INTRODUCTION:Neonatal lung biopsy guides management of unusually severe, diffuse lung disease with an uncertain diagnosis. Childhood interstitial lung disease (chILD) constitutes a diverse group of uncommon respiratory diseases which are associated with major morbidity and mortality. The incidence, outcome and mortality of chILD and other severe respiratory diseases in resource-limited settings (RLS) are unclear. OBJECTIVE:This retrospective, descriptive study examined lung biopsy in an RLS on infants up to 3 months of age to diagnose and facilitate management. This study included neonates with severe respiratory distress not responding to surfactant replacement. RESULTS:Lung biopsy was diagnostic in 94% (29/31) of patients without procedure-related mortality. The mean gestational age at birth was 35.8 weeks (SD ± 4.6). The mean presentation age was 20 days of life (IQR 1-28). Of 31 participants, 16% (n = 5) had histological findings in keeping with pulmonary interstitial glycogenosis (PIG) only. Sixteen percent (n = 5) of biopsies showed findings in keeping with adenosine triphosphate (ATP)-binding cassette subfamily A member 3 (ABCA3) deficiency in combination with features of PIG on electron microscopy. Surfactant protein (SFTP)-B deficiency and undefined surfactant deficiency were equally prevalent (6% (n = 2). Pulmonary hypertension (PHT) featured in 61% (n = 17) of infants. Genetic testing was performed on 29% (n = 9) of infants, with 56% (n = 5) showing normal results. The cohort mortality was 42% (n = 13). CONCLUSIONS:ChILD should be considered in neonates with severe respiratory distress and PHT not responding to surfactant replacement. Lung biopsy is safe and diagnostic and may prevent long and futile treatment. Histopathological diagnosis frequently assists treatment decisions. Future multicentre studies should include children from an RLS to collect information on diagnoses, genetics and treatment responses.
BACKGROUND:BAE has become a well-established, minimally invasive first-line therapy for hemoptysis. Coils may be useful in selected vascular lesions, including pseudoaneurysms and arteriovenous malformations, but their more proximal occlusive effect may limit distal access and could affect later retreatment and whether adding coils to embosphere embolization improves clinical outcomes remains uncertain. We compared recurrence and safety after embosphere-based BAE performed with or without adjunctive coils. METHODS:We retrospectively reviewed all consecutive adult patients who underwent first-time BAE for hemoptysis at our single tertiary care center between January 2019 and December 2024. Patients treated with embosphere were grouped according to whether coils were also deployed. Residual confounding arising from baseline covariate imbalances was mitigated via 1:1 propensity score-based matching, with matched pairs constrained to a caliper of 0.2 standard deviations of the logit of the propensity score. Kaplan-Meier analysis was used to estimate survival without hemoptysis recurrence, and the results were further analyzed based on the cause of hemoptysis. Factors linked to recurrent hemoptysis were evaluated using Cox proportional hazards models. RESULTS:The study cohort included 260 patients (median age, 56 years; 161 women), of whom 82 received embosphere plus coils and 178 received embosphere without coils. Propensity score matching yielded 62 patients in each group. At 1, 3, and 5 years prior to matching, recurrence-free survival stood at 92.6%, 75.0%, and 59.2% in the coil cohort, respectively, compared with 90.9%, 76.0%, and 50.3% in the control cohort (p = 0.979). After matching, the corresponding rates were 91.8%, 73.8%, and 51.8% versus 85.2%, 66.8%, and 40.5% (p = 0.358). Etiology-stratified analyses also showed no significant benefit from coil use after matching (bronchiectasis, p = 0.770; tuberculosis [TB] sequelae, p = 0.868; non-TB and nonbronchiectasis, p = 0.835). The duration of the procedure varied significantly between the groups (p = 0.003), while the rates of complications showed no significant difference (p = 0.181). On multivariable analysis, TB sequelae emerged as an independent predictor of recurrent bleeding, with a hazard ratio (HR) of 1.69 (95% CI 1.20-2.15, p = 0.002). Systemic arterial-pulmonary shunts (SPSs) were also independently tied to recurrence, carrying an HR of 1.52 (95% CI 1.32-3.72, p = 0.048). CONCLUSIONS:In patients undergoing embosphere-based BAE for hemoptysis, adjunctive coils did not improve long-term recurrence-free survival or reduce complications. Coil use was associated with shorter procedure duration.
