The European respiratory journal : official journal of the European Society for Clinical Respiratory Physiology
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Observational Study
Predictors of delirium after cardiac surgery in patients with sleep disordered breathing.
Delirium ranks among the most common complications after cardiac surgery. Although various risk factors have been identified, the association between sleep disordered breathing (SDB) and delirium has barely been examined so far. Here, our objectives were to determine the incidence of post-operative delirium and to identify the risk factors for delirium in patients with and without SDB. ⋯ Among the established risk factors for delirium, central sleep apnoea was independently associated with delirium. Our findings contribute to identifying patients at high risk of developing post-operative delirium who may benefit from intensified delirium prevention strategies.
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Protective immunity against Mycobacterium tuberculosis is poorly understood. The role of interleukin (IL)-4, the archetypal T-helper type 2 (Th2) cytokine, in the immunopathogenesis of human tuberculosis remains unclear. Blood and/or bronchoalveolar lavage fluid (BAL) were obtained from participants with pulmonary tuberculosis (TB) (n=23) and presumed latent TB infection (LTBI) (n=22). ⋯ Blocking IL-4 significantly neutralised mycobacterial containment (p=0.03), CD4+IFNγ+ levels (p=0.03) and Treg expression (p=0.03). IL-4 can subvert mycobacterial containment in human macrophages, probably via perturbations in Treg and Th1-linked pathways. These data may have implications for the design of effective TB vaccines and host-directed therapies.
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Patients with fibrotic interstitial lung disease (ILD) frequently develop resting or exertional hypoxaemia. There is heterogeneity in clinical practice and a paucity of evidence guiding supplemental oxygen use in this patient population. The objectives of this study were to build international expert-based consensus on the indications and goals of supplemental oxygen from the perspective of healthcare providers, and identify potential barriers to its access. ⋯ Experts achieved consensus on 20 items guiding supplemental oxygen use in fibrotic ILD. These findings may inform research, clinical recommendations and funding policy.