Respiratory investigation最新文献

Advancements in the treatment of interstitial lung disease in systemic sclerosis with the approval of mycophenolate mofetil 随着霉酚酸酯（mycophenolate mofetil）的批准，系统性硬化症间质性肺病的治疗取得了进展。

IF 2.4 Q2 RESPIRATORY SYSTEM

Respiratory investigation

Pub Date : 2024-11-01 DOI: 10.1016/j.resinv.2024.11.003

Toshinori Takada , Ami Aoki , Kenjiro Shima , Toshiaki Kikuchi

Systemic sclerosis (SSc) is an autoimmune connective tissue disease characterized by widespread fibrosis affecting various organs. This disorder has two main subtypes based on the extent of cutaneous fibrosis (limited and diffuse cutaneous SSc). Interstitial lung disease (ILD) occurs in approximately 50% and 25% of patients with diffuse cutaneous SSc and limited cutaneous SSc, respectively. In Japan, over 10,000 people are estimated to have ILD. Out of 10,000 SSc-ILD, at least 4000 patients may have slowly progressive ILD which leads to respiratory failure. Treatment of ILD in patients with SSc includes immunosuppressive and anti-fibrotic agents. Mycophenolate mofetil (MMF) is strongly recommended as a first-line immunosuppressive agent for the treatment of SSc-ILD according to recent American Thoracic Society clinical practice guidelines. However, as of February 2024, MMF was only approved in Japan for patients with organ transplants or lupus nephritis through health insurance policies. Cyclophosphamide is an alternative initial immunomodulatory agent for patients with the disease because it has an efficacy comparable to that of MMF. However, this agent had significantly higher toxicity than MMF. For patients with progressive pulmonary fibrosis, despite the use of immunosuppressive agents, adding nintedanib or rituximab to MMF or cyclophosphamide is recommended. This review explores the treatment of ILD associated with SSc in Japan with the approval of MMF based on the latest American Thoracic Society guideline.

系统性硬化症（SSc）是一种自身免疫性结缔组织疾病，其特征是影响各种器官的广泛纤维化。根据皮肤纤维化的程度，这种疾病主要有两种亚型（局限性和弥漫性皮肤硬化症）。在弥漫性皮肤鳞状上皮细胞炎和局限性皮肤鳞状上皮细胞炎患者中，分别约有50%和25%会出现间质性肺病（ILD）。在日本，估计有超过 10,000 人患有间质性肺病。在 10,000 名 SSc-ILD 患者中，至少有 4000 名患者可能患有缓慢进展的 ILD，从而导致呼吸衰竭。治疗 SSc 患者 ILD 的方法包括使用免疫抑制剂和抗纤维化药物。根据美国胸科学会最近的临床实践指南，强烈建议将霉酚酸酯（MMF）作为治疗 SSc-ILD 的一线免疫抑制剂。然而，截至 2024 年 2 月，日本仅通过医疗保险政策批准器官移植或狼疮肾炎患者使用 MMF。环磷酰胺是该病患者的另一种初始免疫调节药物，因为它的疗效与 MMF 相当。然而，这种药物的毒性明显高于 MMF。对于进展性肺纤维化患者，尽管使用了免疫抑制剂，但仍建议在 MMF 或环磷酰胺的基础上添加宁替达尼或利妥昔单抗。本综述探讨了根据美国胸科学会最新指南批准 MMF 后，日本对 SSc 相关 ILD 的治疗情况。

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引用次数: 0

Temporal changes over time in sputum rheological parameters after SARS-CoV-2 infection in two patients with chronic cough 两名慢性咳嗽患者感染 SARS-CoV-2 后痰液流变学参数的时间变化。