BACKGROUND:There is a lack of evidence related to weaning noninvasive ventilation in bronchiolitis. The purpose of this study was to identify variables related to NIV weaning readiness and approach in bronchiolitis. METHODS:A retrospective cohort study of 74 children less than two years of age with bronchiolitis, requiring NIV and admitted to a pediatric intensive care unit (PICU) from 2022 to 2023. Demographic variables, clinical metrics, NIV mode, and weaning metrics were collected. RESULTS:Mean total duration of NIV therapy was 40 h with weans lasting 13 h. Duration for children on CPAP alone was shorter (26 h) than for children on combination of BiPAP and CPAP (45 h, 95% CI 4.258 to 33.742, p = 0.0123). Wean times were also shorter for children on CPAP alone (mean 5 h) than children on BiPAP and CPAP (mean 16 h) (95% CI 1.899 to 20.101, p = 0.0185). Patients were more likely to have a "complex wean," defined as escalation and de-escalation between multiple settings, with BiPAP (44.6%) than with CPAP (18.8%). RR at first wean was a significant predictor of NIV weaning duration (p = 0.007). CONCLUSION:There is a need for NIV weaning guidelines. RR may be an important predictor of NIV weaning readiness and approach. A "complex wean" may be a potential outcome variable for weaning NIV in children with bronchiolitis. This study may be used to inform future research and guidelines for weaning NIV in children with bronchiolitis.
BACKGROUND:To assess the clinical relevance of high-mobility group box 1 (HMGB1) in bronchopulmonary dysplasia (BPD), we conducted a systematic review and meta-analysis comparing HMGB1 levels in neonates with and without BPD. METHODS:Eight databases (PubMed, Cochrane Library, Web of Science, Embase, CNKI, VIP, Wanfang, and CBM) were searched up to March 1, 2025. Cohort studies reporting serum or bronchoalveolar lavage fluid (BALF) HMGB1 levels in neonates were included. Meta-analysis was performed using RevMan 5.4. RESULTS:Seven studies (n = 527 neonates; 308 BPD, 219 controls) were included. HMGB1 concentrations in BALF were significantly higher in neonates with BPD than in those without BPD (mean difference [MD], 5.04 ng/mL; 95% confidence interval [CI], 4.09-5.99; p < 0.00001). Serum HMGB1 concentrations were also higher in neonates with BPD (MD, 7.24 ng/mL; 95% CI, 4.53-9.96; p < 0.00001). Subgroup analyses across postnatal time points indicated that serum HMGB1 levels tended to be higher in infants with BPD than in controls; however, the progressive increase observed from Stage I to Stage III plateaued thereafter, with no further increase in Stage IV (> 20 days). CONCLUSION:Total HMGB1 concentrations in serum and BALF are elevated in neonates with BPD, which may reflect BPD-associated inflammatory lung injury. However, the clinical utility of HMGB1 is limited by its lack of disease specificity and the inability of current assays to distinguish among biologically distinct redox isoforms. Further prospective studies are needed to clarify its diagnostic and therapeutic relevance.
The transition toward non-animal methods for vaccine quality control has accelerated in recent years, driven by scientific advances and evolving regulatory expectations. To assess the current status of replacing animal-based methods, international stakeholders from regulatory authorities, industry, and public health institutions convened in Bangkok, Thailand from 2 to 4 December 2025 for the conference "Animal Testing Replacement for Vaccines: A One Health View - Global Outlook and Future Strategy," organized by Animal-Free Safety Assessment Collaboration and the International Alliance for Biological Standardization. This report synthesizes key discussions from the meeting, including advancements in in vitro potency, safety, and pyrogenicity testing; challenges associated with validation and global regulatory acceptance; access to critical reagents and reference standards; implementation of reliance and work-sharing models; and capacity building for national control laboratories across human and veterinary sectors. Despite recent progress in some areas, significant barriers remain, including fragmented regulatory requirements, limited access to reference standards, and inconsistent validation and implementation pathways across regions and sectors. Collectively, the outcomes underscore the need for coordinated international action to enable broader adoption of scientifically robust, non-animal testing strategies for quality control of vaccines.
