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Association between albumin corrected anion gap and in-hospital mortality in critically ill patients with chronic obstructive pulmonary disease.
IF 3.3 3区 医学 Q2 RESPIRATORY SYSTEM Pub Date : 2025-01-01 DOI: 10.1177/17534666251315352
Mohan Giri, Anju Puri, Lan Huang, Shuliang Guo

Background: The relationship between albumin-corrected anion gap (ACAG) and in-hospital mortality in critically ill patients with COPD remains unclear.

Objective: This study investigated the association between ACAG levels and the risk of in-hospital mortality in critically ill patients with COPD.

Design: A retrospective cohort study.

Methods: This study uses data from the Medical Information Mart for Intensive Care (MIMIC-IV) database. The receiver operating characteristic (ROC) curve was used to determine the optimal threshold for ACAG, and participants were divided into two categories based on this threshold. The primary outcome was in-hospital mortality. We employed univariable and multivariable logistic regression analyses and Kaplan-Meier (KM) survival curves to assess the relationship between ACAG and the risk of in-hospital mortality. Moreover, subgroup analyses were conducted.

Results: A total of 2121 patients (54.7% male) were enrolled in the study. The in-hospital mortality rate was 18.9%. In patients with elevated ACAG levels, the in-hospital mortality rate was significantly higher than in those with lower ACAG levels (27.7% vs 11.3%, p < 0.001). Multivariate logistic regression analysis indicated that even after mitigating for potential confounders, patients in the high ACAG group had significantly greater odds of in-hospital mortality across all models (Model I: OR = 3.000, 95% CI: 2.383-3.777, p < 0.001; Model II: OR = 3.021, 95% CI: 2.397-3.808, p < 0.001; Model III: OR = 1.916, 95% CI: 1.458-2.519, p < 0.001). Patients with elevated ACAG levels have more than twice the risk of in-hospital mortality compared to those with lower levels (hazard ratio (HR): 2.1277, 95% CI: 1.7490-2.5884).

Conclusion: This study demonstrates that elevated ACAG levels are strongly associated with an increased risk of in-hospital mortality in critically ill COPD patients, suggesting that ACAG could serve as a potential predictor of adverse outcomes in this patient population.

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引用次数: 0
Potential of phosphodiesterase 4B inhibition in the treatment of progressive pulmonary fibrosis. 抑制磷酸二酯酶4B治疗进行性肺纤维化的潜力。
IF 3.3 3区 医学 Q2 RESPIRATORY SYSTEM Pub Date : 2025-01-01 DOI: 10.1177/17534666241309795
Rebecca Keith, Anoop M Nambiar

Idiopathic pulmonary fibrosis (IPF) is often regarded as the archetypal progressive fibrosing interstitial lung disease (ILD). The term "progressive pulmonary fibrosis" (PPF) generally describes progressive lung fibrosis in an individual with an ILD other than IPF. Both IPF and PPF are associated with loss of lung function, worsening dyspnea and quality of life, and premature death. Current treatments slow the decline in lung function but have side effects that may deter the initiation or continuation of treatment. There remains a high unmet need for additional therapies that can be used alone or in combination with current therapies to preserve lung function in patients with IPF and PPF. Phosphodiesterase-4 (PDE4) is an enzyme involved in the regulation of inflammatory processes. Pre-clinical studies have shown that preferential inhibition of PDE4B has anti-inflammatory and antifibrotic effects and a lower potential for gastrointestinal adverse events than pan-PDE4 inhibition. The preferential PDE4B inhibitor nerandomilast demonstrated efficacy in preserving lung function in a phase II trial in patients with IPF and is under investigation in phase III trials as a treatment for IPF and PPF.

特发性肺纤维化(IPF)通常被认为是典型的进行性纤维化间质性肺疾病(ILD)。“进行性肺纤维化”(PPF)一词通常用于描述除IPF外的ILD患者的进行性肺纤维化。IPF和PPF均与肺功能丧失、呼吸困难和生活质量恶化以及过早死亡有关。目前的治疗方法减缓了肺功能的下降,但有副作用,可能会阻止开始或继续治疗。对于IPF和PPF患者单独使用或与现有疗法联合使用以保护肺功能的额外疗法的需求仍未得到满足。磷酸二酯酶-4 (PDE4)是一种参与炎症过程调节的酶。临床前研究表明,优先抑制PDE4B具有抗炎和抗纤维化作用,与泛pde4抑制相比,胃肠道不良事件的可能性更低。首选的PDE4B抑制剂nerandomilast在IPF患者的II期试验中显示出保护肺功能的功效,并且正在III期试验中研究作为IPF和PPF的治疗方法。
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引用次数: 0
A real-world study to evaluate effectiveness of mepolizumab in treating severe asthma in Taiwan (REMIT). 一项评估美波珠单抗治疗台湾严重哮喘疗效的真实世界研究(REMIT)。
IF 3.3 3区 医学 Q2 RESPIRATORY SYSTEM Pub Date : 2025-01-01 DOI: 10.1177/17534666241308406
Shih-Lung Cheng, Shu-Min Lin, Chung-Kan Peng, Ming-Cheng Chan, Sheng-Yeh Shen, Ping-Hung Kuo, Chien-Hao Lai, Chou-Chin Lan, Chung-Yu Chen, Ching-Hsiung Lin, Kuang-Ming Liao, Po-Hao Feng, Jiin-Torng Wu, Yu-Feng Wei, Xiaomeng Xu, Rafael Alfonso-Christancho, Tina Lai, Aldo Navarro, Dominique Milea, Diahn-Warng Perng

Background: REMIT is the first real-world study of mepolizumab effectiveness in patients with severe asthma (SA) in Taiwan.

