The effect of traditional Chinese medicine rehabilitation exercise(pulmonary Daoyin)in patients with chronic obstructive pulmonary disease:A systematic review and meta-analysis

Objective:Previous research has demonstrated that pulmonary Daoyin could be an efficacious way to ameliorate the physical and psychological state of sufferers with chronic obstructive pulmonary disease(COPD)and bolster the quality of life.However,the results are not consistent.Thus,the objective of this research is to assess the impacts of pulmonary Daoyin in individuals with COPD.Methods:Relevant articles were searched in Web of Science,Cochrane Library,PubMed,EMBASE,SinoMed,CNKI,Wanfang,and VIP from database inception to January 2024.Results:There were a total of 15 randomized controlled trials(RCTs)included in this meta-analysis involving 1732 patients,of which 864 participated in the intervention group and 868 in the control group.When comparing with the control group,the COPD patients practicing pulmonary Daoyin demonstrated a significant improvement in 6 min walking distance(mean difference[MD]=24.53,95%confidence interval[CI][18.55,30.52],P<0.00001),forced expiratory volume in the 1 s(FEV_(1))(MD=0.39,95%CI[0.18,0.59],P=0.0002),percentage of FEV_(1)to the predicted value(FEV_(1)%)(MD=5.35,95%CI[3.22,7.48],P<0.0001),the forced vital capacity(FVC)(MD=0.39,95%CI[0.06,0.73],P=0.02),percentage of FVC to the predicted value(FVC%)(MD=7.52,95%CI[4.91,10.13],P<0.00001),the ratio of FEV_(1)/FVC(MD=4.95,95%CI[0.91,8.99],P=0.02),peak expiratory flow rate(standardized MD=0.98,95%CI[0.74,1.22],P<0.00001),modified Medical Research Council(mMRC)scale(MD=-0.47,95%CI[-0.89,-0.04],P=0.03),and Borg scale(MD=-0.65,95%CI[-0.75,-0.55],P<0.00001).Conclusions:Our findings may illuminate the influence of pulmonary Daoyin on exercise ability,breathlessness,and pulmonary function in COPD patients.More rigorous RCTs with larger samples and longer-term interventions will be required moving forward.

Test of incremental respiratory endurance as home-based, standalone therapy in chronic obstructive pulmonary disease: A case report

BACKGROUND The prevalence of chronic obstructive pulmonary disease(COPD)is increasing worldwide,and at the same time it is associated with increased mortality and reduced quality of life.Efforts to build sustainable rehabilitation approaches to COPD treatment and prevention are crucial.The system of long-term pulmonary rehabilitation care is insufficient.The main reasons for the absence of these outpatient programs are the lack of experience,the lack of interest of insurance companies in secondary prevention programs,and the lack of healthcare facilities in large geographical areas.The possibility of at-home pulmonary rehabilitation models(telemonitoring and telecoaching)could solve this problem.CASE SUMMARY A 71-year-old man with severe COPD,Global Initiative for Obstructive Lung Diseases stage 3 underwent an 8-wk remotely monitored inspiratory muscle training with a device based on the test of incremental respiratory endurance method.Spirometry,body plethysmography,test of incremental respiratory endurance examination,6-min walking test,body mass index,airflow obstruction,dyspnea,exercise capacity index,and subjective perception of dyspnea were performed as part of the initial and final examination.The patient performed training at home,and the physiotherapist monitored the patient remotely through a web application that allowed the physiotherapist to evaluate all training parameters in real-time and respond to any problems.After 8 wk of home training,there was a significant increase in all monitored values:maximal inspiratory pressure,a novel parameter sustained maximal inspiratory pressure,forced expiratory volume in 1 s,total lung capacity,forced vital capacity,peak expiratory flow,and inspiratory capacity.There was also an improvement in the perception of dyspnea according to the COPD Assessment Test and a modified Medical Research Council Breathlessness Scale,an increase in exercise tolerance according to the 6-min walking test,and a decrease in the exercise capacity index as a predictor of prognosis.CONCLUSION Respiratory telerehabilitation was greatly beneficial in a cooperative patient with COPD and may represent an alternative therapeutic approach to the increasing incidence of all lung diseases.

