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Children’s interstitial lung disease (chILD): less rare than we thought? 儿童间质性肺病 (chILD):没有我们想象的那么罕见?
IF 1 1区 医学 Q1 RESPIRATORY SYSTEM Pub Date : 2024-07-16 DOI: 10.1136/thorax-2024-221951
Andrew Bush, Lawrence Nogee
The presentation of childhood interstitial lung disease (chILD) is non-specific,1 and chILD is usually low on the list of diagnoses in children with combinations of respiratory symptoms, feeding difficulties and failure to thrive. However, if a diagnosis is not considered, it will never be made. In this issue of the Journal , Fletcher et al describe nearly 800 French children, suggesting that chILD may not be as rare as once thought.2 The French RespiRare network has long been systematically collecting incidence and prevalence data of rare diseases, and in this excellent publication, they report a chILD prevalence of 44/million children (95% CI 40.76 to 47.46) and thus a computed incidence of 4.4/million children (95% CI 3.44 to 5.56). This is similar to a recent Spanish study,3 and far greater than previous studies,4 5 which were likely underestimated due to incomplete ascertainment. The major strength of the present study is the collection of data from a well-organised network spanning the whole of France, with multiple different ways of ensuring chILDs were captured. Despite this, cases may still have been missed. For example, it is a surprise that they reported not a single ILD related to e-cigarettes.6 Newborns with rapidly progressive disease due to …
儿童间质性肺病(children interstitial lung disease,chILD)的表现无特异性1,对于合并呼吸道症状、喂养困难和发育不良的儿童,chILD 通常在诊断名单中排名靠后。然而,如果不考虑诊断,就永远不会做出诊断。法国RespiRare网络长期以来一直在系统地收集罕见病的发病率和流行率数据,在这篇出色的文章中,他们报告了罕见病的流行率为44/百万儿童(95% CI 40.76-47.46),因此计算出的发病率为4.4/百万儿童(95% CI 3.44-5.56)。这与西班牙最近的一项研究3 相似,也远远高于之前的研究4 5 ,而之前的研究很可能由于不完全确定而低估了发病率。本研究的主要优势在于从一个覆盖全法国的组织良好的网络中收集数据,并通过多种不同方式确保chILDs被采集到。尽管如此,仍有可能遗漏病例。例如,令人惊讶的是,他们没有报告一起与电子烟有关的 ILD。
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引用次数: 0
Undertreating cardiovascular disease in people with chronic obstructive pulmonary disease (COPD). 对慢性阻塞性肺病(COPD)患者的心血管疾病治疗不足。
IF 9 1区 医学 Q1 RESPIRATORY SYSTEM Pub Date : 2024-07-16 DOI: 10.1136/thorax-2023-221141
Andrea S Gershon, Alina Blazer, Dennis Ko
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引用次数: 0
Distinct trajectories of lung function from childhood to mid-adulthood. 从童年到成年中期肺功能的不同轨迹。
IF 9 1区 医学 Q1 RESPIRATORY SYSTEM Pub Date : 2024-07-16 DOI: 10.1136/thorax-2023-220436
Xian Zhang, Andrew R Gray, Robert J Hancox

Rationale: Life course trajectories of lung function development and decline influence the risk for lung disease but are poorly documented.

Objective: To document lung function trajectories from childhood to mid-adult life.

Methods: We modelled forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC) and FEV1/FVC at ages 9, 11, 13, 15, 18, 21, 26, 32, 38 and 45 years from a population-based cohort using latent profile analysis to identify distinct subgroups of participants with similar lung function trajectories. Regression analyses were used to assess associations between the trajectories, early life factors and postbronchodilator airflow obstruction at age 45.

Results: Among 865 participants with ≥6 measures of lung function, we identified 10 distinct FEV1 trajectories. Most were approximately parallel except for a childhood airway hyper-responsiveness-related persistently low trajectory (3% of study population); two accelerated-decline trajectories, one of which (8%) was associated with smoking and higher adult body mass index (BMI) and a catch-up trajectory (8%). Findings for FEV1/FVC trajectories were similar. Nine trajectories were identified for FVC: most were also approximately parallel except for a higher BMI-related accelerated-decline trajectory. The three FEV1 trajectories leading to the lowest FEV1 values comprised 19% of the cohort but contributed 55% of airflow obstruction at age 45.

