Lung最新文献

Background: Along with lung volume reduction surgery (LVRS), bronchoscopic lung volume reduction is a treatment option for end-stage emphysema. However, comparisons among interventions remain insufficient.

Methods: We searched on PubMed, CENTRAL, Embase, and Web of Science. We included randomized controlled trials with outcomes measuring mid-term mortality within 6 months, changes in forced expiratory volume in one second (FEV₁), St. George's Respiratory Questionnaire (SGRQ), six-minute walk distance (6MWD) from baseline, adverse event related to procedures, and long-term mortality within 5 years. Bayesian network meta-analysis was performed. The certainty was assessed by CINeMA.

Results: Twenty-five randomized controlled trials involving 4,283 patients were included, identifying seven types of procedures and standard of care. Mid-term mortality increased in LVRS and endobronchial valve (EBV) (LVRS, risk ratio [RR] 3.26, 95% CrI 1.98-6.21, low certainty; EBV, RR 2.06 95% CrI 1.07-4.36, moderate certainty). LVRS showed the largest improvements: change in FEV₁ (187.2 mL, 95% CrI 166.4-209.6), 6MWD (42.2 m, 95% CrI 33.2-50.5), and SGRQ (- 13.29 points, 95% CrI - 27.25-0.75). Among bronchoscopic procedures, high efficacy was noted in EBV and endobronchial coil (EBC) for FEV₁ changes (EBV, 111.8 mL, 95% CrI 92.2-136.2; EBC, 74.1 mL, 95% CrI 47.6-101.7). Pneumothorax increased in these two procedures (EBV, RR 12.75, 95% CrI 5.52-35.48; EBC, RR 4.95, 95% CrI 1.12-40.90).

Conclusion: LVRS offers high efficacies but is accompanied by increased mid-term mortality. EBV and EBC also showed effectiveness; however, they increased pneumothorax, and EBV slightly increased mortality. For accurate assessment, long-term survival data of BLVR are needed.

Purpose: To determine effects of colonization with multidrug-resistant bacteria (MDRB) in general wards on characteristics, treatment, and prognosis of hospital-acquired pneumonia (HAP).

Methods: This was a multicenter retrospective cohort study of patients with HAP admitted to 16 tertiary or university hospitals in Korea from July 2019 to December 2019. From the entire cohort, patients who developed pneumonia in general wards with known colonization status before the onset of pneumonia were included in this study. Patients were categorized into a colonization group and a non-colonization group according to MDRB colonization. Patients of the two groups were then compared.

Results: Among a total of 400 patients, 63 were in the MDRB colonization group. HAP caused by MDR-Staphylococcus aureus or MDR-Pseudomonas aeruginosa was more common in the colonization group than in the non-colonization group (24.4% vs. 8.1%, P = 0.006 or 20.0% vs. 5.4%, P = 0.013, respectively). Colonization with certain bacteria was correlated with subsequent infection with the same bacteria. Carbapenem use (36.5% vs. 24.3%, P = 0.044) and appropriateness of initial antibiotics (50.8% vs. 12.8%) were higher in the colonization group than in the non-colonization group. Although in-hospital mortality was similar in the two groups (34.9% vs. 32.9%, P = 0.759), hospital length of stay was longer (38 days vs. 31 days, P = 0.009) and rate of discharge to home was lower (34.1% vs 59.7%, P = 0.002) in the colonization group.

Conclusions: Colonization with MDRB might influence characteristics and treatment of HAP. However, prognosis of HAP was not associated with MDRB colonization.

Purposes: Immunoglobulin G4-related disease (IgG4-RD) and plasma cell-type idiopathic multicentric Castleman disease (PC-iMCD) have many overlapping features. Their differential diagnosis is challenging and crucial for clinical management due to their different prognoses and treatments. However, reports that compare these conditions are scarce, especially for patients with lung involvement. In this study, we attempted to clarify the clinical and radiologic differences in lung involvement between IgG4-RD and PC-iMCD.

Methods: Patients with IgG4-RD or PC-iMCD who exhibited lung involvement were enrolled. Clinical and chest CT findings at baseline were compared.

