Table of Content

20 January 2023, Volume 26 Issue 03

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Guide·Consensus·Pathway

Hot Point Problems in Clinical Diagnosis, Treatment and Management of Pulmonary Hypertension: Comparison and Interpretation of 2022 ESC/ERS Guidelines for the Diagnosis and Treatment of Pulmonary Hypertension and Chinese Guidelines for the Diagnosis and Treatment of Pulmonary Artery Hypertension (2021 Edition)

WAN Jun, ZHAI Zhenguo

2023, 26(03):  255-261.  DOI: 10.12114/j.issn.1007-9572.2022.0692

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The clinical and translational research of pulmonary hypertension (PH) has been continuously deepened, which has promoted the updating of PH related guidelines. On August 26, 2022, the European Society of Cardiology (ESC) and the Respiratory Society (ERS) jointly released the 2022 ESC/ERS Guidelines for the Diagnosis and Treatment of Pulmonary Hypertension (hereinafter referred to as the "2022 ESC/ERS Guidelines") . In January 2021, Chinese Thoracic Society and Chinese Association of Chest Physicians jointly released the Chinese Guidelines for the Diagnosis and Treatment of Pulmonary Hypertension (2021 Edition) (hereinafter referred to as the "Chinese Guidelines") , in which a lot of recommendations were put forward in line with China's national conditions combining with the research at home and abroad at that time. This paper will focus on the interpretation of the update points of the ESC/ERS Guidelines in combination with the relevant contents of the Chinese Guidelines.

Early Screening and Standardized Management Pathway for Bronchial Asthma in Shenzhen Community Healthcare Settings (Trial Version)

Shenzhen Group of Integrated Medical and Preventive Medicine Program for Respiratory Diseases, Shenzhen Center for the Prevention and Treatment of Major Respiratory Diseases, Shenzhen Community Health Association

2023, 26(03):  262-267.  DOI: 10.12114/j.issn.1007-9572.2022.0736

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Early screening, standardized diagnosis and treatment as well as effective management are keys to improve the control level and quality of life in patients with bronchial asthma (BA) , a common chronic airway disease. Frequent acute attacks of BA are associated with decreased quality of life, increased medical costs, and increased economic burden of patients. The management level of BA has increased in urban areas, but is still low in rural areas in China. To improve the level of early screening and diagnosing BA in community healthcare settings, and to enhance primary physicians' capability of standardized diagnosis and management of BA, Shenzhen Group of Integrated Medical and Preventive Medicine Program for Respiratory Diseases developed an early screening program and an standardized management pathway for BA after a group discussion based on relevant BA guidelines and consensuses that are applicable to Shenzhen community healthcare settings.

Editorial

Pre-COPD: a New Advance in COPD

BAI Yahu, GAO Shenghan, JI Siyu, SHANG Jinyu, DONG Yanchun, NING Kang

2023, 26(03):  268-273.  DOI: 10.12114/j.issn.1007-9572.2022.0621

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Chronic obstructive pulmonary disease (COPD) is a common chronic disease of the respiratory system that has high morbidity and mortality across the world. Like other chronic diseases, the development of COPD is a long process, and its prognosis could be improved significantly by early prevention and intervention. As the understanding of COPD in the international academic community gradually deepens, the 2022 Global Initiative for Chronic Obstructive Pulmonary Disease (GOLD) report first proposed the concept of pre-COPD. We reviewed the development of pre-COPD, analyzed its definition and diagnostic criteria, and summarized the significance of early identification of pre-COPD patients. Pre-COPD results from the widening and deepening of the existing concept of COPD prevention and treatment. A full understanding of pre-COPD will contribute to guiding the direction of COPD pathogenesis research and basic COPD research, and to improving the awareness of primary prevention of COPD in clinical practice, thereby reducing the prevalence and mortality of COPD and the burden of COPD on families and society.

Hypertension with Bronchial Asthma: Interaction Mechanism and Management

SUN Rui, PAN Yi, TAN Aihua, WANG Jianxin, WANG Xuan, ZHANG Lijing

2023, 26(03):  274-279.  DOI: 10.12114/j.issn.1007-9572.2022.0587

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Genetic susceptibility, inflammatory mechanism and unhealthy lifestyle are associated with increased risk of hypertension, a common chronic cardiovascular disease, and asthma, a common chronic respiratory disease. The research on the pathogenesis and management of hypertension with bronchial asthma has become a hotspot recently. We did a review of the latest relevant studies on hypertension and bronchial asthma. It was concluded that the co-morbidity of hypertension and asthma was related to common genetic disorders, systemic inflammation and poor lifestyle. Then gave a summary of the interaction mechanism between the two diseases and related management methods. Calcium channel blockers and angiotensin receptor antagonists were recommended as the first choice for drug treatment. This study aims at offering insights into clinical research on the pathogenesis and scientific management of hypertension with asthma.

Different Body Fluid Biopsies for Detecting Minimal Residual Disease in Lung Cancer: a Review of the Latest Advances

YAN Xing, LIU Shanmei, LIU Changhong

2023, 26(03):  280-286.  DOI: 10.12114/j.issn.1007-9572.2022.0641

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Post-treatment recurrence is a major difficulty in the treatment of lung cancer, one of the deadliest cancers worldwide. Minimal residual disease (MRD) as a "bridgehead" for the recurrence of solid tumors, is described as the presence of free circulating tumor cells or other tumor cell derivatives in the biological fluid of patients without any clinical cancer symptoms after the primary tumor treatment. China recently issued its first Consensus on the Detection and Clinical Application of MRD in Lung Cancer, aiming at improving the postoperative individualized treatment for lung cancer patients in accordance with the MRD status detected by the liquid biopsy. We reviewed the latest advances in the use of several most widely used body fluids (peripheral blood, urine, saliva, sputum and pleural effusion) in the detection of MRD in lung cancer, and discussed their values in guiding the precise treatment of MRD in lung cancer.

