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clinical evaluation of ventilation mode on acute exacerbation of chronic obstructive pulmonary disease with respiratory failure

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世界临床病例杂志 2023年第26期11卷 6040-6050页

作者： Jun-Jun Wang Zhong Zhou Li-Ying Zhang Department of respiratory and Critical Care Medicine The First People's Hospital of Yangquan CityYangquan 045000Shanxi ProvinceChina Department of respiratory and Critical Care Medicine Guiyang Public Health Treatment CenterGuiyang 550001Guizhou ProvinceChina Department of respiratory and Critical Care Medicine The Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of MedicineShanghai 200023China

BACKGROUND At present,understanding of the most effective ventilation methods for treating chronic obstructive pulmonary disease(COPD)patients experiencing acute worsening symptoms and respiratory failure remains relatively *** report analyzed the efficiency and side effects of various ventilation techniques used for individuals experiencing an acute COPD *** To determine whether pressure-controlled ventilation(PCV)can lower peak airway pressures(PAPs)and reduce the incidence of barotrauma compared to volume-controlled ventilation(VCV),without compromising clinical outcomes and oxygenation *** We have evaluated 600 patients who were hospitalized due to a severe COPD exacerbation,with 400 receiving mechanical ventilation for the respiratory *** participants were divided into two different groups,who were administered either VCV or PCV,along with appropriate *** thereafter observed patients'attributes,clinical factors,and laboratory,radiographic,and arterial blood gas evaluations at the start and during their stay in the intensive care unit(ICU).We have also employed appropriate statistical methods for the data *** Both the VCV and PCV groups experienced significant enhancements in the respiratory rate,tidal volume,and arterial blood gas values during their time in the ***,no significant distinctions were detected between the groups in terms of oxygenation indices(partial pressures of oxygen/raction of inspired oxygen ratio)and partial pressures of carbon dioxide *** was no considerable disparity observed between the VCV and PCV groups in the hospital mortality(32%vs 28%,P=0.53),the number of days of ICU stay[median interquartile range(IQR):9(6-14)d vs 8(5-13)d,P=0.41],or the duration of the mechanical ventilation[median(IQR):6(4-10)d vs 5(3-9)d,P=0.47].The PCV group displayed lower PAPs compared to the VCV group(P<0.05)from the beginning of mechanical ventilation until extubati

关键词： Chronic obstructive pulmonary disease Mechanical ventilation Volume-controlled ventilation Pressurecontrolled ventilation Barotrauma respiratory failure

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COVID-19 vaccination produces exercise-responsive SARS-CoV-2 specific T-cells regardless of infection history

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Journal of Sport and Health Science 2024年第1期13卷 99-107页

作者： Kyle A.Smith Tiffany M.Zúñiga Forrest L.Baker Helena Batatinha Charles R.Pedlar Shane C.Burgess Michael P.Gustafson Emmanuel Katsanis Richard J.Simpson School of Nutritional Sciences and Wellness The University of ArizonaTucsonAZ 85721USA Department of Pediatrics The University of ArizonaTucsonAZ 85724USA Faculty of Sport Allied Health and Performance ScienceSt.Mary's UniversityTwickenham TW14SXUK Institute of Sport Exercise and Health University College LondonLondon WC1E 7HUUK Department of Animal and Comparative Biomedical Sciences The University of ArizonaTucsonAZ 85721USA The University of Arizona Cancer Center The University of ArizonaTucsonAZ 85719USA Laboratory Medicine and Pathology Mayo Clinic ArizonaPhoenixAZ 85054USA Department of Immunobiology The University of ArizonaTucsonAZ 85724USA Department of Medicine The University of ArizonaTucsonAZ 85724USA Department of Pathology The University of ArizonaTucsonAZ 85724USA

