continued to decrease in the under 80 years age group (all EAPC<-0.50%, P<0.001). The results of ARIMA model showed that the incidence and prevalence of COPD in China from 2022 to 2032 showed an upward trend, and the overall mortality rate declined, but the male mortality rate showed an upward trend, and the female mortality rate fluctuated but generally declined.The incidence rate of COPD in 2032 was estimated to be up to 409.39/100 000, and the prevalence rate was estimated to be up to 4 675.48/100 000. In 2032, the overall mortality rate was projected to reach 71.39/100 000, with the male mortality rate expected to reach 112.10/100 000, and the female mortality rate expected to reach 77.32/100 000.

From 1990 to 2021, the standardized incidence and prevalence of COPD in the whole population, male and female populations in China showed an overall increasing trend. In the elderly population, the standardized incidence and prevalence of COPD showed a growing trend, and the mortality rate of the population aged 80 years or older showed an increasing trend, whereas the mortality rate of COPD for people under 80 years of age showed a decreasing trend. Incidence and prevalence of COPD in China from 2022 to 2032 showed an increasing trend, and the overall mortality rate was decreasing, but the mortality rate of males showed an increasing trend, and the mortality rate of females fluctuates.

Chronic obstructive pulmonary disease (COPD) is associated with a substantial disease burden. The attributes of different treatment options vary, which can affect patient adherence and, consequently, treatment outcomes. Discrete choice experiment (DCE) can identify the key factors (attributes) influencing patient choices, determine the most valued attributes, and quantify the trade-offs between attributes. DCEs have been widely applied in the healthcare field.

To review and evaluate the literature on DCE regarding treatment and device preferences among patients with COPD, with the aim of providing a reference for conducting health preference-related research on COPD patients in China.

Literature utilizing DCEs to measure health preferences among patients with COPD was retrieved from the Web of Science Core Collection, PubMed, CNKI, Wanfang Data, CBM, and VIP Database. The PREFS checklist was employed for quality evaluation. The attributes in the studies and their corresponding dimensions were analyzed and discussed.

A total of 11 studies were included, all from developed countries. Significant differences were observed in the attributes due to variations in research objectives and subjects. Regarding treatment preferences, the proportions of attributes related to efficacy, convenience, treatment burden, risk, and patient characteristics were 29%, 29%, 20%, 11%, and 11%, respectively. Patients with COPD particularly preferred attributes related to efficacy and risk dimensions, followed by treatment burden and patient characteristics, with less emphasis on convenience. For device preferences, the proportions of attributes related to feature design, device usage, and drug-related features were 36%, 32%, and 32%. COPD patients showed a strong preference for attributes related to device design and drug related features, followed by device use. The overall quality of the literature was not relatively high.

There is a discrepancy between the frequency of attributes included in each dimension and the dimensions preferred by patients, particularly with the convenience dimension being the least preferred in treatments. To date, there is no application of DCEs among COPD patients in China. In the future, more relevant research should be carried out based on the actual situation in China to provide evidence for the improvement of COPD treatment.

Chronic obstructive pulmonary disease (COPD) and lung cancer (LC) are high-incidence and high-mortality diseases of the respiratory system. COPD is an independent high-risk factor for LC, and the two conditions influence each other, posing challenges for clinical diagnosis and treatment. Early detection and early treatment are crucial for improving prognosis, making preliminary screening particularly important. This article starts from the current research status of COPD-LC, comprehensively introducing the existing screening tools, including low-dose computed tomography (LDCT), the COPD-LUCSS score and its improved version, the COPD-LUCSS-DLCO score, as well as other COPD-LC risk prediction models. By objectively analyzing the advantages and limitations of existing screening tools, this article proposes countermeasures and precautions for developing new screening tools and envisions future application prospects, aiming to provide support for future COPD-LC screening research.

Idiopathic pulmonary fibrosis (IPF) is a complex global disease with a pathological mechanism that remains poorly understood and for which there is currently no effective treatment. Endothelial-mesenchymal transition (EndMT) , identified as a pathological basis for various chronic vascular diseases, has recently been recognised as a significant risk factor for IPF. However, the related mechanisms have yet to be clarified.

