Objective Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is the leading cause of hospitalization and death in patients with chronic obstructive pulmonary disease (COPD). Exploring the prognostic factors of AECOPD patients will assist in optimizing treatment strategies and standardizing disease management. Methods This study retrospectively collected the clinical data of 664 patients with AECOPD admitted to the Respiratory Department of Dongzhimen Hospital of Beijing University of Chinese Medicine from January 2013 to September 2019. The 3-year survival rate and treatment of the patients were investigated. According to whether the patients died,they were divided into a non-survivors group and a survivors group,and clinical data such as basic information,comorbidities,and auxiliary examination results were compared between the two groups. Incorporating clinical experience of researchers and previous research evidence,a secondary screening of variables was conducted to ultimately determine the covariates to be included in the multifactorial Cox proportional hazards regression model,and the factors affecting the 3-year survival rate of the patients were analyzed. Results A total of 664 cases were included in this study,including 362 males and 302 females,with an average age of (77.25±6.89) years old. The 3-year all-cause mortality rate of older hospitalized patients with AECOPD was 20.48％(136 patients). Older age (HR:1.071,95％CI:1.040-1.102,P<0.001);smoking history (HR:1.788,95％CI:1.173-2.723,P=0.007);Charlson comorbidity index (HR:1.209,95％CI:1.029-1.421,P=0.022);lower arterial partial pressure of oxygen (HR:1.014,95％CI:1.006-1.022,P<0.001);higher brain natriuretic peptide(HR:1.001,95％CI:1.000-1.001,P=0.025);cor pulmonale(HR:1.896,95％CI:1.235-2.908,P=0.004);respiratory failure (HR:2.437,95％CI:1.378-4.311,P=0.003);TCM syndrome differentiation elements,including kidney (HR:1.639,95％CI:1.055-2.546,P=0.028) and fluid retention (HR:2.512,95％CI:1.653-3.816,P<0.001),were independent risk factors for 3-year all-cause death of older hospitalized patients with AECOPD. Long-term regular use of bronchiectasis (HR:0.474,95％CI:0.324-0.695,P<0.001) was an independent protective factor for 3-year all-cause death. Conclusion The 3-year survival rate of elderly hospitalized patients with AECOPD is relatively low,with the TCM syndrome elements manifested as lung-kidney qi deficiency,yang deficiency with water retention,and blood stasis obstruction. Patients with moderate to severe impairment of lung function due to COPD have an increased risk of death within 3 years. Therefore,for such patients,nourishing lung-kidney qi,resolving phlegm and water retention,activating blood circulation to remove blood stasis and dredging collaterals,combined with regular use of bronchodilators,may help improve their 3-year survival rate.

Background and objectiveLeptomeningeal metastases (LM) is one of the most serious complications of advanced non-small cell lung cancer (NSCLC) due to the lower quality of life and poor prognosis. hTe aim of this study is to analyze the clinicopathological features and prognosis of patients with LM from NSCLC (NSCLC-LM).MethodsClinical data of 3 patients with NSCLC-LM collected from January 2015 to June 2016 were analyzed with a brief review.Results All 3 patients had adenocarcinoma histology harboring epidermal growth factor receptor (EGFR) exon 21 point mutations (m). Of the 3 cases, 1 was male, 2 were female. hTe mean age was 61.3 years (range, 59-64 years). hTe main clinical manifestations and positive physical examination included headache (3/3), dizziness (3/3), nausea (3/3) and vomiting (3/3), epilepsy (2/3), diplopia (1/3), hearing loss (1/3) and meningeal stimulation sign (3/3). hTe median time from symptom to diagnosis of LM was 2.3 months (range, 1 to 4 months). Except 1 patient with lung cancer and LM diagnosised at the same time, the other 2 cases received the diagnosis of LM atfer tyrosine kinase inhibitors (TKIs) therapy or chemotherapy respectively, the median time from diagnosis of NSCLC to LC was 8.5 months. hTe brain enhanced magnetic resonance imaging (MRI) manifestations of all 3 cases revealed linear meningeal enhancement. Cerebrospinal lfuid in 3 cases were positive cytology in whom two cases had EGFR exon 21 L858R mutations, consistenting with the lung tissue. hTe symptom of the 2 cases improved atfer TKIs ther-apy, and temozolomide was used as supplement of 1 case of which the progression-free survival (PFS) and overall survival (OS) was 4.9 months and 13.9 months respectively.ConclusionLung adenocarcinoma with sensitiveEGFR mutations are likely to appear LM. Lacking of typical symptoms, NSCLC-LM was easily to be missed and misdiagnosed. TKIs therapy combined with temozolomide may be effective therapies for EGFRm-NSCLC-LM patients.