Background:The mobilization and redistribution of severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)specific T-cells and neutralizing antibodies(nAbs)during exercise is purported to increase immune surveillance and protect against severe coronavirus disease 2019(COVID-19).We sought to determine if COVID-19 vaccination would elicit exercise-responsive SARS-CoV-2 T-cells and transiently alter nAb ***:Eighteen healthy participants completed a 20-min bout of graded cycling exercise before and/or after receiving a COVID-19 *** major leukocyte subtypes were enumerated before,during,and after exercise by flow cytometry,and immune responses to SARS-CoV-2 were determined using whole blood peptide stimulation assays,T-cell receptor(TCR)-βsequencing,and SARS-CoV-2 nAb ***:COVID-19 vaccination had no effect on the mobilization or egress of major leukocyte subsets in response to intensity-controlled graded ***,non-infected participants had a significantly reduced mobilization of CD4+and CD8+naive T-cells,as well as CD4+central memory T-cells,after vaccination(synthetic immunity group);this was not seen after vaccination in those with prior SARS-CoV-2 infection(hybrid immunity group).Acute exercise after vaccination robustly mobilized SARS-CoV-2 specific T-cells to blood in an intensity-dependent *** groups mobilized T-cells that reacted to spike protein;however,only the hybrid immunity group mobilized T-cells that reacted to membrane and nucleocapsid *** increased significantly during exercise only in the hybrid immunity ***:These data indicate that acute exercise mobilizes SARS-CoV-2 specific T-cells that recognize spike protein and increases the redistribution of nAbs in individuals with hybrid immunity.

关键词： Anti-viral COVID-19 Exercise immunology SARS-CoV-2 T-Cells Vaccine

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Diffuse cystic lung diseases

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Frontiers of Medicine 2013年第3期7卷 316-327页

作者： Jay H.Ryu Xinlun Tian Misbah Baqir Kaifeng Xu Division of Pulmonary and Critical Care Medicine Mayo ClinicRochesterMN 55905USA Division of respiratory Medicine Peking Union Medical College HospitalBeijing 100730China

Diffuse cystic lung diseases are uncommon but can present a diagnostic challenge because increasing number of diseases have been associated with this *** in the lung is defined as a round parenchymal lucency with a well-defined thin wall(clinical context with chest imaging findings serve as important clues to defining the underlying nature of the cystic lung disease and guide diagnostic evaluation as well as management.

关键词： cyst lung disease interstitial lung disease lymphangioleiomyomatosis Langerhans’cell histiocytosis Birt-Hogg-Dubésyndrome

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Rutaecarpine attenuates monocrotaline-induced pulmonary arterial hypertension in a Sprague-Dawley rat model

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Traditional Medicine Research 2023年第1期8卷 26-35页

作者： Xiao-Wei Gong Yan-Ling Sheng Shi-Wei Kang Bo-Yun Yuan Ya-Dong Yuan Department of respiratory and Critical Care Medicine The Second Hospital of Hebei Medical UniversityShijiazhuang 050000China Department of respiratory and Critical Care Medicine Huabei Petroleum Administration Bureau General HospitalRenqiu 062550China.

Background:Pulmonary arterial hypertension presents with obliterative remodeling of the pulmonary arteries and progressive elevation of pulmonary vascular resistance,which increase the risk of right ventricular failure and *** has been reported in previous studies that rutaecarpine plays a crucial role in anti-inflammatory and antioxidant activities,which may help regulate cell apoptosis and cell *** purpose of this study was to determine the effects of rutaecarpine in the rat model of monocrotaline-induced pulmonary ***:We induced pulmonary arterial hypertension in adult Sprague-Dawley rats by injecting monocrotaline(60 mg/kg)and then treated with rutaecarpine(40 mg/kg·d)or sildenafil(30 mg/kg·d)(positive control).Subsequently,pulmonary function,inflammation,cytokines and pulmonary vascular remodeling or proliferation were ***:Rutaecarpine was found to improve monocrotaline-induced mean pulmonary artery pressure,cardiac index,right heart index,right ventricular hypertrophy index,pulmonary artery remodeling and pulmonary *** transcription-quantitative polymerase chain reaction demonstrated a decrease in tumor necrosis factor-α,interleukin-6 and interleukin-1β,whereas western blots a significantly decrease in the expression of nuclear factor kappa-B,endothelin-1,extracellular signal-regulated kinases 1/2,B cell lymphoma-2,Beclin1 and microtubule-associated protein1 light chain 3-II protein,and increase in the expression of Bax,caspase-3 and p62 ***:Rutaecarpine attenuated pulmonary arterial hypertension by inhibiting inflammation,oxidative stress,cell proliferation and autophagy,while promoting apoptosis.