Application of Inflammatory Markers in Induced Sputum in Stable Chronic Obstructive Pulmonary Disease Patients with Positive Bronchodilation Tests

Positive bronchodilation (BD) tests can be noticed in some stable chronic obstructive pulmonary disease (COPD) patients.The characteristics of airway inflammation in this entity remain unclear.Our study aimed to identify the characteristics of airway inflammation in stable COPD patients with positive BD tests.The airway inflammation was assessed in 88 patients with stable COPD using the examination of induced sputum in the aftermath of lung function and BD tests.Cellular counts and the levels of molecular markers including eosinophil cationic protein (ECP),myeloperoxidase (MPO),interleukin-5 (IL-5),and IL-8 were assayed by Wright's stain,Immuno-CAP system,and ELISA,RT-PCR.Among the 88 patients with stable COPD,20 (22.7%) showed positive BD tests.The values of eosinophils (4.7%±3.4%) and ECP (90.1±41.6 ng/mL) in induced sputum in stable COPD patients with positive BD tests were markedly elevated as compared with those in stable COPD patients with negative BD tests or in healthy controls (all P<0.05),but significantly lower than those in asthmatic patients (all P<0.01).The IL-5 in sputum supernatant was significantly decreased in stable COPD patients with positive BD tests as compared with the patients with asthma (12.5±7.8 vs.48.2±26.0 ng/mL;P<0.01).However,healthy controls exhibited similar concentrations of IL-5 in induced sputum with patients with stable COPD,whether with positive or negative BD tests (all P>0.05).Moreover,the values of neutrophils (61.8%±15.1%),MPO (574.0±111.8 ng/mL),and IL-8 (32.6±13.4 ng/mL) in induced sputum in stable COPD patients with positive BD tests were significantly higher than those in asthmatics or normal controls (all P<0.01).However,the values of the above inflammatory markers in induced sputum were similar among stable COPD patients with positive or negative BD tests (all P>0.05).The stable COPD patients with positive BD tests may present not only eosinophilic airway inflammation but also neutrophilic airway inflammation.

Effect of Tiotropium Bromide on Expression of CD_8^+CD_(25)^+FoxP_3^+ Regulatory T Cells in Patients with Stable Chronic Obstructive Pulmonary Disease

The expression of CD8＋CD25＋FoxP3＋ regulatory T cells（CD8＋Tregs） in the peripheral blood of patients with stable chronic obstructive pulmonary disease（COPD）,and the effect of muscarinic cholinergic receptor antagonist tiotropium bromide on the expression of CD8＋Tregs were investigated.Twenty-three patients with moderate to severe stable COPD were enrolled in this study.All patients inhaled tiotropium bromide（18 μg daily） for 3 months.Before and after inhalation of tiotropium bromide,peripheral blood samples were collected from the patients,and T cells were labeled by three-color labeled monoclonal antibodies.Flow cytometry was used to detect the quantity and percentage of CD8＋T cells,CD8＋CD25＋T cells,CD8＋Tregs,CD4＋T cells,CD4＋CD25＋T cells and CD4＋CD25＋FoxP3＋ regulatory T cells（CD4＋Tregs） respectively.The percentage of CD4＋T cells was increased from（27.82±2.18）% to（35.53±1.3）%（t=3.20,P=0.004） in the peripheral blood of patients with stable COPD after inhalation of tiotropium bromide for 3 months,that of CD4＋CD25＋T cells was decreased from（10.03 ±1.42）% to（4.21 ±0.65）%（t=3.78,P=0.001）,and that of CD8＋Tregs was increased from（8.41 ±1.68）% to（21.34 ±4.20）%（t=2.72,P=0.013）.At baseline,CD8＋T cells,CD8＋CD25＋T cells and CD4＋Tregs were detectable in the peripheral blood,but no significant changes were observed after treatment.Linear correlation analysis revealed that the difference before and after treatment in CD4＋T cells and CD4＋CD25＋T cells was negatively correlated with the ratio of change in CD8＋Tregs before and after treatment（r=-0.61,P=0.013;r=-0.72,P=0.001 respectively）.In the peripheral blood of patients with stable COPD,there was the expression of CD8＋Tregs and CD4＋Tregs.Muscarinic receptor antagonist,tiotropium bromide,can promote the amplification of CD4＋T cells,inhibit the expression of CD25＋T cells,and enhance the expression of CD8＋Tregs.CD8＋Tregs and CD4＋Tregs can be used as new indicators to understand the immune status of patients.They are helpful in judging the treatment efficacy and disease immunophenotype.