Objectives: The primary objective evaluated changes in clinically significant exacerbations (CSEs; defined as use of oral corticosteroids (OCS) or emergency department (ED) visits and/or hospitalizations) in the 12 months pre- and post-mepolizumab treatment. Secondary objectives assessed changes in the number of CSEs requiring ED visits/hospitalizations and daily maintenance OCS (mOCS) dosage 12 months pre- and post-mepolizumab treatment. Three- and four-component clinical remissions were analyzed based on OCS-free, exacerbation-free, and asthma control (± stability in lung function).

Design: REMIT was a retrospective, observational, self-controlled study analyzing patients in Taiwan with SA who were newly prescribed subcutaneous mepolizumab 100 mg Q4W.

Methods: Data were extracted from records of 15 medical centers in Taiwan for patients indexed between November 1, 2018 and October 31, 2020.

Results: A total of 170 patients were included: mean age at index date, 58.7 years; 53.5% female; 100% Chinese; 7.1% with chronic rhinosinusitis with nasal polyps, 1.8% with eosinophilic granulomatosis with polyangiitis, 1.2% with hypereosinophilic syndrome; and 55.7% with blood eosinophil count >300/µL. Pre-treatment, 71.2% had ⩾2 exacerbations, and 28.7% were on mOCS; 75.3% had no prior biologic treatment, and 24.7% had switched from other biologics. Most patients (80.0%) completed ⩾10 mepolizumab doses. Following the first mepolizumab administration (index date), CSEs reduced by 46.0% (rate ratio (RR): 0.545, 95% confidence interval (CI): 0.418-0.710; p < 0.0001) in the 12 months post-index. Exacerbations requiring ED visits/hospitalization reduced by 46.9% (RR: 0.531, 95% CI: 0.349-0.808; p = 0.0031). Median mOCS dose reduced by 100% by end of study and 81.8% of patients discontinued mOCS post-treatment. After 1 year of mepolizumab treatment, 28% and 23% patients achieved three- and four-component clinical remission, respectively.

Conclusion: Mepolizumab use in a patient population in Taiwan with SA significantly reduced CSEs and mOCS use in routine clinical practice.

背景:REMIT是台湾首个mepolizumab对严重哮喘(SA)患者有效性的真实研究。目的:主要目的评估临床显著加重(CSEs;定义为在美珠单抗治疗前和治疗后的12个月内使用口服皮质类固醇(OCS)或急诊(ED)就诊和/或住院。次要目标评估需要ED就诊/住院和每日维持OCS (mOCS)剂量的CSEs数量在美珠单抗治疗前后12个月的变化。基于无ocs、无加重和哮喘控制(±肺功能稳定性)对三组分和四组分临床缓解进行分析。设计:REMIT是一项回顾性、观察性、自我对照的研究,分析了台湾新开皮下mepolizumab 100mg Q4W的SA患者。方法:数据提取自台湾15家医疗中心2018年11月1日至2020年10月31日检索的患者记录。结果:共纳入170例患者:指数日平均年龄58.7岁;53.5%的女性;100%的中国;7.1%为慢性鼻窦炎伴鼻息肉,1.8%为嗜酸性肉芽肿病伴多血管炎,1.2%为嗜酸性粒细胞增多综合征;55.7%的人血嗜酸性粒细胞计数为100 300/µL。治疗前,71.2%的患者出现大于或等于2的恶化,28.7%的患者接受mOCS治疗;75.3%的患者之前没有接受过生物制剂治疗,24.7%的患者是从其他生物制剂转行的。大多数患者(80.0%)完成了小于10次mepolizumab剂量。第一次给药(指标日期)后,CSEs降低46.0%(比率比(RR): 0.545, 95%可信区间(CI): 0.418-0.710;p = 0.0031)。研究结束时,mOCS的中位剂量减少了100%,81.8%的患者在治疗后停用了mOCS。经过1年的mepolizumab治疗,28%和23%的患者分别达到了三组分和四组分的临床缓解。结论:在台湾SA患者群体中使用Mepolizumab可显著降低CSEs和mOCS在常规临床实践中的使用。
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引用次数: 0
Real-world therapeutic performance of pirfenidone for connective tissue disease-associated interstitial lung diseases. 吡非尼酮对结缔组织病相关间质性肺病的实际治疗效果。
IF 4.3 3区 医学 Q2 RESPIRATORY SYSTEM Pub Date : 2024-01-01 DOI: 10.1177/17534666241292507
Xueting Yuan, Chen Yu, Shengyun Liu, Qiang Shu, Xinwang Duan, Lin Tang, Liying Peng, Shuang Zhou, Chanyuan Wu, Jiuliang Zhao, Dong Xu, Lan Song, Hui Huang, Mengtao Li, Yanhong Wang, Qian Wang, Xiaofeng Zeng

Background: Pirfenidone (PFD) is commonly applied for antifibrotic treatment in patients with idiopathic pulmonary fibrosis but has rarely been studied in cases with connective tissue disease-associated interstitial lung diseases (CTD-ILDs).

Objectives: We aimed to examine the efficacy of PFD in patients with CTD-ILD based on real-world data.

Design: A retrospective cohort study.

Methods: This study assessed the clinical features of CTD-ILD patients with or without a 6-month PFD treatment. A linear mixed effects model was employed to evaluate the effectiveness of PFD in alleviating lung function changes. Differences in response to PFD were analyzed based on CTD subtype, imaging classification, and pattern of pulmonary function at baseline.

