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Morphological Prediction of CPAP Associated Acute Respiratory Instability. CPAP 相关急性呼吸不稳定的形态学预测。
IF 8.3 2区 医学 Q1 RESPIRATORY SYSTEM Pub Date : 2024-09-17 DOI: 10.1513/annalsats.202311-979oc
Thijs-Enagnon Nassi,Eline Oppersma,Gonzalo Labarca,Dirk W Donker,M Brandon Westover,Robert J Thomas
RATIONALEMultiple mechanisms are involved in the pathogenesis of obstructive sleep apnea (OSA). Elevated loop gain is a key target for precision OSA care and may be associated with treatment intolerance when the upper airway is the sole therapeutic target. Morphological or computational estimation of LG is not yet widely available or fully validated - there is a need for improved phenotyping/endotyping of apnea to advance its therapy and prognosis.OBJECTIVESThis study proposes a new algorithm to assess self-similarity as a signature of elevated loop gain using respiratory effort signals and presents its use to predict the probability of acute failure (high residual event counts) of continuous positive airway pressure (CPAP) therapy.METHODSEffort signals from 2145 split-night polysomnography studies from the Massachusetts General Hospital were analyzed for SS and used to predict acute CPAP therapy effectiveness. Logistic regression models were trained and evaluated using 5-fold cross-validation.RESULTSReceiver operating characteristic (ROC) and precision-recall (PR) curves with AUC values of 0.82 and 0.84, respectively, were obtained. Self-similarity combined with the central apnea index (CAI) and hypoxic burden outperformed CAI alone. Even in those with a low CAI by conventional scoring criteria or only mild desaturation, SS was related to poor therapy outcomes.CONCLUSIONSThe proposed algorithm for assessing SS as a measure of expressed high loop gain is accurate, non-invasive, and has the potential to improve phenotyping/endotyping of apnea, leading to more precise sleep apnea treatment strategies.
理论依据阻塞性睡眠呼吸暂停(OSA)的发病机制涉及多个方面。环增益升高是 OSA 精准治疗的关键目标,当上气道是唯一的治疗目标时,环增益升高可能与治疗不耐受有关。LG的形态学或计算估计尚未得到广泛应用或充分验证--需要改进呼吸暂停的表型/终型,以促进其治疗和预后。本研究提出了一种新算法,利用呼吸努力信号评估作为环路增益升高特征的自相似性,并将其用于预测持续气道正压(CPAP)疗法急性失败(高残留事件计数)的概率。方法对麻省总医院 2145 项分夜多导睡眠图研究的努力信号进行了 SS 分析,并将其用于预测急性 CPAP 治疗效果。结果获得了接收器工作特征曲线(ROC)和精确度-召回曲线(PR),AUC 值分别为 0.82 和 0.84。自相似性与中枢性呼吸暂停指数(CAI)和缺氧负荷相结合的结果优于单独使用 CAI 的结果。结论:所提出的用于评估 SS 的算法是对所表达的高环路增益的一种衡量标准,该算法准确、无创,有望改善呼吸暂停的表型/终型,从而制定出更精确的睡眠呼吸暂停治疗策略。
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引用次数: 0
Disparities in Discharge Support Provided to Patients Leaving 'Before Medically Advised' from Hospitalization for COPD Exacerbation. 为慢性阻塞性肺病恶化住院患者提供的 "医学建议前 "出院支持存在差异。
IF 8.3 2区 医学 Q1 RESPIRATORY SYSTEM Pub Date : 2024-09-17 DOI: 10.1513/annalsats.202405-452rl
J Henry Brems,Kevin J Psoter,Sarath Raju,Nirupama Putcha,Ashraf Fawzy,Anil C Singh,Nadia N Hansel,Robert A Wise,Aparna Balasubramanian,Meredith C McCormack
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引用次数: 0
Rural Residence, Tobacco Use, and Nationwide COPD Prevalence: Analyses from the National Health Interview Survey (NHIS). 农村居民、烟草使用和全国慢性阻塞性肺病患病率:全国健康访谈调查 (NHIS) 分析。
IF 8.3 2区 医学 Q1 RESPIRATORY SYSTEM Pub Date : 2024-09-13 DOI: 10.1513/annalsats.202311-973rl
Sarath Raju,Alexander W Steinberg,Jenny E Ozga,James D Sargent,Zhiqun Tang,Cassandra A Stanton,Meredith C McCormack,Laura M Paulin
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引用次数: 0
The Impact of Age of Diagnosis in Children with Primary Ciliary Dyskinesia. 原发性睫状肌运动障碍患儿诊断年龄的影响
IF 8.3 2区 医学 Q1 RESPIRATORY SYSTEM Pub Date : 2024-09-13 DOI: 10.1513/annalsats.202403-230oc
Dvir Gatt,Michelle Shaw,Fiona Kritzinger,Melinda Solomon,Sharon Dell,Felix Ratjen
