Respiratory medicine最新文献_第3页

Hypoglossal nerve stimulation for obstructive sleep apnea in adults: An updated systematic review and meta-analysis 舌下神经刺激治疗成人阻塞性睡眠呼吸暂停：最新系统综述和荟萃分析

IF 3.5 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Respiratory medicine

Pub Date : 2024-10-12 DOI: 10.1016/j.rmed.2024.107826

Objectives

This study aims to evaluate the efficacy of Apnex, Inspire, and ImThera hypoglossal nerve stimulation (HGNS) devices in changing the severity of obstructive sleep apnea (OSA).

Method

ology: A systematic search was conducted across the databases to collect baseline and postoperative outcome measures. Articles were then filtered and data from post-filtration was extracted. The efficacy of each device was assessed individually, and the reported outcomes were analyzed at short-term (≤1 year) and long-term (>1 year) intervals.

Results

A total of 30 papers were included; 26 were single-arm studies encompassing 549 middle-aged overweight patients. Four RCTs included 273 participants. Results show that HGNS is an effective and safe treatment option. The Inspire device significantly improved, reducing the apnea-hypopnea index (AHI) by −20.14 events/h in the short term and −15.91 events/h in the long term. It also decreased the oxygen desaturation index (ODI) by −14.16 events/h (short term) and −12.95 events/h (long term). Patient-reported outcomes showed decreased Epworth Sleepiness Scale (ESS) scores by −5.02 (short term) and −4.90 (long term) and improved Functional Outcomes of Sleep Questionnaire (FOSQ) scores by 3.58 (short term) and 3.28 (long term). The Apnex and the ImThera devices featured similar improvements but to a lesser extent.

Conclusion

Hypoglossal nerve stimulation is a safe and effective treatment for patients with OSA, exhibiting high adherence and satisfaction rates. However, it is important to note the potential for refining selection criteria to include a wider spectrum of patients with OSA.

目的本研究旨在评估 Apnex、Inspire 和 ImThera 舌下神经刺激（HGNS）装置在改变阻塞性睡眠呼吸暂停（OSA）严重程度方面的疗效：在数据库中进行了系统搜索，以收集基线和术后结果指标。然后对文章进行过滤，提取过滤后的数据。结果：共纳入30篇论文；26篇为单臂研究，包括549名中年超重患者。四项研究纳入了 273 名参与者。结果表明，HGNS 是一种有效、安全的治疗方法。Inspire 装置有明显改善，在短期内将呼吸暂停-低通气指数（AHI）降低了-20.14 次/小时，在长期内降低了-15.91 次/小时。此外，氧饱和度指数（ODI）也降低了-14.16 次/小时（短期）和-12.95 次/小时（长期）。患者报告结果显示，埃普沃思嗜睡量表（ESS）评分降低了-5.02分（短期）和-4.90分（长期），睡眠功能结果问卷（FOSQ）评分提高了3.58分（短期）和3.28分（长期）。Apnex和ImThera装置也有类似的改善，但程度较轻。结论舌下神经刺激对OSA患者来说是一种安全有效的治疗方法，具有很高的依从性和满意度。然而，重要的是要注意改进选择标准，以纳入更多的 OSA 患者。

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引用次数: 0

Favorable impact of azithromycin on patients in the intensive care unit with coronavirus disease 2019: Insights from the first wave using a Japanese database 2019年阿奇霉素对重症监护病房冠状病毒疾病患者的有利影响：利用日本数据库开展的第一波研究的启示

IF 3.5 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Respiratory medicine

Pub Date : 2024-10-10 DOI: 10.1016/j.rmed.2024.107834

Background

Azithromycin has favorable effects on critical respiratory diseases owing to its antimicrobial and anti-inflammatory properties. During the early stages of the coronavirus disease 2019 (COVID-19) pandemic, azithromycin was frequently administered before specific treatments were developed. However, the efficacy of this treatment has not been verified. We retrospectively investigated the effects of its intravenous (IV) administration in patients with severe/critical COVID-19 using the National Administrative Database of Japan during the first wave (February–April 2020).

Methods

Patients were categorized based on whether they received IV azithromycin within three days of hospitalization. An overlap weighting method with estimated propensity scores was used to reduce bias.

