Advances in respiratory medicine最新文献_第4页

Correction: Patsaki et al. Benefits from Incorporating Virtual Reality in Pulmonary Rehabilitation of COPD Patients: A Systematic Review and Meta-Analysis. Adv. Respir. Med. 2023, 91, 324–336 更正：Patsaki 等人，《将虚拟现实技术融入慢性阻塞性肺病患者的肺康复治疗中的益处》：系统回顾与元分析》。Adv.Respir.Med.2023, 91, 324-336

IF 1.8 Q3 Medicine

Advances in respiratory medicine

Pub Date : 2024-02-01 DOI: 10.3390/arm92010011

Irini Patsaki, Vasiliki Avgeri, Theodora Rigoulia, Theodoros Zekis, G. Koumantakis, E. Grammatopoulou

Error in Figure 3 [...]

图 3 中的错误 [...]

引用次数: 0

Correction: Patsaki et al. Benefits from Incorporating Virtual Reality in Pulmonary Rehabilitation of COPD Patients: A Systematic Review and Meta-Analysis. Adv. Respir. Med. 2023, 91, 324–336 更正：Patsaki 等人，《将虚拟现实技术融入慢性阻塞性肺病患者的肺康复治疗中的益处》：系统回顾与元分析》。Adv.Respir.Med.2023, 91, 324-336

IF 1.8 Q3 Medicine

Advances in respiratory medicine

Pub Date : 2024-02-01 DOI: 10.3390/arm92010011

Irini Patsaki, Vasiliki Avgeri, Theodora Rigoulia, Theodoros Zekis, G. Koumantakis, E. Grammatopoulou

Error in Figure 3 [...]

图 3 中的错误 [...]

引用次数: 0

Constructing a Nomogram Model to Estimate the Risk of Ventilator-Associated Pneumonia for Elderly Patients in the Intensive Care Unit 构建提名图模型以估算重症监护室老年患者患呼吸机相关肺炎的风险

IF 1.8 Q3 Medicine

Advances in respiratory medicine

Pub Date : 2024-01-19 DOI: 10.3390/arm92010010

Wensi Gan, Zhihui Chen, Zhen Tao, Wenyuan Li

Background: Ventilator-associated pneumonia (VAP) causes heavy losses in terms of finances, hospitalization, and death for elderly patients in the intensive care unit (ICU); however, the risk is difficult to evaluate due to a lack of reliable assessment tools. We aimed to create and validate a nomogram to estimate VAP risk to provide early intervention for high-risk patients. Methods: Between January 2016 and March 2021, 293 patients from a tertiary hospital in China were retrospectively reviewed as a training set. Another 84 patients were enrolled for model validation from April 2021 to February 2022. Least absolute shrinkage and selection operator (LASSO) regression and multivariable logistic regression analysis were employed to select predictors, and a nomogram model was constructed. The calibration, discrimination, and clinical utility of the nomogram were verified. Finally, a web-based online scoring system was created to make the model more practical. Results: The predictors were hypoproteinemia, long-term combined antibiotic use, intubation time, length of mechanical ventilation, and tracheotomy/intubation. The area under the curve (AUC) was 0.937 and 0.925 in the training and validation dataset, respectively, suggesting the model exhibited effective discrimination. The calibration curve demonstrated high consistency with the observed result and the estimated values. Decision curve analysis (DCA) demonstrated that the nomogram was clinically applicable. Conclusions: We have created a novel nomogram model that can be utilized to anticipate VAP risk in elderly ICU patients, which is helpful for healthcare professionals to detect patients at high risk early and adopt protective interventions.

