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Donghao Wang,1,* Yingying Ren,2,* Riken Chen,1,* Xiangxia Zeng,1,* Qiming Gan,1,* Zhiyang Zhuang,1 Xiaofen Su,1 Kang Wu,1 Sun Zhang,1 Yongkang Tang,1 Shiwei Li,1 Haojie Zhang,1,3 Yanyan Zhou,1 Nuofu Zhang,1 Dongxing Zhao1 1State Key Laboratory of Respiratory Disease, Sleep Medicine Center, Guangzhou Institute of Respiratory Health, National Center for Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, People’s Republic of China; 2Medical Records and Statistics Room, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, People’s Republic of China; 3The Clinical Medicine Department, Henan University, Zhengzhou, People’s Republic of China*These authors contributed equally to this workCorrespondence: Dongxing Zhao; Nuofu Zhang, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Sleep Medicine Center, Guangzhou Institute of Respiratory Health, National Center for Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, People’s Republic of China, Tel +86-13650901411 ; +86-13600460056, Email rieast@msn.com; nfzhanggird@163.comObjective: Obstructive sleep apnea (OSA) is a common sleep-disordered breathing disease. We aimed to establish an improved screening questionnaire without physical examinations for OSA named the CNCQ-OSA (Chinese community questionnaire for OSA).Methods: A total of 2585 participants who visited sleep medicine center and underwent overnight polysomnography were grouped into two independent cohorts: derivation (n = 2180) and validation (n = 405). The CNCQ-OSA was designed according to the baseline of patients in derivation cohort. We comprehensively analyzed the data to evaluate the predictive value of the CNCQ-OSA, compared to the GOAL questionnaire, STOP-Bang questionnaire (SBQ) and NoSAS questionnaire.Results: The CNCQ-OSA included seven variables: loud snoring, BMI ≥ 25 kg/m2, male gender, apnea, sleepiness, hypertension and age ≥ 30, with a total score ranging from 7 to 16.7 points (≥ 13.5 points indicating high risk of OSA, ≥ 14.5 points indicating extremely high risk). In the derivation and validation cohorts, the areas under the curve of the CNCQ-OSA were 0.761 and 0.767, respectively. In the validation cohort, the sensitivity and specificity of a CNCQ-OSA score ≥ 13.5 points for the apnea–hypopnea index (AHI) ≥ 5/h were 0.821 and 0.559, respectively (Youden index, 0.380), and the score ≥ 14.5 points were 0.494 and 0.887, respectively (Youden index, 0.375). The CNCQ-OSA had a better predictive value for AHI ≥ 5/h, AHI > 15/h and AHI > 30/h, with the highest Youden index, compared to the other questionnaires.Conclusion: The CNCQ-OSA can effectively identify the risk of OSA, which is appropriate for self-screening at home without physical examinations.Keywords: obstructive sleep apnea, screening, GOAL, STOP-Bang, NoSAS

Introduction: Autonomic dysfunction is common in chronic obstructive pulmonary disease (COPD), and worse autonomic function may be a marker of risk for acute exacerbations of COPD (AECOPD). Heart rate variability (HRV) is a measure of autonomic function. Our objective was to test whether lower (worse) HRV is a risk factor for AECOPD. Methods: We measured standard deviation of normal RR intervals (SDNN) and root mean square of successive RR interval differences (RMSSD) on 10-second electrocardiograms (ECGs) performed at screening and day 42 in participants in the Beta Blockers for the Prevention of Acute Exacerbations of COPD trial ( BLOCK-COPD), a placebo-controlled trial of metoprolol for prevention of AECOPD. We used Cox-proportional hazards models to test if these HRV measures were associated with risk of any AECOPD, and separately, hospitalized AECOPD. We tested associations using baseline HRV measures and incorporating HRV measures from day 42 as a time-varying covariate. We also tested for interactions with metoprolol assignment. Results: Of 532 trial participants, 529 (forced expiratory volume in 1 second [FEV(1) ]41 ± 16.3 % predicted) were included in this analysis. We did not find a significant association between HRV measures and risk of AECOPD when all participants were analyzed together. There was a significant interaction between RMSSD and assignment to metoprolol on time to first hospitalized AECOPD; in the placebo group greater RMSSD was associated with a lower risk of hospitalized AECOPD (adjusted hazard ratio0.71, 95% confidence interval: 0.52 to 0.96, per 10 ms increase) but there was no association in the metoprolol group. Conclusions: Autonomic dysfunction as measured by HRV may be a risk factor for AECOPD. Future studies should analyze longer HRV recordings and their performance in broader samples of people with COPD, including those on beta-blockers.

The gut microbiota is widely considered to be involved in several diseases, including atherosclerosis, obesity, chronic obstructive pulmonary disease (COPD) and pulmonary arterial hypertension (PAH). This study aimed to determine if changes in the gut microbiome and metabolome play a major role in the early pathogenesis of PAH. Male Wistar rats were injected with monocrotaline (MCT) (55 mg/kg) at day 1 and injected with calcium-sensing receptor (CaSR) antagonist NPS2143 (4.5 mg/kg/d) from days 1 to 21. Fecal samples were obtained. The gut microbiota and metabolome were analyzed by 16S rRNA gene sequencing and mass spectrometry-based analysis to investigate the effect of PAH in this rat model. MCT injection had a marked effect on the composition of the gut microbiota. This finding was further confirmed by metabolomic analysis with identification of several metabolites relevant to the gut microflora. However, NPS2143 partially abrogated this intestinal flora disorder and reversed fecal metabolite abnormalities. In conclusion, our study shows correlations between changes in the gut microbiome and the metabolome in PAH, which are affected by NPS2143., Graphical abstract