Original Research

Effect of Fatigue on the Possibility of Acute Exacerbation in COPD: a Prospective Cohort Study

FANG Ziyan, LI Xueer, YANG Xuening, LIU Jing, YANG Congyan, ZHANG Feng, AKIMANA Sandra, WANG Yan, ZHANG Jing

2023, 26(03):  287-292.  DOI: 10.12114/j.issn.1007-9572.2022.0342

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Background

Chronic obstructive pulmonary disease (COPD) is a common respiratory disease that is associated with high risk of disability and mortality. Although evidence suggests that fatigue may induce acute exacerbation in COPD, it needs to be further tested.

Objective

To explore the relationship between fatigue and the acute exacerbation in COPD.

Methods

By use of convenient sampling, a total of 597 COPD patients were selected from the First Affiliated Hospital of Bengbu Medical College, the Second Affiliated Hospital of Bengbu Medical College and the Third People's Hospital of Bengbu to establish a cohort study population between March 2019 and October 2020. During the hospitalization, general information such as gender, age, educational level, marital status, living style, comorbidities, smoking history, and monthly family income were collected from patients. Fatigue Scale-14 was used to measure the fatigue status, BODE index was used to predict the severity and prognosis, Anxiety and depression were assessed by the Anxiety Scale (HADS-A) and the Depression Scale (HADS-D) in the Hospital Anxiety and Depression Scale (HADS) . The patients were followed up for 1 year after discharge, recorded the occurrence of acute exacerbation in COPD, and assessed the quality of life with COPD Assessment Test (CAT) . Univariate analysis and multivariate Cox regression analysis were performed to identity factors possibly associated with the acute exacerbation in COPD. ROC curve analysis was used to measure the performance of fatigue in predicting acute exacerbation in COPD.

Results

The lost cases were screened and eliminated according to the corresponding inclusion criteria and exclusion criteria, five hundred and fifty cases were finally included for analysis, 416 of them had fatigue, and other 134 did not. Patients with and without fatigue had significant differences in smoking prevalence, mean number of acute exacerbations in a year, BODE index, HADS-A score, and CAT score (P<0.05) . Multivariate Cox regression analysis showed that FS-14 score, BODE index and CAT score are risk factors for acute exacerbation in COPD (P<0.05) . ROC curve analysis showed that the area under the curve of fatigue in predicting the acute exacerbation in COPD was 0.826, with 85.2% sensitivity, 65.4% specificity, and 0.506 Youden's index.

Conclusion

Fatigue increases the risk of acute exacerbation in COPD to a certain extent. So clinical delivery of targeted preventive interventions may be beneficial to the reduction of acute exacerbation in COPD.

Mechanistic of Ginkgo Biloba Extract in the Prevention and Treatment of COPD: Regulating Autophagy in Alveolar Macrophages via PI3K/Akt/mTOR Signaling Pathways

GUO Dongwei, ZHANG Pengfei, REN Mingjun, LIAO Lijun, HUANG Ruyan, LUO Xiangrong

2023, 26(03):  293-303.  DOI: 10.12114/j.issn.1007-9572.2022.0558

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Background

Ginkgo biloba extract (GBE) has been found to be effective in inhibiting the airway and systemic inflammatory response and improve airway remodeling in rat models of chronic obstructive pulmonary disease (COPD) , but the mechanism remains unclear.

Objective

To discuss the mechanism of GBE regulating alveolar macrophage autophagy through phosphatidylinositol 3-kinase (PI3K) /protein kinase B (Akt) /mammalian target of rapamycin (mTOR) signaling pathways to prevent and treat COPD.

Methods

A total of 90 SPF male Wistar rats were equally randomized into normal control group, COPD model group, GBE group, bicalutamide group, rapamycin group, and Taselisib group. The normal control group were normally fed except that normal saline was injected into their trachea on the 1st and 14th days of intervention, the other 5 groups were treated with exposure to cigarette smoking combined with intratracheal injection of lipopolysaccharide (LPS) to establish rat models of COPD. The GBE group received intraperitoneal injection of Shuxuening injection from the 15th day to the 28th day of the experiment, while bicalutamide, rapamycin, and Taselisib groups were given bicalutamide, rapamycin, and taselisib, respectively, from the 29th day to the 42nd day of the experiment. HE staining was used to observe alveolar pathological changes and airway remodeling. ELISA was used to detect the levels of interleukin -6 (IL-6) and interleukin -8 (IL-8) in alveolar lavage fluid (BALF) and the serum. The number of alveolar macrophages was counted under microscope. The ultrastructure of alveolar macrophages was observed by transmission electron microscope. Western blotting was used to measure the expression levels of autophagy-related proteins in alveolar macrophages. The ratio of microtubule-associated protein light chain 3 (LC3) -Ⅱ/LC3-Ⅰwas calculated subsequently.

