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Influenza and pneumococcal vaccination are a priority in patients with chronic obstructive pulmonary disease (COPD). However, limited information is available on vaccination coverage among patients with acute exacerbations of COPD (AECOPD) in China. This study aimed to determine the rates and associated factors of influenza and pneumococcal vaccination in patients hospitalized with AECOPD. Baseline data from a national, multicenter, hospital-based study that included adult inpatients with AECOPD between 2017 and 2021 were analyzed. The outcomes of interest were the influenza vaccination in the past year and the pneumococcal vaccination in the past 5 years. To ensure national representativeness, rates were weighted according to the distribution of hospital levels and types enrolled in this study. Multivariable Poisson regression based on mixed-effects models were used to determine the associated factors. The independent variables included the region and hospital features where the participants were located, sociodemographic characteristics (age, sex, rural/urban residence, education, etc.), and clinical indicators (COPD disease history, lung function parameters, comorbidities, etc.). The treatment profiles of the vaccinated and unvaccinated participants were compared. Of 6949 eligible participants, the weighted rates of influenza/pneumococcal, influenza, and pneumococcal vaccination were 2.72% (95% confidence interval [CI]: 2.34%-3.10%), 2.09% (95% CI: 1.76%-2.43%), and 1.25% (95% CI: 0.99%-1.51%), respectively. In multivariable models, age ≥60 years (60-69 years, odds ratio [OR]: 1.90, 95% CI: 1.11-3.25; ≥80 years, OR: 2.00, 95% CI: 1.06-3.78), geographical regions (Northern China relative to Eastern China, OR: 5.09, 95% CI: 1.96-13.21), urban residence (OR: 1.69, 95% CI: 1.07-2.66), a higher education level (junior high school, OR: 1.77, 95% CI: 1.21-2.58; senior high school or above, OR: 2.61, 95% CI: 1.69-4.03), former smoking (OR: 1.79, 95% CI: 1.15-2.79), and regular inhaled medication treatment (OR: 3.28, 95% CI: 2.29-4.70) were positively associated with vaccination. Patients who had experienced severe exacerbations in the past year were less likely to be vaccinated (OR: 0.65, 95% CI: 0.45-0.96). Compared with unvaccinated participants, vaccinated participants adhered better to pharmacological and non-pharmacological treatment. Influenza and pneumococcal vaccination coverage are extremely low. Urgent measures are necessary to increase vaccination coverage among inpatients with AECOPD in China.

Background: Chronic Obstructive Pulmonary Disease (COPD) is a common and prevalent condition that poses a significant threat to human health. Respiratory muscle fatigue is one of the common clinical manifestations of COPD. Currently, no effective treatment has been proposed to alleviate COPD symptoms. Respiratory neuromuscular electrical stimulation (RNES) enhances diaphragmatic contraction, lung volume, and ventilation through selective activation of type II muscle fibers, as evidenced in neurological and respiratory critical care settings. Although many COPD patients are managed through community care interventions, the efficacy of RNES in treating COPD patients has not been sufficiently studied. Here, we aim to investigate whether RNES can improve exercise capacity in COPD patients, as measured by 6-minute walk distance (6MWT). Objectives: To determine the efficacy of a community-based pulmonary rehabilitation (PR) program incorporating RNES on exercise capacity and symptoms in COPD patients. To evaluate its feasibility as a novel, affordable and accessible community PR model for COPD management. Design: This is a prospective, multicenter, randomized, parallel-controlled clinical trial, enrolling 60 patients with COPD. Methods: Sixty patients with stable COPD receiving inhalation therapy in 11 community health service centers in Beijing will be enrolled in the study. The potential of RNES to improve exercise capacity within this population will be explored in the study cohort. The enrolled patients will be randomized into two groups in a 1:1 ratio: control group (to receive conventional treatment) and experimental group (to receive conventional treatment plus RNES). During the treatment, the control group will receive conventional treatment without RNES, and those in the experimental group will receive 20/40 treatments over 6/12 weeks (1 session per day for 30 min) of RNES rehabilitation-assisted therapy plus conventional treatment. The primary outcome is exercise capacity based on changes in 6MWT at 12 weeks. The secondary outcome measures include changes from baseline in several indicators: dyspnea questionnaire, impact on daily living, anxiety and depression, pulmonary function, diaphragm function, respiratory muscle strength and body composition. Discussion: This clinical trial is designed to investigate whether rehabilitation assistance therapy with RNES will improve diaphragm mobility, respiratory muscle strength and endurance, enhance pulmonary ventilation, tidal volume, and promote alveolar carbon dioxide excretion in patients with stable COPD, which will improve the activity and exercise capacity. This study investigates the feasibility of RNES as a scalable rehabilitation intervention for COPD management in community healthcare settings. Conclusion: RNES will improve exercise capacity, quality of life in patients with COPD. Trial registration: The protocol has been registered at the Chinese Clinical Trial Registry (ChiCTR2200061675).

