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Direct hemoperfusion with polymyxin B immobilized fiber column (PMX) treatment for acute exacerbation of idiopathic pulmonary fibrosis: A prospective multicenter cohort study 用多粘菌素 B 固定纤维柱(PMX)直接血液灌流治疗特发性肺纤维化急性加重:一项前瞻性多中心队列研究。
IF 2.4 Q2 RESPIRATORY SYSTEM Pub Date : 2025-01-01 DOI: 10.1016/j.resinv.2024.11.017
Shinji Abe , Arata Azuma , Yoshinobu Saito , Hiroki Hayashi , Takeru Kashiwada , Toru Tanaka , Tomohisa Baba , Akimasa Sekine , Hideya Kitamura , Ryo Okuda , Satoshi Ikeda , Takashi Ogura

Background

The prognosis of acute exacerbation of idiopathic pulmonary fibrosis (AE-IPF) is extremely poor. However, recent clinical reports suggest that direct hemoperfusion with polymyxin B-immobilized fiber column (PMX) treatment may have beneficial effects in patients with AE-IPF. The aim of this multicenter prospective study was to investigate the effectiveness and safety of PMX treatment in AE-IPF.

Methods

We conducted a prospective study of patients with AE-IPF treated by PMX at two institutions in Japan. Each patient received 2–3 sessions of PMX treatment with a target duration of 6–24 h. The primary endpoint was the survival rate at day 28 after the PMX treatment.

Results

The survival rate of the patients on day 28 after PMX treatment was 65% [95% confidence interval (CI): 40.3–81.5%]. The lower limit of 95% CI in the study was higher than the survival rate of 40%, which was the upper limit of the survival rate in AE-IPF receiving conventional treatments, as reported previously. The survival rate of the patients 12 weeks after PMX was 50% (95% CI: 27.1–69.2%). The changes in the difference between alveolar and arterial oxygen tension and the partial pressure of arterial oxygen/fraction of inspired oxygen improved as the number of PMX sessions increased, and significant improvements were observed at the end of the second PMX session. The safety of PMX was clinically acceptable.

Conclusions

This prospective multicenter study suggests that PMX treatment is safe for patients with AE-IPF and may improve their oxygenation and prognosis.
背景:特发性肺纤维化急性加重期(AE-IPF)的预后极差:特发性肺纤维化急性加重期(AE-IPF)的预后极差。然而,最近的临床报告表明,用多粘菌素 B-固定化纤维柱(PMX)直接进行血液灌流治疗可能对 AE-IPF 患者有益。这项多中心前瞻性研究旨在探讨 PMX 治疗 AE-IPF 的有效性和安全性:我们在日本的两家医疗机构对接受 PMX 治疗的 AE-IPF 患者进行了前瞻性研究。每位患者接受 2-3 次 PMX 治疗,目标疗程为 6-24 小时,主要终点是 PMX 治疗后第 28 天的存活率:PMX治疗后第28天患者的存活率为65%[95%置信区间(CI):40.3-81.5%]。研究中95% CI的下限高于40%的存活率,而40%是之前报道的接受常规治疗的AE-IPF存活率的上限。PMX 治疗 12 周后患者的存活率为 50%(95% CI:27.1%-69.2%)。肺泡和动脉血氧张力之差以及动脉血氧分压/吸入氧分压的变化随着PMX疗程次数的增加而改善,在第二次PMX疗程结束时观察到显著改善。PMX 的安全性在临床上是可以接受的:这项前瞻性多中心研究表明,PMX治疗对AE-IPF患者是安全的,并可改善他们的氧合和预后。
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引用次数: 0
Association between the HAL score and the development of progressive pulmonary fibrosis in idiopathic interstitial pneumonia: A prospective observational study HAL评分与特发性间质性肺炎进展性肺纤维化的相关性:一项前瞻性观察研究
IF 2.4 Q2 RESPIRATORY SYSTEM Pub Date : 2025-01-01 DOI: 10.1016/j.resinv.2024.12.011
Hiromasa Nakayasu , Masato Karayama , Noriyuki Enomoto , Yusuke Inoue , Hideki Yasui , Yuzo Suzuki , Hironao Hozumi , Kazuki Furuhashi , Masato Kono , Mikio Toyoshima , Shiro Imokawa , Masato Fujii , Taisuke Akamatsu , Naoki Koshimizu , Koshi Yokomura , Hiroyuki Matsuda , Yusuke Kaida , Yutaro Nakamura , Masahiro Shirai , Masafumi Masuda , Takafumi Suda