背景：呼吸机相关肺炎（VAP）给重症监护病房（ICU）中的老年患者造成了经济、住院和死亡方面的重大损失；然而，由于缺乏可靠的评估工具，很难对风险进行评估。我们的目的是创建并验证一个估计 VAP 风险的提名图，以便对高风险患者进行早期干预。方法：在 2016 年 1 月至 2021 年 3 月期间，我们对中国一家三级医院的 293 名患者进行了回顾性回顾，作为训练集。2021 年 4 月至 2022 年 2 月期间，又招募了 84 名患者进行模型验证。采用最小绝对收缩和选择算子（LASSO）回归和多变量逻辑回归分析来选择预测因子，并构建了一个提名图模型。对提名图的校准、区分度和临床实用性进行了验证。最后，创建了一个基于网络的在线评分系统，使该模型更加实用。结果：预测因素包括低蛋白血症、长期联合使用抗生素、插管时间、机械通气时间和气管切开/插管。训练数据集和验证数据集的曲线下面积（AUC）分别为 0.937 和 0.925，表明该模型具有有效的分辨能力。校准曲线与观察结果和估计值高度一致。决策曲线分析（DCA）表明，提名图适用于临床。结论：我们创建了一个新颖的提名图模型，可用于预测老年 ICU 患者的 VAP 风险，有助于医护人员及早发现高风险患者并采取保护性干预措施。

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引用次数: 0

Clinical Effectiveness of Ritonavir-Boosted Nirmatrelvir-A Literature Review. 利托那韦增强型尼尔马特韦的临床疗效--文献综述。

IF 1.8 Q3 RESPIRATORY SYSTEM

Advances in respiratory medicine

Pub Date : 2024-01-18 DOI: 10.3390/arm92010009

Sydney Paltra, Tim O F Conrad

Nirmatrelvir/Ritonavir is an oral treatment for mild to moderate COVID-19 cases with a high risk for a severe course of the disease. For this paper, a comprehensive literature review was performed, leading to a summary of currently available data on Nirmatrelvir/Ritonavir's ability to reduce the risk of progressing to a severe disease state. Herein, the focus lies on publications that include comparisons between patients receiving Nirmatrelvir/Ritonavir and a control group. The findings can be summarized as follows: Data from the time when the Delta-variant was dominant show that Nirmatrelvir/Ritonavir reduced the risk of hospitalization or death by 88.9% for unvaccinated, non-hospitalized high-risk individuals. Data from the time when the Omicron variant was dominant found decreased relative risk reductions for various vaccination statuses: between 26% and 65% for hospitalization. The presented papers that differentiate between unvaccinated and vaccinated individuals agree that unvaccinated patients benefit more from treatment with Nirmatrelvir/Ritonavir. However, when it comes to the dependency of potential on age and comorbidities, further studies are necessary. From the available data, one can conclude that Nirmatrelvir/Ritonavir cannot substitute vaccinations; however, its low manufacturing cost and easy administration make it a valuable tool in fighting COVID-19, especially for countries with low vaccination rates.

Nirmatrelvir/Ritonavir是一种口服治疗药物，可用于治疗轻度至中度COVID-19病例，这种病例出现严重病程的风险很高。本文进行了一次全面的文献综述，总结了有关尼马瑞韦/利托那韦能够降低病情恶化风险的现有数据。在此，重点关注那些将接受尼尔马特雷韦/利托那韦治疗的患者与对照组进行比较的出版物。研究结果可归纳如下：Delta变异型占主导地位时的数据显示，对于未接种疫苗、未住院的高危人群，Nirmatrelvir/Ritonavir可将住院或死亡风险降低88.9%。奥米克龙变异体占优势时的数据发现，不同疫苗接种状态的相对风险降低率不同：住院风险降低率在 26% 到 65% 之间。已发表的论文对未接种疫苗和已接种疫苗的患者进行了区分，一致认为未接种疫苗的患者从尼马瑞韦/利托那韦治疗中获益更多。不过，关于潜力与年龄和合并症的关系，还需要进一步研究。根据现有数据，我们可以得出结论：Nirmatrelvir/Ritonavir 不能替代疫苗接种；但是，它的生产成本低、易于使用，使其成为抗击 COVID-19 的重要工具，尤其是对于疫苗接种率较低的国家。

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引用次数: 0

Breathing Pattern Response after 6 Weeks of Inspiratory Muscle Training during Exercise. 运动时进行 6 周吸气肌肉训练后的呼吸模式反应

