RESUMO
Chronic obstructive pulmonary disease (COPD) stands as a significant global health challenge, with its intricate pathophysiological manifestations often demanding advanced diagnostic strategies. The recent applications of artificial intelligence (AI) within the realm of medical imaging, especially in computed tomography, present a promising avenue for transformative changes in COPD diagnosis and management. This review delves deep into the capabilities and advancements of AI, particularly focusing on machine learning and deep learning, and their applications in COPD identification, staging, and imaging phenotypes. Emphasis is laid on the AI-powered insights into emphysema, airway dynamics, and vascular structures. The challenges linked with data intricacies and the integration of AI in the clinical landscape are discussed. Lastly, the review casts a forward-looking perspective, highlighting emerging innovations in AI for COPD imaging and the potential of interdisciplinary collaborations, hinting at a future where AI doesn't just support but pioneers breakthroughs in COPD care. Through this review, we aim to provide a comprehensive understanding of the current state and future potential of AI in shaping the landscape of COPD diagnosis and management.
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Inteligência Artificial , Doença Pulmonar Obstrutiva Crônica , Tomografia Computadorizada por Raios X , Humanos , Doença Pulmonar Obstrutiva Crônica/diagnóstico por imagem , Inteligência Artificial/tendências , Tomografia Computadorizada por Raios X/métodos , Índice de Gravidade de DoençaRESUMO
BACKGROUND: Chronic obstructive pulmonary disease (COPD) is a prevalent and debilitating respiratory condition that imposes a significant healthcare burden worldwide. Accurate staging of COPD severity is crucial for patient management and treatment planning. METHODS: The retrospective study included 530 hospital patients. A lobe-based radiomics method was proposed to classify COPD severity using computed tomography (CT) images. First, we segmented the lung lobes with a convolutional neural network model. Secondly, the radiomic features of each lung lobe are extracted from CT images, the features of the five lung lobes are merged, and the selection of features is accomplished through the utilization of a variance threshold, t-Test, least absolute shrinkage and selection operator (LASSO). Finally, the COPD severity was classified by a support vector machine (SVM) classifier. RESULTS: 104 features were selected for staging COPD according to the Global initiative for chronic Obstructive Lung Disease (GOLD). The SVM classifier showed remarkable performance with an accuracy of 0.63. Moreover, an additional set of 132 features were selected to distinguish between milder (GOLD I + GOLD II) and more severe instances (GOLD III + GOLD IV) of COPD. The accuracy for SVM stood at 0.87. CONCLUSIONS: The proposed method proved that the novel lobe-based radiomics method can significantly contribute to the refinement of COPD severity staging. By combining radiomic features from each lung lobe, it can obtain a more comprehensive and rich set of features and better capture the CT radiomic features of the lung than simply observing the lung as a whole.
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Doença Pulmonar Obstrutiva Crônica , Índice de Gravidade de Doença , Máquina de Vetores de Suporte , Tomografia Computadorizada por Raios X , Humanos , Doença Pulmonar Obstrutiva Crônica/diagnóstico por imagem , Doença Pulmonar Obstrutiva Crônica/classificação , Tomografia Computadorizada por Raios X/métodos , Estudos Retrospectivos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Pulmão/diagnóstico por imagem , Pulmão/patologia , Redes Neurais de Computação , RadiômicaRESUMO
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.
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População do Leste Asiático , Predisposição Genética para Doença , Estudo de Associação Genômica Ampla , Embolia Pulmonar , Humanos , China/epidemiologia , População do Leste Asiático/genética , Predisposição Genética para Doença/genética , Estudo de Associação Genômica Ampla/métodos , Genótipo , Polimorfismo de Nucleotídeo Único/genética , Embolia Pulmonar/epidemiologia , Embolia Pulmonar/etnologia , Embolia Pulmonar/genética , Fatores de RiscoRESUMO
Cancer stem cell theory has been proposed to explain tumor heterogeneity and the carcinogenesis process. Highly tumorigenic lung cancer stem cells develop resistance to cisplatin (CDDP), a common chemotherapy drug. Herein, we attempted to clarify whether apigenin (API) can improve the antitumor efficiency of CDDP in lung cancer using cancer stem cells. Lung cancer stem cells were identified as CD 133 positive cancer cells in non-small cell lung cancer (NSCLC) A549, H1299 cells and CDDP-resistant NSCLC A549R cells. The cytotoxic effect of API was measured in CDDP-treated A549, H1299, and A549R cells. API repressed CD 133 positive cells and enhanced the antitumor effect of CDDP in A549, H1299, and A549R cells. The synergistic antitumor effect of API and CDDP was blocked by addition of the p53 inhibitor Pifithrin-α, and siRNA targeting the p53 gene in A549R cells. Furthermore, API eliminates CDDP-induced CSC via p53, since A549R cells lacking p53 and Pifithrin-α addition derepressed the decrease in CD 133 positive cells after API treatment in CDDP-treated A549 and A549R cells. The findings indicate that API might eliminate cancer stem cells and enhance the antitumor effects of CDDP in NSCLC via p53.