Results

Among the 830 patients with severe/critical COVID-19, 148 (17.8 %) received azithromycin, and 682 (82.2 %) did not. After adjustment, the use of azithromycin was associated with a shorter duration of intensive care unit (ICU) management (−3.48 days, 95 % confidence interval [CI]: 4.59 to −2.38). However, other endpoints, including mortality rate, duration of mechanical ventilation, and duration of hospital stay, did not suggest any associations. Furthermore, of the 115 ICU patients, 27 (23.5 %) were treated with IV azithromycin and 88 (76.5 %) were not. After adjustment, azithromycin was associated with favorable outcomes, including reduced in-hospital mortality (odds ratio [OR], 0.45, 95 % CI: 0.22 to 0.92), 30-day mortality (OR, 0.46, 95 % CI: 0.22 to 0.94), and a shorter duration of ICU management (−2.94 days, 95 % CI: 5.15 to −0.73).

Conclusion

We verified that IV azithromycin was associated with favorable impact in patients with COVID-19 requiring ICU management.

背景阿奇霉素因其抗菌和抗炎特性而对危重呼吸道疾病具有良好的疗效。在 2019 年冠状病毒病（COVID-19）大流行的早期阶段，在开发出特定治疗方法之前，人们经常使用阿奇霉素。然而，这种治疗方法的疗效尚未得到验证。我们利用日本国家行政数据库对第一波（2020 年 2 月至 4 月）COVID-19 重症/危重患者静脉注射阿奇霉素的效果进行了回顾性调查。结果在830名重度/危重COVID-19患者中，148人（17.8%）接受了阿奇霉素治疗，682人（82.2%）未接受治疗。经调整后，使用阿奇霉素与重症监护室（ICU）管理时间缩短有关（-3.48 天，95% 置信区间 [CI]：4.59 至 -2.38）。然而，死亡率、机械通气时间和住院时间等其他终点指标并未显示出任何关联。此外，在115名重症监护室患者中，27人（23.5%）接受了阿奇霉素静脉注射治疗，88人（76.5%）未接受治疗。经调整后，阿奇霉素与有利的结果相关，包括降低院内死亡率（比值比 [OR]，0.45，95 % CI：0.22 至 0.92）、30 天死亡率（比值比，0.46，95 % CI：0.22 至 0.94）和缩短 ICU 管理时间（-2.94 天，95 % CI：5.15 至 -0.73）。

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引用次数: 0

Impaired diffusing capacity and COPD incidence in adults with symptoms and normal spirometry 有症状但肺活量正常的成年人弥散能力受损与慢性阻塞性肺病发病率。

IF 3.5 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Respiratory medicine

Pub Date : 2024-10-09 DOI: 10.1016/j.rmed.2024.107832

Background

Impaired diffusing capacity of the lung (DLCO) in the absence of post-bronchodilator (BD) airflow obstruction has been proposed as a marker of ‘Pre-COPD’. However, the relationship between impaired DLCO and subsequent lung function decline and COPD incidence has not been examined in-depth.

Methods

We conducted an observational study of adults aged between 40 and 70 years who were evaluated at a multi-centre lung function laboratory in Australia between 2014 and 2024. Adults referred with respiratory symptoms or a clinical suspicion of obstructive airways disease with follow-up spirometry obtained ≥12 months after the initial assessment were included. The relationship between impaired DLCO and subsequent lung function decline and COPD incidence was assessed among those with normal spirometry at baseline.

Results

A total of 266 patients with a mean age of 53.2 (SD 12.8) years were evaluated after a median follow-up of 2.3 [IQR 1.5 to 3.3] years. We found no evidence of an association between impaired DLCO (below the lower limit of normal) and annualised rate of decline in post-BD FEV₁ (MD -0.1 % predicted per-year, 95%CI -1.3 to 1.2), FVC (−0.4 % predicted, 95%CI -1.6 to 0.8) or FEV₁/FVC (−0.1 % per-year, 95%CI -0.1 to 0.1). The sensitivity of impaired DLCO for COPD incidence was 40 %, and specificity 82 %. Findings were similar in sub-samples limited to current and former smokers, and when impaired DLCO was defined as < 80 % predicted.

Conclusion

Impaired DLCO was not an effective discriminator of lung function decline or COPD incidence in this real-world cohort.

