Canadian respiratory journal最新文献

We present the findings from an evaluation of 144 survivors who experienced post-COVID-19 complications or reinfection. The assessment was conducted at 1, 3, and 6 months following their discharge from an intensive post-COVID care center. The evaluation encompassed a comprehensive analysis of clinical life-critical indicators and mental health states. Based on lung CT scans, pneumonia was identified in 73% of the patients, categorized into four severity groups according to their health conditions: mild (26%), moderate (57%), severe (14%), and extremely severe (3%). Among the extremely severe cases, two patients succumbed to the illness. Self-reported fatigue during the acute phase was prevalent among 79% of participants, which increased to 91% at 1 month, decreased to 64% at 3 months, and further decreased to 56% at 6 months. The vital signs of patients, including systolic and diastolic blood pressure, oxygen saturation, body temperature, respiratory rate, and heart rate, gradually normalized over time. Anxiety and depression symptoms persisted in 17% and 21% of patients, respectively, up to the 6-month mark; even though during the acute phase, these figures were 15% and 13%. The limitations of this study include issues related to sample representation and the exclusion of hypertension data, which affect the overall balance of its findings. Trial Registration: ClinicalTrials.gov identifier: NCT04987853.

Background: Pulmonary hypertension (PH) in patients undergoing lung transplantation (LT) for pulmonary fibrosis can impair lung function, reduce physical activity, and decrease survival. However, data on outcomes at 1 and 5 years of follow-up remain limited. Methods: In this prospective cohort study, pulmonary function, the 6-min walk test (6MWT), and the St. George's Respiratory Questionnaire (SGRQ) were assessed pretransplant, at hospital discharge, and at 3, 6, and 12 months posttransplant. Additionally, minimal clinically important differences (MCIDs) between patients with and without PH were evaluated. Survival rates were calculated using the Kaplan-Meier method and analyzed using the log-rank test. Results: The study included 39 patients undergoing LT for pulmonary fibrosis. Of these, 82% (32/39) had PH, with a median age of 52.6 years (SD: 10.2). In both the PH and non-PH groups, lung function, 6MWD, and SGRQ total scores showed progressive improvement from pre-LT to 1 year posttransplant. Patients without PH demonstrated MCID in 6MWT and SGRQ total scores from pre-LT through the 6- and 12-month follow-up. The overall 1-year survival rate was 84.6%, with an average survival of 10.51 months (95% CI: 9.29-11.73). The 5-year overall survival rate was 61.5%, with an average survival of 44.89 months (95% CI: 37.62-52.16). No statistically significant differences in survival were found based on sex (p=0.322 and 0.206), mean pulmonary artery pressure (mPAP) (p=0.232 and 0.486), age (p=0.375 and 0.959), or body mass index (BMI) (p=0.884 and 0.594) at 1 and 5 years. Conclusion: Survival at 1 and 5 years was lower in patients with PH. However, no significant differences in survival were observed based on sex, mPAP, age, or BMI. Statistically significant improvements in FVC, FEV1, 6MWT, and SGRQ total scores were observed both before and after LT, continuing through 1 year of follow-up. The 6MWT and SGRQ showed MCID both prior to surgery and during follow-up at 6 and 12 months, in both PH and non-PH patients.

