Yanqiu Wu

Purpose: The study aimed to compare the clinical characteristics and economic burden of Yi and Han hospitalized patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD).Patients and methods: The patients hospitalized for AECOPD were retrospectively enrolled at the Hospital of Integrated Traditional and Western Medicine in Liangshan Yi Autonomous Prefecture, China, from January 2020 to October 2022. Data regarding the characteristics, treatment, clinical outcomes, and economic burden of Yi and Han AECOPD patients included in the cohort were compared and analyzed. Propensity score matching (PSM) adjusted for age and gender differences was used to assess differences between the two groups.Results: Among 685 patients (297 Yi, 388 Han), smoking prevalence was similar (Yi 57.6% vs. Han 55.9%, P > 0.05). Yi patients were significantly younger (66.3 ± 11.0 vs. 76.2 ± 9.9 years, P < 0.001) with more females (36.4% vs. 27.8%, P = 0.017). After PSM, Yi patients showed: (1) lower comorbidity rates (coronary heart disease, hypertension, diabetes, and atrial fibrillation); (2) distinct laboratory profiles (higher hemoglobin, platelets, low-density lipoprotein cholesterol; lower D-dimer, PaO₂, and albumin); (3) reduced intensive care unit (ICU) transfers (P < 0.05) and non-invasive ventilation use (P < 0.05); and (4) more frequent pulmonary infections (45.1% vs. 35.8%, P = 0.014) in unmatched analysis.Conclusion: Significant ethnic differences exist in AECOPD presentation and management between Yi and Han populations, independent of age and gender. These findings highlight the need for ethnicity-tailored COPD management strategies in multi-ethnic regions.

Objectives: Diagnosis and assessment of chronic obstructive pulmonary disease (COPD) rely extensively on spirometry, which necessitates patient cooperation. The clinical value of impulse oscillometry (IOS) as a non-volitional method in patients with COPD remains uncertain.Design: This retrospective observational study was conducted using patient data from between January 2014 and December 2015.Setting: Five public hospitals in China: West China Hospital, Nuclear Industry 416 Hospital, Suining Central Hospital, Affiliated Hospital, Medical College of Chengdu University and 363 Hospital.Participants: The study included 6307 participants aged>40 years, comprising 2109 COPD patients and 4198 general non-COPD individuals, according to the Global Initiative for Obstructive Lung Disease (GOLD) spirometry standard. Participants with lung cancer, pulmonary tuberculosis, pneumonia or those who underwent lung resection were excluded from the study.Outcome measures and analysis: Demographic data, spirometry results and IOS results were collected. Spearman’s correlation analysis was used to examine the correlation between the IOS and spirometry parameters. Receiver operating characteristic curve analysis was used to evaluate the IOS performance in COPD diagnosis and severity staging.Results: Patients with COPD exhibited significant increases in Z5, R5, R20, R5−R20, Fres and Rp, but a decrease in X5 compared with non-COPD subjects (p25%–75%, forced expiratory volume in one second (FEV₁)/forced vital capacity and FEV_1%, respectively. However, the combination of these five IOS parameters did not exhibit ideal performance in diagnosing COPD (area under the curve (AUC) 0.78; sensitivity 63.68%; specificity 80.09%), differentiating GOLD stage 1 patients from the general non-COPD population (AUC 0.71; sensitivity 54.71%; specificity 77.49%) or identifying GOLD stages 3 and 4 patients among those with COPD (AUC 0.75; sensitivity 69.51%; specificity 70.32%).Conclusion: IOS parameters, while showing good correlation with spirometry in patients with COPD, did not perfectly substitute for spirometry in diagnosing COPD, especially in the early and advanced stages of the disease.

