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Correction to Lancet Respir Med 2024; published online Oct 29. https://doi.org/10.1016/S2213-2600(24)00264-9 https://doi.org/10.1016/S2213-2600(24)00264-9
IF 76.2 1区 医学 Q1 CRITICAL CARE MEDICINE Pub Date : 2024-11-22 DOI: 10.1016/s2213-2600(24)00370-9
Léna H, Greiller L, Cropet C, et al. Nivolumab plus ipilimumab versus carboplatin-based doublet as first-line treatment for patients with advanced non-small-cell lung cancer aged ≥70 years or with an ECOG performance status of 2 (GFPC 08–2015 ENERGY): a randomised, open-label, phase 3 study. Lancet Respir Med 2024; published online Oct 29. https://doi.org/10.1016/S2213-2600(24)00264-9—In figure 3B of this Article, the y-axis title should have read “Overall survival (%)”. This correction has been made to the online version as of Nov 22, 2024, and will be made to the printed version.
Léna H, Greiller L, Cropet C, et al. Nivolumab plus ipilimumab versus carboplatin-based doublet as first-line treatment for patients with advanced non-small-cell lung cancer aged ≥70 years or with an ECOG performance status of 2 (GFPC 08-2015 ENERGY): a randomised, open-label, phase 3 study.https://doi.org/10.1016/S2213-2600(24)00264-9-In figure 3B of this Article, the y-axis title should have read "Overall survival (%)".截至 2024 年 11 月 22 日,在线版本已作此更正,印刷版本也将进行更正。
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引用次数: 0
A composite burden score for severe asthma 严重哮喘的综合负担评分
IF 76.2 1区 医学 Q1 CRITICAL CARE MEDICINE Pub Date : 2024-11-22 DOI: 10.1016/s2213-2600(24)00296-0
Jean Bousquet, Renaud Louis, Bernardo Sousa-Pinto
No Abstract
无摘要
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引用次数: 0
Development of an asthma health-care burden score as a measure of severity and predictor of remission in SARP III and U-BIOPRED: results from two major longitudinal asthma cohorts 在 SARP III 和 U-BIOPRED 中开发哮喘医疗负担评分,作为严重程度的衡量标准和缓解的预测指标:两大哮喘纵向队列的结果
IF 76.2 1区 医学 Q1 CRITICAL CARE MEDICINE Pub Date : 2024-11-22 DOI: 10.1016/s2213-2600(24)00250-9
Joe G Zein, Nazanin Zounemat-Kerman, Ian M Adcock, Bo Hu, Amy Attaway, Mario Castro, Sven-Erik Dahlén, Loren C Denlinger, Serpil C Erzurum, John V Fahy, Benjamin Gaston, Annette T Hastie, Elliot Israel, Nizar N Jarjour, Bruce D Levy, David T Mauger, Wendy Moore, Michael C Peters, Kaharu Sumino, Elizabeth Townsend, Eugene R Bleecker

Background

Current asthma guidelines, including those of the European Respiratory Society (ERS) and American Thoracic Society (ATS), suboptimally predict asthma remission, disease severity, and health-care utilisation. We aimed to establish a novel approach to assess asthma severity based on asthma health-care burden data.

Methods

We analysed prospectively collected data from the Severe Asthma Research Program III (SARP III; USA) and the European Unbiased Biomarkers for the Prediction of Respiratory Disease Outcomes (U-BIOPRED; 11 European countries) to calculate a composite burden score based on asthma exacerbations and health-care utilisation, which was modified to include the use of short-acting beta agonists (SABAs) to reflect asthma symptom burden.

Findings

In SARP III, 528 adult participants with asthma were followed up for a mean of 4·4 (SD 1·6) years, and 312 (59%) had severe asthma according to the ERS-ATS definition. Among the 205 participants with asthma who used rescue SABAs daily, 90 used these two or more times a day. In U-BIOPRED, 509 adult participants with asthma were followed up for 1 year, and 421 (83%) had severe asthma. The burden score was less than 1·29 per patient-year in 106 (34%) of 312 SARP III participants and in 80 (19%) of 421 U-BIOPRED participants with severe asthma. By contrast, the burden score was above the median value in 58 (28%) SARP III and 24 (27%) U-BIOPRED participants with non-severe asthma. In both cohorts, the burden score negatively correlated with lung function, asthma control, and quality of life. A burden score of 0·15 or lower predicted asthma remission with a sensitivity greater than 91% and a specificity of 99%.

