Podcasts about lancet respiratory medicine

Bianca Brandon, Senior Editor at The Lancet Respiratory Medicine, is joined by Professor Hjalmar Bouma to discuss a new review on sepsis in immunocompromised patients, exploring the diagnostic challenges, complexities of immune status, and future directions for targeted therapies. The episode also analyses the increased vulnerability of specific patient groups, the importance of biomarker-driven personalised medicine, and the need for improved representation of immunosuppressed patients in clinical trials. Read the full article:https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(25)00124-9/fulltext?dgcid=buzzsprout_icw_podcast_May_25_lanresContinue this conversation on social!Follow us today at...https://thelancet.bsky.social/https://instagram.com/thelancetgrouphttps://facebook.com/thelancetmedicaljournalhttps://linkedIn.com/company/the-lancethttps://youtube.com/thelancettv

O câncer de pulmão cresceu no público feminino e não fumantes, de acordo com um novo estudo da agência especializada em câncer da Organização Mundial da Saúde (OMS). Segundo a pesquisa publicada na revista científica The Lancet Respiratory Medicine, o adenocarcionoma, tipo mais comum de câncer de pulmão entre os não fumantes, é responsável por 60% dos casos da doença em mulheres, em comparação a 45% nos homens. Para falar sobre o assunto, Jota Batista conversa no Canal Saúde com o cirurgião torácico, César Vasconcelos.

În cadrul ediției de pe 18 februarie 2025 a emisiunii Știința360 de pe Radio România Cultural, Dr. Marius Geantă, Președintele Centrului pentru Inovație în Medicină, a comentat ultimele noutăți din domeniul sănătății. Cancerul pulmonar rămâne principala cauză de deces prin cancer la nivel global. Deși rata generală a cancerului pulmonar a scăzut în rândul bărbaților în multe țări, aceasta continuă să crească în rândul femeilor. Această tendință este influențată de schimbările în obiceiurile legate de fumat și de expunerea tot mai mare la poluarea aerului, ambii fiind factori de risc majori. Rezultatele studiului sunt esențiale pentru specialiștii în sănătate publică, care trebuie să implementeze măsuri eficiente de control al consumului de tutun și politici stricte de protecție a mediului pentru a reduce incidența cancerului pulmonar și a îmbunătăți sănătatea populației.Un nou studiu publicat în The Lancet Respiratory Medicine de către Agenția Internațională pentru Cercetarea Cancerului (IARC) analizează incidența globală a cancerului pulmonar în 2022, concentrându-se pe patru subtipuri majore: adenocarcinom, carcinom cu celule scuamoase (SCC), carcinom cu celule mici și carcinom cu celule mari. Cercetarea, bazată pe estimările GLOBOCAN și pe datele anterioare privind incidența cancerului, evidențiază o creștere semnificativă a cazurilor de adenocarcinom, în special în rândul generațiilor mai tinere și al femeilor. Această tendință este atribuită factorilor de risc în evoluție, inclusiv modificărilor în obiceiurile de fumat și expunerii crescute la poluarea aerului.Mai multe detalii despre subiectele discutate - ▶ Riscul cardiovascular este mai scăzut în diabetul zaharat de tip 1 comparativ cu diabetul de tip 2▶ Multe boli cronice care apar împreună au factori de risc genetici comuni care pot fi țintiți în strategiile de prevenție și tratament▶ Datele EKG ar putea fi folosite de AI pentru a identifica îmbătrânirea prematură și declinul cognitiv▶ Cazurile de adenocarcinom pulmonar, în creștere din cauza poluării aeruluiAscultă emisiunea pe Radio România Cultural.

Send us a textEspecial Hot Topics 2024: Atualizações em Terapias para Displasia Broncopulmonar Bem-vindos a mais um episódio do Podcast A Incubadora! No episódio de hoje, exploramos três artigos recentes que trazem insights valiosos para a prática clínica na neonatologia.  Esses assuntos foram discutidos no já tradicional evento americano de neonatologia, o Hot Topics, que aconteceu em dezembro de 2024, em Washington e doa qual a nossa apresentadora Marôla participou.Começamos com a apresentação do artigo "Diuretics use in the management of bronchopulmonary dysplasia in preterm infants: A systematic review", de Eoin Ó Briain e colaboradores, publicado na cta Paediatrica. Este estudo sistemático examina a eficácia e segurança do uso de diuréticos no manejo da displasia broncopulmonar em prematuros, oferecendo uma visão abrangente das evidências mais recentes. Leia o artigo completo aqui: https://onlinelibrary.wiley.com/doi/10.1111/apa.17093Em seguida, destacamos a revisão Cochrane intitulada "Methylxanthine for the prevention and treatment of apnea in preterm infants", organizada por Keri A Marques. A metanálise atualiza o papel das metilxantinas, como cafeína, na prevenção e tratamento da apneia, reforçando sua importância em melhorar os desfechos respiratórios de bebês prematuros. Confira o artigo aqui: https://pmc.ncbi.nlm.nih.gov/articles/pmid/37905735/Finalizamos com o estudo clínico randomizado "Azithromycin therapy for prevention of chronic lung disease of prematurity (AZTEC)", liderado por John Lowe e publicado no Lancet Respiratory Medicine. Este estudo multicêntrico e controlado por placebo investigou o uso de azitromicina como terapia preventiva contra a doença pulmonar crônica da prematuridade, apresentando resultados promissores. Acesse o artigo aqui: https://pubmed.ncbi.nlm.nih.gov/38679042/ Aproveitamos para anunciar que estamos fazendo uma parceria com um dos maiores eventos de Neonatologia do país! O IX Encontro Internacional de Neonatologia e VII Simpósio Interdisciplinar de Atenção ao Prematuro acontece nos dias 3, 4 e 5 de abril, na belíssima cidade de Gramado/RS. O evento contará com palestrantes internacionais que são referência na área, sendo uma oportunidade imperdível para multiprofissionais da saúde que atuam em neonatologia.  A Incubadora vai estar lá, cobrindo o evento e trazendo dois programas dedicados aos principais assuntos discutidos nesse que já está consolidado como um dos principais encontros na área.Inscreva-se agora mesmo: https://evento.fundmed.org.br/encontroneonatologia2025 e venha nos conhecer pessoalmente em Gramado!Fique conosco e aproveite o episódio!

Researchers at the London King's College have developed a new injection that Could Revolutionize Asthma and COPD Treatment. This is the first real breakthrough in 50 years of asthma research. A trial showed that a single dose of the new benralizumab drug significantly reduced flare-ups, improving symptoms and quality of life. The results of the study were recently published in The Lancet Respiratory Medicine.

In this episode of Hot Topics, Dr. Nicholas Morris interviews Claire Dahyot-Fizelier, M.D, Ph.D., a professor of anesthesia and intensive care at the University of Poitiers, to explore the groundbreaking PROPHY-VAP trial published in The Lancet Respiratory Medicine. This landmark study investigates the impact of single-dose ceftriaxone prophylaxis on ventilator-associated pneumonia (VAP) in acute brain injury patients. Dr. Dahyot-Fizelier discusses the rationale behind the study, key findings and the broader implications for ICU practices. Tune in to discover how this trial could reshape approaches to infection prevention and improve patient outcomes in neurocritical care. Show notes: https://doi.org/10.1016/S2213-2600(23)00471-X Dahyot-Fizelier C, Lasocki S, Kerforne T, Perrigault PF, Geeraerts T, Asehnoune K, Cinotti R, Launey Y, Cottenceau V, Laffon M, Gaillard T, Boisson M, Aleyrat C, Frasca D, Mimoz O, on behalf of the PROPHY-VAP Study Group and the ATLANREA Study Group. Ceftriaxone to prevent early ventilator-associated pneumonia in patients with acute brain injury: a multicentre, randomised, double-blind, placebo-controlled, assessor-masked superiority trial. The Lancet Respiratory Medicine. 2024 May 1;12(5):375-85.

Professor Heather Zar joins The Lancet Respiratory Medicine to discuss early-life RSV disease and long-term respiratory health. This topic will be covered in one of four Series papers in a cross-journal Series with The Lancet.You can read the Series of papers at:https://www.thelancet.com/series/respiratory-syncytial-virus?dgcid=buzzsprout_icw_podcast_genericContinue this conversation on social!Follow us today at...https://twitter.com/thelancethttps://instagram.com/thelancetgrouphttps://facebook.com/thelancetmedicaljournalhttps://linkedIn.com/company/the-lancethttps://youtube.com/thelancettv

In the penultimate episode in our ARDS Rapid Fire Journal Club Summer Series we are talking about the DEXA-ARDS trial (published in Lancet Respiratory Medicine in 2020). This trial evaluated the impact of dexamethasone in the treatment of ARDS.   … Continue reading →

Today we discuss the MTBVAC with Dr Montañés. MTBVAC is an attenuated vaccine from a human mycobacterial isolate which has just progressed to a phase 3 trial and shown very promising results in the phase 2 study. Dr Montañés has been involved in this project for over a decade and has an incredible insight into the development and promise of this vaccine for global TB epidemiology.ReferencesMartín, Carlos, et al. "MTBVAC, a live TB vaccine poised to initiate efficacy trials 100 years after BCG." Vaccine 39.50 (2021): 7277-7285.Achkar, Jacqueline M. "Prospects and challenges of a new live tuberculosis vaccine." The Lancet Respiratory Medicine 7.9 (2019): 723-725.Arbues, Ainhoa, et al. "Construction, characterization and preclinical evaluation of MTBVAC, the first live-attenuated M. tuberculosis-based vaccine to enter clinical trials." Vaccine 31.42 (2013): 4867-4873.Tameris, Michele, et al. "Live-attenuated Mycobacterium tuberculosis vaccine MTBVAC versus BCG in adults and neonates: a randomised controlled, double-blind dose-escalation trial." The lancet Respiratory medicine 7.9 (2019): 757-770.Spertini, François, et al. "Safety of human immunisation with a live-attenuated Mycobacterium tuberculosis vaccine: a randomised, double-blind, controlled phase I trial." The lancet Respiratory medicine 3.12 (2015): 953-962.Gonzalo-Asensio, Jesus, et al. "MTBVAC: attenuating the human pathogen of tuberculosis (TB) toward a promising vaccine against the TB epidemic." Frontiers in immunology 8 (2017): 296893.