Background

Progressive pulmonary fibrosis (PPF) is a critical concern in interstitial lung disease (ILD) management. The HAL score, which incorporates honeycombing (H), age >75 years (A), and serum lactate dehydrogenase >222 U/L (L), can predict acute exacerbations in patients with idiopathic interstitial pneumonia (IIP). This study aims to evaluate the predictive utility of the HAL score for PPF development.

Methods

This study was a post-hoc analysis of a multicenter prospective cohort study involving patients with IIP. PPF was diagnosed if at least two of the following three criteria were met: worsening respiratory symptoms, radiological progression, and physiological progression.

Results

Among the 144 patients, 29 (22.3%) developed PPF during the observation period. Among the three criteria for PPF, a higher HAL score significantly correlated with worsening respiratory symptoms (p = 0.001) and radiological progression (p = 0.022), but not with physiological progression (p = 0.717). Therefore, a higher HAL score significantly correlated with an increased PPF risk (12.5% for a score of 0, 25.9% for a score of 1, and 33.3% for a score of ≥2; p = 0.032). The HAL score also correlated with overall survival (p < 0.001). For the 92 patients (70.8%) with non-idiopathic pulmonary fibrosis (IPF), the HAL score was significantly associated with PPF development (p = 0.021), while not for the 38 patients (29.2%) with IPF (p = 0.872).

Conclusion

In patients with non-IPF, the HAL score correlated with PPF development and could be useful to monitor those patients and to avoid missed treatment opportunities.
背景:进行性肺纤维化(PPF)是间质性肺疾病(ILD)治疗的关键问题。HAL评分包括蜂窝(H)、年龄> ~ 75岁(A)和血清乳酸脱氢酶>222 U/L (L),可以预测特发性间质性肺炎(IIP)患者的急性加重。本研究旨在评估HAL评分对PPF发展的预测效用。方法:本研究是一项涉及IIP患者的多中心前瞻性队列研究的事后分析。如果满足以下三个标准中的至少两个,则诊断为PPF:呼吸系统症状恶化,放射学进展和生理进展。结果:144例患者中,29例(22.3%)在观察期内发生PPF。在PPF的三个诊断标准中,HAL评分越高与呼吸道症状恶化(p = 0.001)和影像学进展(p = 0.022)显著相关,而与生理进展无关(p = 0.717)。因此,较高的HAL评分与PPF风险增加显著相关(得分为0分为12.5%,得分为1分为25.9%,得分≥2分为33.3%;p = 0.032)。HAL评分也与总生存率相关(p结论:在非ipf患者中,HAL评分与PPF发展相关,可用于监测这些患者并避免错过治疗机会。
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引用次数: 0
The utility and safety of one-minute sit-to-stand test in pulmonary hypertension: A prospective study 肺动脉高压1分钟坐立试验的有效性和安全性:一项前瞻性研究。
IF 2.4 Q2 RESPIRATORY SYSTEM Pub Date : 2025-01-01 DOI: 10.1016/j.resinv.2024.12.003
Kenichiro Takeda , Ayako Shigeta , Takeshi Inagaki , Nami Hayama , Chiaki Kawame , Yasuyuki Naraki , Akira Naito , Ayumi Sekine , Rika Suda , Toshihiko Sugiura , Nobuhiro Tanabe , Takuji Suzuki

Background

Functional exercise capacity in pulmonary hypertension (PH) is routinely assessed using the 6-min walking test (6MWT). However, alternative tests are useful because of resource requirements. This study aimed to evaluate whether the 1-min sit-to-stand test (1STST) is useful and safe in PH and whether it can replace the 6MWT.

