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Long-term All-Cause Mortality Risk in Obstructive Sleep Apnea Using Hypopneas Defined by a ≥3 Percent Oxygen Desaturation or Arousal. 使用氧饱和度≥3%或唤醒定义的低通气,研究阻塞性睡眠呼吸暂停的长期全因死亡率风险。
Pub Date : 2021-01-01 DOI: 10.13175/swjpcc025-21
Rohit Budhiraja, Stuart F Quan

Study objectives: Some prior studies have demonstrated an increase in mortality associated with obstructive sleep apnea (OSA) utilizing a definition of OSA that requires a minimum 4% oxygen desaturation to identify a hypopnea. No large community-based studies have determined the risk of long-term mortality with OSA with hypopneas defined by a ≥3% O2 desaturation or arousal (AHI3%A).

Methods: Data from 5591 Sleep Heart Health Study participants without prevalent cardiovascular disease at baseline who underwent polysomnography were analyzed regarding OSA diagnosed using the AHI3%A criteria and all-cause mortality over a mean follow up period of 10.9±3.2 years.

Results: There were 1050 deaths in this group during the follow-up period. A Kaplan-Meir plot of survival revealed a reduction in survival with increasing AHI severity. Cox proportional hazards regression models revealed significantly increased all-cause mortality risk with increasing AHI, hazard ratio (HR, 95% CI) 1.13 (1.04-1.23), after adjusting for age, sex, race, BMI, cholesterol, HDL, self-reported hypertension and/or diabetes and smoking status. In categorical models, the mortality risk was significantly higher with severe OSA [adjusted HR 1.38 (1.09-1.76)]. When stratified by gender or age, severe OSA was associated with increased risk of death in men [adjusted HR 1.14 (1.01-1.28)] and in those <70 years of age [adjusted HR 1.51 (1.02-2.26)]. In contrast, AHI severity was not associated with increased mortality in women or those ≥70 years of age in fully adjusted models.

Conclusion: Severe AHI3%A OSA is associated with significantly increased mortality risk, especially in men and those <70 years of age.

