Recurrent Acute Exacerbations Research Articles

Implementing Early Rehabilitation Strategies for Chronic Obstructive Pulmonary Disease (COPD) Patients Undergoing Mechanical Ventilation in the Intensive Care Unit.

Patients afflicted with chronic obstructive pulmonary disease (COPD) frequently manifest acute respiratory failure (ARF), characterized by hypercapnia, hypoxia, malnutrition, muscle weakness, heightened work of breathing (WOB), recurrent acute exacerbations, reliance on mechanical ventilation (MV), and difficulties in the weaning phase. Early implementation of rehabilitation interventions holds promise in mitigating prolonged MV and, consequently, reducing intensive care unit (ICU) morbidity and mortality. A prospective study was undertaken involving COPD type 2 respiratory failure patients receiving MV in an ICU setting. Random assignment was employed to allocate patients to either the experimental or control groups. Both groups received chest physiotherapy, range-of-motion exercises, and standard medical and nursing care. The experimental group additionally underwent early active rehabilitation exercises, including limb strength training and progressive mobility tasks. Various parameters such as mechanical ventilator duration, ICU length of stay (LOS), mortality, and occurrence of adverse events were documented. Group differences were analyzed using independent t-tests. Among 52 patients, 33 were assigned randomly to each group using sealed envelopes. After withdrawals, 15 patients remained in each group. The experimental group had significantly shorter durations of MV (2.29 ± 0.61 vs 2.86 ± 0.66 days; 95% CI: -1.06 to -0.07, t = -2.37, P = 0.02) and ICU stay (7.66 ± 1.17 vs 8.86 ± 1.68 days; 95% CI: -2.28 to -0.11, t = -2.26, P = 0.03) compared to the control group. ICU mortality rates were similar between groups (1.93 ± 0.25 vs 1.93 ± 0.25; 95% CI: -0.19 to 0.19, t = 0.00, P = 1.00). The experimental group had a higher incidence of non-serious adverse events (0.66 ± 0.48 vs 0.26 ± 0.45 events; 95% CI: -0.04 to -0.75, t = 2.31, P = 0.02) and primarily transient physiological changes. Engaging the early active rehabilitation exercises for mechanically ventilated COPD patients is practical and results in a reduction in MV duration, consequently shortening the ICU LOS.

Oral Bacterial Lysate OM-85: Advances in Pharmacology and Therapeutics.

Bacterial lysates are known for having immunomodulatory properties and have been used mainly for the prevention and treatment of respiratory tract infections (RTIs). However, rigorous studies are needed to confirm the clinical efficacy of bacterial lysates with various bacterial antigen components, preparation methods, administration routes and course of treatment. OM-85, an oral standardized lysate prepared by alkaline lysis of 21 strains from 8 species of common respiratory tract pathogens, is indicated as immunotherapy for prevention of recurrent RTIs and acute infectious exacerbations of chronic bronchitis. OM-85 acts on multiple innate and adaptive immune targets and can restore type 1helper T (Th1)/Th2 balance. Sporadic studies have shown advances in pharmacology and therapeutics of OM-85, and thus an update review is necessary. Literature was retrieved by searching PubMed, Web of science, Embase, CNKI, and Full Text Database of Chinese Medical Journals. New roles of OM-85 were discovered in prevention and treatment of lung cancer, pulmonary tuberculosis, SARS-CoV-2 infection, allergic rhinitis, pulmonary fibrosis, atopic dermatitis, and nephrotic syndrome. Pharmacoeconomic values of OM-85 were demonstrated in prophylaxis and treatment of RTIs, chronic obstructive pulmonary disease, asthma, chronic bronchitis, rhinosinusitis and allergic rhinitis. Two consecutive courses of OM-85 (6 or 12 months apart) could prevent recurrent RTIs in children. Maternal OM-85 treatment could offer benefits for offspring. Product-specific response was observed. The efficacy of OM-85 may be associated with patient's characteristics (eg, severity of the disease, age, immune response pattern, malignancy risk stratification). OM-85 can improve effectiveness of standard care for some primary diseases, and carry significant pharmacoeconomic implications. The benefits shown by OM-85 in vitro and in vivo, when extrapolated to humans, are exciting but also require caution. Individualized treatment may need to be considered. It is necessary to compare the efficacy and safety of various bacterial lysate preparations.

