Early smoking lead to worse prognosis of COPD patients: a real world study.

BACKGROUND: Smoking remains a major risk factor for the development and progression of chronic obstructive pulmonary disease (COPD). Due to the adolescent smoking associated with worse health state, the age, at which an individual started smoking, might play a key role in shaping the trajectory of COPD development and the severity. METHODS: We conducted an observational study from September 2016 through January 2023 of eligible patients hospitalized with COPD. Patients who started smoking during the alveolar development stage (ADS, smoking initiation ≤ 24 years old) were defined as early smoking patients, and patients who started smoking after ADS (smoking initiation > 24 years old) were defined as late smoking patients. We collected demographic and clinical data characterizing the patients and documented their condition from hospital discharge to follow-up. The primary endpoints were short-term (within one year), 3-year, and long-term (beyond 3 years) all-cause mortality after discharge. RESULTS: Among 697 COPD patients, early smoking patients had a lower smoking cessation rate (P < 0.001) and a higher smoking index (P < 0.001) than late smoking patients. Although adjusted smoking index, early smoking patients still had poorer lung function (P = 0.023), thicker left ventricular diameters (P = 0.003), higher frequency of triple therapy use during stable stage (P = 0.049), and more acute exacerbations in the past year before enrollment (P < 0.05). Survival analysis showed that they had a higher risk of death after discharge within three years (P = 0.004) and beyond three years (P < 0.001). Furthermore, even in early smoking COPD patients who quit smoking after adjusting the smoking index had poorer lung function (P < 0.05) and thicker left ventricular diameters (P = 0.003), and survival analysis also showed that they had a higher long-term mortality rate (P = 0.010) and shorter survival time (P = 0.0128). CONCLUSION: Early smoking COPD patients exhibited multiple adverse clinical outcomes, including heavy cigarette addiction, compromised pulmonary function, augmented left ventricular diameter, and elevated mortality risk. Additional, smoking cessation could not bring enough improvement of health state in early smoking COPD patients as late smoking COPD patients. Consequently, early intervention and specialized cessation approaches for younger smokers are of paramount importance in this context.

Errors and Adherence to Inhaled Medications in Chinese Adults with COPD.

BACKGROUND: Adherence to inhaled medications is key to chronic obstructive pulmonary disease (COPD) control and management. OBJECTIVE: To assess errors and adherence to inhalation therapy in COPD patients, and identify potential factors associated with poor adherence. METHODS: This cross-sectional study was conducted from October 1, 2022, to November 30, 2022, in 24 hospital outpatient departments in different cities of Hunan Province, China. Adherence to inhaled medications was measured using the 10-item Test of Adherence Inventory, and the results were expressed using both descriptive and inferential statistics. RESULTS: A total of 2218 clinically confirmed adult COPD patients completed the questionnaires, and 1423 patients with more than a 3-month history of inhalation therapy were analyzed. This study found that 61.3% of patients made one or more use errors. Not holding the breath after inhalation or holding the breath for less than 3 s had the highest reporting rate (30.7%). A considerable proportion of patients (66.6%) demonstrated suboptimal adherence to inhaled medications. Patients who resided in rural areas (OR 1.45, 95% CI 1.12-1.88), used dual therapy (OR 1.47, 95% CI 1.05-2.05), and exhibited common use errors (OR 3.02, 95% CI 2.39-3.82) were more likely to present suboptimal adherence. Patients with CAT (Chronic Obstructive Pulmonary Disease Assessment Test) score < 10 (OR 0.73, 95% CI 0.56-0.94), a junior high school education and above (OR 0.73, 95% CI 0.57-0.94), and duration of inhaled medication use > 3 years (OR 0.63, 95% CI 0.47-0.83) were associated with better adherence. CONCLUSION: Suboptimal adherence to inhaled medications and many inhalation therapy errors were identified among COPD patients. Common use errors in inhaled medications, CAT score, and education background were predictive of and influenced adherence to inhaled medications. It is necessary to strengthen training in Chinese patients about inhaler use and follow-up intensively with patients throughout treatment, especially for patients with risk factors.

Model-based assessment of cardiopulmonary autonomic regulation in paced deep breathing.