To observe the effects of the Jagged1/Notch1 signalling pathway on EndMT to elucidate the related mechanisms during IPF.

From March to June 2021, human pulmonary arterial endothelial cells (HPAEC) were cultured in vitro. A control group was established using HPAEC with blank serum, while a model group was created by stimulating HPAEC with 5 mg/L TGF-β₁ for 72 hours. In the DAPT group, the same TGF-β₁ stimulation was followed by the addition of 500 nmol/L Notch signalling inhibitor for 72 hours. Reverse transcription quantitative polymerase chain reaction (RT-PCR) was employed to measure the expression of Notch1, Jagged1, and the CBF1 Promoter (CBF1) mRNA, while Western blotting (WB) was used to assess the protein expressions of Notch1, Jagged1, and CBF1. Co-immunoprecipitation (Co-IP) was conducted to examine the binding of Notch1 intracellular domain protein (NICD1) with CBF1, and the Methylthiazoltetrazolium Colorimetry (MTT) assay was performed to evaluate cell proliferation. Transwell and scratch assays were conducted to measure cell migration ability, and immunofluorescence was used to detect the expression of endothelial cell markers CD₃₁ and VE-cadherin, as well as mesenchymal cell markers fibroblast-specific protein 1 (FSP1) and α-smooth muscle actin (α-SMA) .

Statistical analysis revealed significant differences (P<0.05) in the expression levels of Notch1, Jagged1, CBF1 mRNA and proteins, as well as cell proliferation and migration abilities among the three groups. The blank group and DAPT group exhibited lower expressions of Notch1, Jagged1, and CBF1 mRNA and proteins, alongside reduced cell proliferation and migration compared to the model group, with significant differences noted (P<0.05) . Co-IP results indicated discrepancies in the binding of NICD1 and CBF1 among the three groups, with binding inhibited in the blank and DAPT groups, while binding occurred in the model group. Immunofluorescence results demonstrated differences in the expressions of CD₃₁, VE-Cadherin, FSP1, and α-SMA among the 3 groups, where the blank and DAPT groups showed higher expressions of endothelial markers CD₃₁ and VE-Cadherin compared to the model group, while FSP1 and α-SMA expressions were lower.

The Jagged1/Notch1 signalling pathway is involved in the EndMT process during IPF, and inhibiting this signalling pathway can suppress EndMT.

Non-invasive positive pressure ventilation (NIPPV) is one of the important methods to treat acute exacerbation of chronic obstructive pulmonary disease (AECOPD). NIPPV combined with airway clearance therapy can effectively avoid endotracheal intubation and reduced length of hospital stay. The pathological characteristics of AECOPD make the indication of routine evaluation of airway suction lose its guiding value, frequent or delayed airway sputum aspiration is not beneficial to the positive pressure ventilation treatment of patients with acute phase of disease.

To establish the relationship between the oxygenation dropped dramatically after suction and respiratory effort index (ROX index and VOX index) in patients with AECOPD treated with NIPPV, and the predictive value of respiratory drive index on the time of suction.

Convenience sampling method was used, to investigate 140 AECOPD patients with NIPPV treated in the emergency intensive care unit of Qingdao Municipal Hospital from October 2022 to November 2023, the ROX index and VOX index were monitored and calculated within 24 h of non-invasive positive pressure ventilation and during sputum aspiration, the frequency and duration of a dramatic drop in SpO₂ (>10%) after sputum aspiration were assessed. Then analyzed the correlation between ROX index, VOX index and SpO₂ sharp drop after sputum aspiration, and ROX index and VOX index were plotted to predict the receiver operating characteristic (ROC) curve of SpO₂ sharp drop after sputum aspiration.

