This systematic review and meta-analysis aimed to summarize the prevalence and temporal trajectories of long-term prognosis among adult sepsis survivors after hospital discharge. We searched eight Chinese and English databases from their inception through October 30, 2025, and ultimately included 76 studies in the review. Pooled analyses showed that readmission rates increased over time, reaching 44.0% at 1 year. Mortality remained substantial over time, rising from 15.0% at 1 month to 42.3% at 5 years. Cognitive, physical, and psychological impairments related to post-sepsis syndrome persisted for months to years or followed fluctuating recovery trajectories. Health-related quality of life was generally diminished after discharge, with only transient improvement between 6 months and 1 year, and a substantial proportion of survivors experienced persistent limitations in social functioning. These findings suggest that the health impact of sepsis persists long after hospital discharge, warranting sustained follow-up and more individualized post-discharge management strategies.

BACKGROUND:Global population aging exacerbates the challenges of multimorbidity and polypharmacy in older adults. Clinical practice guidelines are essential for addressing these issues. This systematic review aims to evaluate the quality of existing guidelines and synthesize their recommendations based on the Ariadne principles, to inform future guideline development and clinical practice. METHODS:We searched nine databases and five guideline repositories (e.g., PubMed, Web of Science, Cochrane Library, CNKI, WHO) up to August 2025. Guidelines and consensus documents focusing on multimorbidity or polypharmacy in older adults, published in English or Chinese, were included. Each guideline was evaluated using four validated tools: AGREE II (methodological quality), RIGHT (reporting completeness), AGREE-REX (recommendation credibility and applicability), and GLIA (implementation feasibility). Recommendations were categorized and synthesized according to the Ariadne principles, with independent screening and data extraction and consensus resolution of discrepancies. RESULTS:The multidimensional appraisal of the 21 included guidelines revealed consistent weaknesses. According to AGREE II, the domains of Scope and Purpose (81.9 %) and Clarity of Presentation (61.1 %) demonstrated the highest median scores, whereas Rigor of Development (16.7 %) and Applicability (8.3 %) scored the lowest. Based on the RIGHT checklist, overall reporting completeness was 43.2 %, with the Evidence (0.0 %) and Quality Assurance (0.0 %) domains being particularly underreported. AGREE-REX evaluation indicated limited implementability at the individual recommendation level (12.5 %), and GLIA, while suggesting moderate implementability at the guideline level (65.4 %), identified frequent barriers in the domains of Measurable Outcomes (100.0 %) and Innovation Requirements (66.7 %). Thematically, most guidelines addressed interaction assessment (n = 15, 71.4 %), but far fewer incorporated patient preferences (n = 9, 42.9 %) or monitoring strategies (n = 9, 42.9 %). Only three guidelines (14.3 %) fully adhered to all five steps of Ariadne principles. CONCLUSION:Current guidelines for older adults with multimorbidity or polypharmacy exhibit substantial weaknesses in methodological rigor, reporting completeness, and implementation feasibility. Synthesis based on the Ariadne principles revealed an imbalanced pattern of recommendations, with a predominant focus on medication safety rather than patient-centered and longitudinal care management. Future guideline development should strengthen methodological processes, systematically integrate patient perspectives, and co-design practical implementation strategies to better support personalized care for an aging population.

BACKGROUND:Accurately distinguishing malignant pleural effusion (MPE) from non-malignant pleural effusion is clinically important, but the generalisability and methodological quality of machine-learning (ML) models remain uncertain. METHODS:We searched eight databases to 23 April 2026. Diagnostic performance was pooled using random-effects and Reitsma bivariate models, and study quality was assessed using PROBAST+AI. RESULTS:Forty-two studies were included; 17 contributed to the AUC meta-analysis and 14 to the bivariate analysis. The pooled AUC was 0.90 (95 % CI 0.85-0.94; 95 % prediction interval 0.62-0.98), with sensitivity of 0.80 (95 % CI 0.77-0.83) and specificity of 0.87 (95 % CI 0.79-0.92). Only nine studies reported external, temporal or independent validation. Externally validated studies had a lower pooled AUC than studies without external validation (0.83 vs 0.92), with lower specificity observed in the two externally validated studies contributing sensitivity and specificity data. All 42 development assessments had high overall quality concerns, and all 42 model evaluations were judged at high risk of bias. CONCLUSIONS:ML models showed good apparent accuracy for distinguishing MPE from non-MPE, but the evidence was limited by substantial heterogeneity, high risk of bias and scarce external validation. The pooled estimates reflect the average performance of different selected models rather than the expected accuracy of a single clinical test. ML models should be regarded as adjuncts to existing diagnostic pathways until they are confirmed by rigorous multicentre prospective external validation and clinical-impact studies.

