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Sex-specificity in Surgical Stages of Lung Cancer in Young Adults. 年轻人肺癌手术分期的性别特异性。
Q3 Medicine Pub Date : 2023-07-17 eCollection Date: 2023-01-01 DOI: 10.2174/18743064-v17-230818-2022-20
Mahdi Abdennadher, Mariem Hadj Dahmane, Sarra Zair, Hazem Zribi, Amina Abdelkbir, Imen Bouassida, Mouna Mlika, Imen Sahnoun, Amani Ben Mansour, Adel Marghli

Background: Young Patients with lung cancer represent a distinct subset of patients with this neoplasm. Young International studies show increased lung cancer rates in females, while the incidence in males continues to decline. There is evidence to suggest that this trend recurs in younger patients. We studied the effects of gender differences on the incidence of surgical stages of lung cancer in young adults and its mortality rate.

Methods: This study is a retrospective review (2010-2020) of young adults (aged under 45 years) with surgical-stage of lung cancer. We calculated female-to-male differences in incidence rate ratios, tumor characteristics, surgical management, and survival. Cumulative survival curves were generated by the Kaplan-Meier method.

Results: We examined 46 men and 24 women, under 45 years. Female patients were diagnosed at earlier stages. The proportion of stage IA disease was significantly higher in women than in men (46% versus 13%, respectively) (p=0.03). Women were more likely never smokers (42% versus 83%, p=0.02). A histologic subtype, females were more likely to have typical carcinoid tumors (13.54% versus 10.21% for males) (p>0.05). The largest histological type in men was adenocarcinoma (25.53% versus 4.16%, p>0.05). All the patients were operated. Three men had neoadjuvant chemotherapy and one was operated on for cerebral oligometastatic before his chest surgery. Adjuvant chemotherapy was given to 7 women and 21 men. Despite the small number of postoperative complications in our study (n= 8, 11.2%), the male sex was significant in predicting this complication (p<0.05). The mortality rate was 1.4%. The 5-year overall survival rates were 84% in men and 87% in women.

Conclusion: Our study identified sex differences in the incidence and mortality rates for surgical lung cancers in young adults, but the biological and endocrine mechanisms implicated in these disparities have not yet been determined.

背景:年轻肺癌患者是该肿瘤患者中的一个独特群体。国际青年研究显示,女性肺癌发病率上升,而男性发病率持续下降。有证据表明,这一趋势在年轻患者中再次出现。我们研究了性别差异对青壮年肺癌手术期发病率及其死亡率的影响:本研究是一项回顾性研究(2010-2020 年),研究对象为患有肺癌手术期的年轻成人(45 岁以下)。我们计算了女性与男性在发病率比、肿瘤特征、手术治疗和生存率方面的差异。采用卡普兰-梅耶法生成累积生存曲线:我们对 45 岁以下的 46 名男性和 24 名女性进行了研究。女性患者的确诊时间较早。女性ⅠA期患者的比例明显高于男性(分别为46%和13%)(P=0.03)。女性更有可能从不吸烟(42% 对 83%,P=0.02)。从组织学亚型来看,女性更有可能患有典型类癌(13.54% 对 10.21%)(P>0.05)。男性最大的组织学类型是腺癌(25.53%对4.16%,P>0.05)。所有患者都接受了手术。三名患者接受了新辅助化疗,一名患者在胸部手术前接受了脑寡转移手术。7名女性和21名男性接受了辅助化疗。尽管在我们的研究中术后并发症的发生率较低(8 例,11.2%),但男性在预测这种并发症方面具有重要意义(p 结论:我们的研究发现了青壮年手术肺癌发病率和死亡率的性别差异,但造成这些差异的生物和内分泌机制尚未确定。
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引用次数: 0
Average Volume-assured Pressure Support as Rescue Therapy after CPAP Failure in Pediatric Obstructive Sleep Apnea: A Retrospective Case Series Study. 平均容量保证压力支持作为儿童阻塞性睡眠呼吸暂停患者CPAP失败后的抢救治疗:回顾性病例系列研究
Q3 Medicine Pub Date : 2023-05-15 eCollection Date: 2023-01-01 DOI: 10.2174/18743064-v17-e230418-2022-18
Victor T Peng, Nauras Hwig, Anayansi Lasso-Pirot, Amal Isaiah, Montserrat Diaz-Abad

Background: Continuous positive airway pressure (CPAP) is frequently prescribed for patients with residual obstructive sleep apnea (OSA) following adenotonsillectomy.

