共查询到20条相似文献,搜索用时 46 毫秒
1.
Wilma J. van Veen MD Jean M.M. Driessen MD PhD Elin T.G. Kersten MD Janneke C. van Leeuwen MD Marjolein G.J. Brusse‐Keizer PhD Wim M.C. van Aalderen MD PhD Bernard J. Thio MD PhD 《Pediatric pulmonology》2017,52(9):1130-1134
Background
Exercise induced bronchoconstriction (EIB) is a frustrating morbidity of asthma in children. Obesity has been associated with asthma and with more severe EIB in asthmatic children.Objectives
To quantify the effect of BMI on the risk of the occurrence of EIB in children with asthma.Methods
Data were collected from six studies in which exercise challenge tests were performed according to international guidelines. We included 212 Children aged 7‐18 years, with a pediatrician‐diagnosed mild‐to‐moderate asthma.Results
A total of 103 of 212 children (49%) had a positive exercise challenge (fall of FEV1 ≥ 13%). The severity of EIB, as measured by the maximum fall in FEV1, was significantly greater in overweight and obese children compared to normal weight children (respectively 23.9% vs 17.9%; P = 0.045). Asthmatic children with a BMI z‐score around +1 had a 2.9‐fold higher risk of the prevalence of EIB compared to children with a BMI z‐score around the mean (OR 2.9; 95%CI: 1.3‐6.1; P < 0.01). An increase in BMI z‐score of 0.1 in boys led to a 1.4‐fold increased risk of EIB (OR 1.4; 95%CI: 1.0‐1.9; P = 0.03). A reduction in pre‐exercise FEV1 was associated with a higher risk of EIB (last quartile six times higher risk compared to highest quartile (OR 6.1 [95%CI 2.5‐14.5]).Conclusions
The severity of EIB is significantly greater in children with overweight and obesity compared to non‐overweight asthmatic children. Furthermore, this study shows that the BMI‐z‐score, even with a normal weight, is strongly associated with the incidence of EIB in asthmatic boys.2.
《Pediatric pulmonology》2018,53(7):E21-E23
Presentation
Patient is a 6‐year‐old male with CF, MRSA colonization, and pancreatic insufficiency that presented with worsening ppFEV1 and systemic symptoms despite multiple interventions. BAL grew NTM, Stenotrophomonas maltophilia, and Inquilinus limosus, a rare organism found in patients with CF.Course
I. limosus treatment was deferred. Despite treatment of other pathogens, symptoms worsened. I. limosus was targeted with meropenem, amikacin, and ciprofloxacin along with clindamycin for MRSA colonization. Within weeks, symptoms had resolved with ppFEV1 improvement.Discussion
This case discusses the importance of a rare organism in the CF population. Targeting I. limosus was key to recovery, revealing its potential pathogenicity.3.
《Pediatric pulmonology》2018,53(7):857-865
Objectives
We investigated whether this trend in SAA PICU admissions is present in the Netherlands.Methods
A multicenter retrospective cohort study across all tertiary care PICUs in the Netherlands. Inclusion criteria were children (2‐18 years) hospitalized for SAA between 2003 and 2013. Data included demographic data, asthma diagnosis, treatment, and mortality.Results
In the 11‐year study period 590 children (660 admissions) were admitted to a PICU with a threefold increase in the number of admissions per year over time. The severity of SAA seemed unchanged, based on the first blood gas, length of stay and mortality rate (0.6%). More children received highflow nasal cannula (P < 0.001) and fewer children needed invasive ventilation (P < 0.001). In 58% of the patients the maximal intravenous (IV) salbutamol infusion rate during PICU admission was 1 mcg/kg/min. However, the number of patients treated with IV salbutamol in the referring hospitals increased significantly over time (P = 0.005). The proportion of steroid‐naïve patients increased from 35% to 54% (P = 0.004), with a significant increase in both age groups (2‐4 years [P = 0.026] and 5‐17 years [P = 0.036]).Conclusions
The number of children requiring PICU admission for SAA in the Netherlands has increased. We speculate that this threefold increase is explained by an increasing number of steroid‐naïve children, in conjunction with a lowered threshold for PICU admission, possibly caused by earlier use of salbutamol IV in the referring hospitals.4.
