Effects of acetylcysteine on micro-inflammation and pulmonary ventilation in chronic obstructive pulmonary disease exacerbation

BACKGROUND Acute exacerbation of chronic obstructive pulmonary disease(AECOPD)is a serious complication of chronic obstructive pulmonary disease,often characterized by increased morbidity and mortality.In traditional Chinese medicine,AECOPD is linked to phlegm-heat and blood-stasis,presenting symptoms like thick sputum,fever,and chest pain.It has been shown that acetylcysteine inhalation in conjunction with conventional therapy significantly reduced inflammatory markers and improved lung function parameters in patients with AECOPD,suggesting that acetylcysteine may be an important adjunctive therapy for patients with phlegm-heat-blood stasis type AECOPD.AIM To investigate the effect of acetylcysteine on microinflammation and lung ventilation in patients with phlegm-heat and blood-stasis-type AECOPD.METHODS One hundred patients with phlegm-heat and blood-stasis-type AECOPD were randomly assigned to two groups.The treatment group received acetylcysteine inhalation(10%solution,5 mL,twice daily)along with conventional therapy,whereas the control group received only conventional therapy.The treatment duration was 14 d.Inflammatory markers(C-reactive protein,interleukin-6,and tumor necrosis factor-alpha)in the serum and sputum as well as lung function parameters(forced expiratory volume in one second,forced vital capacity,and peak expiratory flow)were assessed pre-and post-treatment.Acetylcysteine inhalation led to significant reductions in inflammatory markers and improvements in lung function parameters compared to those in the control group(P<0.05).This suggests that acetylcysteine could serve as an effective adjunct therapy for patients with phlegm-heat and blood-stasis-type AECOPD.RESULTS Acetylcysteine inhalation significantly reduced inflammatory markers in the serum and sputum and improved lung ventilation function parameters in patients with phlegm-heat and blood-stasis type AECOPD compared with the control group.These differences were statistically significant(P<0.05).The study concluded that acetylcysteine inhalation had a positive effect on microinflammation and lung ventilation function in patients with this type of AECOPD,suggesting its potential as an adjuvant therapy for such cases.CONCLUSION Acetylcysteine inhalation demonstrated significant improvements in reducing inflammatory markers in the serum and sputum,as well as enhancing lung ventilation function parameters in patients with phlegm-heat and bloodstasis type AECOPD.These findings suggest that acetylcysteine could serve as a valuable adjuvant therapy for individuals with this specific type of AECOPD,offering benefits for managing microinflammation and optimizing lung function.

Protective effect of sevoflurane on lung function of elderly chronic obstructive pulmonary disease patients undergoing total hip arthroplasty

BACKGROUND Chronic obstructive pulmonary disease(COPD)is a common respiratory disorder that affects the elderly population and increases the risk of postoperative pulmonary complications(PPCs)after major surgeries.Sevoflurane is a volatile anesthetic that has been shown to have anti-inflammatory and antioxidant properties and attenuate lung injury in animal models.AIM To evaluate the protective effect of sevoflurane on the lung function of elderly COPD patients undergoing total hip arthroplasty(THA).METHODS In this randomized controlled trial,we randomly assigned 120 elderly patients with COPD,who were scheduled for THA,to receive either sevoflurane(sevoflurane group)or propofol(propofol group)as the maintenance anesthetic.The primary outcome was the incidence of PPCs within seven days after surgery.The secondary outcomes were changes in the lung function parameters,inflammatory markers,oxidative stress markers,and postoperative pain scores.RESULTS The results showed that the incidence of PPCs was significantly lower in the sevoflurane group than in the propofol group(10%vs 25%,P=0.02).Furthermore,the decline in the forced expiratory volume in 1 s,forced vital capacity,and peak expiratory flow was significantly lesser in the sevoflurane group than in the propofol group at 24 h and 48 h after surgery(P<0.05).The interleukin-6,tumor necrosis factor-alpha,malondialdehyde,and 8-hydroxy-2α-deoxyguanosine levels were significantly lower in the sevoflurane group than in the propofol group at 24 h after surgery(P<0.05).The sevoflurane group showed significantly lower postoperative pain scores than the propofol group at 6 h,12 h,and 24 h after surgery(P<0.05).CONCLUSION Sevoflurane protects the lung function of elderly COPD patients undergoing THA under general anesthesia by reducing the incidence of PPCs,attenuating inflammatory and oxidative stress responses,and alleviating postoperative pain.