Results

As of the models being successfully established, the rats in normal control, COPD model, GBE, bicalutamide, rapamycin, and Taselisib groups numbered 12, 11, 12, 12, 12, and 11, respectively. H&E staining showed that the degree of alveolar injury in COPD model group was more severe than that of GBE, bicalutamide, rapamycin, or Taselisib group (P<0.05) . COPD model group had larger mean linear intercept and mean alveolar area as well as less mean alveolar number than GBE, bicalutamide, rapamycin, or Taselisib group (P<0.05) . Moreover, COPD model group had less complete bronchial wall structure than GBE, bicalutamide, rapamycin, or Taselisib group. The levels of BALF and serum IL-6 and IL-8 in COPD model group were higher than those of each of other five groups (P<0.05) . Among all groups, the number of macrophages in the normal control group was the lowest, while that of COPD model group was the highest (P<0.05) .Transmission electron microscopy showed that COPD model group had less autophagolysosomes in alveolar macrophages than GBE, bicalutamide, rapamycin, or Taselisib group. The normal control group had higher expression levels of PI3Kp110α, Akt, p-Ak, mTOR and p-mTOR and lower ratio of LC3-II/LC3-I than each of other five groups (P<0.05) . COPD model group had higher expression levels of PI3Kp110α, Akt, p-Akt, mTOR and p-mTOR, and lower ratio of LC3-Ⅱ/LC3-Ⅰ compared with GBE, bicalutamide, rapamycin or Taselisib group (P<0.05) .

Conclusion

GBE maintained the autophagy function of alveolar macrophages, reduced macrophage infiltration, inhibited the inflammatory response and alveolar damage, and improved airway remodeling in model rats of COPD through regulating the PI3K/Akt/mTOR signaling pathway.

Effect of Impaired Fasting Glucose on Estimated Glomerular Filtration Rate

LIU Linhua, ZHAN Jinfeng, XIA Zhongbin

2023, 26(03):  304-307.  DOI: 10.12114/j.issn.1007-9572.2022.0492

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Background

Estimated glomerular filtration rate (eGFR) is a quantitative indicator assessing the severity of chronic kidney disease. Studies have shown that elevated glucose in prediabetic period increases the risk of chronic kidney disease, but its direct effect on eGFR has been less reported.

Objective

To investigate the effect of fasting blood glucose level on eGFR in a community-dwelling population with impaired fasting glucose (IFG) .

Methods

Participants (n=28 601) were selected from a group of physical examinees from Physical Examination Center, the Second Affiliated Hospital of Nanchang University during January to December 2020 according to the inclusion criteria and exclusion criteria. Demographic and clinical data〔past medical history, sex, age, BMI, blood pressure, serum uric acid, lipids, and creatinine, fasting plasma glucose (FPG) , routine urine parameters〕were collected and compared between subjects with elevated FPG (5.6 mmol/L≤FPG<7.0 mmol/L) and those with normal FPG (3.9 mmol/L≤FPG<5.6 mmol/L) . The influence of FPG on eGFR was assessed by the Mann-Whitney U-test comparing multiple factors〔sex, age, mean arterial pressure (MAP) , serum uric acid, total cholesterol, BMI〕 between subjects with elevated and normal FPG after matching. The correlation between FPG and eGFR was assessed in subjects with elevated and normal FPG before and after matching.

Results

There were 25 539 individuals with normal FPG, and 3 062 with elevated FPG. There were significant difference in age, MAP, serum uric acid, total cholesterol, BMI and eGFR between the two groups (P<0.05) . Individuals with elevated FPG had higher eGFR than those with normal eGFR (P<0.05) after matching age, MAP, serum uric acid, total cholesterol, and BMI between the two groups (P<0.05) . Correlation analysis showed that FPG had a weak negative correlation with eGFR in all participants (r_s=-0.047, P<0.05) , but had a weak positive correlation with eGFR in the matched population (r_s=0.065, P<0.05) , and the correlation coefficient increased further in the matched individuals with elevated FPG (r_s=0.127, P<0.05) .

Conclusion

IFG may be associated with elevated eGFR, which provides a possible basis for the glomerular hyperfiltration state that occurs with elevated glucose in prediabetes.

Sequences of SS_TSE and Modified Abdominal T2WI Magnetic Resonance Imaging in the Diagnosis of Neonatal Pneumonia

LAN Hailong, NING Guanyuan, HUANG Xiangmin, XIAO Yeyu

2023, 26(03):  308-312.  DOI: 10.12114/j.issn.1007-9572.2022.0282

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Background

In the diagnosis of neonatal pneumonia, the possibility of iatrogenic injury caused by magnetic resonance imaging (MRI) may be lower than that by widely used X-ray and even computed tomography scan. However, there are few studies on the application of MRI in the diagnosis of neonatal pneumonia.

Objective

To explore the feasibility of using MRI for the diagnosis of neonatal pneumonia in primary care based analyzing the application of SS_TSE and modified abdominal T2WI sequences at 1.5 Tesla for the diagnosis of this illness.

Methods

Nineteen neonates diagnosed with pneumonia by MRI were selected from Wuchuan People's Hospital from January to November 2020. Six parameters under SS_TSE and modified abdominal T2WI sequences including subjective MR score, signal intensity of the lesion (SI lesion) , lung signal intensity (SI lung) , lung noise (SD lung) , calculated image signal-to-noise ratio (SNR) and lesion signal intensity ratio (SIR) were statistically analyzed.

Results

The values of these six parameters of SS_TSE sequence were 2.2 (2.0, 2.8) , (505.0±102.5) , (243.5±32.0) , (21.8±6.7) , (12.0±3.1) , and 2.1 (2.0, 2.2) , respectively. And The values of subjective score, SI lesion, SI lung, SD lung, SNR and SIR of T2WI sequence were 2.7 (2.0, 3.3) , (293.1±129.6) , (99.7±40.3) , (19.0±7.6) , (5.6±2.3) , and 3.1 (2.6, 3.2) , respectively. Based on the combination of SS_TSE and T2WI images, the diagnoses for all cases were made.

