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Spirometry in Mixed-Race Civil War Veterans. 南北战争中混血退伍军人的肺活量。
IF 6.8 2区 医学 Q1 RESPIRATORY SYSTEM Pub Date : 2023-08-01 DOI: 10.1513/AnnalsATS.202301-090RL
Aaron D Baugh, Prescott Woodruff, Stephen Shiboski, David V Glidden, Victor E Ortega, Neeta Thakur
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引用次数: 0
Multiomics and Multiancestry Approaches: Key Steps to Untangling the Web of Chronic Obstructive Pulmonary Disease Pathogenesis. 多组学和多巢穴方法:解开慢性阻塞性肺病发病机制之网的关键步骤。
IF 6.8 2区 医学 Q1 RESPIRATORY SYSTEM Pub Date : 2023-08-01 DOI: 10.1513/AnnalsATS.202304-311ED
Josiah E Radder, Jessica Bon
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引用次数: 0
Building Career Paths for Ph.D., Basic and Translational Scientists in Clinical Departments in the United States: An Official American Thoracic Society Workshop Report. 为美国临床科室的博士、基础和转化科学家建立职业道路:美国胸科学会官方研讨会报告。
IF 8.3 2区 医学 Q1 RESPIRATORY SYSTEM Pub Date : 2023-08-01 DOI: 10.1513/AnnalsATS.202304-305ST
Bethany B Moore, Megan N Ballinger, Natalie N Bauer, Timothy S Blackwell, Zea Borok, G R Scott Budinger, Blanca Camoretti-Mercado, Serpil C Erzurum, Blanca E Himes, Venkateshwar G Keshamouni, Hrishikesh S Kulkarni, Rama K Mallampalli, Thomas J Mariani, Fernando J Martinez, Janet E McCombs, Dawn C Newcomb, Richard A Johnston, Michael A O'Reilly, Y S Prakash, Karen M Ridge, Patricia J Sime, Anne I Sperling, Shelia Violette, David S Wilkes, Melanie Königshoff

Rationale: To identify barriers and opportunities for Ph.D., basic and translational scientists to be fully integrated into clinical units. Objectives: In 2022, an ad hoc committee of the American Thoracic Society developed a project proposal and workshop to identify opportunities and barriers for scientists who do not practice medicine to develop successful careers and achieve tenure-track faculty positions in clinical departments and divisions within academic medical centers (AMCs) in the United States. Methods: This document focuses on results from a survey of adult and pediatric pulmonary, critical care, and sleep medicine division chiefs as well as a survey of workshop participants, including faculty in departmental and school leadership roles in both basic science and clinical units within U.S. AMCs. Results: We conclude that full integration of non-clinically practicing basic and translational scientists into the clinical units, in addition to their traditional placements in basic science units, best serves the tripartite mission of AMCs to provide care, perform research, and educate the next generation. Evidence suggests clinical units do employ Ph.D. scientists in large numbers, but these faculty are often hired into non-tenure track positions, which do not provide the salary support, start-up funds, research independence, or space often associated with hiring in basic science units within the same institution. These barriers to success of Ph.D. faculty in clinical units are largely financial. Conclusions: Our recommendation is for AMCs to consider and explore some of our proposed strategies to accomplish the goal of integrating basic and translational scientists into clinical units in a meaningful way.