Shuyun Chen,1,2,&ast; Xiaochen Li,1,3,&ast; Zihui Wang,1,&ast; Yumin Zhou,1 Dongxing Zhao,1 Zhuxiang Zhao,1,4 Sha Liu,1 Pixin Ran1 1State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Diseases, National Clinical Research Center for Respiratory Disease Guangzhou, First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, Guangdong Province, People’s Republic of China; 2Department of Respiratory and Critical Care Medicine, First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi Province, People’s Republic of China; 3The People’s Hospital of Hubei Province, Wuhan, Hubei Province, People’s Republic of China; 4The First People’s Hospital of Guangzhou City, Guangzhou, Guangdong Province, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Pixin RanState Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Diseases, National Clinical Research Center for Respiratory Disease Guangzhou, First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, No. 195 Dongfeng Xi Road, Guangzhou, 510000, Guangdong Province, People’s Republic of ChinaTel +86 2083205187Email pxran@gzhmu.edu.cnPurpose: The use of simple and affordable screening tools for chronic obstructive pulmonary disease (COPD) is limited. We aimed to assess the validity of a handheld expiratory flowmeter (Vitalograph Ltd., COPD-6®, Ireland) for COPD screening in Chinese primary care settings.Methods: In our cross-sectional study, subjects were randomly selected in eight primary care settings. Tests with the handheld expiratory flowmeter and the conventional spirometry were sequentially performed on all participants. The correlation between the handheld expiratory flowmeter and the conventional spirometry was determined. Validity was determined by the area under the receiver operator characteristic curve (AUC) of the forced expiratory volume in one second (FEV1)/forced expiratory volume in six seconds (FEV6) that used to detect airway obstruction. The sensitivity, specificity, predictive values, and likelihood ratio were calculated according to different FEV1/FEV6 cut-off points.Results: A total of 229 subjects (15.4%) were diagnosed with airflow limitation by conventional spirometry. FEV1, FEV6, and FEV1/FEV6 measured by the handheld expiratory flowmeter were correlated with FEV1, FVC, and FEV1/FVC measured by the conventional spirometry (r=0.889, 0.835 and 0.647, p< 0.001), respectively. AUC of the FEV1/FEV6 to determine airflow obstruction was 0.857 (95% CI: 0.826 to 0.888). No significant difference of AUC was observed between the symptomatic group and the asymptomatic group (AUC=0.869 vs 0.843, P=0.425). A similar phenomenon was found in the AUC of smokers and never-smokers (AUC=0.862 vs 0.840; P=0.515). The cut-off point for FEV1/FEV6 was 0.77 and the corresponding sensitivity and specificity were 71.2% and 89.8%, respectively.Conclusion: The handheld expiratory flowmeter might be used as a screening device for COPD in Chinese primary care settings.Keywords: COPD screening, airflow limitation, FEV1, FEV6, lung function

Author(s): Zhao, Dongxing; Abbasi, Asghar; Rossiter, Harry B; Su, Xiaofen; Liu, Heng; Pi, Yuhong; Sang, Li; Zhong, Weiyong; Yang, Qifeng; Guo, Xiongtian; Zhou, Yanyan; Li, Tianyang; Casaburi, Richard; Zhang, Nuofu | Abstract: BackgroundWe sought to determine whether circulating inflammatory biomarkers were associated with the frequent exacerbator phenotype in stable COPD patients ie, those with two or more exacerbations in the previous year.MethodsEighty-eight stable, severe, COPD patients (4 females) were assessed for exacerbation frequency, pulmonary function, fraction of expired nitric oxide (FENO); inflammatory variables were measured in venous blood. Logistic regression assessed associations between the frequent exacerbator phenotype and systemic inflammation.ResultsCompared with infrequent exacerbators, frequent exacerbators (n=10; 11.4%) had greater serum concentration (median (25th-75th quartile)) of serum amyloid A (SAA; 134 (84-178) vs 71 (38-116) ng/mL; P=0.024), surfactant protein D (SP-D; 15.6 (9.0-19.3) vs 8.5 (3.6-14.9) ng/mL; P=0.049) and interleukin-4 (IL-4; 0.12 (0.08-1.44) vs 0.03 (0.01-0.10) pg/mL; P=0.001). SAA, SP-D and IL-4 were not significantly correlated with FEV1%predicted or FVC %predicted. After adjusting for sex, age, BMI, FEV1/FVC and smoking pack-years, only SAA remained independently associated with the frequent exacerbator phenotype (OR 1.49[1.09-2.04]; P=0.012). The odds of being a frequent exacerbator was 18-times greater in the highest SAA quartile (≥124.1 ng/mL) than the lowest SAA quartile (≤44.1 ng/mL) (OR 18.34[1.30-258.81]; P=0.031), and there was a significant positive trend of increasing OR with increasing SAA quartile (P=0.008). For SAA, the area under the receiver operating characteristic curve was 0.721 for identification of frequent exacerbators; an SAA cut-off of 87.0 ng/mL yielded an 80% sensitivity and 61.5% specificity.ConclusionIn stable COPD patients, SAA was independently associated with the frequent exacerbator phenotype, suggesting that SAA may be a useful serum biomarker to inform progression or management in COPD.

BACKGROUND: Lower heart rate (HR) increases during exercise and slower HR recovery (HRR) after exercise are markers of worse autonomic function that may be associated with risk of acute respiratory events (ARE). METHODS: Data from 6-minute walk testing (6MWT) in COPDGene were used to calculate the chronotropic index (CI) [(HR immediately post 6MWT – resting HR) / ((220 – age) – resting HR)] and HRR at one minute after 6MWT completion. We used zero-inflated negative binomial regression to test associations of CI and HRR with rates of any ARE (requiring steroids and/or antibiotics) and severe ARE (requiring emergency department visit or hospitalization), among all participants and in spirometry subgroups (normal, chronic obstructive pulmonary disease [COPD], and preserved ratio with impaired spirometry). RESULTS: Among 4,484 participants, mean follow-up time was 4.1 years, and 1,966 had COPD. Among all participants, CI-6MWT was not associated with rate of any ARE [adjusted incidence rate ratio (aIRR) 0.98 (0.95 to 1.01)], but higher CI-6MWT was associated with lower rate of severe ARE [0.95 (0.92 to 0.99)]. Higher HRR was associated with a lower rate of both any ARE [0.97 (0.95 to 0.99)] and severe ARE [0.95 (0.92 to 0.98)]. Results were similar in the COPD spirometry subgroup. CONCLUSION: Heart rate measures derived from 6MWT tests may have utility in predicting risk of acute respiratory events and COPD exacerbations.

