Respiratory medicine最新文献_第3页

Obesity and impaired muscle function in severe asthma: a cross sectional study 肥胖和严重哮喘患者肌肉功能受损：一项横断面研究。

IF 3.1 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Respiratory medicine

Pub Date : 2026-03-01 Epub Date: 2026-02-05 DOI: 10.1016/j.rmed.2026.108698

Ariele Pedroso , Joice M. Oliveira , Vanessa L. Clark , Rebecca F. McLoughlin , Karina C. Furlanetto , Peter G. Gibson , Vanessa M. McDonald

Aims

To compare physical, functional and inflammatory characteristics between adults with severe asthma and controls with and without obesity, and to evaluate factors associated with sarcopenia and muscle quality.

Methods

This cross-sectional study included four groups: adults with severe asthma and controls (without respiratory diseases), stratified by the presence or absence of obesity. Assessments included lung function, asthma outcomes, clinical variables, body composition, sarcopenia, muscle quality index (MQI), muscle function and strength, 6-min walk distance (6MWD), and inflammatory markers.

Results

A total of 233 participants were included (140 with severe asthma, 93 controls). The group with obesity and severe asthma showed worse core function, limb strength, MQI and 6MWD, compared to the other groups (P < 0.0001 for all). No significant differences were observed in lean mass (P = 0.123) or in the prevalence of sarcopenia (P = 0.291) between groups. Inflammatory markers were elevated in asthma, regardless of obesity. A multiple linear regression model including age, sex, asthma, fat mass, lower limb strength and 6MWD explained 43.3% of the variability in appendicular skeletal muscle mass index (ASMMI).

Conclusion

Obesity plays a key role in muscle dysfunction on core, upper, and lower limb muscle groups. This reinforces the need for integrated clinical approaches addressing both asthma and obesity.

目的：比较成人严重哮喘患者和有或没有肥胖的对照组的身体、功能和炎症特征，并评估与肌肉减少症和肌肉质量相关的因素。方法：这项横断面研究包括四组：患有严重哮喘的成年人和对照组（无呼吸系统疾病），按是否存在肥胖进行分层。评估包括肺功能、哮喘结局、临床变量、身体组成、肌肉减少症、肌肉质量指数（MQI）、肌肉功能和力量、6分钟步行距离（6MWD）和炎症标志物。结果：共纳入233名参与者（140名重度哮喘患者，93名对照组）。肥胖合并重度哮喘组核心功能、肢体力量、MQI和6MWD均较其他组差(p)。结论：肥胖在核心肌群、上肢肌群和下肢肌群的肌肉功能障碍中起关键作用。这加强了对综合临床方法解决哮喘和肥胖的需求。

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引用次数: 0

RNA-seq analysis of nintedanib effects on interstitial pneumonia in preoperative NSCLC patients 尼达尼布治疗NSCLC术前间质性肺炎的RNA-Seq分析

IF 3.1 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Respiratory medicine

Pub Date : 2026-03-01 Epub Date: 2026-02-05 DOI: 10.1016/j.rmed.2026.108704

Hiroaki Kuroda , Katsuhiro Masago , Katsutoshi Seto , Yoshitsugu Horio , Eiichi Sasaki , Shiro Fujita , Hirokazu Matsushita

Background

Lung cancer patients with interstitial pneumonia (IP) have limited treatment options due to the risks associated with therapeutic intervention. The underlying causes of IP in these patients are diverse, and there is currently no detailed molecular pathological classification or an established understanding of the effectiveness of anti-fibrotic medications such as nintedanib. This study aimed to elucidate the mechanism of action of nintedanib by analyzing differential RNA expression between normal and fibrotic lung tissues from lung cancer patients with IP.

Methods

RNA was analyzed from the non-tumor lung tissue of 7 patients with IP who received nintedanib before surgery. Non-tumor lung tissue was obtained from 12 lung cancer patients without IP complications who underwent radical surgery between 2017 and 2022 from the tissue bank of our institution. Fibrotic lung tissue from six IP patients who received nintedanib before surgery and 7 who did not (where RNA analysis was possible). Gene expression and microenvironmental analyses were performed using RNA sequencing data.