IF 2.4 Q2 RESPIRATORY SYSTEM

Respiratory investigation

Pub Date : 2024-11-01 DOI: 10.1016/j.resinv.2024.09.018

Haruhiko Ogawa , Yuka Uchida

We report temporal changes in sputum rheological parameters after SARS-CoV-2 infection in two patients with chronic cough (71-year-old, male, sinobronchial syndrome; 80-year-old, female, cough variant asthma). Both patients complained of decreased cough-related quality of life and increased phlegm stickiness after infection. In parallel, their sputum showed decreases in linear viscoelastic region (LVR) parameters, such as viscoelastic modulus (G^∗), elastic modulus (G′), and viscous modulus (G″), and increased tack (tan δ/G′; tan δ = G″/G′) compared to pre-infection levels. Rheological parameters, such as G^∗ and tack, took at least several months to return to almost pre-infection levels after recovery from COVID-19. Further studies are needed to determine whether the viscoelastic fluctuations seen in these two patients are common to patients with post-COVID-19 cough and whether their delayed recovery is associated with prolonged clinical symptoms. A sputum rheology approach may provide new insights into post-COVID-19 cough.

我们报告了两名慢性咳嗽患者（71 岁，男性，鼻窦支气管综合征；80 岁，女性，咳嗽变异性哮喘）感染 SARS-CoV-2 后痰液流变学参数的时间变化。这两名患者都抱怨感染后与咳嗽有关的生活质量下降，痰液粘稠度增加。与此同时，与感染前相比，他们的痰液中的线性粘弹性区域（LVR）参数，如粘弹性模量（G∗）、弹性模量（G'）和粘性模量（G″）都有所下降，粘性（tan δ/G'；tan δ = G″/G'）有所增加。从 COVID-19 中恢复后，流变学参数（如 G∗ 和粘性）至少需要几个月才能恢复到感染前的水平。还需要进一步研究，以确定这两名患者的粘弹性波动是否与 COVID-19 后咳嗽患者相同，以及他们的延迟恢复是否与临床症状的延长有关。痰流变学方法可为研究 COVID-19 后咳嗽提供新的视角。

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引用次数: 0

Viability and diagnostic potential of tissues obtained through cryobiopsy 通过冷冻活组织切片获取的组织的活力和诊断潜力

IF 2.4 Q2 RESPIRATORY SYSTEM

Respiratory investigation

Pub Date : 2024-11-01 DOI: 10.1016/j.resinv.2024.10.011

Ryotaro Kida , Ryohei Yoshida , Kiichi Nitanai , Akari Yagita , Taeka Naraoka , Hiraku Yanada , Ryota Shigaki , Toshiyuki Tenma , Chie Mori , Yasuhiro Umekage , Mamiko Mitsumoto , Mishie Tanino , Yoshinori Minami , Takaaki Sasaki

Background

Transbronchial lung cryobiopsy is primarily used for diagnosing interstitial lung diseases and tumors, providing larger tissue samples with reduced tissue crushing than traditional biopsies. However, freezing during cryobiopsy may damage cells, potentially affecting diagnostic methods that require live cells, such as flow cytometry (FCM). We aimed to determine the extent of freezing-related cell damage in cryobiopsies using cells cultured in vitro.

Methods

To investigate the relationship between freezing duration and sample volume, Jurkat cells underwent freezing for durations ranging from 2 to 6 s, with 1-s intervals, using either 1-mm- or 1.7-mm cryoprobes. FCM was conducted to assess both cell viability (2, 4, and 6 s) and cell-surface molecule expression (3 and 6 s) over varying freezing times. Additionally, we describe a clinical case involving a 70-year-old man suspected of malignant lymphoma, in which tissue samples were obtained via both forceps biopsy and cryobiopsy methods to compare the pathological and cytological features between the methods.

Results

Harvested cell count increased with freezing duration, with a notable increase in viable cell percentage. Moreover, cells distant from the cryoprobe exhibited higher survival rates under milder freezing conditions. FCM revealed significantly higher marker expression levels in viable cryobiopsy samples than in non-viable samples. The clinical case demonstrated that cryobiopsy yields a significant proportion of live cells (>90%), with cytological findings consistent with those of non-frozen samples.

Conclusions

Cryobiopsy may be beneficial for histopathological diagnosis, providing sufficient viable cells for FCM, and can be used for diagnosing malignant lymphomas and other pulmonary conditions.

