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Artificial stone silicosis arrives in the UK: a tragic case of history repeating. 人造石矽肺病在英国出现:历史重演的悲剧。
IF 9 1区 医学 Q1 RESPIRATORY SYSTEM Pub Date : 2024-09-18 DOI: 10.1136/thorax-2024-221806
Christopher Barber
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引用次数: 0
Antenatal exposures to tobacco and biomass or fossil fuels and wheezing in early childhood in South Africa. 南非幼儿产前接触烟草和生物质或化石燃料与喘息。
IF 9 1区 医学 Q1 RESPIRATORY SYSTEM Pub Date : 2024-09-18 DOI: 10.1136/thorax-2024-222071
Rachel Nadif
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引用次数: 0
Intensive care unit interventions to promote sleep and circadian biology in reducing incident delirium: a scoping review. 重症监护病房促进睡眠和昼夜节律生物学以减少谵妄事件的干预措施:范围界定综述。
IF 9 1区 医学 Q1 RESPIRATORY SYSTEM Pub Date : 2024-09-18 DOI: 10.1136/thorax-2023-220036
M Elizabeth Wilcox, Lisa Burry, Marina Englesakis, Briar Coman, Marietou Daou, Frank Mp van Haren, E Wes Ely, Karen J Bosma, Melissa P Knauert

Rationale/objectives: Despite plausible pathophysiological mechanisms, research is needed to confirm the relationship between sleep, circadian rhythm and delirium in patients admitted to the intensive care unit (ICU). The objective of this review is to summarise existing studies promoting, in whole or in part, the normalisation of sleep and circadian biology and their impact on the incidence, prevalence, duration and/or severity of delirium in ICU.

Methods: A sensitive search of electronic databases and conference proceedings was completed in March 2023. Inclusion criteria were English-language studies of any design that evaluated in-ICU non-pharmacological, pharmacological or mixed intervention strategies for promoting sleep or circadian biology and their association with delirium, as assessed at least daily. Data were extracted and independently verified.

Results: Of 7886 citations, we included 50 articles. Commonly evaluated interventions include care bundles (n=20), regulation or administration of light therapy (n=5), eye masks and/or earplugs (n=5), one nursing care-focused intervention and pharmacological intervention (eg, melatonin and ramelteon; n=19). The association between these interventions and incident delirium or severity of delirium was mixed. As multiple interventions were incorporated in included studies of care bundles and given that there was variable reporting of compliance with individual elements, identifying which components might have an impact on delirium is challenging.

Conclusions: This scoping review summarises the existing literature as it relates to ICU sleep and circadian disruption (SCD) and delirium in ICU. Further studies are needed to better understand the role of ICU SCD promotion interventions in delirium mitigation.

理由/目标:尽管病理生理机制貌似合理,但仍需开展研究以确认重症监护病房(ICU)住院患者的睡眠、昼夜节律和谵妄之间的关系。本综述旨在总结全部或部分促进睡眠和昼夜节律生物学正常化的现有研究及其对重症监护病房谵妄的发生率、患病率、持续时间和/或严重程度的影响:于 2023 年 3 月完成了对电子数据库和会议论文集的敏感检索。纳入标准为评估重症监护室内促进睡眠或昼夜节律生物学的非药物、药物或混合干预策略及其与谵妄的关系的任何设计的英语研究,至少每天评估一次。我们对数据进行了提取和独立验证:结果:在7886条引文中,我们收录了50篇文章。常见的评估干预措施包括护理捆绑(20篇)、光疗调节或管理(5篇)、眼罩和/或耳塞(5篇)、一种以护理为重点的干预措施和药物干预措施(如褪黑素和雷美替胺,19篇)。这些干预措施与谵妄事件或谵妄严重程度之间的关系不一。由于纳入的护理捆绑研究中包含了多种干预措施,而且对各个要素的依从性报告不一,因此确定哪些成分可能会对谵妄产生影响具有挑战性:本范围界定综述总结了与重症监护病房睡眠和昼夜节律紊乱(SCD)以及重症监护病房谵妄有关的现有文献。要更好地了解 ICU 促进昼夜节律紊乱干预措施在缓解谵妄方面的作用,还需要进一步的研究。
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引用次数: 0
Untangling the web between menopause and respiratory disease. 解开更年期与呼吸系统疾病之间的联系。
IF 9 1区 医学 Q1 RESPIRATORY SYSTEM Pub Date : 2024-09-18 DOI: 10.1136/thorax-2024-221856
Hannah Whittaker
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引用次数: 0
Relationship between cumulative silica exposure and silicosis: a systematic review and dose-response meta-analysis. 累积矽暴露与矽肺之间的关系:系统回顾与剂量反应荟萃分析。
IF 9 1区 医学 Q1 RESPIRATORY SYSTEM Pub Date : 2024-09-18 DOI: 10.1136/thorax-2024-221447
Patrick Howlett, Jeffrey Gan, Maia Lesosky, Johanna Feary

