99751
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Assimakopoulos SF, Mastronikolis S, DE Lastic AL, Aretha D, Papageorgiou D, Chalkidi T, Oikonomou I, Triantos C, Mouzaki A, Marangos M. Intestinal Barrier Biomarker ZO1 and Endotoxin Are Increased in Blood of Patients With COVID-19-associated Pneumonia. In Vivo 2021; 35:2483-2488. [PMID: 34182534 DOI: 10.21873/invivo.12528] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 05/21/2021] [Accepted: 05/25/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND/AIM The present study was undertaken to investigate (i) whether hospitalized patients with COVID-19 pneumonia present intestinal barrier dysfunction with consequent translocation of endotoxin into the systemic circulation and (ii) whether intestinal barrier biomarkers have any prognostic role in terms of progression to severe respiratory failure. PATIENTS AND METHODS In this prospective study, 22 patients with COVID-19-associated pneumonia and 19 patients with non-COVID-19-related community-acquired pneumonia (CAP group) were studied while 12 healthy persons comprised the control group. Blood samples were collected on admission and analysed for serum levels of endotoxin and zonula occludens-1 (ZO1). Clinical courses regarding progression to severe respiratory failure (SRF) requiring mechanical ventilation were recorded. RESULTS Patients with COVID-19-associated pneumonia and patients with CAP presented significantly higher serum endotoxin and ZO1 concentrations on admission as compared to healthy controls. There was no difference in endotoxin levels between patients with COVID-19-related pneumonia and patients with CAP. In patients with COVID-19-related pneumonia, serum endotoxin concentrations were positively correlated with C-reactive protein and ferritin values. There were no significant differences in serum endotoxin and ZO1 concentrations between patients with severe and not severe COVID-19-related pneumonia, nor between patients who developed SRF and those who did not Conclusion: Patients with COVID-19-related pneumonia present intestinal barrier dysfunction leading to systemic endotoxemia. Admission values of endotoxin and ZO1 do not have any prognostic role for progression to SRF.
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Affiliation(s)
| | | | - Anne-Lise DE Lastic
- Division of Hematology, Department of Internal Medicine, University of Patras Medical School, Patras, Greece
| | - Diamanto Aretha
- Department of Anesthesiology and Intensive Care Medicine, University of Patras Medical School, Patras, Greece
| | - Dimitris Papageorgiou
- Department of Internal Medicine, University of Patras Medical School, Patras, Greece
| | - Theodora Chalkidi
- Department of Internal Medicine, University of Patras Medical School, Patras, Greece
| | - Ioanna Oikonomou
- Department of Internal Medicine, University of Patras Medical School, Patras, Greece
| | - Christos Triantos
- Department of Internal Medicine, University of Patras Medical School, Patras, Greece
| | - Athanasia Mouzaki
- Division of Hematology, Department of Internal Medicine, University of Patras Medical School, Patras, Greece
| | - Markos Marangos
- Department of Internal Medicine, University of Patras Medical School, Patras, Greece
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99752
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Qiu Y, Sessler DI, Chen L, Halvorson S, Cohen B, Bravo M, Ince I, Maheshwari K, Kurz A. Preoperative Vitamin D Deficiency Is Associated With Postoperative Delirium in Critically Ill Patients. J Intensive Care Med 2021; 37:655-662. [PMID: 34196246 DOI: 10.1177/08850666211021330] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Postoperative delirium is common, with a reported incidence of 11% to 80% in critically ill patients. Delirium is an independent prognostic factor for poor hospital outcomes. Low vitamin D concentrations are associated with a decline in cognitive function. We therefore tested the hypothesis that low preoperative serum 25-hydroxyvitamin D [25(OH)D] concentrations are associated with postoperative delirium in critically ill patients. METHOD We conducted a retrospective analysis of adults in a surgical intensive care unit for at least 48 hours immediately after non-cardiac and non-neurosurgical operations at Cleveland Clinic between 2013 and 2018. Delirium was assessed by trained nurses using CAM-ICU twice daily for the initial 5 postoperative days. Any positive value was considered evidence of delirium. We assessed the association between 25(OH)D concentrations within a year before surgery and the incidence of postoperative delirium using logistic regression, adjusted for potential confounders. A linear spline term with a knot at 30 ng/ml, the threshold for normal 25(OH)D concentration, was added to accommodate a nonlinear relationship between 25(OH)D concentrations and delirium. RESULTS We included 632 patients, who had a mean (SD) 25(OH)D concentration of 25 (15) ng/ml; 55% (346/632) experienced delirium. We observed an adjusted odds ratio of 1.4 (95% CI: [1.1, 1.8], P = 0.01) for delirium per 10 ng/ml decrease in 25(OH)D concentrations when patients' 25(OH)D concentrations were less than 30 ng/ml. In patients whose 25(OH)D concentrations were at least 30 ng/ml, the adjusted odds ratio was 0.9 (95% CI: [0.7, 1.1], P = 0.36). CONCLUSION Preoperative 25(OH)D concentrations are associated with postoperative delirium in patients whose concentrations are below the normal threshold, but not at concentrations ≥30 ng/ml. A trial will be needed to determine whether the relationship is causal, and whether vitamin D supplementation before surgery might reduce the incidence of delirium.
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Affiliation(s)
- Yuwei Qiu
- Department of Outcomes Research, Cleveland Clinic, OH, USA.,Department of Anesthesiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, China
| | | | - Liang Chen
- Department of Outcomes Research, Cleveland Clinic, OH, USA.,Department of Quantitative Health Sciences, Cleveland Clinic, OH, USA
| | - Sven Halvorson
- Department of Outcomes Research, Cleveland Clinic, OH, USA.,Department of Quantitative Health Sciences, Cleveland Clinic, OH, USA
| | - Barak Cohen
- Department of Outcomes Research, Cleveland Clinic, OH, USA
| | - Mauro Bravo
- Department of Outcomes Research, Cleveland Clinic, OH, USA
| | - Ilker Ince
- Department of Outcomes Research, Cleveland Clinic, OH, USA.,Department of Anesthesiology and Reanimation, Ataturk University School of Medicine, Erzurum, Turkey
| | - Kamal Maheshwari
- Department of Outcomes Research, Cleveland Clinic, OH, USA.,Department of General Anesthesiology, Anesthesiology Institute, Cleveland Clinic, OH, USA
| | - Andrea Kurz
- Department of Outcomes Research, Cleveland Clinic, OH, USA.,Department of General Anesthesiology, Anesthesiology Institute, Cleveland Clinic, OH, USA
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99753
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Harris C, Lunt A, Bisquera A, Peacock J, Greenough A. Intrauterine growth retardation and lung function of very prematurely born young people. Pediatr Pulmonol 2021; 56:2284-2291. [PMID: 33666356 DOI: 10.1002/ppul.25359] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 01/27/2021] [Accepted: 03/01/2021] [Indexed: 11/08/2022]
Abstract
OBJECTIVES To assess if intrauterine growth retardation (IUGR) was associated with reduced lung function at 16-19 years. WORKING HYPOTHESIS Very prematurely born young people who had IUGR would have reduced lung function postpuberty. STUDY DESIGN Prospective follow-up study. PATIENT-SUBJECT SELECTION One hundred and fifty-nine 16-19 year olds born before 29 weeks of gestation; 37 had IUGR. METHODOLOGY Lung function tests were performed: spirometry was used to assess forced expiratory volume in one second (FEV1), forced expiratory flow at 75%, 50% and 25% of expired vital capacity (FEF75, FEF50 and FEF25), peak expiratory flow (PEF) and forced vital capacity (FVC). Functional residual capacity (FRCpleth) total lung capacity (TLCpleth) and residual volume (RVpleth) were measured. Alveolar function was assessed by diffusion capacity within the lungs of carbon monoxide (DLCO). Impulse oscillometry was used to assess respiratory resistance and lung clearance index to assess ventilation homogeneity. Exercise capacity was assessed using a shuttle sprint test. RESULTS After adjustment for BMI, the mean FEV-1/FVC, FEF75, FEF25-75, FRCpleth and RVpleth were poorer in those who had had IUGR, with differences between 0.56 and 0.75 z-scores. After further adjustment for BPD and postnatal corticosteroid use, only the difference in RVpleth z-scores remained statistically significant, adjusted difference (95% CI): 0.66 (0.18,1.13). Exercise capacity was lower in those with IUGR and this was more pronounced in males (p=0.04). CONCLUSIONS At 16-19 years of age, those who had IUGR had poorer lung function and exercise capacity compared with those with adequate intrauterine growth.
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Affiliation(s)
- Christopher Harris
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Alan Lunt
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Alessandra Bisquera
- School of Population Health and Environmental Sciences, King's College London, London, UK
| | - Janet Peacock
- Department of Epidemiology, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire, USA.,NIHR Biomedical Research Center based at Guy's and St Thomas' NHS Foundation Trust, King's College London, London, UK
| | - Anne Greenough
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK.,NIHR Biomedical Research Center based at Guy's and St Thomas' NHS Foundation Trust, King's College London, London, UK.,Asthma UK Center in Allergic Mechanisms of Asthma, King's College London, London, UK
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99754
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Jia Z, Yan X, Gao L, Ding S, Bai Y, Zheng Y, Cui Y, Wang X, Li J, Lu G, Xu Y, Zhang X, Li J, Chen N, Shang Y, Han M, Liu J, Zhou H, Li C, Lu W, Liu J, Wang L, Fan Q, Wu J, Shen H, Jiao R, Chen C, Gao X, Tian M, Lu W, Yang Y, Wong GWK, Wang T, Jin R, Shen A, Xu B, Shen K. Comparison of Clinical Characteristics Among COVID-19 and Non-COVID-19 Pediatric Pneumonias: A Multicenter Cross-Sectional Study. Front Cell Infect Microbiol 2021; 11:663884. [PMID: 34277466 PMCID: PMC8281119 DOI: 10.3389/fcimb.2021.663884] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 05/05/2021] [Indexed: 01/08/2023] Open
Abstract
Background The pandemic of Coronavirus Disease 2019 (COVID-19) brings new challenges for pediatricians, especially in the differentiation with non-COVID-19 pneumonia in the peak season of pneumonia. We aimed to compare the clinical characteristics of pediatric patients with COVID-19 and other respiratory pathogens infected pneumonias. Methods We conducted a multi-center, cross-sectional study of pediatric inpatients in China. Based on pathogenic test results, pediatric patients were divided into three groups, including COVID-19 pneumonia group, Non-COVID-19 viral (NCV) pneumonia group and Non-viral (NV) pneumonia group. Their clinical characteristics were compared by Kruskal-Wallis H test or chi-square test. Results A total of 636 pediatric pneumonia inpatients, among which 87 in COVID-19 group, 194 in NCV group, and 355 in NV group, were included in analysis. Compared with NCV and NV patients, COVID-19 patients were older (median age 6.33, IQR 2.00-12.00 years), and relatively fewer COVID-19 patients presented fever (63.2%), cough (60.9%), shortness of breath (1.1%), and abnormal pulmonary auscultation (18.4%). The results were verified by the comparison of COVID-19, respiratory syncytial virus (RSV) and influenza A (IFA) pneumonia patients. Approximately 42.5%, 44.8%, and 12.6% of the COVID-19 patients presented simply ground-glass opacity (GGO), simply consolidation, and the both changes on computed tomography (CT) scans, respectively; the proportions were similar as those in NCV and NV group (p>0.05). Only 47.1% of COVID-19 patients had both lungs pneumonia, which was significantly lower than that proportion of nearly 80% in the other two groups. COVID-19 patients presented lower proportions of increased white blood cell count (16.5%) and abnormal procalcitonin (PCT) (10.7%), and a higher proportion of decreased lymphocyte count (44.0%) compared with the other two groups. Conclusion Majority clinical characteristics of pediatric COVID-19 pneumonia patients were milder than non-COVID-19 patients. However, lymphocytopenia remained a prominent feature of COVID-19 pediatric pneumonia.
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Affiliation(s)
- Zhongwei Jia
- School of Public Health, Peking University, Beijing, China.,Center for Intelligent Public Health, Institute for Artificial Intelligence, Peking University, Beijing, China.,Center for Drug Abuse Control and Prevention, National Institute of Health Data Science, Peking University, Beijing, China
| | - Xiangyu Yan
- School of Public Health, Peking University, Beijing, China.,Center for Intelligent Public Health, Institute for Artificial Intelligence, Peking University, Beijing, China.,Center for Drug Abuse Control and Prevention, National Institute of Health Data Science, Peking University, Beijing, China
| | - Liwei Gao
- China National Clinical Research Center for Respiratory Diseases, Department of Respiratory Medicine, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, Beijing, China.,Research Unit of Critical Infection in Children, Chinese Academy of Medical Sciences, Beijing, China
| | - Shenggang Ding
- Department of Pediatrics, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Yan Bai
- Pediatric Department, Union Hospital, Tongji Medical College, Huazhong University of Science And Technology, Hubei, China
| | - Yuejie Zheng
- Department of Respiratory Medicine, Shenzhen Children's Hospital, Shenzhen, China
| | - Yuxia Cui
- Department of Pediatrics, Guizhou Provincial People's Hospital, Guizhou, China
| | - Xianfeng Wang
- Department of Pediatrics, Shenzhen Third People's Hospital, Second Affiliated Hospital of Southern University of Science and Technology, Shenzhen, China
| | - Jingfeng Li
- Department of Pediatrics, Taihe Hospital, Shiyan, China
| | - Gen Lu
- Department of Pediatric, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Yi Xu
- Department of Pediatric, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Xiangyu Zhang
- School of Public Health, Peking University, Beijing, China.,Center for Intelligent Public Health, Institute for Artificial Intelligence, Peking University, Beijing, China.,Center for Drug Abuse Control and Prevention, National Institute of Health Data Science, Peking University, Beijing, China
| | - Junhua Li
- Department of Pediatrics, Xiangyang Central Hospital, Xiangyang, China
| | - Ning Chen
- Department of Pediatric, Shengjing Hospital of China Medical University, Liaoning, China
| | - Yunxiao Shang
- Department of Pediatric, Shengjing Hospital of China Medical University, Liaoning, China
| | - Mingfeng Han
- Department of Respiratory Medicine, The Second People's Hospital of Fuyang, Anhui, China
| | - Jun Liu
- Department of Pediatrics, The People Hospital of Bozhou, Anhui, China
| | - Hourong Zhou
- Department of General Practice, Guizhou Provincial People's Hospital, Guiyang, Guizhou, China.,Office of Academic Research, Jiangjunshan Hospital, Guizhou, China
| | - Cen Li
- Department of Pediatrics, Guizhou Provincial People's Hospital, Guizhou, China
| | - Wanqiu Lu
- Department of Pediatrics, The Affiliated Hospital of Guizhou University, Guizhou, China
| | - Jun Liu
- China National Clinical Research Center for Respiratory Diseases, Department of Respiratory Medicine, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, Beijing, China.,Research Unit of Critical Infection in Children, Chinese Academy of Medical Sciences, Beijing, China
| | - Lina Wang
- China National Clinical Research Center for Respiratory Diseases, Department of Respiratory Medicine, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, Beijing, China.,Research Unit of Critical Infection in Children, Chinese Academy of Medical Sciences, Beijing, China
| | - Qihong Fan
- Department of Pediatrics, Jingzhou First People's Hospital, Jingzhou, China
| | - Jiang Wu
- Department of Pediatrics, Huangshi Maternity and Child Health Care Hospital, Huangshi, China
| | - Hanling Shen
- Department of Pediatrics, Suizhou Maternity and Child Health Care Hospital, Suizhou, China
| | - Rong Jiao
- Department of Pediatrics, Xiangyang First People's Hospital, Xiangyang, China
| | - Chunxi Chen
- Department of Pediatrics, Xishui People's Hospital, Huanggang, China
| | - Xiaoling Gao
- Department of Pediatrics, People's Hospital of Tuanfeng County, Huanggang, China
| | - Maoqiang Tian
- Department of Pediatrics, Tongren People's Hospital of Guizhou Province, Guizhou, China
| | - Wei Lu
- Department of Pediatrics, Yichang Central People's Hospital, Yichang, China
| | - Yonghong Yang
- Beijing Pediatric Research Institute, Beijing, China.,Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, Beijing, China
| | - Gary Wing-Kin Wong
- Department of Pediatrics, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Tianyou Wang
- Center of Hematologic Oncology, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, Beijing, China
| | - Runming Jin
- Pediatric Department, Union Hospital, Tongji Medical College, Huazhong University of Science And Technology, Hubei, China
| | - Adong Shen
- Beijing Key Laboratory of Pediatric Respiratory Infection Diseases, Beijing Pediatric Research Institute, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, Beijing, China
| | - Baoping Xu
- China National Clinical Research Center for Respiratory Diseases, Department of Respiratory Medicine, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, Beijing, China.,Research Unit of Critical Infection in Children, Chinese Academy of Medical Sciences, Beijing, China
| | - Kunling Shen
- China National Clinical Research Center for Respiratory Diseases, Department of Respiratory Medicine, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, Beijing, China
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99755
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Okanobu H, Kohno T, Mouri R, Hatsushika Y, Yamashita Y, Miyaki E, Fukuhara T, Okazaki A, Sakano A, Urabe A, Takaki S, Mori N, Tsuji K, Ochi H, Furukawa Y. Efficacy of vonoprazan 10 mg compared with 20 mg for the initial treatment in patients with erosive esophagitis: a randomized pilot study. Esophagus 2021; 18:669-675. [PMID: 33221955 DOI: 10.1007/s10388-020-00798-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 11/04/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND The study aimed to investigate the efficacy of vonoprazan 10 mg compared with 20 mg in patients with erosive esophagitis. METHOD Seventy-three patients with erosive esophagitis were randomly divided into two groups either vonoprazan 20 mg (n = 37) or 10 mg (n = 36). They were administered each dose for 4 weeks as the initial treatment followed by maintenance treatment with 10 mg for 8 weeks. The primary endpoints were mucosal healing rate and symptom relief at 4 weeks. The secondary endpoint was symptom relief at 12 weeks after the maintenance treatment. Mucosal healing was assessed endoscopically, and symptom relief was assessed using the FSSG score. RESULTS At 4 weeks, the endoscopic healing rates of the 20 mg and 10 mg groups were 94.6% and 94.4%, respectively. The FSSG scores of the 20 mg and 10 mg groups were significantly decreased in both treatment groups from 13 (4-39) to 4 (0-25) and 14 (4-40) to 3 (0-29), respectively. At 12 weeks, the scores further decreased to 2 (0-13) and 2 (0-26), respectively. The vonoprazan 10 mg group showed a similar therapeutic effect to the 20 mg group in mucosal healing at 4 weeks and in symptom relief throughout the study period. When stratified by esophagitis grading, these findings were still demonstrated in grade A/B patients but not in grade C/D patients. CONCLUSION Our findings suggest that initial treatment with vonoprazan 10 mg might be useful especially in patients with mild erosive esophagitis. Large controlled studies are warranted to confirm our investigation.