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Antineoplásicos , Carcinoma Pulmonar de Células não Pequenas , Neoplasias Pulmonares , Antineoplásicos/farmacologia , Antineoplásicos/uso terapêutico , Apigenina/farmacologia , Carcinoma Pulmonar de Células não Pequenas/tratamento farmacológico , Linhagem Celular Tumoral , Cisplatino/farmacologia , Cisplatino/uso terapêutico , Resistencia a Medicamentos Antineoplásicos , Humanos , Neoplasias Pulmonares/tratamento farmacológico , Células-Tronco NeoplásicasRESUMO
Particulate matter 2.5 (PM2.5)-induced pulmonary inflammation has become a public concern in recent years. In which, the activation of the NLRP3/caspase-1 pathway was closely related to the inflammatory response of various diseases. However, the promotion effect of the NLRP3/caspase-1 pathway on PM2.5-induced pulmonary inflammation remains largely unclear. Here, our data showed that PM2.5 exposure caused lung injury in the mice by which inflammatory cell infiltration occurred in lung and alveolar structure disorder. Meanwhile, the exposure of human bronchial epithelial cells (16HBE) to PM2.5 resulted in suppressed cell viability, as well as elevated cell apoptosis. Moreover, a higher level of inflammatory cytokine and activation of the NLRP3/caspase-1 pathway in PM2.5-induced inflammation mice models and 16HBE cells. Mechanistically, pretreatment with MCC950, a NLRP3/caspase-1 pathway inhibitor, prevented PM2.5-induced lung injury, inflammatory response, and the number of inflammatory cells in BALFs, as well as promoted cell viability and decreased inflammatory cytokine secretion. Collectively, our findings indicated that the NLRP3/caspase-1 pathway serves a vital role in the pathological changes of pulmonary inflammation caused by PM2.5 exposure. MCC950 was expected to be the therapeutic target of PM2.5 inhalation mediated inflammatory diseases.
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Poluentes Atmosféricos/toxicidade , Caspase 1/metabolismo , Proteína 3 que Contém Domínio de Pirina da Família NLR/metabolismo , Material Particulado/toxicidade , Animais , Apoptose , Citocinas/metabolismo , Células Epiteliais/metabolismo , Humanos , Inflamassomos/metabolismo , Inflamação/induzido quimicamente , Pulmão/efeitos dos fármacos , Lesão Pulmonar/patologia , Camundongos , Material Particulado/efeitos adversos , Pneumonia/induzido quimicamente , Transdução de Sinais/efeitos dos fármacosRESUMO
Doxophylline (DOXO) and theophylline are widely used as bronchodilators for treating asthma and chronic obstructive pulmonary disease, and DOXO has a better safety profile than theophylline. How DOXO's metabolism and disposition affect its antiasthmatic efficacy and safety remains to be explored. In this study, the metabolites of DOXO were characterized. A total of nine metabolites of DOXO were identified in vitro using liver microsomes from human and four other animal species. Among them, six metabolites were reported for the first time. The top three metabolites were theophylline acetaldehyde (M1), theophylline-7-acetic acid (M2), and etophylline (M4). A comparative analysis of DOXO metabolism in human using liver microsomes, S9 fraction, and plasma samples demonstrated the following: 1) The metabolism of DOXO began with a cytochrome P450 (P450)-mediated, rate-limiting step at the C ring and produced M1, the most abundant metabolite in human liver microsomes. However, in human plasma, the M1 production was rather low. 2) M1 was further converted to M2 and M4, the end products of DOXO metabolism in vivo, by non-P450 dismutase in the cytosol. This dismutation process also relied on the ratio of NADP+/NADPH in the cell. These findings for the first time elucidated the metabolic sites and routes of DOXO metabolism in human. SIGNIFICANCE STATEMENT: We systematically characterized doxophylline metabolism using in vitro and in vivo assays. Our findings evolved the understandings of metabolic sites and pathways for methylxanthine derivatives with the aldehyde functional group.