Results: A total of 289 patients with CTD-ILD were included, with 155 (53.6%) receiving PFD treatment and the remaining constituting the control group. Patients with the usual interstitial pneumonia (UIP) pattern were more likely to receive PFD treatment, and a relatively lower proportion of cases in the PFD group received immunosuppressive therapies compared to the control group (p < 0.05). At the 6-month follow-up, patients in the PFD group demonstrated a more significant improvement in forced vital capacity (FVC) and diffusion capacity for carbon monoxide (DLCO) (ΔFVC%: 2.9% vs 0.45%, p = 0.009; ΔDLCO%: 1.9% vs -1.1%, p = 0.004). In the linear mixed model analysis, there was a statistically significant group-time interaction between FVC% and DLCO% changes over time (FVC%: β = 4.52, p < 0.001; DLCO%: β = 4.13, p = 0.003). Furthermore, subgroup analysis indicated that pirfenidone may have superior therapeutic effects in patients with systemic sclerosis (SSc)-associated ILD, non-UIP pattern, and restrictive pattern of lung function at baseline.

Conclusion: This study provided real-world data demonstrating the effectiveness of PFD in terms of lung function improvement in patients with CTD-ILD.

背景:吡非尼酮(PFD)通常用于特发性肺纤维化患者的抗纤维化治疗,但在结缔组织病相关性间质性肺疾病(CTD-ILDs)病例中却鲜有研究:我们旨在根据实际数据研究PFD对CTD-ILD患者的疗效:设计:一项回顾性队列研究:本研究评估了接受或未接受 6 个月 PFD 治疗的 CTD-ILD 患者的临床特征。采用线性混合效应模型评估 PFD 在缓解肺功能变化方面的效果。根据 CTD 亚型、影像学分类和基线肺功能模式分析了对 PFD 反应的差异:共纳入 289 名 CTD-ILD 患者,其中 155 人(53.6%)接受了 PFD 治疗,其余为对照组。与对照组相比,PFD组中接受免疫抑制疗法的病例比例相对较低(P = 0.009;ΔDLCO%:1.9% vs -1.1%, P = 0.004)。在线性混合模型分析中,FVC% 和 DLCO% 随时间的变化存在显著的组间交互作用(FVC%:β = 4.52,P = 0.003)。此外,亚组分析表明,对于基线肺功能为系统性硬化症(SSc)相关性 ILD、非 UIP 模式和限制性模式的患者,吡非尼酮可能具有更好的治疗效果:这项研究提供了真实世界的数据,证明了 PFD 在改善 CTD-ILD 患者肺功能方面的有效性。
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引用次数: 0
Video-assisted thoracoscopic surgery for non-cystic fibrosis bronchiectasis in children. 视频辅助胸腔镜手术治疗儿童非囊性纤维化支气管扩张症。
IF 4.3 3区 医学 Q2 RESPIRATORY SYSTEM Pub Date : 2024-01-01 DOI: 10.1177/17534666241228159
Fengxia Ding, Zhengxia Pan, Chun Wu, Hongbo Li, Yonggang Li, Yong An, Jiangtao Dai, Gang Wang, Bo Liu

Background: Pediatric bronchiectasis is a common respiratory disease in children. The use of video-assisted thoracoscopic surgery (VATS) for its treatment remains controversial.

Objectives: The objective of our study was to compare and analyze the clinical efficacy of thoracoscopic surgery and thoracotomy in the treatment of pediatric bronchiectasis and summarize the surgical treatment experience of VATS in children with bronchiectasis.

Design: Retrospective single-center cohort study.

Methods: A retrospective analysis was conducted on the clinical data of 46 pediatric patients who underwent surgery with bronchiectasis at the Children's Hospital of Chongqing Medical University from May 2015 to May 2023. The patients were divided into two groups: the VATS group (25 cases) and the thoracotomy group (21 cases). Comparative analysis was performed on various parameters including basic clinical data, surgical methods, operation time, intraoperative blood loss, transfusion status, postoperative pain, postoperative mechanical ventilation time, chest tube drainage time, length of hospital stay, incidence of complications, and follow-up information.

Results: There were no statistically significant differences between the two groups of patients in terms of age, weight, gender, etiology, duration of symptoms, site of onset, and comorbidities (p > 0.05). The operation time in the VATS group was longer than that in the thoracotomy group (p < 0.001). However, the VATS group had better outcomes in terms of intraoperative blood loss, transfusion status, postoperative pain, postoperative mechanical ventilation time, chest tube drainage time, and length of hospital stay (p < 0.05). The incidence of postoperative complications in the VATS group was lower than that in the thoracotomy group, although the difference was not statistically significant (p = 0.152). Follow-up data showed no statistically significant difference in the surgical treatment outcomes between the two groups (p = 0.493).

Conclusion: The incidence of complications and mortality in surgical treatment of bronchiectasis is acceptable. Compared with thoracotomy surgery, VATS has advantages such as smaller trauma, less pain, faster recovery, and fewer complications. For suitable pediatric patients with bronchiectasis, VATS is a safe and effective surgical method.

