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Malhotra A, Martinot JB, Pépin JL. Insights on mandibular jaw movements during polysomnography in obstructive sleep apnea. J Clin Sleep Med 2024; 20:151-163. [PMID: 37767856 PMCID: PMC10758568 DOI: 10.5664/jcsm.10830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 09/13/2023] [Accepted: 09/13/2023] [Indexed: 09/29/2023]
Abstract
A strong and specific comprehensive physiological association has been documented between mandibular jaw movements and related periods of normal or disturbed breathing across different sleep stages. The mandibular jaw movement biosignal can be incorporated in the polysomnography, displayed on the screen as a function of time like any standard polysomnography signal (eg, airflow, oxygen saturation, respiratory inductance plethysmography bands) and interpreted in the context of the target period of breathing and its associated respiratory effort level. Overall, the mandibular jaw movement biosignal that depicts the muscular trigeminal respiratory drive is a highly effective tool for differentiating between central and obstructive sleep episodes including hypopneas and for providing clinicians with valuable insights into wake/sleep states, arousals, and sleep stages. These fundamental characteristics of the mandibular jaw movement biosignal contrast with photoplethysmography, airflow, or oxygen saturation signals that provide information more about the consequence of the disturbed breathing episode than about the event itself. CITATION Malhotra A, Martinot J-B, Pépin J-L. Insights on mandibular jaw movements during polysomnography in obstructive sleep apnea. J Clin Sleep Med. 2024;20(1):151-163.
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Affiliation(s)
- Atul Malhotra
- University of California San Diego, La Jolla, California
| | - Jean-Benoit Martinot
- Sleep Laboratory, CHU Université catholique de Louvain Namur Site Sainte-Elisabeth, Namur, Belgium
- Institute of Experimental and Clinical Research, Université catholique de Louvain Bruxelles Woluwe, Brussels, Belgium
| | - Jean-Louis Pépin
- HP2 Laboratory, Inserm U1300, University Grenoble Alpes, Grenoble, France
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Martinot JB, Le-Dong NN, Borel AL, Tamisier R, Malhotra A, Pépin JL. Respiratory effort during sleep and the rate of prevalent type 2 diabetes in obstructive sleep apnoea. Diabetes Obes Metab 2023; 25:2815-2823. [PMID: 37312670 PMCID: PMC10527265 DOI: 10.1111/dom.15169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 05/15/2023] [Accepted: 05/24/2023] [Indexed: 06/15/2023]
Abstract
AIM To determine the association between total sleep time (TST) spent in increased respiratory effort (RE) and the prevalence of type 2 diabetes in a large cohort of individuals with suspected obstructive sleep apnoea (OSA) referred for in-laboratory polysomnography (PSG). MATERIALS AND METHODS We conducted a retrospective cross-sectional study using the clinical data of 1128 patients. Non-invasive measurements of RE were derived from the sleep mandibular jaw movements (MJM) bio-signal. An explainable machine-learning model was built to predict prevalent type 2 diabetes from clinical data, standard PSG indices, and MJM-derived parameters (including the proportion of TST spent with increased respiratory effort [REMOV [%TST]). RESULTS Original data were randomly assigned to training (n = 853) and validation (n = 275) subsets. The classification model based on 18 input features including REMOV showed good performance for predicting prevalent type 2 diabetes (sensitivity = 0.81, specificity = 0.89). Post hoc interpretation using the Shapley additive explanation method found that a high value of REMOV was the most important risk factor associated with type 2 diabetes after traditional clinical variables (age, sex, body mass index), and ahead of standard PSG metrics including the apnoea-hypopnea and oxygen desaturation indices. CONCLUSIONS These findings show for the first time that the proportion of sleep time spent in increased RE (assessed through MJM measurements) is an important predictor of the association with type 2 diabetes in individuals with OSA.
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Affiliation(s)
- Jean-Benoit Martinot
- Sleep Laboratory, CHU Université catholique de Louvain (UCL) Namur Site Sainte-Elisabeth, Namur, Belgium
- Institute of Experimental and Clinical Research, UCL Bruxelles Woluwe, Brussels, Belgium
| | | | - Anne-Laure Borel
- University of Grenoble Alpes, HP2 Laboratory, Inserm U1300, Grenoble, France
| | - Renaud Tamisier
- University of Grenoble Alpes, HP2 Laboratory, Inserm U1300, Grenoble, France
| | - Atul Malhotra
- University of California San Diego, La Jolla, California, USA
| | - Jean-Louis Pépin
- University of Grenoble Alpes, HP2 Laboratory, Inserm U1300, Grenoble, France
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Martinot JB, Le-Dong NN, Malhotra A, Pépin JL. Respiratory effort during sleep and prevalent hypertension in obstructive sleep apnoea. Eur Respir J 2023; 61:13993003.01486-2022. [PMID: 36455958 PMCID: PMC9978160 DOI: 10.1183/13993003.01486-2022] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 11/16/2022] [Indexed: 12/03/2022]
Abstract
BACKGROUND Mechanisms underlying blood pressure changes in obstructive sleep apnoea (OSA) are incompletely understood. Increased respiratory effort is one of the main features of OSA and is associated with sympathetic overactivity, leading to increased vascular wall stiffness and remodelling. This study investigated associations between a new measure of respiratory effort (percentage of total sleep time spent with increased respiratory effort based on measurement of mandibular jaw movements (MJM): REMOV, %TST) and prevalent hypertension in adults referred for evaluation of suspected OSA. METHODS A machine learning model was built to predict hypertension from clinical data, conventional polysomnography (PSG) indices and MJM-derived parameters (including REMOV). The model was evaluated in a training subset and a test subset. RESULTS The analysis included 1127 patients: 901 (80%) in the training subset and 226 (20%) in the test subset. The prevalence of hypertension was 31% and 30%, respectively, in the training and test subsets. A risk stratification model based on 18 input features including REMOV had good accuracy for predicting prevalent hypertension (sensitivity 0.75 and specificity 0.83). Using the Shapley additive explanation method, REMOV was the best predictor of hypertension after clinical risk factors (age, sex, body mass index and neck circumference) and time with oxygen saturation <90%, ahead of standard PSG metrics (including the apnoea-hypopnoea index and oxygen desaturation index). CONCLUSION The proportion of sleep time spent with increased respiratory effort automatically derived from MJM was identified as a potential new reliable metric to predict prevalent hypertension in patients with OSA.
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Affiliation(s)
- Jean-Benoit Martinot
- Sleep Laboratory, CHU Université Catholique de Louvain (UCL) Namur Site Sainte-Elisabeth, Namur, Belgium
- Institute of Experimental and Clinical Research, UCL Bruxelles Woluwe, Brussels, Belgium
| | | | - Atul Malhotra
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Jean-Louis Pépin
- HP2 Laboratory, Inserm U1300, University Grenoble Alpes, Grenoble, France
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Martinot JB, Pépin JL, Malhotra A, Le-Dong NN. Near-boundary double-labeling-based classification: the new standard when evaluating performances of new sleep apnea diagnostic solutions against polysomnography? Sleep 2022; 45:zsac188. [PMID: 35997163 PMCID: PMC9758507 DOI: 10.1093/sleep/zsac188] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/25/2023] Open
Affiliation(s)
- Jean-Benoit Martinot
- Sleep Laboratory, CHU Université Catholique de Louvain (UCL) Namur Site Sainte-Elisabeth, Namur, Belgium
- Institute of Experimental and Clinical Research, UCL Bruxelles Woluwe, Brussels, Belgium
| | - Jean-Louis Pépin
- HP2 Laboratory, Inserm U1300, University Grenoble Alpes, Grenoble, France
| | - Atul Malhotra
- Division of Pulmonary, Critical Care and Sleep Medicine, School of Medicine, University of California San Diego, La Jolla, CA 92121, USA
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Martinot JB, Cuthbert V, Le-Dong NN, Coumans N, De Marneffe D, Letesson C, Pépin JL, Gozal D. Clinical validation of a mandibular movement signal based system for the diagnosis of pediatric sleep apnea. Pediatr Pulmonol 2022; 57:1904-1913. [PMID: 33647188 DOI: 10.1002/ppul.25320] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 02/08/2021] [Accepted: 02/09/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND Given the high prevalence and risk for outcomes associated with pediatric obstructive sleep apnea (OSA), there is a need for simplified diagnostic approaches. A prospective study in 140 children undergoing in-laboratory polysomnography (PSG) evaluates the accuracy of a recently developed system (Sunrise) to estimate respiratory efforts by monitoring sleep mandibular movements (MM) for the diagnosis of OSA (Sunrise™). METHODS Diagnosis and severity were defined by an obstructive apnea/hypopnea index (OAHI) ≥ 1 (mild), ≥ 5 (moderate), and ≥ 10 events/h (severe). Agreement between PSG and Sunrise™ was assessed by Bland-Altman method comparing respiratory disturbances hourly index (RDI) (obstructive apneas, hypopneas, and respiratory effort-related arousals) during PSG (PSG_RDI), and Sunrise RDI (Sr_RDI). Performance of Sr_RDI was determined via ROC curves evaluating the device sensitivity and specificity at PSG_OAHI ≥ 1, 5, and 15 events/h. RESULTS A median difference of 1.57 events/h, 95% confidence interval: -2.49 to 8.11 was found between Sr_RDI and PSG_RDI. Areas under the ROC curves of Sr_RDI were 0.75 (interquartile range [IQR]: 0.72-0.78), 0.90 (IQR: 0.86-0.92) and 0.95 (IQR: 0.90-0.99) for detecting children with PSG_OAHI ≥ 1, PSG_OAHI ≥ 5, or PSG_ OAHI ≥ 10, respectively. CONCLUSION MM automated analysis shows significant promise to diagnose moderate-to-severe pediatric OSA.
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Affiliation(s)
- Jean-Benoit Martinot
- Sleep Laboratory, CHU UCL Namur Site Sainte-Elisabeth, Belgium
- Institute of Experimental and Clinical Research, UCL, Bruxelles Woluwe, Belgium
| | | | | | | | | | | | - Jean L Pépin
- Inserm, CHU Grenoble Alpes, HP2, Université Grenoble Alpes, Grenoble, France
| | - David Gozal
- Department of Child Health, University of Missouri, Columbia, Missouri, USA
- Child Health Research Institute, University of Missouri, Columbia, Missouri, USA
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Martinot JB, Le Dong NN, Cuthbert V, Coumans N, Tamisier R, Malhotra A, Pépin JL. 0736 Mandibular Movements Are a Reliable Noninvasive Alternative to Esophageal Pressure for Measuring Respiratory Effort in Patients with Sleep Apnea Syndrome. Sleep 2022. [DOI: 10.1093/sleep/zsac079.732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Differentiation between obstructive and central apneas and hypopneas requires quantitative measurement of respiratory effort (RE) using esophageal pressure (PES), which is rarely implemented. This study investigated whether the sleep mandibular movements (MM) signal recorded with a tri-axial chin sensor (Sunrise, Namur, Belgium) is a reliable surrogate of PES in patients with suspected obstructive sleep apnea (OSA).
Methods
In-laboratory polysomnography (PSG) with PES and concurrent MM monitoring was performed. PSGs were scored manually using AASM 2012 rules. Data blocks (n=8042) were randomly sampled during normal breathing (NB), obstructive or central apnea/hypopnea (OA/OH/CA/CH), respiratory effort-related arousal (RERA), and mixed apnea (MxA). Analyses were: evaluation of the similarity and linear correlation between PES and MM using the longest common subsequence (LCSS) algorithm and Pearson’s coefficient; description of signal amplitudes; estimation of the marginal effect for crossing from NB to a respiratory disturbance for a given change in MM signal using a mixed linear-regression.
