BMC Pulmonary Medicine最新文献

Background: Bronchial asthma, a chronic inflammatory airway disease, is characterized by airway remodeling, including thickening of the airway smooth muscle layer, primarily due to abnormal proliferation of airway smooth muscle cells (ASMCs). CBL0137 (Curaxin-137 hydrochloride), a histone chaperone facilitate chromatin transcription (FACT) inhibitor, has demonstrated anti-tumor properties, including inhibition of proliferation, promotion of apoptosis, and increased autophagy. However, its effects on ASMCs and airway remodeling remain unexplored.

Methods: Asthma models were established using ovalbumin (OVA) in female C57BL/6 J mice, with therapeutic interventions using CBL0137 and budesonide. Lung tissues were analyzed using Hematoxylin and eosin (H&E), PAS, Masson's trichrome, and α-SMA immunofluorescence staining. ASMCs extracted from Sprague-Dawley rats were cultured in vitro experiments, with phenotypic changes assessed via flow cytometry. Gene and protein expressions were analyzed using RT-PCR and Western blotting.

Results: CBL0137 significantly reduced airway resistance, goblet cell proliferation, alveolar collagen deposition, and airway smooth muscle layer thickening in asthmatic mice. In vitro, CBL0137 inhibited ASMC proliferation and induced apoptosis, downregulating cyclin-B1, Cdc2, and Bcl-2 while upregulating caspase-3.

Conclusions: CBL0137 mitigates airway remodeling of asthmatic mice by modulating ASMC proliferation and apoptosis, presenting a potential therapeutic strategy for asthma treatment.

Background: Postoperative pulmonary infection (POI) is strongly associated with a poor prognosis and has a high incidence in elderly patients undergoing major surgery. Machine learning (ML) algorithms are increasingly being used in medicine, but the predictive role of logistic regression (LR) and ML algorithms for POI in high-risk populations remains unclear.

Methods: We conducted a retrospective cohort study of older adults undergoing major surgery over a period of six years. The included patients were randomly divided into training and validation sets at a ratio of 7:3. The features selected by the least absolute shrinkage and selection operator regression algorithm were used as the input variables of the ML and LR models. The random forest of multiple interpretable methods was used to interpret the ML models.

Results: Of the 9481 older adults in our study, 951 developed POI. Among the different algorithms, LR performed the best with an AUC of 0.80, whereas the decision tree performed the worst with an AUC of 0.75. Furthermore, the LR model outperformed the other ML models in terms of accuracy (88.22%), specificity (90.29%), precision (44.42%), and F1 score (54.25%). Despite employing four interpretable methods for RF analysis, there existed a certain degree of inconsistency in the results. Finally, to facilitate clinical application, we established a web-friendly version of the nomogram based on the LR algorithm; In addition, patients were divided into three significantly distinct risk intervals in predicting POI.

Conclusions: Compared with popular ML algorithms, LR was more effective at predicting POI in older patients undergoing major surgery. The constructed nomogram could identify high-risk elderly patients and facilitate perioperative management planning.

Trial registration: The study was retrospectively registered (NCT06491459).

Background: The association between the presence of common pathogens in the maternal cervicovaginal tract as well as neonatal gastric fluid and adverse outcomes in preterm newborns remains uncertain.

Methods: Cervicovaginal swabs were collected from 98 mothers, and gastric fluid specimens were obtained from 121 premature infants with gestational ages of ≤ 32 weeks within 24 h of birth. Thirteen pathogens were tested using suspension microarray. Neonatal outcomes were monitored until either death or discharge. RESULTS UREAPLASMA: was the predominant species identified in both maternal cervicovaginal swabs and neonatal gastric fluid. Preterm newborns with Ureaplasma in gastric fluid at birth exhibited a smaller gestational age (P < 0.001), a lower 1-min Apgar score (P = 0.01), an increased requirement for pulmonary surfactant (P = 0.029), and a higher incidence of bronchopulmonary dysplasia (BPD) (P = 0.02) compared to those who tested negative for Ureaplasma. Similarly, pregnant women with Ureaplasma colonization in the genital tract were more likely to deliver babies with a smaller gestational age (P = 0.002), a higher rate of tracheal intubation after birth (P = 0.013), a lower proportion of small for gestational age (SGA) infants (P = 0.018), and an increased occurrence of BPD (P = 0.048) than mothers without the agent. Furthermore, the presence of Ureaplasma in the gastric fluid of premature infants was identified as a risk factor for BPD, with an odds ratio (OR) of up to 6, alongside gestational age and SGA as independent predictors of BPD.