Autonomic dysfunction can lead to many physical and psychological diseases. The assessment of autonomic regulation plays an important role in the prevention, diagnosis, and treatment of these diseases. A physiopathological mathematical model for cardiopulmonary autonomic regulation, namely Respiratory-Autonomic-Sinus (RSA) regulation Model, is proposed in this study. A series of differential equations are used to simulate the whole process of RSA phenomenon. Based on this model, with respiration signal and ECG signal simultaneously acquired in paced deep breathing scenario, we manage to obtain the cardiopulmonary autonomic regulation parameters (CARP), including the sensitivity of respiratory-sympathetic nerves and respiratory-parasympathetic nerves, the time delay of sympathetic, the sensitivity of norepinephrine and acetylcholine receptor, as well as cardiac remodeling factor by optimization algorithm. An experimental study has been conducted in healthy subjects, along with subjects with hypertension and coronary heart disease. CARP obtained in the experiment have shown their clinical significance.

Extracellular vesicles and COPD: foe or friend?

Chronic obstructive pulmonary disease (COPD) is a chronic inflammatory airway disease characterized by progressive airflow limitation. The complex biological processes of COPD include protein hydrolysis tissue remodeling, innate immune inflammation, disturbed host-pathogen response, abnormal cellular phenotype conversion, and cellular senescence. Extracellular vesicles (EVs) (including apoptotic vesicles, microvesicles and exosomes), are released by almost all cell types and can be found in a variety of body fluids including blood, sputum and urine. EVs are key mediators in cell-cell communication and can be used by using their bioactive substances (DNA, RNA, miRNA, proteins and other metabolites) to enable cells in adjacent and distant tissues to perform a wide variety of functions, which in turn affect the physiological and pathological functions of the body. Thus, EVs is expected to play an important role in the pathogenesis of COPD, which in turn affects its acute exacerbations and may serve as a diagnostic marker for it. Furthermore, recent therapeutic approaches and advances have introduced EVs into the treatment of COPD, such as the modification of EVs into novel drug delivery vehicles. Here, we discuss the role of EVs from cells of different origins in the pathogenesis of COPD and explore their possible use as biomarkers in diagnosis, and finally describe their role in therapy and future prospects for their application. Graphical Abstract.

Automatic Detection of the Cyclic Alternating Pattern of Sleep and Diagnosis of Sleep-Related Pathologies Based on Cardiopulmonary Resonance Indices.

The cyclic alternating pattern is the periodic electroencephalogram activity occurring during non-rapid eye movement sleep. It is a marker of sleep instability and is correlated with several sleep-related pathologies. Considering the connection between the human heart and brain, our study explores the feasibility of using cardiopulmonary features to automatically detect the cyclic alternating pattern of sleep and hence diagnose sleep-related pathologies. By statistically analyzing and comparing the cardiopulmonary characteristics of a healthy group and groups with sleep-related diseases, an automatic recognition scheme of the cyclic alternating pattern is proposed based on the cardiopulmonary resonance indices. Using the Hidden Markov and Random Forest, the scheme combines the variation and stability of measurements of the coupling state of the cardiopulmonary system during sleep. In this research, the F1 score of the sleep-wake classification reaches 92.0%. In terms of the cyclic alternating pattern, the average recognition rate of A-phase reaches 84.7% on the CAP Sleep Database of 108 cases of people. The F1 score of disease diagnosis is 87.8% for insomnia and 90.0% for narcolepsy.

[Effects of transcranial magneto-acoustic electrical stimulation on calcium signals in prefrontal nerve clusters].

