Chronic obstructive pulmonary disease(COPD)is a persistent airflow obstructive disease caused by airway and/or alveolar abnormalities and has become the third leading cause of death worldwide.Dupilumab,the first fully...Chronic obstructive pulmonary disease(COPD)is a persistent airflow obstructive disease caused by airway and/or alveolar abnormalities and has become the third leading cause of death worldwide.Dupilumab,the first fully humanized monoclonal antibody targeting the IL-4 receptor subunit alpha(IL-4Rα),is mainly used to treat COPD patients with elevated blood eosinophils that cannot be effectively controlled by traditional drugs.Studies have shown that dupilumab effectively improves pulmonary function,reduces airway inflammation and exacerbation rate,and significantly improves quality of life in COPD patients by blocking interleukin-4(IL-4)and interleukin-13(IL-13)signaling.Several clinical trials and real-world studies have shown that dupilumab significantly reduces the rate of exacerbations,particularly in patients with high baseline eosinophil or FeNO levels.In addition,dupilumab showed positive efficacy in improving lung function,reducing airway inflammation and improving the quality of life of patients.Although the preliminary efficacy of dupilumab in the treatment of COPD is promising,its safety and efficacy need to be further validated,particularly in long-term use and in different patient subgroups.Future studies should focus on the precise classification of COPD,the exploration of relevant biomarkers,and the use of dupilumab at different stages of treatment in order to achieve personalized treatment.展开更多
In China,omalizumab is indicated for patients with moderate to severe persistent allergic asthma in whom symptoms remain inadequately controlled despite treatment with inhaled corticosteroids(ICS)in combination with l...In China,omalizumab is indicated for patients with moderate to severe persistent allergic asthma in whom symptoms remain inadequately controlled despite treatment with inhaled corticosteroids(ICS)in combination with long actingβ-agonists(LABA)(GINA step 3 or higher),and urticaria.We report a case of joint and Achilles tendon inflammatory reactions in a patient with Th2-type asthma receiving omalizumab treatment.An adult male presented with recurrent episodes of sneezing,rhinorrhea,wheezing,chest tightness,shortness of breath,and dyspnea.He exhibited allergies to multiple substances and demonstrated impaired lung function,ultimately being diagnosed with allergic rhinitis and asthma.Following initial treatment with ICS and LABA,his symptoms were initially controlled.However,as the disease progressed,the frequency of nocturnal attacks increased,and the incidence of attacks during the allergy season escalated,leading to a significant decline in lung function.Subsequently,he commenced subcutaneous injections of omalizumab at a dosage of 600 mg monthly.There was a partial improvement in the frequency of asthma attacks after two injections.Unfortunately,four days after the first treatment,he reported pain in the right Achilles tendon.Rheumatological screenings,including a five-item antinuclear antibody test and an 11-item autoantibody profile test,revealed no significant abnormalities.Ankle joint ultrasound indicated hyperechoic spots around the Achilles tendon with acoustic shadows,suggesting the presence of Achilles tendinopathy.Ten days later,the pain symptoms resolved spontaneously.Due to the sig-nificant improvement in asthma symptoms,omalizumab treatment continued,albeit with a dosage reduction to 300mg.After intermittent treatment over four sessions,asthma symptoms improved markedly,with the Asthma Control Test(ACT)score increasing from 14 to 20.Lung function improved from moderate obstruction to mild obstruction.The only drawback was the patient’s recurrent swelling,pain,and joint effusion in the joints(specifically the knee and ankle)during the treatment period.Omalizumab is an effective therapeutic option for the treatment of allergic asthma.Although the