Development and Validation of an In-Hospital Mortality Prediction Model for Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease.

Purpose: Patients with chronic obstructive pulmonary disease (COPD) often face unknown risks during acute exacerbation of the disease (AECOPD), which could potentially result in mortality. This study aimed to develop and validate a nomogram model for predicting the risk of in-hospital mortality in AECOPD patients. Patients and Methods: Clinical data of patients hospitalized at The Second People's Hospital of Wuhu City for AECOPD between January 2013 and December 2022 were retrospectively collected. Variables underwent selection through LASSO regression and multivariable logistic regression to develop a nomogram model. The model's predictive performance was assessed using the concordance index, calibration curve, and decision curve analysis (DCA), with internal validation conducted using the bootstrap method. Results: A total of 1224 patients were included in this study, with 98 (8%) deaths occurring during hospitalization. LASSO regression identified 11 variables, used to construct model A. Further multivariable logistic regression was conducted to select variables with P < 0.05 to establish model B. model B was selected as the final model based on discrimination, calibration, and clinical utility, encompassing variables including acute respiratory failure, lung cancer, heart rate, hemoglobin, absolute neutrophil count, serum albumin, blood urea nitrogen, and serum chloride. The nomogram model achieved a concordance index of 0.858. Internal validation of the model was conducted using the bootstrap method with 500 repetitions, resulting in a concordance index of 0.851 (95% CI: 0.805, 0.893). The calibration curve demonstrated a good fit, with a Hosmer-Lemeshow goodness-of-fit test P-value of 0.520. Moreover, DCA findings suggested patient benefit within a threshold probability range of 0.02 to 0.73, with a maximum net benefit of 0.07. Conclusion: The model constructed in this study has good predictive performance, which helps clinical doctors identify patients at high risk of death early.

Pt/Al2O3@Ce/ZrO2-S bifunctional catalysts prepared by mechanically milling for selective catalytic oxidation of high-concentration ammonia.

The selective catalytic oxidation (SCO) is an effective method for removing slipped high-concentration ammonia from NH3-fueled engine exhaust gas. Herein a novel bifunctional catalyst was synthesized by mechanically mixing sulfated Ce/ZrO2 (Ce/ZrO2-S) with a small fraction of Pt/Al2O3 (Pt 0.1 wt.%) for SCO of NH3. As expected, the introduction of a small amount of Pt/Al2O3 significantly improved NH3 conversion ability of Ce/ZrO2-S catalysts toward low-temperature direction. When the mass ratio of Pt/Al2O3 to Ce/ZrO2-S was 7.5% (the corresponding mixed catalyst was denoted as P@CZS-7.5), T90 temperature was 312 °C. More importantly, P@CZS-7.5 catalyst exhibited a much better N2 selectivity (> 96%) in a wide temperature range (320 ~ 450 °C). H2-TPR results revealed that the addition of a trace amount of Pt/Al2O3 significantly led to a distinct shift of reduction temperature peak toward low-temperature direction, thereby greatly improved the low-temperature redox performance of mixed catalysts. Furthermore, NH3-TPD and BET results showed that P@CZS-7.5 catalyst exhibited a similar NH3 adsorption capacity to Ce/ZrO2-S catalyst, while the former had a relatively higher specific surface area than the latter. It was considered as a crucial factor for P@CZS-7.5 catalyst maintaining superior N2 selectivity in high-concentration NH3 (5000 ppm) removal processes. In situ DRIFTS results indicated that P@CZS-7.5 catalyst followed the internal selective catalytic reduction (i-SCR) mechanism in NH3-SCO reactions.

Assessing the sustainability and competitiveness of tourism economies in China's Chengdu-Chongqing metropolitan area.