RATIONALEThe typical symptoms for primary ciliary dyskinesia (PCD) manifest after birth and in early infancy, however diagnosis is often not confirmed during infancy. There is currently a lack of evidence in PCD regarding the impact of the age of diagnosis on clinical outcomes.OBJECTIVETo determine whether early diagnosis is related to improved long-term outcomes.METHODThis was a retrospective study of patients diagnosed with PCD between 2000 to 2022. We divided our cohort to three groups according to the age of diagnosis. 1) early diagnosis (<1 year); typical diagnosis (1-7 years) and late diagnosis (8-14 years). We compared various clinical long-term outcomes between the groups.RESULTSOver the study period, 110 patients were included in the analysis, with 41 patients in the early diagnosis group, 35 in the typical diagnosis group and 34 patients in the late diagnosis group. The presence of unexplained neonatal respiratory distress (NRDS) and organ laterality defect were higher in the early diagnosis group with rates between the early, typical, and late diagnosis groups for NRDS (80% vs 53% vs 61%, p=0.045) and laterality defect (64% vs 50% vs 18%, p<0.001). At the end of the first decade of life, patients in the early diagnosis and the typical age of diagnosis had better forced expiratory volume in 1 second (FEV1), compared to the late diagnosis group (93.5% and 93.1% vs 80.2%, P=0.002), respectively, but there was no significant change in the annual rate of decline between the groups once diagnosis was confirmed. Patient diagnosed late had significantly higher rates of pulmonary exacerbations (Pex) compared to typical age (1.95 vs 0.75 Pex/year, p<0.01) Conclusion: Late diagnosis (>8 years) was associated with lower FEV1 throughout childhood, although once diagnosed, the annual rate of decline was not different. These findings demonstrate the negative effect of delayed diagnosis in pediatric PCD.
理论依据原发性睫状肌运动障碍(PCD)的典型症状表现在出生后和婴儿早期,但在婴儿期往往无法确诊。目前还缺乏有关 PCD 诊断年龄对临床预后影响的证据。目的确定早期诊断是否与长期预后的改善有关。我们根据诊断年龄将队列分为三组。1)早期诊断(8 岁)与整个儿童期较低的 FEV1 有关,尽管一旦确诊,每年的下降率并无不同。这些发现表明,延迟诊断对小儿肺结核有负面影响。
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引用次数: 0
Longitudinal Magnetic Resonance Imaging of Changes in Lung Morphology and Perfusion in Children with Cystic Fibrosis From Infancy through Adolescence. 囊性纤维化儿童从婴儿期到青春期肺形态和灌注变化的纵向磁共振成像。
IF 8.3 2区 医学 Q1 RESPIRATORY SYSTEM Pub Date : 2024-09-10 DOI: 10.1513/annalsats.202404-396oc
Mark O Wielpütz,Mirjam Stahl,Simon M F Triphan,Lena Wucherpfennig,Patricia Leutz-Schmidt,Sonja Gestewitz,Eva Steinke,Simon Y Graeber,Hans-Ulrich Kauczor,Monika Eichinger,Michael U Puderbach,Abdulsattar Alrajab,Jens-Peter Schenk,Olaf Sommerburg,Marcus A Mall
RATIONALEThe progression of lung changes in cystic fibrosis (CF) from infancy through adolescence remains poorly understood due to limited longitudinal imaging data.OBJECTIVESTo assess changes in lung morphology and perfusion in children with CF through the pediatric age range by longitudinal chest magnetic resonance imaging (MRI).METHODS1112 annual chest MRI were performed in 226 patients with CF aged 0-18yr. MRI was assessed using a validated MRI scoring system.MEASUREMENTS AND MAIN RESULTSThe MRI global score continuously increased from 5.5±4.6 at infancy (0yr) to 17.9±8.4 at adolescence (range 12-18yr), and the MRI morphology score from 5.0±3.9 to 12.4±6.0 (P<0.001). Bronchiectasis/wall thickening prevalence increased from 89.1% at infancy to approx. 100% from preschool age (1-5yr), and the subscore increased from 3.1±1.9 at infancy to 6.6±2.1 at adolescence (P<0.001). Mucus plugging prevalence increased from 55.4% at infancy to 83.5% at adolescence, and the subscore increased from 1.2±1.6 to 3.7±2.5 in the same period (P<0.001). Perfusion abnormalities were found in 44.4% at infancy, and increased to approx. 90% from preschool age (P<0.001). The MRI perfusion score increased from 1.1±1.6 at infancy to 5.6±3.0 at adolescence (P<0.001). Chronic Pseudomonas aeruginosa infection was associated with higher MRI scores from school age (6-11yr, P<0.05-0.001).CONCLUSIONSThis is the first study assessing longitudinal changes in lung morphology and perfusion in CF throughout the pediatric age range, providing percentiles as age-specific reference for lung disease severity. Our data may facilitate the use of MRI as an endpoint in clinical trials in children with CF.