Results
Participants (n=38) had mild to severe OSA (median AH index 28.9/h; median arousal index 23.2/h). MM showed a high level of synchronization with concurrent PES signals. Distribution of gyroscope MM signal amplitude differed significantly between event types: median (95% confidence interval) values of 0.60 (0.17–2.43) for CA, 0.83 (0.23–4.71) for CH, 1.93 (0.54–5.57) for MxA, 3.23 (0.72–18.09) for OH, and 6.42 (0.88–26.81) units for OA. Mixed regression indicated that crossing from NB to central events would decrease gyroscope MM signal amplitude by –1.23 (CH) and –2.04 (CA) units, while obstructive events would increase gyroscope MM signal amplitude by +3.27 (OH) and +6.79 (OA) units (all p<10-6).
Conclusion
In OSA patients, MM signals facilitated the measurement of specific levels of RE associated with obstructive, central or mixed apneas and/or hypopneas. A high degree of similarity was observed with the PES gold-standard signal.
Support (If Any)
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Chabert C, Vitte AL, Iuso D, Chuffart F, Trocme C, Buisson M, Poignard P, Lardinois B, Debois R, Rousseaux S, Pepin JL, Martinot JB, Khochbin S. AKR1B10, One of the Triggers of Cytokine Storm in SARS-CoV2 Severe Acute Respiratory Syndrome. Int J Mol Sci 2022; 23:ijms23031911. [PMID: 35163833 PMCID: PMC8836815 DOI: 10.3390/ijms23031911] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 02/02/2022] [Accepted: 02/04/2022] [Indexed: 02/07/2023] Open
Abstract
Preventing the cytokine storm observed in COVID-19 is a crucial goal for reducing the occurrence of severe acute respiratory failure and improving outcomes. Here, we identify Aldo-Keto Reductase 1B10 (AKR1B10) as a key enzyme involved in the expression of pro-inflammatory cytokines. The analysis of transcriptomic data from lung samples of patients who died from COVID-19 demonstrates an increased expression of the gene encoding AKR1B10. Measurements of the AKR1B10 protein in sera from hospitalised COVID-19 patients suggests a significant link between AKR1B10 levels and the severity of the disease. In macrophages and lung cells, the over-expression of AKR1B10 induces the expression of the pro-inflammatory cytokines Interleukin-6 (IL-6), Interleukin-1β (IL-1β) and Tumor Necrosis Factor a (TNFα), supporting the biological plausibility of an AKR1B10 involvement in the COVID-19-related cytokine storm. When macrophages were stressed by lipopolysaccharides (LPS) exposure and treated by Zopolrestat, an AKR1B10 inhibitor, the LPS-induced production of IL-6, IL-1β, and TNFα is significantly reduced, reinforcing the hypothesis that the pro-inflammatory expression of cytokines is AKR1B10-dependant. Finally, we also show that AKR1B10 can be secreted and transferred via extracellular vesicles between different cell types, suggesting that this protein may also contribute to the multi-organ systemic impact of COVID-19. These experiments highlight a relationship between AKR1B10 production and severe forms of COVID-19. Our data indicate that AKR1B10 participates in the activation of cytokines production and suggest that modulation of AKR1B10 activity might be an actionable pharmacological target in COVID-19 management.
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Affiliation(s)
- Clovis Chabert
- Institute for Advanced Biosciences—UGA—INSERM U1209—CNRS UMR 5309, 38700 La Tronche, France; (A.-L.V.); (D.I.); (F.C.); (S.R.); (S.K.)
- Correspondence: ; Tel.: +33-6-8898-4506
| | - Anne-Laure Vitte
- Institute for Advanced Biosciences—UGA—INSERM U1209—CNRS UMR 5309, 38700 La Tronche, France; (A.-L.V.); (D.I.); (F.C.); (S.R.); (S.K.)
| | - Domenico Iuso
- Institute for Advanced Biosciences—UGA—INSERM U1209—CNRS UMR 5309, 38700 La Tronche, France; (A.-L.V.); (D.I.); (F.C.); (S.R.); (S.K.)
| | - Florent Chuffart
- Institute for Advanced Biosciences—UGA—INSERM U1209—CNRS UMR 5309, 38700 La Tronche, France; (A.-L.V.); (D.I.); (F.C.); (S.R.); (S.K.)
| | - Candice Trocme
- Laboratoire BEP (Biochimie des Enzymes et les Protéines), Institut de Biologie et de Pathologie, CHU Grenoble Alpes, 38700 La Tronche, France;
| | - Marlyse Buisson
- Institut de Biologie Structurale, CEA, CNRS and Centre Hospitalier Universitaire Grenoble Alpes, Université Grenoble Alpes, 38000 Grenoble, France; (M.B.); (P.P.)
| | - Pascal Poignard
- Institut de Biologie Structurale, CEA, CNRS and Centre Hospitalier Universitaire Grenoble Alpes, Université Grenoble Alpes, 38000 Grenoble, France; (M.B.); (P.P.)
| | - Benjamin Lardinois
- Laboratory Department, CHU UCL Namur Site de Ste Elisabeth, 5000 Namur, Belgium; (B.L.); (R.D.)
| | - Régis Debois
- Laboratory Department, CHU UCL Namur Site de Ste Elisabeth, 5000 Namur, Belgium; (B.L.); (R.D.)
| | - Sophie Rousseaux
- Institute for Advanced Biosciences—UGA—INSERM U1209—CNRS UMR 5309, 38700 La Tronche, France; (A.-L.V.); (D.I.); (F.C.); (S.R.); (S.K.)
| | - Jean-Louis Pepin
- HP2 Laboratory, INSERM U1300, Grenoble Alpes University, 38000 Grenoble, France;
- Sleep Laboratory, Pole Thorax et Vaisseaux, Grenoble Alpes University Hospital, 38000 Grenoble, France
| | - Jean-Benoit Martinot
- Sleep Laboratory and Pulmonology and Allergy Department—CHU UCL Namur, St. Elisabeth Site, 5000 Namur, Belgium;
- Institute of Experimental and Clinical Research, UCL Bruxelles Woluwe, 1200 Brussels, Belgium
| | - Saadi Khochbin
- Institute for Advanced Biosciences—UGA—INSERM U1209—CNRS UMR 5309, 38700 La Tronche, France; (A.-L.V.); (D.I.); (F.C.); (S.R.); (S.K.)
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Bravo L, Smolenov I, Han HH, Li P, Hosain R, Rockhold F, Clemens SAC, Roa C, Borja-Tabora C, Quinsaat A, Lopez P, López-Medina E, Brochado L, Hernández EA, Reynales H, Medina T, Velasquez H, Toloza LB, Rodriguez EJ, de Salazar DIM, Rodríguez CA, Sprinz E, Cerbino-Neto J, Luz KG, Schwarzbold AV, Paiva MS, Carlos J, Montellano MEB, de Los Reyes MRA, Yu CY, Alberto ER, Panaligan MM, Salvani-Bautista M, Buntinx E, Hites M, Martinot JB, Bhorat QE, Badat A, Baccarini C, Hu B, Jurgens J, Engelbrecht J, Ambrosino D, Richmond P, Siber G, Liang J, Clemens R. Efficacy of the adjuvanted subunit protein COVID-19 vaccine, SCB-2019: a phase 2 and 3 multicentre, double-blind, randomised, placebo-controlled trial. Lancet 2022; 399:461-472. [PMID: 35065705 PMCID: PMC8776284 DOI: 10.1016/s0140-6736(22)00055-1] [Citation(s) in RCA: 55] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 12/05/2021] [Accepted: 12/21/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND A range of safe and effective vaccines against SARS CoV 2 are needed to address the COVID 19 pandemic. We aimed to assess the safety and efficacy of the COVID-19 vaccine SCB-2019. METHODS This ongoing phase 2 and 3 double-blind, placebo-controlled trial was done in adults aged 18 years and older who were in good health or with a stable chronic health condition, at 31 sites in five countries (Belgium, Brazil, Colombia, Philippines, and South Africa). The participants were randomly assigned 1:1 using a centralised internet randomisation system to receive two 0·5 mL intramuscular doses of SCB-2019 (30 μg, adjuvanted with 1·50 mg CpG-1018 and 0·75 mg alum) or placebo (0·9% sodium chloride for injection supplied in 10 mL ampoules) 21 days apart. All study staff and participants were masked, but vaccine administrators were not. Primary endpoints were vaccine efficacy, measured by RT-PCR-confirmed COVID-19 of any severity with onset from 14 days after the second dose in baseline SARS-CoV-2 seronegative participants (the per-protocol population), and the safety and solicited local and systemic adverse events in the phase 2 subset. This study is registered on EudraCT (2020-004272-17) and ClinicalTrials.gov (NCT04672395). FINDINGS 30 174 participants were enrolled from March 24, 2021, until the cutoff date of Aug 10, 2021, of whom 30 128 received their first assigned vaccine (n=15 064) or a placebo injection (n=15 064). The per-protocol population consisted of 12 355 baseline SARS-CoV-2-naive participants (6251 vaccinees and 6104 placebo recipients). Most exclusions (13 389 [44·4%]) were because of seropositivity at baseline. There were 207 confirmed per-protocol cases of COVID-19 at 14 days after the second dose, 52 vaccinees versus 155 placebo recipients, and an overall vaccine efficacy against any severity COVID-19 of 67·2% (95·72% CI 54·3-76·8), 83·7% (97·86% CI 55·9-95·4) against moderate-to-severe COVID-19, and 100% (97·86% CI 25·3-100·0) against severe COVID-19. All COVID-19 cases were due to virus variants; vaccine efficacy against any severity COVID-19 due to the three predominant variants was 78·7% (95% CI 57·3-90·4) for delta, 91·8% (44·9-99·8) for gamma, and 58·6% (13·3-81·5) for mu. No safety issues emerged in the follow-up period for the efficacy analysis (median of 82 days [IQR 63-103]). The vaccine elicited higher rates of mainly mild-to-moderate injection site pain than the placebo after the first (35·7% [287 of 803] vs 10·3% [81 of 786]) and second (26·9% [189 of 702] vs 7·4% [52 of 699]) doses, but the rates of other solicited local and systemic adverse events were similar between the groups. INTERPRETATION Two doses of SCB-2019 vaccine plus CpG and alum provides notable protection against the entire severity spectrum of COVID-19 caused by circulating SAR-CoV-2 viruses, including the predominating delta variant. FUNDING Clover Biopharmaceuticals and the Coalition for Epidemic Preparedness Innovations.