背景经支气管肺冷冻活检主要用于诊断肺间质疾病和肿瘤，与传统活检相比，冷冻活检能提供更大的组织样本，减少组织破碎。然而，冷冻活检过程中的冷冻可能会损伤细胞，从而可能影响需要活细胞的诊断方法，如流式细胞术（FCM）。为了研究冷冻持续时间与样本体积之间的关系，我们使用 1 毫米或 1.7 毫米的冷冻探针对 Jurkat 细胞进行了持续时间为 2 到 6 秒、间隔时间为 1 秒的冷冻。在不同的冷冻时间内，我们对细胞存活率（2、4 和 6 秒）和细胞表面分子表达（3 和 6 秒）进行了 FCM 评估。此外，我们还描述了一个 70 岁男性疑似恶性淋巴瘤的临床病例，病例中的组织样本是通过镊子活检和冷冻活检两种方法获得的，以比较两种方法的病理学和细胞学特征。此外，在较温和的冷冻条件下，远离冷冻探针的细胞存活率更高。FCM 显示，存活的冷冻活检样本的标记物表达水平明显高于未存活样本。临床病例表明，冷冻活组织切片可获得相当比例的活细胞（90%），细胞学结果与非冷冻样本一致。

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引用次数: 0

A systematic review of factors associated with poor prognosis despite appropriate antibiotics usage for pneumonia 系统回顾肺炎抗生素使用得当但预后不良的相关因素

IF 2.4 Q2 RESPIRATORY SYSTEM

Respiratory investigation

Pub Date : 2024-11-01 DOI: 10.1016/j.resinv.2024.10.012

Akihiko Goto , Kentaro Ishikawa , Kosaku Komiya

Treatment with appropriate antibiotics does not seem to be associated with prognosis among elderly patients with pneumonia. Identifying factors associated with poor prognosis despite the use of appropriate antibiotics might help withhold aggressive antibiotic treatment in patients with pneumonia. This systematic review aims to identify the risk factors associated with unfavored outcomes despite using appropriate antibiotics for pneumonia. The PubMed database was searched for studies focusing on appropriate antibiotic use in patients with pneumonia (assessed on Aug 7, 2024). Appropriate antibiotics were defined as those sensitive to microorganisms isolated from patients. The risk of bias was evaluated using the Risk of Bias Assessment tool for nonrandomized Studies utilized for controlled observational studies.

A total of 1563 studies were identified from the database, and eight observational studies were included in this review: ventilator-associated pneumonia (n = 4), community-onset pneumonia (n = 2), P. aeruginosa pneumonia (n = 1), and S. maltophilia pneumonia (n = 1). Advanced age was the most commonly evaluated factor associated with mortality. Additionally, high severity scores were related to the unfavored outcomes even after treatment with appropriate antibiotics. Advanced age and high severity scores may be associated with increased mortality despite appropriate antibiotic usage for pneumonia. Broad-spectrum antibiotics might not be indicated in elderly pneumonia patients with high severity status who do not wish to receive aggressive antibiotic treatments.

使用适当的抗生素治疗似乎与老年肺炎患者的预后无关。找出与使用适当抗生素但预后不良相关的因素，可能有助于暂停对肺炎患者进行积极的抗生素治疗。本系统综述旨在确定肺炎患者在使用适当抗生素治疗后仍出现不良预后的相关风险因素。我们在 PubMed 数据库中搜索了有关肺炎患者适当使用抗生素的研究（评估日期为 2024 年 8 月 7 日）。适当的抗生素被定义为对从患者体内分离出的微生物敏感的抗生素。数据库中共识别出 1563 项研究，本综述共纳入 8 项观察性研究：呼吸机相关肺炎（4 项）、社区发病性肺炎（2 项）、铜绿假单胞菌肺炎（1 项）和嗜麦芽糖酶肺炎（1 项）。高龄是最常见的与死亡率相关的评估因素。此外，即使在使用适当的抗生素治疗后，严重程度评分高也与不利的结果有关。尽管肺炎患者使用了适当的抗生素，但高龄和严重程度评分高可能与死亡率增加有关。对于不希望接受积极抗生素治疗、病情严重程度高的老年肺炎患者来说，广谱抗生素可能并不适用。

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引用次数: 0

Preliminary investigation of the significance of cavitary lesions in recurrent hemoptysis following bronchial artery embolization for nontuberculous mycobacterial pulmonary disease 支气管动脉栓塞治疗非结核分枝杆菌肺病后复发性咯血中空洞病变重要性的初步研究。

