BACKGROUND & AIMS: :Aim: In this study, we aimed to investigate the role of presepsin in detecting concomitant pneumonia in patients presenting with acute exacerbation of chronic obstructive pulmonary disease (COPD) in the emergency department. Patients & methods: Three groups were formed in the study. Group 1: patients diagnosed with acute exacerbation of COPD; group 2: patients with acute exacerbation of COPD + pneumonia; group 3: healthy individuals. Results: Presepsin levels of the patients in group 2 were significantly higher than those of group 1 and group 3 (p < 0.05). There was a statistically significant difference in erythrocyte sedimentation rate, CRP, procalcitonin and presepsin values between two patient groups (p < 0.05). Conclusion: Presepsin can be used to diagnose pneumonia in patients with acute exacerbation of COPD admitted to the emergency department.

背景与目标： ：目的：在这项研究中，我们旨在调查急诊中presepsin在检测患有慢性阻塞性肺疾病（COPD）急性加重的患者并发肺炎中的作用。患者与方法：研究分为三组。第1组：诊断为COPD急性加重的患者；第2组：COPD肺炎急性加重患者；第三组：健康的个体。结果：第2组患者的胃蛋白酶水平显着高于第1组和第3组（p <0.05）。在两个患者组之间，红细胞沉降率，CRP，降钙素和防腐酶值存在统计学差异（p <0.05）。结论：葡萄膜蛋白酶可用于急诊入院的COPD急性加重患者的肺炎诊断。

BACKGROUND & AIMS: :Rationale: Acute exacerbation during the course of idiopathic pulmonary fibrosis causes a poor prognosis. Coagulation abnormalities and endothelial damage are involved in its pathogenesis. Thrombomodulin alfa, a recombinant human soluble thrombomodulin, has anticoagulant and antiinflammatory effects. Several clinical studies have shown that thrombomodulin alfa may improve survival of acute exacerbation.Objectives: To determine the efficacy and safety of thrombomodulin alfa compared with placebo in acute exacerbation of idiopathic pulmonary fibrosis.Methods: This randomized, double-blind placebo-controlled phase 3 study conducted at 27 sites in Japan involved patients with an acute exacerbation of idiopathic pulmonary fibrosis. Subjects were randomized 1:1 to receive placebo or thrombomodulin alfa (380 U/kg/d for 14 d by intravenous drip infusion). All subjects were treated with high-dose corticosteroid therapy. The primary endpoint was the survival proportion on Day 90.Measurements and Main Results: Of the 82 randomized subjects, 77 completed the study and were included in the full analysis set (thrombomodulin alfa, n = 40; placebo, n = 37). The survival proportions on Day 90 were 72.5% (29 of 40) in the thrombomodulin alfa group and 89.2% (33 of 37) in the placebo group, a difference of -16.7 percentage points (95% confidence interval, -33.8 to 0.4%; P = 0.0863). In the safety population (n = 80), bleeding adverse events occurred in the thrombomodulin alfa group (10 of 42; 23.8%) and the placebo group (4 of 38; 10.5%).Conclusions: Thrombomodulin alfa did not improve the 90-day survival proportion. The present results suggest that the use of thrombomodulin alfa for the treatment of acute exacerbation of idiopathic pulmonary fibrosis not be recommended.Clinical trial registered with www.clinicaltrials.gov (NCT02739165).

背景与目标： ：合理性：特发性肺纤维化过程中急性加重预后不良。凝血异常和内皮损伤涉及其发病机理。血栓调节蛋白α，一种重组人可溶性血栓调节蛋白，具有抗凝和抗炎作用。几项临床研究表明，血栓调节素α可以改善急性加重生存率。目的：确定血栓调节素α与安慰剂相比在特发性肺纤维化急性加重中的有效性和安全性。方法：该随机，双盲安慰剂对照阶段3在日本27个地点进行的研究涉及患有特发性肺纤维化急性加重的患者。受试者以1：1的比例随机接受安慰剂或血栓调节素α（380 U / kg / d，静脉滴注持续14 d）。所有受试者均接受大剂量皮质类固醇激素治疗。主要终点指标是第90天的生存率。测量和主要结果：在82位随机受试者中，有77位完成了研究并被纳入完整的分析组（血栓调节素α，n = 40；安慰剂，n = 37）。血栓调节素α组在第90天的生存率是72.5％（40中的29）和安慰剂组是89.2％（37中的33），相差-16.7个百分点（95％置信区间，-33.8至0.4％） ； P = 0.0863）。在安全人群中（n = 80），血栓调节素α组（42例中的10例； 23.8％）和安慰剂组（38例中4例； 10.5％）中发生了出血不良事件。日生存比例。目前的结果表明，不建议使用血栓调节素α治疗特发性肺纤维化急性加重。在www.clinicaltrials.gov（NCT02739165）注册的临床试验。

