BackgroundFractional exhaled nitric oxide (FENO) is a useful and noninvasive biomarker for eosinophilic airway inflammation, particularly in asthma. However, its utility in chronic obstructive pulmonary disease (COPD) remains controversial. In this study, we performed a systematic review and meta-analysis to evaluate FENO levels in COPD.MethodsA search of PubMed, Embase, Cochrane Library, and clinical trial registry was conducted from inception to January 2018. Studies were included if they reported FENO levels in patients with COPD and healthy controls. We then extracted relevant information and analyzed data. Standard mean difference (SMD) with 95% confidence interval (CI) was applied in this meta-analysis.ResultsA total of 2,073 studies were reviewed for eligibility, with 24 studies pooled for analysis. The FENO levels in patients with COPD were elevated mildly compared with healthy controls (SMD 1.28, 95% CI 0.60–1.96). A similar result was also observed in stable COPD, with an SMD of 1.21 (95% CI 0.47–1.96). On the other hand, we found no association between FENO levels and exacerbated COPD. Additionally, for patients with COPD, ex-smokers had higher levels of FENO than current smokers (SMD 2.05, 95% CI 1.13–2.97).ConclusionOur studies demonstrated a mild elevation of FENO in COPD, and the association between exacerbated COPD and FENO levels needs to be further explored. The potential mechanism is still unknown and conflicting.

Objective Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is the most common cause of hospitalization and death among COPD patients. Clinicians are seeking simple, inexpensive, and easily obtained biomarkers for prognostic evaluation. The aim of this study was to evaluate the association of the neutrophil:lymphocyte ratio (NLR), platelet:lymphocyte ratio (PLR) and lymphocyte:monocyte ratio (LMR) with 28-day mortality and assess the clinical prognostic utility of the NLR, PLR, and LMR in patients with AECOPD. Methods A retrospective study was conducted from January 2017 to April 2020 at Ningbo First Hospital. Clinical characteristics, NLR, PLR, LMR, serum levels of CRP, and other data were collected. Relationships between the NLR/PLR/LMR and CRP were evaluated with Pearson’s correlation test. Receiver-operating characteristic curves and area under the curve were used to assess the ability of NLR/PLR/LMR to predict 28-day mortality in patients with AECOPD. Optimal cutoff values were determined by the Youden index. Univariate and multivariate logistic regression analysis were used to identify risk factors for 28-day mortality in patients with AECOPD. Results By reviewing the medical case records, we collected 533 cases diagnosed with AECOPD for analysis. Death had occurred in 48 (9%) patients within 28 days. Univariate analysis identified age, smoking history, FEV 1 % predicted, neutrophil count, lymphocyte count, NLR, PLR, CRP and blood-urea nitrogen as being associated with increased 28-day mortality. Multivariate analysis demonstrated that elevated NLR and PLR were significantly associated with death at 28 days. Receiver-operating characteristic analysis showed that the NLR had the highest area under the curve (0.801), with optimal cutoff of 6.74, sensitivity of 82.54%, and specificity of 71.38%. At a cutoff of 203.6, the corresponding sensitivity, specificity, and area under the curve of the PLR were 76.86%, 65.27%, and 0.75. The LMR failed to show prognostic significance. Conclusion Our results indicated that the NLR and PLR were associated with 28-day mortality in patients with AECOPD. These ratios may serve as prognostic biomarkers for short-term mortality in patients hospitalized with AECOPD.

Aim This study aimed to explore the effect of implementing pre‐operative WeChat‐assisted health education for parents of children with restrictive ventricular septal defects to improve their quality of life. Methods A prospective randomised controlled study was conducted in a provincial hospital in China. Participants were randomly divided into the intervention group (WeChat group, n = 35) and the control group (leaflet group, n = 35). The quality of life of parents of children with restricted ventricular septal defects was studied. Results Compared with the leaflet group, the WeChat group had a significantly lower score for the pre‐operative Self‐Rating Anxiety Scale (SAS) (P < 0.05). The pre‐operative SAS score in the WeChat group was significantly lower than that at the first visit (P < 0.05). However, the SAS score in the leaflet group was similar at the time of preoperation and the first visit (P > 0.05). The pre‐operative scores of the World Health Organization Quality of Life‐BREF (WHOQOL‐BREF) scale in the physiological, psychological, social, and environmental fields and the total life quality score in the WeChat group were significantly higher than those of the leaflet group (P < 0.05). Conclusion Implementing pre‐operative WeChat‐assisted health education for parents of children with restrictive ventricular septal defects can effectively relieve their anxiety and improve their quality of life.

