BACKGROUND Hepatocellular carcinoma(HCC)is a major type of liver cancer worldwide.In advanced stages,portal vein tumor thrombosis(PVTT)and jaundice are common,whereas obstructive jaundice(OJ)is relatively rare.Both co...BACKGROUND Hepatocellular carcinoma(HCC)is a major type of liver cancer worldwide.In advanced stages,portal vein tumor thrombosis(PVTT)and jaundice are common,whereas obstructive jaundice(OJ)is relatively rare.Both conditions markedly reduce survival and increase therapeutic complexity.Recently,hepatic artery infusion chemotherapy(HAIC)in combination with targeted immunotherapy has shown promise for advanced HCC.CASE SUMMARY We report a 47-year-old male with advanced HCC complicated by PVTT and OJ,who was admitted with marked jaundice of the skin and sclera.Imaging revealed a large hepatic mass(14.5 cm×11.3 cm)in the right lobe with associated portal vein tumor thrombus.The tertiary bile duct was only mildly dilated,making percutaneous transhepatic cholangiography drainage infeasible.The patient underwent reduced-dose HAIC,which resulted in significant tumor shrinkage and marked reduction in serum bilirubin.This improvement enabled sequential treatment with lenvatinib and camrelizumab.After six cycles,both liver function and alphafetoprotein levels improved.The patient achieved a progression-free survival of 20 months and an overall survival of 29 months.CONCLUSION HAIC can treat high-bilirubin HCC with PVTT and OJ,allowing for subsequent targeted immunotherapy.展开更多
Dear Editor,Inguinal hernia repair(IHR)performed during childhood is a prevalent etiological factor for obstructive azoospermia(OA)attributed to vasal injury.OA couples can achieve pregnancy through intracytoplasmic s...Dear Editor,Inguinal hernia repair(IHR)performed during childhood is a prevalent etiological factor for obstructive azoospermia(OA)attributed to vasal injury.OA couples can achieve pregnancy through intracytoplasmic sperm injection or natural pregnancy after microsurgical anastomosis.Recent advancements have highlighted the potential utility of laparoscopy-assisted vasovasostomy for treating OA caused by childhood herniorrhaphy.展开更多
BACKGROUND The degree of obstruction plays an important role in decision-making for obstructive colorectal cancer(OCRC).The existing assessment still relies on the colorectal obstruction scoring system(CROSS)which is ...BACKGROUND The degree of obstruction plays an important role in decision-making for obstructive colorectal cancer(OCRC).The existing assessment still relies on the colorectal obstruction scoring system(CROSS)which is based on a comprehensive analysis of patients’complaints and eating conditions.The data collection relies on subjective descriptions and lacks objective parameters.Therefore,a scoring system for the evaluation of computed tomography-based obstructive degree(CTOD)is urgently required for OCRC.AIM To explore the relationship between CTOD and CROSS and to determine whether CTOD could affect the short-term and long-term prognosis.METHODS Of 173 patients were enrolled.CTOD was obtained using k-means,the ratio of proximal to distal obstruction,and the proportion of nonparenchymal areas at the site of obstruction.CTOD was integrated with the CROSS to analyze the effect of emergency intervention on complications.Short-term and long-term outcomes were compared between the groups.RESULTS CTOD severe obstruction(CTOD grade 3)was an independent risk factor[odds ratio(OR)=3.390,95%confidence interval(CI):1.340-8.570,P=0.010]via multivariate analysis of short-term outcomes,while CROSS grade was not.In the CTOD-CROSS grade system,for the non-severe obstructive(CTOD 1-2 to CROSS 1-4)group,the complication rate of emergency interventions was significantly higher than that of non-emergency interventions(71.4%vs 41.8%,P=0.040).The postoperative pneumonia rate was higher in the emergency intervention group than in the non-severe obstructive group(35.7%vs 8.9%,P=0.020).However,CTOD grade was not an independent risk factor of overall survival and progression-free survival.CONCLUSION CTOD was useful in preoperative decision-making to avoid unnecessary emergency interventions and complications.展开更多
Male infertility has seen an increase in prevalence with cases of azoospermia estimated to affect 10%–15%of infertile men.Confirmation of azoospermia subsequently necessitates an early causal differentiation between ...Male infertility has seen an increase in prevalence with cases of azoospermia estimated to affect 10%–15%of infertile men.Confirmation of azoospermia subsequently necessitates an early causal differentiation between obstructive azoospermia(OA)and nonobstructive azoospermia(NOA).Although less common when compared to NOA,OA can represent upward 20%–40%of cases of azoospermia.While there are a multitude of etiologies responsible for causing NOA and OA,correctly distinguishing between the two types of azoospermia has profound implications in managing the infertile male.This review represents an amalgamation of the current guidelines and literature which will supply the reproductive physician with a diagnostic armamentarium to properly distinguish between NOA and OA,therefore providing the best possible care to the infertile couple.展开更多
Objective:To investigate the clinical efficacy of levofloxacin combined with ambroxol in the treatment of elderly patients with chronic obstructive pulmonary disease(COPD)and pulmonary infection.Methods:A total of 80 ...Objective:To investigate the clinical efficacy of levofloxacin combined with ambroxol in the treatment of elderly patients with chronic obstructive pulmonary disease(COPD)and pulmonary infection.Methods:A total of 80 elderly COPD patients with pulmonary infection,treated between December 2022 and November 2023,were randomly divided into a control group and an observation group,with 40 cases in each group.The control group was treated with levofloxacin hydrochloride,while the observation group received ambroxol hydrochloride injection in addition to the treatment in the control group.Laboratory indices(white blood cell count,procalcitonin,C-reactive protein,and apolipoprotein E levels),imaging-based pulmonary lesion absorption time,hospital stay,and incidence of adverse reactions were compared between the two groups.Results:After treatment,the biochemical indices of the observation group were significantly lower than those of the control group,with highly significant differences(P<0.001).Compared to the control group,the imaging-based pulmonary lesion absorption time and hospital stay of the observation group were significantly shorter(P<0.001).Additionally,the incidence of adverse reactions in the observation group was significantly lower than in the control group(P<0.05).Conclusion:Levofloxacin combined with ambroxol demonstrates advantages in improving biochemical indices,shortening imaging-based pulmonary lesion absorption time and hospital stay,and reducing adverse reaction rates in elderly COPD patients with pulmonary infection.It holds significant clinical application value.展开更多