Methods

Adult patients with PH were recruited from our hospital between September 2023 and April 2024. The correlations between the number of 1STST repetitions (1STSTr) and 6-min walk distance (6MWD), pulmonary hemodynamic parameters, and quadriceps muscle strength; adverse events; and vital sign fluctuations during the tests were evaluated, and a questionnaire with an 11-point Likert scale (−5, 6MWT favor; 5, 1STST favor) was administered.

Results

Twenty-one patients with PH were enrolled in this study. The 1STSTr and 6MWD were 23.8 ± 7.8/min and 425.8 ± 116.8 m, respectively, with a strong correlation (r = 0.771). 1STSTr was significantly correlated with brain natriuretic peptide, but not with other pulmonary hemodynamic markers, respiratory function, or quadriceps muscle strength. No serious adverse events or motor impairments occurred with the 1STST.
The minimum SpO2 during the tests was significantly lower with the 6MWT (92.6 ± 3.1 vs. 88.0 ± 11.0). The questionnaire showed a predominant preference for the 1STST (3.2 ± 2.6).

Conclusions

To our knowledge, this is the first study in Japan to adapt the 1STST to PH patients. The 1STST is a reliable alternative to the 6MWT for measuring exercise capacity in PH patients.

Trial registration

This study was registered with the UMIN-CTR (number UMIN000052010).
背景:肺动脉高压(PH)患者的功能性运动能力通常通过6分钟步行试验(6MWT)进行评估。但是,由于资源需求,替代测试是有用的。本研究旨在评估1分钟坐立试验(1STST)在PH下是否有用和安全,是否可以取代6MWT。方法:于2023年9月至2024年4月在我院招募成年PH患者。1STST重复次数(1STSTr)与6分钟步行距离(6MWD)、肺血流动力学参数、股四头肌力量的相关性;不良事件;并采用李克特11分量表(- 5,6 mwt赞成;5, 1STST支持)。结果:21例PH患者入组本研究。1STSTr和6MWD分别为23.8±7.8 m /min和425.8±116.8 m,相关性较强(r = 0.771)。1STSTr与脑利钠肽显著相关,但与其他肺血流动力学指标、呼吸功能或股四头肌力量无关。1STST未发生严重不良事件或运动障碍。试验期间的最小SpO2明显低于6MWT(92.6±3.1 vs. 88.0±11.0)。问卷调查结果显示,1STST(3.2±2.6)占主导地位。结论:据我们所知,这是日本第一个将1STST应用于PH患者的研究。1STST是测量PH患者运动能力的可靠替代方案。试验注册:本研究已在UMIN-CTR注册(编号为UMIN000052010)。
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引用次数: 0
Effectiveness of intrabronchial local anesthesia with a spray catheter and continuous oral suction in reducing cough during bronchoscopy: A prospective study 支气管局部麻醉雾化导管和持续口腔吸痰在支气管镜检查中减少咳嗽的有效性:一项前瞻性研究。
IF 2.4 Q2 RESPIRATORY SYSTEM Pub Date : 2025-01-01 DOI: 10.1016/j.resinv.2024.12.002
Kazuo Tsuchiya, Tomotsugu Nuki, Tomo Tsunoda, Taisuke Ito, Rie Mori, Takuro Akashi, Yoshiyuki Oyama, Masaki Ikeda

Background

Coughing and other distress during bronchoscopy are undesirable for both patients and bronchoscopists. The efficacy of local anesthetics administered via aerosol sprays in the airways has been documented; however, the optimal administration method remains unclear. Furthermore, the efficacy of continuous salivary aspiration in reducing cough and other distress has not yet been evaluated.

