Visualization Analysis of Research Trends and Hotspots in Inspiratory Muscle Training.

BACKGROUND Inspiratory muscle training (IMT) aims to train inspiratory muscles based mainly on the diaphragm by applying a load resistance during the inspiratory process. Many papers related to IMT have been published in various journals; however, no articles objectively and directly present the development trends and research hotspots of IMT. Therefore, this study used CiteSpace to visually analyze recent IMT-related publications to provide valuable information for future IMT-related studies. MATERIAL AND METHODS CiteSpace was applied to analyze the IMT-related publications by countries, institutions, journals, authors, references, and keywords. RESULTS We included 504 papers. The number of IMT-related publications trended upward between 2009 and 2022. Leuven had the highest number of publications by an institution. The American Journal of Respiratory and Critical Care Medicine was the most frequently co-cited journal. Half of the top 10 references cited were from Journal Citation Reports (JCR) Q1 and half were about the application of IMT in chronic obstructive pulmonary disorder. Gosselink was the author with the highest number of publications and Aldrich was the author with the highest co-citation frequency. The preponderance of studies on the surgical population and postoperative pulmonary complications reflects potential application of IMT in enhanced recovery after surgery. CONCLUSIONS This study provides scholars with important information related to IMT research. It analyzes IMT research trends and status, which can help researchers identify primary topics in the field and find ways to explore new research directions to promote the application of IMT in clinical practice and the cooperation of IMT-related disciplines.

Exhausting T Cells During HIV Infection May Improve the Prognosis of Patients with COVID-19.

T-cell reduction is an important characteristic of coronavirus disease 2019 (COVID-19), and its immunopathology is a subject of debate. It may be due to the direct effect of the virus on T-cell exhaustion or indirectly due to T cells redistributing to the lungs. HIV/AIDS naturally served as a T-cell exhaustion disease model for recognizing how the immune system works in the course of COVID-19. In this study, we collected the clinical charts, T-lymphocyte analysis, and chest CT of HIV patients with laboratory-confirmed COVID-19 infection who were admitted to Jin Yin-tan Hospital (Wuhan, China). The median age of the 21 patients was 47 years [interquartile range (IQR) = 40-50 years] and the median CD4 T-cell count was 183 cells/µl (IQR = 96-289 cells/µl). Eleven HIV patients were in the non-AIDS stage and 10 were in the AIDS stage. Nine patients received antiretroviral treatment (ART) and 12 patients did not receive any treatment. Compared to the reported mortality rate (nearly 4%-10%) and severity rate (up to 20%-40%) among COVID-19 patients in hospital, a benign duration with 0% severity and mortality rates was shown by 21 HIV/AIDS patients. The severity rates of COVID-19 were comparable between non-AIDS (median CD4 = 287 cells/µl) and AIDS (median CD4 = 97 cells/µl) patients, despite some of the AIDS patients having baseline lung injury stimulated by HIV: 7 patients (33%) were mild (five in the non-AIDS group and two in the AIDS group) and 14 patients (67%) were moderate (six in the non-AIDS group and eight in the AIDS group). More importantly, we found that a reduction in T-cell number positively correlates with the serum levels of interleukin 6 (IL-6) and C-reactive protein (CRP), which is contrary to the reported findings on the immune response of COVID-19 patients (lower CD4 T-cell counts with higher levels of IL-6 and CRP). In HIV/AIDS, a compromised immune system with lower CD4 T-cell counts might waive the clinical symptoms and inflammatory responses, which suggests lymphocyte redistribution as an immunopathology leading to lymphopenia in COVID-19.