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OBJECTIVE: This study sought to examine the association between inactive time, leisure-time physical activity (LTPA), and mortality in individuals diagnosed with chronic obstructive pulmonary disease (COPD). DESIGN: This study utilized a nationally representative sample of patients with COPD from National Health and Nutrition Examination Survey (NHANES) survey (n = 1817; weighted population, 23,698,840). Mortality was tracked from the date of interview and examination. LTPA and sedentary time were assessed using a Global Physical Activity Questionnaire. RESULTS: The study found that only 28% of patients with COPD achieved sufficient LTPA (LTPA ≥150 min/week), while 58% reported no physical activity and 47% sat for over six hours per day. Over a nine-year follow-up period, 501 deaths occurred, with 101 due to heart diseases. Adequate LTPA levels were associated with a decreased risk of mortality from any cause. Moreover, patients who engaged in sufficient LTPA and reduced sitting time had a lower risk of mortality from any cause compared to those who did not engage in sufficient LTPA. CONCLUSION: Participating in an adequate amount of LTPA was linked to a reduced risk of death from any cause in patients with COPD. However, irrespective of the extent of the LTPA, there was no significant correlation between sedentary behavior and the risk of mortality.

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OBJECTIVE: To investigate the relationship between the neutrophil-to-lymphocyte ratio and chronic obstructive pulmonary disease complicated with pulmonary hypertension (COPD + PH). METHODS: We retrospectively analyzed clinical data from 242 COPD patients at our hospital from July 2018 to July 2019. Patients underwent examinations including blood analysis, C-reactive protein, N-terminal brain natriuretic peptide (BNP), pulmonary function, and cardiac color ultrasound. RESULTS: Patients were divided into the COPD and COPD + PH groups using pulmonary arterial pressure (<50 and ≥50 mmHg, respectively). Compared with the COPD group, the COPD + PH group had greater pulmonary arterial pressure, smoking history, neutrophil-to-lymphocyte ratio (NLR), C-reactive protein, BNP, Chronic Obstructive Pulmonary Disease Assessment Test score, and right atrium and ventricular diameters, but smaller body mass index, forced vital capacity, lymphocyte count, and left ventricular diameter. BNP and NLR had positive effects on PH; forced vital capacity had a negative impact. Moreover, BNP (area under the curve [AUC] = 0.748, sensitivity = 0.692, specificity = 0.701) and NLR (AUC = 0.679, sensitivity = 0.831, specificity = 0.452) had predictive value for PH, and both were positively correlated with PH. CONCLUSIONS: NLR is associated with COPD + PH, and may be useful for its diagnosis.

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BACKGROUND: Extensively drug-resistant Acinetobacter baumannii (XDR-AB) infections have become difficult to treat and are associated with a high mortality rate. Tigecycline is one of the most effective agents used to treat XDR-AB infections, but data from treating bloodstream infection (BSI) in standard dose do not look promising, because of its low plasma concentration. Secondary BSI with primary infection source may indicate tigecycline treatment with a higher dose. Currently, little is known about the application of high-dose tigecycline among patients with secondary BSI caused by XDR-AB. We aimed to investigate the outcomes for high-dose (HD) tigecycline treatment versus standard-dose (SD) treatment of these patients. METHODS: An observational cohort study was conducted at four university affiliated hospitals in mainland China. Adult inpatients who were confirmed as having secondary BSI caused by XDR-AB and received definitive tigecycline treatment were consecutively included. Patients who were treated with 50 mg every 12 h were defined as the SD group, and a twice dose was defined as the HD group. RESULTS: Of the enrolled patients, 63 received SD and 88 received HD tigecycline treatment. Patients in the two groups had similar with regard to baseline clinical conditions. The 30-day survival was affected by the source of the primary infection. Survival was significantly better in patients with non-pulmonary-infection-related BSI than in patients with pulmonary-infection-related BSI. Multivariate Cox regression confirmed that HD had a protective effect only observed in patients with non-pneumonia-related BSI. CONCLUSION: A tigecycline dose that is twice its standard dose is better for the treatment of XDR-AB infection only in BSI associated with non-pulmonary infection.