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Affiliation(s)
- Hideharu Okanobu
- Department of Gastroenterology, Hiroshima Red Cross Hospital and Atomic-Bomb, Survivors Hospital, 1-9-6, Sendamachi, Naka-ku, Hiroshima, 730-8619, Japan.
| | - Tomohiko Kohno
- Department of Gastroenterology, Hiroshima Red Cross Hospital and Atomic-Bomb, Survivors Hospital, 1-9-6, Sendamachi, Naka-ku, Hiroshima, 730-8619, Japan
| | - Ritsuo Mouri
- Department of Gastroenterology, Hiroshima Red Cross Hospital and Atomic-Bomb, Survivors Hospital, 1-9-6, Sendamachi, Naka-ku, Hiroshima, 730-8619, Japan
| | - Yoshiki Hatsushika
- Department of Gastroenterology, Hiroshima Red Cross Hospital and Atomic-Bomb, Survivors Hospital, 1-9-6, Sendamachi, Naka-ku, Hiroshima, 730-8619, Japan
| | - Yumiko Yamashita
- Department of Gastroenterology, Hiroshima Red Cross Hospital and Atomic-Bomb, Survivors Hospital, 1-9-6, Sendamachi, Naka-ku, Hiroshima, 730-8619, Japan
| | - Eisuke Miyaki
- Department of Gastroenterology, Hiroshima Red Cross Hospital and Atomic-Bomb, Survivors Hospital, 1-9-6, Sendamachi, Naka-ku, Hiroshima, 730-8619, Japan
| | - Takayuki Fukuhara
- Department of Gastroenterology, Hiroshima Red Cross Hospital and Atomic-Bomb, Survivors Hospital, 1-9-6, Sendamachi, Naka-ku, Hiroshima, 730-8619, Japan
| | - Akihito Okazaki
- Department of Gastroenterology, Hiroshima Red Cross Hospital and Atomic-Bomb, Survivors Hospital, 1-9-6, Sendamachi, Naka-ku, Hiroshima, 730-8619, Japan
| | - Ayaka Sakano
- Department of Medical Checkup Center, Hiroshima Red Cross Hospital and Atomic-Bomb Survivors Hospital, 1-9-6, Sendamachi, Naka-ku, Hiroshima, 730-8619, Japan
| | - Ayako Urabe
- Department of Medical Checkup Center, Hiroshima Red Cross Hospital and Atomic-Bomb Survivors Hospital, 1-9-6, Sendamachi, Naka-ku, Hiroshima, 730-8619, Japan
| | - Shintaro Takaki
- Department of Gastroenterology, Hiroshima Red Cross Hospital and Atomic-Bomb, Survivors Hospital, 1-9-6, Sendamachi, Naka-ku, Hiroshima, 730-8619, Japan
| | - Nami Mori
- Department of Gastroenterology, Hiroshima Red Cross Hospital and Atomic-Bomb, Survivors Hospital, 1-9-6, Sendamachi, Naka-ku, Hiroshima, 730-8619, Japan
| | - Keiji Tsuji
- Department of Gastroenterology, Hiroshima Red Cross Hospital and Atomic-Bomb, Survivors Hospital, 1-9-6, Sendamachi, Naka-ku, Hiroshima, 730-8619, Japan
| | - Hidenori Ochi
- Department of Medical Checkup Center, Hiroshima Red Cross Hospital and Atomic-Bomb Survivors Hospital, 1-9-6, Sendamachi, Naka-ku, Hiroshima, 730-8619, Japan
| | - Yoshinari Furukawa
- Department of Gastroenterology, Hiroshima Red Cross Hospital and Atomic-Bomb, Survivors Hospital, 1-9-6, Sendamachi, Naka-ku, Hiroshima, 730-8619, Japan
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99756
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Haque R, Kim Y, Park K, Jang H, Kim SY, Lee H, Kim HJ. Altered distributions in circulating follicular helper and follicular regulatory T cells accountable for imbalanced cytokine production in multiple sclerosis. Clin Exp Immunol 2021; 205:75-88. [PMID: 33759187 PMCID: PMC8209573 DOI: 10.1111/cei.13596] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 03/11/2021] [Accepted: 03/16/2021] [Indexed: 12/15/2022] Open
Abstract
Follicular T helper (Tfh) and regulatory (Tfr) cells are distinct subsets of CD4+ T lymphocytes, regulating humoral immune responses in the germinal center. It is widely accepted that dysregulated Tfh and Tfr cells are associated with autoimmunity. In this study, we evaluated the frequencies of circulating chemokine receptor (CXCR)5+ programmed cell death 1 (PD-1+ ) Tfh (cTfh) and CXCR5+ PD-1+ forkhead box protein 3 (FoxP3+ ) CD25+ Tfr (cTfr) cells, and their corresponding cytokines from the peripheral blood mononuclear cells of 28 patients with relapsing-remitting multiple sclerosis (MS) and 16 age- and sex-matched healthy controls (HC). Subsets of cTfh cells by Th1- and Th17-related surface markers (CXCR3 and CCR6) were also evaluated. We found that the frequency of cTfh cells was significantly higher in MS patients compared to that of HC. Conversely, the frequency of cTfr cells was lower in MS patients than that of HC. Interleukin (IL)-21-producing cTfh cells were significantly increased in MS patients, while IL-10-secreting cTfr cells were lower in MS patients compared to levels in HC. Among cTfh cells, cTfh17.1 cells were the major subtypes that were significantly increased in MS patients compared to HC, with the frequency of IL-21-secreting cells being the highest. These results suggest that an imbalanced distribution of cTfh and cTfr exist in MS patients, which contributes to the reciprocally altered IL-21 and IL-10 production.
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Affiliation(s)
- R. Haque
- Department of Cancer Biomedical ScienceGraduate School of Cancer Science and PolicyNational Cancer CenterGoyangSouth Korea
- Department of NeurologyNational Cancer CenterGoyangSouth Korea
- Division of Clinical ResearchNational Cancer CenterGoyangSouth Korea
| | - Y. Kim
- Department of NeurologyNational Cancer CenterGoyangSouth Korea
- Division of Clinical ResearchNational Cancer CenterGoyangSouth Korea
| | - K. Park
- Division of Clinical ResearchNational Cancer CenterGoyangSouth Korea
| | - H. Jang
- Department of NeurologyNational Cancer CenterGoyangSouth Korea
| | - S. Y. Kim
- Department of NeurologyNational Cancer CenterGoyangSouth Korea
- Division of Clinical ResearchNational Cancer CenterGoyangSouth Korea
| | - H. Lee
- Department of Cancer Biomedical ScienceGraduate School of Cancer Science and PolicyNational Cancer CenterGoyangSouth Korea
| | - H. J. Kim
- Department of Cancer Biomedical ScienceGraduate School of Cancer Science and PolicyNational Cancer CenterGoyangSouth Korea
- Department of NeurologyNational Cancer CenterGoyangSouth Korea
- Division of Clinical ResearchNational Cancer CenterGoyangSouth Korea
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99757
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Rabelo LM, Stival RSM, Drevenowski D, Serafini J, Leão GL, Ferreira MFRQ, Costa FM. Clinical evolution of a severe asthmatics group in the use of immunobiological therapy in a Brazilian Public Hospital. Rev Assoc Med Bras (1992) 2021; 67:931-936. [DOI: 10.1590/1806-9282.20210088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 05/23/2021] [Indexed: 11/22/2022] Open
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99758
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Wang Z, Gao X, Miao H, Ma X, Ding R. Understanding COVID-19-associated coagulopathy: From PIC to SIC or DIC. JOURNAL OF INTENSIVE MEDICINE 2021; 1:35-41. [PMID: 36943814 PMCID: PMC7997848 DOI: 10.1016/j.jointm.2021.03.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 01/29/2021] [Accepted: 03/03/2021] [Indexed: 12/15/2022]
Abstract
Coagulopathy, characterized by a high D-dimer level, is a common pathological occurrence in coronavirus disease 2019 (COVID-19) and is associated with poor prognosis. Severe cases with COVID-19 is associated with a significantly higher risk of deep vein thrombosis and acute pulmonary embolism. Pulmonary intravascular coagulopathy is the characteristic coagulopathy in COVID-19. Unlike sepsis-induced coagulopathy and disseminated intravascular coagulation, which are manifestations of systemic coagulopathy, pulmonary intravascular coagulopathy is a manifestation of a local coagulation disorder in the lung. The progression from pulmonary intravascular coagulopathy to sepsis-induced coagulopathy or disseminated intravascular coagulation in the context of COVID-19 may indicate that the patient's coagulation dysfunction has progressed from local to systemic. Exploring the associated coagulation disease will aid in the understanding of the pathophysiological mechanisms underlying severe COVID-19.
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Affiliation(s)
| | | | | | | | - Renyu Ding
- Corresponding author: Renyu Ding, Department of Critical Care Medicine, The First Hospital of China Medical University, North Nanjing Street 155, Shenyang, Liaoning 110001, China.
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99759
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Brei BK, Sawyer T, Umoren R, Gray MM, Krick J, Foglia EE, Ades A, Glass K, Kim JH, Singh N, Jung P, Johnston L, Moussa A, Napolitano N, Barry J, Zenge J, Quek B, DeMeo SD, Shults J, Unrau J, Nadkarni V, Nishisaki A. Associations between family presence and neonatal intubation outcomes: a report from the National Emergency Airway Registry for Neonates: NEAR4NEOS. Arch Dis Child Fetal Neonatal Ed 2021; 106:392-397. [PMID: 33478956 PMCID: PMC8237190 DOI: 10.1136/archdischild-2020-319709] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 11/21/2020] [Accepted: 12/02/2020] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Describe the current practice of family presence during neonatal tracheal intubations (TIs) across neonatal intensive care units (NICUs) and examine the association with outcomes. DESIGN Retrospective analysis of TIs performed in NICUs participating in the National Emergency Airway Registry for Neonates (NEAR4NEOS). SETTING Thirteen academic NICUs. PATIENTS Infants undergoing TI between October 2014 and December 2017. MAIN OUTCOME MEASURES Association of family presence with TI processes and outcomes including first attempt success (primary outcome), success within two attempts, adverse TI-associated events (TIAEs) and severe oxygen desaturation ≥20% from baseline. RESULTS Of the 2570 TIs, 242 (9.4%) had family presence, which varied by site (median 3.6%, range 0%-33%; p<0.01). Family member was more often present for older infants and those with chronic respiratory failure. Fewer TIs were performed by residents when family was present (FP 10% vs no FP 18%, p=0.041). Among TIs with family presence versus without family presence, the first attempt success rate was 55% vs 49% (p=0.062), success within two attempts was 74% vs 66% (p=0.014), adverse TIAEs were 18% vs 20% (p=0.62) and severe oxygen desaturation was 49% vs 52%, (p=0.40). In multivariate analyses, there was no independent association between family presence and intubation success, adverse TIAEs or severe oxygen desaturation. CONCLUSION Family are present in less than 10% of TIs, with variation across NICUs. Even after controlling for important patient, provider and site factors, there were no significant associations between family presence and intubation success, adverse TIAEs or severe oxygen desaturation.
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Affiliation(s)
- Brianna K Brei
- Pediatrics, Division of Neonatology, University of Nebraska Medical Center, Omaha, Nebraska, USA .,Pediatrics, Division of Neonatology, University of Washington School of Medicine, Seattle, Washington, USA
| | - Taylor Sawyer
- Pediatrics, Division of Neonatology, University of Washington School of Medicine, Seattle, Washington, USA
| | - Rachel Umoren
- Pediatrics, Division of Neonatology, University of Washington School of Medicine, Seattle, Washington, USA
| | - Megan M Gray
- Pediatrics, Division of Neonatology, University of Washington School of Medicine, Seattle, Washington, USA
| | - Jeanne Krick
- Department of Pediatrics, Madigan Army Medical Center, Tacoma, Washington, USA
| | - Elizabeth E Foglia
- Department of Pediatrics, Division of Neonatology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Anne Ades
- Department of Pediatrics, Division of Neonatology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Kristen Glass
- Department of Pediatrics, Division of Neonatology, Penn State Health Milton S Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Jae H Kim
- Perinatal Institute, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA,Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Neetu Singh
- Neonatology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Philipp Jung
- Pediatrics, Universitatsklinikum Schleswig-Holstein, Kiel, Schleswig-Holstein, Germany
| | - Lindsay Johnston
- Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut, USA
| | - Ahmed Moussa
- Pediatrics- Neonatology, Centre Hospitalier Universitaire Sainte-Justine, Montreal, Québec, Canada
| | - Natalie Napolitano
- Nursing and Respiratory Care, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - James Barry
- Pediatrics, Section of Neonatology, University of Colorado Denver School of Medicine, Aurora, Colorado, USA
| | - Jeanne Zenge
- Pediatrics, Section of Neonatology, University of Colorado Denver School of Medicine, Aurora, Colorado, USA
| | - Binhuey Quek
- Department of Neonatology, KK Women's and Children's Hospital, Singapore
| | - Stephen D DeMeo
- Pediatrics, WakeMed Health and Hospitals, Raleigh, North Carolina, USA
| | - Justine Shults
- Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Jennifer Unrau
- Pediatrics, Section of Neonatology, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Vinay Nadkarni
- Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA,Center for Simulation, Advanced Education, and Innovation, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Akira Nishisaki
- Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA,Center for Simulation, Advanced Education, and Innovation, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
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99760
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Braillon A. Letter to the Editor. Crit Care Nurs Q 2021; 44:357-358. [PMID: 34010209 DOI: 10.1097/cnq.0000000000000370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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99761
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Olson AL, Patnaik P, Hartmann N, Bohn RL, Garry EM, Wallace L. Prevalence and Incidence of Chronic Fibrosing Interstitial Lung Diseases with a Progressive Phenotype in the United States Estimated in a Large Claims Database Analysis. Adv Ther 2021; 38:4100-4114. [PMID: 34156606 PMCID: PMC8279991 DOI: 10.1007/s12325-021-01786-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 05/10/2021] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Many fibrosing interstitial lung diseases (ILDs) develop a chronic progressive phenotype. While idiopathic pulmonary fibrosis, which is always progressive, is well characterized with established treatment options, the epidemiology of other chronic fibrosing ILDs with a progressive phenotype has not been widely investigated. Treatment options are limited, with a high unmet need. This claims database study estimates the incidence and prevalence of these diseases in the USA. METHODS Diagnosis, procedure and resource utilization codes from insurance claims were used to identify patients with fibrosing ILD and those with a chronic progressive phenotype among 37,565,644 adult patients in the IBM® MarketScan® Research Database 2012-2015. Two eligible ILD claims were required for a fibrosing ILD diagnosis. Progression was defined using a novel algorithm constituted by criteria considered proxies for progression. Patients were defined as having incident (new) or existing diagnoses based on claims during a 365-day period before study entry. RESULTS The estimated age- and sex-adjusted prevalence per 100,000 persons of fibrosing ILD (95% confidence interval) was 117.82 (116.56, 119.08) and of chronic fibrosing ILDs with a progressive phenotype was 70.30 (69.32, 71.27). The estimated adjusted incidence per 100,000 patient-years of fibrosing ILD was 51.56 (50.88, 52.24) and of chronic fibrosing ILDs with a progressive phenotype was 32.55 (32.01, 33.09). Among incident fibrosing ILD patients, 57.3% experienced progression over a median of 117 days (interquartile range 63-224), with largely comparable rates of progression among different diseases. CONCLUSIONS Chronic fibrosing ILDs with a progressive phenotype comprise a relatively new disease construct requiring varied approaches to obtain reliable estimates of prevalence and incidence. This is the first large claims database study using real-world data to provide estimates of the prevalence and incidence of these diseases among a very large segment of the US population and could form the groundwork for future studies.
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Affiliation(s)
- Amy L Olson
- Interstitial Lung Disease Program, Division of Pulmonary and Critical Care Medicine, Autoimmune Lung Center, National Jewish Health, Denver, CO, USA.
| | - Padmaja Patnaik
- Boehringer Ingelheim Pharmaceuticals, Inc., Ridgefield, CT, USA
| | - Nadine Hartmann
- Boehringer Ingelheim International GmbH, Ingelheim am Rhein, Germany
| | | | | | - Laura Wallace
- Boehringer Ingelheim International GmbH, Ingelheim am Rhein, Germany
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99762
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Reactivation of latent tuberculosis with TNF inhibitors: critical role of the beta 2 chain of the IL-12 receptor. Cell Mol Immunol 2021; 18:1644-1651. [PMID: 34021269 PMCID: PMC8245521 DOI: 10.1038/s41423-021-00694-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 04/26/2021] [Indexed: 02/04/2023] Open
Abstract
Tumor necrosis factor (TNF) inhibitors have improved a lot the treatment of numerous diseases, with the well-known example of rheumatoid arthritis (RA). In the early 2000s, postmarketing data quickly revealed an alarming number of severe tuberculosis (TB) under such treatment. These findings were consistent with previous results in mice where TNF is essential for lymph node formation and granuloma organization. The effects of TNF inhibition on RA synovium structure are very similar to those on granuloma, with changes in cellular interactions, cytokine, and chemokine production. In addition to the role of TNF in granuloma, the interleukin (IL)-12/interferon (IFN)-γ pathway is required for an efficient host defense against TB. Primary and secondary immunodeficiencies affecting this pathway lead to severe bacillus Calmette-Guérin (BCG) reaction or full TB. Any chronic inflammation as in RA induces a systemic Th1 defect that predisposes to TB through specific downregulation of the IL-12Rß2 chain. When TNF inhibitors are initiated, this transiently increases this risk of TB, through effects on cellular interactions in a latent TB granuloma. At a later stage, when a better control disease activity is obtained, the risk of TB is reduced but not abrogated. Given the clear benefit from TNF inhibition, latent TB infection screening at baseline is essential for an optimal safety.
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99763
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Swenson KE, Ruoss SJ, Swenson ER. The Pathophysiology and Dangers of Silent Hypoxemia in COVID-19 Lung Injury. Ann Am Thorac Soc 2021; 18:1098-1105. [PMID: 33621159 PMCID: PMC8328372 DOI: 10.1513/annalsats.202011-1376cme] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 02/23/2021] [Indexed: 01/08/2023] Open
Abstract
The ongoing coronavirus disease (COVID-19) pandemic has been unprecedented on many levels, not least of which are the challenges in understanding the pathophysiology of these new critically ill patients. One widely reported phenomenon is that of a profoundly hypoxemic patient with minimal to no dyspnea out of proportion to the extent of radiographic abnormality and change in lung compliance. This apparently unique presentation, sometimes called "happy hypoxemia or hypoxia" but better described as "silent hypoxemia," has led to the speculation of underlying pathophysiological differences between COVID-19 lung injury and acute respiratory distress syndrome (ARDS) from other causes. We explore three proposed distinctive features of COVID-19 that likely bear on the genesis of silent hypoxemia, including differences in lung compliance, pulmonary vascular responses to hypoxia, and nervous system sensing and response to hypoxemia. In the context of known principles of respiratory physiology and neurobiology, we discuss whether these particular findings are due to direct viral effects or, equally plausible, are within the spectrum of typical ARDS pathophysiology and the wide range of hypoxic ventilatory and pulmonary vascular responses and dyspnea perception in healthy people. Comparisons between lung injury patterns in COVID-19 and other causes of ARDS are clouded by the extent and severity of this pandemic, which may underlie the description of "new" phenotypes, although our ability to confirm these phenotypes by more invasive and longitudinal studies is limited. However, given the uncertainty about anything unique in the pathophysiology of COVID-19 lung injury, there are no compelling pathophysiological reasons at present to support a therapeutic approach for these patients that is different from the proven standards of care in ARDS.