Prof Greg Fox speaks with Prof Philip Hill about TB household contact tracing and building research capacity in TB. Prof Hill is an ID specialist and public health physician who did his PhD in TB Epidemiology. He is the current McAuley Chair in International Health as well as being Founding Direction & Co-Director of the Centre for International Health at the University of Otago.References1) Martinez, Leonardo, et al. "The risk of tuberculosis in children after close exposure: a systematic review and individual-participant meta-analysis." The Lancet 395.10228 (2020): 973-984.2) Hill, Philip C., et al. "Incidence of tuberculosis and the predictive value of ELISPOT and Mantoux tests in Gambian case contacts." PLoS One 3.1 (2008): e1379.3) Martinez, Leonardo, et al. "Transmission of Mycobacterium tuberculosis in households and the community: a systematic review and meta-analysis." American journal of epidemiology 185.12 (2017): 1327-1339.4) Martinez, Leonardo, et al. "Paediatric tuberculosis transmission outside the household: challenging historical paradigms to inform future public health strategies." The Lancet Respiratory Medicine 7.6 (2019): 544-552.5) Hill, Philip C., and Martin OC Ota. "Tuberculosis case-contact research in endemic tropical settings: design, conduct, and relevance to other infectious diseases." The Lancet infectious diseases 10.10 (2010): 723-732.6) Alisjahbana, Bachti, et al. "Are neighbourhoods of tuberculosis cases a high-risk population for active intervention? A protocol for tuberculosis active case finding." Plos one 16.8 (2021): e0256043.

Today we speak with Dr Guglielmetti about the END-TB trial which looks at new all oral regimens for MDR-TB.REFERENCES1) https://endtb.org/2) Nyang'wa, Bern-Thomas, et al. "A 24-week, all-oral regimen for rifampin-resistant tuberculosis." New England Journal of Medicine 387.25 (2022): 2331-2343.3) Conradie, Francesca, et al. "Treatment of highly drug-resistant pulmonary tuberculosis." New England Journal of Medicine 382.10 (2020): 893-902.4) Diacon, Andreas H., et al. "Multidrug-resistant tuberculosis and culture conversion with bedaquiline." New England Journal of Medicine 371.8 (2014): 723-732.5) Gler, Maria Tarcela, et al. "Delamanid for multidrug-resistant pulmonary tuberculosis." New England Journal of Medicine 366.23 (2012): 2151-2160.6) Ahmad, Nafees, et al. "Treatment correlates of successful outcomes in pulmonary multidrug-resistant tuberculosis: an individual patient data meta-analysis." The Lancet 392.10150 (2018): 821-834.7) Lan, Zhiyi, et al. "Drug-associated adverse events in the treatment of multidrug-resistant tuberculosis: an individual patient data meta-analysis." The Lancet Respiratory Medicine 8.4 (2020): 383-394.APA | 

Episode 30! This episode is a little different. We recap the SCCM conference first. THEN we go into PROPHY-VAP or "Ceftriaxone to prevent early ventilator-associated pneumonia in patients with acute brain injury" published January 2024 by Professor Dahyot-Fizelier in Lancet Respiratory Medicine. Then we dive into our long neglected mailbag to review listener questions about MINT, intubation timing, ACORN, and all the steroids in ARDS talkPROPHY-VAP: https://pubmed.ncbi.nlm.nih.gov/38262428/SCCM Steroid guidelines: https://pubmed.ncbi.nlm.nih.gov/38240492/Counter-Point should we use steroids in ARDS: https://pubmed.ncbi.nlm.nih.gov/33422201/sRAGE in NIV and HFNC: https://pubmed.ncbi.nlm.nih.gov/38250011/Anaerobes in Aspiration: https://pubmed.ncbi.nlm.nih.gov/37250794/Anaerobes in Gut: https://pubmed.ncbi.nlm.nih.gov/36229047/Be sure to follow us on the social @icucast for the associated figures, comments, and other content not available in the audio format! Email us at icuedandtoddcast@gmail.com with any questions or suggestions! Thank you Mike Gannon for the intro and exit music!

Dr. Jennifer Taylor-Cousar is an amazing woman I can't wait to meet in person one day.  She is a Board Certified Pediatric and adult pulmonologist at National Jewish Health in Colorado. She's a rock star in the world of CF, and she's doing incredible work raising awareness about systemic and individual bias and racism in medicine. She also talks about the importance of representation in the field of medicine. I hope after you hear this podcast you are more inspired to speak up and do more to change the world.About Dr. Taylor-Cousar:Dr. Taylor-Cousar is a tenured professor of adult and pediatric pulmonary medicine at NationalJewish Health (NJHhttps://www.nationaljewish.org/home), where she serves as the Medical Director of Clinical Research Services,President of the Medical Staff, and is co-director of the Adult Cystic Fibrosis (CF) Program andDirector of the CF Therapeutics Development Network (TDN) center. She received herundergraduate degree in human biology from Stanford University, and completed her doctoratein medicine, combined residency in internal medicine and pediatrics, and her combinedfellowship in adult and pediatric pulmonary medicine at Duke University. She obtained herMaster of Clinical Science from the University of Colorado.Dr. Taylor-Cousar's expertise is clinical trial design and conduct; she has been national/globalprimary investigator on multiple CF TDN trials. Her investigator-initiated research focuses onthe development and evaluation of novel therapies for the treatment of CF, and on sexual andreproductive health in people with CF. Additionally, she serves on a number of nationalscientific advisory committees for the Cystic Fibrosis Foundation, American Thoracic Societyand the National Institutes of Health. She is an Associate Editor for the Journal of Cystic Fibrosisand a member of the International Advisory Board for the Lancet Respiratory Medicine.Dr. Taylor-Cousar is an elected member of the American Society for Clinical Investigation(ASCI). Her recent awards include the American Thoracic Society's Distinguished AchievementAward (2023,) the American Thoracic Society William J. Martin II Public Advisory RoundTable Distinguished Achievement Award (2022), the Emily's Entourage CF Trailblazer Award(2022) and the Cystic Fibrosis Research Incorporated CF Champion Award (2021).Michele and Terry Wright screening tool: https://noaacf.org/the-wright-cystic-fibrosis-screening-tool/Please consider making a donation: https://thebonnellfoundation.org/donate/The Bonnell Foundation website: https://thebonnellfoundation.orgBonnell Foundation email: thebonnellfoundation@gmail.comThanks to our sponsors:Vertex:  https://www.vrtx.comGenentech: https://www.gene.comViatris: https://www.viatris.com/en

Today I had the pleasure of speaking with Dr Emily MacLean about the exciting modern tests both commercially available and in research development for diagnosing tuberculosis. Emily talked to us about how GeneXpert has evolved and how we can get the most out of this amazing test but also about the extraordinary diagnostic tests being investigated at the moment from blood tests of host response to bacilli to AI learning cough acoustic markers of tuberculosis!REFERENCES:MacLean, Emily, et al. "Diagnostic accuracy of stool Xpert MTB/RIF for detection of pulmonary tuberculosis in children: a systematic review and meta-analysis." Journal of clinical microbiology 57.6 (2019): e02057-18.Singhroy, Diane N., et al. "Adoption and uptake of the lateral flow urine LAM test in countries with high tuberculosis and HIV/AIDS burden: current landscape and barriers." Gates open research 4 (2020).MacLean, Emily Lai-Ho, et al. "Integrating tuberculosis and COVID-19 molecular testing in Lima, Peru: a cross-sectional, diagnostic accuracy study." The Lancet Microbe (2023).Zifodya, Jerry S., et al. "Xpert Ultra versus Xpert MTB/RIF for pulmonary tuberculosis and rifampicin resistance in adults with presumptive pulmonary tuberculosis." Cochrane Database of Systematic Reviews 2 (2021).APA | Mishra, Hridesh, et al. "Xpert MTB/RIF Ultra and Xpert MTB/RIF for diagnosis of tuberculosis in an HIV-endemic setting with a high burden of previous tuberculosis: a two-cohort diagnostic accuracy study." The Lancet Respiratory Medicine 8.4 (2020): 368-382.APA | Kohli, Mikashmi, et al. "Xpert MTB/RIF Ultra and Xpert MTB/RIF assays for extrapulmonary tuberculosis and rifampicin resistance in adults." Cochrane Database of Systematic Reviews 1 (2021).APA | Branigan D. Tuberculosis Diagnostics. Nov 2022. Available at:https://www.treatmentactiongroup.org/wp-content/uploads/2022/11/pipeline_TB_diagnostics_2022.pdfMacLean, Emily, et al. "Advances in molecular diagnosis of tuberculosis." Journal of clinical microbiology 58.10 (2020): e01582-19.Sweeney, Timothy E., et al. "Genome-wide expression for diagnosis of pulmonary tuberculosis: a multicohort analysis." The Lancet Respiratory Medicine 4.3 (2016): 213-224.Sutherland, Jayne S., et al. "Diagnostic accuracy of the Cepheid 3-gene host response fingerstick blood test in a prospective, multi-site study: interim results." Clinical Infectious Diseases 74.12 (2022): 2136-2141.Moreira, Flora Martinez Figueira, et al. "Blood-based host biomarker diagnostics in active case finding for pulmonary tuberculosis: A diagnostic case-control study." EClinicalMedicine 33 (2021): 100776.Peter, Jonny G., et al. "Effect on mortality of point-of-care, urine-based lipoarabinomannan testing to guide tuberculosis treatment initiation in HIV-positive hospital inpatients: a pragmatic, parallel-group, multicountry, open-label, randomised controlled trial." The Lancet 387.10024 (2016): 1187-1197.