《Pediatric pulmonology》2018,53(10):1429-1435
Introduction
Acute bronchiolitis is a major cause of acute respiratory distress in infants. The soluble receptor for advanced glycation end‐products (sRAGE) is a biomarker of pulmonary damage processes, with a diagnostic and a prognostic value in acute respiratory distress syndrome (ARDS). The RAGE pathway is also implicated in the pathogenesis of other respiratory diseases like asthma, but the value of sRAGE levels in acute bronchiolitis remains under‐investigated.Material and methods
A prospective, observational, and analytical study was conducted at Clermont‐Ferrand University Hospital. The main objective was to evaluate the correlation between serum sRAGE and clinical severity of bronchiolitis in hospitalized infants aged <1 year. We analyzed correlations between serum sRAGE and Wainwright score, short‐term morbidity attributable to bronchiolitis, causal viruses and risk for recurrent wheezing at 1 year.Results
The study included 93 infants. sRAGE levels were significantly lower in acute bronchiolitis patients (mean 1101 pg/mL) than in controls (2203 pg/mL, P < 0.001) but did not correlate with clinical severity. No correlation was found between serum sRAGE and severity score, respiratory viruses, and recurrent wheezing at 1 year. Serum sRAGE levels were negatively correlated with age (r = −0.45, P < 0.001).Conclusion
Serum sRAGE levels are decreased in acute bronchiolitis but not correlated with disease severity. sRAGE levels should be age‐adjusted in infants. Serum sRAGE levels measured in the setting of acute bronchiolitis were not predictive of recurrent wheezing.5.
《Pediatric pulmonology》2018,53(9):1299-1306
Objective
Aim of this study was to analyze whether children with objectively measured second‐hand cigarette smoke (SHS) exposure suffer from a more severe course of disease when hospitalized with lower respiratory tract infection (LRTI) due to respiratory syncytial virus (RSV).Methods
This prospective study was conducted at the Department of Pediatrics, Wilhelminen‐Hospital, Vienna, Austria in children aged below 1 year without a history of preceding lung disease and with acute symptoms of LRTI and a positive nasopharyngeal swab for RSV. On admission, urinary cotinine was measured as a marker of recent SHS and clinical severity of LRTI was assessed by oxygen saturation SpO2 and the “admission clinical severity score” (CSSA). Parents/caregivers were asked to complete a customized questionnaire assessing risks for SHS and demographic characteristics.Results
After inclusion of 217 patients, data of 185 patients with a mean (SD) age of 106 days (80) were analyzed. Twenty‐five patients (13.5%) were “cotinine‐positive” (COT+) defined as a urinary cotinine level of ≥7 μg/L. SpO2 on admission was significantly lower in children recently exposed to SHS defined objectively by COT+ (94.8% ±2.0) in urine on admission compared to children not recently exposed (COT−) (96.8% ±3.0; P < 0.01). Disease severity, assessed via mean clinical severity score on admission (CSSA) for COT+ and COT− was 2.56 and 1.71, respectively (P = 0.03).Conclusions
Recent exposure to SHS was associated with lower O2 saturation and higher clinical severity score, measured by urine cotinine levels in children hospitalized for RSV infection under 1 year of age.6.