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Affiliation(s)
- Kai E. Swenson
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Stephen J. Ruoss
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, Stanford University, Stanford, California
| | - Erik R. Swenson
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Washington, Seattle, Washington; and
- Medical Service, Veterans Affairs Puget Sound Health Care System, Seattle, Washington
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99764
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Ryou MG, Chen X, Cai M, Wang H, Jung ME, Metzger DB, Mallet RT, Shi X. Intermittent Hypoxia Training Prevents Deficient Learning-Memory Behavior in Mice Modeling Alzheimer's Disease: A Pilot Study. Front Aging Neurosci 2021; 13:674688. [PMID: 34276338 PMCID: PMC8282412 DOI: 10.3389/fnagi.2021.674688] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 05/27/2021] [Indexed: 11/16/2022] Open
Abstract
In mouse models of Alzheimer's disease (AD), normobaric intermittent hypoxia training (IHT) can preserve neurobehavioral function when applied before deficits develop, but IHT's effectiveness after onset of amyloid-β (Aβ) accumulation is unclear. This study tested the hypothesis that IHT improves learning-memory behavior, diminishes Aβ accumulation in cerebral cortex and hippocampus, and enhances cerebrocortical contents of the neuroprotective trophic factors erythropoietin and brain-derived neurotrophic factor (BDNF) in mice manifesting AD traits. Twelve-month-old female 3xTg-AD mice were assigned to untreated 3xTg-AD (n = 6), AD+IHT (n = 6), and AD+sham-IHT (n = 6) groups; 8 untreated wild-type (WT) mice also were studied. AD+IHT mice alternately breathed 10% O2 for 6 min and room air for 4 min, 10 cycles/day for 21 days; AD+sham-IHT mice breathed room air. Spatial learning-memory was assessed by Morris water maze. Cerebrocortical and hippocampal Aβ40 and Aβ42 contents were determined by ELISA, and cerebrocortical erythropoietin and BDNF were analyzed by immunoblotting and ELISA. The significance of time (12 vs. 12 months + 21 days) and treatment (IHT vs. sham-IHT) was evaluated by two-factor ANOVA. The change in swimming distance to find the water maze platform after 21 d IHT (-1.6 ± 1.8 m) differed from that after sham-IHT (+5.8 ± 2.6 m). Cerebrocortical and hippocampal Aβ42 contents were greater in 3xTg-AD than WT mice, but neither time nor treatment significantly affected Aβ40 or Aβ42 contents in the 3xTg-AD mice. Cerebrocortical erythropoietin and BDNF contents increased appreciably after IHT as compared to untreated 3xTg-AD and AD+sham-IHT mice. In conclusion, moderate, normobaric IHT prevented spatial learning-memory decline and restored cerebrocortical erythropoietin and BDNF contents despite ongoing Aβ accumulation in 3xTg-AD mice.
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Affiliation(s)
- Myoung-Gwi Ryou
- Department of Medical Laboratory Science and Public Health, Tarleton State University, Texas A&M University System, Stephenville, TX, United States
| | - Xiaoan Chen
- Department of Pharmacology and Neuroscience, University of North Texas Health Science Center, Fort Worth, TX, United States
- College of Sports Science, Jishou University, Jishou, China
| | - Ming Cai
- Department of Pharmacology and Neuroscience, University of North Texas Health Science Center, Fort Worth, TX, United States
- College of Rehabilitation Sciences, Shanghai University of Medicine and Health Sciences, Shanghai, China
| | - Hong Wang
- Department of Pharmacology and Neuroscience, University of North Texas Health Science Center, Fort Worth, TX, United States
- College of Rehabilitation Sciences, Shanghai University of Medicine and Health Sciences, Shanghai, China
| | - Marianna E. Jung
- Department of Pharmacology and Neuroscience, University of North Texas Health Science Center, Fort Worth, TX, United States
| | - Daniel B. Metzger
- Department of Pharmacology and Neuroscience, University of North Texas Health Science Center, Fort Worth, TX, United States
| | - Robert T. Mallet
- Department of Physiology and Anatomy, University of North Texas Health Science Center, Fort Worth, TX, United States
| | - Xiangrong Shi
- Department of Pharmacology and Neuroscience, University of North Texas Health Science Center, Fort Worth, TX, United States
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99765
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Kupari M, Lehtonen J. POINT: Should Isolated Cardiac Sarcoidosis Be Considered a Significant Manifestation of Sarcoidosis? Yes. Chest 2021; 160:36-38. [PMID: 34246374 DOI: 10.1016/j.chest.2020.12.037] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 12/13/2020] [Indexed: 10/20/2022] Open
Affiliation(s)
- Markku Kupari
- Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland.
| | - Jukka Lehtonen
- Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland
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99766
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Laddu DR, Ozemek C, Sabbahi A, Severin R, Phillips SA, Arena R. Prioritizing movement to address the frailty phenotype in heart failure. Prog Cardiovasc Dis 2021; 67:26-32. [PMID: 33556427 PMCID: PMC8342629 DOI: 10.1016/j.pcad.2021.01.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 01/29/2021] [Indexed: 12/12/2022]
Abstract
Frailty is a highly prevalent multisystem syndrome in older adults with heart failure (HF) and is associated with poor clinical prognosis and increased complexity of care. While frailty is neither disease nor age specific, it is a clinical manifestation of aging-related processes that reflects a reduced physiological ability to tolerate and recover from stress associated with aging, disease, or therapy. Within this context, physical frailty, which is distinctly oriented to physical functional domains (e.g., muscle weakness, slowness, and low activity), has been recognized as a critical vital sign in older persons with HF. Identification and routine assessment of physical frailty, using objective physical performance measures, may guide the course of patient-centered treatment plans that maximize the likelihood of improving clinical outcomes in older HF patients. Exercise-based rehabilitation is a primary therapy to improve cardiovascular health in patients with HF; however, the limited evidence supporting the effectiveness of exercise tailored to older and frail HF patients underscores the current gaps in management of their care. Interdisciplinary exercise interventions designed with consideration of physical frailty as a therapeutic target may be an important strategy to counteract functional deficits characteristic of frailty and HF, and to improve patient-centered outcomes in this population. The purpose of this current review is to provide a better understanding of physical frailty and its relation to management of care in older patients with HF. Implications of movement-based interventions, including exercise and physical rehabilitation, to prevent or reverse physical frailty and improve clinical outcomes will further be discussed.
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Affiliation(s)
- Deepika R Laddu
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, United States of America; Healthy Living for Pandemic Event Protection (HL - PIVOT) Network, Chicago, IL, USA.
| | - Cemal Ozemek
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, United States of America; Integrative Physiology Laboratory, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, United States of America
| | - Ahmad Sabbahi
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, United States of America; Healthy Living for Pandemic Event Protection (HL - PIVOT) Network, Chicago, IL, USA
| | - Richard Severin
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, United States of America; Integrative Physiology Laboratory, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, United States of America; Healthy Living for Pandemic Event Protection (HL - PIVOT) Network, Chicago, IL, USA
| | - Shane A Phillips
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, United States of America; Integrative Physiology Laboratory, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, United States of America; Healthy Living for Pandemic Event Protection (HL - PIVOT) Network, Chicago, IL, USA
| | - Ross Arena
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, United States of America; Healthy Living for Pandemic Event Protection (HL - PIVOT) Network, Chicago, IL, USA
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99767
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DeBoer EM, Liptzin DR, Humphries SM, Lynch DA, Robison K, Galambos C, Dishop MK, Deterding RR, Weinman JP. Ground glass and fibrotic change in children with surfactant protein C dysfunction mutations. Pediatr Pulmonol 2021; 56:2223-2231. [PMID: 33666361 DOI: 10.1002/ppul.25356] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 02/08/2021] [Accepted: 02/21/2021] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Therapeutics exist to treat fibrotic lung disease in adults, but these have not been investigated in children. Defining biomarkers for pediatric fibrotic lung disease in children is crucial for clinical trials. Children with surfactant protein C (SFTPC) dysfunction mutations develop fibrotic lung disease over time. We evaluated chest computed tomography (CT) changes over time in children with SFTPC dysfunction mutations. METHODS We performed an institutional review board-approved retrospective review of children with SFTPC dysfunction mutations. We collected demographic and clinical information. Chest CT scans were evaluated using visual and computerized scores. Chest CT scores and pulmonary function tests were reviewed. RESULTS Eleven children were included. All children presented in infancy and four children suffered from respiratory failure requiring mechanical ventilation. Those who performed pulmonary function tests had stable forced vital capacities over time by percent predicted, but increased forced vital capacity in liters. CT findings evolved over time in most patients with earlier CT scans demonstrating ground glass opacities and later CT scans with more fibrotic features. In a pilot analysis, data-driven textural analysis software identified fibrotic features in children with SFTPC dysfunction that increased over time and correlated with visual CT scores. DISCUSSION We describe 11 children with SFTPC dysfunction mutations. Increases in forced vital capacity over time suggest that these children experience lung growth and that therapeutic intervention may maximize lung growth. Ground glass opacities are the primary early imaging findings while fibrotic features dominate later. CT findings suggest the development of and increases in fibrotic features that may serve as potential biomarkers for antifibrotic therapeutic trials.
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Affiliation(s)
- Emily M DeBoer
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.,Breathing Institute, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Deborah R Liptzin
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.,Breathing Institute, Children's Hospital Colorado, Aurora, Colorado, USA
| | | | - David A Lynch
- Department of Radiology, National Jewish Health, Denver, Colorado, USA
| | - Kyle Robison
- Breathing Institute, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Csaba Galambos
- Breathing Institute, Children's Hospital Colorado, Aurora, Colorado, USA.,Department of Pathology and Laboratory Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Megan K Dishop
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.,Breathing Institute, Children's Hospital Colorado, Aurora, Colorado, USA.,Department of Pathology, University of Arizona, Phoenix, Arizona, USA
| | - Robin R Deterding
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.,Breathing Institute, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Jason P Weinman
- Breathing Institute, Children's Hospital Colorado, Aurora, Colorado, USA.,Department of Radiology, University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, Aurora, Colorado, USA
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99768
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Dispenzieri A. POEMS syndrome: 2021 Update on diagnosis, risk-stratification, and management. Am J Hematol 2021; 96:872-888. [PMID: 34000085 DOI: 10.1002/ajh.26240] [Citation(s) in RCA: 55] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 05/14/2021] [Indexed: 01/03/2023]
Abstract
DISEASE OVERVIEW POEMS syndrome is a paraneoplastic syndrome due to an underlying plasma cell neoplasm. The major criteria for the syndrome are polyradiculoneuropathy, clonal plasma cell disorder (PCD), sclerotic bone lesions, elevated vascular endothelial growth factor, and the presence of Castleman disease. Minor features include organomegaly, endocrinopathy, characteristic skin changes, papilledema, extravascular volume overload, and thrombocytosis. DIAGNOSIS The diagnosis of POEMS syndrome is made with three of the major criteria, two of which must include polyradiculoneuropathy and clonal plasma cell disorder, and at least one of the minor criteria. RISK STRATIFICATION Because the pathogenesis of the syndrome is not well understood, risk stratification is limited to clinical phenotype rather than specific molecular markers. Risk factors include low serum albumin, age, pleural effusion, pulmonary hypertension, and reduced eGFR. RISK-ADAPTED THERAPY For those patients with a dominant plasmacytoma, first line therapy is irradiation. Patients with diffuse sclerotic lesions or disseminated bone marrow involvement and for those who have progression of their disease 3-6 months after completing radiation therapy should receive systemic therapy. Corticosteroids are temporizing, but alkylators are the mainstay of treatment, either in the form of low dose conventional therapy or high dose with stem cell transplantation. Lenalidomide shows promise with manageable toxicity. Thalidomide and bortezomib also have activity, but their benefit needs to be weighed against their risk of exacerbating the peripheral neuropathy. Prompt recognition and institution of both supportive care measures and therapy directed against the plasma cell result in the best outcomes.
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Affiliation(s)
- Angela Dispenzieri
- Division of Hematology, Department of Medicine Mayo Clinic Rochester Minnesota USA
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99769
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Hugo Montes A, Valle-Garay E, Martin G, Collazos J, Alvarez V, Meana A, Pérez-Is L, Carton JA, Taboada F, Asensi V. The TNF-α ( -238 G/A) polymorphism could protect against development of severe sepsis. Innate Immun 2021; 27:409-420. [PMID: 34472396 PMCID: PMC8419297 DOI: 10.1177/17534259211036186] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 07/13/2021] [Indexed: 12/15/2022] Open
Abstract
Primary responses in sepsis-mediated inflammation are regulated by pro-inflammatory cytokines. Variations in the cytokine genes might modify their transcription or expression, plasma cytokines levels and response to sepsis. Activation protein-1 (AP-1) and NF-κB regulate cytokines gene expression in sepsis. A total of 90 severely septic and 91 non-infected patients were prospectively studied. IL-1α (-889 C/T), IL-1β (+3954 C/T), IL-6 (-174 G/C), TNF-α (-238 G/A), TNF-α (-308G/A), IL-8 (-251A/T) and IL-10 (-1082 G/A) SNPs, plasma IL-1β, IL-4, IL-6, IL-8, IL-10, IL-13, IFN-γ, TNF-α and monocyte chemoattractant protein 1 (MCP-1) levels, and AP-1 and NF-κB gene expression by neutrophils were assessed. A allele carriers of TNF-α (-238 G/A) SNP were less frequent among septic patients. IL-6, IL-8, IL-10, TNF-α and MCP-1 levels were higher, and AP-1 and NF-κB gene expressions lower in septic patients. Sepsis was independently associated with higher fibrinogen, neutrophils counts and IL-8 levels, lower prothrombin, absence of the variant A allele of the TNF-α (-238 G/A) SNP, and haemodynamic failure. Death was independently associated with a higher APACHE II score, higher IL-8 levels, and the diagnosis of sepsis. TNF-a (-238 G/A) SNP could protect against sepsis development. Higher IL-8 levels are predictive of sepsis and mortality.
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Affiliation(s)
- A. Hugo Montes
- Biochemistry and Molecular Biology, Oviedo University School of Medicine, Spain
- Group of Translational Research in Infectious Diseases, Instituto de investigación Sanitaria del Principado de Asturias (ISPA), Spain
| | - Eulalia Valle-Garay
- Biochemistry and Molecular Biology, Oviedo University School of Medicine, Spain
- Group of Translational Research in Infectious Diseases, Instituto de investigación Sanitaria del Principado de Asturias (ISPA), Spain
| | - Guadalupe Martin
- Critical Care, Hospital Universitario Central de Asturias (HUCA), Spain
| | | | - Victoria Alvarez
- Molecular Genetics Unit-Nephrology Research Institute, Hospital Universitario Central de Asturias (HUCA), Spain
| | - Alvaro Meana
- Community Centre for Blood and Tissues of Asturias, CIBERER U714, Spain
| | - Laura Pérez-Is
- Biochemistry and Molecular Biology, Oviedo University School of Medicine, Spain
- Group of Translational Research in Infectious Diseases, Instituto de investigación Sanitaria del Principado de Asturias (ISPA), Spain
| | - José A. Carton
- Group of Translational Research in Infectious Diseases, Instituto de investigación Sanitaria del Principado de Asturias (ISPA), Spain
- Infectious Diseases Unit, Hospital Universitario Central de Asturias (HUCA), Oviedo University School of Medicine, Spain
| | - Francisco Taboada
- Critical Care, Hospital Universitario Central de Asturias (HUCA), Spain
| | - Víctor Asensi
- Group of Translational Research in Infectious Diseases, Instituto de investigación Sanitaria del Principado de Asturias (ISPA), Spain
- Infectious Diseases Unit, Hospital Universitario Central de Asturias (HUCA), Oviedo University School of Medicine, Spain
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99770
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Venugopala KN, Chandrashekharappa S, Deb PK, Tratrat C, Pillay M, Chopra D, Al-Shar'i NA, Hourani W, Dahabiyeh LA, Borah P, Nagdeve RD, Nayak SK, Padmashali B, Morsy MA, Aldhubiab BE, Attimarad M, Nair AB, Sreeharsha N, Haroun M, Shashikanth S, Mohanlall V, Mailavaram R. Anti-tubercular activity and molecular docking studies of indolizine derivatives targeting mycobacterial InhA enzyme. J Enzyme Inhib Med Chem 2021; 36:1472-1487. [PMID: 34210233 PMCID: PMC8259857 DOI: 10.1080/14756366.2021.1919889] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
A series of 1,2,3-trisubstituted indolizines (2a-2f, 3a-3d, and 4a-4c) were screened for in vitro whole-cell anti-tubercular activity against the susceptible H37Rv and multidrug-resistant (MDR) Mycobacterium tuberculosis (MTB) strains. Compounds 2b-2d, 3a-3d, and 4a-4c were active against the H37Rv-MTB strain with minimum inhibitory concentration (MIC) ranging from 4 to 32 µg/mL, whereas the indolizines 4a-4c, with ethyl ester group at the 4-position of the benzoyl ring also exhibited anti-MDR-MTB activity (MIC = 16-64 µg/mL). In silico docking study revealed the enoyl-acyl carrier protein reductase (InhA) and anthranilate phosphoribosyltransferase as potential molecular targets for the indolizines. The X-ray diffraction analysis of the compound 4b was also carried out. Further, a safety study (in silico and in vitro) demonstrated no toxicity for these compounds. Thus, the indolizines warrant further development and may represent a novel promising class of InhA inhibitors and multi-targeting agents to combat drug-sensitive and drug-resistant MTB strains.