Objectives: The goal was to examine the efficacy of noninvasive ventilation with average volume-assured pressure support (AVAPS) as a potential option for children with failed CPAP titration.

Methods: In a single-center retrospective study, we included children aged 1-17 years, with polysomnographically confirmed OSA who underwent AVAPS titration following failed CPAP titration. In addition to describing the clinical characteristics of the included patients, we compared polysomnographic parameters before and after AVAPS.

Results: Nine patients met the inclusion criteria; out of them, 8 (89%) were males with an age range of 6.7 ± 3.9 years and a body mass index percentile of 81.0 ± 28.9. Reasons for failed CPAP titration were: 3 (33%) patients due to inability to control apnea-hypopnea index (AHI), 3 (33%) patients due to sleep-related hypoventilation, 2 (22%) patients due to treatment-emergent central sleep apnea, and 1 (11%) patient due to intolerance to CPAP. AVAPS resulted in a greater reduction in AHI than CPAP (reduction following CPAP = 24.6 ± 29.3, reduction following AVAPS = 42.5 ± 37.6, p = 0.008). All patients had resolution of the problems which caused CPAP failure.

Conclusion: In this case a series of children with OSA and with failed CPAP titration, AVAPS resulted in a greater reduction in AHI compared with CPAP as well as resolution of the problems which caused CPAP failure.

持续气道正压通气(CPAP)常用于腺扁桃体切除术后残余阻塞性睡眠呼吸暂停(OSA)患者。目的是检查无创通气与平均容量保证压力支持(AVAPS)作为CPAP滴定失败儿童的潜在选择的有效性。在一项单中心回顾性研究中,我们纳入了1-17岁的儿童,多导睡眠图证实OSA,在CPAP滴定失败后接受AVAPS滴定。除了描述纳入患者的临床特征外,我们还比较了AVAPS前后的多导睡眠图参数。9例患者符合纳入标准;其中男性8例(89%),年龄6.7±3.9岁,体重指数为81.0±28.9。CPAP滴定失败的原因有:3例(33%)患者由于无法控制呼吸暂停低通气指数(AHI), 3例(33%)患者由于睡眠相关性低通气,2例(22%)患者由于治疗后出现的中枢性睡眠呼吸暂停,1例(11%)患者由于CPAP不耐受。AVAPS的AHI降低幅度大于CPAP (CPAP后降低= 24.6±29.3,AVAPS后降低= 42.5±37.6,p = 0.008)。所有患者均解决了导致CPAP失败的问题。在本病例中,一系列患有OSA且CPAP滴定失败的儿童,与CPAP相比,AVAPS导致AHI更大的降低,并解决了导致CPAP失败的问题。
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引用次数: 0
CAR Selectively Enhances the Pulmonary Vasodilatory Effect of Fasudil in a Microsphere Model of Pulmonary Hypertension. CAR选择性地增强法舒地尔在肺动脉高压微球模型中的肺血管扩张作用
Q3 Medicine Pub Date : 2023-04-27 eCollection Date: 2023-01-01 DOI: 10.2174/18743064-v17-e230404-2022-19
Abraham Rothman, Humberto Restrepo, William N Evans, Valeri Sarukhanov, David Mann

Background: Despite the approval of several medications for pulmonary hypertension, morbidity and mortality are unacceptably high. Systemic hypotension may limit the use of pulmonary hypertension medications.

Objectives: This study aimed to assess whether the homing peptide CAR (CARSKNKDC) improves the vasodilatory selectivity of fasudil in the pulmonary circulation or systemic circulation in a porcine pulmonary hypertension model.