《Pediatric pulmonology》2018,53(6):720-727
Objective
To compare medication adherence, pulmonary exacerbations, healthcare utilization, and costs for patients with cystic fibrosis (CF) who utilized a pharmacy‐based therapy management program to a matched control group. We hypothesized that patient management services would be associated with better medication adherence, and thus require fewer visits to the emergency room or hospitalizations.Methods
This retrospective, observational cohort study used claims data from the MORE2 claims Registry®. The sample consisted of CF patients, aged 6+, who had ≥1 pharmacy claim for inhaled tobramycin, inhaled aztreonam, ivacaftor, or dornase alfa from 6/2/2014‐5/31/2015. Adherence was measured as proportion of days covered (PDC). Propensity score matching and multivariable regression techniques were used to compare outcomes in program participants to matched controls.Results
Of the 236 intervention and 724 control patients meeting selection criteria, 202 were propensity‐matched from each cohort. Relative to the control cohort, program patients had 23% higher mean PDC for tobramycin (IRR = 1.23, P = 0.01) and were twice as likely to be adherent to tobramycin (PDC ≥ 80%) than matched controls (OR = 2.14, P = 0.04). Program patients had fewer ER visits (IRR = 0.52, P < 0.01) and slightly lower ER costs (IRR = 0.66, P = 0.06) than the control patients.Conclusion
A pharmacy‐based therapy management program for CF patients was associated with higher adherence to inhaled tobramycin and lower ER rates. Pharmacies that provide therapy management can support effective CF care management.7.
《Pediatric pulmonology》2018,53(1):103-107
Objectives
Kawasaki disease (KD) is a multisystemic vasculitis with predominant mucocutaneous manifestations. Pulmonary involvement in KD is distinctly uncommon and is not commonly recognized. We describe our experience of managing children with KD wherein the initial presentation was predominantly pulmonary.Methods
Six hundred and two children have been diagnosed with KD during the period January 1993 to May 2017 in the Allergy Immunology Unit, Advanced Pediatrics Centre, Postgraduate Institute of Medical Education and Research, Chandigarh. Data were collected from inpatient records in Allergy Immunology Unit and follow‐up files in the Pediatric Rheumatology Clinic.Results
Of 602 children, 11 (1.83%) had a predominant pulmonary presentation of KD. Mean age at diagnosis of KD was 2.5 years. Fever, cough and respiratory distress were the presenting complaints in all patients. First sign of KD was noted at a mean duration of 14.5 days from the onset of symptoms. Periungual desquamation was the most common clinical sign (72.7%). Persistent fever in spite of antimicrobials, thrombocytosis, and elevated erythrocyte sedimentation rate and C‐reactive protein levels pointed toward a diagnosis of KD in our patients. Parenchymal consolidation was evident on chest X‐ray in all patients, pleural effusion in six, empyema in three, and pneumothorax in two patients. Coronary artery abnormalities were evident in three patients. Intravenous immunoglobulin was given after a mean period of 22.4 days of onset of fever.Conclusions
The diagnosis of KD is often delayed in children who have a predominantly pulmonary presentation. This can have adverse clinical consequences.8.
《Pediatric pulmonology》2018,53(9):1179-1192
Background
Asthma attacks are common and have significant physical, psychological, and financial consequences. Improving the assessment of a child's risk of subsequent asthma attacks could support front‐line clinicians’ decisions on augmenting chronic treatment or specialist referral. We aimed to identify predictors for emergency department (ED) or hospital readmission for asthma from the published literature.Methods
We searched MEDLINE, EMBASE, AMED, PsycINFO, and CINAHL with no language, location, or time restrictions. We retrieved observational studies and randomized controlled trials (RCT) assessing factors (personal and family history, and biomarkers) associated with the risk of ED re‐attendance or hospital readmission for acute childhood asthma.Results
Three RCTs and 33 observational studies were included, 31 from Anglophone countries and none from Asia or Africa. There was an unclear or high risk of bias in 14 of the studies, including 2 of the RCTs. Previous history of emergency or hospital admissions for asthma, younger age, African‐American ethnicity, and low socioeconomic status increased risk of subsequent ED and hospital readmissions for acute asthma. Female sex and concomitant allergic diseases also predicted hospital readmission.Conclusion
Despite the global importance of this issue, there are relatively few high quality studies or studies from outside North America. Factors other than symptoms are associated with the risk of emergency re‐attendance for acute asthma among children. Further research is required to better quantify the risk of future attacks and to assess the role of commonly used biomarkers.9.
