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Unplanned Perioperative Reoperation Following Pulmonary Resection in Lung Cancer Patients: A Report of a Single-Center Experience 肺癌患者肺切除术后非计划围手术期再次手术:单中心经验报告
IF 1.9 4区 医学 Q3 RESPIRATORY SYSTEM Pub Date : 2024-08-06 DOI: 10.1111/crj.13810
Hongxiang Feng, Yue Zhao, Chaoyang Liang, Yuhui Shi, Deruo Liu, Jin Zhang, Zhenrong Zhang

Background

Pulmonary resection is an important part of comprehensive treatment of lung cancer. Despite the progress in recent thoracic surgery, reoperation is occasionally inevitable for managing severe perioperative complications. This study aimed to investigate the incidence and causes of perioperative reoperation in lung cancer patients.

Methods

We retrospectively collected patients who underwent reoperation following pulmonary resection from January 2010 to February 2021 in China-Japan Friendship Hospital.

Results

Among the 5032 lung cancer patients who received primary pulmonary resection in our institute, 37 patients underwent perioperative reoperation with the rate being 0.74%. Lobectomy was the most frequently executed procedure (56.8%). The mean duration of the primary surgery was 143.6 ± 65.1 min. About half of the cases received secondary surgery within 24 h of the primary surgery, whereas only one case underwent secondary surgery 30 days after the primary surgery (due to chylous leakage). The major causes of the reoperation were bleeding (73.0%), chylous leakage (13.5%), lobar torsion (5.4%), air leakage (2.7%), atelectasis (2.9%), and cardiac herniation (2.7%).

Conclusion

The most prevalent reasons for unplanned reoperation following pulmonary resection in lung cancer patients include bleeding, chylous leakage, and lobar torsion. The strict control of the surgical indications and standardization of surgical procedures are fundamental to reduce unplanned secondary operations after pulmonary resections. Timely identification of the need to secondary surgery is also important to ensure patients' safety.

背景:肺切除术是肺癌综合治疗的重要组成部分。尽管近年来胸外科手术取得了很大进展,但为了处理严重的围手术期并发症,再次手术有时仍不可避免。本研究旨在调查肺癌患者围手术期再次手术的发生率和原因:我们回顾性收集了 2010 年 1 月至 2021 年 2 月期间在中日友好医院接受肺切除术后再次手术的患者:结果:在我院接受原发性肺切除术的5032例肺癌患者中,有37例患者进行了围手术期再手术,再手术率为0.74%。肺叶切除术是最常见的手术(56.8%)。初次手术的平均时间为(143.6 ± 65.1)分钟。约半数病例在初次手术后24小时内接受了二次手术,只有一例在初次手术后30天接受了二次手术(由于乳糜漏)。再次手术的主要原因是出血(73.0%)、乳糜漏(13.5%)、肺叶扭转(5.4%)、漏气(2.7%)、肺不张(2.9%)和心脏疝(2.7%):结论:肺癌患者肺切除术后最常见的非计划再手术原因包括出血、乳糜漏和肺叶扭转。严格控制手术适应症和规范手术流程是减少肺切除术后意外二次手术的根本。及时发现是否需要二次手术对于确保患者的安全也很重要。
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引用次数: 0
Identification of Biomarkers for Lung Adenocarcinoma With Qi Deficiency and Phlegm Dampness 气虚痰湿型肺腺癌生物标志物的鉴定
IF 1.9 4区 医学 Q3 RESPIRATORY SYSTEM Pub Date : 2024-08-06 DOI: 10.1111/crj.13812
Jiabin Chen, Sheng Wang, Qiaolei Yang, Yongjun Zhang, Jianfei Shen, Kequn Chai

Background

Qi deficiency and phlegm dampness (QPD) is one of the most common traditional Chinese medicine (TCM) syndromes in lung adenocarcinoma (LUAD). This study aimed to identify syndrome-specific biomarkers for LUAD with QPD syndrome.

Methods

Peripheral blood mononuclear cells (PBMCs) from LUAD patients with QPD, LUAD patients with non-QPD (N-QPD), and healthy control (H) were collected and analyzed with RNA-seq to identify differentially expressed genes (DEGs). The area under the receiver operator characteristic curve (AUC) of each DEG was calculated, and the top 10 highest AUC DEGs were validated by qRT-PCR. Logistic regression analysis was used to develop a diagnostic model evaluated with AUC.

Results

A total of 135 individuals were enrolled in this study (training set: 15 QPD, 15 N-QPD, 15 H; validation set: 30 QPD, 30 N-QPD, 30 H). A total of 1480 DEGs were identified between QPD and N-QPD. The qRT-PCR results showed that the expression of DDR2 was downregulated, and PPARG was upregulated, which was in line with the finding of the training set. We developed a diagnostic model with these two genes. The AUC of the diagnostic model in the training cohort and validation cohort was 0.891 and 0.777, respectively.

Conclusions

We identified the two genes (DDR2 and PPARG) as syndrome-specific biomarkers for LUAD with QPD syndrome and developed a novel diagnostic model, which may help to improve the accuracy and sensibility of clinical diagnosis and provide a new target for natural drug treatment of LUAD.