Results

Nintedanib modulated inflammation in non-tumor lung tissue, suppressing PLA2G2D and upregulating CST2 and MMP11, suggesting minimal impact on normal tissue and a favorable safety profile. In fibrotic lung lesions, nintedanib suppressed MUC6, ITLN1, and AREG expression. xCell2 analysis indicated reduced plasma cells and increased smooth muscle, muscle, adipocyte, and endothelial cells, suggesting normalization of tissue remodeling.

Interpritation

Nintedanib appears to exert anti-inflammatory effects and promote tissue repair in non-tumor lung, while facilitating tissue remodeling in fibrotic areas, indicating potential benefits in patients with interstitial pneumonia and lung cancer.

背景：肺癌间质性肺炎（IP）患者由于治疗干预相关的风险，治疗选择有限。这些患者发生IP的潜在原因是多种多样的，目前还没有详细的分子病理分类，也没有对抗纤维化药物如尼达尼布的有效性有明确的认识。本研究旨在通过分析肺癌IP患者正常肺组织和纤维化肺组织中RNA的差异表达，阐明尼达尼布的作用机制。方法：对7例术前接受尼达尼布治疗的IP患者的非肿瘤肺组织进行RNA分析。非肿瘤肺组织来源于我院组织库2017 - 2022年间行根治性手术的12例无IP并发症的肺癌患者。术前接受尼达尼布治疗的6名IP患者和未接受尼达尼布治疗的7名IP患者的纤维化肺组织（RNA分析是可能的）。利用RNA测序数据进行基因表达和微环境分析。结果：尼达尼布可调节非肿瘤肺组织的炎症，抑制PLA2G2D，上调CST2和MMP11，表明对正常组织的影响最小，具有良好的安全性。在纤维化肺病变中，尼达尼布抑制MUC6、ITLN1和AREG的表达。xCell2分析显示浆细胞减少，平滑肌、肌肉、脂肪细胞和内皮细胞增加，表明组织重塑正常化。解释：尼达尼布似乎在非肿瘤肺中发挥抗炎作用，促进组织修复，同时促进纤维化区域的组织重塑，表明对间质性肺炎和肺癌患者有潜在的益处。

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引用次数: 0

Feasibility of tracking mental health in cystic fibrosis registries: lessons from current practice 在囊性纤维化登记中跟踪精神健康的可行性：来自当前实践的教训。

IF 3.1 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Respiratory medicine

Pub Date : 2026-03-01 Epub Date: 2026-02-12 DOI: 10.1016/j.rmed.2026.108703

Anna M. Georgiopoulos , Alexandra L. Quittner , Michael S. Schechter , Jianghua He , Nivedita Chaudhary , Riley C. Merowitz , Ruobin Wei , Edward R. Canda , Katie Kirby , Laura Tillman , Cathy T. Price , Beth A. Smith

Background

Patient registries are central to improving cystic fibrosis (CF) treatment and outcomes. Although mental health (MH) is a top research priority, MH data in the CF Foundation Patient Registry (CFFPR) is limited. We aimed to inform the feasibility of including additional MH variables in CF registries such as the CFFPR.

Methods

We conducted a cross-sectional healthcare provider survey (N = 100; March-April 2023) regarding current practices in MH screening and data tracking at US CF programs. We then purposively sampled survey respondents to participate in a focus group and post-survey (N = 11; September 2024).

Results

Nearly all programs screened adolescents and adults for anxiety/depression with GAD-7/PHQ-9 and 95% systematically tracked MH data (e.g., in database, spreadsheet, electronic medical records). Respondents with >5 years of CF experience were more likely to track total and item-level GAD-7/PHQ-9 scores; there were no differences by region or program size. Over 80% screened using paper. Half screened for MH side effects of modulators; 16% screened for MH conditions beyond anxiety/depression. Few (27%) pediatric programs screened children <12 years. Focus group participants endorsed adding new variables to the CFFPR, identifying barriers, facilitators and resource needs.

Conclusions

CF programs are successfully screening and tracking GAD-7/PHQ-9 scores, supporting feasibility of including these data in patient registries. Further work to increase electronic screening and to recommend screening measures for children <12 and for other MH conditions is needed. Expanding the scope of mental health data collection will enable CF registries to support longitudinal CF mental health research that addresses identified priorities.