Specific emitter identification (SEI) is extracting the features of the received radio signals and determining the emitter individuals that generate the signals. Although deep learning-based methods have been effectively applied for SEI, their performance declines dramatically with the smaller number of labeled training samples and in the presence of significant noise. To address this issue, we propose an improved Bootstrap Your Own Late (BYOL) self-supervised learning scheme to fully exploit the unlabeled samples, which comprises the pretext task adopting contrastive learning conception and the downstream task. We designed three optimized data augmentation methods for communication signals in the former task to serve the contrastive concept. We built two neural networks, online and target networks, which interact and learn from each other. The proposed scheme demonstrates the generality of handling the small and sufficient sample cases across a wide range from 10 to 400, being labeled in each group. The experiment also shows promising accuracy and robustness where the recognition results increase at 3-8% from 3 to 7 signal-to-noise ratio (SNR). Our scheme can accurately identify the individual emitter in a complicated electromagnetic environment.

Jinglong Chen,1,2,&ast; Changbin Jiang,1,&ast; Youlan Zheng,1,&ast; Dongxing Zhao,1,&ast; Fan Wu,1 Zhuxiang Zhao,3 Jun Zhao,2 Qing Li,2 Bing Li,4 Gongyong Peng,1 Yumin Zhou,1 Pixin Ran1 1National Center for Respiratory Medicine, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, People’s Republic of China; 2Department of Geriatrics, National Clinical Key Specialty, Guangzhou First People’s Hospital, South China University of Technology, Guangzhou, 510180, People’s Republic of China; 3The Pulmonary Medicine, Guangzhou First People’s Hospital, School of Medicine, South China University of Technology, Guangzhou, 510180, People’s Republic of China; 4GMU-GIBH Joint School of Life Sciences, Guangzhou Medical University, Guangzhou, 511436, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Pixin RanNational Center for Respiratory Medicine, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, People’s Republic of ChinaEmail pxran@gzhmu.edu.cnBackground and Objective: To determine the effects of BSE (biomass smoke exposure) on pulmonary and non-pulmonary changes in patients with COPD compared with normal individuals.Methods: Using a cohort, we recruited 16 healthy individuals with BSE (BSE normal), 19 patients with BSE+COPD, 13 healthy individuals with cigarette smoke exposure (CSE normal), 25 patients with CSE+COPD, and 25 healthy controls. Patients with GOLD stage I and II COPD were included. Baseline data (demographic data, BSE or CSE, lung function, and CT findings) and follow-up lung function data were collected. CT parameters of emphysema, pulmonary small vessels, airway remodeling, pectoralis muscles, and erector spinae muscle were measured.Results: Individuals with BSE were mainly women (32/35, 91.43%). Compared with the CSE+COPD group, the BSE+COPD group demonstrated slower lung function decline, increased lower lung emphysema, narrower airway lumen dimensions and increased airway wall thickening in the moderate and small airways (all P< 0.05). Compared with healthy controls, the CSE normal and BSE normal groups exhibited significant reductions in pulmonary small vessel area and obvious airway remodeling in small airways (P< 0.05). Compared with the BSE normal group, the BSE+COPD group showed significantly more severe emphysema and airway remodeling, as well as reduced left pectoralis major muscle area (all P< 0.05).Conclusion: Healthy individuals with BSE had reduced pulmonary small vessel area and evidence of airway remodeling; patients with BSE and COPD showed more severe emphysema, airway remodeling, and reductions in pectoralis major muscle area.Clinical Trial Registration: ChiCTR-OO-14004264.Keywords: biomass smoke, chronic obstructive pulmonary disease, computed tomography, pulmonary function