研究目的:之前的一些研究表明,阻塞性睡眠呼吸暂停(OSA)导致的死亡率增加,而 OSA 的定义要求氧饱和度至少达到 4% 才能确定呼吸暂停。目前还没有基于社区的大型研究确定OSA长期死亡的风险,OSA的低通气定义为≥3%的氧气饱和度或唤醒(AHI3%A):方法:对5591名睡眠心脏健康研究参与者的数据进行了分析,这些参与者基线时没有流行性心血管疾病,并接受了多导睡眠图检查,其OSA诊断采用AHI3%A标准,全因死亡率平均随访时间为10.9±3.2年:结果:在随访期间,该组共有 1050 人死亡。Kaplan-Meir 存活率图显示,随着 AHI 严重程度的增加,存活率也随之降低。在调整年龄、性别、种族、体重指数、胆固醇、高密度脂蛋白、自我报告的高血压和/或糖尿病以及吸烟状况后,Cox 比例危险回归模型显示,随着 AHI 的增加,全因死亡风险显著增加,危险比 (HR, 95% CI) 为 1.13 (1.04-1.23)。在分类模型中,严重 OSA 患者的死亡风险明显更高[调整后 HR 1.38(1.09-1.76)]。当按性别或年龄分层时,严重 OSA 会增加男性的死亡风险[调整后 HR 1.14 (1.01-1.28)],结论也是如此:严重 AHI3%A OSA 与死亡风险显著增加有关,尤其是男性和以下人群
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引用次数: 0
January 2021 Critical Care Case of the Month: A 35-Year-Old Man Found Down on the Street 2021年1月本月重症监护病例:一名35岁男子被发现倒在街上
Pub Date : 2021-01-01 DOI: 10.13175/swjpcc051-20
John-Ih Lee, Ling Obrand, J. Campion
No abstract available. Article truncated after 150 words. History of Present Illness A 35-year-old African-American man with a history of alcohol abuse presented to Emergency Department after he was found down. He was seen by a passerby on the street who witnessed the patient fall with a possible convulsive event. He was brought in by ambulance and was unconscious and unresponsive. PMH, SH, and FH The patient had a history of prior ICU admission in Yuma with septic shock secondary to a dental procedure requiring a tracheostomy in 2018. He also had a history of alcohol intoxication requiring an ED visit about 10 years ago and history of sickle cell trait. Per chart review, the patient took no home medications. Further history was unable to be obtained due to the patient's condition. Physical Examination On arrival the patient had a core temperature of 41°C, systolic blood pressure in the 70s-80s, heart rate of 185, respiratory rate of 19 …
没有摘要。文章在150字后被删节。现病史一名35岁非裔美国人,有酗酒史,被发现昏倒后被送往急诊室。一位路人在街上看到了他,他目睹了病人摔倒,可能是抽搐。他被救护车送来时已经失去知觉,没有反应。患者在2018年因牙科手术需要气管切开术而继发感染性休克,曾在尤马ICU住院。他也有酒精中毒史,大约10年前需要去急诊室就诊,并有镰状细胞特征史。根据病历回顾,患者没有在家服用药物。由于患者的病情,无法获得进一步的病史。入院时患者体温41℃,收缩压70 -80,心率185,呼吸频率19…
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引用次数: 0
Association between Spirometric Parameters and Depressive Symptoms in New Mexico Uranium Workers. 新墨西哥州铀矿工人肺活量测定参数与抑郁症状的关系
Pub Date : 2021-01-01 Epub Date: 2021-02-13 DOI: 10.13175/swjpcc015-20
Shiva Sharma, Xin W Shore, Satyajit Mohite, Orrin Myers, Denece Kesler, Kevin Vlahovich, Akshay Sood

Background: Uranium workers are at risk of developing lung disease, characterized by low forced expiratory volume in one second (FEV1) and/or forced vital capacity (FVC). Previous studies have found an association between decreased lung function and depressive symptoms in patients with pulmonary pathologies, but this association has not been well examined in occupational cohorts, especially uranium workers.

Methods: This cross-sectional study evaluated the association between spirometric measures and depressive symptoms in a sample of elderly former uranium workers screened by the New Mexico Radiation Exposure Screening & Education Program (NM-RESEP). Race- and ethnicity-specific reference equations were used to determine predicted spirometric indices (predictor variable). At least one depressive symptom [depressed mood and/or anhedonia, as determined by a modified Patient Health Questionnaire-2 (PHQ-2)], was the outcome variables. Chi-square tests and multivariable logistic regression models were used for statistical analyses.

Results: At least one depressive symptom was self-reported by 7.6% of uranium workers. Depressed mood was reported over twice as much as anhedonia (7.2% versus 3.3%). Abnormal FVC was associated with at least one depressive symptom after adjustment for covariates. There was no significant interaction between race/ethnicity and spirometric indices on depressive symptoms.

Conclusions: Although depressive symptoms are uncommonly reported in uranium workers, they are an important comorbidity due to their overall clinical impact. Abnormal FVC was associated with depressive symptoms. Race/ethnicity was not found to be an effect modifier for the association between abnormal FVC and depressive symptoms. To better understand the mechanism underlying this association and determine if a causal relationship exists between spirometric indices and depressive symptoms in occupational populations at risk for developing lung disease, larger longitudinal studies are required. We recommend screening for depressive symptoms for current and former uranium workers as part of routine health surveillance of this occupational cohort. Such screening may help overcome workers' reluctance to self-report and seek treatment for depression and may avoid negative consequences to health and safety from missed diagnoses.