Randomized Double-blind Placebo-controlled Clinical Trial andAssessment of Fermentation Product of Cordyceps Sinensis (Cs-4) inEnhancing Aerobic Capacity and Respiratory Function ofThe Healthy Elderly Volunteers

Objective:Cordyceps sinensis (CS) is a popular natural Chinese herbal medicine for invigoration, health preservation and reducing fatigue. Its natural substance has been prepared as a fermentation product of a specific strain of Cordyceps sinensis (Cs-4). Our objective was to assess the effect of Cs-4 on the exercise capacity of the healthy elderly people in a randomized, double-blind, placebo-controlled trial. Methods:Thirty-seven healthy, elderly Chinese subjects were randomly assigned to receive either Cs-4 (3 g/ day) or identical placebo capsules. Their exercise performance was tested before and after 6 weeks of treatment with a symptom-limited, incremental work rate protocol on a cycle ergometer. Maximum oxygen uptake (VO2max) was measured using a metabolic chart. Anaerobic thresholds (VO26) were identified by two observers using plots of both VCO2 vs VO2 and VE/VO2 vs time. Results: After taking Cs-4 for 6 weeks, VO2max (1 88±0.13 to 2.00±0 14 L/min; P=0.050) and VO2(1.15±0.07 to 1.30±0.09 L/min; P = 0.012) were significantly increased, whereas after placebo application they were unchanged. Conclusion: These findings support the belief held in China that Cs-4 could improve oxygen uptake or aerobic capacity and ventilation function and resistance to fatigue of elderly people in exercise.

Impact of Tobacco Smoking on Health Care Utilization and Medical Costs in Chronic Obstructive Pulmonary Disease,Coronary Heart Disease and Diabetes

Objective To determine the impact of smoking on disease-specific health care utilization and medical costs in patients with chronic non-communicable diseases(NCDs).Methods Participants were middle-aged and elderly adults with chronic NCDs from a prospective cohort in China.Logistic regressions and linear models were used to assess the relationship between tobacco smoking,health care utilization and medical costs.Results Totally,1020 patients with chronic obstructive pulmonary disease(COPD),3144 patients with coronary heart disease(CHD),and 1405 patients with diabetes were included in the analysis.Among patients with COPD,current smokers(β:0.030,95%CI:−0.032-0.092)and former smokers(β:0.072,95%CI:0.014-0.131)had 3.0%and 7.2%higher total medical costs than never smokers.Medical costs of patients who had smoked for 21-40 years(β:0.028,95%CI:−0.038-0.094)and≥41 years(β:0.053,95%CI:−0.004β0.110)were higher than those of never smokers.Patients who smoked≥21 cigarettes(β:0.145,95%CI:0.051-0.239)per day had more inpatient visits than never smokers.The association between smoking and health care utilization and medical costs in people with CHD group was similar to that in people with COPD;however,there were no significant associations in people with diabetes.Conclusion This study reveals that the impact of smoking on health care utilization and medical costs varies among patients with COPD,CHD,and diabetes.Tobacco control might be more effective at reducing the burden of disease for patients with COPD and CHD than for patients with diabetes.

Establishment of a diagnostic model of coronary heart disease in elderly patients with diabetes mellitus based on machine learning algorithms

OBJECTIVE To establish a prediction model of coronary heart disease(CHD)in elderly patients with diabetes mellitus(DM)based on machine learning(ML)algorithms.METHODS Based on the Medical Big Data Research Centre of Chinese PLA General Hospital in Beijing,China,we identified a cohort of elderly inpatients(≥60 years),including 10,533 patients with DM complicated with CHD and 12,634 patients with DM without CHD,from January 2008 to December 2017.We collected demographic characteristics and clinical data.After selecting the important features,we established five ML models,including extreme gradient boosting(XGBoost),random forest(RF),decision tree(DT),adaptive boosting(Adaboost)and logistic regression(LR).We compared the receiver operating characteristic curves,area under the curve(AUC)and other relevant parameters of different models and determined the optimal classification model.The model was then applied to 7447 elderly patients with DM admitted from January 2018 to December 2019 to further validate the performance of the model.RESULTS Fifteen features were selected and included in the ML model.The classification precision in the test set of the XGBoost,RF,DT,Adaboost and LR models was 0.778,0.789,0.753,0.750 and 0.689,respectively;and the AUCs of the subjects were 0.851,0.845,0.823,0.833 and 0.731,respectively.Applying the XGBoost model with optimal performance to a newly recruited dataset for validation,the diagnostic sensitivity,specificity,precision,and AUC were 0.792,0.808,0.748 and 0.880,respectively.CONCLUSIONS The XGBoost model established in the present study had certain predictive value for elderly patients with DM complicated with CHD.

