Pneumologie最新文献

Background: Smoking of tobacco and cannabis is widespread in Germany. Preventing children and adolescents from starting to use these products is an important goal of prevention. The aim of the present study was to examine how often depiction or mention of cannabis and nicotine use occurs in German-language music videos, which can be seen as advertising for smoking.

Method: The sample, which comprised the population of all German-language music videos listed in the YouTube Top 100 Charts in 2023, included 600 music videos. Using a coding scheme, the music videos were categorised as 'smoke-free' or 'not smoke-free' and the depiction or mention of consumption was counted.

Results: Of the videos examined, 54.7% (n=328) contained at least one depiction or mention of cannabis or tobacco use; 31.7% of the videos (n=190) were exclusively about tobacco use, 12.5% of the videos (n=75) were exclusively about cannabis use, and 10.5% (n=63) were about both. While tobacco or cannabis use was shown or mentioned in 67.0% of the videos from the 'German rap' genre, the average for the other genres was 20.6% (OR=7.83; p<0.001). When considering cannabis use alone, the difference between the genres was even more pronounced. The proportion of videos in which cannabis was shown or mentioned was 29.7% in the 'German rap' genre and 4.4% in the other genres (OR=9.27; p<0.001). The 328 videos in which tobacco or cannabis use was shown received 3.2 billion clicks (64.5% of clicks). This means that these 328 videos generated a total of 9.7 trillion impressions. Of these, 5.8 trillion impressions were about nicotine use and 3.9 trillion about cannabis use.

Discussion: Music videos expose children and adolescents to a wide range of scenes of nicotine and cannabis use, which remains largely unregulated.

Aspiration pneumonia (AP) may present as gross aspiration of large gastric contents or as a consequence of silent aspiration of contaminated oropharyngeal secretions.AP due to silent aspiration is caused by dysphagia and, in some instances, impaired cough reflex. Factors favouring the development of pneumonia include advanced age as well as severe comorbidity and impaired functional status.Therefore, silent aspiration is a frequent etiology of community-acquired pneumonia in aged patients but also of nosocomial pneumonia. Recurrent pneumonia should always prompt the consideration of AP.Treatment of acute AP should include not only the use of antimicrobial agents but also chest physiotherapy and airway clearance techniques. In addition, all patients with silent aspiration and AP should be subject to an investigation of swallowing function and, in the presence of dysphagia, also receive treatment for this condition. This includes methods of restitution, compensation and adaptation of impaired swallowing function.

Treatment perspectives for non-small cell lung cancer (NSCLC) have been significantly expanded by the integration of immune checkpoint inhibitors into multimodal therapy concepts. Currently, combined, immune checkpoint-inhibitor-based therapy concepts are also advancing into early, resectable stages of NSCLC. Neoadjuvant and perioperative chemoimmunotherapy opened up a promising new preoperative treatment approach, but also raises some new questions and challenges. With the expanded perioperative treatment options and the perspective on a further improvement in the absence of recurrence after tumor resection, there is push towards comprehensively collecting therapy-relevant findings for imaging, molecular and histopathological diagnostics at an early stage. All patients with lung carcinoma, regardless of the therapy intention, should be presented to an interdisciplinary tumor board with thoracic oncological expertise. This is regularly given in certified lung cancer centers.A standardized procedure contributes to optimized pre-therapeutic diagnostics and facilitates coordination for the best possible multimodal approach in the interdisciplinary tumor board. In the case of centrally located resectable tumors, for example, neoadjuvant treatment increases the chances of a procedure that is as parenchymal sparing as possible. Some questions cannot yet be answered conclusively. Perioperative systemic therapy with molecular-targeted and immune checkpoint inhibitors is the subject of numerous ongoing studies. The considerable dynamics in newly approved therapies and the development of perioperative therapy concepts require continuous adaptation of diagnostic algorithms and standards. Integration into standard pre-surgical routine makes rapid classification of the relevant findings as well as close coordination between the diagnostic and interventional disciplines essential.

Bronchoscopy has changed considerably in recent years as a result of technical innovations and health economic pressure. There is little current information available on the reality of bronchoscopy care in Germany.

Methodology: In September 2022, sites where bronchoscopy was carried out were systematically surveyed regarding structural and process quality features in an anonymized DGP survey with 33 questions. The data collected were analyzed descriptively.

Results: Of the 196 participating sites, bronchoscopies were performed regularly at 180 sites. The majority were standard secondary care (n=51) and tertiary care (n=43) hospitals (range of services: diagnostic bronchoscopy, predominantly (80%) including endobronchial ultrasound-guided transbronchial needle aspiration, EBUS-TBNA). Extended treatment options were guaranteed for acute cases at >90% of these locations. University hospitals (n=24) and specialist pulmonary hospitals (n=35) also offered more complex diagnostic procedures and therapeutic-interventional techniques. The performance figures were significantly higher in the specialist pulmonary hospital (specialist pulmonary hospitals: 62%: >2000 bronchoscopies/year; university hospitals: 25%: >2000 bronchoscopies/year; p<0.001). In the practice setting (n=21, partly in co-operation with hospitals) , <500 bronchoscopies/year were performed.Intensive care units were available in 97% of the hospitals; 88% of the hospitals had fluoroscopy facilities in the bronchoscopy room. Propofol (91%) and/or midazolam (62%) were the preferred drugs for sedation. At 21% of the sites, >200 bronchoscopies under ventilation/year were performed. BAL and transbronchial forceps biopsies were mainly performed via the nasal or oral approach, EBUS-TBNA via a bronchoscopy tube or the oral approach, the EBUS mini-probe/navigation, cryotechnique or more complex interventions via the rigid tube or a bronchoscopy tube. ASA >2 led to involvement of a second physician at 46% of clinical sites, at 47% of sites at an ASA classification >3.

