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Mashup Score: 66Definition of diaphragmatic sleep disordered breathing and clinical meaning in Duchenne muscular dystrophy - 4 day(s) ago
Background Diaphragmatic sleep disordered breathing (dSDB) has been recently identified as sleep dysfunction secondary to diaphragmatic weakness in Duchenne muscular dystrophy (DMD). However, scoring criteria for the identification of dSDB are missing. This study aimed to define and validate dSDB scoring criteria and to evaluate whether dSDB severity correlates with respiratory progression in DMD. Methods Scoring criteria for diaphragmatic apnoea (dA) and hypopnoeas (dH) have been defined by the authors considering the pattern observed on cardiorespiratory polygraphy (CR) and the dSDB pathophysiology. 10 sleep professionals (physiologists, consultants) blinded to each other were involved in a two-round Delphi survey to rate each item of the proposed dSDB criteria (Likert scale 1–5) and to recognise dSDB among other SDB. The scorers’ accuracy was tested against the authors’ panel. Finally, CR previously conducted in DMD in clinical setting were rescored and diaphragmatic Apnoea–Hypopnoe
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Mashup Score: 46Actinomycosis mimicking metastatic lung malignancy - 5 day(s) ago
A 66-year-old Nepalese man with a medical history of hypertension presented with a 4-month history of an intermittently productive cough, worsening breathlessness, unintentional weight loss and a progressively enlarging lump on the right anterior chest wall that had become red and warm in the days prior to admission. On examination, he was cachectic, febrile and tachycardic, but the chest was clear on auscultation and there was no oxygen requirement. A 16 cm tender, erythematous and warm lump was evident on the right anterolateral chest wall. Initial bloods demonstrated normocytic anaemia, neutrophilia, thrombocytosis, hypoalbuminaemia and serum C reactive protein of 208 (range 0–5 mg/L). Chest radiograph demonstrated right middle and lower zone opacities (figure 1A). CT of the chest revealed multiple ‘nodules and masses in the right hemithorax’ and was reported as a ‘widespread primary lung malignancy’ with a provisional …
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Mashup Score: 8Impact of age at ivacaftor initiation on pulmonary outcomes among people with cystic fibrosis - 6 day(s) ago
Background Ivacaftor (IVA) improves lung function and other extrapulmonary outcomes in people with cystic fibrosis (CF). However, the effect of initiating IVA at earlier versus later ages has not been studied. Methods We conducted an observational cohort study of people in the US CF Foundation Patient Registry aged ≥6 years with ≥1 CF transmembrane conductance regulator–gating mutation to compare the effects of initiating IVA at earlier ages on per cent predicted forced expiratory volume in 1 s (ppFEV1) and pulmonary exacerbation (PEx) outcomes. People with CF were grouped by age at IVA initiation (ages 6–10, 11–15, 16–20 and 21–25 years) to perform three analyses of younger versus older IVA initiation (6–10 vs 11–15, 11–15 vs 16–20 and 16–20 vs 21–25 years). For each analysis, baseline characteristics assessed over 1-year periods at the same age prior to IVA initiation were balanced by standardised mortality/morbidity ratio (SMR) weighting. For each analysis, outcomes were compared ov
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Mashup Score: 3Epigenome-wide association study of lung cancer among never smokers in two prospective cohorts in Shanghai, China - 9 day(s) ago
Background The aetiology of lung cancer among individuals who never smoked remains elusive, despite 15% of lung cancer cases in men and 53% in women worldwide being unrelated to smoking. Epigenetic alterations, particularly DNA methylation (DNAm) changes, have emerged as potential drivers. Yet, few prospective epigenome-wide association studies (EWAS), primarily focusing on peripheral blood DNAm with limited representation of never smokers, have been conducted. Methods We conducted a nested case-control study of 80 never-smoking incident lung cancer cases and 83 never-smoking controls within the Shanghai Women’s Health Study and Shanghai Men’s Health Study. DNAm was measured in prediagnostic oral rinse samples using Illumina MethylationEPIC array. Initially, we conducted an EWAS to identify differentially methylated positions (DMPs) associated with lung cancer in the discovery sample of 101 subjects. The top 50 DMPs were further evaluated in a replication sample of 62 subjects, and res
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Mashup Score: 8Epidemiology of idiopathic pulmonary fibrosis: opportunities and hurdles for population-level studies of rare disease - 10 day(s) ago
Idiopathic pulmonary fibrosis (IPF) is a rare condition for which reliable disease trends over time can be difficult to obtain. Understanding the epidemiology of IPF is crucial given its impact on quality of life and productivity of affected individuals and their families,1 as well as substantial costs to the healthcare system.2 The occurrence of IPF over time has likely changed with growing awareness of the disease, the advent of antifibrotic therapies that slow disease progression and multiple promising clinical trials that may alter the disease’s natural history. Knowledge of the incidence and prevalence of IPF informs healthcare needs, which range from access to specialists and pharmacotherapy to availability of hospice and resources for end-of-life care. Although smaller studies based on primary sources (eg, medical chart review) exist,3 4 many epidemiological studies on IPF have used patient registries.5 Clinical registries allow for increased accuracy in case identification and
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Mashup Score: 1