Biomarker defined infective and inflammatory asthma exacerbation phenotypes in hospitalized adults: clinical impact and phenotype stability at recurrent exacerbation

Objective Acute exacerbations (AEs) of asthma are heterogeneous in terms of triggers, outcomes, and treatment response. This study investigated biomarker defined infective and inflammatory AE phenotypes in hospitalized adult asthma patients, and their impact on clinical outcomes and phenotype stability at AE recurrence. Method Patients with asthma admitted with an AE between January 2010 and December 2011 with a 3-year follow-up were retrospectively studied. AEs were categorized into infective (CRP >10 mg/L) vs non-infective, eosinophilic (blood eosinophils ≥ 0.2 × 109 cells/L) vs non-eosinophilic, and viral (CRP >10 to <40 mg/L) vs bacterial (CRP ≥40 mg/L) phenotypes. Clinical impact of the index AE, the risk and time to a second AE and AE phenotype stability were analyzed using Kaplan-Meier survival curves and McNamar’s test. Result 294 asthma patients were included: 47% had infective AE with a longer length of stay than non-infective AE (2.0 vs. 1.0 days, p = 0.01). The proportion of patients with eosinophilic AEs was evenly distributed across infective and non-infective AE (40% vs. 46%), although more patients with viral had eosinophilia than bacterial AE (46% vs. 26%). During follow-up, 18% had recurrent AE; with a higher risk in viral AE than bacterial AE (25% vs. 8%, p = 0.02). Both inflammatory and infective AE phenotype were stable at recurrent AE. Conclusion AE phenotyping in hospitalized asthma patients, based on CRP and blood eosinophils, revealed prolonged hospital stay in infective AEs and a higher risk of recurrent AE requiring hospitalization in viral versus bacterial AEs. Moreover, infective, and inflammatory AE phenotypes were rather stable at recurrent AE. Our results suggest a role for biomarker guided phenotyping of AEs of asthma.

A Case of Primary Immunodeficiency Syndrome that was Diagnosed in Adulthood Due to Recurrent Acute Exacerbations of Chronic Rhinosinusitis

A Case of Primary Immunodeficiency Syndrome that was Diagnosed in Adulthood Due to Recurrent Acute Exacerbations of Chronic Rhinosinusitis

Exercise Rehabilitation and Chronic Respiratory Diseases: Effects, Mechanisms, and Therapeutic Benefits.

Chronic respiratory diseases (CRD), is a group of disorders, primarily chronic obstructive pulmonary disease and asthma, which are characterized by high prevalence and disability, recurrent acute exacerbations, and multiple comorbidities, resulting in exercise limitations and reduced health-related quality of life. Exercise training, an important tool in pulmonary rehabilitation, reduces adverse symptoms in patients by relieving respiratory limitations, increasing gas exchange, increasing central and peripheral hemodynamic forces, and enhancing skeletal muscle function. Aerobic, resistance, and high-intensity intermittent exercises, and other emerging forms such as aquatic exercise and Tai Chi effectively improve exercise capacity, physical fitness, and pulmonary function in patients with CRD. The underlying mechanisms include enhancement of the body's immune response, better control of the inflammatory response, and acceleration of the interaction between the vagus and sympathetic nerves to improve gas exchange. Here, we reviewed the new evidence of benefits and mechanisms of exercise intervention in the pulmonary rehabilitation of patients with chronic obstructive pulmonary disease, bronchial asthma, bronchiectasis, interstitial lung disease, and lung cancer.

Acute exacerbations of chronic obstructive pulmonary disease in a cohort of Chinese never smokers goes along with decreased risks of recurrent acute exacerbation, emphysema and comorbidity of lung cancer as well as decreased levels of circulating eosinophils and basophils.