目的通过纵向胸部磁共振成像(MRI)评估囊性纤维化(CF)患儿肺部形态和灌注的变化。测量和主要结果MRI总体评分从婴儿期(0yr)的5.5±4.6分持续上升到青春期(12-18yr)的17.9±8.4分,MRI形态评分从5.0±3.9分上升到12.4±6.0分(P<0.001)。支气管扩张/管壁增厚的患病率从婴儿期的89.1%增加到学龄前(1-5岁)的约100%,子分数从婴儿期的3.1±1.9增加到青春期的6.6±2.1(P<0.001)。黏液堵塞发生率从婴儿期的 55.4% 增加到青春期的 83.5%,同期的子分数从 1.2±1.6 增加到 3.7±2.5(P<0.001)。婴儿期发现灌注异常的比例为 44.4%,学龄前期增加到约 90%(P<0.001)。核磁共振灌注评分从婴儿期的 1.1±1.6 增加到青春期的 5.6±3.0(P<0.001)。结论:这是第一项评估 CF 儿童整个年龄段肺部形态和灌注纵向变化的研究,提供了百分位数作为肺部疾病严重程度的年龄特异性参考。我们的数据有助于将磁共振成像作为CF患儿临床试验的终点。
{"title":"Longitudinal Magnetic Resonance Imaging of Changes in Lung Morphology and Perfusion in Children with Cystic Fibrosis From Infancy through Adolescence.","authors":"Mark O Wielpütz,Mirjam Stahl,Simon M F Triphan,Lena Wucherpfennig,Patricia Leutz-Schmidt,Sonja Gestewitz,Eva Steinke,Simon Y Graeber,Hans-Ulrich Kauczor,Monika Eichinger,Michael U Puderbach,Abdulsattar Alrajab,Jens-Peter Schenk,Olaf Sommerburg,Marcus A Mall","doi":"10.1513/annalsats.202404-396oc","DOIUrl":"https://doi.org/10.1513/annalsats.202404-396oc","url":null,"abstract":"RATIONALEThe progression of lung changes in cystic fibrosis (CF) from infancy through adolescence remains poorly understood due to limited longitudinal imaging data.OBJECTIVESTo assess changes in lung morphology and perfusion in children with CF through the pediatric age range by longitudinal chest magnetic resonance imaging (MRI).METHODS1112 annual chest MRI were performed in 226 patients with CF aged 0-18yr. MRI was assessed using a validated MRI scoring system.MEASUREMENTS AND MAIN RESULTSThe MRI global score continuously increased from 5.5±4.6 at infancy (0yr) to 17.9±8.4 at adolescence (range 12-18yr), and the MRI morphology score from 5.0±3.9 to 12.4±6.0 (P<0.001). Bronchiectasis/wall thickening prevalence increased from 89.1% at infancy to approx. 100% from preschool age (1-5yr), and the subscore increased from 3.1±1.9 at infancy to 6.6±2.1 at adolescence (P<0.001). Mucus plugging prevalence increased from 55.4% at infancy to 83.5% at adolescence, and the subscore increased from 1.2±1.6 to 3.7±2.5 in the same period (P<0.001). Perfusion abnormalities were found in 44.4% at infancy, and increased to approx. 90% from preschool age (P<0.001). The MRI perfusion score increased from 1.1±1.6 at infancy to 5.6±3.0 at adolescence (P<0.001). Chronic Pseudomonas aeruginosa infection was associated with higher MRI scores from school age (6-11yr, P<0.05-0.001).CONCLUSIONSThis is the first study assessing longitudinal changes in lung morphology and perfusion in CF throughout the pediatric age range, providing percentiles as age-specific reference for lung disease severity. Our data may facilitate the use of MRI as an endpoint in clinical trials in children with CF.","PeriodicalId":8018,"journal":{"name":"Annals of the American Thoracic Society","volume":"2 1","pages":""},"PeriodicalIF":8.3,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142181802","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"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
Further Insight into the Association of Long-Term Particulate Matter Exposure and Mortality in Hospitalized Patients with COVID-19. 进一步了解 COVID-19 患者长期接触微粒物质与死亡率之间的关系。