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Affiliation(s)
- Lulu Bravo
- University of the Philippines Manila, Ermita, Manila, Philippines
| | | | | | - Ping Li
- Clover Biopharmaceuticals, Cambridge, MA, USA
| | | | - Frank Rockhold
- Duke University Clinical Research Institute, Duke University Medical Center, Durham, NC, USA
| | | | - Camilo Roa
- Manila Doctors Hospital, Manila, Philippines
| | | | | | - Pio Lopez
- Centro de Estudios en Infectología Pediátrica, Universidad Del Valle Clínica Imbanaco, Cali, Colombia
| | - Eduardo López-Medina
- Centro de Estudios en Infectología Pediátrica, Universidad Del Valle Clínica Imbanaco, Cali, Colombia
| | | | | | | | - Tatiana Medina
- Center of Attention in Medical Research, Bogotá, Colombia
| | | | | | | | | | | | - Eduardo Sprinz
- Hospital de Clinicas de Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | | | | | | | - Maria Sanali Paiva
- Atena Institute of Clinical Research, Rio Grande do Norte, Natal, Brazil
| | - Josefina Carlos
- University of the East Ramon Magsaysay Memorial Medical Center, Quezon City, Philippines
| | | | | | - Charles Y Yu
- De La Salle Medical and Health Sciences Institute, Cavite City, Philippines
| | | | - Mario M Panaligan
- Infection Control Service, St Luke's Medical Center, Taguig, Philippines
| | | | | | - Maya Hites
- Clinic of Infectious Diseases, CUB-Hôpital Erasme, Bruxelles, Belgium
| | - Jean-Benoit Martinot
- Pulmonology Department, CHU Universite Catholique de Louvain Namur Site Sainte-Elisabeth, Namur, Belgium
| | - Qasim E Bhorat
- Soweto Clinical Trials Centre, Johannesburg, South Africa
| | - Aysha Badat
- Wits Clinical Research, Soweto, Johannesburg, South Africa
| | | | - Branda Hu
- Clover Biopharmaceuticals, Cambridge, MA, USA
| | - Jaco Jurgens
- DJW Research, Noordheuwel, Krugersdorp, Gauteng, South Africa
| | - Jan Engelbrecht
- Dr JM Engelbrecht Trial Site, Vergelegen Mediclinic, Western Cape, South Africa
| | | | - Peter Richmond
- Division of Paediatrics, University of Western Australia, Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute and Perth Children's Hospital, Perth, WA, Australia
| | | | | | - Ralf Clemens
- Global Research in Infectious Diseases, Rio de Janeiro, Brazil.
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Pepin JL, Le-Dong NN, Cuthbert V, Coumans N, Tamisier R, Malhotra A, Martinot JB. Mandibular Movements are a Reliable Noninvasive Alternative to Esophageal Pressure for Measuring Respiratory Effort in Patients with Sleep Apnea Syndrome. Nat Sci Sleep 2022; 14:635-644. [PMID: 35444480 PMCID: PMC9013709 DOI: 10.2147/nss.s346229] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 03/07/2022] [Indexed: 01/22/2023] Open
Abstract
PURPOSE Differentiation between obstructive and central apneas and hypopneas requires quantitative measurement of respiratory effort (RE) using esophageal pressure (PES), which is rarely implemented. This study investigated whether the sleep mandibular movements (MM) signal recorded with a tri-axial gyroscopic chin sensor (Sunrise, Namur, Belgium) is a reliable surrogate of PES in patients with suspected obstructive sleep apnea (OSA). PATIENTS AND METHODS In-laboratory polysomnography (PSG) with PES and concurrent MM monitoring was performed. PSGs were scored manually using AASM 2012 rules. Data blocks (n=8042) were randomly sampled during normal breathing (NB), obstructive or central apnea/hypopnea (OA/OH/CA/CH), respiratory effort-related arousal (RERA), and mixed apnea (MxA). Analyses were evaluation of the similarity and linear correlation between PES and MM using the longest common subsequence (LCSS) algorithm and Pearson's coefficient; description of signal amplitudes; estimation of the marginal effect for crossing from NB to a respiratory disturbance for a given change in MM signal using a mixed linear-regression. RESULTS Participants (n=38) had mild to severe OSA (median AH index 28.9/h; median arousal index 23.2/h). MM showed a high level of synchronization with concurrent PES signals. Distribution of MM amplitude differed significantly between event types: median (95% confidence interval) values of 0.60 (0.16-2.43) for CA, 0.83 (0.23-4.71) for CH, 1.93 (0.46-12.43) for MxA, 3.23 (0.72-18.09) for OH, and 6.42 (0.88-26.81) for OA. Mixed regression indicated that crossing from NB to central events would decrease MM signal amplitude by -1.23 (CH) and -2.04 (CA) units, while obstructive events would increase MM amplitude by +3.27 (OH) and +6.79 (OA) units (all p<10-6). CONCLUSION In OSA patients, MM signals facilitated the measurement of specific levels of RE associated with obstructive, central or mixed apneas and/or hypopneas. A high degree of similarity was observed with the PES gold-standard signal.
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Affiliation(s)
- Jean-Louis Pepin
- HP2 Laboratory, Inserm U1300, University Grenoble Alpes, Grenoble, France
| | | | - Valérie Cuthbert
- Sleep Laboratory, CHU Université Catholique de Louvain (UCL) Namur Site Sainte-Elisabeth, Namur, Belgium
| | - Nathalie Coumans
- Sleep Laboratory, CHU Université Catholique de Louvain (UCL) Namur Site Sainte-Elisabeth, Namur, Belgium
| | - Renaud Tamisier
- HP2 Laboratory, Inserm U1300, University Grenoble Alpes, Grenoble, France
| | - Atul Malhotra
- University of California San Diego, La Jolla, CA, USA
| | - Jean-Benoit Martinot
- Sleep Laboratory, CHU Université Catholique de Louvain (UCL) Namur Site Sainte-Elisabeth, Namur, Belgium.,Institute of Experimental and Clinical Research, UCL Bruxelles Woluwe, Brussels, Belgium
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Le-Dong NN, Martinot JB, Coumans N, Cuthbert V, Tamisier R, Bailly S, Pépin JL. Machine Learning-based Sleep Staging in Sleep Apnea Patients Using a Single Mandibular Movement Signal. Am J Respir Crit Care Med 2021; 204:1227-1231. [PMID: 34297641 PMCID: PMC8759305 DOI: 10.1164/rccm.202103-0680le] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Affiliation(s)
| | - Jean-Benoit Martinot
- CHU Université Catholique de Louvain (UCL), Sleep Laboratory, Namur, Belgium.,Université Catholique de Louvain (UCL), Institute of Experimental and Clinical Research, Brussels, Belgium;
| | - Nathalie Coumans
- CHU Université Catholique de Louvain (UCL) , Sleep laboratory , Namur, Belgium
| | - Valérie Cuthbert
- CHU Université Catholique de Louvain (UCL) , Sleep laboratory , Namur, Belgium
| | - Renaud Tamisier
- University Grenoble Alpes, 27015, HP2 Laboratory, Inserm U1042, Grenoble, France.,Grenoble Alpes University Hospital (CHU), EFRC Laboratory, Grenoble, France
| | - Sébastien Bailly
- University Grenoble Alpes, 27015, HP2 Laboratory, Inserm U1042, Grenoble, France.,Grenoble Alpes University Hospital (CHU), EFRC Laboratory, Grenoble, France
| | - Jean-Louis Pépin
- University Grenoble Alpes, 27015, HP2 Laboratory, INSERM U1042, Grenoble, France.,Grenoble Alpes University Hospital (CHU), EFRC Laboratory, Grenoble, France
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11
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Martinot JB, Le-Dong NN, Cuthbert V, Denison S, Gozal D, Lavigne G, Pépin JL. Artificial Intelligence Analysis of Mandibular Movements Enables Accurate Detection of Phasic Sleep Bruxism in OSA Patients: A Pilot Study. Nat Sci Sleep 2021; 13:1449-1459. [PMID: 34466045 PMCID: PMC8397703 DOI: 10.2147/nss.s320664] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 08/05/2021] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Sleep bruxism (SBx) activity is classically identified by capturing masseter and/or temporalis masticatory muscles electromyographic activity (EMG-MMA) during in-laboratory polysomnography (PSG). We aimed to identify stereotypical mandibular jaw movements (MJM) in patients with SBx and to develop rhythmic masticatory muscles activities (RMMA) automatic detection using an artificial intelligence (AI) based approach. PATIENTS AND METHODS This was a prospective, observational study of 67 suspected obstructive sleep apnea (OSA) patients in whom PSG with masseter EMG was performed with simultaneous MJM recordings. The system used to collect MJM consisted of a small hardware device attached on the chin that communicates to a cloud-based infrastructure. An extreme gradient boosting (XGB) multiclass classifier was trained on 79,650 10-second epochs of MJM data from the 39 subjects with a history of SBx targeting 3 labels: RMMA episodes (n=1072), micro-arousals (n=1311), and MJM occurring at the breathing frequency (n=77,267). RESULTS Validated on unseen data from 28 patients, the model showed a very good epoch-by-epoch agreement (Kappa = 0.799) and balanced accuracy of 86.6% was found for the MJM events when using RMMA standards. The RMMA episodes were detected with a sensitivity of 84.3%. Class-wise receiver operating characteristic (ROC) curve analysis confirmed the well-balanced performance of the classifier for RMMA (ROC area under the curve: 0.98, 95% confidence interval [CI] 0.97-0.99). There was good agreement between the MJM analytic model and manual EMG signal scoring of RMMA (median bias -0.80 events/h, 95% CI -9.77 to 2.85). CONCLUSION SBx can be reliably identified, quantified, and characterized with MJM when subjected to automated analysis supported by AI technology.
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Affiliation(s)
- Jean-Benoit Martinot
- Sleep Laboratory, CHU Université Catholique de Louvain (UCL) Namur Site Sainte-Elisabeth, Namur, 5000, Belgium.,Institute of Experimental and Clinical Research, UCL Bruxelles Woluwe, Brussels, 1200, Belgium
| | | | - Valérie Cuthbert
- Sleep Laboratory, CHU Université Catholique de Louvain (UCL) Namur Site Sainte-Elisabeth, Namur, 5000, Belgium
| | | | - David Gozal
- Department of Child Health and Child Health Research Institute, University of Missouri, Columbia, MO, 65201, USA
| | - Gilles Lavigne
- Faculté de médecine dentaire, Université de Montréal, Montréal, Québec, H3C 3J7, Canada
| | - Jean-Louis Pépin
- HP2 Laboratory, Inserm U1042, University Grenoble Alpes, Grenoble, 38000, France
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12
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Martinot JB, Borel JC, Le-Dong NN, Silkoff PE, Denison S, Gozal D, Pépin JL. Bruxism Relieved Under CPAP Treatment in a Patient With OSA Syndrome. Chest 2020; 157:e59-e62. [DOI: 10.1016/j.chest.2019.07.032] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 07/10/2019] [Accepted: 07/27/2019] [Indexed: 11/26/2022] Open
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13
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Martinot JB, Le-Dong NN, Cuthbert V, Denison S, Borel JC, Gozal D, Pépin JL. Respiratory Mandibular Movement Signals Reliably Identify Obstructive Hypopnea Events During Sleep. Front Neurol 2019; 10:828. [PMID: 31456731 PMCID: PMC6701450 DOI: 10.3389/fneur.2019.00828] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 07/18/2019] [Indexed: 12/04/2022] Open
Abstract
Context: Accurate discrimination between obstructive and central hypopneas requires quantitative assessments of respiratory effort by esophageal pressure (OeP) measurements, which preclude widespread implementation in sleep medicine practice. Mandibular Movement (MM) signals are closely associated with diaphragmatic effort during sleep. Objective: We aimed at reliably detecting obstructive off central hypopneas events using MM statistical characteristics. Methods: A bio-signal learning approach was implemented whereby raw MM fragments corresponding to normal breathing (NPB; n = 501), central (n = 263), and obstructive hypopneas (n = 1861) were collected from 28 consecutive patients (mean age = 54 years, mean AHI = 34.7 n/h) undergoing in-lab polysomnography (PSG) coupled with a MM magnetometer, and OeP recordings. Twenty three input features were extracted from raw data fragments to explore distinctive changes in MM signals. A Random Forest model was built upon those input features to classify the central and obstructive hypopnea events. External validation and interpretive analysis were performed to evaluate the model's performance and the contribution of each feature to the model's output. Results: Obstructive hypopneas were characterized by a longer duration (21.9 vs. 17.8 s, p < 10−6), more extreme low values (p < 10−6), a more negative trend reflecting mouth opening amplitude, wider variation, and the asymmetrical distribution of MM amplitude. External validation showed a reliable performance of the MM features-based classification rule (Kappa coefficient = 0.879 and a balanced accuracy of 0.872). The interpretive analysis revealed that event duration, lower percentiles, central tendency, and the trend of MM amplitude were the most important determinants of events. Conclusions: MM signals can be used as surrogate markers of OeP to differentiate obstructive from central hypopneas during sleep.
