Effect of respiratory muscle training in patients with stable chronic obstructive pulmonary disease: A systematic review and meta-analysis.

Objectives: Chronic obstructive pulmonary disease (COPD) is a prevalent respiratory disorder characterized by progressive airflow limitation. This meta-analysis aims to evaluate the effectiveness of respiratory muscle training (RMT) on key pulmonary function parameters, inspiratory muscle strength and quality of life in patients with stable COPD. Methods: A comprehensive search was conducted in the databases including PubMed, Cochrane, Web of Science, Embase, and ClinicalTrials.gov, from their inception to June 12, 2023. Randomized controlled trials (RCTs) evaluating the impact of RMT on stable COPD were included for meta-analysis. Results: In total, 12 RCTs involving 453 participants were included in the meta-analysis. RMT demonstrated a significant increase in maximal inspiratory pressure (PImax, MD, 95% CI: 14.34, 8.17 to 20.51, P < 0.001) but not on maximal expiratory pressure (PEmax). No significant improvement was observed in 6-Min walk test (6MWT), dyspnea, forced expiratory volume in 1 s (FEV1), forced vital capacity ratio (FVC) and quality of life between RMT and control groups. However, subgroup analysis revealed a significant negative effect of RMT alone on FEV1/FVC (MD, 95% CI: 2.59, -5.11 to -0.06, P = 0.04). When RMT was combined with other interventions, improvements in FEV1/FVC and FEV1 were found, although not statistically significant. Conclusion: RMT can effectively improve maximal inspiratory pressure in stable COPD patients, but the effect is slight in improving lung function, dyspnea and quality of life. It is recommended to combine with other treatment strategies to comprehensively improve the prognosis of COPD patients.

Clinical features of elderly patients with COVID-19 in Wuhan, China.

BACKGROUND: Elderly patients with coronavirus disease 2019 (COVID-19) who have comorbidities, frailty or profound disabilities experience poor outcomes. We analyzed the clinical characteristics of elderly patients from Wuhan who had COVID-19 during the early stages of the pandemic. AIM: To identify factors affecting the early mortality of elderly patients with COVID-19. METHODS: The records of 234 patients who were 65-years-old or more and were hospitalized in Wuhan Huoshenshan Hospital from February 4 to March 4, 2020 were reviewed. All patients had confirmed COVID-19 and the final date of follow-up was April 4, 2020. RESULTS: There were 163 cases of mild disease (69.66%), 39 cases of severe disease (16.67%) and 32 cases of critical disease (13.68%). Twenty-nine patients died within 1 mo (12.40%), all of whom had critical disease. Surviving patients and deceased patients had no significant differences in age or chronic diseases. Overall, the most common symptoms were fever (65.4%), dry cough (57.3%), fatigue (47.4%) and shortness of breath (41%). The deceased patients had higher levels of multiple disease markers (C-reactive protein, D-dimer, lactate dehydrogenase, alanine amino transferase, aspartate aminotransferase, creatinine kinase and creatinine kinase-MB) and higher incidences of lymphocytopenia and hypoproteinemia. CONCLUSION: This single-center study of elderly patients from Wuhan, China who were hospitalized with COVID-19 indicated that age and chronic diseases were not associated with mortality. Hypertension, diabetes and cardiovascular disease were the most common comorbidities and the most common symptoms were fever, dry cough, fatigue and shortness of breath. Lymphocytopenia, increased levels of D-dimer and other markers indicative of damage to the heart, kidneys or liver were associated with an increased risk of death.

Effect of EGFR-TKI targeted therapy in patients with advanced non-small cell lung cancer.