背景：有人提出，在没有支气管扩张剂（BD）后气流阻塞的情况下，肺弥散容量（DLCO）受损是 "慢性阻塞性肺病前期 "的标志。然而，DLCO受损与随后的肺功能下降和慢性阻塞性肺病发病率之间的关系尚未得到深入研究：我们对 2014 年至 2024 年期间在澳大利亚一家多中心肺功能实验室接受评估的 40 岁至 70 岁的成年人进行了一项观察性研究。研究纳入了有呼吸道症状或临床怀疑患有阻塞性气道疾病，并在初次评估后≥12个月进行了肺活量随访的成年人。在基线肺活量正常的患者中，评估了DLCO受损与随后肺功能下降和慢性阻塞性肺病发病率之间的关系：中位随访 2.3 [IQR 1.5 至 3.3] 年后，共对 266 名平均年龄为 53.2 (SD 12.8) 岁的患者进行了评估。我们没有发现证据表明 DLCO 受损（低于正常下限）与 BD 后 FEV1（MD -0.1% 预测值/年，95%CI -1.3-1.2）、FVC（-0.4% 预测值/年，95%CI -1.6-0.8）或 FEV1/FVC （-0.1%预测值/年，95%CI -0.1-0.1）的年下降率之间存在关联。DLCO受损对慢性阻塞性肺病发病率的敏感性为40%，特异性为82%。在仅限于当前吸烟者和曾经吸烟者的子样本中，以及在将DLCO受损定义为预测值<80%时，结果相似：结论：在这个真实世界的队列中，受损的 DLCO 并不是肺功能下降或慢性阻塞性肺病发病率的有效判别指标。

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引用次数: 0

Appraisal and evaluation of the quality of life in pulmonary arterial hypertension instruments: A systematic review using COSMIN methodology 肺动脉高压生活质量的评估和评价工具：使用 COSMIN 方法的系统回顾。

IF 3.5 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Respiratory medicine

Pub Date : 2024-10-06 DOI: 10.1016/j.rmed.2024.107829

Aim

The aim of this review was to identify specific instruments currently available for measuring quality of life in patients with pulmonary arterial hypertension (PAH) and to evaluate their psychometric properties in order to provide robust evidence for their application in clinical practice.

Background

Pulmonary arterial hypertension is a rare pulmonary vascular disorder predominantly affecting women aged 30–50 years. It leads to elevated pulmonary artery pressure, causing increased cardiac workload. Symptoms such as dyspnea and fatigue progressively deteriorate. Given the substantial impact on patient well-being, quality of life assessment is a critical concern. Generic quality of life measures often fail to capture the unique challenges associated with PAH. Therefore, identifying a PAH-specific quality of life instrument is essential for optimising patient management.

Design

A systematic literature review.

Methods

A systematic review was performed to assess the psychometric properties of quality of life instruments for PAH patients, following the 2018 Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) guidelines. The literature search was conducted across Pubmed, Scopus, CINAHL, EMBASE, and APA PsycINFO databases.

Results

This review included four quality of life instruments: CAMPHOR, LPHQ, emPHasis-10, and PAH-SYMPACT. CAMPHOR and PAH-SYMPACT received a GRADE A rating, while LPHQ and emPHasis-10 were rated GRADE B. Despite some sample size limitations, these instruments demonstrated varying degrees of internal reliability, validity, and content coverage for assessing quality of life in pulmonary arterial hypertension patients.

Conclusions

This review provides an overview of available tools for assessing quality of life in patients with pulmonary arterial hypertension. Critical evaluation of these tools highlights incomplete psychometric assessments and methodological limitations in reference studies. Future research should prioritise more rigorous methodologies to ensure comprehensive psychometric evaluations.

