Molecular mechanisms and cellular process in signal transduction pathway related to air pollutants in obstructive lung diseases:A mini-review

Exposure to air pollutants such as PM_(10),PM_(2.5),PM_(0.1),O_(3),CO,NO2,and SO_(2),and biological pollutants are important factors causing the evolution and furtherance of obstructive lung diseases(OLD),including asthma and chronic obstructive pulmonary disease(COPD).Asthma is the most frequent chronic inflammatory airway disease,characterized by breathlessness,wheezing,chest tightness,and cough,together with the presence of exaggerated expiratory airflow fluctuation that varies over time.COPD is a heterogeneous lung condition characterized by chronic respiratory symptoms such as dyspnea,cough,expectoration,and/or exacerbations due to abnormalities of the airways and/or alveoli that cause persistent,often progressive,airflow obstruction.Understanding the molecular mechanisms and cellular processes based on the development of OLD on exposure to air pollutants will provide insights into the solution of pathogenesis,prevention,and treatment of these conditions.The molecular mechanisms and cellular process involved in signal transduction pathway plays a role in the binding of extracellular signaling molecules and ligands to receptors placed on the cell surface or on the inner side cell that trigger inflammation that occurs,especially when something important enters the cell to bring into a cascade response.This binding then alters the cell metabolism,shape,and gene expression in the airway.This review aimed to reveal the effect of air pollutants on the molecular mechanisms and cellular processes involved in the signal transduction pathways in OLD.

Role of diaphragmatic ultrasound in patients with acute exacerbation of chronic obstructive pulmonary disease

Assessing diaphragm function status is vital for diagnosing and treating acute exacerbation of chronic obstructive pulmonary disease(AECOPD).Diaphrag-matic ultrasound has become increasingly important due to its non-invasive nature,absence of radiation exposure,widespread availability,prompt results,high accuracy,and repeatability at the bedside.The diaphragm is a crucial respiratory muscle.Decline or dysfunction of the diaphragm can lead to dyspnea and even respiratory failure in AECOPD patients.In this editorial,we comment on an article,retrospectively analyzed ninety-four acute exacerbations of chronic obstructive pulmonary disease patients who received mechanical ventilation from January 2022 to December 2023.The study found that the diaphragm thickening fraction,an index from diaphragm ultrasound,can better predict the outcome of non-invasive ventilation in patients with AECOPD.The value of non-invasive ventilation in treating respiratory failure caused by AECOPD has been widely acknowledged.Diaphragmatic dysfunction diagnosed with ultrasound is asso-ciated with prolonged mechanical ventilation and weaning times and higher mortality.

Non-Invasive Early Diagnosis of Obstructive Lung Diseases Leveraging Machine Learning Algorithms

Lungs are a vital human body organ,and different Obstructive Lung Diseases(OLD)such as asthma,bronchitis,or lung cancer are caused by shortcomings within the lungs.Therefore,early diagnosis of OLD is crucial for such patients suffering from OLD since,after early diagnosis,breathing exercises and medical precautions can effectively improve their health state.A secure non-invasive early diagnosis of OLD is a primordial need,and in this context,digital image processing supported by Artificial Intelligence(AI)techniques is reliable and widely used in the medical field,especially for improving early disease diagnosis.Hence,this article presents an AIbased non-invasive and secured diagnosis for OLD using physiological and iris features.This research work implements different machine-learning-based techniques which classify various subjects,which are healthy and effective patients.The iris features include gray-level run-length matrix-based features,gray-level co-occurrence matrix,and statistical features.These features are extracted from iris images.Additionally,ten different classifiers and voting techniques,including hard and soft voting,are implemented and tested,and their performances are evaluated using several parameters,which are precision,accuracy,specificity,F-score,and sensitivity.Based on the statistical analysis,it is concluded that the proposed approach offers promising techniques for the non-invasive early diagnosis of OLD with an accuracy of 97.6%.

Heat Shock Protein 70 Gene Polymorphisms in Han Nationality of China with Chronic Obstructive Pulmonary Diseases

In order to investigate whether polymorphism in gene for heat shock protein 70 (HSP70) has any bearing on individual susceptibility to the development of chronic obstructive pulmonary disease(COPD), the geotypes of 88 patients with COPD and 87 healthy smoking control subjects were tested by polymerase chain reaction followed by restriction fragment polymorphism analysis for HSP70 gene. In COPD group, HSP70 1 genotype A/A, A/B and B/B was 59.1 %, 35.2 % and 5.7 %, HSP70 2 genotype A/A, A/B and B/B was 26.1 %, 54.6 % and 19.3 %, and HSP70 hom genotype A/A, A/B and B/B was 70.4 %, 27.3 % and 2.3 % respectively. In the control group, it was 60.9 %, 27.5 % and 3.5 %, 20.7 %, 56.3 % and 23.0 %, and 54.0 %, 42.5 % and 3.5 %, respectively. The frequency of polymorphic genetypes showed no difference between the COPD group and the control group ( P >0.05). It was suggested that geneic polymorphism in HSP70 is not associated with development of COPD in Han nationality of China.

