Background: The BODE index is a multidimensional grading system for predicting the prognoses of patients with chronic obstructive pulmonary disease (COPD). This study investigated whether an amino acids-based metabolic profile developed for heart failure patients (including histidine, ornithine, phenylalanine, and leucine) could identify COPD patients and further discriminates COPD patients in advanced BODE stages. Methods: Ultra-performance liquid chromatography was performed on 119 participants, including 75 COPD patients at different BODE stages and 44 normal controls. Albumin, pre-albumin, transferrin, high sensitivity C-reactive protein, and hand grip strength were also measured. Receiver operating characteristic curves and area under curves were used for estimation. Results: The BODE points in our patients were 3.29 [95% confidence interval (CI) = 2.74–3.85]. Compared to normal controls, COPD patients had lower leucine but higher ornithine levels. A COPD score, developed based on leucine and ornithine, significantly discriminated COPD from normal controls [odds ratio (OR) = 2.71, 95% CI = 1.83–4.04, p <0.001]. A COPD score of ≥ 3.00 had an OR of 15.58 (95% CI = 5.96–40.73, p <0.001). In COPD patients from BODE 1 to BODE 4, the levels of histidine, ornithine and phenylalanine increased significantly. In multivariable analysis, histidine and phenylalanine were independently able to distinguish BODE stages 3 and 4 from BODE 1 and were adopted to develop a metabolic score. Metabolic scores identified patients at BODE 3 and 4 (OR = 2.74, 95% CI =1.41–5.29, p = 0.003) better than hand grip strength, high sensitive C-reactive protein, albumin, pre-albumin, and transferrin value. A metabolic score of ≥9.53 significantly discriminated BODE 3 and 4 from BODE 1 and 2 (OR = 8.56, 95% CI = 2.77–26.39, p <0.001). Conclusion: Amino acid-based COPD score and metabolic score discriminate COPD patients from normal controls, and identify patients in advanced stages of COPD.

Objectives: To assess the effect of continuous positive airway pressure (CPAP) on nocturia in ischemic stroke patients with obstructive sleep apnea (OSA). Methods: This was a prospective and non-randomized controlled study in which ischemic stroke patients with OSA being treated in a rehabilitation ward were enrolled. The participants who tolerated CPAP were classified as the CPAP group, while those who refused or could not tolerate CPAP were classified as the control group. The percentage change of nocturia before and after 2 weeks of CPAP therapy between the two groups were compared. Results: A total of 44 participants were enrolled in and 35 participants (mean age=59.8±11.7 years old; mean apnea hypopnea index=42.9±16.7/h) completed the study (control group: 14, CPAP group: 21). Overall, 69% of the participants had nocturnal polyuria and 69% of them had more than one nocturia episode per night. The baseline and initial nocturia characteristics did not differ significantly between the two groups. As compared to the control group, CPAP therapy significantly decreased the nocturnal polyuria index (mean percentage change: 9% vs -21% (P=0.005)) and nocturnal urine output (mean percentage change: 6% vs -26% (P=0.04)), but not the nocturia episodes or 24-hours total urine output. Conclusion: Nocturia due to nocturnal polyuria is very common in post-stroke patients with OSA. Treating OSA by CPAP significantly reduces nocturnal polyuria, but not nocturia frequency, in ischemic stroke patients.

Previous studies suggested that the location of the primary tumor in non-small cell lung cancer (NSCLC) is associated with clinical features and prognosis, but results are conflicting. The purpose of this study was to explore tumor location as an independent risk factor of survival for patients with completely resected pathological stage I NSCLC. This was a multicenter retrospective study conducted in Taiwan. Included patients were diagnosed with stage I NSCLC and had undergone primary tumor resection. Variables including tumor location, pathological stage, histological differentiation, and International Association for the Study of Lung Cancer (IASLC) grade were evaluated for predictive ability for disease-free survival (DFS) and overall survival (OS). A total of 208 patients were included, with 123 (59.1%) patients having a primary tumor in the upper and middle lobes. The median duration of follow-up for survivors was 60.5 months. Compared to patients with IASLC Grade 3 disease, patients with Grade 1 disease had significantly longer DFS. Tumor location and IASLC grade were independent predictors for OS in multivariate analysis. Specifically, patients with NSCLC in the lower lobe and patients who are histologically classified as IASLC Grade 3 may have poorer prognosis and require greater attention to improve outcomes.

Background. A conventional centrally inserted central catheter (CICC) is frequently used to measure central venous pressure (CVP) to monitor the cardiocirculatory status of patients. The tip of the totally implanted port (TIP) is inserted at the same location in the superior vena cava as that of a CICC, and the TIP has been implanted in many patients with cancer. Measurements of CVP using CICC (CICCP) and TIP (TIPP) may be closely related. Material and Methods. Ten patients with TIPs in an intensive care unit were prospectively studied, and 121 records of 4536 paired CICCP and TIPP measurements were collected. A bench test in a static or dynamic setting was performed, and 598 paired measurements taken using CICC and TIP were recorded. Results. The measurement of TIPP was highly correlated with that of CICCP in patients with cancer, especially those in a calm state. Patients with a calm state and ≥3 consecutive identical TIPP were recorded (≥30 seconds), and 90% of the mean difference between CICCP and TIPP was ≤2 mmHg. The pressure measurements recorded using CICC and TIP were identical in both the static and dynamic bench tests. Conclusions. TIP may be an alternative to CICC for measuring CVP.

Background/Objectives: Chronic Obstructive Pulmonary Disease (COPD) exacerbations affect health and mortality, yet current risk assessments based on previous events have limitations and are less preventative. This study used metabolomics to assess if amino acid profiles are linked to higher COPD exacerbation risk, compared to an amino acid-based panel to standard risk stratification methods, and explored its clinical decision-making and prevention potential. Methods: This prospective cohort study measured plasma concentrations of 19 amino acids in 88 individuals with COPD using ultra-performance liquid chromatography. Participants were observed for 2.5 years to track occurrences of moderate and severe COPD exacerbations. Results: During follow-up, 44 participants (50%) had an exacerbation. Tyrosine and hsCRP were independently linked to exacerbations in multivariable analysis and formed the basis of the “COPDAE score.” This score independently predicted future exacerbations after adjusting for Global Initiative for Chronic Obstructive Lung Disease (GOLD) classifications. A COPDAE score above 1.73 correlated with lower event-free survival in several subgroups: GOLD group A (log-rank = 13.7, p < 0.001), groups A and B (log-rank = 5.0, p = 0.025), and groups A and C (log-rank = 15.2, p < 0.001). Conclusions: Tyrosine and hsCRP together form a biomarker panel to assess and stratify COPD exacerbation risk. This score can help identify stable patients at risk, even with mild symptoms or few prior events, enabling earlier, more personalized interventions.