Background: Silicosis, a chronic respiratory disease caused by crystalline silica exposure, is a persistent global lung health issue. No systematic review of the relationship between cumulative respirable crystalline silica (RCS) exposure and silicosis exists. UK exposure limits are currently under review. We therefore performed a systematic review and dose-response meta-analysis of this relationship.

Methods: Web of Science, Medline and Embase were searched on 24 February 2023. Studies of radiographic, autopsy or death certificate silicosis, with an estimated average follow-up of over 20 years since first employment, were included. Cumulative silicosis risk methods were compared. The relative risks (RR) of silicosis at increasing cumulative exposures were calculated and used to estimate the absolute risk reduction (ARR).

Results: Eight eligible studies, including 10 cohorts, contributed 8792 cases of silicosis among 65 977 participants. Substantial differences in cumulative risk estimates between methodologies exist. Using the same method, we observed higher cumulative silicosis risks among mining compared with non-mining cohorts. A reduction from 4 to 2 mg/m³-years in cumulative RCS exposure corresponded to substantial risk reductions among miners (RR 0.23 (95% CI 0.18 to 0.29, I2=92.9%) with an ARR of 323 (95% CI 298 to 344) per 1000) and non-miners (RR 0.55 (95% CI 0.36 to 0.83, I2=77.0%) with an ARR of 23 (95% CI 9 to 33) per 1000).

Conclusion: Despite significant heterogeneity, our findings support a reduction in permissible exposure limits from 0.1 mg/m3 to 0.05 mg/m³, particularly among mining populations. Further research is needed among non-miners as only two studies were eligible.

背景:矽肺病是一种由接触结晶二氧化硅引起的慢性呼吸道疾病,是一个长期存在的全球性肺部健康问题。目前还没有关于累积接触可吸入结晶二氧化硅(RCS)与矽肺之间关系的系统性研究。英国目前正在审查暴露限值。因此,我们对这种关系进行了系统回顾和剂量反应荟萃分析:方法:于 2023 年 2 月 24 日对 Web of Science、Medline 和 Embase 进行了检索。方法:于 2023 年 2 月 24 日检索了 Web Science、Medline 和 Embase,纳入了自首次就业起平均随访 20 年以上的放射学、尸检或死亡证明矽肺研究。比较了累积性矽肺风险方法。计算累积暴露量增加时矽肺病的相对风险(RR),并以此估算绝对风险降低率(ARR):结果:8 项符合条件的研究(包括 10 个队列)在 65 977 名参与者中发现了 8792 例矽肺病。不同方法的累积风险估计值存在很大差异。使用相同的方法,我们观察到采矿业队列的累积矽肺风险高于非采矿业队列。将累积 RCS 暴露从 4 毫克/立方米-年减少到 2 毫克/立方米-年可大幅降低矿工(RR 0.23 (95% CI 0.18 to 0.29, I2=92.9%),ARR 为 323 (95% CI 298 to 344) per 1000)和非矿工(RR 0.55 (95% CI 0.36 to 0.83, I2=77.0%),ARR 为 23 (95% CI 9 to 33) per 1000)的风险:尽管存在明显的异质性,但我们的研究结果支持将允许接触限值从 0.1 mg/m3 降至 0.05 mg/m³,尤其是在采矿人群中。由于只有两项研究符合条件,因此需要在非矿工中开展进一步研究。
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引用次数: 0
Multiple intrathoracic extramedullary haematopoiesis as visualised on medical thoracoscopy. 医学胸腔镜观察到的多发性胸腔内髓外造血。
IF 9 1区 医学 Q1 RESPIRATORY SYSTEM Pub Date : 2024-09-18 DOI: 10.1136/thorax-2024-221593
Jiun Hang Lee, Larry Ellee Nyanti, Nai-Chien Huan, Hema Yamini Ramarmuty, Kunji Kannan Sivaraman Kannan
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引用次数: 0
Ageing and ivacaftor: unravelling the long-term effects. 老龄化与 ivacaftor:了解长期影响。
IF 9 1区 医学 Q1 RESPIRATORY SYSTEM Pub Date : 2024-09-18 DOI: 10.1136/thorax-2024-221923
Paul D Robinson
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引用次数: 0
Environmental exposures associated with early childhood recurrent wheezing in the mother and child in the environment birth cohort: a time-to-event study. 环境暴露与环境出生队列中母亲和儿童幼儿期反复喘息的相关性:时间到事件研究。
IF 9 1区 医学 Q1 RESPIRATORY SYSTEM Pub Date : 2024-09-18 DOI: 10.1136/thorax-2023-221150
Kareshma Asharam, Aweke A Abebaw Mitku, Lisa Ramsay, Prakash Mohan Jeena, Rajen N Naidoo