背景:气虚痰湿证(QPD)是肺腺癌(LUAD)最常见的中医证候之一。本研究旨在确定肺腺癌气虚痰湿证的特异性生物标志物:方法:收集患有 QPD 的 LUAD 患者、患有非 QPD 的 LUAD 患者(N-QPD)和健康对照(H)的外周血单核细胞(PBMCs),并进行 RNA-seq 分析,以确定差异表达基因(DEGs)。计算每个 DEG 的接收者操作特征曲线下面积(AUC),并通过 qRT-PCR 验证 AUC 最高的前 10 个 DEG。利用逻辑回归分析建立了一个用AUC评估的诊断模型:结果:共有 135 人参加了这项研究(训练集:15 个 QPD、15 个 N-QPD、15 个 N-QPD):结果:共有 135 人参加了这项研究(训练集:15 QPD、15 N-QPD、15 H;验证集:30 QPD、30 N-QPD、30 H):30个QPD、30个N-QPD、30个H)。在 QPD 和 N-QPD 之间共鉴定出 1480 个 DEGs。qRT-PCR 结果显示,DDR2 表达下调,PPARG 表达上调,这与训练集的结果一致。我们利用这两个基因建立了一个诊断模型。在训练组和验证组中,诊断模型的AUC分别为0.891和0.777:结论:我们发现了两个基因(DDR2和PPARG)是LUAD伴QPD综合征的综合征特异性生物标志物,并建立了一个新的诊断模型,这可能有助于提高临床诊断的准确性和敏感性,并为LUAD的天然药物治疗提供新的靶点。
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引用次数: 0
Which Is More Suitable for First-Line Treatment of Extensive-Stage Small Cell Lung Cancer, PD-L1 Inhibitors Versus PD-1 Inhibitors? A Systematic Review and Network Meta-Analysis PD-L1抑制剂与PD-1抑制剂哪个更适合广泛期小细胞肺癌的一线治疗?系统综述与网络荟萃分析》。
IF 1.9 4区 医学 Q3 RESPIRATORY SYSTEM Pub Date : 2024-07-29 DOI: 10.1111/crj.13804
Wenjing Liu, Lulin Yu, Yuqian Feng, Siyu Huang, Yuxin Hua, Mingying Peng, Shanming Ruan, Kai Zhang

Background

In this network meta-analysis (NMA), the efficiency and safety of PD-1 inhibitors + chemotherapy and PD-L1 inhibitors + chemotherapy were compared in the first-line therapy of patients with extensive-stage small cell lung cancer (ES-SCLC).

Methods

We searched research databases, conference abstracts, and trial registries and subsequently chose relevant studies and extracted dates. The NMA was conducted to estimate the efficiency and safety of the PD-1 inhibitors + chemotherapy and PD-L1 inhibitors + chemotherapy on overall survival (OS), progression-free survival (PFS), overall remission rate (ORR), and adverse events (AEs). Studies were assessed for quality. Subgroup analyses were used to evaluate study heterogeneity.

Results

We included six randomized trials with a total of 3163 patients. Direct comparisons showed that patients who received either PD-1 inhibitors + chemotherapy (HR: 0.71, 95% CI: 0.57–0.87) or PD-L1 inhibitors + chemotherapy (HR: 0.74, 0.61–0.89) demonstrated significantly longer OS than those who received placebo + chemotherapy. The results of the NMA showed that no significant differences in OS (HR 0.96 95% CI: 0.72–1.3), PFS (HR 0.83, 95% CI: 0.51–1.4), and ORR (OR 1.3 95% CI: 0.66–2.5) were observed for PD-1 inhibitors + chemotherapy compared with PD-L1 inhibitors + chemotherapy, but the Bayesian ranking revealed that patients receiving PD-1 inhibitors + chemotherapy tended to have longer OS, PFS benefit, and better treatment response than patients receiving PD-L1 inhibitors + chemotherapy. In terms of safety, no significant difference was observed in their safety profiles.

Conclusion

In comparison to placebo + chemotherapy, PD-L1 inhibitors + chemotherapy and PD-1 inhibitors + chemotherapy significantly improved survival for ES-SCLC. According to the available data, PD-L1 inhibitors + chemotherapy and PD-1 inhibitors + chemotherapy had equivalent efficacy and safety; however, the level of evidence of this type of comparison is limited.

研究背景在这项网络荟萃分析(NMA)中,比较了PD-1抑制剂+化疗和PD-L1抑制剂+化疗在广泛期小细胞肺癌(ES-SCLC)患者一线治疗中的有效性和安全性:我们检索了研究数据库、会议摘要和试验登记,随后选择了相关研究并提取了日期。NMA旨在估算PD-1抑制剂+化疗和PD-L1抑制剂+化疗对总生存期(OS)、无进展生存期(PFS)、总缓解率(ORR)和不良事件(AEs)的有效性和安全性。对研究进行了质量评估。亚组分析用于评估研究的异质性:我们纳入了六项随机试验,共3163名患者。直接比较显示,接受PD-1抑制剂+化疗(HR:0.71,95% CI:0.57-0.87)或PD-L1抑制剂+化疗(HR:0.74,0.61-0.89)的患者的OS明显长于接受安慰剂+化疗的患者。NMA结果显示,OS(HR 0.96 95% CI:0.72-1.3)、PFS(HR 0.83,95% CI:0.51-1.4)和ORR(OR 1.3 95% CI:0.66-2.5)与PD-1抑制剂+化疗(HR:0.74,95% CI:0.61-0.89)相比无明显差异。5),但贝叶斯排序显示,接受PD-1抑制剂+化疗的患者往往比接受PD-L1抑制剂+化疗的患者有更长的OS、PFS获益和更好的治疗反应。在安全性方面,两者的安全性无明显差异:结论:与安慰剂+化疗相比,PD-L1抑制剂+化疗和PD-1抑制剂+化疗能明显改善ES-SCLC的生存率。根据现有数据,PD-L1抑制剂+化疗和PD-1抑制剂+化疗具有同等的疗效和安全性;然而,这类比较的证据水平有限。
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引用次数: 0
Evaluation of the diagnostic role of radial probe endobronchial ultrasound for peripheral pulmonary lesions 评估径向探头支气管内超声波对周围肺部病变的诊断作用。
IF 1.9 4区 医学 Q3 RESPIRATORY SYSTEM Pub Date : 2024-07-28 DOI: 10.1111/crj.13792
Wei Wang, Li Li, Qian Zhang, Yan Wang, Chun Hua Xu

Objective

To evaluate the predictive value of echo features of radial probe endobronchial ultrasound (RP-EBUS) in the differential diagnosis of malignant and benign 1esions.