Conclusions: Lung function trajectories to mid-adult life are largely established before adolescence, with a few exceptions: a childhood airway hyper-responsiveness-related persistently low trajectory, which starts low and gets worse with age, and accelerated adult decline trajectories associated with smoking and obesity. Adverse trajectories are associated with a high risk of airflow obstruction in mid-adult life.

理由:肺功能发展和衰退的生命历程轨迹影响着肺部疾病的风险,但却鲜有记录:肺功能发展和衰退的生命过程轨迹会影响肺部疾病的风险,但这方面的文献却很少:目的:记录从童年到成年中期的肺功能轨迹:方法:我们利用潜伏特征分析,从基于人群的队列中模拟了 9、11、13、15、18、21、26、32、38 和 45 岁时的 1 秒用力呼气容积 (FEV1)、用力肺活量 (FVC) 和 FEV1/FVC,以识别具有相似肺功能轨迹的不同参与者亚群。回归分析用于评估肺功能轨迹、早期生活因素和45岁时支气管扩张剂后气流阻塞之间的关系:结果:在肺功能测量指标≥6项的865名参与者中,我们发现了10种不同的FEV1轨迹。除了一条与儿童气道高反应性相关的持续低值轨迹(占研究人群的 3%)、两条加速下降轨迹(其中一条(8%)与吸烟和成年体重指数(BMI)较高有关)和一条追赶轨迹(8%)外,大多数轨迹大致平行。FEV1/FVC轨迹的研究结果类似。发现了九条 FVC 的轨迹:除了一条与较高的 BMI 相关的加速下降轨迹外,大多数轨迹也近似平行。导致 FEV1 值最低的三个 FEV1 轨迹占队列的 19%,但在 45 岁时造成了 55% 的气流阻塞:到中年时的肺功能轨迹大多在青春期之前就已确定,但也有少数例外:与儿童气道高反应性相关的持续低水平轨迹(起始值低且随年龄增长而恶化),以及与吸烟和肥胖相关的成年加速下降轨迹。不良轨迹与中年气流阻塞的高风险有关。
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引用次数: 0
Survival outcomes following urgent lung transplantation in France and the USA. 法国和美国紧急肺移植手术后的存活率。
IF 9 1区 医学 Q1 RESPIRATORY SYSTEM Pub Date : 2024-07-16 DOI: 10.1136/thorax-2023-220847
Arnaud Roussel, Edouard Sage, Pierre-Emmanuel Falcoz, Pascal Alexandre Thomas, Yves Castier, Elie Fadel, Françoise Le Pimpec-Barthes, François Tronc, Jacques Jougon, Philippe Lacoste, Johanna Claustre, Laurent Brouchet, Richard Dorent, Edward Cantu, Michael Harhay, Raphaël Porcher, Pierre Mordant

Introduction: Lung graft allocation can be based on a score (Lung Allocation Score) as in the USA or sequential proposals combined with a discrete priority model as in France. We aimed to analyse the impact of allocation policy on the outcome of urgent lung transplantation (LT).

Methods: US United Network for Organ Sharing (UNOS) and French Cristal databases were retrospectively reviewed to analyse LT performed between 2007 and 2017. We analysed the mortality risk of urgent LT by fitting Cox models and adjusted Restricted Mean Survival Time. We then compared the outcome after urgent LT in the UNOS and Cristal groups using a propensity score matching.

Results: After exclusion of patients with chronic obstructive pulmonary disease/emphysema and redo LT, 3775 and 12 561 patients underwent urgent LT and non-urgent LT in the USA while 600 and 2071 patients underwent urgent LT and non-urgent LT in France. In univariate analysis, urgent LT was associated with an HR for death of 1.24 (95% CI 1.05 to 1.48) in the Cristal group and 1.12 (95% CI 1.05 to 1.19) in the UNOS group. In multivariate analysis, the effect of urgent LT was attenuated and no longer statistically significant in the Cristal database (HR 1.1 (95% CI 0.91 to 1.33)) while it remained constant and statistically significant in the UNOS database (HR 1.12 (95% CI 1.05 to 1.2)). Survival comparison of urgent LT patients between the two countries was significantly different in favour of the UNOS group (1-year survival rates 84.1% (80.9%-87.3%) vs 75.4% (71.8%-79.1%) and 3-year survival rates 66.3% (61.9%-71.1%) vs 62.7% (58.5%-67.1%), respectively).

