BACKGROUND:Early withdrawal of invasive mechanical ventilation(IMV) followed by noninvasive MV(NIMV) is a new strategy for changing modes of treatment in patients with acute exacerbations of chronic obstructive pulmon...BACKGROUND:Early withdrawal of invasive mechanical ventilation(IMV) followed by noninvasive MV(NIMV) is a new strategy for changing modes of treatment in patients with acute exacerbations of chronic obstructive pulmonary disease(AECOPD) with acute respiratory failure(ARF).Using pulmonary infection control window(PIC window) as the switch point for transferring from invasive to noninvasive MV,the time for early extubation can be more accurately judged,and therapy efficacy can be improved.This study aimed to prospectively investigate the clinical effectiveness of fiberoptic bronchscopy(FOB) in patients with AECOPD during sequential weaning of invasive-noninvasive MV.METHODS:Since July 2006 to January 2011,106 AECOPD patients with ARF were treated with comprehensive medication and IMV after hospitalization.Patients were randomly divided into two groups according to whether fiberoptic bronchoscope is used(group A,n=54) or not(group B,n=52) during sequential weaning from invasive to noninvasive MV.In group A,for sputum suction and bronchoalveolar lavage(BAL),a fiberoptic bronchoscope was put into the airway from the outside of an endotracheal tube,which was accompanied with uninterrupted use of a ventilator.After achieving PIC window,patients of both groups changed to NIMV mode,and weaned from ventilation.The following listed indices were used to compare between the groups after treatment:1) the occurrence time of PIC,the duration of MV,the length of ICU stay,the success rate of weaning from MV for the first time,the rate of reventilatJon and the occurrence rate of ventilator-associated pneumonia(VAP);2) the convenience and safety of FOB manipulation.The results were compared using Student's f test and the Chi-square test.RESULTS:The occurrence time of PIC was(5.01 ±1.49) d,(5.87±1.87) d in groups A and B,respectively(P<0.05);the duration of MV was(6.98±1.84) d,(8.69±2.41) d in groups A and B,respectively(P<0.01);the length of ICU stay was(9.25±1.84) d,(11.10±2.63) d in groups A and B,respectively(P<0.01);the success rate of weaning for the first time was 96.30%,76.92%in groups A and B,respectively(P<0.01);the rate of reventilation was 5.56%,19.23%in groups A and B,respectively(P<0.05);and the occurrence rate of VAP was 3.70%,23.07%in groups A and B,respectively(P<0.01).Moreover,it was easy and safe to manipulate FOB,and no side effect was observed.CONCLUSIONS:The application of FOB in patients with AECOPD during sequential weaning of invasive-noninvasive MV is effective in ICU.It can decrease the duration of MV and the length of ICU stay,increase the success rate from weaning MV for the first time,reduce the rate of reventilation and the occurrence rate of VAP.In addition,such a method is convenient and safe in patients of this kind.展开更多
Objective:To study the effects of low molecular weight heparin on the function of blood coagulation and serum levels of tumor necrosis factor-α(TNF-α), creatine kinase isoenzyme (CK-MB), C-reactive protein (CRP) of ...Objective:To study the effects of low molecular weight heparin on the function of blood coagulation and serum levels of tumor necrosis factor-α(TNF-α), creatine kinase isoenzyme (CK-MB), C-reactive protein (CRP) of patients with acute exacerbations of chronic obstructive pulmonary diseases and respiratory failure.Methods:A total of 80 patients with acute exacerbations of chronic obstructive pulmonary diseases and respiratory failure in our hospital from June 2014 to October 2016 were enrolled in this study. The subjects were divided into the control group (n=40) and the treatment group (n=40) randomly. The control group were treated with conventional treatment, the treatment group were treated with the conventional treatment combined with low molecular weight heparin. The two groups were treated for 7 d. The D-dimer (D-D), fibrinogen (FBG), pro thrombin time (PT), thrombin time (TT), TNF-α, CK-MB and CRP of the two groups before and after treatment were compared.Results:There were no significantly differences of the blood levels of D-D, FBG, PT and TT of the two groups before treatment. After treatment, the blood levels of D-D and FBG of the two groups were significantly lower than before treatment, and that of the treatment group were significantly lower than the control group, the PT and TT of the two groups were significantly higher than before treatment, and that of the treatment group were significantly higher than the control group. There were no significantly differences of the serum levels of the TNF-α, CK-MB and CRP of the two groups before treatment. After treatment, the serum levels of the TNF-α, CK-MB and CRP of the two groups were significantly lower than before treatment, and that of the treatment group were significantly lower than the control group.Conclusion:Low molecular weight heparin can significantly reduce the inflammatory factors of the patients with acute exacerbations of chronic obstructive pulmonary diseases and respiratory failure, can alleviath the patients conditions and reduce the myocardial damage.展开更多
Background: Multiple hospitalizations for acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are associated with considerable morbidity and mortality. Objectives: To identify predictive factors of m...Background: Multiple hospitalizations for acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are associated with considerable morbidity and mortality. Objectives: To identify predictive factors of multiples hospitalizations for AECOPD. Methods: This is a retrospective single center study of consecutive patients with COPD hospitalized at the Department of Respiratory Medicine between January 1990 and December 2015. We calculated for each patient the mean number of hospitalizations for AECOPD/year (H/y). We distinguished 2 groups (G) of patients. G1: <2 H/y and G2: ≥2 H/y. Predictors of multiple admissions identified by univariate analysis were included in the multivariate analysis. Results: The study included 1167 COPD patients (mean age 67 ± 10 years, 97% males). Three hundred six (26%) COPD patients had a mean number of hospitalizations per year ≥ 2. Multivariate logistic regression analysis demonstrated that an mMRC ≥ 2 (Odd ratio [OR] 1.8, 95% confidence interval [CI] 1.08 - 2.99, p = 0.022), a low PaO2 (PaO2 OR 0.97, 95% CI 0.95 - 0.99, p = 0.007) and frequent exacerbations (OR 2.95, 95% CI 2.56 - 3.39, p < 0.001) are independent factors associated with multiple admissions for AECOPD. Conclusions: An mMRC ≥ 2, a low PaO2 and frequent exacerbations are independently associated with multiple hospitalizations for AECOPD. The identification of these high risk COPD patients will be helpful in the decision of intervention strategies.展开更多