IF 8.3 2区 医学 Q1 RESPIRATORY SYSTEM Pub Date : 2024-09-10 DOI: 10.1513/annalsats.202406-655le
Kai Zhang,Yu Shi,Mao Xun Huang
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引用次数: 0
Reply to Zhang et al.: Further Insight into the Association of Long-Term Particulate Matter Exposure and Mortality in Hospitalized Patients with COVID-19. 回复 Zhang 等人:进一步了解 COVID-19 患者长期接触颗粒物与死亡率的关系。
IF 8.3 2区 医学 Q1 RESPIRATORY SYSTEM Pub Date : 2024-09-10 DOI: 10.1513/annalsats.202407-679le
Tak Kyu Oh,In-Ae Song
{"title":"Reply to Zhang et al.: Further Insight into the Association of Long-Term Particulate Matter Exposure and Mortality in Hospitalized Patients with COVID-19.","authors":"Tak Kyu Oh,In-Ae Song","doi":"10.1513/annalsats.202407-679le","DOIUrl":"https://doi.org/10.1513/annalsats.202407-679le","url":null,"abstract":"","PeriodicalId":8018,"journal":{"name":"Annals of the American Thoracic Society","volume":"22 1","pages":""},"PeriodicalIF":8.3,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142181801","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"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
Deep Learning-based Fibrosis Extent on Computed Tomography Predicts Outcome of Fibrosing Interstitial Lung Disease Independent of Visually Assessed Computed Tomography Pattern. 基于深度学习的计算机断层扫描纤维化程度预测纤维化间质性肺病的预后,与视觉评估的计算机断层扫描模式无关
IF 8.3 2区 医学 Q1 RESPIRATORY SYSTEM Pub Date : 2024-02-01 DOI: 10.1513/AnnalsATS.202301-084OC
Andrea S Oh, David A Lynch, Jeffrey J Swigris, David Baraghoshi, Debra S Dyer, Valerie A Hale, Tilman L Koelsch, Cristina Marrocchio, Katherine N Parker, Shawn D Teague, Kevin R Flaherty, Stephen M Humphries

Rationale: Radiologic pattern has been shown to predict survival in patients with fibrosing interstitial lung disease. The additional prognostic value of fibrosis extent by quantitative computed tomography (CT) is unknown. Objectives: We hypothesized that fibrosis extent provides information beyond visually assessed CT pattern that is useful for outcome prediction. Methods: We performed a retrospective analysis of chest CT, demographics, longitudinal pulmonary function, and transplantation-free survival among participants in the Pulmonary Fibrosis Foundation Patient Registry. CT pattern was classified visually according to the 2018 usual interstitial pneumonia criteria. Extent of fibrosis was objectively quantified using data-driven textural analysis. We used Kaplan-Meier plots and Cox proportional hazards and linear mixed-effects models to evaluate the relationships between CT-derived metrics and outcomes. Results: Visual assessment and quantitative analysis were performed on 979 enrollment CT scans. Linear mixed-effect modeling showed that greater baseline fibrosis extent was significantly associated with the annual rate of decline in forced vital capacity. In multivariable models that included CT pattern and fibrosis extent, quantitative fibrosis extent was strongly associated with transplantation-free survival independent of CT pattern (hazard ratio, 1.04; 95% confidence interval, 1.04-1.05; P < 0.001; C statistic = 0.73). Conclusions: The extent of lung fibrosis by quantitative CT is a strong predictor of physiologic progression and survival, independent of visually assessed CT pattern.