Conclusion

The brightness of the lesions in SS_TSE sequence is higher, with better objective definition of the images. T2WI sequence has higher subjective definition, and the signal of the lesions was markedly different from the background, which is helpful to observe the border of the lesions. SS_TSE and T2WI sequences are complementary in the diagnosis of neonatal pneumonia. In a word, it is feasible to apply MRI for the diagnosis of neonatal pneumonia at 1.5 Tesla to reduce the possibility of iatrogenic injury.

Reliability and Validation of a Chinese Version of the Sleep Disturbance Scale for Children in Preschoolers

CHEN Xianrui, LIN Xiaoxia, XU Ping, CHEN Yanhui, CHEN Shan, YAO Yonghua

2023, 26(03):  313-320.  DOI: 10.12114/j.issn.1007-9572.2022.0479

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Background

There are less studies on sleep disturbance and limited effective screening and assessment scales for sleep disturbance in Chinese preschoolers.

Objective

To assess the reliability and validity of the Chinese version of Sleep Disturbance Scale for Children (SDSC-C) in Chinese preschoolers, providing evidence for expanding the application of SDSC in preschoolers.

Methods

By use of convenience sampling, preschool children (3-5 years old) were selected as survey participants for testing the psychometrics of the draft of the SDSC-C from one urban community and one rural community in each of five cities (Fuzhou, Quanzhou, Longyan, Sanming and Nanping) of Fujian Province from June to November 2021 with the assistance of the Fujian Family Planning Association Network, and their parents were selected as their agents to complete the questionnaire survey. Then its items were modified, screened and evaluated by an expert group, after that, the draft was developed into a formal version consisting of six domains and 23 items. The reliability and validity of the scale were assessed by item analysis, reliability analysis, validity analysis, exploratory factor analysis, and confirmatory factor analysis.

Results

The survey obtained a response rate of 92.04% (370/402) . The high-score group〔n=106, ranked the top 27% in terms of total score of SDSC-C (≥49 points) 〕and low-score group〔n=113, ranked the bottom 27% in terms of total score of SDSC-C (≤37 points) 〕divided by critical ratio method had significant differences in the score of each item of the SDSC-C (P<0.05) . The Cronbach's α of the scale was 0.86, with 0.87 of estimating interrater agreement. The I-CVI for each item was >0.78, with kappa values were > 0.74. The S-CVI/UA was 0.87 and S-CVI/Ave was 0.98. For SDSC-C , KMO= 0.85, results of Bartlett's test of sphericity were χ²=3 013.30, P<0.001. By principal component analysis, 7 factors with an engivalue >1 were extracted, explaining 65.125% of the total variance. However, a six-factor solution (i.e. six types of sleep disorder) based on parent-reported sleep disorder symptoms in our study indicated the factor loading of items ranged from 0.34-0.85, which could explain 60.539% of the total variance. The confirmatory factor analysis showed the values of fitting indicator as follows: χ²/DF=2.66, CFI=0.84, TLI=0.81, SRMR=0.08, and RMSEA=0.08.

Conclusion

This study revealed that the SDSC-C is a valid and reliable scale that can provide a comprehensive and detailed assessment of sleep disturbances in Chinese preschool children, which is beneficial to clinicians for early screening and assessment of sleep-related problems in preschool children.

Literature-based Research on Common Syndromes of Cough Variant Asthma

WANG Jun, ZHANG Dong, FENG Zhenzhen, ZHANG Shujuan, ZHAO Guixiang, ZHANG Hailong, LI Jiansheng

2023, 26(03):  321-328.  DOI: 10.12114/j.issn.1007-9572.2022.0287

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Background

Recent studies about the use of Traditional Chinese Medicine (TCM) to treat cough variant asthma (CVA) , a common respiratory disease, are increasing. TCM has proven to be effective in improving symptoms and the overall treatment efficacy of CVA, but relevant research is still in the exploratory stage, and there are no unified and standardized diagnostic criteria for CVA.

Objective

To explore the common syndromes and symptom characteristics of CVA.

Methods

The literature related to CVA syndromes or symptoms treated by TCM was searched in CNKI, Wanfang Data, VIP, and SinoMed databases from inception to October 2, 2021. SPSS 25.0 software was used to support the input of extracted information to establish a database, and the statistical treatment of the frequencies of CVA-related syndromes and symptoms. The symptoms with a frequency over 5% were selected for factor analysis, and the common factors were extracted for further hierarchical cluster analysis, and the potential syndromes were inferred from the results. Using Lantern 5.0 software, based on the LTM-EAST (Latent Tree Model-Extension Adjustment Simplification until Termination algorithm) , a latent structure model was constructed and a comprehensive cluster analysis was performed to infer potential syndromes. Then the common syndromes and symptom characteristics of CVA were obtained by combining the results of frequency statistics, hierarchical clustering, and latent structure analysis.

Results

A total of 621 studies were included, involving 115 symptoms, including cough, pharyngeal itching, low sputum volume, etc. Thirty-nine syndromes were involved, among which the highly frequent syndromes were pathogenic wind invading the lung, wind and cold invading the lung, and lung yin deficiency. Six potential syndromes were derived from hierarchical cluster analysis, including wind and heat invading the lung, liver fire invading the lung, lung qi deficiency and so on. The latent structure analysis was performed on the symptoms with frequency over 3%, by which 21 latent variables, and 42 latent classes were obtained, and 12 potential syndromes were further inferred by comprehensive clustering, including pathogenic wind invading the lung, wind and cold invading the lung, wind and heat invading the lung, and so on. Based on the above analyses, 11 common syndromes were finally identified. Each syndrome has specific symptom characteristics, for example, the syndrome of pathogenic wind invading the lung manifests itself as cough, sneezing, running nose, and nasal congestion.