The Efficacy Analysis of Transbronchoscopic Large Volume Lung Lavage in Treatment of Pneumoconiosis Complicated with Chronic Obstructive Pulmonary Disease

Objective:To evaluate the efficacy of transbronchoscopic large volume lung lavage in the treatment of pneumoconiosis complicated with chronic obstructive pulmonary disease(COPD).Methods:The clinical data of 80 patients with pneumoconiosis complicated with COPD admitted to our hospital from June 2017 to January 2019 were retrospectively analyzed.40 patients in the control group were treated with conventional drugs and 40 patients in the observation group treated with conventional drugs plus transbronchoscopic large-volume lung lavage.Dyspnea score and healthy quality of life were compared between the two groups.Results:the scores of dyspnea in the observation group were significantly lower than those in the control group at 12,24 and 48 weeks after treatment,and the(SGRQ)scores of George’s respiratory problems questionnaire in the observation group were significantly lower than those in the control group at 12,24 and 48 weeks after treatment.Conclusion:Thetransbronchoscopic large volume of lung lavage has a significant effect on the treatment of pneumoconiosis patients with COPD,which can effectively reduce the degree of dyspnea and improve the quality of life.

Effects of Combined Inhalation of Budesonide,Formoterol,and Tiotropium Bromide on Arterial Blood Gas and Pulmonary Function Indexes in Patients with Chronic Obstructive Pulmonary Disease

Objective:To analyze the effect of combined inhalation of budesonide formoterol and tiotropium bromide on arterial blood gas and pulmonary function indexes in patients with chronic obstructive pulmonary disease(COPD).Methods:100 patients with COPD treated from January to December 2022 were selected as observation objects,and were divided into a control group(n=50,in which budesonide and formoterol were administered)and an experimental group(n=50,the treatment drug was budesonide formoterol combined with tiotropium bromide)according to the computer grouping method,and compared the treatment results.Results:(i)Before treatment,there was no difference in the partial pressure of carbon dioxide and partial pressure of oxygen between the control group and the experimental group(P>0.05);after treatment,the partial pressure of carbon dioxide and partial pressure of oxygen in the experimental group were higher than those in the control group,with significant differences(P<0.05).(ii)Before treatment,there was no difference in forced vital capacity(FVC),forced expiratory volume in one second(FEV1),FEV1/FVC between the control group and the experimental group(P>0.05);after treatment,the FVC,FEV1,and FEV1/FVC in the experimental group were significantly higher than those in the control group(P<0.05).(iii)There was no difference in the levels of CRP,IL-6,and TNF-αbetween the control group and the experimental group(P>0.05);after treatment,the levels of CRP,IL-6,and TNF-αin the experimental group were lower than those in the control group,with significant differences(P<0.05).(iv)Compared to the total incidence of adverse reactions in the control group(28.00%),the incidence of total adverse reactions in the experimental group was lower at 10.00%,and the difference was significant(P<0.05).Conclusion:The combined inhalation of budesonide and formoterol with tiotropium bromide has demonstrated a clear therapeutic efficacy and safety in treating chronic obstructive pulmonary disease.This treatment approach effectively enhances arterial blood gas levels and lung function,showing promising potential for widespread application.

Chronic obstructive pulmonary disease as a risk factor for lung cancer

The association between chronic obstructive pulmonary disease(COPD) and lung cancer has long been a subject of intense debate. The high prevalence of COPD in elderly smokers inevitably strengthens their coincidence. In addition to this contingent coincidence, recent studies have revealed a close association between the two diseases that is independent of the smoking history; that is, the existence of COPD is an independent risk factor for the development of lung cancer. Molecular-based evidence has been accumulating as a result of the efforts to explain the underlying mechanisms of this association. These mechanisms may include the following: the retention of airborne carcinogens followed by the activation of oncogenes and the suppression of tumor suppressor genes; the complex molecular mechanism associated with chronic inflammation in the distal airways of patients with COPD; the possible in-volvement of putative distal airway stem cells; and gel netic factors that are common to both COPD and lung cancer. The existence of COPD in patients with lung l cancer may potentially affect the process of diagnosis, surgical resection, radiotherapy, chemotherapy, and end-of-life care. The comprehensive management of COPD is extremely important for the appropriate treatment of lung cancer. Surgical resections with the aid of early interventions for COPD are often possible, even for patients with mild-to-moderate COPD. New challenges, such as lung cancer CT screening for individuals t at high risk, are now in the process of being implemented. Evaluating the risk of lung cancer in patients with COPD may be warranted in community-based lung cancer screening.