Conclusion: Urgent LT is associated with adverse outcome in the USA and in France with a better prognosis in the US score-based system taking post-transplant survival into account. This difference between two healthcare systems is multifactorial.

导言:肺移植的分配可以像美国那样基于评分(肺分配评分),也可以像法国那样基于顺序建议结合离散优先模式。我们旨在分析分配政策对紧急肺移植(LT)结果的影响:我们对美国器官共享联合网络(UNOS)和法国Cristal数据库进行了回顾性审查,分析了2007年至2017年间进行的肺移植手术。我们通过拟合Cox模型和调整后的限制平均生存时间分析了紧急LT的死亡风险。然后,我们采用倾向得分匹配法比较了UNOS组和Cristal组紧急LT术后的结果:在排除慢性阻塞性肺病/肺气肿和重做LT的患者后,美国分别有3775名和12561名患者接受了紧急LT和非紧急LT治疗,而法国分别有600名和2071名患者接受了紧急LT和非紧急LT治疗。在单变量分析中,紧急LT与Cristal组死亡HR的相关性为1.24(95% CI 1.05至1.48),与UNOS组死亡HR的相关性为1.12(95% CI 1.05至1.19)。在多变量分析中,紧急LT的影响在Cristal数据库中有所减弱,不再具有统计学意义(HR 1.1 (95% CI 0.91 to 1.33)),而在UNOS数据库中则保持不变,具有统计学意义(HR 1.12 (95% CI 1.05 to 1.2))。两国急诊LT患者的存活率比较结果显示,UNOS组患者的存活率明显高于急诊LT组(1年存活率分别为84.1%(80.9%-87.3%)vs 75.4%(71.8%-79.1%),3年存活率分别为66.3%(61.9%-71.1%)vs 62.7%(58.5%-67.1%)):结论:在美国和法国,急诊LT与不良预后有关,而在美国基于评分的系统中,考虑到移植后存活率,LT的预后更好。两种医疗体系之间的这种差异是多因素造成的。
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引用次数: 0
Bilateral mediastinal cysts with müllerian differentiation. 双侧纵隔囊肿伴有苗勒氏分化。
IF 9 1区 医学 Q1 RESPIRATORY SYSTEM Pub Date : 2024-07-16 DOI: 10.1136/thorax-2024-221708
Nuria Domedel Puig, Marta Cufí Quintana, Vanessa Escobedo Rodriguez, Manuela Iglesias Sentís, Miguel Gallego
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引用次数: 0
Human mesenchymal stromal cells inhibit Mycobacterium avium replication in clinically relevant models of lung infection. 在临床相关的肺部感染模型中,人间质基质细胞可抑制分枝杆菌的复制。
IF 9 1区 医学 Q1 RESPIRATORY SYSTEM Pub Date : 2024-07-16 DOI: 10.1136/thorax-2023-220819
Timothy D Shaw, Anna D Krasnodembskaya, Gunnar N Schroeder, Declan F Doherty, Johnatas Dutra Silva, Shikha M Tandel, Yue Su, David Butler, Rebecca J Ingram, Cecilia M O'Kane

Introduction: Novel therapeutic strategies are urgently needed for Mycobacterium avium complex pulmonary disease (MAC-PD). Human mesenchymal stromal cells (MSCs) can directly inhibit MAC growth, but their effect on intracellular bacilli is unknown. We investigated the ability of human MSCs to reduce bacterial replication and inflammation in MAC-infected macrophages and in a murine model of MAC-PD.