Licensed typhoid vaccines contain Vi polysaccharide (ViPS), a capsular antigen of Salmonella. Typhi (S.typhi), either unconjugated or conjugated to carrier proteins like tetanus toxoid (TT), diphtheria toxoid (DT), and Cross-reactive material 197 (CRM-197). Quantitation of ViPS during vaccine development, is challenging, as ViPS demonstrates limited adsorption to solid phases, resulting in poor binding and reduced sensitivity in conventional ELISA formats. We developed a novel competitive enzyme-linked immunosorbent assay (c-ELISA) using biotinylated ViPS as a detector probe for ViPS quantitation. The performance of c-ELISA with a novel Biotinylation approach was evaluated with WHO recommended orthogonal colorimetry based Hestrin assay and High Performance Anion Exchange Chromatography with Pulsed Amperometric Detection (HPAEC-PAD) method. Both c-ELISA and HPAEC-PAD demonstrated comparable specificity, accuracy and repeatability, however c-ELISA showed a higher sensitivity than HPAEC-PAD in the estimation of unconjugated polysaccharide (free-PS) in typhoid conjugates with a range of 90-10,000 ng/ml. Overall, the newly developed c-ELISA is a reliable and sensitive immunochemical method for the quantification of ViPS, which complements the HPAEC-PAD. Together, these tests can serve as orthogonal analytical platforms for the monitoring of the ViPS during the production of typhoid vaccines and for the quality control.
Cellular stress is implicated in the progression of lipopolysaccharide (LPS)-evoked acute lung injury (ALI). The goal of this study was to evaluate the effect of oral supplementation with rosiglitazone (RSG), which is an agonist of peroxisome proliferator-activated receptor (PPAR)-γ, on pulmonary inflammatory response, oxidative stress, and endoplasmic reticulum (ER) stress during LPS-evoked ALI in mice. The mice were randomly divided into four groups and orally supplemented with or without RSG (10 mg/kg) once daily for 5 consecutive days before LPS (1 mg/kg) intraperitoneal injection. The mice were sacrificed at 12 h after LPS injection. As expected, LPS-evoked ALI and death were attenuated in mice that were pretreated with RSG. LPS-evoked increase in chemokines (KC, MIP-2, and MCP-1) and proinflammatory cytokines (TNF-α and IL-1β) was inhibited in the mouse lungs by RSG. RSG pretreatment significantly mitigated LPS-evoked nuclear translocation of NF-κB p65 and p50, which regulate inflammatory gene transcription in the lungs. Additionally, LPS-evoked glutathione depletion and lipid peroxidation were alleviated by RSG. The abnormal expression of NADPH oxidases and antioxidant enzymes was restored in the lung tissues by RSG. Further experiments revealed that LPS-evoked upregulation of GRP78, p-IRE1α, and p-EIF2α was blocked by RSG pretreatment. Mechanistically, RSG pretreatment enhanced PPARγ activity in the mouse lungs and bronchial epithelial cells. RSG promoted the interaction between NF-κB p65 and PPARγ in the mouse lungs. Overall, RSG pretreatment protects against LPS-evoked ALI partially through enhancing PPARγ activity and inhibiting the cellular stress response in the mouse lungs.