Associations between maternal mental health and early child wheezing in a South African birth cohort
《Pediatric pulmonology》2018,53(6):741-754
Background
Wheezing in early childhood is common and has been identified in high‐income countries (HIC) as associated with maternal antenatal or postnatal psychosocial risk factors. However, the association between maternal mental health and childhood wheezing has not been well studied in low and middle‐income countries (LMIC), such as South Africa.Methods
A total of 1137 pregnant women over 18 year old, between 20 and 28 weeks’ gestation, and attending either of two catchment area clinics were enrolled in a South African parent study, the Drakenstein Child Health Study (DCHS). Psychosocial risk factors including maternal depression, psychological distress, early adversity, and intimate partner violence (IPV), were measured antenatally and postnatally by validated questionnaires. Two outcomes were evaluated: Presence of wheeze (at least one episode of child wheeze during the first 2 years of life); and recurrent wheeze (two or more episodes of wheezing in a 12‐month period). Logistic regression was used to investigate the association between antenatal or postnatal psychosocial risk factors and child wheeze, adjusting for clinical and socio‐demographic covariates.Results
Postnatal psychological distress and IPV were associated with both presence of wheeze (adjusted OR = 2.09, 95%CI: 1.16‐3.77 and 1.63, 95%CI: 1.13‐2.34, respectively), and recurrent child wheeze (adjusted OR = 2.26, 95%CI: 1.06‐4.81 and 2.20, 95%CI: 1.35‐3.61, respectively).Conclusion
Maternal postnatal psychological distress and IPV were associated with wheezing in early childhood. Thus, screening and treatment programs to address maternal psychosocial risk factors may be potential strategies to reduce the burden of childhood wheeze in LMICs.10.
《Pediatric pulmonology》2018,53(1):88-94
Aim
To assess the role of human bocavirus 1 (HBoV1) as a causative agent of non‐severe community‐acquired pneumonia (CAP) in children.Methods
Patients aged 2‐59 months with non‐severe CAP (respiratory complaints and radiographic pulmonary infiltrate/consolidation) attending a University Hospital in Salvador, Brazil were enrolled in a prospective cohort. From 820 recruited children in a clinical trial ( ClinicalTrials.gov NCT01200706), nasopharyngeal aspirate (NPA), and acute and convalescent serum samples were obtained from 759 (92.6%) patients. NPAs were tested for 16 respiratory viruses by PCR. Acute HBoV1 infection was confirmed by measuring specific IgM and IgG responses in paired serum samples.Results
Respiratory viruses were detected in 693 (91.3%; 95%CI: 89.1‐93.2) CAP cases by PCR. HBoV1‐DNA was detected in 159 (20.9%; 95%CI: 18.2‐24.0) cases. Of these 159 PCR positive cases, acute HBoV1 infection was confirmed serologically in 38 cases (23.9%; 95%CI: 17.8‐31.0). Overall, acute HBoV1 infection was confirmed in 5.0% (38/759) of non‐severe CAP patients. HBoV1 was detected in 151 cases with at least one other virus making 31.7% of all multiple virus (n = 477) detections. Among all 759 cases, 216 had one respiratory virus detected, and sole HBoV1 was detected in only 8 (3.7%). Acute HBoV1 infection was serologically diagnosed in 34 (22.5%) HBoV1‐DNA‐positive cases with another virus, compared to 4 (50.0%) cases with sole virus detection (p = 0.09).Conclusion
HBoV1 was detected by PCR in one fifth of the children with non‐severe CAP and acute HBoV1 infection was serologically confirmed in one quarter of these cases.11.