BACKGROUND:Patients initially diagnosed with idiopathic pulmonary fibrosis (IPF) have an underlying risk of being in a preclinical phase of rheumatoid arthritis (RA), but effective biomarkers for early identification of this transition are lacking. OBJECTIVE:This review aims to comprehensively summarize predictive markers for future RA in patients meeting IPF diagnostic criteria, supporting early risk stratification and pre-arthritic intervention. METHODS:Using "idiopathic pulmonary fibrosis", "rheumatoid arthritis", "predictive markers", "markers", "clinical research", "in vitro experiments", "mechanism", and their combinations as keywords, a structured literature search was conducted in the PubMed database for relevant literature from 2001 to 2025. RESULTS:The propensity for RA to develop in patients initially meeting IPF diagnostic criteria has a multi-dimensional basis: genetic susceptibility provides the background; immune dysregulation mediates the dissemination of autoimmunity from a pulmonary origin to systemic involvement; inflammatory markers reflect disease activity; environmental exposure acts as an external trigger. Based on these mechanisms, four predictive marker types were identified: genetic susceptibility, immune activation, inflammatory injury, and environmental exposure. However, current studies are mainly cross-sectional and retrospective, lacking prospective validation of predictive efficacy; combined application strategies, clinical value and microbiome-based indicators all require further clinical verification. CONCLUSION:This review identified four early-warning markers-genetic susceptibility, immune activation, inflammatory injury, and environmental exposure-that may signal future RA in patients initially presenting with IPF. These findings support shifting from passive diagnosis to active screening for earlier intervention. Future research should focus on multi-dimensional prediction models, prospective cohort studies, and ultimately achieving early identification and intervention for this hidden RA-prone population.

The incidence of idiopathic pulmonary fibrosis (IPF) is rising globally. Existing meta-analyses and Mendelian randomization (MR) studies have yielded inconsistent findings with uncertain evidence quality. This study aimed to synthesize available evidence and assess its credibility for potential risk factors of IPF. We systematically searched 8 databases and selected meta-analyses and MR studies related to IPF risk factors from inception to March 11, 2025. We assessed the quality of meta-analyses using the AMSTAR-2 tool and evaluated MR studies using the STROBE-MR guidelines. We categorized the evidence into four levels and performed pooled analysis for risk factors reported in at least two MR studies. A total of 8 meta-analyses were included, reporting 22 associations, mainly involving genetics, infections, occupational and environmental exposures, lifestyle, and clinical variables. According to the grading of evidence credibility, 12 were rated as suggestive associations, and 10 as weak associations. The overall credibility of the evidence is relatively low. The 36 MR studies investigated a total of 124 associations, with evidence grading showed 13 as robust, 90 as possible, 17 as suggestive, and 4 as insufficient. The pooled analysis identified 108 associations covering lifestyle, diet and nutrition, anthropometric indices, biomarkers, and clinical variables. The quality level of the included meta-analyses was low and critically low, while the MR studies strictly adhered to STROBE-MR, demonstrating good reporting quality. This umbrella review uncovers the evidence regarding the associations between IPF risk and factors such as genetics, viral infections, occupational and environmental exposures, lifestyle, and clinical variables through a comprehensive analysis of meta-analyses and MR studies. These findings provide an evidence base for IPF risk factor research and support clinical decisions and public health strategies. CRD42024575341.