目的：本综述旨在确定目前可用于测量肺动脉高压（PAH）患者生活质量的特定工具，并评估其心理测量特性，从而为其在临床实践中的应用提供有力证据：背景：肺动脉高压是一种罕见的肺血管疾病，主要影响 30-50 岁的女性。它导致肺动脉压力升高，增加了心脏的工作负荷。呼吸困难和疲劳等症状会逐渐恶化。鉴于对患者福祉的重大影响，生活质量评估是一个关键问题。通用的生活质量衡量标准往往无法捕捉到 PAH 所带来的独特挑战。因此，确定 PAH 专用的生活质量工具对于优化患者管理至关重要：设计：系统性文献综述：根据 2018 年基于共识的健康测量工具选择标准（COSMIN）指南，对 PAH 患者生活质量工具的心理测量特性进行了系统性回顾评估。文献检索在 Pubmed、Scopus、CINAHL、EMBASE 和 APA PsycINFO 数据库中进行：结果：本综述包括四种生活质量工具：CAMPHOR、LPHQ、emPHasis-10 和 PAH-SYMPACT。CAMPHOR和PAH-SYMPACT被评为A级，LPHQ和emPHasis-10被评为B级。尽管存在一些样本量的限制，但这些工具在评估肺动脉高压患者生活质量方面表现出了不同程度的内部可靠性、有效性和内容覆盖性：本综述概述了现有的肺动脉高压患者生活质量评估工具。对这些工具的严格评估强调了参考研究中不完整的心理计量评估和方法上的局限性。未来的研究应优先采用更严格的方法，以确保心理计量评估的全面性：在提交论文时，请在标题页上注明 TWEETABLE ABSTRACT：可选择附加 140 个字符的信息，并可 "推送"。

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引用次数: 0

Hyperpolarized 129Xe MRI and spectroscopy of gas exchange abnormalities in chronic hypersensitivity pneumonitis 超极化 129Xe 磁共振成像和慢性超敏性肺炎气体交换异常光谱。

IF 3.5 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Respiratory medicine

Pub Date : 2024-10-05 DOI: 10.1016/j.rmed.2024.107827

Purpose

To evaluate 3D gas-exchange functional imaging characteristics using ¹²⁹Xe MRI in a group of study participants with chronic hypersensitivity pneumonitis (CHP) as compared with healthy control participants.

Methods

In this prospective study, 11 participants with clinical and CT findings of CHP (4M 7F, mean age 67 ± 6.1 years) as well as 41 healthy subjects (25M 16F, mean age 44 ± 18 years) were enrolled between 2017 and 2022 and underwent ¹²⁹Xe MRI. Three-dimensional images of ventilation, interstitial membrane uptake, and RBC transfer were rendered into quantitative 3D maps relative to a healthy reference cohort. In addition, ¹²⁹Xe spectroscopy was used to assess the RBC:membrane ratio (RBC:M), the oxygen-dependent RBC chemical shift, and cardiogenically-driven RBC oscillation amplitude. Differences between the CHP participants and healthy subjects were assessed using the two-sample t-test or Wilcoxon rank-sum test as appropriate.

Results

CHP participants demonstrated significant differences in 6 parameters (p < 0.001) including regions of reduced ventilation, increased membrane uptake, and reduced RBC transfer as compared to healthy subjects. Gas exchange abnormalities measured on spectroscopy included a reduced RBC:M, reduced RBC chemical shift, and increased RBC oscillation amplitude.

Conclusion

In participants with CHP, ¹²⁹Xe MRI demonstrated gas exchange abnormalities common to other fibrotic lung diseases including increased membrane uptake, deficits in RBC transfer, and reduced RBC:M. However, CHP participants also exhibited prominent ventilation abnormalities, which may be reflective of the airway-centric nature of the disease. Further, the high variability observed in the membrane uptake could suggest varying degrees of disease progression or activity.

目的：使用 129Xe MRI 评估一组慢性超敏性肺炎（CHP）患者与健康对照组患者的三维气体交换功能成像特征：在这项前瞻性研究中，2017 年至 2022 年期间，11 名临床和 CT 检查结果为 CHP 的参与者（4 名男性 7 名女性，平均年龄为 67 ± 6.1 岁）以及 41 名健康受试者（25 名男性 16 名女性，平均年龄为 44 ± 18 岁）接受了 129Xe MRI 检查。相对于健康参考队列，通气、间质膜摄取和红细胞转移的三维图像被渲染成定量三维图。此外，129Xe 光谱法还用于评估红细胞与膜的比率（RBC:M）、氧依赖性红细胞化学位移和心源性红细胞振荡幅度。采用双样本 t 检验或 Wilcoxon 秩和检验评估慢性阻塞性肺病患者与健康人之间的差异：结果：CHP 参与者在 6 个参数上表现出显著差异（p 结论：CHP 参与者在 6 个参数上表现出显著差异（p）：在 CHP 参与者中，129Xe MRI 显示了其他肺纤维化疾病常见的气体交换异常，包括膜摄取增加、RBC 转移缺陷和 RBC:M 降低。不过，CHP 患者也表现出明显的通气异常，这可能反映了该疾病以气道为中心的性质。此外，膜摄取量的高度可变性可能表明疾病的进展或活动程度各不相同。