Nitric oxide‐releasing microparticles as a potent antimicrobial therapeutic against chronic rhinosinusitis bacterial isolates 下载免费PDF全文
Waleed M. Abuzeid MD Vallerinteavide Mavelli Girish PhD Judd H. Fastenberg MD Andrew R. Draganski PhD Andrew Y. Lee MD Joshua D. Nosanchuk MD Joel M. Friedman MD PhD 《International forum of allergy & rhinology》2018,8(10):1190-1198
Background
Bacteria, particularly in the biofilm state, may be implicated in the pathogenesis of chronic rhinosinusitis (CRS) and enhance antibiotic resistance. Nitric oxide (NO) is a gaseous immunomodulator with antimicrobial activity and a short half‐life, complicating achievement of therapeutic concentrations. We hypothesized that a novel microparticle‐based delivery platform, which allows for adjustable release of NO, could exhibit potent antibacterial effects.Methods
Porous organosilica microparticles (SNO‐MP) containing nitrosylated thiol groups were formulated. Dissociation of the nitrosothiol groups generates NO at body temperature. The susceptibility of bacterial isolates from CRS patients to SNO‐MP was evaluated through a colony forming unit (CFU) assay. Serial dilutions of SNO‐MP in triplicate were incubated with isolates in suspension for 6 hours followed by plating on tryptic soy agar and overnight incubation followed by CFU quantification. Statistical analysis was performed with SPSS using one‐way analysis of variance with Bonferroni correction.Results
SNO‐MP displayed antibacterial activity against gram‐positive (methicillin‐resistant and ‐sensitive Staphylococcus aureus) and gram‐negative (Pseudomonas aeruginosa, Enterobacter aerogenes, and Proteus mirabilis) isolates. SNO‐MP induced dose‐dependent reductions in CFU across all strains. Compared with controls and blank nanoparticles, SNO‐MP (10 mg/mL) induced a 99.99%‐100% reduction in CFU across all isolates, equivalent to a 5–9 log kill (p < 0.005). There was no statistically significant difference in CFU concentration between controls and blank microparticles.Conclusion
SNO‐MP demonstrates potent bactericidal effect against antibiotic‐resistant CRS bacterial strains.12.
《Pediatric pulmonology》2018,53(4):426-430
Background
While the prevalence of Stenotrophomonas maltophilia lung infection in cystic fibrosis (CF) patients has increased in the last decades, its pathogenicity remains controversial. The aim of this study was to investigate the effects of S. maltophilia initial infection on the progression of lung disease in CF children.Methods
This case‐control retrospective study took place in a pediatric CF center. A total of 23 cases defined by at least one sputum culture positive for S. maltophilia, were matched for age, sex, and CFTR mutations to 23 never infected CF controls. The clinical data were collected for 2 years before and after S. maltophilia initial infection and comprised lung function analyses, rates of exacerbations and of antibiotic courses.Results
Compared with controls, cases had lower lung function (P = 0.05), more frequent pulmonary exacerbations (P = 0.01), hospitalizations (P = 0.02), and intravenous antibiotic courses (P = 0.04) before S. maltophilia acquisition. In the year following S. maltophilia initial infection, lung function decline was similar in cases and controls but cases remained more severe, with more frequent pulmonary exacerbations (P = 0.01), hospitalizations (P = 0.02) and intravenous antibiotic courses (P = 0.02).Conclusions
S. maltophilia seems to be a marker of CF lung disease severity and international recommendations to reduce lung infection by this pathogen should rapidly emerge.13.
Nicole S. L. Goh Srihari Veeraraghavan Sujal R. Desai Derek Cramer David M. Hansell Christopher P. Denton Carol M. Black Roland M. du Bois Athol U. Wells 《Arthritis \u0026amp; Rheumatology》2007,56(6):2005-2012
Objective
To evaluate the prognostic value of bronchoalveolar lavage (BAL) cellular profiles in patients with systemic sclerosis–associated interstitial lung disease (SSc‐ILD).Methods
BAL cellularity was examined in relation to mortality (n = 141), serial pulmonary function findings (n = 134), and “progression‐free survival” (n = 134), by proportional hazards analysis. Baseline severity was quantified according to the extent of disease on high‐resolution computed tomography, the diffusing capacity for carbon monoxide, and the presence or absence of pulmonary hypertension. Mortality was subclassified into overall mortality (during 10 years of followup), early mortality (occurring within 2 years of presentation), and late mortality (occurring 2–10 years after presentation).Results
Overall mortality was associated with neutrophilia on BAL (hazard ratio 2.23 [95% confidence interval 1.20–4.14], P = 0.01), but this effect was lost when disease severity was taken into account. Early mortality was associated with neutrophilia on BAL (hazard ratio 8.40 [95% confidence interval 1.91–36.95], P = 0.005), independent of disease severity. Late mortality was not associated with neutrophilia on BAL. The presence of neutrophilia on BAL was not associated with time to decline in pulmonary function or progression‐free survival. Neither eosinophilia nor lymphocytosis on BAL was associated with mortality, rapidity of functional deterioration, or progression‐free survival. These findings were unaltered when treatment status was taken into account.Conclusion
BAL findings provide only limited prognostic information in SSc‐ILD. Neutrophilia on BAL is linked to early mortality, but BAL findings are not linked to long‐term survival or the rapidity of progression of lung disease. The usefulness of BAL to define alveolitis in SSc is questionable.14.