关键词： rutaecarpine pulmonary arterial hypertension inflammatory response oxidative stress vascular proliferation

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Metabolomics studies identify novel diagnostic and prognostic indicators in patients with alcoholic hepatitis

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World Journal of Hepatology 2016年第10期8卷 499-508页

作者： Mona Ascha Zeneng Wang Mustafa S Ascha Raed Dweik Nizar N Zein David Grove J Mark Brown Stephanie Marshall Rocio Lopez Ibrahim A Hanouneh Department of Gastroenterology and Hepatology Cleveland Clinic Department of Cellular and Molecular Medicine Cleveland Clinic Department of Pulmonary Allergy and Critical Care Medicine/Respiratory Institute Cleveland Clinic Department of Quantitative Health Science Cleveland Clinic Minnesota Gastroenterology Min- neapolis

AIM: To identify plasma analytes using metabolomics that correlate with the diagnosis and severity of liver disease in patients with alcoholic hepatitis(AH).METHODS: We prospectively recruited patients with cirrhosis from AH(n = 23) and those with cirrhosis with acute decompensation(AD) from etiologies other than alcohol(n = 25). We used mass spectrometry to identify 29 metabolic compounds in plasma samples from fasted subjects. A receiver operating characteristics analysis was performed to assess the utility of biomarkers in distinguishing acute AH from alcoholic cirrhosis. Logistic regression analysis was performed to build a predictive model for AH based on clinical characteristics. A survival analysis was used to construct Kaplan Meier curves evaluating transplant-free ***: A comparison of model for end-stage liver disease(MELD)-adjusted metabolomics levels between cirrhosis patients who had AD or AH showed that patients with AH had significantly higher levels of betaine, and lower creatinine, phenylalanine, homocitrulline, citrulline, tyrosine, octenoyl-carnitine, and symmetric dimethylarginine. When considering combined levels, betaine and citrulline were highly accurate predictors for differentiation between AH and AD(area under receiver operating characteristics curve = 0.84). The plasma levels of carnitine [0.54(0.18, 0.91); P = 0.005], homocitrulline [0.66(0.34, 0.99); P < 0.001] and pentanoyl-carnitine [0.53(0.16, 0.90); P = 0.007] correlated with MELD scores in patients diagnosed with AH. Increased levels of many biomarkers(carnitine P = 0.005, butyrobetaine P = 0.32, homocitrulline P = 0.002, leucine P = 0.027, valine P = 0.024, phenylalanine P = 0.037, tyrosine P = 0.012, acetyl-carnitine P = 0.006, propionyl-carnitine P = 0.03, butyryl-carnitine P = 0.03, trimethyl-lisine P = 0.034, pentanoyl-carnitine P = 0.03, hexanoyl-carnitine P = 0.026) were associated with increased mortality in patients with AH. CONCLUSION: Metabolomics plasma anal

关键词： Metabolomics Biomarkers Liver disease Model for end-stage liver disease Cirrhosis Alcoholic hepatiti

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Fulminant myocarditis in adults: a narrative review

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Journal of Geriatric Cardiology 2022年第2期19卷 137-151页

作者： Santiago Montero Darryl Abrams Enrico Ammirati Florent Huang Dirk WDonker Guillaume Hekimian Cosme García-García Antoni Bayes-Genis Alain Combes Matthieu Schmidt Acute Cardiovascular Care Unit Heart InstituteHospital Germans Trias i PujolDepartament de MedicinaUniversitat Autònoma de BarcelonaCIBERCVSpain Assistance Publique-Hôpitaux de Paris Pitié-Salpêtrière HospitalMedical Intensive Care UnitParisFrance Columbia University Vagelos College of Physicians&Surgeons/NewYork-Presbyterian Hospital New YorkUSA Center for Acute respiratory failure Columbia University Irving Medical CenterNew YorkUSA De Gasperis Cardio Center and Transplant Center Niguarda HospitalMilanoItaly Cardiology Hôpital FochSuresnesParisFrance Intensive Care Center University Medical Center UtrechtUtrechtthe Netherlands Cardiovascular and respiratory Physiology TechMed CenterUniversity of TwenteEnschedethe Netherlands Sorbonne Université INSERM UMRS_1166-iCANInstitute of Cardiometabolism and NutritionParisFrance