IF 2.4 Q2 RESPIRATORY SYSTEM

Respiratory investigation

Pub Date : 2024-11-01 DOI: 10.1016/j.resinv.2024.11.001

Hiroto Hatano, Manabu Suzuki, Mio Sugino, Mikako Nakamura, Yusaku Kusaba, Yoshie Tsujimoto, Akane Ishida, Masao Hashimoto, Eriko Morino, Jin Takasaki, Naoki Nishimura, Hiroshi Nokihara, Shinyu Izumi, Masayuki Hojo

Background

Nontuberculous mycobacterial pulmonary disease (NTM-PD) varies widely in clinical presentation, and some patients experience hemoptysis. Bronchial artery embolization (BAE) is a treatment option for hemoptysis caused by NTM-PD. However, the association between post-BAE rebleeding risk and the presence of cavitary lesions has not been fully elucidated.

Methods

A retrospective observational study was conducted on patients with NTM-PD who had undergone BAE at our institution. Patients were classified into Cavitary and Non-cavitary groups, and baseline characteristics and clinical outcomes were compared.

Results

Among the 155 BAE cases between 2013 and 2023, 18 were included in the analysis, and four experienced rebleeding. The Cavitary group tended to have a higher rebleeding rate 24 months after BAE (37.5% vs. 10.0%, p = 0.27). Furthermore, the Cavitary group showed a significantly higher number of non-bronchial arteries involved (median number: 1.5 vs. 0.0, p = 0.02), a higher proportion of patients with a prior antibiotic treatment history (100% vs. 20%, p = 0.001), and longer duration from diagnosis to BAE (median year: 9.0 vs. 0.6, p = 0.02). The Kaplan-Meier curves showed a tendency for shorter rebleeding-free survival in the Cavitary group (p = 0.10).

Conclusions

Cavitary lesions in patients with NTM-PD may predict higher rebleeding rates after BAE. Further research with larger cohorts is needed to better understand rebleeding risk factors in BAE for NTM-PD.

背景：非结核分枝杆菌肺病（NTM-PD）的临床表现千差万别，部分患者会出现咯血。支气管动脉栓塞术（BAE）是治疗非结核分枝杆菌肺病引起的咯血的一种方法。然而，BAE术后再出血风险与是否存在空洞性病变之间的关系尚未完全阐明：我们对在本院接受 BAE 的 NTM-PD 患者进行了一项回顾性观察研究。将患者分为腔隙性和非腔隙性两组，并比较基线特征和临床结果：在2013年至2023年的155例BAE病例中，有18例纳入分析，其中4例出现再出血。腔镜组在 BAE 24 个月后的再出血率往往更高（37.5% 对 10.0%，P = 0.27）。此外，腔镜组非支气管动脉受累的数量明显更高（中位数：1.5 对 0.0，p = 0.02），既往有抗生素治疗史的患者比例更高（100% 对 20%，p = 0.001），从诊断到 BAE 的时间更长（中位数：9.0 年对 0.6 年，p = 0.02）。Kaplan-Meier曲线显示，腔隙性病变组的无再出血生存期更短（p = 0.10）：结论：NTM-PD 患者的腔隙性病变可能预示着 BAE 后较高的再出血率。要更好地了解 NTM-PD BAE 的再出血风险因素，还需要对更大的队列进行进一步研究。