incidence of adverse events reported in current studies is low,there have been emerging reports of joint swelling,pain,and myalgia reactions in both children and adults receiving treatment for asthma and urticaria.Given the rarity and non-specific nature of these reactions,it is challenging to ascertain the true incidence rate.Previous reports have described symptoms that occur upon initiation of the medication,which can recur upon re-administration.While the factors that may increase the risk of joint inflammatory reactions to omalizumab remain to be elucidated,this case contributes to a deeper understanding of this adverse reaction associated with a well-tolerated and important therapeutic agent.展开更多
Problem:Chest radiography is a crucial tool for diagnosing thoracic disorders,but interpretation errors and a lack of qualified practitioners can cause delays in treatment.Aim:This study aimed to develop a reliable mu...Problem:Chest radiography is a crucial tool for diagnosing thoracic disorders,but interpretation errors and a lack of qualified practitioners can cause delays in treatment.Aim:This study aimed to develop a reliable multi-classification artificial intelligence(AI)tool to improve the accuracy and efficiency of chest radiograph diagnosis.Methods:We developed a convolutional neural network(CNN)capable of distinguishing among 26 thoracic diagnoses.The model was trained and externally validated using 795,055 chest radiographs from 13 datasets across 4 countries.Results:The CNN model achieved an average area under the curve(AUC)of 0.961 across all 26 diagnoses in the testing set.COVID-19 detection achieved perfect accuracy(AUC 1.000,[95%confidence interval{CI},1.000 to 1.000]),while effusion or pleural effusion detection showed the lowest accuracy(AUC 0.8453,[95%CI,0.8417 to 0.8489]).In external validation,the model demonstrated strong reproducibility and generalizability within the local dataset,achieving an AUC of 0.9634 for lung opacity detection(95%CI,0.9423 to 0.9702).The CNN outperformed both radiologists and nonradiological physicians,particularly in trans-device image recognition.Even for diseases not specifically trained on,such as aortic dissection,the AI model showed considerable scalability and enhanced diagnostic accuracy for physicians of varying experience levels(all P<0.05).Additionally,our model exhibited no gender bias(P>0.05).Conclusion:The developed AI algorithm,now available as professional web-based software,substantively improves chest radiograph interpretation.This research advances medical imaging and offers substantial diagnostic support in clinical settings.展开更多
文摘Chronic obstructive pulmonary disease(COPD)is a persistent airflow obstructive disease caused by airway and/or alveolar abnormalities and has become the third leading cause of death worldwide.Dupilumab,the first fully humanized monoclonal antibody targeting the IL-4 receptor subunit alpha(IL-4Rα),is mainly used to treat COPD patients with elevated blood eosinophils that cannot be effectively controlled by traditional drugs.Studies have shown that dupilumab effectively improves pulmonary function,reduces airway inflammation and exacerbation rate,and significantly improves quality of life in COPD patients by blocking interleukin-4(IL-4)and interleukin-13(IL-13)signaling.Several clinical trials and real-world studies have shown that dupilumab significantly reduces the rate of exacerbations,particularly in patients with high baseline eosinophil or FeNO levels.In addition,dupilumab showed positive efficacy in improving lung function,reducing airway inflammation and improving the quality of life of patients.Although the preliminary efficacy of dupilumab in the treatment of COPD is promising,its safety and efficacy need to be further validated,particularly in long-term use and in different patient subgroups.Future studies should focus on the precise classification of COPD,the exploration of relevant biomarkers,and the use of dupilumab at different stages of treatment in order to achieve personalized treatment.