Purpose: To analyze the relationship between body mass index (BMI) and lung function, which may help optimize the screening and management process for chronic obstructive pulmonary disease (COPD) in the early stages. Patients and Methods: In this cross-sectional study using data from the Enjoying Breathing Program in China, participants were divided into two groups according to COPD Screening Questionnaire (COPD-SQ) scores (at risk and not at risk of COPD) and three groups based on lung function (normal lung function, preserved ratio impaired spirometry [PRISm], and obstructive lung function). Results: A total of 32,033 subjects were enrolled in the current analysis. First, in people at risk of COPD, overweight and obese participants had better forced expiratory volume in one second (FEV1; overweight: 0.33 liters (l), 95% confidence interval [CI]: 0.27 to 0.38; obesity: 0.31 L, 95% CI: 0.22 to 0.39) values than the normal BMI group. Second, among people with PRISm, underweight participants had a lower FEV1 (-0.56 L, 95% CI: -0.86 to -0.26) and forced vital capacity (FVC; -0.33 L, 95% CI: - 0.55 to -0.11) than participants with a normal weight, and obese participants had a higher FEV1 (0.22 L, 95% CI: 0.02 to 0.42) and FVC (0.16 L, 95% CI: 0.02 to 0.30) than participants with a normal weight. Taking normal BMI as the reference group, lower FEV1 (- 0.80 L, 95% CI: -0.97 to -0.63) and FVC (-0.53 L, 95% CI: -0.64 to -0.42) were found in underweight participants with obstructive spirometry, and better FEV1 (obesity: 0.26 L, 95% CI: 0.12 to 0.40) was found in obese participants with obstructive spirometry. Conclusion: Being underweight and severely obese are associated with reduced lung function. Slight obesity was shown to be a protective factor for lung function in people at risk of COPD and those with PRISm. Keywords: body mass index, lung function, preserved ratio impaired spirometry, chronic obstructive pulmonary disease

ObjectiveTo explore the clinical features and prognoses of dermatomyositis (DM) associated with a double-positive anti-MDA5 and anti-aminoacyl-tRNA synthetase (anti-ARS) antibody presentation.MethodsWe retrospectively analyzed 1280 consecutive patients with idiopathic inflammatory myopathy (IIM). Individuals with anti-MDA5 and anti-ARS antibodies (anti-MDA5+/ARS+) were compared to anti-MDA5-/ARS+ and anti-MDA5+/ARS- control individuals based on clinical, pulmonary radiological characteristics, treatment, and follow-up information.ResultsSix individuals (0.47%) presented with anti-MDA5+/ARS+; of these, 2 (33.3%) were anti-PL-12+, 2 (33.3%) were anti-Jo-1+, 1 (16.7%) was anti-EJ+, and 1 (16.7%) was anti-PL-7+. Hallmark cutaneous manifestations, including Gottron’s sign (100%), heliotrope rash (50%), mechanic’s hand (66.7%), and skin ulcers (16.7%) were common. Anti-MDA5+/ARS+ patients tended to have higher ferritin levels (p = 0.038) than anti-MDA5-/ARS+ group, and higher CD4+ T-cell counts (p = 0.032) compared to the anti-MDA5+/ARS- group. Radiologically, NSIP with OP overlap was predominant (60%). Consolidation (60%), ground-glass attenuation (GGA) (80%), traction bronchiectasis (80%), and intralobular reticulation (100%) were common in anti-MDA5+/ARS+ individuals. All were diagnosed with ILD and 50% were categorized as RPILD. All patients received glucocorticoids combined with one or more immunosuppressants. Most (83.3%) had a good prognosis following treatment, but there was no difference in the survival rate between the three subgroups.ConclusionPresentation with anti-MDA5+/ARS+ DM was rare. The clinical and radiological characteristics of anti-MDA5+/ARS+ DM combined the features of anti-MDA5+ and anti-ARS+ individuals. Individuals with anti-MDA5+/ARS+ antibodies may respond well to glucocorticoid therapy; glucocorticoids combined with one or more immunosuppressants may be considered a basic treatment approach.

