Extracorporeal Membrane Oxygenation and Lung Transplantation: Initial Experience at a Single Brazilian Center.

体外膜肺氧合和肺移植: 巴西单一中心的初步经验。

  • 影响因子:1.35
  • DOI:10.6061/clinics/2020/e1698
  • 作者列表:"Pola-Dos-Reis F","Samano MN","Abdalla LG","Carvalho GVS","Fernandes LM","Gomes-Júnior O","Carraro RM","Camargo PCLB","Teixeira RHOB","Afonso-Júnior JE","Pêgo-Fernandes PM
  • 发表时间:2020-04-30

OBJECTIVE:To report initial experience from the use of extracorporeal membrane oxygenation (ECMO) in patients who received lung transplantation. METHODS:Retrospective study of a single tertiary center in the Brazilian state of São Paulo, a national reference in lung transplantation, based on the prospective collection of data from electronic medical records. The period analyzed extended from January 2009 (beginning of the program) until December 2018. RESULTS:A total of 75 lung transplants were performed, with ECMO used in 8 (10.7%) cases. Of the patients, 4 (50%) were female. The mean age was 46.4±14.3 years. The causes of the end-stage lung disease that led to transplantation were pulmonary arterial hypertension in 3 (37.5%) patients, bronchiectasis in 2 (25%) patients, pulmonary fibrosis in 2 (25%) patients, and pulmonary emphysema in 1 (12.5%) patient. In our series, 7 (87.5%) cases were sequential bilateral transplantations. Prioritization was necessary in 4 (50%) patients, and in 1 patient, ECMO was used as a bridge to transplantation. The ECMO route was central in 4 (50%), peripheral venovenous in 2 (25%) and peripheral venoarterial in 2 (25%) patients. The mean length of the intensive care unit (ICU) stay was 14±7.5 days and of the hospital stay was 34.1±34.2 days. The mean ECMO duration was 9.3±6.6 days with a 50% decannulation rate. Three patients were discharged (37.5%). CONCLUSION:Lung transplantation requires complex treatment, and ECMO has allowed extending the indications for transplantation and provided adjuvant support in the clinical management of these patients.


目的: 报告肺移植患者使用体外膜肺氧合 (ECMO) 的初步经验。 方法: 对巴西圣保罗州的一个单一三级中心进行回顾性研究,该中心是肺移植的国家参考,基于对电子病历数据的前瞻性收集。分析的时间从2009年1月 (计划开始) 延长至2018年12月。 结果: 共完成75例肺移植,8例 (10.7%) 使用ECMO。患者中,4例 (50%) 为女性。平均年龄为46.4 ± 14.3岁。导致移植的终末期肺病的原因是3例 (37.5%) 患者的肺动脉高压,2例 (25%) 患者的支气管扩张,2例 (25%) 患者的肺纤维化和1例 (12.5%) 患者的肺气肿。在我们的系列研究中,7例 (87.5%) 是双侧连续移植。4例 (50%) 患者需要优先排序,1例患者使用ECMO作为移植的桥梁。4例 (50%) 患者的ECMO途径为中枢,2例 (25%) 患者的外周静脉为外周静脉,2例 (25%) 患者的外周静脉为外周静脉。重症监护病房 (ICU) 的平均住院时间为14 ± 7.5天,住院时间为34.1 ± 34.2天。平均ECMO持续时间为9.3 ± 6.6天,拔管率为50%。3例患者出院 (37.5%)。 结论: 肺移植需要复杂的治疗,ECMO允许延长移植的适应症,并在这些患者的临床管理中提供辅助支持。



作者列表:["van der Schans J","Cao Q","Bos EH","Rours GIJG","Hoekstra PJ","Hak E","de Vries TW"]