Episode 8! In this episode we discuss NUTRIREA 3 or  "Low versus standard calorie and protein feeding in ventilated adults with shock: a randomised, controlled, multicentre, open-label, parallel-group trial" by Reigner et al published Lancet Respiratory Medicine 2023. The "old" article is NUTRIREA 1 or "Effect of not monitoring residual gastric volume on risk of ventilator-associated pneumonia in adults receiving mechanical ventilation and early enteral feeding: a randomized controlled trial"NUTRIREA 3: https://pubmed.ncbi.nlm.nih.gov/36958363/NUTRIREA 3 editorial: https://pubmed.ncbi.nlm.nih.gov/37028438/NUTRIREA 1: https://pubmed.ncbi.nlm.nih.gov/23321763/Questioning Gastric Residual Volumes: https://pubmed.ncbi.nlm.nih.gov/15699835/If you enjoy the podcast please share on social media or by word of mouth! Thank you!Be sure to follow us on the social @icucast for the associated figures, comments, and other content not available in the audio format! Email us at icuedandtoddcast@gmail.com with any questions or suggestions! Thank you Mike Gannon for the intro and exit music!

Episode 6! In this episode we discuss 1) "Treating Rhythmic and Periodic EEG Patterns in Comatose Survivors of Cardiac Arrest" by Ruijter et al published NEJM 2022 and 2) "Dexamethasone treatment for the acute respiratory distress synrome" by Villar et al published Lancet Respiratory Medicine 2020. This episode is a little bit longer than normal because we also extended our conversation of steroids in ARDS to the LaSRS (steroids in late ARDS) and Meduri 2007 methylprednisolone in early ARDS studies!TELSTAR: https://pubmed.ncbi.nlm.nih.gov/35196426/DEXA-ARDS: https://pubmed.ncbi.nlm.nih.gov/32043986/Steroids in ARDS CHEST Point: https://pubmed.ncbi.nlm.nih.gov/33422200/and Counterpoint: https://pubmed.ncbi.nlm.nih.gov/33422201/Be sure to follow us on the social @icucast for the associated figures, comments, and other content not available in the audio format! Email us at icuedandtoddcast@gmail.com with any questions or suggestions! Thank you Mike Gannon for the intro and exit music!

Emma Grainger, Editor-in-Chief of The Lancet Respiratory Medicine, discusses the January issue and plans to celebrate the 10-year anniversary of the journal. Read the Editorial from the 10th anniversary issue:Past learnings and new beginnings in the digital age

Dr. MeiLan Han, MD, MS.. MS, is a Professor of Medicine and Chief of the Division of Pulmonary and Critical Care at the University of Michigan.  Dr. Han is also  the author of Breathing Lessons: A Doctor's Guide to Lung Health.Dr. Han explains the importance of lung health for people of all ages. During this episode she spends time discussing COPD, Asthma, COVID 19, and other lung health issues. "Dr. Han's research has focused on defining phenotypes in COPD using imaging. She is a lead investigator for several NIH sponsored COPD studies. She also serves on the scientific advisory committees for both the COPD Foundation and American Lung Association, the board for the COPD Foundation and serves as a spokesperson for the American Lung Association. She is currently a Deputy Editor for the American Journal of Respiratory and Critical Care Medicine and serves on the editorial boards for Thorax, Lancet Respiratory Medicine and Journal of the COPD Foundation. She is also a member of the Global Obstructive Lung Disease scientific committee which is charged with developing internationally an internationally recognized consensus statement on COPD diagnosis and management. "(Retrieved from https://www.uofmhealth.org/profile/769/meilan-king-han-md-ms. Retrieved on June 11, 2022.)The show's goal is to express the importance of lung health and to inform, inspire, influence, and educate Metropolitan Detroiters on how to address lung health, wellness, and issues at various ages and stages. Hosted by Dr. Cleamon Moorer Sponsored by: American Advantage Home Care, Inc.

This week on Pharm5: Adenovirus 41 infections in kids

Après avoir parlé du Paxlovid, on s'intéresse aux thérapies alternatives contre la COVID. Quelles sont les données d'efficacité concernant le remdésivir, la fluvoxamine et le budésonide inhalé? Quelles clientèles peuvent bénéficier de ces traitements? On en discute avec Jean-François Tessier, pharmacien à l'hôpital Maisonneuve-Rosemont du CIUSSS de l'Est-de-l'Ile de Montréal et président du RPE d'infectiologie de l'A.P.E.S. RÉFÉRENCES : Anil Gupta A, Gonzalez-Rojas Y, Juarez E et al. Early Treatment for Covid-19 with SARS-CoV-2 Neutralizing Antibody Sotrovimab. N Engl J Med 2021; 385:1941-1950. DOI: 10.1056/NEJMoa2107934. Hammond J, Leister-Tebbe H, Gardner A et al. Oral Nirmatrelvir for High-Risk, Nonhospitalized Adults with Covid-19. N Engl J Med 2022 (February). DOI: 10.1056/NEJMoa2118542. Lee T C, Morris M, Grover A S et al. Outpatient therapies for COVID-19: How do we choose? medRxiv 2021.12.17.21268007. DOI: 10.1101/2021.12.17.21268007 Canadian Treatments for COVID-19 for the Association of Medical Microbiology and Infectious Disease Canada Clinical Research Network and the Canadian Critical Care Trials Group. Remdesivir for the treatment of patients in hospital with COVID-19 in Canada: a randomized controlled trial. CMAJ February 22, 2022 194 (7) E242-E251; DOI: 10.1503/cmaj.211698 Sanjay Ramakrishnan S, Nicolau Jr D V, Langford B et al. Inhaled budesonide in the treatment of early COVID-19 (STOIC): a phase 2, open-label, randomised controlled trial. The Lancet Respiratory Medicine, volume 9, issue 7, p763-772, july 01, 2021. DOI: 10.1016/S2213-2600(21)00160-0 Robert L. Gottlieb, R, Vaca C E, Paredes R et al. Early Remdesivir to Prevent Progression to Severe Covid-19 in Outpatients. N Engl J Med 2022; 386:305-315. DOI: 10.1056/NEJMoa2116846. COVID-19 advisory for Ontario. Science table. https://covid19-sciencetable.ca

Le Pr Stephan Ehrmann, qui est professeur de médecine intensive au CHU de Tours, nous parle de son article concernant le décubitus ventral vigile au cours du Covid-19 publié dans le The Lancet Respiratory Medicine. Aucun intérêt n'est déclaré. Sommaire Quel est le type d'étude et en quoi consiste une méta-trial ? Quelle a été l'intervention menée dans cette étude et comment ont été recrutés les patients ? Quels en sont les principaux résultats et quels sont les changements qu'apporte cette étude dans notre pratique ?

On average, a person takes around 20,000 breaths each day; yet most of us never notice the rhythmic rush of air flowing in and out, keeping our bodies oxygenated and alive. And as many asthma or respiratory distress sufferers will attest, you don't want to notice. But things are happening all around us that threaten our blissful ignorance of breathing — wildfire smoke, indoor and outdoor pollution, and Viruses like COVID-19, to name a few — and they will continue to impact us unless we take action. In her new book, Breathing Lessons: A Doctor's Guide to Lung Health, leading pulmonologist Dr. MeiLan K. Han broke down the wonders of breathing in an authoritative guide to how our lungs work and how to protect them. Dr. Han, a national spokesperson for the American Lung Association, shared some of the latest scientific thinking about the respiratory risks we currently face. As the threat of seasonal wildfire smoke grows, new diseases develop, and pollutants continue to be dispersed in the air, we still need to breathe. There's no better time to learn more about how lungs work; and, Dr. Han argued, focus on social policy that prioritizes lung health nationwide. MeiLan K. Han, MD, is a professor of medicine in the Division of Pulmonary and Critical Care at the University of Michigan. She also serves on the scientific advisory committees for both the COPD Foundation and American Lung Association and serves as a spokesperson for the American Lung Association. She is currently an Associate Editor for the American Journal of Respiratory and Critical Care Medicine and serves on the editorial boards for Thorax, Lancet Respiratory Medicine, and Journal of the COPD Foundation. Albert A. Rizzo, M.D., FACP, is Chief Medical Officer for the American Lung Association and is a member of Christiana Care Pulmonary Associates in Newark, Delaware. He has been featured in national news outlets including CNN, The New York Times, ABC News, The TODAY Show, and hundreds more. He serves as the host of the Lung Association's LungCast™ podcast. Buy the Book: Breathing Lessons: A Doctor's Guide to Lung Health (Hardcover) from Third Place Books Presented by Town Hall Seattle. To become a member or make a donation click here. 

Daniel Atlmann discusses the duration of immune protection from COVID vaccination and the crucial implications for the implementation of booster vaccination programmes.Read the full article:Waning immunity to SARS-CoV-2: implications for vaccine booster strategies - The Lancet Respiratory Medicine 

這集講高端疫苗二期臨床試驗正式刊登的消息。 1.二期臨床試驗的數據本身其實就是EUA時公布的數據，這裡就不重複了。 2.這篇文章在最後一段的討論中，用WHO的標準血清來校正，並以兩種免疫橋接的方式去推估出高端疫苗可能的保護力。國內有些報導標題直接寫"高端保護力80~90%"，這是不嚴謹的。這僅是免疫橋接推估的結果。 3.文中結論提到，這個二期研究的結果支持高端繼續去做第三期驗證保護力的研究，且計畫在台灣以外新冠盛行率較高的地方執行。 4.此外，是刊登在刺胳針呼吸醫學期刊（Lancet Respiratory Medicine），不是刺胳針本身（The Lancet）。前者影響指數（Impact Factor）約30，後者約79。這數字代表的是論文被學術界引用的程度，越高就是越有公信力的期刊。 但30分已經是非常好的期刊了，我們臨床醫學投的期刊能有個5~10分已經非常好了，刺胳針呼吸醫學在重症醫學及呼吸系統兩大領域的排名都是第一名。 高端新聞稿：高端新冠肺炎疫苗二期數據，於Lancet RM期刊審查發表 https://www.medigenvac.com/public/news/detail/93 Published online October 13, 2021 https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(21)00402-1/fulltext 中央社：高端疫苗二期保護力8至9成 登醫學期刊刺胳針發表 https://www.cna.com.tw/news/firstnews/202110140073.aspx　 Delta變種病毒懶人包！ Podcast版 https://linshibi.pros.is/3pankg 部落格版 https://linshibi.com/?p=39717 各國分年齡的新冠致死率 https://linshibi.com/?p=35732 混打疫苗可行嗎？AZ混打輝瑞/BNT AZ混打莫德納等等 https://linshibi.com/?p=39613 給長輩的AZ疫苗懶人包 https://linshibi.com/?p=39590 高端 聯亞 國產疫苗懶人包 第二期結束就緊急授權可行嗎？ https://linshibi.com/?p=39547 新冠快篩懶人包 普篩 抗體快篩 抗原快篩 https://linshibi.com/?p=36564 新冠肺炎疫情下的防疫須知 常見問題解答FAQ https://linshibi.com/?p=35408 新冠疫苗常見問題懶人包 https://linshibi.com/?p=38945 林氏璧醫師的電子名片 https://lit.link/linshibi Powered by Firstory Hosting