背景:小儿支气管扩张症是一种常见的儿童呼吸道疾病。使用视频辅助胸腔镜手术(VATS)进行治疗仍存在争议:我们的研究旨在比较和分析胸腔镜手术和开胸手术在治疗小儿支气管扩张症中的临床疗效,并总结 VATS 在小儿支气管扩张症中的手术治疗经验:回顾性单中心队列研究:对2015年5月至2023年5月期间在重庆医科大学附属儿童医院接受支气管扩张症手术治疗的46例小儿患者的临床资料进行回顾性分析。患者分为两组:VATS组(25例)和开胸手术组(21例)。对两组患者的基本临床资料、手术方式、手术时间、术中失血量、输血情况、术后疼痛、术后机械通气时间、胸腔置管引流时间、住院时间、并发症发生率、随访资料等各项指标进行对比分析:两组患者在年龄、体重、性别、病因、症状持续时间、发病部位和合并症等方面差异无统计学意义(P > 0.05)。VATS 组的手术时间长于开胸手术组(p p = 0.152)。随访数据显示,两组患者的手术治疗效果差异无统计学意义(P = 0.493):结论:支气管扩张症手术治疗的并发症发生率和死亡率是可以接受的。与开胸手术相比,VATS 具有创伤小、疼痛轻、恢复快、并发症少等优点。对于合适的儿童支气管扩张症患者,VATS 是一种安全有效的手术方法。
{"title":"Video-assisted thoracoscopic surgery for non-cystic fibrosis bronchiectasis in children.","authors":"Fengxia Ding, Zhengxia Pan, Chun Wu, Hongbo Li, Yonggang Li, Yong An, Jiangtao Dai, Gang Wang, Bo Liu","doi":"10.1177/17534666241228159","DOIUrl":"10.1177/17534666241228159","url":null,"abstract":"<p><strong>Background: </strong>Pediatric bronchiectasis is a common respiratory disease in children. The use of video-assisted thoracoscopic surgery (VATS) for its treatment remains controversial.</p><p><strong>Objectives: </strong>The objective of our study was to compare and analyze the clinical efficacy of thoracoscopic surgery and thoracotomy in the treatment of pediatric bronchiectasis and summarize the surgical treatment experience of VATS in children with bronchiectasis.</p><p><strong>Design: </strong>Retrospective single-center cohort study.</p><p><strong>Methods: </strong>A retrospective analysis was conducted on the clinical data of 46 pediatric patients who underwent surgery with bronchiectasis at the Children's Hospital of Chongqing Medical University from May 2015 to May 2023. The patients were divided into two groups: the VATS group (25 cases) and the thoracotomy group (21 cases). Comparative analysis was performed on various parameters including basic clinical data, surgical methods, operation time, intraoperative blood loss, transfusion status, postoperative pain, postoperative mechanical ventilation time, chest tube drainage time, length of hospital stay, incidence of complications, and follow-up information.</p><p><strong>Results: </strong>There were no statistically significant differences between the two groups of patients in terms of age, weight, gender, etiology, duration of symptoms, site of onset, and comorbidities (<i>p</i> > 0.05). The operation time in the VATS group was longer than that in the thoracotomy group (<i>p</i> < 0.001). However, the VATS group had better outcomes in terms of intraoperative blood loss, transfusion status, postoperative pain, postoperative mechanical ventilation time, chest tube drainage time, and length of hospital stay (<i>p</i> < 0.05). The incidence of postoperative complications in the VATS group was lower than that in the thoracotomy group, although the difference was not statistically significant (<i>p</i> = 0.152). Follow-up data showed no statistically significant difference in the surgical treatment outcomes between the two groups (<i>p</i> = 0.493).</p><p><strong>Conclusion: </strong>The incidence of complications and mortality in surgical treatment of bronchiectasis is acceptable. Compared with thoracotomy surgery, VATS has advantages such as smaller trauma, less pain, faster recovery, and fewer complications. For suitable pediatric patients with bronchiectasis, VATS is a safe and effective surgical method.</p>","PeriodicalId":22884,"journal":{"name":"Therapeutic Advances in Respiratory Disease","volume":"18 ","pages":"17534666241228159"},"PeriodicalIF":4.3,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10851711/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139703509","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
Optimal flow of high-flow nasal cannula oxygenation to prevent desaturation during sedation for bronchoscopy: a randomized controlled study. 预防支气管镜检查镇静过程中出现失饱和的最佳高流量鼻插管吸氧:随机对照研究。
IF 4.3 3区 医学 Q2 RESPIRATORY SYSTEM Pub Date : 2024-01-01 DOI: 10.1177/17534666241246637
Wen Zhang, Xiaohong Yuan, Yajian Shen, Jiangling Wang, Kangjie Xie, Xinzhong Chen

Background: Although high-flow nasal cannula (HFNC) oxygenation is currently recommended to prevent desaturation during sedation for bronchoscopy, there is no consensus on an optimal flow rate.

Objective: To determine the optimal oxygen flow rate for HFNC to effectively prevent desaturation during sedation for bronchoscopy.

Design: Prospective, randomized, and controlled study.

Methods: Patients (n = 240) scheduled for bronchoscopy were randomized to receive HFNC with propofol sedation (fraction of inspired oxygen, 100%) at one of six flow rates of 10, 20, 30, 40, 50, and 60 L/min, designated as groups 1-6, respectively.

Results: The incidence of desaturation significantly decreased by increasing the oxygen flow rate (42.5%, 17.5%, 15%, 10%, 2.5%, and 0% for groups 1-6, respectively, p < 0.0001). The optimal oxygen flow rate for HFNC determined by probit regression to effectively prevent desaturation in 95% of patients was 43.20 (95% confidence interval, 36.43-55.96) L/min. The requirement for airway intervention was significantly decreased by increasing the oxygen flow rate.

Conclusion: An HFNC flow rate of 50-60 L/min is recommended to prevent desaturation during sedation for bronchoscopy.

Registration: NCT05298319 at ClinicalTrials.gov.