{"title":"Hyperpolarized 129Xe MRI and spectroscopy of gas exchange abnormalities in chronic hypersensitivity pneumonitis","authors":"","doi":"10.1016/j.rmed.2024.107827","DOIUrl":"10.1016/j.rmed.2024.107827","url":null,"abstract":"<div><h3>Purpose</h3><div>To evaluate 3D gas-exchange functional imaging characteristics using <sup>129</sup>Xe MRI in a group of study participants with chronic hypersensitivity pneumonitis (CHP) as compared with healthy control participants.</div></div><div><h3>Methods</h3><div>In this prospective study, 11 participants with clinical and CT findings of CHP (4M 7F, mean age 67 ± 6.1 years) as well as 41 healthy subjects (25M 16F, mean age 44 ± 18 years) were enrolled between 2017 and 2022 and underwent <sup>129</sup>Xe MRI. Three-dimensional images of ventilation, interstitial membrane uptake, and RBC transfer were rendered into quantitative 3D maps relative to a healthy reference cohort. In addition, <sup>129</sup>Xe spectroscopy was used to assess the RBC:membrane ratio (RBC:M), the oxygen-dependent RBC chemical shift, and cardiogenically-driven RBC oscillation amplitude. Differences between the CHP participants and healthy subjects were assessed using the two-sample <em>t</em>-test or Wilcoxon rank-sum test as appropriate.</div></div><div><h3>Results</h3><div>CHP participants demonstrated significant differences in 6 parameters (p < 0.001) including regions of reduced ventilation, increased membrane uptake, and reduced RBC transfer as compared to healthy subjects. Gas exchange abnormalities measured on spectroscopy included a reduced RBC:M, reduced RBC chemical shift, and increased RBC oscillation amplitude.</div></div><div><h3>Conclusion</h3><div>In participants with CHP, <sup>129</sup>Xe MRI demonstrated gas exchange abnormalities common to other fibrotic lung diseases including increased membrane uptake, deficits in RBC transfer, and reduced RBC:M. However, CHP participants also exhibited prominent ventilation abnormalities, which may be reflective of the airway-centric nature of the disease. Further, the high variability observed in the membrane uptake could suggest varying degrees of disease progression or activity.</div></div>","PeriodicalId":21057,"journal":{"name":"Respiratory medicine","volume":null,"pages":null},"PeriodicalIF":3.5,"publicationDate":"2024-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142392890","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Activities of daily living limitation and functional decline during hospitalization predict 180-day readmission and mortality in older patients with pneumonia: A single-center, retrospective cohort study 住院期间日常生活活动受限和功能下降可预测老年肺炎患者 180 天后的再次入院和死亡率：单中心回顾性队列研究。

IF 3.5 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Respiratory medicine

Pub Date : 2024-10-04 DOI: 10.1016/j.rmed.2024.107830

Background

The role of activities of daily living (ADL) as a predictor of adverse outcomes in patients with pneumonia is unclear. This study aimed to assess the association between ADL, including physical and cognitive function, and death or readmission in older inpatients with pneumonia.

Methods

This retrospective, single-center, observational study included consecutive older inpatients with pneumonia between October 2018 and December 2019. ADL was assessed using the Functional Independence Measure (FIM). Functional decline during hospitalization was defined as a decrease of at least 1 point in FIM at discharge from admission. The primary outcome was the time to composite 180-day mortality and readmission from any cause after discharge.

Results

In total, 363 patients (median [interquartile range] age: 80 [73–86] years, male: 68 %) were divided according to the median FIM scores (≥100, n = 183 and < 100, n = 180). Among the patients, 25 experienced functional decline during hospitalization, 69 were readmitted, and 17 died. In the Kaplan–Meier analysis, both the lower FIM group and the functional decline group had significantly lower event-free rates than the higher FIM groups and the non-functional decline groups (log-rank test, p < 0.001), respectively. After multivariate analysis, both the lower FIM (adjusted HR, 2.11; 95 % CI, 1.24–3.58; p = 0.006) and functional decline (adjusted HR, 3.18; 95 % CI, 1.44–7.05; p = 0.005) were significantly associated with the primary outcome.

Conclusions

In older patients hospitalized with pneumonia, ADL limitations at discharge and a decline in ADL were associated with poor outcomes.