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Acetaldeído/metabolismo , Broncodilatadores/farmacocinética , Fígado/enzimologia , Teofilina/análogos & derivados , Teofilina/metabolismo , Acetaldeído/química , Adulto , Animais , Asma/tratamento farmacológico , Broncodilatadores/administração & dosagem , Sistema Enzimático do Citocromo P-450/metabolismo , Feminino , Voluntários Saudáveis , Humanos , Macaca fascicularis , Camundongos , Microssomos Hepáticos , Oxirredução , Doença Pulmonar Obstrutiva Crônica/tratamento farmacológico , Coelhos , Ratos , Teofilina/administração & dosagem , Teofilina/química , Teofilina/farmacocinéticaRESUMO
BACKGROUND: This study aims to explore the effect of thymoquinone (TQ) on particulate matter 2.5 (PM2.5)-induced lung injury. METHODS: The PM2.5 sample was provided by Shenyang Environment Monitor Central Station. Lung injury was established by intratracheal instillation PM2.5 (7.5 mg/kg) followed by TQ treatment (20 and 40 mg/kg) for 14 d in rats. Hematoxylin and eosin (HE) and Evans blue dye (EBD) staining were detected on lung tissues. ELISA, real-time PCR, western blotting and TUNEL assays were also performed. RESULTS: The data showed that TQ diminished lung injury and EBD accumulation. The number of macrophages, neutrophils, eosinophils, and lymphocytes was ameliorated after TQ treatment. In addition, TQ suppressed the inflammation reaction parameters (interleukin-1ß and -6, IL-1ß and IL-6; tumor necrosis factor-α, TNF-α) and oxidative stress in PM2.5-induced lung injury. The levels of nuclear factor erythroid 2-related factor 2 (Nrf2) and heme oxygenase (HO-1) were increased due to the treatment of TQ. The number of TUNEL-positive cells was prominently reduced in TQ-treated rats compared with that in PM2.5 group. Intratracheal instillation PM2.5 activated autophagy, whilst TQ blocked it in lung. CONCLUSIONS: Taken together, this study provides the first in vivo evidence that TQ suppresses inflammation, oxidative stress, apoptosis, and autophagy in PM2.5-induced lung injury.
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Benzoquinonas/farmacologia , Lesão Pulmonar/induzido quimicamente , Lesão Pulmonar/tratamento farmacológico , Pulmão/efeitos dos fármacos , Material Particulado/efeitos adversos , Animais , Apoptose/efeitos dos fármacos , Autofagia/efeitos dos fármacos , Heme Oxigenase-1/metabolismo , Inflamação/induzido quimicamente , Inflamação/tratamento farmacológico , Inflamação/metabolismo , Pulmão/metabolismo , Lesão Pulmonar/metabolismo , Masculino , Fator 2 Relacionado a NF-E2/metabolismo , Estresse Oxidativo/efeitos dos fármacos , Ratos , Ratos Wistar , Transdução de Sinais/efeitos dos fármacosRESUMO
BACKGROUND: The effects of the combination therapy of varenicline and bupropion in smoking cessation are still controversial. METHODS: Databases including PubMed, EMBASE, Cochrane Library and Web of Science were scanned without time and language limitation. Subgroup analysis was performed to assess the effect of combination therapy in smokers with different level of nicotine dependence and cigarette consumption. RESULTS: Four randomized controlled trials involving a total of 1230 smokers were included. Compared with varenicline monotherapy, combination treatment with varenicline and bupropion could significantly improve the abstinence rate at the end of treatment (RR 1.153, 95% CI 1.019 to 1.305, P=0.024). The benefit existed at 6months follow-up (RR 1.231, 95% CI 1.017 to 1.490, P=0.033), disappeared at 12months follow-up (RR 1.130, 95% CI 0.894 to 1.428, P=0.305), and mainly concentrated in highly dependent smokers (RR 1.631, 95% CI 1.290 to 2.061, P<0.001) and heavy smokers (RR 1.515, 95% CI 1.226 to 1.873, P<0.001) rather than individuals with low nicotine dependence (RR 0.989, 95% CI 0.815 to 1.199, P=0.907) or low cigarette consumption (RR 0.985, 95% CI 0.800 to 1.212, P=0.252). For safety outcomes, the combination treatment was associated with more anxiety (RR 1.717, 95% CI 1.176 to 2.505, P=0.005) and insomnia (RR 1.268, 95% CI 1.076 to 1.494, P=0.005) symptoms compared with varenicline monotherapy. CONCLUSION: Compared with varenicline monotherapy, combination treatment with varenicline and bupropion can significantly improve the abstinence rate at the end of treatment and 6months follow-up, mainly in highly dependent smokers and heavy smokers.