Results: A total of 178 patients with IgG4-RD and 61 patients with PC-iMCD exhibited lung involvement. The IgG4-RD group consisted of older patients (P < 0.001) and had a higher male‒female ratio (P = 0.004). Patients with PC-iMCD were more inclined to present constitutional and respiratory symptoms, anemia, thrombocytosis and hypoalbuminemia (all P < 0.001). Although IgG4 levels were commonly elevated in both diseases, they were significantly greater in the IgG4-RD (median: 16,100 mg/L) than in the PC-iMCD (median: 3130 mg/L) (P < 0.001). Patients with IgG4-RD showed significantly lower levels of IgG, IgA, IgM (median: 21.59 g/L, 1.70 g/L, and 0.68 g/L, respectively) than in the PC-iMCD (median: 34.42 g/L, 4.85 g/L, and 2.11 g/L, respectively) (all P < 0.001). The levels of CRP, ESR and IL-6 were significantly greater in the PC-iMCD (median: 72.15 mg/L, 103 mm/h, and 18.30 pg/mL, respectively) than that in the IgG4-RD (median: 1.54 mg/L, 22 mm/h, and 2.85 pg/mL, respectively) (all P < 0.001). Although both nodular lesions and thickened bronchovascular bundles were common in these two diseases, PC-iMCD patients presented more extensive nodular lesions (P < 0.001), and IgG4-RD patients presented more diffuse thickened bronchovascular bundles (P < 0.001). Cysts were almost exclusively observed in PC-iMCD patients.

Conclusions: Compared with IgG4-RD, PC-iMCD is a more aggressive condition, associated with more common symptoms and more severe inflammation. Radiologically, extensive nodular lesions or cysts suggest a diagnosis of PC-iMCD, whereas diffuse thickened bronchovascular bundles indicate a diagnosis of IgG4-RD.

Background: Hemoptysis, the expectoration of blood from the lower respiratory tract, varies in severity and necessitates effective management to mitigate morbidity. Traditional treatments include bronchial artery embolization and pharmacological approaches. Tranexamic acid (TXA), an antifibrinolytic agent known for its efficacy in reducing bleeding during surgery and trauma, is being explored for its efficacy in treating Hemoptysis via both intravenous and inhalational routes. Inhalational administration has garnered interest because of its targeted action and minimal systemic effects. This study aimed to assess the effectiveness of inhalational TXA in nonmassive hemoptysis.

Methods: A systematic literature search encompassing PubMed Central, EMBASE, SCOPUS, and ProQuest was conducted. Randomized controlled trials (RCTs) and observational studies assessing the effectiveness of inhalational tranexamic acid for nonmassive hemoptysis were included. Comparative intervention effect estimates from meta-analyses are reported as pooled odds ratios and pooled mean differences with 95% confidence interval (CI).

Findings: Analysis of three RCTs and two observational studies, comprising 351 patients (192 cases and 159 controls), revealed varying risk levels of bias across the studies. Nebulized tranexamic acid was 3.85 times more likely to achieve hemoptysis cessation than alternative treatments across all RCTs. Moreover, patients receiving nebulized tranexamic acid required fewer (43%) pulmonary interventional procedures than those receiving other treatments. Despite showing a trend towards reducing posttherapy bleeding (20 ml less), conclusive results were hindered by wide CI, necessitating further investigation.

Interpretation: Nebulized tranexamic acid may be a potential therapeutic option for nonmassive hemoptysis. While our analysis suggests its potential benefits in halting bleeding and reducing the need for invasive procedures, the quality of the available evidence is limited due to the risk of bias and study limitations. This underscores the necessity for additional randomized controlled trials with larger sample sizes and rigorous study designs to strengthen evidence and optimize clinical utility.

Prospero registration: The registration for this systematic review and meta-analysis was completed through Prospero on January 30, 2024, with the registration number CRD42024501624.