One hundred and forty patients within 24 hours a total of 861 sputum aspiration, SpO₂ decreased sharply after sputum aspiration in 98 patients (70.0%) ; in 96 patients (68.6%), the incidence of SpO₂ decrease was more than 60%; in 75 patients (53.6%), SpO₂ decreased dramatically for 16-30 seconds, and in 10 patients (7.1%), SpO₂ decreased more than 30 seconds. The baseline ROX index and the ROX index 1 hour before sputum aspiration were negatively correlated with the incidence and duration of SpO₂ decrease after sputum aspiration (P<0.05), baseline VOX index and VOX index 1 hour before sputum aspiration were positively correlated with the incidence and duration of SpO₂ sharp decline after sputum aspiration (P<0.05). The area under the ROC curve of the baseline VOX index was 0.970 (95%CI=0.939-0.967), the best threshold was 0.007 4; the area under the ROC curve of the VOX index 1 hour before sputum aspiration was 0.893 (95%CI=0.826-0.959), the best threshold was 0.008 7.

When VOX index ≥0.007 4 after 1 h of NIPPV and VOX index ≥0.008 7 within 1 h before sputum aspiration, we should be alert to the occurrence of dramatic SpO₂ reduction after sputum aspiration.

This dissertation introduces a case study on the "screen-diagnose-treat-manage" process for patients with chronic obstructive pulmonary disease Chronic obstructive pulmonary disease (COPD) under a community-level COPD prevention and treatment platform. Explored how general practitioners can utilize their unique advantages, integrate various resources, and develop treatment plans based on individual patient conditions through questionnaire surveys, lung function tests, and comprehensive evaluations, in order to achieve early identification, accurate diagnosis, effective intervention, and comprehensive care for chronic obstructive pulmonary disease. This approach provides an innovative perspective and practical pathway for managing COPD at the community level. This enhances the ability of primary healthcare providers to effectively prevent and treat chronic obstructive pulmonary disease COPD, ultimately improving patient outcomes at the community level.

Chronic obstructive pulmonary disease (COPD) patients often present with multiple comorbidities, which increase the complexity of treatment and the healthcare of burden. While comorbidities significantly impact the management of COPD patients, existing research primarily focuses on individual comorbidities, lacking systematic analysis of multiple comorbidity patterns and hospitalization costs.

To investigate the comorbidity characteristics and patterns in patients with COPD, analyzing how different features and comorbidity patterns affect hospitalization costs. The findings will provide a basis for personalized health management and resource allocation for COPD patients.

A retrospective analysis was conducted on 5 061 inpatients diagnosed with COPD at the First Affiliated Hospital, Guangzhou Medical University from 2020 to 2023. Systematic clustering analysis was employed to construct dendrograms, identifying comorbidity patterns among COPD patients. Multiple group comparisons were performed to assess the basic characteristics of these patterns, then multiple linear regression analysis was utilized to evaluate the impact of each comorbidity pattern on total hospitalization costs, western medicine costs, and antibacterial medication costs.

There are a total of 4 343 patients with COPD, and the comorbidity was 85.81%. Systematic clustering analysis identified six comorbidity patterns among COPD patients: cardiovascular and metabolic diseases, hepatorenal diseases, digestive system diseases, arthropathy diseases, cancer and respiratory system diseases. There were significant differences in sex, age, BMI and smoking history among patients with 6 comorbidity models (P<0.05). Multiple linear regression analysis revealed that BMI, cancer pattern, and respiratory system diseases pattern all had impacts on total hospitalization costs, western medicine costs and antibacterial medication costs (P<0.05), with the respiratory system diseases pattern having the most substantial impact on total hospitalization costs (β=0.125, P<0.001) .

Comorbidity patterns in COPD can be categorized into six clusters. BMI, cancer pattern and respiratory system diseases pattern are the primary factors influencing hospitalization costs.