Interpretation

Our findings highlight considerable discrepancies between the current definition of asthma severity and our burden score. Although the definition of severe asthma proposed by the ERS-ATS and the and Global Initiative for Asthma (GINA) is based on prescribed asthma medications, our personalised health-care burden score includes patient-centred data that reflect disease severity and accurately predicts asthma remission. Subject to prospective validation, the burden score could help to optimise the management of high-risk individuals with asthma.

Funding

SARP III: US National Heart, Lung, and Blood Institute; AstraZeneca; Boehringer Ingelheim; Genentech; GlaxoSmithKline; Sanofi Genzyme/Regeneron; and Teva Pharmaceuticals. U-BIOPRED: Innovative Medicines Initiative Joint Undertaking (EU's Seventh Framework Programme and European Federation of Pharmaceutical Industries and Associations) and eTRIKS project.
背景目前的哮喘指南,包括欧洲呼吸学会(ERS)和美国胸科学会(ATS)的指南,对哮喘缓解、疾病严重程度和医疗保健利用率的预测不够理想。我们旨在建立一种基于哮喘医疗负担数据评估哮喘严重程度的新方法。方法我们分析了从严重哮喘研究计划 III(SARP III,美国)和欧洲呼吸系统疾病结果预测无偏生物标记物(U-BIOPRED,欧洲 11 个国家)中收集的前瞻性数据,计算出了基于哮喘恶化和医疗保健利用率的综合负担评分,并对其进行了修改,将短效β受体激动剂(SABAs)的使用纳入其中,以反映哮喘症状负担。研究结果在 SARP III 中,对 528 名患有哮喘的成年参与者进行了平均 4-4 年(SD 1-6 年)的随访,根据 ERS-ATS 的定义,其中 312 人(59%)患有重度哮喘。在 205 名每天使用 SABAs 的哮喘患者中,有 90 人每天使用两次或两次以上。U-BIOPRED 对 509 名患有哮喘的成年参与者进行了为期一年的随访,其中 421 人(83%)患有重度哮喘。在 312 名 SARP III 参与者中,有 106 人(34%)的负担得分低于 1-29 分/人-年,在 421 名 U-BIOPRED 参与者中,有 80 人(19%)患有重度哮喘。相比之下,在 58 名(28%)SARP III 参与者和 24 名(27%)U-BIOPRED 参与者中,非重度哮喘患者的负担评分高于中值。在这两个组群中,负担评分与肺功能、哮喘控制和生活质量呈负相关。负担评分为 0-15 分或更低时,预测哮喘缓解的灵敏度大于 91%,特异度为 99%。解释:我们的研究结果凸显了目前哮喘严重程度的定义与我们的负担评分之间存在相当大的差异。虽然 ERS-ATS 和全球哮喘倡议(GINA)提出的重症哮喘定义是基于哮喘处方药,但我们的个性化医疗负担评分包含以患者为中心的数据,能反映疾病的严重程度并准确预测哮喘缓解情况。经前瞻性验证,该负担评分有助于优化哮喘高危人群的管理。资助SARP III:美国国家心肺血液研究所、阿斯利康、勃林格殷格翰、基因泰克、葛兰素史克、赛诺菲Genzyme/Regeneron和梯瓦制药。U-BIOPRED:创新药物倡议联合企业(欧盟第七框架计划和欧洲制药工业和协会联合会)和 eTRIKS 项目。
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引用次数: 0
New territories: perioperative chemoimmunotherapy in early-stage NSCLC 新领域:早期 NSCLC 的围手术期化学免疫疗法
IF 76.2 1区 医学 Q1 CRITICAL CARE MEDICINE Pub Date : 2024-11-21 DOI: 10.1016/s2213-2600(24)00302-3
Yusuke Okuma
No Abstract
无摘要
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引用次数: 0
Perioperative tislelizumab plus neoadjuvant chemotherapy for patients with resectable non-small-cell lung cancer (RATIONALE-315): an interim analysis of a randomised clinical trial 针对可切除非小细胞肺癌患者的围手术期替莱利珠单抗加新辅助化疗(RATIONALE-315):随机临床试验的中期分析
IF 76.2 1区 医学 Q1 CRITICAL CARE MEDICINE Pub Date : 2024-11-21 DOI: 10.1016/s2213-2600(24)00269-8
Dongsheng Yue, Wenxiang Wang, Hongxu Liu, Qixun Chen, Chun Chen, Lunxu Liu, Peng Zhang, Guofang Zhao, Fan Yang, Guang Han, Ying Cheng, Bentong Yu, Yue Yang, Haiquan Chen, Jie Jiang, Lijie Tan, Shidong Xu, Naiquan Mao, Jian Hu, Lanjun Zhang, Xibin Zhuang
