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Thorax 10/17/2019 12:00
The acute respiratory distress syndrome (ARDS) is characterised by diffuse impairment in gas exchange that can result from heterogenous aetiologies. ARDS causes 10% of intensive care unit admissions worldwide with inpatient mortality rates ranging from 35% for mild cases to 46% for severe cases.1 Despite being a common and frequently fatal process, there are no widely accepted pharmacological therapies available to treat ARDS, the management of which primarily rests on appropriate mechanical ventilation and supportive care.2 Unfortunately, numerous promising pharmacological therapies that demonstrated benefit in preclinical models or early clinical investigation have failed to demonstrate reliable improvement in clinical outcomes.3–7 In the.
Thorax 10/15/2019 04:10
Nearly 3 billion people worldwide cook and heat their homes using biomass fuels, primarily in low and middle-income countries.1 Smoke from biomass fuel combustion contains a combination of gases, particulate matter and volatile organic compounds that is particularly harmful to the developing lungs of children.2 Over time, chronic exposure to household air pollution results in mucus hypersecretion, emphysema and bronchiolar fibrosis,3 and exposure to household air pollution is a well-described risk factor for both acute and chronic respiratory disease.4–6. The settings in which biomass smoke exposure is most common are also settings in which there is a high prevalence of reduced lung function.7 8 A recent study of 2000 primarily non-smokers i.
Thorax 10/15/2019 04:10
Images in thorax. Ventilation heterogeneity in asthma could be due to many reasons. Luminal obstruction due to inflammatory cells or mucus, smooth muscle constriction and airway wall thickness could all contribute individually or collectively to ventilation heterogeneity. Interleukin-4 and interleukin-13, acting through the common interleukin-4 receptor, have the potential to modulate all of these features of asthma.1 Inhaled hyperpolarised gas MRI provides a way to regionally visualise and quantify the functional consequence of these features.2 Dupilumab is a fully human monoclonal antibody directed against the alpha-subunit of the interleukin-4 receptor.3 Here, we report a severe asthmatic who showed significant improvement and normalisati.
Thorax 10/15/2019 04:10
Background. Non-communicable lung disease and exposure to air pollution are major problems in sub-Saharan Africa. A high burden of chronic respiratory symptoms, spirometric abnormalities and air pollution exposures has been found in Malawian adults; whether the same would be true in children is unknown. Methods. This cross-sectional study of children aged 6–8 years, in rural Malawi, included households from communities participating in the Cooking and Pneumonia Study (CAPS), a trial of cleaner-burning biomass-fuelled cookstoves. We assessed; chronic respiratory symptoms, anthropometry, spirometric abnormalities (using Global Lung Initiative equations) and personal carbon monoxide (CO) exposure. Prevalence estimates were calculated, and multiv.
Thorax 10/15/2019 04:10
Fireworks Night is an annual British event that marks the occasion of the foiling of the Gunpowder Plot on the 5 th November 1605. These nocturnal festivities recount the arrest of Guy Fawkes, whilst he was guarding the explosives secretly placed beneath the House of Lords. Airwaves reports the gunpowder, treason and plot found in this month’s Thorax... Expecting the unexpected... Guys Fawkes would never have expected to be arrested for his part in the Gunpowder Plot. Indeed, predicting this unplanned event would have been far from the plotter’s thoughts. However, Nazir Lone and colleagues ( see page 1046 ). have done exactly that and focused on predicting unplanned events, in this case predicting the risk of unplanned hospital readmission
Thorax 10/15/2019 04:10
In their published article, Alif et al report the findings from a carefully conducted longitudinal study showing the effects of occupational exposures on lung function decline between the ages of 45 and 50 years.1 Data from 767 participants in the Tasmanian Longitudinal Health Study (TLHS) were examined: ‘ever’ exposure to aromatic solvents was associated with an excess decline in FEV 1 over that expected by ageing (15.5 mL/year (95% CI –24.8 to 6.3)) and in FVC (14.1 mL/year (95% CI –28.8 t0 –0.7)); as was ‘ever’ exposure to metals (FEV 1 (11.3 mL/year (95% CI –21.9 to –0.7)) and FVC (17.5 mL/year (95% CI –34.3 to –0.8))).