《Pediatric pulmonology》2018,53(5):605-612
Background
The objective was to develop a risk scoring tool which predicts respiratory syncytial virus hospitalisation (RSVH) in moderate‐late preterm infants (32‐35 weeks’ gestational age) in the Northern Hemisphere.Methods
Risk factors for RSVH were pooled from six observational studies of infants born 32 weeks and 0 days to 35 weeks and 6 days without comorbidity from 2000 to 2014. Of 13 475 infants, 484 had RSVH in the first year of life. Logistic regression was used to identify the most predictive risk factors, based on area under the receiver operating characteristic curve (AUROC). The model was validated internally by 100‐fold bootstrapping and externally with data from a seventh observational study. The model coefficients were converted into rounded multipliers, stratified into risk groups, and number needed to treat (NNT) calculated.Results
The risk factors identified in the model included (i) proximity of birth to the RSV season; (ii) second‐hand smoke exposure; and (iii) siblings and/or daycare. The AUROC was 0.773 (sensitivity: 68.9%; specificity: 73.0%). The mean AUROC from internal bootstrapping was 0.773. For external validation with data from Ireland, the AUROC was 0.707 using Irish coefficients and 0.681 using source model coefficients. Cut‐off scores for RSVH were ≤19 for low‐ (1.0%), 20‐45 for moderate‐ (3.3%), and 50‐56 (9.5%) for high‐risk infants. The high‐risk group captured 62.0% of RSVHs within 23.6% of the total population (NNT 15.3).Conclusions
This risk scoring tool has good predictive accuracy and can improve targeting for RSVH prevention in moderate‐late preterm infants.15.
《Clinical cardiology》2017,40(12):1309-1315
Background
Chronic kidney disease is a worldwide public health concern due to the increased prevalence the high fatalities related to heart disease in this population. Among novel cardiovascular risk markers, the coronary artery calcification score (CAC) emerged as an independent predictor of cardiovascular events.Hypothesis
We aimed to test if glomerular filtration rate or albuminuria are independently associated with coronary calcification.Methods
The Brazilian Longitudinal Study of Adult Health is a cohort of men and women aged 35 to 74 years old addressing cardiovascular diseases. We analyzed the association of CAC, estimated glomerular filtration rate (eGFR), albumin‐to‐creatinine ratio (ACR) according to stages of eGFR (1 = ≥90; 2 = 60–89; 3 = <60 mL/min/1.73 m2), and ACR (<30; 30 to 300; >300 mg/g). These associations were estimated by logistic regression with a model including age, sex, race, income, and cardiovascular risk factors.Results
Among 4189 persons (median age = 51 years, 54% women), 1183 had CAC. The odds ratio (OR) and the 95% confidence interval (95% CI) in the multivariate model was 0.86 (0.58‐1.29) for the category of eGFR <60 mL/min/1.73 m2 compared to people with eGFR >90 mL/min/1.73m2. On the other hand, the OR (95% CI) for individuals with ACR >300 mg/g was 4.31 (1.27‐14.64) compared to people with ACR <30 mg/g. A discrete interaction factor for the association with CAC between eGFR and ACR were analyzed as continuous variable.Conclusions
Albuminuria was independently associated with coronary calcification, but the reduction of the glomerular filtration rate was not associated with CAC score in this sample of apparently healthy adults.16.
