INTRODUCTION

Acute coronary syndrome (ACS) and end-stage renal disease (ESRD) are both prevalent globally. The diagnosis and management of ACS in ESRD is difficult because the interplay of cardiovascular and renal disease is complicated. The guidelines for ACS may not be applicable to the ESRD population because the trials from which these are drawn mostly excluded ESRD patients.

To determine the clinical profile and outcomes of CKD patients on dialysis admitted for ACS in the Philippine General Hospital (PGH).

We did a retrospective cohort study and employed a retrospective review of electronic medical records among ESRD patients presenting with ACS in PGH from May 2021 to November 2023. The collected data was analyzed using univariate and bivariate statistics using PRISM software.

A total of 48 patients with ESRD were admitted for ACS in this study – 8 with STEMI and 40 with NSTEMI. The mean age was 61 years old and 33 (68.8%) were male. Among those with STEMI, six (75%) presented with Kilip II or more. While among those with NSTEMI, 17 (42.5%) had a GRACE score >140 and 27 (67.5%) had an NSTEMI TIMI risk score >2. On average, the patients were on hemodialysis for 31 months prior to admission. The most common comorbidities were hypertension (91.7%) and heart failure (83.3%). On admission, 18 (37.5%) presented with SBP >160, 7 (14.6%) patients presented with shock, and 4 (8.3%) patients presented with cardiac arrest. 38 (79.2%) patients had anemia on admission. 21 (43.8%) patients had left ventricular hypertrophy on electrocardiogram while 34 (70.8%) patients had cardiomegaly on chest radiography. The average left ventricular ejection fraction on echocardiogram was 46% and 27 (90%) patients had segmental wall motion abnormalities. The most common angiographic finding was 3-vessel coronary artery disease seen in 50% of patients. Almost all patients received dualantiplatelet therapy, high dose statin, and beta-blocker. The mortality rate was high at 43.8% with cardiovascular causes being the most common cause of death.

This study demonstrates the high mortality rate among patients with ESRD presenting with ACS. Our study portrays that patients with ESRD present with higher risk features including abnormalities in vital signs, laboratories, imaging, high prognostications score, and high in-hospital morbidity.

BACKGROUND

Self-management is crucial for individuals with chronic illnesses. While mobile applications (mAPPs) have emerged to support diverse health needs, evidence regarding their efficacy for self-management among chronically ill Filipino patients is inconsistent and limited, particularly in provincial settings.

To investigate the effectiveness of the Health Storylines mAPP compared to a traditional pamphlet for enhancing self-management among individuals with chronic illnesses in Baguio City, Philippines.

We conducted a two-arm quasi-experimental study with 33 participants diagnosed with cancer, type 2 diabetes, or heart disease/hypertension. Participants were recruited via convenience sampling and allocated to an intervention group (n=17), which used the Health Storylines mAPP for four weeks, or a comparison group (n=16), which received a traditional pamphlet. Selfmanagement was assessed pre- and post-intervention using the Self-Management Assessment Scale (SMASc).

Participants demonstrated a high level of selfmanagement at baseline (μ=5.20, SD=0.70). After four weeks, the intervention group showed a non-significant decrease in self-management scores (from μ=5.25 to 5.00, p=0.27), while the comparison group exhibited a non-significant increase (from μ=5.19 to 5.37, p=0.61). There was no statistically significant difference in posttest self-management scores between the two groups (U=83.50, p=0.23).

In a population of chronically ill patients already proficient in managing their condition, the Health Storylines mAPP had a marginal impact on selfmanagement, while the use of a traditional pamphlet showed a slight positive effect. The findings suggest that for this population, familiar, low-barrier resources remain valuable, and mHealth interventions must account for baseline self-management capabilities and digital literacy. Chronic Illness; Health Storylines mAPP; Self-management; mHealth; Philippines.