Background: Antenatal factors and environmental exposures contribute to recurrent wheezing in early childhood.

Aim: To identify antenatal and environmental factors associated with recurrent wheezing in children from birth to 48 months in the mother and child in the environment cohort, using time-to-event analysis.

Method: Maternal interviews were administered during pregnancy and postnatally and children were followed up from birth to 48 months (May 2013-October 2019). Hybrid land-use regression and dispersion modelling described residential antenatal exposure to nitrogen dioxide (NO2) and particulate matter of 2.5 µm diameter (PM2.5). Wheezing status was assessed by a clinician. The Kaplan-Meier hazard function and Cox-proportional hazard models provided estimates of risk, adjusting for exposure to environmental tobacco smoke (ETS), maternal smoking, biomass fuel use and indoor environmental factors.

Results: Among 520 mother-child pairs, 85 (16%) children, had a single wheeze episode and 57 (11%) had recurrent wheeze. Time to recurrent wheeze (42.9 months) and single wheeze (37.8 months) among children exposed to biomass cooking fuels was significantly shorter compared with children with mothers using electricity (45.9 and 38.9 months, respectively (p=0.03)). Children with mothers exposed to antenatal ETS were 3.8 times more likely to have had recurrent wheeze compared with those not exposed (adjusted HR 3.8, 95% CI 1.3 to 10.7). Mean birth month NO2 was significantly higher among the recurrent wheeze category compared with those without wheeze. NO2 and PM2.5 were associated with a 2%-4% adjusted increased wheezing risk.

Conclusion: Control of exposure to ETS and biomass fuels in the antenatal period is likely to delay the onset of recurrent wheeze in children from birth to 48 months.

