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Efficacy of Acupuncture Is Noninferior to Nicotine Replacement Therapy for Tobacco Cessation Results of a Prospective, Randomized, Active-Controlled Open-Label Trial

第一作者:Wang, YY

期刊: CHEST, 2018; 153 (无)

BACKGROUND: We designed and conducted this multicenter randomized active-controlled open-label trial to evaluate the efficacy of acupuncture, auricular point pressing, and nicotine replacement therapy (NRT) on tobacco cessation in the Chinese population. METHODS: This randomized controlled trial was conducted in seven hospitals in China between October 2013 and February 2016. Eligible participants were recruited and randomly assigned to receive acupuncture or auricular point pressing or NRT via a central randomization system with a 1:1:1 ratio. All treatment was given for a total of 8 weeks, and follow-up visit was at 16 weeks. The primary outcome measure was carbon monoxide (CO)-confirmed 24-h point abstinence rate (<10 parts per million), 24 weeks after quit day. RESULTS: A total of 300 participants were recruited and 195 participants finished, with a dropout rate of 35.00%. Two cases of adverse events in the acupuncture group and 2 cases in the NRT group were observed. The CO-confirmed 24-h point abstinence rate was 43.00% at 24 weeks in the acupuncture group, which was similar to 44.00% in the NRT group (P > .05), but significantly higher than the 30.00% in the auricular point group (P < .05). At 24 weeks, the Fagerstrom Nicotine Dependence Test and the Minnesota Nicotine Withdrawal Scale scores in the acupuncture group were significantly lower than those in the auricular point group and in the NRT group (P < .05). Kaplan-Meier analysis showed the time to relapse for acupuncture (44.12 days) was insignificantly longer than NRT (41.18 days), but significantly longer than auricular point pressing (29.53 days). CONCLUSIONS: We found acupuncture was safe and a possible treatment for tobacco cessation, but it requires further study to establish its role.

IF:9.66

A 38-Year-Old Woman With Global Aphasia and Migraine

第一作者:Yang, JL

期刊: CHEST, 2018; 153 (无)

CASE PRESENTATION: A 38-year-old right-handed woman presented to the hospital with subtle right facial palsy and global aphasia of 4 days' duration. She found that she had aphasia when she suddenly woke up at midnight and reported a headache lasting for several hours. She had no fever, vomiting, seizures, or limb paralysis. She had had migraines with an occasional visual aura for > 10 years. She was not taking any medication and was a nondrinker and nonsmoker. She had no other significant medical background and family history.

IF:9.66

Hemostasis and Lipoprotein Indices Signify Exacerbated Lung Injury in TB With Diabetes Comorbidity

第一作者:Dong, ZW

期刊: CHEST, 2018; 153 (无)

BACKGROUND: Exacerbated immunopathology is a frequent consequence of TB that is complicated by diabetes mellitus (DM); however, the underlying mechanisms are still poorly defined. METHODS: In the two groups of age-and sex-matched patients with TB and DM (DM-TB) and with TB and without DM, we microscopically evaluated the areas of caseous necrosis and graded the extent of perinecrotic fibrosis in lung biopsies from the sputum smear-negative (SN) patients. We scored acid-fast bacilli in sputum smear-positive (SP) patients and compiled CT scan data from both the SN and SP patients. We compared inflammatory biomarkers and routine hematologic and biochemical parameters. Binary logistic regression analyses were applied to define the indices associated with the extent of lung injury. RESULTS: Enlarged caseous necrotic areas with exacerbated fibrotic encapsulations were found in SN patients with DM-TB, consistent with the higher ratio of thick-walled cavities and more bacilli in the sputum from SP patients with DM-TB. Larger necrotic foci were detected in men compared with women within the SN TB groups. Significantly higher fibrinogen and lower high-density lipoprotein cholesterol (HDL-C) were observed in SN patients with DM-TB. Regression analyses revealed that diabetes, activation ofu the coagulation pathway (shown by increased platelet distribution width, decreased mean platelet volume, and shortened prothrombin time), and dyslipidemia (shown by decreased low-density lipoprotein cholesterol, HDL-C, and apolipoprotein A) are risk factors for severe lung lesions in both SN and SP patients with TB. CONCLUSIONS: Hemostasis and dyslipidemia are associated with granuloma necrosis and fibroplasia leading to exacerbated lung damage in TB, especially in patients with DM-TB.

IF:9.66

Clinical Evaluation of Sepsis-1 and Sepsis-3 in the ICU

第一作者:Fang, XL

期刊: CHEST, 2018; 153 (无)

BACKGROUND: There has been considerable controversy between sepsis-1 and sepsis-3 criteria. METHODS: Patients with infection meeting two or more systemic inflammatory response syndrome (SIRS) criteria (sepsis-1) or a Sequential Organ Failure Assessment (SOFA) score >= 2 (sepsis-3) on the first day after ICU admission were selected from the Medical Information Mart for Intensive Care-III database, and their outcomes were compared using all-cause death as the end point. Subgroup analysis was also performed based on prior chronic organ dysfunction. RESULTS: There were 21,491 infected patients included. Of those meeting the diagnostic criteria for sepsis-1, 13.42% did not satisfy sepsis-3 criteria, and this population had a 21-day mortality rate of 6.96%. In contrast, 7.00% of the patients meeting sepsis-3 criteria did not meet sepsis-1 criteria, and their 21-day mortality rate was 10.76%. When excluding preexisting organ conditions, 18.41% of patients with sepsis-1 did not meet sepsis-3 criteria, with a 21-day mortality rate of 6.39%, and 6.00% of patients with sepsis-3 did not meet sepsis-1 criteria, with a 21-day mortality rate of 9.11%. When two or more SIRS criteria or SOFA score >= 2 were applied to predict 21-day all-cause mortality in infected patients without prior chronic organ dysfunction, the sensitivity was 96.0% or 91.0%, respectively. Although the areas under the receiver operator curve of both SOFA and SIRS criteria could be used for predicting mortality, SOFA score represented the severity of the condition, whereas SIRS score represented a clinically evident host response to infection. CONCLUSIONS: Sepsis-3 diagnostic criteria narrow the sepsis population at the expense of sensitivity, and the resulting false negatives may delay disease diagnosis. It may be inappropriate to compare the prediction performance of SIRS and SOFA criteria when sepsis-3 is defined.

IF:9.66

A 63-Year-Old Man With Recurrent Dyspnea

第一作者:Wang, SB

期刊: CHEST, 2018; 154 (无)

CASE PRESENTATION: A 63-year-old man presented with a 12-month history of recurrent dyspnea, dry cough, fatigue, and weight loss. He denied chest pain, fever, or chills. Chest radiographs during those months revealed bilateral pleural effusions, and he was subjected to serial thoracenteses. Pleural fluid analyses suggested invariably a transudate, and he had received an empirical antiheart failure regimen for several months. However, his symptoms did not improve. He reported no smoking or alcohol use and his medical history was unremarkable.

IF:9.66

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