Hasil untuk "Diseases of the respiratory system"

Wei-Hsiang Chang, Samuel Herianto, Ching‐Chang Lee et al.

K. D’Silva, Naomi Serling-Boyd, Rachel S Wallwork et al.

Objective To investigate differences in manifestations and outcomes of coronavirus disease 2019 (COVID-19) infection between those with and without rheumatic disease. Methods We conducted a comparative cohort study of patients with rheumatic disease and COVID-19 (confirmed by severe acute respiratory syndrome coronavirus 2 PCR), compared in a 1:2 ratio with matched comparators on age, sex and date of COVID-19 diagnosis, between 1 March and 8 April 2020, at Partners HealthCare System in the greater Boston, Massachusetts area. We examined differences in demographics, clinical features and outcomes of COVID-19 infection. The main outcomes were hospitalisation, intensive care admission, mechanical ventilation and mortality. Results We identified 52 rheumatic disease patients with COVID-19 (mean age, 63 years; 69% female) and matched these to 104 non-rheumatic disease comparators. The majority (39, 75%) of patients with rheumatic disease were on immunosuppressive medications. Patients with and without rheumatic disease had similar symptoms and laboratory findings. A similar proportion of patients with and without rheumatic disease were hospitalised (23 (44%) vs 42 (40%)), p=0.50) but those with rheumatic disease required intensive care admission and mechanical ventilation more often (11 (48%) vs 7 (18%), multivariable OR 3.11 (95% CI 1.07 to 9.05)). Mortality was similar between the two groups (3 (6%) vs 4 (4%), p=0.69). Conclusions Patients with rheumatic disease and COVID-19 infection were more likely to require mechanical ventilation but had similar clinical features and hospitalisation rates as those without rheumatic disease. These findings have important implications for patients with rheumatic disease but require further validation.

Qingbin Zeng, Binglin Bie, Qianni Guo et al.

Significance Hyperpolarized 129Xe NMR/MRI is a useful method for diagnosis of diseases of the respiratory system. However, the sensitive detection of specific compounds in blood remains a challenge because of the weak 129Xe signal in aqueous solution. We developed a way, Hyper-SAME, to promote the 129Xe signal in aqueous solution. The 129Xe signal intensity is four times beyond that of free 129Xe in water and 200 times better than the benchmark molecular cage, cryptophane-A, in its saturated aqueous solution. Additionally, the hyperpolarized 129Xe signal can be amplified further by combining Hyper-SAME with hyperpolarized 129Xe chemical exchange saturation transfer. We report hyperpolarized Xe signal advancement by metal-organic framework (MOF) entrapment (Hyper-SAME) in aqueous solution. The 129Xe NMR signal is drastically promoted by entrapping the Xe into the pores of MOFs. The chemical shift of entrapped 129Xe is clearly distinguishable from that of free 129Xe in water, due to the surface and pore environment of MOFs. The influences from the crystal size of MOFs and their concentration in water are studied. A zinc imidazole MOF, zeolitic imidazole framework-8 (ZIF-8), with particle size of 110 nm at a concentration of 100 mg/mL, was used to give an NMR signal with intensity four times that of free 129Xe in water. Additionally, Hyper-SAME is compatible with hyperpolarized 129Xe chemical exchange saturation transfer. The 129Xe NMR signal can be amplified further by combining the two techniques. More importantly, Hyper-SAME provides a way to make detection of hyperpolarized 129Xe in aqueous solution convenient and broadens the application area of MOFs.

Jean-Paul Henri Dedam, Matthew Fogel, Elizabeth Fogel

E. V. Krishnakumar, Sandhra Satish, Joy Augustine et al.

A 28-year-old female, a known case of neurofibromatosis 1, presented to the respiratory medicine department with complaints of breathlessness and cough for 2 weeks’ duration. Clinical examination revealed right-sided moderate pleural effusion. Computed tomography (CT) chest revealed a large anterior mediastinal mass with chest wall infiltration. Histopathology showed neoplasm with epithelioid cells, arranged as sheets and interlacing spindle cells with a moderate amount of eosinophilic cytoplasm and inconspicuous nucleoli. Histopathological examination of excised specimen showed a malignant peripheral nerve sheath tumor with rhabdomyoblastic differentiation also known as malignant triton tumor. After palliative chemotherapy, later on follow-up, CT-guided biopsy from right side chest wall lesion also showed the same. Because of this rare presentation, we are reporting this case.