Fulminant myocarditis(FM)is an uncommon syndrome characterized by sudden and severe hemodynamic compromise secondary to acute myocardial inflammation,often presenting as profound cardiogenic shock,life-threatening ventricular arrhythmias and/or electrical *** may be refractory to conventional therapies and require mechanical circulatory support(MCS).The immune system has been recognized as playing a pivotal role in the pathophysiology of myocarditis,leading to an increased focus on immunosuppressive treatment *** data have highlighted not only the fact that FM has significantly worse outcomes than non-FM,but that prognosis and management strategies of FM are heavily dependent on histological subtype,placing greater emphasis on the role of endomyocardial biopsy in *** impact of subtype on severity and prognosis will likewise influence how aggressively the myocarditis is managed,including whether MCS is *** patients with refractory cardiogenic shock secondary to FM end up requiring MCS,with venoarterial extracorporeal membrane oxygenation demonstrating favorable survival rates,particularly when initiated prior to the development of multiorgan *** the challenges facing the field are the need to more precisely identify immunopathophysiological pathways in order to develop targeted therapies,and the need to better optimize the timing and management of MCS to minimize complications and maximize outcomes.

关键词： myocarditis initiated storm

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Cardiac risk factors limiting survival to liver transplantation in patients with nonalcoholic fatty liver disease

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World Journal of Hepatology 2022年第7期14卷 1398-1407页

作者： Michael Delicce Joseph Mauch Abel Joseph Ruishen Lyu Heather Kren Rose Bartow Donna Ferchill Maan Fares Jamile Wakim-Fleming Department of Internal Medicine Cleveland ClinicClevelandOH 44195United States Lerner College of Medicine at Case Western Reserve University Cleveland ClinicClevelandOH 44195United States Department of Quantitative Health Sciences Cleveland ClinicClevelandOH 44195United States Department of Liver Transplantation Cleveland ClinicClevelandOH 44195United States Department of Cardiovascular Medicine Cleveland ClinicClevelandOH 44195United States Department of Gastroenterology Hepatology and NutritionCleveland ClinicClevelandOH 44195United States

BACKGROUND Nonalcoholic fatty liver disease(NAFLD)describes the hepatic manifestations of metabolic syndrome,which is estimated to affect 25%of adults,and currently represents the second most common indication for liver transplant in the United *** have shown that patients with NAFLD are at an increased risk for heart failure,arrhythmia,and coronary artery disease(CAD),which may impact outcomes of liver ***,it remains unclear whether the presence of cardiac disease affects survival prior to liver *** so,this would represent an important opportunity to optimize cardiac status and improve outcomes before liver *** To identify cardiac factors that impact survival to liver transplantation in patients with NAFLD and on the transplant *** The aim of this study was to identify cardiac risk factors that limit survival to transplant in patients with *** performed a retrospective analysis of patients with NAFLD listed for liver transplant at a tertiary academic medical center in the United States from January 2015 to January 2021,identified through United Network of Organ Sharing *** criteria included a concurrent etiology of liver disease and removal from the transplant list due to chemical dependency,lack of social support,improvement in liver disease,or being lost to *** manually reviewed patient charts including electrocardiogram,echocardiogram,and cardiac catheterization reports as well as physician notes to identify cardiac disease states(i.e.,heart failure,arrhythmia,valvular disease and CAD)and other related *** performed a survival analysis by Cox proportional hazards regression model to analyze the association between cardiac factors at the time listed for transplant and death or clinical deterioration prior to *** Between January 2015 and January 2021,265 patients with nonalcoholic fatty liver disease were listed for liver transplant at our instituti

关键词： Nonalcoholic fatty liver disease Liver transplant Cardiovascular disease Pre-transplant outcomes Coronary artery disease Risk factors

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Sequential non-invasive mechanical ventilation following short-term invasive mechanical ventilation in COPD induced hypercapnic respiratory failure

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Chinese Medical Journal 2003年第1期116卷 39-43页

作者：王辰商鸣宇黄克武童朝晖孔维民姜超美代华平张洪玉翁心植 Beijing Institute of respiratory Medicine

Objective To estimate the feasibility and the efficacy of early extubation and sequential non-invasive mechanical ventilation (MV) in chronic obstructive pulmonary disease (COPD) with exacerbated hypercapnic respiratory *** Twenty-two intubated COPD patients with severe hypercapnic respiratory failure due to pulmonary infection (pneumonia or purulent bronchitis) were involved in the study. At the time of pulmonary infection control window (PIC window) appeared, when pulmonary infection had been significantly controlled (resolution of fever and decrease in purulent sputum, radiographic infiltrations, and leukocytosis) after the antibiotic and the comprehensive therapy, the early extubation was conducted and followed by non-invasive MV via facial mask immediately in 11 cases (study group). Other 11 COPD cases with similar clinical characteristics who continuously received invasive MV after PIC window were recruited as control *** All patients had similar clinical characteristics and gas exchange before treatment, as well as the initiating time and all indices at the time of the PIC window. For study group and control group, the duration of invasive MV was (7.1±2.9) vs (23.0±14.0) days, respectively, Prespiratory failure, early extubation followed by non-invasive MV initiated at the point of PIC window significantly decreases the invasive and total durations of ventilatory support, the risk of VAP, and the duration of ICU stay.