Role of chronic obstructive pulmonary disease in lung cancer pathogenesis

Chronic obstructive pulmonary disease(COPD) and lung cancer are two important smoking related conditions. However, COPD has been shown to be an independent risk factor for lung cancer regardless of smoking history, suggesting that COPD and lung cancer may share a common pathogenesis. This review summarizes the epidemiology of lung cancer and COPD briefly, as well as discussing the potential for shared genetic risk, and shared genomic mechanisms, such as epigenetic changes or DNA damage induced by smoking. How key areas of COPD pathogenesis, such as inflammation, oxidative stress and protease imbalance may contribute to subsequent development of cancer will also be covered. Finally the possibility that consequences of COPD, such as hypoxia, influence carcinogenesis will be reviewed. By understanding the pathogenesis of COPDand lung cancer in detail it is possible that new treatments may be developed and the risk of lung cancer in COPD may be reduced.

Efficacy Evaluation of Self-created"Lung Health Breathing Exercise"in Adjuvant Therapy for Patients with Stable Chronic Obstructive Pulmonary Disease

[Objectives]To evaluate the intervention effect and safety of self-created Lung Health Breathing Exercise on TCM syndromes,6-min walk test(6MWT)and quality of life in patients with stable chronic obstructive pulmonary disease(COPD).[Methods]76 cases of outpatient or inpatient patients who were diagnosed with stable COPD in Nanchong Traditional Chinese Medicine Hospital from January 2020 to March 2021 were selected,randomly divided into experimental group and control group,38 cases in each group.Both groups were given conventional western medicine treatment and nursing measures.The experimental group was added with the self-created Lung Health Breathing Exercise.After 12 weeks of treatment,the TCM syndrome score,6MWT distance,quality of life score and the incidence of adverse events were observed in the both groups.[Results]After treatment,the 6MWT distance and quality of life scores in both groups were significantly improved(P<0.01),and the TCM syndrome scores were significantly lower than those before treatment(P<0.01).[Conclusions]Lung Health Breathing Exercise can benefit patients in terms of symptom improvement,quality of life and exercise ability,and is a safe and effective rehabilitation measure for patients with stable COPD.

Summary of the Best Evidence for Preoperative Pre-Rehabilitation in Patients with Lung Cancer Complicated with COPD

Objective: To search, evaluate and integrate the best domestic and foreign evidence on the preoperative pre-rehabilitation of lung cancer patients with COPD, and summarize the best evidence. Methods: Cochrane Library, BMJ Best Practice, JBI Center for International Cooperation in Evidence-Based Health Care Library, and Up to were searched by computer system Date, Embase, CINAHL, PubMed, Evidence-Based Health Care Center Database (JBI), American Guidenet, Global Guidenet, CNKI, CMBM, Wanfang, and VIP databases on preoperative pre-rehabilitation of patients with lung cancer and COPD. Literature screening and quality evaluation were conducted independently by two researchers, and evidence was extracted, summarized and summarized according to the theme. Results: A total of 13 kinds of literature were included, including 4 guidelines, 4 systematic reviews, 3 evidence summaries, and 2 expert consensus articles. This paper summarizes 44 best evidence on pre-rehabilitation of lung cancer patients with COPD, including 8 aspects: pre-rehabilitation content and principle, pre-rehabilitation assessment, exercise rehabilitation, nutrition management, psychological guidance, health education, multidisciplinary cooperation, quality control and follow-up. Conclusion: The best evidence of preoperative pre-rehabilitation for patients with lung cancer complicated with COPD is rich in content, and needs to be selected according to the characteristics of the hospital and the clinical environment. Some of the evidence still needs to be confirmed by higher-quality studies. .