MinJae Lee, Anna M Georgiopoulos, Raksha Jain et al.

Introduction People with cystic fibrosis (CF) are living longer and healthier lives with a growing number considering and pursuing parenthood. The decision of whether to become a parent is complex for people with CF, and CF is a major factor in reproductive decision-making. Unfortunately, in people with CF who become parents, there are no prospective studies of disease trajectory, no data on the impact of parenthood on mental health, disease self-management, or quality of life, and no research regarding non-genetic parenthood.Methods and analysis Health Outcomes of Parents with CF (HOPeCF) is a prospective, multicentre observational cohort study which will enrol 146 new parents with CF of children less than 5 years of age. The primary aim of this 60-month study is to assess the rate of lung function decline as impacted by mental health, parental stress and responsibility, and the use of CF transmembrane conductance regulator modulators. In addition, we will conduct dyadic interviews with a subset of study participants and their key supports (partner/family/friend) to inform future interventions.Ethics and dissemination This longitudinal, observational multicentre study is a necessary and timely step in understanding parental health outcomes in CF and will provide data essential for care guidance to people with CF, their partners, and healthcare providers. The University of Pittsburgh Institutional Review Board approved this study (STUDY23080161). As people with a variety of paediatric-onset chronic diseases are living longer and considering parenthood, these results may have widespread applicability and will be distributed at international meetings and submitted to peer-reviewed journals.

H. Santos, Mariana Santos, Sofia B Paula et al.

INTRODUCTION Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) led to changes in healthcare institutions and medical assistance. Non-SARS-CoV-2 related diseases were indirectly affected by the pandemic. Nonetheless, their treatment remains crucial. Cardiovascular conditions such as acute coronary syndrome (ACS) are common, and it was necessary to adjust medical assistance to these diseases during the pandemic. This study aimed to assess the national impact and healthcare system response during the first wave of the pandemic in patients admitted for ACS. MATERIAL AND METHODS Multicenter retrospective study based on the Acute Coronary Syndrome Portuguese National Registry between the 1st January 2016 and the 28th February 2021. Two groups were defined: the previous year to the SARS-CoV-2 pandemic (March, April, May and June 2019) (952 patients) and the first wave of the pandemic (March, April, May and June 2020) (642 patients). Clinical course, time until reperfusion, in-hospital outcomes and follow-up at one year were compared between both periods. RESULTS There was a lower incidence of ACS between March and June 2020 compared with the same period in 2019, with a reduction of 32.6%. There were no statistically significant differences between the two periods regarding patient demographic characteristics (except for a higher prevalence of familiar cardi vascular history and chronic obstructive pulmonary disease in 2020 and higher prevalence of diabetes in 2019), clinical features, clinical management, in-hospital major adverse cardiac events, mortality and readmission at one-year follow-up. There was a trend towards longer delays until reperfusion, yet without statistical significance. The patients that developed ACS during the first wave of the SARS-CoV-2 pandemic were less often referred to percutaneous coronary intervention centers (p = 0.034) and were more frequently transferred to another hospital (p < 0.001). CONCLUSION During the first wave of the SARS-CoV-2 pandemic there was a nationwide reduction in demand of healthcare services due to ACS events. Even though the Portuguese healthcare system was under strain and forced to divert resources and medical assistance towards the pandemic management, it was capable of responding adequately to ACS.

Changhui Yu, Wufeng Huang, Zicong Zhou et al.