This article discusses Wang et al’s essay.Endoscopic biliary stenting,a less invasive alternative to surgery,is effective for malignant obstructive jaundice.This article summarizes the pathophysiology of biliary obst...This article discusses Wang et al’s essay.Endoscopic biliary stenting,a less invasive alternative to surgery,is effective for malignant obstructive jaundice.This article summarizes the pathophysiology of biliary obstruction,the technical aspects of stenting,and the clinical outcomes.By comparison of endoscopic stenting with percutaneous biliary drainage,improvements and complications are focused on.Additionally,patient selection for stenting and future advancements in stent technology are important.Overall,endoscopic biliary stenting is a valuable palliative option for patients with malignant jaundice,especially those ineligibles for surgery.展开更多
This letter responds to Wang et al's recent publication on endoscopic biliary stenting for malignant obstructive jaundice(MOJ)by offering constructive feedback and suggestions for future research.We commend the au...This letter responds to Wang et al's recent publication on endoscopic biliary stenting for malignant obstructive jaundice(MOJ)by offering constructive feedback and suggestions for future research.We commend the authors for their comprehensive study design and execution,which included a clear delineation of study groups and a robust set of outcome measures.We suggest that future studies incorporate additional biomarkers,such as serum levels of liver enzymes and bilirubin,to provide a more nuanced understanding of liver function changes post-intervention.The study's focus on short-term survival rates is appreciated,but we recommend exploring longer-term follow-up periods to capture the full spectrum of survival outcomes.Additionally,the inclusion of quality of life assessments using validated instruments could offer a more holistic view of patient outcomes.From a critical care perspective,we advocate for the integration of advanced imaging techniques to better characterize biliary anatomy and potentially predict treatment response or complications.We believe that incor-porating these suggestions could enhance the understanding of endoscopic biliary stenting's role in MOJ management and its impact on patient outcomes,influ-encing future clinical guidelines and practice.展开更多
BACKGROUND Malignant obstructive jaundice(MOJ)is characterized by the presence of malignant tumors infiltrating or compressing the bile duct,causing poor bile drainage,generalized yellowing,pain,itching,and malaise.MO...BACKGROUND Malignant obstructive jaundice(MOJ)is characterized by the presence of malignant tumors infiltrating or compressing the bile duct,causing poor bile drainage,generalized yellowing,pain,itching,and malaise.MOJ is burdensome for both the society and the families of affected patients and should be taken seriously.AIM To evaluate the clinical effect of stent placement during endoscopic retrograde cholangiopancreatography for relieving MOJ and the efficacy of percutaneous transhepatic biliary drainage in terms of liver function improvement,complication rates,and long-term patient outcomes.METHODS The clinical data of 59 patients with MOJ who were admitted to our hospital between March 2018 and August 2019 were retrospectively analyzed.According to the treatment method,the patients were divided into an observation group(29 patients)and a control group(30 patients).General data,liver function indices,complications,adverse effects,and 3-year survival rates after different surgical treatments were recorded for the two groups.RESULTS There were no significant differences in baseline information(sex,age,tumor type,or tumor diameter)between the two groups(P>0.05).Alanine aminotransferase,aspartate aminotransferase,and total bilirubin levels were significantly better in both groups after surgery than before surgery(P<0.05).The overall incidence of biliary bleeding,gastrointestinal bleeding,pancreatitis,and cholangitis was 6.9%in the observation group and 30%in the control group(P<0.05).No significant differences in the rates of blood transfusion,intensive care unit admission,or death within 3 years were observed between the two groups at the 1-month follow-up(P>0.05).The 3-year survival rates were 46.06%and 39.71%in the observation and control groups,respectively.CONCLUSION Endoscopic biliary stenting effectively relieves MOJ and significantly improves liver function,with minimal complications.This technique is a promising palliative approach for patients ineligible for radical surgery.However,further research is needed to optimize current treatment strategies and to explore their potential in treating nonmalignant cases of obstructive jaundice.展开更多
OBJECTIVE:To investigate the mechanisms of the effect of Shenji Guben(SJGB)decoction(参吉固本方)on chronic obstructive pulmonary disease(COPD).METHODS:A murine model of COPD was established through lipopolysaccharide(...OBJECTIVE:To investigate the mechanisms of the effect of Shenji Guben(SJGB)decoction(参吉固本方)on chronic obstructive pulmonary disease(COPD).METHODS:A murine model of COPD was established through lipopolysaccharide(LPS)nasal drops and passive smoke exposure,followed by evaluation of SJGB decoction efficacy via lung function tests and histological analysis.Non-targeted liquid chromatography-mass spectrometry(LC-MS)-based metabolomics was used to explore the mechanisms of SJGB decoction in COPD.RESULTS:We found that the SJGB decoction effectively reduced inflammatory cell infiltration in the airways and lungs,and improved lung function in the COPD model mice.LC-MS-based metabolomics identified 86 biomarkers in COPD models.Compared to the model group,SJGB decoction significantly altered 34 metabolites.Prostaglandin E2 and DL-Citrulline were highlighted as two representative differential metabolites.MetaboAnalyst 5.0 highlighted glycerophospholipid and riboflavin metabolisms as key pathways affected by SJGB decoction.CONCLUSION:This study evaluated the protective effect of SJGB decoction against COPD and provided insights into its potential mechanisms in COPD treatment.展开更多
Objective:To explore the obstructive factors in the behavior of medical staff during the implementation of respiratory rehabilitation process,and to provide a basis for the rehabilitation management intervention of CO...Objective:To explore the obstructive factors in the behavior of medical staff during the implementation of respiratory rehabilitation process,and to provide a basis for the rehabilitation management intervention of COPD.Methods:A descriptive nature research method was adopted.An interview outline was formulated based on the theoretical domain framework.From October to December 2024,15 medical staff from the respiratory department of a tertiary hospital in Shaanxi Province were selected for semi-structured interviews.The interview data were analyzed using the Colaizzi 7-step analysis method.Result:The analysis of this study found that the obstructive factors for medical staff to implement respiratory rehabilitation include five theoretical domains.The problems are respectively the lack of knowledge about respiratory rehabilitation and insufficient training intensity,the insufficient self-recognition of implementing respiratory rehabilitation,the low awareness rate of patients and the low cooperation degree,the insufficient provision of instruments and facilities,the lack of rehabilitation training venues and respiratory rehabilitation clinics,and the lack of scientific and standardized respiratory rehabilitation management processes.Conclusion:There are many obstructive factors affecting the implementation of respiratory rehabilitation by medical staff.Clinical managers should take corresponding measures,continuously improve the rehabilitation management strategies for COPD,and promote the clinical application of the best evidence for respiratory rehabilitation.展开更多