背景:尽管目前推荐使用高流量鼻插管(HFNC)吸氧来防止支气管镜检查镇静期间出现失饱和,但对于最佳流速尚未达成共识:确定 HFNC 的最佳氧流量,以有效防止支气管镜检查镇静过程中出现失饱和:设计:前瞻性、随机对照研究:计划接受支气管镜检查的患者(n = 240)被随机分配到接受异丙酚镇静(吸入氧饱和度为 100%)的 HFNC,六种流速分别为 10、20、30、40、50 和 60 L/min(1-6 组):结果:随着氧气流速的增加,饱和度降低的发生率明显降低(1-6 组分别为 42.5%、17.5%、15%、10%、2.5% 和 0%,p 结论:50-60 L/min 的高频核磁共振(HFNC)流速可减少饱和度降低的发生率:建议使用 50-60 升/分钟的 HFNC 流速来防止支气管镜检查镇静期间出现不饱和现象:注册:ClinicalTrials.gov 上的 NCT05298319。
{"title":"Optimal flow of high-flow nasal cannula oxygenation to prevent desaturation during sedation for bronchoscopy: a randomized controlled study.","authors":"Wen Zhang, Xiaohong Yuan, Yajian Shen, Jiangling Wang, Kangjie Xie, Xinzhong Chen","doi":"10.1177/17534666241246637","DOIUrl":"https://doi.org/10.1177/17534666241246637","url":null,"abstract":"<p><strong>Background: </strong>Although high-flow nasal cannula (HFNC) oxygenation is currently recommended to prevent desaturation during sedation for bronchoscopy, there is no consensus on an optimal flow rate.</p><p><strong>Objective: </strong>To determine the optimal oxygen flow rate for HFNC to effectively prevent desaturation during sedation for bronchoscopy.</p><p><strong>Design: </strong>Prospective, randomized, and controlled study.</p><p><strong>Methods: </strong>Patients (<i>n</i> = 240) scheduled for bronchoscopy were randomized to receive HFNC with propofol sedation (fraction of inspired oxygen, 100%) at one of six flow rates of 10, 20, 30, 40, 50, and 60 L/min, designated as groups 1-6, respectively.</p><p><strong>Results: </strong>The incidence of desaturation significantly decreased by increasing the oxygen flow rate (42.5%, 17.5%, 15%, 10%, 2.5%, and 0% for groups 1-6, respectively, <i>p</i> < 0.0001). The optimal oxygen flow rate for HFNC determined by probit regression to effectively prevent desaturation in 95% of patients was 43.20 (95% confidence interval, 36.43-55.96) L/min. The requirement for airway intervention was significantly decreased by increasing the oxygen flow rate.</p><p><strong>Conclusion: </strong>An HFNC flow rate of 50-60 L/min is recommended to prevent desaturation during sedation for bronchoscopy.</p><p><strong>Registration: </strong>NCT05298319 at ClinicalTrials.gov.</p>","PeriodicalId":22884,"journal":{"name":"Therapeutic Advances in Respiratory Disease","volume":"18 ","pages":"17534666241246637"},"PeriodicalIF":4.3,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11044788/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140868667","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
Building and validating an artificial intelligence model to identify tracheobronchopathia osteochondroplastica by using bronchoscopic images. 建立并验证人工智能模型,利用支气管镜图像识别气管软骨发育不良症。
IF 4.3 3区 医学 Q2 RESPIRATORY SYSTEM Pub Date : 2024-01-01 DOI: 10.1177/17534666241253694
Chongxiang Chen, Fei Tang, Felix J F Herth, Yingnan Zuo, Jiangtao Ren, Shuaiqi Zhang, Wenhua Jian, Chunli Tang, Shiyue Li

Background: Given the rarity of tracheobronchopathia osteochondroplastica (TO), many young doctors in primary hospitals are unable to identify TO based on bronchoscopy findings.

Objectives: To build an artificial intelligence (AI) model for differentiating TO from other multinodular airway diseases by using bronchoscopic images.

Design: We designed the study by comparing the imaging data of patients undergoing bronchoscopy from January 2010 to October 2022 by using EfficientNet. Bronchoscopic images of 21 patients with TO at Anhui Chest Hospital from October 2019 to October 2022 were collected for external validation.

Methods: Bronchoscopic images of patients with multinodular airway lesions (including TO, amyloidosis, tumors, and inflammation) and without airway lesions in the First Affiliated Hospital of Guangzhou Medical University were collected. The images were randomized (4:1) into training and validation groups based on different diseases and utilized for deep learning by convolutional neural networks (CNNs).

Results: We enrolled 201 patients with multinodular airway disease (38, 15, 75, and 73 patients with TO, amyloidosis, tumors, and inflammation, respectively) and 213 without any airway lesions. To find multinodular lesion images for deep learning, we utilized 2183 bronchoscopic images of multinodular lesions (including TO, amyloidosis, tumor, and inflammation) and compared them with images without any airway lesions (1733). The accuracy of multinodular lesion identification was 98.9%. Further, the accuracy of TO detection based on the bronchoscopic images of multinodular lesions was 89.2%. Regarding external validation (using images from 21 patients with TO), all patients could be diagnosed with TO; the accuracy was 89.8%.

Conclusion: We built an AI model that could differentiate TO from other multinodular airway diseases (mainly amyloidosis, tumors, and inflammation) by using bronchoscopic images. The model could help young physicians identify this rare airway disease.