BACKGROUND & AIMS: :Previous studies have reported that ST2 is preferentially expressed on Th2 cells and plays a critical part in controlling airway inflammation in murine models of asthma. However, the clinical role of ST2 in patients with bronchial asthma remains unclear. In our study, we examined 56 patients with atopic asthma in a nonattack phase and 200 nonatopic normal volunteers for healthy control, and analyzed the relationship of their serum ST2 levels to asthma severity, pulmonary function, and laboratory data. Of the 56 patients with atopic asthma, 30 exhibited asthmatic exacerbation, and their serum ST2 levels were also analyzed. The serum ST2 levels were low, but a statistical difference was found between patients with nonattack asthma and the healthy control group (p < 0.05). We also found a differential rise of serum ST2 level that correlates well with the severity of asthma exacerbation. Furthermore, the serum ST2 levels during asthma exacerbation statistically correlated with the percentage of predicted peak expiratory flow (r = -0.634, p = 0.004) and Pa(CO(2)) (r = 0.516, p = 0.003). These results suggest that soluble human ST2 protein in sera may be related to Th2-mediated allergic inflammation inducing acute exacerbation in patients with atopic asthma.

背景与目标： ：先前的研究报道，ST2在Th2细胞上优先表达，并在控制哮喘小鼠模型的气道炎症中起关键作用。然而，ST2在支气管哮喘患者中的临床作用仍不清楚。在我们的研究中，我们检查了56位无发作期特应性哮喘患者和200位非特应性正常志愿者进行健康对照，并分析了其血清ST2水平与哮喘严重程度，肺功能和实验室数据之间的关系。在56例特应性哮喘患者中，有30例出现哮喘急性发作，并对其血清ST2水平进行了分析。血清ST2水平较低，但非攻击性哮喘患者与健康对照组之间存在统计学差异（p <0.05）。我们还发现血清ST2水平的差异升高与哮喘发作的严重程度密切相关。此外，哮喘急性发作期间的血清ST2水平与预计的最大呼气流量百分比（r = -0.634，p = 0.004）和Pa（CO（2））（r = 0.516，p = 0.003）在统计学上相关。这些结果表明，血清中可溶性人ST2蛋白可能与特应性哮喘患者Th2介导的过敏性炎症引起急性加重有关。

BACKGROUND & AIMS: BACKGROUND AND OBJECTIVE:The aim of this study was to develop and validate two models to estimate the probabilities of frequent exacerbations (more than 1 per year) and admissions for chronic obstructive pulmonary disease (COPD) that can be used in a primary care setting. METHODS:Information was obtained in a cross-sectional observational study on ambulatory COPD patients performed in 201 general practices located throughout Spain. The model for admissions included 713 cases, 499 for the developmental sample and 214 in the validation sample; the model for frequent exacerbations included 896 patients, 627 in the developmental sample and 269 in the validation model. Candidate variables to be included in both models were: age, sex, body mass index (BMI), FEV(1) as percent predicted [FEV(1 )(% pred.)], active smoking, chronic mucus hypersecretion (CMH) and significant comorbidity. RESULTS:The admission model contained 2 readily obtainable variables: comorbidity (OR = 1.97; CI 95% = 1. 24-3.14) and FEV(1)(% pred.) (OR = 0.72; 0.58-0.88, for every 10 units), and well calibrated in developmental and validation samples (goodness-of-fit tests: p = 0.989 and p = 0.720, respectively). The model for frequent exacerbations included 3 variables: age (OR = 1. 21; 1.01-1.44; for every 10 years of increasing age), FEV(1 )(% pred. ) (OR = 0.82; 0.70-0.96, for every 10 units) and CMH (OR = 1.54; 1. 11-2.14) and also well calibrated (p = 0.411 and p = 0.340 in the developmental and validation samples, respectively). CONCLUSIONS:Our results suggest that FEV(1) impairment explains part of the risk of frequent exacerbations and hospital admissions. Furthermore, CMH and increasing age are significantly associated with the risk of frequent exacerbations, but severity of exacerbations provoking hospital admissions is associated with the presence of significant comorbidity. These important and easily measurable variables contain valuable information for optimal management of ambulatory patients with COPD.

