Respiratory medicine最新文献

Background: Bronchiectasis is a chronic airway disease characterized by persistent inflammation and structural damage, with substantial clinical and etiologic heterogeneity. Although previous studies have identified associations between blood cells and bronchiectasis, the causal relationships remain unclear. Moreover, the mechanisms underlying blood cell perturbation responses and their potential mediation by immune cells in disease progression are largely unexplored.

Methods: Two-sample Mendelian randomization (MR) analysis was used to explore genetically predicted associations among immune cell traits, blood cell perturbation response phenotypes, and bronchiectasis, based on genome-wide association study summary data. Mediation MR analysis was further applied to assess whether immune cells mediate these associations. Multiple sensitivity analyses, including tests for heterogeneity and horizontal pleiotropy, were performed to evaluate the validity and robustness.

Results: Five blood cell perturbation response phenotypes and twenty-nine immune cell traits showed significant genetically predicted associations with bronchiectasis. Mediation analysis showed that natural killer (NK) cell absolute count partially mediated the causal effect between the eosinophil perturbation response and bronchiectasis, with a mediation proportion of 9.626%. CD38 on transitional B cells mediated the causal effect between the monocyte perturbation response and bronchiectasis, with a mediation proportion of 10.580%. Additionally, CD45 on NK cells played a mediating role in the association between the white blood cell perturbation response and bronchiectasis, with a mediation proportion of 10.651%.

Conclusion: This study systematically explores genetically predicted associations between blood cell perturbation responses and bronchiectasis and highlights potential immune-mediated pathways. These exploratory findings provide novel genetic insights into the pathogenesis of bronchiectasis and identify potential therapeutic targets for future strategies.

Purpose: The aim of this study was to identify perceived cognitive impairment and its associated factors in patients newly diagnosed with lung cancer.

Methods: This cross-sectional analysis utilized pretreatment data sourced from an ongoing multicenter longitudinal investigation (registration: ChiCTR2300076232). A total of 340 participants were enrolled between September 2023 and March 2024 from two public hospitals in Anhui Province, China. The well-validated Chinese version of the FACT-Cog was used to collect the information of perceived cognitive function. Data on sociodemographic and clinical characteristics, as well as cancer-related symptoms were obtained through structured questionnaires and medical records.

Results: 170 Patients newly diagnosed with lung cancer and 170 non-cancer controls matched in age and gender. Patients scored significantly lower on the FACT-Cog and four subscales than controls (all P < 0.05). The prevalence of perceived cognitive impairment in patients was 15.3%, which was significantly higher than 6.5% in controls (P = 0.009). Multivariate regression analysis revealed that fatigue [(95% CI: -2.527 ∼ -1.701); P < 0.001], gender [(95% CI: -15.722 ∼ -4.670); P < 0.001], age [(95% CI: -0.711 ∼ -0.082); P = 0.014] and depression [(95% CI: 0.222 ∼ 1.963); P = 0.014] emerged as significant predictors of perceived cognitive impairment, explaining 54.5% of the total variance (P < 0.001).

Conclusions: Patients newly diagnosed with lung cancer exhibited a significant decrement in cognitive function compared to controls. Healthcare professionals ought to provide prompt attention and implement early rehabilitative interventions to prevent further cognitive decline subsequent to the initiation of systemic treatment.

Background: Elexacaftor/Tezacaftor/Ivacaftor (ETI) therapy is highly effective for people with cystic fibrosis (pwCF) carrying at least one F508del mutation. However, clinical trials often include a limited subset of eligible patients, with inclusion rates as low as 31%. Additionally, some adverse effects linked to ETI may stem from restored CFTR function (side effects) rather than drug toxicity (adverse effects). This study evaluates the real-world efficacy and tolerability of ETI in adults with CF, while differentiating side from adverse effects.

Methods: In this retrospective single-centre cohort study, 198 adults with CF (46.5% female) initiating ETI between January 2022 and April 2023 were analysed. Clinical data, laboratory results, and adverse events were collected. Subgroup-analyses were performed based on baseline ppFEV1 and genotype.

Results: ETI therapy increased mean ppFEV1 by 11.2% (95% CI: 9.7%, 12.7%) and BMI by 0.7 kg/m² (95% CI: 0.5, 0.9), decreased sweat chloride by 43.7 mmol/L (95% CI: 46.7, -40.6), and reduced yearly exacerbation rate (70 vs. 12, p < 0.001). Common side effects included increased sputum, cough, and headache. Headache was more frequent in patients with ppFEV1 <40% (p < 0.001). Increased sputum and cough were most prevalent in F/F and F/MF subgroups. Frequent adverse effects were fatigue, depressed state, and mood swings. Side effects resolved spontaneously more often than adverse effects (89.3% vs. 47.9%).

Conclusion: ETI demonstrates robust real-world efficacy in adults with CF. Side effects due to CFTR restoration are generally self-limiting, whereas adverse effects from drug toxicity persist longer and are more frequently cause for permanent discontinuation of ETI.

Background: By 2030, healthcare expenditures related to congestive heart failure (CHF) in the United States are projected to surpass $70 billion. Despite substantial advances in guideline-directed medical therapy, morbidity and mortality remain unacceptably high, particularly among patients with concomitant chronic obstructive pulmonary disease (COPD), a comorbidity reported in approximately 5%-41% of individuals with CHF. Although COPD is independently associated with worse CHF outcomes, its influence on the mortality benefit conferred by sodium-glucose cotransporter-2 (SGLT-2) inhibitors remains poorly defined.

Objective: To evaluate whether COPD alters the cardiovascular and mortality benefit of SGLT-2 inhibitors in CHF patients.