Methods

The clinical data of 336 patients with peripheral pulmonary lesions (PPLs) undergoing RP-EBUS were analyzed in order to evaluate the predictive value of the three EBUS echo features including continuous margin, absence of a linear-discrete air bronchogram, and heterogeneous in pulmonary lesions. The sensitivity and specificity for each echoic feature or in combination in diagnosing malignancy or benignity were determined.

Results

336 cases of PPLs including 216 cases of malignant lesions and 120 cases of benign lesions. The sensitivity and specificity of the continuous margin to the diagnosis of malignant lesions were 86.11% and 17.50%. The sensitivity and specificity of the absence of a linear-discrete air bronchogram to the diagnosis of malignant lesions were 66.67% and 57.50%, and the positive predictive value was 73.85%. The sensitivity and specificity of heterogeneity to the diagnosis of malignant lesions were 65.28% and 72.50%, and the positive predictive value was 81.03%. The combination of heterogeneous and absence of a linear-discrete air bronchogram could improve the diagnostic specificity to 87.50%, and the positive predictive value to 80.77%.

Conclusion

The two EBUS echo features of heterogeneous and absence of a linear-discrete air bronchogram have predictive value for PPLs, especially in the presence of two features the pulmonary lesions should be highly suspected malignant tumors.

目的评估径向探头支气管内超声(RP-EBUS)回声特征在恶性和良性病变鉴别诊断中的预测价值:分析336例接受RP-EBUS检查的肺外周病变(PPLs)患者的临床资料,以评估连续边缘、无线状离散空气支气管图和肺部病变异质性等三种EBUS回声特征的预测价值。确定了每个回声特征或其组合诊断恶性或良性病变的敏感性和特异性:336 例 PPL,包括 216 例恶性病变和 120 例良性病变。连续边缘对诊断恶性病变的敏感性和特异性分别为 86.11% 和 17.50%。无线状离散空气支气管造影对恶性病变诊断的敏感性和特异性分别为 66.67% 和 57.50%,阳性预测值为 73.85%。异质性对恶性病变诊断的敏感性和特异性分别为 65.28% 和 72.50%,阳性预测值为 81.03%。异型性和无线状离散空气支气管图的组合可将诊断特异性提高到 87.50%,阳性预测值提高到 80.77%:结论:异型性和无线状离散空气支气管图这两个 EBUS 回声特征对 PPL 具有预测价值,尤其是出现这两个特征的肺部病变应高度怀疑为恶性肿瘤。
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引用次数: 0
Treatment Adherence and Health Status of Patients With COPD Under Treatment With Salmeterol/Fluticasone via the Elpenhaler® Device: The AHEAD Study 通过 Elpenhaler® 设备接受沙美特罗/氟替卡松治疗的慢性阻塞性肺病患者的治疗依从性和健康状况:AHEAD研究。
IF 1.9 4区 医学 Q3 RESPIRATORY SYSTEM Pub Date : 2024-07-26 DOI: 10.1111/crj.13803
Konstantinos P. Exarchos, Georgios Hillas, Paschalis Steiropoulos, Polyanthi Papanastasiou, Athena Gogali, Konstantinos Kostikas

Background

Chronic obstructive pulmonary disease (COPD) is a heterogeneous progressive lung condition characterized by long-term respiratory symptoms and airflow limitation. Appropriate bronchodilation is the cornerstone of COPD treatment, leading to better health status as well as benefits in prognosis and mortality.

Methods

In the current open, noninterventional, observational study, 716 patients diagnosed with COPD of variable severity were administered a fixed-dose combination (FDC) of fluticasone propionate and salmeterol (500 + 50 mcg) through the Elpenhaler® device. The patients' adherence to treatment (based on the MMAS-8 [8-item Morisky Medication Adherence Scale]) and health status (based on the CCQ [Clinical COPD Questionnaire]) were assessed at the beginning of the study and at the end of the 3-month follow-up period.

Results

The mean ± SD MMAS-8 score at 1 and 3 months was 6.12 ± 1.89 and 6.45 ± 1.80, respectively, indicating medium adherence overall; however, there was a statistically significant increase of 0.33 units in the MMAS-8 score at the end of the follow-up (paired t-test p < 0.0001), suggestive of an improvement in adherence throughout the study. Higher adherence was associated with better health status at baseline, which further improved by the end of the follow-up. Moreover, we observed a statistically significant decrease of 1.07 points (p < 0.0001) in the mean CCQ total score from the baseline (CCQ score = 2.2 ± 1.00) until the end of the study follow-up (CCQ score = 1.13 ± 0.67). Similar conclusions were also drawn in the mean domain scores regarding symptoms (score equal to 1.36 ± 0.72, decrease by 1.18) as well as functional and mental state (scores equal to 0.86 ± 0.73 and 1.20 ± 0.88, decrease by 1.04 and 1.00, respectively, p < 0.0001). Similarly, when patients were stratified into subgroups with and without comorbidities, the former group showed an increase of 7% in the patients with medium to high adherence during the course of the study. In the same patient subgroup, there was a notable decrease in CCQ score by 1.18 points (p < 0.0001) during the study.