Pulmonary complications in patients with chronic obstructive pulmonary disease following transthoracic esophagectomy

AIM： To investigate the incidence of various types of postoperative pulmonary complications （POPCs） and to evaluate the significance of perioperative arterial blood gases in patients with esophageal cancer accompanied with chronic obstructive pulmonary disease （COPD） after esophagectomy. MEHTODS： Three hundred and fifty-eight patients were divided into POPC group and COPD group. We performed a retrospective review of the 358 consecutive patients after esophagectomy for esophageal cancer with or without COPD to assess the possible influence of COPD on postoperative pulmonary complications. We classified COPD into four grades according to percent-predicted forced expiratory volume in 1 s （FEV1） and analyzed the incidence rate of complications among the four grades. Perioperative arterial blood gases were tested in patients with or without pulmonary complications in COPD group and compared with POP（： group. RESULTS： Patients with COPD （29/86, 33.7%）had more pulmonary complications than those without COPD （36/272, 13.2%） （P〈0.001）. Pneumonia （15/29, 51.7%）, atelectasis （13/29, 44.8%）, prolonged 02 supplement （10/29, 34.5%）, and prolonged mechanical ventilation （8/29, 27.6%） were the major complications in COPD group. Moreover, patients with severe COPD （grade Ⅱ B, FEV1 〈 50% of predicted） had more POPCs than those with moderate（gradeⅡA,50%-80% of predicted） and mild （grade Ⅰ≥80% of predicted） COPD （P〈0.05）. PaO2 was decreased and PaCO2 was increased in patients with pulmonary complications in COPD group in the first postoperative week.CONCLUSION： The criteria of COPD are the critical predictor for pulmonary complications in esophageal cancer patients undergoing esophagectomy. Severity of COPD affects the incidence rate of the pulmonary complication,and percent-predicted FEV1 is a good predictive variable for pulmonary complication in patients-with COPD.Arterial blood gases are helpful in directing perioperative management.

Effects of Suhuang Zhike Capsule on Pulmonary Function, Blood Gas Analysis Index, Serum PCT and CRP Expression in Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease

OBJECTIVE: To observe the effects of Suhuang Zhike Capsule on pulmonary function, blood gas analysis index, serum PCT and CRP expression in patients with acute exacerbation of chronic obstructive pulmonary disease. METHODS: A total of 88 patients with acute exacerbation of chronic obstructive pulmonary disease admitted to the Department of Respiratory Medicine, Xuancheng People's Hospital of Anhui Province from December 2014 to December 2016 were randomly divided into the observation group and the control group, with 44 cases in each group. The control group was given routine clinical treatment, and the observation group was given Suhuang Zhike Capsule on the basis of the treatment method of the control group. After 7 days' treatment, the improvement of lung function indexes were observed and evaluated before and after treatment(forced expiratory volume in one second(FEV_1), forced expiratory volume occupancy in the 1^(st) second percentage of vital capacity(FEVl/FVC), peak expiatory flow(PEF)), blood gas analysis index(Arterial oxygen partial pressure(PaO_2) and arterial blood carbon dioxide partial pressure(PaCO_2), oxygenation index(OI)) and serum cytokine levels(procalcitonin(PCT) and C reactive protein(CRP). RESULTS: The total effective rate of the observation group was significantly higher than that of the control group(P < 0.05). The FEV_1, FEV_1/FVC and PEF in 2 groups were significantly increased after the treatment(P < 0.05), and the above lung function indexes in the observation group were significantly higher than the control group(P < 0.05). PaO_2 and OI were significantly increased after the treatment(P < 0.05), PaCO_2 was significantly decreased after the treatment(P < 0.05), and the improvement of above blood gas analysis indexes were significantly superior of the observation group than the control group(P < 0.05). The serum PCT and CRP levels in 2 groups were significantly decreased after the treatment(P < 0.05), and the improvement in the observation group were more significant than that in the control group(P < 0.05). CONCLUSION: Suhuang Zhike Capsule can inhibit serum inflammatory cytokine levels in patients with acute exacerbation of chronic obstructive pulmonary disease, improve blood gas analysis indicators, and improve lung functions.