背景：患者登记是改善囊性纤维化（CF）治疗和预后的核心。虽然精神健康（MH）是一个最重要的研究重点，但CF基金会患者登记处（cfpr）的MH数据有限。我们的目的是告知在CF注册表（如cfpr）中包括其他MH变量的可行性。方法：我们进行了一项横断面医疗保健提供者调查（N=100； 2023年3月至4月），涉及美国CF项目中MH筛查和数据跟踪的当前做法。然后，我们在2024年9月有目的地抽样调查对象参加焦点小组和后调查（N=11）。结果：几乎所有的项目都用GAD-7/PHQ-9筛查青少年和成年人的焦虑/抑郁，95%的项目系统地跟踪了MH数据（例如，在数据库、电子表格、电子病历中）。具有50年CF经验的被调查者更有可能跟踪总体和项目层面的GAD-7/PHQ-9得分；不同地区或项目规模之间没有差异。80%以上使用纸张筛选。对调制器的MH副作用进行半筛选；16%的人接受了焦虑/抑郁以外的MH筛查。结论：CF项目成功筛查和跟踪GAD-7/PHQ-9评分，支持将这些数据纳入患者登记的可行性。进一步加强电子筛查并为儿童推荐筛查措施

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引用次数: 0

Eligibility for biological treatments in COPD patients experiencing a severe COPD exacerbation 重度COPD加重期COPD患者接受生物治疗的资格

IF 3.1 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Respiratory medicine

Pub Date : 2026-03-01 Epub Date: 2026-01-28 DOI: 10.1016/j.rmed.2026.108681

Stavroula Zaneli , Agamemnon Bakakos , Konstantinos Bartziokas , Anastasia Papaporfyriou , Kyriaki Cholidou , Nektarios Anagnostopoulos , Georgios Zakynthinos , Evangelos Oikonomou , Angelos Vontetsianos , Nikolaos Chynkiamis , Christina Anagnostopoulou , Nikoletta Rovina , Petros Bakakos , Andriana I. Papaioannou

Introduction

Chronic obstructive pulmonary disease (COPD) exacerbations are important events in the natural history of the disease with debilitating consequences which include more rapid lung function decline, quality of life deterioration and increased risk of cardiovascular events and mortality. Inflammation in COPD is complex and is intrinsically less responsive to corticosteroids compared to asthma. Biologics could possibly reduce the burden of inflammation in selected patients.

Methods

In this single center retrospective study, we evaluated the eligibility of COPD patients hospitalized during the last 6 years in the respiratory department of a tertiary hospital for a severe COPD exacerbation, to receive either dupilumab or mepolizumab according to the inclusion criteria of their respective randomized controlled trials and GOLD 2026 recommendations.

Results

496 patients were included in the study, 83 (16.7 %) patients were eligible for treatment with mepolizumab and 29 (5.8 %) for treatment with dupilumab, while 413 (83.3 %) were not eligible for any of the biologics currently approved for COPD treatment. Patients who were eligible for biologics had lower FEV₁/FVC ratio and had experienced more COPD exacerbations and more hospitalizations for COPD exacerbations in the previous year compared to those characterized as non-eligible. The main factor missing from non-eligible patients was treatment with triple inhaled medication, prior to hospitalization.

Conclusion

Only a minority of patients hospitalized due to severe COPD exacerbation would have been eligible to receive biologic therapy. Optimization of medical treatment including inhaled medication in addition to disease phenotyping are pivotal for the recognition of the patients which will benefit from the use of biologics.