Transcranial magneto-acoustic electrical stimulation (TMAES) is a novel method of brain nerve regulation and research, which uses induction current generated by the coupling of ultrasound and magnetic field to regulate neural electrical activity in different brain regions. As the second special envoy of nerve signal, calcium plays a key role in nerve signal transmission. In order to investigate the effect of TMAES on prefrontal cortex electrical activity, 15 mice were divided into control group, ultrasound stimulation (TUS) group and TMAES group. The TMAES group received 2.6 W/cm 2 and 0.3 T of magnetic induction intensity, the TUS group received only ultrasound stimulation, and the control group received no ultrasound and magnetic field for one week. The calcium ion concentration in the prefrontal cortex of mice was recorded in real time by optical fiber photometric detection technology. The new object recognition experiment was conducted to compare the behavioral differences and the time-frequency distribution of calcium signal in each group. The results showed that the mean value of calcium transient signal in the TMAES group was (4.84 ± 0.11)% within 10 s after the stimulation, which was higher than that in the TUS group (4.40 ± 0.10)% and the control group (4.22 ± 0.08)%, and the waveform of calcium transient signal was slower, suggesting that calcium metabolism was faster. The main energy band of the TMAES group was 0-20 Hz, that of the TUS group was 0-12 Hz and that of the control group was 0-8 Hz. The cognitive index was 0.71 in the TMAES group, 0.63 in the TUS group, and 0.58 in the control group, indicating that both ultrasonic and magneto-acoustic stimulation could improve the cognitive ability of mice, but the effect of the TMAES group was better than that of the TUS group. These results suggest that TMAES can change the calcium homeostasis of prefrontal cortex nerve clusters, regulate the discharge activity of prefrontal nerve clusters, and promote cognitive function. The results of this study provide data support and reference for further exploration of the deep neural mechanism of TMAES.

Chronotropic Competence Indices Extracted from Wearable Sensors for Cardiovascular Diseases Management.

Chronotropic incompetence (CI) has been proven to be an important factor in the diagnosis and management of cardiovascular diseases. In this paper, we extend the existing CI parameters and propose chronotropic competence indices (CCI) to describe the exercise response of the cardiopulmonary system. A cardiac chronotropic competence Test (3CT), dedicated to CCI measurement using a wearable device, is also presented. Preliminary clinical trials are presented for the validation of 3CT measurement accuracy, and to show the potential of CCI in the prevention and rehabilitation of cardiovascular diseases.

A Pilot Study of Individual Muscle Force Prediction during Elbow Flexion and Extension in the Neurorehabilitation Field.

This paper proposes a neuromusculoskeletal (NMS) model to predict individual muscle force during elbow flexion and extension. Four male subjects were asked to do voluntary elbow flexion and extension. An inertial sensor and surface electromyography (sEMG) sensors were attached to subject's forearm. Joint angle calculated by fusion of acceleration and angular rate using an extended Kalman filter (EKF) and muscle activations obtained from the sEMG signals were taken as the inputs of the proposed NMS model to determine individual muscle force. The result shows that our NMS model can predict individual muscle force accurately, with the ability to reflect subject-specific joint dynamics and neural control solutions. Our method incorporates sEMG and motion data, making it possible to get a deeper understanding of neurological, physiological, and anatomical characteristics of human dynamic movement. We demonstrate the potential of the proposed NMS model for evaluating the function of upper limb movements in the field of neurorehabilitation.

Satisfaction with medication in older adult patients with chronic respiratory diseases: a multicenter cross-sectional observational study.

Purpose: To gain insight into medication satisfaction and factors associated with chronic respiratory disease, particularly chronic obstructive pulmonary disease (COPD) in older adults, focusing on public health issues and improving the health of the older adult population. Methods: This cross-sectional study was conducted from October 2022 to November 2022 in 24 hospitals in different regions of Hunan Province, China. Older adult patient treatment satisfaction was assessed using the Treatment Satisfaction Questionnaire for Medication version II. Multiple regression analysis was used to identify factors independently associated with patient treatment satisfaction. Results: Only 15.9% of all patients scored above 80 in the effectiveness domain, while 11.6 and 16.5% scored above 80 in the convenience and global satisfaction domains, respectively, while 17.3% reported having side effects. Interstitial lung disease was associated with lower drug satisfaction than other disorders (p < 0.05). Multifactorial regression analysis showed that age, education background, profession, and smoking status were independently associated with satisfaction among patients with chronic respiratory diseases (p < 0.05). Education background, profession, CAT score, number of acute exacerbations, duration of home oxygenation and duration of home ventilator use were independently associated with satisfaction in patients with COPD (p < 0.05). Conclusion: Low satisfaction with chronic respiratory drug therapy was associated with age, education background, profession and smoking status. Satisfaction was lower for patients with interstitial lung disease. For COPD, CAT score, education background, profession, number of acute exacerbations, home oxygen and ventilator use influence satisfaction. Clinicians can identify appropriate patients and communicate effectively with them throughout treatment and follow-up, vigorously promote smoking cessation and home oxygen therapy, increase medication satisfaction, especially among older adults, and in turn improve public health and the quality of life of older adults.