The global initiative for chronic obstructive lung disease (GOLD) 2025 report, released on November 11th, 2024, marks the second update since GOLD 2023. Overall, this version maintains similar definition, diagnosis, assessment, and treatment for COPD as in GOLD 2024, but with revisions and expansions in 12 specific areas. These include: added explanations and references on lung function trajectories, expanded content on dysbiosis, updates and additions to spirometry, revised cardiovascular risk information for COPD patients, updated guidance on CT imaging for COPD, new insights into the impact of climate change on COPD, updated vaccination recommendations, updated follow-up pharmacological treatments, new guidance for delivery of pulmonary rehabilitation, revised recommendations on ICS withdrawal in patients on LABA+ICS therapy, updated information on PDE3 and PDE4 inhibitors and other exacerbation-reducing medications, and additional content on pulmonary hypertension. The article introduces and interprets the new contents.

20%-30% of individuals with Preserved Ratio Impaired Spirometry (PRISm) will develop chronic obstructive pulmonary disease (COPD). However studies on characteristics of PRISm in China remain limited.

To analyze factors associated with PRISm, and to explore the difference in the distribution of risk factors between individuals with PRISm and COPD.

This study was conducted as part of health management in Shanghai communities. Elderly individuals over 60 years old from 11 communities in Putuo District, Shanghai, who participated COPD screening from July 2022 to June 2023, were surveyed and underwent lung function tests. A total of 876 participants were initially included, but 141 were excluded due to incomplete questionnaire information or poor lung function test quality, resulting in 735 valid subjects. According to the "Guidelines for Graded Diagnosis and Treatment of Chronic Obstructive Pulmonary Disease" and GOLD 2024, participants were classified into three subgroups based on post-bronchodilator lung function: COPD group (FEV₁/FVC < 70%), PRISm group (FEV₁%Pred< 80% and FEV₁/FVC≥ 70%), and normal lung function group. Multivariate Logistic regression analyses were conducted to identify factors associated with COPD and PRISm, using normal lung function as the control.

A total of 735 individuals aged 60~81 were included. COPD and PRISm were observed in 157 (21.36%) and 113 (15.37%) participants, respectively. COPD-SQ scores were highest in the COPD group (20.46±4.53), followed by the PRISm group (19.04±4.41) and lowest in the normal lung function group (18.03±4.26) with statistically significant differences (P<0.001). Univariate analysis showed that the PRISm group had higher proportions of males, smokers, individuals with frequent wheezing, chronic bronchitis and hypertension compared to the normal lung function group (P<0.05). Compared to COPD patients, the PRISm group had lower proportions of males, smokers, individuals with symptoms of wheezing or coughing after exercise, and those with a history of emphysema, but a higher prevalence of hypertension (P<0.05). Multivariable Logistic regression analyses revealed that increasing age, male gender, higher smoking levels, insufficient physical activity, frequent wheezing, wheezing or coughing after exercise, family history of COPD or bronchial asthma, and history of bronchial asthma or emphysema were associated with COPD (P<0.05). In contrast, higher smoking levels, insufficient physical activity, frequent wheezing, chronic bronchitis, and hypertension were associated with PRISm (P<0.05) .

PRISm is a high-risk state between COPD and normal lung function, sharing similar associated factors with COPD such as age, smoking states, physical activity, symptoms and comorbidities. However, the COPD-SQ score and the predictive performance of multivariable logistic regression model for lung function status were significantly lower for PRISm compared to COPD. Hypertension was an independent associated factor for PRISm, but not for COPD, suggesting a potential risk of cardiovascular disease independent of COPD. Further research is warranted to verify the role of PRISm characteristics in disease progression.

The imaging of COVID-19 (COVID-19) in children is different from that of adults, mainly manifested as subpleural ground glass shadows, patchy high-density shadow, and solid shadow, and rarely complicated with pneumomediastinum. The formation of a large number of emphysema can seriously affect the respiratory and circulatory function, resulting in obvious wheezing and hypoxemia, which need to be actively treated.

To analyze and summarize the imaging and clinical characteristics of COVID-19 with pneumomediastinum in children.

A retrospective analysis was conducted on 8 pediatric patients with COVID-19 complicated with pneumomediastinum admitted to the Department of Pediatrics at Jingzhou Hospital Affiliated with Yangtze University from December 1, 2022 to January 30, 2023, including age, gender, imaging, clinical characteristics, and treatment.

