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Arto Yuwono Soeroto,1 Dadan Setiawan,2 Nabila Nauli Asriputri,3 Guntur Darmawan,4 Geraldo Laurus,3 Prayudi Santoso1 1Division of Respiratory and Critical Illness, Department of Internal Medicine, Faculty of Medicine Universitas Padjadjaran, Hasan Sadikin General Hospital, Bandung, Indonesia; 2Department of Internal Medicine, Occupational Health General Hospital, Bandung, West Java, Indonesia; 3Department of Internal Medicine, Faculty of Medicine Universitas Padjadjaran, Hasan Sadikin General Hospital, Bandung, Indonesia; 4Department of Internal Medicine, Faculty of Medicine, Krida Wacana Christian University, Jakarta, IndonesiaCorrespondence: Arto Yuwono Soeroto Tel +62 811 246 930Email aysoeroto@yahoo.co.idPurpose: This study aimed to assess the association between vitamin D levels and forced expiratory volume in one second (FEV1), number of exacerbations, and symptoms based on COPD assessment test (CAT) scores in stable COPD patients in Indonesia.Patients and Methods: An observational cross-sectional study was conducted. Subjects were stable COPD patients who were treated at a pulmonary clinic in a tertiary referral hospital in West Java from March to June 2018.Results: Thirty subjects were recruited this study with an average age 62± 8 years. The mean vitamin D level was 20.17± 8.91 ng/mL. Half of the patients had low vitamin D level (< 20ng/mL) (50%). The mean FEV1 (%) predicted value was 37.2± 14. The median exacerbation per year was 1 (0– 5) and symptoms based on CAT score was 14 (3– 34). No correlation was found between vitamin D levels and FEV1 (%) predicted value (r=0.126, p=0.253). Vitamin D level was inversely correlated with number of exacerbations (r=− 0.639, p< 0.001) and CAT (r= − 0.802, p< 0.001).Conclusion: Low level of vitamin D was associated with more frequent exacerbation and higher CAT scores but was not associated with FEV1 (%) predicted.Keywords: COPD, vitamin D, FEV1, CAT score

Introduction/Objective. The chronic obstructive pulmonary disease (COPD) exacerbations have a major impact on outcomes of COPD patients. Pulmonary rehabilitation (PR) interrupts the vicious circle caused by exacerbations. It has not been widely implemented as standard of COPD treatment yet. The aim of study was to examine the effectiveness of PR in prevention of exacerbations. Method. The prospective observation study included stable COPD patients between January 2015 and December 2018. The effects of PR on exacerbation rates were evaluated using univariate and multivariate logistic regression analysis, taking into account age, comorbidity, vaccination status (against seasonal flu), body mass index (BMI). Results. Study included 1,674 patients (956 males, age 65.93 ?} 8.45, current or ex-smokers 94.9%; 21 ? BMI 1,406 patients, 84%, FEV1 < 80% 1,448 patients, 86.5%). The PR rate was 48.1%. There was significant difference in PR status with respect to age (p = 0.020), comorbidities (p = 0.015), FEV1 (p < 0.001), respiratory symptoms using COPD assessment test (CAT) score (p < 0.001), vaccination against seasonal flu (p < 0.001). Exacerbations occurred more frequently in non-PR patients (415 (51.6%) vs. 641 (73.7%), p < 0.001). In multivariate analysis, PR (RR 0.421; 95% CI (0.307?0.577); p < 0.001) and BMI ? 21kg/m2 (RR 0.605; 95% CI (0.380?0.965); p = 0.035) were independent protective factors and CAT score >10 (RR 2.375; 95% CI (1.720?3.280); p < 0.001) and FEV1 < 80% (RR 2.021; 95% CI (1.303?3.134); p = 0.002) were independent risk factors from exacerbations. Conclusion. Patients who successfully completed PR treatment had significantly less frequent exacerbations compared to patients that not pass through PR program.

Studies have shown that the pandemic has led to an increase in sick leave periods among healthcare workers (HCWs); however, this might have changed over time considering increase in vaccination coverage and change in COVID-19 variant predominance. Therefore, we conducted an observational study to evaluate whether the type of symptoms and the duration of sick leave period for healthcare workers working in a large university hospital in the South of Italy changed between January 2021 and January 2022; 398 cases of COVID-19 were identified for a total of 382 subjects involved. A total of 191 subjects answered the questionnaire about symptoms; of these, 79 had COVID-19 during the period from March 2020 until February 2022. The results showed a decrease of about 1.2 days in sick leave period for each quarter without finding significant differences in the perception of symptoms. It is possible to hypothesize a contribution from the Omicron variant to the decrease in sick leave period in the last quarter, from vaccination coverage, from optimization of COVID-19 management, and from change in the regulations for the assessment of positivity.