慢性阻塞性肺疾病（COPD）恶化是该疾病自然史上的重要事件，其衰弱后果包括肺功能更快下降、生活质量恶化、心血管事件和死亡率风险增加。慢性阻塞性肺病的炎症是复杂的，与哮喘相比，其本质上对皮质类固醇的反应较弱。生物制剂可能会减轻某些患者的炎症负担。方法在这项单中心回顾性研究中，我们根据随机对照试验的纳入标准和GOLD 2026推荐，评估了过去6年在某三级医院呼吸科因严重COPD加重住院的COPD患者接受dupilumab或mepolizumab治疗的资格。结果496例患者纳入研究，83例（16.7%）患者适合mepolizumab治疗，29例（5.8%）患者适合dupilumab治疗，而413例（83.3%）患者不适合目前批准用于COPD治疗的任何生物制剂。与不符合条件的患者相比，符合生物制剂条件的患者FEV1/FVC比较低，并且在过去一年中经历了更多的COPD加重和更多的COPD加重住院治疗。不符合条件的患者缺少的主要因素是住院前三次吸入药物治疗。结论只有少数因严重COPD加重而住院的患者有资格接受生物治疗。除了疾病表型外，包括吸入药物在内的医疗治疗优化对于识别将从生物制剂使用中受益的患者至关重要。

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引用次数: 0

Dynamic ultrasound evaluation of inferior vena cava and lung B-lines predicts intradialytic hypotension in critically ill AKI patients 动态超声评价下腔静脉和肺b线预测急性肾损伤危重患者的透析内低血压。

IF 3.1 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Respiratory medicine

Pub Date : 2026-03-01 Epub Date: 2026-02-03 DOI: 10.1016/j.rmed.2026.108705

Débora Soares , Conrado Lysandro , José Hermógenes Rocco Suassuna , Renata de Souza Mendes

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.

背景：本研究旨在通过评估机械通气急性肾损伤（AKI）患者接受肾替代治疗（RRT）的下腔静脉塌陷指数（IVCCi）和肺b线（BL），评估超便携式超声在预测溶栓性低血压（IDH）和由于血流动力学不稳定而早期中断肾替代治疗（RRT）中的应用。方法：对72例机械通气AKI患者共150次RRT进行评估。在开始治疗后的基线（T0）、30min （T30）和60min （T60）分别评估IVCCi和BL。使用广义线性混合模型确定IDH和早期会话中断的预测因子。进行受试者工作特征（ROC）曲线分析，以确定T0和T30之间IVCCi变化的预测性能（ΔIVCCi），并确定潜在的截止值。结果：IDH发生率为57.3%，早期中断发生率为26%。IDH的显著预测因子包括T0时较低的MAP （OR 0.92, p = 0.002）、去甲肾上腺素使用（OR 2.67, p = 0.038）、ΔIVCCi （OR 0.96, p = 0.031）和BL （OR 0.96, p = 0.007）。早期中断与T0时较低的MAP （OR 0.93, p = 0.005）、去甲肾上腺素使用（OR 11.04, p = 0.029）、ΔIVCCi T30 （OR 0.94, p = 0.014）和BL T30 （OR 0.87, p = 0.034）相关。ΔIVCCi的ROC分析得出AUC为0.601，最佳截止值为-9.315（敏感性87.5%，特异性65.1%）。结论：IVCCi在T0、T30和肺b线之间的变化可预测危重患者IDH和RRT早期中断。确定的ΔIVCCi截止值-9.315可作为早期风险分层和在治疗前30分钟内及时调整透析处方的实用工具，潜在地防止血流动力学不稳定和过早停药。

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引用次数: 0

The bacterial lysate OM-85 reduces exacerbations and oral corticosteroid use in frequently exacerbating patients with T2-High asthma: The OMREXA real-world evidence study 细菌裂解物OM-85可减少频繁加重的t2级高哮喘患者的加重和口服皮质类固醇的使用：OMREXA真实世界证据研究

IF 3.1 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Respiratory medicine

Pub Date : 2026-03-01 Epub Date: 2026-02-04 DOI: 10.1016/j.rmed.2026.108695

Maria Elpida Christopoulou , Lilia S. Panteli , John Α. Moisidis , Ioannis A. Christopoulos I , Amalia S. Tryphonidou , Antonios I. Christopoulos

Background

Underlying immune modifications are offered by the Polyvalent Chemical Bacterial Lysate OM-85 (i.e., anti-viral properties, enhancement of the epithelium barrier function, and induction of a tolerance landscape in the lungs). This secondary post hoc analysis used data from the OMRIA study, to assess the effect of add-on OM-85 on reducing the risk for exacerbations of any origin in adults with difficult-to-treat T2-high asthma.

