Airwaves Highlights from this issue Thorax: first published as 10.1136/thoraxjnl-2020-214580 on 4 March 2020. Downloaded from

doi:10.1136/thoraxjnl-2020-214580 The Triumvirate

To celebrate the current six nations rugby in bronchiolitis admission rates is explained by Crown. This focus on the home was employed tournament, this month’s Airwaves draws local demographic characteristics. It is unlikely by Duiverman and colleagues (see page 244) in inspiration from the giants (literally) that GPS tracking of rugby players will predict their clinical trial investigating the home initi- later hospitalisation but at least it will make ation of non-­invasive ventilation, with the use comprising the national teams of England, sure no one is slacking! of telemedicine, in stable hypercapnic COPD. Wales, Scotland, Ireland, France and Italy. Primary outcome was daytime arterial carbon No matter which team you are rooting for Grand Slam dioxide pressure reduction after 6 months there is something for everyone in this issue! The Six nations Grand Slam happens when one NIV treatment. Home NIV initiation was non-­ team wins all the games in the competitions inferior to in-hospital­ initiation with the both Back pain and hypoxia from the and was last won by Wales in 2019. There are groups showing a PaCO2 reduction at 6 months Irish team a number of different types of Grand Slam and compared with baseline. Indeed, health-related­ Ireland won the Six Nations Championship in in interstitial lung disease the combination of quality of life improved similarly in both groups 2018 – a tournament marred by numerous inju- infection on the background of progressive with reduced cost in the home initiation group. ries, including back injuries. This month’s pulmo- pulmonary fibrosis leads tom the Grand Slam There is no place like home as Dr Hill discusses nary puzzle (see page 290) comes from another of an acute exacerbation with an uncomfort- in the accompanying editorial (see page 196). Irish team – from Galway University Hospitals in ably high mortality rate of around 75%. In the West of Ireland. The authors describe unex- this issue of Thorax (see page 227) Cho and Zinc muscle rub pected pre-operative­ hypoxaemia in a patient colleagues define the mechanism of altered With so many games being played, both domes- with a back injury – although the individual in metabolism in the development of acute exac- tically and in Europe, the chances of having question was an octogenarian and a little too erbations of pulmonary fibrosis. They used a everyone available for all the matches are slim old for the Ireland squad. The Triumvirate don’t bleomycin model of pulmonary fibrosis in mice to none so the coaches such as Eddie Jones, engage in plot spoilers but suffice to say that the with myeloid deficiency of Glut1 or global Noel McNamara, Gregor Townsend and Wayne diagnosis was reached with the help of echocar- deficiency of the Aim2 genes and induced an Pivac must simply cross their fingers and pray diography and a surgical intervention proved acute exacerbation with S. pneumonia infec- that players do not suffer an injury. Perhaps the effective. As the 2020 Six Nations Tournament tion. They demonstrated that these mice had coaching staff can consider zinc supplementa- begins, let’s hope for no collapsed vertebrae. At reduced fibrosis following infection suggesting tion similar to Wessel and colleagues (see page least one of The Triumvirate will be cheering for that GLUT1 mediated glycolysis was important 253) who used this to ameliorate acute lung another Irish victory! for the development of regulating the AIM2 injury (ALI) by reducing neutrophil recruitment inflammasome and subsequent lung fibrosis. and activity. Unlike rugby players, the authors Maybe GLUT1 deficiency will be the only way investigated the effect of zinc on deregulated to prevent another Welsh Grand Slam? neutrophil recruitment and hyper-activation­ in Raging rugby an ALI mouse model. Injecting zinc 24 hours http://thorax.bmj.com/ prior to lipopolysaccharide-induced­ ALI It has been said that Rugby Union is ‘a game decreased the recruitment of neutrophils to the for thugs played by male’ and indeed the lungs and prevented their hyperactivity. Using brutal rage on show can be quite shocking at zinc supplementation could be considered to times. In this issue of Thorax (see page 209) prevent acute lung injury, but The Triumvirate Zhang and colleagues investigate a different are unsure if Eddie, Noel, Gregor and Wayne ‍ ‍ type of shock to understand how the immune should rub zinc into the injuries of their players. system’s response to shock may contribute to GPS and rugby coaching the lethality of haemorrhage. They found that GPS tracking of the activity of individual on September 29, 2021 by guest. Protected copyright. group two innate lymphoid cells (ILC2s) are World TB Day 2020 players on the field is now widely used in elite increased after haemorrhagic shock. In an in level rugby coaching. For an in depth discussion As well as celebrating rugby prowess, our March vivo model the investigators demonstrated issue draws your attention to World TB Day on 24 of this topic please see: Int J Sports Sci Coach. that increased RAGE signalling promoted type 2016;11(2):200–11. Another use of geospatial March. Please see our TB articles in this issue (see two cytokine mediated inflammation and lung pages 269 and 292). data is described by Lewis and colleagues in injury which contributes to the adverse conse- Thorax this month (see page 262). The authors quences of haemorrhagic shock. So it would Funding The authors have not declared a specific (from the England team) measured deprivation appear that in life, as in Rugby, if you dial down grant for this research from any funding agency in the indices for geographic areas in England and your rage, you can reduce the consequences of public, commercial or not-­for-­profit sectors. compared these with bronchiolitis admission shock. rates and with the timing of the winter peak in Competing interests None declared. admissions. They found a positive association Home nations Patient consent for publication Not required. between area level deprivation and bronchi- In 1883, the first Home Nations Championship olitis admission rates as well as an association was played between England, Ireland, Scotland Provenance and peer review Commissioned; between higher population densities and the and Wales with victories by any Home Nation internally peer reviewed. timing of the peak of the winter epidemic. They over all of the other three Home Nations in © Author(s) (or their employer(s)) 2020. No commercial conclude that around a quarter of the variation one Championship season termed the Triple re-­use. See rights and permissions. Published by BMJ.

Thorax March 2020 Vol 75 No 3 193