A new in ammation marker of chronic obstructive pulmonary disease– adiponectin

BACKGROUND： This study was undertaken to measure the concentration of adiponectin （APN） in serum and induced sputum in patients with chronic obstructive pulmonary disease （COPD during acute exacerbation （AECOPD） and at stable stage and to determine the role of APN as a marker of in？ ammation in the pathogenesis of COPD.METHODS： All the patients in this prospective study were enrolled from October 2008 to October 2009, including 30 male AECOPD patients from the emergency department, 30 male stable COPD patients from the department of respiratory diseases, and 30 healthy non-smoking male controls from the department of medical examination. The serum and induced sputum were collected from each patient. All of the patients had normal weight （BMI range 18.5-24.9 kg/m2）. Patients with severe bronchial asthma, bronchiectasis or autoimmune disease were excluded. Cell count and classi？ cation was performed for the induced sputum. The concentrations of APN, IL-8, IL-6 and TNF-α were measured by ELISA. Pulmonary function was tested among the three groups. Comparisons between the groups were conducted by Student＇s t test, ANOVA analysis or nonparametric test. Correlation analysis was carried out by Pearson＇s product-moment correlation coef？ cient test or Spearman＇s rank-order correlation coef？ cient test.RESULTS： The concentrations of APN in the serum or induced sputum in AECOPD patients were signi？ cantly higher than those in stable COPD patients or healthy non-smoking controls （P〈0.01）. The concentration of APN in stable COPD patients was signi？ cantly higher than that in healthy non-smoking controls （P〈0.01）. For the AECOPD patients, APN was positively correlated with IL-8 and TNF-α in the serum and induced sputum （r=0.739, 0.734, 0.852, 0.857 respectively, P〈0.05）. For the stable COPD patients, APN was also positively correlated with IL-8 and TNF-α in the serum and induced sputum （r=0.751, 0.659, 0.707, 0.867 respectively, P〈0.05）. In addition, for the AECOPD patients, APN was positively correlated with the percentage of neutrophils in the induced sputum （r=0.439, P〈0.05）.CONCLUSIONS： APN is involved in the process of systematic and airway inflammation ofCOPD. This process is related to neutrophils in the airway, IL-8 and TNF-α. APN could be used as a new marker for in？ ammation of COPD.

Effects of modified pulmonary rehabilitation on patients with moderate to severe chronic obstructive pulmonary disease:A randomized controlled trail

Objectives:This study aimed to assess the effects of modified pulmonary rehabilitation(PR)on patients with moderate to severe chronic obstructive pulmonary disease(COPD).Methods:A total of 125 patients(63 in the PR group and 62 in the control group)were recruited in this study.The patients in the PR group received 12 weeks of conventional treatment,nursing,and modified pulmonary rehabilitation,while the patients in the control group underwent 12 weeks of conventional treatment,nursing,pursed-lip breathing training,and abdominal breathing training.Baseline characteristics,St.George's Respiratory Questionnaire(SGRQ),the six-minute walk test(6MWT),modified medical research council(MMRC)dyspnea scale,and lung function were compared between the two groups.Results:A total of 112 patients(58 patients in the PR group and 54 patients in the control group)completed the 12-week monitoring and follow-up.The SGRQ scores,symptoms(54.933±11.900),activity(52.644±14.334),impact(55.400±9.905),and total score(54.655±10.681)of the PR group did not significantly differ in pre-and post-treatments(P<0.05).No significant change was also observed in the control group(P>0.05).6MWT[(372.089±67.149)m]was significantly improved in the PR group(P<0.05)but was not significantly different in the control group(P>0.05).MMRC(actual rank sum 1719,rank sum 2047.5)was significantly reduced in the PR group(P<0.05)but not in the control group(P>0.05).The lung function(FVC,FEV1,FEV1/FVC,FEV1%and PEF)of the patients in both groups did not significantly change(P>0.05).Conclusion:Modified PR reduces the symptoms of dyspnea,increases exercise capacity,and improves the quality of life of patients with moderate to severe COPD.