IF 1.8 Q3 RESPIRATORY SYSTEM

Advances in respiratory medicine

Pub Date : 2024-01-17 DOI: 10.3390/arm92010008

Eduardo Salazar-Martínez

(1) Background: The breathing pattern is defined as the relationship between the tidal volume (VT) and breathing frequency (BF) for a given VE. The aim of this study was to evaluate whether inspiratory muscle training influenced the response of the breathing pattern during an incremental effort in amateur cyclists. (2) Methods: Eighteen amateur cyclists completed an incremental test to exhaustion, and a gas analysis on a cycle ergometer and spirometry were conducted. Cyclists were randomly assigned to two groups (IMTG = 9; CON = 9). The IMTG completed 6 weeks of inspiratory muscle training (IMT) using a PowerBreathe K3^® device at 50% of the maximum inspiratory pressure (Pimax). The workload was adjusted weekly. The CON did not carry out any inspiratory training during the experimental period. After the 6-week intervention, the cyclists repeated the incremental exercise test, and the gas analysis and spirometry were conducted. The response of the breathing pattern was evaluated during the incremental exercise test. (3) Results: The Pimax increased in the IMTG (p < 0.05; d = 3.1; +19.62%). Variables related to the breathing pattern response showed no differences between groups after the intervention (EXPvsCON; p > 0.05). Likewise, no differences in breathing pattern were found in the IMTG after training (PREvsPOST; p > 0.05). (4) Conclusions: IMT improved the strength of inspiratory muscles and sport performance in amateur cyclists. These changes were not attributed to alterations in the response of the breathing pattern.

(1) 背景：呼吸模式是指在给定 VE 的情况下，潮气量（VT）和呼吸频率（BF）之间的关系。本研究旨在评估吸气肌肉训练是否会影响业余自行车运动员在增量努力过程中的呼吸模式反应。(2）方法：18 名业余自行车运动员完成了增量测试，并在自行车测力计上进行了气体分析和肺活量测定。自行车运动员被随机分配到两组（IMTG=9；CON=9）。IMTG组使用PowerBreathe K3®设备，以50%的最大吸气压力（Pimax）完成为期6周的吸气肌肉训练（IMT）。每周调整工作量。在实验期间，CON 没有进行任何吸气训练。为期 6 周的干预结束后，骑车者重复了增量运动测试，并进行了气体分析和肺活量测定。在增量运动测试期间，对呼吸模式的反应进行了评估。(3）结果：IMTG 的 Pimax 增加了（p < 0.05; d = 3.1; +19.62%）。与呼吸模式反应相关的变量显示，干预后各组之间没有差异（EXPvsCON；P > 0.05）。同样，IMTG 在训练后的呼吸模式也没有发现差异（PREVSPOST；P > 0.05）。(4) 结论：IMT 改善了业余自行车运动员的吸气肌肉力量和运动表现。这些变化并不是因为呼吸模式的反应发生了改变。

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引用次数: 0

Pulmonary Embolism (PE) to Chronic Thromboembolic Pulmonary Disease (CTEPD): Findings from a Survey of UK Physicians 从肺栓塞 (PE) 到慢性血栓栓塞性肺病 (CTEPD)：英国医生调查发现

IF 1.8 Q3 Medicine

Advances in respiratory medicine

Pub Date : 2024-01-09 DOI: 10.3390/arm92010007

Joanna Pepke-Zaba, Luke Howard, D. Kiely, Shruti Sweeney, Martin Johnson

Chronic thromboembolic pulmonary disease (CTEPD) is a complication of pulmonary embolism (PE). We conducted an online survey of UK PE-treating physicians to understand practices in the follow-up of PE and awareness of CTEPD. The physicians surveyed (N = 175) included 50 each from cardiology, respiratory and internal medicine, plus 25 haematologists. Most (89%) participants had local guidelines for PE management, and 65% reported a PE follow-up clinic, of which 69% were joint clinics. Almost half (47%) had a protocol for the investigation of CTEPD. According to participants, 129 (74%) routinely consider a diagnosis of CTEPD and 97 (55%) routinely investigate for CTEPD, with 76% of those 97 participants investigating in patients who are symptomatic at 3 months and 22% investigating in all patients. This survey demonstrated variability in the follow-up of PE and the awareness of CTEPD and its investigation. The findings support the conduct of a national audit to understand the barriers to the timely detection of CTEPD.