Relationship between nighttime symptoms and clinical features in COPD patients: A cross-sectional multicenter study in China.

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is a chronic respiratory disease that causes breathing difficulties, coughing, and other symptoms. Nighttime symptoms, such as coughing, wheezing, and shortness of breath, can significantly impact the quality of life for people with COPD. OBJECTIVE: To investigate the relationship between nighttime symptoms and other clinical features in patients with COPD, and identify potential risk factors associated with nighttime symptoms. METHODS: This cross-sectional study was conducted from October 1, 2022 to November 30, 2022 in 24 hospital outpatient departments in different cities of Hunan Province, China. The COPD Nighttime Symptom Instrument (NiSCI) was used to measure the severity of night time symptoms in COPD patients. Descriptive and inferential statistics were used to express patient socio-demographics and factors influencing nighttime symptoms. RESULTS: The study included 2219 COPD patients. The results showed that nighttime symptom scores differed significantly based on gender, whether the patient had experienced acute exacerbation in the past year, mMRC and CAT scores, the duration of home oxygen therapy and home non-invasive ventilation (all P < 0.0001). Multiple linear regression analysis revealed that CAT score (P < 0.0001) was significantly associated with nighttime symptom scores. CONCLUSION: Nighttime symptoms are prevalent in Chinese COPD patients and correlate with disease severity. The assessment and management of nighttime symptoms in COPD patients must take into account gender, CAT and mMRC scores, history of acute exacerbations, and duration of home oxygen therapy and home non-invasive ventilation to enable tailoring of treatment strategies to individual needs.

GERD-related chronic cough: Possible mechanism, diagnosis and treatment.

GERD, or gastroesophageal reflux disease, is a prevalent medical condition that affects millions of individuals throughout the world. Chronic cough is often caused by GERD, and chronic cough caused by GER is defined as GERD-related chronic cough (GERC). It is still unclear what the underlying molecular mechanism behind GERC is. Reflux theory, reflex theory, airway allergies, and the novel mechanism of esophageal motility disorders are all assumed to be linked to GERC. Multichannel intraluminal impedance combined with pH monitoring remains the gold standard for the diagnosis of GERC, but is not well tolerated by patients due to its invasive nature. Recent discoveries of new impedance markers and new techniques (mucosal impedance testing, salivary pepsin, real-time MRI and narrow band imaging) show promises in the diagnosis of GERD, but the role in GERC needs further investigation. Advances in pharmacological treatment include potassium-competitive acid blockers and neuromodulators (such as Baclofen and Gabapentin), prokinetics and herbal medicines, as well as non-pharmacological treatments (such as lifestyle changes and respiratory exercises). More options have been provided for the treatment of GERC other than acid suppression therapy and anti-reflux surgery. In this review, we attempt to review recent advances in GERC mechanism, diagnosis, and subsequent treatment options, so as to provide guidance for management of GERC.

Primitive muscle synergies reflect different modes of coordination in upper limb motions.

The motor system relies on the recruitment of motor modules to perform various movements. Muscle synergies are the modules used by the central nervous system to simplify the control of complex motor tasks. In this paper, we aim to explore the primitive synergies to reflect different modes of coordination in upper limb motions. Muscle synergies and corresponding activation coefficients were extracted via non-negative matrix factorization from the electromyography signals of three basic and four complex upper limb motions in sagittal plane and coronal plane. Similarities of muscle synergies and activation coefficients between different tasks and different subjects were compared. Moreover, we used network theory to assess the coordination between multiple muscles and to elucidate the neural implementation of muscle synergies. The results showed that the combination of different sets of primitive muscle synergies can achieve complex motions in different planes. The muscle synergy network topology differed significantly between different tasks. We also demonstrated the potential of this study for the understanding of human motor control mechanism and implications for neurorehabilitation.

Motor Function Assessment of Upper Limb in Stroke Patients.