Objectives： To determine whether traditional Chinese medicine （TCM） aerosol inhalation treatment is effective inthe treatment of acute exacerbation of chronic bronchitis. Methods： Search double-blind randomised cl...Objectives： To determine whether traditional Chinese medicine （TCM） aerosol inhalation treatment is effective inthe treatment of acute exacerbation of chronic bronchitis. Methods： Search double-blind randomised clinical trials（RCT） about the use of TCM aerosol inhalation in patient with acute exacerbation of chronic bronchitis via database including Chinese biomedicine literature database, Wanfang Data, CNKI, Pubmed, EMBASE and CochraneLibrary from the beginning to October 2016. Quality evaluation, data extraction and data analysis of these RCT wascarried out with reference to the Cochrane systematic review. Results： 16 studies with 738 patients in TCM aerosolinhalation group and 675 in control group were included. The results of meta-analysis showed, （1） TCM aerosolinhalation group could improve the total cure rate. （2） TCM aerosol inhalation could increase the expression of IL-2while decrease the expression of IL-8 and MDA in sputum and blood. （3） TCM aerosol inhalation could improvethe symptoms of cough, cough with sputum, cough with dyspnea and lung wet rales. It also improve the symptomsof cough, expectorate and lung wet rales. （4） Shorten the time of cough and lung rale. （5） The adverse reactionswere light only with 1 occurrence of nausea and vomiting. Conclusions： The use of TCM aerosol inhalation in thetreatment of acute exacerbation of chronic bronchitis was effective. However, the inclusion researches quality werenot very high, which only provided limited evidence for clinical application. Higher-quality randomized controlledtrials were needed for further study.展开更多
Background:The eosinophilic chronic obstructive pulmonary disease(COPD)is known to be more sensitive to corticosteroid.The sputum microbiome has been shown to affect COPD prognosis,but its role in acute exacerbations ...Background:The eosinophilic chronic obstructive pulmonary disease(COPD)is known to be more sensitive to corticosteroid.The sputum microbiome has been shown to affect COPD prognosis,but its role in acute exacerbations of eosinophilic COPD is unclear.This study aimed to investigate the dynamic changes of the airway microbiome in patients with acute exacerbations of eosinophilic COPD.Methods:Fifty-seven patients with acute exacerbations of COPD from the First Affiliated Hospital of Guangxi Medical University between June 2017 and June 2018 were divided into two groups.Patients with eosinophils≥300 cells/mL in the peripheral venous blood were assigned to the eosinophilic group(Eos)and the rest to the non-eosinophilic group(Noneos).All patients received similar treatment including inhaled budesonide according to the guidelines.The induced sputum microbiome was analyzed on the 1st and 7th day of treatment using the 16S ribosomal RNA(rRNA)method.The levels of interleukin(IL)-6 and IL-8 were measured in the plasma and the sensitivity to corticosteroids was determined in isolated peripheral blood mononuclear cells.Quantitative data were compared between the two groups using the independent samples t test or Mann-Whitney U test.Categorical data were evaluated using Chi-squared test or Fisher’s exact test.Results:Twenty-six patients were classified into Eos group and 31 patients were classified into Noneos group.Prior to treatment,the alpha diversity(Shannon index)(2.65±0.63 vs.2.56±0.54,t=0.328,P=0.747)and the structure of the sputum microbiome were similar in the Eos group and the Noneos group.After 7 days of treatment,alpha diversity increased in both groups,while the microbiome richness(Ace index)was significantly lower in the Eos group(561.87±109.13 vs.767.88±148.48,t=-3.535,P=0.002).At the same time,IL-6(12.09±2.85 pg/mL vs.15.54±2.45 pg/mL,t=-4.913,P<0.001)and IL-8(63.64±21.69 pg/mL vs.78.97±17.13 pg/mL,t=-2.981,P=0.004)decreased more significantly in the Eos group,and the percentages of inhibition of IL-8 at dexamethasone concentrations 10-8 to 10-6 mol/L were significantly higher in the Eos group than those in the Noneos group(all P<0.05).Conclusions:The induced sputum microbiome richness decreased more significantly following treatment in the Eos patients compared to the Noneos patients.The lower plasma inflammatory factor levels and the higher percentage of inhibition of IL-8 might be due to higher corticosteroid sensitivity in Eos patients.展开更多
The shared links between Alzheimer’s disease and type 2 diabetes mellitus:Alzheimer’s disease(AD)and type 2 diabetes mellitus(T2DM)are two prevalent conditions that come with substantial daily struggles.Emerging evi...The shared links between Alzheimer’s disease and type 2 diabetes mellitus:Alzheimer’s disease(AD)and type 2 diabetes mellitus(T2DM)are two prevalent conditions that come with substantial daily struggles.Emerging evidence highlights that these diseases share similar pathophysiological features,including insulin resistance and chronic inflammation,which contribute to their rapid progression(Chen et al.,2022).Insulin resistance,a hallmark of T2DM,has been suggested to exacerbate neurodegeneration in AD.Similarly,chronic low-grade inflammation in T2DM parallels with neuroinflammation,which is observed in AD,suggesting overlapping pathophysiological mechanisms in T2DM and AD.展开更多
Background Respiratory muscle fatigue plays an important role in acute exacerbations of chronic obstructivepulmonary disease (AECOPD)·In previous clinical studies, non-invasive positive pressure ventilation (NPPV...Background Respiratory muscle fatigue plays an important role in acute exacerbations of chronic obstructivepulmonary disease (AECOPD)·In previous clinical studies, non-invasive positive pressure ventilation (NPPV)was proved to be successful only for AECOPD patients with severe respiratory failure·We hypothesized that, theoutcomes of AECOPD would be improved if NPPVis early (within 24 to 48 hours of admission) administered inthose patients with respiratory muscle fatigue and mild respiratory insufficiency, especially in patients withoutfulfilling the conventional criteria of mechanical ventilatory support·Methods Aprospective multicentre randomized controlled trial was conducted in19 hospitals in China over16months·Three hundred and forty-two AECOPD patients with pH≥7·25 and PaCO2>45 mmHg were recruitedon general ward and randomly assigned to standard medical treatment (control group) or early administration ofadditional NPPV (NPPV group)·Results The characteristics of two groups on admission were similar·The number of AECOPD patientsrequiring intubations in NPPV group was much fewer than that of the control group (8/171 vs 26/71,P=0·002)·Subgroup analysis showed the needs for intubation in mildly (pH≥7·35) and severe (pH<7·30)acidotic patients in NPPVgroup were both decreased (9/80 vs2/71,P=0·047 and 8/30 vs3/43,P=0·048,respectively)·The mortality in hospital was reduced slightly by NPPV but with no significant difference (7/171vs 12/171,P=0·345)·Respiratory rate (RR),scale for accessory muscle use and arterial pHimproved rapidlyat the first 2 hours only in patients of NPPV group·After 24 hours, the differences of pH, PaO2, scale foraccessory muscle use and RR in NPPV group [(7·36±0·06) mmHg, (72±22) mmHg, (2·5±0·9) /min,(22±4) /min] were statistically significant compared with control group (7·37±0·05) mmHg, (85±34)mmHg, (2·3±1·1) /min, (21±4) /min,P<0·01 for all comparisons]·Conclusions The early use of NPPV on general ward improves arterial blood gas and respiratory pattern,decreases the rate of need for intubation in AECOPD patients·NPPV is indicative for alleviating respiratorymuscle fatigue and preventing respiratory failure from exacerbation·展开更多