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Bupropiona/uso terapêutico , Abandono do Hábito de Fumar/métodos , Fumar/tratamento farmacológico , Vareniclina/uso terapêutico , Adulto , Quimioterapia Combinada , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Agonistas Nicotínicos/uso terapêutico , Ensaios Clínicos Controlados Aleatórios como Assunto , Agentes de Cessação do Hábito de Fumar/uso terapêutico , Tabagismo/tratamento farmacológicoRESUMO
PURPOSE: Lung cancer is one among the most commonly diagnosed malignancies in developed countries with highest rates of morbidity and mortality. The treatment options for lung cancer are limited and have side effects. Hence, researches are being directed at the exploration and evaluation of new molecules showing anticancer activity. In this study we investigated the anticancer effects of lupeol on the lung cancer A427 cancer cells and normal MRC-5 cells. METHODS: Growth inhibitory effects were checked by MTT assay. Apoptosis was detected by DAPI and annexin V/PI staining. Reactive oxygen species (ROS) and mitochondrial membrane potential (MMP) were estimated by flow cytometry. Protein expression analysis was performed by western blotting. RESULTS: The results showed that lupeol inhibited the growth of A427 lung cancer cells as observed by MTT and colony formation assay. The antiproliferative effects were due to induction of apoptosis as indicated by DAPI and annexin V/PI staining. This was further confirmed by Bax and Bcl-2 expression. Moreover, lupeol triggered generation of ROS and decrease of MMP. Lupeol could also inhibit the mTOR/ PI3K/AKT signalling pathway. Taken together, lupeol could prove beneficial in the treatment of lung cancer. CONCLUSIONS: In brief, the present study indicated that lupeol induced potent and selective cytotoxic effects and these effects were mediated via apoptosis, ROS generation, loss of MMP and inhibition of mTOR/PI3K/AKT signalling pathway.
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Apoptose/efeitos dos fármacos , Neoplasias Pulmonares/tratamento farmacológico , Potencial da Membrana Mitocondrial/efeitos dos fármacos , Triterpenos Pentacíclicos/farmacologia , Espécies Reativas de Oxigênio/metabolismo , Anti-Inflamatórios/farmacologia , Regulação para Baixo , Humanos , Neoplasias Pulmonares/metabolismo , Neoplasias Pulmonares/patologia , Mitocôndrias/efeitos dos fármacos , Fosfatidilinositol 3-Quinases/metabolismo , Proteínas Proto-Oncogênicas c-akt/metabolismo , Transdução de Sinais , Serina-Treonina Quinases TOR/metabolismoRESUMO
OBJECTIVE: To investigate the clinical value of urinary antigen detection of Legionella, and to describe the clinical characteristics of Legionella pneumonia. METHODS: Patients with suspected Legionella pneumonia were enrolled from the Respiratory departments of 3 tertiary hospitals in Shenyang during May 2011 to November 2013. Urinary Legionella antigen was detected for all the enrolled patients. Bacterial culture, polymerase chain reaction (PCR) for Legionella, and double Legionella antibody detection in sera were performed for each patient whose urinary antigen was positive. Patients confirmed to have Legionella pneumonia were pooled and analyzed. RESULTS: Totally 13 cases presenting with pneumonia were positive for Legionella by the urinary antigen method, and in one of them Legionella strain was isolated from the secretion of lower respiratory tract. PCR detection was performed in 8 patients, and 4 of them were positive. Legionella antibody detection was performed in 12 patients, and 7 of them were positive. Nine patients had a history of exposure to Legionella high-risk environments. The characteristics of the cases with Legionella pneumonia were as follows: characteristic orange sputum in 4 patients, digestive symptoms in 6, neurologic disorders in 8, hyponatremia in 10, hypoxia with oxygenation index < 300 mmHg (1 mmHg = 0.133 kPa) in 11, and severe pneumonia with PSI of grade V (PSI score > 130) in 8 patients . Chest CT scan showed bilateral involvement in 6, ground-glass opacity combined with consolidation in 11, and moderate pleural effusion in 11 patients. Cavity and reversed halo sign were found in one case, respectively. All of the patients received fluoroquinolone treatment, and 11 patients recovered completely while 2 died of multiple organ dysfunction syndrome, one of them was complicated with secondary infection. CONCLUSION: Detection of urinary antigen of Legionella is very useful in the diagnosis of Legionella pneumonia. Attention should be paid to exposure history to the high-risk environments and multiple organ impairment when Legionella infection is suspected. Orange sputum may be characteristic for Legionella pneumonia and therefore a clue for diagnosis. In critical cases, secondary infection and additional lung injuries induced by high concentration oxygen therapy may occur.