Chinese herbal medicine for hand-foot-and-mouth disease in children: An overview of systematic reviews

Objective:To summarize the use of Chinese herbal medicines (CHM) for the treatment of hand-foot-and-mouth disease (HFMD) in children and to provide high-level evidence for clinical decision-making.Methods:We conducted an overview of systematic reviews (SRs).Two English-language and four Chinese-language electronic databases were searched from inception to March 31,2018.Published SRs and meta-analyses evaluating CHM use in children with HFMD and reporting clinically-relevant outcomes such as time to fever resolution were eligible for inclusion in this overview.Reviews were accepted if the intervention featured CHM with or without other treatment.Two authors evaluated the methodological quality of the included SRs by using ASMTAR and ROBIS.Results:Thirty SRs comprising 90 244 children with HFMD were included in this overview of SRs.All SRs were published in Chinese between 2011 and 2017.All intervention arms received CHM with or without conventional treatment and were compared against control arms receiving no treatment,conventional treatment alone,or placebo.All 30 reviews reported the time to fever resolution and results demonstrated that CHM had a greater benefit in reducing fever compared with controls.Twenty-three reviews reported the time to rash resolution which presented similar results.Fourteen SRs reported the time to oral ulcer healing and CHM demonstrated a significantly reduced time to resolution compared to controls.The quality of the included SRs was low to moderate as assessed by the AMSTAR tool.Conclusion:Published reviews demonstrated potential benefits of CHM in children with HFMD.Overall,the methodological quality of reviews included in this overview of SRs was low and our findings should be interpreted with caution.We would strongly recommend that future SRs be designed and reported rigorously following PRISMA in order to provide more robust evidence on which to base clinical guidance.

Role of Salmonella enterica exposure in Chilean Crohn's disease patients

AIM:To study the association between exposure toSalmonella enterica(SE)and Crohn’s disease(CD)and its clinical implications in Chilean patients.METHODS:Ninety-four unrelated Chilean CD patients from CAREI(Active Cohort Registry of Inflammatory Bowel Disease)presenting to a single inflammatory bowel disease(IBD)unit of a University Hospital were prospectively included in this study.A complete clinical evaluation,including smoking history,was performed at the initial visit,and all the important data of clinical evolution of CD were obtained.Blood samples from these CD patients and 88 healthy sex-and agematched control subjects were analyzed for exposure to SE and for their NOD2/CARD15 gene status using the presence of anti-Salmonella lipopolysaccharide antibodies[immunoglobulin-G type(IgG)]and polymerase chain reaction(PCR),respectively.We also evaluated exposure to SE in 90 sex-and age-matched patients without CD,but with known smoking status(30 smokers,30 non-smokers,and 30 former smokers).RESULTS:CD patients comprised 54 females and 40males,aged 35.5±15.2 years at diagnosis with a mean follow-up of 9.0±6.8 years.CD was inflammatory in 59 patients(62.7%),stricturing in 24(25.5%)and penetrating in 15(15.5%).Thirty cases(31.9%)had lesions in the ileum,29(30.8%)had ileocolonic lesions,32(34.0%)had colonic lesions and 23(24.4%)had perianal disease.Sixteen CD patients(17%)were exposed to SE compared to 15(17%)of 88 healthy control subjects(P=0.8).Thirty-one CD patients(32.9%)were smokers,and 7(7.4%)were former smokers at diagnosis.In the group exposed to SE,10 of 16 patients(62.5%)were active smokers compared to 21 of 78 patients(26.9%)in the unexposed group(P=0.01).On the other hand,10 of 31 smoking patients(32%)were exposed to SE compared to 5 of 56 nonsmoking patients(9%),and one of the seven former smokers(14%)(P=0.01).In the group of 90 patients without CD,but whose smoking status was known,there was no differ-ence in exposure to SE[3 of 30 smokers(10%),5 of30 non-smokers(16%),and 5 of 30 former smokers(16%);P=0.6].There were no differences in disease severity between CD patients with and those without anti-SE IgG antibodies,estimated as the appearance of stricturing[2(12.5%)vs 22(28.2%);P=0.2]or penetrating lesions[2(12.5%)vs 13(16.6%);P=1.0];or the need for immunosuppressants[11(68.7%)vs 55(70.5%);P=1.0],anti-tumor necrosis factor therapy[1(6.2%)vs 7(8.9%);P=1.0],hospitalization[13(81.2%)vs 58(74.3%);P=0.7],or surgery[3(18.7%)vs 12(15.3%);P=0.3),respectively].No other factors were associated with SE,including NOD2/CARD15 gene status.Seventeen CD patients(18%)had at least one mutation of the NOD2/CARD15 gene.CONCLUSION:Our study found no association between exposure to SE and CD.We observed a positive correlation between SE exposure and cigarette smoking in Chilean patients with CD,but not with disease severity.