理由:找出博士、基础和转化科学家完全融入临床科室的障碍和机遇。目标:2022 年,美国胸科学会的一个特设委员会制定了一份项目建议书并举办了一次研讨会,以确定不行医的科学家在美国学术医疗中心 (AMC) 的临床科室和部门成功发展事业并获得终身教职的机会和障碍。方法:本文重点介绍对成人和儿科肺病、重症监护和睡眠医学科主任的调查结果,以及对研讨会参与者的调查结果,包括美国 AMC 内基础科学和临床科室担任部门和学校领导职务的教师。结果:我们得出的结论是,除了将非临床实践的基础和转化科学家安排在传统的基础科学科室外,将他们完全纳入临床科室最符合医学中心的三重使命,即提供医疗服务、开展研究和教育下一代。有证据表明,临床科室确实聘用了大量的博士科学家,但这些教职员工往往受聘于非终身教职,无法获得薪资支持、启动资金、研究独立性或空间,而在同一机构的基础科学科室聘用这些教职员工通常都能获得薪资支持、启动资金、研究独立性或空间。这些阻碍博士教师在临床单位取得成功的因素主要是资金问题。结论:我们的建议是,AMC 应考虑并探索我们提出的一些策略,以实现将基础和转化科学家有意义地融入临床科室的目标。
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引用次数: 0
Disparities in Adult Patient Selection for Extracorporeal Membrane Oxygenation in the United States: A Population-Level Study. 美国成人体外膜氧合患者选择的差异:人口层面的研究。
IF 6.8 2区 医学 Q1 RESPIRATORY SYSTEM Pub Date : 2023-08-01 DOI: 10.1513/AnnalsATS.202212-1029OC
Anuj B Mehta, Jennifer K Taylor, Gwenyth Day, Trevor C Lane, Ivor S Douglas

Rationale: Disparities in patient selection for advanced therapeutics in health care have been identified in multiple studies, but it is unclear if disparities exist in patient selection for extracorporeal membrane oxygenation (ECMO), a rapidly expanding critical care resource. Objectives: To determine if disparities exist in patient selection for ECMO based on sex, primary insurance, and median income of the patient's neighborhood. Methods: In a retrospective cohort study using the Nationwide Readmissions Database 2016-2019, we identified patients treated with mechanical ventilation (MV) and/or ECMO with billing codes. Patient sex, insurance, and income level for patients receiving ECMO were compared with the patients treated with MV only, and hierarchical logistic regression with the hospital as a random intercept was used to determine odds of receiving ECMO based on patient demographics. Results: We identified 2,170,752 MV hospitalizations with 18,725 cases of ECMO. Among patients treated with ECMO, 36.1% were female compared with 44.5% of patients treated with> MV only (adjusted odds ratio [aOR] for ECMO, 0.73; 95% confidence interval [CI], 0.70-0.75). Of patients treated with ECMO, 38.1% had private insurance compared with 17.4% of patients treated with MV only. Patients with Medicaid were less likely to receive ECMO than patients with private insurance (aOR, 0.55; 95% CI, 0.52-0.57). Patients treated with ECMO were more likely to live in the highest-income neighborhoods compared with patients treated with MV only (25.1% vs. 17.3%). Patients living in the lowest-income neighborhoods were less likely to receive ECMO than those living in the highest-income neighborhoods (aOR, 0.63; 95% CI, 0.60-0.67). Conclusions: Significant disparities exist in patient selection for ECMO. Female patients, patients with Medicaid, and patients living in the lowest-income neighborhoods are less likely to be treated with ECMO. Despite possible unmeasured confounding, these findings were robust to multiple sensitivity analyses. On the basis of previous work describing disparities in other areas of health care, we speculate that limited access in some neighborhoods, restrictive/biased interhospital transfer practices, differences in patient preferences, and implicit provider bias may contribute to the observed differences. Future studies with more granular data are needed to identify and modify drivers of observed disparities.