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Affiliation(s)
- Katharigatta N Venugopala
- Department of Pharmaceutical Sciences, College of Clinical Pharmacy, King Faisal University, Al-Ahsa, Saudi Arabia.,Department of Biotechnology and Food Technology, Durban University of Technology, Durban, South Africa
| | | | - Pran Kishore Deb
- Faculty of Pharmacy, Department of Pharmaceutical Sciences, Philadelphia University, Amman, Jordan
| | - Christophe Tratrat
- Department of Pharmaceutical Sciences, College of Clinical Pharmacy, King Faisal University, Al-Ahsa, Saudi Arabia
| | - Melendhran Pillay
- Department of Microbiology, National Health Laboratory Services, KZN Academic Complex, Inkosi Albert Luthuli Central Hospital, Durban, South Africa
| | - Deepak Chopra
- Department of Chemistry, Indian Institute of Science Education and Research Bhopal, Bhopal, India
| | - Nizar A Al-Shar'i
- Faculty of Pharmacy, Department of Medicinal Chemistry and Pharmacognosy, Jordan University of Science and Technology, Irbid, Jordan
| | - Wafa Hourani
- Faculty of Pharmacy, Department of Pharmaceutical Sciences, Philadelphia University, Amman, Jordan
| | - Lina A Dahabiyeh
- Department of Pharmaceutical Sciences, School of Pharmacy, The University of Jordan, Amman, Jordan
| | - Pobitra Borah
- Pratiksha Institute of Pharmaceutical Sciences, Guwahati, India
| | - Rahul D Nagdeve
- Department of Chemistry, Visvesvaraya National Institute of Technology, Nagpur, India
| | - Susanta K Nayak
- Department of Chemistry, Visvesvaraya National Institute of Technology, Nagpur, India
| | - Basavaraj Padmashali
- Department of Chemistry, School of Basic Science, Rani Channamma University, Belagavi, India
| | - Mohamed A Morsy
- Department of Pharmaceutical Sciences, College of Clinical Pharmacy, King Faisal University, Al-Ahsa, Saudi Arabia.,Faculty of Medicine, Department of Pharmacology, Minia University, El-Minia, Egypt
| | - Bandar E Aldhubiab
- Department of Pharmaceutical Sciences, College of Clinical Pharmacy, King Faisal University, Al-Ahsa, Saudi Arabia
| | - Mahesh Attimarad
- Department of Pharmaceutical Sciences, College of Clinical Pharmacy, King Faisal University, Al-Ahsa, Saudi Arabia
| | - Anroop B Nair
- Department of Pharmaceutical Sciences, College of Clinical Pharmacy, King Faisal University, Al-Ahsa, Saudi Arabia
| | - Nagaraja Sreeharsha
- Department of Pharmaceutical Sciences, College of Clinical Pharmacy, King Faisal University, Al-Ahsa, Saudi Arabia.,Department of Pharmaceutics, Vidya Siri College of Pharmacy, Bangalore, India
| | - Michelyne Haroun
- Department of Pharmaceutical Sciences, College of Clinical Pharmacy, King Faisal University, Al-Ahsa, Saudi Arabia
| | - Sheena Shashikanth
- Department of Studies in Organic Chemistry, University of Mysore, Mysore, India
| | - Viresh Mohanlall
- Department of Biotechnology and Food Technology, Durban University of Technology, Durban, South Africa
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99771
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Chan KH, Yan M, Bennett DA, Guo Y, Chen Y, Yang L, Lv J, Yu C, Pei P, Lu Y, Li L, Du H, Lam KBH, Chen Z. Long-term solid fuel use and risks of major eye diseases in China: A population-based cohort study of 486,532 adults. PLoS Med 2021; 18:e1003716. [PMID: 34324491 PMCID: PMC8321372 DOI: 10.1371/journal.pmed.1003716] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 06/29/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Over 3.5 billion individuals worldwide are exposed to household air pollution from solid fuel use. There is limited evidence from cohort studies on associations of solid fuel use with risks of major eye diseases, which cause substantial disease and economic burden globally. METHODS AND FINDINGS The China Kadoorie Biobank recruited 512,715 adults aged 30 to 79 years from 10 areas across China during 2004 to 2008. Cooking frequency and primary fuel types in the 3 most recent residences were assessed by a questionnaire. During median (IQR) 10.1 (9.2 to 11.1) years of follow-up, electronic linkages to national health insurance databases identified 4,877 incident conjunctiva disorders, 13,408 cataracts, 1,583 disorders of sclera, cornea, iris, and ciliary body (DSCIC), and 1,534 cases of glaucoma. Logistic regression yielded odds ratios (ORs) for each disease associated with long-term use of solid fuels (i.e., coal or wood) compared to clean fuels (i.e., gas or electricity) for cooking, with adjustment for age at baseline, birth cohort, sex, study area, education, occupation, alcohol intake, smoking, environmental tobacco smoke, cookstove ventilation, heating fuel exposure, body mass index, prevalent diabetes, self-reported general health, and length of recall period. After excluding participants with missing or unreliable exposure data, 486,532 participants (mean baseline age 52.0 [SD 10.7] years; 59.1% women) were analysed. Overall, 71% of participants cooked regularly throughout the recall period, of whom 48% used solid fuels consistently. Compared with clean fuel users, solid fuel users had adjusted ORs of 1.32 (1.07 to 1.37, p < 0.001) for conjunctiva disorders, 1.17 (1.08 to 1.26, p < 0.001) for cataracts, 1.35 (1.10 to 1.66, p = 0.0046) for DSCIC, and 0.95 (0.76 to 1.18, p = 0.62) for glaucoma. Switching from solid to clean fuels was associated with smaller elevated risks (over long-term clean fuel users) than nonswitching, with adjusted ORs of 1.21 (1.07 to 1.37, p < 0.001), 1.05 (0.98 to 1.12, p = 0.17), and 1.21 (0.97 to 1.50, p = 0.088) for conjunctiva disorders, cataracts, and DSCIC, respectively. The adjusted ORs for the eye diseases were broadly similar in solid fuel users regardless of ventilation status. The main limitations of this study include the lack of baseline eye disease assessment, the use of self-reported cooking frequency and fuel types for exposure assessment, the risk of bias from delayed diagnosis (particularly for cataracts), and potential residual confounding from unmeasured factors (e.g., sunlight exposure). CONCLUSIONS Among Chinese adults, long-term solid fuel use for cooking was associated with higher risks of not only conjunctiva disorders but also cataracts and other more severe eye diseases. Switching to clean fuels appeared to mitigate the risks, underscoring the global health importance of promoting universal access to clean fuels.
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Affiliation(s)
- Ka Hung Chan
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, United Kingdom
- Oxford British Heart Foundation Centre of Research Excellence, University of Oxford, United Kingdom
| | - Mingshu Yan
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, United Kingdom
- MRC Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, United Kingdom
| | - Derrick A. Bennett
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, United Kingdom
- NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, United Kingdom
| | - Yu Guo
- Chinese Academy of Medical Science, Beijing, China
| | - Yiping Chen
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, United Kingdom
- MRC Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, United Kingdom
| | - Ling Yang
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, United Kingdom
- MRC Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, United Kingdom
| | - Jun Lv
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China
| | - Canqing Yu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China
| | - Pei Pei
- Chinese Academy of Medical Science, Beijing, China
| | - Yan Lu
- NCD Prevention and Control Department, Suzhou Center for Disease Control and Prevention, Suzhou, China
| | - Liming Li
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China
| | - Huaidong Du
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, United Kingdom
- MRC Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, United Kingdom
| | - Kin Bong Hubert Lam
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, United Kingdom
| | - Zhengming Chen
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, United Kingdom
- MRC Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, United Kingdom
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99772
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Nair S, Rocha‐Ferreira E, Fleiss B, Nijboer CH, Gressens P, Mallard C, Hagberg H. Neuroprotection offered by mesenchymal stem cells in perinatal brain injury: Role of mitochondria, inflammation, and reactive oxygen species. J Neurochem 2021; 158:59-73. [PMID: 33314066 PMCID: PMC8359360 DOI: 10.1111/jnc.15267] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 12/03/2020] [Accepted: 12/03/2020] [Indexed: 12/11/2022]
Abstract
Preclinical studies have shown that mesenchymal stem cells have a positive effect in perinatal brain injury models. The mechanisms that cause these neurotherapeutic effects are not entirely intelligible. Mitochondrial damage, inflammation, and reactive oxygen species are considered to be critically involved in the development of injury. Mesenchymal stem cells have immunomodulatory action and exert mitoprotective effects which attenuate production of reactive oxygen species and promote restoration of tissue function and metabolism after perinatal insults. This review summarizes the present state, the underlying causes, challenges and possibilities for effective clinical translation of mesenchymal stem cell therapy.
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Affiliation(s)
- Syam Nair
- Centre of Perinatal Medicine and Health, Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden
- Institute of Neuroscience and PhysiologySahlgrenska Academy, University of GothenburgGothenburgSweden
- Institute of Clinical SciencesSahlgrenska Academy, University of GothenburgGothenburgSweden
| | - Eridan Rocha‐Ferreira
- Centre of Perinatal Medicine and Health, Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden
- Institute of Neuroscience and PhysiologySahlgrenska Academy, University of GothenburgGothenburgSweden
- Institute of Clinical SciencesSahlgrenska Academy, University of GothenburgGothenburgSweden
| | - Bobbi Fleiss
- School of Health and Biomedical SciencesRMIT UniversityBundooraVictoriaAustralia
- Université de Paris, NeuroDiderotParisFrance
| | - Cora H Nijboer
- Department for Developmental Origins of DiseaseUniversity Medical Center Utrecht Brain Center and Wilhelmina Children’s Hospital, Utrecht UniversityUtrechtNetherlands
| | | | - Carina Mallard
- Centre of Perinatal Medicine and Health, Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden
- Institute of Neuroscience and PhysiologySahlgrenska Academy, University of GothenburgGothenburgSweden
| | - Henrik Hagberg
- Centre of Perinatal Medicine and Health, Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden
- Institute of Clinical SciencesSahlgrenska Academy, University of GothenburgGothenburgSweden
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99773
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Shah PH, Lee JH, Salvi DJ, Rabbani R, Gavini DR, Hamid P. Cardiovascular System Involvement in Cystic Fibrosis. Cureus 2021; 13:e16723. [PMID: 34513358 PMCID: PMC8405250 DOI: 10.7759/cureus.16723] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 07/29/2021] [Indexed: 11/05/2022] Open
Abstract
Cystic fibrosis (CF) is an autosomal recessive disease primarily affecting the respiratory system and gastrointestinal system. The life expectancy of patients with CF has significantly improved due to medical advancement and the effective use of screening techniques. However, new challenges have emerged. Particularly those involving cardiovascular pathology. This study aims to provide a better understanding of the different mechanisms that cause cardiovascular complications in patients with CF, which would help find an efficient treatment that not only prolongs survival but also improves their quality of life. This study extensively reviews different theories such as right ventricular hypertrophy due to lung pathology, ventricular interdependence, the association of nutritional deficiencies and severe cystic fibrosis transmembrane conductance regulator (CFTR) genotypes with myocardial fibrosis, effects of hypoxia, recurrent infections, and systemic inflammation of the heart and blood vessels that explain the direct or indirect involvement of the cardiovascular system in CF. For this review, 258 articles were retrieved from PubMed and Google Scholar. Out of which, a total of 12 high-quality articles were selected using appropriate quality assessment tools and preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. The result of this study suggests that early detection of cardiovascular dysfunction can improve the survival rate of the patient. Furthermore, this study could aid future researchers in the exploration of various best screening modality techniques for the early detection of cardiovascular dysfunction.
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Affiliation(s)
- Prutha H Shah
- Internal Medicine, Pediatrics, California Institute of Behavioral Neurosciences & Psychology (CIBNP), Fairfield, USA
| | - Jun Hee Lee
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology (CIBNP), Fairfield, USA
| | - Dhairya J Salvi
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology (CIBNP), Fairfield, USA
| | - Rizwan Rabbani
- Nephrology, California Institute of Behavioral Neurosciences & Psychology (CIBNP), Fairfield, USA
| | - Divya R Gavini
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology (CIBNP), Fairfield, USA
| | - Pousette Hamid
- Neurology, California Institute of Behavioral Neurosciences & Psychology (CIBNP), Fairfield, USA
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99774
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Lamau MC, Ruiz E, Merrer J, Sibiude J, Huon C, Lepercq J, Goffinet F, Jarreau PH. A new individualized prognostic approach to the management of women at risk of extreme preterm birth in France: Effect on neonatal outcome. Arch Pediatr 2021; 28:366-373. [PMID: 34059380 DOI: 10.1016/j.arcped.2021.04.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 03/19/2021] [Accepted: 04/16/2021] [Indexed: 11/17/2022]
Abstract
INTRODUCTION After discussion with the parents, periviable infants can receive either active treatment or palliative care. The rate of active treatment in France is lower than in other developed countries, as is the survival rate of infants in this gestational age range. This study's main objective was to assess the effect of a standardized perinatal management protocol (EXPRIM) on the neonatal outcome of children born before 27 weeks of gestation. METHODS A before-and-after study was conducted in the two level-3 hospitals of the Risks and Pregnancy DHU to compare two 16-month periods. The EXPRIM protocol was based on routine administration of prenatal corticosteroid therapy and a scheduled combined obstetric-pediatric group prenatal prognostic evaluation, not based solely on gestational age. The study included all births between 22 weeks and 26 weeks+6 days of gestation, except in utero deaths diagnosed at admission and medical terminations of pregnancy for fetal malformation, both excluded. The principal endpoint was survival without severe neonatal morbidity. RESULTS The study included 267 women: 116 (128 newborns) in period 1 and 151 (172 newborns) in period 2. The median gestational age at admission to the maternity unit was 2.5 days younger in period 2, and the number of women admitted at 22-23 weeks doubled in period 2 (59 vs 29, respectively). Overall, the rates of live births, NICU transfer, and survival without severe morbidity were similar during the two periods. More infants were liveborn between 22 and 24 weeks in period 2 (66 vs 43). Of all newborns transferred to the NICU, 26 (29%) survived without severe morbidity in period 1 and 46 (39%) in period 2. After multivariate analysis, survival without severe morbidity did not differ significantly. CONCLUSION Implementation of the EXPRIM protocol led to active treatment of more mothers and their children at the border of viability, and increased the number of children who survived without severe morbidity even if, overall, there was no statistically significant difference in percentage.
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Affiliation(s)
- M C Lamau
- Maternité Port-Royal, AP-HP, APHP, Centre-Université de Paris, FHU PREMA, 123, Bd de Port-Royal, 75014 Paris, France
| | - E Ruiz
- Service de médecine et réanimation néonatales de Port-Royal, AP-HP, APHP, Centre-Université de Paris, FHU PREMA, 123, Bd de Port-Royal, 75014 Paris, France
| | - J Merrer
- Clinical Research Unit of Paris Descartes Necker Cochin, AP-HP, 123, Bd de Port-Royal, 75014 Paris, France; Université de Paris, INSERM U1153, Équipe de recherche en Epidémiologie Obstétricale, Périnatale et Pédiatrique (EPOPé), Centre de Recherche Épidémiologie et Biostatistique Sorbonne Paris Cité (CRESS), 123, Bd de Port-Royal, 75014 Paris, France
| | - J Sibiude
- Service de Gynécologie-Obstétrique, AP-HP, Nord-Université de Paris, Hôpital Louis Mourier, DMU Gynécologie-Périnatalité, FHU PREMA, Colombes, France, IAME-INSERM, Paris, France
| | - C Huon
- Service de Néonatologie, AP-HP, APHP. Nord-Université de Paris, Hôpital Louis Mourier, DMU Gynécologie-Périnatalité, FHU PREMA, 178, rue des Renouillers, 92700 Colombes, France
| | - J Lepercq
- Maternité Port-Royal, AP-HP, APHP, Centre-Université de Paris, FHU PREMA, 123, Bd de Port-Royal, 75014 Paris, France
| | - F Goffinet
- Maternité Port-Royal, AP-HP, APHP, Centre-Université de Paris, FHU PREMA, 123, Bd de Port-Royal, 75014 Paris, France; Université de Paris, INSERM U1153, Équipe de recherche en Epidémiologie Obstétricale, Périnatale et Pédiatrique (EPOPé), Centre de Recherche Épidémiologie et Biostatistique Sorbonne Paris Cité (CRESS), 123, Bd de Port-Royal, 75014 Paris, France
| | - Pierre Henri Jarreau
- Service de médecine et réanimation néonatales de Port-Royal, AP-HP, APHP, Centre-Université de Paris, FHU PREMA, 123, Bd de Port-Royal, 75014 Paris, France; Université de Paris, INSERM U1153, Équipe de recherche en Epidémiologie Obstétricale, Périnatale et Pédiatrique (EPOPé), Centre de Recherche Épidémiologie et Biostatistique Sorbonne Paris Cité (CRESS), 123, Bd de Port-Royal, 75014 Paris, France.
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99775
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Panta P, Dhopathi SR, Andhavarapu A, Patil S. Yogic-humming: A Respiratory Defense Booster for COVID Times. J Contemp Dent Pract 2021; 22:721-723. [PMID: 34615773 DOI: 10.5005/jp-journals-10024-3134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/13/2023]
Abstract
The traditional Indian healthcare system of Yoga contains a wealth of health-promotional practices-some of which are based on "humming." "Humming" is produced when a wordless sound is forced to exit through the nose while keeping the mouth either fully closed or nearly closed; it is a low, prolonged, and buzzing sound. In humming practices like "Bhramari pranayama" (normal inhalation followed by lengthened exhalation + bee-like humming), there is a full-mouth closure,1 and in practices like "OM chanting" (normal inhalation followed by lengthened exhalation +OM humming), there is a near-closure. Besides these, other mantra-oriented practices also generate a similar humming effect.
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Affiliation(s)
- Prashanth Panta
- Department of Oral Medicine and Radiology, MNR Dental College and Hospital, Sangareddy, Telangana, India, Phone +91 9701806830, e-mail:
| | - Sravya Reddy Dhopathi
- Department of Periodontics, MNR Dental College and Hospital, Sangareddy, Telangana, India
| | - Archana Andhavarapu
- Department of Respiratory Medicine, Malla Reddy Medical College for Women, Hyderabad, Telangana, India
| | - Shankargouda Patil
- Department of Maxillofacial Surgery and Diagnostic Sciences, Division of Oral Pathology, College of Dentistry, Jazan University, Jazan, Saudi Arabia
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99776
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Elmunzer BJ, Spitzer RL, Foster LD, Merchant AA, Howard EF, Patel VA, West MK, Qayed E, Nustas R, Zakaria A, Piper MS, Taylor JR, Jaza L, Forbes N, Chau M, Lara LF, Papachristou GI, Volk ML, Hilson LG, Zhou S, Kushnir VM, Lenyo AM, McLeod CG, Amin S, Kuftinec GN, Yadav D, Fox C, Kolb JM, Pawa S, Pawa R, Canakis A, Huang C, Jamil LH, Aneese AM, Glamour BK, Smith ZL, Hanley KA, Wood J, Patel HK, Shah JN, Agarunov E, Sethi A, Fogel EL, McNulty G, Haseeb A, Trieu JA, Dixon RE, Yang JY, Mendelsohn RB, Calo D, Aroniadis OC, LaComb JF, Scheiman JM, Sauer BG, Dang DT, Piraka CR, Shah ED, Pohl H, Tierney WM, Mitchell S, Condon A, Lenhart A, Dua KS, Kanagala VS, Kamal A, Singh VK, Pinto-Sanchez MI, Hutchinson JM, Kwon RS, Korsnes SJ, Singh H, Solati Z, Willingham FF, Yachimski PS, Conwell DL, Mosier E, Azab M, Patel A, Buxbaum J, Wani S, Chak A, Hosmer AE, Keswani RN, DiMaio CJ, Bronze MS, Muthusamy R, Canto MI, Gjeorgjievski VM, Imam Z, Odish F, Edhi AI, Orosey M, Tiwari A, Patwardhan S, Brown NG, Patel AA, Ordiah CO, Sloan IP, Cruz L, Koza CL, Okafor U, Hollander T, Furey N, Reykhart O, Zbib NH, Damianos JA, Esteban J, Hajidiacos N, Saul M, Mays M, Anderson G, Wood K, Mathews L, Diakova G, Caisse M, Wakefield L, Nitchie H, Waljee AK, Tang W, Zhang Y, Zhu J, Deshpande AR, Rockey DC, Alford TB, Durkalski V. Digestive Manifestations in Patients Hospitalized With Coronavirus Disease 2019. Clin Gastroenterol Hepatol 2021; 19:1355-1365.e4. [PMID: 33010411 PMCID: PMC7527302 DOI: 10.1016/j.cgh.2020.09.041] [Citation(s) in RCA: 55] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 09/21/2020] [Accepted: 09/22/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND & AIMS The prevalence and significance of digestive manifestations in coronavirus disease 2019 (COVID-19) remain uncertain. We aimed to assess the prevalence, spectrum, severity, and significance of digestive manifestations in patients hospitalized with COVID-19. METHODS Consecutive patients hospitalized with COVID-19 were identified across a geographically diverse alliance of medical centers in North America. Data pertaining to baseline characteristics, symptomatology, laboratory assessment, imaging, and endoscopic findings from the time of symptom onset until discharge or death were abstracted manually from electronic health records to characterize the prevalence, spectrum, and severity of digestive manifestations. Regression analyses were performed to evaluate the association between digestive manifestations and severe outcomes related to COVID-19. RESULTS A total of 1992 patients across 36 centers met eligibility criteria and were included. Overall, 53% of patients experienced at least 1 gastrointestinal symptom at any time during their illness, most commonly diarrhea (34%), nausea (27%), vomiting (16%), and abdominal pain (11%). In 74% of cases, gastrointestinal symptoms were judged to be mild. In total, 35% of patients developed an abnormal alanine aminotransferase or total bilirubin level; these were increased to less than 5 times the upper limit of normal in 77% of cases. After adjusting for potential confounders, the presence of gastrointestinal symptoms at any time (odds ratio, 0.93; 95% CI, 0.76-1.15) or liver test abnormalities on admission (odds ratio, 1.31; 95% CI, 0.80-2.12) were not associated independently with mechanical ventilation or death. CONCLUSIONS Among patients hospitalized with COVID-19, gastrointestinal symptoms and liver test abnormalities were common, but the majority were mild and their presence was not associated with a more severe clinical course.