Meta-analysis of the treatment of chronic obstructive pulmonary disease by tonifying lung and kidney

Objective:To A randomized controlled trial(RCTS)of lung tonifying and kidney tonifying in the treatment of chronic obstructive pulmonary disease(copd)by meta-analysis.Methods:Computer retrieval of databases such as CNKI、VIP、WanFang、Cochrane Library、EMbase、PubMed.The retrieval time was from the database construction to March 2020,and two evaluators were selected to screen the documents according to the na sorting standards,extract the data with Excel 2010 software,and perform Meta analysis with Rev Man5.3 software.Results:21 RCTS were included.Meta-analysis results show that compared with the conventional treatment,the method of supplementing lung and tonifying kidney can obviously improve lung function(MD=1.69,95%CI[1.36,2.01],P<0.00001)、reduce TCM syndrome score(MD=39.83,95%CI[18.10,61.56],P=0.0003)、improve life quality(MD=-5.90,95%CI[-8.95,-2.85],P=0.0001)、regulates serum immunoglobulin(MD=0.37,95%CI[0.31,0.44],P<0.00001)、improve 6MWD(MD=39.83,95%CI[18.10,61.56],P=0.0003)、improve CAT(MD=-1.68,95%CI[-2.05,-1.30],P<0.00001).The differences were statistically significant.For improved T lymphocyte subsets(MD=0.96,95%CI[-0.10,2.03],P=0.08)not statistically significant.Conclusion:Lung-tonifying kidney-tonifying method had better efficacy in improving lung function,reducing TCM syndrome score,improving quality of life,improving immunoglobulin,improving 6WMD,improving CAT,but the efficacy in improving t-lymphocyte subgroup was similar to that in the control group.Due to the limited quantity and quality of samples included in this paper,more multicenter randomized controlled trials with rigorous design of large samples should be carried out for verification.

Anti-inflammatory effects of Tao Hong Si Wu Tang in mice with lung cancer and chronic obstructive pulmonary disease

BACKGROUND Lung cancer(LC)combined with chronic obstructive pulmonary disease(COPD)is a common combination of comorbidities.Anti-inflammation and modulation of oxidative/antioxidative imbalance may prevent COPD-induced LC,and are also crucial to the treatment of LC combined with COPD.Modern studies have shown that Tao Hong Si Wu Tang(THSW)has vasodilatory,anti-inflammatory,anti-fatigue,anti-shock,immunoregulatory,lipid-reducing,micronutrient-supplementing,and anti-allergy effects.AIM To observe the effects of THSW on COPD and LC in mice.METHODS A total of 100 specific pathogen-free C57/BL6 mice were randomly divided into five groups:Blank control group(group A),model control group(group B),THSW group(group C),IL-6 group(group D),and THSW+IL-6 group(group E),with 20 mice in each group.A COPD mouse model was established using fumigation plus lipopolysaccharide intra-airway drip,and an LC model was replicated by in situ inoculation using the Lewis cell method.RESULTS The blank control group exhibited a clear alveolar structure.The model control and IL-6 groups had thickened alveolar walls,with smaller alveolar lumens,interstitial edema,and several inflammatory infiltrating cells.Histopathological changes in the lungs of the THSW and THSW+IL-6 groups were less than those of the model control group.The serum IL-1β,IL-6,and TNF-αlevels and IL-6R,JAK,p-JAK,STAT1/3,p-STAT1/3,FOXO,p-FOXO,and IL-7R expression levels in lung tissues of mice in the rest of the groups were significantly higher than those of the blank control group(P<0.01).Compared with the model control group,the IL-6 group demonstrated significantly higher levels for the abovementioned proteins in the serum and lung tissues(P<0.01),and the THSW group had significantly higher serum IL-1β,IL-6,and TNF-αlevels and IL-7R expression levels in lung tissues(P<0.01)but significantly decreased IL-6R,JAK,p-JAK,STAT1/3,p-STAT1/3,FOXO,p-FOXO,and IL-7R levels(P<0.01).CONCLUSION THSW reduces the serum IL-1β,IL-6,and TNF-αlevels in the mouse model with anti-inflammatory effects.Its antiinflammatory mechanism lies in inhibiting the overactivation of the JAK/STAT1/3 signaling pathway.