背景:产前因素和环境暴露会导致幼儿期反复喘息:产前因素和环境暴露会导致幼儿期反复喘息。目的:采用时间到事件分析法,在母婴环境队列中确定与出生至 48 个月儿童反复喘息相关的产前因素和环境因素:方法:对孕期和产后的母亲进行访谈,对出生至 48 个月(2013 年 5 月至 2019 年 10 月)的儿童进行随访。混合土地利用回归和分散模型描述了居民产前接触二氧化氮(NO2)和直径为2.5微米的颗粒物(PM2.5)的情况。喘息状况由临床医生进行评估。卡普兰-梅耶危害函数和考克斯比例危害模型提供了风险估计值,并对暴露于环境烟草烟雾(ETS)、产妇吸烟、生物质燃料使用和室内环境因素进行了调整:在520对母子中,有85名(16%)儿童出现过一次喘息,57名(11%)儿童出现过反复喘息。与母亲使用电力的儿童(分别为 45.9 个月和 38.9 个月(P=0.03))相比,接触生物质烹饪燃料的儿童出现反复喘息(42.9 个月)和单次喘息(37.8 个月)的时间明显较短。与未接触产前排放有毒有害物质的儿童相比,母亲接触产前排放有毒有害物质的儿童出现反复喘息的几率是未接触产前排放有毒有害物质的儿童的 3.8 倍(调整后 HR 为 3.8,95% CI 为 1.3 至 10.7)。与无喘息者相比,复发性喘息者出生月份的二氧化氮平均值明显较高。二氧化氮和PM2.5与调整后增加2%-4%的喘息风险有关:结论:控制产前暴露于排放有毒物质和生物质燃料可能会延缓出生至 48 个月儿童反复喘息的发生。
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引用次数: 0
Nasal epithelial gene expression identifies relevant asthma endotypes in the ATLANTIS study. 在 ATLANTIS 研究中,鼻上皮基因表达确定了相关的哮喘内型。
IF 9 1区 医学 Q1 RESPIRATORY SYSTEM Pub Date : 2024-09-18 DOI: 10.1136/thorax-2023-221230
Tatiana Karp, Alen Faiz, Jos van Nijnatten, Huib A M Kerstjens, Ilse Boudewijn, Monica Kraft, Judith M Vonk, Martijn C Nawijn, Irene H Heijink, Bianca Beghé, Klaus F Rabe, Alberto Papi, Chris Brightling, Dave Singh, Thys van der Molen, Salman Siddiqui, Stephanie Christenson, Victor Guryev, Maarten van den Berge

Introduction: Asthma is an inflammatory airways disease encompassing multiple phenotypes and endotypes. Several studies suggested gene expression in nasal epithelium to serve as a proxy for bronchial epithelium, being a non-invasive approach to investigate lung diseases. We hypothesised that molecular differences in upper airway epithelium reflect asthma-associated differences in the lower airways and are associated with clinical expression of asthma.

Methods: We analysed nasal epithelial gene expression data from 369 patients with asthma and 58 non-asthmatic controls from the Assessment of Small Airways Involvement in Asthma study. Unsupervised hierarchical clustering was performed on asthma-associated genes. Asthma-associated gene signatures were replicated in independent cohorts with nasal and bronchial brushes data by comparing Gene Set Variation Analysis scores between asthma patients and non-asthmatic controls.

Results: We identified 67 higher expressed and 59 lower expressed genes in nasal epithelium from asthma patients compared with controls (false discovery rate<0.05), including CLCA1, CST1 and POSTN, genes well known to reflect asthma in bronchial airway epithelium. Hierarchical clustering revealed several molecular asthma endotypes with distinct clinical characteristics, including an endotype with higher blood and sputum eosinophils, high fractional exhaled nitric oxide, and more severe small airway dysfunction, as reflected by lower forced expiratory flow at 50%. In an independent cohort, we demonstrated that genes higher expressed in the nasal epithelium reflect asthma-associated changes in the lower airways.

Conclusion: Our results show that the nasal epithelial gene expression profile reflects asthma-related processes in the lower airways. We suggest that nasal epithelium may be a useful non-invasive tool to identify asthma endotypes and may advance personalised management of the disease.

导言:哮喘是一种气道炎症性疾病,包括多种表型和内型。一些研究表明,鼻腔上皮细胞的基因表达可作为支气管上皮细胞的替代物,是研究肺部疾病的一种非侵入性方法。我们假设上呼吸道上皮细胞的分子差异反映了下呼吸道与哮喘相关的差异,并与哮喘的临床表现相关:我们分析了哮喘小气道受累评估研究中 369 名哮喘患者和 58 名非哮喘对照者的鼻上皮基因表达数据。对哮喘相关基因进行了无监督分层聚类。通过比较哮喘患者和非哮喘对照组的基因组变异分析得分,在具有鼻腔和支气管刷数据的独立队列中复制了哮喘相关基因特征:与对照组相比,我们在哮喘患者的鼻腔上皮细胞中发现了 67 个表达较高的基因和 59 个表达较低的基因(假发现率CLCA1、CST1 和 POSTN,众所周知,这些基因在支气管气道上皮细胞中反映了哮喘。分层聚类发现了几种具有不同临床特征的哮喘分子内型,包括血液和痰中嗜酸性粒细胞较高、呼出一氧化氮分数较高以及小气道功能障碍较严重的内型(50% 强迫呼气流量较低)。在一个独立的队列中,我们证实鼻上皮中表达较高的基因反映了下呼吸道与哮喘相关的变化:我们的研究结果表明,鼻上皮基因表达谱反映了下呼吸道与哮喘相关的过程。我们认为,鼻上皮可能是识别哮喘内型的一种有用的非侵入性工具,可促进对该疾病的个性化管理。
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引用次数: 0
Early menopause and hormone therapy as determinants for lung health outcomes: a secondary analysis using the PLCO trial. 更年期提前和激素治疗是肺部健康结果的决定因素:利用 PLCO 试验进行的二次分析。
IF 9 1区 医学 Q1 RESPIRATORY SYSTEM Pub Date : 2024-09-18 DOI: 10.1136/thorax-2023-220956
Xiaochun Gai, Yue Feng, Tessa M Flores, Huining Kang, Hui Yu, Kimberly K Leslie, Yiliang Zhu, Jennifer A Doherty, Yan Guo, Steven A Belinsky, Linda S Cook, Shuguang Leng