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Affiliation(s)
- B Joseph Elmunzer
- Division of Gastroenterology and Hepatology, Department of Medicine, Charleston, South Carolina.
| | - Rebecca L Spitzer
- Division of Gastroenterology and Hepatology, Department of Medicine, Charleston, South Carolina
| | - Lydia D Foster
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina
| | - Ambreen A Merchant
- Division of Digestive Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Eric F Howard
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Vaishali A Patel
- Division of Digestive Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Mary K West
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Emad Qayed
- Division of Digestive Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia; Division of Digestive Diseases, Department of Medicine, Grady Memorial Hospital, Atlanta, Georgia
| | - Rosemary Nustas
- Division of Digestive Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia; Division of Digestive Diseases, Department of Medicine, Grady Memorial Hospital, Atlanta, Georgia
| | - Ali Zakaria
- Division of Gastroenterology, Department of Medicine, Ascension Providence Hospital/Michigan State University, College of Human Medicine, Southfield, Michigan
| | - Marc S Piper
- Division of Gastroenterology, Department of Medicine, Ascension Providence Hospital/Michigan State University, College of Human Medicine, Southfield, Michigan
| | - Jason R Taylor
- Division of Gastroenterology and Hepatology, Department of Medicine, Saint Louis University, St. Louis, Missouri
| | - Lujain Jaza
- Division of Gastroenterology and Hepatology, Department of Medicine, Saint Louis University, St. Louis, Missouri
| | - Nauzer Forbes
- Division of Gastroenterology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Millie Chau
- Division of Gastroenterology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Luis F Lara
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Georgios I Papachristou
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Michael L Volk
- Division of Gastroenterology, Department of Medicine, Loma Linda University, Loma Linda, California
| | - Liam G Hilson
- Division of Gastroenterology, Department of Medicine, University of Southern California, Los Angeles, California
| | - Selena Zhou
- Division of Gastroenterology, Department of Medicine, University of Southern California, Los Angeles, California
| | - Vladimir M Kushnir
- Division of Gastroenterology, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Alexandria M Lenyo
- Division of Gastroenterology, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Caroline G McLeod
- Division of Gastroenterology and Hepatology, Department of Medicine, Charleston, South Carolina
| | - Sunil Amin
- Division of Gastroenterology, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida
| | - Gabriela N Kuftinec
- Division of Gastroenterology, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida
| | - Dhiraj Yadav
- Division of Gastroenterology and Hepatology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Charlie Fox
- Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Jennifer M Kolb
- Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Swati Pawa
- Division of Gastroenterology, Department of Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Rishi Pawa
- Division of Gastroenterology, Department of Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Andrew Canakis
- Section of Gastroenterology, Department of Medicine, Boston University Medical Center, Boston, Massachusetts
| | - Christopher Huang
- Section of Gastroenterology, Department of Medicine, Boston University Medical Center, Boston, Massachusetts
| | - Laith H Jamil
- Section of Gastroenterology and Hepatology, Department of Internal Medicine, Beaumont Health, Royal Oak, Michigan; Oakland University William Beaumont School of Medicine, Rochester, Michigan
| | - Andrew M Aneese
- Section of Gastroenterology and Hepatology, Department of Internal Medicine, Beaumont Health, Royal Oak, Michigan
| | - Benita K Glamour
- Division of Gastroenterology, Department of Medicine, University Hospitals of Cleveland Medical Center, Cleveland, Ohio
| | - Zachary L Smith
- Division of Gastroenterology, Department of Medicine, University Hospitals of Cleveland Medical Center, Cleveland, Ohio
| | - Katherine A Hanley
- Division of Gastroenterology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Jordan Wood
- Division of Gastroenterology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Harsh K Patel
- Department of Gastroenterology, Ochsner Health, New Orleans, Louisiana
| | - Janak N Shah
- Department of Gastroenterology, Ochsner Health, New Orleans, Louisiana
| | - Emil Agarunov
- Division of Gastroenterology, Department of Medicine, Columbia University Medical Center, New York, New York
| | - Amrita Sethi
- Division of Gastroenterology, Department of Medicine, Columbia University Medical Center, New York, New York
| | - Evan L Fogel
- Division of Gastroenterology and Hepatology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Gail McNulty
- Division of Gastroenterology and Hepatology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Abdul Haseeb
- Division of Gastroenterology and Nutrition, Department of Medicine, Loyola University Medical Center, Chicago, Illinois
| | - Judy A Trieu
- Division of Gastroenterology and Nutrition, Department of Medicine, Loyola University Medical Center, Chicago, Illinois
| | - Rebekah E Dixon
- The Dr. Henry D. Janowitz Division of Gastroenterology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Jeong Yun Yang
- The Dr. Henry D. Janowitz Division of Gastroenterology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Robin B Mendelsohn
- Gastroenterology, Hepatology and Nutrition service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Delia Calo
- Gastroenterology, Hepatology and Nutrition service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Olga C Aroniadis
- Division of Gastroenterology, Department of Medicine, Renaissance School of Medicine at Stony Brook University, Stony Brook, New York
| | - Joseph F LaComb
- Division of Gastroenterology, Department of Medicine, Renaissance School of Medicine at Stony Brook University, Stony Brook, New York
| | - James M Scheiman
- Division of Gastroenterology, Department of Medicine, University of Virginia Medical School, Charlottesville, Virginia
| | - Bryan G Sauer
- Division of Gastroenterology, Department of Medicine, University of Virginia Medical School, Charlottesville, Virginia
| | - Duyen T Dang
- Division of Gastroenterology, Department of Medicine, Henry Ford Health System, Detroit, Michigan
| | - Cyrus R Piraka
- Division of Gastroenterology, Department of Medicine, Henry Ford Health System, Detroit, Michigan
| | - Eric D Shah
- Section of Gastroenterology and Hepatology, Department of Medicine, Dartmouth-Hitchcock Health, Lebanon, New Hampshire
| | - Heiko Pohl
- Section of Gastroenterology and Hepatology, Department of Medicine, Dartmouth-Hitchcock Health, Lebanon, New Hampshire; Section of Gastroenterology and Hepatology, Department of Medicine, VA Medical Center, White River Junction, Vermont
| | - William M Tierney
- Section of Digestive Diseases and Nutrition, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Stephanie Mitchell
- Section of Digestive Diseases and Nutrition, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Ashwinee Condon
- Division of Gastroenterology, Department of Medicine, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California
| | - Adrienne Lenhart
- Division of Gastroenterology, Department of Medicine, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California
| | - Kulwinder S Dua
- Division of Gastroenterology, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Vikram S Kanagala
- Division of Gastroenterology, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Ayesha Kamal
- Division of Gastroenterology, Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Vikesh K Singh
- Division of Gastroenterology, Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Maria Ines Pinto-Sanchez
- Division of Gastroenterology, Department of Medicine, McMaster University Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Joy M Hutchinson
- Division of Gastroenterology, Department of Medicine, McMaster University Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Richard S Kwon
- Division of Gastroenterology and Hepatology, Department of Medicine, Michigan Medicine, Ann Arbor, Michigan
| | - Sheryl J Korsnes
- Division of Gastroenterology and Hepatology, Department of Medicine, Michigan Medicine, Ann Arbor, Michigan
| | - Harminder Singh
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Zahra Solati
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Field F Willingham
- Division of Digestive Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Patrick S Yachimski
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Darwin L Conwell
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Evan Mosier
- Division of Gastroenterology, Department of Medicine, Loma Linda University, Loma Linda, California
| | - Mohamed Azab
- Division of Gastroenterology, Department of Medicine, Loma Linda University, Loma Linda, California
| | - Anish Patel
- Division of Gastroenterology, Department of Medicine, Loma Linda University, Loma Linda, California
| | - James Buxbaum
- Division of Gastroenterology, Department of Medicine, University of Southern California, Los Angeles, California
| | - Sachin Wani
- Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Amitabh Chak
- Division of Gastroenterology, Department of Medicine, University Hospitals of Cleveland Medical Center, Cleveland, Ohio
| | - Amy E Hosmer
- Division of Gastroenterology, Department of Medicine, University Hospitals of Cleveland Medical Center, Cleveland, Ohio
| | - Rajesh N Keswani
- Division of Gastroenterology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Christopher J DiMaio
- The Dr. Henry D. Janowitz Division of Gastroenterology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Michael S Bronze
- Section of Digestive Diseases and Nutrition, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Raman Muthusamy
- Division of Gastroenterology, Department of Medicine, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California
| | - Marcia I Canto
- Division of Gastroenterology, Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - V Mihajlo Gjeorgjievski
- Section of Gastroenterology and Hepatology, Department of Internal Medicine, Beaumont Health, Royal Oak, Michigan
| | - Zaid Imam
- Section of Gastroenterology and Hepatology, Department of Internal Medicine, Beaumont Health, Royal Oak, Michigan
| | - Fadi Odish
- Section of Gastroenterology and Hepatology, Department of Internal Medicine, Beaumont Health, Royal Oak, Michigan
| | - Ahmed I Edhi
- Section of Gastroenterology and Hepatology, Department of Internal Medicine, Beaumont Health, Royal Oak, Michigan
| | - Molly Orosey
- Section of Gastroenterology and Hepatology, Department of Internal Medicine, Beaumont Health, Royal Oak, Michigan
| | - Abhinav Tiwari
- Section of Gastroenterology and Hepatology, Department of Internal Medicine, Beaumont Health, Royal Oak, Michigan
| | - Soumil Patwardhan
- Section of Gastroenterology and Hepatology, Department of Internal Medicine, Beaumont Health, Royal Oak, Michigan
| | - Nicholas G Brown
- Division of Gastroenterology, Department of Medicine, Columbia University Medical Center, New York, New York
| | - Anish A Patel
- Division of Gastroenterology, Department of Medicine, Columbia University Medical Center, New York, New York
| | - Collins O Ordiah
- Division of Gastroenterology and Hepatology, Department of Medicine, Charleston, South Carolina
| | - Ian P Sloan
- Division of Gastroenterology, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Lilian Cruz
- Division of Gastroenterology, Department of Medicine, Renaissance School of Medicine at Stony Brook University, Stony Brook, New York
| | - Casey L Koza
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Uchechi Okafor
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Thomas Hollander
- Division of Gastroenterology, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Nancy Furey
- Division of Gastroenterology, Department of Medicine, University Hospitals of Cleveland Medical Center, Cleveland, Ohio
| | - Olga Reykhart
- Division of Gastroenterology, Department of Medicine, Renaissance School of Medicine at Stony Brook University, Stony Brook, New York
| | - Natalia H Zbib
- Section of Gastroenterology and Hepatology, Department of Medicine, Dartmouth-Hitchcock Health, Lebanon, New Hampshire
| | - John A Damianos
- Section of Gastroenterology and Hepatology, Department of Medicine, Dartmouth-Hitchcock Health, Lebanon, New Hampshire
| | - James Esteban
- Division of Gastroenterology, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Nick Hajidiacos
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Melissa Saul
- Division of Gastroenterology and Hepatology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Melanie Mays
- Division of Gastroenterology and Hepatology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Gulsum Anderson
- Division of Gastroenterology and Hepatology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Kelley Wood
- Division of Gastroenterology and Hepatology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Laura Mathews
- Division of Gastroenterology and Hepatology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Galina Diakova
- Division of Gastroenterology, Department of Medicine, University of Virginia Medical School, Charlottesville, Virginia
| | - Molly Caisse
- Section of Gastroenterology and Hepatology, Department of Medicine, Dartmouth-Hitchcock Health, Lebanon, New Hampshire
| | - Lauren Wakefield
- Division of Gastroenterology and Hepatology, Department of Medicine, Charleston, South Carolina
| | - Haley Nitchie
- Division of Gastroenterology and Hepatology, Department of Medicine, Charleston, South Carolina
| | - Akbar K Waljee
- Division of Gastroenterology and Hepatology, Department of Medicine, Michigan Medicine, Ann Arbor, Michigan
| | - Weijing Tang
- Department of Statistics, University of Michigan, Ann Arbor, Michigan
| | - Yueyang Zhang
- Department of Statistics, University of Michigan, Ann Arbor, Michigan
| | - Ji Zhu
- Department of Statistics, University of Michigan, Ann Arbor, Michigan
| | - Amar R Deshpande
- Division of Gastroenterology, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida
| | - Don C Rockey
- Division of Gastroenterology and Hepatology, Department of Medicine, Charleston, South Carolina
| | - Teldon B Alford
- Division of Gastroenterology and Hepatology, Department of Medicine, Charleston, South Carolina
| | - Valerie Durkalski
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina
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99777
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Flannery AH, Li X, Delozier NL, Toto RD, Moe OW, Yee J, Neyra JA. Sepsis-Associated Acute Kidney Disease and Long-term Kidney Outcomes. Kidney Med 2021; 3:507-514.e1. [PMID: 34401718 PMCID: PMC8350838 DOI: 10.1016/j.xkme.2021.02.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
RATIONALE & OBJECTIVE Sepsis-associated acute kidney injury often leads to acute kidney disease (AKD), predisposing patients to long-term complications such as chronic kidney disease (CKD), kidney failure with replacement therapy (KFRT), or mortality. Risk stratification of patients with AKD represents an opportunity to assist with prognostication of long-term kidney complications. STUDY DESIGN Single-center retrospective cohort. SETTING & PARTICIPANTS 6,290 critically ill patients admitted to the intensive care unit with severe sepsis or septic shock. Patients were separated into cohorts based on incident acute kidney injury or not, and survivors identified who were alive and free of KFRT up to 90 days. PREDICTORS AKD stage (0A, 0C, or ≥1) using the last serum creatinine concentration available by discharge or up to 90 days postdischarge. OUTCOME Time to development of incident CKD, progression of CKD, KFRT, or death. ANALYTICAL APPROACH Multivariable Cox proportional hazards models. RESULTS Patients surviving kidney injury associated with sepsis often fail to return to baseline kidney function by discharge: 577/1,231 (46.9%) with stage 0C or 1 or greater AKD. AKD stage was significantly associated with the composite primary outcome. Stages 0C AKD and 1 or greater AKD were significantly and progressively associated with the primary outcome when compared with stage 0A AKD (adjusted HR [aHR], 1.74; 95% CI, 1.32-2.29, and aHR, 3.25; 95% CI, 2.52-4.20, respectively). Additionally, stage 1 or greater AKD conferred higher risk above stage 0C AKD (aHR, 1.87; 95% CI, 1.44-2.43). CKD incidence or progression and KFRT, more so than mortality, occurred with greater frequency in higher stages of AKD. LIMITATIONS Retrospective design, single center, exclusion of patients with KFRT within 90 days of discharge, potential ascertainment bias, and inability to subclassify above AKD stage 1. CONCLUSIONS Risk stratification using recommended AKD stages at hospital discharge or shortly thereafter associates with the development of long-term kidney outcomes following sepsis-associated acute kidney injury.
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Affiliation(s)
- Alexander H. Flannery
- Department of Pharmacy Practice and Science, University of Kentucky College of Pharmacy, Lexington, KY
| | - Xilong Li
- Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX
| | - Natalie L. Delozier
- Department of Pharmacy Practice and Science, University of Kentucky College of Pharmacy, Lexington, KY
| | - Robert D. Toto
- Division of Nephrology, Department of Internal Medicine, Charles and Jane Pak Center for Mineral Metabolism and Clinical Research, University of Texas Southwestern Medical Center, Dallas, TX
| | - Orson W. Moe
- Division of Nephrology, Department of Internal Medicine, Charles and Jane Pak Center for Mineral Metabolism and Clinical Research, University of Texas Southwestern Medical Center, Dallas, TX
| | - Jerry Yee
- Division of Nephrology and Hypertension, Henry Ford Hospital, Detroit, MI
| | - Javier A. Neyra
- Division of Nephrology, Bone and Mineral Metabolism, Department of Internal Medicine, University of Kentucky College of Medicine, Lexington, KY
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99778
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Behal M, Barlow B, Mefford B, Thompson Bastin ML, Donaldson JC, Laine M, Bissell BD. Pharmacotherapy in Coronavirus Disease 2019 and Risk of Secondary Infections: A Single-Center Case Series and Narrative Review. Crit Care Explor 2021; 3:e0492. [PMID: 34278319 PMCID: PMC8280010 DOI: 10.1097/cce.0000000000000492] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Since the onset of the coronavirus disease 2019 pandemic, immune modulators have been considered front-line candidates for the management of patients presenting with clinical symptoms secondary to severe acute respiratory syndrome coronavirus 2 infection. Although heavy emphasis has been placed on early clinical efficacy, we sought to evaluate the impact of pharmacologic approach to coronavirus disease 2019 within the ICU on secondary infections and clinical outcomes. DATA SOURCES PubMed (inception to March 2021) database search and manual selection of bibliographies from selected articles. STUDY SELECTION AND DATA EXTRACTION Articles relevant to coronavirus disease 2019, management of severe acute respiratory syndrome coronavirus 2-associated respiratory failure, and prevalence of secondary infections with pharmacotherapies were selected. The MeSH terms "COVID-19," "secondary infection," "SARS-CoV-2," "tocilizumab," and "corticosteroids" were used for article identification. Articles were narratively synthesized for this review. DATA SYNTHESIS Current data surrounding the use of tocilizumab and/or corticosteroids for coronavirus disease 2019 management are limited given the short follow-up period and conflicting results between studies. Further complicating the understanding of immune modulator role is the lack of definitive understanding of clinical impact of the immune response in coronavirus disease 2019. CONCLUSIONS Based on the current available literature, we suggest prolonged trials and follow-up intervals for those patients managed with immune modulating agents for the management of coronavirus disease 2019.
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Affiliation(s)
- Michael Behal
- Department of Pharmacy Practice, University of Kentucky, College of Pharmacy, Lexington, KY
| | - Brooke Barlow
- Department of Pharmacy Practice, University of Kentucky, College of Pharmacy, Lexington, KY
| | - Breanne Mefford
- Department of Pharmacy Practice, University of Kentucky, College of Pharmacy, Lexington, KY
| | | | - J Chris Donaldson
- Department of Pharmacy Practice, University of Kentucky, College of Pharmacy, Lexington, KY
| | - Melanie Laine
- Department of Pharmacy Practice, University of Kentucky, College of Pharmacy, Lexington, KY
| | - Brittany D Bissell
- Department of Pharmacy Practice, University of Kentucky, College of Pharmacy, Lexington, KY
- Department of Pulmonary, Critical Care, and Sleep Medicine, University of Kentucky, College of Medicine, Lexington, KY
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99779
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Huang X, Chen W, Wang C, Lin L, Yang Q, Pan B, Jiang H. Evaluation of respiratory system anomalies associated with microtia in a Chinese specialty clinic population. Int J Pediatr Otorhinolaryngol 2021; 146:110762. [PMID: 33992970 DOI: 10.1016/j.ijporl.2021.110762] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 04/26/2021] [Accepted: 05/06/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND Microtia is a congenital malformation of the external ear often with one or more associated congenital anomalies. The purpose of this study was to identify the characteristics and prevalence of respiratory anomalies in patients with microtia, and clarify the importance of this association in the perioperative period of patients' external ear reconstruction surgery. METHODS Data were collected from 923 microtia patients between August 2017 and December 2020 in the Department of Auricular Reconstruction at the Plastic Surgery Hospital of Peking Union Medical College. Co-occurring respiratory anomalies were detected using chest computed tomography plus three-dimensional reconstruction and Chest X-ray. Physical examination was performed to assess the severity and type of microtia by trained clinicians. Fisher's exact test was used to analyze the relation between laterality of pulmonary underdevelopment and microtia type. RESULTS Among the 923 participants enrolled in the study, we identified 21 cases (2.3%) having respiratory system anomalies, consisting of 6 cases with pulmonary underdevelopment (28.6% of all anomalies of respiratory system detected), 2 cases with tracheal bronchus (9.5%), 1 case with tracheal diverticula (4.8%), 11 cases with lung bullae(52.4%), and 1 case with pulmonary azygos lobe (4.8%). The laterality of pulmonary underdevelopment was related to the type of microtia (difference between types, p < 0.05), as patients with concha-type remnant ear had pulmonary underdevelopment ipsilaterally. CONCLUSIONS This study represents the first detailed and thematic study of a association featured by microtia and respiratory anomalies. Characteristics and prevalence of respiratory anomalies was observed in a Chinese clinical microtia population. Early diagnosis of associated respiratory malformations had practical clinical significance for microtia patients, plastic surgeons and anesthesiologists. Future studies are required to improve understanding of this association and its cause.