Objective:To explore the mechanism of Ma-Xing Shi-Gan decoction combined with Xiao-Chai-Hu decoction (hereinafter referred to as " Sanyang combined treatment" ) in alleviating colon injury in mice infected with influenza virus by transcriptome sequencing technique.Methods:The mouse model of colonic injury caused by influenza virus was induced by intranasal drip of influenza A virus H1N1 suspension. The mice were divided into Control group, Model group, and Sanyang combined treatment (SCT) group. Model group and SCT group were fed with PBS and Ma-Xing Shi-Gan decoction combined with Xiao-Chai-Hu decoction respectively. Seven days later, the colon tissues of each group were taken, the colon length and pathological damage were observed, and the transcriptome was sequenced to screen the significantly different genes between the SCT group and model group for Gene Ontology (GO), Kyoto Encyclopedia of Genes and Genomes (KEGG) and Gene Set Enrichment Analysis(GSEA).Results:After the therapy with SCT, the length of the colon of mice was significantly improved and the pathological injury of the colon was reduced. There are 92 differentially expressed genes between the SCT group and the model group. GO analysis indicated that the differential genes were enriched in biological processes such as regulation of cytokine and chemokine production, inflammatory response, defense response, immune response, regulation of NF-κB inducing kinase(NIK)/Nuclear factor-κB(NF-κB) signal and Mitogen-activated protein kinase(MAPK) cascade, as well as cell components related to intestinal barrier such as brush border membrane, brush border and microvilli. KEGG analysis indicated that the differential genes were enriched in Toll-like receptor signaling pathway, intestinal immune network for IgA production, complement and coagulation cascade, and Peroxisome proliferator-activated receptor(PPAR) signaling pathway. GSEA indicated that the intestinal immune network for IgA production, PPAR signaling pathway, propionic acid metabolism and butyrate metabolism were significantly up-regulated after the intervention with SCT, while apoptosis and MAPK signaling pathway were significantly down-regulated.Conclusions:Sanyang combined therapy can protect the intestinal tract of mice infected with influenza virus mainly through immunity, inflammation and metabolism pathways.

From the perspective of state differentiation and treatment， it is believed that the pathogenesis of acute respiratory distress syndrome （ARDS） is that evil poisons injured the lungs， and the lung qi suddenly collapsed， then blocked and exhausted， and the qi failure to control blood and liquid， then the fluids overflow outside the vessels， and damp phlegm， stasis， and toxins became knotted up in the body， which ultimately leads to qi dysfunction， and a series of symptom arise， so qi impairment is the principal mechanism of ARDS. A combination of Chinese and Western medicine was proposed to treat ARDS by combining tangible qi and intangible qi， using Chinese herbal medicine to boost qi and relieve collapse， percolate and drain dampness with bland medicinals， resolve toxins and dissolve stasis， and regulate qi， and combining with Western medicine to assist qi circulation to improve qi's consolidation， propulsion， and transformation， so as to make the evil qi go away， the positive qi restored， the viscera qi circulated， qi， blood， yin， and yang connected， and the activities of life maintained， and thus to achieve the goal of treating ARDS by integrated Chinese medicine and Western medicine.

BACKGROUNDIdiopathic pulmonary fibrosis (IPF) is a lethal chronic interstitial lung disease (ILD) of unknown cause and having a variable and unpredictable course. This study aimed to summarize the clinical features and follow-up outcomes and to identify potential factors useful for the assessment of prognosis in IPF.

METHODSTwo hundred and ten patients hospitalized and diagnosed as IPF in our unit from January 1999 to June 2007 were enrolled into this study. The baseline demographic, clinical, radiologic and physiologic characteristics were summarized. Clinical follow-up data until February 2010 were collected, and the median survival time and 1-, 2-, and 5-year survival rates, as well as the influences of the summarized baseline variables on the prognosis were analyzed.

RESULTSThe age at diagnosis as IPF was (64 ± 10) years, the duration before diagnosis of 106 patients (50%) was shorter than 2 years, and 73% were males. One hundred and forty-five patients (69%) had a history of smoking with a median pack-year of 18. Eighty-nine patients (42%) had emphysema and 62 patients (29%) pulmonary arterial hypertension (PAH). One hundred and twenty-four patients were followed up, of which 99 patients died from various causes including respiratory failure related to IPF (93%). The follow-up period was (21 ± 23) months. The median survival time was 38 months. The 1-, 2-, and 5-year survival rates were 61%, 52%, and 39%, respectively. Multivariate analysis showed clubbing, PAH, duration from initial onset to diagnosis, and forced expiratory volume in 1 second (FEV1)/forced vital capacity (FVC) were independent prognostic indicators of IPF.

CONCLUSIONIPF patients who have clubbing, PAH, a higher FEV1/FVC, and a short duration from initial onset to diagnosis have a poorer outcome.

Aged ; Emphysema ; diagnosis ; mortality ; physiopathology ; Female ; Humans ; Hypertension, Pulmonary ; diagnosis ; pathology ; physiopathology ; Idiopathic Pulmonary Fibrosis ; diagnosis ; mortality ; physiopathology ; Male ; Middle Aged