Conclusion

We identified 11 common syndromes of CVA with typical symptom characteristics, which are pathogenic wind invading the lung, wind and cold invading the lung, wind and heat invading the lung, wind and dryness damaging the lung, phlegm and heat congesting in the lung, phlegm and dampness accumulating in the lung, liver fire invading the lung, cold fluid retention in the lung, lung qi deficiency, lung yin deficiency, and lung-spleen qi deficiency. Our analysis will provide a basis for clinical syndrome differentiation and clinical investigation of CVA.

Evaluation of Inflammatory Factors from Bronchoalveolar Lavage Fluid on the Potential of Lung Recruitment Maneuvers in Patients with Acute Respiratory Distress Syndrome

HUAI Jiaping, JIANG Chenlin, DENG Hongsheng, YE Xiaohua

2023, 26(03):  329-334.  DOI: 10.12114/j.issn.1007-9572.2022.0471

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Background

At present, there is a lack of practical and effective methods to evaluate lung recruitment maneuver in patients with acute respiratory distress syndrome (ARDS) in the clinic.

Objective

To evaluate the potential of inflammatory factors (IF) from bronchoalveolar lavage fluid (BALF) for lung recruitment maneuver (RM) in patients with ARDS.

Methods

Sixty-two ARDS patients requiring invasive mechanical ventilation in ICU at Affiliated Jinhua hospital of Zhejiang University School of Medicine from March 2020 to March 2022 were included for the study. The levels of IL-6, IL-8, IL-10 in BALF, lung ultrasound score (LUS) and oxygenation index (PaO₂/FiO₂) , which were monitored before and on the 3rd day after the RM. According to the differences in LUS (ΔLUS) before and after RM, patients were divided into RM effective group (RM-E group) with the value greater than 5 points and RM inactive group (RM-N group) with the value less than 5 points, and the changes of IF in BALF were compared between the two groups; the correlations between ΔIF, differences of IF between the two groups before and after RM, and ΔLUS (ΔIL-6, ΔIL-8, ΔIL-10 and ΔLUS) were analyzed. The ROC was used to calculate the predictive value of IF in BALF for the potential of RM.

Results

The study enrolled 38 patients in the RM-E group and 24 in the RM-N group. There was no statistical difference in the levels of IL-6, IL-8 and IL-10 in BALF and LUS between the two groups before RM (P>0.05) . There was also no significant difference in tidal volume (VT) , positive end expiratory pressure (PEEP) , plateau pressure (P_plat) , fraction of inspiration O₂ (FiO₂) and PaO₂/FiO₂ between the two groups (P>0.05) . The levels of IL-6, IL-8, IL-10 in BALF and PaO₂/FiO₂ before and after RM in the two groups were statistically significant (P<0.05) . There was significant difference in LUS before and after RM in RM-E group (P<0.05) , but no significant difference in LUS before and after RM in RM-N group (P>0.05) . After RM, the difference of ΔIL-6, ΔIL-8, ΔIL-10 and ΔLUS was statistically significant in the two groups (P<0.05) . Correlation analysis showed that ΔIL-6 and ΔLUS had a significant positive correlation (P<0.05) , while ΔIL-8, ΔIL-10 and ΔLUS had no significant correlation (P>0.05) . The area under the curve (AUC) predicted RM potential by ΔIL-6 in patients with ARDS was 0.794, the sensitivity was 94.7%, and the specificity was 70.8%.

Conclusion

The detection of IF in BALF, especially IL-6, has a certain clinical value in evaluating the lung recruitment maneuver potential in patients with ARDS.

Association between Nutritional Status and Prognosis in Elderly Patients with Heart Failure with Preserved Ejection Fraction and Coronary Heart Diseases

CHEN Ying, ZHENG Hui, HE Yu

2023, 26(03):  335-342.  DOI: 10.12114/j.issn.1007-9572.2022.0276

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Background

The prevalence of heart failure (HF) is growing in a rapidly increased number of older adults (≥60 years) , which, together with older age, produces an impact on nutritional status of the HF cases. But there are relatively few studies on the impact of nutritional status on the prognosis in elderly patients with chronic HF.

Objective

To investigate the association of nutritional status with prognosis in elderly patients with HF with preserved ejection fraction (HFpEF) and coronary heart disease.

Methods

A retrospective cohort study was conducted. Inpatients with HFpEF and coronary heart disease (≥60 years old, NYHA gradeⅡ-Ⅳ) treated in Department of Geriatrics, Beijing Tongren Hospital, Capital Medical University between 2017 and 2019 were enrolled. Clinical and laboratory data were collected. HF-related readmission and all-cause mortality within one year after discharge were followed up. Nutritional status was evaluated by controlling nutritional status (CONUT) score, geriatric nutritional risk index (GNRI) and prognostic nutritional index (PNI) . Patients were divided into non-malnutrition group (CONUT score 0-1, n=42) , low malnutrition risk group (CONUT score 2-4, n=181) and medium-high malnutrition risk group (CONUT score 5-12, n=156) . The differences in clinical data and prognosis among the three groups were compared. Univariate and multivariate logistic regression analyses were used to explore the influencing factors of readmission due to HF and all-cause mortality within one year after discharge. ROC analysis was used to analyze the prognostic value of CONUT score, GNRI and PNI for readmission due to HF and all-cause mortality within 1 year after discharge.

