Influenza and pneumococcal vaccination coverage and associated factors in patients hospitalized with acute exacerbations of COPD in China:Findings from real-world data

Background:Influenza and pneumococcal vaccination are a priority in patients with chronic obstructive pulmonary disease(COPD).However,limited information is available on vaccination coverage among patients with acute exacerbations of COPD(AECOPD)in China.This study aimed to determine the rates and associated factors of influenza and pneumococcal vaccination in patients hospitalized with AECOPD.Methods:Baseline data from a national,multicenter,hospital-based study that included adult inpatients with AECOPD between 2017 and 2021 were analyzed.The outcomes of interest were the influenza vaccination in the past year and the pneumococcal vaccination in the past 5 years.To ensure national representativeness,rates were weighted according to the distribution of hospital levels and types enrolled in this study.Multivariable Poisson regression based on mixed-effects models were used to determine the associated factors.The independent variables included the region and hospital features where the participants were located,sociodemographic characteristics(age,sex,rural/urban residence,education,etc.),and clinical indicators(COPD disease history,lung function parameters,comorbidities,etc.).The treatment profiles of the vaccinated and unvaccinated participants were compared.Results:Of 6949 eligible participants,the weighted rates of influenza/pneumococcal,influenza,and pneumococcal vaccination were 2.72%(95%confidence interval[CI]:2.34%-3.10%),2.09%(95%CI:1.76%-2.43%),and 1.25%(95%CI:0.99%-1.51%),respectively.In multivariable models,age≥60 years(60-69 years,odds ratio[OR]:1.90,95%CI:1.11-3.25;≥80 years,OR:2.00,95%CI:1.06-3.78),geographical regions(Northern China relative to Eastern China,OR:5.09,95%CI:1.96-13.21),urban residence(OR:1.69,95%CI:1.07-2.66),a higher education level(junior high school,OR:1.77,95%CI:1.21-2.58;senior high school or above,OR:2.61,95%CI:1.69-4.03),former smoking(OR:1.79,95%CI:1.15-2.79),and regular inhaled medication treatment(OR:3.28,95%CI:2.29-4.70)were positively associated with vaccination.Patients who had experienced severe exacerbations in the past year were less likely to be vaccinated(OR:0.65,95%CI:0.45-0.96).Compared with unvaccinated participants,vaccinated participants adhered better to pharmacological and non-pharmacological treatment.Conclusions:Influenza and pneumococcal vaccination coverage are extremely low.Urgent measures are necessary to increase vaccination coverage among inpatients with AECOPD in China.

Therapeutic potentials of peptide-derived nanoformulations in atherosclerosis:present status and future directions

Atherosclerosis is a severe cardiovascular disease followed by the accumulation of atherosclerotic plaques within the lumen of blood vessels resulting in reduced blood flow thus initiating a series of events.Conventional therapies for atherosclerosis encounter multiple chal-lenges,especially difficulty in precisely concentrating in certain affected regions and the potential for unwanted side effects.Consequently,scientists are focused on developing nanoformulations for atherosclerosis diagnosis and therapy.Peptide-based nanomedi-cines improve conventional therapies by offering improved structural and therapeutic stability and enabling target-specific delivery.Their inherent biocompatibility and biodegradability additionally render them desirable materials intended for in vivo use.This review manu-script aims to provide an in-depth overview of peptide-based nano-medicines for atherosclerosis,focusing on targeted cells like endothelial cells,macrophages,and monocytes and their interaction with different plaque components.Moreover,the manuscript also highlights the latest progress in multimodal techniques and provides a comprehensive overview of limitations associated with their practical implementation.

Portable spirometer-based pulmonary function test willingness in China:A nationwide cross-sectional study from the"Happy Breathing Program"

Background:Understanding willingness to undergo pulmonary function tests(PFTs)and the factors associated with poor uptake of PFTs is crucial for improving early detection and treatment of chronic obstructive pulmonary disease(COPD).This study aimed to understand willingness to undergo PFTs among high-risk populations and identify any barriers that may contribute to low uptake of PFTs.Methods:We collected data from participants in the"Happy Breathing Program"in China.Participants who did not follow physicians’recommendations to undergo PFTs were invited to complete a survey regarding their willingness to undergo PFTs and their reasons for not undergoing PFTs.We estimated the proportion of participants who were willing to undergo PFTs and examined the various reasons for participants to not undergo PFTs.We conducted univariable and multivariable logistic regressions to analyze the impact of individual-level factors on willingness to undergo PFTs.Results:A total of 8475 participants who had completed the survey on willingness to undergo PFTs were included in this study.Out of these participants,7660(90.4%)were willing to undergo PFTs.Among those who were willing to undergo PFTs but actually did not,the main reasons for not doing so were geographical inaccessibility(n=3304,43.1%)and a lack of trust in primary healthcare institutions(n=2809,36.7%).Among the 815 participants who were unwilling to undergo PFTs,over half(n=447,54.8%)believed that they did not have health problems and would only consider PFTs when they felt unwell.In the multivariable regression,individuals who were≤54 years old,residing in rural townships,with a secondary educational level,with medical reimbursement,still working,with occupational exposure to dust,and aware of the abbreviation"COPD"were more willing to undergo PFTs.Conclusions:Willingness to undergo PFTs was high among high-risk populations.Policymakers may consider implementing strategies such as providing financial incentives,promoting education,and establishing community-based programs to enhance the utilization of PFTs.