Conclusions: These findings suggest that antenatal exposure to Ureaplasma is correlated with the occurrence of BPD in premature infants, which has potential clinical implications.

Background: Thyroid hormones play a crucial role in numerous physiological processes, including pulmonary function. However, the relationship between thyroid function and different patterns of pulmonary ventilation remains unclear.

Methods: This study employed a bidirectional two-sample Mendelian randomization (MR) approach combined with a cross-sectional study from the National Health and Nutrition Examination Survey (NHANES) to explore the relationship between thyroid function and pulmonary ventilation indicators. We used genomic data from the ThyroidOmics Consortium and the UK Biobank to derive instrumental variables for thyroid and pulmonary functions. Adults from the NHANES 2007-2012 were included to validate the MR findings through weighted generalized linear model (GLM) regression and restricted cubic spline (RCS) analysis.

Results: Genetically predicted thyroid-stimulating hormone (TSH) was associated with pulmonary ventilatory function (forced expiratory volume in 1 s (FEV1): β = 0.0223, 95% confidence interval (CI) 0.0040-0.0406, p-value = 0.0170), particularly with a restrictive ventilatory pattern (forced vital capacity (FVC): β = 0.0237, 95% CI 0.0047-0.0427, p-value = 0.0143). This association was more robust in the low TSH subgroup. Additionally, the NHANES data revealed a nonlinear relationship between both FEV1% predicted and FVC% predicted and TSH, characterized by a positive relationship at lower TSH ranges and a negative relationship at higher TSH ranges.

Conclusions: Our findings highlight a significant association between TSH levels and a restrictive ventilatory pattern, underscoring the importance of thyroid health in the clinical evaluation of certain pulmonary diseases. These insights may guide more personalized interventions in respiratory medicine.

Background: Research is limited in describing the association between admission source and mortality in critically ill patients. Therefore, this study investigated how intensive care units (ICUs) admission source (emergency department (ED) or ward) correlates with mortality rates.

Methods: This retrospective observational cross-sectional study was conducted in a tertiary pulmonology teaching hospital's ICU from January 1, 2018, to December 31, 2019. Patients were ICU patients admitted for acute respiratory failure. Demographic, comorbidities, diagnoses, APACHE II score, ICU admission (ED or ward), mechanical breathing support (invasive or noninvasive), length of stay, and mortality were recorded. Comparisons of ICU admission sources and mortality factors were established.

Results: A total of 2,173 ICU patients were studied; 1,011 (46%) were admitted from the ED and 1,162 (54%) from the ward. Their mean age was 70 years, and 66% of them were men. Pneumonia was the leading cause of ICU admission at 60% and Chronic Obstructive Pulmonary Disease (COPD) was the most common comorbidity at 54%. When both groups were evaluated in terms of respiratory support, non-invasive mechanical ventilation use was higher in patients admitted from the emergency room (ED: 50% vs. Ward: 35%), invasive mechanical ventilation was more frequently required in patients admitted from the ward compared to those admitted from the emergency department (ED: 17% vs. Ward: 25%). Length of ICU stay (2 vs. 3 days P < 0.001) and ICU mortality (odds ratio: 1.66, 95% confidence interval 1.297-2.124, P < 0.001) were higher in patients admitted from the ward than in patients admitted from the emergency department. In addition, pneumonia patients and those with malignancies, interstitial lung disease, or noninvasive mechanical ventilation (NIV) failure were associated with higher mortality.