Methods

Patients scheduled for bronchoscopy were assigned to 1 of 4 groups—group A (intrabronchial local anesthesia using a syringe without continuous oral suction); group B (intrabronchial local anesthesia using a spray catheter without continuous oral suction); group C (intrabronchial local anesthesia using a syringe with continuous oral suction using a saliva ejector); group D (intrabronchial local anesthesia using a spray catheter with continuous oral suction using a saliva ejector). The distress levels of the patients were evaluated using a questionnaire with a visual analog scale, and cough counts were quantified during bronchoscopy. Additionally, we assessed the total amount of lidocaine consumed and changes in vital signs.

Results

Local anesthesia in the airway using a spray catheter did not reduce patient distress; however, it reduced cough frequency (P = 0.03) and lidocaine dosage (P = 0.0004). Continuous suctioning of saliva did not reduce the patients’ distress or cough frequency.

Conclusion

The use of a spray catheter rather than a syringe is recommended for administering local anesthesia with lidocaine during bronchoscopy. Conversely, continuous suctioning of saliva is not routinely recommended for all patients.
背景:支气管镜检查时咳嗽和其他不适对患者和支气管镜医师都是不可取的。局部麻醉药通过气雾喷雾在气道中施用的有效性已被记录;然而,最佳给药方法尚不清楚。此外,持续唾液吸吸在减少咳嗽和其他痛苦方面的疗效尚未得到评估。方法:将拟行支气管镜检查的患者分为1组,共4组:A组(支气管局部麻醉,使用注射器,不进行连续口腔吸痰);B组(支气管局部麻醉,使用喷雾导管,不持续口腔吸痰);C组(支气管局部麻醉,使用注射器持续口腔吸痰);D组(支气管局部麻醉,使用喷雾导管,使用唾液喷射器持续口腔吸引)。采用带有视觉模拟量表的问卷评估患者的痛苦程度,并对支气管镜检查期间的咳嗽计数进行量化。此外,我们评估了利多卡因消耗总量和生命体征的变化。结果:气道局部麻醉使用喷雾导管不能减轻患者的痛苦;而咳嗽频次(P = 0.03)和利多卡因用量(P = 0.0004)明显降低。持续吸痰并不能减轻患者的痛苦和咳嗽频率。结论:在支气管镜检查过程中,利多卡因局部麻醉推荐使用喷雾导管而不是注射器。相反,并非所有患者都常规推荐持续吸痰。
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引用次数: 0
Pneumococcal vaccines for prevention of adult pneumonia 预防成人肺炎的肺炎球菌疫苗。
IF 2.4 Q2 RESPIRATORY SYSTEM Pub Date : 2025-01-01 DOI: 10.1016/j.resinv.2024.12.007
Konosuke Morimoto , Shingo Masuda
Streptococcus pneumoniae, pneumococcus, is one of most important bacterial pathogens in adult community-acquired pneumonia. Although it can cause a variety of illness including invasive diseases (IPD), pneumonia has a greater impact than IPD from the perspective of health economics. 23 valent pneumococcal polysaccharide vaccine (PPSV23) and 13 valent pneumococcal conjugate vaccine (PCV13) have been recommended for people ≥65 years old until recently based on evidence in preventing IPD and pneumonia. Because the introduction and dissemination of PCVs for infants and its effects on herd immunity have led ‘serotype replacement’ in adult IPD and pneumococcal pneumonia since the 2000s, serotypes targeted by vaccines have sifted accordingly. With the availability of PCV21 this year, in addition to PCV15 and PCV20, vaccine prevention strategies for adult pneumococcal pneumonia need to be reconsidered. In this narrative review, we discuss current and future challenges regarding pneumococcal vaccines to prevent adult pneumococcal pneumonia.
肺炎链球菌,即肺炎球菌,是成人社区获得性肺炎最重要的致病菌之一。虽然肺炎可以引起包括侵袭性疾病(IPD)在内的多种疾病,但从卫生经济学的角度来看,肺炎的影响要大于IPD。直到最近,基于预防IPD和肺炎的证据,23价肺炎球菌多糖疫苗(PPSV23)和13价肺炎球菌结合疫苗(PCV13)被推荐用于≥65岁的人群。由于自2000年代以来,婴儿pcv的引入和传播及其对群体免疫的影响导致了成人IPD和肺炎球菌肺炎的“血清型替代”,因此疫苗针对的血清型也相应地进行了筛选。除了PCV15和PCV20之外,随着今年PCV21的可用性,需要重新考虑成人肺炎球菌肺炎的疫苗预防策略。在这篇叙述性综述中,我们讨论了目前和未来关于肺炎球菌疫苗预防成人肺炎球菌肺炎的挑战。
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引用次数: 0
Safe surgical lung biopsy in the diagnosis of interstitial lung disease under strict patient selection 安全外科肺活检在诊断间质性肺疾病时应严格选择患者。
IF 2.4 Q2 RESPIRATORY SYSTEM Pub Date : 2025-01-01 DOI: 10.1016/j.resinv.2024.11.018
Takamitsu Hayakawa , Keigo Sekihara , Tomoya Tajiri , Motohisa Shibata , Tomoyuki Fujisawa , Takafumi Suda , Norihiko Shiiya , Kazuhito Funai