Abstract Background Up-regulation of aerobic glycolysis has been reported as a characterization of asthma and facilitates airway inflammation. We has been previously reported that short isoform thymic stromal lymphopoietin (sTSLP) could reduce inflammation in asthmatic airway epithelial cells. Here we wanted to investigate whether the inhibition of sTSLP on asthma is related to aerobic glycolysis. Methods Asthmatic model was established in challenging Male BALB/c mice and 16-HBE (human bronchial epithelial) cell line with house dust mite (HDM). Indicators of glycolysis were assessed to measure whether involve in sTSLP regulating airway epithelial cells inflammation in asthmatic model in vivo and in vitro. Results sTSLP decreased inflammation of asthmatic airway and aerobic glycolysis in mice. HDM or long isoform thymic stromal lymphopoietin (lTSLP) promoted HIF-1α expression and aerobic glycolysis by miR-223 to target and inhibit VHL (von Hippel-Lindau) expression 16-HBE. Inhibition of aerobic glycolysis restrained HDM- and lTSLP-induced inflammatory cytokines production. sTSLP along had almost no potential to alter aerobic glycolysis of 16-HBE. But sTSLP decreased LDHA (lactate dehydrogenase A) and LD (Lactic acid) levels in BALF, and HIF-1α and LDHA protein levels in airway epithelial cells of asthma mice model. lTSLP and sTSLP both induced formation of TSLPR and IL-7R receptor complex, and lTSLP obviously facilitated phosphorylation of JAK1, JAK2 and STAT5, while sTSLP induced a little phosphorylation of JAK1 and STAT5. Conclusion We identified a novel mechanism that lTSLP could promote inflammatory cytokines production by miR-223/VHL/HIF-1α pathway to upregulate aerobic glycolysis in airway epithelial cells in asthma. This pathway is suppressed by sTSLP through occupying binding site of lTSLP in TSLPR and IL-7R receptor complex.

Ricardo Mingarini Terra, Pedro Henrique Xavier Nabuco de Araujo, Leticia Leone Lauricella et al.

ABSTRACT Objective: To compare 90-day morbidity in patients undergoing lung lobectomy performed by either robotic-assisted thoracic surgery (RATS) or video-assisted thoracic surgery (VATS). Intraoperative complications, drainage time, length of hospital stay, postoperative pain, postoperative quality of life, and readmissions within 90 days were also compared. Methods: This was a two-arm randomized clinical trial including patients with lung lesions (primary lung cancer or lung metastasis) who were candidates for lung lobectomy. Patients with comorbidities that precluded surgical treatment were excluded. All patients followed the same postoperative protocol. Results: The overall sample comprised 76 patients (39 in the VATS group and 37 in the RATS group). The two groups were similar regarding gender, age, BMI, FEV1 in % of predicted, and comorbidities. Postoperative complications within 90 days tended to be more common in the VATS group than in the RATS group, but the difference was not significant (p = 0.12). However, when only major complications were analyzed, this tendency disappeared (p = 0.58). Regarding postoperative outcomes, the VATS group had a significantly higher number of readmissions within 90 days than did the RATS group (p = 0.029). No significant differences were found regarding intraoperative complications, drainage time, length of hospital stay, postoperative pain, and postoperative quality of life. Conclusions: RATS and VATS lobectomy had similar 90-day outcomes. However, RATS lobectomy was associated with a significant reduction in the 90-day hospital readmission rate. Larger studies are necessary to confirm such a finding. (ClinicalTrials.gov identifier: NCT02292914 [http://www.clinicaltrials.gov/])

Sisi Chen, Ting Luo, Lingzhi Huang et al.

Abstract In recent years, the treatment of pulmonary arterial hypertension (PAH) has gradually increased, including new drugs and surgical methods, the mortality rate of PAH patients has significantly decreased, and the average survival rate has significantly improved. However, there was no obvious improvement in sexual health, mental health, and quality of life (QoL) in patients with PAH. Although an important dimension of QoL, little is known about sexual health and sexual health‐related QoL of patients with PAH in China. In this study, the female sexual function index (FSFI) scale, the Symptom Checklist‐90 (SCL‐90), and emPHasis‐10 were used to evaluate PAH associated with congenital heart disease (CHD‐PAH) patients’ sexual function, mental health, and QoL. The score of sexual function in female CHD‐PAH patients ranged from 4.40 to 34.80 points, and the average score was 26.80 (19.00–27.80) points. The detection rate of sexual dysfunction was 48.30%. The FSFI score of all dimensions of the sexual dysfunction group was significantly lower than that of the nonsexual dysfunction group. In addition, the scores of SCL‐90 and emPHasis‐10 were significantly higher than that of the nonsexual dysfunction group (p < 0.01). The sexual function was negatively correlated with mental health (r = −0.58, p < 0.01) and QoL (r = −0.62, p < 0.01) in female CHD‐PAH patients. The sexual function of female patients with CHD‐PAH is not optimistic. Sexual health may impact mental health and overall QoL in female PAH patients. Reasonable intervention measures should be taken to improve their sexual health, so as to improve their overall QoL.