Methods: Human monocyte-derived macrophages (MDMs) were infected with M. avium Chester strain and treated with human bone marrow-derived MSCs. Intracellular and extracellular colony-forming units (CFUs) were counted at 72 hours. Six-week-old female balb/c mice were infected by nebulisation of M. avium Chester. Mice were treated with 1×106 intravenous human MSCs or saline control at 21 and 28 days post-infection. Lungs, liver and spleen were harvested 42 days post-infection for bacterial counts. Cytokines were quantified by ELISA.

Results: MSCs reduced intracellular bacteria in MDMs over 72 hours (median 35% reduction, p=0.027). MSC treatment increased extracellular concentrations of prostaglandin E2 (PGE2) (median 10.1-fold rise, p=0.002) and reduced tumour necrosis factor-α (median 28% reduction, p=0.025). Blocking MSC PGE2 production by cyclo-oxygenase-2 (COX-2) inhibition with celecoxib abrogated the antimicrobial effect, while this was restored by adding exogenous PGE2. MSC-treated mice had lower pulmonary CFUs (median 18% reduction, p=0.012), but no significant change in spleen or liver CFUs compared with controls.

Conclusion: MSCs can modulate inflammation and reduce intracellular M. avium growth in human macrophages via COX-2/PGE2 signalling and inhibit pulmonary bacterial replication in a murine model of chronic MAC-PD.

导言:复合分枝杆菌肺病(MAC-PD)迫切需要新的治疗策略。人间质基质细胞(MSCs)可直接抑制分枝杆菌的生长,但其对细胞内分枝杆菌的影响尚不清楚。我们研究了人类间充质干细胞在MAC感染巨噬细胞和MAC-PD小鼠模型中减少细菌复制和炎症的能力。方法:用M. avium Chester菌株感染人类单核细胞衍生巨噬细胞(MDM),并用人类骨髓间充质干细胞处理。72小时后对细胞内和细胞外的集落形成单位(CFU)进行计数。六周大的雌性 balb/c 小鼠通过雾化感染 M. avium Chester。感染后 21 天和 28 天,小鼠静脉注射 1×106 人间充质干细胞或生理盐水对照。感染后 42 天收获肺、肝和脾,进行细菌计数。用酶联免疫吸附法对细胞因子进行量化:结果:间充质干细胞在 72 小时内减少了 MDMs 细胞内的细菌数量(中位数减少 35%,P=0.027)。间充质干细胞治疗增加了前列腺素 E2(PGE2)的细胞外浓度(中位数增加 10.1 倍,p=0.002),并减少了肿瘤坏死因子-α(中位数减少 28%,p=0.025)。用塞来昔布抑制环氧化酶-2(COX-2)来阻断间叶干细胞 PGE2 的产生,可减弱抗菌效果,而加入外源性 PGE2 则可恢复抗菌效果。与对照组相比,间叶干细胞治疗小鼠的肺部CFU较低(中位数减少18%,P=0.012),但脾脏或肝脏CFU无明显变化:结论:在慢性 MAC-PD 小鼠模型中,间叶干细胞可通过 COX-2/PGE2 信号调节炎症,减少人巨噬细胞内的 M. avium 生长,并抑制肺部细菌复制。
{"title":"Human mesenchymal stromal cells inhibit <i>Mycobacterium avium</i> replication in clinically relevant models of lung infection.","authors":"Timothy D Shaw, Anna D Krasnodembskaya, Gunnar N Schroeder, Declan F Doherty, Johnatas Dutra Silva, Shikha M Tandel, Yue Su, David Butler, Rebecca J Ingram, Cecilia M O'Kane","doi":"10.1136/thorax-2023-220819","DOIUrl":"10.1136/thorax-2023-220819","url":null,"abstract":"<p><strong>Introduction: </strong>Novel therapeutic strategies are urgently needed for <i>Mycobacterium avium</i> complex pulmonary disease (MAC-PD). Human mesenchymal stromal cells (MSCs) can directly inhibit MAC growth, but their effect on intracellular bacilli is unknown. We investigated the ability of human MSCs to reduce bacterial replication and inflammation in MAC-infected macrophages and in a murine model of MAC-PD.</p><p><strong>Methods: </strong>Human monocyte-derived macrophages (MDMs) were infected with <i>M. avium</i> Chester strain and treated with human bone marrow-derived MSCs. Intracellular and extracellular colony-forming units (CFUs) were counted at 72 hours. Six-week-old female balb/c mice were infected by nebulisation of <i>M. avium</i> Chester. Mice were treated with 1×10<sup>6</sup> intravenous human MSCs or saline control at 21 and 28 days post-infection. Lungs, liver and spleen were harvested 42 days post-infection for bacterial counts. Cytokines were quantified by ELISA.</p><p><strong>Results: </strong>MSCs reduced intracellular bacteria in MDMs over 72 hours (median 35% reduction, p=0.027). MSC treatment increased extracellular concentrations of prostaglandin E2 (PGE2) (median 10.1-fold rise, p=0.002) and reduced tumour necrosis factor-α (median 28% reduction, p=0.025). Blocking MSC PGE2 production by cyclo-oxygenase-2 (COX-2) inhibition with celecoxib abrogated the antimicrobial effect, while this was restored by adding exogenous PGE2. MSC-treated mice had lower pulmonary CFUs (median 18% reduction, p=0.012), but no significant change in spleen or liver CFUs compared with controls.</p><p><strong>Conclusion: </strong>MSCs can modulate inflammation and reduce intracellular <i>M. avium</i> growth in human macrophages via COX-2/PGE2 signalling and inhibit pulmonary bacterial replication in a murine model of chronic MAC-PD.</p>","PeriodicalId":23284,"journal":{"name":"Thorax","volume":" ","pages":"778-787"},"PeriodicalIF":9.0,"publicationDate":"2024-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11287638/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140176607","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"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
Adaptive multi-interventional trial platform to improve patient care for fibrotic interstitial lung diseases. 适应性多干预试验平台,改善纤维化间质性肺病的患者护理。
IF 9 1区 医学 Q1 RESPIRATORY SYSTEM Pub Date : 2024-07-16 DOI: 10.1136/thorax-2023-221148
Leticia Kawano-Dourado, Tejaswini Kulkarni, Christopher J Ryerson, Pilar Rivera-Ortega, Bruno Guedes Baldi, Nazia Chaudhuri, Manuela Funke-Chambour, Anna-Maria Hoffmann-Vold, Kerri A Johannson, Yet Hong Khor, Sydney B Montesi, Lucilla Piccari, Helmut Prosch, María Molina-Molina, Jacobo Sellares Torres, Iazsmin Bauer-Ventura, Sujeet Rajan, Joseph Jacob, Duncan Richards, Lisa G Spencer, Barbara Wendelberger, Tom Jensen, Melanie Quintana, Michael Kreuter, Anthony C Gordon, Fernando J Martinez, Naftali Kaminski, Victoria Cornelius, Roger Lewis, Wendy Adams, Gisli Jenkins