背景:铀工人有发生肺部疾病的危险,其特征是一秒钟用力呼气量(FEV1)和/或用力肺活量(FVC)低。先前的研究发现肺部病变患者的肺功能下降与抑郁症状之间存在关联,但这种关联尚未在职业队列中得到很好的检验,特别是铀工人。方法:本横断面研究评估了新墨西哥州辐射暴露筛查与教育计划(NM-RESEP)筛选的老年前铀工人样本中肺活量测量与抑郁症状之间的关系。使用种族和民族特异性参考方程来确定预测的肺活量指数(预测变量)。至少一种抑郁症状[抑郁情绪和/或快感缺乏,由修改后的患者健康问卷-2 (PHQ-2)确定]是结果变量。采用卡方检验和多变量logistic回归模型进行统计分析。结果:7.6%的铀矿工人自述至少有一种抑郁症状。抑郁情绪的报告是快感缺乏的两倍多(7.2%对3.3%)。校正协变量后,异常FVC与至少一种抑郁症状相关。种族/民族与肺量测定指标对抑郁症状没有显著的相互作用。结论:虽然抑郁症状在铀矿工人中很少报道,但由于其整体临床影响,它们是一种重要的合并症。FVC异常与抑郁症状相关。种族/民族未被发现是异常FVC与抑郁症状之间关联的影响调节因素。为了更好地理解这种关联背后的机制,并确定肺量测定指标与肺病高危职业人群抑郁症状之间是否存在因果关系,需要进行更大规模的纵向研究。我们建议对目前和以前的铀工人进行抑郁症状筛查,作为这一职业队列常规健康监测的一部分。这种筛查可能有助于克服工人不愿自我报告和寻求抑郁症治疗的情况,并可能避免漏诊对健康和安全造成的负面影响。
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引用次数: 0
Home-Based Physiological Monitoring of Patients with COVID-19. 对 COVID-19 患者进行家庭生理监测。
Pub Date : 2021-01-01 Epub Date: 2021-09-03 DOI: 10.13175/swjpcc005-21
Akshay Warrier, Akshay Sood

The COVID-19 pandemic has necessitated the rise of telehealth modalities to relieve the incredible stress the pandemic has placed on the healthcare system. This rise has seen the emergence of new software, applications, and hardware for home-based physiological monitoring, leading to the promise of innovative predictive and therapeutic practices. This article is a literature-based review of the most promising technologies and advances regarding home-based physiological monitoring of patients with COVID-19. We conclude that the applications currently on the market, while helping stem the flow of patients to the hospital during the pandemic, require additional evidence related to improvement in patient outcomes. However, new devices and technology are a promising and successful venture into home-based monitoring with clinical implications reaching far into the future.