Thorax 10/15/2019 04:10
Muscle mitochondrial dysfunction is implicated in intensive care unit-acquired weakness, but there is no serum biomarker of muscle mitochondrial function for critical illness survivors. Higher serum growth differentiation factor-15 (GDF-15) is a biomarker of inherited mitochondrial myopathy disease and is associated with mortality in several age-related diseases. Among 142 older (age 65 years) survivors of acute respiratory failure, we found that higher serum GDF-15 measured during the week prior to hospital discharge was cross-sectionally associated with weaker diaphragm, limb and hand-grip strength, and longitudinally associated with lower rates of functional recovery over 6 months, independent of age, sex, pre-existing disability, comorb.
Thorax 10/15/2019 04:10
Clinical presentation. A 64-year-old woman presented to our hospital complaining of generalised fatigue and history of mechanical fall with rib fractures while in Africa. Chest X-ray (CXR) incidentally discovered multiple bilateral pulmonary nodules. She has a history of rheumatoid arthritis on methotrexate, Hashimoto’s thyroiditis, Sjögren’s syndrome (SS) and psoriatic arthritis on immunotherapy. She denied symptoms of cough, chest pain, dyspnoea, weight loss, night sweats, fever or haemoptysis. She denied smoking, alcohol consumption, illicit drug use and environmental exposures. She had a family history of lymphoma in sister but no personal/family history of arteriovenous malformations, hamartomas or vasculitis. CXR conducted 3 years pri.
Thorax 10/15/2019 04:10
Nintedanib in systemic sclerosis-associated interstitial lung disease (ILD). ILD is a common complication of systemic sclerosis, conveying a considerable impact on morbidity and mortality. Nintedanib is approved for clinical use in idiopathic pulmonary fibrosis (IPF), where it has been shown to significantly reduce forced vital capacity (FVC) decline. The Safety and Efficacy of Nintedanib in Systemic Sclerosis (SENSCIS) trial (NEJM 2019;380:2518) used a randomised, double-blind placebo-controlled trial design to assess the impact of nintedanib on the annual rate of decline of FVC in patients with systemic sclerosis-associated ILD . The trial randomised 580 patients with scleroderma and ILD on high-resolution CT, to either placebo or nintedan.
Thorax 10/15/2019 04:10
The world’s urban population is growing rapidly. In 1950, only 751 million individuals resided in urban areas whereas by 2018 this had increased to 4.2 billion, with 828 million estimated to be living in urban slums.1 2 Current projections show that urbanisation could add 2.5 billion people to urban settings by 2050, a figure which translates to approximately two-thirds of the global population.1 The pace of urbanisation presents important challenges to development for many cities in Africa, Asia and Latin America, where much of this expansion is unplanned or poorly planned, and exacerbates socioeconomic disparities and unsanitary conditions.3 Slum environments bear the largest burden of inadequate urban infrastructure, which in turn result.
Thorax 10/15/2019 04:10
Interstitial lung disease encompasses a heterogeneous group of disorders characterised by excessive deposition of collagen within the extracellular matrix and thickening of the pulmonary insterstitium. Many interstitial lung diseases are linked with known environmental exposures including tobacco smoke (idiopathic pulmonary fibrosis), inhaled dust, mould or other irritants (hypersensitivity pneumonitis) and occupational exposures (ie, silicosis, asbestosis).1 However, the role of potentially relevant environmental exposures is difficult to establish due to the long latency period of these disorders (eg, 40–50 years for asbestosis). In a recent advance in the detection of early stage interstitial lung disease, interstitial lung abnormalities.