慢性血栓栓塞性肺疾病（CTEPD）是肺栓塞（PE）的一种并发症。我们对英国接受过肺栓塞治疗的医生进行了在线调查，以了解他们在肺栓塞后续治疗中的做法以及对 CTEPD 的认识。接受调查的医生（N = 175）包括来自心脏科、呼吸科和内科的各 50 名医生，以及 25 名血液科医生。大多数参与者（89%）都有当地的 PE 管理指南，65% 的参与者称有 PE 随访诊所，其中 69% 是联合诊所。近一半（47%）的参与者制定了 CTEPD 调查方案。据参与者称，129 人（74%）常规考虑 CTEPD 诊断，97 人（55%）常规进行 CTEPD 检查，其中 76% 的参与者对 3 个月后有症状的患者进行检查，22% 的参与者对所有患者进行检查。这项调查表明，在 PE 的随访以及对 CTEPD 的认识和调查方面存在差异。调查结果支持开展全国性审计，以了解及时发现 CTEPD 的障碍。

引用次数: 0

Predictive Value of Fractional Exhaled Nitric Oxide (FeNO) in the Diagnosis of Asthma for Epidemiological Purposes—An 8-Year Follow-Up Study 分量呼出一氧化氮（FeNO）在哮喘诊断中的流行病学预测价值--一项为期 8 年的随访研究

IF 1.8 Q3 Medicine

Advances in respiratory medicine

Pub Date : 2024-01-04 DOI: 10.3390/arm92010006

K. Barański

At the population level, respiratory symptoms in children can be estimated cross-sectionally. However, such methods require additional objective support parameters, such as the measurement of fractional exhaled nitric oxide (FeNO). The aim of the present study was to analyze if the FeNO value measured at baseline can have a predictive value for asthma-like symptoms after 8 years of measurement. Methods: The follow-up included 128 (out of 447) children, 70 girls and 58 boys. The FeNO was measured at baseline only. The prevalence of asthma-like symptoms was measured with the adopted version of the ISAAC questionnaire. Results: After 8 years of FeNO measurement, 5 new cases of asthma, 2 cases of attacks of dyspnoea, 1 case of wheezy in the chest, and 18 cases of allergic rhinitis occurred. The FeNO values, measured at the baseline of the study, for new cases of the above diseases were 53.4 ± 75.9 ppb, 11 ± 1.5 ppb, 12.0 ppb, and 16.3 ± 12.4 ppb, respectively. The best diagnostic accuracy parameters were found in the new cases of asthma, where the sensitivity was 40.0%, the specificity was 98.6%, and the AUC was 66.6%. The diagnostic odds ratio was 46.9 when considering the FeNO cut-off >35 ppb. Conclusions: The FeNO measurement is a fair method for asthma prognosis in early school-aged children with asthma-like symptoms measured on the population level but requires further confirmation at the clinical level with more accurate diagnostic tools.

在人口层面，儿童的呼吸道症状可以通过横截面进行估算。然而，这种方法需要额外的客观支持参数，如测量呼出一氧化氮分数（FeNO）。本研究旨在分析基线时测量的一氧化氮值是否对 8 年后的哮喘样症状具有预测价值。研究方法随访对象包括 128 名儿童（共 447 名），其中 70 名女孩，58 名男孩。仅在基线时测量 FeNO 值。哮喘样症状的发生率通过采用的 ISAAC 问卷进行测量。结果显示经过 8 年的 FeNO 测量，新出现了 5 例哮喘、2 例呼吸困难发作、1 例胸部喘息和 18 例过敏性鼻炎。上述疾病新病例在研究基线测量的 FeNO 值分别为 53.4 ± 75.9 ppb、11 ± 1.5 ppb、12.0 ppb 和 16.3 ± 12.4 ppb。哮喘新病例的诊断准确性参数最佳，灵敏度为 40.0%，特异度为 98.6%，AUC 为 66.6%。当 FeNO 临界值大于 35 ppb 时，诊断几率比为 46.9。结论在人群水平上测量 FeNO 是对有类似哮喘症状的学龄前儿童进行哮喘预后判断的一种公平方法，但在临床水平上还需要更精确的诊断工具来进一步确认。

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引用次数: 0

Expression of Inflammatory Genes in Murine Lungs in a Model of Experimental Pulmonary Hypertension: Effects of an Antibody-Based Targeted Delivery of Interleukin-9 实验性肺动脉高压模型中小鼠肺部炎症基因的表达：基于抗体的白细胞介素-9靶向递送的影响