BackgroundSepsis remains a leading cause of mortality among critically ill patients worldwide. Although an increasing number of prediction models have been published in recent years, their predictive performance, methodological quality, and major predictors have not been comprehensively evaluated in a systematic and quantitative manner. This study aims to evaluate the performance of these models and to identify common predictors associated with sepsis mortality.MethodsWe systematically searched PubMed, Embase, Cochrane Library, and Web of Science for studies on sepsis mortality prediction models published up to July 1, 2025. Data were extracted and appraised using the Checklist for Critical Appraisal and Data Extraction for Systematic Reviews of Prediction Modeling Studies (CHARMS), and risk of bias was assessed with the Prediction Model Risk of Bias Assessment Tool for Artificial Intelligence (PROBAST+AI). Meta-analyses were performed to pool area under the curve of the receiver operating characteristic (AUC) metric of externally validated models and the odds ratio (OR) of common predictors. The study was registered in PROSPERO (CRD42024604119).ResultsA total of 84 eligible studies were included, reporting 235 prediction models for sepsis mortality and involving approximately 2.7 million patient records reported across studies, with 461,387 deaths. Only 11(13.10%) studies encompassed model development, internal validation, and external validation. The included studies comprised 78(92.86%) retrospective cohort studies, 57(67.86%) studies developed in intensive care unit (ICU) settings, with MIMIC databases being among the most commonly used data sources. The most prevalent mortality endpoints were in-hospital (n = 38, 45.24%), 28-day (n = 23, 27.38%), and 30-day mortality (n = 16, 19.05%). The included studies employed various modeling approaches, such as logistic regression (LR), random forest (RF), eXtreme Gradient Boosting (XGBoost), and K-nearest neighbors (KNN). Of the included studies, 46(54.76%) evaluated the calibration, 26(30.95%) conducted decision curve analysis, and 25(29.76%) applied SHAP for interpretability, while most did not provide visual model presentation (e.g., nomograms). The reported AUCs ranged from 0.590–0.976 for model development and 0.530–0.992 for internal validation. The pooled AUC of externally validated models, based on one representative model per study, was 0.794 (95% CI: 0.755–0.834), indicating moderate discriminative performance. Overall, the most commonly used predictors were age (n = 19, 22.62%), lactate (n = 13, 15.48%), albumin (n = 8, 9.52%), SOFA score (n = 8, 9.52%), and vasopressor (n = 7, 8.33%). Notably, 64 (76.19%) studies and 50 (65.79%) studies were judged to have a high risk of bias in model development and model evaluation phases, respectively.ConclusionExternally validated prediction models generally demonstrate moderate discriminative performance for predicting sepsis mortality, but a substantial proportion of these studies were evaluated as having a high risk of bias. Age, lactate, albumin, SOFA score, and vasopressor use were identified as predictors of mortality. Future studies with larger cohorts, rigorous designs, and multicenter external validation are warranted to improve their generalizability and facilitate clinical implementation.Systematic review registrationThe unique registration identifier is CRD42024604119, and the publicly accessible website is https://www.crd.york.ac.uk/prospero/.

Objective:To preliminarily construct a patient-reported outcome(PRO)scale for pneumoconiosis under the disease-syndrome combination model using the Delphi method.To provide a basis for the development of a formal scale.Methods:The framework of the PRO scale for pneumoconiosis was established under the disease-syndrome combination model.The scale item pool was drafted by the research team through literature analysis,interview,and derivation methods following group discussions.Two rounds of expert consultations were conducted using the Delphi method.The reliability and validity of the initial draft scale were tested.Results:The effective questionnaire recovery rates for the two rounds of consultations were 85%and 94%,respectively.The expert authority coefficients were 0.900 and 0.785,respectively.The average importance scores of items ranged from 2.29 to 4.76 and ranged from 3.35 to 4.82,respectively.The full score rates ranged from 0 to 82%and ranged from 18%to 82%,respectively.The Kendall's coordination coefficients were 0.415 and 0.243,respectively(both P<0.001).The coefficient of variation were ranged from 0.11 to 0.49 and ranged from 0.08 to 0.35,respectively.The item-level content validity indices ranged from 0.41 to 1.00 and ranged from 0.76 to 1.00,respectively.The average scale-level content validity indices were 0.87 and 0.97,respectively.The Cronbach's α coefficients for the total scale were 0.992 and 0.966,respectively.The Cronbach's α coefficients for the various domains ranged from 0.893 to 0.989 and ranged from 0.751 to 0.941,respectively.Ultimately,the initial draft of the pneumoconiosis PRO scale was established,which comprises 49 items across the physiological,psychological,social,and satisfaction domains.Conclusions:The initial draft of the pneumoconiosis PRO scale was consistent with the disease characteristics of pneumoconiosis and could be used to evaluate the quality of life of pneumoconiosis patients.It could provide a scientific basis for the development of a formal scale and offer an appropriate evaluation tool for clinical research.

Triple quadrupole (QQQ) MS based pseudotargeted lipidomics combines high coverage and quantitative accuracy, is commonly established by selecting the most responsive lipid ion pairs identified from high-resolution mass spectrometry (HRMS), then sending them to QQQ MS for quantification by multiple reaction monitoring. Due to the low resolution of QQQ MS, it may result in faulty peak identification in integration and method transition from HRMS to QQQ MS, thus, directly establish pseudotargeted lipidomics on HRMS is needed to improve the accuracy of present methods. We propose a method for rapidly screening high-resolution ion pairs for constructing multiplex-HRMS-based pseudotargeted lipidomics (MHPL). Firstly, high-resolution precursor and product ions for lipid quantification were obtained by HRMS. To solve the problem of lower acquisition speed in HRMS, we used the multiplex mode to simultaneously fragment co-eluting lipid precursor ions within one isolation window, scan the MS/MS mass spectra, and quantify the unique product ions (UPI) of co-eluting lipid (defined as Quan-PIs). Meanwhile, we provide a group of scripts for searching for lipid Quan-PIs in multiplex mode. The proposed MHPL strategy could ensure accurate quantification of 460 lipids within 5 injections, and was applied in serum differential lipid discovery for chronic obstructive pulmonary disease (COPD) patients. As a result, 47 differential lipids were found to comprise a potential biomarker panel for COPD diagnosis. The lipid identification and quantification in this work were conducted in the same instrument, and faulty peak identification was considerably reduced in integration and when transitioning methods from HRMS to QQQ MS.