Dongxing Zhao,1,2 Asghar Abbasi,1 Richard Casaburi,1 Alessandra Adami,3 Nicholas B Tiller,1 Wei Yuan,1,4 Christopher Yee,5 Nicholas G Jendzjowsky,1 David M MacDonald,6,7 Ken M Kunisaki,6,7 William W Stringer,1 Janos Porszasz,1 Barry J Make,8 Russell P Bowler,8 Harry B Rossiter1 On behalf of the COPDGene Investigators1Rehabilitation Clinical Trials Center, Division of Respiratory and Critical Care Physiology and Medicine, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA, USA; 2State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, 510120, People’s Republic of China; 3Department of Kinesiology, University of Rhode Island, Kingston, RI, USA; 4Respiratory Medicine Department, Beijing Friendship Hospital Affiliated of Capital Medical University, Beijing, 100050, People’s Republic of China; 5MemorialCare Long Beach Medical Center, Long Beach, CA, USA; 6Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, University of Minnesota, Minneapolis, MN, USA; 7Minneapolis VA Health Care System, Minneapolis, MN, USA; 8National Jewish Health, Denver, CO, USACorrespondence: Harry B Rossiter Email hrossiter@ucla.eduBackground: Slow heart rate recovery (HRR) after exercise is associated with autonomic dysfunction and increased mortality. What HRR criterion at 1-minute after a 6-minute walk test (6MWT) best defines pulmonary impairment?.Study Design and Methods: A total of 5008 phase 2 COPDGene (NCT00608764) participants with smoking history were included. A total of 2127 had COPD and, of these, 385 were followed-up 5-years later. Lung surgery, transplant, bronchiectasis, atrial fibrillation, heart failure and pacemakers were exclusionary. HR was measured from pulse oximetry at end-walk and after 1-min seated recovery. A receiver operator characteristic (ROC) identified optimal HRR cut-off. Generalized linear regression determined HRR association with spirometry, chest CT, symptoms and exacerbations.Results: HRR after 6MWT (bt/min) was categorized in quintiles: ≤ 5 (23.0% of participants), 6– 10 (20.7%), 11– 15 (18.9%), 16– 22 (18.5%) and ≥ 23 (18.9%). Compared to HRR≤ 5, HRR≥ 11 was associated with (p< 0.001): lower pre-walk HR and 1-min post HR; greater end-walk HR; greater 6MWD; greater FEV1%pred; lower airway wall area and wall thickness. HRR was positively associated with FEV1%pred and negatively associated with airway wall thickness. An optimal HRR ≤ 10 bt/min yielded an area under the ROC curve of 0.62 (95% CI 0.58– 0.66) for identifying FEV1< 30%pred. HRR≥ 11 bt/min was the lowest HRR associated with consistently less impairment in 6MWT, spirometry and CT variables. In COPD, HRR≤ 10 bt/min was associated with (p< 0.001): ≥ 2 exacerbations in the previous year (OR=1.76[1.33– 2.34]); CAT≥ 10 (OR=1.42[1.18– 1.71]); mMRC≥ 2 (OR=1.42[1.19– 1.69]); GOLD 4 (OR=1.98[1.44– 2.73]) and GOLD D (OR=1.51[1.18– 1.95]). HRR≤ 10 bt/min was predicted COPD exacerbations at 5-year follow-up (RR=1.83[1.07– 3.12], P=0.027).Conclusion: HRR≤ 10 bt/min after 6MWT in COPD is associated with more severe expiratory flow limitation, airway wall thickening, worse dyspnoea and quality of life, and future exacerbations, suggesting that an abnormal HRR≤ 10 bt/min after a 6MWT may be used in a comprehensive assessment in COPD for risk of severity, symptoms and future exacerbations.Keywords: autonomic dysfunction, chest computed tomography, COPD exacerbation, exercise, spirometry

BackgroundBiomass smoke exposure (BSE) is an important etiological factor in chronic obstructive pulmonary disease (COPD). However, few studies have focused on the effects of BSE in the respiratory muscles or lungs.MethodsUsing a cohort, we selected 98 participants in underdeveloped rural areas: 16 healthy individuals with BSE (“BSE normal”), 19 patients with BSE and COPD (“BSE+COPD”), 13 healthy individuals with cigarette smoke exposure (“CSE normal”), 25 patients with cigarette smoke exposure and COPD (“CSE+COPD”), and 25 healthy controls. Patients with GOLD stage I and II COPD were included. Baseline data (demographic data, BSE or CSE, lung function, and CT findings) and follow-up lung function data were collected. CT parameters of emphysema, pulmonary small vessels, airway remodeling, pectoralis muscles, and erector spinae muscle were measured.ResultsIndividuals with BSE were mainly women (32/35, 91.43%). Compared with the CSE+COPD group, the BSE+COPD group demonstrated slow lung function decline, increased lower lung emphysema, and narrower airway lumen and airway wall thickening in moderate and small airways (all PPPConclusionsHealthy individuals with BSE had reduced pulmonary small vessel area and obvious airway remodeling; patients with BSE and COPD showed more severe emphysema, airway remodeling, and pectoralis major muscle change. More investigations are needed regarding interventions for BSE.Trial registration: ChiCTR, ChiCTR-OO-14004264 . Registered 12 February 2014, http://www.chictr.org.cn/showproj.aspx?proj=5304

Background: The use of simple and affordable screening tools for chronic obstructive pulmonary disease (COPD) is limited. We aimed to assess the validity of a handheld expiratory flow meter (COPD-6®, Vitalograph Ltd., Ireland) for COPD screening in Chinese primary care settings.Methods: In our cross-sectional study, subjects were randomly selected in eight primary care settings. Testing with the Vitalograph-COPD-6® and conventional spirometry were sequentially performed on subjects. The correlation between COPD-6® and conventional spirometry was determined. Validity was analyzed by the area under the receiver operator characteristic curve (AUC) of the forced expiratory volume in one second (FEV1) / forced expiratory volume in six seconds (FEV6) that used to detect airway obstruction. The sensitivity, specificity, predictive values, and likelihood ratio were calculated according to different FEV1/FEV6 cut-off points.Results: 229 subjects (15.4%) were diagnosed with airflow limitation by standard spirometry. FEV1, FEV6, and FEV1/FEV6 measured by COPD-6® were correlated with FEV1, FVC, and FEV1/FVC measured by spirometry (r=0.889, 0.835and 0.647, p1/FEV6 to determine airflow obstruction was 0.857 (95%CI: 0.826 to 0.888). No significant difference of AUC was observed between the symptomatic group and the asymptomatic population (AUC=0.869 vs. 0.843, P=0.425). A similar phenomenon was found in the AUC of smokers and never-smokers (AUC=0.862 vs.0.840; P=0.515). The value of AUC was largest (i.e., 0.80) when the cut-off point for FEV1/FEV6 was 0.77.Conclusions: The handheld COPD-6® could be used as a pre-screening device on early diagnosis of COPD in Chinese primary care settings.