This podcast is sponsored by Anelto, a leading technology platform that enables innovative healthcare solutions to keep seniors connected to healthcare providers from anywhere. Visit www.anelto.com.Welcome to this episode of Physician's Weekly Podcast. My name is Dr. Rachel Giles, from Medicom Medical Publishers, in collaboration with Physician's Weekly. We have 3 great in-depth interviews for you this week covering a new trial with promising results to relieve common lower back pain, remote patient monitoring of senior citizens, and a trial showing that having COVID patients position themselves in the prone position, so-called “awake prone positioning”, has improved outcomes in patients with severe COVID-19.     Todd Alamin, MD, spinal surgeon at Stanford University: About 140,000 back pain patients are treated with lumbar fusion in the US every year, and we discuss their clinical trial data suggesting that perioperative outcomes are far better using a perispinous tension band after decompression, as opposed to lumbar fusion after decompression, with at least identical, if not better, long term resultsLater in this episode, Physician's Weekly speaks with Jie Li, PhD, RRT, RRT-ACCS, RRT-NPS from Rush University in Chicago and Professor Stephan Ehrmann, MD, PhD, from the Intensive Care Unit at the University Hospital in Tours, France about their recent study published in the Lancet Respiratory Medicine looking at awake prone positioning in patients with severe COVID-19. In this prospectively designed, multicenter, international, randomized, open-label meta-trial, with a large sample size (1121 patients), these 2 researchers found that awake prone positioning reduced the incidence of treatment failure within 28 days of enrolment (the primary composite outcome of intubation or death) in patients with acute severe hypoxemic respiratory failure due to COVID-19 supported with high-flow nasal cannula.Also in this episode, our correspondent Dylan Prentner speaks with Mark Denissen , the President and Chief Executive Officer of Anelto about remote patient monitoring  (RPM) of seniors by real-time symptom tracking. Anelto RemoteCare tracks patient engagement, identifies common requests, questions, and commands; and even tracks user responses and adherence to protocols with alerts and reminders.Technologies such as Remote Patient Monitoring are helping transform senior patient care, ensuring patient safety and well-being while ​continuing to live independently. Most ​RPM ​solutions​ ​are not developed specifically with the senior population in mind, especially those with chronic conditions.  ​For seniors, RPM needs to be a complete solution that is easy to use with 24/7 access to care management providers. ​ Visit www.anelto.com.Ehrmann S, Li J, et al; Awake Prone Positioning Meta-Trial Group. Awake prone positioning for COVID-19 acute hypoxaemic respiratory failure: a randomised, controlled, multinational, open-label meta-trial. Lancet Respir Med. 2021 Aug 20:S2213-2600(21)00356-8. Let us know what you thought of this week's episode on Twitter: @physicianswkly Want to share your medical expertise, research, or unique experience in medicine on the PW podcast? Email us at editorial@physweekly.com! Thanks for listening!

Pasar ocho horas al día en posición boca abajo o decúbito prono puede beneficiar a los enfermos graves de Covid no intubados pero hospitalizados con oxigenoterapia de alto flujo, la etapa anterior a ser intubado. Así lo confirma un ensayo clínico internacional publicado en The Lancet Respiratory Medicine que abarca 1126 pacientes de 6 países hospitalizados por Covid. Una sencilla técnica que puede mejorar la oxigenación de estos pacientes y evitar una intubación. Entre los 42 centros médicos que participaron en este ensayo, se encuentra el Hospital Civil de Guadalajara, México.  Decúbito prono, es como se dice en términos médicos a la postura boca abajo que se practica en pacientes intubados en las ucis, las unidades de cuidados intensivos. Una técnica que ayuda a mejorar la respiración del paciente y que se practica desde hace más de diez años en pacientes intubados. Miguel Angel Ibarra, médico intensivista del Hospital Civil de Guadalajara  y uno de los autores de este estudio explicó a RFI sobre lo que aporta al paciente en insuficiencia respiratoria esta posición boca abajo: “Digamos que es una posición más favorable, hablando de la mecánica del pulmón, es como si el pulmón se hiciera más grande, o tuviera más espacio, porque el corazón, los vasos, que tenemos en el centro del tórax, aplastan menos tejido pulmonar, hay menos presión en los pulmones”. Escuche aquí la entrevista con el doctor Miguel Angel Ibarra en su versión larga: Y si bien es una técnica practicada en pacientes intubados, hasta la fecha no había evidencia científica si esta postura también podía beneficiar a los enfermos despiertos no intubados, en particular a aquellos que tienen graves problemas de oxigenación y que tienen cánulas de alto flujo, la etapa anterior a ser intubado.    Para confirmar científicamente esta hipótesis y en un esfuerzo conjunto innovador, se logró hacer un ensayo clínico con 1126 pacientes, hospitalizados por Covid y  provenientes de 6 países y se comprobó que este simple método reduce la necesidad de intubación y por ende de mortalidad. El ensayo clínico fue posible gracias a la participación de 42 centros médicos de Canadá, Mexico, Estados Unidos, España, Irlanda y Francia. En el ensayo clínico, en el grupo que no se puso boca abajo, 46 %  necesitó después ser intubado. Del grupo que sí adoptaron la postura boca abajo, el 40 % fue intubado. Un 6 % de diferencia, es decir, de las 1126 personas del ensayo, más de 60 personas no fueron intubadas. Sabiendo el bajo porcentaje de sobrevivencia al ser un paciente intubado, se puede decir que 60 personas fueron salvadas. Entre los hospitales involucrados en este ensayo clínico está el Hospital Civil de Guadalajara, México, el cual atiende a la población que carece de seguro médico de todo el occidente del país. Una participación importante ya que de los 1126 pacientes que abarca este ensayo clínico, el Hospital Civil colaboró con 400 casos. Los resultados de este ensayo han sido publicados en The Lancet Respiratory Medicine y los autores proponen incorporar la postura boca abajo para "los pacientes de Covid con insuficiencia respiratoria aguda que necesiten oxigenoterapia de alto flujo". La recomendación estipulada es la de ocho horas al día en decúbito prono (postura boca abajo) o más si el paciente lo soporta, hasta que su oxigenación se mejore. Para ello, no dudar en aportar cojines para la comodidad del paciente o que éste pueda ver su celular, la tele, un libro, todo para que soporte el mayor tiempo posible estar en esta posición para facilitar la respiración. Entrevistado: Miguel Ángel Ibarra Estrada, médico internista e intensivista del Hospital Civil de Guadalajara, México. Otros temas relacionados que le pueden interesar: Fundación 101 One O One: apoyar la medicina intensiva Doble trasplante de pulmón para salvar la vida de una joven paciente infectada con la Covid 19

Comment author Michael Kreuter discusses a series of papers published in the Lancet and the Lancet Respiratory Medicine on interstitial lung disease.

La doctora Elisa Estenssoro, se refirió Características clínicas y resultados de los pacientes con COVID-19 con ventilación invasiva en Argentina (SATICOVID), un estudio que lideró y que fue publicado por la revista The Lancet Respiratory Medicine, en el que se advierte sobre los niveles de mortalidad de los pacientes ventilados mecánicamente. "Es una enfermedad muy grave. Cuando requiere de ventilación mecánica, el pronóstico se oscurece", advirtió. La profesional informó que en nuestro país falleció el 57%. En tanto Estenssoro se refirió al agotamiento de los profesionales de la salud, al tiempo que abogó por la formación y capacitación de personal de salud para posibles futuros escenarios como la pandemia. Estenssoro es médica intensivista, integrante de la Sociedad Argentina de Terapia intensiva y asesora del Ministerio de Salud de la Provincia de Buenos Aires; y fue jefa de la unidad de Terapia Intensiva del Hospital Policlínico San Martín durante 22 años.  

Vaccines are the mainstay of care in the COVID-19 pandemic. However, patients may still become infected and need treatment options. Two studies have evaluated the role of inhaled budesonide for the early treatment of outpatient COVID-19 infections. Can budesonide hasten the resolution of symptoms or prevent hospitalizations?Redeem your CPE or CME credit here!References and resources:Ramakrishnan S, Nicolau DV, Langford B, et al. Inhaled budesonide in the treatment of early COVID-19 (STOIC): a phase 2, open-label, randomised controlled trial. The Lancet Respiratory Medicine. April 2021. doi:10.1016/s2213-2600(21)00160-0Yu L-M, Bafadhel M, Dorward J, et al. Inhaled budesonide for COVID-19 in people at higher risk of adverse outcomes in the community: interim analyses from the PRINCIPLE trial. medRxiv. Published online January 1, 2021:2021.04.10.21254672. doi:10.1101/2021.04.10.21254672Continuing Education Information:Learning Objective: Identify the appropriate patient population for inhaled budesonide in the treatment of COVID-190.05 CEU | 0.5 HrsACPE UAN: 0107-0000-21-228-H01-P0.50 AMA PRA Category 1 CreditsTM.(the TM needs to be super scripted)Initial release date: 6/29/21Expiration date: 6/29/22Complete CPE & CME details can be found here.