This special issue of the Asian Journal of Andrology is fully dedicated to the thematic area of non-obstructive azoospermia(NOA),one of the most complex and challenging conditions in the realm of andrology,urology,and...This special issue of the Asian Journal of Andrology is fully dedicated to the thematic area of non-obstructive azoospermia(NOA),one of the most complex and challenging conditions in the realm of andrology,urology,and reproductive medicine.展开更多
BACKGROUND Managing left ventricular outflow tract obstruction(LVOTO)and systolic anterior motion(SAM)of the mitral valve can be challenging,especially in the context of circulatory shock and pulmonary edema post card...BACKGROUND Managing left ventricular outflow tract obstruction(LVOTO)and systolic anterior motion(SAM)of the mitral valve can be challenging,especially in the context of circulatory shock and pulmonary edema post cardiac surgery.CASE SUMMARY We describe a case of an 80-year-old female patient with a history of severe aortic stenosis and hypertrophic obstructive cardiomyopathy that underwent aortic valve replacement and myectomy.The patient presented with acute pulmonary edema and low blood pressure due to LVOTO and SAM post cardiac surgery in the intensive care unit.She was paced with an epicardial dual-chamber pacing system due to complete atrioventricular block and treated initially with norepinephrine,furosemide,and esmolol infusion and continuous positive pressure ventilation.The patient remained hypoxemic and kept deteriorating hemodynamically despite titrating up norepinephrine.The addition of vasopressin infusion and tapering of norepinephrine finally stabilized the patient with significant reduction of LVOTO,confirmed by transthoracic echocardiography assessment,improved oxygenation and increased urine output.CONCLUSION Vasopressin seems to be the preferred vasopressor for managing LVOTO and SAM post-cardiac surgery,because of its absence of inotropic effects.Echocardiography is crucial for early diagnosis and therapeutic management.展开更多
Obstructive sleep apnea-hypopnea syndrome(OSAHS)is a common form of sleep breathing disorder characterized by apnea and hypopnea resulting from recurrent upper airway obstruction during sleep.This leads to intermitten...Obstructive sleep apnea-hypopnea syndrome(OSAHS)is a common form of sleep breathing disorder characterized by apnea and hypopnea resulting from recurrent upper airway obstruction during sleep.This leads to intermittent hypoxia in the brain and disruptions in sleep architecture,ultimately causing cognitive impairment.In OSAHS patients,cognitive dysfunction manifests mainly as diminished attention,memory,and executive function.These effects impact an individual’s daily and social abilities,significantly reducing their quality of life.This article primarily reviews four aspects of OSAHS patients’cognitive function,namely,characteristics,pathogenesis,assessment tools,influencing factors,and heterogeneity,to provide a theoretical basis for healthcare professionals to identify high-risk groups for cognitive impairment among OSAHS patients at an early stage and to construct a more objective and feasible intervention program to further prevent the occurrence and development of dementia.展开更多
The high comorbidity rates of depression and chronic obstructive pulmonary disease(COPD)have garnered widespread attention.As a refractory disease,its long-term stress effects exacerbate the coexistence of depression....The high comorbidity rates of depression and chronic obstructive pulmonary disease(COPD)have garnered widespread attention.As a refractory disease,its long-term stress effects exacerbate the coexistence of depression.Depression is linked to a decline in lung function in patients with COPD through reduced heart rate variability,increased inflammatory cytokines,dysregulation of the hypothalamic-pituitary-adrenal axis,and the interplay of various biological and psychological factors.Sole reliance on biomedical treatment cannot fully counteract these negative effects,which are detrimental to improving patients’quality of life and long-term prognosis.Antidepressant medications and traditional Chinese medicine combined with conventional COPD therapy,psychotherapy(e.g.,cognitive behavioral therapy,mindfulness training),and lifestyle adjustments(e.g.,yoga,qigong,or walking)can not only alleviate depression and compensate for the limitations of biomedical approaches but also help improve heart rate variability and lung function.In this editorial,we suggest that clinicians,when prescribing antidepressants,must carefully weigh the benefit-risk ratio based on the patient’s specific physical condition to ensure precise medication use.展开更多
Increased mortality rates in chronic obstructive pulmonary disease(COPD)patients with heart failure(HF)are believed to be driven by various factors,including disparities in access to healthcare services and shifting d...Increased mortality rates in chronic obstructive pulmonary disease(COPD)patients with heart failure(HF)are believed to be driven by various factors,including disparities in access to healthcare services and shifting dynamics of the population characteristics.In this study,we examined the racial and ethnic disparities in the clinical outcomes of HF in COPD patients in the United States,analyzing data from the Nationwide Inpatient Sample database.The database was searched retrospectively from 2016 to 2022 to identify COPD and HF patients by International Classification of Diseases-10 codes.A total of 2445545 individuals were included of which 76%were Whites,16%were Blacks,5%Hispanics and 3%others.Whites were significantly older than other populations(P<0.001),and a significantly higher proportion of Blacks were females compared to other racial groups.Regarding clinical outcomes,Black COPD patients with HF had the lowest mortality rates while it was similar between Whites and Hispanics(P<0.001).Compared to Whites,the adjusted odds ratio was significantly lower for Blacks,0.797[95%confidence interval(CI):0.783-0.812;P<0.001]and Hispanics,0.956(95%CI:0.932-0.981;P=0.001).Other racial groups had significantly higher mortality compared to Whites,with an adjusted odds ratio of 1.131(95%CI:1.099-1.164;P<0.001).Individuals from other racial groups had significantly longer hospital stay,and hospitalization cost adjusted for inflation.Cardiac arrest was the strongest predictor(P<0.001)for in-hospital mortality in all racial groups.展开更多