8 children were 3.5 years to 12 years, with a female ratio of 3∶5. High Resolution CT Scan in all children showed double lung infection combined with pneumomediastinum, and multiple emphysema involved the neck and chest wall. The pulmonary manifestations were various: subpleural ground glass shadow, consolidation, tree bud sign, vascular bronchial bundle thickening and bronchial wall thickening, grid sign, etc., no large consolidation and "white lung" found. One case was observed to have a small amount of pleural effusion. In addition to fever and cough, the clinical manifestations were obvious shortness of breath, pulmonary auscultation, but dry or moist rales were not significant. Four children with mycoplasma infection were treated with azithromycin, and one with B. catarrhalis. was treated with azithromycin. All given oxygen therapy. A patient was treated with an invasive ventilator because traditional treatment was unable to alleviate her dyspnea and hypoxemia. The patient's leucocytes and hypersensitive CRP were significantly increased. After 3 days, the symptoms improved and the machine was successfully withdrawn. 5 cases were treated with intravenous immunoglobulin (IVIG), and 3 cases were treated with glucocorticoids. a week after the review of chest CT, pneumomethinum were completely absorbed, and lung lesions significantly improved.

Children with pneumomediastinum complicated by COVID-19 were mostly pre-school or school-age children, rare in infants. Pneumomediastinum can coexist with gas accumulation in the neck and chest wall. In addition, pulmonary lesions could involve the stroma or parenchyma, and both lungs were affected, with various manifestations. At the onset of the disease, there were obvious shortness of breath, active oxygen therapy was recommended. When the white blood cell count and hypersensitivity CRP significantly increase, close attention should be paid to respiratory conditions. IVIG and glucocorticoids may have positive effects, and if necessary, a mechanical ventilation should also be used.

In patient involvement, patients are transforming from mere recipients to collaborators in medical services by integrating their experiences and needs throughout the entire healthcare process into medical practice. This aims to enhance the effectiveness, efficiency, and quality of healthcare services. However, the implementation of proven patient-centered strategies for patient involvement in the quality improvement among chronic obstructive pulmonary disease (COPD) in our country remains to be explored.

This scoping review systematically reviews and analyzes the existing strategies for patient involvement among patients with COPD to provide a reference for implementation that in China.

Employing the scoping review guidelines of Joanna Briggs Institute in Australia as the methodological framework, the relevant studies on patient involvement among patient with COPD were searched by computer on PubMed, Embase, Cochrane Library, CNKI, Wanfang Data, China Biology Medicine disc, from the establishment of the database to November 29, 2022. A thematic analysis was methodically applied to distill and synthesize findings.

A total of 37 articles were included in this review. The categorization of patient involvement was divided into three types: direct involvement in medical care, organizational-level, and clinical research. Based on the intensity of involvement, categories were further classified into three levels: consultation, engagement, and collaborative leadership. A nine-category matrix of patient involvement behaviors was constructed through intensity and type. The implementation of COPD patient engagement was primarily reflected in five categories encompassing eight behaviors, including: integration in direct medical care (patients expressing their preferences and wishes regarding treatment plans) ; consultation at the organizational management level (assessing patient treatment experiences and organizing discussions around patients' concerns) ; as well as involvement in clinical research, including consultation (listening to patient needs) and engagement (expressing preferences and wishes for interventions, involved in the development of assessment tools, and in discussions about research design and implementation). Assessing patient treatment experiences (10 articles, 27.03%) and expressing patient preferences and wishes regarding interventions (10 articles, 27.03%) were the two most frequently implemented behaviors of patient involvement in COPD.

There are numerous measures for patient involvement in the improvement of medical quality, but there is still limited practice in the field of COPD. Very few studies have assessed the impact of patient involvement on clinical outcomes and quality of life, indicating that the practice of patient involvement in China requires further exploration.