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Affiliation(s)
- Jean-Benoit Martinot
- Sleep Laboratory, CHU UCL Namur Site Sainte-Elisabeth, Namur, Belgium.,Institute of Experimental and Clinical Research, UCL Bruxelles Woluwe, Brussels, Belgium
| | | | | | | | - Jean C Borel
- HP2 INSERM U1042, Université Grenoble Alpes, Grenoble, France
| | - David Gozal
- Department of Child Health and Child Health Research Institute, University of Missouri, Columbia, MO, United States
| | - Jean L Pépin
- HP2 INSERM U1042, Université Grenoble Alpes, Grenoble, France
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14
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Martinot JB, Le-Dong NN, Crespeigne E, Silkoff PE, Cuthbert V, Denison S, Borel JC, Pépin JL. Mandibular Movement Analysis to Assess Efficacy of Oral Appliance Therapy in OSA. Chest 2018; 154:1340-1347. [DOI: 10.1016/j.chest.2018.08.1027] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 07/11/2018] [Accepted: 08/01/2018] [Indexed: 11/29/2022] Open
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15
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Pavord ID, Chanez P, Criner GJ, Kerstjens HAM, Korn S, Lugogo N, Martinot JB, Sagara H, Albers FC, Bradford ES, Harris SS, Mayer B, Rubin DB, Yancey SW, Sciurba FC. Mepolizumab for Eosinophilic Chronic Obstructive Pulmonary Disease. N Engl J Med 2017; 377:1613-1629. [PMID: 28893134 DOI: 10.1056/nejmoa1708208] [Citation(s) in RCA: 344] [Impact Index Per Article: 49.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Patients with chronic obstructive pulmonary disease (COPD) with an eosinophilic phenotype may benefit from treatment with mepolizumab, a monoclonal antibody directed against interleukin-5. METHODS We performed two phase 3, randomized, placebo-controlled, double-blind, parallel-group trials comparing mepolizumab (100 mg in METREX, 100 or 300 mg in METREO) with placebo, given as a subcutaneous injection every 4 weeks for 52 weeks in patients with COPD who had a history of moderate or severe exacerbations while taking inhaled glucocorticoid-based triple maintenance therapy. In METREX, unselected patients in the modified intention-to-treat population with an eosinophilic phenotype were stratified according to blood eosinophil count (≥150 per cubic millimeter at screening or ≥300 per cubic millimeter during the previous year). In METREO, all patients had a blood eosinophil count of at least 150 per cubic millimeter at screening or at least 300 per cubic millimeter during the previous year. The primary end point was the annual rate of moderate or severe exacerbations. Safety was also assessed. RESULTS In METREX, the mean annual rate of moderate or severe exacerbations in the modified intention-to-treat population with an eosinophilic phenotype (462 patients) was 1.40 per year in the mepolizumab group versus 1.71 per year in the placebo group (rate ratio, 0.82; 95% confidence interval [CI], 0.68 to 0.98; adjusted P=0.04); no significant between-group differences were found in the overall modified intention-to-treat population (836 patients) (rate ratio, 0.98; 95% CI, 0.85 to 1.12; adjusted P>0.99). In METREO, the mean annual rate of moderate or severe exacerbations was 1.19 per year in the 100-mg mepolizumab group, 1.27 per year in the 300-mg mepolizumab group, and 1.49 per year in the placebo group. The rate ratios for exacerbations in the 100-mg and 300-mg mepolizumab groups versus the placebo group were 0.80 (95% CI, 0.65 to 0.98; adjusted P=0.07) and 0.86 (95% CI, 0.70 to 1.05; adjusted P=0.14), respectively. A greater effect of mepolizumab, as compared with placebo, on the annual rate of moderate or severe exacerbations was found among patients with higher blood eosinophil counts at screening. The safety profile of mepolizumab was similar to that of placebo. CONCLUSIONS Mepolizumab at a dose of 100 mg was associated with a lower annual rate of moderate or severe exacerbations than placebo among patients with COPD and an eosinophilic phenotype. This finding suggests that eosinophilic airway inflammation contributes to COPD exacerbations. (Funded by GlaxoSmithKline; METREX and METREO ClinicalTrials.gov numbers, NCT02105948 and NCT02105961 .).
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MESH Headings
- Adult
- Aged
- Antibodies, Monoclonal, Humanized/adverse effects
- Antibodies, Monoclonal, Humanized/immunology
- Antibodies, Monoclonal, Humanized/therapeutic use
- Biomarkers/blood
- Dose-Response Relationship, Drug
- Double-Blind Method
- Drug Therapy, Combination
- Eosinophils
- Female
- Glucocorticoids/therapeutic use
- Humans
- Injections, Subcutaneous
- Intention to Treat Analysis
- Leukocyte Count
- Male
- Middle Aged
- Pulmonary Disease, Chronic Obstructive/drug therapy
- Pulmonary Disease, Chronic Obstructive/immunology
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Affiliation(s)
- Ian D Pavord
- From the Respiratory Medicine Unit and Oxford Respiratory Biomedical Research Centre, Nuffield Department of Medicine, University of Oxford, Oxford (I.D.P.), and Clinical Statistics, GlaxoSmithKline, Uxbridge (B.M.) - both in the United Kingdom; the Department of Respiratory Medicine and CIC Nord, Aix-Marseille University, Marseille, France (P.C.); the Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia (G.J.C.); the Department of Pulmonary Medicine and Tuberculosis, University of Groningen and University Medical Center Groningen, Groningen, the Netherlands (H.A.M.K.); the Pulmonary Department, Mainz University Hospital, Mainz, Germany (S.K.); the Division of Pulmonary, Allergy, and Critical Care Medicine, Duke University, Durham (N.L.), and the Respiratory Medical Franchise (F.C.A.) and the Respiratory Therapeutic Area (E.S.B., S.S.H., D.B.R., S.W.Y.), GlaxoSmithKline, Research Triangle Park - all in North Carolina; the Department of Pneumology, Centre Hospitalier Universitaire-Université Catholique de Louvain, Namur, Namur, Belgium (J.-B.M.); the Division of Allergology and Respiratory Medicine, Showa University School of Medicine, Tokyo (H.S.); and the Department of Medicine, University of Pittsburgh, Pittsburgh (F.C.S.)
| | - Pascal Chanez
- From the Respiratory Medicine Unit and Oxford Respiratory Biomedical Research Centre, Nuffield Department of Medicine, University of Oxford, Oxford (I.D.P.), and Clinical Statistics, GlaxoSmithKline, Uxbridge (B.M.) - both in the United Kingdom; the Department of Respiratory Medicine and CIC Nord, Aix-Marseille University, Marseille, France (P.C.); the Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia (G.J.C.); the Department of Pulmonary Medicine and Tuberculosis, University of Groningen and University Medical Center Groningen, Groningen, the Netherlands (H.A.M.K.); the Pulmonary Department, Mainz University Hospital, Mainz, Germany (S.K.); the Division of Pulmonary, Allergy, and Critical Care Medicine, Duke University, Durham (N.L.), and the Respiratory Medical Franchise (F.C.A.) and the Respiratory Therapeutic Area (E.S.B., S.S.H., D.B.R., S.W.Y.), GlaxoSmithKline, Research Triangle Park - all in North Carolina; the Department of Pneumology, Centre Hospitalier Universitaire-Université Catholique de Louvain, Namur, Namur, Belgium (J.-B.M.); the Division of Allergology and Respiratory Medicine, Showa University School of Medicine, Tokyo (H.S.); and the Department of Medicine, University of Pittsburgh, Pittsburgh (F.C.S.)
| | - Gerard J Criner
- From the Respiratory Medicine Unit and Oxford Respiratory Biomedical Research Centre, Nuffield Department of Medicine, University of Oxford, Oxford (I.D.P.), and Clinical Statistics, GlaxoSmithKline, Uxbridge (B.M.) - both in the United Kingdom; the Department of Respiratory Medicine and CIC Nord, Aix-Marseille University, Marseille, France (P.C.); the Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia (G.J.C.); the Department of Pulmonary Medicine and Tuberculosis, University of Groningen and University Medical Center Groningen, Groningen, the Netherlands (H.A.M.K.); the Pulmonary Department, Mainz University Hospital, Mainz, Germany (S.K.); the Division of Pulmonary, Allergy, and Critical Care Medicine, Duke University, Durham (N.L.), and the Respiratory Medical Franchise (F.C.A.) and the Respiratory Therapeutic Area (E.S.B., S.S.H., D.B.R., S.W.Y.), GlaxoSmithKline, Research Triangle Park - all in North Carolina; the Department of Pneumology, Centre Hospitalier Universitaire-Université Catholique de Louvain, Namur, Namur, Belgium (J.-B.M.); the Division of Allergology and Respiratory Medicine, Showa University School of Medicine, Tokyo (H.S.); and the Department of Medicine, University of Pittsburgh, Pittsburgh (F.C.S.)
| | - Huib A M Kerstjens
- From the Respiratory Medicine Unit and Oxford Respiratory Biomedical Research Centre, Nuffield Department of Medicine, University of Oxford, Oxford (I.D.P.), and Clinical Statistics, GlaxoSmithKline, Uxbridge (B.M.) - both in the United Kingdom; the Department of Respiratory Medicine and CIC Nord, Aix-Marseille University, Marseille, France (P.C.); the Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia (G.J.C.); the Department of Pulmonary Medicine and Tuberculosis, University of Groningen and University Medical Center Groningen, Groningen, the Netherlands (H.A.M.K.); the Pulmonary Department, Mainz University Hospital, Mainz, Germany (S.K.); the Division of Pulmonary, Allergy, and Critical Care Medicine, Duke University, Durham (N.L.), and the Respiratory Medical Franchise (F.C.A.) and the Respiratory Therapeutic Area (E.S.B., S.S.H., D.B.R., S.W.Y.), GlaxoSmithKline, Research Triangle Park - all in North Carolina; the Department of Pneumology, Centre Hospitalier Universitaire-Université Catholique de Louvain, Namur, Namur, Belgium (J.-B.M.); the Division of Allergology and Respiratory Medicine, Showa University School of Medicine, Tokyo (H.S.); and the Department of Medicine, University of Pittsburgh, Pittsburgh (F.C.S.)
| | - Stephanie Korn
- From the Respiratory Medicine Unit and Oxford Respiratory Biomedical Research Centre, Nuffield Department of Medicine, University of Oxford, Oxford (I.D.P.), and Clinical Statistics, GlaxoSmithKline, Uxbridge (B.M.) - both in the United Kingdom; the Department of Respiratory Medicine and CIC Nord, Aix-Marseille University, Marseille, France (P.C.); the Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia (G.J.C.); the Department of Pulmonary Medicine and Tuberculosis, University of Groningen and University Medical Center Groningen, Groningen, the Netherlands (H.A.M.K.); the Pulmonary Department, Mainz University Hospital, Mainz, Germany (S.K.); the Division of Pulmonary, Allergy, and Critical Care Medicine, Duke University, Durham (N.L.), and the Respiratory Medical Franchise (F.C.A.) and the Respiratory Therapeutic Area (E.S.B., S.S.H., D.B.R., S.W.Y.), GlaxoSmithKline, Research Triangle Park - all in North Carolina; the Department of Pneumology, Centre Hospitalier Universitaire-Université Catholique de Louvain, Namur, Namur, Belgium (J.-B.M.); the Division of Allergology and Respiratory Medicine, Showa University School of Medicine, Tokyo (H.S.); and the Department of Medicine, University of Pittsburgh, Pittsburgh (F.C.S.)