BACKGROUND The correlation conclusions between self-management,frailty,and quality of life(QoL)of chronic obstructive pulmonary disease(COPD)patients are inconsistent.AIM To comprehensively assess the current status o...BACKGROUND The correlation conclusions between self-management,frailty,and quality of life(QoL)of chronic obstructive pulmonary disease(COPD)patients are inconsistent.AIM To comprehensively assess the current status of self-management,psychological cognitive impairment,and QoL in elderly patients with COPD.METHODS Convenient sampling was employed to select 312 elderly patients with COPD who were receiving treatment in the respiratory and critical care medicine department of a tertiary grade A hospital from November 2023 to February 2024.The study utilized demographic information and clinical characteristics,selfmanagement behavior,occurrence of psychological cognitive impairment,and QoL as evaluated through general information questionnaires,the COPD patient self-management scale,simple frailty scale,simple mental status scale,clinical dementia assessment scale,and the clinical COPD assessment test questionnaire.This research aims to describe the current status and correlations among selfmanagement behavior,cognitive impairment occurrence,and QoL.RESULTS The average score for self-management behavior in elderly COPD patients was 136.00(119.00,164.50),indicating a moderate level overall.There were 98 cases of cognitive impairment,accounting for 31.4%,with a mental status score of 3(2,3.75).The average QoL score was 24(19,28),indicating a low level.Additionally,there was a negative correlation between total self-management behavior score and cognitive impairment occurrence(r=-0.589,P<0.001),and QoL total score(r=-0.409,P<0.001).Cognitive impairment occurrence was positively correlated with QoL total score(r=0.345,P<0.001).Disease course and self-management behavior score were independent factors affecting the total QoL score in elderly COPD patients(P<0.05).CONCLUSION The self-management behavior of elderly patients with COPD is at a moderate level.However,the occurrence of cognitive impairment is high and significantly influenced by disease course,level of self-management,and mental status.The QoL is low,emphasizing the urgent need to intervene in the self-management behaviors of elderly COPD patients,actively reduce the occurrence of cognitive impairment,and mitigate the impact of the disease on QoL.展开更多
Self-management interventions for chronic obstructive pulmonary disease(COPD)patients using mobile health technology are beneficial for relieving disease symptoms,improving patients’adherence to rehabilitation self-m...Self-management interventions for chronic obstructive pulmonary disease(COPD)patients using mobile health technology are beneficial for relieving disease symptoms,improving patients’adherence to rehabilitation self-management,and improving quality of life.This paper reviews the application of mobile health technology in self-management of patients with chronic obstructive pulmonary disease,introduces the application form of mobile health technology in self-management of patients with chronic obstructive pulmonary disease,summarizes its application effect in self-management of patients with chronic obstructive pulmonary disease,analyzes the problems and proposes solutions in the process of research and implementation at this stage,with a view to providing a theory for the application of mobile health technology in pulmonary rehabilitation and management of patients with chronic obstructive pulmonary disease This study summarize the effect of its application in the self-management of patients with chronic obstructive pulmonary disease.展开更多
OBJECTIVE:To examine the effects of the Jianpi Yifei Tongluo recipe(健脾益肺通络方剂,JYTR)on chronic obstructive pulmonary disease(COPD)within an animal model and to elucidate its anti-inflammatory mechanisms.METHODS:...OBJECTIVE:To examine the effects of the Jianpi Yifei Tongluo recipe(健脾益肺通络方剂,JYTR)on chronic obstructive pulmonary disease(COPD)within an animal model and to elucidate its anti-inflammatory mechanisms.METHODS:In this study,we utilized cigarette smoke(CS)exposure and lipopolysaccharide(LPS)-induced models of COPD in rats to evaluate the effects of the JYTR on airway inflammation.Sprague-Dawley rats were randomly assigned to various groups:control,model,budesonide,synbiotics,and low,medium,and high JYTR.Pulmonary function was gauged using an animal volumetric tracer.Pathological alterations in lung tissue were examined under a light microscope.To ascertain cytokine production,we conducted enzyme-linked immunosorbent assay tests,and we employed Western blotting to measure the expression levels of interferon regulatory factor 4(IRF4),arginase 1(Arg1),inducible nitric oxide synthase(iNOS),nuclear factor of kappa light polypeptide gene enhancer in B-cells inhibitor,alpha(IKB-α),and P65.RESULTS:Compared to the control group,rats in the COPD model group exhibited significantly compromised pulmonary function and severe inflammatory pathology in the lungs.Treatment with budesonide,synbiotics,and the JYTR markedly improved pulmonary function and diminished the production of inflammatory cytokines transforming growth factor-beta(TGF-β),tumor necrosis factor-alpha(TNF-α),and interleukin-6(IL-6).These improvements were particularly notable in the budesonide group and the high-dose JYTR group.Additionally,the JYTR increased the expression of IRF4 and upregulated the protein expression of Arg1,while concurrently downregulating the protein expression of iNOS,phosphorylated IKB-α,and phosphorylated P65.CONCLUSION:Our current study reveals that JYTR can mitigate inflammatory lung injury,enhance lung function,and lower levels of inflammatory cytokines induced by CS or LPS exposure in COPD model rats.The mechanism behind its anti-inflammatory effect likely involves the regulation of IRF4 expression and M2 polarization through the nuclear factor kappa-light-chain-enhancer of activated B cells signaling pathway.展开更多
Objective Our earlier research revealed a connection between microRNA-29b(miR-29b)and bromodomain-containing protein 4(BRD4)and airway inflammation in chronic obstructive pulmonary disease(COPD).We examined their corr...Objective Our earlier research revealed a connection between microRNA-29b(miR-29b)and bromodomain-containing protein 4(BRD4)and airway inflammation in chronic obstructive pulmonary disease(COPD).We examined their correlation with airway inflammation and dysbiosis in COPD individuals who had ceased smoking.Methods Bacterial community composition and diversity were evaluated in bronchoalveolar lavage fluid(BALF)from COPD patients who had ceased smoking,and the expression of miR-29b/BRD4,interleukin(IL)-6 and IL-8 in bronchial brushings was measured.BEAS-2B cells were exposed to COPD BALF filtrate to establish an in vitro model.The expression levels of miR-29b,BRD4,IL-6,and IL-8 were subsequently assessed in these treated cells.Results The bacterial community composition in the lungs of individuals with COPD was different from that in the lungs of non-COPD subjects.In COPD patients,lung microbial diversity was significantly reduced,and this decline was correlated with both pulmonary function and airway inflammation.Additionally,the expression of miR-29b was lowered,whereas BRD4 expression was elevated in the lower airways of individuals with COPD.Both miR-29b and BRD4 were linked with pulmonary function,airway inflammation,and diversity indices.miR-29b regulated the production of inflammatory cytokines induced by BALF filtrate through its targeting of BRD4 in bronchial epithelial cells.Conclusion Our findings indicate that airway inflammation is associated with airway dysbiosis in COPD patients after smoking cessation and that miR-29b/BRD4 are involved in dysbiosis-associated airway inflammation.展开更多