PANoptosis is a newly defined type of programmed cell death (PCD), which is triggered by a variety of stimuli and covers three known forms of PCD: apoptosis, pyroptosis and necroptosis. In physiological state, cell death plays an important protective role against pathogen invasion, but its over-activation may aggravate inflammatory response and cause tissue damage. Studies have shown that the occurrence and progression of acute lung injury/acute respiratory distress syndrome (ALI/ARDS), asthma, chronic obstructive pulmonary disease (COPD) and other lung diseases are closely related to PANoptosis. The purpose of this review is to deeply explore the molecular mechanism of PANoptosis and its regulatory factors in lung diseases, in order to discover potential therapeutic targets and provide new targets and innovative ideas for clinical treatment for lung diseases.
Humans ; Lung Diseases ; Apoptosis ; Pyroptosis ; Pulmonary Disease, Chronic Obstructive ; Necroptosis ; Acute Lung Injury

OBJECTIVE: To investigate the relationship between peripheral blood circular RNA Bardet-Biedl syndrome 9 (circBBS9) and circRNA catenin beta 1 (circCTNNB1) and weaning failure of mechanical ventilation in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). METHODS: A prospective, observational cohort study was conducted. The patients with AECOPD who received invasive mechanical ventilation and passed the spontaneous breathing test (SBT) admitted to the First Affiliated Hospital of Hebei North University from January 2022 to February 2024 were selected as the study subjects. According to the outcome of weaning, the patients were divided into failed weaning group and successful weaning group. At admission and before SBT, the expression levels of circBBS9 and circCTNNB1 in peripheral blood were detected by fluorescence quantitative polymerase chain reaction (PCR). General information, acute physiology and chronic health evaluation II (APACHEII) score within 24 hours of admission, vital signs before SBT and the most recent laboratory indicators before SBT of the patients were collected. The differences in circBBS9 and circCTNNB1 expression levels and clinical data between the two groups were compared. Multivariate Logistic regression was used to analyze the influencing factors of the weaning failure. Receiver operator characteristic curve (ROC curve) was used to analyze the predictive value of each index on weaning failure. RESULTS: Ultimately, 132 patients with AECOPD who underwent invasive mechanical ventilation and passed the SBT were enrolled in the study. Among them, 82 patients were successfully weaned from mechanical ventilation, while 50 patients failed to be weaned, resulting in a weaning failure rate of 37.88%. There was no statistically significant difference in the expression levels of circBBS9 and circCTNNB1 in the peripheral blood at admission of patients between the two groups. The expression level of circBBS9 in the peripheral blood before SBT of patients in the failed weaning group was significantly higher than that in the successful weaning group (2^-ΔΔCt: 131.64±30.24 vs. 100.00±21.32), and the expression level of circCTNNB1 was significantly lower than that in the successful weaning group (2^-ΔΔCt: 79.90±16.82 vs. 100.00±26.43), and the differences were statistically significant (both P < 0.05). The APACHEII score within 24 hours of admission and the levels of RSBI, SCr, and PCT before SBT in the failed weaning group were significantly higher than those in the successful weaning group [APACHEII score: 22.54±4.62 vs. 16.56±4.58, RSBI: 81.90±16.56 vs. 63.25±17.00, SCr (μmol/L): 100.20±17.27 vs. 89.93±26.29, PCT (μg/L): 1.08±0.18 vs. 0.87±0.22], and the Alb level before SBT was significantly lower than that in the successful weaning group (g/L: 29.71±2.73 vs. 33.93±2.89), and the differences were statistically significant (all P < 0.05). There was no statistically significant difference in other clinical data between the two groups. Multivariate Logistic regression analysis showed that circBBS9 [odds ratio (OR) = 1.291, 95% confidence interval (95%CI) was 1.049-1.588] and APACHEII score (OR = 2.897, 95%CI was 1.004-8.353), RSBI (OR = 1.413, 95%CI was 1.057-1.890) were independent risk factors for weaning failure (all P < 0.05), and circCTNNB1 (OR = 0.812, 95%CI was 0.688-0.959) and Alb (OR = 0.149, 95%CI was 0.036-0.614) were protective factors (both P < 0.05). ROC curve analysis showed that circBBS9, circCTNNB1, APACHEII score, RSBI, and Alb all had certain value for predicting weaning failure. The area under the ROC curve (AUC) and 95%CI were 0.820 (0.750-0.890), 0.755 (0.674-0.835), 0.827 (0.757-0.897), 0.795 (0.715-0.876), and 0.854 (0.791-0.919), respectively. Using the multivariate Logistic regression equation as the combined indicator, the AUC for predicting weaning failure reached 0.997 (95%CI was 0.993-1.000), which was significantly higher than that of the single indicators including circBBS9, circCTNNB1, APACHEII score, RSBI, and Alb (the Z value was 5.582, 6.093, 5.771, 5.932, and 5.182, respectively, all P < 0.05). CONCLUSIONS High expression of circBBS9 and low expression of circCTNNB1 in the peripheral blood of AECOPD patients receiving invasive mechanical ventilation before SBT are associated with weaning failure. circBBS9, circCTNNB1 combined with APACHEII score, RSBI and Alb are helpful for predicting the failure of weaning in these patients.
Humans ; Pulmonary Disease, Chronic Obstructive/blood* ; Prospective Studies ; Ventilator Weaning ; RNA, Circular/blood* ; Respiration, Artificial ; Male ; Female ; Aged