理由:多项研究发现,在选择医疗保健先进疗法的患者时存在差异,但目前尚不清楚在选择体外膜肺氧合(ECMO)这种快速发展的重症护理资源时是否存在差异。目标:确定体外膜肺氧合患者的选择是否存在差异:根据性别、主要保险和患者所在社区的收入中位数,确定患者在选择 ECMO 时是否存在差异。方法:在一项使用 2016-2019 年全国再入院数据库(Nationwide Readmissions Database 2016-2019)进行的回顾性队列研究中,我们确定了接受机械通气(MV)和/或 ECMO 治疗的患者的账单代码。将接受 ECMO 治疗的患者的性别、保险和收入水平与仅接受 MV 治疗的患者进行比较,并以医院为随机截距进行分层逻辑回归,以确定基于患者人口统计学特征的接受 ECMO 的几率。结果:我们确定了 2,170,752 例 MV 住院病例和 18,725 例 ECMO 病例。在接受 ECMO 治疗的患者中,36.1% 为女性,而在仅接受> MV 治疗的患者中,44.5% 为女性(ECMO 的调整赔率比 [aOR],0.73;95% 置信区间 [CI],0.70-0.75)。在接受 ECMO 治疗的患者中,38.1% 有私人保险,而仅接受 MV 治疗的患者中只有 17.4%有私人保险。与有私人保险的患者相比,有医疗补助的患者接受 ECMO 的可能性较低(aOR,0.55;95% CI,0.52-0.57)。与仅接受 MV 治疗的患者相比,接受 ECMO 治疗的患者更有可能居住在收入最高的社区(25.1% 对 17.3%)。生活在最低收入社区的患者接受 ECMO 的可能性低于生活在最高收入社区的患者(aOR,0.63;95% CI,0.60-0.67)。结论:在选择 ECMO 患者方面存在显著差异。女性患者、享受医疗补助的患者以及生活在最低收入社区的患者接受 ECMO 治疗的可能性较低。尽管可能存在未测量的混杂因素,但这些结果在多重敏感性分析中都是稳健的。根据以往描述其他医疗领域差异的工作,我们推测,某些社区的就医机会有限、医院间转院的限制性/偏向性做法、患者偏好的差异以及医疗服务提供者的隐性偏见可能是造成观察到的差异的原因。未来的研究需要更详细的数据,以确定和改变观察到的差异的驱动因素。
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引用次数: 0
Effects of Lumacaftor/Ivacaftor on Cystic Fibrosis Disease Progression in Children 2 through 5 Years of Age Homozygous for F508del-CFTR: A Phase 2 Placebo-controlled Clinical Trial. Lumacaftor/Ivacaftor对2 - 5岁儿童囊性纤维化疾病进展的影响纯合子F508del-CFTR:一项2期安慰剂对照临床试验
IF 8.3 2区 医学 Q1 RESPIRATORY SYSTEM Pub Date : 2023-08-01 DOI: 10.1513/AnnalsATS.202208-684OC
Mirjam Stahl, Jobst Roehmel, Monika Eichinger, Felix Doellinger, Lutz Naehrlich, Matthias V Kopp, Anna-Maria Dittrich, Christopher Lee, Olaf Sommerburg, Simon Tian, Tu Xu, Pan Wu, Aniket Joshi, Partha Ray, Margaret E Duncan, Mark O Wielpütz, Marcus A Mall

Rationale: Lumacaftor/ivacaftor (LUM/IVA) was shown to be safe and well tolerated in children 2 through 5 years of age with cystic fibrosis (CF) homozygous for F508del-CFTR in a Phase 3 open-label study. Improvements in sweat chloride concentration, markers of pancreatic function, and lung clearance index2.5 (LCI2.5), along with increases in growth parameters, suggested the potential for early disease modification with LUM/IVA treatment. Objective: To further assess the effects of LUM/IVA on CF disease progression in children 2 through 5 years of age using chest magnetic resonance imaging (MRI). Methods: This Phase 2 study had two parts: a 48-week, randomized, double-blind, placebo-controlled treatment period in which children 2 through 5 years of age with CF homozygous for F508del-CFTR received either LUM/IVA or placebo (Part 1) followed by an open-label period in which all children received LUM/IVA for an additional 48 weeks (Part 2). The results from Part 1 are reported. The primary endpoint was absolute change from baseline in chest MRI global score at Week 48. Secondary endpoints included absolute change in LCI2.5 through Week 48 and absolute changes in weight-for-age, stature-for-age, and body mass index-for-age z-scores at Week 48. Additional endpoints included absolute changes in sweat chloride concentration, fecal elastase-1 levels, serum immunoreactive trypsinogen, and fecal calprotectin through Week 48. The primary endpoint was analyzed using Bayesian methods, where the actual Bayesian posterior probability of LUM/IVA being superior to placebo in the chest MRI global score at Week 48 was calculated using a vague normal prior distribution; secondary and additional endpoints were analyzed using descriptive summary statistics. Results: Fifty-one children were enrolled and received LUM/IVA (n = 35) or placebo (n = 16). For the change in chest MRI global score at Week 48, the Bayesian posterior probability of LUM/IVA being better than placebo (treatment difference, <0; higher score indicates greater abnormality) was 76%; the mean treatment difference was -1.5 (95% credible interval, -5.5 to 2.6). Treatment with LUM/IVA also led to within-group numerical improvements in LCI2.5, growth parameters, and biomarkers of pancreatic function as well as greater decreases in sweat chloride concentration compared with placebo from baseline through Week 48. Safety data were consistent with the established safety profile of LUM/IVA. Conclusions: This placebo-controlled study suggests the potential for early disease modification with LUM/IVA treatment, including that assessed by chest MRI, in children as young as 2 years of age. Clinical trial registered with www.clinicaltrials.gov (NCT03625466).