BACKGROUND:Chronic obstructive pulmonary disease (COPD) often coexists with various systemic diseases, forming a comorbid condition. The causal evidence from Mendelian randomization (MR) studies on the impact of comorbidities on COPD is accumulating, yet information for comprehensive summary is limited. OBJECTIVES:This study aimed to systematically summarize the evidence from MR studies on the impact of comorbidities on COPD. DESIGN:Systematic review and meta-analysis of MR studies. DATA SOURCES AND METHODS:Eight electronic databases were searched to identify relevant MR studies about comorbidities associated with COPD from inception to June 3, 2024. Strengthening the Reporting of Observational Studies in Epidemiology-Mendelian Randomization (STROBE-MR) guidelines were used for reporting quality assessment. We used either a random-effects model or a fixed-effects model to estimate pooled causal evidence from MR studies of comorbidities and COPD. RESULTS:A total of 26 studies were included, of which 8, 4, and 3 studies summarized the causal effects of GERD, depression, obesity on the risk of COPD, respectively. Overall, the studies included had high reporting quality. Our meta-analysis using inverse variance weighted (IVW) of main MR analyses revealed positive causal effects of GERD (OR: 1.64; 95% CI: 1.47-1.84), depression (OR: 1.31, 95% CI: 1.01-1.71), and obesity (OR: 1.51; 95% CI: 1.25-1.83) on COPD. Our qualitative analysis also identified multisystem diseases such as asthma, bronchiectasis, peptic ulcers, heart failure, hypertension, rheumatoid arthritis, and osteoarthritis, as well as systemic conditions like anemia and frailty, were related to the risk of COPD. CONCLUSIONS:This study revealed the causal effects of comorbidities on COPD, providing new scientific evidence for the prevention and treatment of COPD, and aiding in the guidance of effective clinical strategies. REGISTRATION:This systematic review and meta-analysis protocol was prospectively registered with PROSPERO (No CRD42024575341).

BackgroundInterstitial Lung Disease (ILD) represents the most common extra-articular manifestation of Rheumatoid Arthritis (RA) and is a major cause of mortality. This study aims to identify and evaluate biomarkers associated with Rheumatoid Arthritis-Associated Interstitial Lung Disease (RA-ILD).MethodsWe searched PubMed, Cochrane Library, EMBASE, and Web of Science databases for studies related to biomarkers of RA-ILD up until October 7, 2023. The Newcastle-Ottawa Scale (NOS) and standards recommended by the Agency for Healthcare Research and Quality (AHRQ) were used for quality assessment, and meta-analysis was conducted using Stata18.0 software.ResultsA total of 98 articles were assessed for quality, 48 of which were included in the meta-analysis. 83 studies were of high quality, and 15 were of moderate quality. The meta-analysis showed significant differences in biomarkers such as C-Reactive Protein (CRP), Erythrocyte Sedimentation Rate (ESR), Anti-Cyclic Citrullinated Peptide (anti-CCP) antibody, Rheumatoid Factor (RF), Krebs von den Lungen-6 (KL-6), Surfactant Protein D (SP-D), Carcinoembryonic Antigen (CEA), Carbohydrate Antigen 19-9 (CA19-9), Matrix Metalloproteinase-7 (MMP-7), C-X-C Motif Chemokine Ligand 10 (CXCL-10), and Neutrophil-to-Lymphocyte Ratio (NLR) between RA-ILD patients and RA patients. However, Platelet-to-Lymphocyte Ratio [Platelet-to-Lymphocyte Ratio (PLR)], Cancer Antigen 125 [Cancer Antigen 125 (CA-125)], and Cancer Antigen 153 [Cancer Antigen 153 (CA-153)] did not show significant differences between the two groups. KL-6, MMP-7, and Human Epididymis Protein 4 (HE4) are negatively correlated with lung function, and KL-6 is associated with the prognosis of RA-ILD.ConclusionsBiomarkers hold promising clinical value for prediction, diagnosis, severity assessment, and prognosis evaluation in RA-ILD. However, these findings need to be validated through multicenter, large-sample, prospective cohort studies.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/, identifier CRD42023448372.