背景与目标： 背景与目的：本研究的目的是开发和验证两个模型，以评估可在基层医疗机构中使用的慢性阻塞性肺疾病（COPD）的频繁发作和加重的可能性（每年超过1次）。
方法：在横断面观察性研究中获得信息，该研究是在西班牙全国201种常规实践中进行的门诊COPD患者的研究。入院模型包括713例，发展样本499例，验证样本214例。频繁发作的模型包括896例患者，发育样本627例，验证模型269例。两种模型中都应包括的候选变量为：年龄，性别，体重指数（BMI），FEV（1），占预测百分比[FEV（1）（％pred。）]，积极吸烟，慢性粘液高分泌（CMH）和重大合并症。
结果：入院模型包含2个易于获得的变量：合并症（OR = 1.97; CI 95％= 1. 24-3.14）和FEV（1）（％pred。）（OR = 0.72; 0.58-0.88，每10个单位），并在开发和验证样品中进行了很好的校准（拟合优度测试：分别为p = 0.989和p = 0.720）。频繁发作的模型包括3个变量：年龄（OR = 1. 21； 1.01-1.44；每增加10岁就增加一次），FEV（1）（％pred。）（OR = 0.82； 0.70-0.96，每10个单元）和CMH（OR = 1.54； 1。11-2.14），并且校准良好（分别在开发和验证样本中分别为p = 0.411和p = 0.340）。
结论：我们的结果表明，FEV（1）损伤可解释部分频繁发作和住院的风险。此外，CMH和年龄增长与频繁加重的风险显着相关，但诱发医院入院的加重的严重程度与严重合并症相关。这些重要且易于测量的变量包含有价值的信息，可用于对COPD卧床患者的最佳管理。

BACKGROUND & AIMS: BACKGROUND:Viral infections are known to exacerbate asthma in adults. Previous studies have found few patients with asthma among severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pneumonia cases. However, the relationship between SARS-CoV-2 infection and severe asthma exacerbation is not known. OBJECTIVE:To assess the frequency of asthma exacerbation in patients with asthma hospitalized for SARS-CoV-2 pneumonia and compare symptoms and laboratory and radiological findings in patients with and without asthma with SARS-CoV-2 pneumonia. METHODS:We included 106 patients between March 4 and April 6, 2020, who were hospitalized in the Chest Diseases Department of Strasbourg University Hospital; 23 had asthma. To assess the patients' asthma status, 3 periods were defined: the last month before the onset of COVID-19 symptoms (p1), prehospitalization (p2), and during hospitalization (p3). Severe asthma exacerbations were defined according to Global INitiative for Asthma guidelines during p1 and p2. During p3, we defined severe asthma deterioration as the onset of breathlessness and wheezing requiring systemic corticosteroids and inhaled β2 agonist. RESULTS:We found no significant difference between patients with and without asthma in terms of severity (length of stay, maximal oxygen flow needed, noninvasive ventilation requirement, and intensive care unit transfer); 52.2% of the patients with asthma had Global INitiative for Asthma step 1 asthma. One patient had a severe exacerbation during p1, 2 patients during p2, and 5 patients were treated with systemic corticosteroids and inhaled β2 agonist during p3. CONCLUSIONS:Our results demonstrate that patients with asthma appeared not to be at risk for severe SARS-CoV-2 pneumonia. Moreover, SARS-CoV-2 pneumonia did not induce severe asthma exacerbation.