Methods

The Oral Bacterial Lysate OM-85 Prevents Respiratory Tract Infections in Asthma (OMRIA) study enrolled adults with T2-high asthma frequently exacerbating, under standard of care asthma therapy (SoC), who were started on OM-85 (two 3-month courses with a 3-month treatment-off period in between). Patients were assigned to two groups (OM-85 plus SoC n = 70 and SoC group n = 67) and all AEXs and OCS bursts were recorded throughout a 12-month period. A clinical categorization to identify infectious and non-infectious AEXs was also applied: 1. Asthma symptoms alone (non-infectious), 2. Combined asthma and common cold symptoms (infectious), 3. Combined asthma and bronchitis, sinusitis, or pneumonia symptoms (infectious).

Results

The weighted with propensity scores analyses (Poisson and negative binomial regression model), verified the statistically significant decreases in the average numbers of AEXs and OCS bursts reported in OMRIA study, in patients treated with OM-85. Same tendencies were recorded in each AEX class (class 1-non-infectious: 50.5% decrease, classes 2 and 3-infectious: 72.2% and 89.8% decrease, respectively).

Conclusion

This secondary post hoc analysis supports the therapeutic benefit of OM-85 in patients with T2-high asthma who have frequent exacerbations despite adherence to SoC asthma therapy.

背景：潜在的免疫修饰是由多价化学细菌裂解液OM-85提供的（即抗病毒特性，增强上皮屏障功能，并诱导肺部耐受景观）。这项二级事后分析使用了来自OMRIA研究的数据，以评估附加的OM-85对降低难以治疗的成人t2级高哮喘患者任何来源的恶化风险的影响。方法：口服细菌裂解液OM-85预防哮喘呼吸道感染（OMRIA）研究招募了在标准护理哮喘治疗（SoC）下经常加重的t2高哮喘患者，他们开始使用OM-85（两个3个月的疗程，中间有3个月的治疗期）。患者被分为两组（OM-85 + SoC n=70和SoC组n=67），记录12个月期间所有aex和OCS爆发。采用临床分类方法区分传染性和非传染性aex：仅哮喘症状（非传染性）；2 .合并哮喘和普通感冒症状（传染性）；哮喘合并支气管炎、鼻窦炎或肺炎症状（感染性）。结果：加权倾向得分分析（泊松和负二项回归模型）证实，在使用OM-85治疗的患者中，OMRIA研究报告的AEXs和OCS爆发的平均次数有统计学意义的减少。各AEX类别的趋势相同（1-非感染性类别下降50.5%，2和3感染性类别分别下降72.2%和89.8%）。结论：这一次要事后分析支持OM-85对坚持SoC哮喘治疗但仍频繁发作的t2级高哮喘患者的治疗益处。

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引用次数: 0

Under the surface: Unveiling the respiratory health crisis among mussel pickers in Kozhikode district, Southern India 在表面之下：揭示在印度南部Kozhikode地区贻贝采摘者的呼吸健康危机。

IF 3.1 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Respiratory medicine

Pub Date : 2026-03-01 Epub Date: 2026-01-17 DOI: 10.1016/j.rmed.2026.108653

Binub K , Dhananjayan V , Madayil D , Akshaya K , Ravichandran B , Thamaraikannan M , Panjakumar K , Mala A , Jaseer M

Occupational respiratory diseases pose a considerable health challenge in various industries, especially within the global seafood processing sector. The intricate interactions between lifestyle, pre-existing medical disorders and occupational exposures pose a serious threat to respiratory health. This cross-sectional study explores the respiratory health crisis among mussel workers in Kozhikode District, Southern India. The study aimed to quantify lung function morbidity and the prevalence of respiratory illnesses in this population. Pulmonary function test revealed key finding, including a concerning prevalence of respiratory impairment among mussel workers (21.5 %). Cough with phlegm (14 %), sinusitis (11.8 %), wheezing (4.3 %), shortness of breath (4.3 %), epistaxis (6.5 %), and most significantly, hemoptysis (3 %), other symptoms vertigo (7.53 %) and ophthalmic complaints (4.3 %) were observed. Significant correlations between lung health and variables such as alcohol consumption, history of tuberculosis, smoking, adherence to personal protective equipment (PPE) were determined. The occupational practice of marine mussel harvesting through breath-hold free-diving imposes significant pulmonary risk. Our findings demonstrate that mussel pickers develop a mixed obstructive and restrictive pulmonary impairment. This pathology may be driven by the synergistic effects of repetitive mechanical lung injury.