Acute exacerbations show a significant impact on disease morbidity and mortality in chronic obstructive pulmonary disease (COPD). In contrast to stable COPD, the association of smoking status with clinical and laboratory characteristics in patients with acute exacerbations of COPD (AECOPD) has not been well studied. In this retrospective study, we compared never smokers and ever smokers on their demographic, clinical, and laboratory characteristics in a Chinese clinical cohort of AECOPD. In this cohort comprising 1,034 consecutive patients with AECOPD, never smokers were older (75 vs 70.5 years, padjusted < 0.001) and had a higher body mass index than smokers (21.1 ± 4.0 vs 20.3 ± 3.4, padjusted = 0.028). Furthermore, never smokers showed a decreased risk of recurrent acute exacerbation (13.0 vs 21.8%, padjusted = 0.029), a lower risk of development of emphysema (77.8 vs 89.1%, padjusted < 0.001), a lower prevalence of the co-morbidity of lung cancer (0.5 vs 6.6%, padjusted < 0.001), lower levels of circulating eosinophils (EO; 0.04 × 109/L vs 0.10 × 109/L, padjusted = 0.007) and basophils (BA; 0.02 × 109/L vs 0.03 × 109/L, padjusted = 0.019), and a higher plasma levels of D-dimer (0.62 μg/ml vs 0.51 μg/ml, padjusted = 0.02). Furthermore, multivariate logistic regression analysis identified several risk factor for the recurrent acute exacerbation, such as smoking [odds ratio (OR) = 1.84, 95% CI: 1.03–3.40, p = 0.044], urban residential area (OR = 1.43, 95% CI: 1.01–2.05, p = 0.045), and the presence of emphysema (OR = 2.31, 95% CI: 1.25–4.69, p = 0.012). In conclusion, this study demonstrates that the smoking status of patients is associated with recurrent acute exacerbations, emphysema, lung cancer, and levels of circulating EO and BA in AECOPD. Identification of cigarette smoking as a risk factor for recurrent acute exacerbation supports behavioral intervention of smoking cessation in the management of patients with AECOPD.

CFTR Modulator Therapies: Potential Impact on Airway Infections in Cystic Fibrosis.

Cystic Fibrosis (CF) is an autosomal recessive disease caused by mutations in the gene encoding for the Cystic Fibrosis Transmembrane conductance Regulator (CFTR) protein, expressed on the apical surface of epithelial cells. CFTR absence/dysfunction results in ion imbalance and airway surface dehydration that severely compromise the CF airway microenvironment, increasing infection susceptibility. Recently, novel therapies aimed at correcting the basic CFTR defect have become available, leading to substantial clinical improvement of CF patients. The restoration or increase of CFTR function affects the airway microenvironment, improving local defence mechanisms. CFTR modulator drugs might therefore affect the development of chronic airway infections and/or improve the status of existing infections in CF. Thus far, however, the full extent of these effects of CFTR-modulators, especially in the long-term remains still unknown. This review aims to provide an overview of current evidence on the potential impact of CFTR modulators on airway infections in CF. Their role in affecting CF microbiology, the susceptibility to infections as well as the potential efficacy of their use in preventing/decreasing the development of chronic lung infections and the recurrent acute exacerbations in CF will be critically analysed.

Effect of Autoimmune Cell Therapy on Immune Cell Content in Patients with COPD: A Randomized Controlled Trial.

Objective To explore the effect of autoimmune cell therapy on immune cells in patients with chronic obstructive pulmonary disease (COPD) and to provide a reference for clinical treatment of COPD. Methods Sixty patients with stable COPD were randomly divided into control group and treatment group (n = 30). The control group was given conventional treatment, and the treatment group was given one autoimmune cell therapy on the basis of conventional treatment. The serum levels of CD3+ T cells, CD4+ T cells, CD8+ cells, B cells, and NK cells in the peripheral blood were detected by flow cytometry. Possible adverse reactions were detected at any time during treatment. Results There were no significant differences in the contents of CD3+ T cells, CD4+ T cells, CD8+ cells, B cells, and NK cells in the serum of the control group (P > 0.05). Compared with before treatment, the contents of CD3+ T cells, CD4+ T cells, CD8+ cells, B cells, and NK cells in the serum of the treatment group were significantly increased (P < 0.05). The ratio of CD4 + /CD8+ T cells in both control and treatment groups did not change significantly during treatment (P > 0.05). There were no significant differences in serum CD3+ T cells, CD4+ T cells, CD8+ cells, B cells, and NK cells in the treatment group at 30 days and 90 days after treatment (P > 0.05), but they were significantly higher than those in the control group (P < 0.05). Conclusion Autoimmune cell therapy can significantly increase the level of immune cells in the body and can be maintained for a long period of time, which has certain clinical benefits for recurrent respiratory tract infections and acute exacerbation in patients with COPD.