背景与目标： 背景：已知病毒感染会加剧成人哮喘。先前的研究发现，在严重的急性呼吸系统综合症冠状病毒2（SARS-CoV-2）肺炎病例中，很少有哮喘患者。但是，SARS-CoV-2感染与严重哮喘加重之间的关系尚不清楚。
目的：评估因SARS-CoV-2肺炎住院的哮喘患者的哮喘发作频率，并比较有无SARS-CoV-2肺炎的哮喘患者的症状以及实验室和影像学检查结果。
方法：我们纳入了2020年3月4日至4月6日在史特拉斯堡大学医院胸部疾病科住院的106例患者。 23人患有哮喘。为了评估患者的哮喘状况，定义了3个时期：COVID-19症状发作前的最后一个月（p1），院前住院（p2）和住院期间（p3）。根据全球哮喘发作指南p1和p2定义严重哮喘加重。在p3期间，我们将严重哮喘恶化定义为需要系统性皮质类固醇和吸入β2激动剂的呼吸困难和喘息发作。
结果：我们发现哮喘患者与非哮喘患者之间在严重程度（住院时间，所需最大氧气流量，无创通气需求和重症监护病房转移）方面无显着差异； 52.2％的哮喘患者患有哮喘第1步整体哮喘。在p1期间有1例患者严重加重病情，在p2期间有2例患者病情严重，在p3期间有5例患者接受了全身性皮质类固醇和吸入β2激动剂治疗。
结论：我们的结果表明，哮喘患者似乎没有严重的SARS-CoV-2肺炎的危险。而且，SARS-CoV-2肺炎并未引起严重的哮喘加重。

BACKGROUND & AIMS: :To determine the clinical efficacy of combined vaccination with 23-valent pneumococcal vaccine (PV) and influenza vaccine (IV) against pneumonia and acute exacerbation of chronic lung diseases (CLD), we conducted an open-label, randomized, controlled study among 167 adults with CLD over a 2-year period. Subjects were randomly assigned to a PV+IV group (n=87) or an IV group (n=80). The number of patients with CLD experiencing infectious acute exacerbation (P=0.022), but not pneumonia (P=0.284), was significantly lower in the PV+IV group compared with the IV group. When these subjects were divided into subgroups, an additive effect of PV with IV in preventing infectious acute exacerbation was significant only in patients with chronic obstructive pulmonary diseases (P=0.037). In patients with CLD, the Kaplan-Meier survival curves demonstrated a significant difference for infectious acute exacerbation (P=0.016) between the two groups. An additive effect of PV with IV on infectious acute exacerbation was found during the first year after vaccination (P=0.019), but not during the second year (P=0.342), and was associated with serotype-specific immune response in sera of these patients who used PV during the same period.

背景与目标： ：为确定23价肺炎球菌疫苗（PV）和流感疫苗（IV）联合疫苗接种对肺炎和慢性肺疾病（CLD）急性加重的临床疗效，我们在167名患者中进行了一项开放标签，随机对照研究2年内患有CLD的成人。将受试者随机分配至PV IV组（n = 87）或IV组（n = 80）。与IV组相比，PV IV组中发生感染性急性加重的CLD患者数量（P = 0.022），但未出现肺炎（P = 0.284），明显减少。将这些受试者分为亚组时，PV与IV预防感染性急性加重的加和效应仅在患有慢性阻塞性肺疾病的患者中才有意义（P = 0.037）。在患有CLD的患者中，Kaplan-Meier生存曲线显示出两组之间感染性急性加重的显着差异（P = 0.016）。在疫苗接种后的第一年（P = 0.019）发现PV与IV对传染性急性加重的累加作用，而在第二年（P = 0.342）则没有，并且与这些血清中血清型特异性免疫反应有关同期使用PV的患者。

BACKGROUND & AIMS: BACKGROUND AND OBJECTIVE:Exacerbation(s) of chronic obstructive pulmonary disease (eCOPD) entail important events describing an acute deterioration of respiratory symptoms. Changes in medication and/or hospitalization are needed to gain control over the event. However, an exacerbation leading to hospitalization is associated with a worse prognosis for the patient. The objective of this study is to explore factors that could predict the probability of an eCOPD-related hospitalization. METHODS:Data from 128 patients with COPD included in a prospective, longitudinal study were used. At baseline, physical, emotional, and social status of the patients were assessed. Moreover, hospital admission during a one year follow-up was captured. Different models were made based on univariate analysis, literature, and practice. These models were combined to come to one final overall prediction model. RESULTS:During follow-up, 31 (24.2%) participants were admitted for eCOPD. The overall model contained six significant variables: currently smoking (OR = 3.93), forced vital capacity (FVC; OR = 0.97), timed-up-and-go time (TUG-time) (OR = 14.16), knowledge (COPD knowledge questionnaire, percentage correctly answered questions (CIROPD%correct)) (<60% (OR = 1.00); 60%-75%: (OR = 0.30); >75%: (OR = 1.94), eCOPD history (OR = 9.98), and care dependency scale (CDS) total score (OR = 1.12). This model was well calibrated (goodness-of-fit test: p = 0.91) and correctly classified 79.7% of the patients. CONCLUSION:A combination of TUG-time, eCOPD-related admission(s) prior to baseline, currently smoking, FVC, CDS total score, and CIROPD%correct allows clinicians to predict the probability of an eCOPD-related hospitalization.