职业性呼吸系统疾病对各行各业，特别是全球海产品加工部门的健康构成相当大的挑战。生活方式、先前存在的疾病和职业暴露之间复杂的相互作用对呼吸系统健康构成严重威胁。横断面研究探讨了呼吸健康危机的贻贝工人在Kozhikode区，印度南部。目的是量化这一人群中肺功能的发病率和呼吸系统疾病的患病率。肺功能测试揭示了关键发现，包括贻贝工人中呼吸障碍的患病率（21.5%）。咳嗽伴痰（14%）、鼻窦炎（9.6%）、喘息（4.3%）、呼吸短促（4.3%）、鼻出血（6.5%），最显著的是咯血（3%）、其他症状(眩晕（7.53%）和眼病（4.3%）。确定了肺部健康与饮酒、结核病史、吸烟、个人防护装备（PPE）依从性等变量之间的显著相关性。通过屏住呼吸自由潜水捕捞贻贝的职业实践会带来严重的肺部风险。我们的研究结果表明，贻贝采摘者发展为混合性阻塞性和限制性肺损伤。这种病理可能是由重复性机械性肺损伤的协同作用驱动的。

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引用次数: 0

Efficacy of therapies based on muscle strength training among individual with obstructive sleep apnea - a systematic review and meta-analysis 基于肌肉力量训练的治疗对阻塞性睡眠呼吸暂停患者的疗效——一项系统回顾和荟萃分析。

IF 3.1 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Respiratory medicine

Pub Date : 2026-03-01 Epub Date: 2026-02-05 DOI: 10.1016/j.rmed.2026.108702

Szymon Siatkowski , Jan Walencik , Marcin Sikora , Aleksandra Żebrowska

Background

Exercise modalities that target upper-airway and respiratory muscles may modify obstructive sleep apnea (OSA) severity.

Objective

To synthesize randomized controlled trials (RCTs) of resistance training (RT), oropharyngeal training (OT), and respiratory muscle training (RMT) on OSA severity (apnea–hypopnea index, AHI) and daytime sleepiness (Epworth Sleepiness Scale, ESS).

Methods

PubMed, EBSCO, and Scopus were searched (1 Jan 2015–31 Jan 2025). Of 1805 records identified, 13 RCTs (n = 429) met eligibility. Random-effects meta-analyses were performed within modality.

Results

OT reduced AHI (mean difference, MD −7.55 events·h⁻¹, 95% CI −13.39 to −1.71; p = 0.02). RMT reduced AHI (MD −3.73 events·h⁻¹, −7.44 to −0.03; p = 0.049). RT showed no significant change (MD −5.88 events·h⁻¹, −17.25 to 5.49; p = 0.16). Across modalities, ESS showed no consistent, clinically meaningful improvement. Heterogeneity was substantial for RT trials for AHI and for OT trials in ESS, reflecting variability in protocols, duration, and participant characteristics.

Conclusions

When analyzed within modality, OT and RMT are associated with reductions in AHI, whereas RT alone does not demonstrate a significant effect. Symptom change measured by ESS was not consistently observed. These findings support OT and RMT as adjunctive options for reducing physiological OSA severity, while underscoring the need for standardized protocols, longer follow-up, and patient-important outcomes.