Introduction The presence of increased oxidative stress and airway inflammation has been proven in subjects with chronic obstructive pulmonary disease (COPD). Several studies have demonstrated that drugs with antioxidant and anti-inflammatory properties such as N-acetylcysteine (NAC) can reduce the rate of exacerbations in patients with COPD. However, the beneficial effects of NAC in early-stage COPD are minimally discussed. We are investigating whether high-dose NAC has therapeutic effects in Chinese patients with early-stage COPD. Method and analysis A randomized, double-blinded, placebo-controlled, parallel-group, multicenter clinical trial is evaluating the efficacy and safety of NAC for the long-term treatment of patients with early-stage COPD at 24 centers in China. Subjects aged 40–80 years and recruited by physicians or researchers with special training will be randomized to either NAC 600 mg twice daily group or matching placebo group for 2 years. Measurements will include forced expiratory volume in 1 s (FEV1), the number of COPD exacerbations, health-related quality, and pharmacoeconomic analysis. Discussion Currently, there are no randomized controlled trials with high-dose N-acetylcysteine (600 mg twice daily) for patients with mild-to-moderate COPD (GOLD I–II). We designed this multicenter randomized controlled trial (RCT) to assess the effectiveness, safety, and cost-effectiveness of long-term treatment with high-dose N-acetylcysteine. The results of this trial may guide clinical practice and change the standard of early COPD management. Trial registration Chinese Clinical Trial Registry ChiCTR-IIR-17012604. Registered on 07 September 2017.

Background Reward sensitivity can generalize across domains, but evidence for generalization of suppressive reward-related stimulation is sparse, especially in the context of interoceptive nutrient-related stimuli. We hypothesized that subliminal fatty acid-induced gut-brain signals could attenuate sensitivity to exteroceptive rewards, not only within the food domain but also across domains. Method Intragastric infusion of 2.5 g lauric acid (fat condition) or saline (saline condition) was administered to 59 healthy heterosexual male volunteers in a blinded fashion. To assess whether the resulting interoceptive signals attenuate reward sensitivity within the food domain, participants rated the palatability of food images and performed a progressive ratio task. To assess whether such attenuation effect generalizes to the sexual and financial reward domains, participants rated attractiveness of female face images and performed an intertemporal monetary choice task. Results Participants' ratings of food images were lower (F1,172 = 4.51, p = 0.035, Cohen's d: -0.20) in the fat condition. The progressive ratio task terminated earlier in the fat condition compared to saline (F1,52 = 4.17, p = 0.046, odds ratio = 0.31, 95%CI [0.11, 0.98]). Participants' ratings of female face images did not differ between conditions (F1,172 = 1.85, p = 0.19, Cohen's d: -0.15). Moreover, the monetary discounting rate did not differ significantly between conditions. Conclusion Overall, these findings suggest a domain-specific effect of subliminal fatty acid infusion on decreasing reward sensitivity. ispartof: PHYSIOLOGY & BEHAVIOR vol:219 ispartof: location:United States status: published

By means of quantum tensor network calculations, we investigate the large Purcell effect experienced by an organic molecule placed in the vicinity of a plasmonic nanostructure. In particular, we consider a donor-πbridge-acceptor dye at the gap of two Ag nanospheres. Our theoretical approach allows for a realistic description of the continua of both molecular vibrations and optical nanocavity modes. We analyze both the ultrafast exciton dynamics in the large Purcell enhancement regime and the corresponding emission spectrum, showing that these magnitudes are not accurately represented by the simplified models used up to date. Specifically, both the two-level system model and the single vibrational mode model can only reproduce the dynamics over short time scales, whereas the Fermi's golden rule approach accounts only for the behavior at very long times. We demonstrate that including the whole set of vibrational modes is necessary to capture most of the dynamics and the corresponding spectrum. Moreover, by disentangling the coupling of the molecule to radiative and nonradiative plasmonic modes, we also shed light into the quenching phenomenology taking place in the system, This work has been funded by the National Natural Science Foundation of China under Grant No. 11804283, by the European Research Council through Grant ERC-2016-STG- 714870, and by the Spanish Ministry for Science and Innovation − AEI Grants RTI2018-099737-B-I00, PCI2018- 093145 (through the QuantERA program of the European Commission), and CEX2018-000805-M (through the “Maria de Maeztu” Programme for Units of Excellence in R&D). A.I.F.-D. acknowledges support from a 2019 Leonardo Grant for Researchers and Cultural Creators, BBVA Foundation. D.Z. acknowledges financial support from the China Scholarship Council to fund his stay at Universidad Autónoma de Madrid as a postdoctoral fellow

Dongxing Zhao1,2 ,* Asghar Abbasi2 ,* Harry B Rossiter,2,3 Xiaofen Su,1 Heng Liu,1 Yuhong Pi,1 Li Sang,1 Weiyong Zhong,1 Qifeng Yang,1 Xiongtian Guo,1 Yanyan Zhou,1 Tianyang Li,1 Richard Casaburi,2 Nuofu Zhang1 1State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong 510120, People’s Republic of China; 2Rehabilitation Clinical Trials Center, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA, 90502, USA; 3Faculty of Biological Sciences, University of Leeds, Leeds LS2 9JT, UK*These authors contributed equally to this workCorrespondence: Nuofu ZhangState Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong 510120, People’s Republic of ChinaEmail nfzhanggird@163.comBackground: We sought to determine whether circulating inflammatory biomarkers were associated with the frequent exacerbator phenotype in stable COPD patients ie, those with two or more exacerbations in the previous year.Methods: Eighty-eight stable, severe, COPD patients (4 females) were assessed for exacerbation frequency, pulmonary function, fraction of expired nitric oxide (FENO); inflammatory variables were measured in venous blood. Logistic regression assessed associations between the frequent exacerbator phenotype and systemic inflammation.Results: Compared with infrequent exacerbators, frequent exacerbators (n=10; 11.4%) had greater serum concentration (median (25th-75th quartile)) of serum amyloid A (SAA; 134 (84– 178) vs 71 (38– 116) ng/mL; P=0.024), surfactant protein D (SP-D; 15.6 (9.0– 19.3) vs 8.5 (3.6– 14.9) ng/mL; P=0.049) and interleukin-4 (IL-4; 0.12 (0.08– 1.44) vs 0.03 (0.01– 0.10) pg/mL; P=0.001). SAA, SP-D and IL-4 were not significantly correlated with FEV1%predicted or FVC %predicted. After adjusting for sex, age, BMI, FEV1/FVC and smoking pack-years, only SAA remained independently associated with the frequent exacerbator phenotype (OR 1.49[1.09– 2.04]; P=0.012). The odds of being a frequent exacerbator was 18-times greater in the highest SAA quartile (≥ 124.1 ng/mL) than the lowest SAA quartile (≤ 44.1 ng/mL) (OR 18.34[1.30– 258.81]; P=0.031), and there was a significant positive trend of increasing OR with increasing SAA quartile (P=0.008). For SAA, the area under the receiver operating characteristic curve was 0.721 for identification of frequent exacerbators; an SAA cut-off of 87.0 ng/mL yielded an 80% sensitivity and 61.5% specificity.Conclusion: In stable COPD patients, SAA was independently associated with the frequent exacerbator phenotype, suggesting that SAA may be a useful serum biomarker to inform progression or management in COPD.Keywords: inflammation, surfactant protein D, interleukin-4