Rationale: Early natural menopause (early-M; <45 years of age) increases the risk of lung morbidities and mortalities in smokers. However, it is largely unknown whether early-M due to surgery demonstrates similar effects and whether menopausal hormone therapy (MHT) is protective against lung diseases.

Objectives: To assess the associations of early-M and MHT with lung morbidities and mortalities using the prospective Prostate, Lung, Colorectal and Ovarian (PLCO) trial.

Methods: We estimated the risk among 69 706 postmenopausal women in the PLCO trial, stratified by menopausal types and smoking status.

Results: Early-M was associated with an increased risk of most lung disease and mortality outcomes in ever smokers with the highest risk seen for respiratory mortality (HR 1.98, 95% CI 1.34 to 2.92) in those with bilateral oophorectomy (BO). Early-M was positively associated with chronic bronchitis, and all-cause, non-cancer and respiratory mortality in never smokers with natural menopause or BO, with the highest risk seen for BO- respiratory mortality (HR 1.91, 95% CI 1.16 to 3.12). Ever MHT was associated with reduced all-cause, non-cancer and cardiovascular mortality across menopause types regardless of smoking status and was additionally associated with reduced risk of non-ovarian cancer, lung cancer (LC) and respiratory mortality in ever smokers. Among smokers, ever MHT use was associated with a reduction in HR for all-cause, non-cancer and cardiovascular mortality in a duration-dependent manner.

Conclusions: Smokers with early-M should be targeted for smoking cessation and LC screening regardless of menopause types. MHT users had a lower likelihood of dying from LC and respiratory diseases in ever smokers.

理由:早期自然绝经(early-M;Objectives:利用前瞻性的前列腺、肺、结直肠和卵巢(PLCO)试验,评估早期自然绝经和MHT与肺部疾病和死亡率的关系:我们估算了 PLCO 试验中 69 706 名绝经后妇女的风险,并按绝经类型和吸烟状况进行了分层:结果:在曾经吸烟的妇女中,早期绝经与大多数肺部疾病和死亡风险的增加有关,其中双侧输卵管切除术(BO)妇女的呼吸系统死亡风险最高(HR 1.98,95% CI 1.34 至 2.92)。在自然绝经或双侧输卵管切除术的从不吸烟者中,早期M与慢性支气管炎、全因、非癌症和呼吸系统死亡率呈正相关,其中双侧输卵管切除术-呼吸系统死亡率的风险最高(HR 1.91,95% CI 1.16 至 3.12)。无论吸烟与否,曾经使用过MHT均可降低各种更年期类型的全因死亡率、非癌症死亡率和心血管死亡率,而且还可降低曾经吸烟者罹患非卵巢癌、肺癌(LC)和呼吸系统疾病的风险。在吸烟者中,曾经使用 MHT 与全因死亡率、非癌症死亡率和心血管死亡率的降低有关,其降低与持续时间有关:结论:无论更年期类型如何,都应针对早期M吸烟者进行戒烟和LC筛查。在曾经吸烟的人群中,MHT使用者死于低密度脂蛋白血症和呼吸系统疾病的可能性较低。
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引用次数: 0
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