Retraction notice to"Effects of modified pulmonary rehabilitation on patients with moderate to severe chronic obstructive pulmonary disease: A randomized controlled trail" [IJNSS Volume 4, Issue 3, 10 July 2017, Pages 219e224]

This article has been retracted:please see Elsevier Policy on Article Withdrawal(https://www.elsevier.com/about/our-business/policies/article-withdrawal).This article has been retracted at the request of Editorial Office and Authors.The article duplicates significant parts of a paper that had already appeared in[Nurs J Chin PLA,2017,34(8):22e26,68.http://www.cnki.com.cn/Article/CJFDTotal-JFHL201708006.htm],written in Chinese.One of the conditions of submission of a paper for publication is that authors declare explicitly that the paper has not been previously published and is not under consideration for publication elsewhere.Re-use of any data should be appropriately cited.Apologies are offered to readers of the journal that this was not detected during the submission process.

Preliminary Exploration of the Initial Diagnostic Prediction Model of Moderate Coronavirus Disease 2019 (2019-nCoV) Based on Clinical Data

Objective: To explore those differences and relationships of the initial diagnostic clinical data between confirmed cases of 2019-nCoV and suspected cases of COVID-19, and then to establish prediction models for predicting the probability of the first diagnosis of 2019-nCoV. Methods: A total of 81 suspected cases and 87 confirmed cases of moderate 2019-nCoV diagnosed initially in the isolation wards of the First People’s Hospital of Wuhu and the People’s Hospital of Wuwei and Wuhan Caidian Module Hospital with the help of our hospital doctors were gathered, and retrospectively analyzed. Results: The most common symptoms were fever (76.79%) and cough (64.29%) in the total of 168 cases. The median age was 45 (35 - 56) years old in the 87 confirmed cases of moderate 2019-nCoV, older than the median age 36 (29 - 50) in the 81 suspected cases. There were significant more in the former than in the latter in the incidence of myalgia, ground-glass opacity (GGO), invasions of lesion in the peripheral lobes, vascular thickening and bronchial wall thickening, interlobular septal thicking, and small pulmonary nodules. On the contrary, there were less in the former than in the latter in the total number of leukocytes and neutrophils in blood routine examination and the levels of procalcitonin (PCT). Two groups were statistically significantly different (P < 0.05). Multivariate logistic regression analysis showed that age, fever, myalgia, GGO, vascular thickening and bronchial wall thickening, invasions of lesion in the peripheral lobes were independent factors for identification of 2019-nCoV, and the total number of leukocytes, cough, pharyngalgia and headache were negatively related. The established mathematical equation for predicting model for predicting the probability of the first diagnosis of 2019-nCoV is: P = ex/(1 + ex), x = −6.226 + (0.071 × ages) + (1.720 × fever) + (2.858 × myalgia) + (2.131 × GGO) + (3.000 × vascular thickening and bron-chial wall thickening) + (3.438 × invasions of lesion in the peripheral lobes) + (−0.304 × the number of leukocytes) + (−1.478 × cough) + (−1.830 × pharyngalgia) + (−2.413 × headache), where e is a natural logarithm. The area under the ROC curve (AUC) of this model was calculated to be 0.945 (0.915 - 0.976). The sensitivity is 0.920 and the specificity is 0.827 when the appropriate critical point is 0.360. Conclusions: A mathematical equation prediction model for predicting the probability of the first diagnosis of 2019-nCoV can be established based on the initial diagnostic clinical data of moderate 2019-nCoV. The prediction model is a good assistant diagnostic method for its high accurateness.

ROLE OF TOLL-LIKE RECEPTOR 4 IN AIRWAY INFLAMMATION OF CHRONIC OBSTRUCTIVE PULMONARY DISEASES

Objective To confirm if pulmonary epithelial cells express Toll-like receptor 4 （TLR4） and investigate the role of TLR4 in airway inflammation of chronic obstructive pulmonary diseases （COPD）. Methods The expressions of TLR4, IL-8 mRNA and NF-KB activation stimulated by differen factors E lipopolysacharides （LPS）, interleukin-lβ, cigarette smoking extract （CSE）] in pulmonary epithelial cells were investigated. Results LPS, CSE and IL-lβ induced the production of IL-8 and activation of NF-KB. The levels of 1L-8 mRNA and NF-KB protein in E1A ＋ cell were markedly higher than E1A- cell and A549 cell （ P 〈0. 05）. The TLR4 mRNA of all the cells increased along with the increase of LPS＇ stimulated time. There was significant difference among different LPS＇ doses （ 12 h： P = O. 039 ; 24 h ： P = O. 013 ）. The TLR4 mRNA of E1A ＋ cell was higher than the other two groups （ P 〈0. 05）. IL-lβ induced all the cells expressing TLR4 mRNA. CSE had no effect on the expression of TLR4 mRNA. Conclusion Pulmonary epithelial cells express TLR4. LPS and IL-lβ up-regulate IL-8 mediated via the activation of NF-KB induced by TLR4. But CSE up-regulates IL-8 mediated via the activation of NF-KB, which has no relation to TLR4 and may have another signal transduction pathway.