理由:在一项3期开放标签研究中,Lumacaftor/ivacaftor (LUM/IVA)在2至5岁患有F508del-CFTR的囊性纤维化(CF)纯合子的儿童中显示出安全性和良好的耐受性。汗液氯化物浓度、胰腺功能标志物和肺清除率指数2.5 (LCI2.5)的改善,以及生长参数的增加,表明LUM/IVA治疗有可能早期改善疾病。目的:利用胸部磁共振成像(MRI)进一步评估LUM/IVA对2 ~ 5岁儿童CF疾病进展的影响。方法:该2期研究分为两部分:48周,随机,双盲,安慰剂对照治疗期,2至5岁CF纯合子F508del-CFTR的儿童接受LUM/IVA或安慰剂(第一部分),然后是开放标签期,所有儿童接受LUM/IVA额外48周(第二部分)。第一部分的结果报告。主要终点是第48周胸部MRI总体评分相对于基线的绝对变化。次要终点包括48周LCI2.5的绝对变化,48周年龄体重、年龄身高和年龄体重指数z分数的绝对变化。其他终点包括48周时汗液氯化物浓度、粪便弹性酶-1水平、血清免疫反应性胰蛋白酶原和粪便钙保护蛋白的绝对变化。使用贝叶斯方法分析主要终点,其中使用模糊正态先验分布计算LUM/IVA在第48周胸部MRI总体评分中优于安慰剂的实际贝叶斯后验概率;次要终点和附加终点采用描述性汇总统计进行分析。结果:51名儿童入组,接受了LUM/IVA (n = 35)或安慰剂(n = 16)。对于第48周胸部MRI总体评分的变化,从基线到第48周,LUM/IVA的贝叶斯后后概率优于安慰剂(治疗差异,2.5,生长参数和胰腺功能的生物标志物),汗液氯化物浓度的下降幅度大于安慰剂。安全性数据与LUM/IVA的既定安全性一致。结论:这项安慰剂对照研究表明,LUM/IVA治疗早期疾病改善的潜力,包括通过胸部MRI评估的2岁以下儿童。临床试验注册于www.clinicaltrials.gov (NCT03625466)。
{"title":"Effects of Lumacaftor/Ivacaftor on Cystic Fibrosis Disease Progression in Children 2 through 5 Years of Age Homozygous for <i>F508del-CFTR</i>: A Phase 2 Placebo-controlled Clinical Trial.","authors":"Mirjam Stahl,&nbsp;Jobst Roehmel,&nbsp;Monika Eichinger,&nbsp;Felix Doellinger,&nbsp;Lutz Naehrlich,&nbsp;Matthias V Kopp,&nbsp;Anna-Maria Dittrich,&nbsp;Christopher Lee,&nbsp;Olaf Sommerburg,&nbsp;Simon Tian,&nbsp;Tu Xu,&nbsp;Pan Wu,&nbsp;Aniket Joshi,&nbsp;Partha Ray,&nbsp;Margaret E Duncan,&nbsp;Mark O Wielpütz,&nbsp;Marcus A Mall","doi":"10.1513/AnnalsATS.202208-684OC","DOIUrl":"https://doi.org/10.1513/AnnalsATS.202208-684OC","url":null,"abstract":"<p><p><b>Rationale:</b> Lumacaftor/ivacaftor (LUM/IVA) was shown to be safe and well tolerated in children 2 through 5 years of age with cystic fibrosis (CF) homozygous for <i>F508del-CFTR</i> in a Phase 3 open-label study. Improvements in sweat chloride concentration, markers of pancreatic function, and lung clearance index<sub>2.5</sub> (LCI<sub>2.5</sub>), along with increases in growth parameters, suggested the potential for early disease modification with LUM/IVA treatment. <b>Objective:</b> To further assess the effects of LUM/IVA on CF disease progression in children 2 through 5 years of age using chest magnetic resonance imaging (MRI). <b>Methods:</b> This Phase 2 study had two parts: a 48-week, randomized, double-blind, placebo-controlled treatment period in which children 2 through 5 years of age with CF homozygous for <i>F508del-CFTR</i> received either LUM/IVA or placebo (Part 1) followed by an open-label period in which all children received LUM/IVA for an additional 48 weeks (Part 2). The results from Part 1 are reported. The primary endpoint was absolute change from baseline in chest MRI global score at Week 48. Secondary endpoints included absolute change in LCI<sub>2.5</sub> through Week 48 and absolute changes in weight-for-age, stature-for-age, and body mass index-for-age <i>z</i>-scores at Week 48. Additional endpoints included absolute changes in sweat chloride concentration, fecal elastase-1 levels, serum immunoreactive trypsinogen, and fecal calprotectin through Week 48. The primary endpoint was analyzed using Bayesian methods, where the actual Bayesian posterior probability of LUM/IVA being superior to placebo in the chest MRI global score at Week 48 was calculated using a vague normal prior distribution; secondary and additional endpoints were analyzed using descriptive summary statistics. <b>Results:</b> Fifty-one children were enrolled and received LUM/IVA (<i>n</i> = 35) or placebo (<i>n</i> = 16). For the change in chest MRI global score at Week 48, the Bayesian posterior probability of LUM/IVA being better than placebo (treatment difference, <0; higher score indicates greater abnormality) was 76%; the mean treatment difference was -1.5 (95% credible interval, -5.5 to 2.6). Treatment with LUM/IVA also led to within-group numerical improvements in LCI<sub>2.5</sub>, growth parameters, and biomarkers of pancreatic function as well as greater decreases in sweat chloride concentration compared with placebo from baseline through Week 48. Safety data were consistent with the established safety profile of LUM/IVA. <b>Conclusions:</b> This placebo-controlled study suggests the potential for early disease modification with LUM/IVA treatment, including that assessed by chest MRI, in children as young as 2 years of age. Clinical trial registered with www.clinicaltrials.gov (NCT03625466).</p>","PeriodicalId":8018,"journal":{"name":"Annals of the American Thoracic Society","volume":"20 8","pages":"1144-1155"},"PeriodicalIF":8.3,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/ee/cc/AnnalsATS.202208-684OC.PMC10405608.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10010310","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: 1
Unexplained Dyspnea: Hepatopulmonary Syndrome without Cirrhosis? 不明原因的呼吸困难:无肝硬化的肝肺综合征?
IF 6.8 2区 医学 Q1 RESPIRATORY SYSTEM Pub Date : 2023-08-01 DOI: 10.1513/AnnalsATS.202301-087CC
Justin Rafael O De la Fuente, Laura K Buckley, Steven M Kawut, Steven C Pugliese
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引用次数: 0
Sex-related Differences in Loop Gain during High-Altitude Sleep-disordered Breathing. 高海拔睡眠呼吸障碍时环路增益的性别差异
IF 6.8 2区 医学 Q1 RESPIRATORY SYSTEM Pub Date : 2023-08-01 DOI: 10.1513/AnnalsATS.202211-918OC
Jordan D Bird, Scott A Sands, Raichel M Alex, Conan L H Shing, Brooke M Shafer, Nicholas G Jendzjowsky, Richard J A Wilson, Trevor A Day, Glen E Foster

Rationale: Central sleep apnea (CSA) is pervasive during sleep at high altitude, disproportionately impacting men and associated with increased peripheral chemosensitivity. Objectives: We aimed to assess whether biological sex affects loop gain (LGn) and CSA severity during sleep over 9-10 days of acclimatization to 3,800 m. We hypothesized that CSA severity would worsen with acclimatization in men but not in women because of greater increases in LGn in men. Methods: Sleep studies were collected from 20 (12 male) healthy participants at low altitude (1,130 m, baseline) and after ascent to (nights 2/3, acute) and residence at high altitude (nights 9/10, prolonged). CSA severity was quantified as the respiratory event index (REI) as a surrogate of the apnea-hypopnea index. LGn, a measure of ventilatory control instability, was quantified using a ventilatory control model fit to nasal flow. Linear mixed models evaluated effects of time at altitude and sex on respiratory event index and LGn. Data are presented as contrast means with 95% confidence intervals. Results: REI was comparable between men and women at acute altitude (4.1 [-9.3, 17.5] events/h; P = 0.54) but significantly greater in men at prolonged altitude (23.7 [10.3, 37.1] events/h; P = 0.0008). Men had greater LGn than did women for acute (0.08 [0.001, 0.15]; P = 0.047) and prolonged (0.17 [0.10, 0.25]; P < 0.0001) altitude. The change in REI per change in LGn was significantly greater in men than in women (107 ± 46 events/h/LGn; P = 0.02). Conclusions: The LGn response to high altitude differed between sexes and contributed to worsening of CSA over time in men but not in women. This sex difference in acclimatization appears to protect females from high altitude-related CSA. These data provide fundamental sex-specific physiological insight into high-altitude acclimatization in healthy individuals and may help to inform sex differences in sleep-disordered breathing pathogenesis in patients with cardiorespiratory disease.