Materials and methods: Pulmonary hypertension (to approximately 2/3-3/4 systemic pressure levels) was induced by chronic and acute administration of microspheres in 3 micro Yucatan pigs (mean weight 19.9 kg, mean age 4.3 months). Fasudil (0.3 mg/kg) was administered without and with CAR (1.5 mg/kg), and the effect on aortic (Ao) and right ventricular (RV) pressure was recorded with indwelling catheters.

Results: Immediately after fasudil administration, there was a decrease in Ao pressure followed by prompt recovery to baseline. The RV pressure decrease was progressive and sustained. Fasudil alone resulted in a 12% decrease in RV pressure, whereas co-administration of CAR with fasudil resulted in a 22% decrease in RV pressure (p < 0.0001). Fasudil alone caused an average decrease of 34% in the RV/Ao pressure ratio, and fasudil + CAR caused an average decrease of 40% in the RV/Ao pressure ratio (p < 0.0001).

Conclusion: The homing peptide CAR selectively enhanced the acute vasodilatory effects of fasudil on the pulmonary vascular bed in a porcine experimental model of pulmonary hypertension.

尽管已经批准了几种治疗肺动脉高压的药物,但发病率和死亡率高得令人无法接受。系统性低血压可能限制肺动脉高压药物的使用。本研究旨在评估归巢肽CAR(CARSKNKDC)是否能改善猪肺动脉高压模型中法舒地尔在肺循环或体循环中的血管舒张选择性。在3头尤卡坦微型猪(平均体重19.9kg,平均年龄4.3个月)中,通过慢性和急性给药微球诱导肺动脉高压(达到约2/3-3/4的全身压力水平)。Fasudil(0.3 mg/kg)在无CAR和有CAR的情况下给药(1.5 mg/kg),并用留置导管记录对主动脉(Ao)和右心室(RV)压力的影响。法舒地尔给药后,Ao压力立即下降,随后迅速恢复到基线。RV压力的下降是渐进和持续的。Fasudil单独用药可使RV压力降低12%,而CAR与Fasudil联合用药可使右心室压力降低22%(p<0.0001)。Fasudil单药可使RV/Ao压力比平均降低34%,在猪肺动脉高压实验模型中,归巢肽CAR选择性增强了法舒地尔对肺血管床的急性血管舒张作用。
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引用次数: 0
Risk Factors Related to the Death of Admitted COVID-19 Patients: A Buffalo Study. 与新冠肺炎住院患者死亡相关的危险因素:水牛城研究。
Q3 Medicine Pub Date : 2023-04-06 eCollection Date: 2023-01-01 DOI: 10.2174/18743064-v17-e230322-2022-21
Doan Le Minh Hanh, Phan Thai Hao, Do Thi Tuong Oanh, Nguyen Van Tho

Background: Coronavirus disease 2019 (COVID-19) may result in a severe acute respiratory syndrome that leads to a worldwide pandemic. Despite the increasing understanding of COVID-19 disease, the mortality rate of hospitalized COVID-19 patients remains high.

Objective: To investigate the risk factors related to the mortality of admitted COVID-19 patients during the peak of the epidemic from August 2021 to October 2021 in Vietnam.

Methods: This is a prospective cohort study performed at the Hospital for Rehabilitation-Professional diseases. The baseline and demographic data, medical history, clinical examination, the laboratory results were recorded for patients admitted to the hospital with confirmed COVID-19. A radiologist and a pulmonologist will read the chest radiographs on admission and calculate the Brixia scores to classify the severity of lung abnormalities. Patients were followed up until beingrecovered or their death. Comparison of clinical and subclinical characteristics between recovery and death groups to find out risk factors related to the death of COVID-19 patients.

Results: Among 104 admitted COVID-19 patients, men accounted for 42.3%, average age of 61.7 ± 13.7. The most common symptoms were fever 76.9%, breathlessness 74%, and fatigue 53.8%. The majority (84.6%) of the study population had at least one co-morbidity, including hypertension (53.8%), diabetes (25.9%), gastritis (19.2%), ischemic heart disease (15.4) %), stroke (9.6%) and osteoarthritis (9.6%). The rate of mild and moderate COVID-19 is 13.4%, severe 32.7%, and critical 40.4%. There are 88 inpatients (84.6%) who needed respiratory support. The median hospital stay was 13 days (IQR 10-17.75 days). The rate of intubated patients with mechanical ventilation was 31.7%. The overall mortality rate was 29.8%. Risk factors related to death included Brixia scores > 9, Urea > 7 mmol/L, Ferrtin > 578 ng/ml, Failure to get vaccinated, Age > 60 years, and Low Oxygen SpO2 < 87% (BUFFALO).