As the competition of tourism industry becomes increasingly white-hot, the sustainability and competitiveness of tourism economies inside a zone gradually gets people's attentions. Based on data of 16 cities from 2010 to 2019, this paper aims to investigate the sustainability and competitiveness of tourism economies in the Chengdu-Chongqing metropolitan area, by constructing a niche evaluation index and four niche models (niche ecostate-ecorole model, niche expansion model, niche breadth model, and niche overlap degree model). The results show that (1) during the sample period, the niche values of tourism competitiveness in most cities of the Chengdu-Chongqing metropolitan area have shown a sustained increasing trend, indicating that the status of these cities in resources, market, environment, social economy, and other dimensions is rising steadily, and their competitive advantages are gradually increasing; (2) the niche values of tourism competitiveness in the core cities of Chengdu-Chongqing metropolitan area (Chengdu and Chongqing) remain stable, while the niche values of tourism competitiveness in the remaining cities vary greatly; the comprehensive niche values of tourism industry competitiveness of the cities in the central area are significantly lower than those of the cities in the peripheral area; (3) the niche overlap of tourism competitiveness in the Chengdu-Chongqing metropolitan area is relatedly high, indicating that the homogenization of tourism in these cities is more serious.

Geographical distribution of hyperuricemia in mainland China: a comprehensive systematic review and meta-analysis.

BACKGROUND: Fructose plays an important role in the complex metabolism of uric acid in the human body. However, high blood uric acid concentration, known as hyperuricemia, is the main risk factor for development of gout. Therefore, we conducted an updated meta-analysis on the prevalence and geographical distribution of hyperuricemia among the general population in mainland China using systematic literature search. METHODS: Five electronic databases were used to search for relevant articles published until 2019. All calculations were conducted using the Comprehensive Meta-Analysis (CMA) software. We included 108 eligible articles (172 studies by sex, 95 studies by regions, and 107 studies by study type) and an overall sample size of > 808,505 participants. RESULTS: The pooled prevalence of hyperuricemia among the general population in mainland China was 17.4% (95% CI: 15.8-19.1%). Our subgroup analysis indicated that the pooled prevalence by regions ranged from 15.5 to 24.6%. Those living Northeast region and being males had the highest prevalence (P < 0.001). In addition, some provinces in South Central, East and Northeast regions reported a high prevalence (> 20%), particularly in males. An increasing prevalence was reported since 2005-2009 until 2015-2019. No publication of bias was observed as indicated by a symmetrical funnel plot and Begg and Mazumdar rank correlation (P = 0.392). CONCLUSION: Prevalence of hyperuricemia is increasing in China, and future studies should investigate the association between the prevalence of hyperuricemia and its risk factors in order to tackle the issue, particularly among the vulnerable groups. Also, our study was the first comprehensive study to investigate the overall prevalence of hyperuricemia in mainland China covering the six different regions.

Increased stressful impact among general population in mainland China amid the COVID-19 pandemic: A nationwide cross-sectional study conducted after Wuhan city's travel ban was lifted.

OBJECTIVES: Our study aimed to determine the impact of the COVID-19 pandemic on psychological responses and lifestyle changes among the general population in mainland China following the re-opening of the Wuhan city. METHODS: A cross-sectional survey was conducted in April 2020. Participants of Chinese nationality aged ⩾ 18 years were asked to complete a modified validated Chinese version of a questionnaire regarding the impact of event scale (IES), family and social support, mental health-related lifestyle changes, and indicators of negative mental health impacts. RESULTS: A total of 728 participants (i.e., 217 males and 511 females) completed the questionnaire. The mean age of the participants was 32.9 ± 10.4 years, with a majority of them (92.2%) having a higher educational qualification level. The overall mean IES in participants was 21.5 ± 7.0, reflecting mild stressful impact (i.e., following the re-opening of the Wuhan city); 25.5% of the participants had an IES score ⩾ 26. Being females and married were significantly associated with a higher mean IES score. The overall mean scores for intrusion and avoidance score scales in participants were 9.4 ± 3.7 and 12.1 ± 4.2, respectively. CONCLUSIONS: The COVID-19 pandemic was associated with increased stressful impact in our participants following the re-opening of the Wuhan city when compared with our previous study, which should not be taken lightly.