OBJECTIVE: To investigate whether the presence or absence of improvement in chronic severe functional constipation (CSFC) at the early stage of treatment with electroacupuncture predicts subsequent response or non-response, and to determine the optimal treatment duration for assessing subsequent responses to electroacupuncture. METHODS: This is a post hoc analysis using data pooled from two large-scale randomized controlled trials. Patients with CSFC were recruited, and those in the electroacupuncture groups were included in the present study. Early improvement was defined as a weekly increase of ≥1 complete spontaneous bowel movement (CSBM) compared to baseline. Three treatment response criteria were evaluated: ≥ 3 CSBMs per week, overall CSBM response, and sustained CSBM response. Predictive statistics, including sensitivity, specificity, positive predictive value, and negative predictive value, were calculated at weeks 1-4. Receiver operating characteristic curves and accuracy rates were used to determine the optimal timepoint for differentiation between responders and non-responders. RESULTS: Cases from a total of 813 participants who received electroacupuncture were analyzed. The proportion of improvers was 40.34% by week 1, increasing to 52.52% by week 4. After 8 weeks of treatment, the response rates were 30.14%, 25.83% and 25.58% according to the three aforementioned criteria, respectively. Early improvement was a strong predictor of treatment response, with week 3 demonstrating the highest predictive accuracy. CONCLUSION Early improvement with electroacupuncture, especially at week 3, can predict subsequent outcomes. Our findings suggest that acupuncturists may identify non-responders who might require adjustments to therapeutic strategies early in treatment. Please cite this article as: Xiong ZY, Yan SY, Liu SX, Liu ZS. Early improvement to electroacupuncture at week 3 predicts ultimate response in patients with chronic severe functional constipation. J Integr Med. 2025; 23(3): 274-281.
Humans ; Constipation/physiopathology* ; Electroacupuncture ; Male ; Female ; Middle Aged ; Chronic Disease ; Adult ; Treatment Outcome ; Aged