Background: Patients with esophageal cancer (EC) who have undergone esophagectomy are at risk of developing hypoxemia and encountering postoperative complications. It is essential to ascertain whether the high-flow nasal cannula (HFNC) therapy offers superior clinical efficacy compared to conventional oxygen therapy (COT). Methods: Clinical data from 80 patients who experienced hypoxemia subsequent to radical esophagectomy were retrospectively collected at our institution spanning January 2020 to December 2022. The whole cohort was divided into two groups: the HFNC group and the COT group. Following oxygen administration, we evaluated the variations in arterial blood gas parameters and infection indices within each group, in addition to scrutinizing the occurrence of postoperative pulmonary complications. Results: The HFNC group was associated with a better oxygenation index (F _group=41.779, p < 0.001) and partial pressure of carbon dioxide (F _group=16.760, p < 0.001) compared with the COT group. Moreover, there were statistically significant differences in the reduction of C-reactive protein (F _group = 17.603, p < 0.001) and neutrophil count (F _group = 4.395, p=0.039) in the HFNC group compared with the COT group after 3 days of oxygen therapy. Notably, patients treated with HFNC exhibited a markedly reduced risk of developing postoperative complications, especially pneumonia (p=0.039). Conclusion: HFNC outperformed COT in enhancing oxygenation and reducing carbon dioxide levels and infection indices among patients with hypoxemia after radical resection of EC and also lowered the risk of postoperative pneumonia.

Objective: To evaluate the relationship between air pollution, meteorological factors, and eosinophils in the peripheral blood of allergic rhinitis (AR) patients. Methods: We conducted a retrospective study of medical records from the Ninth Medical Center of PLA General Hospital in Beijing. A review of medical records (1^st January 2014-31^th August 2022) of 1080 AR patients who underwent peripheral blood eosinophil count tests. Patients were stratified into elevated and normal eosinophil count groups. Daily meteorological data (mean temperature and relative humidity) and ambient pollutant levels (PM2.5, PM10, NO₂, SO₂, CO, and ozone [O₃]) were collected. The mean pollutant levels and meteorological factors on the day of eosinophil count measurement were calculated separately for each group. Linear regression was performed to analyze the association between eosinophil counts and both meteorological factors and pollutant levels among AR patients. Results: In 1080 AR patients, 11.85% had elevated eosinophil counts. Higher temperature (16.88 ± 9.09°C), humidity (57.75 ± 17.22%), and O₃ levels (116.54 ± 54.92 μg/m³) correlated significantly (p < 0.05) with elevated eosinophil counts. Linear regression confirmed positive associations between eosinophil count and temperature (β = 0.003), humidity (β = 0.001), and O₃ (β = 0.0004) (p < 0.05). Other pollutants showed no significant differences. Conclusion: Elevated eosinophil counts in AR patients correlated significantly with higher temperature, humidity, and O₃ levels. Linear regression confirmed positive associations between eosinophil count and these meteorological factors.

Pulmonary arterial hypertension (PAH) is a malignant cardiovascular disease with a complex etiology, in which several types of cells play important roles. Sex differences in disease susceptibility and survival have been observed in PAH patients, but few studies have analyzed the effect of changes in cell type and number on sex differences in PAH at the single-cell level. In this study, we performed a series of analyses on GSE169471 and GSE228644 datasets and found significant changes in the ratio of several types of cells in male PAH lung tissues. Surprisingly, we found that the ratio of macrophages in male PAH samples was 7 times higher than that in females. Consistently, the ratio of M1 macrophages was also significantly increased in male PAH samples. The different expression genes (DEGs) in macrophages were mainly involved in the ribosome pathway, which is closely related to cell proliferation. Inhibition of ribosomal protein L39 (RPL39), a core gene in the ribosome pathway, can inhibit macrophage proliferation and attenuate the sex differences in PAH. In conclusion, our study suggests that ribosome pathway-associated cell proliferation of macrophages might be associated with sex differences in PAH.