Conclusions

The administration of FDC of fluticasone propionate and salmeterol, (500 + 50 mcg) via the Elpenhaler® device for COPD, resulted in a well-maintained or slight increase in treatment adherence and a subsequent benefit in health status, which further persisted after

背景:慢性阻塞性肺疾病(COPD)是一种以长期呼吸道症状和气流受限为特征的异质性进行性肺部疾病。适当的支气管扩张是慢性阻塞性肺病治疗的基石,可改善患者的健康状况,改善预后,降低死亡率:在本项开放性、非干预性、观察性研究中,716 名严重程度不等的慢性阻塞性肺病患者通过 Elpenhaler® 设备接受了丙酸氟替卡松和沙美特罗(500 + 50 mcg)的固定剂量复合制剂(FDC)治疗。在研究开始时和 3 个月的随访期结束时,对患者的治疗依从性(基于 MMAS-8 [8 项莫里斯基用药依从性量表])和健康状况(基于 CCQ [临床慢性阻塞性肺病问卷])进行了评估:随访1个月和3个月时,MMAS-8评分的平均值(± SD)分别为6.12±1.89和6.45±1.80,表明总体依从性中等;但随访结束时,MMAS-8评分在统计学上显著增加了0.33个单位(配对t检验P 结论:氟丁胺口服溶液(FDC)的治疗效果显著:通过 Elpenhaler® 设备服用丙酸氟替卡松和沙美特罗(500 + 50 微克)的 FDC 治疗慢性阻塞性肺疾病,治疗依从性保持良好或略有提高,健康状况随之改善,并在治疗 3 个月后继续保持。
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引用次数: 0
A Randomized Controlled Clinical Trial Investigating the Weaning Process From Mechanical Ventilation in Elderly Patients With Dementia 研究老年痴呆症患者机械通气断奶过程的随机对照临床试验
IF 1.9 4区 医学 Q3 RESPIRATORY SYSTEM Pub Date : 2024-07-16 DOI: 10.1111/crj.13808
Jian-Feng Liang, Zhi-Yong Li, Hai-Shan Dong, Chang Xu, Chao-Qun Yin

Background

Limited data is available regarding the weaning techniques employed for mechanical ventilation (MV) in elderly patients with dementia in China.

Objective

The primary objective of this study is to investigate diverse weaning methods in relation to the prognostic outcomes of elderly patients with dementia undergoing MV in the intensive care unit (ICU). Specifically, we seek to compare the prognosis, likelihood of successful withdrawal from MV, and the length of stay (LOS) in the ICU.

Methods

The study was conducted as a randomized controlled trial, encompassing a group of 169 elderly patients aged ≥ 65 years with dementia who underwent MV. Three distinct weaning methods were used for MV cessation, namely, the tapering parameter, spontaneous breathing trial (SBT), and SmartCare (Dräger, Germany).

Results

In the tapering parameter group, the LOS in the ICU was notably prolonged compared to both the SBT and SmartCare groups. However, no statistically significant differences were observed among the groups with respect to demographic characteristics, such as age and sex, as well as factors including the rationale for ICU admission, cause of MV, MV mode, oxygenation index, hemoglobin levels, albumin levels, ejection fraction, sedation and analgesia practices, tracheotomy, duration of MV, successful extubation, successful weaning, incidences of ventilator-associated pneumonia, and overall prognosis.

Conclusions

Both the SBT and SmartCare withdrawal methods demonstrated a reduction in the duration of MV and LOS in the ICU when compared to the tapering parameter method.

Trial Registration

Chinese Clinical Trial Registry: ChiCTR1900028449

背景关于中国老年痴呆症患者机械通气(MV)断流技术的数据有限:本研究的主要目的是调查在重症监护室(ICU)接受机械通气治疗的老年痴呆症患者的不同断流方法与预后结果的关系。具体而言,我们试图比较预后、成功退出 MV 的可能性以及在重症监护室的住院时间(LOS):研究以随机对照试验的形式进行,169 名年龄≥ 65 岁的老年痴呆症患者接受了 MV 治疗。研究采用了三种不同的停用中压方法,即渐减参数、自主呼吸试验(SBT)和 SmartCare(德国 Dräger):结果:与 SBT 组和 SmartCare 组相比,减量参数组患者在重症监护室的住院时间明显延长。然而,在人口统计学特征(如年龄和性别)、入住 ICU 的原因、中风原因、中风模式、氧合作用指数、血红蛋白水平、白蛋白水平、射血分数、镇静和镇痛方法、气管切开术、中风持续时间、成功拔管、成功断奶、呼吸机相关肺炎发病率和总体预后等因素方面,各组间未观察到明显差异:结论:与减量参数法相比,SBT 和 SmartCare 拔管法均可缩短中压持续时间和重症监护室的住院时间:中国临床试验注册中心ChiCTR1900028449。
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引用次数: 0
Usefulness of Transbronchial Lung Cryobiopsy When Starting Antifibrotic Treatment and Predicting Progressive Fibrosing Interstitial Lung Disease: Descriptive Research 经支气管肺冷冻活组织检查在开始抗纤维化治疗和预测进展性纤维化间质性肺病时的作用:描述性研究。
IF 1.9 4区 医学 Q3 RESPIRATORY SYSTEM Pub Date : 2024-07-16 DOI: 10.1111/crj.13809
Makiko Takatsuka, Hideaki Yamakawa, Tamiko Takemura, Shintaro Sato, Hiroki Ohta, Kenji Kusano, Tomohiro Oba, Rie Kawabe, Keiichi Akasaka, Hiroki Sasaki, Masako Amano, Jun Araya, Hidekazu Matsushima

Background

Although transbronchial lung cryobiopsy (TBLC) is widely used in diagnostic algorithms for various interstitial lung diseases (ILDs), its real-world utility in the therapeutic decision-making strategy for ILD patients remains unclear, in particular, when judging the time to start antifibrotic agents.