Liver Cirrhosis in Chronic Hepatitis B: is it due to Hepatic Vena Cava Syndrome: case report

Chronic hepatitis B (CHB) is a common chronic viral infection of man. Hepatitis B Virus is not a cytopathic virus. Extensive intrahepatic viral replication is compatible with normally functioning hepatocytes. Patients with CHB in the West manifest as a ‘healthy carrier’, whereas in Asia and Africa some develop liver cirrhosis and hepatocellular cancer. Liver cirrhosis in CHB is assumed to evolve through chronic hepatitis but its pathogenesis and the geographic difference in the outcome of CHB is not explained adequately. Nepal is a country with low prevalence of CHB, where patients with CHB have hepatic vena cava syndrome (HVCS) as a comorbid condition. HVCS is a bacterial infection induced chronic obstructive disease of inferior vena cava at the site of hepatic vein opening. It is clinically characterized by long asymptomatic courses and occasional episodes of acute exacerbation precipitated by bacterial infection that result in hepatic venous outflow obstruction. Increased frequencies of acute exacerbations led to development of hypersplenism, liver cirrhosis and hepatocellular carcinoma. Long time follow up of patients with CHB in Nepal showed development of cirrhosis in many but it was not related to the severity of viral replication or to the duration of the viral infection. Cirrhosis developed more frequently in patients with hypersplenism and those with severe and recurrent acute exacerbation of HVCS. These observations suggested that the development of cirrhosis in CHB in Afro-Asian countries may be due to the presence of HVCS as a comorbid condition. Reported here are a few cases of CHB that illustrate this point. Pathogenesis of cirrhosis in these patients is discussed.

A Review on the Effect of Kinesiotaping on Lung Function and Perception of Dyspnea in COPD Patients

Background: Chronic Obstructive Pulmonary Disease (COPD) is complicated by the presence of frequent and recurrent acute exacerbations. The patients are asymptomatic and stable in the early stages. They develop weakness of primary respiratory muscles and use accessory muscles, which lead to postural changes. The forward head posture is very common in COPD patients due to increased usage of accessory muscles and aging changes. Kinesiotaping application has been used to correct posture and lung function recently. Objective: The aim of this paper is to review the evidence on the effect of Kinesiotaping on lung function and posture in COPD patients. Methods: The research articles published in the major databases including Web of Science, Pubmed, and Google Scholar, were searched from January 2010 to January 2021 to be included in the review. Twenty-one articles were retrieved and six articles were selected for the review based on the inclusion criteria. Results: The studies indicate that Kinesiotaping of the thoracic wall in COPD patients has an immediate effect on accessory inspiratory muscle activity, chest expansion, pulmonary function, and postural alignment. Further research is required to determine the long-term effects of this special taping method in comparison with conventional therapy in COPD patients. Conclusion: The application of kinesiotaping as an adjunct to conventional breathing exercises in COPD patients helps in improving lung function, posture and reduces the perception of dyspnea.

Initial therapeutic dose of corticosteroid for an acute exacerbation of IPF is associated with subsequent early recurrence of another exacerbation

Some patients with idiopathic pulmonary fibrosis (IPF) undergo recurrent acute exacerbations (AEs). This study aimed to elucidate the risk factors for recurrent AEs of IPF (AE-IPF). Consecutive patients with IPF admitted for their first AE-IPF between January 2008 and December 2018 were retrospectively recruited. Of 63 patients admitted for an AE-IPF and discharged alive, 9 (14.3%) developed a recurrence of AE within 1 year. The mean time to recurrence was 233 ± 103 days. Total doses (mg/month and mg/kg/month) of corticosteroids administered over day 1 to 30 after the AE were significantly higher in patients without recurrences of AE-IPF (5185 ± 2414 mg/month, 93.5 ± 44.0 mg/kg/month) than the doses in patients with recurrences (3133 ± 1990 mg/month, 57.2 ± 37.7 mg/kg/month) (p = 0.02 and p = 0.03, respectively). However, no differences were observed between the total doses of corticosteroids administered over days 31 to 60, 61 to 90, 91 to 120, and 151 to 180 after the AE. Furthermore, differences between the administration rates of immunosuppressive and antifibrotic treatments administered to the 2 patient groups were not significant. An increased total dose of corticosteroid administered over day 1 to 30 after an AE-IPF was associated with a decreased risk of subsequent recurrence of AE-IPF within 1 year after the first AE.