Background

Surgical lung biopsy (SLB) is recommended for diagnosing idiopathic pulmonary fibrosis in patients with interstitial lung disease (ILD). The safety of SLB is controversial, as the reported mortality and mobility vary according to the patient's background. This study aimed to assess SLB safety using eligibility criteria that excluded patients at the risk of postoperative complications, including acute exacerbations.

Methods

We retrospectively reviewed 94 patients with ILD who underwent SLB at our institution between 2010 and 2021. Two peripheral lung locations were resected using 3-port video-assisted thoracoscopic surgery. Complications within 30 and 90 days after surgery were evaluated based on the Clavien-Dindo classification. Preoperative high-resolution computed tomography findings were evaluated according to the guidelines of the American Thoracic Society, 2018. Patients with a radiological usual interstitial pneumonia (UIP) pattern, preoperative oxygen dependence, or organ failure incompatible with general anesthesia were excluded from the study.

Results

The median age of the patients was 66 years. The median vital capacity percentage was 81.0%. The following radiological patterns were observed: UIP, 0%; probable UIP, 30%; indeterminate UIP, 14%; and alternative diagnoses, 56%. The median operative time was 45 min. The 30- and 90-day mortality rates were both 0%. One patient (1%) developed an acute exacerbation of ILD on postoperative day 66. Other grade ≥ III complications were observed in 4 cases (4%), 3 of which were associated with air leakage. Home oxygen therapy was not initiated.