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Affiliation(s)
- Xin Huang
- Department of Auricular Reconstruction, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 100043, Beijing, People's Republic of China
| | - Weiwei Chen
- Department of Radiology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 100043, Beijing, People's Republic of China
| | - Changchen Wang
- Department of Auricular Reconstruction, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 100043, Beijing, People's Republic of China
| | - Lin Lin
- Department of Auricular Reconstruction, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 100043, Beijing, People's Republic of China
| | - Qinghua Yang
- Department of Auricular Reconstruction, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 100043, Beijing, People's Republic of China
| | - Bo Pan
- Department of Auricular Reconstruction, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 100043, Beijing, People's Republic of China.
| | - Haiyue Jiang
- Department of Auricular Reconstruction, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 100043, Beijing, People's Republic of China.
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99780
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Brügger M, Démoulins T, Barut GT, Zumkehr B, Oliveira Esteves BI, Mehinagic K, Haas Q, Schögler A, Rameix-Welti MA, Eléouët JF, Moehrlen U, Marti TM, Schmid RA, Summerfield A, Posthaus H, Ruggli N, Hall SRR, Alves MP. Pulmonary mesenchymal stem cells are engaged in distinct steps of host response to respiratory syncytial virus infection. PLoS Pathog 2021; 17:e1009789. [PMID: 34320038 PMCID: PMC8351988 DOI: 10.1371/journal.ppat.1009789] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 08/09/2021] [Accepted: 07/08/2021] [Indexed: 02/06/2023] Open
Abstract
Lung-resident (LR) mesenchymal stem and stromal cells (MSCs) are key elements of the alveolar niche and fundamental regulators of homeostasis and regeneration. We interrogated their function during virus-induced lung injury using the highly prevalent respiratory syncytial virus (RSV) which causes severe outcomes in infants. We applied complementary approaches with primary pediatric LR-MSCs and a state-of-the-art model of human RSV infection in lamb. Remarkably, RSV-infection of pediatric LR-MSCs led to a robust activation, characterized by a strong antiviral and pro-inflammatory phenotype combined with mediators related to T cell function. In line with this, following in vivo infection, RSV invades and activates LR-MSCs, resulting in the expansion of the pulmonary MSC pool. Moreover, the global transcriptional response of LR-MSCs appears to follow RSV disease, switching from an early antiviral signature to repair mechanisms including differentiation, tissue remodeling, and angiogenesis. These findings demonstrate the involvement of LR-MSCs during virus-mediated acute lung injury and may have therapeutic implications.
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Affiliation(s)
- Melanie Brügger
- Institute of Virology and Immunology, University of Bern, Bern, Switzerland
- Department of Infectious Diseases and Pathobiology, Vetsuisse Faculty, University of Bern, Bern, Switzerland
- Graduate School for Cellular and Biomedical Sciences, University of Bern, Bern, Switzerland
| | - Thomas Démoulins
- Institute of Virology and Immunology, University of Bern, Bern, Switzerland
- Department of Infectious Diseases and Pathobiology, Vetsuisse Faculty, University of Bern, Bern, Switzerland
| | - G. Tuba Barut
- Institute of Virology and Immunology, University of Bern, Bern, Switzerland
- Department of Infectious Diseases and Pathobiology, Vetsuisse Faculty, University of Bern, Bern, Switzerland
- Graduate School for Cellular and Biomedical Sciences, University of Bern, Bern, Switzerland
| | - Beatrice Zumkehr
- Institute of Virology and Immunology, University of Bern, Bern, Switzerland
- Department of Infectious Diseases and Pathobiology, Vetsuisse Faculty, University of Bern, Bern, Switzerland
| | - Blandina I. Oliveira Esteves
- Institute of Virology and Immunology, University of Bern, Bern, Switzerland
- Department of Infectious Diseases and Pathobiology, Vetsuisse Faculty, University of Bern, Bern, Switzerland
| | - Kemal Mehinagic
- Institute of Virology and Immunology, University of Bern, Bern, Switzerland
- Department of Infectious Diseases and Pathobiology, Vetsuisse Faculty, University of Bern, Bern, Switzerland
- Graduate School for Cellular and Biomedical Sciences, University of Bern, Bern, Switzerland
| | - Quentin Haas
- Institute of Pharmacology, University of Bern, Bern, Switzerland
| | - Aline Schögler
- Department of Biomedical Research, University of Bern, Bern, Switzerland
| | - Marie-Anne Rameix-Welti
- Université Paris-Saclay, INSERM, Université de Versailles St. Quentin, UMR 1173 (2I), Versailles, France
| | | | - Ueli Moehrlen
- Pediatric Surgery, University Children’s Hospital Zurich, Zurich, Switzerland
| | - Thomas M. Marti
- Department of Biomedical Research, University of Bern, Bern, Switzerland
- Department of General Thoracic Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Ralph A. Schmid
- Department of Biomedical Research, University of Bern, Bern, Switzerland
- Department of General Thoracic Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Artur Summerfield
- Institute of Virology and Immunology, University of Bern, Bern, Switzerland
- Department of Infectious Diseases and Pathobiology, Vetsuisse Faculty, University of Bern, Bern, Switzerland
| | - Horst Posthaus
- Department of Infectious Diseases and Pathobiology, Vetsuisse Faculty, University of Bern, Bern, Switzerland
- Institute of Animal Pathology, Vetsuisse Faculty, University of Bern, Bern, Switzerland
| | - Nicolas Ruggli
- Institute of Virology and Immunology, University of Bern, Bern, Switzerland
- Department of Infectious Diseases and Pathobiology, Vetsuisse Faculty, University of Bern, Bern, Switzerland
| | - Sean R. R. Hall
- Department of General Thoracic Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Gillies McIndoe Research Institute, Wellington, New Zealand
| | - Marco P. Alves
- Institute of Virology and Immunology, University of Bern, Bern, Switzerland
- Department of Infectious Diseases and Pathobiology, Vetsuisse Faculty, University of Bern, Bern, Switzerland
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99781
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Marques L, Fregonezi GADF, Marcelino AA, Dourado-Júnior MET, Sarmento A, Pennati F, Aliverti A, Resqueti VR. Thoracoabdominal asynchrony and paradoxical motion in Duchenne muscular dystrophy and healthy subjects during cough: A case control study. Pediatr Pulmonol 2021; 56:2136-2145. [PMID: 33866686 DOI: 10.1002/ppul.25412] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 03/09/2021] [Accepted: 03/29/2021] [Indexed: 01/13/2023]
Abstract
OBJECTIVE To assess thoracoabdominal asynchrony (TAA) and inspiratory paradoxical motion at different positionings in subjects with Duchenne muscular dystrophy (DMD) versus healthy subjects during quiet spontaneous breathing (QB) and cough. METHODS This is a case control study with a matched-pair design. We assessed 14 DMD subjects and 12 controls using optoelectronic plethysmography (OEP) during QB and spontaneous cough in 3 positions: supine, supine with headrest raised at 45°, and sitting with back support at 80°. The TAA was assessed using phase angle (θ) between upper (RCp) and lower rib cage (RCa) and abdomen (AB), as well as the percentage of inspiratory time the RCp (IPRCp ), RCa (IPRCa ), and AB (IPAB ) moved in opposite directions. RESULTS During cough, DMD group showed higher RCp and RCa θ (p < .05), RCp and AB θ (p < .05) in supine and 45° positions, and higher RCp and Rca θ (p = .006) only in supine position compared with controls. Regarding the intragroup analysis, during cough, DMD group presented higher RCp and AB θ (p = .02) and RCa and AB θ (p = .002) in supine and higher RCa and AB θ (p = .002) in 45° position when compared to 80°. Receiver operating characteristic curve analyzes were able to discriminate TAA between controls and DMD in RCa supine position (area under the curve: 0.81, sensibility: 78.6% and specificity: 91.7%, p = .001). CONCLUSION Subjects with DMD yields TAA with insufficient deflation of chest wall compartments and rib cage distortion during cough, by noninvasive assessment.
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Affiliation(s)
- Layana Marques
- Departamento de Fisioterapia, Pneumo CardioVascular Lab/HUOL, Hospital Universitário Onofre Lopes, Empresa Brasileira de Serviços Hospitalares (EBSERH), Universidade Federal do Rio Grande do Norte, Natal, Rio Grande do Norte, Brasil.,Laboratório de Inovação Tecnológica em Reabilitação, Departamento de Fisioterapia, Universidade Federal do Rio Grande do Norte, Natal, Rio Grande do Norte, Brasil
| | - Guilherme Augusto de Freitas Fregonezi
- Departamento de Fisioterapia, Pneumo CardioVascular Lab/HUOL, Hospital Universitário Onofre Lopes, Empresa Brasileira de Serviços Hospitalares (EBSERH), Universidade Federal do Rio Grande do Norte, Natal, Rio Grande do Norte, Brasil.,Laboratório de Inovação Tecnológica em Reabilitação, Departamento de Fisioterapia, Universidade Federal do Rio Grande do Norte, Natal, Rio Grande do Norte, Brasil
| | - Ana Aline Marcelino
- Departamento de Fisioterapia, Pneumo CardioVascular Lab/HUOL, Hospital Universitário Onofre Lopes, Empresa Brasileira de Serviços Hospitalares (EBSERH), Universidade Federal do Rio Grande do Norte, Natal, Rio Grande do Norte, Brasil.,Laboratório de Inovação Tecnológica em Reabilitação, Departamento de Fisioterapia, Universidade Federal do Rio Grande do Norte, Natal, Rio Grande do Norte, Brasil
| | | | - Antonio Sarmento
- Departamento de Fisioterapia, Pneumo CardioVascular Lab/HUOL, Hospital Universitário Onofre Lopes, Empresa Brasileira de Serviços Hospitalares (EBSERH), Universidade Federal do Rio Grande do Norte, Natal, Rio Grande do Norte, Brasil
| | - Francesca Pennati
- The Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milan, Italy
| | - Andrea Aliverti
- The Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milan, Italy
| | - Vanessa Regiane Resqueti
- Departamento de Fisioterapia, Pneumo CardioVascular Lab/HUOL, Hospital Universitário Onofre Lopes, Empresa Brasileira de Serviços Hospitalares (EBSERH), Universidade Federal do Rio Grande do Norte, Natal, Rio Grande do Norte, Brasil.,Laboratório de Inovação Tecnológica em Reabilitação, Departamento de Fisioterapia, Universidade Federal do Rio Grande do Norte, Natal, Rio Grande do Norte, Brasil
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99782
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Moreno-Pérez Ó, Andrés M, León-Ramirez JM, Sánchez-Payá J, Boix V, Gil J, Merino E. The COVID-GRAM Tool for Patients Hospitalized With COVID-19 in Europe. JAMA Intern Med 2021; 181:1000-1001. [PMID: 33818609 PMCID: PMC8022262 DOI: 10.1001/jamainternmed.2021.0491] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
This study applies a clinical risk assessment tool (COVID-GRAM) developed in China to a population of patients hospitalized with COVID-19 in Spain to evaluate the tool’s usefulness in Europe.
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Affiliation(s)
- Óscar Moreno-Pérez
- Endocrinology and Nutrition Department, Alicante General University Hospital-Alicante Institute of Sanitary and Biomedical Research (ISABIAL), Alicante, Spain.,Clinical Medicine Department, Miguel Hernández University, Alicante, Spain
| | - Mariano Andrés
- Clinical Medicine Department, Miguel Hernández University, Alicante, Spain.,Rheumatology Department, Alicante General University Hospital-Alicante Institute of Sanitary and Biomedical Research (ISABIAL), Alicante, Spain
| | - José Manuel León-Ramirez
- Pneumology Department, Alicante General University Hospital-Alicante Institute of Sanitary and Biomedical Research (ISABIAL), Alicante, Spain
| | - José Sánchez-Payá
- Preventive Department, Alicante General University Hospital-Alicante Institute of Sanitary and Biomedical Research (ISABIAL), Alicante, Spain
| | - Vicente Boix
- Unit of Infectious Diseases, Alicante General University Hospital-Alicante Institute of Health and Biomedical Research (ISABIAL), Alicante, Spain.,Clinical Medicine Department, Miguel Hernández University, Elche, Spain
| | - Joan Gil
- Pneumology Department, Alicante General University Hospital-Alicante Institute of Sanitary and Biomedical Research (ISABIAL), Alicante, Spain
| | - Esperanza Merino
- Unit of Infectious Diseases, Alicante General University Hospital-Alicante Institute of Health and Biomedical Research (ISABIAL), Alicante, Spain
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99783
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Mostaço-Guidolin LB, Yang CX, Hackett TL. Pulmonary Vascular Remodeling Is an Early Feature of Fatal and Nonfatal Asthma. Am J Respir Cell Mol Biol 2021; 65:114-118. [PMID: 34241585 DOI: 10.1165/rcmb.2020-0339le] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Leila B Mostaço-Guidolin
- St. Paul's Hospital Vancouver, British Columbia, Canada.,University of British Columbia Vancouver, British Columbia, Canada, and.,Carleton University Ottawa, Ontario, Canada
| | - Chen Xi Yang
- St. Paul's Hospital Vancouver, British Columbia, Canada.,University of British Columbia Vancouver, British Columbia, Canada, and
| | - Tillie-Louise Hackett
- St. Paul's Hospital Vancouver, British Columbia, Canada.,University of British Columbia Vancouver, British Columbia, Canada, and
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99784
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Commentary: A little is way too much: What we have learned about perioperative acute kidney injury. J Thorac Cardiovasc Surg 2021; 162:153-154. [DOI: 10.1016/j.jtcvs.2019.12.100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Revised: 12/15/2019] [Accepted: 12/16/2019] [Indexed: 02/03/2023]
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99785
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Alunno A, Najm A, Sivera F, Haines C, Falzon L, Ramiro S. Assessment of competences in rheumatology training: results of a systematic literature review to inform EULAR points to consider. RMD Open 2021; 6:rmdopen-2020-001330. [PMID: 32883720 PMCID: PMC7508213 DOI: 10.1136/rmdopen-2020-001330] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 07/16/2020] [Accepted: 08/21/2020] [Indexed: 11/08/2022] Open
Abstract
Objective To summarise the literature on the assessment of competences in postgraduate medical training. Methods A systematic literature review was performed within a EULAR taskforce on the assessment of competences in rheumatology training and other related specialities (July 2019). Two searches were performed: one search for rheumatology and one for related medical specialities. Two reviewers independently identified eligible studies and extracted data on assessment methods. Risk of bias was assessed using the medical education research study quality instrument. Results Of 7335 articles in rheumatology and 2324 reviews in other specialities, 5 and 31 original studies were included, respectively. Studies in rheumatology were at variable risk of bias and explored only direct observation of practical skills (DOPS) and objective structured clinical examinations (OSCEs). OSCEs, including clinical, laboratory and imaging stations, performed best, with a good to very good internal consistency (Cronbach’s α=0.83–0.92), and intrarater reliability (r=0.80–0.95). OSCEs moderately correlated with other assessment tools: r=0.48 vs rating by programme directors; r=0.2–0.44 vs multiple-choice questionnaires; r=0.48 vs DOPS. In other specialities, OSCEs on clinical skills had a good to very good inter-rater reliability and OSCEs on communication skills demonstrated a good to very good internal consistency. Multisource feedback and the mini-clinical evaluation exercise showed good feasibility and internal consistency (reliability), but other data on validity and reliability were conflicting. Conclusion Despite consistent data on competence assessment in other specialities, evidence in rheumatology is scarce and conflicting. Overall, OSCEs seem an appropriate tool to assess the competence of clinical skills and correlate well with other assessment strategies. DOPS, multisource feedback and the mini-clinical evaluation exercise are feasible alternatives.
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Affiliation(s)
- Alessia Alunno
- Rheumatology Unit, University of Perugia Department of Medicine, Perugia, Italy
| | - Aurélie Najm
- University Hospital, Inserm Umr 1238, Nantes, France
| | - Francisca Sivera
- Department of Rheumatology, Hospital General Universitario Elda, Elda, Spain.,Department of Medicine, Miguel Hernandez University of Elche, Elche, Spain
| | | | - Louise Falzon
- Center for Personalized Health, Northwell Health Feinstein Institutes for Medical Research, Manhasset, New York, USA
| | - Sofia Ramiro
- Department of Rheumatology, Leiden University Medical Center, Leiden, Netherlands.,Department of Rheumatology, Zuyderland Medical Centre Heerlen, Heerlen, Netherlands
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99786
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Abundo MEC, Ngunjiri JM, Taylor KJM, Ji H, Ghorbani A, Kc M, Elaish M, Jang H, Weber B, Johnson TJ, Lee CW. Evaluation of Sampling Methods for the Study of Avian Respiratory Microbiota. Avian Dis 2021; 64:277-285. [PMID: 33205170 DOI: 10.1637/aviandiseases-d-19-00200] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 03/16/2020] [Indexed: 11/05/2022]
Abstract
Although poultry microbiome discoveries are increasing due to the potential impact on poultry performance, studies examining the poultry respiratory microbiome are challenging because of the low microbial biomass and uniqueness of the avian respiratory tract, making it difficult to sample enough material for microbial analysis. Invasive sampling techniques requiring euthanasia are currently used to increase microbial mass for the analysis, thus making it impossible to sample individual birds longitudinally. In this study, we compared invasive (nasal wash, upper tracheal wash, lower tracheal wash, and lower respiratory lavage) and noninvasive (tracheal and choanal swabs) respiratory sampling techniques in two independent experiments by using 4-wk-old chickens. We first established the experimental baseline of respiratory microbiota by using invasive techniques to enable reasonable comparisons between sampling methods and between experiments. Although noninvasive sampling (live-bird swabs) resulted in lower 16S ribosomal RNA gene copy numbers compared with invasive sampling, live swabs were able to detect the dominant microbes captured by invasive techniques. Nevertheless, swabs from euthanatized birds were more reflective of the microbiota captured through invasive methods than live swab. Furthermore, from two separate experiments, we also demonstrated that respiratory microbiota sampling is highly reproducible, especially in the trachea and lower respiratory tract. Our study provides new insights and perspectives on decision making when sampling and studying poultry respiratory microbiota.