Potential Contributions of Anaerobes in Cystic Fibrosis Airways

Cystic fibrosis (CF) is the most common, lethal genetic disease among the Caucasian population. The leading cause of mortality is recurrent acute exacerbations resulting in chronic airway inflammation and subsequent downward progression of pulmonary function. Traditionally, these periods of clinical deterioration have been associated with several principal pathogens. However, a growing body of literature has demonstrated a polymicrobial lower respiratory community compromised of facultative and obligate anaerobes. Despite the understanding of a complex bacterial milieu in CF patient airways, specific roles of anaerobes in disease progression have not been established. In this paper, we first present a brief review of the anaerobic microorganisms that have been identified within CF lower respiratory airways. Next, we discuss the potential contribution of these organisms to CF disease progression, in part by pathogenic potential and also through synergistic interaction with principal pathogens. Finally, we propose a variety of clinical scenarios in which these anaerobic organisms indirectly facilitate principal CF pathogens by modulating host defense and contribute to treatment failure by antibiotic inactivation. These mechanisms may affect patient clinical outcomes and contribute to further disease progression.

BMI and adipocytokine changes in COPD exacerbation and stable COPD

COPD is described by progressive airflow restriction and recurrent acute exacerbations, which is caused by inflammatory response occurring in lungs as a result of chronic inhalation of harmful particles and gases. The study was designed to determine the link of interleukin-6 (IL-6), adiponectin and visfatin with BMI and oxidant/antioxidant balance in Chronic Obstructive Pulmonary Disease (COPD), a systemic disease. The study comprised control (n=20), patients with COPD (n=37) from the Chest Diseases Clinic of Firat University Hospital. The serum MDA, IL-6, Visfatin and Adiponectin levels were evaluated by ELISA. Also, Pulmonary Function Tests were done. There was no significant difference between control and patients with COPD in terms of sex and age averages. On the contrary, BMI levels were statistically significantly lower in COPD group compared to the controls. MDA and adiponectin levels were higher, IL-6 and visfatin levels were lower in COPD groups contrary to controls. It was thought that the level changes of these parameters (MDA, IL-6, visfatin and adiponectin) may be an important factor in the development of COPD and in monitoring the treatment of COPD-related diseases.

Identification of bioactive compounds with anti-inflammatory potential in the methanolic fruit extract of Areca catechu L. (Palmaceae)

COPD is described by progressive airflow restriction and recurrent acute exacerbations, which is caused by inflammatory response occurring in lungs as a result of chronic inhalation of harmful particles and gases. The study was designed to determine the link of interleukin-6 (IL-6), adiponectin and visfatin with BMI and oxidant/antioxidant balance in Chronic Obstructive Pulmonary Disease (COPD), a systemic disease. The study comprised control (n=20), patients with COPD (n=37) from the Chest Diseases Clinic of Firat University Hospital. The serum MDA, IL-6, Visfatin and Adiponectin levels were evaluated by ELISA. Also, Pulmonary Function Tests were done. There was no significant difference between control and patients with COPD in terms of sex and age averages. On the contrary, BMI levels were statistically significantly lower in COPD group compared to the controls. MDA and adiponectin levels were higher, IL-6 and visfatin levels were lower in COPD groups contrary to controls. It was thought that the level changes of these parameters (MDA, IL-6, visfatin and adiponectin) may be an important factor in the development of COPD and in monitoring the treatment of COPD-related diseases.

Splenomegaly and hypersplenism in hepatic vena cava syndrome.