Lingguizhugan Decoction (LGZG) demonstrates significant efficacy in treating various cardiovascular diseases clinically, yet its precise mechanism of action remains elusive. This study aimed to elucidate the potential mechanisms and effects of LGZG on isoproterenol (ISO) continuous stimulation-induced chronic heart failure (CHF) in mice, providing direct experimental evidence for further clinical applications. In vivo, continuous ISO infusion was administered to mice, and ventricular myocytes were utilized to explore LGZG?s potential mechanism of action on the ?1-adrenergic receptor (?1-AR)/Gs/G protein-coupled receptor kinases (GRKs)/?-arrestin signaling deflection system in the heart. The findings reveal that LGZG significantly reduced the messenger ribonucleic acid (mRNA) expression of hypertrophy-related biomarkers [atrial natriuretic peptide (ANP) and B-type natriuretic peptide (BNP)] and improved cardiac remodeling and left ventricular diastolic function in mice with ISO-induced CHF. Furthermore, LGZG inhibited the overactivation of Gs/cyclic adenosine monophosphate (cAMP)/protein kinase A (PKA) signaling and downregulated the downstream transcriptional activity of cAMP-response element binding protein (CREB) and the expression of the coactivator CBP/P300. Notably, LGZG downregulated the expression of ?-arrestin1 and GRK 2/3/5 while upregulating the expression of ?1-AR and ?-arrestin2. These results suggest that LGZG inhibits Gs/cAMP/PKA signaling and ?-arrestin/GRK-mediated desensitization and internalization of ?1-AR, potentially exerting cardioprotective effects through the synergistic regulation of the ?1-AR/Gs/GRKs/?-arrestin signaling deflection system via multiple pathways.
Animals ; Heart Failure/genetics* ; Signal Transduction/drug effects* ; Drugs, Chinese Herbal/pharmacology* ; Mice ; Male ; G-Protein-Coupled Receptor Kinases/genetics* ; Mice, Inbred C57BL ; Humans ; Isoproterenol ; Arrestins/genetics* ; Chronic Disease

Heart failure (HF) and chronic obstructive pulmonary disease (COPD) are common chronic conditions worldwide. The coexistence of HF and COPD creates a detrimental synergy that accelerates disease progression and substantially worsens patient prognosis. To guide the evidence-based management of patients with HF and COPD, experts from the Cardiac Electrophysiology and Cardiac Function Branch of the Chinese Society of Geriatrics and the COPD Group of the Chinese Thoracic Society systematically reviewed the research progress, guidelines, and expert experience, formulating this consensus. The consensus covers epidemiological data, diagnosis, drug treatment, non-pharmacological interventions, and long-term management, while highlighting the critical role of multidisciplinary collaborations. Furthermore, it introduces an integrated diagnostic framework that addresses the complex interplay between HF and COPD. The document advocates for personalized therapeutic approaches and structured follow-up protocols to improve patient outcomes and quality of life.
Humans ; Pulmonary Disease, Chronic Obstructive/complications* ; Heart Failure/complications* ; Consensus ; Quality of Life

OBJECTIVE: The Asia-Pacific region has a high chronic obstructive pulmonary disease (COPD) burden, but studies on its trends are limited. Using the Global Burden of Disease (GBD) 2019 data, we analyzed COPD trends in 36 countries and territories from 1990 to 2019 and predicted future incidence trends through 2034. METHODS: COPD data by age and sex from the GBD 2019 database were analyzed for incidence, prevalence, mortality, and disability-adjusted life years (DALY) rates from 1990 to 2019. Joinpoint regression identified significant annual trends, and age-standardized incidence rates were predicted through 2034 using age-period-cohort models. RESULTS: The incidence, prevalence, mortality, and disease burden of COPD have been decreasing, and the incidence rates will continue to decrease or remain stable until 2034 in most selected countries and territories, except for a few Southeastern Asian countries. The Lao People's Democratic Republic and Vietnam are projected to experience an increase in COPD incidence from 165.3 per 100,000 in 2019 to 177 per 100,000 in 2034 and from 179.9 per 100,000 in 2019 to 192.5 per 100,000 in 2034, respectively. Older males had a higher incidence than any other sex or age group. The sex gap in incidence rates continues to widen, though it is smaller and less significant in the younger age group than in those in the older one. CONCLUSION COPD rates are expected to decline until 2034 but remain a health risk, especially in countries with rising rates. Urgent action on tobacco control, air pollution, and public education is needed.
Humans ; Pulmonary Disease, Chronic Obstructive/mortality* ; Male ; Female ; Middle Aged ; Aged ; Incidence ; Asia/epidemiology* ; Adult ; Prevalence ; Cost of Illness ; Aged, 80 and over ; Disability-Adjusted Life Years ; Young Adult ; Global Burden of Disease ; Adolescent