Metformin promotes anti-tumor immunity in STK11 mutant NSCLC through AXIN1-dependent upregulation of multiple nucleotide metabolites

Background:Metformin has pleiotropic effects beyond glucose reduction,including tumor inhibition and immune regulation.It enhanced the anti-tumor effects of programmed cell death protein 1(PD-1)inhibitors in serine/threonine kinase 11(STK11)mutant non-small cell lung cancer(NSCLC)through an axis inhibition protein 1(AXIN1)-dependent manner.However,the alterations of tumor metabolism and metabolites upon metformin administration remain unclear.Methods:We performed untargeted metabolomics using liquid chromatography(LC)-mass spectrometry(MS)/MS system and conducted cell experiments to verify the results of bioinformatics analysis.Results:According to the Kyoto Encyclopedia of Genes and Genomes(KEGG)pathway database,most metabolites were annotated into metabolism,including nucleotide metabolism.Next,the differentially expressed metabolites in H460(refers to H460 cells),H460_met(refers to metformin-treated H460 cells),and H460_KO_met(refers to metformin-treated Axin1-/-H460 cells)were distributed into six clusters based on expression patterns.The clusters with a reversed expression pattern upon metformin treatment were selected for further analysis.We screened out metabolic pathways through KEGG pathway enrichment analysis and found that multiple nucleotide metabolites enriched in this pathway were upregulated.Furthermore,these metabolites enhanced the cytotoxicity of activated T cells on H460 cells in vitro and can activate the stimulator of the interferon genes(STING)pathway independently of AXIN1.Conclusion:Relying on AXIN1,metformin upregulated multiple nucleotide metabolites which promoted STING signaling and the killing of activated T cells in STK11 mutant NSCLC,indicating a potential immunotherapeutic strategy for STK11 mutant NSCLC.

Pioneering role of machine learning in unveiling intensive care unitacquired weakness

In the research published in the World Journal of Clinical Cases,Wang and Long conducted a quantitative analysis to delineate the risk factors for intensive care unit-acquired weakness(ICU-AW)utilizing advanced machine learning methodologies.The study employed a multilayer perceptron neural network to accurately predict the incidence of ICU-AW,focusing on critical variables such as ICU stay duration and mechanical ventilation.This research marks a significant advancement in applying machine learning to clinical diagnostics,offering a new paradigm for predictive medicine in critical care.It underscores the importance of integrating artificial intelligence technologies in clinical practice to enhance patient management strategies and calls for interdisciplinary collaboration to drive innovation in healthcare.

Functional and psychosocial effects of pulmonary Daoyin on patients with COPD in China:study protocol of a multicenter randomized controlled trial

BACKGROUND： Chronic obstructive pulmonary disease （COPD） is a major public health problem worldwide. Pulmonary rehabilitation （PR） is an established intervention for the management of patients with COPD. Exercise training is an important part of PR, and its effectiveness in patients with COPD is well established. However, alternative methods of PR training such as Daoyin have not been appropriately studied. Hence, alternative forms of exercise training that require less exercise equipment and no specific training place should be evaluated. This paper describes the study protocol of a clinical trial that aims to determine if pulmonary Daoyin training will improve the exercise capacity and psychosocial function of patients with COPD in China. METHODS AND DESIGN： A multicenter, randomized, controlled trial will be conducted. A total of 464 patients meeting the inclusion criteria will be enrolled into this study with 232 patients in each of the trial group and the control group. Based on patient education, patients in the trial group will receive pulmonary Daoyin and continue with their usual therapy for three months. In the control group, patients will continue with their usual therapy. The primary outcome measures are exercise capacity assessed by the six-minute walking distance test and lung function. Secondary outcomes include dyspnea and quality of life. Measurements will be taken at baseline （month 0） and after the study period （month 3）. DISCUSSION： It is hypothesized that pulmonary Daoyin will have beneficial effects in improving exercise capacity and psychosocial function of patients with stable COPD, and will provide an alternative form of exercise training that is accessible for the large number of people with COPD. TRIAL REGISTRATION： This trial has been registered in ClinicalTrials.gov. The identifier is NCT01482000.