Additional file 1. List of research centers.

Emitter identification technology can distinguish the types of radiation sources and identify the identity of emitter. It has broad application prospects in both military and civilian fields. The article mainly reviews the radiation source feature extraction methods for individual identification in recent years, and discusses the advantages and disadvantages of manually extracted features and the feature extraction based on deep learning. The technical difficulties of radiation source feature extraction methods are summarized with respect to the environment, the number of radiation sources, and the performance of algorithms, etc. Finally, the article points out the possible future development directions of individual radiation source identification.

Background and objective Chronic exposure to biomass smoke (BS) can significantly compromise pulmonary function and lead to chronic obstructive pulmonary disease (COPD). To determine whether BS exposure induces a unique phenotype of COPD from an early stage, with different physiopathological features compared with COPD associated with smoking (cigarette-smoke (CS) COPD), we assessed the physiopathology of early COPD associated with BS exposure (BS COPD) by incorporating spirometry, high-resolution computed tomography (HRCT) imaging, bronchoscopy and pathological examinations. Methods In this cross-sectional study, we recruited 29 patients with BS COPD, 31 patients with CS COPD and 22 healthy controls, including 12 BS-exposed subjects who did not smoke and 10 healthy smokers without BS exposure. Spirometry, HRCT scans, bronchoscopy and bronchial mucosa biopsies were performed to assess lung function, emphysema and air trapping, as well as the pathological characteristics and levels of inflammatory cells in bronchoalveolar lavage fluid (BALF). Results Among COPD patients with mild-to-moderate airflow limitation, BS exposure caused greater small airway dysfunction in BS COPD patients, although these patients had less emphysema and air trapping, as detected by HRCT (P

Quantitative computed tomography (CT) measures of emphysema have been shown to be associated with increased mortality in humans, but genetic variants affecting the quantitative parameters of chest CT that measure degree of emphysema have not yet been examined. In this study, using available chest CT data from a total of 344 emphysema patients, we assessed the correlations between five chronic obstructive pulmonary disease (COPD) susceptibility variants in the cholinergic receptor nicotinic (CHRN) genes and the degree of emphysema and chest CT manifestations. We verified that most of the parameters were significantly correlated with the degree of emphysema. Compared to rs76071148AA and TT genotype carriers, the rs76071148AT genotype carriers exhibited a decreased probability of having severe emphysema (odds ratio [OR] =0.63, 95% confidence interval [CI] =0.40-0.99), whereas the variant rs8040868C allele was negatively correlated with the emphysema index (P=0.002). Interestingly, further stratification analysis grouped by spirometry-diagnosed COPD status revealed that the variant rs8040868C (CT + CC) genotypes exerted a protective effect against severe emphysema with borderline significance (OR =0.41, 95% CI =0.16-1.05) and affected the mean lung density, emphysema index, ratio of airway wall thickness to airway dimensions (AWT/AD), and AWT grade in spirometry-diagnosed non-COPD subjects. The rs76071148 variant was also significantly associated with AWT/AD and AWT grade in those individuals. In summary, we determined that rs8040868 and rs76071148 are promising indicators of the degree of emphysema and chest CT manifestations, especially in spirometry-diagnosed non-COPD subjects.

BACKGROUND: Subliminal intragastric fatty acid infusion attenuates subjective and brain responses to negative emotion induction. However, the underlying gut-brain signaling mechanisms remain unclear, and it is unknown whether such effect equally applies to positive emotion. OBJECTIVE: We aimed to investigate the interaction between fatty acid-induced gut-brain signaling and subjective responses to positive emotion, and the potential mediational role of gastrointestinal (GI) hormones. DESIGN: Twelve fasting healthy women underwent intragastric infusion of 2.5 g lauric acid or saline, after which either positive or neutral emotion was induced for 30 min, in 4 separate visits. Appetite-related sensations, subjective emotional state, and GI hormones were measured at baseline and every 10 min after infusion. Heart rate variability was measured at baseline and at t = 20-30 min to quantify vagal tone (root mean square of successive differences, RMSSD), and sympathovagal balance (low frequency to high frequency ratio, LF/HF). RESULTS: Fatty acid infusion did not influence appetite-related sensations (as expected), nor emotional state ratings (contrary to expectations). As anticipated, fatty acid stimulated release of CCK at t = 20-40 min (p