COVID-19 大流行促使远程医疗模式的兴起,以缓解大流行给医疗系统带来的巨大压力。在这一趋势下,用于家庭生理监测的新软件、应用程序和硬件不断涌现,为创新预测和治疗方法带来了希望。本文以文献为基础,综述了对 COVID-19 患者进行家庭生理监测的最有前景的技术和进展。我们的结论是,目前市场上的应用虽然有助于在大流行期间阻止病人流向医院,但还需要更多与改善病人预后相关的证据。不过,新设备和新技术在家庭监测领域是一项充满希望的成功尝试,对未来的临床影响深远。
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引用次数: 0
Respiratory papillomatosis with small cell carcinoma: case report and brief review 呼吸道乳头状瘤病伴小细胞癌1例报告及简要回顾
Pub Date : 2020-12-15 DOI: 10.13175/swjpcc064-20
Priya G. Sharma, A. Jha, Bharath Janapati, Anil Jain
Respiratory Papillomatosis is a rare disease in which multiple exophytic squamous wart-like lesions occur within the respiratory tract. Recurrent Respiratory Papillomatosis (RRP) has the potential for malignant transformation to squamous lung cell carcinoma with a dismal prognosis. Most of the prior literature has shown malignant transformation of respiratory papillomatosis into squamous cell carcinoma. Here, we report a rare presentation of respiratory papillomatosis coexisting with small cell carcinoma and a review of relevant literature.
呼吸道乳头状瘤病是一种罕见的疾病,在呼吸道内发生多发性外生鳞状疣样病变。复发性呼吸道乳头状瘤病(RRP)有可能恶性转化为鳞状肺细胞癌,预后不佳。大多数先前的文献显示呼吸道乳头状瘤病恶性转化为鳞状细胞癌。在此,我们报告了一种罕见的呼吸道乳头状瘤病合并小细胞癌的表现,并对相关文献进行了综述。
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引用次数: 0
Why My Experience as a Patient Led Me to Join Osler’s Alliance 为什么我作为病人的经历促使我加入奥斯勒联盟
Pub Date : 2020-12-03 DOI: 10.13175/swjpcc066-20
R. Robbins, Phoenix Pulmonary
No abstract available. Article truncated after 150 words. There are a number of books and articles written by doctors that relate their own experience as patients. Count this as another although I promise it will not be nearly as entertaining as “The House of God”. Over a month ago I became short of breath and a chest x-ray revealed left lower lobe consolidation. Despite lack of fever, it seemed that an infectious process was most likely, and when multiple tests for COVID-19 were negative, it was felt by my pulmonary physician to be most likely coccidioidomycosis despite a negative cocci serology. After beginning on empirical therapy with fluconazole for nearly a month, I am feeling better. Most of us know that there is considerable laboratory to laboratory variation in serologic tests for Valley Fever (1). However, when my initial cocci serology was negative, efforts to send it a good reference lab such as Pappagianis’ Lab at UC Davis …
没有可用的摘要。文章在150字后被截断。医生们写了很多书和文章,讲述了他们作为病人的经历。尽管我保证它不会像《上帝之家》那样有趣,但这是另一部。一个多月前,我呼吸急促,胸部x光片显示左下叶实变。尽管没有发烧,但似乎最有可能是感染过程,而且当新冠肺炎的多项检测呈阴性时,我的肺部医生认为,尽管球菌血清学呈阴性,但很有可能是球霉菌病。在开始使用氟康唑进行近一个月的经验性治疗后,我感觉好多了。我们大多数人都知道,山谷热的血清学检测存在相当大的实验室间差异(1)。然而,当我最初的球菌血清学结果为阴性时,我努力给它送去一个很好的参考实验室,比如加州大学戴维斯分校的Pappagianis实验室…
{"title":"Why My Experience as a Patient Led Me to Join Osler’s Alliance","authors":"R. Robbins, Phoenix Pulmonary","doi":"10.13175/swjpcc066-20","DOIUrl":"https://doi.org/10.13175/swjpcc066-20","url":null,"abstract":"No abstract available. Article truncated after 150 words. There are a number of books and articles written by doctors that relate their own experience as patients. Count this as another although I promise it will not be nearly as entertaining as “The House of God”. Over a month ago I became short of breath and a chest x-ray revealed left lower lobe consolidation. Despite lack of fever, it seemed that an infectious process was most likely, and when multiple tests for COVID-19 were negative, it was felt