<h3>Background</h3>Treatment guidelines recommend neoadjuvant or adjuvant chemotherapy, with or without immune checkpoint inhibitors, for resectable non-small-cell lung cancer (NSCLC). We report the interim results for the phase 3 RATIONALE-315 study, which aimed to investigate perioperative tislelizumab for the treatment of resectable NSCLC.<h3>Methods</h3>RATIONALE-315 is a randomised, double-blind, placebo-controlled phase 3 trial conducted at 50 sites (hospitals or academic research centres) in China. Patients (aged ≥18 years) with untreated stage II–IIIA squamous or non-squamous NSCLC were randomly assigned (1:1) to neoadjuvant tislelizumab 200 mg or placebo intravenously every 3 weeks, plus platinum-based doublet chemotherapy followed by surgery and adjuvant tislelizumab 400 mg or placebo every 6 weeks. Dual primary endpoints were major pathological response rate and event-free survival, analysed by intention to treat. Safety was also assessed in all patients who received at least one dose of study treatment. RATIONALE-315 is registered with <span><span>ClinicalTrials.gov</span><svg aria-label="Opens in new window" focusable="false" height="20" viewbox="0 0 8 8"><path d="M1.12949 2.1072V1H7V6.85795H5.89111V2.90281L0.784057 8L0 7.21635L5.11902 2.1072H1.12949Z"></path></svg></span>, <span><span>NCT04379635</span><svg aria-label="Opens in new window" focusable="false" height="20" viewbox="0 0 8 8"><path d="M1.12949 2.1072V1H7V6.85795H5.89111V2.90281L0.784057 8L0 7.21635L5.11902 2.1072H1.12949Z"></path></svg></span>, and is active but not recruiting.<h3>Findings</h3>Between June 8, 2020, and Aug 31, 2022, 453 patients were assigned to tislelizumab (n=226) or placebo (n=227). The median age of patients was 62·0 years (IQR 56·0–67·0). 410 (91%) of 453 patients were male and 43 (9%) were female. As of Aug 21, 2023 (data cutoff for the interim analysis of event-free survival), median duration of follow-up was 22·0 months (IQR 15·5–28·0). Tislelizumab significantly improved event-free survival versus placebo (stratified hazard ratio 0·56 [95% CI 0·40–0·79]; one-sided p=0·0003). The major pathological response rate was significantly higher in the tislelizumab group (56% [95% CI 50–63]) than in the placebo group (15% [11–20]; difference 41% [33–49]; one-sided p<0·0001). Grade 3 or worse adverse events and serious treatment-related adverse events occurred in 163 (72%) of 226 patients and 35 (15%) of 226 patients, respectively, in the tislelizumab group, and in 150 (66%) and 18 (8%) patients, respectively, in the placebo group. The most common grade 3 or worse treatment-related adverse event was decreased neutrophil count (138 [61%] of 226 in the tislelizumab group <em>vs</em> 134 [59%] of 226 in the placebo group). 31 (14%) of 226 patients in the tislelizumab group and 45 (20%) of 227 patients in the placebo group died during the study.<h3>Interpretation</h3>Perioperative tislelizumab plus neoadjuvant chemotherapy showed a clinically meaningful and