This study aimed to investigate the effect of Fuzheng Yiai Decoction (FZYA) on epidermal growth factor receptor-tyrosine kinase inhibitor (EGFR-TKI) drug resistance in lung adenosquamous carcinoma (ASC). The expression of thyroid transcription factor 1 (TTF1) and p63 in tumor cells was observed by immunofluorescence staining. Meanwhile, 25 nude mice successfully inoculated with the human lung ASC cell line NCI-H596 were randomly divided into five groups, namely, the model, gefitinib, low-, medium-, and high-dose FZYA with gefitinib groups. After four weeks of daily intragastric administration of the various treatments, the tumor weight and volume inhibition rates were calculated. The positive expression rate and protein expression of TTF1 and p63 in mouse tumor tissues were evaluated by immunohistochemistry and western blot assays. The results showed that the adenocarcinoma part and the squamous cell carcinoma part of the lung tissue were not either one or the other, and each had unique biological behavior patterns. In terms of the tumor volume and weight, gefitinib treatment along with FZYA reduced the acquired resistance of EGFR-TKIs in lung ASC, and its inhibitory effect was superior to EGFR-TKI (gefitinib) treatment alone. Moreover, it was discovered that FZYA inhibited the pedigree transformation among cancer subtypes due to EGFR-TKI treatment. In conclusion, the application of FZYA inhibited the pedigree transformation among lung cancer subtypes, thus increasing the tumor inhibitory effect and decreasing the EGFR-TKI drug resistance of tumor cells.

Background: Thymoma is a common malignancy with low incidence, and pleural metastases are common pattern of recurrence. It is necessary that the spatial location of pleural metastatic lesions be analyzed. This study aimed to analyze the spatial distribution patterns of pleural dissemination in patients with thymoma and evaluate the variables that influence the survival of pleural metastasis in this population. Methods: This retrospective study investigated hospital admissions of patients diagnosed with pleural metastasis from thymoma. The spatial distribution pattern and visualization of the pleural metastases were analyzed after establishing a coordinate system. We further analyzed the survival and influencing factors in patients with pleural metastases from thymoma. Results: The analysis included 56 patients with a cumulative count of 365 pleural metastases, with 351 metastases from Zones 1-5 finally included in the analysis. The spatial distribution of the 285 initially diagnosed pleural metastases was significantly concentrated in Zones 3 and 4 near the lateral half of the spine (56.5%), followed by Zone 5 (17.5%). Collectively, these two components accounted for 74.0% (211/285) of all initial metastatic lesions. The survival rates at 5 years for those who underwent surgery versus nonsurgical treatment were 68.3% and 37.1%, respectively (p=0.015). Univariate Cox regression analysis showed that surgical intervention reduced the risk of death by 61%. Conclusions: The distribution of pleural metastatic lesions exhibited a nonuniform pattern, primarily concentrated on the spinal aspect below the aortic arch of the costal pleura and the spinal aspect of the diaphragmatic pleura.

Background: With a diverse geographic and sociocultural landscape, Vancouver Coastal Health (VCH) Authority (British Columbia, Canada) encompasses both urban and rural regions, providing a case study to examine the delivery of care services for asthma and chronic obstructive pulmonary disease (COPD). To better understand the landscape of care services within VCH, we aimed to (1) identify asthma and COPD care services availability in urban and rural communities and (2) identify where asthma and COPD quality improvement (QI) initiatives were implemented and their implementation-related characteristics. Methods: An environmental scan was conducted to identify asthma and COPD care services provided in VCH communities. A literature review was conducted to determine where VCH asthma and COPD QI initiatives were implemented and identify their implementation-related characteristics. This case study was analysed descriptively and summarised in tables and figures. Results: The environmental scan analysis revealed that specialty outpatient care, pulmonary rehabilitation, respiratory education and clinical smoking cessation services were limited in urban and unavailable in rural VCH communities. Spirometry services were limited in urban and rural VCH communities. Cross-referencing recommendations from asthma and COPD clinical practice guidelines against prevalence data, we estimated that rural VCH communities could provide 0%-23% of required spirometry while urban could provide 40%-75%. Further, of the 16 asthma and COPD QI initiatives identified within 21 papers, none were conducted at rural VCH healthcare sites. Conclusion: Our findings suggest rural VCH communities have lower access to asthma and COPD care services and the limited urban care services were insufficient to make up for this difference. Past asthma and COPD QI initiatives have not apparently translated to care service improvements in rural regions. Future QI initiatives should focus on overcoming barriers to conducting and participating in QI to improve urban and rural regions' access to asthma and COPD care services.