理由中枢性睡眠呼吸暂停(CSA)在高海拔地区的睡眠中普遍存在,对男性的影响尤为严重,并与外周化疗敏感性增加有关。研究目的:我们旨在评估生理性别是否会影响 CSA:我们的假设是,由于男性的 LGn 增加较多,CSA 的严重程度会随着男性的适应而加重,但女性不会。研究方法我们收集了 20 名(12 名男性)健康参与者在低海拔(1,130 米,基线)、上升到高海拔(第 2/3 夜,急性)和居住在高海拔(第 9/10 夜,长期)后的睡眠研究数据。CSA 严重程度以呼吸事件指数(REI)量化,作为呼吸暂停-低通气指数的代用指标。通气控制不稳定性的测量指标 LGn 是通过与鼻流量拟合的通气控制模型进行量化的。线性混合模型评估了海拔时间和性别对呼吸事件指数和 LGn 的影响。数据以对比均值和 95% 置信区间表示。结果:在急性高海拔地区,男性和女性的 REI 相当(4.1 [-9.3, 17.5] 事件/小时;P = 0.54),但在长期高海拔地区,男性的 REI 明显高于女性(23.7 [10.3, 37.1] 事件/小时;P = 0.0008)。在急性(0.08 [0.001, 0.15];P = 0.047)和长时间(0.17 [0.10, 0.25];P = 0.02)时,男性的 LGn 均高于女性。结论LGn对高海拔的反应在性别上存在差异,随着时间的推移,男性的CSA会恶化,而女性则不会。这种适应性的性别差异似乎能保护女性免受高海拔相关 CSA 的影响。这些数据为健康人的高海拔适应性提供了基本的性别特异性生理学见解,并可能有助于了解心肺疾病患者睡眠呼吸障碍发病机制的性别差异。
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引用次数: 0
Systemic Markers of Lung Function and Forced Expiratory Volume in 1 Second Decline across Diverse Cohorts. 不同人群肺功能和一秒用力呼气量下降的系统标志物。
IF 6.8 2区 医学 Q1 RESPIRATORY SYSTEM Pub Date : 2023-08-01 DOI: 10.1513/AnnalsATS.202210-857OC
Debby Ngo, Katherine A Pratte, Claudia Flexeder, Hans Petersen, Hong Dang, Yanlin Ma, Michelle J Keyes, Yan Gao, Shuliang Deng, Bennet D Peterson, Laurie A Farrell, Victoria M Bhambhani, Cesar Palacios, Juweria Quadir, Lucas Gillenwater, Hanfei Xu, Claire Emson, Christian Gieger, Karsten Suhre, Johannes Graumann, Deepti Jain, Matthew P Conomos, Russell P Tracy, Xiuqing Guo, Yongmei Liu, W Craig Johnson, Elaine Cornell, Peter Durda, Kent D Taylor, George J Papanicolaou, Stephen S Rich, Jerome I Rotter, Steven I Rennard, Jeffrey L Curtis, Prescott G Woodruff, Alejandro P Comellas, Edwin K Silverman, James D Crapo, Martin G Larson, Ramachandran S Vasan, Thomas J Wang, Adolfo Correa, Mario Sims, James G Wilson, Robert E Gerszten, George T O'Connor, R Graham Barr, David Couper, Josée Dupuis, Ani Manichaikul, Wanda K O'Neal, Yohannes Tesfaigzi, Holger Schulz, Russell P Bowler

Rationale: Chronic obstructive pulmonary disease (COPD) is a complex disease characterized by airway obstruction and accelerated lung function decline. Our understanding of systemic protein biomarkers associated with COPD remains incomplete. Objectives: To determine what proteins and pathways are associated with impaired pulmonary function in a diverse population. Methods: We studied 6,722 participants across six cohort studies with both aptamer-based proteomic and spirometry data (4,566 predominantly White participants in a discovery analysis and 2,156 African American cohort participants in a validation). In linear regression models, we examined protein associations with baseline forced expiratory volume in 1 second (FEV1) and FEV1/forced vital capacity (FVC). In linear mixed effects models, we investigated the associations of baseline protein levels with rate of FEV1 decline (ml/yr) in 2,777 participants with up to 7 years of follow-up