Conclusion: The main result of the study is the independent risk factors related to the death of admitted COVID-19 patients including Brixia scores > 9, Urea > 7 mmol/L, Ferrtin > 578 ng/ml, Failure to get vaccinated, Age > 60 years, and Low Oxygen SpO2 < 87% ((BUFFALO) which suggests that these COVID-19 patients should be closely followed up.

背景:2019冠状病毒病(新冠肺炎)可能导致严重急性呼吸综合征,从而导致全球大流行。尽管人们对新冠肺炎疾病的了解越来越多,但新冠肺炎住院患者的死亡率仍然很高。目的:调查2021年8月至2021年10月越南疫情高峰期新冠肺炎住院患者死亡率的相关危险因素。方法:这是一项在职业病康复医院进行的前瞻性队列研究。记录确诊为新冠肺炎的住院患者的基线和人口统计数据、病史、临床检查和实验室结果。放射科医生和肺科医生将在入院时阅读胸部X线片,并计算Brixia评分,以对肺部异常的严重程度进行分类。对患者进行随访,直至被覆盖或死亡。比较康复组和死亡组的临床和亚临床特征,以找出与新冠肺炎患者死亡相关的危险因素。结果:在104名新冠肺炎住院患者中,男性占42.3%,平均年龄为61.7±13.7岁。最常见的症状是发热76.9%,呼吸困难74%,疲劳53.8%。大多数(84.6%)研究人群至少有一种合并发病率,包括高血压(53.8%)、糖尿病(25.9%)、胃炎(19.2%)、缺血性心脏病(15.4%)、中风(9.6%)和骨关节炎(9.6%,危重40.4%。需要呼吸支持的住院患者有88人(84.6%)。中位住院时间为13天(IQR 10-17.75天)。机械通气插管患者的发病率为31.7%。总死亡率为29.8%。与死亡相关的危险因素包括Brixia评分>9,尿素>7mmol/L,Ferrtin>578ng/ml,未接种疫苗,年龄>60岁,结论:研究的主要结果是与新冠肺炎住院患者死亡相关的独立危险因素,包括Brixia评分>9,尿素>7mmol/L,Ferrtin>578ng/ml,未接种疫苗,年龄>60岁,低氧SpO2<87%(BUFFALO),这表明这些新冠肺炎患者应密切随访。
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引用次数: 1
Risk Factors Related to the Death of Admitted COVID-19 Patients: A Buffalo Study 与新冠肺炎住院患者死亡相关的危险因素:水牛城研究
Q3 Medicine Pub Date : 2023-04-03 DOI: 10.2174/18743064-v17-e230403-2022-21
Doan Le Minh Hanh, Phan Thai Hao, Do Thi Tuong Oanh, N. V. Tho
Coronavirus disease 2019 (COVID-19) may result in a severe acute respiratory syndrome that leads to a worldwide pandemic. Despite the increasing understanding of COVID-19 disease, the mortality rate of hospitalized COVID-19 patients remains high. To investigate the risk factors related to the mortality of admitted COVID-19 patients during the peak of the epidemic from August 2021 to October 2021 in Vietnam. This is a prospective cohort study performed at the Hospital for Rehabilitation–Professional diseases. The baseline and demographic data, medical history, clinical examination, the laboratory results were recorded for patients admitted to the hospital with confirmed COVID-19. A radiologist and a pulmonologist will read the chest radiographs on admission and calculate the Brixia scores to classify the severity of lung abnormalities. Patients were followed up until beingrecovered or their death. Comparison of clinical and subclinical characteristics between recovery and death groups to find out risk factors related to the death of COVID-19 patients Among 104 admitted COVID-19 patients, men accounted for 42.3%, average age of 61.7 ± 13.7. The most common symptoms were fever 76.9%, breathlessness 74%, and fatigue 53.8%. The majority (84.6%) of the study population had at least one co-morbidity, including