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Antígenos de Bactérias/urina , Legionella/isolamento & purificação , Doença dos Legionários/diagnóstico , Anticorpos Antibacterianos , Fluoroquinolonas , Humanos , Doença dos Legionários/urina , Derrame Pleural , Pneumonia/diagnóstico , Pneumonia/urinaRESUMO
The efficacy of administering high doses of vitamin D to patients diagnosed with COVID-19 remains uncertain. We conducted a comprehensive search across multiple databases (PubMed, EMBASE, Cochrane Library, and ISI Web of Science) from inception until August 2022, with no limitations on language, to locate randomized controlled trials (RCTs) that investigated the impact of high-dose vitamin D supplementation (defined as a single dose of ≥100,000 IU or daily dose of ≥10,000 IU reaching a total dose of ≥100,000 IU) on COVID-19 patients. Risk ratios (RR) with 95% confidence intervals (CI) and weighted mean differences (WMD) with 95% CI were calculated. Our meta-analysis included 5 RCTs with a total of 834 patients. High-dose vitamin D supplementation did not show any significant benefits for mortality (I 2 = 0.0%, p = .670; RR 1.092, 95% CI 0.685-1.742, p = .711) or intensive care unit (ICU) admission (I 2 = 0.0%, p = .519; RR 0.707, 95% CI 0.454-1.102, p = .126) in COVID-19 patients compared to the control group. However, it was found to be safe and well-tolerated (I 2 = 0.0%, p = .887; RR 1.218, 95% CI 0.930-1.594, p = .151). Subgroup analysis also showed no benefits in overall mortality, including for patients with vitamin D deficiency (I 2 = 0.0%, p = .452; RR 2.441, 95% CI 0.448-13.312, p = .303) or compared to the placebo (I 2 = 0.0%, p = .673; RR 1.666, 95% CI 0.711-3.902, p = .240). Our research indicates that there is no evidence to support the efficacy of high-dose vitamin D supplementation in improving clinical outcomes among individuals with COVID-19, in line with previous studies focused on contexts including rickets. Considering the limitations of the study, additional research may be required.
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Purpose: Although cigarette smoke exposure is the major risk factor for chronic obstructive pulmonary disease (COPD), the mechanism is not completely understood. The aim of the present study was to investigate whether ACSL4-mediated ferroptosis in lung epithelial cells plays a part in the COPD development process and its association. Patients and Methods: In this study, animal and cell models of COPD were modelled using cigarette smoke extracts (CSEs), and cell viability, lipid ROS, iron ion deposition, and ferroptosis-related markers were measured in lung tissue and lung epithelial cells following CSE exposure. Morphological changes in mitochondria were observed in lung tissue and epithelial cells of the lung by transmission electron microscope. The expression levels of ACSL4 mRNA and protein in lung tissue and epithelial cells were measured by real-time PCR and Western blotting. In addition, animal-interfering lentivirus and cell-interfering RNA against ACSL4 were constructed in this study, ferroptosis in lung tissue and lung epithelial cells after ACSL4 interference was detected, and ACSL4 mRNA and protein expression levels were detected. Results: CSE induced ferroptosis in lung tissues and lung epithelial cells, and the expression levels of ACSL4 were elevated in CSE-treated lung tissues and lung epithelial cells. After ACSL4 interference, the expression of ACSL4 decreased, mitochondrial morphology was restored, and ferroptosis in lung tissues and lung epithelial cells was alleviated. Both respiratory frequency and enhanced pause of COPD mice models decreased after ACSL4 interference. Conclusion: ACSL4-mediated ferroptosis in lung epithelial cells is associated with COPD and positively correlated with ferroptosis in epithelial cells.