spirometry. Results: We identified 254 proteins associated with FEV1 in our discovery analyses, with 80 proteins validated in the Jackson Heart Study. Novel validated protein associations include kallistatin serine protease inhibitor, growth differentiation factor 2, and tumor necrosis factor-like weak inducer of apoptosis (discovery β = 0.0561, Q = 4.05 × 10-10; β  = 0.0421, Q = 1.12 × 10-3; and β = 0.0358, Q = 1.67 × 10-3, respectively). In longitudinal analyses within cohorts with follow-up spirometry, we identified 15 proteins associated with FEV1 decline (Q < 0.05), including elafin leukocyte elastase inhibitor and mucin-associated TFF2 (trefoil factor 2; β = -4.3 ml/yr, Q = 0.049; β = -6.1 ml/yr, Q = 0.032, respectively). Pathways and processes highlighted by our study include aberrant extracellular matrix remodeling, enhanced innate immune response, dysregulation of angiogenesis, and coagulation. Conclusions: In this study, we identify and validate novel biomarkers and pathways associated with lung function traits in a racially diverse population. In addition, we identify novel protein markers associated with FEV1 decline. Several protein findings are supported by previously reported genetic signals, highlighting the plausibility of certain biologic pathways. These novel proteins might represent markers for risk stratification, as well as novel molecular targets for treatment of COPD.

理由慢性阻塞性肺疾病(COPD)是一种以气道阻塞和肺功能加速衰退为特征的复杂疾病。我们对与慢性阻塞性肺病相关的全身蛋白质生物标志物的了解仍不全面。研究目的确定哪些蛋白质和途径与不同人群的肺功能受损有关。方法我们对六项队列研究中的 6722 名参与者进行了研究,这些参与者同时拥有基于适配体的蛋白质组和肺活量数据(4566 名主要为白人的参与者参与了发现分析,2156 名非裔美国人队列参与者参与了验证分析)。在线性回归模型中,我们研究了蛋白质与基线1秒用力呼气容积(FEV1)和FEV1/用力肺活量(FVC)的关系。在线性混合效应模型中,我们研究了基线蛋白质水平与 FEV1 下降率(毫升/年)之间的关系,2777 名参与者进行了长达 7 年的随访肺活量测定。结果发现我们在发现分析中发现了 254 种与 FEV1 相关的蛋白质,其中 80 种蛋白质在杰克逊心脏研究中得到了验证。新验证的蛋白质关联包括kallistatin丝氨酸蛋白酶抑制剂、生长分化因子2和肿瘤坏死因子样细胞凋亡弱诱导剂(发现β=0.0561,Q=4.05×10-10;β=0.0421,Q=1.12×10-3;β=0.0358,Q=1.67×10-3)。在有随访肺活量测定的队列中进行的纵向分析中,我们发现了 15 种与 FEV1 下降相关的蛋白质(Q Q = 0.049;β = -6.1 ml/yr,Q = 0.032)。我们的研究强调的途径和过程包括细胞外基质重塑异常、先天性免疫反应增强、血管生成失调和凝血。结论:在这项研究中,我们发现并验证了与不同种族人群肺功能特征相关的新型生物标记物和通路。此外,我们还发现了与 FEV1 下降相关的新型蛋白质标记物。一些蛋白质的发现得到了之前报道的遗传信号的支持,突出了某些生物通路的合理性。这些新型蛋白质可能是风险分层的标志物,也可能是治疗慢性阻塞性肺病的新型分子靶标。
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引用次数: 0
Shifting the Overton Window on Nontuberculous Mycobacterial Disease Infection Susceptibility by Race. 非结核分枝杆菌疾病感染易感性的奥弗顿窗口的种族转移。
IF 8.3 2区 医学 Q1 RESPIRATORY SYSTEM Pub Date : 2023-08-01 DOI: 10.1513/AnnalsATS.202305-420ED
John E McGinniss
The Overton window is a concept based on the work of Joseph Overton, a public-policy thinker, that posits that creating policy is feasible only within the generally accepted realm
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引用次数: 0
Impact of Global Climate Change on Pulmonary Health: Susceptible and Vulnerable Populations. 全球气候变化对肺部健康的影响:易感人群和易感人群。
