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BackgroundThe benefit of pulmonary rehabilitation (PR) for patients with COPD diminishes over time. We investigated a new strategy involving home-visit and phone contact and compared this to usual care in maintenance of PR benefits.MethodsA total of 172 stable COPD patients receiving 8-week PR program were recruited for this prospective study. Patients were allocated into usual care group (UC) and PR maintenance group (PRMG) randomly. Patients in PRMG participated in maintenance strategy at home under supervision through home-visit and phone contact. The 6-minute walking test (6MWT), COPD assessment test (CAT), and modified Medical Research Council scale (mMRC) scores were evaluated every 3 months.ResultsOf the total, 151 patients completed 8-week PR program with satisfactory PR results (p<0.001), and 104 patients finished the follow-up. The clinical improvements in 6MWT, CAT, and mMRC scores were maintained (p<0.001) in PRMG. In comparison, the benefit of PR diminished gradually in UC. The differences in 6MWT, CAT, and mMRC scores between groups were observed 6, 9, and 6 months after PR, respectively (p<0.05). Total frequency of exacerbations in PRMG was lower than UC (p=0.021).ConclusionMaintenance strategy involving home-visit and phone contact is superior to usual care to preserve PR benefits, and reduces the acute COPD exacerbation rate.

The aim of this study was to identify the association polymorphism (rs11536889) in the 3′‐untranslated region (3′‐UTR) of Toll‐like receptors 4 (TLR4) and the risk for ventilator‐associated pneumonia (VAP). miRNA database online and luciferase assays were used to validate TLR4 as the target gene of miR‐1236. Enzyme‐linked immunosorbent assay analysis and western blot were used to analyze the level of TLR4 in different genotype groups. In the present study, miR‐1236 was predicted to bind to the rs11536889 G allele rather than the rs11536889 C allele, which was further confirmed by the luciferase activity suppressed by a fragment of 3′‐UTR containing the rs11536889 G allele induced by lipopolysaccharide (LPS) and interleukin‐6 (IL‐6). Bronchial epithelial cells isolated from participants genotyped as GG, GC, and CC, with no remarkable difference in TLR4 messenger RNA (mRNA) levels were observed among these genotype groups. After stimulating by LPS, a TLR4 ligand, the CC‐genotyped cells expressed higher levels of IL‐8, IL‐6, and tumor necrosis factor alpha (TNF‐α) on their surfaces than cells with the other genotypes. Finally, the western blot analysis results showed that the expression level of IL‐8, IL‐6, and TNF‐α protein was much higher in the CC group than the GC and GG groups subsequent to stimulation by LPS, and the IL‐8, IL‐6, and TNF‐α protein levels in the GC were grouped much lower compared with the GG group. These findings indicated the regulatory association of miR‐1236 with TLR4 and the abnormal expression of TLR4 caused by the presence of rs11536889 in the 3′‐UTR of mRNA, which interfere with its interaction with the miR‐1236, contributing to the risk of VAP.

Many machine intelligence techniques are developed in E-commerce and one of the most essential components is the representation of IDs, including user ID, item ID, product ID, store ID, brand ID, category ID etc. The classical encoding based methods (like onehot encoding) are inefficient in that it suffers sparsity problems due to its high dimension, and it cannot reflect the relationships among IDs, either homogeneous or heterogeneous ones. In this paper, we propose an embedding based framework to learn and transfer the representation of IDs. As the implicit feedbacks of users, a tremendous amount of item ID sequences can be easily collected from the interactive sessions. By jointly using these informative sequences and the structural connections among IDs, all types of IDs can be embedded into one low-dimensional semantic space. Subsequently, the learned representations are utilized and transferred in four scenarios: (i) measuring the similarity between items, (ii) transferring from seen items to unseen items, (iii) transferring across different domains, (iv) transferring across different tasks. We deploy and evaluate the proposed approach in Hema App and the results validate its effectiveness.

Background. Metagenomic next-generation sequencing (mNGS) is a new technology that allows for unbiased detection of pathogens. However, there are few reports on mNGS of lung biopsy tissues for pulmonary infection diagnosis. In addition, radial endobronchial ultrasound (R-EBUS) is widely used to detect peripheral pulmonary lesions (PPLs), but it is rarely used in the diagnosis of peripheral lung infection. Objective. The present study aims to evaluate the combined application of R-EBUS-guided transbronchial lung biopsy (TBLB) and mNGS for the diagnosis of peripheral pulmonary infectious lesions. Methods. From July 2018 to April 2019, 121 patients from Tianjin Medical University General Hospital diagnosed with PPLs and lung infection were enrolled in this prospective randomized study . Once the lesion was located, either TBLB or R-EBUS-guided-TBLB was performed in randomly selected patients, and mNGS was applied for pathogen detection in lung biopsy tissues. The results of mNGS were compared between the TBLB group and R-EBUS-guided TBLB group. In addition, the clinical characteristics and EBUS images from 61 patients receiving bronchoscopy for peripheral lung infectious detection were analyzed and compared with the results of mNGS. Results. The positivity rate of mNGS in R-EBUS-guided TBLB was (78.7%, 48/61) that was significantly higher than (60.0%, 36/60) in the TBLB group. Difference in the position of R-EBUS probe and image characteristics of peripheral lung infectious lesions affected the positivity rate of mNGS. Tissue collected by R-EBUS within the lesion produced higher positivity rate than samples collected adjacent to the lesion (P=0.030, odds ratio 17.742; 95% confidence interval, from 1.325 to 237.645). Anechoic areas and luminant areas of ultrasonic image characteristics were correlated with lower positivity rate of mNGS (respectively, P=0.019, odds ratio 17.878; 95% confidence interval, from 1.595 to 200.399; P=0.042, odds ratio 16.745; 95% confidence interval, from 1.106 to 253.479). Conclusions. R-EBUS-guided TBLB is a safe and effective technique in the diagnosis of peripheral lung infectious lesions. R-EBUS significantly facilitates the accurate insertion of bronchoscope into the lesions, which improves positivity rate of mNGS analysis in pathogen detection. The R-EBUS probe position within lesion produced a higher positivity rate of mNGS analysis. Nevertheless, the presence of anechoic and luminant areas on ultrasonic image was correlated with poor mNGS positivity rate.