Background: Vitamin D deficiency elevates the risk of chronic obstructive pulmonary disease (COPD) patients. Iron parameters elevation and glutathione peroxidase 4 (GPX4) reduction are involved in the process of COPD. The goal is to explore the associations of vitamin D with GPX4 and iron parameters in COPD patients through a case-control study. Methods: COPD patients and control subjects were enrolled. Serum samples and lung tissues were collected. Serum vitamin D and iron levels and pulmonary ferritin and GPX4 expressions were determined. In addition, human pulmonary epithelial cells (BEAS-2B) were incubated with 1,25(OH)₂D₃ (100 nM), the active form of vitamin D3. Then, vitamin D receptor (VDR) and nuclear factor (erythroid-derived 2)-like 2 (Nrf-2) signaling were detected. Results: In patients with COPD, serum 25-hydroxyvitamin D (25(OH)D) decreased, and iron and ferritin levels in serum and lung tissues increased. Furthermore, pulmonary expression of GPX4 was reduced. Correlative analyzes indicated that lung function was inversely correlated with iron parameters and positively correlated with GPX4. The results showed that serum 25(OH)D deficiency was associated with an elevation in serum iron parameters and a reduction in pulmonary GPX4. In addition, VDR- and Nrf-2-positive lung nuclei were decreased in COPD patients than in control subjects. In patients with COPD, the results indicated a positive relationship between VDR and Nrf-2. Further analysis revealed that Nrf-2-positive nuclei were negatively correlated with iron parameters. In vitro experiments found that 1,25(OH)₂D₃ treatment activated VDR signaling and elevated the expression of Nrf-2 and GPX4 in BEAS-2B cells. Conclusions: Vitamin D deficiency is positively associated with GPX4 reduction and iron parameters elevation in COPD patients. It is recommended to explore the role of vitamin D supplementation in the progression of COPD.

Objective: To explore the complications of long-term placement of Montgomery T silicone stent (T-tube) in the treatment of subglottic benign airway stenosis (SBAS) and the timing of successful T-tube removal. Methods: We retrospectively collected the clinical data of 32 patients with SBAS who underwent the treatment of T-tube and analyzed their placement and successful removal of the T-tube. Results: There were 22 males and 10 females, aged from 21 to 79 years (60.9 ± 13.7 years). The T-tubes were successfully placed in all 32 patients, and 6 patients (18.8%) with mild stenosis were placed by the intravenous conscious sedation. The longest follow-up period was 60.4 months, and 17 patients (53.1%) had the T-tubes for more than 12 months; 5 patients (15.6%) were changed to the tracheostomy cannula after unplanned removal of the T-tubes for various reasons; the T-tubes were successfully removed in 9 patients (28.1%), and the duration of T-tubes placement was 5.2-22.7 months (12.1 ± 6.3 months), among them anatomical stenosis in 9 patients (100%). Secretion retention was observed in 32 patients (100%), granulation tissue hyperplasia was observed in 9 patients (28.1%), and the normal ventilation was not affected in most patients by bronchoscopic treatment and follow-up; the T-tubes were removed in 3 patients due to severe complications. There was no significant difference in the incidences of secretion retention and granulation tissue hyperplasia between the time point at 1 week, 1 month, 3 months, and 12 months, p > 0.05. In patients with T-tube more than 12 months, the severity of secretion retention at 1 week, 1 month, 3 months, and 12 months was significantly different, p < 0.05, however, there was no significant difference in the severity of granulation tissue hyperplasia, p > 0.05. Conclusions: T-tube is safe and effective in the treatment of SBAS. The severity of secretion retention increased in patients with long-term placement of the T-tube. For patients with mild stenosis and anatomical stenosis, the T-tube removal can be attempted at about 1 year of follow-up.