In recent years, the Internet of Things technology (IoT) has been developed extremely rapidly, and has been widely applied in the medicine field. Chronic obstructive pulmonary disease (COPD) is one of the most common chronic respiratory diseases in China, and it is worth exploring how IoT can be used to improve the clinical practice of COPD management. We summarized the research progress of IoT technology in COPD management at home and abroad and found that the current research on the application of IoT in COPD management is still in the exploratory stage and lacks high-quality, large-sample studies by reviewing the literature. Real-world studies are needed to conduct systematic evaluation of designed mature models or products in the future, especially the impacts on long-term clinical outcomes of patients, quality of life and health economics evaluation. Products design should be tailored to the characteristics and target of COPD and the characteristics of users, and emphasis should also be placed on qualitative researches to understand the experiences, opinions or attitudes of users toward such products.

Chronic obstructive pulmonary disease (COPD) is one of the common respiratory diseases, and the acute exacerbation of COPD is an acute event that severely reduces the quality of life in patients with COPD. We searched PubMed, CNKI, Wanfang Data Knowledge Service Platform, Vip.com and Chinese Biomedical Literature, sifted out 69 representative literatures according to the inclusion and exclusion criteria, and found that there were 23 patient-reported outcome (PRO) assessment tools used in patients with acute exacerbation of COPD. Except for the EXACT-PRO, all of them directly use PRO assessment tools of stable patients. These assessment tools are divided into general, disease-specific and symptom-specific assessment tools, mainly involving symptoms, physiological field, social field, psychological emotion, daily activities and other fields. The number of items is from one to 100, and the response scale is mostly in the form of Likert, and its development and assessment are based on classical test theory. It is suggested that future studies on quality of life of patients with acute exacerbation of COPD should focus on the following points: strengthening the research on specific assessment tools; attaching importance to the combined application of classical test theory, item response theory and generalizability theory; paying attention to the study of the minimal clinically important difference of assessment tools; selecting assessment tools appropriately.

Chronic obstructive pulmonary disease (COPD) is one of the most common respiratory diseases in elderly patients, and a decrease in oxygen saturation during activity is a common phenomenon correlated with the prognosis. Current assessment of exercise-induced hypoxia (EID) has yielded controversial results.

To explore methods suitable for inducing EID in community and home-based COPD patients.

This was a retrospective study involving 76 patients with stable COPD admitted to China-Japan Friendship Hospital from January 2021 to August 2023. Resting oxygen saturation and the lowest oxygen saturation during exercise (ΔSpO₂) in the six-minute walk test 6MWT) were recorded. Based on the criterion of ΔSpO₂ ≥4% for the diagnosis of EID, patients were assigned into non-EID group and EID group. Pulmonary function indicators, ΔSpO₂ during 30-second sit-to-stand-test (30s STST), and COPD Assessment Test (CAT) were compared between the two groups. The correlation of EID with ΔSpO₂ of 30s STST and CAT scores was identified. The predictive value of ΔSpO₂ of 30s STST, CAT score, andΔSpO₂ of 30s STST combined with CAT score in predicting EID was analyzed using the receiver operating characteristic (ROC) curves.

There were significant differences in the ΔSpO₂ of 30s STST and CAT score between non-EID group and EID group. The cut-off value of ΔSpO₂ of 30s STST in predicting EID was 2%, with the sensitivity, specificity and area under the curve (AUC) of 59.6%, 82.8%, 0.730 (95%CI=0.614-0.846, P<0.05), respectively. The cut-off value of CAT scores in predicting EID was 13, with the sensitivity, specificity and AUC of 48.9%, 79.3%, 0.712 (95%CI=0.596-0.828, P<0.05), respectively. The cut-off value of ΔSpO₂ of 30s STST combined with CAT scores in predicting EID was 0.593, with the sensitivity, specificity and AUC of 70.2%, 72.4% and 0.765 (95%CI= 0.659-0.871, P<0.001), respectively.

ΔSpO₂ of 30s STST ≥ 2% and CAT score ≥13 points alarm the development of EID. The 30s STST and CAT can be used as community and home-based measures to predict the induction of EID in patients with stable COPD.