hypertension (53.8%), diabetes (25.9%), gastritis (19.2%), ischemic heart disease (15.4) %), stroke (9.6%) and osteoarthritis (9.6%). The rate of mild and moderate COVID-19 is 13.4%, severe 32.7%, and critical 40.4%. There are 88 inpatients (84.6%) who needed respiratory support. The median hospital stay was 13 days (IQR 10-17.75 days). The rate of intubated patients with mechanical ventilation was 31.7%. The overall mortality rate was 29.8%. Risk factors related to death included Brixia scores > 9, Urea > 7 mmol/L, Ferrtin > 578 ng/ml, Failure to get vaccinated, Age > 60 years, and Low Oxygen SpO2 < 87% (BUFFALO). The main result of the study is the independent risk factors related to the death of admitted COVID-19 patients including Brixia scores > 9, Urea > 7 mmol/L, Ferrtin > 578 ng/ml, Failure to get vaccinated, Age > 60 years, and Low Oxygen SpO2 < 87% ((BUFFALO) which suggests that these COVID-19 patients should be closely followed up.
2019冠状病毒病(新冠肺炎)可能导致严重急性呼吸综合征,从而导致全球大流行。尽管人们对新冠肺炎疾病的了解越来越多,但新冠肺炎住院患者的死亡率仍然很高。调查2021年8月至2021年10月越南疫情高峰期新冠肺炎住院患者死亡率的相关风险因素。这是一项在专业疾病康复医院进行的前瞻性队列研究。记录确诊为新冠肺炎的住院患者的基线和人口统计数据、病史、临床检查和实验室结果。放射科医生和肺科医生将在入院时阅读胸部X线片,并计算Brixia评分,以对肺部异常的严重程度进行分类。对患者进行随访,直至被覆盖或死亡。比较康复组和死亡组的临床和亚临床特征,找出与新冠肺炎患者死亡相关的危险因素在104名入院的新冠肺炎患者中,男性占42.3%,平均年龄为61.7±13.7。最常见的症状是发热76.9%,呼吸困难74%,疲劳53.8%。大多数(84.6%)研究人群至少有一种合并发病率,包括高血压(53.8%)、糖尿病(25.9%)、胃炎(19.2%)、缺血性心脏病(15.4%)、中风(9.6%)和骨关节炎(9.6%,危重40.4%。需要呼吸支持的住院患者有88人(84.6%)。中位住院时间为13天(IQR 10-17.75天)。机械通气插管患者的死亡率为31.7%。总死亡率为29.8%。与死亡相关的危险因素包括Brixia评分>9,尿素>7mmol/L,Ferrtin>578ng/ml,未接种疫苗,年龄>60岁,低氧SpO2<87%(BUFFALO)。该研究的主要结果是与入院新冠肺炎患者死亡相关的独立风险因素,包括Brixia评分>9,尿素>7 mmol/L,Ferrtin>578 ng/ml,未能接种疫苗,年龄>60岁,低氧SpO2<87%(BUFFALO),这表明应密切跟踪这些新冠肺炎患者。
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引用次数: 1
Spirometry Reference Equations Including Existing and Novel Parameters. 包括现有参数和新参数的肺活量测量参考方程
Q3 Medicine Pub Date : 2023-02-23 eCollection Date: 2023-01-01 DOI: 10.2174/18743064-v16-e221227-2022-14
Douglas Clark Johnson, Bradford Gardner Johnson

Introduction: Spirometry is an essential component of pulmonary function testing, with interpretation dependent upon comparing results to normal. Reference equations for mean and lower limit of normal (LLN) are available for usual parameters, including forced vital capacity (FVC), forced expiratory volume in the first second of an FVC maneuver (FEV1), and FEV1/FVC. However, standard parameters do not fully characterize the flow-volume loop and equations are unavailable for the upper limit of normal (ULN). The aim of this study was to develop reference equations for existing and novel spirometry parameters, which more fully describe the flow-volume loop, and to compare these to previously reported equations.