理论依据:放射学模式已被证明可预测纤维化间质性肺病患者的生存期。定量计算机断层扫描(CT)对纤维化程度的额外预后价值尚不清楚。我们的目标是我们假设,纤维化范围提供了视觉评估 CT 模式之外的信息,这些信息对预后预测很有用。方法:我们对肺纤维化基金会患者登记处参与者的胸部 CT、人口统计学、纵向肺功能和无移植生存率进行了回顾性分析。根据2018年通常间质性肺炎标准对CT模式进行视觉分类。纤维化的程度通过数据驱动的纹理分析进行客观量化。我们使用 Kaplan-Meier 图、Cox 比例危险模型和线性混合效应模型来评估 CT 衍生指标与预后之间的关系。结果我们对 979 例注册 CT 扫描进行了目视评估和定量分析。线性混合效应模型显示,基线纤维化程度越大,强迫生命容量的年下降率就越高。在包括CT模式和纤维化程度的多变量模型中,定量纤维化程度与无移植生存率密切相关,而与CT模式无关(危险比为1.04;95%置信区间为1.04-1.05;P 结论:定量CT显示的肺纤维化程度是生理进展和生存期的有力预测指标,与目测CT模式无关。
{"title":"Deep Learning-based Fibrosis Extent on Computed Tomography Predicts Outcome of Fibrosing Interstitial Lung Disease Independent of Visually Assessed Computed Tomography Pattern.","authors":"Andrea S Oh, David A Lynch, Jeffrey J Swigris, David Baraghoshi, Debra S Dyer, Valerie A Hale, Tilman L Koelsch, Cristina Marrocchio, Katherine N Parker, Shawn D Teague, Kevin R Flaherty, Stephen M Humphries","doi":"10.1513/AnnalsATS.202301-084OC","DOIUrl":"10.1513/AnnalsATS.202301-084OC","url":null,"abstract":"<p><p><b>Rationale:</b> Radiologic pattern has been shown to predict survival in patients with fibrosing interstitial lung disease. The additional prognostic value of fibrosis extent by quantitative computed tomography (CT) is unknown. <b>Objectives:</b> We hypothesized that fibrosis extent provides information beyond visually assessed CT pattern that is useful for outcome prediction. <b>Methods:</b> We performed a retrospective analysis of chest CT, demographics, longitudinal pulmonary function, and transplantation-free survival among participants in the Pulmonary Fibrosis Foundation Patient Registry. CT pattern was classified visually according to the 2018 usual interstitial pneumonia criteria. Extent of fibrosis was objectively quantified using data-driven textural analysis. We used Kaplan-Meier plots and Cox proportional hazards and linear mixed-effects models to evaluate the relationships between CT-derived metrics and outcomes. <b>Results:</b> Visual assessment and quantitative analysis were performed on 979 enrollment CT scans. Linear mixed-effect modeling showed that greater baseline fibrosis extent was significantly associated with the annual rate of decline in forced vital capacity. In multivariable models that included CT pattern and fibrosis extent, quantitative fibrosis extent was strongly associated with transplantation-free survival independent of CT pattern (hazard ratio, 1.04; 95% confidence interval, 1.04-1.05; <i>P</i> < 0.001; C statistic = 0.73). <b>Conclusions:</b> The extent of lung fibrosis by quantitative CT is a strong predictor of physiologic progression and survival, independent of visually assessed CT pattern.</p>","PeriodicalId":8018,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":"218-227"},"PeriodicalIF":8.3,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10267284","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"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
Ambient Air Pollution and Outpatient Morbidities in Bronchopulmonary Dysplasia. 环境空气污染与支气管肺发育不良的门诊发病率。
IF 8.3 2区 医学 Q1 RESPIRATORY SYSTEM Pub Date : 2024-01-01 DOI: 10.1513/AnnalsATS.202302-096OC
Jelte Kelchtermans, Brianna C Aoyama, Jessica L Rice, Amanda Martin, Joseph M Collaco, Sharon A McGrath-Morrow