Background: Fibrotic interstitial lung diseases (fILDs) are a heterogeneous group of lung diseases associated with significant morbidity and mortality. Despite a large increase in the number of clinical trials in the last 10 years, current regulatory-approved management approaches are limited to two therapies that prevent the progression of fibrosis. The drug development pipeline is long and there is an urgent need to accelerate this process. This manuscript introduces the concept and design of an innovative research approach to drug development in fILD: a global Randomised Embedded Multifactorial Adaptive Platform in fILD (REMAP-ILD).

Methods: Description of the REMAP-ILD concept and design: the specific terminology, design characteristics (multifactorial, adaptive features, statistical approach), target population, interventions, outcomes, mission and values, and organisational structure.

Results: The target population will be adult patients with fILD, and the primary outcome will be a disease progression model incorporating forced vital capacity and mortality over 12 months. Responsive adaptive randomisation, prespecified thresholds for success and futility will be used to assess the effectiveness and safety of interventions. REMAP-ILD embraces the core values of diversity, equity, and inclusion for patients and researchers, and prioritises an open-science approach to data sharing and dissemination of results.

Conclusion: By using an innovative and efficient adaptive multi-interventional trial platform design, we aim to accelerate and improve care for patients with fILD. Through worldwide collaboration, novel analytical methodology and pragmatic trial delivery, REMAP-ILD aims to overcome major limitations associated with conventional randomised controlled trial approaches to rapidly improve the care of people living with fILD.