{"title":"Preliminary investigation of the significance of cavitary lesions in recurrent hemoptysis following bronchial artery embolization for nontuberculous mycobacterial pulmonary disease","authors":"Hiroto Hatano, Manabu Suzuki, Mio Sugino, Mikako Nakamura, Yusaku Kusaba, Yoshie Tsujimoto, Akane Ishida, Masao Hashimoto, Eriko Morino, Jin Takasaki, Naoki Nishimura, Hiroshi Nokihara, Shinyu Izumi, Masayuki Hojo","doi":"10.1016/j.resinv.2024.11.001","DOIUrl":"10.1016/j.resinv.2024.11.001","url":null,"abstract":"<div><h3>Background</h3><div>Nontuberculous mycobacterial pulmonary disease (NTM-PD) varies widely in clinical presentation, and some patients experience hemoptysis. Bronchial artery embolization (BAE) is a treatment option for hemoptysis caused by NTM-PD. However, the association between post-BAE rebleeding risk and the presence of cavitary lesions has not been fully elucidated.</div></div><div><h3>Methods</h3><div>A retrospective observational study was conducted on patients with NTM-PD who had undergone BAE at our institution. Patients were classified into Cavitary and Non-cavitary groups, and baseline characteristics and clinical outcomes were compared.</div></div><div><h3>Results</h3><div>Among the 155 BAE cases between 2013 and 2023, 18 were included in the analysis, and four experienced rebleeding. The Cavitary group tended to have a higher rebleeding rate 24 months after BAE (37.5% vs. 10.0%, p = 0.27). Furthermore, the Cavitary group showed a significantly higher number of non-bronchial arteries involved (median number: 1.5 vs. 0.0, p = 0.02), a higher proportion of patients with a prior antibiotic treatment history (100% vs. 20%, p = 0.001), and longer duration from diagnosis to BAE (median year: 9.0 vs. 0.6, p = 0.02). The Kaplan-Meier curves showed a tendency for shorter rebleeding-free survival in the Cavitary group (p = 0.10).</div></div><div><h3>Conclusions</h3><div>Cavitary lesions in patients with NTM-PD may predict higher rebleeding rates after BAE. Further research with larger cohorts is needed to better understand rebleeding risk factors in BAE for NTM-PD.</div></div>","PeriodicalId":20934,"journal":{"name":"Respiratory investigation","volume":"62 6","pages":"Pages 1227-1232"},"PeriodicalIF":2.4,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142627092","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Association of constipation with the survival of patients with idiopathic interstitial pneumonias 便秘与特发性间质性肺炎患者存活率的关系。

IF 2.4 Q2 RESPIRATORY SYSTEM

Respiratory investigation

Pub Date : 2024-11-01 DOI: 10.1016/j.resinv.2024.10.010

Sho Takuma , Kazutaka Mori , Masato Karayama , Yusuke Inoue , Hideki Yasui , Hironao Hozumi , Yuzo Suzuki , Kazuki Furuhashi , Tomoyuki Fujisawa , Noriyuki Enomoto , Naoki Inui , Takafumi Suda

Background

Constipation is associated with the prognosis of several chronic diseases. However, the effect of constipation on the prognosis of idiopathic interstitial pneumonias (IIPs) remains unclear. This study aimed to investigate the association between constipation and the prognosis of patients with IIPs.

Methods

In this single-center, observational study, the association between constipation and survival of patients with IIPs was retrospectively investigated using a marginal structural model (MSM) analysis with weighting of age, sex, body mass index, treatment (corticosteroids, immunosuppressants, and antifibrotic agents), and pulmonary function (percent predicted forced vital capacity and diffusing capacity of the lungs for carbon monoxide).

Results

A total of 433 patients with IIPs (148 and 285 patients with idiopathic pulmonary fibrosis [IPF] and those without IPF) were included in the study. During the observation period, 238 patients developed constipation. The MSM analysis showed that constipation was significantly associated with shorter overall survival (hazard ratio [HR], 2.374; 95% confidence interval, 1.924–2.928, p < 0.001). When the use of antifibrotic agents was weighted separately as nintedanib or pirfenidone, constipation was significantly associated with shorter survival (HR, 2.427; 95% CI, 1.972–2.988, p < 0.001; and HR, 2.395; 95% CI, 1.940–2.957, p < 0.001, respectively). Furthermore, a subgroup analysis showed that constipation was associated with worse survival in patients with IPF and in those without IPF, regardless of the disease severity.

Conclusions

This study shows that constipation is an independent prognostic factor for patients with IIPs, suggesting its potential clinical utility.