FDA 批准布格替尼作为ALK阳性的非小细胞肺癌的一线用药Lancet Respir Med 急性呼吸衰竭患者机械通气强度与死亡率的关系NEJM 对危重机械通气患者采取非镇静或浅镇静的比较JAMA 质子泵抑制剂或H2受体抑制剂对机械通气患者住院死亡率的影响Nature Fc区优化的抗体可以诱导CD8对病毒性呼吸道感染的免疫布格替尼（brigatinib）布格替尼（Brigatinib）是一种间变性淋巴瘤激酶（ALK）抑制剂。2017年布格替尼被批准用于治疗ALK阳性的晚期非小细胞肺癌；2020年5月，布格替尼被FDA批准用于治疗ALK阳性的转移性非小细胞肺癌的一线治疗。《ALTA研究2年随访：布格替尼在克唑替尼难治性、ALK阳性的非小细胞肺癌的2期临床研究》Journal of Thoracic Oncology，2020年3月 (1)这项多中心、随机对照、2期临床研究，纳入克唑替尼难治性、ALK阳性的非小细胞肺癌患者共222人，随机分为口服布格替尼 90mg qd组（A组）、 布格替尼 180mg qd 7天后90mg qd 维持治疗组（B组），中位随访时间:19.6个月和24.3个月经治疗后客观缓解率分别为46%对56%，无进展生存期为9.2个月和16.7个月，总生存期为29.5个月和34.1个月。基线时，A组和B组分别有71%和67%的脑转移。脑转移患者经治疗后，颅内客观缓解率为50%和67%，颅内缓解持续时间为9.4和16.6个月，颅内无进展生存期为12.8个月和18.4个月。随访中没有观察到新发的安全事件。结论：克唑替尼难治性、ALK阳性的非小细胞肺癌中，布格替尼180 mg qd 7天后、予90mg qd维持治疗，显示了良好而持久的抗肿瘤效果，显著延长生存期和颅内病灶缓解时间。《ALTA-1L研究的第二个中期分析：布格替尼与克唑替尼在治疗晚期ALK阳性的非小细胞肺癌疗效的比较》Journal of Clinical Oncology，2020年11月 (2)在开放标签3期ALTA-1L试验中，纳入晚期ALK阳性、非小细胞肺癌患者共275人，随机分为布格替尼组（180 mg qd，7天后90mg qd），或克唑替尼250 mg bid。中位随访时间为24.9个月，布格替尼显著延长无进展生存期（P < .0001，24.0 vs 11.0个月）。布格替尼延缓了生活质量评分恶化的进展（P = 0.049）。研究同时发现，布格替尼的血浆浓度-时间曲线下的面积不是无进展生存期的预测因子。结论：布格替尼作为一种一日一次的ALK抑制剂在疗效上优于克唑替尼，有望成为ALK阳性的非小细胞肺癌的一线疗法。机械通气机械通气又称为正压通气，可完全替代或部分替代自主呼吸，目的是改善氧合不足、肺泡通气不足或两者同时。在急性和慢性呼吸衰衰竭期间，机械通气的主要受益是改善气体交换和减少呼吸做功。正压通气的肺部不良影响包括：肺气压伤、呼吸机相关肺损伤、内源性呼气末正压通气、通气/血流比例失调、膈肌萎缩、呼吸机无力和黏液腺毛运动减弱。此外，正压通气可能降低心输出量并影响血液动力学检测，与胃肠道应激性溃疡、内脏灌注减少、胃肠动力不足、液体潴留、急性肾衰竭、颅内压升高、肌无力、炎症和睡眠障碍相关。《前瞻性队列研究：急性呼吸衰竭患者机械通气强度与死亡率的关系》Lancet Respiratory Medicine，2020年9月 (3)尽管使用了肺保护性通气，但急性呼吸衰竭的死亡率仍然很高。最近的研究表明，基线通气参数与急性呼吸窘迫综合征患者预后之间存在相关性。该前瞻性队列研究的目的是评估急性呼吸衰竭患者长期暴露于不同强度的、机械通气与ICU死亡率之间的关系，共纳入13408例、接受≥4小时机械通气的患者。研究中，18%的患者死于ICU，对年龄和疾病严重程度进行调整后，发现机械通气驱动力 （driving pressure）与死亡风险显著升高有关（风险比1·064）；机械通气的机械功率（mechanical power）与死亡风险显著升高有关（风险比1·060）。这些关联在机械通气期间持续存在。结论：即使持续时间很短，高强度机械通气的累计暴露量是有害的。在进一步的研究中，应当对限制高强度机械通气以降低急性呼吸衰竭患者死亡率的治疗策略进行评估。《对照研究：健康受试者和危重病人膈肌的组织多普勒成像》American Journal of Respiratory and Critical Care Medicine，2020年10月 (4)组织多普勒成像是一种测量组织运动速度的超声心动图方法。该研究将此技术应用于膈肌，以评估膈肌在收缩和放松时的运动速度。研究对20名健康志愿者进行膈肌组织多普勒检查，以评估膈肌运动速度模式，测量其正常值，并确定测量值在观察者间的变异性。然后，在116例连续的ICU患者中，对脱机期间膈肌的偏移、增厚和组织多普勒参数（峰值收缩速度、峰值松弛速度、速度-时间积分和组织多普勒导出的最大松弛率）进行了评估。在一个18例患者亚组中，同时使用组织多普勒记录跨膈压（Pdi）、峰值Pdi、压力-时间乘积和膈肌最大舒张率。在可重复性方面，所有组织多普勒参数的相关系数为>0.89（P < 0.001）。除速度-时间积分外，健康志愿者和脱机成功患者的组织多普勒参数均低于脱机失败患者，分别为：峰值收缩速度1.35±0.34 cm/s、1.50±0.59 cm/s、2.66±2.14 cm/s（P < 0.001）；峰值松弛速度1.19±0.39 cm/s、1.53±0.73 cm/s、3.36±2.40 cm/s（P < 0.001）；组织多普勒最大舒张率分别为3.64±2.02 cm/s2、10.25±5.88 cm/s2、29.47±23.95 cm/s2（P < 0.001）。收缩速度峰值、与跨膈压峰值和压力-时间乘积有显著相关性，而最大舒张速率与最大舒张速率有显著相关性。结论：膈组织多普勒可实时评估膈肌组织的运动速度。膈肌组织多普勒衍生参数区分了脱机试验失败的患者和成功的患者，并与Pdi衍生参数有良好的相关性。《荟萃分析：危重病人的肌力与临床预后之间的关系》European Respiratory Journal，2020年9月 (5)研究的目的是评估肌无力与机械通气死亡率、或脱机成功率之间的联系，以及每种评估工具预测结果的能力。荟萃分析共分析了60项研究，包括4382名患者。ICU相关肌无力与总死亡率增加相关，风险比从1.2到4.48不等。其中刺激双侧膈神经产生的颤搐性跨膈压（transdiaphragmatic twitch pressure，TwPdi）对总死亡率的预测能力最高，敏感度为87%、特异性36%、曲线下面积 0.74。肌无力与机械通气脱机失败率增加相关，风险比为2.64至19.07不等。隔肌 增厚分数（diaphragm thickening fraction，DTF）对脱机失败率的预测能力最高，敏感性76%、特异性86%、曲线下面积为0.86。结论：ICU相关肌无力与高死亡率和更长时间机械通气相关。《综述：肺和膈保护通气》American Journal of Respiratory and Critical Care Medicine，2020年6月 (6)机械通气可引起急性膈肌萎缩和损伤，这与不良临床结果有关。肺部保护性通气的重要性和影响已得到广泛认识和确认，而膈肌保护性通气的概念最近已成为一种潜在的补充治疗策略。这一观点是在欧洲重症医学学会胸膜压工作组召开的一次国际专家会议的讨论中提出的，基于越来越多的损伤机制的证据，提出了一种综合肺和膈膜保护机械通气的概念框架。文章提出隔肌保护的目标基于呼吸努力和病人-呼吸机同步。讨论了在一定条件下隔肌保护与肺保护之间可能发生的冲突；我们强调，当冲突发生时，肺保护必须优先于隔肌保护。为了实施肺和膈保护通气，需要新的监测、设置呼吸机和滴定镇静的方法。未来，体外生命支持技术、膈神经刺激和临床决策支持系统等辅助干预措施也可能在特定的患者中发挥重要作用。由于干预的复杂性，评估这种新模式的临床影响将具有挑战性。结论：肺和膈保护通气的概念为显著改善危重病人的临床结果提供了一个引人注目的新理念。小羽点评：机械通气本身会导致膈肌功能障碍（ventilator induced diaphragmatic dysfunction，VIDD），控制型机械通气时甚至在第一天就可以发生，显著延长了通气和住院时间、导致撤机困难、并发症风险升高，这可能与膈肌损伤、萎缩、蛋白水解有关，通过氧化应激介导，但临床上有效避免该现象的最佳方法尚无定论。目前主要的策略是：保持适当水平的自主呼吸、避免病人-呼吸机不同步、根据膈肌活动监测指标调整呼吸机参数等。 《随机对照研究：对危重机械通气患者采取非镇静或浅镇静的比较》New England Journal of Medicine，2020年3月 (7)在危重的机械通气患者中，每日唤醒已被证明能够缩短通气时间和ICU住院时间。该研究的目的是讨论非镇静与浅镇静计划相比是否会影响死亡率。这项多中心、随机、对照试验中，随机分为非镇静组、和每日唤醒的浅镇静组，共纳入700名患者。非镇静组的平均Richmond躁动和镇静评分（RASS评分）从第1日的－1.3分提高至第7日的－0.8分；浅镇静组则从第1日的－2.3分提高至第7日的－1.8分。非镇静组和镇静组的90日死亡率分别为42.4%和37.0%（P=0.65）。两组患者离开ICU的天数、和不使用呼吸机的天数无显著差异。非镇静组患者中，无昏迷且无谵妄的中位天数为27日；浅镇静组患者中，无昏迷且无谵妄的中位天数为26日。非镇静组1例患者和浅镇静组10例患者发生了血栓栓塞事件。结论：在接受机械通气的ICU患者中，非镇静和浅镇静治疗策略90天死亡率无显著差异。《PEPTIC研究：质子泵抑制剂与抗组胺-2受体抑制剂剂对ICU有创机械通气患者住院死亡率的影响》JAMA，2020年1月 (8)研究的目的比较应用质子泵抑制剂（PPI）与组胺-2受体抑制剂（H2RB），在ICU有创机械通气患者中，预防应激性溃疡的疗效和对住院死亡率的影响。共26 982名患者被随机分配至PPI组或H2RB组，平均年龄58岁。PPI组和H2RB组中，90天住院死亡率分别为18.3%和17.5%（P=0.054），严重上消化道出血发生率分别为1.3%和1.8%的H2RB组（P = .009)。治疗组艰难梭菌感染率、ICU和住院时间无显著差异。在PPI组1例患者出现过敏反应。结论：在需要机械通气的ICU患者中，使用质子泵抑制剂与组胺-2受体阻滞剂相比，在预防应激性溃疡的医院死亡率方面没有统计学差异。呼吸机相关性肺炎呼吸机相关性肺炎（VAP）是指患者气管插管48小时后发生的肺炎，与以下因素相关：进入下呼吸道的微生物数量和宿主的机械、体液、细胞防御受损。约75%的重症患者在入院48小时内发生院内微生物定植。此外，肺部感染的主要途径是微量吸入已定植于口咽部、胃肠道的微生物，因此广泛使用的抑酸药提高胃液的pH值会改变上消化系统几乎无菌的状态，增加呼吸机相关性肺炎的发生几率。多重耐药菌危险因素包括：住院时间较长（>5天）和/或过去90天使用过抗生素。《双盲随机对照研究：心脏停搏后早发性呼吸机相关性肺炎的预防》New England Journal of Medicine，2019年11月 (9)院外心脏停搏、电击复律后后，接受体温管理的患者发生呼吸机相关性肺炎的风险增加。目前尚未证明抗生素短期预防性用药的益处。这项多中心、双盲、随机、安慰剂对照试验，纳入心脏停搏后、在ICU接受机械通气治疗、并且接受32～34℃目标体温管理的成人患者共 198例。于入院6小时内开始阿莫西林克拉维酸或安慰剂2日。7天内，抗生素预防组的早发呼吸机相关性肺炎发生率低于安慰剂组（19% vs 34%；风险比 0.53；P=0.03）。晚发性呼吸机相关性肺炎发生率、不使用呼吸机的天数、ICU停留时间和第28天时死亡率，两组均无差异。第7天未发现耐药菌增多。结论：院外发生心脏停搏后，接受32～34℃目标体温管理策略的患者，2日的阿莫西林克拉维酸降低了早发性呼吸机相关性肺炎的发生率。《2项前瞻性研究：英国ICU疑似呼吸机相关肺炎患者的肺曲霉菌病》American Journal of Emergency Medicine，2020年11月 (10)疑似呼吸机相关肺炎患者中，曲霉菌感染仍然缺乏十分敏感的诊断。这篇文章的目的是评估疑似呼吸机相关肺炎的曲霉菌感染的患病率和预后。文章纳入的这2项前瞻性研究招募了360名影像学、临床、实验室检查疑似的、呼吸机相关性肺炎的危重症患者，并获得了194名患者的血清样本和肺泡灌洗液，并进行了真菌学测试。最后根据临床、影像学和真菌学标准的定义诊断曲霉菌感染。在评估的194名患者中，曲霉菌感染患病率为12.4%，24例曲霉菌感染中有4人血清中半乳甘露聚糖阳性，16例肺泡灌洗液中半乳甘露聚糖阳性，两者均阳性共4例，3例肺泡灌洗液中培养出曲霉菌。疑似曲霉菌感染的患者ICU住院时间更长（25.5天 vs 15.5天，P = 0.02），死亡率略高（33.3% vs. 22.8%，P = 0.23）。结论：在调查疑似呼吸机相关肺炎患者时，即使不是曲霉菌感染高危，仍应考虑曲霉菌感染的可能。《DEDECAP研究：气管切开拔管前应用高流量氧疗联合堵管或联合吸引的比较》New England Journal，2020年9月 (11)应用气管切开套管的患者拔管前，通常做法是将气管切开套管堵管24小时，确定患者可否能自主呼吸。该研究的目的是比较这种做法是否比根据呼吸道吸引频率更好决定是否能够拔管更好。来自西班牙的研究人员在5个ICU进行了这项研究，纳入330例、气管切开后、有意识的、危重成人患者，患者的平均年龄58岁，68.2%为男性。一组接受24小时堵管试验+间歇性高流量氧疗（对照组），另一组接受连续高流量氧疗+将吸引频率作为拔管准备指标（干预组）。干预组至拔管的时间比对照组短（中位数，6天 vs. 13天）。干预组的肺炎和气管支气管炎发生率低于对照组，住院时长也比对照组短。 结论：与24小时堵管试验+间歇性高流量吸氧相比，依据吸引频率制定的拔管决策+连续高流量氧疗缩短了拔管时间，失败率不存在差异。《基础研究：Fc区优化的抗体可以诱导CD8对病毒性呼吸道感染的免疫》Nature，2020年10月(12)针对病毒病原体的抗体是控制病毒感染的一种很有前途的治疗方式，之前的一些研究已经证实，抗体的抗病毒效果需要Fab区和Fc区的协同作用。抗体Fc区在免疫系统中的各类细胞上的受体结合，激活免疫系统清除病毒、杀死被感染的细胞。这项研究的目的是，通过对抗流感IgG单抗的Fc区选择性的修饰，使之能够特异性的与已激活的Fcγ受体、Fcγ IIa受体结合，则能够进一步增强树突状细胞成熟、诱导保护性CD8+T细胞应答，从而提高预防或治疗致命性呼吸道病毒感染的疗效。结论：当IgG抗体选择性激活树突状细胞-T细胞通路时，能够诱导对病毒感染的保护性、适应性免疫，这对发展抗体疗法，提高对抗病毒的疗效具有重要意义。参考文献1.Huber RM, Hansen KH, Paz-Ares Rodríguez L, West HL, Reckamp KL, Leighl NB, et al. 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FDA 批准MAPK激酶抑制剂治疗手术无法切除的1型神经纤维瘤BMJ 哮喘发作与空气污染和母亲孕期吸烟有关Nature Metabolism 母亲运动带来的后代的健康获益是通过母乳中的3′-唾液酸乳糖介导的司美替尼（selumetinib）神经纤维瘤是常染色体显性遗传病，分1、2和3型。1型神经纤维瘤最常见，标志性特征是多发的牛奶咖啡斑和相关皮肤神经纤维瘤。没有针对性的总体的治疗，只能对症治疗。50%的1型神经纤维瘤患者合并丛状神经纤维瘤，丛状神经纤维瘤是一种组织学上良性的周围神经鞘肿瘤，常累及多个神经束，造成毁容、运动功能障碍、疼痛、甚至脊髓受压。司美替尼是一种MAPK激酶的抑制剂，在2020年4月，FDA批准了司美替尼用于治疗1型神经纤维瘤。《司美替尼治疗不能手术的丛状神经纤维瘤患儿》New England Journal of Medicine，2020年4月 (1)这项开放标签的2期试验，旨在确定丛状神经纤维瘤患儿服用司美替尼后的临床益处和安全性。50名、平均年龄10.2岁的、不能手术的丛状神经纤维瘤的1型神经纤维瘤病患儿入组，随机接受了司美替尼和安慰剂治疗。最常见的神经纤维瘤相关症状包括毁容（44人）、运动功能障碍（33人）和疼痛（26人）。治疗后70%达到了部分缓解，56%≥1年的持久缓解。1年后，肿瘤疼痛评分平均降低了2分，疼痛对日常功能、总体健康相关生活质量、力量和关节活动范围等多项功能结局也观察到了有临床意义的改善。其中5人因副作用停药；6人疾病发展。最常见的毒性作用为恶心、呕吐或腹泻、无症状的肌酸磷酸激酶水平升高、痤疮样皮疹及甲沟炎。结论：对于手术无法切除的丛状神经纤维瘤患儿，司美替尼产生了持久的缩小肿瘤作用。儿童哮喘哮喘（asthma）是一种异质性疾病，特点是慢性气道炎症。12岁以下儿童哮喘是最常见的儿童期慢性疾病，约80%的患儿在5岁以前出现症状，咳嗽、哮鸣、呼吸急促、胸闷胸痛是常见的症状。最常见的诱发因素包括病毒性上呼吸道感染（合胞病毒、流感病毒、鼻病毒）、运动、天气、二手烟和变应原（如尘螨、宠物毛发、花粉、霉菌）。《病例队列研究：空气污染和家庭相关因素与儿童哮喘发作和持续性喘息的关系》BMJ，2020年8月(2)研究目的探讨儿童哮喘和持续性喘息发病的危险因素（空气污染和家庭相关因素）。这项全国病例对照研究中随访了1-15岁儿童儿童哮喘发病率升高，与父母患有哮喘（风险比 2.29）、母亲在怀孕期间吸烟（风险比 1.20）相关。儿童哮喘发病率低，与父母受教育程度高（风险比0.72）和父母收入高（风险比 0.85）相关。空气污染物PM2.5和PM10与哮喘的风险增加和持续喘息相关。结论：暴露于空气污染中的儿童更容易患哮喘和持续性喘息，哮喘与父母哮喘病史、父母教育程度和母亲在怀孕期间吸烟有关。《观察性研究：母亲在怀孕期间吸烟影响子女成年后哮喘发作》European Respiratory Journal 2020年7月 (3)研究的目的是确定产前哮喘和成人哮喘发病之间的关系。研究纳入5200名、1966年芬兰北部出生的、31岁前未诊断为哮喘的人群。研究发现孕妇妊娠最后3个月吸烟，其后代31岁至46岁之间哮喘累积发病率（男性为5.1%，女性为8.8%），尤其是与无哮喘病史（风险比9.63）或咳嗽喘息病史（风险比3.21）的后代中有显著相关性。同时在妊娠期吸烟与31岁时子代的用力呼气量（FEV1）/用力肺活量（FVC）比率之间有发现了显著的相关性，在在RUNX1单倍型rs11702779-AA的后代中成年期患哮喘的风险比为5.53。结论：怀孕期间吸烟与后代成年后哮喘累积发病率有关。《观察性研究：空气污染和从出生到成年的哮喘发展》European Respiratory Journal 2020年7月 (4)空气污染对青春期至成年期哮喘发展的影响尚不清楚，研究纳入了3687个参与者，评估空气污染和哮喘发生的年龄的相关关系。研究20岁之前哮喘的发病率，与出生地空气污染物的比例增加相关（接触PM10的风险比为1.09，接触NO2的风险比为1.20）。对近期家庭居住地的空气污染进行分析后，得到了类似的结果。结论：早年暴露在空气污染中，特别是来自机动交通的污染，与儿童、青春期到成年早期罹患哮喘的风险增加有关。《哮喘患儿卧室颗粒物过滤与气道病理生理变化的关系》JAMA Pediatrics，2020年8月 (5)细颗粒物PM2.5是一种普遍存在的空气污染物，可沉积在小气道中，对哮喘起着至关重要的作用。来自杜克大学与北京上海的研究人员合作，研究PM2.5过滤装置的使用是否能改善哮喘患儿的小气道生理学和呼吸系统炎症。研究人员在患儿的卧室里随机安装了真实的过滤设备和假的过滤设备，试验前有2周的洗脱期，研究是在臭氧含量低的季节在中国上海的郊区进行的。研究纳入轻中度哮喘的、共43个、5-13岁的儿童参加了研究。室外PM2.5浓度中度升高（28.6-69.8μg/m3)；经过滤的卧室PM2.5浓度比不经过滤降低63.4%。过滤的卧室空气能显著改善气道力学，总气道阻力下降24.4%，减少小气道阻力43.5%，呼气流量峰值也显著改善。这些改善与卧室PM2.5的减少显著相关。总体的小气道功能改善均没有统计学意义，但在不伴有嗜酸性气道炎症的参与者中改善显著（13.2%）。结论：室内PM2.5过滤可以通过改善气道力学和功能，减少炎症，改善哮喘患者肺部的气体流动。《VDKA研究：补充维生素D3对低维生素D和哮喘患儿哮喘加重的影响》JAMA，2020年8月 (6)研究的目的探讨维生素D3的补充是否能改善儿童哮喘和低维生素D水平严重恶化的时间。这项随机、双盲、安慰剂对照临床试验，纳入6-16岁的、哮喘严重发作高危儿童共192人，平均年龄9.8岁，女孩40%维生素D3组的37.5%和安慰剂组的34.4%出现≥1次严重恶化。补充维生素D3并没有显著改善哮喘严重恶化的时间，没有显著改善病毒诱导哮喘严重加重的时间，没有显著改善糖皮质激素剂量减量的患者比例，也没有显著减少糖皮质激素的累积剂量。两组严重不良事件相似。结论：该研究不支持在持续性哮喘和低维生素D水平的儿童维生素D3来预防哮喘加重。《前瞻性队列研究：抗生素的使用减少，影响肠道菌群和儿童哮喘发病率》Lancet Respiratory Medicine，2020年7月 (7)在欧洲和北美的一些地区，儿童哮喘的发病率正在下降；有研究提示婴儿期使用抗生素与哮喘风险增加有关。该研究的目的是验证哮喘发病率的降低是否与抗生素处方减少有关，并验证这种变化是由肠道菌群变化介导的。本研究包括基于人群和前瞻性队列分析，使用加拿大不列颠哥伦比亚省（人口400万·700万）每年抗生素处方率和哮喘诊断率的管理数据进行人群分析。2000 - 2014年，1-4岁儿童的哮喘发病率从27·3‰ 下降到20·2‰，降幅26·0%。发病率的降低与