Results

Age, proportion of elderly patients, sex, BMI, bed rest, length of hospital stay, NYHA grade, hemoglobin, lymphocytes, urea nitrogen, creatinine, total protein, albumin, triacylglycerol, total cholesterol, low density lipoprotein cholesterol, B-type brain natriuretic peptide (BNP) , all-cause death within 1 year were compared among the three groups, and there were statistically significant differences (P<0.05) ; among them, age, proportion of elderly patients, bed rest, length of hospital stay, NYHA grade, old myocardial infarction, urea nitrogen, creatinine, BNP, and all-cause death within 1 year in the no-malnutrition risk group and the low-malnutrition risk group were significantly lower than those in the medium-high malnutrition risk group (P<0.05) , and BMI, hemoglobin, lymphocytes, total protein, albumin, triacylglycerol, total cholesterol and low-density lipoprotein cholesterol were significantly higher than those in the medium-high malnutrition risk group (P<0.05) . Univariate logistic regression analysis showed that age, bed rest, length of stay, NYHA grade, hemoglobin, albumin, BNP, left ventricular ejection fraction, CONUT score, GNRI and PNI are the influencing factors of readmission due to HF and all-cause death within 1 year (P<0.05) . Multivariate logistic regression analysis showed that CONUT score〔OR=1.567, 95%CI (1.302, 1.885) , P<0.05〕 is an influence factor of all-cause death within 1 year (P<0.05) . ROC analysis estimating the performance in predicting all-cause mortality within one year after discharge showed that the AUC of CONUT score was 0.780〔95%CI (0.714, 0.845) 〕 with 0.723 sensitivity and 0.722 specificity when the optimal cut-off value was determined as 7.5, the AUC of GNRI was 0.695〔95%CI (0.604, 0.786) 〕with 0.532 sensitivity and 0.833 specificity when the optimal cut-off value was determined as 89, and the AUC of PNI was 0.722〔95%CI (0.643, 0.800) 〕 with 0.723 sensitivity and 0.654 specificity when the optimal cut-off value was determined as 41.

Conclusion

CONUT score can be used as the preferred nutritional evaluation tool for mortality risk assessment in elderly patients with HFpEF and coronary heart disease, and nutritional intervention may become one of the therapeutic targets for reducing mortality in the future.

Clinical Application of a Novel Noninvasive Positive Pressure Ventilation Face Mask with Two Channels and Constant Leakage for Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease and Carbon Dioxide Retention

HUANG Tao, LUO Na, LUO Song, XU Qin

2023, 26(03):  343-347.  DOI: 10.12114/j.issn.1007-9572.2022.0088

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Background

Noninvasive positive pressure ventilation (NPPV) is a major respiratory support technique for patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) and carbon dioxide (CO₂) retention. However, the obvious dead space in available masks used for NPPV could easily lead to repeated CO₂ inhalation, which affects the correction of CO₂ retention.

Objective

To develop a face mask with two channel and constant leakage (TCCL) used for NPPV, and to examine its value in NPPV treatment of AECOPD patients with CO₂ retention.

Methods

Thirty patients with AECOPD and typeⅡ respiratory failure treated with NPPV were recruited from the ICU, the First Affiliated Hospital of Chongqing Medical University from 2020 to 2021, and equally randomized into an experimental group (using the TCCL mask) and an control group (using the traditional mask with an exhalation valve on the side for NPPV) . Treatment effectiveness was assessed using arterial partial pressure of oxygen (PaO₂) and partial pressure of carbon dioxide (PaCO₂) monitored at baseline, and at the end of 4, 8, 24, and 48 hours of NPPV treatment as well as 24 hours after NPPV cessation.

Results

The two-way repeated measures ANOVA indicated that treatment time and treatment approach had no interactive effects on PaO₂ (P>0.05) . Treatment time produced significant main effects on PaO₂ (P<0.001) , while treatment approach did not (F=0.153, P=0.699) . In both groups, the level of PaO₂ at baseline was lower than that at the end of 4, 8, 24, and 48 hours of NPPV treatment and 24 hours after NPPV cessation (P<0.05) ; the level of PaO₂ at the end of 4 hours of treatment was lower than that measured at the subsequent four time points (P<0.05) ; the PaO₂ level at the end of 8 hours of treatment was lower than that at 48 hours of treatment and 24 hours after NPPV cessation (P<0.05) . The PaO₂ level at 24 hours of treatment was lower than that at 48 hours of treatment in the control group (P<0.05) . The PaO₂ level at 24 hours of treatment was lower than that at 48 hours of treatment and 24 hours after NPPV cessation in the experimental group (P<0.05) . But there was no significant difference in PaO₂ level measured at each time point between the groups (P>0.05) . Treatment time and treatment approach had no interactive effects on PaCO₂ (P>0.05) . Treatment time produced significant main effect on PaCO₂ (P<0.001) , treatment approach also exerted obvious effect on it (F=5.129, P=0.031) . Compared with the control group, the experimental group demonstrated lower PaCO₂ levels at the end of 4, 8 and 24 hours of treatment (P<0.05) . In both groups, the PaCO₂ level at baseline was higher than that at the end of 4, 8, 24, and 48 hours after NPPV treatment and 24 hours after NPPV cessation (P<0.05) . The PaCO₂ level at the end of 4 hours of treatment was higher than that measured at the subsequent four time points (P<0.05) . The PaCO₂ level at the end of 8 hours of treatment was higher than that measured at the subsequent three time points (P<0.05) . The PaCO₂ level of the control group at 24 hours of treatment was higher than that at 48 hours of treatment and 24 hours after NPPV cessation (P<0.05) . The PaCO₂ level in the experimental group at 24 or 48 hours of treatment was higher than that at 24 hours after NPPV cessation.

Conclusion

TCCL mask may contribute to rapid correction of CO₂ retention and effective improvement of oxygenation in AECOPD patients.