背景：日常生活活动（ADL）对肺炎患者不良预后的预测作用尚不明确。本研究旨在评估日常生活活动（包括身体和认知功能）与老年肺炎住院患者的死亡或再入院之间的关系：这项回顾性、单中心、观察性研究纳入了2018年10月至2019年12月期间连续住院的老年肺炎患者。使用功能独立性测量（FIM）评估ADL。住院期间的功能下降定义为入院出院时 FIM 下降至少 1 分。主要研究结果为出院后 180 天综合死亡率和因任何原因再次入院的时间：共有 363 名患者（中位数[四分位数间距]年龄：80 [73-86] 岁，男性：68%）根据 FIM 中位数得分进行了划分（≥100 分，183 人；<100 分，180 人）。其中，25 名患者在住院期间出现功能衰退，69 名患者再次入院，17 名患者死亡。在 Kaplan-Meier 分析中，FIM 值较低组和功能衰退组的无事件发生率均显著低于 FIM 值较高组和非功能衰退组（对数秩检验，P < 0.001）。经过多变量分析，FIM较低组（调整后HR，2.11；95% CI，1.24-3.58；p = 0.006）和功能衰退组（调整后HR，3.18；95% CI，1.44-7.05；p = 0.005）与主要结局显著相关：结论：在因肺炎住院的老年患者中，出院时ADL受限和ADL下降与不良预后有关。

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引用次数: 0

The impact of the COVID-19 pandemic on RSV outbreaks in children: A multicenter study from China COVID-19 大流行对儿童 RSV 爆发的影响：中国多中心研究

IF 3.5 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Respiratory medicine

Pub Date : 2024-10-03 DOI: 10.1016/j.rmed.2024.107828

Objective

The aim of the study is to describe the season of RSV prevalence in China during the COVID-19 pandemic.

Methods

This multicenter retrospective study analyzed the epidemiology of pediatric RSV infections and the possible factors contributing to its variations in China from January 1, 2019, to October 31, 2022.

Results

A total of 872,565 children were included. During the pandemic, RSV detection rate increased across various regions, including South China, East China, Central China, and Northeast China. From 2019 to 2021, the detection rates of RSV showed an increasing trend among children aged <1 year, 1–2 years, and 3–5 years, but decreased in 2022. Among those tested positive for RSV, the proportion of children under 1 year old significantly decreased during the pandemic. The spring season of RSV in China in 2020 was shortened, and most regions experienced a summer season of RSV in 2021. This shift led to a year-round RSV outbreak throughout 2021. After April 2022, RSV positive rate significantly decreased, and no clear seasonal pattern was observed.

Conclusion

Our study found that the COVID-19 pandemic has disrupted the seasonal pattern of RSV outbreaks in China, leading to increased RSV positive rate and off-season outbreaks.

研究目的本研究旨在描述COVID-19大流行期间中国RSV流行季节：这项多中心回顾性研究分析了2019年1月1日至2022年10月31日期间中国小儿RSV感染的流行病学及其可能的变化因素：研究共纳入872565名儿童。大流行期间，华南、华东、华中、东北等不同地区的RSV检出率均有所上升。从2019年到2021年，RSV的检出率在育龄期儿童中呈上升趋势：我们的研究发现，COVID-19 大流行扰乱了中国 RSV 爆发的季节性模式，导致 RSV 阳性率上升和淡季爆发。

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引用次数: 0

Severe community-acquired pneumonia at a tertiary academic hospital in Johannesburg, South Africa 南非约翰内斯堡一家三级学术医院的重症社区获得性肺炎。

IF 3.5 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Respiratory medicine

Pub Date : 2024-10-02 DOI: 10.1016/j.rmed.2024.107823

Purpose

There is a paucity of data from sub-Saharan Africa describing Severe Community Acquired Pneumonia (SCAP), a condition with significant morbidity and mortality.

Materials and methods

This was a retrospective, single-centre, observational study of consecutive patients with SCAP admitted to the ICU at Charlotte Maxeke Johannesburg Academic Hospital, in South Africa between 1 July 2007 and 31 May 2019. Pneumonia was categorised as community-acquired if there had been no hospitalization in the preceding 2 weeks.