Methods

We analyzed medical records of 40 consecutive patients with idiopathic or fibrotic hypersensitivity pneumonitis who underwent TBLC. A TBLC-based usual interstitial pneumonia (UIP) score was used to assess three morphologic descriptors: patchy fibrosis, fibroblastic foci, and honeycombing.

Results

In our 40 patients with ILD, the most frequent radiological feature was indeterminate for UIP (45.0%). Final diagnosis included idiopathic pulmonary fibrosis (22.5%), fibrotic nonspecific interstitial pneumonia (5.0%), fibrotic hypersensitivity pneumonitis (35.0%), and unclassifiable ILD (37.5%). Linear mixed-effects analysis showed that declines in the slopes of %FVC and %DLCO in patients with TBLC-based UIP “Score ≥ 2” were significantly steeper than those of patients with “Score ≤ 1.” During follow-up of patients with Score ≥ 2 (n = 24), more than half of them (n = 17) received an antifibrotic agent, with most patients (n = 13) receiving early administration of the antifibrotic agent within 6 months after the TBLC procedure.

Conclusions

TBLC-based UIP Score ≥ 2 indicated the increased possibility of a progressive fibrosis course that may prove helpful in predicting progressive pulmonary fibrosis/progressive fibrosing ILD even if disease is temporarily stabilized due to anti-inflammatory agents. Patients may benefit from early introduction of antifibrotic agents by treating clinicians.

背景:尽管经支气管肺冷冻活检(TBLC)被广泛应用于各种间质性肺疾病(ILDs)的诊断算法中,但其在ILD患者治疗决策策略中的实际效用仍不明确,尤其是在判断开始使用抗纤维化药物的时间时:我们分析了 40 名连续接受 TBLC 检查的特发性或纤维化超敏性肺炎患者的病历。采用基于 TBLC 的常见间质性肺炎(UIP)评分来评估三种形态描述:斑片状纤维化、成纤维细胞灶和蜂窝状:在 40 名 ILD 患者中,最常见的放射学特征是无法确定是否为 UIP(45.0%)。最终诊断包括特发性肺纤维化(22.5%)、纤维化非特异性间质性肺炎(5.0%)、纤维化超敏性肺炎(35.0%)和无法分类的 ILD(37.5%)。线性混合效应分析显示,基于 TBLC 的 UIP "评分≥2 "患者的 %FVC 和 %DLCO 的斜率下降明显比 "评分≤1 "的患者陡峭。在对评分≥2的患者(24人)进行随访期间,超过半数的患者(17人)接受了抗纤维化药物治疗,其中大多数患者(13人)在TBLC术后6个月内接受了早期抗纤维化药物治疗:结论:基于 TBLC 的 UIP 评分≥2 表明纤维化病程进展的可能性增加,这可能有助于预测进展性肺纤维化/进展性纤维化 ILD,即使疾病因使用抗炎药物而暂时稳定。临床医生及早使用抗纤维化药物可能会使患者受益。
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引用次数: 0
Clinical Characteristics of Hospitalized Patients With COVID-19 and Their Association With the Progression to Critical Illness and Death: A Single-Center Retrospective Study From Northwestern Mexico COVID-19 住院病人的临床特征及其与病情恶化和死亡的关系:墨西哥西北部单中心回顾性研究》。
IF 1.9 4区 医学 Q3 RESPIRATORY SYSTEM Pub Date : 2024-07-16 DOI: 10.1111/crj.13813
Francisco A. Martínez-Villa, Uriel A. Angulo-Zamudio, Nidia Leon-Sicairos, Ricardo González-Esparza, Jaime Sanchez-Cuen, Jesus J. Martinez-Garcia, Hector Flores-Villaseñor, Julio Medina-Serrano, Adrian Canizalez-Roman

Objective

The objective of this study was to associate the epidemiological and clinical characteristics of patients hospitalized for COVID-19 with the progression to critical illness and death in northwestern Mexico.

Methods

From March to October 2020, we collected the demographic and clinical characteristics of 464 hospitalized patients from northwestern Mexico.

Results

Sixty-four percent (295/464) of the patients became critically ill. Age, occupation, steroid and antibiotic use at previous hospitalization, and underlying diseases (hypertension, obesity, and chronic kidney disease) were associated with critical illness or death (p: < 0.05). No symptoms were associated with critical illness. However, the parameters such as the heart rate, respiratory rate, oxygen saturation, and diastolic pressure and the laboratory parameters such as the glucose, creatinine, white line cells, hemoglobin, D-dimer, and C-reactive protein, among others, were associated with critical illness (p: < 0.05). Finally, advanced age, previous hospital treatment, and the presence of one or more underlying diseases were associated with critical illness and death (p: < 0.02).

Conclusions

Several epidemiological (e.g., age and occupation) and clinical factors (e.g., previous treatment, underlying diseases, and vital signs and laboratory parameters) were associated with critical illness and death in patients hospitalized with COVID-19. These data provide us with possible markers to avoid critical illness or death from COVID-19 in our region.