Cardiopulmonary exercise testing (CPET) is essential for assessing the maximal exercise capacity of patients with chronic obstructive pulmonary disease (COPD) and for developing rehabilitation prescriptions. Body composition has been shown to be associated with CPET results, which is complex, time-consuming, contraindicated, and risky, and cannot be performed in some COPD patients, whereas body composition analysis is simple and fast.

This paper focuses on the correlation between body composition and CPET in patients with COPD, and provides a basis for predicting maximal exercise capacity, formulating rehabilitation prescriptions, and rational nutritional support for patients with COPD who are unable to complete cardiopulmonary exercise testing.

Stable COPD patients were enrolled in the outpatient respiratory clinic of China-Japan Friendship Hospital between July 2021 and March 2022, and were sequentially subjected to body composition measurements and CPET with continuous incremental loading, and the test results were analyzed to assess the relationship between body composition and CPET results, and to analyze the value of the body composition indexes in predicting the results of CPET.

Seventy-seven eligible patients with stable COPD completed body composition measurement and exercise cardiopulmonary exercise testing. Correlation analysis showed that body fat percentage (BFP) was negatively correlated with peak metabolic equivalents (peakMETs) (P<0.01) ; skeletal muscle mass index (SMI) was positively correlated with peak oxygen uptake (peakVO₂), peak load, peak ventilation volume (peakVE), maximum heart rate (peakHR), peak oxygen pulse (peakO₂pulse), and oxygen uptake efficiency slope (OUES) at the highest exercise state were positively correlated (P<0.01) ; and the fat free mass index (FFMI) was positively correlated with peakVO₂, peakLoad, peakVE, peakO₂pulse, and OUES (P<0.01). The results of multivariable linear regression analysis showed that SMI and FFMI were independently and positively correlated with peakLoad, peakVE, peakO₂pulse, and OUES in patients with COPD (P<0.05). BFP was independently and negatively correlated with peakMETs in patients with COPD (P<0.05). SMI had better predictive ability than FFMI for the results of the CPET trial in COPD patients peakLoad, peakVE, peakO₂pulse, and OUES.

Muscle content is positively correlated with the exercise capacity of COPD patients, and the results of body composition measurement can be used as an important criterion for predicting the exercise capacity of COPD patients, guiding the rehabilitation exercise and rational nutritional support therapy.

Respiratory problems in chronic obstructive pulmonary disease (COPD) patients are prone to poor sleep quality, anxiety and depression, but they are often ignored by medical staff and patients themselves. Understanding the sleep quality, anxiety and depression symptoms of patients with COPD and their influencing factors can help to improve the quality of life of patients, however, there are few relevant studies.

To investigate the sleep quality, anxiety and depression of patients with COPD and explore the influencing factors.

Convenience sampling was used to recruit COPD patients who visited the Department Respiratory Diseases and Critical Care Medicine of seven hospitals in Anhui Province from August to November 2022. Demographic characteristics, dyspnea grade, airflow restriction severity, risk of malnutrition, physical activity level, vaccination, and acute exacerbations in the last 1 year were collected. The Pittsburgh Sleep Quality Index (PSQI) and the Hospital Anxiety and Depression Scale (HADS) were used to evaluate the sleep quality and anxiety and depression symptoms of COPD patients, and the influencing factors were analyzed by multivariate Logistic regression.

A total of 248 patients with COPD were investigated, among which the incidence of poor sleep quality was 60.9% (151/248), only 8.9% (22/248) of the patients thought they had good sleep quality, and more than half of the patients actually had insufficient sleep time (54.4%) or low sleep efficiency (60.1%). 29.4% (73/248) of COPD patients had at least one of the symptoms of anxiety or depression, of which 35 had anxiety symptoms, 61 had depression symptoms, and 23 had both anxiety and depression symptoms. Multivariate Logistic regression analysis showed that older ages (OR=1.052, 95%CI=1.018-1.086) and risk of malnutrition (OR=3.393, 95%CI=1.855-6.206) were risk factors for poor sleep quality in COPD patients. Regular physical activity was a protective factor for poor sleep quality in COPD patients (OR=0.450, 95%CI=0.242-0.834) (P<0.05). Acute exacerbations ≥2 times (OR=2.220, 95%CI=1.093-4.510) and malnutrition risk (OR=1.961, 95%CI=1.044-3.683) were risk factors for anxiety and depression symptoms in COPD patients (P<0.04). In COPD patients, PSQI score was positively correlated with HADS-A (r_s=0.413) and HADS-D score (r_s=0.430), and there was a positive correlation between HADS-A score and HADS-D score (r_s=0.719, P<0.05) .