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Ferroptose , Doença Pulmonar Obstrutiva Crônica , Camundongos , Animais , Doença Pulmonar Obstrutiva Crônica/genética , Pulmão/metabolismo , Células Epiteliais/metabolismo , RNA Mensageiro/metabolismo , Coenzima A Ligases/metabolismoRESUMO
Accurate airway segmentation from computed tomography (CT) images is critical for planning navigation bronchoscopy and realizing a quantitative assessment of airway-related chronic obstructive pulmonary disease (COPD). Existing methods face difficulty in airway segmentation, particularly for the small branches of the airway. These difficulties arise due to the constraints of limited labeling and failure to meet clinical use requirements in COPD. We propose a two-stage framework with a novel 3D contextual transformer for segmenting the overall airway and small airway branches using CT images. The method consists of two training stages sharing the same modified 3D U-Net network. The novel 3D contextual transformer block is integrated into both the encoder and decoder path of the network to effectively capture contextual and long-range information. In the first training stage, the proposed network segments the overall airway with the overall airway mask. To improve the performance of the segmentation result, we generate the intrapulmonary airway branch label, and train the network to focus on producing small airway branches in the second training stage. Extensive experiments were performed on in-house and multiple public datasets. Quantitative and qualitative analyses demonstrate that our proposed method extracts significantly more branches and longer lengths of the airway tree while accomplishing state-of-the-art airway segmentation performance. The code is available at https://github.com/zhaozsq/airway_segmentation.
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Doença Pulmonar Obstrutiva Crônica , Humanos , Doença Pulmonar Obstrutiva Crônica/diagnóstico por imagem , Redes Neurais de Computação , Tomografia Computadorizada por Raios XRESUMO
OBJECTIVE: This study aimed to investigate the effectiveness of doxofylline as an adjuvant in reducing severe exacerbation for different clinical subtypes of chronic obstructive pulmonary disease (COPD). METHODS: The clinical trial was an open-label non-randomized clinical trial that enrolled patients with COPD. The patients were divided into two groups (doxofylline group[DG] and non-doxofylline group[NDG]) according to whether the adjuvant was used. Based on the proportion of inflammatory cells present, the patients were divided into neutrophilic, eosinophilic, and mixed granulocytic subtypes. The rates of severe acute exacerbation, use of glucocorticoids, and clinical symptoms were followed up in the first month, the third month, and the sixth month after discharge. RESULTS: A total of 155 participants were included in the study. The average age of the participants was 71.2 ± 10.1 years, 52.3% of the patients were male, and 29.7% of the participants had extremely severe cases of COPD. In the third month after discharge the numbers of patients exhibiting severe exacerbation among the neutrophilic subtype were 5 (6.6%) in the DG versus 17 (22.4%) in the NDG (incidence rate ratio[IRR] = 0.4 [95% CI: 0.2-0.9] P = 0.024). In the sixth month after discharge, the numbers were 3 (3.9%) versus 13 (17.1%; IRR = 0.3 [95%; CI: 0.1-0.9], P = 0.045), and those for the eosinophilic subtype were 0 (0.0%) versus 4 (14.8%), P = 0.02. In the eosinophilic subtype, the results for forced expiratory volume in the first second and maximal mid-expiratory flow were significantly higher in the DG. The mean neutrophil and eosinophil levels were significantly lower than in the NDG among the neutrophilic subtype, and the neutrophil percentage was lower than in the NDG among the eosinophilic subtype. At the six-month follow-up, the dose adjustment rates of the neutrophilic and eosinophilic subtypes showed a significant difference (P< 0.05). CONCLUSIONS: As an adjuvant drug, doxofylline has a good therapeutic effect on patients with the neutrophilic and eosinophilic clinical subtypes of COPD. It can reduce the incidence of severe exacerbation, the use of glucocorticoids, and inflammatory reactions in the long term (when used for a minimum of 3 months).
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Glucocorticoides , Doença Pulmonar Obstrutiva Crônica , Humanos , Masculino , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Feminino , Glucocorticoides/uso terapêutico , Progressão da Doença , Prognóstico , Eosinófilos , Volume Expiratório ForçadoRESUMO
Background: The effects of high-flow nasal cannula (HFNC) compared to non-invasive positive pressure ventilation (NIPPV) on children with bronchiolitis remain unclear. Methods: This meta-analysis was performed following the preferred reporting items for systematic reviews and meta-analysis (PRISMA) statement. Randomized controlled trials (RCTs) were identified from a comprehensive search in PubMed, EMBASE, Cochrane Library, and Web of Science without time and language limitations. Primary endpoints include the rate of treatment failure, the rate of need for intubation, and the pediatric intensive care unit (PICU) length of stay. Results: Five RCTs including 541 children of less than 24 months were enrolled in the meta-analysis. Compared to the NIPPV group, the rate of treatment failure was significantly higher in the HFNC treatment group (I 2 = 0.0%, P = 0.574; RR 1.523, 95% CI 1.205 to 1.924, P < 0.001). No significant difference was noted in the need for intubation (I 2 = 0.0%, P = 0.431; RR 0.874, 95% CI 0.598 to 1.276, P = 0.485) and the PICU length of stay (I 2 = 0.0%, P = 0.568; WMD = -0.097, 95% CI = -0.480 to 0.285, P = 0.618) between the HFNC group and the NIPPV treatment. Conclusion: Compared to the NIPPV group, HFNC therapy was associated with a significantly higher treatment failure rate in children suffering from bronchiolitis. The intubation rate and the PICU length of stay were comparable between the two approaches.