OBJECTIVE:This study aimed to identify factors that predict progression to necrotizing pneumonia (NP) in children with Mycoplasma pneumoniae pneumonia (MPP) who fail to respond to initial therapy and to develop a predictive model to support early clinical decision-making. METHODS:We retrospectively analyzed clinical and laboratory data of children with macrolide-unresponsive Mycoplasma pneumoniae pneumonia (MUMPP) admitted to Tianjin Children's Hospital from January 2021 to January 2025. MUMPP was defined as persistent fever (≥ 38.5°C, lasting ≥ 4 h/day) after ≥ 72 h of standardized intravenous macrolide therapy. Patients were classified into an observation group (n = 106, those who developed NP) and a control group (n = 130, those who did not). Independent predictors of NP were identified by multivariable logistic regression and incorporated into a nomogram. Model performance was evaluated using ROC analysis, calibration plots, and decision curve analysis. RESULTS:In multivariable analysis, increased white blood cell (WBC) count (OR = 2.484, 95% CI: 1.406-4.613), longer fever duration (OR = 1.618, 95% CI: 1.217-2.193), pleural effusion (OR = 3.955, 95% CI: 1.664-10.00), and elevated C-reactive protein (CRP) (OR = 2.152, 95% CI: 1.547-3.074) were independently associated with NP among children with MPP after initial treatment failure. Calibration curves indicated close agreement between predicted and observed risks in both the derivation cohort (p = 0.588) and the validation cohort (p = 0.424). The model showed good discrimination, with an AUC of 0.848 (95% CI: 0.789-0.908) in the derivation cohort and 0.889 (95% CI: 0.815-0.963) in the validation cohort. Decision curve analysis suggested net clinical benefit across relevant threshold probabilities. CONCLUSION:Among children with MUMPP, higher WBC count, prolonged fever, pleural effusion, and higher CRP identify increased risk of NP.
Evaluating the risk of out-of-specification (OOS) occurrence before it happens is essential to prevent delays or interruptions in the supply of biological products. This study proposes a practical and quantitative evaluation approach using two indices, S1 and S2, as OOS risk screening and monitoring tools under finite-sample conditions. S1 evaluates whether the variability of data points in a dataset satisfies a low OOS risk criterion, defined as an acceptable level of inherent variability. S2 evaluates whether the observed data range remains within the specification limits with a range-proportional safety margin. Monte Carlo simulations based on normal distributions with sample sizes up to 500 demonstrated that S1 > 1 effectively identified datasets that deviated from the low OOS risk criterion, whereas S2 > 1 functioned as an early alert indicator that predicted or coincided with OOS occurrences. Regardless of the distribution type, both indices increase by definition as the spread of data points increases, suggesting their potential applicability as practical monitoring tools even for non-normal datasets. The combined use of S1 and S2 provides complementary and early warning insights into potential quality deviations and supports proactive quality risk management of biological products.
In October 2023, the UK National Centre for the Replacement, Refinement and Reduction of Animals in Research (NC3Rs) presented recommendations to the World Health Organisation (WHO) Expert Committee for Biological Standardization following an audit of WHO vaccine and biotherapeutic guidelines. These recommendations aimed to promote greater and more harmonised adoption of 3Rs principles (i.e. Replacement, Reduction and Refinement) in quality control and batch release testing. Building on the success of the WHO audit, the NC3Rs initiated a new project to accelerate wider adoption of 3Rs approaches for batch release testing by global biologics manufacturers and regulators. To facilitate this, a survey was developed and distributed to individuals who work for biologicals manufacturers, contract research organisations, national regulatory authorities and national control laboratories. This paper presents the key findings from the survey and outlines how these insights will inform the NC3Rs' ongoing work to advance the wider integration of 3Rs approaches in quality control and batch release testing of vaccines and biotherapeutics.
