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One health, one flu: the re-emergence of avian influenza 一种健康,一种流感:禽流感的再次出现
IF 76.2 1区 医学 Q1 CRITICAL CARE MEDICINE Pub Date : 2024-11-20 DOI: 10.1016/s2213-2600(24)00375-8
No Abstract
无摘要
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引用次数: 0
Health care in Ukraine: If everybody leaves, who will stay? 乌克兰的医疗保健:如果所有人都离开,谁还会留下?
IF 76.2 1区 医学 Q1 CRITICAL CARE MEDICINE Pub Date : 2024-11-15 DOI: 10.1016/s2213-2600(24)00377-1
Talha Burki
No Abstract
无摘要
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引用次数: 0
Clinical remission attainment, definitions, and correlates among patients with severe asthma treated with biologics: a systematic review and meta-analysis 接受生物制剂治疗的重症哮喘患者的临床缓解程度、定义和相关因素:系统回顾和荟萃分析
IF 76.2 1区 医学 Q1 CRITICAL CARE MEDICINE Pub Date : 2024-11-14 DOI: 10.1016/s2213-2600(24)00293-5
Amy Shackleford, Liam G Heaney, Charlene Redmond, P Jane McDowell, John Busby
<h3>Background</h3>Clinical remission has emerged as an important treatment goal in severe asthma; however, studies have reported variable attainment due to differences in study populations, definitions, and methods. We aimed to perform a systematic review and meta-analysis of clinical remission attainment, definitions, and correlates among patients with severe asthma who have been treated with biologics.<h3>Methods</h3>In this systematic review and meta-analysis, we searched Web of Science, Embase, and MEDLINE, using the keywords “asthma” and “remission”, for studies published between database inception and June 13, 2024, that reported clinical remission among patients with severe asthma treated with biologics. Studies were eligible for inclusion in both the systematic review and meta-analysis if they were published in English language peer-reviewed journals and reported rates of clinical remission for patients treated with biologics for severe asthma. There were no limitations by study design. Two reviewers independently screened identified papers (AS and CR), with disagreements resolved through consensus or referral to a third reviewer (JB). Study-level data on study characteristics, clinical remission definitions, clinical remission attainment, and the potential correlates of clinical remission were extracted independently by two reviewers (AS and CR) using Covidence. We defined a three-component definition of clinical remission, which included use of maintenance oral corticosteroids, exacerbations, and asthma symptom burden, and a four-component definition, which additionally included lung function. We meta-analysed the rate of attainment of clinical remission and assessed the correlates of clinical remission using DerSimonian-Laird random-effects models. Statistical heterogeneity was assessed using the <em>I</em><sup>2</sup> statistic. This study was registered with PROSPERO, CRD42024507233.