OBJECTIVE: To investigate the relationship between physical activity and genetic risk and their combined effects on the risk of developing chronic obstructive pulmonary disease. METHODS: This prospective cohort study included 318,085 biobank participants from the UK. Physical activity was assessed using the short form of the International Physical Activity Questionnaire. The participants were stratified into low-, intermediate-, and high-genetic-risk groups based on their polygenic risk scores. Multivariate Cox regression models and multiplicative interaction analyses were used. RESULTS: During a median follow-up period of 13 years, 9,209 participants were diagnosed with chronic obstructive pulmonary disease. For low genetic risk, compared to low physical activity, the hazard ratios ( HRs) for moderate and high physical activity were 0.853 (95% confidence interval [ CI]: 0.748-0.972) and 0.831 (95% CI: 0.727-0.950), respectively. For intermediate genetic risk, the HRs were 0.829 (95% CI: 0.758-0.905) and 0.835 (95% CI: 0.764-0.914), respectively. For participants with high genetic risk, the HRs were 0.809 (95% CI: 0.746-0.877) and 0.818 (95% CI: 0.754-0.888), respectively. A significant interaction was observed between genetic risk and physical activity. CONCLUSION Moderate or high levels of physical activity were associated with a lower risk of developing chronic obstructive pulmonary disease across all genetic risk groups, highlighting the need to tailor activity interventions for genetically susceptible individuals.
Humans ; Pulmonary Disease, Chronic Obstructive/epidemiology* ; Exercise ; Male ; Female ; Middle Aged ; Prospective Studies ; Aged ; Genetic Predisposition to Disease ; Risk Factors ; United Kingdom/epidemiology* ; Incidence ; Adult

OBJECTIVE: Chronic obstructive pulmonary disease (COPD) is a major health concern in northwest China; however, the impact of particulate matter (PM) exposure during sand-dust storms (SDS) remains poorly understood. Therefore, this study aimed to investigate the association between PM exposure on SDS days and COPD hospitalization risk in arid regions. METHODS: Data on daily COPD hospitalizations were collected from 323 hospitals from 2018 to 2022, along with the corresponding air pollutant and meteorological data for each city in Gansu Province. Employing a space-time-stratified case-crossover design and conditional Poisson regression, we analyzed 265,379 COPD hospitalizations. RESULTS: PM exposure during SDS days significantly increased COPD hospitalization risk [relative risk ( RR) for PM _2.5, lag 3:1.028, 95% confidence interval ( CI): 1.021-1.034], particularly among men and the elderly, and during the cold season. The burden of PM exposure on COPD hospitalization was substantially high in Northwest China, especially in the arid and semi-arid regions. CONCLUSION Our findings revealed a positive correlation between PM exposure during SDS episodes and elevated hospitalization rates for COPD in arid and semi-arid zones in China. This highlights the urgency of developing region-specific public health strategies to address adverse respiratory outcomes associated with SDS-related air quality deterioration.
Humans ; China/epidemiology* ; Pulmonary Disease, Chronic Obstructive/chemically induced* ; Particulate Matter/analysis* ; Hospitalization/statistics & numerical data* ; Male ; Female ; Middle Aged ; Aged ; Air Pollutants/analysis* ; Environmental Exposure/adverse effects* ; Spatio-Temporal Analysis ; Adult ; Sand ; Air Pollution