Results

We identified 931 patients, (median age 37 [IQR 30–48] years), with the predominant co-morbidity being HIV co-infection (77.1 %). The median CURB-65 and APACHE II scores were 3 (IQR 2–3) and 18 (IQR 14–23) respectively, and most patients had multilobar consolidation on chest X-ray. Mycobacterium tuberculosis was the most common aetiology, followed by Streptococcus pneumoniae. The latter, and Pneumocystis jirovecii were more common amongst survivors and non-survivors, respectively. ICU mortality was 50.1 % and 85 % of patients required ventilation, mostly invasive mechanical ventilation. Ventilated patients and those requiring inotropic support and/or dialysis were more likely to die.

Conclusion

We have described a cohort of patients with SCAP, with a comprehensive overview of all putative microbiological causes, which to our knowledge, is the largest reported in the literature.

目的：撒哈拉以南非洲地区关于严重社区获得性肺炎（SCAP）的数据极少，而这种疾病的发病率和死亡率都很高：这是一项回顾性、单中心、观察性研究，研究对象是2007年7月1日至2019年5月31日期间入住南非约翰内斯堡夏洛特-马克塞克学术医院重症监护室的连续重症社区获得性肺炎患者。如果前两周没有住院治疗，则将肺炎归类为社区获得性肺炎：我们确定了 931 名患者（中位年龄为 37 [IQR 30-48] 岁），主要合并疾病为艾滋病病毒感染（77.1%）。CURB-65和APACHE II评分的中位数分别为3（IQR 2-3）和18（IQR 14-23），大多数患者的胸部X光片上都有多叶状的合并症。结核分枝杆菌是最常见的病原体，其次是肺炎链球菌。后者和肺孢子菌分别在幸存者和非幸存者中更为常见。重症监护室的死亡率为 50.1%，85% 的患者需要通气，其中大部分是侵入性机械通气。通气患者和需要肌力支持和/或透析的患者更容易死亡：我们描述了一组 SCAP 患者，全面概述了所有可能的微生物病因，据我们所知，这是文献报道中规模最大的一组患者。

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引用次数: 0

Metabolomic signature identifies HDL and apolipoproteins as potential biomarker for systemic sclerosis with interstitial lung disease 代谢组特征确定高密度脂蛋白和脂蛋白是系统性硬化症伴间质性肺病的潜在生物标志物。

IF 3.5 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Respiratory medicine

Pub Date : 2024-09-30 DOI: 10.1016/j.rmed.2024.107825

Background

High-density lipoproteins (HDL) affect endothelial functions such as the expression of endothelial cell adhesion molecules and exert anti-apoptotic/-thrombotic functionalities. Therefore, profound analysis of lipoproteins may unveil biomarkers for (micro-)vasculopathy in systemic sclerosis (SSc) and mortality determining disease manifestations like interstitial lung disease (SSc-ILD). Because nuclear magnetic resonance (NMR) spectroscopy provides a wide range of lipoprotein parameters beyond the capabilities of classical analyses it has been used herein to examine lipoprotein profiles in SSc.

Methods

To detect the metabolic and lipidomic profile serum samples from clinically well-characterized SSc patients (n = 100) and age-and sex-matched healthy controls (n = 40) were analyzed by 1H NMR spectroscopy using Bruker's in-vitro diagnostic research (IVDr) protocol. Statistical analyses were performed to validate significant findings and to search for associations between lipoproteins and clinical phenotypes.

Results

Patients with SSc-ILD and lung fibrosis displayed reduced HDL levels. Furthermore, a reduction in apolipoprotein A1 + A2 and its HDL fractions reflected a distinct lipoprotein profile for SSc-ILD patients. This association was independent of potential clinical confounders for dyslipidemia. Notably, in SSc-ILD HDL levels correlate with FVC (forced vital capacity), DLCO (diffusion capacity of the lungs for carbon monoxide), and the modified Rodnan-Skin-Score.

Conclusion

These results suggest HDL and its lipoproteins may be considered as potential new biomarkers for SSc-ILD. Immune-mediated HDL effects on the endothelium facilitate microvasculopathy - one of the pathophysiological hallmarks in SSc. Therefore, a closer prospective evaluation of the capability of HDL-determination and its lipoproteins regarding a more individualized evaluation of SSc-ILD is warranted.