Background Although acute congestive heart failure （CHF） patients typically present with abnormal auscultatory findings on lung examination, lung sounds are not normally subjected to rigorous analysis. The goals of ...Background Although acute congestive heart failure （CHF） patients typically present with abnormal auscultatory findings on lung examination, lung sounds are not normally subjected to rigorous analysis. The goals of this study were to use a computerized analytic acoustic tool to evaluate lung sound patterns in CHF patients during acute exacerbation and after clinical improvement and to compare CHF profiles with those of normal individuals.Methods Lung sounds throughout the respiratory cycle was captured using a computerized acoustic-based imaging technique. Thirty-two consecutive CHF patients were imaged at the time of presentation to the emergency department and after clinical improvement. Digital images were created, geographical area of the images and lung sound patterns were quantitatively analyzed.Results The geographical areas of the vibration energy image of acute CHF patients without and with radiographically evident pulmonary edema were （67.9±4.7） and （60.3±3.5） kilo-pixels, respectively （P 〈0.05）. In CHF patients without and with radiographically evident pulmonary edema （REPE）, after clinical improvement the geographical area of vibration energy image of lung sound increased to （74.5±4.4） and （73.9±3.9） kilo-pixels （P 〈0.05）, respectively. Vibration energy decreased in CHF patients with REPE following clinical improvement by an average of （85±19）% （P 〈0.01）. Conclusions With clinical improvement of acute CHF exacerbations, there was more homogenous distribution of lung vibration energy, as demonstrated by the increased geographical area of the vibration energy image. Lung sound analysis may be useful to track in acute CHF exacerbations.展开更多
Appropriate management of acute exacerbation of chronic obstructive pulmonary disease(AECOPD)is very important because such exacerbation negatively impacts patients’health status,disease progression,and mortality.Exa...Appropriate management of acute exacerbation of chronic obstructive pulmonary disease(AECOPD)is very important because such exacerbation negatively impacts patients’health status,disease progression,and mortality.Exacerbation episodes are mainly triggered by viral and bacterial infections,and one study showed that 55%of hospitalized patients with AECOPD had a bacterial infection.[1]Some analyses have suggested that antibiotic therapy can reduce the risk of short-term mortality and improve the prognosis.However,not all patients with AECOPD benefit from antibiotic therapy.The blood eosinophil count has been used as a biomarker for eosinophil-associated airway inflammation and sepsis.However,the association between the peripheral blood eosinophil count and bacterial pathogens has not been reported.Our aim was to analyze the associations among the eosinophil count,bacterial pathogens,clinical treatments,and prognosis of patients and provide useful and comprehensive references for AECOPD management.展开更多
BACKGROUND The relationship between diabetes mellitus(DM)and asthma is complex and can impact disease trajectories.AIM To explore the bidirectional influences between the two conditions on clinical outcomes and diseas...BACKGROUND The relationship between diabetes mellitus(DM)and asthma is complex and can impact disease trajectories.AIM To explore the bidirectional influences between the two conditions on clinical outcomes and disease control.METHODS We systematically reviewed the literature on the relationship between DM and asthma,focusing on their impacts,mechanisms,and therapeutic implications.Various studies were assessed,which investigated the effect of glycemic control on asthma outcomes,lung function,and exacerbations.The study highlighted the role of specific diabetes medications in managing asthma.RESULTS The results showed that poor glycemic control in diabetes can exacerbate asthma,increase hospitalizations,and reduce lung function.Conversely,severe asthma,especially in obese individuals,can complicate diabetes management and make glycemic control more difficult.The diabetes-associated mechanisms,such as inflammation,microangiopathy,and oxidative stress,can exacerbate asthma and decrease lung function.Some diabetes medications exhibit anti-inflammatory effects that show promise in mitigating asthma exacerbations.CONCLUSION The complex interrelationship between diabetes and asthma suggests bidirectional influences that affect disease course and outcomes.Inflammation and microvascular complications associated with diabetes may worsen asthma outcomes,while asthma severity,especially in obese individuals,complicates diabetes control.However,the current research has limitations,and more diverse longitudinal studies are required to establish causal relationships and identify effective treatment strategies for individuals with both conditions.展开更多
Alzheimer's disease(AD),the leading cause of dementia,remains a formidable challenge to neurology.Despite decades of research focused on amyloid-β(Aβ)and tau pathologies,most clinical trials targeting these mole...Alzheimer's disease(AD),the leading cause of dementia,remains a formidable challenge to neurology.Despite decades of research focused on amyloid-β(Aβ)and tau pathologies,most clinical trials targeting these molecules failed,highlighting the need for alternative strategies[1].Recent attention has turned to neuroinflammation,particularly the role of microglia,the brain's resident immune cells[1].Microglia are central to AD progression.They can degrade Aβplaques and protect neurons,but may also exacerbate neurotoxicity through chronic inflammation[1].展开更多
Objective:This study aims to investigate the patterns of symptom occurrence in patients experiencing acute exacerbations of chronic obstructive pulmonary disease(AECOPD).It will explore the composition of symptom clus...Objective:This study aims to investigate the patterns of symptom occurrence in patients experiencing acute exacerbations of chronic obstructive pulmonary disease(AECOPD).It will explore the composition of symptom clusters and analyze the correlation between these clusters and health-related quality of life(HRQoL).Methods:A total of 207 patients with AE-COPD were surveyed from a tertiary grade A hospital.Data collection was conducted using three validated instruments:the Basic Information Questionnaire(BIQ),Disease Symptom Survey Questionnaire(MSAS),and Quality of Life Questionnaire(CAT).Statistical software SPSS 22.0 was used to analyze the correlation between symptom clusters and quality of life.Results:Exploratory factor analysis showed that five major symptom clusters existed in the patients,including the psycho-emotional symptom cluster,the sleep-related symptom cluster,the other side effects symptom cluster,the energy deficiency symptom cluster and the cough-loss of appetite symptom cluster,and the severity of the symptom clusters showed a significant negative correlation with the quality of life of the patients(P<0.05).Conclusion:Strengthening the comprehensive management of symptom clusters in patients with AE-COPD can help to effectively reduce the symptom burden of patients,and then significantly improve their quality of life.展开更多