Purpose: Electronic noses (eNose) and gas chromatography mass spectrometry (GC-MS) are two important breath analysis approaches for differentiating between respiratory diseases. We evaluated the performance of a novel electronic nose for different respiratory diseases, and exhaled breath samples from patients were analyzed by GC-MS.

Materials and methods: Patients with lung cancer, pneumonia, structural lung diseases, and healthy controls were recruited (May 2019-July 2022). Exhaled breath samples were collected for eNose and GC-MS analysis. Breathprint features from eNose were analyzed using support vector machine model and leave-one-out cross-validation was performed.

Results: A total of 263 participants (including 95 lung cancer, 59 pneumonia, 71 structural lung disease, and 38 healthy participants) were included. Three-dimensional linear discriminant analysis (LDA) showed a clear distribution of breathprints. The overall accuracy of eNose for four groups was 0.738 (194/263). The accuracy was 0.86 (61/71), 0.81 (77/95), 0.53 (31/59), and 0.66 (25/38) for structural lung disease, lung cancer, pneumonia, and control groups respectively. Pair-wise diagnostic performance comparison revealed excellent discriminant power (AUC: 1-0.813) among four groups. The best performance was between structural lung disease and healthy controls (AUC: 1), followed by lung cancer and structural lung disease (AUC: 0.958). Volatile organic compounds revealed a high individual occurrence rate of cyclohexanone and N,N-dimethylacetamide in pneumonic patients, ethyl acetate in structural lung disease, and 2,3,4-trimethylhexane in lung cancer patients.

Conclusions: Our study showed that the novel eNose effectively distinguishes respiratory diseases and holds potential as a point-of-care diagnostic tool, with GC-MS identifying candidate VOC biomarkers.

Purpose: This study examined the concavity (angle β, central and peripheral concavity) of the descending limb of the maximal expiratory flow-volume (MEFV) curves to reflect various ventilatory defects, including obstructive, restrictive, or mixed patterns.

Methods: We conducted a cross-sectional study collecting spirometry data from a healthcare center and a tertiary hospital between 2017 and 2022, with additional raw flow-volume curve data from primary healthcare institutions in 2023. We analyzed differences in concavity between spirometric patterns. Receiver operating characteristic curves were used to assess the predictive power of concavity for spirometric patterns. The relationship among concavity indices was examined.

Results: This study included 18,938 cases, with 22% exhibiting an obstructive pattern. The dataset comprised 14,868 cases for training, 3716 cases for validation, and 354 cases for testing. In the training set, the mean angle β were 180.3 ± 12.4 and 148.5 ± 12.7 degrees in normal and obstruction patterns. The angle β had an AUC of 0.970 (95% CI 0.966-0.973) for identifying normal and obstructive patterns, with a cut-off value of 163.0 degrees. In the validation set, out of 2311 cases with a normal forced vital capacity (FVC), 3.1% cases exhibited a Z-score of forced expiratory volume in 1 s to FVC ratio (FEV₁/FVC) ≥  - 1.645 but an angle β < 163.0 degrees. In testing set, a correlation coefficient of - 0.96 and - 0.79 was found between the angle β and the central or peripheral concavity.

Conclusion: The concavity of the descending limb of MEFV curves may be crucial in identifying spirometric patterns.

Background: The antibiotic resistance of Pseudomonas aeruginosa (PA) is increasingly severe in bronchiectasis patients. However, there is currently a lack of research on the clinical outcomes of carbapenem-resistant PA (CRPA) isolation in hospitalized exacerbations of bronchiectasis (HEB) patients. We investigated the incidence, risk factors, and clinical outcomes of PA and CRPA isolation in HEB patients.

Methods: This was an observational, retrospective cohort study of PA and CRPA isolated from sputum or bronchoalveolar lavage fluid cultures of HEB patients from January 1, 2018 to December 31, 2022. The primary outcomes were respiratory failure, mechanical ventilation, and length of hospital stay. The incidence, risk factors, and clinical outcomes of PA and CRPA isolation were analyzed using multivariate logistic and Poisson regression.