Takayasu Ito, Yasushi Makino, Shuko Mashimo et al.

Abstract A 59‐year‐old woman complained of continuous dyspnea. Computed tomography revealed multiple pulmonary nodules, mildly small enlarged mediastinal lymph nodes and a nodule in the liver segment 8. Her dyspnea worsened with respiratory failure 4 days after presentation. Liver biopsy was not possible as she could not hold her breath; thus, we performed bronchoscopy. For biopsy, the pulmonary nodules with a positive bronchus sign were preferred over the mildly small enlarged mediastinal lymph nodes. Bronchoscopy under non‐invasive positive pressure ventilation (NPPV) or high‐flow nasal cannula (HFNC) was impossible because of the lack of equipment. Therefore, we biopsied via thin bronchoscope through nasal cavity under a high‐concentration oxygen mask. Pathological findings revealed epidermal growth factor receptor mutation‐positive lung adenocarcinoma. For patients with respiratory failure who cannot undergo bronchoscopy under NPPV or HFNC, thin bronchoscopy through the nasal cavity under a high‐concentration oxygen mask may be clinically useful to prevent hypoxaemia during the procedure

Abir Nasır, E. Yabalak

ABSTRACT Pimpinella plants have traditionally been used to treat many diseases related to respiratory system and have analgesic, antidepressant, and antispasmodic effects. They belong to the Umbelliferae family and grow in dry rocky places, rock crevices, meadows, mountain pastures, and grasslands. This review contains a summary of all extraction methods of different Pimpinella species from 2003 to 2020. Most of the studies focused on the main components of essential oils. They also indicated that the presence of the anethol and its isomers in the essential oils leads to its antioxidant, antibacterial, antifungal and antiviral properties. Also, recent studies suggested that essential oil of Pimpinella anisum L. medicinal plants prevents infection of COVID-19 virus and treats mild infections. However, few studies have demonstrated the toxicity of some Pimpinella species, most confirmed the anti-cancer effect of many species and the safe use of different Pimpinella species at moderate doses.

Wei Zhou, Ziyi Chen, A. Lu et al.

Citri Reticulatae Pericarpium (CRP), also known as Chenpi in Chinese, is the dry mature peel of Citrus reticulata Blanco or its cultivated varieties. CRP as the health-care food and dietary supplement has been widely used in various diseases. However, the potential pharmacological mechanisms of CRP to predict and treat various diseases have not yet been fully elucidated. A systems pharmacology-based approach is developed by integrating absorption, distribution, metabolism, and excretion screening, multiple target fishing, network pharmacology, as well as pathway analysis to comprehensively dissect the potential mechanism of CRP for therapy of various diseases. The results showed that 39 bioactive components and 121 potential protein targets were identified from CRP. The 121 targets are closely related to various diseases of the cardiovascular system, respiratory system, gastrointestinal system, etc. These targets are further mapped to compound-target, target-disease, and target-pathway networks to clarify the therapeutic mechanism of CRP at the system level. The current study sheds light on a promising way for promoting the discovery of new botanical drugs.

Rui Wang, Hai-Chao Li, Xu-Yan Li et al.