| | - Njira Lugogo
- From the Respiratory Medicine Unit and Oxford Respiratory Biomedical Research Centre, Nuffield Department of Medicine, University of Oxford, Oxford (I.D.P.), and Clinical Statistics, GlaxoSmithKline, Uxbridge (B.M.) - both in the United Kingdom; the Department of Respiratory Medicine and CIC Nord, Aix-Marseille University, Marseille, France (P.C.); the Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia (G.J.C.); the Department of Pulmonary Medicine and Tuberculosis, University of Groningen and University Medical Center Groningen, Groningen, the Netherlands (H.A.M.K.); the Pulmonary Department, Mainz University Hospital, Mainz, Germany (S.K.); the Division of Pulmonary, Allergy, and Critical Care Medicine, Duke University, Durham (N.L.), and the Respiratory Medical Franchise (F.C.A.) and the Respiratory Therapeutic Area (E.S.B., S.S.H., D.B.R., S.W.Y.), GlaxoSmithKline, Research Triangle Park - all in North Carolina; the Department of Pneumology, Centre Hospitalier Universitaire-Université Catholique de Louvain, Namur, Namur, Belgium (J.-B.M.); the Division of Allergology and Respiratory Medicine, Showa University School of Medicine, Tokyo (H.S.); and the Department of Medicine, University of Pittsburgh, Pittsburgh (F.C.S.)
| | - Jean-Benoit Martinot
- From the Respiratory Medicine Unit and Oxford Respiratory Biomedical Research Centre, Nuffield Department of Medicine, University of Oxford, Oxford (I.D.P.), and Clinical Statistics, GlaxoSmithKline, Uxbridge (B.M.) - both in the United Kingdom; the Department of Respiratory Medicine and CIC Nord, Aix-Marseille University, Marseille, France (P.C.); the Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia (G.J.C.); the Department of Pulmonary Medicine and Tuberculosis, University of Groningen and University Medical Center Groningen, Groningen, the Netherlands (H.A.M.K.); the Pulmonary Department, Mainz University Hospital, Mainz, Germany (S.K.); the Division of Pulmonary, Allergy, and Critical Care Medicine, Duke University, Durham (N.L.), and the Respiratory Medical Franchise (F.C.A.) and the Respiratory Therapeutic Area (E.S.B., S.S.H., D.B.R., S.W.Y.), GlaxoSmithKline, Research Triangle Park - all in North Carolina; the Department of Pneumology, Centre Hospitalier Universitaire-Université Catholique de Louvain, Namur, Namur, Belgium (J.-B.M.); the Division of Allergology and Respiratory Medicine, Showa University School of Medicine, Tokyo (H.S.); and the Department of Medicine, University of Pittsburgh, Pittsburgh (F.C.S.)
| | - Hironori Sagara
- From the Respiratory Medicine Unit and Oxford Respiratory Biomedical Research Centre, Nuffield Department of Medicine, University of Oxford, Oxford (I.D.P.), and Clinical Statistics, GlaxoSmithKline, Uxbridge (B.M.) - both in the United Kingdom; the Department of Respiratory Medicine and CIC Nord, Aix-Marseille University, Marseille, France (P.C.); the Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia (G.J.C.); the Department of Pulmonary Medicine and Tuberculosis, University of Groningen and University Medical Center Groningen, Groningen, the Netherlands (H.A.M.K.); the Pulmonary Department, Mainz University Hospital, Mainz, Germany (S.K.); the Division of Pulmonary, Allergy, and Critical Care Medicine, Duke University, Durham (N.L.), and the Respiratory Medical Franchise (F.C.A.) and the Respiratory Therapeutic Area (E.S.B., S.S.H., D.B.R., S.W.Y.), GlaxoSmithKline, Research Triangle Park - all in North Carolina; the Department of Pneumology, Centre Hospitalier Universitaire-Université Catholique de Louvain, Namur, Namur, Belgium (J.-B.M.); the Division of Allergology and Respiratory Medicine, Showa University School of Medicine, Tokyo (H.S.); and the Department of Medicine, University of Pittsburgh, Pittsburgh (F.C.S.)
| | - Frank C Albers
- From the Respiratory Medicine Unit and Oxford Respiratory Biomedical Research Centre, Nuffield Department of Medicine, University of Oxford, Oxford (I.D.P.), and Clinical Statistics, GlaxoSmithKline, Uxbridge (B.M.) - both in the United Kingdom; the Department of Respiratory Medicine and CIC Nord, Aix-Marseille University, Marseille, France (P.C.); the Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia (G.J.C.); the Department of Pulmonary Medicine and Tuberculosis, University of Groningen and University Medical Center Groningen, Groningen, the Netherlands (H.A.M.K.); the Pulmonary Department, Mainz University Hospital, Mainz, Germany (S.K.); the Division of Pulmonary, Allergy, and Critical Care Medicine, Duke University, Durham (N.L.), and the Respiratory Medical Franchise (F.C.A.) and the Respiratory Therapeutic Area (E.S.B., S.S.H., D.B.R., S.W.Y.), GlaxoSmithKline, Research Triangle Park - all in North Carolina; the Department of Pneumology, Centre Hospitalier Universitaire-Université Catholique de Louvain, Namur, Namur, Belgium (J.-B.M.); the Division of Allergology and Respiratory Medicine, Showa University School of Medicine, Tokyo (H.S.); and the Department of Medicine, University of Pittsburgh, Pittsburgh (F.C.S.)
| | - Eric S Bradford
- From the Respiratory Medicine Unit and Oxford Respiratory Biomedical Research Centre, Nuffield Department of Medicine, University of Oxford, Oxford (I.D.P.), and Clinical Statistics, GlaxoSmithKline, Uxbridge (B.M.) - both in the United Kingdom; the Department of Respiratory Medicine and CIC Nord, Aix-Marseille University, Marseille, France (P.C.); the Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia (G.J.C.); the Department of Pulmonary Medicine and Tuberculosis, University of Groningen and University Medical Center Groningen, Groningen, the Netherlands (H.A.M.K.); the Pulmonary Department, Mainz University Hospital, Mainz, Germany (S.K.); the Division of Pulmonary, Allergy, and Critical Care Medicine, Duke University, Durham (N.L.), and the Respiratory Medical Franchise (F.C.A.) and the Respiratory Therapeutic Area (E.S.B., S.S.H., D.B.R., S.W.Y.), GlaxoSmithKline, Research Triangle Park - all in North Carolina; the Department of Pneumology, Centre Hospitalier Universitaire-Université Catholique de Louvain, Namur, Namur, Belgium (J.-B.M.); the Division of Allergology and Respiratory Medicine, Showa University School of Medicine, Tokyo (H.S.); and the Department of Medicine, University of Pittsburgh, Pittsburgh (F.C.S.)
| | - Stephanie S Harris
- From the Respiratory Medicine Unit and Oxford Respiratory Biomedical Research Centre, Nuffield Department of Medicine, University of Oxford, Oxford (I.D.P.), and Clinical Statistics, GlaxoSmithKline, Uxbridge (B.M.) - both in the United Kingdom; the Department of Respiratory Medicine and CIC Nord, Aix-Marseille University, Marseille, France (P.C.); the Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia (G.J.C.); the Department of Pulmonary Medicine and Tuberculosis, University of Groningen and University Medical Center Groningen, Groningen, the Netherlands (H.A.M.K.); the Pulmonary Department, Mainz University Hospital, Mainz, Germany (S.K.); the Division of Pulmonary, Allergy, and Critical Care Medicine, Duke University, Durham (N.L.), and the Respiratory Medical Franchise (F.C.A.) and the Respiratory Therapeutic Area (E.S.B., S.S.H., D.B.R., S.W.Y.), GlaxoSmithKline, Research Triangle Park - all in North Carolina; the Department of Pneumology, Centre Hospitalier Universitaire-Université Catholique de Louvain, Namur, Namur, Belgium (J.-B.M.); the Division of Allergology and Respiratory Medicine, Showa University School of Medicine, Tokyo (H.S.); and the Department of Medicine, University of Pittsburgh, Pittsburgh (F.C.S.)
| | - Bhabita Mayer
- From the Respiratory Medicine Unit and Oxford Respiratory Biomedical Research Centre, Nuffield Department of Medicine, University of Oxford, Oxford (I.D.P.), and Clinical Statistics, GlaxoSmithKline, Uxbridge (B.M.) - both in the United Kingdom; the Department of Respiratory Medicine and CIC Nord, Aix-Marseille University, Marseille, France (P.C.); the Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia (G.J.C.); the Department of Pulmonary Medicine and Tuberculosis, University of Groningen and University Medical Center Groningen, Groningen, the Netherlands (H.A.M.K.); the Pulmonary Department, Mainz University Hospital, Mainz, Germany (S.K.); the Division of Pulmonary, Allergy, and Critical Care Medicine, Duke University, Durham (N.L.), and the Respiratory Medical Franchise (F.C.A.) and the Respiratory Therapeutic Area (E.S.B., S.S.H., D.B.R., S.W.Y.), GlaxoSmithKline, Research Triangle Park - all in North Carolina; the Department of Pneumology, Centre Hospitalier Universitaire-Université Catholique de Louvain, Namur, Namur, Belgium (J.-B.M.); the Division of Allergology and Respiratory Medicine, Showa University School of Medicine, Tokyo (H.S.); and the Department of Medicine, University of Pittsburgh, Pittsburgh (F.C.S.)
| | - David B Rubin
- From the Respiratory Medicine Unit and Oxford Respiratory Biomedical Research Centre, Nuffield Department of Medicine, University of Oxford, Oxford (I.D.P.), and Clinical Statistics, GlaxoSmithKline, Uxbridge (B.M.) - both in the United Kingdom; the Department of Respiratory Medicine and CIC Nord, Aix-Marseille University, Marseille, France (P.C.); the Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia (G.J.C.); the Department of Pulmonary Medicine and Tuberculosis, University of Groningen and University Medical Center Groningen, Groningen, the Netherlands (H.A.M.K.); the Pulmonary Department, Mainz University Hospital, Mainz, Germany (S.K.); the Division of Pulmonary, Allergy, and Critical Care Medicine, Duke University, Durham (N.L.), and the Respiratory Medical Franchise (F.C.A.) and the Respiratory Therapeutic Area (E.S.B., S.S.H., D.B.R., S.W.Y.), GlaxoSmithKline, Research Triangle Park - all in North Carolina; the Department of Pneumology, Centre Hospitalier Universitaire-Université Catholique de Louvain, Namur, Namur, Belgium (J.-B.M.); the Division of Allergology and Respiratory Medicine, Showa University School of Medicine, Tokyo (H.S.); and the Department of Medicine, University of Pittsburgh, Pittsburgh (F.C.S.)
| | - Steven W Yancey
- From the Respiratory Medicine Unit and Oxford Respiratory Biomedical Research Centre, Nuffield Department of Medicine, University of Oxford, Oxford (I.D.P.), and Clinical Statistics, GlaxoSmithKline, Uxbridge (B.M.) - both in the United Kingdom; the Department of Respiratory Medicine and CIC Nord, Aix-Marseille University, Marseille, France (P.C.); the Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia (G.J.C.); the Department of Pulmonary Medicine and Tuberculosis, University of Groningen and University Medical Center Groningen, Groningen, the Netherlands (H.A.M.K.); the Pulmonary Department, Mainz University Hospital, Mainz, Germany (S.K.); the Division of Pulmonary, Allergy, and Critical Care Medicine, Duke University, Durham (N.L.), and the Respiratory Medical Franchise (F.C.A.) and the Respiratory Therapeutic Area (E.S.B., S.S.H., D.B.R., S.W.Y.), GlaxoSmithKline, Research Triangle Park - all in North Carolina; the Department of Pneumology, Centre Hospitalier Universitaire-Université Catholique de Louvain, Namur, Namur, Belgium (J.-B.M.); the Division of Allergology and Respiratory Medicine, Showa University School of Medicine, Tokyo (H.S.); and the Department of Medicine, University of Pittsburgh, Pittsburgh (F.C.S.)