文摘In China,omalizumab is indicated for patients with moderate to severe persistent allergic asthma in whom symptoms remain inadequately controlled despite treatment with inhaled corticosteroids(ICS)in combination with long actingβ-agonists(LABA)(GINA step 3 or higher),and urticaria.We report a case of joint and Achilles tendon inflammatory reactions in a patient with Th2-type asthma receiving omalizumab treatment.An adult male presented with recurrent episodes of sneezing,rhinorrhea,wheezing,chest tightness,shortness of breath,and dyspnea.He exhibited allergies to multiple substances and demonstrated impaired lung function,ultimately being diagnosed with allergic rhinitis and asthma.Following initial treatment with ICS and LABA,his symptoms were initially controlled.However,as the disease progressed,the frequency of nocturnal attacks increased,and the incidence of attacks during the allergy season escalated,leading to a significant decline in lung function.Subsequently,he commenced subcutaneous injections of omalizumab at a dosage of 600 mg monthly.There was a partial improvement in the frequency of asthma attacks after two injections.Unfortunately,four days after the first treatment,he reported pain in the right Achilles tendon.Rheumatological screenings,including a five-item antinuclear antibody test and an 11-item autoantibody profile test,revealed no significant abnormalities.Ankle joint ultrasound indicated hyperechoic spots around the Achilles tendon with acoustic shadows,suggesting the presence of Achilles tendinopathy.Ten days later,the pain symptoms resolved spontaneously.Due to the sig-nificant improvement in asthma symptoms,omalizumab treatment continued,albeit with a dosage reduction to 300mg.After intermittent treatment over four sessions,asthma symptoms improved markedly,with the Asthma Control Test(ACT)score increasing from 14 to 20.Lung function improved from moderate obstruction to mild obstruction.The only drawback was the patient’s recurrent swelling,pain,and joint effusion in the joints(specifically the knee and ankle)during the treatment period.Omalizumab is an effective therapeutic option for the treatment of allergic asthma.Although the incidence of adverse events reported in current studies is low,there have been emerging reports of joint swelling,pain,and myalgia reactions in both children and adults receiving treatment for asthma and urticaria.Given the rarity and non-specific nature of these reactions,it is challenging to ascertain the true incidence rate.Previous reports have described symptoms that occur upon initiation of the medication,which can recur upon re-administration.While the factors that may increase the risk of joint inflammatory reactions to omalizumab remain to be elucidated,this case contributes to a deeper understanding of this adverse reaction associated with a well-tolerated and important therapeutic agent.
基金supported by the Fundamental Research Funds for the Central Universities(2019PT350005)National Natural Science Foundation of China(nos.81970444 and 82300345)+6 种基金Beijing Municipal Science and Technology Project(Z201100005420030)National high level talents special supportplan(2020-RSW02)CAMS Innovation Fund for MedicalSciences(2021-I2M-1-065)Sanming Project of Medicine in Shenzhen(SZSM202011013)the project for the distinguishing academic discipline of Fuwai Hospital(2022-FWQN16)the National High Level Hospital Clinical Research Funding(2023-GSP-QN-23)the National High Level Hospital Clinical Research Funding(2023-GSP-RC-04).
文摘Problem:Chest radiography is a crucial tool for diagnosing thoracic disorders,but interpretation errors and a lack of qualified practitioners can cause delays in treatment.Aim:This study aimed to develop a reliable multi-classification artificial intelligence(AI)tool to improve the accuracy and efficiency of chest radiograph diagnosis.Methods:We developed a convolutional neural network(CNN)capable of distinguishing among 26 thoracic diagnoses.The model was trained and externally validated using 795,055 chest radiographs from 13 datasets across 4 countries.Results:The CNN model achieved an average area under the curve(AUC)of 0.961 across all 26 diagnoses in the testing set.COVID-19 detection achieved perfect accuracy(AUC 1.000,[95%confidence interval{CI},1.000 to 1.000]),while effusion or pleural effusion detection showed the lowest accuracy(AUC 0.8453,[95%CI,0.8417 to 0.8489]).In external validation,the model demonstrated strong reproducibility and generalizability within the local dataset,achieving an AUC of 0.9634 for lung opacity detection(95%CI,0.9423 to 0.9702).The CNN outperformed both radiologists and nonradiological physicians,particularly in trans-device image recognition.Even for diseases not specifically trained on,such as aortic dissection,the AI model showed considerable scalability and enhanced diagnostic accuracy for physicians of varying experience levels(all P<0.05).Additionally,our model exhibited no gender bias(P>0.05).Conclusion:The developed AI algorithm,now available as professional web-based software,substantively improves chest radiograph interpretation.This research advances medical imaging and offers substantial diagnostic support in clinical settings.