背景与目标： 背景与目的：慢性阻塞性肺疾病（eCOPD）的恶化会引起描述呼吸道症状急性恶化的重要事件。需要改变用药和/或住院治疗以控制事件。然而，导致住院的恶化与患者预后较差有关。这项研究的目的是探讨可以预测eCOPD相关住院的可能性的因素。
方法：采用一项前瞻性，纵向研究中的128例COPD患者的数据。在基线时，评估患者的身体，情绪和社会状况。此外，在一年的随访期间还记录了入院情况。基于单变量分析，文献和实践建立了不同的模型。将这些模型组合起来，得出一个最终的整体预测模型。
结果：在随访期间，有31名（24.2％）参与者被录入了eCOPD。总体模型包含六个重要变量：当前吸烟（OR = 3.93），强制肺活量（FVC； OR = 0.97），定时走走时间（TUG时间）（OR = 14.16），知识（COPD知识）问卷，正确回答问题的百分比（CIROPD％正确））（<60％（OR = 1.00）; 60％-75％：（OR = 0.30）;> 75％：（OR = 1.94），eCOPD历史记录（OR = 9.98） ）和护理依赖性量表（CDS）的总评分（OR = 1.12），该模型已经过很好的校准（拟合优度检验：p = 0.91），并正确分类了79.7％的患者。
结论：TUG时间，基线之前的eCOPD相关入院，当前吸烟，FVC，CDS总分和CIROPD％correct的组合使临床医生可以预测eCOPD相关住院的可能性。

BACKGROUND & AIMS: :REM sleep behavior disorder (RBD) is manifest by loss of normal rapid eye movement sleep atonia and the acting out of dreams of often violent content. Both idiopathic and secondary forms of RBD exist. We report on chocolate as a possible new precipitating agent for RBD and comment on a possible mechanism of action in this disorder.

背景与目标： ：REM睡眠行为障碍（RBD）表现为正常的快速眼球运动睡眠性失语和行为失常，通常表现为暴力。 RBD的特发性和继发性形式均存在。我们报道了巧克力作为RBD的一种新的沉淀剂，并评论了这种疾病的可能作用机理。

BACKGROUND & AIMS: :Aim: To determine the prognostic value of Glasgow Prognostic Score (GPS) in acute exacerbation of Chronic Obstructive Pulmonary Disease (AECOPD) requiring hospitalization.Methods: Hospital electronic database of 129 patients with AECOPD was retrospectively searched and CRP levels, complete blood count, arterial blood gas (ABG) values and pulmonary function test (PFT) parameters of patients were recorded. Hospital mortality and need for ICU transfer were determined as adverse outcomes from files of cases.Results: 106 of 129 patients were male (82.2%) and rest of them were female (17.8%). GPS 0 was not observed in any patient, GPS 1 was observed in 101 patients, and GPS 2 was observed in 28 patients. The rate of adverse outcomes (ICU/Ex) was significantly increased in the GPS 2 group when compared to the GPS 1 group (X2:7.631, p < 0.01). Logistic regression analysis indicated that pH≤7.35 (p < 0.05, OR: 5.65, CI: 1.35-23.58%) and GPS 2 score (p < 0.05, OR: 5.52, CI: 1.45-20.97%) were independent predictors for adverse outcomes for AECOPD.Conclusion: Our results demonstrate that the GPS may have predictive value for adverse outcomes in patients with AECOPD.