In this article,we comment on the study by Yang et al,which demonstrated significant cross-sectional associations between heart rate variability(HRV)indices,depressive symptoms,and lung function in patients with chron...In this article,we comment on the study by Yang et al,which demonstrated significant cross-sectional associations between heart rate variability(HRV)indices,depressive symptoms,and lung function in patients with chronic obstructive pulmonary disease(COPD).Building on these findings,we further explore the underlying mechanisms,particularly inflammatory-autonomic-oxidative stress pathways,as key causal mediators.Moreover,analyzing genetic polymorphisms alongside environmental factors may uncover susceptibility pathways explaining interindividual differences in HRV and comorbidity risk.Additionally,longitudinal studies tracking HRV trajectories could identify thresholds predictive of accelerated lung function decline or cardiovascular events,informing personalized prevention strategies.Integrating longitudinal HRV data with multi-omics biomarkers and machine learning models could enable real-time prediction of depression relapses or COPD exacerbations,facilitating proactive interventions such as personalized biofeedback training or precision anti-inflammatory therapies.By synthesizing these perspectives,this integrative approach promises to advance precision medicine for COPD patients,particularly those with comorbid depression,by addressing both mechanistic insights and clinical translation.展开更多
文摘BACKGROUND Hepatocellular carcinoma(HCC)is a major type of liver cancer worldwide.In advanced stages,portal vein tumor thrombosis(PVTT)and jaundice are common,whereas obstructive jaundice(OJ)is relatively rare.Both conditions markedly reduce survival and increase therapeutic complexity.Recently,hepatic artery infusion chemotherapy(HAIC)in combination with targeted immunotherapy has shown promise for advanced HCC.CASE SUMMARY We report a 47-year-old male with advanced HCC complicated by PVTT and OJ,who was admitted with marked jaundice of the skin and sclera.Imaging revealed a large hepatic mass(14.5 cm×11.3 cm)in the right lobe with associated portal vein tumor thrombus.The tertiary bile duct was only mildly dilated,making percutaneous transhepatic cholangiography drainage infeasible.The patient underwent reduced-dose HAIC,which resulted in significant tumor shrinkage and marked reduction in serum bilirubin.This improvement enabled sequential treatment with lenvatinib and camrelizumab.After six cycles,both liver function and alphafetoprotein levels improved.The patient achieved a progression-free survival of 20 months and an overall survival of 29 months.CONCLUSION HAIC can treat high-bilirubin HCC with PVTT and OJ,allowing for subsequent targeted immunotherapy.
基金supported by the National Key R&D Program of China(No.2022YFC2702701)Shanghai Scientific and Technological Project(No.20Y11907600)Clinical Research Innovation Plan of Shanghai General Hospital(No.CTCCR-2021C17).
文摘Dear Editor,Inguinal hernia repair(IHR)performed during childhood is a prevalent etiological factor for obstructive azoospermia(OA)attributed to vasal injury.OA couples can achieve pregnancy through intracytoplasmic sperm injection or natural pregnancy after microsurgical anastomosis.Recent advancements have highlighted the potential utility of laparoscopy-assisted vasovasostomy for treating OA caused by childhood herniorrhaphy.
基金the Youth Foundation of Fujian Provincial Health Commission,No.2021QNA014the Construction Project of Fujian Province Minimally Invasive Medical Center,No.[2021]76.
文摘BACKGROUND The degree of obstruction plays an important role in decision-making for obstructive colorectal cancer(OCRC).The existing assessment still relies on the colorectal obstruction scoring system(CROSS)which is based on a comprehensive analysis of patients’complaints and eating conditions.The data collection relies on subjective descriptions and lacks objective parameters.Therefore,a scoring system for the evaluation of computed tomography-based obstructive degree(CTOD)is urgently required for OCRC.AIM To explore the relationship between CTOD and CROSS and to determine whether CTOD could affect the short-term and long-term prognosis.METHODS Of 173 patients were enrolled.CTOD was obtained using k-means,the ratio of proximal to distal obstruction,and the proportion of nonparenchymal areas at the site of obstruction.CTOD was integrated with the CROSS to analyze the effect of emergency intervention on complications.Short-term and long-term outcomes were compared between the groups.RESULTS CTOD severe obstruction(CTOD grade 3)was an independent risk factor[odds ratio(OR)=3.390,95%confidence interval(CI):1.340-8.570,P=0.010]via multivariate analysis of short-term outcomes,while CROSS grade was not.In the CTOD-CROSS grade system,for the non-severe obstructive(CTOD 1-2 to CROSS 1-4)group,the complication rate of emergency interventions was significantly higher than that of non-emergency interventions(71.4%vs 41.8%,P=0.040).The postoperative pneumonia rate was higher in the emergency intervention group than in the non-severe obstructive group(35.7%vs 8.9%,P=0.020).However,CTOD grade was not an independent risk factor of overall survival and progression-free survival.CONCLUSION CTOD was useful in preoperative decision-making to avoid unnecessary emergency interventions and complications.
文摘Male infertility has seen an increase in prevalence with cases of azoospermia estimated to affect 10%–15%of infertile men.Confirmation of azoospermia subsequently necessitates an early causal differentiation between obstructive azoospermia(OA)and nonobstructive azoospermia(NOA).Although less common when compared to NOA,OA can represent upward 20%–40%of cases of azoospermia.While there are a multitude of etiologies responsible for causing NOA and OA,correctly distinguishing between the two types of azoospermia has profound implications in managing the infertile male.This review represents an amalgamation of the current guidelines and literature which will supply the reproductive physician with a diagnostic armamentarium to properly distinguish between NOA and OA,therefore providing the best possible care to the infertile couple.
文摘Objective:To investigate the clinical efficacy of levofloxacin combined with ambroxol in the treatment of elderly patients with chronic obstructive pulmonary disease(COPD)and pulmonary infection.Methods:A total of 80 elderly COPD patients with pulmonary infection,treated between December 2022 and November 2023,were randomly divided into a control group and an observation group,with 40 cases in each group.The control group was treated with levofloxacin hydrochloride,while the observation group received ambroxol hydrochloride injection in addition to the treatment in the control group.Laboratory indices(white blood cell count,procalcitonin,C-reactive protein,and apolipoprotein E levels),imaging-based pulmonary lesion absorption time,hospital stay,and incidence of adverse reactions were compared between the two groups.Results:After treatment,the biochemical indices of the observation group were significantly lower than those of the control group,with highly significant differences(P<0.001).Compared to the control group,the imaging-based pulmonary lesion absorption time and hospital stay of the observation group were significantly shorter(P<0.001).Additionally,the incidence of adverse reactions in the observation group was significantly lower than in the control group(P<0.05).Conclusion:Levofloxacin combined with ambroxol demonstrates advantages in improving biochemical indices,shortening imaging-based pulmonary lesion absorption time and hospital stay,and reducing adverse reaction rates in elderly COPD patients with pulmonary infection.It holds significant clinical application value.