研究目的本研究旨在将墨西哥西北部因COVID-19住院患者的流行病学和临床特征与病情恶化和死亡联系起来:2020年3月至10月,我们收集了墨西哥西北部464名住院患者的人口统计学和临床特征:结果:64%的患者(295/464)病情危重。年龄、职业、之前住院时使用类固醇和抗生素的情况以及基础疾病(高血压、肥胖和慢性肾病)与危重病或死亡有关(P.0.05):结论一些流行病学因素(如年龄和职业)和临床因素(如既往治疗、基础疾病、生命体征和实验室指标)与 COVID-19 住院患者的危重症和死亡有关。这些数据为我们提供了在本地区避免 COVID-19 引起危重病或死亡的可能标记。
{"title":"Clinical Characteristics of Hospitalized Patients With COVID-19 and Their Association With the Progression to Critical Illness and Death: A Single-Center Retrospective Study From Northwestern Mexico","authors":"Francisco A. Martínez-Villa,&nbsp;Uriel A. Angulo-Zamudio,&nbsp;Nidia Leon-Sicairos,&nbsp;Ricardo González-Esparza,&nbsp;Jaime Sanchez-Cuen,&nbsp;Jesus J. Martinez-Garcia,&nbsp;Hector Flores-Villaseñor,&nbsp;Julio Medina-Serrano,&nbsp;Adrian Canizalez-Roman","doi":"10.1111/crj.13813","DOIUrl":"10.1111/crj.13813","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>The objective of this study was to associate the epidemiological and clinical characteristics of patients hospitalized for COVID-19 with the progression to critical illness and death in northwestern Mexico.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>From March to October 2020, we collected the demographic and clinical characteristics of 464 hospitalized patients from northwestern Mexico.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Sixty-four percent (295/464) of the patients became critically ill. Age, occupation, steroid and antibiotic use at previous hospitalization, and underlying diseases (hypertension, obesity, and chronic kidney disease) were associated with critical illness or death (<i>p</i>: &lt; 0.05). No symptoms were associated with critical illness. However, the parameters such as the heart rate, respiratory rate, oxygen saturation, and diastolic pressure and the laboratory parameters such as the glucose, creatinine, white line cells, hemoglobin, D-dimer, and C-reactive protein, among others, were associated with critical illness (<i>p</i>: &lt; 0.05). Finally, advanced age, previous hospital treatment, and the presence of one or more underlying diseases were associated with critical illness and death (<i>p</i>: &lt; 0.02).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Several epidemiological (e.g., age and occupation) and clinical factors (e.g., previous treatment, underlying diseases, and vital signs and laboratory parameters) were associated with critical illness and death in patients hospitalized with COVID-19. These data provide us with possible markers to avoid critical illness or death from COVID-19 in our region.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55247,"journal":{"name":"Clinical Respiratory Journal","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/crj.13813","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141629327","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"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
The Novel Fusion Protein Melittin-MIL-2 Exhibits Strong Antitumor Immune Effect in Lung Adenocarcinoma Cell A549 新型融合蛋白 Melittin-MIL-2 在肺腺癌细胞 A549 中表现出强烈的抗肿瘤免疫效应
IF 1.9 4区 医学 Q3 RESPIRATORY SYSTEM Pub Date : 2024-07-14 DOI: 10.1111/crj.13805
Weize Gao, Wenshuai Li, Zhan Wang, Yongxin Li, Mingjun Liu

In previous studies, we developed a novel fusion protein named “melittin-MIL-2” which exhibited more anti-tumor activity. However, it remains unclear whether melittin-MIL-2 possesses antitumor immune effect on lung adenocarcinoma. In this study, the immune effect and mechanism of melittin-MIL-2 inhibiting the growth and invasion of lung adenocarcinoma will be investigated, in order to provide novel perspectives for the immunotherapy of lung cancer. The results indicated that melittin-MIL-2 promoted T cell proliferation, enhanced NK cell cytotoxicity, and boosted IFN-γ secretion in PBMCs. After melittin-MIL-2 stimulation, perforin expression and LAK/NK-like killing activities of human PBMCs and NK cells were significantly enhanced. Melittin-MIL-2 is capable of hampering the development and proliferation of lung adenocarcinoma cell A549. ICAM-1 and Fas expression in A549 cells exposed to melittin-MIL-2 rose significantly. The expression levels of TLR8 and VEGF in A549 cells decreased significantly after melittin-MIL-2 stimulation. In vivo, melittin-MIL-2 substantially impeded the growth of lung adenocarcinoma and formed an immune-stimulating microenvironment locally in tumor tissues. In conclusion, the novel fusion protein melittin-MIL-2 exhibits strong anti-tumor immune effect in lung adenocarcinoma cell A549 via activating the LFA-1/ICAM-1 and Fas/FasL pathways to enhance cytolytic activity, upregulating the secretion of IFN-γ and perforin, and boosting LAK/NK-like killing activities. Immuno-effector cells and their secreted cytokines can form immune stimulation microenvironment locally in lung adenocarcinoma Lewis mice tissue.