背景与目标： 目的：确定格拉斯哥预后评分（GPS）在需要住院的慢性阻塞性肺疾病（AECOPD）急性加重中的预后价值。方法：回顾性搜索129例AECOPD患者的医院电子数据库，并检索CRP水平，全血细胞计数，记录患者的动脉血气（ABG）值和肺功能测试（PFT）参数。从病例档案中确定医院死亡率和需要ICU转移为不良结果。结果：129例患者中有106例为男性（82.2％），其余为女性（17.8％）。在任何患者中均未观察到GPS 0，在101位患者中观察到GPS 1，在28位患者中观察到GPS 2。与GPS 1组相比，GPS 2组的不良结局发生率（ICU / Ex）显着增加（X2：7.631，p <0.01）。 Logistic回归分析表明pH≤7.35（p <0.05，OR：5.65，CI：1.35-23.58％）和GPS 2评分（p <0.05，OR：5.52，CI：1.45-20.97％）是不良后果的独立预测因子结论：我们的结果表明，GPS可能对AECOPD患者的不良结局具有预测价值。

BACKGROUND & AIMS: INTRODUCTION:Acute exacerbation (AE) is a major cause of disease progression and death in patients with chronic obstructive pulmonary disease (COPD), accounting for majority of medical expenditures. Correct inhalation therapy is effective in preventing AE attacks. However, inappropriate usage of dry powder inhaler, partially due to the unrecovered peak inhalation flow rate (PIFR) after acute exacerbation of COPD (AECOPD), results in increased risk of early treatment failure. Therefore, we designed a multicentre, randomised clinical trial to determine whether PIFR-based optimised inhalation therapy and training on inhaler usage at discharge could effectively reduce early treatment failure events. METHODS AND ANALYSIS:A total of 416 hospitalised patients just recovering from AECOPD will be recruited and equally randomised into the PIFR group and the control group at a 1:1 ratio. The PIFR group will receive additive support before discharge, including choice of PIFR-guided inhaler and education on its usage. PIFR is measured by InCheck DIAL. In comparison, the control group will receive inhalers based on judgement of the respiratory physician. The primary outcome of the study is 30-day treatment failure rate. Other endpoints include PIFR, error rate of inhalation device use, satisfaction with inhalation devices, 30-day mortality, 90-day mortality, symptoms and quality of life of patients, and COPD-related treatment costs. ETHICS AND DISSEMINATION:The trial has been approved by the Ethics Committee of Zhongshan Hospital of Fudan University (B2019-142). Participants will be screened and enrolled from hospitalised patients with AECOPD by clinicians, with no public advertisement for recruitment. After the trial has completed, the results will be reported to the public through conference presentations and peer-reviewed journals. TRIAL REGISTRATION NUMBER:NCT04000958.

背景与目标： 简介：急性加重（AE）是慢性阻塞性肺疾病（COPD）患者疾病进展和死亡的主要原因，占医疗支出的大部分。正确的吸入疗法可有效预防AE发作。但是，干粉吸入器使用不当，部分是由于COPD急性加重（AECOPD）后未恢复峰值吸入流速（PIFR），导致早期治疗失败的风险增加。因此，我们设计了一项多中心随机临床试验，以确定基于PIFR的优化吸入疗法和出院吸入器使用培训是否可以有效减少早期治疗失败事件。
方法与分析：总共416名刚从AECOPD中恢复的住院患者将被招募，并按1：1的比例平均分为PIFR组和对照组。 PIFR组将在出院前获得额外的支持，包括选择PIFR引导的吸入器并对其使用进行教育。 PIFR由InCheck DIAL测量。相比之下，对照组将根据呼吸内科医师的判断接受吸入剂。该研究的主要结果是30天的治疗失败率。其他指标包括PIFR，吸入装置使用的错误率，吸入装置的满意度，30天死亡率，90天死亡率，患者的症状和生活质量以及与COPD相关的治疗费用。
伦理与传播：该试验已得到复旦大学中山医院伦理委员会的批准（B2019-142）。将由临床医生从住院的AECOPD患者中筛选并招募参与者，而不会公开招募广告。试验完成后，结果将通过会议报告和同行评审期刊向公众报告。
试用注册号：NCT04000958。

BACKGROUND & AIMS: :Hospital at home and early discharge schemes for patients experiencing an acute exacerbation of their chronic obstructive pulmonary disease, appear to be an effective and safe option for selected patients and these services have become increasingly common. Here we discuss the evaluation of such schemes including: the rationale for evaluation; aspects of quality which might be considered for evaluation; the role of evaluation frameworks, quantitative and qualitative evaluation and steps in planning an evaluation.