1 Subcellular Organelle Dysfunction and Disease Progression The precise organization of subcellular organelles is important for maintaining cellular homeostasis.Compartmentalization orchestrates metabolic processes,si...1 Subcellular Organelle Dysfunction and Disease Progression The precise organization of subcellular organelles is important for maintaining cellular homeostasis.Compartmentalization orchestrates metabolic processes,signal transductions,and stress responses.Disturbances in organelles,including the nucleus,mitochondria,lysosomes,and endoplasmic reticulum,can lead to widespread intracellular dysfunction and contribute to diverse pathologies.For example,mitochondrial reactive oxygen species(ROS)exacerbate endoplasmic reticulum(ER)stress,as demonstrated in studies linking ROS-mediated mitochondrial dysfunction to apoptosis in neurodegenerative diseases,cancer,and inflammatory diseases[1–4].ER stress has also been implicated in cardiac hypertrophy[5],lung fibrosis[6],liver fibrosis[7],and ulcerative colitis[8].展开更多
Patients with acute exacerbation of chronic obstructive pulmonary disease(COPD)often suffer from respiratory failure and require respiratory support therapy.High-flow nasal cannula oxygen therapy(HFNC)and non-invasive...Patients with acute exacerbation of chronic obstructive pulmonary disease(COPD)often suffer from respiratory failure and require respiratory support therapy.High-flow nasal cannula oxygen therapy(HFNC)and non-invasive positive pressure ventilation(NIPPV)are commonly used non-invasive respiratory support methods.HFNC can provide precisely heated and humidified high-flow oxygen,reducing dead space and increasing alveolar ventilation.NIPPV can supply stable high-concentration oxygen and improve gas exchange.This article reviews the application of HFNC and NIPPV in the acute exacerbation stage of COPD,aiming to provide references for reasonable clinical selection.展开更多
The U.S.Food and Drug Administration today approved the first generic of Advair Diskus(fluticasone propionate and salmeterol inhalation powder)for the twice-daily treatment of asthma in patients aged four years and ol...The U.S.Food and Drug Administration today approved the first generic of Advair Diskus(fluticasone propionate and salmeterol inhalation powder)for the twice-daily treatment of asthma in patients aged four years and older and maintenance treatment of airflow obstruction and reducing exacerbations in patients with chronic obstructive pulmonary disease (COPD).展开更多
Chronic obstructive pulmonary disease(COPD)is one of the leading causes of mortality and morbidity worldwide.One of the most important features of this disease is exacerbations where a patient’s respiratory symptoms ...Chronic obstructive pulmonary disease(COPD)is one of the leading causes of mortality and morbidity worldwide.One of the most important features of this disease is exacerbations where a patient’s respiratory symptoms episodically worsen.Exacerbations accounted for over 140000 hospital admissions in 2012 in the United Kingdom with considerably more exacerbations being treated in primary care.Despite significant research in this area in recent years,treatment of acute exacerbations in the community remains limited to oral glucocorticoids,antibiotics and bronchodilators.One of the issues with unpicking the complexity of exacerbations is trying to find out the exact underlying cause and mechanism that leads to symptoms and lung destruction.Currently symptoms are initially guided by symptoms alone though multiple causes of exacerbations have common presentations.This includes viral and bacterial infections and episodes relating to environmental triggers such as pollen and pollution.There is also evidence that cardiovascular factors can contribute to symptoms of breathlessness that can mimic COPD exacerbations.In this editorial we discuss recent advances in the use of precision medicine to more accurately treat exacerbations of COPD.This includes identification of phenotypes that could help rationalise treatment and more importantly identify novel drug targets.We also consider the future role of precision medicine in preventing exacerbations and identifying COPD patients that are at increased risk of developing them.展开更多
Objective:To analyze key factors associated with the failure of non-invasive ventilation(NIV)in patients with acute exacerbations of chronic obstructive pulmonary disease(AECOPD)complicated by type II respiratory fail...Objective:To analyze key factors associated with the failure of non-invasive ventilation(NIV)in patients with acute exacerbations of chronic obstructive pulmonary disease(AECOPD)complicated by type II respiratory failure.Methods:A total of 122 patients with AECOPD and type II respiratory failure admitted to Gaoyou People’s Hospital between January 2020 and June 2023 were selected for the study.Upon admission,all patients received ECG monitoring and NIV,along with comprehensive therapies such as anti-infective treatment,antispasmodics,bronchodilators,and expectorants.NIV was provided using the S/T mode,with ventilator parameters adjusted based on the patient’s respiratory status and blood gas analysis results.Clinical data were retrospectively analyzed from electronic medical records.Results:Out of the 122 patients,30 experienced NIV failure,accounting for 24.59%.Significant differences were observed in C-reactive protein(CRP),pH,and partial pressure of arterial carbon dioxide(PaCO_(2))between patients with successful and failed NIV outcomes(P<0.05).There were no statistically significant differences in gender,age,arterial oxygen partial pressure(PaO_(2)),neutrophil count(NEUT),procalcitonin(PCT),albumin(ALB),or tidal volume between the two groups(P>0.05).Logistic regression analysis confirmed that CRP,pH,and PaCO_(2)were significant risk factors for NIV failure(P<0.05).Conclusion:CRP,pH,and PaCO_(2)are independent risk factors influencing NIV failure.展开更多
Hepatitis B virus(HBV) associated acute-on-chronic liver failure(ACLF) is an increasingly recognized fatal liver disease encompassing a severe acute exacerbation of liver function in patients with chronic hepatitis B(...Hepatitis B virus(HBV) associated acute-on-chronic liver failure(ACLF) is an increasingly recognized fatal liver disease encompassing a severe acute exacerbation of liver function in patients with chronic hepatitis B(CHB). Despite the introduction of an artificial liver support system and antiviral therapy, the short-term prognosis of HBV-ACLF is still extremely poor unless emergency liver transplantation is performed. In such a situation, stopping or slowing the progression of CHB to ACLF at an early stage is the most effective way of reducing the morbidity and mortality of HBV-ACLF. It is well-known that the occurrence and progression of HBV-ACLF is associated with many factors, and the outcomes of HBV-ACLF patients can be significantly improved if timely and appropriate interventions are provided. In this review, we highlight recent developments in early warning and clinical outcome prediction in patients with HBV-ACLF and provide an outlook for future research in this field.展开更多