<h3>Findings</h3>Our search identified 3014 potentially eligible studies, of which 1812 were screened. 25 studies were included, which reported 28 analyses of clinical remission attainment. 68 definitions of clinical remission were identified, of which 48 were unique. Little consensus was found between studies in terms of the clinical remission definition, particularly for symptoms and lung function. Eight analyses used the three-component definition of clinical remission and 25 used the four-component definition. The pooled proportion of patients who attained clinical remission was 38% (95% CI 29–47; <em>I</em><sup>2</sup>=93%) for the three-component definition and 30% (27–34; <em>I</em><sup>2</sup>=83%) for the four-component definition. Several pulmonary factors were associated with lower clinical remission rates, including worse FEV<sub>1</sub> (odds ratio 0·09 [95% CI 0·01–0·92]; <em>I</em><sup>2</sup>=87%), worse asthma symptoms (0·23 [0·17–0·33]; <em>I</em><sup>2</sup>=0%), longer asthma duration (0·49 [0·32–0·76]; <em>I</em><sup>2</sup>=22%), an
背景临床缓解已成为重症哮喘的一个重要治疗目标;然而,由于研究人群、定义和方法的不同,研究报告的临床缓解率也不尽相同。我们的目的是对接受生物制剂治疗的重症哮喘患者的临床缓解率、定义和相关因素进行系统回顾和荟萃分析。在本系统回顾和荟萃分析中,我们使用关键词 "哮喘 "和 "缓解 "检索了 Web of Science、Embase 和 MEDLINE,以查找从数据库开始到 2024 年 6 月 13 日之间发表的、报告接受生物制剂治疗的重症哮喘患者临床缓解情况的研究。如果研究发表在英语同行评审期刊上,并报告了接受生物制剂治疗的重症哮喘患者的临床缓解率,则符合纳入系统综述和荟萃分析的条件。研究设计不受限制。两名审稿人(AS 和 CR)独立筛选确定的论文,有分歧时达成共识或提交给第三名审稿人(JB)。两位审稿人(AS 和 CR)使用 Covidence 软件独立提取了有关研究特征、临床缓解定义、临床缓解实现情况以及临床缓解潜在相关因素的研究级数据。我们定义了临床缓解的三要素定义,其中包括维持性口服皮质类固醇的使用、病情恶化和哮喘症状负担,以及四要素定义,其中还包括肺功能。我们使用 DerSimonian-Laird 随机效应模型对临床缓解率进行了荟萃分析,并评估了临床缓解的相关因素。统计异质性采用 I2 统计量进行评估。本研究已在 PROSPERO 注册,注册号为 CRD42024507233。共纳入 25 项研究,这些研究报告了 28 项临床缓解的分析结果。确定了 68 种临床缓解的定义,其中 48 种是唯一的。在临床缓解的定义方面,特别是在症状和肺功能方面,各研究之间几乎没有达成共识。有 8 项分析采用了临床缓解的三要素定义,25 项分析采用了四要素定义。达到临床缓解的患者总比例为:三组份定义为 38% (95% CI 29-47;I2=93%),四组份定义为 30% (27-34;I2=83%)。一些肺部因素与较低的临床缓解率相关,包括较差的 FEV1(几率比 0-09 [95% CI 0-01-0-92];I2=87%)、较差的哮喘症状(0-23 [0-17-0-33];I2=0%)、较长的哮喘持续时间(0-49 [0-32-0-76];I2=22%)和使用维持性口服皮质类固醇(0-57 [0-40-0-79];I2=49%)。合并症的存在,尤其是抑郁症(0-38 [0-23-0-61]; I2=6%)和肥胖症(0-41 [0-31-0-54]; I2=0%),是临床缓解的重要非肺部障碍。不同研究对临床缓解的定义大相径庭,并对临床缓解的实现产生了实质性影响,这表明迫切需要进一步达成共识。病程较长、哮喘严重程度较高以及合并症的存在被认为是临床缓解的重要障碍,这表明尽早采用有效的治疗方法和更广泛的可治疗性状方法进行干预可能会改善治疗效果。
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引用次数: 0
Thoracentesis: an old story and some new sources 胸腔穿刺术:一个老故事和一些新来源
IF 76.2 1区 医学 Q1 CRITICAL CARE MEDICINE Pub Date : 2024-11-14 DOI: 10.1016/s2213-2600(24)00342-4
Emmanuel Drouin, Eric Wiel, Edouard Lansiaux, Jacalyn Duffin, Arnaud Chambellan