BACKGROUND:The Bronchiectasis Health Questionnaire (BHQ) was developed to assess the health-related quality of life (HRQOL) in patients with noncystic fibrosis (CF) bronchiectasis. This study aimed to translate, culturally adapt, and validate the BHQ for use among Chinese patients. METHODS:The traditional Chinese version of the BHQ (TC-BHQ) was created through a process of translation, cognitive debriefing interviews, and expert panel reviews. The psychometric evaluation of the TC-BHQ encompassed assessments of factor structure, convergent validity, known-group comparison, internal consistency, and test-retest reliability. RESULTS:We recruited 150 non-CF bronchiectasis patients. Confirmatory factor analysis (CFA) supported the one-factor structure of the BHQ. In terms of concurrent validity, the TC-BHQ total score showed a significant correlation with the St. George's Respiratory Questionnaire (SGRQ) total score (r = -0.77, p < 0.01). In addition, the TC-BHQ total score significantly correlated with all SGRQ subscale scores, including the symptom score (r = -0.62, p < 0.01), activity score (r = -0.60, p < 0.01), and impact score (r = -0.75, p < 0.01). There was a statistically significant change in the total score between baseline and follow-up (p = 0.007). Both internal consistency and test-retest reliability of the TC-BHQ were acceptable. CONCLUSION:TC-BHQ is a promising tool for assessing HRQOL in patients with non-CF bronchiectasis. It has the potential to be a useful instrument in both clinical and research settings.
INTRODUCTION:Bacteriophages are increasingly recognized as vital modulators of the human microbiome and promising candidates for alternative antimicrobial therapies. Critics raise concerns about immune neutralization with prolonged use. This study examines the presence of bacteriophages in human body fluids and assesses their interaction with autologous and heterologous serum to evaluate immune neutralization of human phage isolates. METHODS:Inactivation and neutralization experiments were conducted by exposing samples to neat serum and complement-inactivated serum for 1 h to assess their ability to inactivate human-origin phages. RESULTS:This finding suggests that autologous bacteriophages from human subjects are recognized as self. These phages were not inactivated by either the complement system or neutralized by either homologous or heterologous antibodies. CONCLUSION:This finding indicates that endogenous phages may reduce worries that antibody or complement activation could inactivate them. It provides evidence that these phages might bypass antibody- or complement-induced neutralization, thereby strengthening their case for therapeutic use.
BACKGROUND:Bronchiolitis obliterans (BO) is a rare chronic pulmonary condition in pediatric patients, characterized by irreversible fibrotic constriction of the small airways. This study aims to analyze the risk factors for BO caused by severe adenovirus pneumonia (SAP) and to develop a nomogram model for personalized prediction. METHODS:We retrospectively analyzed 251 children with SAP admitted to the Children's Hospital of Nanjing Medical University between January 2017 and March 2024. Among them, 77 were classified into the BO group and 174 into the non-BO group. A predictive nomogram was developed based on independent risk factors identified through univariate analysis, least absolute shrinkage and selection operator (LASSO) regression, and multivariate logistic regression. RESULTS:Multivariable analysis identified the following independent risk factors for BO: wheezing (odds ratio [OR] = 4.78; 95% confidence interval [CI], (2.00∼11.40); p < 0.001), large lobar consolidation (OR = 8.53; 95% CI, 3.63∼20.02; p < 0.001), length of hospital stay (OR = 1.20; 95% CI, 1.08-1.33; p < 0.001), and duration of fever (OR = 1.20; 95% CI, 1.09-1.32; p < 0.001). Mechanical ventilation showed a trend toward increased risk but did not reach statistical significance (OR = 5.35; 95% CI, 0.74-38.56; p = 0.096). The nomogram demonstrated excellent discriminative ability, with an area under the curve of 0.90 (95% CI: 0.85-0.94). Calibration curves indicated good agreement between predicted and observed outcomes. Decision curve analysis showed a net clinical benefit within a clinically relevant threshold probability range of 0.10-0.70. CONCLUSIONS:A nomogram incorporating five independent risk factors-wheezing, duration of fever, length of hospital stay, mechanical ventilation, and large lobar consolidation-was developed to predict BO risk in children with SAP.