Pulmonary <i>Mycobacterium avium </i>Complex Disease Requiring Differentiation from Recurrence of Lung Cancer during the Follow-Up Period for Lung Cancer

Case 1 was a 49-year-old woman who visited with a dry cough. She had an underlying disease of lung adenocarcinoma and received cancer immunotherapy because of an ALK-positive response and several cancer chemotherapies. The clinical effect was a complete response. Chest CT was performed because of continuous dry cough, and a new tumor shadow was recognized in the lingula portion of the left upper lobe. We performed CT-guided lung biopsy and could aspirate pus-fluid. The culture test for acid-fast bacilli was positive and the causative microorganism was identified as Mycobacterium avium by the DDH method. The final diagnosis was pulmonary abscess due to M. avium. Treatment using combined chemotherapy including CAM was performed and a good clinical response was obtained. Case 2 was a 67-year-old man who had a past history of surgical resection of lung adenocarcinoma eight and two years ago and received several cancer chemotherapies and radiation therapy. Because a new nodular shadow appeared in the right middle lobe one year ago and showed strong positivity on PET/CT, surgical resection was performed with the suspected recurrence of lung cancer. Subsequently, the histological diagnosis was epithelioid granuloma and a culture test of acid-fast bacilli was positive, with the identification of Mycobacterium intracellulare by the DDH method. Combined chemotherapy was not performed because the lesion was completely resected. Afterwards, a new nodular shadow appeared in the left lower lobe again and bronchoscopy was performed. Because M. intracellulare was isolated from the local specimen, we diagnosed the patient with recurrence of pulmonary MAC disease and combined chemotherapy including CAM was performed for one year. Finally, the nodular lesion disappeared. It is difficult to differentiate pulmonary MAC disease from lung cancer. Therefore, careful follow-up of patients with lung cancer while keeping in mind the possible complication of pulmonary MAC disease is necessary.

Does the 2017 global initiative for chronic obstructive lung disease revision really improve the assessment of Chinese chronic obstructive pulmonary disease patients?A multicenter prospective study for more than 5 years

Background:The Global Initiative for Chronic Obstructive Lung Disease(GOLD)2017 proposed a new classification that reclassified many chronic obstructive pulmonary disease(COPD)patients from group D to B.However,there is a paucity of data related to the comparison between reclassified and non-reclassified COPD patients in terms of long-term prognosis.This study aimed to investigate long-term outcomes of them and determine whether the GOLD 2017 revision improved the assessment of COPD patients.Methods:This observational,multicenter,prospective study recruited outpatients at 12 tertiary hospitals in China from November 2016 to February 2018 and followed them up until February 2022.All enrolled patients were classified into groups A toDbased on GOLD 2017,and the subjects in group B included patients reclassified from group D to B(group DB)and those remaining in group B(group BB).Incidence rates and hazard ratios(HRs)were calculated for the exacerbation of COPD and hospitalization in each group.Results:We included and followed up 845 patients.During the first year of follow-up,the GOLD 2017 classification had a better discrimination ability for different risks of COPD exacerbation and hospitalization than GOLD 2013.Group DB was associated with a higher risk of moderate-to-severe exacerbation(HR=1.88,95%confidence interval[CI]=1.37-2.59,P<0.001)and hospitalization for COPD exacerbation(HR=2.23,95%CI=1.29-3.85,P=0.004)than group BB.However,during the last year of follow-up,the differences in the risks of frequent exacerbations and hospitalizations between group DB and BB were not statistically significant(frequent exacerbations:HR=1.02,95%CI=0.51-2.03,P=0.955;frequent hospitalizations:HR=1.66,95%CI=0.58-4.78,P=0.348).The mortality rates of the two groups were both approximately 9.0%during the entire follow-up period.Conclusions:The long-term prognosis of patients reclassified into group B and of those remaining in group B was similar,although patients reclassified from group D to group B had worse short-term outcomes.The GOLD 2017 revision could improve the assessment of Chinese COPD patients in terms of long-term prognosis.

Post-tuberculosis lung disease and chronic obstructive pulmonary disease

The burden of chronic airway diseases,including chronic obstructive pulmonary disease(COPD),continues to increase,especially in low-and middle-income countries.Post-tuberculosis lung disease(PTLD)is characterized by chronic lung changes after the"cure"of pulmonary tuberculosis(TB),which may be associated with the pathogenesis of COPD.However,data on its prevalence,clinical manifestations,computed tomography features,patterns of lung function impairment,and influencing factors are limited.The pathogenic mechanisms underlying PTLD remain to be elucidated.This review summarizes the recent advances in PTLD and TB-associated COPD.Research is urgently needed both for the prevention and management of PTLD.