Evidence-based Medicine

A Meta-analysis of the Impact of COVID-19 on Stroke Mortality

HUANGFU Xiaojuan, LI Xiaojuan, CHEN Min, LIU Jihong, ZHAI Rui, CAI Zhipeng, LI Litao

2023, 26(03):  348-355.  DOI: 10.12114/j.issn.1007-9572.2022.0480

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Background

The COVID-19 pandemic seriously affects human health and life. COVID-19 has been reportedly associated with a high risk of thrombotic events, which are closely associated with stroke.

Objective

To assess the effect and possible mechanism of COVID-19 on stroke morbidity, providing a reliable theoretical basis for scientific prevention and treatment of COVID-19 in stroke.

Methods

We searched databases of Web of Science, PubMed, EmBase, Cochrane Library, CNKI and Wanfang Data for cohort studies and case-control studies related to COVID-19 and stroke published from December 2019 to January 2022. Two researchers conducted literature screening and data extraction separately. The Newcastle-Ottawa Scale was used to assess the quality of included studies. Meta-analysis was used to evaluate the impact of COVID-19 on stroke mortality. Funnel plot was used to evaluate the potential publication bias.

Results

A total of 18 studies were included, 12 of them were of good quality, and other 6 were of fair quality. Meta-analysis showed that stroke patients with COVID-19 had higher mortality〔RR=4.16, 95%CI (2.82, 6.13) , P<0.000 01〕, prolonged prothrombin time (PT) 〔MD=0.78, 95%CI (0.35, 1.20) , P=0.000 3〕, higher D-dimer level〔MD=1.34, 95%CI (0.83, 1.84) , P<0.000 01〕 and higher NIHSS score〔MD=6.66, 95%CI (4.54, 8.79) , P<0.000 01〕, as well as younger age〔MD=-2.04, 95%CI (-3.48, -0.61) , P=0.005〕than those without COVID-19. There was no statistically significant difference in activated partial thromboplastin time between stroke patients with and without COVID-19〔MD=2.51, 95%CI (-2.69, 7.71) , P=0.34〕. Funnel plot assessing potential publication bias in the impact of COVID-19 on stroke mortality was basically symmetrical.

Conclusion

COVID-19 could increase the risk of stroke mortality, which may be related to alterations in the coagulation system manifested by abnormal PT and D-dimer level and so on. And the outcomes of stroke patients with COVID-19 were associated with age and NIHSS score at admission.

Risk Factors for Bronchopulmonary Dysplasia in Premature Infants: a Meta-analysis

YU Zhumei, LIU Annuo, XIAO Juan, TANG Yuxia, YU Li, TONG Huanhuan

2023, 26(03):  356-366.  DOI: 10.12114/j.issn.1007-9572.2022.0544

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Background

Bronchopulmonary dysplasia (BPD) is the most common severe lung disease in premature infants, which is the damage to immature lung caused by multiple factors. Identifying risk factors of BPD is important for developing prevention strategies. The risk factors of BPD are still controversial, and there are few systematic reviews.

Objective

To systematically analyze the risk factors for BPD in preterm infants.

Methods

This study searched CNKI, Wanfang Data, CBM, VIP, PubMed, Embase, Web of Science and Cochrane Library for studies evaluating risk factors of BPD from inception to October 2021. We used RevMan 5.3 software to perform meta-analysis.

Results

We included 23 studies of 33 508 BPD premature infants. The overall NOS scores of included studies were relatively high. The results of meta-analysis showed that mother with chorioamnionitis〔OR=1.46, 95%CI (1.18, 1.80) , P=0.000 6〕, gestational hypertension〔OR=1.26, 95%CI (1.15, 1.37) , P<0.000 01〕, premature rupture of membranes〔OR=1.18, 95%CI (1.10, 1.26) , P<0.000 01〕, preterm infants with small for gestational age (SGA) 〔OR=2.64, 95%CI (1.85, 3.77) , P<0.000 01〕, delivery room intubation of preterm infants〔OR=2.50, 95%CI (1.39, 4.50) , P=0.002〕, premature 5 min Apgar score<7 points〔OR=2.47, 95%CI (1.36, 4.47) , P=0.003〕, male preterm infants〔OR=1.49, 95%CI (1.43, 1.55) , P<0.000 01〕, mechanical ventilation in preterm infants〔OR=1.59, 95%CI (1.28, 1.96) , P<0.000 1〕, mechanical ventilation in preterm infants>7 days〔OR=7.99, 95%CI (4.47, 14.29) , P<0.000 01〕, preterm infants treated with surfactant〔OR=3.46, 95%CI (1.96, 6.11) , P<0.000 1〕, steroids used in preterm infants〔OR=2.42, 95%CI (1.93, 3.03) , P<0.000 01〕, preterm infants with respiratory distress syndrome (RDS) 〔OR=3.40, 95%CI (2.01, 5.75) , P<0.000 01〕, preterm infants with patent ductus arteriosus (PDA) 〔OR=1.96, 95%CI (1.38, 2.79) , P=0.002〕, preterm infants with sepsis〔OR=1.82, 95%CI (1.36, 2.44) , P<0.000 1〕, preterm infants with necrotizing enterocolitis (NEC) 〔OR=1.62, 95%CI (1.18, 2.22) , P=0.003〕were risk factors for BPD in preterm infants. Preterm infants with high birth weight〔OR=0.79, 95%CI (0.76, 0.83) , P<0.000 01〕 and preterm infants with large gestational age〔OR=0.80, 95%CI (0.73, 0.87) , P<0.000 01〕were protective factors for BPD in preterm infants. Funnel plots, Begg's test and Egger's test showed that there was no publication bias (P>0.05) .