FDA 批准免疫疗法治疗青少年花生过敏NEJM 妊娠期呼吸道合胞病毒预防接种及其对婴儿的影响Stem Cells子刊 脐带血注射治疗孤独症AR101口服免疫疗法2020年1月，FDA已经批准花生过敏原粉剂，也称为palforzia，上市用于治疗花生过敏。《ARTEMIS研究：AR101口服免疫疗法治疗花生过敏的3期试验》Lancet: Child & Adolescent Health，2020年 (1)这项多中心、双盲、随机、安慰剂对照的3期试验旨在评估AR101对花生过敏的疗效和安全性，研究纳入175例、4-17岁、患有花生过敏的青少年，分别每天给予花生蛋白过敏原粉剂或安慰剂组。每两周增加一次剂量，6个月内到达300毫克（相当于一颗花生），并维持3个月。研究结束时，参与者接受1000mg花生蛋白的挑战，治疗组有58%的参与者和安慰剂组2%的参与者能够耐受1000mg花生蛋白。大多数不良事件为轻中度。结论：口服免疫治疗诱导花生蛋白快速脱敏，是相对安全有效的。呼吸道合胞病毒感染呼吸道合胞病毒（RSV）能在所有年龄段人群中引发急性呼吸道疾病，季节性爆发一般出现在10或11月直至次年4或5月。RSV是1岁以下的及5岁以下儿童、中下呼吸道感染的最常见病因，占这个年龄段儿童全因死亡的2.3%-6.7%。RSV感染通常为自限性的，但有一些患者可能出现复发性哮鸣。药物治疗：利巴韦林虽然已被批准用于RSV感染的治疗，但是美国儿科学会只推荐利巴韦林用于重症感染合并免疫抑制的患儿（利巴韦林因其致畸作用禁用于孕妇）。免疫预防：帕利佐单抗（pavilizumab，抗RSV F糖蛋白的单克隆抗体）。《全国性队列研究：幼儿呼吸道合胞病毒相关住院情况》Pediatrics，2020年7月 (2)这个基于人群的研究，统计了2015-2016年美国因急性呼吸道感染住院的、5岁以下儿童公2969名。其中检测合胞病毒阳性占35%，