背景：针对上呼吸道和呼吸肌的运动模式可能会改变阻塞性睡眠呼吸暂停（OSA）的严重程度。目的：综合阻力训练（RT）、口咽训练（OT）和呼吸肌训练（RMT）对OSA严重程度（呼吸暂停低通气指数，AHI）和日间嗜睡（Epworth嗜睡量表，ESS）的随机对照试验（rct）。方法：检索PubMed、EBSCO和Scopus（2015年1月1日- 2025年1月31日）。在鉴定的1805份记录中，13份rct （n=429）符合资格。随机效应荟萃分析在模态内进行。结果：OT降低了AHI（平均差异，MD -7.55事件·h-1, 95% CI -13.39 ~ -1.71; p=0.02）。RMT降低AHI （MD -3.73事件·h-1， -7.44至-0.03;p=0.049）。RT无显著变化（MD -5.88事件·h-1， -17.25至5.49;p=0.16）。在不同的治疗方式中，ESS没有表现出一致的、有临床意义的改善。AHI的RT试验和ESS的OT试验的异质性很大，反映了方案、持续时间和参与者特征的差异。结论：在模式内分析时，OT和RMT与AHI降低相关，而单独RT没有显着影响。ESS测量的症状变化并不一致。这些发现支持OT和RMT作为降低生理性OSA严重程度的辅助选择，同时强调需要标准化的方案，更长的随访时间和患者重要的结果。

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引用次数: 0

Comorbidities in pediatric cystic fibrosis: ABPA, celiac disease and prediabetes in Georgia 乔治亚州儿童囊性纤维化的合并症：ABPA、乳糜泻和前驱糖尿病

IF 3.1 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Respiratory medicine

Pub Date : 2026-03-01 Epub Date: 2026-01-29 DOI: 10.1016/j.rmed.2026.108674

Nino Vardosanidze , Dodo Agladze , Lali Margvelashvili , Oleg Kvlividze , Nani Kavlashvili

Background

Cystic fibrosis is a chronic autosomal-recessive disorder characterized by progressive lung disease, pancreatic insufficiency, and multiple systemic complications. Early identification and treatment of comorbidities such as allergic bronchopulmonary aspergillosis (ABPA), celiac disease (CD), and prediabetes/cystic fibrosis–related diabetes (CFRD) improves outcomes.

Methods

This prospective observational study included 68 pediatric CF patients registered in the Georgian National Monitoring Program of Rare Diseases (2022–2025). All children had a confirmed diagnosis of CF based on national criteria, established either through newborn screening (elevated IRT followed by sweat chloride and fecal elastase testing) or direct clinical referral for sweat chloride testing. Sweat chloride <29 mmol/L was considered negative, 30–60 mmol/L borderline (requiring repeat testing), and ≥60 mmol/L abnormal and referred for CFTR gene testing [4]. All patients underwent three fasting plasma glucose tests, total IgE measurement, and Aspergillus-specific IgG testing. Anti-tissue transglutaminase IgA (anti-TTG IgA) was measured once for celiac disease screening. Age-specific reference ranges and established diagnostic criteria for ABPA, CD, and CFRD were applied.

Results

Three patients had elevated anti-TTG IgA; one was diagnosed with CD and treated with a gluten-free diet. Impaired fasting glucose was observed in 14 patients (22 %). Two patients with persistently elevated HbA1c (≥6.0 %) were referred to endocrinology for evaluation of prediabetes/CFRD. Aspergillus-specific IgG was elevated in two patients; one had markedly elevated total IgE (>1500 IU/mL) and was diagnosed with ABPA requiring systemic corticosteroids and antifungal therapy. Several patients had elevated IgE without ABPA but due to sensitization to multiple allergens, they were referred to an allergologist.

Conclusion

Comorbidities including CD, prediabetes/CFRD, and ABPA are present in Georgian children with CF and can negatively affect nutrition and lung function if untreated. Routine screening for glucose abnormalities, CD, and ABPA should be implemented into national CF care protocols for timely treatment and better outcomes.