| | - Frank C Sciurba
- From the Respiratory Medicine Unit and Oxford Respiratory Biomedical Research Centre, Nuffield Department of Medicine, University of Oxford, Oxford (I.D.P.), and Clinical Statistics, GlaxoSmithKline, Uxbridge (B.M.) - both in the United Kingdom; the Department of Respiratory Medicine and CIC Nord, Aix-Marseille University, Marseille, France (P.C.); the Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia (G.J.C.); the Department of Pulmonary Medicine and Tuberculosis, University of Groningen and University Medical Center Groningen, Groningen, the Netherlands (H.A.M.K.); the Pulmonary Department, Mainz University Hospital, Mainz, Germany (S.K.); the Division of Pulmonary, Allergy, and Critical Care Medicine, Duke University, Durham (N.L.), and the Respiratory Medical Franchise (F.C.A.) and the Respiratory Therapeutic Area (E.S.B., S.S.H., D.B.R., S.W.Y.), GlaxoSmithKline, Research Triangle Park - all in North Carolina; the Department of Pneumology, Centre Hospitalier Universitaire-Université Catholique de Louvain, Namur, Namur, Belgium (J.-B.M.); the Division of Allergology and Respiratory Medicine, Showa University School of Medicine, Tokyo (H.S.); and the Department of Medicine, University of Pittsburgh, Pittsburgh (F.C.S.)
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16
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Giraud X, Le-Dong NN, Hogben K, Martinot JB. The measurement of DLNO and DLCO: A manufacturer's perspective. Respir Physiol Neurobiol 2017; 241:36-44. [PMID: 28214604 DOI: 10.1016/j.resp.2017.02.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Revised: 02/06/2017] [Accepted: 02/10/2017] [Indexed: 02/01/2023]
Abstract
The simultaneous measurement of the lung transfer factor for carbon monoxide (DLCO) and nitric oxide (DLNO) is now available as a powerful method for studying the alveolar-capillary gas exchange. However, application of the DLNO-CO technique in daily settings is still limited by some technical drawbacks. This paper provides a manufacturer's overview of the measuring principles, technical challenges and current available solutions for implementing the DLNO-CO measurement in to a marketed device. This includes the recent developments in technology for NO sensors, latest findings on NO uptake and new statistical methods.
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Affiliation(s)
- X Giraud
- Medisoft-MGCD, Sorinnes, Belgium
| | - N N Le-Dong
- RespiSom Private Research Medical Center, Namur, Belgium.
| | - K Hogben
- Medisoft-MGCD, Sorinnes, Belgium
| | - J B Martinot
- CHU-UCL Namur, Place Louise Godin 15, 5000, Namur, Belgium
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17
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Lebret M, Martinot JB, Arnol N, Zerillo D, Tamisier R, Pepin JL, Borel JC. Factors Contributing to Unintentional Leak During CPAP Treatment: A Systematic Review. Chest 2016; 151:707-719. [PMID: 27986462 DOI: 10.1016/j.chest.2016.11.049] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Revised: 11/09/2016] [Accepted: 11/29/2016] [Indexed: 12/30/2022] Open
Abstract
CPAP is the first-line treatment for moderate to severe OSA syndrome. Up to 25% of patients with OSA syndrome discontinue CPAP treatment due to side effects. Unintentional leakage and its associated annoying consequences are the most frequently reported adverse effects of CPAP. Successive technological improvements have not succeeded in addressing this issue. A systematic review was conducted (1) to assess the impact of different technological advances on unintentional leaks and (2) to determine if any patient characteristics have already been identified as determinants of unintentional leakage. No CPAP modality was superior to another in reducing unintentional leaks and, surprisingly, oronasal masks were associated with higher unintentional leaks. Nasal obstruction, older age, higher BMI, central fat distribution, and male sex might be associated with an increased risk of unintentional leakage. Such leaks remain an important problem. Further studies are needed to improve the understanding of underlying clinical factors so that patients at risk of unintentional leaks may be identified and individualized solutions applied.
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Affiliation(s)
- Marius Lebret
- Department of Research and Development, Association AGIR à dom, HP2 Laboratory, INSERM U 1042, Meylan, France.
| | | | - Nathalie Arnol
- Department of Research and Development, Association AGIR à dom, HP2 Laboratory, INSERM U 1042, Meylan, France
| | - Daniel Zerillo
- Department of Research and Development, Association AGIR à dom, HP2 Laboratory, INSERM U 1042, Meylan, France
| | - Renaud Tamisier
- Thorax and Vessels Division, Sleep Laboratory, Grenoble Alpes University, HP2 Laboratory, INSERM U 1042, Grenoble, France
| | - Jean-Louis Pepin
- Thorax and Vessels Division, Sleep Laboratory, Grenoble Alpes University, HP2 Laboratory, INSERM U 1042, Grenoble, France
| | - Jean-Christian Borel
- Department of Research and Development, Association AGIR à dom, HP2 Laboratory, INSERM U 1042, Meylan, France; Thorax and Vessels Division, Sleep Laboratory, Grenoble Alpes University, HP2 Laboratory, INSERM U 1042, Grenoble, France
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18
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Martinot JB, Borel JC, Cuthbert V, Guénard HJP, Denison S, Silkoff PE, Gozal D, Pepin JL. Mandibular position and movements: Suitability for diagnosis of sleep apnoea. Respirology 2016; 22:567-574. [DOI: 10.1111/resp.12929] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Revised: 08/16/2016] [Accepted: 08/16/2016] [Indexed: 11/29/2022]
Affiliation(s)
| | - Jean-Christian Borel
- ‘AGIR à dom’ Association, La Tronche; Grenoble France
- University Grenoble Alpes; Grenoble France
| | | | | | | | - Philip E. Silkoff
- Department of Physiology; Temple University; Philadelphia Pennsylvania USA
| | - David Gozal
- Department of Medicine; University of Chicago; Chicago Illinois USA
| | - Jean-Louis Pepin
- University Grenoble Alpes; Grenoble France
- Sleep and Exercise Laboratory; Thorax and Vessels Division, Grenoble Alpes University Hospital; Grenoble France
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19
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Guénard HJP, Martinot JB, Martin S, Maury B, Lalande S, Kays C. In vivo estimates of NO and CO conductance for haemoglobin and for lung transfer in humans. Respir Physiol Neurobiol 2016; 228:1-8. [DOI: 10.1016/j.resp.2016.03.003] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Revised: 03/02/2016] [Accepted: 03/03/2016] [Indexed: 11/26/2022]
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20
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Martinot JB, Chambellan A, Kays C, Silkoff PE, Guenard H. Partial versus maximal forced exhalations in COPD: enhanced signal detection for novel therapies. Pulm Pharmacol Ther 2014; 29:58-65. [PMID: 24661905 DOI: 10.1016/j.pupt.2014.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2013] [Revised: 02/20/2014] [Accepted: 03/13/2014] [Indexed: 11/17/2022]
Abstract
BACKGROUND Evaluation of novel compounds for COPD often relies on FEV1 for signal detection. Partial forced exhalations from end-tidal inspiration (PEFV) might complement FEV1 in identifying such a signal. We examined the prevalence of bronchodilator response (BDR) using PEFV and FEV1 in patients with COPD. METHODS 110 consecutive COPD patients were tested prospectively with PEFV and maximal expiratory flow before and after inhalation of a short-acting β2 agonist (salbutamol, 400 μg). Partial flow at 800 ml above residual volume was derived from the PEFV (PF800). Significant changes in PF800 and/or FEV1 were set at the upper 95% confidence interval after placebo (n = 28). RESULTS Four groups were identified by the presence (+) or absence (-) of a BDR: Group 1 [PF800 (-)FEV1(-)] when no change was observed (n = 31), Group 2 [PF800(+)FEV1(-)] when PF800 alone improved (n = 31), Group 3 [PF800(-)FEV1(+)] when FEV1 alone improved (n = 26), and Group 4 [PF800(+)FEV1(+)] when both variables improved (n = 18). There were 35 non-responders in any parameter, and 75/110 subjects who showed a response in at least one parameter. The changes in PF800 and FEV1 were not correlated suggesting these assess different airway generations. CONCLUSIONS The use of PF800 increased detection of a BDR in COPD compared to FEV1 alone and may reflect small airway responses. The PEFV maneuver is simple, repeatable and may avoid some of the theoretical disadvantages of FEV1. The role of PF800 for evaluating novel anti-inflammatory agents remains to be determined.
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Affiliation(s)
- J B Martinot
- Department of Pneumology, Clinique et Maternité St. Elisabeth, Namur, Belgium.
| | - A Chambellan
- Institut du Thorax, INSERM UMR 1087, Université de Nantes, France
| | - C Kays
- Laboratoire de physiologie, Université de Bordeaux, France
| | - P E Silkoff
- Department of Medicine, Temple University, Philadelphia, PA, USA
| | - H Guenard
- Laboratoire de physiologie, Université de Bordeaux, France
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21
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Pavelescu A, Faoro V, Guenard H, de Bisschop C, Martinot JB, Mélot C, Naeije R. Pulmonary vascular reserve and exercise capacity at sea level and at high altitude. High Alt Med Biol 2013; 14:19-26. [PMID: 23537256 DOI: 10.1089/ham.2012.1073] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
It has been suggested that increased pulmonary vascular reserve, as defined by reduced pulmonary vascular resistance (PVR) and increased pulmonary transit of agitated contrast measured by echocardiography, might be associated with increased exercise capacity. Thus, at altitude, where PVR is increased because of hypoxic vasoconstriction, a reduced pulmonary vascular reserve could contribute to reduced exercise capacity. Furthermore, a lower PVR could be associated with higher capillary blood volume and an increased lung diffusing capacity. We reviewed echocardiographic estimates of PVR and measurements of lung diffusing capacity for nitric oxide (DL(NO)) and for carbon monoxide (DL(CO)) at rest, and incremental cardiopulmonary exercise tests in 64 healthy subjects at sea level and during 4 different medical expeditions at altitudes around 5000 m. Altitude exposure was associated with a decrease in maximum oxygen uptake (VO2max), from 42±10 to 32±8 mL/min/kg and increases in PVR, ventilatory equivalents for CO2 (V(E)/VCO2), DL(NO), and DL(CO). By univariate linear regression VO2max at sea level and at altitude was associated with V(E)/VCO2 (p<0.001), mean pulmonary artery pressure (mPpa, p<0.05), stroke volume index (SVI, p<0.05), DL(NO) (p<0.02), and DL(CO) (p=0.05). By multivariable analysis, VO2max at sea level and at altitude was associated with V(E)/VCO2, mPpa, SVI, and DL(NO). The multivariable analysis also showed that the altitude-related decrease in VO2max was associated with increased PVR and V(E)/VCO2. These results suggest that pulmonary vascular reserve, defined by a combination of decreased PVR and increased DL(NO), allows for superior aerobic exercise capacity at a lower ventilatory cost, at sea level and at high altitude.