背景:鉴于气管软骨发育不全(TO)的罕见性,许多基层医院的年轻医生无法根据支气管镜检查结果识别气管软骨发育不全:目的:建立一个人工智能(AI)模型,通过支气管镜图像区分气管骨软骨发育不良(TO)和其他多结节性气道疾病:设计:我们设计了这项研究,利用效能网对 2010 年 1 月至 2022 年 10 月期间接受支气管镜检查的患者的影像数据进行比较。收集2019年10月至2022年10月安徽省胸科医院21例TO患者的支气管镜图像进行外部验证:收集广州医科大学附属第一医院多结节性气道病变(包括TO、淀粉样变、肿瘤和炎症)和无气道病变患者的支气管镜图像。根据不同疾病将图像随机(4:1)分为训练组和验证组,并利用卷积神经网络(CNN)进行深度学习:我们招募了 201 名患有多结节性气道疾病的患者(分别为 38、15、75 和 73 名 TO、淀粉样变性、肿瘤和炎症患者)和 213 名无任何气道病变的患者。为了找到用于深度学习的多结节病变图像,我们利用了2183张多结节病变(包括TO、淀粉样变、肿瘤和炎症)的支气管镜图像,并将它们与没有任何气道病变的图像(1733张)进行了比较。多结节病变识别的准确率为 98.9%。此外,根据多结节病变的支气管镜图像检测 TO 的准确率为 89.2%。在外部验证方面(使用 21 名 TO 患者的图像),所有患者均可被诊断为 TO;准确率为 89.8%:结论:我们建立了一个人工智能模型,可以通过支气管镜图像将 TO 与其他多结节性气道疾病(主要是淀粉样变性、肿瘤和炎症)区分开来。该模型可帮助年轻医生识别这种罕见的气道疾病。
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引用次数: 0
Prescriptions of opioid-containing drugs in patients with chronic cough. 慢性咳嗽患者的含阿片类药物处方。
IF 3.3 3区 医学 Q2 RESPIRATORY SYSTEM Pub Date : 2024-01-01 DOI: 10.1177/17534666241259373
Michael Weiner, Ziyue Liu, Jonathan Schelfhout, Paul Dexter, Anna R Roberts, Ashley Griffith, Vishal Bali, Jessica Weaver

Background: Chronic cough (CC) affects about 10% of adults, but opioid use in CC is not well understood.

Objectives: To determine the use of opioid-containing cough suppressant (OCCS) prescriptions in patients with CC using electronic health records.

Design: Retrospective cohort study.

Methods: Through retrospective analysis of Midwestern U.S. electronic health records, diagnoses, prescriptions, and natural language processing identified CC - at least three medical encounters with cough, with 56-120 days between first and last encounter - and a 'non-chronic cohort'. Student's t-test, Pearson's chi-square, and zero-inflated Poisson models were used.

Results: About 20% of 23,210 patients with CC were prescribed OCCS; odds of an OCCS prescription were twice as great in CC. In CC, OCCS drugs were ordered in 38% with Medicaid insurance and 15% with commercial insurance.

Conclusion: Findings identify an important role for opioids in CC, and opportunity to learn more about the drugs' effectiveness.

背景:慢性咳嗽(CC)影响着约 10% 的成年人,但人们对慢性咳嗽患者使用阿片类药物的情况还不甚了解:利用电子健康记录确定慢性咳嗽患者使用含阿片类止咳药(OCCS)处方的情况:设计:回顾性队列研究:通过对美国中西部地区的电子健康记录、诊断、处方和自然语言处理进行回顾性分析,确定了CC(至少有三次咳嗽就诊经历,第一次和最后一次就诊间隔56-120天)和 "非慢性队列"。研究采用了学生 t 检验、皮尔逊卡方检验和零膨胀泊松模型:结果:在23210名CC患者中,约20%的患者开具了OCCS处方;CC患者开具OCCS处方的几率是其他患者的两倍。在CC中,38%的医疗补助保险患者和15%的商业保险患者开具了OCCS药物处方:研究结果表明,阿片类药物在CC中发挥着重要作用,我们有机会进一步了解这些药物的有效性。
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引用次数: 0
Observational study on the prescription practices of family and pulmonary physicians for airway clearance devices in chronic obstructive pulmonary disease management. 家庭医生和肺科医生在慢性阻塞性肺疾病治疗中气道清除装置处方实践的观察性研究
IF 3.3 3区 医学 Q2 RESPIRATORY SYSTEM Pub Date : 2024-01-01 DOI: 10.1177/17534666241307066
Saeed Mardy Alghamdi, Abdulaziz A Alzahrani, Mohammad S Dairi, Hassan Alwafi, Abdulelah M Aldhahir, Jaber S Alqahtani, Mohammed M Alqahtani, Abdullah M Alanazi, Abdullah A Alqarni, Rayan A Siraj, Noha Saeed Alghamdi, Hassan A Alzahrani, Abdulghani A Alhindi

Background: Productive cough with sputum is a prominent sign generally associated with respiratory diseases, including chronic obstructive pulmonary disease (COPD). Airway clearance devices are an option for COPD management, but physicians' preferences for and clinical practice with them are not known.

Objective: This study aims to explore preferences for and clinical practice with airway clearance devices among physicians in Saudi Arabia.

Design: An observational, cross-sectional survey.

Methods: A self-administered questionnaire was conducted between October 2022 and September 2023, which included a review of respiratory medication prescriptions by physicians for patients with COPD. The analysis was performed using the Statistical Package for the Social Sciences.

Results: The participants were 445 physicians. The majority were female, accounting for 64.3% of the sample. Flutter and Acapella were the most commonly preferred airway clearance devices (45.8% and 20.7%, respectively). Among the participants, 12.6% reported unfamiliarity with any of the mentioned devices. Of the participants, 43.6% "usually" suggested the devices for patients with daily, difficult-to-clear, thick sputum, while 27% "sometimes" recommended them to COPD patients who had experienced four exacerbations or more. In routine clinical practice, physicians prescribe pharmacological therapies as the main treatment. The prescribing data showed that in the last year, there was no record of prescribed airway clearance devices for COPD by physicians.