Conclusion: The majority of bronchoscopic examinations are performed in respiratory departments at secondary care centres as well as maximum care hospitals. For more complex procedures, cooperation with hospitals specialized in bronchoscopy (e.g. university hospital or a specialist lung clinic) is advisable.

Bronchoscopy courses should be an integral part of bronchoscopy training. Course graduates should be familiar with the indications, prerequisites and technical possibilities of bronchoscopy. In addition to theoretical content, practical bronchoscopic skills are taught and trained in small supervised groups using various methods of simulation-based bronchoscopy training. The course content is based on the current guidelines and recommendations of the DGP as well as the applicable national directives and KRINKO recommendations. The standardization of central course elements serves to ensure quality assurance across the board, whilst explicitly supporting local site-specific focuses and preferences.

We report on a 32-year-old woman with multiple, progressive cavitary lung lesions. Lung cavities may occur in the context of various diseases and, thus, represent a huge diagnostic challenge. The spectrum of diseases comprises infections, systemic autoimmune rheumatic diseases, and malignancies. Several microorganisms may cause lung cavities such as common bacteria (e.g. Haemophilus influenzae, Klebsiella pneumoniae), Mycobacterium tuberculosis, non-tuberculous mycobacteria, uncommon bacteria such as Nocardia species, fungi (e.g. Aspergillus species), and parasites such as Echinococcus species. In respect of systemic autoimmune rheumatic diseases, granulomatosis with polyangiitis is frequently associated with cavitary lung lesions. Malignancies such as lung carcinomas and pulmonary metastasis may also manifest with cavern formation. In our case, we primarily assumed infection as the cause of the cavitary lung lesions - in fact, an infection with Actinomyces species. However, despite antibiotic therapy according to the resistance test results and the removal of the supposed focus of infection (tonsillectomy with proof of Actinomyces colonization of the tonsils), there was clear progression of lung cavities. Therefore, diagnostics were expanded and enhanced including FDG-PET-CT, bone marrow puncture, VATS pulmonary wedge resection, as well as EBUS- and CT-guided lymph node puncture. Finally, a rare clinical manifestation of Hodgkin lymphoma was diagnosed as the underlying cause of the multiple cavitary lung lesions.

A wide range of substances is currently available for the treatment of patients with pulmonary arterial hypertension. The current recommendations for initial drug therapy are based on the patient's risk profile. For patients at high risk, an initial triple combination therapy with different substances including prostanoids is recommended. The aim of the prospective, single-arm, unblinded study was to clarify whether PAH patients on triple therapy benefit from switching from selexipag to intravenous treprostinil. The primary endpoint was the achievement of a "low-risk" status after 6 (12) months. 27 PAH patients (45 (37; 61) years, 77.8% women) were included. At study entry they were assigned to low-risk (n=1), intermediate (n=12) or high-risk status (n=14). On average, 22 patients were followed for 8 (range 5-11) months. One patient was successfully transplanted after four months, another four patients died (in one case septic complications of unknown origin; in three cases progressive right heart failure). The primary endpoint (reaching "low-risk" status) was achieved in 12/21 (57.1%) patients (one further patient remained in "low-risk" status). These data indicate (despite the small number of patients) that even with established triple therapy, clinical improvement in individual patients is possible by switching from selexipag to intravenous treprostinil.

Pharyngeal stability is ensured by both anatomical and non-anatomical factors. In addition to the anatomical width, functional factors are also significant in determining the degree of obstruction of the upper airway. The functionality of the pharyngeal muscles depends on an undisturbed sensorimotor system. In patients with rhonchopathy or obstructive sleep apnea (OSA), sensorimotor function and muscle morphology change progressively. It is hypothesised that long-term snoring leads to vibration-induced sensorimotor neuropathy, resulting in the loss of function and structure of the pharyngeal muscles. Pharyngeal mechanoreceptors lose their sensitivity, and due to neural damage, information can no longer be adequately translated into motor responses. This raises the question of the timeframe within which irreversible vibration-induced receptor damage occurs due to snoring.

Palliative medical care for patients with pulmonary diseases has improved significantly in recent years - particularly in the field of pneumooncology and in acute and intensive care medicine. For patients with non-malignant lung diseases, however, palliative care is often provided very late in the course of the disease. Our article is intended to provide incentives and explanations for the contemporary integration of palliative care - regardless of the underlying disease.