背景：囊性纤维化是一种慢性常染色体隐性疾病，以进行性肺部疾病、胰腺功能不全和多种全身并发症为特征。早期识别和治疗合并症，如过敏性支气管肺曲霉病（ABPA）、乳糜泻（CD）和前驱糖尿病/囊性纤维化相关糖尿病（CFRD），可改善预后。方法：这项前瞻性观察性研究纳入了在格鲁吉亚国家罕见疾病监测计划（2022-2025）中登记的68例儿童CF患者。所有儿童均根据国家标准确诊CF，这些标准是通过新生儿筛查（IRT升高，随后进行汗液氯化物和粪便弹性酶检测）或直接临床转诊进行汗液氯化物检测确定的。结果：3例患者抗ttg IgA升高；其中一名被诊断患有乳糜泻，并接受无谷蛋白饮食治疗。14例（22%）患者空腹血糖受损。2例HbA1c持续升高（≥6.0%）的患者转介内分泌科评估糖尿病前期/CFRD。2例患者曲霉特异性IgG升高；1例总IgE明显升高（约1500 IU/mL），诊断为ABPA，需要全身皮质类固醇和抗真菌治疗。一些患者没有ABPA，但由于对多种过敏原的致敏，他们被转介到过敏症专家。结论：格鲁吉亚CF患儿存在CD、前驱糖尿病/CFRD和ABPA等合并症，如果不治疗，会对营养和肺功能产生负面影响。常规筛查葡萄糖异常、乳糜泻和ABPA应纳入国家CF护理方案，以便及时治疗并获得更好的结果。

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引用次数: 0

Profiles of circulating T follicular helper (cTfh) cell subpopulations in patients with asthma, COPD and asthma-COPD overlap (ACO) 哮喘、COPD和哮喘-COPD重叠（ACO）患者循环T滤泡辅助细胞（cTfh）亚群的特征

IF 3.1 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Respiratory medicine

Pub Date : 2026-03-01 Epub Date: 2026-01-30 DOI: 10.1016/j.rmed.2026.108672

Vanesa Cunill , Valero Andreu , Amanda Iglesias , María Berman , Núria Toledo-Pons , Elisabet Pol-Pol , Mireia Vicens , Miguel A. Estévez , Jaume Sauleda , Javier Verdú , Joana M. Ferrer , Borja G. Cosío , Jaime Pons

Background

Asthma, chronic obstructive pulmonary disease (COPD) and asthma-COPD Overlap (ACO) are inflammatory diseases characterized by specific T helper (Th) phenotypes. CD4 T follicular helper (Tfh) cells constitute a heterogeneous subset of T cells (Tfh1, Tfh2, Tfh17, Tfh17.1 and Tfr) essential for B cell differentiation and immunoglobulin production. Although alterations in their distribution and/or function have been associated with several pathologies, little is known about their relevance in these airway diseases.

Methods

We sought to evaluate, by flow cytometry, the pattern of blood follicular and non-follicular Th cell subpopulations in patients with asthma, COPD and ACO.

Results

We found a distinct and characteristic T cell pattern in these three inflammatory conditions: a predominance of cTfh2 in asthma patients, a Th17.1 and cTfh17.1 inflammatory profile in COPD patients, and a Th1 pattern in ACO patients. Regarding tobacco smoke, COPD patients who were active smokers had a higher ratio Th1/Th17 compared to ex-smokers with COPD, a trend not observed in ACO patients.

Conclusions

These results suggest that the assessment of the characteristic inflammatory profile for each of these pathologies could help to understand the pathobiology and to identify the most appropriate therapeutic target.

背景：哮喘、慢性阻塞性肺疾病（COPD）和哮喘-COPD重叠（ACO）是炎症性疾病，其特征是特异性辅助性T （Th）表型。CD4 T滤泡辅助细胞（Tfh）是B细胞分化和免疫球蛋白产生所必需的T细胞（Tfh1、Tfh2、Tfh17、Tfh17.1和Tfr）的异质亚群。虽然它们的分布和/或功能的改变与几种病理有关，但对它们在这些气道疾病中的相关性知之甚少。方法：我们试图通过流式细胞术评估哮喘、COPD和ACO患者血液滤泡和非滤泡Th细胞亚群的模式。结果：我们在这三种炎症中发现了一种独特的特征性T细胞模式：哮喘患者以cTfh2为主，COPD患者以Th17.1和cTfh17.1为主，ACO患者以Th1为主。在吸烟方面，活跃吸烟者的COPD患者Th1/Th17比值高于已戒烟的COPD患者，但在ACO患者中未观察到这一趋势。结论：这些结果表明，评估每种病理的特征性炎症特征有助于了解病理生物学并确定最合适的治疗靶点。

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引用次数: 0