Background: Quantitative assessment of motor function is extremely important for poststroke patients as it can be used to develop personalized treatment strategies. This study aimed to propose an evaluation method for upper limb motor function in stroke patients. Methods: Thirty-four stroke survivors and twenty-five age-matched healthy volunteers as the control group were recruited for this study. Inertial sensor data and surface electromyography (sEMG) signals were collected from the upper limb during voluntary upward reaching. Five features included max shoulder joint angle, peak and average speeds, torso balance calculated from inertial sensor data, and muscle synergy similarity extracted from sEMG data by the nonnegative matrix factorization algorithm. Meanwhile, the Fugl-Meyer score of each patient was graded by professional rehabilitation therapist. Results: Statistically significant differences were observed among severe, mild-to-moderate, and control group of five features (p ≤ 0.001). The features varied as the level of upper limb motor function changes since these features significantly correlated with the Fugl-Meyer assessment scale (p ≤ 0.001). Moreover, the Bland-Altman method was conducted and showed high consistency between the evaluation method of five features and Fugl-Meyer scale. Therefore, the five features proposed in this paper can quantitatively evaluate the motor function of stroke patients which is very useful in the rehabilitation process.

Numerical analysis of field-modulated electroosmotic flows in microchannels with arbitrary numbers and configurations of discrete electrodes.

The formation of an electric double layer and electroosmosis are important theoretic foundations associated with microfluidic systems. Field-modulated electroosmotic flows in microchannels can be obtained by applying modulating electric fields in a direction perpendicular to a channel wall. This paper presents a systematic numerical analysis of modulated electroosmotic flows in a microchannel with discrete electrodes on the basis of the Poisson equation of electric fields in a liquid-solid coupled domain, the Navier-Stokes equation of liquid flow, and the Nernst-Planck equation of ion transport. These equations are nonlinearly coupled and are simultaneously solved numerically for the electroosmotic flow velocity, electric potential, and ion concentrations in the microchannel. A number of numerical examples of modulated electroosmotic flows in microchannels with discrete electrodes are presented, including single electrodes, symmetric/asymmetric double electrodes, and triple electrodes. Numerical results indicate that chaotic circulation flows, micro-vortices, and effective fluid mixing can be realized in microchannels by applying modulating electric fields with various electrode configurations. The interaction of a modulating field with an applied field along the channel is also discussed.

Cardiopulmonary Resonance Function and Indices-A Quantitative Measurement for Respiratory Sinus Arrhythmia.

Respiratory sinus arrhythmia (RSA) represents a physiological phenomenon of cardiopulmonary interaction. It is known as a measure of efficiency of the circulation system, as well as a biomarker of cardiac vagal and well-being. In this article, RSA is modeled as modulation of heart rate by respiration in an interactive cardiopulmonary system with the most effective system state of resonance. By mathematically modeling of this modulation, we propose a quantitative measurement for RSA referred to as "Cardiopulmonary Resonance Function (CRF) and Cardiopulmonary Resonance Indices (CRI)," which are derived by disentanglement of the RR-intervals series into respiratory-modulation component, R-HRV, and the rest, NR-HRV using spectral G-causality. Evaluation of CRI performance in quantifying RSA has been conducted in the scenarios of paced breathing and in the different sleep stages. The preliminary experimental results have shown superior representation ability of CRF and CRI compared to Heart Rate Variability (HRV) and Cardiopulmonary Coupling index (CPC).

Modular Organization of Muscle Synergies to Achieve Movement Behaviors.

Muscle synergy has been applied to comprehend how the central nervous system (CNS) controls movements for decades. However, it is not clear about the motion control mechanism and the relationship between motions and muscle synergies. In this paper, we designed two experiments to corroborate the hypothesis: (1) motions can be decomposed to motion primitives, which are driven by muscle synergy primitives and (2) variations of motion primitives in direction and scale are modulated by activation coefficients rather than muscle synergy primitives. Surface electromyographic (EMG) signals were recorded from nine muscles of the upper limb. Nonnegative matrix factorization (NMF) was applied to extract muscle synergy vectors and corresponding activation coefficients. We found that synergy structures of different movement patterns were similar (α=0.05). The motion modulation indexes (MMI) among movement patterns in reaching movements showed apparent differences. Merging coefficients and reconstructed similarity of synergies between simple motions and complex motions were significant. This study revealed the motion control mechanism of the CNS and provided a rehabilitation and evaluation method for patients with motor dysfunction in exercise and neuroscience.