IF 1.8 Q3 Medicine

Advances in respiratory medicine

Pub Date : 2024-01-03 DOI: 10.3390/arm92010005

Judith Heiss, K. Grün, I. Singerer, L. Tempel, M. Matasci, Christian Jung, Alexander Pfeil, P. C. Schulze, Dario Neri, Marcus Franz

Background: Pathogenesis of pulmonary hypertension (PH) is a multifactorial process driven by inflammation and pulmonary vascular remodeling. To target these two aspects of PH, we recently tested a novel treatment: Interleukin-9 (IL9) fused to F8, an antibody that binds to the extra-domain A of fibronectin (EDA+ Fn). As EDA+ Fn is not found in healthy adult tissue but is expressed during PH, IL9 is delivered specifically to the tissue affected by PH. We found that F8IL9 reduced pulmonary vascular remodeling and attenuated PH compared with sham-treated mice. Purpose: To evaluate possible F8IL9 effects on PH-associated inflammatory processes, we analysed the expression of genes involved in pulmonary immune responses. Methods: We applied the monocrotaline (MCT) model of PH in mice (n = 44). Animals were divided into five experimental groups: sham-induced animals without PH (control, n = 4), MCT-induced PH without treatment (PH, n = 8), dual endothelin receptor antagonist treatment (dual ERA, n = 8), F8IL9 treatment (n = 12, 2 formats with n = 6 each), or with KSFIL9 treatment (KSFIL9, n = 12, 2 formats with n = 6 each, KSF: control antibody with irrelevant antigen specificity). After 28 days, a RT-PCR gene expression analysis of inflammatory response (84 genes) was performed in the lung. Results: Compared with the controls, 19 genes exhibited relevant (+2.5-fold) upregulation in the PH group without treatment. Gene expression levels in F8IL9-treated lung tissue were reduced compared to the PH group without treatment. This was the case especially for CCL20, CXCL5, C-reactive protein, pentraxin related (CRPPR), and Kininogen-1 (KNG1). Conclusion: In accordance with the hypothesis stated above, F8IL9 treatment diminished the upregulation of some genes associated with inflammation in a PH animal model. Therefore, we hypothesize that IL9-based immunocytokine treatment will likely modulate various inflammatory pathways.

背景：肺动脉高压（PH）的发病机制是一个由炎症和肺血管重塑驱动的多因素过程。针对 PH 的这两个方面，我们最近测试了一种新型疗法：白细胞介素-9（IL9）与 F8（一种与纤连蛋白外域 A（EDA+ Fn）结合的抗体）融合。由于 EDA+ Fn 不存在于健康的成人组织中，但会在 PH 期间表达，因此 IL9 可被特异性地输送到受 PH 影响的组织中。我们发现，与假治疗小鼠相比，F8IL9 可减少肺血管重塑并减轻 PH。目的：为了评估 F8IL9 对 PH 相关炎症过程的可能影响，我们分析了参与肺免疫反应的基因的表达。方法我们在小鼠（n = 44）中应用单克洛汀（MCT）PH 模型。动物被分为五个实验组：无 PH 的假诱导动物（对照组，n = 4）、无处理的 MCT 诱导 PH（PH，n = 8）、双内皮素受体拮抗剂处理（双 ERA，n = 8）、F8IL9 处理（n = 12，2 种格式，每种格式 n = 6）或 KSFIL9 处理（KSFIL9，n = 12，2 种格式，每种格式 n = 6，KSF：具有无关抗原特异性的对照抗体）。28 天后，对肺部炎症反应（84 个基因）进行 RT-PCR 基因表达分析。结果显示与对照组相比，未经治疗的 PH 组有 19 个基因出现了相关的上调（+2.5 倍）。与未接受治疗的 PH 组相比，接受 F8IL9 治疗的肺组织中的基因表达水平有所降低。尤其是 CCL20、CXCL5、C 反应蛋白、五肽相关（CRPPR）和激肽原-1（KNG1）。结论根据上述假设，在 PH 动物模型中，F8IL9 治疗可减少与炎症相关的一些基因的上调。因此，我们假设基于 IL9 的免疫细胞因子治疗可能会调节各种炎症通路。