Corticosteroid treatment of patients with coronavirus disease 2019 (COVID-19).

OBJECTIVES: To assess the efficacy of corticosteroid treatment of patients with coronavirus disease 2019 (COVID-19). DESIGN, SETTING: Observational study in the two COVID-19-designated hospitals in Wuhu, Anhui province, China, 24 January - 24 February 2020. PARTICIPANTS: Thirty-one patients infected with the severe acute respiratory coronavirus 2 (SARS-CoV-2) treated at the two designated hospitals. MAIN OUTCOME MEASURES: Virus clearance time, length of hospital stay, and duration of symptoms, by treatment type (including or not including corticosteroid therapy). RESULTS: Eleven of 31 patients with COVID-19 received corticosteroid treatment. Cox proportional hazards regression analysis indicated no association between corticosteroid treatment and virus clearance time (hazard ratio [HR], 1.26; 95% CI, 0.58-2.74), hospital length of stay (HR, 0.77; 95% CI, 0.33-1.78), or duration of symptoms (HR, 0.86; 95% CI, 0.40-1.83). Univariate analysis indicated that virus clearance was slower in two patients with chronic hepatitis B infections (mean difference, 10.6 days; 95% CI, 6.2-15.1 days). CONCLUSIONS: Corticosteroids are widely used when treating patients with COVID-19, but we found no association between therapy and outcomes in patients without acute respiratory distress syndrome. An existing HBV infection may delay SARS-CoV-2 clearance, and this association should be further investigated.

Low fermentable oligosaccharides, disaccharides, monosaccharides, and polypols diet and irritable bowel syndrome in Asia.

Functional bowel disorders, including irritable bowel syndrome (IBS), are a chronic condition that can significantly reduce patients' quality of life. Therefore, this paper will review the roles of a low fermentable oligosaccharides, disaccharides, monosaccharides, and polypols (FODMAP) diet in treating IBS, particularly in an Asian setting. About 20% of the general population is diagnosed with IBS. However, there are limited effective medical therapies available for treating IBS. Therefore, IBS presents a major challenge to the health-care providers. Recently, there is an increasing interest in the use of a diet low in FODMAP for the treatment of IBS. A low FODMAP diet can decrease the delivery of readily fermentable substrates to the small intestine and colon, thereby improving functional gastrointestinal symptoms.

Exposure to Ambient Particles Alters the Evolution of Macrophage Phenotype and Amplifies the Inducible Release of Eotaxin-1 in Allergen-Sensitized Mice.

So far, epidemiological data have revealed that the elevation of fine ambient particulate matter (aerodynamic diameter ≤2.5 µm; PM2.5) is closely associated with an exacerbation of asthma while the underlying mechanism is poorly understood. Using a murine model, we investigated the impact of PM2.5 on the development of asthma. Before OVA challenge, mice were administrated with PM2.5, phosphate-buffer saline (PBS) or control filter extracts (CFE). Results showed that compared to PBS or CSF, PM2.5 co-exposure with OVA led to a higher airway hyperresponsiveness (AHR) and a severer eosinophils infiltration. Both alveolar and interstitial macrophages are alternatively activated in OVA-challenged mice with a propensity to M2, marked by arginase-1, CD206, and YM-1. PM2.5 co-exposure dramatically elicited a YM-1 upregulation, implying an aggravated M2 polarization and macrophages recruitment. Eotaxin-1 was predominantly detected in YM-1-positive macrophages, and the level as well as those of IgE, IL-4 or IL-13 was notably increased by PM2.5 co-exposure. With IL-4/IL-13-induced transformation of bone marrow-derived macrophages (BMDM), these M2-polarized macrophages were adoptively transferred into allergic mice. An increase of CD11b+ Siglec+eosinophils was observed in these mice while in vitro, no significant polarization of BMDM was found when treated with PM2.5. Together, our findings suggested that PM2.5 could exacerbate asthma by aggravating M2-polarization, highlighting for the first time that Eotaxin-1 released from M2 macrophages plays a crucial role in asthma pathogenesis.