BACKGROUND:While the individual effects of biologics in asthma are well demonstrated, the potential impact of the use of biologics on overall asthma-related hospitalization at a population-based level has not been reported. METHODS:A territory-wide study conducted in Hong Kong, involving all adult patients with asthma managed in Hospital Authority. The primary outcome was the change in asthma-related hospitalization from 2014 to 2023, correlating with the number of biologic use among patients with asthma and adjusted for Air Quality Health Index and influenza case number. RESULTS:The weekly asthma-related hospitalization was 96 episodes at the start of the study period and 78 episodes at the end of the study period. There was a significant reduction of asthma-related hospitalization associated with biologic usage, giving the estimated risk ratio of 0.994 (95% CI = 0.991-0.996, p value < 0.05). The estimated break-point for the change in asthma-related hospitalization was at Week 169 (95% CI = 130.3-207.7), which was the week of 19/3/2017 to 25/3/2017. The slopes before and after the break-point were 0.022 and -0.191 with the difference in the two slope estimates being significant (p < 0.001) according to the Davies test. The significant difference in the slope before and after the break-point suggested that beyond Week 169, there was a trend of significant reduction in asthma-related hospitalization. CONCLUSION:We observed a reduction in asthma-related hospitalizations throughout the study period with a potential temporal association with the increase in biologic prescription. While biologics provided benefits in individual level, the possible benefits in a population-based level could be related to a more comprehensive care in severe asthma patients from the introduction of biologics for severe asthma.
OBJECTIVE:To clarify the predictive role of club cell 10-kDa protein (CC10) and cysteinyl leukotrienes (CysLTs) for subsequent wheezing after RSV infection. METHODS:From October 1, 2022, to October 31, 2023, children diagnosed with RSV-induced bronchiolitis hospitalized in the pediatric ward were included. Nasopharyngeal aspirates (NPAs) were obtained on the day of admission. NPAs from hospitalized children without respiratory infections served as the control group. We analyzed the correlation between CC10 and CysLTs levels in NPAs and disease severity. Follow-up assessments were conducted to observe the subsequent wheezing. RESULTS:There were 169 hospitalized infants diagnosed with RSV-bronchiolitis, and 22 healthy controls matched for age were selected. The levels of CC10 in the NPAs were significantly lower in the RSV group (219.4 ± 83.1 pg/mL) than those in the control group (284.1 ± 68.1 pg/mL; p < 0.001). Levels of CysLTs were significantly greater in the RSV group (346.3 ± 98.1 pg/mL) than in the control group (288.3 ± 82.5 pg/mL; p < 0.05). Pearson correlation analysis showed that CC10 protein level was negatively correlated with severity (r2 = 0.34, p < 0.001). Conversely, the level of CysLTs was positively correlated with severity (r2 = 0.09, p < 0.001). 142 cases were completed with follow-up within a year after discharge. 47 cases (33.1%) had experienced subsequent wheezing, and 95 cases (66.9%) did not have subsequent wheezing. The multivariate logistic regression analysis indicates a higher likelihood of subsequent wheezing in children with CysLTs levels over 335.3 pg/mL (OR = 5.496), allergy history (OR = 3.466), and longer ventilation duration (OR = 1.364). CONCLUSIONS:While CC10 and CysLTs levels correlated with the severity of RSV-bronchiolitis, only CysLTs, along with allergy history and duration of ventilation, showed a suggestive link to subsequent wheezing, but further validation is needed.
Background: The advanced lung cancer inflammation index (ALI) is an important characteristic of cancer and other diseases. This retrospective study aimed to explore the prognostic value of the ALI in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) using noninvasive ventilation (NIV). Methods: This is a retrospective cohort study. A nonrandom sampling method was employed to collect the inpatients diagnosed with AECOPD and used noninvasive ventilators in the Department of Respiratory and Critical Medicine, Beijing Chao-yang Hospital, affiliated with Capital Medical University, from January 2017 to December 2022. Participants were categorized into a success group (NIV-S) and a failure group (NIV-F) based on the outcome of their noninvasive ventilator use in hospitals. The laboratory indices of both groups were compared. A multivariate logistic regression analysis was conducted to identify the risk factors influencing patient prognosis when using noninvasive ventilators, and the subject working a characteristic curve was employed to assess the predictive power of associated risk factors for the failure of noninvasive ventilators. Results: A total of 137 patients suffering from AECOPD complicated with respiratory failure were included, including 117 cases in the NIV successful group (NIV-S, 85.4%) and 20 cases in the NIV failed group (NIV-F, 14.6%). The arterial blood carbon dioxide partial pressure (PaCO2), fibrinogen, and urea nitrogen in the NIV-S were lower. At the same time, the total protein, albumin, body mass index (BMI), and ALI were higher than those in the NIV-F. Moreover, our data revealed that ALI could be considered a reliable biomarker for predicting NIV-F (AUC: 0.822 and 95% CI: 0.710-0.934). The ALI group, along with an OR of 12.206 (95% CI: 3.086-48.279; p < 0.001). Conclusions: Low ALI is associated with NIV-F in patients with AECOPD and is a practical and valuable tool for prognostic assessment.