BACKGROUND Acute exacerbation in patients with chronic hepatitis B virus(HBV) infection results in different severities of liver injury. The risk factors related to progression to hepatic decompensation(HD) and acute-...BACKGROUND Acute exacerbation in patients with chronic hepatitis B virus(HBV) infection results in different severities of liver injury. The risk factors related to progression to hepatic decompensation(HD) and acute-on-chronic liver failure(ACLF) in patients with severe acute exacerbation(SAE) of chronic HBV infection remain unknown.AIM To identify risk factors related to progression to HD and ACLF in compensated patients with SAE of chronic HBV infection.METHODS The baseline characteristics of 164 patients with SAE of chronic HBV infection were retrospectively reviewed. Independent risk factors associated with progression to HD and ACLF were identified. The predictive values of our previously established prediction model in patients with acute exacerbation(AE model) and the model for end-stage liver disease(MELD) score in predicting the development of ACLF were evaluated.RESULTS Among 164 patients with SAE, 83(50.6%) had compensated liver cirrhosis(LC),43 had progression to HD without ACLF, and 29 had progression to ACLF within 28 d after admission. Independent risk factors associated with progression to HD were LC and low alanine aminotransferase. Independent risk factors for progression to ACLF were LC, high MELD score, high aspartate aminotransferase(AST) levels, and low prothrombin activity(PTA). The area under the receiver operating characteristic of the AE model [0.844, 95%confidence interval(CI): 0.779-0.896] was significantly higher than that of MELD score(0.690, 95%CI: 0.613-0.760, P < 0.05) in predicting the development of ACLF.CONCLUSION In patients with SAE of chronic HBV infection, LC is an independent risk factor for progression to both HD and ACLF. High MELD score, high AST, and low PTA are associated with progression to ACLF. The AE model is a better predictor of ACLF development in patients with SAE than MELD score.展开更多
文摘BACKGROUND:Early withdrawal of invasive mechanical ventilation(IMV) followed by noninvasive MV(NIMV) is a new strategy for changing modes of treatment in patients with acute exacerbations of chronic obstructive pulmonary disease(AECOPD) with acute respiratory failure(ARF).Using pulmonary infection control window(PIC window) as the switch point for transferring from invasive to noninvasive MV,the time for early extubation can be more accurately judged,and therapy efficacy can be improved.This study aimed to prospectively investigate the clinical effectiveness of fiberoptic bronchscopy(FOB) in patients with AECOPD during sequential weaning of invasive-noninvasive MV.METHODS:Since July 2006 to January 2011,106 AECOPD patients with ARF were treated with comprehensive medication and IMV after hospitalization.Patients were randomly divided into two groups according to whether fiberoptic bronchoscope is used(group A,n=54) or not(group B,n=52) during sequential weaning from invasive to noninvasive MV.In group A,for sputum suction and bronchoalveolar lavage(BAL),a fiberoptic bronchoscope was put into the airway from the outside of an endotracheal tube,which was accompanied with uninterrupted use of a ventilator.After achieving PIC window,patients of both groups changed to NIMV mode,and weaned from ventilation.The following listed indices were used to compare between the groups after treatment:1) the occurrence time of PIC,the duration of MV,the length of ICU stay,the success rate of weaning from MV for the first time,the rate of reventilatJon and the occurrence rate of ventilator-associated pneumonia(VAP);2) the convenience and safety of FOB manipulation.The results were compared using Student's f test and the Chi-square test.RESULTS:The occurrence time of PIC was(5.01 ±1.49) d,(5.87±1.87) d in groups A and B,respectively(P<0.05);the duration of MV was(6.98±1.84) d,(8.69±2.41) d in groups A and B,respectively(P<0.01);the length of ICU stay was(9.25±1.84) d,(11.10±2.63) d in groups A and B,respectively(P<0.01);the success rate of weaning for the first time was 96.30%,76.92%in groups A and B,respectively(P<0.01);the rate of reventilation was 5.56%,19.23%in groups A and B,respectively(P<0.05);and the occurrence rate of VAP was 3.70%,23.07%in groups A and B,respectively(P<0.01).Moreover,it was easy and safe to manipulate FOB,and no side effect was observed.CONCLUSIONS:The application of FOB in patients with AECOPD during sequential weaning of invasive-noninvasive MV is effective in ICU.It can decrease the duration of MV and the length of ICU stay,increase the success rate from weaning MV for the first time,reduce the rate of reventilation and the occurrence rate of VAP.In addition,such a method is convenient and safe in patients of this kind.
文摘Objective:To study the effects of low molecular weight heparin on the function of blood coagulation and serum levels of tumor necrosis factor-α(TNF-α), creatine kinase isoenzyme (CK-MB), C-reactive protein (CRP) of patients with acute exacerbations of chronic obstructive pulmonary diseases and respiratory failure.Methods:A total of 80 patients with acute exacerbations of chronic obstructive pulmonary diseases and respiratory failure in our hospital from June 2014 to October 2016 were enrolled in this study. The subjects were divided into the control group (n=40) and the treatment group (n=40) randomly. The control group were treated with conventional treatment, the treatment group were treated with the conventional treatment combined with low molecular weight heparin. The two groups were treated for 7 d. The D-dimer (D-D), fibrinogen (FBG), pro thrombin time (PT), thrombin time (TT), TNF-α, CK-MB and CRP of the two groups before and after treatment were compared.Results:There were no significantly differences of the blood levels of D-D, FBG, PT and TT of the two groups before treatment. After treatment, the blood levels of D-D and FBG of the two groups were significantly lower than before treatment, and that of the treatment group were significantly lower than the control group, the PT and TT of the two groups were significantly higher than before treatment, and that of the treatment group were significantly higher than the control group. There were no significantly differences of the serum levels of the TNF-α, CK-MB and CRP of the two groups before treatment. After treatment, the serum levels of the TNF-α, CK-MB and CRP of the two groups were significantly lower than before treatment, and that of the treatment group were significantly lower than the control group.Conclusion:Low molecular weight heparin can significantly reduce the inflammatory factors of the patients with acute exacerbations of chronic obstructive pulmonary diseases and respiratory failure, can alleviath the patients conditions and reduce the myocardial damage.
文摘Background: Multiple hospitalizations for acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are associated with considerable morbidity and mortality. Objectives: To identify predictive factors of multiples hospitalizations for AECOPD. Methods: This is a retrospective single center study of consecutive patients with COPD hospitalized at the Department of Respiratory Medicine between January 1990 and December 2015. We calculated for each patient the mean number of hospitalizations for AECOPD/year (H/y). We distinguished 2 groups (G) of patients. G1: <2 H/y and G2: ≥2 H/y. Predictors of multiple admissions identified by univariate analysis were included in the multivariate analysis. Results: The study included 1167 COPD patients (mean age 67 ± 10 years, 97% males). Three hundred six (26%) COPD patients had a mean number of hospitalizations per year ≥ 2. Multivariate logistic regression analysis demonstrated that an mMRC ≥ 2 (Odd ratio [OR] 1.8, 95% confidence interval [CI] 1.08 - 2.99, p = 0.022), a low PaO2 (PaO2 OR 0.97, 95% CI 0.95 - 0.99, p = 0.007) and frequent exacerbations (OR 2.95, 95% CI 2.56 - 3.39, p < 0.001) are independent factors associated with multiple admissions for AECOPD. Conclusions: An mMRC ≥ 2, a low PaO2 and frequent exacerbations are independently associated with multiple hospitalizations for AECOPD. The identification of these high risk COPD patients will be helpful in the decision of intervention strategies.