Conclusions

By excluding patients with poor SLB indications, our criteria are suggested to be valid for safe SLB.
背景:手术肺活检(SLB)被推荐用于诊断间质性肺病(ILD)患者的特发性肺纤维化。由于报告的死亡率和移动性因患者的背景而异,SLB 的安全性备受争议。本研究旨在评估 SLB 的安全性,采用的资格标准排除了术后并发症(包括急性加重)风险患者:我们对 2010 年至 2021 年期间在我院接受 SLB 的 94 例 ILD 患者进行了回顾性研究。使用 3 端口视频辅助胸腔镜手术切除了两个周围肺部位置。术后 30 天和 90 天内的并发症根据 Clavien-Dindo 分类法进行评估。术前高分辨率计算机断层扫描结果根据 2018 年美国胸科学会指南进行评估。研究中排除了具有放射学常见间质性肺炎(UIP)模式、术前氧依赖或与全身麻醉不相容的器官衰竭的患者:结果:患者的中位年龄为 66 岁。结果:患者的中位年龄为 66 岁,中位生命容量百分比为 81.0%。观察到以下放射学模式:UIP:0%;可能UIP:30%;不确定UIP:14%;其他诊断:56%。手术时间中位数为 45 分钟。30 天和 90 天的死亡率均为 0%。一名患者(1%)在术后第 66 天出现 ILD 急性加重。其他≥III级并发症有4例(4%),其中3例与漏气有关。未启动家庭氧疗:通过排除适应症不佳的 SLB 患者,我们的标准被认为是安全的 SLB 的有效标准。
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引用次数: 0
Idiopathic pleuroparenchymal fibroelastosis: A review of the previous literature and current knowledge 特发性胸膜实质纤维弹性增生:回顾以往的文献和目前的知识。
IF 2.4 Q2 RESPIRATORY SYSTEM Pub Date : 2025-01-01 DOI: 10.1016/j.resinv.2024.12.009
Yuzo Suzuki
Idiopathic pleuroparenchymal fibroelastosis (iPPFE) is characterized by upper lobe-dominant fibrosis involving the pleura and subpleural lung parenchyma. Pathologically, it is characterized by parenchymal intra-alveolar fibrosis with marked deposition of elastic fibers and dense thickening of the visceral pleura. Since iPPFE was categorized as a rare idiopathic interstitial pneumonia (IIP) by the America Thoracic Society/European Respiratory Society, several studies have been conducted, revealing an overall picture of iPPFE in terms of epidemiology, clinical manifestations, and mortality, in addition to its radiological and histological characteristics. Subsequently, several clinical diagnostic criteria that were not necessary for pathological analyses were proposed. Further, the underlying diseases responsible for secondary PPFE and PPFE-like lesions and their clinical implications were delineated. Typically, patients with iPPFE exhibit lean body stature together with platythorax, as well as relatively severe impairment of pulmonary function. In addition to upper-lobe PPFE lesions, lower-lobe interstitial lung disease (ILD) is commonly observed in patients with iPPFE, with the usual interstitial pneumonia pattern being most frequent. These distinct features of iPPFE were mostly associated with mortality, resulting in a poor prognosis relative to fibrotic ILD. Despite increased knowledge regarding the clinical characteristics of iPPFE, no effective therapy has been established other than lung transplantation. The efficacy of antifibrotic therapy, nutrition intervention, and pulmonary rehabilitation has not been determined. This article reviews previous studies and discusses the etiology, clinical manifestations, mortality risk, and treatment of iPPFE.
特发性胸膜实质纤维弹性病(iPPFE)的特点是上肺叶为主纤维化,累及胸膜和胸膜下肺实质。病理表现为实质肺泡内纤维化,弹性纤维明显沉积,内脏胸膜致密增厚。由于iPPFE被美国胸科学会/欧洲呼吸学会归类为一种罕见的特发性间质性肺炎(IIP),因此开展了多项研究,揭示了iPPFE的流行病学、临床表现、死亡率以及放射学和组织学特征的总体情况。随后,提出了一些不需要病理分析的临床诊断标准。此外,还描述了继发性PPFE和PPFE样病变的潜在疾病及其临床意义。iPPFE患者典型表现为身材瘦削,胸厚,肺功能损害较严重。除了上肺叶PPFE病变外,下肺叶间质性肺疾病(ILD)也常见于iPPFE患者,其中以通常的间质性肺炎模式最为常见。iPPFE的这些明显特征大多与死亡率相关,导致纤维化性ILD的预后较差。尽管对iPPFE临床特征的了解有所增加,但除了肺移植外,尚无有效的治疗方法。抗纤维化治疗、营养干预和肺康复的疗效尚未确定。本文就iPPFE的病因、临床表现、死亡风险及治疗进行综述。
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引用次数: 0
Association between preserved ratio impaired spirometry and 1-year clinical outcomes in patients with bronchiectasis patients: A cohort study 支气管扩张患者保留比例受损肺活量与1年临床结果的关系:一项队列研究。
IF 2.4 Q2 RESPIRATORY SYSTEM Pub Date : 2025-01-01 DOI: 10.1016/j.resinv.2024.12.013
Fei Gao , Siqi He , Jing Li , Xiaoyue Wang , Xiaoting Chen , Xiaoning Bu

Background

Preserved Ratio Impaired Spirometry (PRISm) (defined as the ratio of forced expired volume in the first second to forced vital capacity (FEV1/FVC) greater than 0·70 with a FEV1 of less than 80% predicted) is associated with a higher risk of hospitalizations and mortality in the general population. However, less is known about whether PRISm is associated with adverse clinical outcomes in patients with bronchiectasis. We aimed to investigate whether PRISm is associated with adverse clinical outcomes in bronchiectasis patients.