Conclusion: Our study suggests that ward-to-ICU patients had higher mortality rates compared to ED-to-ICU patients. Triage protocols to better identify potentially critically ill patients in the ED may improve outcomes by avoiding delays in care and better assignment of admission location.

Background: Chronic obstructive pulmonary disease (COPD) represents a significant public health challenge. This study aimed to investigate the epidemiological characteristics of COPD across different altitudes and evaluate the potential influence of altitude on its prevalence of high-risk populations.

Methods: This cross-sectional study employed a multi-stage randomized cluster sampling method and enrolled 11,095 adult residents aged ≥ 20 years at different elevations in Yunnan Province, China. Screening questionnaires identified high-risk individuals among participants, who then underwent pulmonary function tests. COPD was diagnosed based on post-bronchodilator test results. We utilized multivariate logistic regression models to examine the association between altitudes and COPD prevalence while controlling for demographic variables, lifestyle factors, and disease characteristics.

Results: A total of 2,252 (20.3%) were in the high-risk group. The prevalence of COPD in high-risk populations increased with age across low, intermediate, and high altitude areas. COPD patients in high-risk populations at high-altitude areas had a higher prevalence of ethnic minorities and significant biomass fuel exposure. Conversely, the proportion of COPD patients in the severe stages (GOLD III-IV) was notably lower in high-altitude regions. Logistic regression models revealed COPD prevalence in high-risk populations at high altitudes to be significantly lower than at low altitudes, with odds ratios of 0.538(95% CI: 0.343-0.844), 0.470(95% CI: 0.289-0.766), and 0.518 (95% CI: 0.316-0.848) for Models 1, 2, and 3, respectively (all P < 0.05).

Conclusion: The prevalence of COPD in high-risk populations is the lowest in the high-altitude regions of Yunnan Province, and high altitude is an independent factor negatively associated with COPD.

Background: Asthma self-management education empowers patients to manage their condition effectively. However, evidence on its impact in Ethiopia remains limited. This study evaluated the effect of asthma education on asthma control and self-management knowledge among adult asthma patients in Ethiopia.

Methods: A quasi-experimental design was employed, with a total of 204 participants, comprising 102 individuals in the intervention group and 102 in the control group at baseline. After accounting for follow-up losses (20.6% in the intervention group and 23.5% in the control group), 81 participants from the intervention group and 78 from the control group were retained six months after the completion of the education (post-intervention). Pre- and post-intervention assessments were conducted using validated questionnaires to measure asthma control levels and self-management knowledge. The intervention group received a structured, small-group asthma education program comprising three sessions over six months. The intervention's effect was analyzed using linear regression models for difference-in-differences and interaction effects, while heterogeneity analysis was performed using a generalized linear model.

Results: 10% of the intervention group and 7.8% of the control group reported prior asthma management education, most of which (60%) was over a decade ago. Asthma control levels significantly improved in the intervention group, with a 19.4% increase compared to 0.6% in the control group. The overall increase in the intervention group was 18.8% higher than in the control group (P = 0.03). Similarly, self-management knowledge improved markedly in the intervention group, with a 24.3% increase compared to 0.7% in the control group. The intervention group demonstrated a 23.6% overall improvement relative to the control group (P = 0.000).Participants in the intervention group were six times more likely to achieve well-controlled asthma and 13 times more likely to exhibit good self-management knowledge compared to the comparison group (p < 0.01). The intervention's impact was consistent across subgroups, with no significant variations by socio-demographic and asthma related factors.

Conclusions: Asthma self-management education interventions significantly enhance asthma management knowledge and control levels. This study highlights the need to implement and expand asthma education programs during patient follow-ups to empower patients, to reduce medical costs, unscheduled hospital visits, emergency department visits, and premature mortality.

Trial registration: Registered retrospectively with TRN PACTR202407741896902.