The incidence of poor sleep quality, anxiety and depression symptoms was high in COPD patients, and age, malnutrition risk, regular physical activity and number of acute exacerbations in the past year are important influencing factors. Medical staff, family members and patients themselves should improve the awareness of sleep quality, anxiety and depression, and actively carry out screening and intervention work for key patients to improve the sleep quality and mental health of patients.

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.

Preserved Ratio Impired Spirometry (PRISm) refers to the non-obstructive pulmonary function abnormalities with a decrease forced expiratory volume in one second (FEV₁) while the FEV₁/forced vital capacity (FVC) remains constant. The PRISm population may be one of the pre-chronic obstructive pulmonary disease (COPD) populations. However, the incidence, characteristics and risk factors of PRISm in the physical examination population in China are still unknown.

To analyze the characteristics and influencing factors of PRISm in physical examination population.

From January 2017 to December 2019, a total of 970 patients received physical examination in the Third Medical Center of Chinese PLA General Hospital were selected. The baseline data and physical examination results were collected, pulmonary function was measured for vital capacity (VC), FVC, FEV₁, forced expiratory volume in six second (FEV₆), FEV₁/FVC, peak expiratory flow (PEF), FEF₂₅, FEF₅₀ and FEF₇₅, the relevant indexes were expressed as "%pre" as a percentage of the expected value. The included subjects were divided into the airflow obstruction group with FEV₁/FVC<0.7 (n=61), PRISm group with FEV₁/FVC≥0.7 and FEV₁%pre<0.8 (n=111), normal lung function group with FEV₁/FVC≥0.7 and FEV₁%pre≥0.8 (n=798) according to FEV₁/FVC and FEV₁%pre. The incidence of PRISm in physical examination population was calculated, the basic characteristics and the characteristics of lung function indexes were compared, the ordinal logistic regression analysis were used to analyze the influencing factors of lung function impairment.

The incidence of PRISm was 11.4% and the incidence of airflow obstruction was 6.3% in 970 patients. The proportion of people over 60 years old in the PRISm group and the airflow obstruction group was higher than that the normal lung function group, and the proportion of people between 41 and 60 years old was lower than the normal lung function group (P=0.019). The proportion of smokers in the PRISm group was significantly higher than the normal lung function group (P<0.001). The proportion of patients with hypertension in the PRISm group was higher than the normal lung function group (P=0.03). VC%pre, FVC%pre, FEV₁%pre, FEV₆%pre, PEF%pre, FEF₂₅%pre, FEF₅₀%pre, FEF₇₅%pre were higher in the normal lung function group than the PRISm group and the airflow obstruction group (P<0.001) ; VC%pre, FVC%pre, FEV₆%pre, PEF%pre, FEF₂₅%pre, FEF₅₀%pre, and FEF₇₅%pre were higher in the PRISm group than the airflow obstruction group (P<0.05). FEV₁/FVC in the normal lung function group and PRISm group was higher than the airflow obstruction group (P<0.001). The ordinal logistic regression analysis with different groups of lung function as dependent variables showed that age>60 years (OR=0.951, 95%CI=0.602-1.504, P=0.002), smoking history (OR=2.201, 95%CI=1.519-3.187, P<0.001) and history of hypertension (OR=1.673, 95%CI=1.106-3.187, P=0.015) were risk factors for lung function impairment in the physical examination population.

PRISm is common in physical examination population. Attention should be paid to the changes in lung function in those aged >60 years old, with the history of smoking and hypertension. Early intervention may alleviate the progression of COPD.

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.