Methods: Data from healthy participants in NHANES III was used to derive reference equations for existing and novel spirometry parameters accounting for birth sex, age, height, and ethnicity (Caucasian, Mexican American, Black) for ages 8 to 90 years. An iterative process determined %predicted LLN and ULN. Equations were compared to published reported equations.

Results: Reference equations were developed for mean, LLN and ULN for existing and novel spirometry parameters for ages 8 to 90. The derived equations closely match mean values of previously published equations, but more closely fit the LLN. Mexican-American and Caucasian values were similar (within 2%) so they were combined, while Black relative to Caucasian/Mexican-American values were lower for some parameters.

Conclusion: These reference equations, which account for birth sex, age, height, and ethnicity for existing and novel spirometry parameters, provide a more comprehensive and quantitative evaluation of spirometry and the flow-volume curve.

肺活量计是肺功能测试的一个重要组成部分,其解释取决于与正常结果的比较。正常值的平均值和下限(LLN)的参考方程可用于通常的参数,包括用力肺活量(FVC)、FVC动作的第一秒用力呼气量(FEV1)和FEV1/FVC。然而,标准参数并不能完全表征流量-体积回路,并且方程不适用于正常值上限(ULN)。本研究的目的是为现有和新的肺活量测量参数开发参考方程,更全面地描述流量-体积回路,并将其与先前报道的方程进行比较。来自NHANES III健康参与者的数据用于推导现有和新的肺活量测定参数的参考方程,这些参数考虑了8至90岁的出生性别、种族(高加索人、墨西哥裔美国人、黑人)。迭代过程确定了预测LLN和ULN的百分比。将方程式与已发表的报告方程式进行比较。针对8至90岁年龄段的现有和新的肺活量测定参数,制定了平均值、LLN和ULN的参考方程。导出的方程与以前发布的方程的平均值非常匹配,但更接近LLN。墨西哥裔美国人和高加索人的数值相似(在2%以内),因此合并起来,而黑人相对于高加索/墨西哥裔美国人在某些参数上更低。这些参考方程考虑了现有和新的肺活量测定参数的出生性别、年龄、身高和种族,为肺活量测量和流量-体积曲线提供了更全面和定量的评估。
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引用次数: 0
Urinary Incontinence and Quality of Life in Women With Cystic Fibrosis 囊性纤维化妇女尿失禁与生活质量
Q3 Medicine Pub Date : 2022-09-27 DOI: 10.2174/18743064-v16-e220927-2022-9
Marinice Nunes Soares, Luciana L. Paiva, P. Dalcin, B. Ziegler
Stress urinary incontinence (SUI) is recognized as a common complication in women with CF. The primary objective of this study was to verify the prevalence of urinary incontinence (UI) and its associations with quality of life (QoL) in adult women with CF. The secondary objective was to identify possible associations of UI with cough score, nutritional parameters, and pulmonary function. This cross-sectional study included female patients aged 18 years and older. All patients answered the International Consultation on Incontinence Questionnaire Short Form, the Kings Health Questionnaire, and the Leicester Cough Questionnaire. Nutritional assessment was obtained. Sputum bacteriology and lung function were also performed. Fifty-two women were included, with mean age of 29.0±9.7 years and mean forced expiratory volume in one second (FEV1) of 50.1±21.7% of predicted. Thirty-two patients (61.5%) presented symptoms of UI, 23 (44.2%) of stress UI and 9 (17.3%) of mixed UI. However, there was no significant association between UI and pulmonary function, sputum bacteriology, and cough score (p>0.05). There was a significant association between UI and QoL variables (p<0.05). This study identified a prevalence of 61.5% of UI in women with CF. The presence of UI in women with CF resulted in a negative impact on QoL.