Conclusion: Family and pulmonary physicians prefer Flutter and Acapella devices, but a significant number of physicians are unaware of such devices. Prescribing data showed no record of prescribed airway clearance devices for COPD management. Further initiatives are needed to increase awareness in clinical practice.

背景:咳痰是呼吸系统疾病(包括慢性阻塞性肺疾病(COPD))的一个显著体征。气道清除装置是COPD治疗的一种选择,但医生对其的偏好和临床实践尚不清楚。目的:本研究旨在探讨沙特阿拉伯医生对气道清除装置的偏好和临床实践。设计:观察性横断面调查。方法:在2022年10月至2023年9月期间进行了一项自我管理的问卷调查,其中包括对医生为COPD患者开具的呼吸药物处方的回顾。使用社会科学统计软件包进行分析。结果:共纳入445名医生。以女性居多,占样本的64.3%。扑动和Acapella是最常用的气道清除装置(分别为45.8%和20.7%)。在参与者中,12.6%的人表示不熟悉上述任何一种设备。在参与者中,43.6%的人“通常”建议对日常痰难清、痰厚的患者使用这种设备,而27%的人“有时”建议对经历过四次或更多次急性加重的COPD患者使用这种设备。在常规临床实践中,医生将药物治疗作为主要治疗方法。处方数据显示,在过去的一年里,没有医生为慢性阻塞性肺病开具气道清除设备的记录。结论:家庭医生和肺科医生更喜欢Flutter和Acapella装置,但相当多的医生不知道这类装置。处方数据显示没有用于COPD管理的气道清除装置的记录。需要采取进一步的举措来提高临床实践中的认识。
{"title":"Observational study on the prescription practices of family and pulmonary physicians for airway clearance devices in chronic obstructive pulmonary disease management.","authors":"Saeed Mardy Alghamdi, Abdulaziz A Alzahrani, Mohammad S Dairi, Hassan Alwafi, Abdulelah M Aldhahir, Jaber S Alqahtani, Mohammed M Alqahtani, Abdullah M Alanazi, Abdullah A Alqarni, Rayan A Siraj, Noha Saeed Alghamdi, Hassan A Alzahrani, Abdulghani A Alhindi","doi":"10.1177/17534666241307066","DOIUrl":"10.1177/17534666241307066","url":null,"abstract":"<p><strong>Background: </strong>Productive cough with sputum is a prominent sign generally associated with respiratory diseases, including chronic obstructive pulmonary disease (COPD). Airway clearance devices are an option for COPD management, but physicians' preferences for and clinical practice with them are not known.</p><p><strong>Objective: </strong>This study aims to explore preferences for and clinical practice with airway clearance devices among physicians in Saudi Arabia.</p><p><strong>Design: </strong>An observational, cross-sectional survey.</p><p><strong>Methods: </strong>A self-administered questionnaire was conducted between October 2022 and September 2023, which included a review of respiratory medication prescriptions by physicians for patients with COPD. The analysis was performed using the Statistical Package for the Social Sciences.</p><p><strong>Results: </strong>The participants were 445 physicians. The majority were female, accounting for 64.3% of the sample. Flutter and Acapella were the most commonly preferred airway clearance devices (45.8% and 20.7%, respectively). Among the participants, 12.6% reported unfamiliarity with any of the mentioned devices. Of the participants, 43.6% \"usually\" suggested the devices for patients with daily, difficult-to-clear, thick sputum, while 27% \"sometimes\" recommended them to COPD patients who had experienced four exacerbations or more. In routine clinical practice, physicians prescribe pharmacological therapies as the main treatment. The prescribing data showed that in the last year, there was no record of prescribed airway clearance devices for COPD by physicians.</p><p><strong>Conclusion: </strong>Family and pulmonary physicians prefer Flutter and Acapella devices, but a significant number of physicians are unaware of such devices. Prescribing data showed no record of prescribed airway clearance devices for COPD management. Further initiatives are needed to increase awareness in clinical practice.</p>","PeriodicalId":22884,"journal":{"name":"Therapeutic Advances in Respiratory Disease","volume":"18 ","pages":"17534666241307066"},"PeriodicalIF":3.3,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11648012/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142829950","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
A real-world study of quality of life following treatment with xylometazoline hydrochloride in individuals with common cold. 一项关于普通感冒患者使用盐酸甲氧甲唑啉治疗后生活质量的真实世界研究。
IF 4.3 3区 医学 Q2 RESPIRATORY SYSTEM Pub Date : 2024-01-01 DOI: 10.1177/17534666241228927
Martina Hagen, Kim Clark, Pranab Kalita, Gessica Serra, Edwin Sanchez, Gabor Varbiro, Mathieu M Albasser

Background: The common cold is a frequent, acute, and mild upper respiratory human disease. Nasal congestion has been considered the most bothersome symptom in the common cold, impacting quality of life (QoL). Topical decongestants containing steroids benefit QoL in allergic rhinitis, but no published research has assessed the impact of topical decongestants on QoL in the common cold.

Objective: To evaluate the effects of xylometazoline hydrochloride 0.1% (Otrivin, GSK Consumer Healthcare SARL, Switzerland) for up to 7 days on QoL in participants with nasal congestion associated with the common cold.

Design: This was a decentralized, longitudinal, open-label study.