Non-Invasive Pressure Support Ventilation in Major Lung Resection for High Risk Patients: Does It Matter?

Background and purpose: Patients with severely impaired pulmonary function have an increased operative risk for major lung resection. The clinical benefits of pre- and perioperative, non-invasive pressure support ventilation (NIPSV) have up to now not been extensively evaluated. Patients with severely reduced pulmonary function were investigated in this prospective and randomised single centre clinical trial. Methods: Standard pulmonary evaluation was performed in all patients before major lung resection. To predict postoperative pulmonary function, a lung perfusion-ventilation scan was carried out. All patients enrolled in the study were instructed preoperatively on how to use a NIPSV respirator. Af-ter lung resection patients were randomised either for continuation of NIPSV or for standard treatment. Results: Of the 52 patients assessed, 21 patients met the inclusion criteria for the study protocol. Predicted mean postoperative FEV1 was 1.10 L (range 0.92 - 1.27 L). Lobectomy was performed in 14 patients, pneumonectomy in 6 patients and a segmentectomy in 1 patient. No inhospital deaths occurred. Pulmonary complications (reintubation, pneumonia) were more frequent in the NIPSV group than in the control group (3 patients versus 1 patient), without statistical significance (p = 0.31). Conclusions: We observed no mortality and a low morbidity in this high risk group. Postoperative continuation of NIPSV had no beneficial effect on the clinical outcome. Preoperative conditioning with NIPSV, however, seems to be a suitable tool for patients with severely impaired pulmonary function. This study may serve therefore as basis for further investigations for the potential clinical benefits of prophylactic NIPSV in major lung surgery.

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.

Twenty years of changes in the disease assessment method of the Global Initiative for Chronic Obstructive Lung Disease

The Global Initiative for Chronic Obstructive Lung Disease(GOLD)has been changing for nearly 20 years.GOLD has moved from single assessment using spirometry to a more comprehensive assessment of chronic obstructive pulmonary disease using spirometry,symptoms and exacerbation history.And subsequently,a new assessment system for chronic obstructive pulmonary disease separated spirometric grades from the old assessment system,and classified patients only according to their symptoms and history of exacerbation.The distribution,clinical characteristics,treatment,and prognosis of the new subgroups were different from the old ones.In this review,we will present a brief profile of changes made to the disease assessment method of GOLD,based on the relevant existing literature.

Deaths of obstructive lung disease in the Yangpu district of Shanghai from 2003 through 2011： a multiple cause analysis

Background Obstructive lung disease （OLD, chronic obstructive pulmonary disease or asthma） is an important cause of death in older people. There has been no exhaustive population-based mortality study of this subject in Shanghai. The objective of this study was to use a multiple cause of death methodology in the analysis of OLD mortality trends in the Yangpu district of Shanghai, from 2003 through 2011. Methods We analyzed death data from the Shanghai Yangpu District Center for Disease Control and Prevention for Medical Cause of Death database, selecting all death certificates for individuals 40 years or older on which OLD was listed as a cause of death. Results From 2003 to 2011, there were 8 775 deaths with OLD listed, of which 6 005 （68%） were identified as the underlying cause of death. For the entire period, a significantly decreasing trend of age standardized rates of death from OLD was observed in men （-6.2% per year） and in women （-5.7% per year）, similar trends were observed in deaths with OLD. The mean annual rates of deaths from OLD per 100 000 were 161.2 for men and 80.8 for women from 2003 to 2011. While, as the underlying cause of death, the main associated causes of death were as follows： cardiovascular diseases （70.7%）, carebrovascular diseases （13.3%）, diabetes （8.6%）, and cancer （4.3%）. The associated causes and the principal overall underlying causes of death were cardiovascular diseases （37.0%）, cancer （30.3%）, and cerebrovascular disease （15.3%）. A significant seasonal variation, with the highest frequency in winter, occurred in deaths identified with underlying causes of chronic bronchitis, other obstructive pulmonary diseases, and asthma. Conclusions Multiple cause mortality analysis provides a more accurate picture than underlying cause of total mortality attributed on death certificates to OLD. The major comorbidities associated with OLD were cardiovascular disease, cancer, and cerebrovascular disease. From 2003 to 2011, the mortality rate from OLD decreased substantially in the Yangpu district of Shanghai.