应激性尿失禁(SUI)被认为是CF女性的常见并发症。本研究的主要目的是验证成年CF女性尿失禁(UI)的患病率及其与生活质量(QoL)的关系。次要目的是确定UI与咳嗽评分、营养参数和肺功能的可能关联。这项横断面研究包括18岁及以上的女性患者。所有患者均填写了国际失禁咨询问卷简表、国王健康问卷和莱斯特咳嗽问卷。进行营养评价。痰液细菌学检查和肺功能检查。纳入52名女性,平均年龄29.0±9.7岁,平均每秒用力呼气量(FEV1)为预测值的50.1±21.7%。出现尿失禁症状32例(61.5%),应激性尿失禁23例(44.2%),混合性尿失禁9例(17.3%)。然而,尿失速与肺功能、痰细菌学和咳嗽评分无显著相关性(p < 0.05)。UI与QoL变量之间存在显著相关性(p<0.05)。本研究发现,CF女性患者的尿失禁发生率为61.5%。CF女性患者的尿失禁会对生活质量产生负面影响。
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引用次数: 0
Diaphragm Ultrasound in the Evaluation of Diaphragmatic Dysfunction in Lung Disease 膈肌超声对肺部疾病膈肌功能障碍的评价
Q3 Medicine Pub Date : 2021-12-31 DOI: 10.2174/1874306402115010082
S. Lux, Daniel Ramos, A. Pinto, Sara Schilling, M. Salinas
The diaphragm is the most important respiratory muscle, and its function may be limited by acute and chronic diseases. A diaphragmatic ultrasound, which quantifies dysfunction through different approaches, is useful in evaluating work of breathing and diaphragm atrophy, predicting successful weaning, and diagnosing critically ill patients. This technique has been used to determine reduced diaphragmatic function in patients with chronic obstructive pulmonary disease and interstitial diseases, while in those with COVID-19, diaphragmatic ultrasound has been used to predict weaning failure from mechanical ventilation.
膈肌是最重要的呼吸肌肉,其功能可能受到急性和慢性疾病的限制。膈肌超声通过不同的方法量化功能障碍,可用于评估呼吸和膈肌萎缩的工作,预测成功断奶和诊断危重患者。这项技术已用于确定慢性阻塞性肺病和间质性疾病患者的膈功能降低,而在新冠肺炎患者中,膈超声已用于预测机械通气的断奶失败。
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引用次数: 1
Hypoxemia and Respiratory Failure: Clinical Conditions and Pathophysiological Approaches 低氧血症与呼吸衰竭:临床条件和病理生理学途径
Q3 Medicine Pub Date : 2021-12-31 DOI: 10.2174/1874306402115010059
R. Castillo
Type 1 (hypoxemic) RF has a PaO2 < 60 mmHg with normal or subnormal PaCO2. In this type, the gas exchange is impaired at the level of the aveolo-capillary membrane. Examples of type I RF are carcinogenic or non-cardiogenic pulmonary edema and severe pneumonia. Type 2 (hypercapnic) RF has a PaCO2 > 50 mmHg. Hypoxemia is common, and it is due to respiratory pump failure. Also, respiratory failure is classified according to its onset, course, and duration into acute and chronic; acute (ARF) on top of chronic respiratory failure (CRF) [1].
1型(低氧血症)RF的PaO2<60 mmHg,PaCO2正常或低于正常。在这种类型中,气体交换在aveolo毛细管膜的水平上受到损害。I型RF的例子是致癌或非心源性肺水肿和严重肺炎。2型(高碳酸血症)RF的PaCO2>50 mmHg。低氧血症是常见的,它是由于呼吸泵故障引起的。此外,呼吸衰竭根据其发作、病程和持续时间分为急性和慢性;慢性呼吸衰竭(CRF)之上的急性(ARF)[1]。
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引用次数: 0
High Flow Nasal Cannula as Support in Immunocompromised Patients with Acute Respiratory Failure: A Retrospective Study 高流量鼻插管支持免疫功能低下患者急性呼吸衰竭:一项回顾性研究
Q3 Medicine Pub Date : 2021-12-31 DOI: 10.2174/1874306402115010061
C. Giugliano-Jaramillo, J. Leon, Cristobal Enriquez, J. Keymer, R. Pérez-Araos