背景与目标： ：对于慢性阻塞性肺疾病急性加重的患者，住院和早期出院计划对于某些患者而言似乎是一种有效而安全的选择，并且这些服务已变得越来越普遍。在这里，我们讨论对此类计划的评估，包括：评估的理由；可以考虑进行评估的质量方面；评估框架，定量和定性评估的作用以及规划评估的步骤。

BACKGROUND & AIMS: BACKGROUND:This study was conducted to compare the effectiveness of noninvasive ventilation (NIV) with pressure support (NIV-PSV) to noninvasive neurally-adjusted ventilatory assist (NIV-NAVA) during COPD exacerbation. METHODS:In this study, 40 subjects with COPD and acute hypercapnic respiratory failure were randomized to receive either NIV-NAVA (n = 20) or NIV-PSV (n = 20) via a critical care ventilator. Subjects' vital parameters, arterial blood gas values, patient-ventilator asynchrony events, and asynchrony index were noted at specific time intervals in both groups. The duration of NIV, rate of NIV failure, and length hospital stay were also recorded for these 2 modes of NIV. RESULTS:NIV-NAVA significantly reduced the total number (median [interquartile range]) of asynchrony events compared to NIV-PSV: 22 (15-32.5) versus 65 (50.75-104.25), respectively, P = .002. Severe asynchrony defined as asynchrony index > 10% was also significantly lower in NIV-NAVA than in NIV-PSV (P < .001). There was no significant difference between the 2 groups regarding improvement in gas exchange and vital parameters. Rate of failure of NIV (P = .73), duration of the requirement of ventilatory support (P = .40), and hospital length of stay (P = .46) were also comparable between the 2 modes of ventilation. CONCLUSIONS:Compared to NIV-PSV, NIV-NAVA was associated with better patient-ventilator synchrony and a reduction in the number of asynchrony events in subjects with an exacerbation of COPD, with similar effects on improvement in gas exchange, duration of NIV, hospital lenght of stay, and rate of NIV failure. (Clinicaltrials.gov registration NCT02912689.).

背景与目标： 背景：本研究旨在比较无创通气（NIV）和压力支持（NIV-PSV）与无创神经调节通气辅助（NIV-NAVA）在COPD急性发作期间的有效性。
方法：在这项研究中，将40名患有COPD和急性高碳酸血症性呼吸衰竭的受试者随机分配通过危重监护呼吸机接受NIV-NAVA（n = 20）或NIV-PSV（n = 20）。在两组中的特定时间间隔记录受试者的生命参数，动脉血气值，患者-呼吸机异步事件和异步指数。还记录了这两种NIV模式的NIV持续时间，NIV失败率和住院时间。
结果：与NIV-PSV相比，NIV-NAVA显着减少了异步事件的总数（中位数[四分位数范围]）：分别为22（15-32.5）和65（50.75-104.25），P = .002。 NIV-NAVA中定义为异步指数> 10％的严重异步也显着低于NIV-PSV（P <.001）。两组之间在气体交换和生命参数改善方面无显着差异。 NIV的失败率（P = .73），需要通气支持的持续时间（P = .40）和住院时间（P = .46）在两种通气模式之间也具有可比性。
结论：与NIV-PSV相比，NIV-NAVA与COPD恶化的患者更好的通气同步性和异步事件次数减少相关，对改善气体交换，NIV持续时间，医院具有相似的作用停留时间和NIV失败率。 （Clinicaltrials.gov注册号为NCT02912689。）。

BACKGROUND & AIMS: :Multiple sclerosis (MS) is an inflammatory, demyelinating disease of the central nervous system (CNS). MS is thought to be T-cell-mediated, with prior research predominantly focusing on CD4+ T-cells. There is a high prevalence of CNS-specific CD8+ T-cell responses in MS patients and healthy subjects. However, the role of neuroantigen-specific CD8+ T-cells in MS is poorly understood, with the prevalent notion that these may represent pathogenic T-cells. We show here that healthy subjects and MS patients demonstrate similar magnitudes of CD8+ and CD4+ T-cell responses to various antigenic stimuli. Interestingly, CD8+ T-cells specific for CNS autoantigens, but not those specific for control foreign antigens, exhibit immune regulatory ability, suppressing proliferation of CD4+CD25- T-cells when stimulated by their cognate antigen. While CD8+ T-cell-mediated immune suppression is similar between healthy subjects and clinically quiescent treatment-naïve MS patients, it is significantly deficient during acute exacerbation of MS. Of note, the recovery of neuroantigen-specific CD8+ T-cell suppression correlates with disease recovery post-relapse. These studies reveal a novel immune suppressor function for neuroantigen-specific CD8+ T-cells that is clinically relevant in the maintenance of peripheral tolerance and the intrinsic regulation of MS immune pathology.