Methods: PubMed, Cochrane and Google Scholar were searched from inception to February 2025 to identify studies meeting inclusion criteria. Review Manager was employed to calculate results in the form of relative risk (RR) with 95% confidence interval.

Results: Our analysis of 15,058 patients (1725 (11%) COPD patients) showed that COPD was associated with significantly higher risks of composite outcomes (RR = 1.63; 95% CI: 1.49-1.79; p < 0.00001), CV mortality (RR = 1.62; 95% CI: 1.39-1.88; p < 0.0001), heart failure hospitalization (RR = 1.84; 95% CI: 1.40-2.40; p < 0.00001), and all-cause mortality (RR = 1.59; 95% CI: 1.42-1.78; p < 0.00001). Additionally, adverse outcomes were more frequent in COPD patients, including volume depletion (RR = 1.34; 95% CI: 1.25-1.51; p < 0.00001), and adverse renal events (RR = 1.46, 95% CI: 1.17-1.82; P = 0.0007).

Conclusion: Our analysis indicates that heart failure (HF) patients with COPD may drive a somewhat attenuated benefit from SGLT-2 inhibitors, underscoring a clinical profile that merits careful consideration.

Background: This study aimed to evaluate the utility of ultraportable ultrasound in predicting intradialytic hypotension (IDH) and early interruption of renal replacement therapy (RRT) due to hemodynamic instability, by assessing the inferior vena cava collapsibility index (IVCCi) and pulmonary B-lines (BL) in mechanically ventilated patients with acute kidney injury (AKI) undergoing RRT.

Methods: A total of 150 RRT sessions were evaluated in 72 mechanically ventilated patients with AKI. The IVCCi and BL were assessed at baseline (T0), 30 min (T30), and 60 min (T60) after initiation. Predictors of IDH and early session interruption were identified using generalized linear mixed models. Receiver operating characteristic (ROC) curve analysis was conducted to determine the predictive performance of the change in IVCCi between T0 and T30 (ΔIVCCi) and to identify a potential cutoff value.

Results: The IDH occurred in 57.3% of the sessions and early interruption occurred in 26%. Significant predictors of IDH included lower MAP at T0 (OR 0.92, p = 0.002), norepinephrine use (OR 2.67, p = 0.038), ΔIVCCi (OR 0.96, p = 0.031), and BL (OR 0.96, p = 0.007). Early interruption was associated with lower MAP at T0 (OR 0.93, p = 0.005), norepinephrine use (OR 11.04, p = 0.029), ΔIVCCi T30 (OR 0.94, p = 0.014), and BL T30 (OR 0.87, p = 0.034). ROC analysis for ΔIVCCi yielded an AUC of 0.601, with best cutoff of -9.315 (sensitivity, 87.5%; specificity, 65.1%).

Conclusions: IVCCi variation between T0 and T30 and pulmonary B-lines were predictive of IDH and early interruption of RRT in critically ill patients. The identified ΔIVCCi cutoff of -9.315 may serve as a practical tool for early risk stratification and timely adjustment of dialysis prescriptions within the first 30 min of therapy, potentially preventing hemodynamic instability and premature discontinuation.

Background: Adherence is an important factor contributing to the effectiveness of pulmonary rehabilitation (PR) in patients with chronic obstructive pulmonary disease (COPD). However, there appears to be a lack of reliable and validated measures to assess adherence in PR.

Objective: The purpose of this study was to systematically review and analyze existing PR adherence assessment tools, describe their application effects in different contexts, and explore the scientific validity and applicability of each assessment method.

Methods: MEDLINE, PubMed, Web of Science and other data sources were searched for target articles. To ensure all pertinent papers were included, reference lists from articles that met the inclusion criteria were reviewed. A combination of EndNote 21 software and manual screening of the literature was used for quality assessment, employing the JBI Critical Appraisal Checklist. Both researchers conducted the entire process independently, without interfering with each other.

Results: Three studies were included, reporting three tools in three different countries. The quality and validity of these three articles are high. Two of the tools were developed specifically for the COPD population, one tool was developed initially for athlete participant but used to assess the adherence of PR in patients with COPD.

Conclusion: The results show a gap in the literature for well-developed tools that capture adherence for PR of patients with COPD.

Background: To analyze the long-term trend and spatial distribution of lung cancer incidence in China, and to analyze the potential influences of major environmental and socioeconomic factors.

Methods: Collect the data on the incidence of lung cancer in China over the years from 2010 to 2018, as well as the annual reports of the Chinese Cancer Registry during the same period and the environmental and socio-economic data of each tumor surveillance site. The jointpoint technique was used to analyze the long-term trend of lung cancer incidence. SatScan technology was used to visualize the spatial distribution of lung cancer incidence. A spatial regression model was used to quantitatively analyze the potential association between lung cancer incidence and major environmental and socioeconomic factors.

Results: During 2010-2018, the incidence of lung cancer in China showed an increasing trend. The primary cluster area with high incidence is located in the eastern coastal area of China, with a radius of 283.09 km. The primary cluster area with low incidence is located in northwest China, with a radius of 767.09 km. The primary cluster with high mortality is also located in the eastern coastal areas of China, with a radius of 283.09 km. The primary cluster with low mortality is located in northwest China, with a radius of 828.12 km. PM_2.5, annual mean temperature, and population density were positively associated with the incidence of lung cancer in men, while annual mean air temperature and population density were positively correlated with the incidence of lung cancer in women. PM_2.5 and population density were positively associated with male lung cancer mortality, while total grain production and population density were positively correlated with female lung cancer mortality.

Conclusions: From 2010 to 2018, The incidence of lung cancer is increasing in all regions of China, with a particularly high incidence in the eastern coastal areas and a low incidence in the western and southern parts. PM2.5, average annual temperature, population density, and total grain production were significantly associated with the incidence of lung cancer.