背景：便秘与多种慢性疾病的预后有关：便秘与多种慢性疾病的预后有关。然而，便秘对特发性间质性肺炎（IIPs）预后的影响仍不清楚。本研究旨在探讨便秘与特发性间质性肺炎患者预后之间的关系：在这项单中心观察性研究中，采用边际结构模型（MSM）分析法对便秘与间质性肺炎患者生存率之间的关系进行了回顾性研究，并对年龄、性别、体重指数、治疗（皮质类固醇、免疫抑制剂和抗纤维化药物）和肺功能（预测用力肺活量百分比和肺对一氧化碳的弥散能力）进行了加权分析：研究共纳入了 433 名 IIPs 患者（特发性肺纤维化 [IPF] 患者和非 IPF 患者分别为 148 人和 285 人）。在观察期间，238 名患者出现便秘。MSM 分析表明，便秘与总生存期缩短显著相关（危险比 [HR]，2.374；95% 置信区间，1.924-2.928，p 结论：该研究表明，便秘与总生存期缩短显著相关：本研究表明，便秘是 IIP 患者的一个独立预后因素，这表明便秘具有潜在的临床实用性。

{"title":"Association of constipation with the survival of patients with idiopathic interstitial pneumonias","authors":"Sho Takuma , Kazutaka Mori , Masato Karayama , Yusuke Inoue , Hideki Yasui , Hironao Hozumi , Yuzo Suzuki , Kazuki Furuhashi , Tomoyuki Fujisawa , Noriyuki Enomoto , Naoki Inui , Takafumi Suda","doi":"10.1016/j.resinv.2024.10.010","DOIUrl":"10.1016/j.resinv.2024.10.010","url":null,"abstract":"<div><h3>Background</h3><div>Constipation is associated with the prognosis of several chronic diseases. However, the effect of constipation on the prognosis of idiopathic interstitial pneumonias (IIPs) remains unclear. This study aimed to investigate the association between constipation and the prognosis of patients with IIPs.</div></div><div><h3>Methods</h3><div>In this single-center, observational study, the association between constipation and survival of patients with IIPs was retrospectively investigated using a marginal structural model (MSM) analysis with weighting of age, sex, body mass index, treatment (corticosteroids, immunosuppressants, and antifibrotic agents), and pulmonary function (percent predicted forced vital capacity and diffusing capacity of the lungs for carbon monoxide).</div></div><div><h3>Results</h3><div>A total of 433 patients with IIPs (148 and 285 patients with idiopathic pulmonary fibrosis [IPF] and those without IPF) were included in the study. During the observation period, 238 patients developed constipation. The MSM analysis showed that constipation was significantly associated with shorter overall survival (hazard ratio [HR], 2.374; 95% confidence interval, 1.924–2.928, <em>p</em> < 0.001). When the use of antifibrotic agents was weighted separately as nintedanib or pirfenidone, constipation was significantly associated with shorter survival (HR, 2.427; 95% CI, 1.972–2.988, <em>p</em> < 0.001; and HR, 2.395; 95% CI, 1.940–2.957, <em>p</em> < 0.001, respectively). Furthermore, a subgroup analysis showed that constipation was associated with worse survival in patients with IPF and in those without IPF, regardless of the disease severity.</div></div><div><h3>Conclusions</h3><div>This study shows that constipation is an independent prognostic factor for patients with IIPs, suggesting its potential clinical utility.</div></div>","PeriodicalId":20934,"journal":{"name":"Respiratory investigation","volume":"62 6","pages":"Pages 1204-1208"},"PeriodicalIF":2.4,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142547087","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Telemedicine for long-term continuous positive airway pressure therapy: A six-month follow-up study in Japan using propensity score matching 远程医疗用于长期持续气道正压治疗：使用倾向得分匹配法在日本进行的为期 6 个月的随访研究。

IF 2.4 Q2 RESPIRATORY SYSTEM

Respiratory investigation

Pub Date : 2024-11-01 DOI: 10.1016/j.resinv.2024.11.002

Toshiki Akahoshi , Daisuke Endo , Kenichi Nagaoka , Ayako Hori , Tatsuya Ito , Akihito Uematsu , Yutaka Kozu , Yasuhiro Gon , Kazuo Chin , Ryuji Furihata

Background

During the coronavirus disease (COVID-19) pandemic, Japan's health insurance system allowed continuous positive airway pressure (CPAP) telephone consultations to extend clinic visit intervals. This study aimed to determine whether 6-month CPAP adherence in the telemedicine (TM) group was inferior to that in the standard care group.