Section snippets

Two late 18th century manuscripts

Both of the manuscripts we feature here were written by students hearing the lectures of famous authors, but whose advice on thoracentesis is previously unknown. They are fascinating not only for expanding our understanding of these two important figures but because they provide precise descriptions of the site and technique of thoracic drainage just before auscultation, which would provide the means for locating the pathological change. Student lecture notes could have served as a sort of

Discussion

This Spotlight suggests that until the 18th century, doctors carried out thoracentesis largely in accordance with Hippocrates' recommendations to make the incision low in the chest. The question arose as to whether the approach should be anterior or posterior. We can see that at least two reputed doctors with considerable anatomical knowledge, Astruc and Bichat, raised the question of the drainage technique, with particular reference to the surgical approach. Astruc went further in describing
部分片段两份 18 世纪晚期的手稿我们在此介绍的两份手稿都是由聆听著名作家讲座的学生所写,但他们关于胸腔穿刺术的建议以前却不为人知。这两份手稿之所以引人入胜,不仅是因为它们扩展了我们对这两位重要人物的了解,还因为它们精确描述了听诊前胸腔引流的部位和技术,这将为定位病理变化提供方法。学生的讲课笔记可以作为一种讨论这篇 Spotlight 显示,直到 18 世纪,医生们基本上都是按照希波克拉底的建议进行胸腔穿刺术的,即在胸部低位做切口。问题是,切口应该在前胸还是后胸。我们可以看到,至少有两位具有丰富解剖学知识的著名医生,阿斯特鲁克(Astruc)和比查特(Bichat),提出了引流技术的问题,尤其是手术方法。阿斯特鲁克进一步描述道
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引用次数: 0
Asthma remission: a call for a globally standardised definition 哮喘缓解:呼吁制定全球统一的定义
IF 76.2 1区 医学 Q1 CRITICAL CARE MEDICINE Pub Date : 2024-11-14 DOI: 10.1016/s2213-2600(24)00304-7
Marek Lommatzsch, J Christian Virchow
No Abstract
无摘要
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引用次数: 0
Managing tuberculosis before the onset of symptoms 在肺结核症状出现前进行治疗
IF 76.2 1区 医学 Q1 CRITICAL CARE MEDICINE Pub Date : 2024-11-11 DOI: 10.1016/s2213-2600(24)00372-2
Dennis Falzon, Cecily Miller, Irwin Law, Katherine Floyd, Nimalan Arinaminpathy, Matteo Zignol, Tereza Kasaeva
No Abstract
无摘要
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引用次数: 0
Compassionate use trials and equitable access to variant-specific treatment for cystic fibrosis. 针对囊性纤维化的同情使用试验和公平获得变异特异性治疗。
IF 38.7 1区 医学 Q1 CRITICAL CARE MEDICINE Pub Date : 2024-11-01 Epub Date: 2024-08-13 DOI: 10.1016/S2213-2600(24)00243-1
Katherine Odem-Davis, Jennifer L Taylor-Cousar
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引用次数: 0
Top ten research priorities for sepsis research: UK James Lind Alliance priority setting partnership. 败血症研究的十大研究重点:英国詹姆斯-林德联盟优先事项设定伙伴关系。
IF 38.7 1区 医学 Q1 CRITICAL CARE MEDICINE Pub Date : 2024-11-01 Epub Date: 2024-09-12 DOI: 10.1016/S2213-2600(24)00298-4
Joanne McPeake, Mark Oakes, Colin Graham, Nahid Ahmad, Nazir Lone, Bronwen Connolly
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引用次数: 0
Anti-CTLA-4 in non-small-cell lung cancer: insights from the NIPPON study. 非小细胞肺癌中的抗 CTLA-4:NIPPON 研究的启示。
IF 38.7 1区 医学 Q1 CRITICAL CARE MEDICINE Pub Date : 2024-11-01 Epub Date: 2024-08-16 DOI: 10.1016/S2213-2600(24)00218-2
Molly S C Li, Stephanie P L Saw, Alfredo Addeo
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引用次数: 0
Easing the stress of chronic cough. 缓解慢性咳嗽的压力
IF 38.7 1区 医学 Q1 CRITICAL CARE MEDICINE Pub Date : 2024-11-01 Epub Date: 2024-08-30 DOI: 10.1016/S2213-2600(24)00254-6
Marta Dąbrowska, Lorcan McGarvey
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引用次数: 0
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Lancet Respiratory Medicine
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