Background: N-acetylcysteine (NAC), which is specifically involved in airway mucus clearance and antioxidation, is recommended by the treatment guideline for non-cystic fibrosis bronchiectasis (NCFB). However, there is little clinical evidence of its long-term efficacy concerning quality of life (QoL) and exacerbation in patients with NCFB. In addition, the influences of NAC on airway bacterial colonization, chronic inflammation and oxidative stress in NCFB are also unclear. Methods: NINCFB is a prospective, multicentre, double-blind, randomised, placebo-controlled trial that will recruit 119 patients with NCFB and randomly divide them into an NAC group (n = 79) and a control group (n = 40). Participants in the NAC group will receive 600 mg oral NAC twice daily for 52 weeks, while patients in the control group will receive 600 mg placebo twice daily for 52 weeks. The information at baseline will be collected once participants are enrolled. The primary endpoints are the changes in St George’s Respiratory Questionnaire scores and the number of exacerbations in 52 weeks. The secondary endpoints are the 16S rRNA of sputum and the levels of inflammatory factors and oxidative stressors in sputum and serum. Other data related to radiography, lung function tests, number of oral and/or intravenous antibiotic therapies and adverse events (AEs) will also be analysed. Further subgroup analysis distinguished by the severity of disease, severity of lung function, airway bacterial colonization and exacerbation frequency will be performed. Discussion: The objective of this study is to determine the long-term efficacy of NAC on QoL and exacerbation of NCFB and to explore the effectiveness of NAC for antibiosis, anti-inflammation and antioxidation in NCFB. The study results will provide high-quality clinical proof for the revision and optimization of treatment guidelines and for expert consensus on NCFB treatment. Trial registration: The trial was registered on the Chinese Clinical Trial Register at April 11, 2020 (chictr.org.cn, ChiCTR2000031817).

Backgrounds and Aims: It is well-known that angiogenesis contributes to the progression of chronic obstructive pulmonary disease (COPD) by initiating the remodeling of bronchial vasculature. However, the molecular mechanisms are incompletely understood. Endostatin, which is a member of endogenous antiangiogenic proteins activated by proteolytic cleavage, has been found to play an important role in angiogenesis and many inflammatory diseases. This research is to firstly explore whether endostatin is a biomarker in COPD. Methods: 100 stable COPD patients, 130 patients with acute exacerbation（AECOPD) and 68 healthy volunteers were recruited in this research. Lung function test was done on the healthy and stable COPD group. Serum endostatin, C-reactive protein (CRP) and vascular endothelial growth factor (VEGF) of all subjects were measured by Human Magnetic Luminex Screening Assay. Results: Serum endostatin significantly increased in stable COPD patients(89.29±30.33ng/mL) compared with healthy control (68.86±29.17ng/mL) and increased more in AECOPD patients (102.09±36.59ng/mL) (P＜0.001). Besides, stable COPD patients with frequent exacerbation (≥2 exacerbations per year) in the last one year had higher concentration of endostatin in the circulation compared to the patients with less exacerbation (P=0.037). Furthermore, endostatin was negatively correlated with FEV₁/FVC (P=0.031) and FEV₁% (Rho=-0.260, P=0.009) in the stable COPD group and positively related to VEGF in all the subjects (p=0.002). Conclusions: These results suggest that endostatin is a biomarker of COPD and associated with lung function decline and exacerbation. Endostatin potentially contributes to the pathogenesis of COPD.

The ability of interleukins (ILs) to differentiate tuberculous pleural effusion from other types of effusion is controversial. The aim of our study was to summarize the evidence for its use of ruling out or in tuberculous pleural effusion. Two investigators independently searched PubMed, EMBASE, Web of Knowledge, CNKI, WANFANG, and WEIPU databases to identify studies assessing diagnostic role of ILs for tuberculous pleural effusion published up to January, 2017. Study quality was assessed using Quality Assessment of Diagnostic Accuracy Studies-2. The pooled diagnostic sensitivity and specificity of ILs were calculated by using Review Manager 5.3. Area under the summary receiver operating characteristic curve (AUC) was used to summarize the overall diagnostic performance of individual markers. Thirty-eight studies met our inclusion criteria. Pooled sensitivity, specificity and AUC for chosen ILs were as follows: IL-2, 0.67,0.76 and 0.86; IL-6, 0.86, 0.84 and 0.90; IL-12, 0.78, 0.83 and 0.86; IL-12p40, 0.82,0.65 and 0.76; IL-18, 0.87, 0.92 and 0.95; IL-27, 0.93, 0.95 and 0.95; and IL-33, 0.84, 0.80 and 0.88. Some of these ILs may assist in diagnosing tuberculous pleural effusion, though no single IL is likely to show adequate sensitivity or specificity on its own. Further studies on a large scale with better study design should be performed to assess the diagnostic potential of ILs.