OBJECTIVE: To investigate the effect of EGFR-TKI targeted therapy in patients with advanced non-small cell lung cancer (NSCLC). METHODS: Eighty-four cases of NSCLC were retrospectively assigned into an observation group (OG, n=42) and a control group (CG, n=42) according to the treatment methods. The CG received conventional chemotherapy, and the OG received icotinib hydrochloride EGFR-TKI targeted therapy. The clinical efficacy, cellular immunity, humoral immunity, quality of life, adverse reactions and survival time were compared between the two groups. Cox regression analysis was used to analyze the factors influencing the prognosis of advanced NSCLC. RESULTS: The total response rate was substantially higher, and the incidence of adverse reactions was considerably lower in the OG than those in the CG (all P<0.05). The post-treatment SF-36 score was increased in both groups with significantly higher score in the OG than the CG (all P<0.001). The post-treatment CD4+ counts in both groups were notably lower than those of pre-treatment, and the count was lower in the CG than that in the OG (all P<0.001). The post-treatment CD8+ counts in both groups were notably higher after treatment than those of pre-treatment and was higher in the CG than that in the OG (all P<0.001). The post-treatment levels of IgM and IgA in both groups were declined compared with those of pre-treatment (P<0.001) with significantly lower levels in the OG than the CG (P<0.01). The 18-month mortality of the OG was significantly lower than that of the CG (P<0.05). Cox regression analysis showed that lesion diameter and differentiation degree of tumor cells were independent factors influencing the prognosis (P<0.05). CONCLUSION: EGFR-TKI targeted therapy can relieve clinical symptoms, and improve immune function and quality of life of patients with advanced NSCLC, which is worthy of clinical application.

Comparison of prognosis predictive value of 4 disease severity scoring systems in patients with acute respiratory failure in intensive care unit: A STROBE report.

ABSTRACT: Various disease severity scoring systems were currently used in critically ill patients with acute respiratory failure, while their performances were not well investigated.The study aimed to investigate the difference in prognosis predictive value of 4 different disease severity scoring systems in patients with acute respiratory failure.With a retrospective cohort study design, adult patients admitted to intensive care unit (ICU) with acute respiratory failure were screened and relevant data were extracted from an open-access American intensive care database to calculate the following disease severity scores on ICU admission: acute physiology score (APS) III, Sequential Organ Failure Assessment score (SOFA), quick SOFA (qSOFA), and Oxford Acute Severity of Illness Score (OASIS). Hospital mortality was chosen as the primary outcome. Multivariable logistic regression analyses were performed to analyze the association of each scoring system with the outcome. Receiver operating characteristic curve analyses were conducted to evaluate the prognosis predictive performance of each scoring system.A total of 4828 patients with acute respiratory failure were enrolled with a hospital mortality rate of 16.78%. APS III (odds ratio [OR] 1.03, 95% confidence interval [CI] 1.02-1.03), SOFA (OR 1.15, 95% CI 1.12-1.18), qSOFA (OR 1.26, 95% CI 1.11-1.42), and OASIS (OR 1.06, 95% CI 1.05-1.08) were all significantly associated with hospital mortality after adjustment for age and comorbidities. Receiver operating characteristic analyses showed that APS III had the highest area under the curve (AUC) (0.703, 95% CI 0.683-0.722), and SOFA and OASIS shared similar predictive performance (area under the curve 0.653 [95% CI 0.631-0.675] and 0.664 [95% CI 0.644-0.685], respectively), while qSOFA had the worst predictive performance for predicting hospital mortality (0.553, 95% CI 0.535-0.572).These results suggested the prognosis predictive value varied among the 4 different disease severity scores for patients admitted to ICU with acute respiratory failure.

The effects and safety of omega-3 fatty for acute lung injury: a systematic review and meta-analysis.