Background:Idiopathic pulmonary fibrosis (IPF) has high mortality and poor prognosis, which brings enormous burdens to families and society. We conducted this meta-analysis to analyze and summarize the risk factors associated with mortality in IPF, hoping to provide reference for clinical prevention and treatment of IPF. Methods:We conducted a comprehensive search of PubMed, Cochrane Library, Embase, and Web of Science from inception to August 10, 2023, to include cohort studies on mortality in patients with IPF. Two researchers independently screened the studies and extracted data. The Newcastle-Ottawa Scale (NOS) was used to assess the methodological quality of studies. Hazard ratios (HRs) and 95% confidence intervals (CIs) were reported to identify risk factors for mortality in IPF. In addition, we also carried out sensitivity analysis, Begg's and Egger's tests to evaluate the heterogeneity and publication bias. Results:Eighteen studies comprising 8,408 patients were included. The meta-analysis suggested that age (HR =1.03; 95% CI: 1.01, 1.04; P<0.001), forced vital capacity (FVC) (HR =0.97; 95% CI: 0.96, 0.99; P=0.005), FVC to predicted value ratio (FVC% pred) (HR =0.98; 95% CI: 0.97, 0.99; P<0.001), diffusing capacity of the lungs for carbon monoxide to predicted value ratio (DLCO% pred) (HR =0.98; 95% CI: 0.97, 0.99; P<0.001), gender-age-physiology (GAP) index (HR =1.70; 95% CI: 1.20, 2.40; P=0.003), and lung cancer (HR =2.75, 95% CI: 1.23, 6.15; P=0.01) were mortality-related risk factors in patients with IPF. Whereas, gender, smoking, body mass index (BMI), diffusing capacity of the lungs for carbon monoxide (DLCO), C-reactive protein (CRP), 6-minute walking distance (6MWD), pulmonary hypertension, gastroesophageal reflux, and cardiovascular disease were not statistically associated with death. Conclusions:Age, FVC, FVC% pred, DLCO% pred, GAP index, and lung cancer have been identified as potential risk factors for mortality in patients with IPF. Due to the limited number and quality of included studies, the conclusions need to be verified by further studies.

Objective To assess the effects of telerehabilitation on clinical symptoms, physical function, psychological function and quality of life (QoL) in patients with post-COVID-19.Design Systematic review and meta-analysis of randomised controlled trials (RCTs).Data sources PubMed, Web of Science, Embase and Cochrane Library were searched for publications from 1 January 2020 to 17 April 2024.Eligibility criteria RCTs investigating the effects of telerehabilitation in patients with post-COVID-19 were included. The outcomes of interest encompassed clinical symptoms, physical function, psychological function and QoL. Only studies reported in English were included.Data extraction and synthesis Two reviewers independently extracted data and evaluated the risk of bias. Statistical analysis was conducted using Review Manager V.5.3, employing mean difference (MD) with a 95% CI, and the corresponding P value was used to ascertain the treatment effect between groups. Heterogeneity was quantified using the I2 statistic. The quality of evidence was assessed by GRADE.Results 16 RCTs (n=1129) were included in this systematic review, 15 of which (n=1095, 16 comparisons) were included in the meta-analysis. The primary pooled analysis demonstrated that, compared with no rehabilitation or usual care, telerehabilitation can improve physical function (measured by 30 s sit-to-stand test [6 RCTs, n=310, MD=1.58 stands, 95% CI 0.50 to 2.66; p=0.004]; 6 min walking distance [6 RCTs, n=324, MD=76.90 m, 95% CI 49.47 to 104.33; p<0.00001]; and physical function from the 36-item short-form health survey [5 RCTs, n=380, MD=6.12 units, 95% CI 2.85 to 9.38; p=0.0002]). However, the pooled results did not indicate significant improvements in clinical symptoms, pulmonary function, psychological function or QoL. The quality of the evidence was graded as low for physical function and Hospital Anxiety and Depression Scale-anxiety and very low for other assessed outcomes. The overall treatment completion rate was 78.26%, with no reports of severe adverse events in any included trials.Conclusions Despite the lack of significant improvements in certain variables, telerehabilitation could be an effective and safe option for enhancing physical function in patients with post-COVID-19. It is advisable to conduct further well-designed trials to continue in-depth exploration of this topic.Study registration PROSPERO, CRD42023404647.