IF 8.3 2区 医学 Q1 RESPIRATORY SYSTEM Pub Date : 2023-08-01 DOI: 10.1513/AnnalsATS.202212-996CME
Hasan Bayram, Mary B Rice, Waleed Abdalati, Muge Akpinar Elci, Mehdi Mirsaeidi, Isabella Annesi-Maesano, Kent E Pinkerton, John R Balmes

As fossil fuel combustion continues to power the global economy, the rate of climate change is accelerating, causing severe respiratory health impacts and large disparities in the degree of human suffering. Hotter and drier climates lead to longer and more severe wildland fire seasons, impairing air quality around the globe. Hotter temperatures lead to higher amounts of ozone and particles, causing the exacerbation of chronic respiratory diseases and premature mortality. Longer pollen seasons and higher pollen concentrations provoke allergic airway diseases. In arid regions, accelerated land degradation and desertification are promoting dust pollution and impairing food production and nutritional content that are essential to respiratory health. Extreme weather events and flooding impede healthcare delivery and can lead to poor indoor air quality due to mold overgrowth. Climate and human activities that harm the environment and ecosystem may also affect the emergence and spread of viral infections, including severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and associated morbidity and mortality exacerbated by air pollution. Children and elderly individuals are more susceptible to the adverse health effects of climate change. Geographical and socioeconomic circumstances, together with a decreased capacity to adapt, collectively increase vulnerability to the adverse effects of climate change. Successful mitigation of anthropogenic climate change is dependent on the commitment of energy-intensive nations to manage greenhouse gas emissions, as well as societal support and response to aggravating factors. In this review, we focus on the respiratory health impacts of global climate change, with an emphasis on susceptible and vulnerable populations and low- and middle-income countries.

随着化石燃料燃烧继续为全球经济提供动力,气候变化的速度正在加快,对呼吸系统健康造成严重影响,人类痛苦程度也存在巨大差异。更热、更干燥的气候会导致更长、更严重的荒地火灾季节,损害全球的空气质量。更高的温度会导致臭氧和颗粒物的含量增加,导致慢性呼吸道疾病的恶化和过早死亡。较长的花粉季节和较高的花粉浓度会引发过敏性呼吸道疾病。在干旱地区,土地退化和荒漠化加剧了灰尘污染,损害了对呼吸系统健康至关重要的粮食生产和营养含量。极端天气事件和洪水阻碍了医疗服务的提供,并可能由于霉菌过度生长而导致室内空气质量不佳。损害环境和生态系统的气候和人类活动也可能影响病毒感染的出现和传播,包括严重急性呼吸综合征冠状病毒2型(严重急性呼吸系统综合征冠状病毒冠状病毒2型),以及因空气污染而加剧的相关发病率和死亡率。儿童和老年人更容易受到气候变化对健康的不利影响。地理和社会经济环境,加上适应能力下降,共同增加了受气候变化不利影响的脆弱性。成功缓解人为气候变化取决于能源密集型国家对管理温室气体排放的承诺,以及社会支持和对加剧因素的反应。在这篇综述中,我们重点关注全球气候变化对呼吸系统健康的影响,重点关注易感人群和弱势人群以及中低收入国家。
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引用次数: 0
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Annals of the American Thoracic Society
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