Abstract Background: Understanding willingness to undergo pulmonary function tests (PFTs) and the factors associated with poor uptake of PFTs is crucial for improving early detection and treatment of chronic obstructive pulmonary disease (COPD). This study aimed to understand willingness to undergo PFTs among high-risk populations and identify any barriers that may contribute to low uptake of PFTs. Methods: We collected data from participants in the “Happy Breathing Program” in China. Participants who did not follow physicians’ recommendations to undergo PFTs were invited to complete a survey regarding their willingness to undergo PFTs and their reasons for not undergoing PFTs. We estimated the proportion of participants who were willing to undergo PFTs and examined the various reasons for participants to not undergo PFTs. We conducted univariable and multivariable logistic regressions to analyze the impact of individual-level factors on willingness to undergo PFTs. Results: A total of 8475 participants who had completed the survey on willingness to undergo PFTs were included in this study. Out of these participants, 7660 (90.4%) were willing to undergo PFTs. Among those who were willing to undergo PFTs but actually did not, the main reasons for not doing so were geographical inaccessibility (n = 3304, 43.1%) and a lack of trust in primary healthcare institutions (n = 2809, 36.7%). Among the 815 participants who were unwilling to undergo PFTs, over half (n = 447, 54.8%) believed that they did not have health problems and would only consider PFTs when they felt unwell. In the multivariable regression, individuals who were ≤54 years old, residing in rural townships, with a secondary educational level, with medical reimbursement, still working, with occupational exposure to dust, and aware of the abbreviation “COPD” were more willing to undergo PFTs. Conclusions: Willingness to undergo PFTs was high among high-risk populations. Policymakers may consider implementing strategies such as providing financial incentives, promoting education, and establishing community-based programs to enhance the utilization of PFTs.

Background The tricuspid annular plane systolic excursion/systolic pulmonary artery pressure ratio (TAPSE/sPAP) has limitations in evaluating right ventricle–to–pulmonary artery (RV-PA) coupling, particularly when pulmonary artery pressure cannot be accurately estimated by tricuspid regurgitation or when TAPSE cannot accurately reflect right ventricular systolic function in certain scenarios. Therefore, this study aimed to explore the value of three-dimensional echocardiography (3DE) coupling parameters in assessing RV-PA coupling in patients with pre-capillary pulmonary hypertension (PH). Methods Fifty-nine patients with pre-capillary PH were retrospectively recruited. The surrogate “gold standard” of RV-PA coupling was derived from right heart catheterization (RHC) and cardiac magnetic resonance imaging (CMR). The relationships between echocardiographic RV-PA coupling parameters and RHC-CMR coupling standard were analyzed by Pearson’s test and Bland‒Altman test. Additionally, 24 chronic thromboembolic pulmonary hypertension (CTEPH) patients were enrolled to explore the changes in echocardiographic RV-PA coupling parameters before and after PEA. Multivariate ordinal regression analysis was performed to identify echocardiographic parameters associated with prognostic risk stratification in pre-capillary PH patients. Results 3DE coupling parameters demonstrated strong correlation and good agreement with the RHC-CMR coupling standard. In contrast, TAPSE/sPAP was moderately correlated to the RHC-CMR coupling standard, but showed poor consistency, with a significant bias of 0.44 (95% CI: 0.374, 0.511). Before and after PEA, stroke volume/end-systolic volume (SV/ESV) derived by 3DE remained moderately correlated with pulmonary vascular resistance (PVR) and mean pulmonary artery pressure (mPAP) ( r =-0.614, -0.655, P  < 0.001), whereas TAPSE/sPAP was only associated with PVR and mPAP in CTEPH patients before PEA ( r =-0.605, -0.758, P  < 0.001). Multivariate regression analysis revealed TAPSE/sPAP as the strongest predictor of prognostic risk. Conclusions 3DE-derived coupling parameters offer a noninvasive and reliable approach for assessing RV-PA coupling in patients with pre-capillary PH, especially for patients who cannot accurately estimate pulmonary artery pressure or have undergone cardiac surgery. 3DE SV/ESV is superior to TAPSE/sPAP for assessing postoperative RV-PA coupling in CTEPH patients, TAPSE/sPAP remains a valuable parameter for prognostic risk stratification in pre-capillary PH patients. Echocardiography can provide valuable information for assessing RV-PA coupling and prognosis in patients with pre-capillary PH. However, the application of echocardiographic coupling parameters should be determined based on the specific clinical context.

Background A large proportion of pulmonary embolism (PE) heritability remains unexplained, particularly among the East Asian (EAS) population. Our study aims to expand the genetic architecture of PE and reveal more genetic determinants in Han Chinese. Methods We conducted the first genome-wide association study (GWAS) of PE in Han Chinese, then performed the GWAS meta-analysis based on the discovery and replication stages. To validate the effect of the risk allele, qPCR and Western blotting experiments were used to investigate possible changes in gene expression. Mendelian randomization (MR) analysis was employed to implicate pathogenic mechanisms, and a polygenic risk score (PRS) for PE risk prediction was generated. Results After meta-analysis of the discovery dataset (622 cases, 8853 controls) and replication dataset (646 cases, 8810 controls), GWAS identified 3 independent loci associated with PE, including the reported loci FGG rs2066865 ( p -value = 3.81 × 10 −14 ), ABO rs582094 ( p -value = 1.16 × 10 −10 ) and newly reported locus FABP2 rs1799883 ( p -value = 7.59 × 10 −17 ). Previously reported 10 variants were successfully replicated in our cohort. Functional experiments confirmed that FABP2-A163G (rs1799883) promoted the transcription and protein expression of FABP2 . Meanwhile, MR analysis revealed that high LDL-C and TC levels were associated with an increased risk of PE. Individuals with the top 10% of PRS had over a fivefold increased risk for PE compared to the general population. Conclusions We identified FABP2 , related to the transport of long-chain fatty acids, contributing to the risk of PE and provided more evidence for the essential role of metabolic pathways in PE development.