Thorax 10/15/2019 04:10
Background. Urbanisation has been associated with temporal and geographical differences in asthma prevalence in low-income and middle-income countries (LMICs). However, little is known of the mechanisms by which urbanisation and asthma are associated, perhaps explained by the methodological approaches used to assess the urbanisation-asthma relationship. Objective. This review evaluated how epidemiological studies have assessed the relationship between asthma and urbanisation in LMICs, and explored urban/rural differences in asthma prevalence. Methods. Asthma studies comparing urban/rural areas, comparing cities and examining intraurban variation were assessed for eligibility. Included publications were evaluated for methodological quality and
Thorax 10/15/2019 04:10
The aim of this investigation was to elucidate the effect of CPAP withdrawal on neurometabolic and cardiometabolic markers in patients with obstructive sleep apnoea. We evaluated 70 patients (mean age 61±10 years, 82% men) treated with CPAP in two 2-week, parallel, randomised controlled trials. CPAP withdrawal resulted in elevated 3,4-dihydroxyphenylglycol, norepinephrine and cortisol after 2 weeks of CPAP withdrawal; however, no statistically significant changes of the renin–angiotensin–aldosterone system (RAAS) determinants were documented. In summary, CPAP withdrawal may be more prominently linked to short-term increases in sympathetic activation than hypothalamic–pituitary–adrenal axis or RAAS activation. ClinicalTrials.gov Identifier:
Thorax 10/15/2019 04:10
Prolonged intensive care unit (ICU) hospitalisations are costly, increasing in prevalence and strain ICU resources.1–4 One-year mortality is high and the recovery for survivors of prolonged ICU hospitalisations is typically long and marked by new morbidities.3 4 Thus, with advances in critical care technology, patients with prolonged ICU hospitalisations, their families and physicians are challenged to make complex, high-stakes decisions without clear guidance about long-term prognosis. Recent work has focused on who these patients are and why they remain in the ICU for prolonged periods of time.5–8 Commonly measured patient characteristics on admission such as age and comorbidities have not consistently been associated with the need for pr.
Thorax 10/14/2019 12:01
Serum IgA ≤70 mg/dL (low IgA) is associated with exacerbations of chronic obstructive pulmonary disease. The association of low IgA with longitudinal lung function is poorly defined. This study included 917 World Trade Center (WTC)-exposed firefighters with longitudinal spirometry measured between September 2001 and September 2018 and IgA measured between October 2001 and March 2002. Low IgA, compared with IgA >70 mg/dL, was associated with lower forced expiratory volume in 1 s (FEV 1 ) % predicted in the year following 11 September 2001 (94.1% vs 98.6%, p <0.001), increased risk of FEV 1 /FVC <0.70 (HR 3.8, 95% CI 1.6 to 8.8) and increased antibiotic treatment (22.5/100 vs 11.6/100 person-years, p=0.002). Following WTC exposure, early IgA
Thorax 10/14/2019 12:01
Background. Perturbed iron homeostasis is a risk factor for tuberculosis (TB) progression and an indicator of TB treatment failure and mortality. Few studies have evaluated iron homeostasis as a TB diagnostic biomarker. Methods. We recruited participants with TB, latent TB infection (LTBI), cured TB (RxTB), pneumonia (PN) and healthy controls (HCs). We measured serum levels of three iron biomarkers including serum iron, ferritin and transferrin, then established and validated our prediction model. Results. We observed and verified that the three iron biomarker levels correlated with patient status (TB, HC, LTBI, RxTB or PN) and with the degree of lung damage and bacillary load in patients with TB. We then built a TB prediction model, neural ne.
Thorax 10/08/2019 12:00
Digital healthcare is a rapidly growing healthcare sector. Its importance has been recognised at both national and international level, with the WHO recently publishing its first global strategy for digital health. The use of digital technology within cystic fibrosis (CF) has also increased. CF is a chronic, life-limiting condition, in which the treatment burden is high and treatment regimens are not static. Digital technologies present an opportunity to support the lives of people with CF. We included 59 articles and protocols in this state-of-the-art review, relating to 48 studies from 1999 until 2019. This provides a comprehensive overview of the expansion and evolution of the use of digital technology. Technology has been used with the
Thorax 09/26/2019 12:00
Huang B, Szczesniak R. Can’t see the wood for the trees: confounders, colliders and causal inference- a statistician’s approach. Thorax 2019;74:323–325. doi: 10.1136/thoraxjnl-2018-212780. Significant changes have been made to the text of this article, including Table 1, since it was first published online and in print. The correct version is available online here:

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