Background: Past research has demonstrated that moderate urge to urinate im‐ proves inhibitory control, specifically among participants with higher behavioral inhi‐ bition sensitivity (BIS). The effect was absent when the urge exceeded intolerable level. The present research examines whether rectal distension‐induced urge to def‐ ecate has similar effects. Methods: The moderate and high defecatory urge were induced by rectal distension in healthy volunteers (n = 35), while they completed Stroop task and monetary delay discounting task. The difference of average reaction time between incongruent and congruent trials in the Stroop task (Stroop interference) and the preference for larger‐ later rewards in the delay discounting task were the primary outcomes. Key Results: Participants with high BIS (n = 17) showed greater ability to inhibit their automatic response tendencies, as indexed by their Stroop interference, under mod‐ erate urge relative to no urge (128 ± 41 ms vs 202 ± 37 ms, t64 = 2.07; P = 0.021, Cohen's d: 0.44), but not relative to high urge (154 ± 45 ms, t64 = 1.20; P = 0.12, Cohen's d: 0.30). High BIS participants also showed a higher preference for larger‐ later reward in the delay discounting task under high (odds ratio = 1.51 [1.02‐2.25], P = 0.039) relative to no urge, but not relative to moderate urge (odds ratio = 1.02 [0.73‐1.42], P = 0.91). In contrast, rectal distension did not influence performance on either of the tasks in participants with low BIS (n = 18).Conclusions and inference: These findings may be interpreted as a “spill‐over” effect of inhibition of the urge to defecate to volitional cognitive control among healthy participants with high BIS.

Objective The association between exposure to ambient particles with a median aerodynamic diameter less than 10/2.5 µm (particulate matter, PM 10 / 2.5 ) and COPD remains unclear. Our study objective was to examine the association between ambient PM 10 / 2.5 concentrations and lung functions in adults. Methods A cross-sectional study was conducted in southern China. Seven clusters were randomly selected from four cities across Guangdong province. Residents aged ≥20 years in the participating clusters were randomly recruited; all eligible participants were examined with a standardised questionnaire and spirometry. COPD was defined as a post-bronchodilator FEV 1 /FVC less than 70%. Atmosphere PM sampling was conducted across the clusters along with our survey. Results Of the subjects initially recruited, 84.4% (n=5993) were included for analysis. COPD prevalence and atmosphere PM concentration varied significantly among the seven clusters. COPD prevalence was significantly associated with elevated PM concentration levels: adjusted OR 2.416 (95% CI 1.417 to 4.118) for >35 and ≤75 µg/m 3 and 2.530 (1.280 to 5.001) for >75 µg/m 3 compared with the level of ≤35 µg/m 3 for PM 2.5 ; adjusted OR 2.442 (95% CI 1.449 to 4.117) for >50 and ≤150 µg/m 3 compared with the level of ≤50 µg/m 3 for PM 1 . A 10 µg/m 3 increase in PM 2.5 concentrations was associated with a 26 mL (95% CI −43 to −9) decrease in FEV 1 , a 28 mL (−49 to −8) decrease in FVC and a 0.09% decrease (−0.170 to −0.010) in FEV 1 /FVC ratio. The associations of COPD with PM 10 were consistent with PM 2.5 but slightly weaker. Conclusions Exposure to higher PM concentrations was strongly associated with increased COPD prevalence and declined respiratory function. Trial registration number ChiCTR-OO-14004264; Post-results.

This study was conducted to validate the NoSAS score in clinical populations and to compare it with the Berlin, STOP, and STOP-Bang questionnaires, as well as the Epworth Sleepiness Scale (ESS), in screening for sleep-disordered breathing (SDB).A retrospective analysis was conducted of all patients aged 18 to 80 years who had completed a full-night polysomnography (PSG) at the sleep center of the First Affiliated Hospital of Guangzhou Medical University from October 2012 to November 2016. Patients who had incomplete or unanswered questionnaires were excluded. The data for the NoSAS score, ESS, STOP, STOP-Bang, and Berlin questionnaires were collected, after which the NoSAS score was compared against the other questionnaires for SDB screening.A total of 2,208 participants were enrolled in this study. The NoSAS scores, which ranged from 0 to 17 and allocated a threshold of 8 points, identified individuals at risk of clinically significant SDB (defined as an apnea-hypopnea index [AHI] cutoff of ≥ 20 events/h), with an area under the curve (AUC) of 0.707. The NoSAS score performed significantly better than the STOP (AUC 0.655) and STOP-Bang (AUC 0.704) questionnaires and the ESS (AUC 0.642), and it was at par with the Berlin (AUC 0.697) scores for SDB screening. A significant correlation was found between the AHI and NoSAS score (The NoSAS score is a simple, efficient, and easy method for screening SDB in the clinical setting, especially in moderate to severe SDB. It demonstrates a moderately high level of sensitivity for SDB.

The motilin agonist, erythromycin, induces gastric phase III of the migrating motor complex, which in turn generates hunger peaks. To identify the brain mechanisms underlying these orexigenic effects, 14 healthy women participated in a randomized, placebo-controlled crossover study. Functional magnetic resonance brain images were acquired for 50 minutes interprandially. Intravenous infusion of erythromycin (40 mg) or saline started 10 minutes after the start of scanning. Blood samples (for glucose and hormone levels) and hunger ratings were collected at fixed timepoints. Thirteen volunteers completed the study, without any adverse events. Brain regions involved in homeostatic and hedonic control of appetite and food intake responded to erythromycin, including pregenual anterior cingulate cortex, anterior insula cortex, orbitofrontal cortex, amygdala, caudate, pallidum and putamen bilaterally, right accumbens, hypothalamus, and midbrain. Octanoylated ghrelin levels decreased, whereas both glucose and insulin increased after erythromycin. Hunger were higher after erythromycin, and these differences covaried with the brain response in most of the abovementioned regions. The motilin agonist erythromycin increases hunger by modulating neurocircuitry related to homeostatic and hedonic control of appetite and feeding. These results confirm recent behavioural findings identifying motilin as a key orexigenic hormone in humans, and identify the brain mechanisms underlying its effect. ispartof: Scientific Reports vol:8 issue:1 pages:1819- ispartof: location:England status: published

We propose an all-optical scheme to control the photon statistics using the hybrid quantum plasmonic system. With the aid of dressed-state-assisted quantum interference effects, it is shown that the photon correlations of a signal field can be continuously modulated from bunching to antibunching under the control of a pump field. Apart from the exact multimode model, a single-mode model and an analytical treatment are also provided to help us identify the roles of multimode coupling and quantum interference between probability amplitudes. The proposed scheme, in contrast to the cavity quantum electrodynamics methods, works well even in the bad cavity limit. These findings suggest that this composite system provides a feasible nanophotonic platform for active modulation of photon statistics and for future quantum devices.