Methods

We performed a retrospective cohort study with inpatients admitted with acute exacerbations of bronchiectasis between January 2017 and January 2022. Clinical data including anthropometry, spirometry, laboratory, etiological and radiologic variables were collected. Patients were divided into the normal spirometry group, the PRISm group and the obstructive spirometry group. All patients were followed up for 1 year. The primary outcome was readmission of bronchiectasis at 1 year.

Results

Of 487 bronchiectasis patients, we found 142 (29.2%) had normal spirometry, 67 (13.8%) had PRISm and 278 (57.1%) had obstructive spirometry. Patients with obstructive spirometry were more likely to be male and to smoke, had higher fibrinogen values and more lobes affected. Patients with PRISm (HR 1.929, 95% CI 1.049 to 3.546) and obstructive spirometry (HR 2.406, 95%CI 1.506 to 3.845) had a higher risk of readmissions compared with those with normal spirometry after adjustment for potential confounders.

Conclusions

PRISm was associated with significant increased risk for readmissions in patients with bronchiectasis compared with normal spirometry, which should receive special attention.
背景:保存比受损肺活量测定法(PRISm)(定义为第一秒强制呼气容积与强制肺活量(FEV1/FVC)的比值大于0.70,FEV1低于预测的80%)与一般人群较高的住院和死亡风险相关。然而,PRISm是否与支气管扩张患者的不良临床结果相关尚不清楚。我们的目的是研究PRISm是否与支气管扩张患者的不良临床结果相关。方法:我们对2017年1月至2022年1月期间因支气管扩张急性加重住院的患者进行了回顾性队列研究。临床资料包括人体测量、肺活量测定、实验室、病因学和放射学变量。患者分为正常肺活量测定组、PRISm组和阻塞性肺活量测定组。所有患者均随访1年。主要终点为1年后支气管扩张再入院。结果:487例支气管扩张患者中,正常肺量142例(29.2%),PRISm肺量67例(13.8%),阻塞性肺量278例(57.1%)。阻塞性肺活量测定患者多为男性、吸烟、纤维蛋白原值较高、肺叶受影响较多。校正潜在混杂因素后,PRISm (HR 1.929, 95%CI 1.049 ~ 3.546)和阻塞性肺量计(HR 2.406, 95%CI 1.506 ~ 3.845)患者再入院风险高于正常肺量计患者。结论:与正常肺活量测定相比,PRISm与支气管扩张患者再入院风险显著增加相关,应引起特别注意。
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引用次数: 0
Impact of COVID-19 pandemic on pneumonia trends in Japan: Insights from diagnosis procedure combination data COVID-19大流行对日本肺炎趋势的影响:来自诊断程序组合数据的见解。
IF 2.4 Q2 RESPIRATORY SYSTEM Pub Date : 2025-01-01 DOI: 10.1016/j.resinv.2024.12.014
Akihito Ueda , Kanji Nohara
This study analyzed changes in pneumonia hospitalizations in Japan before and after the COVID-19 pandemic using Diagnosis Procedure Combination data. The proportion of inpatients with non-aspiration pneumonia (non-AP) decreased by 48.8%, whereas that of inpatients with aspiration pneumonia (AP) decreased by only 8.8%. The proportion of AP among all pneumonia cases increased from approximately 33%–47% post-pandemic. The significant reduction in non-AP incidence likely reflects its sensitivity to external factors such as public health measures. Conversely, the limited decrease in AP demonstrates its stronger association with internal factors that are less affected by lifestyle changes. This study provides insights into the differential impact of the pandemic on pneumonia subtypes, revealing how external interventions may have varying effects on different forms of pneumonia. These findings highlight the complex interplay between public health measures and the epidemiology of respiratory infections in the context of a global pandemic.