Oligomeric proanthocyanidins attenuate airway inflammation in asthma by inhibiting dendritic cells maturation.

To date, although a promising anti-inflammatory activity of oligomeric proanthocyanidins (OPCs) has been observed in asthma, the mechanism responsible for these immunomodulatory properties remains obscure. Dendritic cells (DCs) that reside in the airway have been widely perceived as an important contributor to asthma. Our study was to demonstrate OPCs' effects on maturation and immunoregulation of pulmonary CD11c+ dendritic cells (DCs). BALB/c mice were exposed to ovalbumin (OVA) to induce murine model of asthma. In addition, pulmonary DCs and bone marrow-derived DCs (BMDCs) cultures were used to evaluate impacts of OPCs on DCs function. The results obtained here indicated that OPCs treatment dramatically reduced airway inflammation, such as the infiltration of inflammatory cells and the levels of allergen-specific serum IgE and Th2 cytokines. The expression of co-stimulatory molecules especially CD86 distributed on pulmonary DCs and bone marrow-derived DCs (BMDCs) also markedly declined. The phosphorylation of cAMP responsive element-binding protein (CREB) was significantly inhibited while no changes were observed in the expression of cAMP responsive element modulator (CREM). By transferring BMDCs into the airways of naïve mice, we found that OPCs-treated DCs (DC+OVA+OPC) were much less potent in promoting CD4+ T cells proliferation than OVA-pulsed DCs (DC+OVA), followed by the ameliorated eosinophilic inflammation in airway. Our findings tailor a novel profile of OPCs in the regulation of DCs function, shedding new light on the therapeutic potential of OPCs in asthma management.

Diosmetin prevents TGF-ß1-induced epithelial-mesenchymal transition via ROS/MAPK signaling pathways.

AIMS: Epithelial-mesenchymal transition (EMT) plays a critical role in airway repair and remodeling in many respiratory diseases such as asthma and pulmonary fibrosis. The flavone aglycone, diosmetin, possesses anti-remodeling activity in a murine model of chronic asthma, but little is known about its effects on EMT. Herein, we investigated whether diosmetin inhibits transforming growth factor-ß1 (TGF-ß1)-induced EMT with underlying mechanisms in human bronchial epithelial (HBE) cells. MAIN METHODS: HBE cells were incubated with TGF-ß1 (10ng/ml), either alone or in combination with diosmetin for indicated times. We measured reactive oxygen species (ROS) levels using FACScan and immunofluorescent assays. We assessed protein expression of NADPH oxidase 4 (NOX4), superoxide dismutase (SOD), catalase, Akt, Erk, p38, and phosphorylation levels of Akt, Erk and p38 by Western blot analysis. KEY FINDINGS: TGF-ß1 promoted EMT and ROS generation in HBE cells. Diosmetin significantly suppressed TGF-ß1-induced increases in cell migration and altered N-cadherin, E-cadherin, and α-smooth muscle actin expression. In addition, diosmetin prevented TGF-ß1-induced intracellular ROS generation, down-regulated NOX4, and up-regulated SOD and catalase expression. Furthermore, diosmetin remarkably inhibited TGF-ß1-induced phosphorylation of phosphoinositide 3-kinase (PI3K)/Akt and mitogen activated protein kinase (MAPK) pathways in HBE cells. SIGNIFICANCE: Our results demonstrate for the first time that diosmetin alleviates TGF-ß1-induced EMT by inhibiting ROS generation and inactivating PI3K/Akt and MAPK pathways. Our findings revealed a new role for diosmetin in reducing airway remodeling and fibrogenesis.