文摘This article discusses Wang et al’s essay.Endoscopic biliary stenting,a less invasive alternative to surgery,is effective for malignant obstructive jaundice.This article summarizes the pathophysiology of biliary obstruction,the technical aspects of stenting,and the clinical outcomes.By comparison of endoscopic stenting with percutaneous biliary drainage,improvements and complications are focused on.Additionally,patient selection for stenting and future advancements in stent technology are important.Overall,endoscopic biliary stenting is a valuable palliative option for patients with malignant jaundice,especially those ineligibles for surgery.
文摘This letter responds to Wang et al's recent publication on endoscopic biliary stenting for malignant obstructive jaundice(MOJ)by offering constructive feedback and suggestions for future research.We commend the authors for their comprehensive study design and execution,which included a clear delineation of study groups and a robust set of outcome measures.We suggest that future studies incorporate additional biomarkers,such as serum levels of liver enzymes and bilirubin,to provide a more nuanced understanding of liver function changes post-intervention.The study's focus on short-term survival rates is appreciated,but we recommend exploring longer-term follow-up periods to capture the full spectrum of survival outcomes.Additionally,the inclusion of quality of life assessments using validated instruments could offer a more holistic view of patient outcomes.From a critical care perspective,we advocate for the integration of advanced imaging techniques to better characterize biliary anatomy and potentially predict treatment response or complications.We believe that incor-porating these suggestions could enhance the understanding of endoscopic biliary stenting's role in MOJ management and its impact on patient outcomes,influ-encing future clinical guidelines and practice.
文摘BACKGROUND Malignant obstructive jaundice(MOJ)is characterized by the presence of malignant tumors infiltrating or compressing the bile duct,causing poor bile drainage,generalized yellowing,pain,itching,and malaise.MOJ is burdensome for both the society and the families of affected patients and should be taken seriously.AIM To evaluate the clinical effect of stent placement during endoscopic retrograde cholangiopancreatography for relieving MOJ and the efficacy of percutaneous transhepatic biliary drainage in terms of liver function improvement,complication rates,and long-term patient outcomes.METHODS The clinical data of 59 patients with MOJ who were admitted to our hospital between March 2018 and August 2019 were retrospectively analyzed.According to the treatment method,the patients were divided into an observation group(29 patients)and a control group(30 patients).General data,liver function indices,complications,adverse effects,and 3-year survival rates after different surgical treatments were recorded for the two groups.RESULTS There were no significant differences in baseline information(sex,age,tumor type,or tumor diameter)between the two groups(P>0.05).Alanine aminotransferase,aspartate aminotransferase,and total bilirubin levels were significantly better in both groups after surgery than before surgery(P<0.05).The overall incidence of biliary bleeding,gastrointestinal bleeding,pancreatitis,and cholangitis was 6.9%in the observation group and 30%in the control group(P<0.05).No significant differences in the rates of blood transfusion,intensive care unit admission,or death within 3 years were observed between the two groups at the 1-month follow-up(P>0.05).The 3-year survival rates were 46.06%and 39.71%in the observation and control groups,respectively.CONCLUSION Endoscopic biliary stenting effectively relieves MOJ and significantly improves liver function,with minimal complications.This technique is a promising palliative approach for patients ineligible for radical surgery.However,further research is needed to optimize current treatment strategies and to explore their potential in treating nonmalignant cases of obstructive jaundice.
基金Supported by Traditional Chinese Medicine Science and Technology Development Plan of Jiangsu Province (No. MS2021013, ZD202215):Exploring the Efficacy and Mechanism of Professor Cao Shihong's Shenji Guben Decoction in Treating Chronic Obstructive Pulmonary Disease Based on Metabolomicsa Real-World Cohort Study on Traditional Chinese Medicine for the Treatment of Acute Exacerbation of Chronic Obstructive Pulmonary DiseaseIntra-hospital Fund of Jiangsu Provincial Hospital of Traditional Chinese Medicine Development (No. Y2021ZR11):Investigating the Mechanism of Shenji Guben Decoction in Treating Chronic Obstructive Pulmonary Disease Based on Metabolomics
文摘OBJECTIVE:To investigate the mechanisms of the effect of Shenji Guben(SJGB)decoction(参吉固本方)on chronic obstructive pulmonary disease(COPD).METHODS:A murine model of COPD was established through lipopolysaccharide(LPS)nasal drops and passive smoke exposure,followed by evaluation of SJGB decoction efficacy via lung function tests and histological analysis.Non-targeted liquid chromatography-mass spectrometry(LC-MS)-based metabolomics was used to explore the mechanisms of SJGB decoction in COPD.RESULTS:We found that the SJGB decoction effectively reduced inflammatory cell infiltration in the airways and lungs,and improved lung function in the COPD model mice.LC-MS-based metabolomics identified 86 biomarkers in COPD models.Compared to the model group,SJGB decoction significantly altered 34 metabolites.Prostaglandin E2 and DL-Citrulline were highlighted as two representative differential metabolites.MetaboAnalyst 5.0 highlighted glycerophospholipid and riboflavin metabolisms as key pathways affected by SJGB decoction.CONCLUSION:This study evaluated the protective effect of SJGB decoction against COPD and provided insights into its potential mechanisms in COPD treatment.
基金Shaanxi Provincial People’s Hospital Science and Technology Development Incubation Fund Program 2023(Project No.:2023HL-12)。
文摘Objective:To explore the obstructive factors in the behavior of medical staff during the implementation of respiratory rehabilitation process,and to provide a basis for the rehabilitation management intervention of COPD.Methods:A descriptive nature research method was adopted.An interview outline was formulated based on the theoretical domain framework.From October to December 2024,15 medical staff from the respiratory department of a tertiary hospital in Shaanxi Province were selected for semi-structured interviews.The interview data were analyzed using the Colaizzi 7-step analysis method.Result:The analysis of this study found that the obstructive factors for medical staff to implement respiratory rehabilitation include five theoretical domains.The problems are respectively the lack of knowledge about respiratory rehabilitation and insufficient training intensity,the insufficient self-recognition of implementing respiratory rehabilitation,the low awareness rate of patients and the low cooperation degree,the insufficient provision of instruments and facilities,the lack of rehabilitation training venues and respiratory rehabilitation clinics,and the lack of scientific and standardized respiratory rehabilitation management processes.Conclusion:There are many obstructive factors affecting the implementation of respiratory rehabilitation by medical staff.Clinical managers should take corresponding measures,continuously improve the rehabilitation management strategies for COPD,and promote the clinical application of the best evidence for respiratory rehabilitation.