《Clinical cardiology》2017,40(12):1297-1302
Background
Excessive daytime sleepiness is a frequent symptom of obstructive sleep apnea (OSA) and has been proposed as a motivator for adherence to continuous positive airway pressure (CPAP) therapy. However, excessive daytime sleepiness is absent in many patients with coronary artery disease (CAD) and concomitant OSA. We evaluated long‐term use of CPAP and predictors of CPAP use in nonsleepy and sleepy OSA patients from a CAD cohort.Hypothesis
Long‐term CPAP use is lower in CAD patients with nonsleepy OSA vs sleepy OSA.Methods
Nonsleepy (Epworth Sleepiness Scale [ESS] score < 10) OSA patients randomized to CPAP (n = 122) and sleepy (ESS ≥10) OSA patients offered CPAP (n = 155) in the RICCADSA trial in Sweden were included in this substudy. The median follow‐up was 4.8 years for the main trial, with a predefined minimum follow‐up of 2 years.Results
The probability of remaining on CPAP at 2 years was 60% in nonsleepy patients and 77% in sleepy patients. Multivariate analyses indicated that age and hours of CPAP use per night at 1 month were independently associated with long‐term CPAP use in nonsleepy patients. In the sleepy phenotype, body mass index, acute myocardial infarction at baseline, and hours of CPAP use per night at 1 month were predictors of long‐term CPAP use.Conclusions
Long‐term use of CPAP is likely to be challenging for CAD patients with nonsleepy OSA. Early CPAP use is an important predictor of continued long‐term use of CPAP, so optimizing patients' initial experience with CPAP could promote adherence.17.
Minimum Performance on Clinical Tests of Physical Function to Predict Walking 6,000 Steps/Day in Knee Osteoarthritis: An Observational Study 下载免费PDF全文
Hiral Master Louise M. Thoma Meredith B. Christiansen Emily Polakowski Laura A. Schmitt Daniel K. White 《Arthritis care & research》2018,70(7):1005-1011
Objective
Evidence of physical function difficulties, such as difficulty rising from a chair, may limit daily walking for people with knee osteoarthritis (OA). The purpose of this study was to identify minimum performance thresholds on clinical tests of physical function predictive to walking ≥6,000 steps/day. This benchmark is known to discriminate people with knee OA who develop functional limitation over time from those who do not.Methods
Using data from the Osteoarthritis Initiative, we quantified daily walking as average steps/day from an accelerometer (Actigraph GT1M) worn for ≥10 hours/day over 1 week. Physical function was quantified using 3 performance‐based clinical tests: 5 times sit‐to‐stand test, walking speed (tested over 20 meters), and 400‐meter walk test. To identify minimum performance thresholds for daily walking, we calculated physical function values corresponding to high specificity (80–95%) to predict walking ≥6,000 steps/day.Results
Among 1,925 participants (mean ± SD age 65.1 ± 9.1 years, mean ± SD body mass index 28.4 ± 4.8 kg/m2, and 55% female) with valid accelerometer data, 54.9% walked ≥6,000 steps/day. High specificity thresholds of physical function for walking ≥6,000 steps/day ranged 11.4–14.0 seconds on the 5 times sit‐to‐stand test, 1.13–1.26 meters/second for walking speed, or 315–349 seconds on the 400‐meter walk test.Conclusion
Not meeting these minimum performance thresholds on clinical tests of physical function may indicate inadequate physical ability to walk ≥6,000 steps/day for people with knee OA. Rehabilitation may be indicated to address underlying impairments limiting physical function.18.