High Flow Nasal Cannula (HFNC) is a novel technique for respiratory support that improves oxygenation. In some patients, it may reduce the work of breathing. In immunocompromised patients with Acute Respiratory Failure (ARF), Non-Invasive Ventilation (NIV) is the main support recommended strategy, since invasive mechanical ventilation could increase mortality rates. NIV used for more than 48 hours may be associated with increased in-hospital mortality and hospital length of stay. Therefore HFNC seems like a respiratory support alternative. To describe clinical outcomes of immunocompromised patients with ARF HFNC-supported. Retrospective study in patients admitted with ARF and HFNC-supported. 25 adult patients were included, 21 pharmacologically and 4 non- pharmacologically immunosuppressed. Median age of the patients was 64 [60-76] years, APACHE II 15 [11-19], and PaO2:FiO2 218 [165-248]. Demographic information, origin of immunosuppression, Respiratory Rate (RR), Heart Rate (HR), Mean Arterial Pressure (MAP), oxygen saturation (SpO2) and PaO2:FiO2 ratio were extracted from clinical records of our HFNC local protocol. Data acquisition was performed before and after the first 24 hours of connection. In addition, the need for greater ventilatory support after HFNC, orotracheal intubation, in-hospital mortality and 90 days out-patients’ mortality was recorded. Mean RR before the connection was 25±22 breaths/min and 22±4 breaths/min after the first 24 hours of HFNC use (95% CI; p=0.02). HR mean before connection to HFNC was 96±22 beats/min, and after, it was 86±15 beats/min (95%CI; p=0.008). Previous mean MAP was 86±15 mmHg, and after HFNC, it was 80±12 mmHg (95%CI; p=0.09); mean SpO2 after was 93±5% and before it was 95±4% (95% CI; p=0.13); and previous PaO2:FiO2 mean was 219±66, and after it was 324±110 (95%CI; p=0.52). In-hospital mortality was 28% and 90 days out-patients’ mortality was 32%. HFNC in immunosuppressed ARF subjects significantly decreases HR and RR, being apparently an effective alternative to decrease work of breathing. In-hospital mortality in ARF immunosuppressed patients was high even though respiratory support was used. Better studies are needed to define the role of HFNC-support in ARF.
高流量鼻插管(HFNC)是一种新型的呼吸支持技术,可改善氧合。对一些患者来说,它可能会减少呼吸的工作量。在免疫功能受损的急性呼吸衰竭(ARF)患者中,无创通气(NIV)是推荐的主要支持策略,因为有创机械通气可能会增加死亡率。NIV使用时间超过48小时可能会增加住院死亡率和住院时间。因此,HFNC似乎是一种呼吸支持的替代方案。描述免疫功能低下的ARF HFNC支持患者的临床结果。对ARF和HFNC患者的回顾性研究支持。包括25名成年患者,21名为药理学患者,4名为非药理学免疫抑制患者。患者的中位年龄为64[60-76]岁,APACHE II 15[11-19],PaO2:FiO2 218[165-248]。人口统计学信息、免疫抑制的起源、呼吸频率(RR)、心率(HR)、平均动脉压(MAP)、血氧饱和度(SpO2)和PaO2:FiO2比率从我们的HFNC局部方案的临床记录中提取。在连接的前24小时之前和之后进行数据采集。此外,记录了HFNC后需要更多的通气支持、经口气管插管、住院死亡率和90天患者死亡率。连接前的平均RR为25±22次呼吸/分钟,使用HFNC前24小时后为22±4次呼吸/分(95%CI;p=0.02)。连接HFNC前的HR平均值为96±22次心跳/分钟,连接后为86±15次心跳/分(95%CI;p=0.008)。之前的平均MAP为86±15mmHg,连接HFNC后为80±12mmHg(95%CI,p=0.09);术后平均SpO2为93±5%,术前为95±4%(95%CI;p=0.013);既往PaO2:FiO2平均值为219±66,术后为324±110(95%CI;p=0.52)。住院死亡率为28%,90天后患者死亡率为32%。HFNC在免疫抑制的ARF受试者中显著降低HR和RR,显然是减少呼吸功的有效替代方案。即使使用了呼吸支持,ARF免疫抑制患者的住院死亡率也很高。需要更好的研究来确定HFNC支持在ARF中的作用。
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引用次数: 0
期刊
Open Respiratory Medicine Journal
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