BACKGROUND:Patients with obstructive sleep apnea (OSA) are at increased risk of perioperative complications, such as hypoxemia, respiratory depression, and airway obstruction. This study aims to evaluate the effectiveness of individualized nursing in the perioperative management of patients with OSA. METHODS:We retrospectively analyzed 107 patients with OSA undergoing elective surgery between January 2023 and January 2025, who were allocated to a conventional group (n = 55) or an individualized group (n = 52) according to the nursing approach. Perioperative respiratory safety (postanesthesia care unit [PACU], minimum oxygen saturation [SpO2], Aldrete score, and respiratory adverse events within 48 h), analgesia and functional recovery (visual analog scale [VAS] scores, opioid consumption, time to first ambulation), postoperative Epworth Sleepiness Scale (ESS) scores, continuous positive airway pressure (CPAP) adherence, Short Form-36 (SF-36) quality of life, complications, ICU transfer, length of stay, and hospitalization costs were compared between groups. RESULTS:Compared with the conventional group, the individualized nursing group showed significantly higher PACU minimum SpO2 (p = 0.001) and Aldrete scores (p < 0.001), a lower incidence of postoperative respiratory adverse events within 48 h (p < 0.05), reduced 24-h and 48-h VAS scores and opioid consumption (p < 0.05), and earlier ambulation (p < 0.001). During the 6-month follow-up, the individualized group demonstrated lower ESS scores, improved CPAP adherence, and greater improvements across all SF-36 domains (all p < 0.001), as well as reduced overall complications, ICU transfer rates, length of hospital stay, and hospitalization costs (p < 0.05). CONCLUSION:Individualized nursing is associated with improved perioperative respiratory safety and recovery quality, better long-term sleep outcomes and quality of life, and reduced complications and healthcare resource use in patients with OSA.
OBJECTIVE:To investigate the regulatory effects of bronchial epithelial cell-released autophagosome (BA)-induced neutrophils on bronchial epithelial cells and the underlying mechanisms. METHODS:Transmission electron microscopy and western blotting were used to identify autophagosomes in 16HBE cells stimulated with house dust mite (HDM) antigen. The production of reactive oxygen species (ROS) and neutrophil extracellular traps (NETs) was detected after BA were cocultured with human peripheral blood neutrophils. Flow cytometry was used to detect the apoptosis rate of 16HBE cells incubated with cocultured supernatant, and BAX, Bcl-2, and cleaved caspase 3 expression was detected by western blotting. In mouse acute asthma, hematoxylin and eosin (HE) staining was used to detect lung tissue injury. Apoptosis was detected by TUNEL, and neutrophils, macrophages, LC3, BAX, and Bcl-2 were detected by immunohistochemistry. RESULTS:HDM induced the release of autophagosomes by 16HBE cells. BA induced ROS production in neutrophils by activating NF-κB signaling pathway and further promotes the formation of NETs, which induced apoptosis of 16HBE cells and was mediated by the regulation of BAX, Bcl-2, and cleaved caspase 3. In the HDM-induced mouse acute asthma, the lung tissue structure was destroyed, the content of neutrophils and macrophages increased, the macrophages showed M1 polarization, and the expression of LC3, BAX, Bcl-2, and apoptosis increased. CONCLUSION:HDM-stimulated 16HBE cells released autophagosomes, which induced ROS production in neutrophils via NF-κB pathway activation and further promoted NET formation, ultimately leading to 16HBE cell apoptosis and lung injury in mice.