Background and Aim:Hepatic vena cava syndrome (HVCS) is a bacterial infection-induced obliterative disease of the inferior vena cava at the site of the hepatic vein openings that causes chronic liver disease with a high incidence of liver cirrhosis and a moderate incidence of hepatocellular carcinoma (HCC). HVCS typically manifests clinically as recurrent mild jaundice and/or a mild elevation of transaminases or ascites as a result of hepatic venous outflow obstruction. This study is an investigation of the complications and treatment results of a large cohort of HVCS patients with an emphasis on splenomegaly and hypersplenism.Materials and Methods:A total of 1935 (1335 male and 600 female) patients with HVCS seen between 2004 and 2019 for splenomegaly and hypersplenism were enrolled in this retrospective study. The incidence of splenomegaly, ascites, cirrhosis, HCC, and other complications was measured and analyzed.Results:Long-term follow-up of a large study group seen over several years indicated that 16% had mild splenomegaly, and 50% of these developed cytopenia commonly thrombocytopenia and/or leucopenia.Conclusion:The development of hypersplenism was related to recurrent or prolonged acute exacerbation of HVCS. This resulted in an increased incidence of ascites and cirrhosis as well as complications, such as hepatic encephalopathy, gastrointestinal or mucosal bleeding, or mortality.

Mechanisms by Which the MBD2/miR-301a-5p/CXCL12/CXCR4 Pathway Regulates Acute Exacerbations of Chronic Obstructive Pulmonary Disease.

BackgroundChronic obstructive pulmonary disease (COPD) is characterized by irreversible expiratory airflow obstruction, and its chronic course is worsened by recurrent acute exacerbations. Our previous microarray assay identified microRNA (miR)-301a-5p as being associated with progression of acute exacerbation of COPD (AE-COPD); however, the mechanism underlying COPD pathogenesis remains unknown.MethodsSamples of serum and peripheral blood mononuclear cells (PBMCs) were isolated from healthy control subjects and patients with stable COPD (R-COPD) or with an acute exacerbation of COPD (AE-COPD). Human HULEC-5a and human bronchial epithelial (HBE) cells were transfected with methyl-CpG-binding domain protein 2 (MBD2), sh-MBD2, miR-301a-5p mimics or an inhibitor, and then stimulated with cigarette smoke extract (CSE). Conditioned medium co-culture assays were performed by adding the supernatant of medium derived from HULEC-5a cells transfected with miR-301a-5p mimics or inhibitor into wells containing si-c-x-c motif chemokine receptor 4 (CXCR4)-transfected-lung fibroblasts or human leukemic THP-1 cell line macrophages. Transwell assays were performed to analyze cell migration.ResultsOur analysis of clinical samples showed that decreased miR-301a-5p levels in patients with AE-COPD were positively correlated with levels of MBD2 expression, but negatively correlated with levels of chemokine ligand C-X-C motif chemokine ligand 12 (CXCL12) expression. MBD2 overexpression significantly promoted miR-301a-5p production, but suppressed CXCL12 production in HULEC-5a and HBE cells. CXCL12 was confirmed to be a direct target of miR-301a-5p. CXCR4 knockdown significantly enhanced the suppressive effect of miR-301a-5p mimics and attenuated the promotional effects of the miR-301a-5p inhibitor on the migration of circulating fibroblasts and macrophages, as well as the expression levels of phospho-mitogen-activated protein kinase (p-MEK) and phospho-protein kinase B (p-AKT).ConclusionIn summary, the MBD2/miR-301a-5p/CXCL12/CXCR4 pathway was shown to affect the migration of lung fibroblasts and monocyte-derived macrophages, which may play an important role during COPD exacerbations.

Invasive Mechanical Ventilation in Chronic Obstructive Pulmonary Disease Exacerbations.

Chronic obstructive pulmonary disease (COPD) continues to be an important cause of morbidity, mortality, and health care costs worldwide. Although there exist some heterogeneity between patients, the course of COPD is characterized by recurrent acute exacerbations, which are among the most common causes of medical admission to hospital. Patients with frequent exacerbations have accelerated lung function decline, worse quality of life, and greater mortality. Therefore, interest is growing in assessing the effectiveness of interventions used to treat exacerbations. The present review summarizes the current evidence regarding the use of ventilatory management to treat COPD and the implementation of novel cost-effective strategies, such as high-flow oxygenation or extracorporeal carbon dioxide removal to improve clinical outcomes and functional recovery in this disease and to reduce the associated costs.