by my pulmonary physician to be most likely coccidioidomycosis despite a negative cocci serology. After beginning on empirical therapy with fluconazole for nearly a month, I am feeling better. Most of us know that there is considerable laboratory to laboratory variation in serologic tests for Valley Fever (1). However, when my initial cocci serology was negative, efforts to send it a good reference lab such as Pappagianis’ Lab at UC Davis …","PeriodicalId":87365,"journal":{"name":"Southwest journal of pulmonary & critical care","volume":"21 1","pages":"138-140"},"PeriodicalIF":0.0,"publicationDate":"2020-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41850198","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Medical Image of the Month: Superior Vena Cava Syndrome 本月医学影像:上腔静脉综合征
Pub Date : 2020-12-02 DOI: 10.13175/swjpcc060-20
M. Borchart, Daniel K. Yu, Indrajit Nandi
No abstract available. Article truncated after 150 words. History A 74-year- old man with a history of diastolic heart failure, chronic kidney disease (CKD), and chronic lymphocytic leukemia (CLL) presented with a complaint of dyspnea. He has had several hospitalizations in the last year for heart failure exacerbation and his home bumetanide was recently increased from twice to three times daily due to persistently increasing weight. His CLL was diagnosed two years prior and treatment was stopped three months ago due to side effects. In the emergency department he reported three weeks of worsening dyspnea especially when lying flat, as well as increased swelling in his legs, abdomen, arms, and face. His weight was up to 277lbs from 238lbs the month before. His diuretics were transitioned to IV, but over the next few days he remained clinically volume overloaded. A noncontrast chest CT was obtained to help evaluate his ongoing respiratory distress (Figure 1). It demonstrated innumerable lymph …
没有摘要。文章在150字后被删节。74岁男性,有舒张性心力衰竭、慢性肾脏疾病(CKD)和慢性淋巴细胞白血病(CLL)病史,主诉呼吸困难。他去年因心力衰竭加重多次住院,由于体重持续增加,他的家庭布美他尼最近从每天两次增加到每天三次。他的CLL是在两年前被诊断出来的,三个月前由于副作用停止了治疗。在急诊科,他报告了三周的呼吸困难恶化,尤其是平躺时,他的腿、腹部、手臂和面部肿胀加剧。他的体重从一个月前的238磅增加到了277磅。他的利尿剂转为静脉注射,但在接下来的几天里,他的临床容量仍然超负荷。胸部CT平扫有助于评估患者持续的呼吸窘迫(图1)。
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引用次数: 0
December 2020 Pulmonary Case of the Month: Resurrection or Medical Last Rites? 本月肺病例:复活还是医学临终仪式?
Pub Date : 2020-12-01 DOI: 10.13175/swjpcc065-20
L. Wesselius
No abstract available. Article truncated after the first page. History of Present Illness An 88-year-old man who has been short of breath and febrile up to 101.5° F for the past day presented on October 20, 2020. He has no known sick contacts or exposure to COVID-19. PMH, SH, and FH • No reported pulmonary history although he had a Xopenex MDI which he rarely used. • Coronary artery disease with prior coronary artery bypass grafting (1978); multiple subsequent stents; chronic atrial fibrillation; pacemaker (Micra) • Stage 3-4 CKD (creatinine 1.95) • Chronically on warfarin Physical Examination • Temp 37.3, Sat 92% on RA, 95% on 2 lpm, • Lungs: Few crackles in right upper chest • CV: regular, no murmur • Ext: 1 to 2+ edema (chronic, uses TED hose) Which of the following is/are the most likely diagnosis? 1. Community-acquired pneumonia 2. Congestive heart failure 3. COVID-19 4. 1 and 3 5. Any of the above …