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Affiliation(s)
- Michael Edward C Abundo
- Food Animal Health Research Program, Ohio Agricultural Research and Development Center, The Ohio State University, Wooster, OH 44691.,Department of Veterinary Preventive Medicine, College of Veterinary Medicine, The Ohio State University, Columbus, OH 43210
| | - John M Ngunjiri
- Food Animal Health Research Program, Ohio Agricultural Research and Development Center, The Ohio State University, Wooster, OH 44691
| | - Kara J M Taylor
- Food Animal Health Research Program, Ohio Agricultural Research and Development Center, The Ohio State University, Wooster, OH 44691
| | - Hana Ji
- Food Animal Health Research Program, Ohio Agricultural Research and Development Center, The Ohio State University, Wooster, OH 44691
| | - Amir Ghorbani
- Food Animal Health Research Program, Ohio Agricultural Research and Development Center, The Ohio State University, Wooster, OH 44691.,Department of Veterinary Preventive Medicine, College of Veterinary Medicine, The Ohio State University, Columbus, OH 43210
| | - Mahesh Kc
- Food Animal Health Research Program, Ohio Agricultural Research and Development Center, The Ohio State University, Wooster, OH 44691.,Department of Veterinary Preventive Medicine, College of Veterinary Medicine, The Ohio State University, Columbus, OH 43210
| | - Mohamed Elaish
- Food Animal Health Research Program, Ohio Agricultural Research and Development Center, The Ohio State University, Wooster, OH 44691
| | - Hyesun Jang
- Food Animal Health Research Program, Ohio Agricultural Research and Development Center, The Ohio State University, Wooster, OH 44691.,Department of Veterinary Preventive Medicine, College of Veterinary Medicine, The Ohio State University, Columbus, OH 43210
| | - Bonnie Weber
- Department of Veterinary and Biomedical Sciences, University of Minnesota, Saint Paul, MN 55108
| | - Timothy J Johnson
- Department of Veterinary and Biomedical Sciences, University of Minnesota, Saint Paul, MN 55108.,Mid-Central Research and Outreach Center, University of Minnesota, Willmar, MN 56201
| | - Chang-Won Lee
- Food Animal Health Research Program, Ohio Agricultural Research and Development Center, The Ohio State University, Wooster, OH 44691.,Department of Veterinary Preventive Medicine, College of Veterinary Medicine, The Ohio State University, Columbus, OH 43210
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99787
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Gupta K, Pandey S, Singh R, Kumari A, Sen P, Singh G. Roflumilast improves resolution of sepsis-induced acute kidney injury by retarding late phase renal interstitial immune cells infiltration and leakage in urinary sediments. Fundam Clin Pharmacol 2021; 36:114-132. [PMID: 34212425 DOI: 10.1111/fcp.12711] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Accepted: 06/25/2021] [Indexed: 12/21/2022]
Abstract
Some evidence has demonstrated that both inflammation and immune cell dysregulation are coincident at late phase (post 24 h) of sepsis. The present study was designed to determine the pathological role of hyperinflammation and renal immune cells mobilization during late phase of sepsis induced acute kidney injury (S-AKI) and tests the pharmacological effects of PDE-4 inhibitor on these events. Sepsis was induced by cecal ligation puncture and renal function, oxidative-inflammatory stress biomarkers were assessed after 24 h. PDE-4 inhibitor was administered for 7 days prior to induction of S-AKI. Renal immune cells infiltration during sepsis was analyzed by H&E staining and papanicolaou staining method was used for detecting leukocytes and cast in urinary sediments, periodic acid schiff (PAS) staining was used for detection of brush border loss. AKI developed 24 h post sepsis insult as depicted by increase in serum creatinine, blood urea nitrogen (BUN), renal oxidative stress, and elevated inflammatory biomarkers levels. Moreover, septic rats displayed increased bacterial load, renal expression of phosphodiesterase-4B, 4D isoforms, enhanced vascular permeability, caspase-3 and myeloperoxidase activity, electrolyte imbalance, reduced Na+ K+ ATPase activity, declined cAMP levels, increased interstitial leukocyte infiltration, and leakage in urinary sediments along with histological alterations. Pre-treatment with roflumilast at high dose completely prevented the various AKI associated manifestations in septic rats. Renal hyper-inflammation and leukocyte infiltration was detected in late phase of S-AKI. Roflumilast pre-treatment resolved sepsis induced renal dysfunction and histological damage by suppressing late phase renal immune cells invasion and anti-inflammatory effects mediated by up-regulation of renal cAMP levels.
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Affiliation(s)
- Kirti Gupta
- Department of Pharmacy, Maharishi Markandeshwar University, Ambala, India
| | - Sneha Pandey
- Department of Pharmacology, ISF College of Pharmacy, Moga, India
| | - Ragini Singh
- Department of Pharmacology, ISF College of Pharmacy, Moga, India
| | - Abha Kumari
- Department of Pharmacology, ISF College of Pharmacy, Moga, India
| | - Pallavi Sen
- Department of Pharmacology, ISF College of Pharmacy, Moga, India
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99788
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Abstract
PURPOSE OF REVIEW Previous studies mainly described a role for organic agents as possible triggers for sarcoidosis. In this review, we address recent studies suggesting a possible role for inorganic elements, such as metals or silica in sarcoidosis pathogenesis. RECENT FINDINGS Several epidemiological papers suggest that inorganic agents, either by environmental exposures or occupational activities, could trigger sarcoidosis. Association between inorganics and sarcoidosis is also described in several recently published case reports and studies demonstrating immunological sensitization to inorganic agents in sarcoidosis patients.Studies comparing chronic beryllium disease (CBD) and sarcoidosis suggest that although antigenic triggers may differ, underlying processes may be comparable.Besides the fact that a growing number of studies show a possible role for inorganic triggers, it is also suggested that inorganic triggered sarcoidosis may result in a more severe phenotype, including pulmonary fibrosis. SUMMARY We can use the knowledge already gained on CBD pathogenesis to conduct further research into role of inorganics, such as metals and silica as antigens in sarcoidosis. Given the importance of a lymphocyte proliferation test (LPT) in diagnosing CBD, it seems obvious to also implement this test in the diagnostic work-up of sarcoidosis to identify patients with an inorganic antigenic trigger of their disease.
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99789
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Lokken EM, Taylor GG, Huebner EM, Vanderhoeven J, Hendrickson S, Coler B, Sheng JS, Walker CL, McCartney SA, Kretzer NM, Resnick R, Kachikis A, Barnhart N, Schulte V, Bergam B, Ma KK, Albright C, Larios V, Kelley L, Larios V, Emhoff S, Rah J, Retzlaff K, Thomas C, Paek BW, Hsu RJ, Erickson A, Chang A, Mitchell T, Hwang JK, Gourley R, Erickson S, Delaney S, Kline CR, Archabald K, Blain M, LaCourse SM, Adams Waldorf KM. Higher severe acute respiratory syndrome coronavirus 2 infection rate in pregnant patients. Am J Obstet Gynecol 2021; 225:75.e1-75.e16. [PMID: 33607103 PMCID: PMC7884918 DOI: 10.1016/j.ajog.2021.02.011] [Citation(s) in RCA: 58] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Revised: 02/08/2021] [Accepted: 02/09/2021] [Indexed: 10/31/2022]
Abstract
BACKGROUND During the early months of the coronavirus disease 2019 pandemic, risks associated with severe acute respiratory syndrome coronavirus 2 in pregnancy were uncertain. Pregnant patients can serve as a model for the success of clinical and public health responses during public health emergencies as they are typically in frequent contact with the medical system. Population-based estimates of severe acute respiratory syndrome coronavirus 2 infections in pregnancy are unknown because of incomplete ascertainment of pregnancy status or inclusion of only single centers or hospitalized cases. Whether pregnant women were protected by the public health response or through their interactions with obstetrical providers in the early months of pandemic is not clearly understood. OBJECTIVE This study aimed to estimate the severe acute respiratory syndrome coronavirus 2 infection rate in pregnancy and to examine the disparities by race and ethnicity and English language proficiency in Washington State. STUDY DESIGN Pregnant patients with a polymerase chain reaction-confirmed severe acute respiratory syndrome coronavirus 2 infection diagnosed between March 1, 2020, and June 30, 2020 were identified within 35 hospitals and clinics, capturing 61% of annual deliveries in Washington State. Infection rates in pregnancy were estimated overall and by Washington State Accountable Community of Health region and cross-sectionally compared with severe acute respiratory syndrome coronavirus 2 infection rates in similarly aged adults in Washington State. Race and ethnicity and language used for medical care of pregnant patients were compared with recent data from Washington State. RESULTS A total of 240 pregnant patients with severe acute respiratory syndrome coronavirus 2 infections were identified during the study period with 70.7% from minority racial and ethnic groups. The principal findings in our study were as follows: (1) the severe acute respiratory syndrome coronavirus 2 infection rate was 13.9 per 1000 deliveries in pregnant patients (95% confidence interval, 8.3-23.2) compared with 7.3 per 1000 (95% confidence interval, 7.2-7.4) in adults aged 20 to 39 years in Washington State (rate ratio, 1.7; 95% confidence interval, 1.3-2.3); (2) the severe acute respiratory syndrome coronavirus 2 infection rate reduced to 11.3 per 1000 deliveries (95% confidence interval, 6.3-20.3) when excluding 45 cases of severe acute respiratory syndrome coronavirus disease 2 detected through asymptomatic screening (rate ratio, 1.3; 95% confidence interval, 0.96-1.9); (3) the proportion of pregnant patients in non-White racial and ethnic groups with severe acute respiratory syndrome coronavirus disease 2 infection was 2- to 4-fold higher than the race and ethnicity distribution of women in Washington State who delivered live births in 2018; and (4) the proportion of pregnant patients with severe acute respiratory syndrome coronavirus 2 infection receiving medical care in a non-English language was higher than estimates of pregnant patients receiving care with limited English proficiency in Washington State (30.4% vs 7.6%). CONCLUSION The severe acute respiratory syndrome coronavirus 2 infection rate in pregnant people was 70% higher than similarly aged adults in Washington State, which could not be completely explained by universal screening at delivery. Pregnant patients from nearly all racial and ethnic minority groups and patients receiving medical care in a non-English language were overrepresented. Pregnant women were not protected from severe acute respiratory syndrome coronavirus 2 infection in the early months of the pandemic. Moreover, the greatest burden of infections occurred in nearly all racial and ethnic minority groups. These data coupled with a broader recognition that pregnancy is a risk factor for severe illness and maternal mortality strongly suggested that pregnant people should be broadly prioritized for coronavirus disease 2019 vaccine allocation in the United States similar to some states.
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99790
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Luehrs RE, Moreau KL, Pierce GL, Wamboldt F, Aloia M, Weinberger HD, Make B, Bowler R, Crapo JD, Meschede K, Kozora E, Moser DJ, Hoth KF. Cognitive performance is lower among individuals with overlap syndrome than in individuals with COPD or obstructive sleep apnea alone: association with carotid artery stiffness. J Appl Physiol (1985) 2021; 131:131-141. [PMID: 33982592 PMCID: PMC8325616 DOI: 10.1152/japplphysiol.00477.2020] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 04/29/2021] [Accepted: 05/03/2021] [Indexed: 12/13/2022] Open
Abstract
Chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea (OSA) are both independently associated with increased cardiovascular disease (CVD) risk and impaired cognitive function. It is unknown if individuals with both COPD and OSA (i.e., overlap syndrome) have greater common carotid artery (CCA) stiffness, an independent predictor of CVD risk, and lower cognitive performance than either COPD or OSA alone. Elevated CCA stiffness is associated with cognitive impairment in former smokers with and without COPD in past studies. We compared CCA stiffness and cognitive performance between former smokers with overlap syndrome, COPD only, OSA only and former smoker controls using analysis of covariance (ANCOVA) tests to adjust for age, sex, body mass index (BMI), pack years, and postbronchodilator FEV1/FVC. We also examined the association between CCA stiffness and cognitive performance among each group separately. Individuals with overlap syndrome (n = 12) had greater CCA β-stiffness index (P = 0.015) and lower executive function-processing speed (P = 0.019) than individuals with COPD alone (n = 47), OSA alone (n = 9), and former smoker controls (n = 21), differences that remained significant after adjusting for age, BMI, sex, pack years, and FEV1/FVC. Higher CCA β-stiffness index was associated with lower executive function-processing speed in individuals with overlap syndrome (r = -0.58, P = 0.047). These data suggest that CCA stiffness is greater and cognitive performance is lower among individuals with overlap syndrome compared with individuals with COPD or OSA alone and that CCA stiffening may be an underlying mechanism contributing to the lower cognitive performance observed in patients with overlap syndrome.NEW & NOTEWORTHY Previous studies have demonstrated greater carotid artery stiffness and lower cognitive function among individuals with COPD alone and OSA alone. However, the present study is the first to demonstrate that individuals that have both COPD and OSA (i.e., overlap syndrome) have greater carotid artery stiffness and lower executive function-processing speed than individuals with either disorder alone. Furthermore, among individuals with overlap syndrome greater carotid artery stiffness is associated with lower executive function-processing speed.
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Affiliation(s)
- Rachel E Luehrs
- Department of Health and Human Physiology, University of Iowa, Iowa City, Iowa
- Department of Kinesiology, North Central College, Naperville, Illinois
| | - Kerrie L Moreau
- Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
- Eastern Colorado VA Geriatric, Research, Education, and Clinical Center (GRECC), Aurora, Colorado
| | - Gary L Pierce
- Department of Health and Human Physiology, University of Iowa, Iowa City, Iowa
- Abboud Cardiovascular Research Center, University of Iowa, Iowa City, Iowa
| | - Frederick Wamboldt
- Department of Medicine, National Jewish Health, Denver, Colorado
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Mark Aloia
- Department of Medicine, National Jewish Health, Denver, Colorado
| | - Howard D Weinberger
- Department of Medicine, National Jewish Health, Denver, Colorado
- Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Barry Make
- Department of Medicine, National Jewish Health, Denver, Colorado
- Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Russell Bowler
- Department of Medicine, National Jewish Health, Denver, Colorado
- Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - James D Crapo
- Department of Medicine, National Jewish Health, Denver, Colorado
- Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | | | - Elizabeth Kozora
- Department of Medicine, National Jewish Health, Denver, Colorado
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - David J Moser
- Department of Psychiatry, University of Iowa, Iowa City, Iowa
| | - Karin F Hoth
- Department of Psychiatry, University of Iowa, Iowa City, Iowa
- Iowa Neuroscience Institute, University of Iowa, Iowa City, Iowa
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99791
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Prediletto I, Tavalazzi F, Perziano M, Fanfulla F, Fabiani A, Oldani S, Azzi N, Mutti C, Parrino L, Nava S. Sleep features in Lymphangioleiomyomatosis and their relationship with disease severity: a pilot study. Sleep Med 2021; 85:60-65. [PMID: 34274813 DOI: 10.1016/j.sleep.2021.06.038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Revised: 06/18/2021] [Accepted: 06/23/2021] [Indexed: 11/27/2022]
Abstract
Lymphangioleiomyomatosis (LAM) is a rare pulmonary disease characterized by progressive airflow limitation. We conducted a pilot trial to investigate the incidence of sleep disorders, sleep quality and their relationship with disease severity. We performed pulmonary function tests, blood gas analysis, overnight 12-channels polysomnography and clinical assessments in 15 consecutive LAM patients. For statistics, p values < 0.05 were considered significant. Sleep efficiency (SE) was inversely correlated with RV/TLC (p = 0.035) and positively with daytime SpO2 (p = 0.010) and PaO2 (p = 0.011). Three cases had obstructive sleep apnea (OSA); seven patients (46.7%) showed a REMOSA. AHIREM was correlated with FEV1% (r = 0.75, p = 0.003), TLC% (r = 0.57, p = 0.026), RV% (r = 0.8, p=<0.0001) and RV/TLC (r = 0.77, p = 0.001). No correlations were observed between anxiety/depression and SE, CAP rate, pulmonary function test variables and AHIREM (p > 0.05). four subjects had nocturnal hypoxia (T90 ≥ 1% of TST) showing lower values of DLCO%, daytime SpO2%, PaO2, FEV1% and a higher value of VR/TLC comparing with the subgroup with normal T90 (p < 0.05). This pilot study shows that sleep alterations could be frequent in LAM and associated to disease severity. Nocturnal hypoxemia and SE were related to lung function impairment. A dysregulation of sleep seems to involve exclusively REM phase, while NREM appears to be preserved. This phenomenon might be linked to the pathophysiology of disease: our study, even with the limits of the small sample size, showed that the presence of REMOSA is related to the disease severity, in particular to the degree of airflow limitation and hyperinflation. More studies are needed to assess this topic.
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Affiliation(s)
- Irene Prediletto
- Alma Mater Studiorum University of Bologna, Department of Experimental, Diagnostic and Specialty Medicine - DIMES (DIMES), Bologna, Italy; Rare Respiratory Diseases Center, Respiratory and Critical Care Unit, IRCCS Sant'Orsola-Malpighi University Hospital, Bologna, Italy.
| | - Francesco Tavalazzi
- Respiratory and Bronchoendoscopic Unit, Ravenna Hospital, AUSL Romagna, Ravenna, Italy
| | - Massimiliano Perziano
- Respiratory and Critical Care Unit, IRCCS Sant'Orsola-Malpighi University Hospital, Bologna, Italy
| | - Francesco Fanfulla
- Sleep Medicine Unit Istituti Clinici Scientifici Maugeri, IRCCS, Scientific Institute of Pavia, Italy
| | - Andrea Fabiani
- Rare Respiratory Diseases Center, Respiratory and Critical Care Unit, IRCCS Sant'Orsola-Malpighi University Hospital, Bologna, Italy
| | - Stefano Oldani
- Department of Diseases of the Thorax, GB Morgagni Hospital, Forlì, Italy
| | - Nicoletta Azzi
- Sleep Disorders Center, Department of Medicine and Surgery, University of Parma, Italy
| | - Carlotta Mutti
- Sleep Disorders Center, Department of Medicine and Surgery, University of Parma, Italy
| | - Liborio Parrino
- Sleep Disorders Center, Department of Medicine and Surgery, University of Parma, Italy
| | - Stefano Nava
- Alma Mater Studiorum University of Bologna, Department of Experimental, Diagnostic and Specialty Medicine - DIMES (DIMES), Bologna, Italy; Respiratory and Critical Care Unit, IRCCS Sant'Orsola-Malpighi University Hospital, Bologna, Italy
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99792
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Cecchini MJ, Tarmey T, Ferreira A, Mangaonkar AA, Ferrer A, Patnaik MM, Wylam ME, Jenkins SM, Spears GM, Yi ES, Hartman TE, Scott JP, Roden AC. Pathology, Radiology, and Genetics of Interstitial Lung Disease in Patients With Shortened Telomeres. Am J Surg Pathol 2021; 45:871-884. [PMID: 33935155 DOI: 10.1097/pas.0000000000001725] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Interstitial lung diseases (ILDs) in patients with shortened telomeres have not been well characterized. We describe demographic, radiologic, histopathologic, and molecular features, and p16 expression in patients with telomeres ≤10th percentile (shortened telomeres) and compare them to patients with telomere length >10th percentile. Lung explants, wedge biopsies, and autopsy specimens of patients with telomere testing were reviewed independently by 3 pathologists using defined parameters. High-resolution computed tomography scans were reviewed by 3 radiologists. p16-positive fibroblast foci were quantified. A multidisciplinary diagnosis was recorded. Patients with shortened telomeres (N=26) were morphologically diagnosed as usual interstitial pneumonia (UIP) (N=11, 42.3%), chronic hypersensitivity pneumonitis (N=6, 23.1%), pleuroparenchymal fibroelastosis, fibrotic nonspecific interstitial pneumonia, desquamative interstitial pneumonia (N=1, 3.8%, each), and fibrotic interstitial lung disease (fILD), not otherwise specified (N=6, 23.1%). Patients with telomeres >10th percentile (N=18) showed morphologic features of UIP (N=9, 50%), chronic hypersensitivity pneumonitis (N=3, 16.7%), fibrotic nonspecific interstitial pneumonia (N=2, 11.1%), or fILD, not otherwise specified (N=4, 22.2%). Patients with shortened telomeres had more p16-positive foci (P=0.04). The number of p16-positive foci correlated with outcome (P=0.0067). Thirty-nine percent of patients with shortened telomeres harbored telomere-related gene variants. Among 17 patients with shortened telomeres and high-resolution computed tomography features consistent with or probable UIP, 8 (47.1%) patients showed morphologic features compatible with UIP; multidisciplinary diagnosis most commonly was idiopathic pulmonary fibrosis (N=7, 41.2%) and familial pulmonary fibrosis (N=5, 29%) in these patients. In conclusion, patients with shortened telomeres have a spectrum of fILDs. They often demonstrate atypical and discordant features on pathology and radiology leading to diagnostic challenges.