Methods

Patients receiving long-term CPAP therapy for at least 6 months for obstructive sleep apnea (OSA) from two clinics in Japan were recruited between May and July 2020. The TM group consisted of patients who had not visited the clinic in person for 6 months, with physicians providing telephone consultations every 1–2 months. The standard care group included patients who visited the clinic monthly for physician consultation. In both groups, physicians reviewed CPAP usage data via telemonitoring. Patients were classified into three groups according to change in adherence: ≤ −5%, > −5 to <5%, and ≥5%. The primary outcome was the number of patients with worsened CPAP adherence (≤−5%).

Results

Of the 479 patients in the TM group and 146 in the standard care group, 120 were matched using propensity score 1:1 nearest neighbor matching and selected from both groups. Adherence worsened in 41 (34.2%) and 32 (26.7 %) patients in the TM and standard care groups, respectively. The TM group was not inferior to the standard care group in terms of the proportion of patients with worsened CPAP adherence (χ² = 1.81, df = 1, P = 0.178).

Conclusions

This study found no significant difference in the 6-month CPAP adherence between the TM and standard care groups.

背景：在冠状病毒病（COVID-19）大流行期间，日本的医疗保险系统允许通过电话咨询持续气道正压（CPAP）来延长就诊时间。本研究旨在确定远程医疗（TM）组 6 个月的 CPAP 坚持率是否低于标准护理组：在 2020 年 5 月至 7 月期间，从日本两家诊所招募了接受至少 6 个月长期 CPAP 治疗的阻塞性睡眠呼吸暂停（OSA）患者。TM组包括6个月内未亲自到诊所就诊的患者，医生每1-2个月提供一次电话咨询。标准护理组包括每月到诊所接受医生咨询的患者。在这两组患者中，医生都会通过远程监控查看 CPAP 使用数据。根据患者依从性的变化将其分为三组：≤ -5%、>-5 至结果：在 TM 组的 479 名患者和标准护理组的 146 名患者中，采用倾向得分 1:1 近邻匹配法从两组中选出了 120 名患者。TM 组和标准护理组分别有 41 名（34.2%）和 32 名（26.7%）患者的依从性恶化。就 CPAP 依从性恶化的患者比例而言，TM 组并不比标准护理组差（χ2 = 1.81，df = 1，P = 0.178）：本研究发现，TM 组和标准护理组在 6 个月的 CPAP 依从性方面没有明显差异。

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引用次数: 0

A protocol for a Japanese prospective cohort evaluating the features of patients with uncontrolled asthma achieving clinical remission: J-CIRCLE 日本前瞻性队列方案，评估临床缓解的未控制哮喘患者的特征：J-CIRCLE

IF 2.4 Q2 RESPIRATORY SYSTEM

Respiratory investigation

Pub Date : 2024-11-01 DOI: 10.1016/j.resinv.2024.10.009

Naoya Tanabe , Yu Hara , Kaoruko Shimizu , Satoshi Marumo , Jun Miyata , Kyohei Morita , Tetsuya Watanabe , Keiji Oishi , Masafumi Yamaguchi , Kazuhisa Asai , Yasutaka Nakano , Tsunahiko Hirano , Kazuto Matsunaga , Toshiyuki Koya , Hisako Matsumoto , Koichi Fukunaga , Satoshi Konno , Takeshi Kaneko , Toyohiro Hirai

Background

Increasing expectations that biologics can be used as disease-modifying agents have introduced the concept of clinical remission (CR) in managements of severe asthma. Given the clinical relevance of computed tomography (CT) and blood biomarkers, we hypothesized that further refinement of CR criteria as well as incorporation of CT and blood biomarkers as indicators for structural and biological remission (SR, BR) would enable predicting long-term disease stability in patients with severe asthma treated with biologics.

Methods

This Japanese multicenter prospective observational cohort will enroll patients with severe asthma who will start a new biologic (including a change from another biologic). The enrolled patients will be longitudinally followed up for 3 years. At enrollment, patients will undergo postbronchodilator spirometry, blood tests, fractional exhaled nitric oxide, chest and sinus CT, and patient-reported outcome questionnaires. Follow-up examinations will be performed at 1, 3, 6, 12, 24, and 36 months. The rates of CR resulting from different criteria after 1 year of treatment with biologics will be compared, and factors associated with long-term disease stability after 3 years of biologic treatments will be identified.