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Affiliation(s)
- Adriana Pavelescu
- Department of Pathophysiology, Faculty of Medicine, Université Libre de Bruxelles, Brussels, Belgium
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22
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Groepenhoff H, Overbeek MJ, Mulè M, van der Plas M, Argiento P, Villafuerte FC, Beloka S, Faoro V, Macarlupu JL, Guenard H, de Bisschop C, Martinot JB, Vanderpool R, Penaloza D, Naeije R. Exercise Pathophysiology in Patients With Chronic Mountain Sickness. Chest 2012; 142:877-884. [DOI: 10.1378/chest.11-2845] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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de Bisschop C, Martinot JB, Leurquin-Sterk G, Faoro V, Guénard H, Naeije R. Improvement in lung diffusion by endothelin A receptor blockade at high altitude. J Appl Physiol (1985) 2011; 112:20-5. [PMID: 21979801 DOI: 10.1152/japplphysiol.00670.2011] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Lung diffusing capacity has been reported variably in high-altitude newcomers and may be in relation to different pulmonary vascular resistance (PVR). Twenty-two healthy volunteers were investigated at sea level and at 5,050 m before and after random double-blind intake of the endothelin A receptor blocker sitaxsentan (100 mg/day) vs. a placebo during 1 wk. PVR was estimated by Doppler echocardiography, and exercise capacity by maximal oxygen uptake (Vo(2 max)). The diffusing capacities for nitric oxide (DL(NO)) and carbon monoxide (DL(CO)) were measured using a single-breath method before and 30 min after maximal exercise. The membrane component of DL(CO) (Dm) and capillary volume (Vc) was calculated with corrections for hemoglobin, alveolar volume, and barometric pressure. Altitude exposure was associated with unchanged DL(CO), DL(NO), and Dm but a slight decrease in Vc. Exercise at altitude decreased DL(NO) and Dm. Sitaxsentan intake improved Vo(2 max) together with an increase in resting and postexercise DL(NO) and Dm. Sitaxsentan-induced decrease in PVR was inversely correlated to DL(NO). Both DL(CO) and DL(NO) were correlated to Vo(2 max) at sea level (r = 0.41-0.42, P < 0.1) and more so at altitude (r = 0.56-0.59, P < 0.05). Pharmacological pulmonary vasodilation improves the membrane component of lung diffusion in high-altitude newcomers, which may contribute to exercise capacity.
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Affiliation(s)
- Claire de Bisschop
- Laboratory of Physiologic Adaptations to Physical Activities, UPRES EA 3813, Poitiers University, Poitiers, France
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Huez S, Faoro V, Guénard H, Martinot JB, Naeije R. Echocardiographic and tissue Doppler imaging of cardiac adaptation to high altitude in native highlanders versus acclimatized lowlanders. Am J Cardiol 2009; 103:1605-9. [PMID: 19463523 DOI: 10.1016/j.amjcard.2009.02.006] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2009] [Revised: 02/05/2009] [Accepted: 02/05/2009] [Indexed: 11/18/2022]
Abstract
High-altitude exposure is a cause of pulmonary hypertension and decreased exercise capacity, but associated changes in cardiac function remain incompletely understood. The aim of this study was to investigate right ventricular (RV) and left ventricular function in acclimatized Caucasian lowlanders compared with native Bolivian highlanders at high altitudes. Standard echocardiography and tissue Doppler imaging studies were performed in 15 healthy lowlanders at sea level; <24 hours after arrival in La Paz, Bolivia, at 3,750 m; and after 10 days of acclimatization and ascent to Huayna Potosi, at 4,850 m, and the results were compared with those obtained in 15 age- and body size-matched inhabitants of Oruro, Bolivia, at 4,000 m. Acute exposure to high altitude in lowlanders caused an increase in mean pulmonary arterial pressure, to 20 to 25 mm Hg, and altered RV and left ventricular diastolic function, with prolonged isovolumic relaxation time, an increased RV Tei index, and maintained RV systolic function as estimated by tricuspid annular plane excursion and the tricuspid annular S wave. This profile was essentially unchanged after acclimatization and ascent to 4,850 m, except for higher pulmonary arterial pressure. The native highlanders presented with relatively lower pulmonary arterial pressures but more pronounced alterations in diastolic function, decreased tricuspid annular plane excursion and tricuspid annular S waves, and increased RV Tei indexes. In conclusion, cardiac adaptation to high altitude was qualitatively similar in acclimatized Caucasian lowlanders and in Bolivian native highlanders. However, lifelong exposure to high altitude may be associated with different cardiac adaptation to milder hypoxic pulmonary hypertension.
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Affiliation(s)
- Sandrine Huez
- Department of Physiology, Faculty of Medicine, Université Libre de Bruxelles, Brussels, Belgium
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25
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Morelle J, Tintillier M, Martinot JB, Moortgat S, Hermans C. Unexpected Pulseless Disease Associated With Recurrent Venous Thromboembolisms. Clin Appl Thromb Hemost 2009; 15:239-40. [DOI: 10.1177/1076029607305782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Venous thromboembolic disease is a well-documented complication of Klinefelter’s syndrome, even if mechanisms underlying this prothrombotic state have not been conclusively established. On the contrary, arterial thrombosis is far less frequent, and a case of a patient with Klinefelter’s syndrome presenting with simultaneous venous thrombtoembolic disease and a complete thrombosis of the left subclavian artery is presented. Elevated levels of type 1 plasminogen activator inhibitor, in the absence of other usual thrombophilic abnormalities, raise the question of the role played by this inhibitor of the fibrinolysis in the arterial and venous thromboses presented by this patient.
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Affiliation(s)
- Johann Morelle
- Department of Internal Medicine and Nephrology, Clinique Sainte-Elisabeth, Namur,
| | - Michel Tintillier
- Department of Internal Medicine and Nephrology, Clinique Sainte-Elisabeth, Namur
| | | | - Stephanie Moortgat
- Institute of Pathology and Genetics, Department of Pediatrics, Cliniques Universitaires Saint-Luc, Bruxelles, Belgium
| | - Cedric Hermans
- Haemostasis and Thrombosis Unit, Department of Haematology Cliniques Universitaires Saint-Luc, Bruxelles, Belgium
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Affiliation(s)
- Sandrine Huez
- Department of Pathophysiology and Cardiology, Faculty of Medicine of the Free University of Brussels, Brussels, Belgium
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Beier J, Chanez P, Martinot JB, Schreurs AJM, Tkácová R, Bao W, Jack D, Higgins M. Safety, tolerability and efficacy of indacaterol, a novel once-daily beta(2)-agonist, in patients with COPD: a 28-day randomised, placebo controlled clinical trial. Pulm Pharmacol Ther 2006; 20:740-9. [PMID: 17088091 DOI: 10.1016/j.pupt.2006.09.001] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2006] [Revised: 09/05/2006] [Accepted: 09/15/2006] [Indexed: 11/18/2022]
Abstract
In patients with chronic obstructive pulmonary disease (COPD) classified as moderate onwards, Global Initiative for Chronic Obstructive Lung Disease (GOLD) Guidelines recommend regular treatment with one or more long-acting bronchodilators, such as beta(2)-agonists or anticholinergics. In contrast to currently available long-acting beta(2)-agonists, which have a duration of action of 12 h, indacaterol has demonstrated effective 24-h bronchodilation on once-daily dosing. A double-blind, randomised, placebo-controlled study was conducted to compare the safety, tolerability and efficacy of indacaterol with that of placebo, over a 28-day period, in patients with moderate COPD (as defined by GOLD 2001 criteria; equivalent to moderate-to-severe COPD in the GOLD 2005 criteria). Patients were randomised 2:2:1 to receive indacaterol 400 microg or 800 microg or placebo once-daily (between 07:00 and 11:00 h) via a single-dose dry-powder inhaler for 28 days. Assessments included monitoring of adverse events (AEs), blood chemistry (including serum potassium and blood glucose), vital signs (blood pressure and heart rate), electrocardiograms and spirometry. One hundred and sixty-three patients were randomised, with 155 (95%) completing the study. There were no statistically significant differences between treatment groups in the overall incidence of AEs, with AEs reported by 35%, 51% and 25% of patients in the indacaterol 400 microg, 800 microg and placebo groups, respectively. The majority of AEs were mild or moderate in severity, and there were no study-drug related serious AEs. There were no statistically significant differences between indacaterol groups and placebo in mean pulse rate and QTc interval, and isolated statistically significant (p<0.05) treatment-placebo differences in mean blood pressure, blood glucose and serum potassium. There was a statistically significant improvement in FEV(1) vs placebo at all post-baseline timepoints for both indacaterol treatment groups; 30 min post-dose, adjusted mean+/-SE FEV(1) indacaterol-placebo differences were: Day 1, 220+/-36 ml and 210+/-36 ml; Day 14, 320+/-50 ml and 270+/-50 ml; Day 28, 260+/-61 ml and 200+/-61 ml for 400 and 800 microg, respectively (all p<0.01 vs placebo). Bronchodilation was still apparent after 24h, with pre-dose (i.e. trough) adjusted mean+/-SE FEV(1) indacaterol-placebo differences of: Day 14, 230+/-44 ml and 210+/-44 ml; Day 28, 220+/-49 ml and 210+/-49 ml for indacaterol 400 and 800 microg, respectively (all p<0.0001 vs placebo). Once-daily indacaterol was well tolerated at doses up to 800 microg with a good overall safety profile. There was no statistical difference at any dose between the safety of indacaterol and placebo. Furthermore, this study supports the previously demonstrated 24-h bronchodilator efficacy of indacaterol.
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Affiliation(s)
- Jutta Beier
- insaf Respiratory Research Institute, Biebricher Allee 34, D-65187 Wiesbaden, Germany.
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Martinot JB, Carr WD, Cullen S, Heredia Budo JL, Bauer K, MacLeod C, Sanguinetti CM, van Veldhuizen WC. A comparative study of clarithromycin modified release and amoxicillin/clavulanic acid in the treatment of acute exacerbation of chronic bronchitis. Adv Ther 2001; 18:1-11. [PMID: 11512528 DOI: 10.1007/bf02850246] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
This phase III, investigator-blind, randomized, parallel-group study compared the efficacy and tolerability of clarithromycin modified release (MR) with those of amoxicillin/clavulanic acid in 250 adult outpatients with acute exacerbationof chronic bronchitis (AECB). Patients received either clarithromycin MR 500 mg once daily or amoxicillin/clavulanic acid 500 mg/125 mg three times daily for 7 days. Primary endpoints were sponsor-defined clinical response and pathogen outcome at the end of treatment. Secondary endpoints were sponsor-defined clinical response and pathogen outcome at study end, investigator-defined clinical response at end of treatment and end of study, resolution or improvement of signs and symptoms, eradication of baseline pathogens, serologic outcome for atypical pathogens, and occurrence of reinfection and superinfection. Adverse events and compliance were also evaluated. Clinical and bacteriologic outcomes with both treatments for all endpoints were statistically equivalent, as were total adverse events, although the incidences of digestive disturbances (13% vs 4%) and discontinuations due to adverse events (8 vs 2 patients; P < or =.05) were significantly higher with amoxicillin/clavulanic acid. Ninety-five percent of patients receiving clarithromycin MR and 80% receiving amoxicillin/clavulanic acid were 100% compliant with medication (P < or =.05). Clarithromycin MR and amoxicillin/clavulanic acid are both well tolerated and effective as therapy for AECB; however, clarithromycin produced fewer side effects and discontinuations and higher compliance rates.
