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Atypical radiological manifestation of sarcoidosis presenting with an anterior mediastinal mass. 肉样瘤病的非典型放射学表现,表现为纵隔前部肿块。
IF 9 1区 医学 Q1 RESPIRATORY SYSTEM Pub Date : 2024-08-22 DOI: 10.1136/thorax-2024-221604
Wan-Ting Tao, Hao-Yu Huang, Wen-Chiuan Tsai, Kai-Hsiung Ko
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引用次数: 0
Indirect impact of childhood 13-valent pneumococcal conjugate vaccine (PCV13) in Canadian older adults: a Canadian Immunization Research Network (CIRN) retrospective observational study. 儿童 13 价肺炎球菌结合疫苗 (PCV13) 对加拿大老年人的间接影响:加拿大免疫研究网络 (CIRN) 的一项回顾性观察研究。
IF 9 1区 医学 Q1 RESPIRATORY SYSTEM Pub Date : 2024-08-19 DOI: 10.1136/thorax-2023-220377
Sharifa Nasreen, Jun Wang, Fawziah Marra, Jeffrey C Kwong, Allison McGeer, Manish Sadarangani, Sarah E Wilson, Shaza A Fadel

Background: 13-valent pneumococcal conjugate vaccine (PCV13) has been part of publicly funded childhood immunisation programmes in Ontario and British Columbia (BC) since 2010. We assessed the indirect impact of infant PCV13 programmes on invasive pneumococcal disease (IPD) and all-cause pneumonia hospitalisation in older adults (aged ≥65 years) using a retrospective observational study.

Methods: We extracted monthly IPD and all-cause pneumonia cases from laboratory and health administrative databases between January 2005 and December 2018. Using a quasi-experimental difference-in-differences design, we calculated the ratio of risk ratios (RRRs) using incidence rates of IPD or all-cause pneumonia cases before (pre-PCV13 period) and after (PCV13 period) 2010 with rates of fractures as controls.

Results: The rates of all IPD or PCV serotype-specific IPD for older adults in both Ontario and BC did not change in 8 years after childhood PCV13 programme implementation. All-cause pneumonia increased in Ontario (RRR 1.38, 95% CI 1.11 to 1.71) but remained unchanged in BC.

Conclusions: Indirect community protection of older adults from hospitalisation with pneumococcal disease stalled despite maturation of childhood PCV13 vaccination programmes in two Canadian provinces.

背景:自 2010 年以来,13 价肺炎球菌结合疫苗 (PCV13) 已成为安大略省和不列颠哥伦比亚省 (BC) 公共资助的儿童免疫计划的一部分。我们通过一项回顾性观察研究评估了婴儿 PCV13 计划对老年人(年龄≥65 岁)侵袭性肺炎球菌疾病(IPD)和全因肺炎住院的间接影响:我们从实验室和卫生行政数据库中提取了2005年1月至2018年12月期间的每月IPD和全因肺炎病例。我们采用准实验差分设计,以 2010 年之前(PCV13 之前)和之后(PCV13 之后)的 IPD 或全因肺炎病例发病率计算风险比(RRR),并以骨折率作为对照:结果:在儿童 PCV13 计划实施后的 8 年中,安大略省和不列颠哥伦比亚省老年人的所有 IPD 或 PCV 血清型特异性 IPD 发病率均未发生变化。安大略省的全因肺炎率有所上升(RRR 1.38,95% CI 1.11 至 1.71),但不列颠哥伦比亚省的全因肺炎率保持不变:尽管加拿大两个省份的儿童 PCV13 疫苗接种计划已经成熟,但社区对老年人免于因肺炎球菌疾病住院的间接保护却停滞不前。
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引用次数: 0
Monocyte NLRP3 inflammasome and interleukin-1β activation modulated by alpha-1 antitrypsin therapy in deficient individuals. 单核细胞 NLRP3 炎性体和白细胞介素-1β的激活受α-1 抗胰蛋白酶缺乏症患者的治疗调节。
IF 9 1区 医学 Q1 RESPIRATORY SYSTEM Pub Date : 2024-08-19 DOI: 10.1136/thorax-2023-221071
Debananda Gogoi, Howard Yu, Michelle Casey, Rory Baird, Azeez Yusuf, Luke Forde, Michael E O' Brien, Jesse R West, Tammy Flagg, Noel G McElvaney, Edward Eden, Christian Mueller, Mark L Brantly, Patrick Geraghty, Emer P Reeves

Introduction: Altered complement component 3 (C3) activation in patients with alpha-1 antitrypsin (AAT) deficiency (AATD) has been reported. To understand the potential impact on course of inflammation, the aim of this study was to investigate whether C3d, a cleavage-product of C3, triggers interleukin (IL)-1β secretion via activation of NOD-, LRR- and pyrin domain-containing protein 3 (NLRP3) inflammasome. The objective was to explore the effect of AAT augmentation therapy in patients with AATD on the C3d/complement receptor 3 (CR3) signalling axis of monocytes and on circulating pro-inflammatory markers.