没有摘要。文章在第一页之后被截断。一名88岁男性,于2020年10月20日出现呼吸急促和发热,过去一天体温高达101.5华氏度。他没有已知的患病接触或暴露于COVID-19。PMH, SH和FH•无肺部病史报告,尽管他很少使用Xopenex MDI。•冠状动脉疾病既往冠状动脉搭桥术(1978年);多个后续支架;慢性心房颤动;•3-4期CKD(肌酸1.95)•长期服用华法林体格检查•体温37.3,Sat为RA 92%, 2lpm 95%,•肺部:右上胸很少有杂音•CV:正常,无杂音•外:1至2+水肿(慢性,使用TED导管)以下哪一种是最有可能的诊断?1. 社区获得性肺炎充血性心力衰竭COVID-19 4。1和35。以上任何一个…
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引用次数: 0
A Case of Athabaskan Brainstem Dysgenesis Syndrome and RSV Respiratory Failure 阿萨巴斯坎脑干发育不全综合征和呼吸道合胞病毒呼吸衰竭1例
Pub Date : 2020-11-05 DOI: 10.13175/swjpcc053-20
Tanner Ellsworth, Nahid Hiermandi, Dian-lei Hu, L. Grimaldi
Athabaskan Brainstem Dysgenesis Syndrome (ABDS) is a nonlethal, homozygous HOXA1 mutation typically marked by central hypoventilation, sensorineural deafness, horizontal gaze palsy, and developmental delay. In this report, we present a case of a 27-month-old Navajo female with a new diagnosis of ABDS after multiple failed attempts at extubation following anesthesia in the setting of respiratory syncytial virus (RSV) bronchiolitis. Her case is significant because she lacks sensorineural hearing loss, a defining feature of previously documented cases thereby underscoring the challenges of diagnosing this disease. This case expands the ever-growing spectrum of homozygous HOXA1 mutations and demonstrates unique junctions for diagnosis of ABDS in the critical care setting in patients lacking key features of the disease.
阿萨巴斯卡脑干发育不全综合征(ABDS)是一种非致命的纯合子HOXA1突变,通常以中枢性通气不足、感音神经性耳聋、水平凝视性麻痹和发育迟缓为特征。在本报告中,我们报告了一例27个月大的纳瓦霍族女性,在呼吸道合胞病毒(RSV)细支气管炎的麻醉下多次拔管失败后,被新诊断为ABDS。她的病例意义重大,因为她没有感觉神经性听力损失,这是先前记录的病例的一个决定性特征,从而突显了诊断这种疾病的挑战。该病例扩大了纯合子HOXA1突变的不断增长的范围,并证明了在缺乏疾病关键特征的患者的重症监护环境中诊断ABDS的独特连接。
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引用次数: 0
Medical Image of the Month: Buffalo Chest Identified at the Time of Lung Nodule Biopsy 本月医学影像:在肺结节活检时发现水牛胸
Pub Date : 2020-11-02 DOI: 10.13175/swjpcc056-20
Phillip M Belone, Jason Lee, Michael Larson
No abstract available. Manuscript truncated after 150 words. A gentleman in his late 50s with a past medical history of squamous cell carcinoma at the base of the tongue had numerous slowly-growing pneumocyst-like lesions despite clinical remission status post surgery and chemoradiation. Biopsy of one of these lesions was recommended by a multidisciplinary tumor board. An outpatient pre-procedural supine chest CT revealed a right pneumothorax above the lesion targeted for biopsy. A subsequent pre-procedural right lateral decubitus chest CT three weeks later demonstrated a left-sided pneumothorax, raising concern for buffalo chest. (A less likely possibility would be spontaneous resolution of the right pneumothorax and development of a new left pneumothorax in the less than 4-week interval.) Intraprocedural imaging continued to demonstrate the left-sided pneumothorax. A biopsy touch preparation of the first sample obtained did not demonstrate malignancy. Therefore, an attempt was made at obtaining another sample. However, the patient developed a brief but forceful coughing fit, resulting in …
没有摘要。手稿在150字后被删节。一位50多岁的男士,既往有舌底鳞状细胞癌病史,尽管手术和放化疗后临床症状缓解,但仍有许多缓慢生长的肺囊虫样病变。多学科肿瘤委员会建议对其中一个病变进行活检。门诊手术前仰卧位胸部CT显示病灶上方有右侧气胸。三周后的手术前右侧卧位胸部CT显示左侧气胸,引起对水牛胸的关注。(不太可能的是在不到4周的时间间隔内,右侧气胸自发消退并发展为新的左侧气胸。)术中影像学继续显示左侧气胸。第一个样本的活检未发现恶性肿瘤。因此,试图获得另一个样本。然而,病人突然一阵短暂但强烈的咳嗽,导致……
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引用次数: 0
期刊
Southwest journal of pulmonary & critical care
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