Analysis of CD4^+CD25^+ Regulatory T Cells and Foxp3 mRNA in the Peripheral Blood of Patients with Asthma

The changes of CD4^＋CD25^＋ regulatory T cells （CD4^＋CD25^＋ Treg） and Foxp3 mRNA in peripheral blood mononuclear cells （PBMCs） from patients with asthma were investigated in order to elucidate the possible roles of CD4^＋CD25^＋ Treg in the development of asthma. The peripheral blood samples were collected from 29 healthy controls （normal control group） and 78 patients with asthma which included 30 patients in exacerbation group, 25 patients in persistent group, and 23 patients in remission group. By using flow cytometry and RT-PCR, the CD4^＋CD25^＋ Treg ratio and Foxp3 mRNA in PBMCs were detected. The CD4^＋CD25^＋ Treg ratio and Foxp3 mRNA in PBMCs of exacerbation and persistent groups were lower than that of remission and normal control groups （P〈0.05）. Although the CD4^＋CD25^＋ Treg ratio and Foxp3 mRNA of remission group were also lower than that of normal control group, there was no significant difference between them （P〉0.05）. As compared with persistent group, exacerbation group had lower CD4^＋CD25^＋ Treg ratio and Foxp3 mRNA （P〈0.05）. It was indicated that the decrease of CD4^＋CD25^＋ Treg ratio and its function in PBMCs may be responsible for pathogenesis of asthma.

Effect of Dachengqi Decoction on NF-κB p65 Expression in Lung of Rats with Partial Intestinal Obstruction and the Underlying Mechanism

To investigate the effect of Dachengqi decoction on NF-κB p65 expression in lung of rats with partial intestinal obstruction and the underlying mechanism, 30 SD rats were randomly divided into three groups： sham-operation group, model group and Dachengqi decoction treatment group （Dachengqi group）, with 10 animals in each group. The models were made by partially ligating their large intestines outside the body. The pathological changes were analyzed by HE staining. The expression of NF-κB p65 in rats lung were measured by using real-time polymerase chain reaction and immunohistochemistry respectively. Moreover, the expression of caveolin-1 in rats lung was also measured to. Increased edema, interstitial thickening, hemorrhage, and infiltration of inflammatory cells were found in the model group. In contrast, this change was significantly reduced in Dachengqi group as compared with model group. In addition, the up-regulated caveolin-1 and NF-κB p65 were also suppressed by Dachengqi decoction in lung of rats with partial intestinal obstruction. We are led to concluded that the caveolin-l-NF-κB pathway plays an important role in the development of lung injury of rats with partial intestinal obstruction and Dachengqi decoction could down-regulate the expression of caveolin-1 and NF-κB p65 in lung of rats with partial intestinal obstruction.

ACEI attenuates the progression of CCl_4-induced rat hepatic fibrogenesis by inhibiting TGF-β1, PDGF-BB, NF-κB and MMP-2,9

AIM： Angiotensin II has pro-fibrotic function in the liver. Blockade of the renin-angiotensin-aldosterone-system （RAAS） attenuates hepatic fibrosis. The aim of the present study was to determine the mechanism of angiotensin-converting enzyme inhibitor （ACEI） on the progression of rat hepatic fibrosis. METHODS： Forty male Wistar rats were divided into three groups. Model group （Mo）： The rats were injected subcutaneously with 40% of CCl4 0.25 mL/100 g. Perindopril group （Pe）： The rats were injected subcutaneously with 40% of CCl4. Perindopril, equivalent to 2 mg/（kg·d）, was administrated. Control group （Nc）： the rats were treated with olive oil only. After 4 and 6 wk, the rats were killed. The liver sections were stained with Masson. The protein expressions of ATIR, TGF-β1 and PDGF-BB were examined by Western blot. Nuclear factor κB （NF-κB） DNA binding activity was examined by EMSA （Electrophoretic gel mobility shift assay）. Matrix metalloproteinase-2,9 （MMP-2,9） activity was assessed by zymography. Serum laminin （LN） and hyaluronic acid （HA） were measured using radioimmunoassays. RESULTS： Using Western blot, we clearly provided direct evidence for the expression of ATIR in liver. The expression was up-regulated when fibrogenesis occurred. Perindopril treatment significantly reduced mean fibrosis score, protein levels of ATIR, TGF-β1 and PDGF-BB, serum levels of HA and LN, and the activity of MMP-2,9. NF-κB DNA bindingactivity markedly increased in model group, perindopril treatment considerably reduced NF-κB DNA binding activity.CONCLUSION： Perindopril attenuates CCl4-induced hepatic fibrogenesis of rat by inhibiting TGF-β1, PDGF-BB, NF-BB and MMP-2,9.