Association between chronic obstructive pulmonary disease and lung cancer： the missing link

Objective This review focuses on current knowledge of specific processes that drive chronic airway inflammation which are important in the pathogenesis of both chronic obstructive pulmonary disease （COPD） and lung cancer. Data sources The data used in this review were obtained mainly from studies reported in the PubMed database （1997-2012） using the terms of COPD and lung cancer. Study selection Data from published articles about prevalence of COPD-lung cancer overlap and mechanism involved in lung cancer development in COPD were identified, retrieved and reviewed. Results COPD prevalence, morbidity and mortality vary and are directly related to the prevalence of tobacco smoking except in developing countries where air pollution resulting from the burning of biomass fuels is also important. COPD is characterized by a chronic inflammation of lower airway and, importantly, the presence of COPD increases the risk of lung cancer up to 4.5 fold among long-term smokers. COPD is by far the greatest risk factor for lung cancer amongst smokers and is found in 50%-90% of patients with lung cancer. Conclusions Both COPD and lung cancer are tobacco smoking-associated chronic diseases that cluster in families and aggravate with age, and 50%-70% of patients diagnosed with lung cancer have declined spirometric evidence of COPD. Understanding and targeting common pathogenic mechanisms for lung cancer and COPD would have potential diagnostic and therapeutic implications for patients with these lung diseases and for people at risk.

Mid-term effects of lung volume reduction surgery on pulmonary function in patients with chronic obstructive pulmonary disease

Background Now lung volume reduction surgery （LVRS） has become one of the most effective methods for the management of some cases of severe chronic obstructive pulmonary disease （COPD）. We evaluated the mid-term effects of LVRS on pulmonary function in patients with severe COPD. Methods Ten male patients with severe COPD aged 38-70 years underwent LVRS and their pulmonary function was assessed before, 3 months and 3 years after surgery. The spirometric and gas exchange parameters included residual volume, total lung capacity, inspiratory capacity, forced vital capacity, forced expiratory volume in one second, diffusion capacity for CO, and arterial blood gas. A 6-minute walk distance （6MWD） test was performed.Results As to preoperative assessment, most spirometric parameters and 6MWD were significantly improved after 3 months and slightly 3 years after LVRS. Gas exchange parameters were significantly improved 3 months after surgery, but returned to the preoperative levels after 3 years. Conclusions LVRS may significantly improve pulmonary function in patients with severe COPD indicating for LVRS. Mid-term pulmonary function 3 years after surgery can be decreased to the level at 3 months after surgery. Three years after LVRS, lung volume and pulmonary ventilation function can be significantly improved, but the improvement in gas exchange function was not significant.

Heart and lung, a dangerous liaison-Tako-tsubo cardiomyopathy and respiratory diseases: A systematic review

AIM: To investigate the possible association between Tako-tsubo cardiomyopathy(TTC)-a reversible clini-cal condition mimicking an acute myocardial infarction characterized by multifactorial pathophysiologic mecha-nisms- and respiratory system diseases. METHODS: We systematically searched PubMed and EMBASE medical information sources, to identify the different triggering causes, limiting our search to ar-ticles in English. The search keywords were: "tako-tsubo cardiomyopathy", "takotsubo", "takotsubo cardiomyopa-thy", "broken heart syndrome", "stress-induced cardio-myopathy", "apical ballooning syndrome", and "ampulla cardiomyopathy in combination with respiratory dis-eases, lung, pulmonary disease. For each kind of dis-ease, we registered: author, year and country of study, patient sex, age, concurring situation, and outcome. RESULTS: Out of a total of 1725 articles found, we se-lected 37 papers reporting a total of 38 patients. As ex-pected, most patients were women(81.6%), mean age was 65 ± 10 years. Outcome was favorable in 100% of cases, and all the patients have been discharged un-eventfully in a few days. CONCLUSION: An association between respiratory diseases and TTC is likely to exist. Patients with severe respiratory diseases, due to the high dosages of β2-agonists used or to the need of invasive procedures, are highly exposed to the risk of developing TTC.