BACKGROUND:The readmission rate following hospitalization for chronic obstructive pulmonary disease (COPD) exacerbations is extremely high and has become a common and challenging clinical problem. This study aimed to systematically summarize COPD readmission rates for acute exacerbations and their underlying risk factors.METHODS:A comprehensive search was performed using PubMed, Embase, Cochrane Library, and Web of Science, published from database inception to April 2, 2022. Methodological quality was evaluated using the Newcastle-Ottawa Scale (NOS). We used a random-effects model or a fixed-effects model to estimate the pooled COPD readmission rate for acute exacerbations and underlying risk factors.RESULTS:A total of 46 studies were included, of which 24, 7, 17, 7, and 20 summarized the COPD readmission rates for acute exacerbations within 30, 60, 90, 180, and 365 days, respectively. The pooled 30-, 60-, 90-, 180-, and 365-day readmission rates were 11%, 17%, 17%, 30%, and 37%, respectively. The study design type, age stage, WHO region, and length of stay (LOS) were initially considered to be sources of heterogeneity. We also identified potential risk factors for COPD readmission, including male sex, number of hospitalizations in the previous year, LOS, and comorbidities such as heart failure, tumor or cancer, and diabetes, whereas obesity was a protective factor.CONCLUSIONS:Patients with COPD had a high readmission rate for acute exacerbations, and potential risk factors were identified. Therefore, we should propose clinical interventions and adjust or targeted the control of avoidable risk factors to prevent and reduce the negative impact of COPD readmission.SYSTEMATIC REVIEW REGISTRATION:PROSPERO, identifier CRD42022333581.

Background: The readmission rate following hospitalization for chronic obstructive pulmonary disease (COPD) is surprisingly high, and frequent readmissions represent a higher risk of mortality and a heavy economic burden. However, information on all-cause readmissions in patients with COPD is limited. Objective: This study aimed to systematically summarize all-cause COPD readmission rates within 30 and 90 days after discharge and their underlying risk factors. Methods: Eight electronic databases were searched to identify relevant observational studies about COPD readmission from inception to 1 August 2022. Newcastle-Ottawa Scale was used for methodological quality assessment. We adopt a random effects model or a fixed effects model to estimate pooled all-cause COPD readmission rates and potential risk factors. Results: A total of 28 studies were included, of which 27 and 8 studies summarized 30- and 90-day all-cause readmissions, respectively. The pooled all-cause COPD readmission rates within 30 and 90 days were 18% and 31%, respectively. The World Health Organization region was initially considered to be the source of heterogeneity. We identified alcohol use, discharge destination, two or more hospitalizations in the previous year, and comorbidities such as heart failure, diabetes, chronic kidney disease, anemia, cancer, or tumor as potential risk factors for all-cause readmission, whereas female and obesity were protective factors. Conclusions: Patients with COPD had a high all-cause readmission rate, and we also identified some potential risk factors. Therefore, it is urgent to strengthen early follow-up and targeted interventions, and adjust or avoid risk factors after discharge, so as to reduce the major health economic burden caused by frequent readmissions. Trial registration: This systematic review and meta-analysis protocol was prospectively registered with PROSPERO (no. CRD42022369894).

Abstract Background Since 2020, novel coronavirus disease (COVID-19) has posed serious threats to health systems and led to tremendous economic decline worldwide. Traditional Chinese medicine (TCM) is considered a promising treatment strategy for COVID-19 in China and is increasingly recognized as a key participant in the battle against COVID-19. Clinicians also need accurate evidence regarding the effectiveness of TCM treatments for COVID-19. Methods We retrospectively analyzed patients diagnosed with COVID-19 by collected from the electronic medical records of the hospitals in Henan Province from January 19, 2020, to March 2, 2020. Demographic characteristics, clinical data, frequency analysis of Chinese patent medicines (CPMs), Chinese medicine injections (CMIs), evaluation of baseline symptom scores, nucleic acid negative conversion, length of hospitalization, and mortality rates were studied. Results Between 15 January 2020 and 2 March 2020, 131 hospitals with 1245 patients were included. Survey response Chinese herbal decoction, CPMs, and CMIs combined with conventional Western medicine (CWM) used for the treatment of COVID-19. The top 8 CPMs were Lianhua Qingwen capsules, Shuanghuanglian oral liquid, Pudilan Xiaoyan oral liquid, Banlangen granules, Lanqin oral liquid, compound licorice tablets, Bailing capsules, montmorillonite powder. The most frequently used CMIs were Xuebijing, Tanreqing, Reduning, Xiyanping and Yanhuning. TCM combined with CWM improved the patients’ symptom scores for fever, cough, chest tightness, shortness of breath, and fatigue. Nucleic acid negative conversion occurred at11.55 ± 5.91 d and the average length of hospitalization was 14.92 ± 6.15 d. The mortality rate was approximately 1.76%, which is a reduction in patient mortality. Conclusions TCM combined with CWM improved clinical symptoms and reduced hospitalization and mortality rates.