《Respirology (Carlton, Vic.)》2018,23(4):399-405
Background and objective
Intratumoral administration of chemotherapeutic agents is a treatment modality that has proven efficacious in reducing the recurrence of tumours and increases specificity of treatment while minimizing systemic side effects. Direct intratumoral injection of malignant airway obstruction has potential therapeutic benefits but tissue drug concentrations and side‐effect profiles are poorly understood.Methods
Bronchial wall injection of generic paclitaxel (PTX) (102 injections of 0.05, 0.5, 1.5 or 2.5 mg/mL in 10 healthy pigs), saline (14 injections in 2 healthy pigs) or Abraxane (ABX) (24 injections of 0.5 mg/mL in 4 healthy pigs) was performed with a microneedle infusion catheter. Local histopathology, plasma and tissue PTX concentrations were evaluated at 7, 20 or 28 days post‐injection.Results
Injection of generic PTX directly into the bronchial wall at doses up to 1.5 mg/mL only caused minimal tissue injury. Dose‐limiting tissue reaction was observed at 2.5 mg/mL. Plasma PTX was detectable for up to 5 days but not at 28 days, with area under the curve (AUC)(0‐5d) 20‐ to 50‐fold lower than the AUC(0‐∞) of 6300 ng h/mL for the approved intravenous dose. At 7 and 28 days post‐injection, bronchial PTX tissue concentrations were above a 10‐nmol/L cancer therapeutic level. PTX was not found in peripheral tissues. Similar results were observed between ABX and generic PTX.Conclusion
Results of these studies confirm the administration of PTX directly into the bronchial wall is safe and feasible. PTX was detectable in plasma for <7 days but tissue concentrations remained therapeutic throughout the follow‐up period.19.
Mark A. Espeland PhD Jose A. Luchsinger MD MPH Rebecca H. Neiberg MS Owen Carmichael PhD Paul J. Laurienti PhD Xavier Pi‐Sunyer MD Rena R. Wing PhD Delilah Cook CCRP Edward Horton MD Ramon Casanova PhD Kirk Erickson PhD R. Nick Bryan MD the Action for Health in Diabetes Brain Magnetic Resonance Imaging Research Group 《Journal of the American Geriatrics Society》2018,66(1):120-126
Objectives
To determine whether long‐term behavioral intervention targeting weight loss through increased physical activity and reduced caloric intake would alter cerebral blood flow (CBF ) in individuals with type 2 diabetes mellitus.Design
Postrandomization assessment of CBF.Setting
Action for Health in Diabetes multicenter randomized controlled clinical trial.Participants
Individuals with type 2 diabetes mellitus who were overweight or obese and aged 45 to 76 (N = 310).Interventions
A multidomain intensive lifestyle intervention (ILI ) to induce weight loss and increase physical activity for 8 to 11 years or diabetes support and education (DSE ), a control condition.Measurements
Participants underwent cognitive assessment and standardized brain magnetic resonance imaging (MRI ) (3.0 Tesla) to assess CBF an average of 10.4 years after randomization.Results
Weight changes from baseline to time of MRI averaged ?6.2% for ILI and ?2.8% for DSE (P < .001), and increases in self‐reported moderate or intense physical activity averaged 444.3 kcal/wk for ILI and 114.8 kcal/wk for DSE (P = .03). Overall mean CBF was 6% greater for ILI than DSE (P = .04), with the largest mean differences between ILI and DSE in the limbic region (3.39 mL /100 g per minute, 95% confidence interval (CI ) = 0.07–6.70 mL /100 g per minute) and occipital lobes (3.52 mL /100 g per minute, 95% CI = 0.20–6.84 mL /100 g per minute). In ILI , greater CBF was associated with greater decreases in weight and greater increases in physical activity. The relationship between CBF and scores on a composite measure of cognitive function varied between intervention groups (P = .02).Conclusions
Long‐term weight loss intervention in overweight and obese adults with type 2 diabetes mellitus is associated with greater CBF .20.
Correlation between sinus and lung cultures in lung transplant patients with cystic fibrosis 下载免费PDF全文
Kevin J. Choi MD MS Tracy Z. Cheng AB Adam L. Honeybrook MBBS Alice L. Gray MD Laurie D. Snyder MD MHS Scott M. Palmer MD MHS Ralph Abi Hachem MD MS David W. Jang MD 《International forum of allergy & rhinology》2018,8(3):389-393