BACKGROUND: Several randomized controlled trials (RCTs) have compared the treatment of acute lung injury (ALI) with omega-3 fatty, yet the results remained inconsistent. Therefore, we attempted this meta-analysis to analyze the role of omega-3 fatty in the treatment of ALI patients. METHODS: We searched PubMed databases from inception date to October 31, 2019, for RCTs that compared the treatment of ALI with or without omega-3 fatty. Two authors independently screened the studies and extracted data from the published articles. Summary mean differences (MD) with 95% confidence intervals (CI) were calculated for each outcome by fixed- or random-effects model. RESULTS: Six RCTs with a total of 277 patients were identified, of whom 142 patients with omega-3 fatty acid treatment and 135 patients without omega-3 fatty treatment. Omega-3 fatty treatments significantly improve the PaO2 (MD = 13.82, 95% CI 8.55-19.09), PaO2/FiO2 (MD = 33.47, 95% CI 24.22-42.72), total protein (MD = 2.02, 95% CI 0.43-3.62) in ALI patients, and omega-3 fatty acid treatments reduced the duration of mechanical ventilation (MD = - 1.72, 95% CI - 2.84 to - 0.60) and intensive care unit stay (MD = - 1.29, 95% CI - 2.14 to - 0.43) in ALI patients. CONCLUSIONS: Omega-3 fatty can effectively improve the respiratory function and promote the recovery of ALI patients. Future studies focused on the long-term efficacy and safety of omega-3 fatty use for ALI are needed.

Association Between Comorbid Chronic Obstructive Pulmonary Disease and Prognosis of Patients Admitted to the Intensive Care Unit for Non-COPD Reasons: A Retrospective Cohort Study.

Background and Aim: Chronic obstructive pulmonary disease (COPD) is a rather common comorbid condition among patients admitted to the intensive care unit (ICU), while evidence of how this comorbidity affects prognosis is limited. This study aimed to investigate the associations between COPD comorbidity and prognoses of patients who were admitted to the ICU for non-COPD reasons, and to examine whether the associations varied between different types of ICU. Methods: A retrospective cohort study was performed using data extracted from a freely accessible critical care database (MIMIC-III). Adult (≥18 years) patients of first ICU admission in the database were enrolled as study participants but those with a primary diagnosis of COPD were excluded. The primary endpoint was 28-day mortality after ICU admission and multivariable Cox regression analyses were employed to assess the associations between COPD comorbidity and the study endpoints. Different adjusting models including a propensity score were used to adjust potential confounders. Results: A total of 29,499 patients were enrolled finally, among which 3,332 patients (11.30%) were comorbid with COPD. A higher 28-day mortality was observed among patients with COPD than those without COPD (13.90% versus 8.07%, P<0.001), but there was no statistically significant difference in the proportion of patients who needed mechanical ventilation on the first day after ICU admission between the two groups. Multivariable Cox regression analyses found a significant association between COPD comorbidity and 28-day mortality (adjusted hazard ratio=1.32, 95% confidence interval=1.19-1.47, P<0.0001). The associations were broadly consistent among patients admitted to different types of ICU, but a much higher estimate was observed in patients admitted to cardiac surgery recovery unit (adjusted hazard ratio=2.03, 95% confidence interval=1.44-2.86, P<0.0001). Conclusion: Comorbid COPD increased the risk of 28-day mortality among patients admitted to the ICU for non-COPD reasons, especially for those admitted to the cardiac surgery recovery unit.

Determination of glucosinolates in 19 Chinese medicinal plants with spectrophotometry and high-pressure liquid chromatography.

Glucosinolates were evaluated in 19 traditional Chinese medicinal plants involved in seven different families: Brassicaceae, Capparaceae, Euphorbiaceae, Phytolaccaceae, Tropaeolaceae, Caricaceae and Rubiaceae. The total glucosinolate contents were determined by spectrophotometry. Results showed that the high contents of total glucosinolates were found in some herbs of Brassicaceae, Capparaceae and Euphorbiaceae families, while low total glucosinolate contents were observed in two Rubiaceae herbs. In addition, eight glucosinolates (glucoraphanin, glucoraphenin, sinalbin, sinigrin, progoitrin, 4-hydroglucobrassicin, glucoiberin and glucoibervirin) in these herbs were measured using HPLC, and the data showed that individual glucosinolates and their contents varied at different degrees among the distinct species. The highest contents of cancer-protective compounds were found in the seeds of Raphanus sativus L. (glucoraphenin), Sinapis alba (sinalbin) and Phyllanthus emblica L. (sinigrin).