文摘Objectives： To determine whether traditional Chinese medicine （TCM） aerosol inhalation treatment is effective inthe treatment of acute exacerbation of chronic bronchitis. Methods： Search double-blind randomised clinical trials（RCT） about the use of TCM aerosol inhalation in patient with acute exacerbation of chronic bronchitis via database including Chinese biomedicine literature database, Wanfang Data, CNKI, Pubmed, EMBASE and CochraneLibrary from the beginning to October 2016. Quality evaluation, data extraction and data analysis of these RCT wascarried out with reference to the Cochrane systematic review. Results： 16 studies with 738 patients in TCM aerosolinhalation group and 675 in control group were included. The results of meta-analysis showed, （1） TCM aerosolinhalation group could improve the total cure rate. （2） TCM aerosol inhalation could increase the expression of IL-2while decrease the expression of IL-8 and MDA in sputum and blood. （3） TCM aerosol inhalation could improvethe symptoms of cough, cough with sputum, cough with dyspnea and lung wet rales. It also improve the symptomsof cough, expectorate and lung wet rales. （4） Shorten the time of cough and lung rale. （5） The adverse reactionswere light only with 1 occurrence of nausea and vomiting. Conclusions： The use of TCM aerosol inhalation in thetreatment of acute exacerbation of chronic bronchitis was effective. However, the inclusion researches quality werenot very high, which only provided limited evidence for clinical application. Higher-quality randomized controlledtrials were needed for further study.
基金supported by the Guangxi Key Research and Development Program of the Department of Science and Technology of Guangxi Zhuang Autonomous Region(No.GuikeAB17292044)China Soong Ching Ling Foundation Respiratory Disease Clinical Research Public Welfare Fund 2018 Chronic Obstructive Pulmonary Special Project(No.2018MZFZY-001).
文摘Background:The eosinophilic chronic obstructive pulmonary disease(COPD)is known to be more sensitive to corticosteroid.The sputum microbiome has been shown to affect COPD prognosis,but its role in acute exacerbations of eosinophilic COPD is unclear.This study aimed to investigate the dynamic changes of the airway microbiome in patients with acute exacerbations of eosinophilic COPD.Methods:Fifty-seven patients with acute exacerbations of COPD from the First Affiliated Hospital of Guangxi Medical University between June 2017 and June 2018 were divided into two groups.Patients with eosinophils≥300 cells/mL in the peripheral venous blood were assigned to the eosinophilic group(Eos)and the rest to the non-eosinophilic group(Noneos).All patients received similar treatment including inhaled budesonide according to the guidelines.The induced sputum microbiome was analyzed on the 1st and 7th day of treatment using the 16S ribosomal RNA(rRNA)method.The levels of interleukin(IL)-6 and IL-8 were measured in the plasma and the sensitivity to corticosteroids was determined in isolated peripheral blood mononuclear cells.Quantitative data were compared between the two groups using the independent samples t test or Mann-Whitney U test.Categorical data were evaluated using Chi-squared test or Fisher’s exact test.Results:Twenty-six patients were classified into Eos group and 31 patients were classified into Noneos group.Prior to treatment,the alpha diversity(Shannon index)(2.65±0.63 vs.2.56±0.54,t=0.328,P=0.747)and the structure of the sputum microbiome were similar in the Eos group and the Noneos group.After 7 days of treatment,alpha diversity increased in both groups,while the microbiome richness(Ace index)was significantly lower in the Eos group(561.87±109.13 vs.767.88±148.48,t=-3.535,P=0.002).At the same time,IL-6(12.09±2.85 pg/mL vs.15.54±2.45 pg/mL,t=-4.913,P<0.001)and IL-8(63.64±21.69 pg/mL vs.78.97±17.13 pg/mL,t=-2.981,P=0.004)decreased more significantly in the Eos group,and the percentages of inhibition of IL-8 at dexamethasone concentrations 10-8 to 10-6 mol/L were significantly higher in the Eos group than those in the Noneos group(all P<0.05).Conclusions:The induced sputum microbiome richness decreased more significantly following treatment in the Eos patients compared to the Noneos patients.The lower plasma inflammatory factor levels and the higher percentage of inhibition of IL-8 might be due to higher corticosteroid sensitivity in Eos patients.
基金supported by grants from NIH T32(DK007260,to WC)the Steno North American Fellowship awarded by the Novo Nordisk Foundation(NNF23OC0087108,to WC).
文摘The shared links between Alzheimer’s disease and type 2 diabetes mellitus:Alzheimer’s disease(AD)and type 2 diabetes mellitus(T2DM)are two prevalent conditions that come with substantial daily struggles.Emerging evidence highlights that these diseases share similar pathophysiological features,including insulin resistance and chronic inflammation,which contribute to their rapid progression(Chen et al.,2022).Insulin resistance,a hallmark of T2DM,has been suggested to exacerbate neurodegeneration in AD.Similarly,chronic low-grade inflammation in T2DM parallels with neuroinflammation,which is observed in AD,suggesting overlapping pathophysiological mechanisms in T2DM and AD.
基金This study was supported by a grant from Beijing Science andTechnology Committee (No.9555102600)
文摘Background Respiratory muscle fatigue plays an important role in acute exacerbations of chronic obstructivepulmonary disease (AECOPD)·In previous clinical studies, non-invasive positive pressure ventilation (NPPV)was proved to be successful only for AECOPD patients with severe respiratory failure·We hypothesized that, theoutcomes of AECOPD would be improved if NPPVis early (within 24 to 48 hours of admission) administered inthose patients with respiratory muscle fatigue and mild respiratory insufficiency, especially in patients withoutfulfilling the conventional criteria of mechanical ventilatory support·Methods Aprospective multicentre randomized controlled trial was conducted in19 hospitals in China over16months·Three hundred and forty-two AECOPD patients with pH≥7·25 and PaCO2>45 mmHg were recruitedon general ward and randomly assigned to standard medical treatment (control group) or early administration ofadditional NPPV (NPPV group)·Results The characteristics of two groups on admission were similar·The number of AECOPD patientsrequiring intubations in NPPV group was much fewer than that of the control group (8/171 vs 26/71,P=0·002)·Subgroup analysis showed the needs for intubation in mildly (pH≥7·35) and severe (pH<7·30)acidotic patients in NPPVgroup were both decreased (9/80 vs2/71,P=0·047 and 8/30 vs3/43,P=0·048,respectively)·The mortality in hospital was reduced slightly by NPPV but with no significant difference (7/171vs 12/171,P=0·345)·Respiratory rate (RR),scale for accessory muscle use and arterial pHimproved rapidlyat the first 2 hours only in patients of NPPV group·After 24 hours, the differences of pH, PaO2, scale foraccessory muscle use and RR in NPPV group [(7·36±0·06) mmHg, (72±22) mmHg, (2·5±0·9) /min,(22±4) /min] were statistically significant compared with control group (7·37±0·05) mmHg, (85±34)mmHg, (2·3±1·1) /min, (21±4) /min,P<0·01 for all comparisons]·Conclusions The early use of NPPV on general ward improves arterial blood gas and respiratory pattern,decreases the rate of need for intubation in AECOPD patients·NPPV is indicative for alleviating respiratorymuscle fatigue and preventing respiratory failure from exacerbation·
文摘Background Although acute congestive heart failure （CHF） patients typically present with abnormal auscultatory findings on lung examination, lung sounds are not normally subjected to rigorous analysis. The goals of this study were to use a computerized analytic acoustic tool to evaluate lung sound patterns in CHF patients during acute exacerbation and after clinical improvement and to compare CHF profiles with those of normal individuals.Methods Lung sounds throughout the respiratory cycle was captured using a computerized acoustic-based imaging technique. Thirty-two consecutive CHF patients were imaged at the time of presentation to the emergency department and after clinical improvement. Digital images were created, geographical area of the images and lung sound patterns were quantitatively analyzed.Results The geographical areas of the vibration energy image of acute CHF patients without and with radiographically evident pulmonary edema were （67.9±4.7） and （60.3±3.5） kilo-pixels, respectively （P 〈0.05）. In CHF patients without and with radiographically evident pulmonary edema （REPE）, after clinical improvement the geographical area of vibration energy image of lung sound increased to （74.5±4.4） and （73.9±3.9） kilo-pixels （P 〈0.05）, respectively. Vibration energy decreased in CHF patients with REPE following clinical improvement by an average of （85±19）% （P 〈0.01）. Conclusions With clinical improvement of acute CHF exacerbations, there was more homogenous distribution of lung vibration energy, as demonstrated by the increased geographical area of the vibration energy image. Lung sound analysis may be useful to track in acute CHF exacerbations.
