ARDS caused by miliary TB was associated with a high in-hospital mortality rate, with SOFA score on the day of ARDS diagnosis being a valuable prognostic indicator.
Background: In allergic rhinitis, a relevant outcome providing information on the effectiveness of interventions is needed. In MASK-air (Mobile Airways Sentinel Network), a visual analogue scale (VAS) for work is used as a relevant outcome. This study aimed to assess the performance of the work VAS work by comparing VAS work with other VAS measurements and symptom-medication scores obtained concurrently. Methods: All consecutive MASK-air users in 23 countries from 1 June 2016 to 31 October 2018 were included (14 189 users; 205 904 days). Geolocalized users selfassessed daily symptom control using the touchscreen functionality on their smart phone to click on VAS scores (ranging from 0 to 100) for overall symptoms (global), nose, eyes, asthma and work. Two symptom-medication scores were used: the modified EAACI CSMS score and the MASK control score for rhinitis. To assess data quality, the intra-individual response variability (IRV) index was calculated. Results: A strong correlation was observed between VAS work and other VAS. The highest levels for correlation with VAS work and variance explained in VAS work were found with VAS global, followed by VAS nose, eye and asthma. In comparison with VAS global, the mCSMS and MASK control score showed a lower correlation with VAS work. Results are unlikely to be explained by a low quality of data arising from repeated VAS measures. Conclusions: VAS work correlates with other outcomes (VAS global, nose, eye and asthma) but less well with a symptom-medication score. VAS work should be considered as a potentially useful AR outcome in intervention studies.
BACKGROUND AND PURPOSEFunctional roles of the N-terminal region of rhodopsin-like GPCR family remain unclear. Using dopamine D2 and D3 receptors as a model system, we probed the roles of the N-terminal region in the signalling, intracellular trafficking of receptor proteins, and explored the critical factors that determine the functionality of the N-terminal region. EXPERIMENTAL APPROACHThe N-terminal region of the D2 receptor was gradually shortened or switched with that of the D3 receptor or a non-specific sequence (FLAG), or potential N-terminal glycosylation sites were mutated. Effects of these manipulations on surface expression, internalization, post-endocytic behaviours and signalling were determined. KEY RESULTSShortening the N-terminal region of the D2 receptor enhanced receptor internalization and impaired surface expression and signalling; ligand binding, desensitization and down-regulation were not affected but their association with a particular microdomain, caveolae, was disrupted. Replacement of critical residues within the N-terminal region with the FLAG epitope failed to restore surface expression but partially restored the altered internalization and signalling. When the N-terminal regions were switched between D2 and D3 receptors, cell surface expression pattern of each receptor was switched. Mutations of potential N-terminal glycosylation sites inhibited surface expression but enhanced internalization of D2 receptors. CONCLUSIONS AND IMPLICATIONSShortening of N-terminus or mutation of glycosylation sites located within the N-terminus enhanced receptor internalization but impaired the surface expression of D2 receptors. The N-terminal region of the D2 receptor, in a sequence-specific manner, controls the receptor's conformation and integration into the plasma membrane, which determine its subcellular localization, intracellular trafficking and signalling properties.
A case of endotracheal tuberculosis with expectorations of the lateral one-third of the multiple tracheal cartilages is reported. Fibreoptic bronchoscopy revealed caseous materials and loosening of the tracheal cartilages. The patient expectorated cartilaginous material several times before and after fibreoptic bronchoscopy. In spite of the loss of tracheal cartilages, tracheal lumen was maintained with a mild airflow limitation. The remaining two-thirds of the tracheal cartilage rings seemed to be strong enough to support the tracheal lumen opening during the respiratory cycle. Endobronchial tuberculosis is listed as one of the serious complications of pulmonary tuberculosis. Expectoration of bronchial cartilage is extremely rare in endobronchial tuberculosis. Only three previously reported cases have been found [1±3]. Coughing up tracheal cartilages has not been reported before. Such a case is reported in this study. Case reportA 29 yr-old female, with a history of tuberculous lymphadenitis, presented with a severe barking cough and mild dyspnoea. She had noted cough, sputum and mild dyspnoea 2 months prior to visiting our hospital. She had taken some medications without improvement. She noted increasing dyspnoea in the supine position. On questioning, one day before the visit, she had expectorated three or four hard objects during coughing. On physical examination, her vital signs were stable. There was no wheezing or crackling sound during auscultation. Laboratory findings were within normal range. The sputum smear for acid-fast bacilli was positive. The chest radiograph showed faint fibro-streaky densities involving the left upper lobe. The forced vital capacity (FVC) was 2.32 L (63% of predicted), forced expiratory volume at 1 second (FEV1 ) 2.09 L (61% pred), peak inspiratory flow (PIF) 2 L . min -1 . On the flow volume curves, the inspiratory limb had a very flat appearance, which suggests the presence of upper airway obstructive lesions ( fig. 1).Bronchoscopy revealed deep ulcers and two projections of cartilage on the left side of the distal trachea ( fig. 2). Multiple, yellowish mucosal elevations were also noted in the distal trachea. The orifice of the left main bronchus was narrowed with caseous material. After the bronchoscopy, the patient expectorated two tracheal cartilages, which were the lateral one-third part of the tracheal cartilage ( fig. 3). After two weeks of treatment with antituberculosis drugs, the second bronchoscopy showed one small remaining tracheal cartilage with caseous material between the distal trachea and the orifice of the left main bronchus. The remaining small tracheal cartilage was removed by biopsy forceps. After treatment with antituberculosis drugs for 6 months and with corticosteroid for 1 month, the third bronchoscopy was performed. The last bronchoscopy was performed 2 yrs after the initial diagnosis. There were no significant differences between the two periods. The mucosal lesions of tuberculosis were completely healed. There was no progressive tracheal...
SETTING: Five referral hospitals, South Korea.OBJECTIVE: To assess epidemiological changes in TB before and during the COVID-19 pandemic.DESIGN: This was a multicentre cohort study of 3,969 patients diagnosed with TB.RESULTS: We analysed 3,453 patients diagnosed with TB prior to the COVID-19 pandemic (January 2016–February 2020) and 516 during the pandemic (March–November 2020). During the pandemic, the number of patients visits declined by 15% from the previous 4-year average, and the number of patients diagnosed with TB decreased by 17%. Patients diagnosed during the pandemic were older than those diagnosed before the pandemic (mean age, 60.2 vs. 56.6 years, P < 0.001). The proportion of patients to have primary TB at a younger age (births after 1980) among those diagnosed with TB was significantly lower during the pandemic than before (17.8% in 2020 vs. 23.5% in 2016, 24.0% in 2017, 22.5% in 2018, 23.5% in 2019; P = 0.005).CONCLUSIONS: The COVID-19 pandemic resulted in a reduction in the number of visits to respiratory departments, leading to fewer patients being diagnosed with TB. However, our results suggest that universal personal preventive measures help to suppress TB transmission in regions with intermediate TB burden.
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