文摘This special issue of the Asian Journal of Andrology is fully dedicated to the thematic area of non-obstructive azoospermia(NOA),one of the most complex and challenging conditions in the realm of andrology,urology,and reproductive medicine.
文摘BACKGROUND Managing left ventricular outflow tract obstruction(LVOTO)and systolic anterior motion(SAM)of the mitral valve can be challenging,especially in the context of circulatory shock and pulmonary edema post cardiac surgery.CASE SUMMARY We describe a case of an 80-year-old female patient with a history of severe aortic stenosis and hypertrophic obstructive cardiomyopathy that underwent aortic valve replacement and myectomy.The patient presented with acute pulmonary edema and low blood pressure due to LVOTO and SAM post cardiac surgery in the intensive care unit.She was paced with an epicardial dual-chamber pacing system due to complete atrioventricular block and treated initially with norepinephrine,furosemide,and esmolol infusion and continuous positive pressure ventilation.The patient remained hypoxemic and kept deteriorating hemodynamically despite titrating up norepinephrine.The addition of vasopressin infusion and tapering of norepinephrine finally stabilized the patient with significant reduction of LVOTO,confirmed by transthoracic echocardiography assessment,improved oxygenation and increased urine output.CONCLUSION Vasopressin seems to be the preferred vasopressor for managing LVOTO and SAM post-cardiac surgery,because of its absence of inotropic effects.Echocardiography is crucial for early diagnosis and therapeutic management.
基金supported by the 2023 Jinzhou Medical University Education and Teaching Research and Reform Project(YB2023004).
文摘Obstructive sleep apnea-hypopnea syndrome(OSAHS)is a common form of sleep breathing disorder characterized by apnea and hypopnea resulting from recurrent upper airway obstruction during sleep.This leads to intermittent hypoxia in the brain and disruptions in sleep architecture,ultimately causing cognitive impairment.In OSAHS patients,cognitive dysfunction manifests mainly as diminished attention,memory,and executive function.These effects impact an individual’s daily and social abilities,significantly reducing their quality of life.This article primarily reviews four aspects of OSAHS patients’cognitive function,namely,characteristics,pathogenesis,assessment tools,influencing factors,and heterogeneity,to provide a theoretical basis for healthcare professionals to identify high-risk groups for cognitive impairment among OSAHS patients at an early stage and to construct a more objective and feasible intervention program to further prevent the occurrence and development of dementia.
文摘The high comorbidity rates of depression and chronic obstructive pulmonary disease(COPD)have garnered widespread attention.As a refractory disease,its long-term stress effects exacerbate the coexistence of depression.Depression is linked to a decline in lung function in patients with COPD through reduced heart rate variability,increased inflammatory cytokines,dysregulation of the hypothalamic-pituitary-adrenal axis,and the interplay of various biological and psychological factors.Sole reliance on biomedical treatment cannot fully counteract these negative effects,which are detrimental to improving patients’quality of life and long-term prognosis.Antidepressant medications and traditional Chinese medicine combined with conventional COPD therapy,psychotherapy(e.g.,cognitive behavioral therapy,mindfulness training),and lifestyle adjustments(e.g.,yoga,qigong,or walking)can not only alleviate depression and compensate for the limitations of biomedical approaches but also help improve heart rate variability and lung function.In this editorial,we suggest that clinicians,when prescribing antidepressants,must carefully weigh the benefit-risk ratio based on the patient’s specific physical condition to ensure precise medication use.
文摘Increased mortality rates in chronic obstructive pulmonary disease(COPD)patients with heart failure(HF)are believed to be driven by various factors,including disparities in access to healthcare services and shifting dynamics of the population characteristics.In this study,we examined the racial and ethnic disparities in the clinical outcomes of HF in COPD patients in the United States,analyzing data from the Nationwide Inpatient Sample database.The database was searched retrospectively from 2016 to 2022 to identify COPD and HF patients by International Classification of Diseases-10 codes.A total of 2445545 individuals were included of which 76%were Whites,16%were Blacks,5%Hispanics and 3%others.Whites were significantly older than other populations(P<0.001),and a significantly higher proportion of Blacks were females compared to other racial groups.Regarding clinical outcomes,Black COPD patients with HF had the lowest mortality rates while it was similar between Whites and Hispanics(P<0.001).Compared to Whites,the adjusted odds ratio was significantly lower for Blacks,0.797[95%confidence interval(CI):0.783-0.812;P<0.001]and Hispanics,0.956(95%CI:0.932-0.981;P=0.001).Other racial groups had significantly higher mortality compared to Whites,with an adjusted odds ratio of 1.131(95%CI:1.099-1.164;P<0.001).Individuals from other racial groups had significantly longer hospital stay,and hospitalization cost adjusted for inflation.Cardiac arrest was the strongest predictor(P<0.001)for in-hospital mortality in all racial groups.
文摘BACKGROUND The correlation conclusions between self-management,frailty,and quality of life(QoL)of chronic obstructive pulmonary disease(COPD)patients are inconsistent.AIM To comprehensively assess the current status of self-management,psychological cognitive impairment,and QoL in elderly patients with COPD.METHODS Convenient sampling was employed to select 312 elderly patients with COPD who were receiving treatment in the respiratory and critical care medicine department of a tertiary grade A hospital from November 2023 to February 2024.The study utilized demographic information and clinical characteristics,selfmanagement behavior,occurrence of psychological cognitive impairment,and QoL as evaluated through general information questionnaires,the COPD patient self-management scale,simple frailty scale,simple mental status scale,clinical dementia assessment scale,and the clinical COPD assessment test questionnaire.This research aims to describe the current status and correlations among selfmanagement behavior,cognitive impairment occurrence,and QoL.RESULTS The average score for self-management behavior in elderly COPD patients was 136.00(119.00,164.50),indicating a moderate level overall.There were 98 cases of cognitive impairment,accounting for 31.4%,with a mental status score of 3(2,3.75).The average QoL score was 24(19,28),indicating a low level.Additionally,there was a negative correlation between total self-management behavior score and cognitive impairment occurrence(r=-0.589,P<0.001),and QoL total score(r=-0.409,P<0.001).Cognitive impairment occurrence was positively correlated with QoL total score(r=0.345,P<0.001).Disease course and self-management behavior score were independent factors affecting the total QoL score in elderly COPD patients(P<0.05).CONCLUSION The self-management behavior of elderly patients with COPD is at a moderate level.However,the occurrence of cognitive impairment is high and significantly influenced by disease course,level of self-management,and mental status.The QoL is low,emphasizing the urgent need to intervene in the self-management behaviors of elderly COPD patients,actively reduce the occurrence of cognitive impairment,and mitigate the impact of the disease on QoL.