The bacteriology of recurrent acute exacerbations of chronic rhinosinusitis: a longitudinal analysis.

The purpose of this study was to describe the microbiology of recurrent acute exacerbations of chronic rhinosinusitis over time. Retrospective review of patients with recurrent acute exacerbations of chronic rhinosinusitis who underwent endoscopic-guided cultures during acute exacerbations of chronic rhinosinusitis. 386 cultures were obtained from 112 patients during recurrent acute exacerbations of CRS. A change of bacterial isolates during the course of recurrent exacerbations was observed in 68% (76/112) of patients, necessitating a change of treatment in 40% (45/112). The main risk factor for the subsequent change in cultures was polymicrobial growth. Sinus surgery was not associated with subsequent change in cultured isolates. Resistant strains developed in 11.6% (13/112) of patients, of whom those with abnormal mucociliary clearance being at the highest risk. Repeated middle meatal cultures should be considered in patients with recurrent exacerbations of CRS, particularly in cases not responding to standard therapy.

Effects of compound Caoshi silkworm granules on stable COPD patients and their relationship with gut microbiota: A randomized controlled trial.

Patients with chronic obstructive pulmonary disease (COPD) usually experience recurrent acute exacerbations. These patients, especially those with stable COPD, require an effective intervention for treating exacerbations. This study aimed to evaluate the efficacy of Compound Caoshi silkworm granules (CCSGs) in stable COPD patients and to investigate their potential mechanism. A randomized controlled trial was performed at Jinhua Hospital, Zhejiang University. Patients were enrolled in this study if they met the criterion of stable COPD. A total of 40 patients were randomly divided into the following 2 groups: Group A (n = 20, routine treatment (RT) group) and Group B (n = 20, RT plus CCSGs [RT plus CCSGs] group). The duration of treatment was 3 months. Stool samples were collected from all patients on day 0 and the gut microbiota was analyzed using 16s rRNA sequencing. The St. George's Respiratory Questionnaire (SGRQ) scores and lung function were assessed at month 0 and month 3. The components of gut microbiota differed between stable COPD patients and the healthy population. The RT plus CCSGs group showed improved SGRQ scores compared to the RT group. There was no difference in forced expiratory volume-one second, forced vital capacity, and forced expiratory volume-one second/forced vital capacity between the two groups. Furthermore, the abundance of gut microbiota in patients with the top 10 SGRQ scores (Group N) differed from the abundance of gut microbiota in those with the lowest 10 SGRQ scores (Group T). CCSGs have beneficial effects in the improvement of symptoms in stable COPD patients over a 3-month treatment period. The potential underlying mechanism may be attributable to the difference in gut microbiota among patients. However, more research is needed to confirm this conclusion.

Lessons from "real life experience" of rifaximin use in the management of recurrent hepatic encephalopathy.

BACKGROUNDHepatic encephalopathy (HE) is a major complication of cirrhosis with independent prognostic significance. The current management of HE is mainly based on lactulose. Rifaximin has been shown to decrease the risk of HE recurrence in patients with episodic forms. HE can also be persistent. However, there is no drug support recommendation for rifaximin use in this setting.AIMTo assess the effectiveness of rifaximin in the management of recurrent episodes of HE and recurrent acute exacerbations on persistent HE, in “real life conditions”.METHODSIn this retrospective study, using a within-subjects design, we collected data of patients treated with rifaximin for HE in two liver diseases centers, during the six-month period before and during the six-month period after the initiation of rifaximin. The primary effectiveness endpoint was the total number of HE events involving hospitalization.RESULTSRifaximin was introduced for prevention of recurrent HE episodes in 29 out of 62 patients with normal mental status between episodes and for prevention of recurrent acute exacerbations on persistent HE in 33 out of 62 patients. In the “prevention of recurrent HE episodes” group, fewer HE events (0.79 vs 1.78; P = 0.013) were reported during the period of time when rifaximin was used. In the “prevention of recurrent acute exacerbations on persistent HE” group, there was no significant difference in the number of HE-events (1.48 vs 1.77; P = 0.582).CONCLUSIONIn this real-life experience, the effectiveness of rifaximin was confirmed in the prevention of HE episodes recurrence but was not proved in the prevention of acute exacerbations recurrence on persistent HE.