Abstract Background Hypoxemia frequently occurs during bronchoscopy. High-flow nasal cannula (HFNC) oxygen therapy may be a feasible alternative to prevent the deterioration of gas exchange during bronchoscopy. With the convenience of clinical use in mind, we modified an HFNC using a single cannula. This clinical trial was designed to test the hypothesis that a modified HFNC would decrease the proportion of patients with a single moment of peripheral arterial oxygen saturation (SpO2) < 90% during bronchoscopy. Methods In this single-center, prospective randomized controlled trial, hospitalized patients in the respiratory department in need of diagnostic bronchoscopy were randomly assigned to a modified HFNC oxygen therapy group or a conventional oxygen therapy (COT) group. The primary outcome was the proportion of patients with a single moment of SpO2 < 90% during bronchoscopy. Results Eight hundred and twelve patients were randomized to the modified HFNC (n = 406) or COT (n = 406) group. Twenty-four patients were unable to cooperate or comply with bronchoscopy. Thus, 788 patients were included in the analysis. The proportion of patients with a single moment of SpO2 < 90% during bronchoscopy in the modified HFNC group was significantly lower than that in the COT group (12.5% vs. 28.8%, p < 0.001). There were no significant differences in the fraction of inspired oxygen between the two groups. The lowest SpO2 during bronchoscopy and 5 min after bronchoscopy in the modified HFNC group was significantly higher than that in the COT group. Multivariate analysis showed that a baseline forced vital capacity (FVC) < 2.7 L (OR, 0.276; 95% CI, 0.083–0.919, p = 0.036) and a volume of fluid instilled > 60 ml (OR, 1.034; 95% CI, 1.002–1.067, p = 0.036) were independent risk factors for hypoxemia during bronchoscopy in the modified HFNC group. Conclusions A modified HFNC could decrease the proportion of patients with a single moment of SpO2 < 90% during bronchoscopy. A lower baseline FVC and large-volume bronchoalveolar lavage may predict desaturation during bronchoscopy when using a modified HFNC. Trial registration ClinicalTrials. Gov: NCT02606188. Registered 17 November 2015.

Martin J. Tobin, Amal Jubran, Franco Laghi

Abstract In the article “The pathophysiology of ‘happy’ hypoxemia in COVID-19,” Dhont et al. (Respir Res 21:198, 2020) discuss pathophysiological mechanisms that may be responsible for the absence of dyspnea in patients with COVID-19 who exhibit severe hypoxemia. The authors review well-known mechanisms that contribute to development of hypoxemia in patients with pneumonia, but are less clear as to why patients should be free of respiratory discomfort despite arterial oxygen levels commonly regarded as life threatening. The authors propose a number of therapeutic measures for patients with COVID-19 and happy hypoxemia; we believe readers should be alerted to problems with the authors’ interpretations and recommendations.

Larry Ellee Anak Nyanti, Sze Shyang Kho,, Chan Sin Chai et al.

Background: The use of conventional flexible forceps during flex-rigid pleuroscopy can be challenging when sampling hard and thickened pleura. Pleuroscopic cryobiopsy is an emerging field, with various early studies demonstrating good yield and minimal complications. Objectives: To review the authors’ early experience of pleuroscopic cryobiopsy in their centre and highlight its utility in the diagnosis of mesothelioma. Method: Six cases of undiagnosed pleural effusion that underwent pleuroscopic cryobiopsy via flexi-rigid pleuroscopy between July 2017 and June 2019 were retrospectively analysed. Results: The cohort had a median age of 59 years, consisting of two females and four males with a median age of 57 years. Mean (aggregate) tissue sample diameter was 9.2±1.9 mm. Cryobiopsy established a definitive diagnosis in all six cases: one case of malignant mesothelioma, one pleural tuberculosis, two small cell carcinomas, and two adenocarcinomas. Immunohistochemical staining was performed in all five of the malignant samples (100%). There were no major complications reported. Conclusions: Based on the case series, pleuroscopic cryobiopsy is a feasible adjunct to conventional forceps biopsy, a safe procedure in the authors’ setting, gives high diagnostic yield, and enables differentiation between the different causes of exudative pleural effusion. A large, prospective study is required to validate this retrospective series.

Shelley Shapiro, Robert C. Bourge, Patti Pozella et al.