Objective: The purpose of this study was to explore the effects of music therapy on pain, anxiety and depression in patients after coronary artery bypass grafting. Methods: A retrospective study of 99 patients after coronary artery bypass from January 2017 to January 2019 was conducted in a cardiac center in China. According to the different interventions, all the participants were divided into 3 groups: group A: music therapy; group B: rest without music therapy; and group C: conventional treatment. The Numerical Rating Scale (NRS), Self-Rating Anxiety Scale (SAS) and Self-Rating Depression Scale (SDS) were used to measure the patient's pain, anxiety and depression before and after 30 min of the intervention. Results: There were no significant differences in the NRS, SDS and SAS scores between the three groups of patients before the intervention. After 30 min of music therapy, the NRS, SDS and SAS scores of patients in group A were significantly lower than those before music therapy, and the differences were statistically significant. However, before and after the intervention in groups B and C, the NRS, SDS and SAS scores were not statistically significant. By comparison among the three groups after 30 min of intervention, the NRS, SDS and SAS scores in patients in group A were significantly lower than those in groups B and C, and the differences were statistically significant. The scores were not significantly different between groups B and C. Conclusion: Music therapy can effectively alleviate the pain, anxiety and depression of patients after coronary artery bypass grafting.

Objective The purpose of this study was to explore the clinical effect of preoperative health education based on the WeChat platform for parents of children with simple congenital heart disease. Methods In this study, participants were randomly divided into an intervention group (WeChat group, n=40) and a control group (leaflet group, n=40) in our center. All parents were required to complete the Family Caregiver Task Inventory (FCTI) on the first visit and the Zarit Burden Interview (ZBI) and FCTI before the operation. Clinical, family and relevant data from children and parents were collected and subsequently analyzed. Results Before the operation, the FCTI score and the ZBI score in the WeChat group were significantly lower than those in the control group ( P =0.010, P =0.027, respectively). Compared to the FCTI score on the first visit, the preoperative status score was significantly lower in the WeChat group ( P =0.008). The rate of loss to follow-up and complications in the WeChat group was also significantly lower than in the control group ( P =0.003). Conclusion Preoperative health education assisted by the WeChat platform for parents of children with simple congenital heart disease can effectively improve the parents' care ability and reduce the burden of care, preoperative complications and the rate of loss to follow-up.

To assess DNA methylation sites as well as gene expression related to ischemic stroke (IS) and comprehensively reveal their correlation and possible pathological mechanisms, we implemented (1) genome-wide DNA methylation profiling from the GEO repository related to IS with and without symptoms; (2) identification of differentially methylation positions (DMPs) and genes (DMGs), functional enrichment analysis along with DMG regulatory network construction; (3) validation tests of 2 differential methylation positions of interest as well as analogous gene expression in other datasets and in IS patients and controls; and (4) correlation analysis of DNA methylation and mRNA expression data. In total, 870 DMPs were physically located within 693 DMGs. After disease ontology (DO), Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway, gene ontology (GO), protein-protein interaction (PPI) network construction as well as module analysis, HLA-DRB1 and HLA-DQB1 were identified. Their expression was validated in 4 other datasets but was significant in only 1, and the expression was lower in the IS group (P < 0.05). After validation in IS patients and controls, we found that these two genes showed more hypermethylation and lower expression levels in the IS group (P < 0.001). The methylation of genes was negatively associated with their expression (P < 0.05). The current study recognized a connection among DNA methylation and gene expression and emphasized the prominence of HLA-DRB1 and HLA-DQB1 in IS pathogenesis.

Summary To address, among other issues, the regional and international challenges of the heavy health care burden caused by an aging population, integrated care organizations (ICOs) were proposed at the end of the 20th century for health care delivery. However, the implementation of ICOs has not progressed smoothly, and the current results have not eliminated the imbalance of medical service capabilities among hospitals of different levels. To make up for the deficiency in the current evaluation system at ICOs and offer suggestions for improved sustainable health planning and management, this study establishes a balanced scorecard based on a comprehensive measurement system valid for a Chinese ICO by surveying the staff at the West China Hospital ICO. This study collected valid responses from 216 professional staff members at the ICO via questionnaires. K‐means clustering and the coefficient of variation method were used to evaluate the weights of the first‐ and second‐level indicators. The results show the importance ranking of the core perspectives of the ICO balanced scorecard in the following order: patient, internal process, learning and growth, and financial. The weight‐based analysis identified the importance ranking of all indicators and pointed to the areas that require close attention in future ICO planning and management.

Objective To explore the effects of using the WeChat platform on the perioperative health education of parents of children who underwent transthoracic device closure of ventricular septal defects (VSDs). Methods Participants were divided into a WeChat group and a leaflet group. Responses to relevant questionnaires and clinical data were recorded and analyzed. Results Before the operation, the scores of the Caretaker Knowledge Questionnaire in the WeChat group were significantly higher than those in the leaflet group. The scores of PSQ-18 in the WeChat group were significantly higher than those in the leaflet group. All the children in the WeChat group were followed up 1 month after discharge, while four children in the leaflet group were lost to follow-up. The rate of attrition in the leaflet group was significantly higher than that in the WeChat group. For the postoperative complications, there was no significant difference between the two groups. Conclusion Perioperative health education for parents of children who undergo transthoracic device closure of VSDs through the WeChat platform can effectively enhance parents’ knowledge of care, improve parent satisfaction, which is an effective method to ensure convenient operation and reduce loss to follow-up.