Tonifying Kidney, Lung, and Spleen Combined with Western Medicine for Stable Chronic Obstructive Pulmonary Disease: A Systematic Review

Introduction:This study aimed to evaluate the clinical effectiveness and safety of tonifying kidney,lung,and spleen(TKLS)combined with Western medicine for stable chronic obstructive pulmonary disease(COPD).Materials and Methods:Randomized controlled trials(RCTs)of TKLS for stable COPD were searched from four databases including Pub Med,the Cochrane Library,China Biology Medicine,and China National Knowledge Infrastructure from inception to December 2017.Two reviewers independently screened the literature,extracted the data,and assessed the risk of bias in the included studies.Rev Man5.3 software was used for meta-analysis.Results:Fourteen RCTs involving 1339 patients with stable COPD were included.Five of the included articles described the specific method of randomization,1 of them was double-blind method research,and 1 of them was single-blind method research.Compared with the conventional Western medicine(CWM)group,the use of TKLS,if combined with CWM demonstrated significantly improved effective rate(relative risk=1.25,95%confidence interval[CI]:1.18–1.33,P<0.00001),decreased traditional Chinese medicine syndrome score(mean difference[MD]-5.72,95%CI:-8.31 to-3.14,P<0.0001),Decreased St George's Respiratory Questionnaire total score(MD-7.39,95%CI:-10.46 to-4.31,P<0.00001),increased 6-min walk distance in meters(MD 78.46,95%CI:60.18–96.73,P<0.00001),increased forced expiratory volume 1%(MD 6.49,95%CI:3.64–9.33,P<0.00001),increased CD4(MD 9.84,95%CI:6.73–12.94,P<0.00001),CD8(MD-1.84,95%CI:-3.62 to-0.06,P=0.04)and CD4/CD8(MD 0.26,95%CI:0.20–0.32,P<0.0001),and increased immunoglobulin M(MD 0.15,95%CI:0.10–0.20 P<0.00001)..Conclusions:For stable COPD,TKLS combined with CWM is superior to CWM alone with regard to clinical effectiveness,symptoms,and quality of life.The above conclusion needs to be validated by further well-designed,multicentric,large-scale,double-blinded RCTs.

Common mechanism of Citrus Grandis Exocarpium in treatment of chronic obstructive pulmonary disease and lung cancer

Objective:"Same treatment for different diseases"is a unique treatment strategy in traditional Chinese medicine.Two kinds of malignant respiratory diseases endanger human health-chronic obstructive pulmonary disease(COPD)and lung cancer.Citrus Grandis Exocarpium(Huajuhong in Chinese,HJH),a famous herbal,is always applied by Chinese medicine practitioners to dispersion the lung to resolve phlegm based on"syndrome differentiation and treatment"theory.However,the common mechanism for HJH’s treatment of COPD and lung cancer is not clear.Methods:In this study,based on network pharmacology and molecular docking technology,the common mechanism of HJH in the treatment of COPD and lung cancer was studied.The active ingredients and related targets of HJH were integrated from TCMSP,BATMAN-TAM,STP,and Pubchem databases.The standard names of these targets were united by Uni Prot database.Targets of COPD and lung cancer were enriched through Gene Cards,NCBI(Gene),Therapeutic Target Database,and Dis Ge NET(v7.0)databases.Then the intersection targets of HJH and diseases were obtained.The STRING network and the Cytoscape 3.7.2 were used to construct PPI network,the DAVID database was used to perform GO and KEGG analysis.Then Cytoscape 3.6.1 was used to build"ingredient-target-signal pathway"network.Finally,Auto Dock 1.5.6 software was used to perform molecular docking of key proteins and molecules.Results:Eleven active ingredients in HJH were obtained by searching the database,corresponding to 184 HJH-COPD-lung cancer targets intersection.The results of biological network analysis showed that naringenin,the active component in HJH,could mainly act on target proteins such as AKT1,EGFR.Then through positive regulation of vasoconstriction and other biological processes,naringenin could regulate estrogen signaling pathway,VEGF signaling pathway,HIF-1 signaling pathway,Erb B signaling pathway,PI3K-Akt signaling pathway to play an important role in the treatment of both COPD and lung cancer.Conclusion:Network pharmacology was employed to systematically investigate the active ingredients and targets of HJH in treatment of COPD and lung cancer.And then,the common pharmacodynamic network of HJH for the two malignant respiratory diseases was firstly described.Furthermore,naringenin was proved to strongly bind with AKT1 and EGFR.It may provide the scientific basis for understanding the"Same treatment for different diseases"strategy in traditional Chinese medicine and inspirit subsequent drug discovery for COPD,lung cancer and other malignant lung diseases.