Methods: Inflammatory mediators were detected in blood from patients with AATD (n=28) and patients with AATD receiving augmentation therapy (n=19). Inflammasome activation and IL-1β secretion were measured in monocytes of patients with AATD, and following C3d stimulation in the presence or absence of CR3 or NLRP3 inhibitors.

Results: C3d acting via CR3 induces NLRP3 and pro-IL-1β production, and through induction of endoplasmic reticulum (ER) stress and calcium flux, triggers caspase-1 activation and IL-1β secretion. Treatment of individuals with AATD with AAT therapy results in decreased plasma levels of C3d (3.0±1.2 µg/mL vs 1.3±0.5 µg/mL respectively, p<0.0001) and IL-1β (115.4±30 pg/mL vs 73.3±20 pg/mL, respectively, p<0.0001), with a 2.0-fold decrease in monocyte NLRP3 protein expression (p=0.0303), despite continued ER stress activation.

Discussion: These results provide strong insight into the mechanism of complement-driven inflammation associated with AATD. Although the described variance in C3d and NLRP3 activation decreased post AAT augmentation therapy, results demonstrate persistent C3d and monocyte ER stress, with implications for new therapeutics and clinical practice.

导言:据报道,α-1抗胰蛋白酶(AAT)缺乏症(AATD)患者的补体成分3(C3)活化发生了改变。为了解其对炎症过程的潜在影响,本研究旨在探讨 C3d(C3 的一种裂解产物)是否会通过激活 NOD-、LRR- 和含吡咯啉结构域蛋白 3(NLRP3)炎性体来触发白细胞介素(IL)-1β 的分泌。该研究旨在探讨AAT增强疗法对AATD患者单核细胞C3d/补体受体3(CR3)信号轴和循环促炎标志物的影响:方法:检测 AATD 患者(28 人)和接受增强疗法的 AATD 患者(19 人)血液中的炎症介质。在CR3或NLRP3抑制剂存在或不存在的情况下,对AATD患者的单核细胞以及C3d刺激后的单核细胞进行了炎症体激活和IL-1β分泌测定:结果:C3d通过CR3诱导NLRP3和促IL-1β产生,并通过诱导内质网(ER)应激和钙通量,引发caspase-1活化和IL-1β分泌。用AAT疗法治疗AATD患者可降低血浆中C3d的水平(分别为3.0±1.2 µg/mL vs 1.3±0.5 µg/mL, pDiscussion):这些结果为了解与AATD相关的补体驱动炎症机制提供了有力的启示。虽然所述的C3d和NLRP3活化差异在AAT增强治疗后有所下降,但结果显示C3d和单核细胞ER应激持续存在,这对新疗法和临床实践具有重要意义。
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引用次数: 0
Airway epithelial cell response to RSV is mostly impaired in goblet and multiciliated cells in asthma. 在哮喘患者中,气道上皮细胞对 RSV 的反应主要在鹅口疮细胞和多纤毛细胞中受损。
IF 9 1区 医学 Q1 RESPIRATORY SYSTEM Pub Date : 2024-08-19 DOI: 10.1136/thorax-2023-220230
Aurore C A Gay, Martin Banchero, Orestes Carpaij, Tessa M Kole, Leonie Apperloo, Djoke van Gosliga, Putri Ayu Fajar, Gerard H Koppelman, Louis Bont, Rudi W Hendriks, Maarten van den Berge, Martijn C Nawijn

Background: In patients with asthma, respiratory syncytial virus (RSV) infections can cause disease exacerbation by infecting the epithelial layer of the airways, inducing subsequent immune response. The type I interferon antiviral response of epithelial cells upon RSV infection is found to be reduced in asthma in most-but not all-studies. Moreover, the molecular mechanisms causing the differences in the asthmatic bronchial epithelium in response to viral infection are poorly understood.

Methods: Here, we investigated the transcriptional response to RSV infection of primary bronchial epithelial cells (pBECs) from patients with asthma (n=8) and healthy donors (n=8). The pBECs obtained from bronchial brushes were differentiated in air-liquid interface conditions and infected with RSV. After 3 days, cells were processed for single-cell RNA sequencing.

Results: A strong antiviral response to RSV was observed for all cell types, for all samples (p<1e-48). Most (1045) differentially regulated genes following RSV infection were found in cells transitioning to secretory cells. Goblet cells from patients with asthma showed lower expression of genes involved in the interferon response (false discovery rate <0.05), including OASL, ICAM1 and TNFAIP3. In multiciliated cells, an impairment of the signalling pathways involved in the response to RSV in asthma was observed.

Conclusion: Our results highlight that the response to RSV infection of the bronchial epithelium in asthma and healthy airways was largely similar. However, in asthma, the response of goblet and multiciliated cells is impaired, highlighting the need for studying airway epithelial cells at high resolution in the context of asthma exacerbation.