Discussion

This multicenter study in Japan will provide data that will help establish more appropriate criteria for CR, structural remission, and biological remission to predict long-term disease stability in patients with severe asthma who receive biologic therapy.

Ethics and dissemination

The study was approved by the Ethics Committee of Kyoto University (No. R4419, approval date June 11th, 2024).

Trial registration

The University Hospital Medical Information Network (UMIN000053771).

背景越来越多的人希望生物制剂能用作疾病调节剂，因此在重症哮喘的治疗中引入了临床缓解（CR）的概念。鉴于计算机断层扫描（CT）和血液生物标志物的临床相关性，我们假设进一步完善 CR 标准，并将 CT 和血液生物标志物作为结构和生物缓解（SR、BR）的指标，将有助于预测接受生物制剂治疗的重症哮喘患者的长期疾病稳定性。入组患者将接受为期 3 年的纵向随访。入组时，患者将接受支气管扩张剂后肺活量测定、血液化验、呼出一氧化氮分数测定、胸部和鼻窦 CT 以及患者报告结果问卷调查。随访检查将在 1、3、6、12、24 和 36 个月时进行。将比较生物制剂治疗 1 年后不同标准导致的 CR 率，并找出生物制剂治疗 3 年后疾病长期稳定的相关因素。讨论这项在日本开展的多中心研究将提供数据，帮助建立更合适的 CR、结构缓解和生物缓解标准，以预测接受生物制剂治疗的重症哮喘患者的长期疾病稳定性。伦理与传播该研究已获得京都大学伦理委员会的批准（编号：R4419，批准日期：2024 年 6 月 11 日）。

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引用次数: 0

Importance of vaccines against respiratory infections in adults 成人呼吸道感染疫苗的重要性。

IF 2.4 Q2 RESPIRATORY SYSTEM

Respiratory investigation

Pub Date : 2024-10-23 DOI: 10.1016/j.resinv.2024.09.006

Koji Kuronuma

引用次数: 0

Refractory bilateral chylothorax and chylous ascites in a patient with systemic lupus erythematosus treated by pleuro-peritoneal and peritoneal-venous shunts along with cell-free and concentrated ascites re-infusion therapy 一名系统性红斑狼疮患者在接受胸膜-腹膜和腹膜-静脉分流术以及无细胞浓缩腹水再灌注疗法治疗后，出现难治性双侧乳糜胸和乳糜腹水。

IF 2.4 Q2 RESPIRATORY SYSTEM

Respiratory investigation

Pub Date : 2024-10-22 DOI: 10.1016/j.resinv.2024.10.006

Yuki Kuwahara , Hiroki Tashiro , Go Takeshita , Yoshiaki Egashira , Akihito Maruyama , Yuki Ikeda , Shinya Kimura , Naoko Sueoka-Aragane , Koichiro Takahashi

A pleural effusion is a common pulmonary manifestation of systemic lupus erythematosus (SLE), and differential diagnosis is needed to perform targeted treatments. An SLE patient with refractory chylothorax is presented. Chylothorax rarely occurs in SLE patients and occasionally follows a refractory clinical course despite intensive treatment with immunosuppressive therapies, resulting in a poor prognosis with malnutrition caused by frequent thoracenteses. In such cases, pleuro-peritoneal and peritoneal-venous shunts along with cell-free and concentrated ascites re-infusion therapy might be effective to improve the dyspnea while maintaining nutrition.

胸腔积液是系统性红斑狼疮（SLE）常见的肺部表现，需要进行鉴别诊断才能实施有针对性的治疗。本文介绍了一名患有难治性乳糜胸的系统性红斑狼疮患者。系统性红斑狼疮患者很少会出现乳糜胸，偶尔会出现难治性临床病程，尽管患者接受了免疫抑制疗法的强化治疗，但仍会因频繁胸腔积液导致营养不良而预后不良。在这种情况下，胸膜-腹膜分流术和腹膜-静脉分流术以及无细胞和浓缩腹水再灌注疗法可能会有效改善呼吸困难，同时维持营养。

引用次数: 0