METHODS::In a recent meta-analysis, we found that atopic diseases, like asthma and allergic rhinitis, occur more frequently prior to the onset of attention-deficit/hyperactivity disorder (ADHD). Our aim was to determine the temporal order of the association between daily fluctuations in atopic disease symptoms and in ADHD symptoms in individual participants. In this observational study among 21 participants, age 7-16 years, we performed a replicated time-series analysis of symptom fluctuations in asthma and/or allergic rhinitis and ADHD. Data were collected through parents who filled in a daily online questionnaire during up to 50 days. In each individual, we investigated the temporal order of fluctuations in atopic disease symptoms and ADHD symptoms using a vector autoregressive (VAR) model while using sleep problems and medication use as covariates. For 16 out of 21 participants, we constructed a VAR model. For a majority of the participants, significant associations were detected between atopic disease symptoms and ADHD symptoms. The results were heterogeneous; the direction, sign, and timing of the relationship between ADHD, atopy, sleep problems, and medication use varied between individuals. This study provides additional evidence that the symptom expression of atopy and ADHD are related. However, the connection between both diseases in children is found to be heterogeneous within our study population.

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作者列表:["Whitworth KW","Berumen-Flucker B","Delclos GL","Fragoso S","Mata C","Gimeno Ruiz de Porras D"]

METHODS::The occupational hazards and respiratory symptoms of domestic cleaners in USA are largely unknown. We conducted a cross-sectional study among 56 Hispanic female domestic cleaner on their health status and frequency of cleaning products used and tasks performed. While women used multi-use products (60.0%) and toilet bowl cleaners (51.8%) most days of the week, many (39.3%) reported not using personal protective equipment while cleaning. Itchy/watery eyes (61.8%) and itchy nose (56.4%) were the most frequently reported symptoms. A history of physician-diagnosed asthma was reported by 14.3% while 33.9% had symptoms of bronchial hyperresponsiveness (BHR). In conclusion, this vulnerable population has high prevalence of physician-diagnosis asthma and BHR symptoms and is potentially exposed to myriad occupational hazards. Further research exploring associations between products use, cleaning tasks and respiratory symptoms is warranted.

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作者列表:["Sunadome H","Matsumoto H","Izuhara Y","Nagasaki T","Kanemitsu Y","Ishiyama Y","Morimoto C","Oguma T","Ito I","Murase K","Muro S","Kawaguchi T","Tabara Y","Chin K","Matsuda F","Hirai T"]

METHODS:BACKGROUND:Obesity affects the pathogenesis of various chronic diseases, including asthma. Research on correlations between obesity/BMI and eosinophilic inflammation in asthma has yielded contradictory results, which could be partly ascribed to the absence of epidemiological data on the correlations. We aimed to elucidate the correlations between blood eosinophil count, its genetic backgrounds, and BMI in the general population. METHODS:This community-based Nagahama study in Japan enrolled 9789 inhabitants. We conducted self-reporting questionnaires, lung function tests, and blood tests in the baseline and 5-year follow-up studies. A genome-wide association study (GWAS) was performed in 4650 subjects at the baseline and in 4206 of these at the follow-up to determine single-nucleotide polymorphisms for elevated blood eosinophil counts. We assessed the correlations between BMI and eosinophil counts using a multifaceted approach, including the cluster analysis. RESULTS:Eosinophil counts positively correlated with BMI, observed upon the interchange of an explanatory variable, except for subjects with the highest quartile of eosinophils (≥200/μL), in whom BMI negatively correlated with eosinophil counts. GWAS and human leukocyte antigen (HLA) imputation identified rs4713354 variant (MDC1 on chromosome 6p21) for elevated eosinophil counts, independent of BMI and IgE. Rs4713354 was accumulated in a cluster characterized by elevated eosinophil counts (mean, 498 ± 178/μL) but normal BMI. CONCLUSIONS:Epidemiologically, there may be a positive association between blood eosinophil counts and BMI in general, but there was a negative correlation in the population with high eosinophil counts. Factors other than BMI, particularly genetic backgrounds, may contribute to elevated eosinophil counts in such populations.

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