BackgroundPatients with mild or moderate chronic obstructive pulmonary disease (COPD) rarely receive medications, because they have few symptoms. We hypothesized that long-term use of tiotropium would improve lung function and ameliorate the decline in lung function in patients with mild or moderate COPD. MethodsIn a multicenter, randomized, double-blind, placebo-controlled trial that was conducted in China, we randomly assigned 841 patients with COPD of Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage 1 (mild) or 2 (moderate) severity to receive a once-daily inhaled dose (18 μg) of tiotropium (419 patients) or matching placebo (422) for 2 years. The primary end point was the between-group difference in the change from baseline to 24 months in the forced expiratory volume in 1 second (FEV1) before bronchodilator use. Secondary end points included the between-group difference in the change from baseline to 24 months in the FEV1 after bronchodilator use and the between-group difference in...

Quantitative computed tomography (CT) measures of emphysema have been shown to be associated with increased mortality in humans, but genetic variants affecting the quantitative parameters of chest CT that measure degree of emphysema have not yet been examined. In this study, using available chest CT data from a total of 344 emphysema patients, we assessed the correlations between five chronic obstructive pulmonary disease (COPD) susceptibility variants in the cholinergic receptor nicotinic (CHRN) genes and the degree of emphysema and chest CT manifestations. We verified that most of the parameters were significantly correlated with the degree of emphysema. Compared to rs76071148AA and TT genotype carriers, the rs76071148AT genotype carriers exhibited a decreased probability of having severe emphysema (odds ratio [OR] =0.63, 95% confidence interval [CI] =0.40–0.99), whereas the variant rs8040868C allele was negatively correlated with the emphysema index (P=0.002). Interestingly, further stratification analysis grouped by spirometry-diagnosed COPD status revealed that the variant rs8040868C (CT + CC) genotypes exerted a protective effect against severe emphysema with borderline significance (OR =0.41, 95% CI =0.16–1.05) and affected the mean lung density, emphysema index, ratio of airway wall thickness to airway dimensions (AWT/AD), and AWT grade in spirometry-diagnosed non-COPD subjects. The rs76071148 variant was also significantly associated with AWT/AD and AWT grade in those individuals. In summary, we determined that rs8040868 and rs76071148 are promising indicators of the degree of emphysema and chest CT manifestations, especially in spirometry-diagnosed non-COPD subjects.

While the health effects of air pollution have been an international public health concern since at least the 1950s, recent research has focused on two broad sources of air pollution, namely, biomass fuel (BMF) and motor vehicle exhaust (MVE). Many studies have shown associations between air pollution PM and exacerbations of pre-existing COPD, but the role of air pollution PM in the development and progression of COPD is still uncertain. The current study indicates that rats can develop pronounced COPD following chronic exposure to air pollution PM (BMF and MVE), as characterized by lung function reduction, mucus metaplasia, lung and systemic inflammation, emphysema, and small airway remodeling. Comparative analyses demonstrate that both BMF and MVE activate similar pathogenesis that are linked to the development of COPD. These findings also show that some differences are found in the lungs of rats exposed to BMF or MVE, which might result in different phenotypes of COPD.

Objective— Recently, we demonstrated that scavenger receptor type BI (SR-BI), a high-density lipoprotein (HDL) receptor, was expressed on murine hematopoietic stem/progenitor cells (HSPC) and infusion of reconstituted HDL and purified human apolipoprotein A-I (apoA-I) suppressed HSPC proliferation. We hypothesized that SR-B1 expression is required for the observed antiproliferative effects of HDL on HSPC. Approach and Results— SR-BI–deficient (SR-BI −/− ) mice and wild-type controls were fed on chow or high-fat diet (HFD) for 8 to 10 weeks. Under chow diet, a significant increase in Lin − Sca1 + cKit + cells (LSK cells, so-called HSPC) was found in the bone marrow of SR-BI −/− mice when compared with wild-type mice. HFD induced a further expansion of CD150 + CD48 - LSK cells (HSC), HSPC, and granulocyte monocyte progenitors in SR-BI −/− mice. Injection of reactive oxygen species inhibitor N-acetylcysteine attenuated HFD-induced HSPC expansion, leukocytosis, and atherosclerosis in SR-BI −/− mice. ApoA-I infusion inhibited HSPC cell proliferation, Akt phosphorylation and reactive oxygen species production in HSPC and plaque progression in low-density lipoprotein receptor knockout (LDLr −/− ) apoA-I −/− mice on HFD but had no effect on SR-BI −/− mice on HFD. Transplantation of SR-BI −/− bone marrow cells into irradiated LDLr −/− recipients resulted in enhanced white blood cells reconstitution, inflammatory cell production, and plaque development. In patients with coronary heart disease, HDL levels were negatively correlated with white blood cells count and HSPC frequency in the peripheral blood. By flow cytometry, SR-BI expression was detected on human HSPC. Conclusions— SR-BI plays a critical role in the HDL-mediated regulation HSPC proliferation and differentiation, which is associated with atherosclerosis progression.