Twenty years of changes in the definition of early chronic obstructive pulmonary disease

Chronic obstructive pulmonary disease(COPD)is a chronic inflammatory airway disease that affects the quality of life of nearly one-tenth of the global population.Due to irreversible airflow obstruction and progressive lung function decline,COPD is characterized by high mortality and disability rates,which imposes a huge economic burden on society.In recent years,the importance of intervention in the early stage of COPD has been recognized and the concept of early COPD has been proposed.Identifying and intervening in individuals with early COPD,some of whom have few or no symptoms,might halt or reverse the progressive decline in lung function,improve the quality of life,and better their prognosis.However,understanding of early COPD is not yet well established,and there are no unified and feasible diagnostic criteria,which complicates clinical research.In this article,we review evolution of the definition of early COPD over the past 20 years,describe the changes in awareness of this concept,and propose future research directions.

Applications of Dynamic-Equilibrium Continuous Markov Stochastic Processes to Elements of Survival Analysis

In this article, we summarize some results on invariant non-homogeneous and dynamic-equilibrium (DE) continuous Markov stochastic processes. Moreover, we discuss a few examples and consider a new application of DE processes to elements of survival analysis. These elements concern the stochastic quadratic-hazard-rate model, for which our work 1) generalizes the reading of its It? stochastic ordinary differential equation (ISODE) for the hazard-rate-driving independent (HRDI) variables, 2) specifies key properties of the hazard-rate function, and in particular, reveals that the baseline value of the HRDI variables is the expectation of the DE solution of the ISODE, 3) suggests practical settings for obtaining multi-dimensional probability densities necessary for consistent and systematic reconstruction of missing data by Gibbs sampling and 4) further develops the corresponding line of modeling. The resulting advantages are emphasized in connection with the framework of clinical trials of chronic obstructive pulmonary disease (COPD) where we propose the use of an endpoint reflecting the narrowing of airways. This endpoint is based on a fairly compact geometric model that quantifies the course of the obstruction, shows how it is associated with the hazard rate, and clarifies why it is life-threatening. The work also suggests a few directions for future research.

New disease severity classification of patients with stable chronic obstructive pulmonary disease in Shanghai

Background The Global Initiative for Chronic Obstructive Lung Disease （GOLD） presented a new ABCD group classification of chronic obstructive pulmonary disease （COPD）.We aimed to examine the association of spirometric classification and the new GOLD classification with exacerbations,and to compare symptoms in different ways.Methods We investigated 848 patients with stable COPD from 24 hospitals.The annual frequencies of acute exacerbation and hospitalization were compared between the old and new classification.The symptom level was assessed using COPD assessment test （CAT） and modified British Medical Research Council （mMRC） questionnaire.Results A total of 848 patients were included in this study.According to spirometric classification,there were 32 patients of grade Ⅰ （3.8％）,315 of grade Ⅱ （37.1％）,366 of grade Ⅲ （43.2％）,and 135 of grade Ⅳ （15.9％）.According to GOLD 2011 classification,there were 59 patients of group A （7.0％）,172 of group B （20.3％）,55 of group C （6.5％）,and 562 of group D （66.3％）.In spirometric classification,the annual frequencies of acute exacerbation and associated hospitalization were respectively 1 （0-3） and 0 （0-2） for grade Ⅰ; 1 （0-5） and 0 （0-2） for grade Ⅱ; 2 （0-6） and 1 （0-3） for grade Ⅲ,and 3 （0-6） and 2 （0-3） for grade Ⅳ.In GOLD 2011,respectively 0 （0-3） and 0 （0-1） （group A）,1 （0-4） and 0 （0-3） （group B）,1 （0-5） and 0 （0-3） （group C）,and 3 （0-6） and 1 （0-3） （group D）.There were no significant difference between group B and C （Z=-1.347,P=0.178; Z=-0.772,P=0.440,respectively）.The coincidence rate using mMRC=1 and CAT=10 as cutoff points was 86.6％ （734/848,x=0.706）,compared with 77.9％ （661/848,K=0.60） using mMRC=2 and CAT=10.Conclusions Lung function test may be a better predictor of acute exacerbation and associated hospitalization of COPD.It is more appropriate to use mMRC=1 as cutoff point for assessing COPD symptoms.