在之前的研究中,我们开发了一种名为 "melittin-MIL-2 "的新型融合蛋白,它具有更强的抗肿瘤活性。然而,melittin-MIL-2 对肺腺癌是否具有抗肿瘤免疫作用仍不清楚。本研究将探讨melittin-MIL-2抑制肺腺癌生长和侵袭的免疫效应和机制,以期为肺癌的免疫治疗提供新的视角。结果表明,melittin-MIL-2能促进T细胞增殖,增强NK细胞的细胞毒性,促进PBMCs中IFN-γ的分泌。经美洛芬-MIL-2 刺激后,人 PBMCs 和 NK 细胞的穿孔素表达和 LAK/NK 样杀伤活性显著增强。Melittin-MIL-2 能够阻碍肺腺癌细胞 A549 的发育和增殖。暴露于 Melittin-MIL-2 的 A549 细胞中 ICAM-1 和 Fas 的表达明显升高。在受到 melittin-MIL-2 刺激后,A549 细胞中 TLR8 和血管内皮生长因子的表达水平明显下降。在体内,melittin-MIL-2 大大阻碍了肺腺癌的生长,并在肿瘤组织局部形成了免疫刺激微环境。总之,新型融合蛋白melittin-MIL-2通过激活LFA-1/ICAM-1和Fas/FasL通路增强细胞溶解活性,上调IFN-γ和穿孔素的分泌,提高LAK/NK样杀伤活性,对肺腺癌细胞A549具有很强的抗肿瘤免疫效应。免疫效应细胞及其分泌的细胞因子可在肺腺癌 Lewis 小鼠组织局部形成免疫刺激微环境。
{"title":"The Novel Fusion Protein Melittin-MIL-2 Exhibits Strong Antitumor Immune Effect in Lung Adenocarcinoma Cell A549","authors":"Weize Gao,&nbsp;Wenshuai Li,&nbsp;Zhan Wang,&nbsp;Yongxin Li,&nbsp;Mingjun Liu","doi":"10.1111/crj.13805","DOIUrl":"10.1111/crj.13805","url":null,"abstract":"<p>In previous studies, we developed a novel fusion protein named “melittin-MIL-2” which exhibited more anti-tumor activity. However, it remains unclear whether melittin-MIL-2 possesses antitumor immune effect on lung adenocarcinoma. In this study, the immune effect and mechanism of melittin-MIL-2 inhibiting the growth and invasion of lung adenocarcinoma will be investigated, in order to provide novel perspectives for the immunotherapy of lung cancer. The results indicated that melittin-MIL-2 promoted T cell proliferation, enhanced NK cell cytotoxicity, and boosted IFN-γ secretion in PBMCs. After melittin-MIL-2 stimulation, perforin expression and LAK/NK-like killing activities of human PBMCs and NK cells were significantly enhanced. Melittin-MIL-2 is capable of hampering the development and proliferation of lung adenocarcinoma cell A549. ICAM-1 and Fas expression in A549 cells exposed to melittin-MIL-2 rose significantly. The expression levels of TLR8 and VEGF in A549 cells decreased significantly after melittin-MIL-2 stimulation. In vivo, melittin-MIL-2 substantially impeded the growth of lung adenocarcinoma and formed an immune-stimulating microenvironment locally in tumor tissues. In conclusion, the novel fusion protein melittin-MIL-2 exhibits strong anti-tumor immune effect in lung adenocarcinoma cell A549 via activating the LFA-1/ICAM-1 and Fas/FasL pathways to enhance cytolytic activity, upregulating the secretion of IFN-γ and perforin, and boosting LAK/NK-like killing activities. Immuno-effector cells and their secreted cytokines can form immune stimulation microenvironment locally in lung adenocarcinoma Lewis mice tissue.</p>","PeriodicalId":55247,"journal":{"name":"Clinical Respiratory Journal","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11246609/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141604509","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"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
Efficacy and Safety of Azvudine in Patients With COVID-19 in China: A Meta-Analysis of Observational Studies 阿兹夫定对中国 COVID-19 患者的疗效和安全性:观察性研究的 Meta 分析。
IF 1.9 4区 医学 Q3 RESPIRATORY SYSTEM Pub Date : 2024-07-12 DOI: 10.1111/crj.13798
Tao Dong, Wentao Zhang, Tingting Wu, Yongxiang Ge, Qi Yang, Jia Xu, Yuna Liu

Background

Azvudine (FNC) is a novel small molecule antiviral drug for treating COVID-19 that is available only on the Chinese market. Despite being recommended for treating COVID-19 by the Chinese guidelines, its efficacy and safety are still unclear. This study aimed to evaluate the protective effect of FNC on COVID-19 outcomes and its safety.

Methods

We followed the PRISMA 2020 guidelines and searched the PubMed, Embase, Web of Science, Scopus, and China National Knowledge Infrastructure (CNKI) databases to evaluate studies on the effectiveness of FNC in treating COVID-19 in China, focusing on mortality and overall outcomes. Additionally, its impact on the length of hospital stay (LOHS), time to first nucleic acid negative conversion (T-FNANC), and adverse events was evaluated. The inclusion criterion was that the studies were published from July 2021 to April 10, 2024. This study uses the ROBINS-I tool to assess bias risk and employs the GRADE approach to evaluate the certainty of the evidence.

Results

The meta-analysis included 24 retrospective studies involving a total of 11 830 patients. Low-certainty evidence revealed no significant difference in mortality (OR = 0.91, 95% CI: 0.76–1.08) or LOHS (WMD = −0.24, 95% CI: −0.83 to 0.35) between FNC and Paxlovid in COVID-19 patients. Low-certainty evidence shows that the T-FNANC was longer (WMD = 1.95, 95% CI: 0.36–3.53). Compared with the Paxlovid group, low-certainty evidence shows the FNC group exhibited a worse composite outcome (OR = 0.77, 95% CI: 0.63–0.95) and fewer adverse events (OR = 0.63, 95% CI: 0.46–0.85). Compared with supportive treatment, low certainty shows FNC significantly reduced the mortality rate in COVID-19 patients (OR = 0.61, 95% CI: 0.51–0.74) and decreased the composite outcome (OR = 0.67, 95% CI: 0.50–0.91), and very low certainty evidence shows significantly decreased the T-FNANC (WMD = −4.62, 95% CI: −8.08 to −1.15). However, in very low certainty, there was no significant difference in LOHS (WMD = −0.70, 95% CI: −3.32 to 1.91) or adverse events (OR = 1.97, 95% CI: 0.48–8.17).