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引用次数: 0

Reply to Salimi, M. Comment on “Patsaki et al. Benefits from Incorporating Virtual Reality in Pulmonary Rehabilitation of COPD Patients: A Systematic Review and Meta-Analysis. Adv. Respir. Med. 2023, 91, 324–336” 回复 Salimi, M. 对 "Patsaki 等人，在慢性阻塞性肺病患者肺康复中融入虚拟现实技术的益处：系统回顾与元分析》。Adv.Respir。Med.2023, 91, 324-336"

IF 1.8 Q3 Medicine

Advances in respiratory medicine

Pub Date : 2023-12-22 DOI: 10.3390/arm92010004

Irini Patsaki, Vasiliki Avgeri, Theodora Rigoulia, Theodoros Zekis, G. Koumantakis, E. Grammatopoulou

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The Added Value of Bronchoalveolar Lavage for Pulmonary Tuberculosis Diagnosis in High-Risk Hospitalized Patients with Negative Sputum Samples 支气管肺泡灌洗液对痰液样本阴性的高危住院患者肺结核诊断的附加价值

IF 1.8 Q3 Medicine

Advances in respiratory medicine

Pub Date : 2023-12-21 DOI: 10.3390/arm92010003

O. Freund, Yitzhac Hadad, Tomer Lagziel, I. Friedman Regev, E. Kleinhendler, A. Unterman, A. Bar-Shai, T. Perluk

Hospitalized patients with a high suspicion of pulmonary tuberculosis (HS-PTB) are isolated until a definite diagnosis can be determined. If doubt remains after negative sputum samples, bronchoscopy with bronchoalveolar lavage (BAL) is often sought. Still, evidence of the added value of BAL in this patient population is scarce. To address this issue, we included consecutive HS-PTB patients with negative sputum samples who underwent BAL between 2017 and 2018. Chest X-rays (CXR) and CT scans were evaluated by a chest radiologist blind to the final diagnosis. Independent predictors for PTB were assessed by multivariate regression, using all positive PTB patients between 2017 and 2019 (by sputum or BAL) as a control group (n = 41). Overall, 42 HS-PTB patients were included (mean age 51 ± 9, 36% female). BAL was a viable diagnostic for PTB in three (7%) cases and for other clinically relevant pathogens in six (14%). Independent predictors for PTB were ≥2 sub-acute symptoms (adjusted OR 3.18, 95% CI 1.04–9.8), CXR upper-lobe consolidation (AOR 8.70, 95% CI 2.5–29), and centrilobular nodules in chest CT (AOR 3.96, 95% CI 1.20–13.0, p = 0.02). In conclusion, bronchoscopy with BAL in hospitalized patients with HS-PTB had a 7% added diagnostic value after negative sputum samples. Our findings highlight specific predictors for PTB diagnosis that could be used in future controlled studies to personalize the diagnostic evaluation.

高度怀疑肺结核（HS-PTB）的住院病人在确诊前应隔离治疗。如果痰标本阴性后仍有疑问，通常会进行支气管镜检查和支气管肺泡灌洗（BAL）。然而，BAL 在这类患者中的附加值证据仍然很少。为了解决这一问题，我们纳入了在 2017 年至 2018 年期间接受 BAL 检查的连续 HS-PTB 患者，这些患者的痰标本均为阴性。胸部 X 光片 (CXR) 和 CT 扫描由对最终诊断保密的胸部放射科医生进行评估。以 2017 年至 2019 年间所有 PTB 阳性患者（通过痰或 BAL）为对照组（n = 41），通过多变量回归评估 PTB 的独立预测因素。共纳入 42 名 HS-PTB 患者（平均年龄为 51 ± 9 岁，36% 为女性）。BAL可诊断为PTB的病例有3例（7%），诊断为其他临床相关病原体的病例有6例（14%）。PTB 的独立预测因素包括：≥2 个亚急性症状（调整 OR 3.18，95% CI 1.04-9.8）、CXR 上叶合并症（AOR 8.70，95% CI 2.5-29）和胸部 CT 中的中心叶结节（AOR 3.96，95% CI 1.20-13.0，P = 0.02）。总之，在痰标本阴性后，对 HS-PTB 住院患者进行支气管镜和 BAL 检查可增加 7% 的诊断价值。我们的研究结果强调了 PTB 诊断的特定预测因素，这些因素可用于未来的对照研究，以实现诊断评估的个性化。

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引用次数: 0