背景:纤维化间质性肺病(fILDs)是一类异质性肺病,发病率和死亡率都很高。尽管过去 10 年中临床试验的数量大幅增加,但目前监管部门批准的治疗方法仅限于两种防止纤维化进展的疗法。药物开发管道漫长,迫切需要加快这一进程。本手稿介绍了一种创新性研究方法的概念和设计:fILD 全球随机嵌入式多因素自适应平台(REMAP-ILD):方法:描述 REMAP-ILD 的概念和设计:具体术语、设计特点(多因素、适应性特征、统计方法)、目标人群、干预措施、结果、使命和价值观以及组织结构:目标人群将是患有 fILD 的成年患者,主要结果将是一个疾病进展模型,其中包括 12 个月内的强迫生命容量和死亡率。将采用反应适应性随机化、预设成功和无效阈值来评估干预措施的有效性和安全性。REMAP-ILD秉承多样性、公平性以及对患者和研究人员包容的核心价值观,并优先采用开放科学的方法进行数据共享和结果传播:通过采用创新、高效的适应性多干预试验平台设计,我们旨在加快和改善对 fILD 患者的治疗。通过全球合作、新颖的分析方法和务实的试验实施,REMAP-ILD 旨在克服传统随机对照试验方法的主要局限性,迅速改善对 fILD 患者的治疗。
{"title":"Adaptive multi-interventional trial platform to improve patient care for fibrotic interstitial lung diseases.","authors":"Leticia Kawano-Dourado, Tejaswini Kulkarni, Christopher J Ryerson, Pilar Rivera-Ortega, Bruno Guedes Baldi, Nazia Chaudhuri, Manuela Funke-Chambour, Anna-Maria Hoffmann-Vold, Kerri A Johannson, Yet Hong Khor, Sydney B Montesi, Lucilla Piccari, Helmut Prosch, María Molina-Molina, Jacobo Sellares Torres, Iazsmin Bauer-Ventura, Sujeet Rajan, Joseph Jacob, Duncan Richards, Lisa G Spencer, Barbara Wendelberger, Tom Jensen, Melanie Quintana, Michael Kreuter, Anthony C Gordon, Fernando J Martinez, Naftali Kaminski, Victoria Cornelius, Roger Lewis, Wendy Adams, Gisli Jenkins","doi":"10.1136/thorax-2023-221148","DOIUrl":"10.1136/thorax-2023-221148","url":null,"abstract":"<p><strong>Background: </strong>Fibrotic interstitial lung diseases (fILDs) are a heterogeneous group of lung diseases associated with significant morbidity and mortality. Despite a large increase in the number of clinical trials in the last 10 years, current regulatory-approved management approaches are limited to two therapies that prevent the progression of fibrosis. The drug development pipeline is long and there is an urgent need to accelerate this process. This manuscript introduces the concept and design of an innovative research approach to drug development in fILD: a global Randomised Embedded Multifactorial Adaptive Platform in fILD (REMAP-ILD).</p><p><strong>Methods: </strong>Description of the REMAP-ILD concept and design: the specific terminology, design characteristics (multifactorial, adaptive features, statistical approach), target population, interventions, outcomes, mission and values, and organisational structure.</p><p><strong>Results: </strong>The target population will be adult patients with fILD, and the primary outcome will be a disease progression model incorporating forced vital capacity and mortality over 12 months. Responsive adaptive randomisation, prespecified thresholds for success and futility will be used to assess the effectiveness and safety of interventions. REMAP-ILD embraces the core values of diversity, equity, and inclusion for patients and researchers, and prioritises an open-science approach to data sharing and dissemination of results.</p><p><strong>Conclusion: </strong>By using an innovative and efficient adaptive multi-interventional trial platform design, we aim to accelerate and improve care for patients with fILD. Through worldwide collaboration, novel analytical methodology and pragmatic trial delivery, REMAP-ILD aims to overcome major limitations associated with conventional randomised controlled trial approaches to rapidly improve the care of people living with fILD.</p>","PeriodicalId":23284,"journal":{"name":"Thorax","volume":" ","pages":"788-795"},"PeriodicalIF":9.0,"publicationDate":"2024-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11287572/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140050440","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"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
Reinforcing the benefits of children's physical activity on lung health. 加强儿童体育锻炼对肺部健康的益处。
IF 9 1区 医学 Q1 RESPIRATORY SYSTEM Pub Date : 2024-07-16 DOI: 10.1136/thorax-2024-221493
Gang Wang, Erik Melén
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引用次数: 0
Improvements of the shape and strength of the diaphragm after endoscopic lung volume reduction. 内窥镜肺容积缩小术后横膈膜形状和强度的改善。
IF 9 1区 医学 Q1 RESPIRATORY SYSTEM Pub Date : 2024-07-16 DOI: 10.1136/thorax-2024-221375
Olivier Taton, Pierre Alain Gevenois, Alain Van Muylem, Benjamin Bondue, Sébastien Van Laethem, Dimitri Leduc