FDA 批准免疫疗法治疗青少年花生过敏NEJM 妊娠期呼吸道合胞病毒预防接种及其对婴儿的影响Stem Cells子刊 脐带血注射治疗孤独症AR101口服免疫疗法2020年1月，FDA已经批准花生过敏原粉剂，也称为palforzia，上市用于治疗花生过敏。《ARTEMIS研究：AR101口服免疫疗法治疗花生过敏的3期试验》Lancet: Child & Adolescent Health，2020年 (1)这项多中心、双盲、随机、安慰剂对照的3期试验旨在评估AR101对花生过敏的疗效和安全性，研究纳入175例、4-17岁、患有花生过敏的青少年，分别每天给予花生蛋白过敏原粉剂或安慰剂组。每两周增加一次剂量，6个月内到达300毫克（相当于一颗花生），并维持3个月。研究结束时，参与者接受1000mg花生蛋白的挑战，治疗组有58%的参与者和安慰剂组2%的参与者能够耐受1000mg花生蛋白。大多数不良事件为轻中度。结论：口服免疫治疗诱导花生蛋白快速脱敏，是相对安全有效的。呼吸道合胞病毒感染呼吸道合胞病毒（RSV）能在所有年龄段人群中引发急性呼吸道疾病，季节性爆发一般出现在10或11月直至次年4或5月。RSV是1岁以下的及5岁以下儿童、中下呼吸道感染的最常见病因，占这个年龄段儿童全因死亡的2.3%-6.7%。RSV感染通常为自限性的，但有一些患者可能出现复发性哮鸣。药物治疗：利巴韦林虽然已被批准用于RSV感染的治疗，但是美国儿科学会只推荐利巴韦林用于重症感染合并免疫抑制的患儿（利巴韦林因其致畸作用禁用于孕妇）。免疫预防：帕利佐单抗（pavilizumab，抗RSV F糖蛋白的单克隆抗体）。《全国性队列研究：幼儿呼吸道合胞病毒相关住院情况》Pediatrics，2020年7月 (2)这个基于人群的研究，统计了2015-2016年美国因急性呼吸道感染住院的、5岁以下儿童公2969名。其中检测合胞病毒阳性占35%，

FDA 治疗高度耐药肺结核的新药NEJM 巴罗萨韦对流感家庭接触者的流感预防效果医学前沿 支气管低温冷冻术和支气管流变成形术治疗慢性支气管炎普托马尼（pretomanid）普托马尼（pretomanid）是一种新型的口服硝基咪唑嗪类抗菌药。2019年8月，普托马尼被批准作为BPaL方案（贝达喹啉、 普托马尼和利奈唑胺）和BPaMZ（贝达喹啉、 普托马尼、莫西沙星和吡嗪酰胺）方案的一部分用于治疗耐药性肺结核。《开放标签单组研究：高度耐药肺结核的治疗》New England Journal of Medicine，2020年3月 (1)这项开放标签、单组研究的目的是评价贝达喹啉、普托马尼和利奈唑胺联合26周治疗广泛耐药结核病患者、以及治疗无效或因副作用而停用二线治疗方案的多药耐药结核病患者的安全性和疗效。共计109例患者被纳入本研究，治疗结束后6个月时，90%的患者结局良好。11例不良结局包括：7例死亡，2例在随访期间复发。利奈唑胺的预期毒性作用包括周围神经病（81%）和骨髓抑制（48%），这些毒性作用虽然常见，但可以控制，常导致利奈唑胺减量或中断用药。结论：在高度耐药结核病患者中，在治疗结束后6个月时，贝达喹啉、普托马尼和利奈唑胺联合治疗使高比例的患者有良好结局。流行性感冒流行性感冒是甲型或乙型流感病毒导致的急性呼吸道疾病，在世界范围内引起爆发和流行，主要发生在冬季。患者出现上呼吸道和/或下呼吸道受累的症状，伴有全身症状，如发热（37.8°C-40.0°C）、头痛、肌痛和无力。一般人群中流感属于自限性疾病，高危人群中并发症和死亡率增加。流感通过大颗粒飞沫和小颗粒气溶胶传播，潜伏期1-4天，无并发症的患者病程持续1周左右，病毒排出时间为病毒暴露后0.5天到7天，病毒排出的高峰在第2天。高危人群包括：年龄≥65岁，妊娠或产后2周，住在长期护理机构，美国印第安人和阿拉斯加原住民，极端肥胖者（BMI≥40kg/m2)，慢性疾病患者，糖皮质激素或免疫抑制治疗的患者。《回顾观察性研究：老年人流感疫苗接种对住院和死亡率的影响》Annual of Internal Medicine，2020年4月 (2)65岁以上的老年人接种疫苗有临床获益的证据非常缺乏，研究者设计了一项“断点回归”分析，他们通过英国7个大型临床数据库分析了疫苗接种率和流感相关疾病。研究发现成人疫苗接种率在65岁这一年，从34%提高至57%。重度呼吸系统疾病均随着年龄的增长而升高，平滑地通过了65岁这一门槛，没有出现急剧下降。假如每年接种流感疫苗的确能给65岁以上的老年人带来明显临床益处的话，预期应出现急剧下降。结论：老年人接种流感疫苗充其量只有很小的直接获益。《双盲随机对照研究：巴罗萨韦对流感家庭接触者的流感预防效果》New England Journal of Medicine，2020年7月 (3)巴罗萨韦在家庭环境中的暴露后预防效果尚不明确。这项多中心、双盲、随机、安慰剂对照试验，在确诊流感病例的545个家庭的752个接触者中，将参与者随机分为两组，分别接受巴罗萨韦或安慰剂单剂给药。巴罗萨韦预防组患临床流感显著低于安慰剂组（1.9% vs. 13.6%；P＜0.001）。巴罗萨韦在高危、儿童和未接种疫苗的参与者的亚组中有效。两组的不良事件发生率相似（巴洛沙韦组22.2%和安慰剂组20.5%）。结论：单剂巴罗萨韦显示出显著的流感病毒暴露后预防效果。流行性感冒的治疗抗病毒治疗包括：神经氨酸酶抑制剂（奥司他韦、扎那米韦和帕拉米韦），流感病毒cap-依赖性核酸内切酶选择性抑制剂巴罗萨韦（baloxavir），金刚烷胺类（金刚烷胺和金刚乙胺）。《开放标签随机对照研究：流感样疾病的治疗中加用奥司他韦的疗效研究》Lancet，2020年1月 (4)研究目的是确定流感样疾病患者在常规初级护理中加入奥司他韦抗病毒治疗是否会缩短康复时间。这项开放标签的、实用的、适应性的、随机对照试验中，将奥司他韦添加到常规治疗中。研究纳入3266名参与者，其中52%经证实感染了流感。总体而言，奥司他韦组的患者恢复时间较短，绝对缩短1.20天。对于没有合并症的、