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Sibille Y, Martinot JB, Polomski LL, Wallaert B, Demusis M, Rankin JA, Voisin C, Gee JB. Phagocyte enzymes in bronchoalveolar lavage from patients with pulmonary sarcoidosis and collagen vascular disorders. Eur Respir J 1990. [DOI: 10.1183/09031936.93.03030249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The balance between proteases and antiproteases in the lower respiratory tract is believed to play a role in the outcome of interstitial lung diseases. In this cross-sectional study, we measure several phagocyte derived enzymes, namely plasminogen activator, neutrophil elastase and an ill-defined protease active on the trialanine chromophore substrate succinyl-alanine3-nitroanilide (SLAPN) in bronchoalveolar lavage (BAL) fluid from 42 patients with pulmonary sarcoidosis and from 43 patients with collagen vascular disease (CVD), 22 without lung disease (group I) and 21 associated with parenchymal lung disease (group II). The results show: a) that sarcoidosis is associated with increased plasminogen activator activity and with the presence of enzymatic activity against SLAPN corresponding at least in part to a metalloprotease; b) that CVD in the absence of radiographic lung disease is associated with an increase of plasminogen activator activity and increased levels of alpha 1-antiprotease-neutrophil elastase complexes; c) that the majority of untreated CVD (group II) patients have detectable levels of neutrophil elastase activity. These data show that patients with pulmonary sarcoidosis and CVD have different enzymatic profiles in their lower respiratory tract as assessed by BAL. Thus, sarcoidosis (mostly lymphocytic) is associated with enhanced macrophage-derived proteolytic activity in BAL, while CVD patients both with and without lung disease have increased neutrophil counts and neutrophil elastase complexed to alpha 1-protease inhibitor and presumably inactive in BAL. Finally, only BAL from untreated CVD patients with interstitial lung disease contain neutrophil elastase activity. This latter activity could contribute to the lung lesions frequently observed in these disorders.
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Sibille Y, Martinot JB, Polomski LL, Wallaert B, Demusis M, Rankin JA, Voisin C, Gee JB. Phagocyte enzymes in bronchoalveolar lavage from patients with pulmonary sarcoidosis and collagen vascular disorders. Eur Respir J 1990; 3:249-56. [PMID: 2187705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The balance between proteases and antiproteases in the lower respiratory tract is believed to play a role in the outcome of interstitial lung diseases. In this cross-sectional study, we measure several phagocyte derived enzymes, namely plasminogen activator, neutrophil elastase and an ill-defined protease active on the trialanine chromophore substrate succinyl-alanine3-nitroanilide (SLAPN) in bronchoalveolar lavage (BAL) fluid from 42 patients with pulmonary sarcoidosis and from 43 patients with collagen vascular disease (CVD), 22 without lung disease (group I) and 21 associated with parenchymal lung disease (group II). The results show: a) that sarcoidosis is associated with increased plasminogen activator activity and with the presence of enzymatic activity against SLAPN corresponding at least in part to a metalloprotease; b) that CVD in the absence of radiographic lung disease is associated with an increase of plasminogen activator activity and increased levels of alpha 1-antiprotease-neutrophil elastase complexes; c) that the majority of untreated CVD (group II) patients have detectable levels of neutrophil elastase activity. These data show that patients with pulmonary sarcoidosis and CVD have different enzymatic profiles in their lower respiratory tract as assessed by BAL. Thus, sarcoidosis (mostly lymphocytic) is associated with enhanced macrophage-derived proteolytic activity in BAL, while CVD patients both with and without lung disease have increased neutrophil counts and neutrophil elastase complexed to alpha 1-protease inhibitor and presumably inactive in BAL. Finally, only BAL from untreated CVD patients with interstitial lung disease contain neutrophil elastase activity. This latter activity could contribute to the lung lesions frequently observed in these disorders.
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Affiliation(s)
- Y Sibille
- Pulmonary Section, Catholic University of Louvain, Belgium
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Martinot JB, Delaunois L, Rahier J, Dehennin JP, Sibille Y. Relationship between inflammatory processes and gas exchanges in pulmonary sarcoidosis. Chest 1989; 96:550-6. [PMID: 2670466 DOI: 10.1378/chest.96.3.550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
In the present study, we investigated whether the analysis of cells and proteins collected by bronchoalveolar lavage (BAL) could accurately reflect the degree of functional impairment in pulmonary sarcoidosis. Eighteen patients with biopsy-proven sarcoidosis were prospectively evaluated. An inverse relationship was demonstrated between BAL coefficient of excretion relative to albumin (RCE) values of IgG and IgA and diffusion for carbon monoxide (Dco). A similar negative correlation existed with PaO2 at the end of a maximal exercise. Steroid therapy in five patients lowered concomitantly BAL RCE of IgA and IgG while Dco values increased. Immunoperoxidase studies in three lung biopsies revealed numerous Ig-containing cells within the lung parenchyma. We suggest that these BAL Ig values reflected the mononuclear cell infiltration of the bronchiolovascular sheaths and lung interstitium. This cellular infiltration likely induces a distortion of the capillary bed and may affect the gas exchanges in a reversible way.
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Affiliation(s)
- J B Martinot
- Department of Internal Medicine, Catholic University of Louvain, Belgium
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Martinot JB, Wallaert B, Hatron PY, Francis C, Voisin C, Sibille Y. Clinical and subclinical alveolitis in collagen vascular diseases: contribution of alpha 2-macroglobulin levels in BAL fluid. Eur Respir J 1989; 2:437-43. [PMID: 2474452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The probability that patients with collagen vascular diseases (CVD) will develop fibrosis is unpredictable. Since changes in bronchoalveolar lavage (BAL) cell data can be observed in CVD patients without evidence of lung involvement, we investigated whether the study of soluble components in BAL could help to distinguish CVD patients with lung involvement (n = 15) from those without pulmonary disease (n = 37). Our results demonstrate that the alveolitis observed in patients with overt lung involvement is associated with an increase of BAL alpha 2-macroglobulin (alpha 2-MA). In contrast, the BAL alpha 2-MA levels were found to be normal in CVD patients without evidence of pulmonary disease as well as in CVD patients with overt lung involvement treated with steroids. This was observed even in the presence of high neutrophil or lymphocyte counts in BAL. In conclusion, when neutrophils or lymphocytes accumulate in the lungs of CVD patients without evidence of lung damage, in the majority of patients this cell accumulation is not associated with an increase of BAL soluble components.
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Affiliation(s)
- J B Martinot
- Pulmonary Section, International Institute of Cellular and Molecular Pathology, Catholic University of Louvain, Belgium
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Martinot JB, Wallaert B, Hatron PY, Francis C, Voisin C, Sibille Y. Clinical and subclinical alveolitis in collagen vascular diseases: contribution of alpha 2-macroglobulin levels in BAL fluid. Eur Respir J 1989. [DOI: 10.1183/09031936.93.02050437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The probability that patients with collagen vascular diseases (CVD) will develop fibrosis is unpredictable. Since changes in bronchoalveolar lavage (BAL) cell data can be observed in CVD patients without evidence of lung involvement, we investigated whether the study of soluble components in BAL could help to distinguish CVD patients with lung involvement (n = 15) from those without pulmonary disease (n = 37). Our results demonstrate that the alveolitis observed in patients with overt lung involvement is associated with an increase of BAL alpha 2-macroglobulin (alpha 2-MA). In contrast, the BAL alpha 2-MA levels were found to be normal in CVD patients without evidence of pulmonary disease as well as in CVD patients with overt lung involvement treated with steroids. This was observed even in the presence of high neutrophil or lymphocyte counts in BAL. In conclusion, when neutrophils or lymphocytes accumulate in the lungs of CVD patients without evidence of lung damage, in the majority of patients this cell accumulation is not associated with an increase of BAL soluble components.
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Sibille Y, Martinot JB, Staquet P, Delaunois L, Chatelain B, Delacroix DL. Antiproteases are increased in bronchoalveolar lavage in interstitial lung disease. Eur Respir J 1988. [DOI: 10.1183/09031936.93.01060498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The present study evaluates different cellular and soluble components in the bronchoalveolar lavage (BAL) from patients with interstitial lung disease. We observed an increased T4/T8 lymphocyte ratio in BAL but not in blood from 24 patients with active pulmonary sarcoidosis compared to sixteen normal individuals and to eleven patients with inactive pulmonary sarcoidosis. Seven patients with hypersensitivity pneumonitis had a normal T4/T8 ratio. In the active sarcoidosis and hypersensitivity pneumonitis groups, alpha 1-Protease Inhibitor (alpha 1 PI) in BAL is significantly higher than in the normal group and a significant correlation between the two antiproteases (alpha 2-macroglobulin and alpha 1 PI) is observed. These data demonstrate that antiprotease levels (alpha 1 PI and alpha 2 M) are increased in the lower respiratory tract of patients with interstitial lung disease and that among cellular and soluble components of BAL, alpha 2 M represents a sensitive marker of the alveolitis.
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Sibille Y, Martinot JB, Staquet P, Delaunois L, Chatelain B, Delacroix DL. Antiproteases are increased in bronchoalveolar lavage in interstitial lung disease. Eur Respir J 1988; 1:498-504. [PMID: 2458961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The present study evaluates different cellular and soluble components in the bronchoalveolar lavage (BAL) from patients with interstitial lung disease. We observed an increased T4/T8 lymphocyte ratio in BAL but not in blood from 24 patients with active pulmonary sarcoidosis compared to sixteen normal individuals and to eleven patients with inactive pulmonary sarcoidosis. Seven patients with hypersensitivity pneumonitis had a normal T4/T8 ratio. In the active sarcoidosis and hypersensitivity pneumonitis groups, alpha 1-Protease Inhibitor (alpha 1 PI) in BAL is significantly higher than in the normal group and a significant correlation between the two antiproteases (alpha 2-macroglobulin and alpha 1 PI) is observed. These data demonstrate that antiprotease levels (alpha 1 PI and alpha 2 M) are increased in the lower respiratory tract of patients with interstitial lung disease and that among cellular and soluble components of BAL, alpha 2 M represents a sensitive marker of the alveolitis.
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Affiliation(s)
- Y Sibille
- Pulmonary Section, University Hospital of Mont-Godinne, Belgium
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Joseph M, Capron A, Ameisen JC, Martinot JB, Tonnel AB. [Blood platelets and asthma caused by aspirin]. Allerg Immunol (Paris) 1987; 19:7-10. [PMID: 3134035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Platelets isolated from patients with aspirin-induced asthma (ASA patients) react abnormally in vitro to aspirin and to non-steroid anti-inflammatory drugs (NSAID), by generating cytocidal molecules, that can kill parasitic larvae and to oxygen-dependent free radicles, which may be detected by chemiluminescence, although these drugs do not have a similar effect on platelets from normal donors or allergic asthmatics. The abnormality appears to be associated with the inhibiting properties of NSAID and aspirin on the cyclo-oxygenase pathway, that leads to a defect of the binding of prostaglandin endoperoxide PGH2 to its receptors on the platelet membrane. In addition, another metabolite from the lipoxygenase pathway which is at present poorly defined seems to participate in the anomaly. Sodium salicylate, a naturally produced catabolite of aspirin, that is well-tolerated by ASA patients, inhibits the abnormal response of the platelets and this opens new perspectives in the management of aspirin-sensitive intolerance.
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Martinot JB, Pedemonte O, Baele PL, Dautrebande J, Jaumin P, Goenen M. Dissecting aneurysm of the ascending aorta with aorto-caval fistula. Fiberoptic oximetric findings and surgical management. Chest 1985; 88:476-9. [PMID: 4028863 DOI: 10.1378/chest.88.3.476] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
A patient presented the rare complication of a dissecting aneurysm of the ascending aorta ruptured into the superior vena cava producing a left-right fistula. Continuous oximetric measurements by a fiberoptic pulmonary artery floated catheter was used to localize the site of the shunt. Emergency surgical repair was successfully performed.
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Martinot JB, Brichant J. [Toxic shock syndrome in a menstruating woman]. Acta Clin Belg 1985; 40:58. [PMID: 4002993 DOI: 10.1080/22953337.1985.11719053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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