Conclusions

FNC appears to be a safe and potentially effective treatment for COVID-19 in China, but further research with larger, high-quality studies is necessary to confirm these findings. Due to the certainty of the evidence and the specific context of the studies conducted in China, caution should be exercised when considering whether the results are

背景:阿兹夫定(FNC)是一种治疗 COVID-19 的新型小分子抗病毒药物,仅在中国市场有售。尽管中国指南推荐用于治疗 COVID-19,但其疗效和安全性仍不明确。本研究旨在评估FNC对COVID-19结果的保护作用及其安全性:我们遵循 PRISMA 2020 指南,检索了 PubMed、Embase、Web of Science、Scopus 和中国国家知识基础设施(CNKI)数据库,评估 FNC 在中国治疗 COVID-19 的有效性研究,重点关注死亡率和总体预后。此外,还评估了其对住院时间(LOHS)、首次核酸阴转时间(T-FNANC)和不良事件的影响。纳入标准为研究发表于 2021 年 7 月至 2024 年 4 月 10 日。本研究使用 ROBINS-I 工具评估偏倚风险,并采用 GRADE 方法评估证据的确定性:荟萃分析包括 24 项回顾性研究,共涉及 11 830 名患者。低确定性证据显示,在COVID-19患者中,FNC和Paxlovid在死亡率(OR = 0.91,95% CI:0.76-1.08)或LOHS(WMD = -0.24,95% CI:-0.83-0.35)方面无明显差异。低确定性证据显示,T-FNANC的时间更长(WMD = 1.95,95% CI:0.36-3.53)。低确定性证据显示,与 Paxlovid 组相比,FNC 组的综合结果更差(OR = 0.77,95% CI:0.63-0.95),不良事件更少(OR = 0.63,95% CI:0.46-0.85)。与支持性治疗相比,低确定性证据显示,FNC可显著降低COVID-19患者的死亡率(OR = 0.61,95% CI:0.51-0.74),减少综合结果(OR = 0.67,95% CI:0.50-0.91),极低确定性证据显示,FNC可显著降低T-FNANC(WMD = -4.62,95% CI:-8.08至-1.15)。然而,在极低确定性证据中,LOHS(WMD = -0.70,95% CI:-3.32 至 1.91)或不良事件(OR = 1.97,95% CI:0.48-8.17)没有明显差异:在中国,FNC似乎是治疗COVID-19的一种安全且潜在有效的方法,但有必要通过更大规模、高质量的研究进一步证实这些发现。由于证据的确定性和在中国进行的研究的特殊背景,在考虑这些结果是否适用于全球时应谨慎:试验注册:PROSPERO 编号:CRD42024520565。
{"title":"Efficacy and Safety of Azvudine in Patients With COVID-19 in China: A Meta-Analysis of Observational Studies","authors":"Tao Dong,&nbsp;Wentao Zhang,&nbsp;Tingting Wu,&nbsp;Yongxiang Ge,&nbsp;Qi Yang,&nbsp;Jia Xu,&nbsp;Yuna Liu","doi":"10.1111/crj.13798","DOIUrl":"10.1111/crj.13798","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Azvudine (FNC) is a novel small molecule antiviral drug for treating COVID-19 that is available only on the Chinese market. Despite being recommended for treating COVID-19 by the Chinese guidelines, its efficacy and safety are still unclear. This study aimed to evaluate the protective effect of FNC on COVID-19 outcomes and its safety.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We followed the PRISMA 2020 guidelines and searched the PubMed, Embase, Web of Science, Scopus, and China National Knowledge Infrastructure (CNKI) databases to evaluate studies on the effectiveness of FNC in treating COVID-19 in China, focusing on mortality and overall outcomes. Additionally, its impact on the length of hospital stay (LOHS), time to first nucleic acid negative conversion (T-FNANC), and adverse events was evaluated. The inclusion criterion was that the studies were published from July 2021 to April 10, 2024. This study uses the ROBINS-I tool to assess bias risk and employs the GRADE approach to evaluate the certainty of the evidence.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The meta-analysis included 24 retrospective studies involving a total of 11 830 patients. Low-certainty evidence revealed no significant difference in mortality (OR = 0.91, 95% CI: 0.76–1.08) or LOHS (WMD = −0.24, 95% CI: −0.83 to 0.35) between FNC and Paxlovid in COVID-19 patients. Low-certainty evidence shows that the T-FNANC was longer (WMD = 1.95, 95% CI: 0.36–3.53). Compared with the Paxlovid group, low-certainty evidence shows the FNC group exhibited a worse composite outcome (OR = 0.77, 95% CI: 0.63–0.95) and fewer adverse events (OR = 0.63, 95% CI: 0.46–0.85). Compared with supportive treatment, low certainty shows FNC significantly reduced the mortality rate in COVID-19 patients (OR = 0.61, 95% CI: 0.51–0.74) and decreased the composite outcome (OR = 0.67, 95% CI: 0.50–0.91), and very low certainty evidence shows significantly decreased the T-FNANC (WMD = −4.62, 95% CI: −8.08 to −1.15). However, in very low certainty, there was no significant difference in LOHS (WMD = −0.70, 95% CI: −3.32 to 1.91) or adverse events (OR = 1.97, 95% CI: 0.48–8.17).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>FNC appears to be a safe and potentially effective treatment for COVID-19 in China, but further research with larger, high-quality studies is necessary to confirm these findings. Due to the certainty of the evidence and the specific context of the studies conducted in China, caution should be exercised when considering whether the results are ","PeriodicalId":55247,"journal":{"name":"Clinical Respiratory Journal","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/crj.13798","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141592226","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"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
期刊
Clinical Respiratory Journal
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