背景治疗指南建议对可切除的非小细胞肺癌(NSCLC)进行新辅助或辅助化疗,同时使用或不使用免疫检查点抑制剂。我们报告了3期RATIONALE-315研究的中期结果,该研究旨在探讨围手术期使用替赛珠单抗治疗可切除的NSCLC。未经治疗的II-IIIA期鳞状或非鳞状NSCLC患者(年龄≥18岁)被随机分配(1:1)到新辅助治疗中,每3周静脉注射替斯利珠单抗200毫克或安慰剂,外加铂类双联化疗,然后进行手术和辅助治疗,每6周静脉注射替斯利珠单抗400毫克或安慰剂。双主要终点是主要病理反应率和无事件生存期,按意向治疗进行分析。此外,还对所有至少接受过一次治疗的患者进行了安全性评估。研究结果2020年6月8日至2022年8月31日期间,453名患者被分配到替斯利珠单抗(226人)或安慰剂(227人)治疗。患者的中位年龄为62-0岁(IQR 56-0-67-0)。453名患者中有410名(91%)为男性,43名(9%)为女性。截至2023年8月21日(无事件生存期中期分析的数据截止日期),中位随访时间为22-0个月(IQR为15-5-28-0)。与安慰剂相比,Tislelizumab能显著改善无事件生存期(分层危险比为0-56 [95% CI 0-40-0-79]; 单侧p=0-0003)。替斯利珠单抗组的主要病理反应率(56% [95% CI 50-63])明显高于安慰剂组(15% [11-20];差异 41% [33-49];单侧 p<0-0001)。3级或更严重的不良事件和严重的治疗相关不良事件分别发生在替舒利珠单抗组226例患者中的163例(72%)和安慰剂组226例患者中的35例(15%),以及替舒利珠单抗组150例(66%)和安慰剂组18例(8%)患者中。最常见的 3 级或更严重的治疗相关不良事件是中性粒细胞计数减少(替莱珠单抗组 226 例患者中有 138 例[61%],安慰剂组 226 例患者中有 134 例[59%])。tislelizumab组226名患者中有31人(14%)在研究期间死亡,安慰剂组227名患者中有45人(20%)在研究期间死亡。解释在可切除的II-IIIA期NSCLC患者中,围手术期tislelizumab联合新辅助化疗与新辅助化疗相比,疗效有临床意义,统计学上有显著改善,安全性可控。
{"title":"Perioperative tislelizumab plus neoadjuvant chemotherapy for patients with resectable non-small-cell lung cancer (RATIONALE-315): an interim analysis of a randomised clinical trial","authors":"Dongsheng Yue, Wenxiang Wang, Hongxu Liu, Qixun Chen, Chun Chen, Lunxu Liu, Peng Zhang, Guofang Zhao, Fan Yang, Guang Han, Ying Cheng, Bentong Yu, Yue Yang, Haiquan Chen, Jie Jiang, Lijie Tan, Shidong Xu, Naiquan Mao, Jian Hu, Lanjun Zhang, Xibin Zhuang","doi":"10.1016/s2213-2600(24)00269-8","DOIUrl":"https://doi.org/10.1016/s2213-2600(24)00269-8","url":null,"abstract":"&lt;h3&gt;Background&lt;/h3&gt;Treatment guidelines recommend neoadjuvant or adjuvant chemotherapy, with or without immune checkpoint inhibitors, for resectable non-small-cell lung cancer (NSCLC). We report the interim results for the phase 3 RATIONALE-315 study, which aimed to investigate perioperative tislelizumab for the treatment of resectable NSCLC.&lt;h3&gt;Methods&lt;/h3&gt;RATIONALE-315 is a randomised, double-blind, placebo-controlled phase 3 trial conducted at 50 sites (hospitals or academic research centres) in China. Patients (aged ≥18 years) with untreated stage II–IIIA squamous or non-squamous NSCLC were randomly assigned (1:1) to neoadjuvant tislelizumab 200 mg or placebo intravenously every 3 weeks, plus platinum-based doublet chemotherapy followed by surgery and adjuvant tislelizumab 400 mg or placebo every 6 weeks. Dual primary endpoints were major pathological response rate and event-free survival, analysed by intention to treat. Safety was also assessed in all patients who received at least one dose of study treatment. RATIONALE-315 is registered with &lt;span&gt;&lt;span&gt;ClinicalTrials.gov&lt;/span&gt;&lt;svg aria-label=\"Opens in new window\" focusable=\"false\" height=\"20\" viewbox=\"0 0 8 8\"&gt;&lt;path d=\"M1.12949 2.1072V1H7V6.85795H5.89111V2.90281L0.784057 8L0 7.21635L5.11902 2.1072H1.12949Z\"&gt;&lt;/path&gt;&lt;/svg&gt;&lt;/span&gt;, &lt;span&gt;&lt;span&gt;NCT04379635&lt;/span&gt;&lt;svg aria-label=\"Opens in new window\" focusable=\"false\" height=\"20\" viewbox=\"0 0 8 8\"&gt;&lt;path d=\"M1.12949 2.1072V1H7V6.85795H5.89111V2.90281L0.784057 8L0 7.21635L5.11902 2.1072H1.12949Z\"&gt;&lt;/path&gt;&lt;/svg&gt;&lt;/span&gt;, and is active but not recruiting.