基金This study was supported by grants from the National Natural Science Foundation of China(Nos.81670034 and 81300250)。
文摘Appropriate management of acute exacerbation of chronic obstructive pulmonary disease(AECOPD)is very important because such exacerbation negatively impacts patients’health status,disease progression,and mortality.Exacerbation episodes are mainly triggered by viral and bacterial infections,and one study showed that 55%of hospitalized patients with AECOPD had a bacterial infection.[1]Some analyses have suggested that antibiotic therapy can reduce the risk of short-term mortality and improve the prognosis.However,not all patients with AECOPD benefit from antibiotic therapy.The blood eosinophil count has been used as a biomarker for eosinophil-associated airway inflammation and sepsis.However,the association between the peripheral blood eosinophil count and bacterial pathogens has not been reported.Our aim was to analyze the associations among the eosinophil count,bacterial pathogens,clinical treatments,and prognosis of patients and provide useful and comprehensive references for AECOPD management.
文摘BACKGROUND The relationship between diabetes mellitus(DM)and asthma is complex and can impact disease trajectories.AIM To explore the bidirectional influences between the two conditions on clinical outcomes and disease control.METHODS We systematically reviewed the literature on the relationship between DM and asthma,focusing on their impacts,mechanisms,and therapeutic implications.Various studies were assessed,which investigated the effect of glycemic control on asthma outcomes,lung function,and exacerbations.The study highlighted the role of specific diabetes medications in managing asthma.RESULTS The results showed that poor glycemic control in diabetes can exacerbate asthma,increase hospitalizations,and reduce lung function.Conversely,severe asthma,especially in obese individuals,can complicate diabetes management and make glycemic control more difficult.The diabetes-associated mechanisms,such as inflammation,microangiopathy,and oxidative stress,can exacerbate asthma and decrease lung function.Some diabetes medications exhibit anti-inflammatory effects that show promise in mitigating asthma exacerbations.CONCLUSION The complex interrelationship between diabetes and asthma suggests bidirectional influences that affect disease course and outcomes.Inflammation and microvascular complications associated with diabetes may worsen asthma outcomes,while asthma severity,especially in obese individuals,complicates diabetes control.However,the current research has limitations,and more diverse longitudinal studies are required to establish causal relationships and identify effective treatment strategies for individuals with both conditions.
基金supported by the National Natural Science Foundation of China(32170980)Guangdong Basic and Applied Basic Research Foundation(2022B1515020012)+7 种基金Shenzhen Fundamental Research Program(RCJC20231211090018040,ZDSYS20220606100801003)the 2023 Key Support Project of the Liaoning Provincial Department of Science and Technology([2023]61-7)the Ciberned(CB06/05/0076)the Spanish MICINN grant(PID2022-143020OB-I00)the Basque Government grant(IT1551-22)the Slovenian Research Agency grant J4-60077the Science and Technology Planning Project of Guangdong Province(2021B1212040006)the Sanming Project of Medicine in Shenzhen(SZSM202411023,SZSM202411013).
文摘Alzheimer's disease(AD),the leading cause of dementia,remains a formidable challenge to neurology.Despite decades of research focused on amyloid-β(Aβ)and tau pathologies,most clinical trials targeting these molecules failed,highlighting the need for alternative strategies[1].Recent attention has turned to neuroinflammation,particularly the role of microglia,the brain's resident immune cells[1].Microglia are central to AD progression.They can degrade Aβplaques and protect neurons,but may also exacerbate neurotoxicity through chronic inflammation[1].
文摘Objective:This study aims to investigate the patterns of symptom occurrence in patients experiencing acute exacerbations of chronic obstructive pulmonary disease(AECOPD).It will explore the composition of symptom clusters and analyze the correlation between these clusters and health-related quality of life(HRQoL).Methods:A total of 207 patients with AE-COPD were surveyed from a tertiary grade A hospital.Data collection was conducted using three validated instruments:the Basic Information Questionnaire(BIQ),Disease Symptom Survey Questionnaire(MSAS),and Quality of Life Questionnaire(CAT).Statistical software SPSS 22.0 was used to analyze the correlation between symptom clusters and quality of life.Results:Exploratory factor analysis showed that five major symptom clusters existed in the patients,including the psycho-emotional symptom cluster,the sleep-related symptom cluster,the other side effects symptom cluster,the energy deficiency symptom cluster and the cough-loss of appetite symptom cluster,and the severity of the symptom clusters showed a significant negative correlation with the quality of life of the patients(P<0.05).Conclusion:Strengthening the comprehensive management of symptom clusters in patients with AE-COPD can help to effectively reduce the symptom burden of patients,and then significantly improve their quality of life.
基金funded by the National Natural Science Foundation of China(No.12272246)(YZ)partially funded by ARO(Army Research Office)(W911NF2310189)a grant from NSF(NSF 2324052)of the USA(BMF).