Rationale: Bronchopulmonary dysplasia (BPD) is the most common long-term complication of prematurity. Although socioeconomic status is associated with BPD morbidities, the drivers of this association are poorly understood. In the United States, ambient air pollution (AAP) exposure is linked to both race/ethnicity and socioeconomic status. Furthermore, AAP exposure is known to have a detrimental effect on respiratory health in children. Objectives: To assess if AAP exposure is linked to BPD morbidity in the outpatient setting. Methods: Participants with BPD were recruited from outpatient clinics at Johns Hopkins University and the Children's Hospital of Philadelphia between 2008 and 2021 (N = 800) and divided into low, moderate, and high AAP exposure groups, based on publicly available U.S. Environmental Protection Agency data. Clinical data were obtained by chart review and caregiver questionnaires. Results: Non-White race, home ventilator use, and lower median household income were associated with higher degrees of air pollution exposure. After adjustment for these factors, moderate and high air pollution exposure were associated with requiring systemic steroids (odds ratio, 1.78 and 2.17, respectively) compared with low air pollution. Similarly, high air pollution exposure was associated with emergency department visits (odds ratio, 1.59). Conclusions: This study demonstrates an association between AAP exposure and BPD morbidity after initial hospital discharge. AAP exposure was closely linked to race and median household income. As such, it supports the notion that AAP exposure may be contributing to health disparities in BPD outcomes. Further studies directly measuring exposure and establishing a link between biomarkers of exposure and outcomes are prerequisites to developing targeted interventions protecting this vulnerable population.

背景:支气管肺发育不良(BPD)是早产儿最常见的长期并发症。虽然社会经济状况与 BPD 的发病率有关,但这种关联的驱动因素却鲜为人知。在美国,环境空气污染(AAP)暴露与种族/民族和社会经济地位都有关系。此外,已知环境空气污染会对儿童的呼吸系统健康产生不利影响。因此,我们开始评估在门诊环境中暴露于 AAP 是否与 BPD 发病率有关:2008 年至 2021 年间,我们从约翰霍普金斯大学和费城儿童医院的门诊中招募了患有 BPD 的参与者(人数=800),并根据环境保护局的公开数据将其分为低、中、高 AAP 暴露组。临床数据通过病历审查和护理人员问卷调查获得:结果:非白人种族、使用家用呼吸机和较低的家庭收入中位数与较高的空气污染暴露水平相关。在对这些因素进行调整后,与低空气污染相比,中度和高度空气污染与需要全身使用类固醇有关(OR 分别为 1.78 和 2.17)。同样,高空气污染暴露与急诊就诊相关(OR 1.59):本研究表明,空气污染暴露与初次出院后的 BPD 发病率之间存在关联。空气污染暴露与种族和家庭收入中位数密切相关。因此,该研究支持这样一种观点,即接触 AAP 可能会导致 BPD 结果的健康差异。进一步研究直接测量接触情况并建立接触情况的生物标志物与结果之间的联系,是制定有针对性的干预措施保护这一弱势群体的先决条件。
{"title":"Ambient Air Pollution and Outpatient Morbidities in Bronchopulmonary Dysplasia.","authors":"Jelte Kelchtermans, Brianna C Aoyama, Jessica L Rice, Amanda Martin, Joseph M Collaco, Sharon A McGrath-Morrow","doi":"10.1513/AnnalsATS.202302-096OC","DOIUrl":"10.1513/AnnalsATS.202302-096OC","url":null,"abstract":"<p><p><b>Rationale:</b> Bronchopulmonary dysplasia (BPD) is the most common long-term complication of prematurity. Although socioeconomic status is associated with BPD morbidities, the drivers of this association are poorly understood. In the United States, ambient air pollution (AAP) exposure is linked to both race/ethnicity and socioeconomic status. Furthermore, AAP exposure is known to have a detrimental effect on respiratory health in children. <b>Objectives:</b> To assess if AAP exposure is linked to BPD morbidity in the outpatient setting. <b>Methods:</b> Participants with BPD were recruited from outpatient clinics at Johns Hopkins University and the Children's Hospital of Philadelphia between 2008 and 2021 (<i>N</i> = 800) and divided into low, moderate, and high AAP exposure groups, based on publicly available U.S. Environmental Protection Agency data. Clinical data were obtained by chart review and caregiver questionnaires. <b>Results:</b> Non-White race, home ventilator use, and lower median household income were associated with higher degrees of air pollution exposure. After adjustment for these factors, moderate and high air pollution exposure were associated with requiring systemic steroids (odds ratio, 1.78 and 2.17, respectively) compared with low air pollution. Similarly, high air pollution exposure was associated with emergency department visits (odds ratio, 1.59). <b>Conclusions:</b> This study demonstrates an association between AAP exposure and BPD morbidity after initial hospital discharge. AAP exposure was closely linked to race and median household income. As such, it supports the notion that AAP exposure may be contributing to health disparities in BPD outcomes. Further studies directly measuring exposure and establishing a link between biomarkers of exposure and outcomes are prerequisites to developing targeted interventions protecting this vulnerable population.