Conclusion

Current evidence showed that mother with chorioamnionitis, gestational hypertension, preterm rupture of membranes and preterm infants with SGA, delivery room intubation, 5 min Apgar score <7 points, male, mechanical ventilation, mechanical ventilation>7 days, administration of pulmonary surfactant, steroids, RDS, PDA, sepsis, NEC were risk factors for BPD in preterm infants. High birth weight and large gestational age were protective factors for BPD in preterm infants. Clinicians should identify and address the relevant risk factors of BPD, thus preventing the BPD in premature infants.

Research Progress of Ferroptosis in Acute Lung Injury

ZHOU Sijiang, NING Zong

2023, 26(03):  367-371.  DOI: 10.12114/j.issn.1007-9572.2022.0186

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Ferroptosis, a novel programmed cell death characterized by intracellular accumulation of lipid peroxides, has played an important role in a wide range of diseases. Acute lung injury is a critical illness caused by several reasons, and the mortality rate is high. With increasing research on the mechanism of acute lung injury, more evidence has shown that ferroptosis played an important role in the pathogenesis of acute lung injury. In this paper, we sorted the previous studies related to ferroptosis and found that all acute lung injury induced by ischemia-reperfusion, sepsis, radiation, drowning and oleic acid were involved in ferroptosis. We hope to provide a promising theoreticalbasis for the future diagnosis and treatment of acute lung injury by summarizing the mechanism of ferroptosis and its role in the pathogenesis of acute lung injury.

Review & Perspectives

Prognostic Biomarkers in Idiopathic Pulmonary Fibrosis: a Recent Review

XU Lili, HONG Yunzhe, LI Zhihui, YU Ningxia, DI Jiaqi, YANG Shuguang, LIN Qingqing, YU Xueqing

2023, 26(03):  372-379.  DOI: 10.12114/j.issn.1007-9572.2022.0327

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Idiopathic pulmonary fibrosis (IPF) is a fibrotic interstitial lung disease characterized by rapid progression, poor prognosis, and short median survival, seriously endangering patients' health. Early accurate prediction of the prognosis is an important part of the diagnosis and management process of IPF, which is conducive to the improvement of management and prognosis in IPF. A growing number of prognostic biomarkers for IPF have been discovered recently, and those with a high prognostic value could help to stratify prognostic risks and assess outcomes. We reviewed the latest literature about potential prognostic biomarkers of IPF, involving proteins, genes, microbial colonies and cells, and considered matrix metalloproteinase-7, telomere length and fibrocytes to be more reliable, while the prognostic values of Krebs von den lungen-6, surfactant protein A, and MUC5B promoter single nucleotide polymorphism are controversial and need to be further studied, and those of latent-transforming growth factor β-binding protein-2, angiopoietin-2, TOLLIP promoter SNP and microbial colony remain to be verified due to little evidence. It is hoped that our review could provide a reference for clinical selection of objective indicators for early identifying high-risk patients and timely initiating treatment, as well as future prognostic research on IPF.

Protocol of Key Project

Development of a New Remote Diagnosis and Treatment Model for Obstructive Sleep Apnea: a Non-inferiority Randomized Controlled Trial Protocol

YI Huijie, LIAO Xinyi, PI Mengyuan, XU liyue, ZHANG Chi, DONG Xiaosong, HAN Fang

2023, 26(03):  380-385.  DOI: 10.12114/j.issn.1007-9572.2022.0485

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Obstructive sleep apnea (OSA) is a high prevalent chronic disease that may lead to many complications, and cause great potential harm to health. Epidemiological studies have showed that OSA is closely related to the development of various cardiovascular diseases. There are about 66 million patients with moderate to severe OSA in China, but 80% of potential OSA patients have not been diagnosed and treated in time. OSA is mainly diagnosed and treated in a hospital-based sleep center currently, as the process is time-consuming and laborious, which may be lead to a delay in diagnosis and treatment of many patients. Supported by the development of Internet of Things, Internet technologies and other emerging technologies, remote medicine has been increasingly used in the diagnosis and management of chronic diseases owing to its advantages of easy access, interactivity, high efficiency, resource sharing, service continuity and without space-time constraints. Our center has initially built a management system for remote diagnosis and treatment of OSA, but its clinical efficacy and economic value need to be further verified. We designed a randomized controlled trial protocol to assess whether the clinical benefits of the low-cost remote healthcare model are similar to those of the traditional healthcare model by comparing them in terms of clinical efficacy and health economic benefits, hoping to provide a reference for the efficient use of medical resources and further promotion of remote diagnosis and treatment of chronic diseases.

Research of Typical Cases

Parkinson's Syndrome Secondary to Congenital Absence of the Left Internal Carotid Artery: a Case Report and Review of the Literature

SUN Xiaoling, LI Zhijun

2023, 26(03):  386-390.  DOI: 10.12114/j.issn.1007-9572.2022.0416

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Congenital absence of the internal carotid artery (ICA) is a rare congenital developmental anomaly, which is often associated with carotid canal atresia and structural abnormalities of the ICA. It may be asymptomatic, or shows noticeable symptoms such as Horner syndrome, loss of visual field, trigeminal neuralgia, pulsing tinnitus, memory dysfunction/dementia, transient ischemic attack, intracranial aneurysm, subarachnoid hemorrhage, pituitary dysfunction, and developmental malformations in multiple organs. We reported a case of congenital absence of the left ICA with Horner syndrome, aneurysm, and secondary Parkinson's syndrome. Along with the retrospective analysis of diagnosis, treatment and disease progression of this case, a review of relevant literature was conducted, to improve the recognition of this rare complication.