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Background: The clinical effects of intravascular ultrasound (IVUS)-guided percutaneous coronary intervention (PCI) in patients with chronic total occlusion (CTO) lesions remain unclear. Methods: We identified all full-text published studies that compared the effects of IVUS-guided CTO-PCI with angiography-guided CTO-PCI by searching electric databases including PubMed, Embase, Cochrane Library, and ISI Web of Science from the establishment to Nov 2021. There was no language limitation. The endpoints included the incidence of major adverse cardiac events (MACE), cardiac death, all-cause death, myocardial infarction (MI), and target vessel revascularization (TVR). Results: Five studies involving a total of 2320 patients were included in this meta-analysis. Compared to the angiography-guided group, IVUS-guided PCI showed no significant reduction in the incidence of MACE (I 2 = 27.4%, P = 0.239; RR 0.929, 95% CI 0.765 to 1.128, P = 0.457), cardiac death (I 2 = 0.0%, P = 0.459; RR 0.574, 95% CI 0.299 to 1.103, P = 0.096), all-cause death (I 2 = 0.0%, P = 0.964; RR 0.677, 95% CI 0.395 to 1.163, P = 0.158), MI (I 2 = 46.7%, P = 0.131; RR0.836, 95% CI 0.508 to 1.377, P = 0.482), and TVR (I 2 = 21.2%, P = 0.279; RR 0.929, 95% CI 0.679 to 1.272, P = 0.648). Conclusions: IVUS-guided PCI demonstrated no significant benefit on MACE, cardiac death, all-cause death, MI, and TVR in patients with CTO lesions. However, given the study's limitations, additional high-quality RCTs are needed.
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BACKGROUND: Chest computed tomography (CT) is crucial in the diagnosis of coronavirus disease 2019 (COVID-19). However, the persistent pandemic and similar CT manifestations between COVID-19 and community-acquired pneumonia (CAP) raise methodological requirements. METHODS: A fully automatic pipeline of deep learning is proposed for distinguishing COVID-19 from CAP using CT images. Inspired by the diagnostic process of radiologists, the pipeline comprises four connected modules for lung segmentation, selection of slices with lesions, slice-level prediction, and patient-level prediction. The roles of the first and second modules and the effectiveness of the capsule network for slice-level prediction were investigated. A dataset of 326 CT scans was collected to train and test the pipeline. Another public dataset of 110 patients was used to evaluate the generalization capability. RESULTS: LinkNet exhibited the largest intersection over union (0.967) and Dice coefficient (0.983) for lung segmentation. For the selection of slices with lesions, the capsule network with the ResNet50 block achieved an accuracy of 92.5% and an area under the curve (AUC) of 0.933. The capsule network using the DenseNet121 block demonstrated better performance for slice-level prediction, with an accuracy of 97.1% and AUC of 0.992. For both datasets, the prediction accuracy of our pipeline was 100% at the patient level. CONCLUSIONS: The proposed fully automatic deep learning pipeline of deep learning can distinguish COVID-19 from CAP via CT images rapidly and accurately, thereby accelerating diagnosis and augmenting the performance of radiologists. This pipeline is convenient for use by radiologists and provides explainable predictions.