背景与目标： ：多发性硬化症（MS）是中枢神经系统（CNS）的一种炎症性脱髓鞘疾病。 MS被认为是T细胞介导的，先前的研究主要集中在CD4 T细胞上。在MS患者和健康受试者中，CNS特异性CD8 T细胞反应的发生率很高。然而，人们对神经抗原特异性CD8 T细胞在MS中的作用了解甚少，普遍认为它们可能代表致病性T细胞。我们在这里显示健康的受试者和MS患者表现出相似程度的CD8和CD4 T细胞对各种抗原刺激的反应。有趣的是，对CNS自身抗原具有特异性的CD8 T细胞（而非对控制外源抗原具有特异性的CD8 T细胞）具有免疫调节能力，当受到其同源抗原刺激时抑制CD4 CD25-T细胞的增殖。尽管健康受试者和未经临床治疗的MS患者之间CD8 T细胞介导的免疫抑制作用相似，但在MS急性加重期间，CD8 T细胞介导的免疫抑制作用明显不足。值得注意的是，神经抗原特异性CD8 T细胞抑制的恢复与复发后疾病的恢复相关。这些研究揭示了神经抗原特异性CD8 T细胞的新型免疫抑制功能，在维持外周耐受和MS免疫病理的内在调节方面具有临床意义。

BACKGROUND & AIMS: :The spectrum of the neurological effects of high-altitude exposure can range from high-altitude headache and acute mountain sickness, to the more severe end of the spectrum with high-altitude cerebral edema. In general, patients with known unstable preexisting neurological conditions and those patients with residual neurological deficits from a preexisting neurological condition are discouraged from climbing to high altitudes because of the risk of exacerbation or worsening of symptoms. Although multiple sclerosis exacerbations can be triggered by environmental factors, high-altitude exposure has not been reported as a potential trigger. We are reporting the case of a multiple sclerosis exacerbation presenting in an active duty U.S. Air Force serviceman upon ascending and descending Mt. Fuji within the same day.

背景与目标： ：高海拔暴露对神经系统的影响范围从高海拔头痛和急性高山病到高海拔脑水肿的更为严重的范围。通常，不鼓励患有已知不稳定的先前存在的神经系统疾病的患者和那些因先前存在的神经系统疾病而具有残留神经系统缺陷的患者，因为其有加剧或症状恶化的风险，因此不建议爬升到高海拔地区。尽管环境因素可能触发多发性硬化症恶化，但尚未报道高海拔暴露是潜在的触发因素。我们正在报告一例现役美国空军军人在Mt.Mt.上升和下降时出现多发性硬化症加重的情况。富士在同一天。

BACKGROUND & AIMS: :A 72-year-old woman with a painful left third cranial nerve palsy due to a basilar artery aneurysm situated between the superior cerebellar and posterior cerebral arteries was treated with Guglielmi detachable coils (GDCs). Despite a good initial angiographic result with a small residual neck and improvement in the ocular motility and pain, the patient experienced worsening of the third cranial nerve palsy 15 months later. Cerebral angiography confirmed coil compaction with aneurysmal regrowth. A second endovascular coil embolization resulted in complete obliteration of the aneurysm. The patient experienced complete resolution of the pain and partial resolution of the third cranial nerve palsy. In some patients, a small residual aneurysm neck after endovascular embolization therapy with GDCs can result in delayed aneurysmal regrowth due to coil compaction. Clinical manifestations may herald this dangerous regrowth.

背景与目标： ：一名因小脑上部和后脑动脉之间的基底动脉瘤而导致左第三颅神经麻痹的痛苦的72岁妇女接受了Guglielmi可分离式线圈（GDC）的治疗。尽管最初的血管造影结果良好，残留的颈部很小，并且眼运动和疼痛有所改善，但患者在15个月后出现了第三颅神经麻痹的恶化。脑血管造影证实线圈压实伴动脉瘤再长。第二次血管内线圈栓塞导致动脉瘤完全消失。患者经历了疼痛的完全缓解和第三颅神经麻痹的部分缓解。在一些患者中，使用GDC进行血管内栓塞治疗后残留的小动脉瘤颈可能会由于线圈压紧而导致延迟的动脉瘤再生长。临床表现可能预示着这种危险的再生长。