Rationale: Endoscopic lung volume reduction improves lung function, quality of life and exercise capacity in severe emphysema patients. However, its effect on the diaphragm function is not well understood. We hypothesised that endoscopic lung volume reduction increases its strength by modifying its shape.

Objectives: To investigate changes in both diaphragm shape and strength induced by the insertion of endobronchial valves.

Methods: In 19 patients, both the diaphragm shape and strength were investigated respectively by 3D Slicer software applied on CT scans acquired at functional residual capacity and by transdiaphragmatic pressure measurements by bilateral magnetic stimulation of the phrenic nerves before and 3 months after unilateral valves insertion.

Measurements and main results: After lung volume reduction (median (IQR), 434 mL (-597 to -156], p<0.0001), diaphragm strength increased (transdiaphragmatic pressure: 3 cmH2O (2.3 to 4.2), p<0.0001). On the treated side, this increase was associated with an increase in the coronal (16 mm (13 to 24), p<0.0001) and sagittal (26 mm (21 to 30), p<0.0001) lengths as well as in the area of the zone of apposition (62 cm2 (3 to 100), p<0.0001) with a decrease in the coronal (8 mm (-12 to -4), p<0.0001) and sagittal (9 mm (-18 to -2), p=0.0029) radii of curvature.

Conclusions: Endoscopic lung volume reduction modifies the diaphragm shape by increasing its length and its zone of apposition and by decreasing its radius of curvature on the treated side, resulting in an increase in its strength.

Trial registration number: NCT05799352.