Methods: The study enrolled 136 participants (⩾18 years) with early symptoms of the common cold, of which 102 were included in the modified intention-to-treat (mITT) population. Within 24 h of study product receipt, participants confirmed a 'plugged nose' and ⩾1 other common cold symptom. Primary endpoints were Wisconsin Upper Respiratory Symptom Survey-21 (WURSS-21) total score, total and individual symptom scores, and total QoL score. Secondary endpoints were additional QoL scores. Exploratory and post hoc analyses included median days to resolution for each QoL factor and analyses of five QoL categories.

Results: Consistent improvements in symptoms and QoL were seen in the mITT population. From day 1, improvements were seen in the 'plugged nose' symptom (p = 0.0023), WURSS-21 total QoL score, and all individual QoL scores (p < 0.0001 for all). After the last dose needed, significant improvements were seen in sleep quality (73%), vitality (76%), physical activity (71%), social activity (80%), and sensation (81%). No serious or unexpected adverse events were reported.

Conclusion: This study is the first to demonstrate in a real-life setting that treating nasal congestion in adults with xylometazoline hydrochloride 0.1% during the common cold positively impacts QoL factors relevant to daily living [Otrivin: Quality of Life (QoL) Impact in a Real-World Setting; https://clinicaltrials.gov/study/NCT05556148].

背景:普通感冒是一种常见、急性、轻微的上呼吸道疾病。鼻塞一直被认为是普通感冒中最令人烦恼的症状,会影响生活质量(QoL)。含有类固醇的局部减充血剂对过敏性鼻炎患者的生活质量有好处,但目前还没有公开发表的研究评估局部减充血剂对普通感冒患者生活质量的影响:评估0.1%盐酸甲氧甲唑啉(Otrivin,葛兰素史克消费者保健有限公司,瑞士)持续7天对普通感冒鼻塞患者QoL的影响:设计:这是一项分散、纵向、开放标签研究:该研究共招募了 136 名有普通感冒早期症状的参与者(18 岁以下),其中 102 人被纳入修改后的意向治疗(mITT)人群。在收到研究产品的 24 小时内,参与者确认出现 "鼻塞 "和⩾1 种其他普通感冒症状。主要终点为威斯康星上呼吸道症状调查-21(WURSS-21)总分、症状总分和单项症状得分以及 QoL 总分。次要终点为其他 QoL 评分。探索性分析和事后分析包括每个 QoL 因素的中位缓解天数和五个 QoL 类别的分析:mITT人群的症状和QoL均有持续改善。从第 1 天起,"鼻塞 "症状(p = 0.0023)、WURSS-21 QoL 总分和所有单项 QoL 评分均有所改善(p 结论:该研究首次证明,在 "鼻塞 "症状和 QoL 改善的患者中,有超过 50%的人接受了治疗:本研究首次在现实生活中证明,在普通感冒期间使用 0.1% 盐酸甲氧甲唑啉治疗成人鼻塞会对与日常生活相关的 QoL 因素产生积极影响[Otrivin:在真实世界环境中的生活质量 (QoL) 影响;https://clinicaltrials.gov/study/NCT05556148]。
{"title":"A real-world study of quality of life following treatment with xylometazoline hydrochloride in individuals with common cold.","authors":"Martina Hagen, Kim Clark, Pranab Kalita, Gessica Serra, Edwin Sanchez, Gabor Varbiro, Mathieu M Albasser","doi":"10.1177/17534666241228927","DOIUrl":"10.1177/17534666241228927","url":null,"abstract":"<p><strong>Background: </strong>The common cold is a frequent, acute, and mild upper respiratory human disease. Nasal congestion has been considered the most bothersome symptom in the common cold, impacting quality of life (QoL). Topical decongestants containing steroids benefit QoL in allergic rhinitis, but no published research has assessed the impact of topical decongestants on QoL in the common cold.</p><p><strong>Objective: </strong>To evaluate the effects of xylometazoline hydrochloride 0.1% (Otrivin, GSK Consumer Healthcare SARL, Switzerland) for up to 7 days on QoL in participants with nasal congestion associated with the common cold.</p><p><strong>Design: </strong>This was a decentralized, longitudinal, open-label study.</p><p><strong>Methods: </strong>The study enrolled 136 participants (⩾18 years) with early symptoms of the common cold, of which 102 were included in the modified intention-to-treat (mITT) population. Within 24 h of study product receipt, participants confirmed a 'plugged nose' and ⩾1 other common cold symptom. Primary endpoints were Wisconsin Upper Respiratory Symptom Survey-21 (WURSS-21) total score, total and individual symptom scores, and total QoL score. Secondary endpoints were additional QoL scores. Exploratory and <i>post hoc</i> analyses included median days to resolution for each QoL factor and analyses of five QoL categories.</p><p><strong>Results: </strong>Consistent improvements in symptoms and QoL were seen in the mITT population. From day 1, improvements were seen in the 'plugged nose' symptom (<i>p</i> = 0.0023), WURSS-21 total QoL score, and all individual QoL scores (<i>p</i> < 0.0001 for all). After the last dose needed, significant improvements were seen in sleep quality (73%), vitality (76%), physical activity (71%), social activity (80%), and sensation (81%). No serious or unexpected adverse events were reported.</p><p><strong>Conclusion: </strong>This study is the first to demonstrate in a real-life setting that treating nasal congestion in adults with xylometazoline hydrochloride 0.1% during the common cold positively impacts QoL factors relevant to daily living [Otrivin: Quality of Life (QoL) Impact in a Real-World Setting; https://clinicaltrials.gov/study/NCT05556148].</p>","PeriodicalId":22884,"journal":{"name":"Therapeutic Advances in Respiratory Disease","volume":"18 ","pages":"17534666241228927"},"PeriodicalIF":4.3,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10878222/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139900479","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
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Therapeutic Advances in Respiratory Disease
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