A real-time QRS detector based on discrete wavelet transform and cubic spline interpolation.

QRS detection is an important step in electrocardiogram signal processing and analysis. Despite a lot of research effort, robustness and high detection accuracy still remain open problems. Here we present a real-time QRS detector, based on wavelet decomposition and spline interpolation, which is working in our portable health monitor system (PHMS). The discrete wavelet transform combined with the Cubic Spline Interpolation is used as the preprocessor. An improved dynamic weights adjusting strategy is adopted to enhance the detection robustness. Finally, peak detector and adaptive threshold detector are used to determine the R fiducial point. We tested the algorithm against the Massachusetts Institute of Technology-Beth Israel Hosptial (MIT-BIH) arrhythmia database, and achieved a sensitivity of 99.75% and positive prediction of 99.83%. Further experiments carried out in the PHMS showed the robustness and sound performance in processing real-time sampled signal despite heavy noise. Time accuracy was also taken into consideration in the test and the total root mean square error was 16.03 ms.

Improved Hill-type musculotendon models with activation-force-length coupling.

BACKGROUND: Hill-type musculotendon models are most commonly used in biomechanical simulations for their computational efficacy and efficiency. But these models are generally built for maximally-activated muscles and linearly scale muscle properties when applied to submaximal conditions. However, the precondition of this scaling, which is muscle activation and properties are independent each other, has been proven unreal in many studies. Actually, the maximal activation condition is not ubiquitous for muscles in vivo, so it is necessary to adapt the linear scaling approach to improve the model practicability. OBJECTIVE: This paper aimed at proposing two improved Hill-type musculotendon models that are better suited for submaximal conditions. METHOD: These two models were built by including the activation-force-length coupling and their biological accuracy and computation speed were evaluated by a series of benchmark simulations. RESULTS: Compared to experimental measurements, the percent root mean square errors of forces calculated by the two AFLC models were less than 13.98% and 13.81% respectively. However, the average running time of the second AFLC model was nearly 17 times that of the first one with only a little improvement in accuracy. CONCLUSION: The two AFLC models were validated more accurate than the common Hill-type model in submaximally activated conditions and the first one was recommended in the construction of upper-layer musculoskeletal models.

Alterations of Muscle Synergies During Voluntary Arm Reaching Movement in Subacute Stroke Survivors at Different Levels of Impairment.

Motor system uses muscle synergies as a modular organization to simplify the control of movements. Motor cortical impairments, such as stroke and spinal cord injuries, disrupt the orchestration of the muscle synergies and result in abnormal movements. In this paper, the alterations of muscle synergies in subacute stroke survivors were examined during the voluntary reaching movement. We collected electromyographic (EMG) data from 35 stroke survivors, ranging from Brunnstrom Stage III to VI, and 25 age-matched control subjects. Muscle synergies were extracted from the activity of 7 upper-limb muscles via nonnegative matrix factorization under the criterion of 95% variance accounted for. By comparing the structure of muscle synergies and the similarity of activation coefficients across groups, we can validate the increasing activation of pectoralis major muscle and the decreasing activation of elbow extensor of triceps in stroke groups. Furthermore, the similarity of muscle synergies was significantly correlated with the Brunnstrom Stage (R = 0.52, p < 0.01). The synergies of stroke survivors at Brunnstrom Stage IV-III gradually diverged from those of control group, but the activation coefficients remained the same after stroke, irrespective of the recovery level.

Robust classification of EEG signal for brain-computer interface.

We report the implementation of a text input application (speller) based on the P300 event related potential. We obtain high accuracies by using an SVM classifier and a novel feature. These techniques enable us to maintain fast performance without sacrificing the accuracy, thus making the speller usable in an online mode. In order to further improve the usability, we perform various studies on the data with a view to minimizing the training time required. We present data collected from nine healthy subjects, along with the high accuracies (of the order of 95% or more) measured online. We show that the training time can be further reduced by a factor of two from its current value of about 20 min. High accuracy, fast learning, and online performance make this P300 speller a potential communication tool for severely disabled individuals, who have lost all other means of communication and are otherwise cut off from the world, provided their disability does not interfere with the performance of the speller.