文献计量学是利用数学与统计学的相关方法分析某一主题的研究现状[1].CiteSpace可视化分析软件能够实现对文献的定量分析和可视化分析,使研究者快捷、准确了解该领域文献的基础知识和研究热点,为预测该领域的研究特征及发展趋势提供依据[2].

Background: Baojin Chenfei formula (BCF), a Chinese herbal formula, has significant effects on improving the clinical symptoms of patients with silicosis. However, its active compounds and the underlying mechanisms have not yet fully been elucidated. Purpose: This study aimed to explore the underlying mechanisms of BCF in treating silicosis. Methods: The rat model of silicosis was developed via a single intratracheal instillation of SiO2 suspension to examine the therapeutic impacts of BCF on silicosis. Subsequently, the active compounds, targets, and mechanisms of BCF were analyzed based on serum pharmacochemistry and network analysis. Finally, the underlying mechanisms of representative compounds of BCF were validated in vitro experiments. Results: BCF significantly alleviated SiO2-induced silicosis in rats, evidenced by improved lung function, decreased pathological injury, and reduced inflammatory response and fibrosis. 19 active compounds were identified from the rat serum samples after BCF gavage. Subsequently, 299 targets for these 19 compounds in BCF and 257 genes related to silicosis were collected. 26 overlapping targets, including AKT1, TNF, IL6, MAPK3, EGFR, and others, were obtained from the intersection of the 299 BCF-related targets and 257 silicosis-associated genes. These overlapping targets mainly corresponded to glycyrrhetic acid and paeoniflorin and were mainly associated with positive regulation of smooth muscle cell proliferation, positive regulation of MAP kinase activity, and inflammatory response. In vitro experiments also demonstrated that the representative compounds of BCF (glycyrrhetic acid and paeoniflorin) could suppress inflammatory response by the MAPK pathway, and also inhibited fibroblast activation by the EGFR-PI3K-AKT pathway. Conclusion: Active compounds of BCF, such as glycyrrhetic acid and paeoniflorin, could suppress inflammatory response by the MAPK pathway and suppress fibroblast activation by the EGFR-PI3K-AKT pathway. These might be the mechanisms of BCF in treating silicosis.

目的 评价银翘败毒方治疗新型冠状病毒(新冠病毒)无症状感染者的疗效和安全性.方法 采用随机、双盲、安慰剂对照试验设计方法.选择 2022 年 10 月至 12 月由河南中医药大学第一附属医院驻会展中心医学观察点收治的新冠病毒无症状感染者 250 例作为研究对象,采用分层随机区组法将受试者随机分为试验组和对照组,每组125例.共有5例患者未完成研究,其中试验组2例,对照组3例,形成符合方案集245例(试验组 123 例、对照组 122 例).试验组给予银翘败毒合剂(由金银花、连翘、青蒿、射干、虎杖、薏苡仁等 13 味中药组成),对照组给予银翘败毒安慰剂(由 5%的中药及调味剂等组成),试验药物均由河南中医药大学第一附属医院制剂室统一煎煮提供,每日 1 剂,分 2 次口服,连续治疗 14 d.以核酸转阴时间为主要结局指标,以核酸转阴率、转型率、转型时间、症状发生率、症状发生时间、不良事件累积发生率为次要结局指标,比较不同治疗方法两组主要结局指标和次要结局指标的差异.结果 试验组核酸转阴时间较对照组明显缩短(d:8.93±2.13 比10.47±3.95,P＜0.05).治疗 7、10 和 14 d,试验组核酸转阴率均明显高于对照组[分别为 44.7%(55/123)比27.9%(34/122)、91.9%(113/123)比 72.1%(88/122)、98.4%(121/123)比 88.5%(108/122),均P＜0.05].治疗 4d和7d,试验组转型率均明显低于对照组[分别为4.9%(6/123)比12.3%(15/122)、5.7%(7/123)比13.1%(16/122),均P＜0.05],转型时间较对照组明显延后(d:7.82±2.99 比 6.15±1.39,P＜0.05).治疗 4d,试验组发热、咳嗽、乏力症状的发生率均明显低于对照组[分别为 4.9%(6/123)比 17.2%(21/122)、8.9%(11/123)比 18.0%(22/122)、14.6%(18/123)比 26.2%(32/122),均P＜0.05],到治疗 10d两组发热症状发生率差异仍有统计学意义[9.8%(12/123)比 18.9%(23/122),P＜0.05],治疗 14d两组发热症状发生率无明显差异,治疗 7d两组对乏力症状的改善程度相当,治疗 10d开始试验组对乏力的改善程度明显优于对照组[25.2%(31/123)比 37.7%(46/122),P＜0.05],持续到治疗 14 d[26.8%(33/123)比 39.3%(48/122),P＜0.05].两组各时间点胸闷、气短、腹胀、腹泻发生率比较差异均无统计学意义,说明银翘败毒方在改善上述症状方面的疗效相当.试验组发热、咳嗽、乏力症状发生的时间较对照组明显延后(d:6.62±1.50 比 5.30±1.22、8.48±3.34 比 6.54±1.45、7.97±3.21 比6.11±0.98,均P＜0.05),两组其他症状发生时间比较差异均无统计学意义.试验组和对照组不良事件发生率比较差异无统计学意义[10.6%(13/123)比 11.5%(14/122),P＞0.05].结论 银翘败毒方治疗新冠病毒无症状感染者在缩短核酸转阴时间、提高核酸转阴率、降低转型率、延后转型时间等方面均有较好的临床疗效,且不良反应少,安全性好.