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Background: There is little evidence on the changing prevalence, microbiological profile, and outcome of nosocomial Acinetobacter baumannii complex (ABC)-caused bloodstream infection (ABCBSI) specified in intensive care units (ICUs) in long-term studies, especially in China. Objective: We aimed to investigate changes in incidence, antibiotic resistance, therapy, and prognosis of ABCBSI in ICUs in eastern China during 2009-2018. Methods: A multicenter retrospective cohort study was conducted, and microbiological and clinical data for patients with ABCBSI acquired in nine adult ICUs in eastern China from 2009 to 2018. Results: A total of 202 cases were enrolled. For the years 2009-2010, 2011-2012, 2013-2014, 2015-2016, and 2017-2018, the incidence of ABCBSI increased significantly, as did the percentage of pan-drug-resistant isolates and resistant rates to most of antimicrobial agents; the percentage of drug-sensitive isolates decreased (all P < 0.05). The frequency of treatment with carbapenems and tigecycline increased, and that of cephalosporins decreased. Compared with those in the first years (2009-2012), ABCBSI patients in the lattermost years (2017-2018) were less often treated with appropriate empirical therapy, more often underwent pneumonia-related ABCBSI and mechanical ventilation support, and had higher 28-day mortality rates. Multivariate Cox regression indicated that increase in the degree of ABC antibiotics resistance, pneumonia-related ABCBSI, and septic shock were risk factors of 28-day mortality and associated with significant lower survival days. Conclusions: The past decade has witnessed a marked increase in the incidence of ABCBSI and in antibiotic resistance, with increasing pneumonia-related infections and worrisome mortality in ICUs in China. Controlling increasing resistance and preventing nosocomial pneumonia may play important roles in combatting these infections.

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PURPOSE: One of the most important events leading to morbidity and mortality in patients with severe sepsis is the development of global tissue hypoperfusion and oxidative damage. Ischemia-modified albumin (IMA), an albumin generated under ischemic and oxidative conditions, is a marker of oxidative stress and hypoperfusion. Here, we investigated whether IMA level could predict short-term mortality with severe sepsis. METHODS: A prospective cohort study was conducted from April 2014 to October 2014 in intensive care units in a tertiary hospital. At the onset of severe sepsis, serum IMA level was measured, and baseline and laboratory data, infection sources, and underlying diseases were recorded; Sequential Organ Failure Assessment and Acute Physiology and Chronic Health Evaluation II scores were calculated. Multivariate logistic regression and receiver operating characteristic curve analyses were used to evaluate predictors of mortality. Kaplan-Meier analysis was used to compare survival at day 28. RESULTS: A total of 117 patients with severe sepsis were included (overall 28-day mortality, 24.8%). The IMA level was higher in nonsurvivors than in survivors (P < .05). It was a strong predictor of 28-day mortality (area under the receiver operating characteristic curve, 0.742; P < .001), and the optimal cutoff for IMA level maximizing sensitivity and specificity was 110 U/mL. On multivariate logistic regression, Acute Physiology and Chronic Health Evaluation II score and IMA level were independent risk factors for death. Survival rate was reduced with very high IMA level (≥110 U/mL; P < .05). CONCLUSIONS: The IMA level, especially at least 110 U/mL, may be a useful predictor of death for patients with severe sepsis.

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Previous studies have indicated that bone morphogenetic protein-7 (BMP-7) is neuroprotective against cerebral ischemia/reperfusion (IR) injury. The present study was undertaken to determine the molecular mechanisms involved in this effect. Adult male Wistar rats were subjected to 2 h of transient middle cerebral artery occlusion (MCAO), followed by 24 h of reperfusion. BMP-7 (10-4 g/kg) or vehicle was infused into rats at the onset of reperfusion via the tail vein. Neurological deficits, infarct volume, histopathological changes, oxidative stress-related biochemical parameters, neuronal apoptosis, and apoptosis-related proteins were assessed. BMP-7 significantly improved neurological and histological deficits, reduced the infarct volume, and decreased apoptotic cells after cerebral ischemia. BMP-7 also markedly enhanced the activities of antioxidant enzymes superoxide dismutase (SOD) and glutathione peroxidase (GSH-PX), and reduced the level of malondialdehyde (MDA) in IR rats. In addition, Western blot analysis indicated that BMP-7 prevented cytochrome c release, inhibited activation of caspase-3, caspase-9 and caspase-8. Our data suggested that BMP-7 has protective effects against cerebral IR injury in rats, and the neuroprotective effects may be attributed to attenuating oxidative stress and inhibiting neuronal apoptosis.

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