Estimates of lung cancer among persons who never smoked are 10%–20% in the USA, translating into 20–40 000 cases annually. Globally, and especially in East Asia, the incidence of lung cancer among non-tobacco users is considerably higher than in the USA, especially in women.1 The causes of lung cancer in lifelong never-smokers are not well understood. Possibilities include exposure to other carcinogens such as air pollution, radon, occupational exposures, secondhand tobacco smoke, genetic mutations, infections and hormonal imbalances. A mechanistic explanation may include epigenetic modifications from accumulated DNA damage as part of the ageing process. Some studies have shown that epigenetic age, or DNA methylation markers may be a better indicator of biological age than simple chronological age.2 3 Genes that are silenced, like the tumour suppressor gene p53, can lead to increased cancer risk. DNA methylation, the addition of methyl groups to DNA mainly along sequences, results in s
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Mashup Score: 12
Background Poorly controlled asthma is associated with increased morbidity and healthcare resource utilisation (HCRU). Therefore, to quantify the environmental impact of asthma care, this retrospective, cohort, healthCARe-Based envirONmental cost of treatment (CARBON) study estimated greenhouse gas (GHG) emissions in the UK associated with the management of well-controlled versus poorly controlled asthma. Methods Patients with current asthma (aged ≥12 years) registered with the Clinical Practice Research Datalink (2008‒2019) were included. GHG emissions, measured as carbon dioxide equivalent (CO2e), were estimated for asthma-related medication use, HCRU and exacerbations during follow-up of patients with asthma classified at baseline as well-controlled (<3 short-acting β2-agonist (SABA) canisters/year and no exacerbations) or poorly controlled (≥3 SABA canisters/year or ≥1 exacerbation). Excess GHG emissions due to suboptimal asthma control included ≥3 SABA canister prescriptions/year,
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Mashup Score: 21Randomised controlled trial for the titration of oral corticosteroids using markers of inflammation in severe asthma - 12 day(s) ago
Introduction Biomarkers are used to select biologic therapies for patients with severe asthma, but not to regularly adjust therapy, especially oral corticosteroids (OCS). Objective Our goal was to test the efficacy of an algorithm to guide the titration of OCS using blood eosinophil count and fraction of exhaled nitric oxide (FeNO) levels. Design, participants, interventions and setting This proof-of-concept prospective randomised controlled trial assigned adult participants with severe uncontrolled asthma (n=32) to biomarker-based management (BBM) where OCS dose was adjusted based on a composite biomarker score comprised of blood eosinophil count and FeNO, or a standard best practice (SBP) arm. The study was conducted at the Hunter Medical Research Institute, Newcastle, Australia. Participants were recruited from the local Severe Asthma Clinic and were blinded to their study allocation. Main outcome The coprimary outcomes were number of severe exacerbations and time to first severe ex
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Mashup Score: 29Effect of obesity on airway and systemic inflammation in adults with asthma: a systematic review and meta-analysis - 12 day(s) ago
Background Obesity is associated with more severe asthma, however, the mechanisms responsible are poorly understood. Obesity is also associated with low-grade systemic inflammation; it is possible that this inflammation extends to the airways of adults with asthma, contributing to worse asthma outcomes. Accordingly, the aim of this review was to examine whether obesity is associated with increased airway and systemic inflammation and adipokines, in adults with asthma. Methods Medline, Embase, CINAHL, Scopus and Current Contents were searched till 11 August 2021. Studies reporting measures of airway inflammation, systemic inflammation and/or adipokines in obese versus non-obese adults with asthma were assessed. We conducted random effects meta-analyses. We assessed heterogeneity using the I2 statistic and publication bias using funnel plots. Results We included 40 studies in the meta-analysis. Sputum neutrophils were 5% higher in obese versus non-obese asthmatics (mean difference (MD)=5
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Mashup Score: 15Influence of age on clinical characteristics, pharmacological management and exacerbations in children with asthma - 12 day(s) ago
Background Asthma trials and guidelines often do not distinguish between adolescents and younger children. Using a large English data set, we evaluated the impact of age on asthma characteristics, management and exacerbations. Methods Primary care medical records, 2004–2021, were linked to hospital records. Children were categorised by age at diagnosis and followed until the next age bracket. Ages (based on management guidelines) were 5–8 years, 9–11 years and adolescents (12–16 years). Characteristics evaluated included body mass index, allergies and events before and after diagnosis (symptoms, medication). Exacerbation incidence was calculated. Multivariable Cox proportional hazards determined associations with exacerbations. Results 119 611 children were eligible: 61 940 (51.8%) 5–8 years, 32 316 (27.7%) 9–11 years and 25 355 (21.2%) adolescents. Several characteristics differed by age; children aged 5–8 years had the highest proportion with eczema, food/drug allergy and cough, but
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Definition of diaphragmatic sleep disordered breathing and clinical meaning in Duchenne muscular dystrophy https://t.co/Ece8ZRERiY https://t.co/lOHZVQaF1s