本研究使用诊断程序组合数据分析了COVID-19大流行前后日本肺炎住院的变化。非吸入性肺炎(non-AP)住院患者比例下降48.8%,吸入性肺炎(AP)住院患者比例仅下降8.8%。大流行后,AP在所有肺炎病例中的比例从大约33%-47%增加。非ap发病率的显著降低可能反映了其对公共卫生措施等外部因素的敏感性。相反,AP的有限下降表明其与受生活方式改变影响较小的内部因素有更强的关联。这项研究为大流行对肺炎亚型的不同影响提供了见解,揭示了外部干预如何对不同形式的肺炎产生不同的影响。这些发现突出了在全球大流行背景下,公共卫生措施与呼吸道感染流行病学之间复杂的相互作用。
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引用次数: 0
Biologics treatment for eosinophilic chronic rhinosinusitis complicated by bronchial asthma: Narrative review 嗜酸性慢性鼻窦炎合并支气管哮喘的生物制剂治疗:叙述性综述。
IF 2.4 Q2 RESPIRATORY SYSTEM Pub Date : 2025-01-01 DOI: 10.1016/j.resinv.2024.11.010
Tatsuya Nagano
There are 4 subtypes of chronic rhinosinusitis (CRS): eosinophilic CRS with nasal polyps (ECRSwNP), ECRS without NPs (ECRSsNP), non-ECRSwNP, and non-ECRSsNP. Most ECRS cases are categorized as ECRSwNP, and the number of patients with ECRSwNP has recently increased. ECRS is associated mainly with helper T-cell type 2 inflammation and eosinophils. Recently, Interleukin-25, -33, or TSLP, helper T-cell type 17, and Group 2 innate lymphoid cells have also been shown to be involved in the molecular mechanism of ECRS. ECRS can lead to several complications including bronchial asthma and/or aspirin intolerance. Conventionally, surgery and corticosteroids have been used to treat ECRS, but biologics have since been applied. Mepolizumab, benralizumab, and tezepelumab have been reported to improve asthma complicated by NPs more than asthma uncomplicated by NPs. Omalizumab, mepolizumab, benralizumab, and dupilumab have been reported to significantly improve Sinonasal Outcome Test-22 scores, nasal polyp scores, and nasal congestion severity in phase III trials. Benralizumab, dupilumab, and tezepelumab have been reported to improve both ECRS and complicated bronchial asthma.
慢性鼻窦炎(CRS)有4种亚型:嗜酸性CRS伴鼻息肉(ECRSwNP)、不伴鼻息肉(ECRSsNP)、非ECRSwNP和非ECRSsNP。大多数ECRS病例被归类为ECRSwNP,并且最近ECRSwNP患者的数量有所增加。ECRS主要与辅助性t细胞2型炎症和嗜酸性粒细胞相关。最近,白细胞介素-25、-33或TSLP、辅助性t细胞17型和2组先天淋巴样细胞也被证明参与了ECRS的分子机制。ECRS可导致多种并发症,包括支气管哮喘和/或阿司匹林不耐受。传统上,手术和皮质类固醇已被用于治疗ECRS,但生物制剂已被应用。据报道,Mepolizumab、benralizumab和tezepelumab对NPs合并哮喘的改善效果优于未合并NPs的哮喘。据报道,在III期临床试验中,Omalizumab、mepolizumab、benralizumab和dupilumab可显著改善Sinonasal Outcome Test-22评分、鼻息肉评分和鼻塞严重程度。据报道,Benralizumab、dupilumab和tezepelumab可改善ECRS和并发支气管哮喘。
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Respiratory investigation
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