</p>","PeriodicalId":8018,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":"88-93"},"PeriodicalIF":8.3,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10867919/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10597266","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"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
Normative Reference Equations for Breathlessness Intensity during Incremental Cardiopulmonary Cycle Exercise Testing. 增量式心肺循环运动测试中呼吸困难强度的标准参考方程。
IF 8.3 2区 医学 Q1 RESPIRATORY SYSTEM Pub Date : 2024-01-01 DOI: 10.1513/AnnalsATS.202305-394OC
Magnus Ekström, Pei Zhi Li, Hayley Lewthwaite, Jean Bourbeau, Wan C Tan, Linus Schiöler, Andrew Brotto, Michael K Stickland, Dennis Jensen

Rationale: Cardiopulmonary exercise testing (CPET) is the gold standard to evaluate exertional breathlessness, a common and disabling symptom. However, the interpretation of breathlessness responses to CPET is limited by a scarcity of normative data. Objectives: We aimed to develop normative reference equations for breathlessness intensity (Borg 0-10 category ratio) response in men and women aged ⩾40 years during CPET, in relation to power output (watts), oxygen uptake, and minute ventilation. Methods: Analysis of ostensibly healthy people aged ⩾40 years undergoing symptom-limited incremental cycle CPET (10 W/min) in the CanCOLD (Canadian Cohort Obstructive Lung Disease) study. Participants had smoking histories <5 pack-years and normal lung function and exercise capacity. The probability of each Borg 0-10 category ratio breathlessness intensity rating by power output, oxygen uptake, and minute ventilation (as an absolute or a relative value [percentage of predicted maximum]) was predicted using ordinal multinomial logistic regression. Model performance was evaluated by fit, calibration, and discrimination (C statistic) and externally validated in an independent sample (n = 86) of healthy Canadian adults. Results: We included 156 participants (43% women) from CanCOLD; the mean age was 65 (range, 42-91) years, and the mean body mass index was 26.3 (standard deviation, 3.8) kg/m2. Reference equations were developed for women and men separately, accounting for age and/or body mass. Model performance was high across all equations, including in the validation sample (C statistic for men = 0.81-0.92, C statistic for women = 0.81-0.96). Conclusions: Normative reference equations are provided to compare exertional breathlessness intensity ratings among individuals or groups and to identify and quantify abnormal breathlessness responses (scores greater than the upper limit of normal) during CPET.

原理:心肺运动测试 (CPET) 是评估劳累性呼吸困难(一种常见的致残症状)的黄金标准。然而,由于缺乏常模数据,对 CPET 呼吸困难反应的解释受到了限制。我们的目标是我们的目的是根据输出功率(瓦特)、摄氧量和分钟通气量,为 40 岁以下男性和女性在 CPET 中的憋气强度(博格 0-10 类别比率)反应制定标准参考方程。方法:对在 CanCOLD(加拿大队列阻塞性肺病)研究中接受症状限制增量循环 CPET(10 瓦/分钟)的 40 岁以下表面健康的人进行分析。参与者中有吸烟史(n = 86)的健康加拿大成年人。研究结果我们纳入了 156 名来自 CanCOLD 的参与者(43% 为女性);平均年龄为 65 岁(42-91 岁不等),平均体重指数为 26.3(标准偏差为 3.8)kg/m2。根据年龄和/或体重,分别为女性和男性制定了参考方程。所有方程的模型性能都很高,包括在验证样本中(男性的 C 统计量 = 0.81-0.92,女性的 C 统计量 = 0.81-0.96)。结论:正常参考方程可用于比较不同个体或群体的用力呼吸困难强度评分,以及识别和量化 CPET 期间的异常呼吸困难反应(评分大于正常值上限)。
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引用次数: 0
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Annals of the American Thoracic Society
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