THE THRESHOLD DYNAMICS OF A WATERBORNE PATHOGEN MODEL WITH SEASONALITY IN A POLLUTED ENVIRONMENT

This paper concentrates on the dynamics of a waterborne pathogen periodic PDE model with environmental pollution.For this model,we derive the basic reproduction number R0and establish a threshold type result on its global dynamics in terms of R0,which predicts the extinction or persistence of diseases.More precisely,the disease-free steady state is globally attractive if R_(0)<1,while the system admits at least one positive periodic solution and the disease is uniformly persistent if R_(0)>1.Moreover,we carry out some numerical simulations to illustrate the long-term behaviors of solutions and explore the influence of environmental pollution and seasonality on the spread of waterborne diseases.

Development of a prediction model to identify undiagnosed chronic obstructive pulmonary disease patients in primary care settings in China

Background:At present,a large number of chronic obstructive pulmonary disease(COPD)patients are undiagnosed in China.Thus,this study aimed to develop a simple prediction model as a screening tool to identify patients at risk for COPD.Methods:The study was based on the data of 22,943 subjects aged 30 to 79 years and enrolled in the second resurvey of China Kadoorie Biobank during 2012 and 2013 in China.We stepwisely selected the predictors using logistic regression model.Then we tested the model validity through P-P graph,area under the receiver operating characteristic curve(AUROC),ten-fold cross validation and an external validation in a sample of 3492 individuals from the Enjoying Breathing Program in China.Results:The final prediction model involved 14 independent variables,including age,sex,location(urban/rural),region,educational background,smoking status,smoking amount(pack-years),years of exposure to air pollution by cooking fuel,family history of COPD,history of tuberculosis,body mass index,shortness of breath,sputum and wheeze.The model showed an area under curve(AUC)of 0.72(95%confidence interval[CI]:0.72-0.73)for detecting undiagnosed COPD patients,with the cutoff of predicted probability of COPD=0.22,presenting a sensitivity of 70.13%and a specificity of 62.25%.The AUROC value for screening undiagnosed patients with clinically significant COPD was 0.68(95%CI:0.66-0.69).Moreover,the ten-fold cross validation reported an AUC of 0.72(95%CI:0.71-0.73),and the external validation presented an AUC of 0.69(95%CI:0.68-0.71).Conclusion:This prediction model can serve as a first-stage screening tool for undiagnosed COPD patients in primary care settings.

Pulmonary rehabilitation restores limb muscle mitochondria and improves the intramuscular metabolic profile

Background: Exercise, as the cornerstone of pulmonary rehabilitation, is recommended to chronic obstructive pulmonary disease (COPD) patients. The underlying molecular basis and metabolic process were not fully elucidated. Methods: Sprague-Dawley rats were classified into five groups: non-COPD/rest ( n = 8), non-COPD/exercise ( n = 7), COPD/rest ( n = 7), COPD/medium exercise ( n = 10), and COPD/intensive exercise ( n = 10). COPD animals were exposed to cigarette smoke and lipopolysaccharide instillation for 90 days, while the non-COPD control animals were exposed to room air. Non-COPD/exercise and COPD/medium exercise animals were trained on a treadmill at a decline of 5° and a speed of 15 m/min while animals in the COPD/intensive exercise group were trained at a decline of 5° and a speed of 18 m/min. After eight weeks of exercise/rest, we used ultrasonography, immunohistochemistry, transmission electron microscopy, oxidative capacity of mitochondria, airflow-assisted desorption electrospray ionization-mass spectrometry imaging (AFADESI-MSI), and transcriptomics analyses to assess rectal femoris (RF). Results: At the end of 90 days, COPD rats’ weight gain was smaller than control by 59.48 ± 15.33 g ( P = 0.0005). The oxidative muscle fibers proportion was lower ( P < 0.0001). At the end of additional eight weeks of exercise/rest, compared to COPD/rest, COPD/medium exercise group showed advantages in weight gain, femoral artery peak flow velocity (Δ58.22 mm/s, 95% CI: 13.85-102.60 mm/s, P = 0.0104), RF diameters (Δ0.16 mm, 95% CI: 0.04-0.28 mm, P = 0.0093), myofibrils diameter (Δ0.06 μm, 95% CI: 0.02-0.10 μm, P = 0.006), oxidative muscle fiber percentage (Δ4.84%, 95% CI: 0.15-9.53%, P = 0.0434), mitochondria oxidative phosphorylate capacity ( P < 0.0001). Biomolecules spatial distribution in situ and bioinformatic analyses of transcriptomics suggested COPD-related alteration in metabolites and gene expression, which can be impacted by exercise. Conclusion: COPD rat model had multi-level structure and function impairment, which can be mitigated by exercise.

Exposure Response Relationship of Acute Effects of Air Pollution on Respiratory Diseases-China,2013−2018

Summary What is already known about this topic?Short-term exposure to air pollutants has been associated with chronic obstructive pulmonary disease(COPD)and asthma,which needs continuous observation.What is added by this report?This study uses the longest time series data so far from 2013 to 2018 and adds additional data analysis for ozone(O_(3))to existing studies.