Parenteral prostanoids are effective for improving outcomes in patients with pulmonary arterial hypertension. However, subcutaneous or intravenous delivery via an external pump places a significant burden on patients. Consequently, the Implantable System for Remodulin© (treprostinil) was developed and is associated with a low rate of complications (United Therapeutics (Research Triangle Park, NC) in collaboration with Medtronic, Inc. (Mounds View, MN)). The current real-world experience study evaluated pulmonary arterial hypertension patients' perceptions of their quality of life, ability to perform activities of daily living, perceptions on the benefits and risks of the implantable system, and their social interactions before and after receiving the implantable system. Pulmonary arterial hypertension patients who had been transitioned from an external infusion pump to the implantable system completed a mix of quantitative and qualitative questions administered online over the course of a six-day period. A total of 20 patients completed the study. All patients reported that their quality of life, confidence out in public, and ability to travel long distances had improved. Over 90% of patients reported that their overall level of independence was better since receiving the implantable system, and most patients indicated that their ability to independently perform specific activities of daily living had improved. Responses to the qualitative questions suggested that the implantable system saved time, improved interpersonal relationships, and increased freedom. Results from this real-world patient experience study suggest this novel delivery system provides improvements in factors that are of substantial importance to patients.

Arturo Borzutzky Schachter, Pamela Morales Matamala

Alexander L. Greninger, A. Waghmare, A. Adler et al.

Abstract Background. Metagenomic next-generation sequencing (mNGS) has been used to uncover unusual causes of infectious diseases but has not been used routinely for the investigation of putative nosocomial outbreaks. Here, we describe the use of mNGS during investigation of a cluster of human rhinovirus (HRV)-positive infections on a high-risk pulmonary ward. Methods. We performed mNGS on 6 midnasal turbinate swabs from 4 case-patients and 10 swabs from 9 control outpatients that tested positive for enterovirus/rhinovirus by the FilmArray system. Results. HRV reads were recovered in 15 (94%) of the 16 samples sequenced. Phylogenetic analysis of HRV whole genomes from the 4 case-patients and 5 outpatient controls along with partial genomes from additional outpatient controls revealed that isolates from the case-patients were not directly related and that the 2 closest case HRV genomes had an estimated time to most recent common ancestor of 172 years. Our turnaround time from receipt of the sample to phylogenetic analysis was 24 hours. Conclusions. We found the use of mNGS downstream of a rapid polymerase chain reaction respiratory panel during an investigation of 4 hospital-acquired rhinovirus infections to rapidly dispel concern of a single-source transmission event.

Roengrudee Patanavanich, Wichai Aekplakorn, Paibul Suriyawongpaisal

Introduction Tobacco use is a major preventable risk factor for many noncommunicable diseases. Smoking-attributable mortality has been well described. However, the prevalence of smoking-attributable hospitalization (SAH) and associated costs have been less documented, especially in low- and middle-income countries. Our objective was to estimate the number of hospital admissions and expenditure attributable to tobacco use during 2007–2014 in Thailand. Methods Hospitalization data between 2007 and 2014 were used for the analysis. SAHs were derived by applying smoking-attributable fractions, based on Thailand’s estimates of smoking prevalence data and relative risks extracted from the published literature, to hospital admissions related to smoking according to the International Classification of Diseases version 10. Age-adjusted SAHs among adults age 35 and older were calculated. Joinpoint regression analysis was used to detect changes in trends among genders and geographical areas, based on annual per cent change (APC) and average annual per cent change (AAPC). Costs related to SAHs were also estimated. Results During 2007–2014, among adults age 35 years and older, smoking accounted for almost 3.6 million hospital admissions, with attributable hospital costs calculated at more than US$572 million annually, which represents 16.8% of the national hospital budget. While the age-adjusted rate of SAHs had been relatively stable (AAPC=1.12), the age-adjusted rate of SAHs due to cancers increased significantly for both sexes (AAPC=2.33). Cardiovascular diseases related to smoking increased significantly among men (AAPC=2.5), whereas, COPD, the most common smoking-related conditions decreased significantly during 2011–2014 (APC= -7.21). Furthermore, more provinces in the northeastern and the southern regions where smoking prevalence was higher than the national average have a significantly higher AAPC of SAH than other parts of the country. Conclusions Smoking remains a significant health and economic burden in Thailand. Findings from this study pose compelling evidence for Thailand to advance tobacco control efforts to reduce the financial and social burden of diseases attributable to smoking.