The COPD Assessment Test (CAT) is in widespread use for the evaluation of patients with chronic obstructive pulmonary disease (COPD). We assessed whether the CAT items carry additional information beyond the sum score regarding COPD characteristics including emphysema. Patients of GOLD grades 1 to 4 from the COPD cohort COSYCONET (German COPD and Systemic Consequences - Comorbidities Network) with complete CAT data were included (n = 2270), of whom 493 had chest CT evaluated for the presence of emphysema. Comorbidities and lung function were assessed following standardised procedures. Cross-sectional data analysis was based on multiple regression analysis of the single CAT items against a panel of comorbidities, lung function, or CT characteristics (qualitative score, 15th percentile of mean lung density), with age, BMI and gender as covariates. This was supported by exploratory factor analysis. Regarding the relationship to comorbidities and emphysema, there were marked differences between CAT items, especially items 1 and 2 versus 3 to 8. This grouping was basically confirmed by factor analysis. Items 4 and 5, and to a lower degree 1, 2 and 6, appeared to be informative regarding the presence of emphysema, whereas the total score was not or less informative. Regarding comorbidities, similar findings as for the total CAT score were obtained for the modified Medical Research Council scale (mMRC) which was also informative regarding emphysema. Our findings suggest that the usefulness of the CAT can be increased if evaluated on the basis of single items which may be indicating the presence of comorbidities and emphysema.

Peng-Fei Liu,1 Peng Yan,1 Da-Hui Zhao,1 Wen-Fang Shi,1 Song Meng,1 Yang Liu,2 Bin Liu,2 Guo-Feng Li,2 Li-Xin Xie1 1Department of Pulmonary and Critical Care Medicine, Chinese PLA General Hospital, Beijing, 2Department of Respiratory and Critical Care Medicine, Affiliated Hospital of Logistic University of Chinese People’s Armed Police Force, Tianjin, People’s Republic of China Objective: The objective of the study was to analyze the effect of environmental factors on the differential expression of microRNAs in the peripheral blood of migratory and local patients in northern People’s Republic of China and on clinical symptoms of local patients in northern People’s Republic of China with COPD. Methods: A total of 118 patients in the northern region and 8 migratory patients were enrolled in this prospective study. We collected general information. Blood samples were collected from 9 patients in the Beijing group, from 8 patients in the migratory group and from 9 healthy control subjects. After extracting the total RNA from these 3 groups, serum miRNA was identified by Solexa sequencing. We collected COPD assessment test (CAT) and Modified British Medical Research Council (mMRC) scores at different levels of air pollution and also collected the number of exacerbations over the year prior to the baseline and in the year preceding the follow-up. Results: In total 9 miRNAs were differentially expressed. When air quality index (AQI) >100, the CAT and mMRC scores at baseline were significantly higher than those when the AQI≤100 (P100, the follow-up CAT and mMRC scores were significantly higher than those when AQI≤100 (P100, the baseline CAT score of this fewer symptoms group was 10.00 (6.25–12.00). The median CAT score was close to 10. When AQI≤100, the follow-up CAT score of the fewer symptoms group was 8.00 (4.25–12.00). However, when AQI>100, the follow-up CAT score of the fewer symptoms group was 9.50 (6.00–16.75). The median CAT score was close to 10. Conclusion: Environmental factors may cause differential expression of miRNAs in the peripheral blood of migratory and local patients in northern People’s Republic of China. Air pollution may aggravate clinical symptoms of patients with COPD. Keywords: COPD, miRNA, environment, CAT score, mMRC

Whitening, or sphering, is a common preprocessing step in statistical analysis to transform random variables to orthogonality. However, due to rotational freedom there are infinitely many possible whitening procedures. Consequently, there is a diverse range of sphering methods in use, for example based on principal component analysis (PCA), Cholesky matrix decomposition and zero-phase component analysis (ZCA), among others. Here we provide an overview of the underlying theory and discuss five natural whitening procedures. Subsequently, we demonstrate that investigating the cross-covariance and the cross-correlation matrix between sphered and original variables allows to break the rotational invariance and to identify optimal whitening transformations. As a result we recommend two particular approaches: ZCA-cor whitening to produce sphered variables that are maximally similar to the original variables, and PCA-cor whitening to obtain sphered variables that maximally compress the original variables., Comment: 14 pages, 2 tables