Results: Among 1,286 patients, the prevalence of PA, CRPA, and multi-drug resistant PA isolation was 20.61% (n = 265), 3.81% (n = 49), and 5.83% (n = 75), respectively. CRPA isolation was associated with an increased risk for respiratory failure (adjusted odds ratio (aOR) 2.56; 95% confidence interval (CI) [1.29, 5.11]; p = 0.007), mechanical ventilation (aOR 3.65; 95% CI [1.50, 8.92]; p = 0.004), and length of hospital stay (Coefficient (Coef) 0.27; 95% CI [0.18,0.35]; p < 0.001) compared to non-CRPA. Antibiotic treatment decreased the risk of respiratory failure (aOR 0.37; 95% CI [0.17, 0.80]; p = 0.011), mechanical ventilation (aOR 0.36; 95% CI [0.13, 0.99]; p = 0.047), and length of hospital stay (Coef - 0.23; 95% CI [- 0.33, - 0.14]; p < 0.001).

Conclusions: CRPA isolation was identified in more severe bronchiectasis patients and significantly increased the risk of respiratory failure, mechanical ventilation and length of hospital stay, while antibiotic treatment reduced this risk.

Purpose: Idiopathic pulmonary fibrosis (IPF) is a chronic, progressive fibrotic lung disorder characterized by dry cough, fatigue, and exacerbated dyspnea. The prognosis of IPF is notably unfavorable, becoming extremely poor when the disease advances acutely. Effective therapeutic intervention is essential to mitigate disease progression; hence, early diagnosis and treatment are paramount. When high-resolution computed tomography (HRCT) reveals usual interstitial pneumonia (UIP), a diagnosis of IPF can be established. However, when HRCT fails to conclusively confirm IPF, the diagnostic pathway becomes intricate and necessitates a multidisciplinary approach involving clinicians, radiologists, and pathologists. Consequently, the objective of this study was to investigate new diagnostic approaches through bronchoalveolar lavage (BAL) analysis.

Methods: BAL is a commonly utilized diagnostic tool for interstitial lung diseases. We review the application of bronchoalveolar lavage (BALF) in idiopathic pulmonary fibrotic disease, emphasizing that the cellular and solute composition of the lower respiratory tract offers valuable insights.

Results: This review delineates the advancements in diagnosing IPF cases that remain indeterminate via HRCT, leveraging BALF analysis. In contrast to surgical lung biopsy, BAL is minimally invasive and offers potential diagnostic utility through the identification of specific BALF biomarkers.

Conclusion: Augment the clinical diagnostic armamentarium for IPF, particularly in scenarios where HRCT findings are inconclusive.

Purpose: Patients with chronic lower respiratory diseases (CLRD) are at a higher risk of lung cancer. Less is known regarding how the risk of CLRD-associated lung cancer death might have changed on a national scale over the past 20 years across demographic and regional groups.

Methods: We calculated age-adjusted mortality rates (AAMR) for lung cancer death among people with CLRD using 1999-2020 data from the CDC WONDER multiple cause of death database. Rates were compared between demographic groups and time periods.

Results: Rates of lung cancer death among people with CLRD were highest among White Americans compared to other racial groups. Elevated rates of lung cancer death were seen among men (AAMR = 25.054, 95% CI: 24.960-25.148) and those aged 65 + (AAMR = 44.776, 95% CI: 44.638-44.913) compared to their counterparts. Rates were higher in the Midwest (AAMR ratio = 1.410, 95% CI: 1.401-1.418) and the South (AAMR ratio = 1.290, 95% CI: 1.282-1.298) compared to the Northeast. Rates were elevated in rural areas (AAMR ratio = 1.444, 95% CI: 1.438-1.451). Between 1999 and 2004 and 2016-2020, the AAMR of CLRD-associated lung cancer death decreased from 21.647 (95% CI: 21.528-21.765) to 17.221 (95% CI: 17.123 - 17.318). Rates decreased over time across demographic groups.

Conclusion: CLRD-associated lung cancer deaths significantly decreased in the United States between 1999 and 2020. Despite this progress, White people, men, older adults (65 +), and people in rural areas continue to experience higher CLRD-associated lung cancer mortality rates than their counterparts.