Rationale and objectives: To investigate the performance of two diagnostic models based on CT-derived lung and mediastinum radiomics nomograms for identifying cardiovascular disease (CVD) in Chronic Obstructive Pulmonary Disease (COPD) patients.

Materials and methods: Hospitalized participants with COPD were retrospectively recruited between September 2015 and April 2023. Clinical data and visual coronary artery calcium score (CACS) were collected. Radiomics features of lung and mediastinum were extracted. Least absolute shrinkage and selection operator (LASSO) logistic regression was applied for feature selection and radiomic model construction. We constructed 3 radiomics models, based on lung, mediastinum, and combined lung-and-mediastinum. Multivariate logistic regression model was used to establish radiomics nomograms. The performance of radiomics nomograms was evaluated by area under the ROC curve (AUC) and decision curve analysis (DCA).

Results: Of 686 COPD patients, 131 had a history of CVD. Age, neutrophilic granulocyte percentage, hematocrit and GOLD stage were independent clinical factors for CVD. 12 lung, and 6 mediastinum radiomic features were collected to construct the radiomics models. As the lung-and-mediastinum radiomics model included the same 6 features as the mediastinum model, finally 2 radiomics models were studied (lung, mediastinum). The 2 radiomics nomograms showed better discriminatory ability (AUC: 0.79, 95%CI [0.72, 0.86] for lung; 0.86, 95%CI [0.81, 0.92]) for mediastinum) than the clinical factors model (AUC: 0.71, 95%CI [0.64, 0.78]) and visual CACS (AUC: 0.65, 95%CI [0.57, 0.72]). DCA demonstrated the 2 radiomics nomograms outperformed the clinical factors and CACS across the majority of the range of reasonable threshold probabilities.

Conclusion: We developed chest CT-based nomograms to identify CVD in COPD patients, in particular based on mediastinum features, had better discriminatory power than clinical factors and visual CACS.

Trial registration: This retrospective study was approved by the institutional review boards at Second Affiliated Hospital of Naval Medical University, Tongji Hospital of Tongji University and Sir Run Run Shaw Hospital (ChiCTR2300069929 March 29, 2023). Retrospectively registered.

Background: Patients with non-Hodgkin lymphoma (NHL) face heightened mortality and accelerated disease progression when persistently infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). This critical situation underscores the urgent need to identify risk factors and establish early intervention strategies tailored to this vulnerable population. The primary aim of this study was to investigate the risk factors associated with persistent SARS-CoV-2 infection in NHL patients during the COVID-19 pandemic.

Methods: A retrospective cohort study was conducted using data from January 2020 to June 2024, obtained from the Aerospace Center Hospital's database, electronic health records, and laboratory archives. Inclusion criteria comprised patients with confirmed NHL and SARS-CoV-2 infection, with persistence defined as positive viral test results beyond 14 days after initial diagnosis. Patients with incomplete medical records or loss of follow-up were excluded. Predictive models were developed and refined using logistic regression and random forest algorithms. The models incorporated data on demographics, comorbidities, laboratory findings, and imaging results. Model performance was evaluated using accuracy, precision, and the area under the receiver operating characteristic curve (AUC-ROC). Validation was conducted on an independent dataset to ensure generalizability, and the best-performing model guided the development of a prediction tool for early risk assessment and intervention.

Results: Key risk factors for persistent SARS-CoV-2 infection in NHL patients included advanced age, hypertension, diabetes, immunosuppressed status, low lymphocyte count, elevated C-reactive protein, high body mass index, anemia, reduced CD4 + cell count, and the presence of lung lesions. The random forest model demonstrated superior predictive performance, achieving an AUC of 0.93. The study further highlighted that prompt antiviral therapy, adjustments to immunosuppressive regimens, and enhanced monitoring significantly reduced infection persistence.

Conclusions: This study identifies critical risk factors for persistent SARS-CoV-2 infection in NHL patients and underscores the importance of early intervention strategies. These findings may guide clinical decision-making to improve outcomes in this high-risk population.