OBJECTIVE:To systematically evaluate the efficacy and safety of Chinese herbal medicine (CHM) combined with conventional Western Medicine (CWM) on acute exacerbation of chronic obstructive pulmonary disease (AECOPD) based on high-quality randomized placebo-controlled trials.METHODS:We searched PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure Database, Chinese Biomedical Literature Database, China Science and Technology Journal Database, and Wanfang databases for randomized placebo-controlled trials of CHM treatment for AECOPD from inception to June 4, 2021. The Cochrane Collaboration's tool and the Grading of Recommendations, Assessment, Development and Evaluation were used to assess the risk of bias and the evidence quality of the included studies. Revman 5.3 software was used for Meta-analysis.RESULTS:A total of 9 trials involving 1591 patients were included. The Meta-analysis showed that based on CWM treatment, CHM group had significant advantages over the placebo group in ameliorating clinical total effective rate [ = 1.29, 95% (1.07, 1.56), = 0.007, low quality] and TCM symptom scores [ = -2.99, 95% (-4.46, -1.53), < 0.0001, moderate quality], improving arterial blood gas results [PaO: = 4.51, 95% (1.97, 7.04), = 0.0005, moderate quality; PaCO: = -2.87, 95% (-4.28, -1.46), < 0.0001, moderate quality], reducing CAT scores [ = -2.08, 95% (-2.85, -1.31), < 0.000 01, moderate quality]，length of hospitalization [ = -1.87, 95% (-3.33, -0.42), = 0.01, moderate quality], and acute exacerbation rate [ = 0.60, 95% (0.43, 0.83), = 0.002, moderate quality]. No serious CHM-related adverse events were reported.CONCLUSIONS:The current evidence indicates that CHM is an effective and well-tolerated adjunct therapy for AECOPD patients receiving CWM. However, considering the high heterogeneity, this conclusion requires confirmation.

Abstract Background Some reports demonstrate that asthma benefits from milk and dairy products, however, the findings are controversial. We used meta-analysis as a tool to summarize published data on the association between dairy products consumption and asthma. Methods A systematic literature search was conducted to identify studies of dairy products and asthma in children in PubMed, ISI (Web of Science), and EMBASE until 21 July 2022. Random-effect meta-analyses with summarized data were performed for total (high/low) milk and dairy intake. Subgroup analysis was used to identify sources of variation in responses. Publication bias and sensitivity analysis were done to examine the stability of results. Results There was no correlation between consumption of dairy products and reduced risk of asthma (OR = 0.82; 95% CI: 0.60–1.05). Our results revealed that elevated consumption of milk and dairy has significant correlation with reduced risk of asthma in Non-Asian population (OR = 0.74; 95% CI = 0.51–0.96) and high quality studies (OR = 0.73; 95% CI = 0.50–0.95). No individual study influence and publication bias was seen in the sensitivity analysis and publication bias assessment. Conclusion There was no correlation between consumption of dairy products and reduced risk of asthma. However, we observed that elevated consumption of milk and dairy has significant correlation with reduced risk of asthma in Non-Asian population and high quality studies. More high-quality and population-specific studies should be conducted to determine the risk link between milk consumption and asthma in children.