Background Human papillomavirus (HPV) infection is the main cause of precancerous lesions and cervical cancer in women. In order to determine the epidemiological characteristics as well as the relationship between the HPV genotype and cytology test results among women in Beijing, China, we retrospectively collected and analyzed the data from a tertiary hospital in Beijing, China. Methods A total of 21,239 women visited the China–Japan Friendship Hospital between 2014 and 2018 and their cervical exfoliations were collected. Thirteen HPV subtypes (16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59 and 68) were examined and ThinPrep cytological test (TCT) was performed. Results Among all cases, 4473 (21.06%) women were infected with HPV. HPV52 (4.64%), HPV16 (4.44%) and HPV58 (4.28%) had higher prevalence. Single-type infection (77.26%) was more common than multiple-type infection (22.74%). Single-type infection was more frequently seen in women aged 50–60 years (17.17%), and multiple-type infection was more common in those aged < 30 years (7.88%). Significant differences in secular trends from 2014 to 2018 were observed for subtypes HPV39, 51, 52 and 58. HPV positive rates of women aged < 30 and 30–40 years changed significantly along with the time period, and the TCT positive rates of women aged 30–40, 40–50, 50–60 and >  60 years also showed significant differences from 2014 to 2018. In addition, 1746 (8.22%) women were TCT positive, of whom, 858 (4.04%), 561 (2.64%) and 327 (1.54%) had atypical squamous cells (ASCs), low-grade squamous intraepithelial lesions (LSILs) and high-grade squamous intraepithelial lesions (HSILs), respectively. Among four types of cytological lesions, the HPV infection rates were 16.76, 66.08, 63.99 and 85.32% in those negative for intraepithelial lesions or malignancy (NILM), ASC, LSIL and HSIL, respectively. Conclusions HPV52, 16 and 58 are the most common infection subtypes in this study and among four types of cytological lesions, HSILs has the highest HPV prevalence. Significant differences in secular trends are observed for different subtypes in recent 5 years. The results on HPV genotype-specific prevalence should be considered when the HPV vaccine program is implemented in Beijing area.

Background: High medication burdens are common in patients with chronic obstructive pulmonary disease (COPD). This study aimed to explore the associations of medication regimen complexity index (MRCI) with medication adherence and clinical outcomes among patients with acute exacerbations of COPD (AECOPD) after hospital discharge. Methods: Data were obtained from a nationwide cohort study of inpatients with AECOPD in China. MRCI scores were calculated using the medication list 30 days after discharge and separated into COPD-specific and non-COPD MRCI scores. Medication adherence was measured by the withdrawal rate of COPD or inhaled long-acting bronchodilators 6 months after discharge. Clinical outcomes included re-exacerbations and COPD-related readmissions during the 30-day to 6-month follow-up period. The associations of MRCI with medication withdrawal and clinical outcomes were evaluated using univariate and multivariate logistic regressions. Potential covariates included sociodemographic factors, year of COPD diagnosis, post-bronchodilator percentage predicted forced expiratory volume in 1 s, mMRC score, CAT score, and comorbidities. Results: Among the 2853 patients included, the median total MRCI score was 7 [interquartile range (IQR), 7−13]. A high MRCI score (>7) was presented in 1316 patients (46.1%). Of the MRCI score, 91% were COPD specific. The withdrawal rates of the COPD and inhaled long-acting bronchodilators were 24.2% and 24.4%, respectively. Re-exacerbation and COPD-related readmission rates were 10.2% and 7.5%, respectively. After adjusting for covariates, patients with high total MRCI scores were less likely to discontinue COPD drugs [odds ratio (OR), 0.62; 95% confidence interval (CI), 0.52−0.74] and inhaled long-acting bronchodilators (OR, 0.68; 95%CI, 0.57−0.81); conversely, these patients were more likely to experience re-exacerbation (OR, 1.64; 95% CI, 1.27−2.11) and readmission (OR, 1.57; 95% CI, 1.17−2.10). Conclusion: MRCI scores were relatively low among post-hospitalized patients with AECOPD in China. Higher MRCI scores were positively associated with adherence to COPD or inhaled medications, and risk of re-exacerbation and readmission. Registration: ClinicalTrials.gov identifier: NCT02657525.