FDA 治疗高度耐药肺结核的新药NEJM 巴罗萨韦对流感家庭接触者的流感预防效果医学前沿 支气管低温冷冻术和支气管流变成形术治疗慢性支气管炎普托马尼（pretomanid）普托马尼（pretomanid）是一种新型的口服硝基咪唑嗪类抗菌药。2019年8月，普托马尼被批准作为BPaL方案（贝达喹啉、 普托马尼和利奈唑胺）和BPaMZ（贝达喹啉、 普托马尼、莫西沙星和吡嗪酰胺）方案的一部分用于治疗耐药性肺结核。《开放标签单组研究：高度耐药肺结核的治疗》New England Journal of Medicine，2020年3月 (1)这项开放标签、单组研究的目的是评价贝达喹啉、普托马尼和利奈唑胺联合26周治疗广泛耐药结核病患者、以及治疗无效或因副作用而停用二线治疗方案的多药耐药结核病患者的安全性和疗效。共计109例患者被纳入本研究，治疗结束后6个月时，90%的患者结局良好。11例不良结局包括：7例死亡，2例在随访期间复发。利奈唑胺的预期毒性作用包括周围神经病（81%）和骨髓抑制（48%），这些毒性作用虽然常见，但可以控制，常导致利奈唑胺减量或中断用药。结论：在高度耐药结核病患者中，在治疗结束后6个月时，贝达喹啉、普托马尼和利奈唑胺联合治疗使高比例的患者有良好结局。流行性感冒流行性感冒是甲型或乙型流感病毒导致的急性呼吸道疾病，在世界范围内引起爆发和流行，主要发生在冬季。患者出现上呼吸道和/或下呼吸道受累的症状，伴有全身症状，如发热（37.8°C-40.0°C）、头痛、肌痛和无力。一般人群中流感属于自限性疾病，高危人群中并发症和死亡率增加。流感通过大颗粒飞沫和小颗粒气溶胶传播，潜伏期1-4天，无并发症的患者病程持续1周左右，病毒排出时间为病毒暴露后0.5天到7天，病毒排出的高峰在第2天。高危人群包括：年龄≥65岁，妊娠或产后2周，住在长期护理机构，美国印第安人和阿拉斯加原住民，极端肥胖者（BMI≥40kg/m2)，慢性疾病患者，糖皮质激素或免疫抑制治疗的患者。《回顾观察性研究：老年人流感疫苗接种对住院和死亡率的影响》Annual of Internal Medicine，2020年4月 (2)65岁以上的老年人接种疫苗有临床获益的证据非常缺乏，研究者设计了一项“断点回归”分析，他们通过英国7个大型临床数据库分析了疫苗接种率和流感相关疾病。研究发现成人疫苗接种率在65岁这一年，从34%提高至57%。重度呼吸系统疾病均随着年龄的增长而升高，平滑地通过了65岁这一门槛，没有出现急剧下降。假如每年接种流感疫苗的确能给65岁以上的老年人带来明显临床益处的话，预期应出现急剧下降。结论：老年人接种流感疫苗充其量只有很小的直接获益。《双盲随机对照研究：巴罗萨韦对流感家庭接触者的流感预防效果》New England Journal of Medicine，2020年7月 (3)巴罗萨韦在家庭环境中的暴露后预防效果尚不明确。这项多中心、双盲、随机、安慰剂对照试验，在确诊流感病例的545个家庭的752个接触者中，将参与者随机分为两组，分别接受巴罗萨韦或安慰剂单剂给药。巴罗萨韦预防组患临床流感显著低于安慰剂组（1.9% vs. 13.6%；P＜0.001）。巴罗萨韦在高危、儿童和未接种疫苗的参与者的亚组中有效。两组的不良事件发生率相似（巴洛沙韦组22.2%和安慰剂组20.5%）。结论：单剂巴罗萨韦显示出显著的流感病毒暴露后预防效果。流行性感冒的治疗抗病毒治疗包括：神经氨酸酶抑制剂（奥司他韦、扎那米韦和帕拉米韦），流感病毒cap-依赖性核酸内切酶选择性抑制剂巴罗萨韦（baloxavir），金刚烷胺类（金刚烷胺和金刚乙胺）。《开放标签随机对照研究：流感样疾病的治疗中加用奥司他韦的疗效研究》Lancet，2020年1月 (4)研究目的是确定流感样疾病患者在常规初级护理中加入奥司他韦抗病毒治疗是否会缩短康复时间。这项开放标签的、实用的、适应性的、随机对照试验中，将奥司他韦添加到常规治疗中。研究纳入3266名参与者，其中52%经证实感染了流感。总体而言，奥司他韦组的患者恢复时间较短，绝对缩短1.20天。对于没有合并症的、

Richard Beasley discusses a Series of three papers in The Lancet and The Lancet Respiratory Medicine that consider the promise of novel strategies to drive down the global burden of asthma.

A BC-based study, recently published in The Lancet Respiratory Medicine, shows that being prescribed antibiotics within the first 12 months of life is associated with almost double the risk of being diagnosed with asthma by age of five. Dr. Stuart Turvey is a paediatrician based at BC Children's Hospital and a professor of paediatrics at UBC. He spoke to our Niki Reitmayer. 

In this cutting-edge podcast with Dr James Hull – a leading authority on respiratory health in athletes - we discuss the challenges facing athletes and healthcare professionals following infection with the novel coronavirus. We cover a few case-studies, and practical points for all SEM professionals to consider. Additional Links: Link to the published article in the Lancet Respiratory Medicine journal https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(20)30175-2/fulltext#.XrHWOYDlNMw.twitter Dr James Hull's twitter page: https://twitter.com/Breathe_to_win Link to Book: https://www.amazon.co.uk/Complete-Guide-Respiratory-Care-Athletes/dp/1138588350/ref=redir_mobile_desktop?ie=UTF8&qid=1586959229&ref_=tmm_pap_title_0&sr=8-1 BJSM Education Review on EILO https://bjsm.bmj.com/content/52/18/1211 BJSM podcast on EILO https://soundcloud.com/bmjpodcasts/do-you-know-athletes-who-have-a-wheeze-and-get-short-of-breath-easily-surely-asthma-right?in=bmjpodcasts%2Fsets%2Fbjsm-1&fbclid=IwAR3tViVFdNwqKZ04hU43y57HeuPcskYQ5OPuGoCJCF4hIlLd-BlL3k2SXVU

Dr Scott Bell and Dr Felix Ratjen discuss The Lancet Respiratory Medicine's Cystic Fibrosis Commission on the future of cystic fibrosis care.

Alex Franciosi talks with The Lancet Respiratory Medicine about the pitfalls and caveats of testing for α1-antitrypsin deficiency.

Use of intensive care unit (ICU) resources in the USA outpaces the rest of the world. The Lancet Respiratory Medicine spoke with Dr James Downar about why ICU usage in the USA is so high, what that means for care, and what can be done about it.

To mark World Pneumonia Day, The Lancet Respiratory Medicine talks with Stefano Aliberti about his Comment calling for international action to tackle pneumonia.

Carolyn Calfee joins The Lancet Respiratory Medicine to discuss precision medicine approaches to acute respiratory distress syndrome, or ARDS.

Bart Rijnders joins The Lancet Respiratory Medicine to discuss his new paper on patients with severe influenza developing invasive pulmonary aspergillosis.

Jennifer Furin joins The Lancet Respiratory Medicine to discuss the use of bedaquiline to combat multi-drug resistant tuberculosis in South Africa.

Tillie Hackett joins The Lancet Respiratory Medicine to discuss her study assessing small airways in chronic obstructive pulmonary disease.

Julian Forton joins The Lancet Respiratory Medicine to talk about his new study into lower airway bacterial sampling in young children with cystic fibrosis.

Dr. Diana Bilton joins The Lancet Respiratory Medicine to discuss how the use of rare disease patient registries helps with long term drug studies after drug authorisation.

Allan Glanville joins The Lancet Respiratory Medicine to discuss the INSPIRE trial that assesses the use of the Portable Organ Care System to reduce primary graft dysfunction in bilateral lung transplantation.

Keertan Dheda joins The Lancet Respiratory Medicine to discuss the hottest topics in TB control and treatment.