理由:内窥镜肺容积缩小术可改善严重肺气肿患者的肺功能、生活质量和运动能力。然而,其对膈肌功能的影响尚不十分清楚。我们假设内窥镜肺容积缩小术通过改变膈肌的形状来增加其强度:研究插入支气管内瓣膜后膈肌形状和强度的变化:在单侧瓣膜植入前和植入 3 个月后,通过应用 3D Slicer 软件对 CT 扫描获得的功能残余能力和通过双侧膈神经磁刺激测量的横膈膜压力分别对 19 例患者的横膈膜形状和强度进行了研究:肺容量缩小后(中位数(IQR),434 mL(-597 至 -156],p2O(2.3 至 4.2),p2(3 至 100),p结论:内窥镜肺容积缩小术通过增加膈肌的长度和贴合区以及减少治疗侧的曲率半径来改变膈肌的形状,从而增加膈肌的强度:NCT05799352.
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引用次数: 0
Journal club 期刊俱乐部
IF 1 1区 医学 Q1 RESPIRATORY SYSTEM Pub Date : 2024-07-01 DOI: 10.1136/thorax-2024-221967
Timothy J Davies
In 2015 the WHO set ambitious targets to tackle the global epidemic of Mycobacterium Tuberculosis (TB), including increased detection, reduced mortality, and decreased economic burden of disease, however, the WHO update from September 2023 reports that none are on track for their 2025 milestones (https://reliefweb.int/report/world/global-tuberculosis-report-2023). This situation is not new- globally all three of the 2020 milestones were missed despite some country specific successes. However, the pandemic has had a major impact, stalling, or outright reversing pre-pandemic progress. For example, overall incidence estimates had declined year-on-year between 2010 and 2020 from 11.4 million (95% CI, 8.94,14.10) to 10 million (95% CI, 9.40,10.70). However, in 2021 and 2022, global incidence estimates increased to 10.3 million (95% CI, 9.64,11.00) and 10.6 million (95% CI, 9.87,11.40) respectively. Similar trends were seen in mortality, although the initial increase was in 2020 with 1.37 million estimated deaths compared with 1.32 million in 2019, with the number returning back to pre-pandemic levels (1.30 million, 95% CI 1.18 to 1.43) in 2022. The timing discrepancy reflects the delayed onset of the disease post infection, compared with the more immediate effects of reduced access to treatment. Shockingly, they estimate that 500 000 excess TB deaths occurred compared with if pre-pandemic trends had been maintained. As it stands, the total reduction in incidence rate and TB deaths in 2022 compared with 2015 were 8.7% and 19% respectively, a long …
2015 年,世卫组织为应对结核分枝杆菌(TB)在全球的流行制定了雄心勃勃的目标,包括提高检测率、降低死亡率和减少疾病的经济负担。然而,世卫组织 2023 年 9 月的最新报告显示,没有一项目标能够如期实现 2025 年的里程碑 (https://reliefweb.int/report/world/global-tuberculosis-report-2023)。这种情况并不新鲜--在全球范围内,尽管一些国家取得了成功,但 2020 年的所有三个里程碑都未能实现。然而,大流行产生了重大影响,使大流行前取得的进展停滞不前,甚至完全逆转。例如,2010 年至 2020 年期间,总发病率估计值逐年下降,从 1140 万(95% CI,894,14.10)降至 1000 万(95% CI,940,10.70)。然而,2021年和2022年,全球发病率估计值分别增至1030万(95% CI,964,11.00)和1060万(95% CI,987,11.40)。死亡率也出现了类似的趋势,但最初的增长是在 2020 年,估计死亡人数为 137 万,而 2019 年为 132 万,到 2022 年,死亡人数将恢复到疫情流行前的水平(130 万,95% CI 118-143 例)。时间上的差异反映了感染后发病的延迟,而获得治疗的机会减少则会产生更直接的影响。令人震惊的是,他们估计,与大流行前的趋势相比,结核病死亡人数将多出 50 万。目前的情况是,与 2015 年相比,2022 年结核病发病率和死亡人数的总降幅分别为 8.7% 和 19%,这是一个漫长的过程......
{"title":"Journal club","authors":"Timothy J Davies","doi":"10.1136/thorax-2024-221967","DOIUrl":"https://doi.org/10.1136/thorax-2024-221967","url":null,"abstract":"In 2015 the WHO set ambitious targets to tackle the global epidemic of Mycobacterium Tuberculosis (TB), including increased detection, reduced mortality, and decreased economic burden of disease, however, the WHO update from September 2023 reports that none are on track for their 2025 milestones (https://reliefweb.int/report/world/global-tuberculosis-report-2023). This situation is not new- globally all three of the 2020 milestones were missed despite some country specific successes. However, the pandemic has had a major impact, stalling, or outright reversing pre-pandemic progress. For example, overall incidence estimates had declined year-on-year between 2010 and 2020 from 11.4 million (95% CI, 8.94,14.10) to 10 million (95% CI, 9.40,10.70). However, in 2021 and 2022, global incidence estimates increased to 10.3 million (95% CI, 9.64,11.00) and 10.6 million (95% CI, 9.87,11.40) respectively. Similar trends were seen in mortality, although the initial increase was in 2020 with 1.37 million estimated deaths compared with 1.32 million in 2019, with the number returning back to pre-pandemic levels (1.30 million, 95% CI 1.18 to 1.43) in 2022. The timing discrepancy reflects the delayed onset of the disease post infection, compared with the more immediate effects of reduced access to treatment. Shockingly, they estimate that 500 000 excess TB deaths occurred compared with if pre-pandemic trends had been maintained. As it stands, the total reduction in incidence rate and TB deaths in 2022 compared with 2015 were 8.7% and 19% respectively, a long …","PeriodicalId":23284,"journal":{"name":"Thorax","volume":"34 1","pages":""},"PeriodicalIF":10.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141319845","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"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
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Thorax
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