基金supported by the 2025 Hangzhou Normal University Teaching Development and Reform Project(Project No.JG2025320)。
文摘Self-management interventions for chronic obstructive pulmonary disease(COPD)patients using mobile health technology are beneficial for relieving disease symptoms,improving patients’adherence to rehabilitation self-management,and improving quality of life.This paper reviews the application of mobile health technology in self-management of patients with chronic obstructive pulmonary disease,introduces the application form of mobile health technology in self-management of patients with chronic obstructive pulmonary disease,summarizes its application effect in self-management of patients with chronic obstructive pulmonary disease,analyzes the problems and proposes solutions in the process of research and implementation at this stage,with a view to providing a theory for the application of mobile health technology in pulmonary rehabilitation and management of patients with chronic obstructive pulmonary disease This study summarize the effect of its application in the self-management of patients with chronic obstructive pulmonary disease.
基金Supported by the National Science Foundation for Distinguished Young Scholars of China to Intestinal Microflora-Mediated Regulation of Breast Regression Protein 39/chitinase-3-like Protein 1 Signaling pathway in the Intervention of Chronic Obstructive Pulmonary Disease by Invigorating Spleen Supplementing Lung and Relaxing Collaterals Method (No. 81804074)
文摘OBJECTIVE:To examine the effects of the Jianpi Yifei Tongluo recipe(健脾益肺通络方剂,JYTR)on chronic obstructive pulmonary disease(COPD)within an animal model and to elucidate its anti-inflammatory mechanisms.METHODS:In this study,we utilized cigarette smoke(CS)exposure and lipopolysaccharide(LPS)-induced models of COPD in rats to evaluate the effects of the JYTR on airway inflammation.Sprague-Dawley rats were randomly assigned to various groups:control,model,budesonide,synbiotics,and low,medium,and high JYTR.Pulmonary function was gauged using an animal volumetric tracer.Pathological alterations in lung tissue were examined under a light microscope.To ascertain cytokine production,we conducted enzyme-linked immunosorbent assay tests,and we employed Western blotting to measure the expression levels of interferon regulatory factor 4(IRF4),arginase 1(Arg1),inducible nitric oxide synthase(iNOS),nuclear factor of kappa light polypeptide gene enhancer in B-cells inhibitor,alpha(IKB-α),and P65.RESULTS:Compared to the control group,rats in the COPD model group exhibited significantly compromised pulmonary function and severe inflammatory pathology in the lungs.Treatment with budesonide,synbiotics,and the JYTR markedly improved pulmonary function and diminished the production of inflammatory cytokines transforming growth factor-beta(TGF-β),tumor necrosis factor-alpha(TNF-α),and interleukin-6(IL-6).These improvements were particularly notable in the budesonide group and the high-dose JYTR group.Additionally,the JYTR increased the expression of IRF4 and upregulated the protein expression of Arg1,while concurrently downregulating the protein expression of iNOS,phosphorylated IKB-α,and phosphorylated P65.CONCLUSION:Our current study reveals that JYTR can mitigate inflammatory lung injury,enhance lung function,and lower levels of inflammatory cytokines induced by CS or LPS exposure in COPD model rats.The mechanism behind its anti-inflammatory effect likely involves the regulation of IRF4 expression and M2 polarization through the nuclear factor kappa-light-chain-enhancer of activated B cells signaling pathway.
基金supported by a grant from the COPD Research Programs of Beijing Bethune Charitable Foundation(No.BJ-RW2020015J).
文摘Objective Our earlier research revealed a connection between microRNA-29b(miR-29b)and bromodomain-containing protein 4(BRD4)and airway inflammation in chronic obstructive pulmonary disease(COPD).We examined their correlation with airway inflammation and dysbiosis in COPD individuals who had ceased smoking.Methods Bacterial community composition and diversity were evaluated in bronchoalveolar lavage fluid(BALF)from COPD patients who had ceased smoking,and the expression of miR-29b/BRD4,interleukin(IL)-6 and IL-8 in bronchial brushings was measured.BEAS-2B cells were exposed to COPD BALF filtrate to establish an in vitro model.The expression levels of miR-29b,BRD4,IL-6,and IL-8 were subsequently assessed in these treated cells.Results The bacterial community composition in the lungs of individuals with COPD was different from that in the lungs of non-COPD subjects.In COPD patients,lung microbial diversity was significantly reduced,and this decline was correlated with both pulmonary function and airway inflammation.Additionally,the expression of miR-29b was lowered,whereas BRD4 expression was elevated in the lower airways of individuals with COPD.Both miR-29b and BRD4 were linked with pulmonary function,airway inflammation,and diversity indices.miR-29b regulated the production of inflammatory cytokines induced by BALF filtrate through its targeting of BRD4 in bronchial epithelial cells.Conclusion Our findings indicate that airway inflammation is associated with airway dysbiosis in COPD patients after smoking cessation and that miR-29b/BRD4 are involved in dysbiosis-associated airway inflammation.
文摘In this article,we comment on the study by Yang et al,which demonstrated significant cross-sectional associations between heart rate variability(HRV)indices,depressive symptoms,and lung function in patients with chronic obstructive pulmonary disease(COPD).Building on these findings,we further explore the underlying mechanisms,particularly inflammatory-autonomic-oxidative stress pathways,as key causal mediators.Moreover,analyzing genetic polymorphisms alongside environmental factors may uncover susceptibility pathways explaining interindividual differences in HRV and comorbidity risk.Additionally,longitudinal studies tracking HRV trajectories could identify thresholds predictive of accelerated lung function decline or cardiovascular events,informing personalized prevention strategies.Integrating longitudinal HRV data with multi-omics biomarkers and machine learning models could enable real-time prediction of depression relapses or COPD exacerbations,facilitating proactive interventions such as personalized biofeedback training or precision anti-inflammatory therapies.By synthesizing these perspectives,this integrative approach promises to advance precision medicine for COPD patients,particularly those with comorbid depression,by addressing both mechanistic insights and clinical translation.