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Affiliation(s)
| | | | | | | | | | | | - Mark E Wylam
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN
| | | | | | - Eunhee S Yi
- Departments of Laboratory Medicine and Pathology
| | | | - John P Scott
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN
| | - Anja C Roden
- Departments of Laboratory Medicine and Pathology
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99793
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Discordances Between Factors Associated With Withholding Extubation and Extubation Failure After a Successful Spontaneous Breathing Trial. Crit Care Med 2021; 49:2080-2089. [PMID: 34259451 DOI: 10.1097/ccm.0000000000005107] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To identify whether factors associated with withholding extubation in the ICU also predict the risk of extubation failure. DESIGN Retrospective cohort study. SETTING Eight medical-surgical ICUs in Toronto. PATIENTS Adult patients receiving invasive mechanical ventilation, with a first successful spontaneous breathing trial within 28 days of initial ICU admission. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS The primary end point had three mutually exclusive levels, including: 1) withholding extubation after a successful spontaneous breathing trial, 2) extubation failure within 48 hours, and 3) successful extubation. Among 9,910 patients, 38% of patients were not extubated within 24 hours of their first successful spontaneous breathing trial. A total of 12.9% of patients who were promptly extubated failed within the next 48 hours. Several discrepancies were evident in the association of factors with risk of withholding extubation and extubation failure. Specifically, both age and female sex were associated with withholding extubation (odds ratio, 1.07; 95% CI, 1.03-1.11; and odds ratio, 1.13; 95% CI, 1.02-1.26, respectively) but not a higher risk of failed extubation (odds ratio, 0.99; 95% CI, 0.93-1.05; and odds ratio, 0.93; 95% CI, 0.77-1.11, respectively). Conversely, both acute cardiovascular conditions and intubation for hypoxemic respiratory failure were associated with a higher risk of failed extubation (odds ratio, 1.32; 95% CI, 1.06-1.66; and odds ratio, 1.46; 95% CI, 1.16-1.82, respectively) but not a higher odds of a withheld extubation attempt (odds ratio, 0.79; 95% CI, 0.68-0.91; and odds ratio, 1.07; 95% CI, 0.93-1.23, respectively). CONCLUSIONS Several factors showed discordance between the decision to withhold extubation and the risk of extubation failure. This discordance may lead to longer duration of mechanical ventilation or higher reintubation rates. Improving the decision-making behind extubation may help to reduce both exposure to invasive mechanical ventilation and extubation failure.
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99794
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Zergane M, Kuebler WM, Michalick L. Heteromeric TRP Channels in Lung Inflammation. Cells 2021; 10:cells10071654. [PMID: 34359824 PMCID: PMC8307017 DOI: 10.3390/cells10071654] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 06/09/2021] [Accepted: 06/25/2021] [Indexed: 12/15/2022] Open
Abstract
Activation of Transient Receptor Potential (TRP) channels can disrupt endothelial barrier function, as their mediated Ca2+ influx activates the CaM (calmodulin)/MLCK (myosin light chain kinase)-signaling pathway, and thereby rearranges the cytoskeleton, increases endothelial permeability and thus can facilitate activation of inflammatory cells and formation of pulmonary edema. Interestingly, TRP channel subunits can build heterotetramers, whereas heteromeric TRPC1/4, TRPC3/6 and TRPV1/4 are expressed in the lung endothelium and could be targeted as a protective strategy to reduce endothelial permeability in pulmonary inflammation. An update on TRP heteromers and their role in lung inflammation will be provided with this review.
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Affiliation(s)
- Meryam Zergane
- Institute of Physiology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 10117 Berlin, Germany; (M.Z.); (L.M.)
| | - Wolfgang M. Kuebler
- Institute of Physiology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 10117 Berlin, Germany; (M.Z.); (L.M.)
- German Centre for Cardiovascular Research (DZHK), 10785 Berlin, Germany
- German Center for Lung Research (DZL), 35392 Gießen, Germany
- The Keenan Research Centre for Biomedical Science, St. Michael’s Hospital, Toronto, ON M5B 1W8, Canada
- Department of Surgery and Physiology, University of Toronto, Toronto, ON M5S 1A8, Canada
- Correspondence:
| | - Laura Michalick
- Institute of Physiology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 10117 Berlin, Germany; (M.Z.); (L.M.)
- German Centre for Cardiovascular Research (DZHK), 10785 Berlin, Germany
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99795
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Sandvik R, Gustafsson PM, Lindblad A, Robinson PD, Nielsen K. Improved agreement between N 2 and SF 6 multiple-breath washout in healthy infants and toddlers with improved EXHALYZER D sensor performance. J Appl Physiol (1985) 2021; 131:107-118. [PMID: 34043468 DOI: 10.1152/japplphysiol.00129.2021] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Recent studies indicate limited utility of nitrogen multiple-breath washout (N2MBW) in infancy and advocate for using sulfur hexafluoride (SF6) MBW in this age-group. Modern N2MBW systems, such as EXHALYZER D (ECO MEDICS AG, Duernten, Switzerland), use O2 and CO2 sensors to calculate N2 concentrations (in principle, N2% = 100 - CO2% - O2%). High O2 and CO2 concentrations have now been shown to significantly suppress signal output from the other sensor, raising apparent N2 concentrations. We examined whether improved EXHALYZER D N2 signal, accomplished after thorough examination of this CO2 and O2 interaction on gas sensors and its correction, leads to better agreement between N2MBW and SF6MBW in healthy infants and toddlers. Within the same session, 52 healthy children aged 1-36 mo [mean = 1.30 (SD = 0.72) yr] completed SF6MBW and N2MBW recordings (EXHALYZER D, SPIROWARE version 3.2.1) during supine quiet sleep. SF6 and N2 SPIROWARE files were reanalyzed offline with in-house software using identical algorithms as in SPIROWARE with or without application of the new correction factors for N2MBW provided by ECO MEDICS AG. Applying the improved N2 signal significantly reduced mean [95% confidence interval (CI)] differences between N2MBW and SF6MBW recorded functional residual capacity (FRC) and lung clearance index (LCI): for FRC, from 26.1 (21.0, 31.2) mL, P < 0.0001, to 1.18 (-2.3, 4.5) mL, P = 0.5, and for LCI, from 1.86 (1.68, 2.02), P < 0.001, to 0.44 (0.33, 0.55), P < 0.001. Correction of N2 signal for CO2 and O2 interactions on gas sensors resulted in markedly closer agreement between N2MBW and SF6MBW outcomes in healthy infants and toddlers.NEW & NOTEWORTHY Modern nitrogen multiple-breath washout (N2MBW) systems such as EXHALYZER D use O2 and CO2 sensors to calculate N2 concentrations. New corrections for interactions between high O2 and CO2 concentrations on the gas sensors now provide accurate N2 signals. The correct N2 signal led to much improved agreement between N2MBW and sulfur hexafluoride (SF6) MBW functional residual capacity (FRC) and lung clearance index (LCI) in 52 sleeping healthy infants and toddlers, suggesting a role for N2MBW in this age-group.
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Affiliation(s)
- Rikke Sandvik
- Danish Paediatric Pulmonary Service, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Per M Gustafsson
- Department of Paediatrics, Central Hospital, Skövde, Sweden.,Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Anders Lindblad
- Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Gothenburg CF Centre, Queen Silvia Children's Hospital, Gothenburg, Sweden
| | - Paul D Robinson
- Department of Respiratory Medicine, The Children's Hospital at Westmead, Westmead, New South Wales, Australia.,The Discipline of Paediatrics and Child Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Kim Nielsen
- Danish Paediatric Pulmonary Service, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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99796
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Cazzaniga M, Fumagalli LAM, D'angelo L, Cerino M, Bonfanti G, Fumagalli RM, Schiavo G, Lorini C, Lainu E, Terragni S, Chiarelli M, Scarazzati C, Bonato C, Zago M. Eosinopenia is a reliable marker of severe disease and unfavourable outcome in patients with COVID-19 pneumonia. Int J Clin Pract 2021; 75:e14047. [PMID: 33497517 PMCID: PMC7995195 DOI: 10.1111/ijcp.14047] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Accepted: 01/19/2021] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND AND AIM Viral pneumonia is the most relevant clinical presentation of COVID-19 which may lead to severe acute respiratory syndrome and even death. Eosinopenia was often noticed in patients with COVID-19 pneumonia, but its role is poorly investigated. The aim of the present study was to investigate the characteristics and clinical outcomes of patients with COVID-19 pneumonia and eosinopenia. METHODS We revised the records of consecutive patients with COVID-19 pneumonia admitted to our ER-COVID-19 area in order to compare clinical characteristics and outcomes of patients with and without eosinopenia. We considered the following clinical outcomes: 4-weeks survival; need for intensive respiratory support; and hospital discharge. RESULTS Out of first 107 consecutive patients with pneumonia and a positive COVID-19 nasopharyngeal swab, 75 patients showed undetectable eosinophil count (absolute eosinopenia). At 4 weeks, 38 patients (38.4%) had required intensive respiratory treatment, 25 (23.4%) deceased and 42 (39.2%) were discharged. Compared with patients without absolute eosinopenia, patients with absolute eosinopenia showed higher need of intensive respiratory treatment (49.3% vs 13.3%, P < .001), higher mortality (30.6% vs 6.2%, P .006) and lower rate of hospital discharge (28% vs 65.6%, P < .001). Binary logistic regression analyses including neutrophil, lymphocyte, eosinophil, basophil and monocyte counts showed that absolute eosinopenia was an independent factor associated with 4-weeks mortality, need for intensive respiratory support and hospital discharge. CONCLUSIONS Absolute eosinopenia is associated with clinical outcomes in patients with COVID-19 pneumonia and might be used as a marker to discriminate patients with unfavourable prognosis.
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Affiliation(s)
| | | | | | | | | | - Riccardo M. Fumagalli
- Università degli Studi dell'InsubriaVareseItaly
- Albert Ludwigs Universität FreiburgFreiburg im BreisgauGermany
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99797
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Clohisey S, Sinha P. Genome-wide association studies in ARDS: SNPing the tangled web of heterogeneity. Intensive Care Med 2021; 47:782-785. [PMID: 34173858 PMCID: PMC8233583 DOI: 10.1007/s00134-021-06462-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 06/16/2021] [Indexed: 11/04/2022]
Affiliation(s)
- Sara Clohisey
- The Roslin Institute, Edinburgh, EH25 9RG Scotland, UK
| | - Pratik Sinha
- Department of Anesthesiology, Washington University Medical School, 660 S. Euclid Ave, Campus, Box 8054, St. Louis, MO 63110 USA
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99798
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Puente-Maestú L, Ortega F, Pedro JGD, Rodríguez-Nieto MJ, Gómez-Seco J, Gáldiz B, Ojanguren I, Muñoz X, Blanco I, Burgos F, Rodríguez-Chiaradía DA, Gea J, García-Rio F. Prediction Equations for Maximal Aerobic Capacity on Cycle Ergometer for the Spanish Adult Population. Arch Bronconeumol 2021; 57:471-478. [PMID: 35698953 DOI: 10.1016/j.arbr.2020.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Accepted: 09/13/2020] [Indexed: 06/15/2023]
Abstract
BACKGROUND Frequently used reference values for clinical exercise testing have been derived from non-random samples and some with poorly defined maximal criteria. Our objective was to obtain population based reference values for peak oxygen uptake (V?O2) and work rate (WR) for cardiopulmonary exercise testing in a representative sample of Caucasian Spanish men and women. METHODS 182 men and women, 20-85 years old, were included and exercised on cycle-ergometer to exhaustion. (V?O2) and WR were measured. The equations obtained from this sample were validated in an independent cohort of 69 individuals, randomly sampled form the same population. Then a final equation merging the two cohorts (=251) was produced. RESULTS Height, sex and age resulted predictive of both V?O2 peak and WR. Weight and physical activity added very little to the accuracy to the equations. The formulas V?O2peak=0.017·height?(cm)-0.023·age?(years)+0.864·sex?(female=0/male=1)±179?l?min-1, and peak WR=1.345 · height (cm) - 2.074 · age (years)+76.54 · sex (female=0/male=1)±21.2W were the best compromise between accuracy and parsimony. CONCLUSIONS This study provides new and accurate V?O2 peak and WR rate reference values for individuals of European Spanish descent.
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Affiliation(s)
- Luis Puente-Maestú
- Servicio de Neumología Hospital General Universitario Gregorio Marañón-Facultad de Medicina: Universidad Complutense de Madrid (UCM), Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain.
| | - Francisco Ortega
- Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/Universidad de Sevilla, Spain; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), (Biomedical Research Networking Center on Respiratory Diseases (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | - Julia Garcia de Pedro
- Servicio de Neumología Hospital General Universitario Gregorio Marañón-Facultad de Medicina: Universidad Complutense de Madrid (UCM), Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
| | - María Jesús Rodríguez-Nieto
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), (Biomedical Research Networking Center on Respiratory Diseases (CIBERES), Instituto de Salud Carlos III, Madrid, Spain; Department of Pulmonary Medicine, IIS-Fundación Jiménez Diaz, Autónoma University Madrid, Madrid, Spain
| | | | - Batxi Gáldiz
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), (Biomedical Research Networking Center on Respiratory Diseases (CIBERES), Instituto de Salud Carlos III, Madrid, Spain; Department of Pulmonary Medicine, Cruces Universitary Hospital, Barakaldo, Vizcaya, Spain; Biocruces Bizkaia Health Research Institute, Barakaldo, Vizcaya, Spain
| | - Iñigo Ojanguren
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), (Biomedical Research Networking Center on Respiratory Diseases (CIBERES), Instituto de Salud Carlos III, Madrid, Spain; Servicio de Neumología, Departamento de Medicina, Hospital Universitario Vall d'Hebron, Universidad Autónoma de Barcelona, Cataluña, Spain
| | - Xavier Muñoz
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), (Biomedical Research Networking Center on Respiratory Diseases (CIBERES), Instituto de Salud Carlos III, Madrid, Spain; Servicio de Neumología, Departamento de Medicina, Hospital Universitario Vall d'Hebron, Universidad Autónoma de Barcelona, Cataluña, Spain; Servicio Neumologia Hospital Vall d'Hebron, Barcelona, Spain; Ciber de Enfermedades respiratorias CIBERes, Barcelona, Spain; Departamento de Biología Celular, Fisiología e Inmunología Univertsidad Autónoma de Barcelona, Cataluña, Spain
| | - Isabel Blanco
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), (Biomedical Research Networking Center on Respiratory Diseases (CIBERES), Instituto de Salud Carlos III, Madrid, Spain; Department of Pulmonary Medicine, Hospital Clinic-Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Felip Burgos
- University of Barcelona Respiratory Diagnostic Center Hospital Clínic, Barcelona, Spain
| | - Diego A Rodríguez-Chiaradía
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), (Biomedical Research Networking Center on Respiratory Diseases (CIBERES), Instituto de Salud Carlos III, Madrid, Spain; Servicio de Neumología, Hospital del Mar-Universitat Pompeu Fabra (UPF), Barcelona, Spain; Institut Hospital del Mar d'Investigacions Mediques (IMIM), CIBERES (ISCIII), Barcelona, Spain
| | - Joaquim Gea
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), (Biomedical Research Networking Center on Respiratory Diseases (CIBERES), Instituto de Salud Carlos III, Madrid, Spain; Servicio de Neumología, Hospital del Mar-Universitat Pompeu Fabra (UPF), Barcelona, Spain; Institut Hospital del Mar d'Investigacions Mediques (IMIM), CIBERES (ISCIII), Barcelona, Spain
| | - Francisco García-Rio
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), (Biomedical Research Networking Center on Respiratory Diseases (CIBERES), Instituto de Salud Carlos III, Madrid, Spain; Servicio de Neumología, Hospital Universitario La Paz-IdiPAZ-Departamento de Medicina, Universidad Autónoma de Madrid, Madrid, Spain
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99799
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Gómez López A, García Luján R, Villena Garrido V. ¿Es posible el diagnóstico de linfangioleiomiomatosis o de hiperplasia micronodular neumocitaria multifocal sin lesiones visibles en la tomografía de tórax? OPEN RESPIRATORY ARCHIVES 2021. [PMID: 37496767 PMCID: PMC10369565 DOI: 10.1016/j.opresp.2021.100120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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99800
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Kwok TC, Swaby R, Sharkey D. Airflow dispersion during common neonatal resuscitation procedures: A simulation study. Pediatr Pulmonol 2021; 56:2057-2066. [PMID: 33826802 DOI: 10.1002/ppul.25378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 02/02/2021] [Accepted: 03/11/2021] [Indexed: 11/05/2022]
Abstract
BACKGROUND Aerosol generating medical procedures (AGMPs) are common during newborn resuscitation. Neonates with respiratory viruses such as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection may pose a risk to healthcare workers. International guidelines differ on methods to minimize the risk due to limited data. OBJECTIVE We examined the expiratory airflow dispersion during common neonatal resuscitation AGMPs using infant simulators. METHODS Expiratory airflow dispersion in term and preterm manikins was simulated (n = 288) using fine particle smoke at tidal volumes of 5 ml/kg. Using ImageJ, we quantified dispersion during common airway procedures including endotracheal tube (ETT) and T-piece ventilation. RESULTS Maximal expiratory dispersion distances for the unsupported airway and disconnected uncuffed ETT scenarios were 30.2 and 22.7 cm (term); 22.1 and 17.2 cm (preterm), respectively. Applying T-piece positive end expiratory pressure (PEEP) via an ETT (ETTPEEP ) generated no expiratory dispersion but increased tube leak during term simulation, while ventilation breaths (ETTVENT ) caused significant expiratory dispersion and leak. There was no measurable dispersion during face mask ventilation. For term uncuffed ETT ventilation, the particle filter eliminated expiratory dispersion but increased leak. No expiratory dispersion and negligible leak were observed when combining a cuffed ETT and filter. Angulated T-pieces generated the greatest median dispersion distances of 35.8 cm (ETTPEEP ) and 23.3 cm (ETTVENT ). CONCLUSIONS Airflow dispersion during neonatal AGMPs is greater than previously postulated and potentially could contaminate healthcare providers during resuscitation of infants infected with contagious viruses such as SARS-CoV-2. It is possible to mitigate this risk using particle filters and cuffed ETTs. Applicability in the clinical setting requires further evaluation.
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Affiliation(s)
- T'ng Chang Kwok
- Academic Child Health, School of Medicine, University of Nottingham, Nottingham, UK.,Nottingham Neonatal Service, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Rabbi Swaby
- Nottingham Neonatal Service, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Don Sharkey
- Academic Child Health, School of Medicine, University of Nottingham, Nottingham, UK.,Nottingham Neonatal Service, Nottingham University Hospitals NHS Trust, Nottingham, UK
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