Assuntos
COVID-19 , Aprendizado Profundo , Pneumonia , Humanos , Redes Neurais de Computação , Pneumonia/diagnóstico por imagem , SARS-CoV-2 , Tomografia Computadorizada por Raios XRESUMO
BACKGROUND: The effects of liraglutide treatment on the left ventricular systolic and diastolic function remain unclear. METHODS: This meta-analysis was conducted according to the preferred reporting items for systematic reviews and meta-analysis (PRISMA) statement. All relevant randomized, placebo-controlled trials (RCTs) were identified by searching PubMed, EMBASE, Cochrane Library, and ISI Web of Science from the establishment to January 2021 without language limitations. The weighted mean difference (WMD) with 95% confidence intervals (CIs) was calculated. RESULTS: Ten placebo-controlled RCTs involving a total of 732 cases were included in the meta-analysis. Compared with the placebo group, liraglutide therapy showed no beneficial effect on the left ventricular ejection fraction (LVEF) at the end of the study (WMD: 2.120, 95% CI: -0.688 to 4.929, P=0.139) and ΔLVEF during the trial period (WMD: -0.651, 95% CI: -1.649 to 0.348, P=0.202). Similarly, no statistical differences were noted in diastolic function parameters between the two groups, including the value early diastolic filling velocity (E)/the mitral annular early diastolic velocity (e') (WMD: -0.763, 95% CI: -2.157 to 0.630, P=0.283), Δe' (WMD: -0.069, 95% CI: -0.481 to 0.343, P=0.742), and ΔE/e' (WMD: -0.683, 95% CI: -1.663 to 0.298, P=0.172). CONCLUSIONS: Liraglutide treatment did not improve the left ventricular systolic and diastolic function. Given the study's limitations, further investigation may be warranted.
RESUMO
Asthma is a common chronic respiratory disease. In the past 10 years, genome-wide association study (GWAS) has been widely used to identify the common asthma genetic variants. Importantly, these publicly available asthma GWAS datasets provide important data support to investigate the causal association of kinds of risk factors with asthma by a Mendelian randomization (MR) design. It is known that socioeconomic status is associated with asthma. However, it remains unclear about the causal association between socioeconomic status and asthma. Here, we selected 162 independent educational attainment genetic variants as the potential instruments to evaluate the causal association between educational attainment and asthma using large-scale GWAS datasets of educational attainment (n = 405,072) and asthma (n = 30,810). We conducted a pleiotropy analysis using the MR-Egger intercept test and the MR pleiotropy residual sum and outlier (MR-PRESSO) test. We performed an MR analysis using inverse-variance weighted, weighted median, MR-Egger, and MR-PRESSO. The main analysis method inverse-variance weighted indicated that each 1 standard deviation increase in educational attainment (3.6 years) could reduce 35% asthma risk [odds ratio (OR) = 0.65, 95% confidence interval (CI) 0.51-0.85, P = 0.001]. Importantly, evidence from other MR methods further supported this finding, including weighted median (OR = 0.55, 95% CI 0.38-0.80, P = 0.001), MR-Egger (OR = 0.48, 95% CI 0.16-1.46, P = 0.198), and MR-PRESSO (OR = 0.65, 95% CI 0.51-0.85, P = 0.0015). Meanwhile, we provide evidence to support that educational attainment protects against asthma risk dependently on cognitive performance using multivariable MR analysis. In summary, we highlight the protective role of educational attainment against asthma. Our findings may have public health applications and deserve further investigation.
RESUMO
Objective. Emphysema is characterized by the destruction and permanent enlargement of the alveoli in the lung. According to visual CT appearance, emphysema can be divided into three subtypes: centrilobular emphysema (CLE), panlobular emphysema (PLE), and paraseptal emphysema (PSE). Automating emphysema classification can help precisely determine the patterns of lung destruction and provide a quantitative evaluation.Approach. We propose a vision transformer (ViT) model to classify the emphysema subtypes via CT images. First, large patches (61×61) are cropped from CT images which contain the area of normal lung parenchyma, CLE, PLE, and PSE. After resizing, the large patch is divided into small patches and these small patches are converted to a sequence of patch embeddings by flattening and linear embedding. A class embedding is concatenated to the patch embedding, and the positional embedding is added to the resulting embeddings described above. Then, the obtained embedding is fed into the transformer encoder blocks to generate the final representation. Finally, the learnable class embedding is fed to a softmax layer to classify the emphysema.Main results. To overcome the lack of massive data, the transformer encoder blocks (pre-trained on ImageNet) are transferred and fine-tuned in our ViT model. The average accuracy of the pre-trained ViT model achieves 95.95% in our lab's own dataset, which is higher than that of AlexNet, Inception-V3, MobileNet-V2, ResNet34, and ResNet50. Meanwhile, the pre-trained ViT model outperforms the ViT model without the pre-training. The accuracy of our pre-trained ViT model is higher than or comparable to that by available methods for the public dataset.Significance. The results demonstrated that the proposed ViT model can accurately classify the subtypes of emphysema using CT images. The ViT model can help make an effective computer-aided diagnosis of emphysema, and the ViT method can be extended to other medical applications.