关键词： pulmonary disease, obstructive respiratory failure mechanical ventilation pulmonary infection control window

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Electrocardiographic markers of cardiac resynchronization therapy response:delayed time to intrinsicoid deflection onset in lateral leads

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Journal of Geriatric Cardiology 2022年第1期19卷 21-30页

作者： Rubén KA Tapia-Orihuela S Michael Gharacholou Samuel J Asirvatham Freddy Del-Carpio Munoz Department of Medicine Universidad Nacional Mayor de San MarcosFacultad de Medicina de San FernandoLimaPeru Department of Cardiovascular Diseases Mayo ClinicJacksonvilleFLUSA Department of Cardiovascular Diseases Mayo ClinicRochesterMNUSA

Cardiac resynchronization therapy(CRT)has emerged as an important intervention for patients with heart failure(HF)with reduced ejection fraction and delayed ventricular *** these patients,CRT has demonstrated to improve quality of life,promote reverse left ventricular(LV)remodeling,reduce HF hospitalizations,and extend ***,despite advancements in our understanding of CRT,a significant number of patients do not respond to this *** invasive and non-invasive parameters have been assessed to predict response to CRT,but the electrocardiogram(ECG)has remained as the prevailing screening method albeit with ***,an accurate,simple,and reproducible ECG marker or set of markers would dramatically overcome the current *** describe the clinical utility of an old ECG parameter that can estimate ventricular activation delay:the onset to intrinsicoid deflection(ID).Based on the concept of direct measurement of ventricular activation time(intrinsic deflection onset),time to ID onset measures on the surface ECG the time that the electrical activation time takes to reach the area subtended by the corresponding surface ECG *** on this principle,the time to ID on the lateral leads can estimate the delay activation to the lateral LV wall and can be used as a predictor for CRT response,particularly in patients with non-specific intraventricular conduction delay or in patients with left bundle branch block and QRS<150 *** aim of this review is to present the current evidence and potential use of this ECG parameter to estimate LV activation and predict CRT response.

关键词： deflection intrinsic synchronization

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Evaluation of Asthma Symptoms to Assess Asthma Control Status in a Primary Care Setting: An Exploratory Analysis of Pooled Data from Three Trials

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Open Journal of respiratory Diseases 2018年第2期8卷 21-32页

作者： Soichiro Hozawa Michikazu Terada Maki Hozawa Hiroshima Allergy and respiratory clinic Hiroshima Japan

Background: Primary care physicians in Japan see many patients in a given day;consequently, they find it challenging to devote sufficient time for detailed clinical consultation and evaluation of asthma control status. The aim of this study was to investigate asthma symptoms that reveal the presence of inadequately controlled asthma. Methods: A pooled analysis of baseline data from 100 patients with asthma treated with inhaled corticosteroid(s) (ICS) alone or ICS/long-acting beta-agonist who participated in three previous clinical trials was performed. Asthma control status and asthmatic symptoms were determined using a five-item Asthma Control Questionnaire, and whether asthmatic symptoms reflect clinical markers was investigated. Results: Nocturnal awakening owing to asthmatic symptoms was observed only in the uncontrolled asthma group. Patient-reported wheezing was not observed in the group with well-controlled asthma, but was observed in all patients in the uncontrolled asthma group. Virtually all patients, irrespective of asthma control status, reported symptoms in the morning, limitation of normal daily activities, and shortness of breath. Conclusions: The presence of nocturnal awakening due to asthma and wheezing likely reflected uncontrolled asthma. These results will lead to re-recognition that clinical interview, querying nocturnal awakening from asthma and wheezing is a simple and useful approach to assess asthma control status in a primary care setting.

关键词： Asthma Control Status Asthma Control Questionnaire Nocturnal Awakening Wheezing Primary Care

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