&lt;h3&gt;Findings&lt;/h3&gt;Between June 8, 2020, and Aug 31, 2022, 453 patients were assigned to tislelizumab (n=226) or placebo (n=227). The median age of patients was 62·0 years (IQR 56·0–67·0). 410 (91%) of 453 patients were male and 43 (9%) were female. As of Aug 21, 2023 (data cutoff for the interim analysis of event-free survival), median duration of follow-up was 22·0 months (IQR 15·5–28·0). Tislelizumab significantly improved event-free survival versus placebo (stratified hazard ratio 0·56 [95% CI 0·40–0·79]; one-sided p=0·0003). The major pathological response rate was significantly higher in the tislelizumab group (56% [95% CI 50–63]) than in the placebo group (15% [11–20]; difference 41% [33–49]; one-sided p&lt;0·0001). Grade 3 or worse adverse events and serious treatment-related adverse events occurred in 163 (72%) of 226 patients and 35 (15%) of 226 patients, respectively, in the tislelizumab group, and in 150 (66%) and 18 (8%) patients, respectively, in the placebo group. The most common grade 3 or worse treatment-related adverse event was decreased neutrophil count (138 [61%] of 226 in the tislelizumab group &lt;em&gt;vs&lt;/em&gt; 134 [59%] of 226 in the placebo group). 31 (14%) of 226 patients in the tislelizumab group and 45 (20%) of 227 patients in the placebo group died during the study.&lt;h3&gt;Interpretation&lt;/h3&gt;Perioperative tislelizumab plus neoadjuvant chemotherapy showed a clinically meaningful and ","PeriodicalId":51307,"journal":{"name":"Lancet Respiratory Medicine","volume":"23 1","pages":""},"PeriodicalIF":76.2,"publicationDate":"2024-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142684542","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
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
{"title":"One health, one flu: the re-emergence of avian influenza","authors":"","doi":"10.1016/s2213-2600(24)00375-8","DOIUrl":"https://doi.org/10.1016/s2213-2600(24)00375-8","url":null,"abstract":"No Abstract","PeriodicalId":51307,"journal":{"name":"Lancet Respiratory Medicine","volume":"6 1","pages":""},"PeriodicalIF":76.2,"publicationDate":"2024-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142678623","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
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
{"title":"Health care in Ukraine: If everybody leaves, who will stay?","authors":"Talha Burki","doi":"10.1016/s2213-2600(24)00377-1","DOIUrl":"https://doi.org/10.1016/s2213-2600(24)00377-1","url":null,"abstract":"No Abstract","PeriodicalId":51307,"journal":{"name":"Lancet Respiratory Medicine","volume":"35 1","pages":""},"PeriodicalIF":76.2,"publicationDate":"2024-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142642705","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
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
期刊
Lancet Respiratory Medicine
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