背景：高密度脂蛋白（HDL）会影响内皮功能，如内皮细胞粘附分子的表达，并具有抗凋亡/抗血栓功能。因此，对脂蛋白的深入分析可能会揭示系统性硬化症（SSc）（微）血管病变的生物标志物，以及决定间质性肺病（SSc-ILD）等疾病表现的死亡率。由于核磁共振（NMR）光谱可提供广泛的脂蛋白参数，超出了传统分析的能力范围，因此本文使用它来检测系统性硬化症的脂蛋白谱：为了检测代谢和脂质体概况，我们使用布鲁克公司的体外诊断研究 (IVDr) 方案，通过 1H-NMR 光谱分析了临床特征良好的 SSc 患者（100 人）和年龄性别匹配的健康对照组（40 人）的血清样本。进行统计分析以验证重大发现，并寻找脂蛋白与临床表型之间的关联：结果：SSc-ILD 和肺纤维化患者的高密度脂蛋白水平降低。此外，载脂蛋白 A1 + A2 及其高密度脂蛋白部分的减少反映了 SSc-ILD 患者独特的脂蛋白谱。这种关联与血脂异常的潜在临床混杂因素无关。值得注意的是，SSc-ILD 患者的高密度脂蛋白水平与 FVC（强迫生命容量）、DLCO（肺部对一氧化碳的弥散能力）和改良罗德南皮肤评分相关：这些结果表明，高密度脂蛋白及其脂蛋白可被视为治疗 SSc-ILD 的潜在新生物标记物。免疫介导的高密度脂蛋白对内皮的影响促进了微血管病变--这是 SSc 的病理生理特征之一。因此，有必要对高密度脂蛋白测定及其脂蛋白的能力进行更密切的前瞻性评估，以便对 SSc-ILD 进行更个体化的评估。

{"title":"Metabolomic signature identifies HDL and apolipoproteins as potential biomarker for systemic sclerosis with interstitial lung disease","authors":"","doi":"10.1016/j.rmed.2024.107825","DOIUrl":"10.1016/j.rmed.2024.107825","url":null,"abstract":"<div><h3>Background</h3><div>High-density lipoproteins (HDL) affect endothelial functions such as the expression of endothelial cell adhesion molecules and exert anti-apoptotic/-thrombotic functionalities. Therefore, profound analysis of lipoproteins may unveil biomarkers for (micro-)vasculopathy in systemic sclerosis (SSc) and mortality determining disease manifestations like interstitial lung disease (SSc-ILD). Because nuclear magnetic resonance (NMR) spectroscopy provides a wide range of lipoprotein parameters beyond the capabilities of classical analyses it has been used herein to examine lipoprotein profiles in SSc.</div></div><div><h3>Methods</h3><div>To detect the metabolic and lipidomic profile serum samples from clinically well-characterized SSc patients (n = 100) and age-and sex-matched healthy controls (n = 40) were analyzed by 1H NMR spectroscopy using Bruker's in-vitro diagnostic research (IVDr) protocol. Statistical analyses were performed to validate significant findings and to search for associations between lipoproteins and clinical phenotypes.</div></div><div><h3>Results</h3><div>Patients with SSc-ILD and lung fibrosis displayed reduced HDL levels. Furthermore, a reduction in apolipoprotein A1 + A2 and its HDL fractions reflected a distinct lipoprotein profile for SSc-ILD patients. This association was independent of potential clinical confounders for dyslipidemia. Notably, in SSc-ILD HDL levels correlate with FVC (forced vital capacity), DLCO (diffusion capacity of the lungs for carbon monoxide), and the modified Rodnan-Skin-Score.</div></div><div><h3>Conclusion</h3><div>These results suggest HDL and its lipoproteins may be considered as potential new biomarkers for SSc-ILD. Immune-mediated HDL effects on the endothelium facilitate microvasculopathy - one of the pathophysiological hallmarks in SSc. Therefore, a closer prospective evaluation of the capability of HDL-determination and its lipoproteins regarding a more individualized evaluation of SSc-ILD is warranted.</div></div>","PeriodicalId":21057,"journal":{"name":"Respiratory medicine","volume":null,"pages":null},"PeriodicalIF":3.5,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142366374","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Variability in chest radiology interpretation between thoracic and non-thoracic radiologists: Implications for pulmonary fibrosis care 胸部放射医师和非胸部放射医师在胸部放射学解释上的差异：对肺纤维化治疗的影响。

IF 3.5 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Respiratory medicine

Pub Date : 2024-09-30 DOI: 10.1016/j.rmed.2024.107824

引用次数: 0