文摘1 Subcellular Organelle Dysfunction and Disease Progression The precise organization of subcellular organelles is important for maintaining cellular homeostasis.Compartmentalization orchestrates metabolic processes,signal transductions,and stress responses.Disturbances in organelles,including the nucleus,mitochondria,lysosomes,and endoplasmic reticulum,can lead to widespread intracellular dysfunction and contribute to diverse pathologies.For example,mitochondrial reactive oxygen species(ROS)exacerbate endoplasmic reticulum(ER)stress,as demonstrated in studies linking ROS-mediated mitochondrial dysfunction to apoptosis in neurodegenerative diseases,cancer,and inflammatory diseases[1–4].ER stress has also been implicated in cardiac hypertrophy[5],lung fibrosis[6],liver fibrosis[7],and ulcerative colitis[8].
基金2022 Inner Mongolia Autonomous Region Health and Wellness Science and Technology Program Project(Project No.:202201533)。
文摘Patients with acute exacerbation of chronic obstructive pulmonary disease(COPD)often suffer from respiratory failure and require respiratory support therapy.High-flow nasal cannula oxygen therapy(HFNC)and non-invasive positive pressure ventilation(NIPPV)are commonly used non-invasive respiratory support methods.HFNC can provide precisely heated and humidified high-flow oxygen,reducing dead space and increasing alveolar ventilation.NIPPV can supply stable high-concentration oxygen and improve gas exchange.This article reviews the application of HFNC and NIPPV in the acute exacerbation stage of COPD,aiming to provide references for reasonable clinical selection.
文摘The U.S.Food and Drug Administration today approved the first generic of Advair Diskus(fluticasone propionate and salmeterol inhalation powder)for the twice-daily treatment of asthma in patients aged four years and older and maintenance treatment of airflow obstruction and reducing exacerbations in patients with chronic obstructive pulmonary disease (COPD).
文摘Chronic obstructive pulmonary disease(COPD)is one of the leading causes of mortality and morbidity worldwide.One of the most important features of this disease is exacerbations where a patient’s respiratory symptoms episodically worsen.Exacerbations accounted for over 140000 hospital admissions in 2012 in the United Kingdom with considerably more exacerbations being treated in primary care.Despite significant research in this area in recent years,treatment of acute exacerbations in the community remains limited to oral glucocorticoids,antibiotics and bronchodilators.One of the issues with unpicking the complexity of exacerbations is trying to find out the exact underlying cause and mechanism that leads to symptoms and lung destruction.Currently symptoms are initially guided by symptoms alone though multiple causes of exacerbations have common presentations.This includes viral and bacterial infections and episodes relating to environmental triggers such as pollen and pollution.There is also evidence that cardiovascular factors can contribute to symptoms of breathlessness that can mimic COPD exacerbations.In this editorial we discuss recent advances in the use of precision medicine to more accurately treat exacerbations of COPD.This includes identification of phenotypes that could help rationalise treatment and more importantly identify novel drug targets.We also consider the future role of precision medicine in preventing exacerbations and identifying COPD patients that are at increased risk of developing them.
文摘Objective:To analyze key factors associated with the failure of non-invasive ventilation(NIV)in patients with acute exacerbations of chronic obstructive pulmonary disease(AECOPD)complicated by type II respiratory failure.Methods:A total of 122 patients with AECOPD and type II respiratory failure admitted to Gaoyou People’s Hospital between January 2020 and June 2023 were selected for the study.Upon admission,all patients received ECG monitoring and NIV,along with comprehensive therapies such as anti-infective treatment,antispasmodics,bronchodilators,and expectorants.NIV was provided using the S/T mode,with ventilator parameters adjusted based on the patient’s respiratory status and blood gas analysis results.Clinical data were retrospectively analyzed from electronic medical records.Results:Out of the 122 patients,30 experienced NIV failure,accounting for 24.59%.Significant differences were observed in C-reactive protein(CRP),pH,and partial pressure of arterial carbon dioxide(PaCO_(2))between patients with successful and failed NIV outcomes(P<0.05).There were no statistically significant differences in gender,age,arterial oxygen partial pressure(PaO_(2)),neutrophil count(NEUT),procalcitonin(PCT),albumin(ALB),or tidal volume between the two groups(P>0.05).Logistic regression analysis confirmed that CRP,pH,and PaCO_(2)were significant risk factors for NIV failure(P<0.05).Conclusion:CRP,pH,and PaCO_(2)are independent risk factors influencing NIV failure.
基金Supported by National Natural Science Foundation of China,No.81300319Science and Technology Support Program of Sichuan Province,China,No.2015SZ0049
文摘Hepatitis B virus(HBV) associated acute-on-chronic liver failure(ACLF) is an increasingly recognized fatal liver disease encompassing a severe acute exacerbation of liver function in patients with chronic hepatitis B(CHB). Despite the introduction of an artificial liver support system and antiviral therapy, the short-term prognosis of HBV-ACLF is still extremely poor unless emergency liver transplantation is performed. In such a situation, stopping or slowing the progression of CHB to ACLF at an early stage is the most effective way of reducing the morbidity and mortality of HBV-ACLF. It is well-known that the occurrence and progression of HBV-ACLF is associated with many factors, and the outcomes of HBV-ACLF patients can be significantly improved if timely and appropriate interventions are provided. In this review, we highlight recent developments in early warning and clinical outcome prediction in patients with HBV-ACLF and provide an outlook for future research in this field.
基金Supported by the National Natural Science Foundation of China,No.81460124 and No.81860114
文摘BACKGROUND Acute exacerbation in patients with chronic hepatitis B virus(HBV) infection results in different severities of liver injury. The risk factors related to progression to hepatic decompensation(HD) and acute-on-chronic liver failure(ACLF) in patients with severe acute exacerbation(SAE) of chronic HBV infection remain unknown.AIM To identify risk factors related to progression to HD and ACLF in compensated patients with SAE of chronic HBV infection.METHODS The baseline characteristics of 164 patients with SAE of chronic HBV infection were retrospectively reviewed. Independent risk factors associated with progression to HD and ACLF were identified. The predictive values of our previously established prediction model in patients with acute exacerbation(AE model) and the model for end-stage liver disease(MELD) score in predicting the development of ACLF were evaluated.RESULTS Among 164 patients with SAE, 83(50.6%) had compensated liver cirrhosis(LC),43 had progression to HD without ACLF, and 29 had progression to ACLF within 28 d after admission. Independent risk factors associated with progression to HD were LC and low alanine aminotransferase. Independent risk factors for progression to ACLF were LC, high MELD score, high aspartate aminotransferase(AST) levels, and low prothrombin activity(PTA). The area under the receiver operating characteristic of the AE model [0.844, 95%confidence interval(CI): 0.779-0.896] was significantly higher than that of MELD score(0.690, 95%CI: 0.613-0.760, P < 0.05) in predicting the development of ACLF.CONCLUSION In patients with SAE of chronic HBV infection, LC is an independent risk factor for progression to both HD and ACLF. High MELD score, high AST, and low PTA are associated with progression to ACLF. The AE model is a better predictor of ACLF development in patients with SAE than MELD score.