背景:在哮喘患者中,呼吸道合胞病毒(RSV)感染可通过感染气道上皮细胞层引起疾病恶化,并诱发随后的免疫反应。大多数研究发现,哮喘患者在感染 RSV 后上皮细胞的 I 型干扰素抗病毒反应会降低,但并非所有研究都发现了这一点。此外,造成哮喘支气管上皮细胞对病毒感染反应差异的分子机制还不甚明了。方法:在此,我们研究了哮喘患者(8 人)和健康供体(8 人)的原发性支气管上皮细胞(pBECs)对 RSV 感染的转录反应。从支气管刷状细胞中获得的 pBECs 在空气-液体界面条件下分化并感染 RSV。3 天后,对细胞进行单细胞 RNA 测序:结果:在所有细胞类型、所有样本(pOASL、ICAM1 和 TNFAIP3)中都观察到了对 RSV 的强烈抗病毒反应。在多纤毛细胞中,观察到哮喘患者对 RSV 反应的信号通路受损:我们的研究结果表明,哮喘和健康气道的支气管上皮细胞对 RSV 感染的反应基本相似。然而,在哮喘中,鹅口疮细胞和多纤毛细胞的反应受到损害,这突出表明在哮喘恶化的情况下需要对气道上皮细胞进行高分辨率研究。
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引用次数: 0
Epidemiology of childhood interstitial lung disease in France: the RespiRare cohort. 法国儿童间质性肺病流行病学:RespiRare 队列。
IF 9 1区 医学 Q1 RESPIRATORY SYSTEM Pub Date : 2024-08-19 DOI: 10.1136/thorax-2023-221325
Camille Fletcher, Alice Hadchouel, Caroline Thumerelle, Julie Mazenq, Manon Fleury, Harriet Corvol, Nouha Jedidi, Myriam Benhamida, Katia Bessaci, Tiphaine Bilhouee, Raphael Borie, Jacques Brouard, Aurélie Cantais, Annick Clement, Laurianne Coutier, Camille Cisterne, Pierrick Cros, Marie-Laure Dalphin, Christophe Delacourt, Eric Deneuville, Jean-Christophe Dubus, Carole Egron, Ralph Epaud, Michael Fayon, Aude Forgeron, Elsa Gachelin, François Galode, Isabelle Gertini, Lisa Giovannini-Chami, Pierre Gourdan, Tamazoust Guiddir, Audrey Herzog, Véronique Houdouin, Églantine Hullo, Pierre-Henri Jarreau, Guillame Labbé, Géraldine Labouret, Alice Ladaurade, Laurence Le Clainche Viala, Christophe Marguet, Alexandra Masson-Rouchaud, Caroline Perisson, Cinthia Rames, Philippe Reix, Marie-Catherine Renoux, Léa Roditis, Cyril Schweitzer, Aurélie Tatopoulos, Pascale Trioche-Eberschweiler, Françoise Troussier, Clémentine Vigier, Laurence Weiss, Marie Legendre, Camille Louvrier, Alix de Becdelievre, Aurore Coulomb, Chiara Sileo, Hubert Ducou le Pointe, Laureline Berteloot, Céline Delestrain, Nadia Nathan

Introduction: Interstitial lung disease in children (chILD) are rare and mostly severe lung diseases. Very few epidemiological data are available in limited series of patients. The aim of this study was to assess the prevalence and incidence of chILD in France.

Methods: We performed within the RespiRare network a multicentre retrospective observational study in patients with chILD from 2000 to 2022 and a prospective evaluation of chILD's incidence between February 2022 and 2023.

Results: chILD was reported in 790 patients in 42 centres. The estimated 2022 prevalence in France was 44 /million children (95% CI 40.76 to 47.46) and the computed incidence was 4.4 /million children (95% CI 3.44 to 5.56). The median age at diagnosis was 3 months with 16.9% of familial forms. Lung biopsy and genetic analyses were performed in 23.4% and 76.9%, respectively. The most frequent chILD aetiologies in the <2 years group were surfactant metabolism disorders (16.3%) and neuroendocrine cell hyperplasia of infancy (11.8%), and in the 2-18 years group diffuse alveolar haemorrhage (12.2%), connective tissue diseases (11.4%), hypersensitivity pneumonitis (8.8%) and sarcoidosis (8.8%). The management included mainly oxygen therapy (52%), corticosteroid pulses (56%), oral corticosteroids (44%), azithromycin (27.2%), enteral nutrition (26.9%), immunosuppressants (20.3%) and hydroxychloroquine (15.9%). The 5-year survival rate was 57.3% for the patients diagnosed before 2 years and 86% between 2 and 18 years.

Conclusion: This large and systematic epidemiological study confirms a higher incidence and prevalence of chILD than previously described. In order to develop international studies, efforts are still needed to optimise the case collection and to harmonise diagnostic and management practices.

简介儿童间质性肺病(chILD)是一种罕见的肺部疾病,大多病情严重。目前只有极少数患者的流行病学数据。本研究旨在评估儿童间质性肺病在法国的流行率和发病率:我们在RespiRare网络内对2000年至2022年的chILD患者进行了多中心回顾性观察研究,并对2022年2月至2023年的chILD发病率进行了前瞻性评估。据估计,2022年法国的发病率为44/百万儿童(95% CI为40.76至47.46),计算出的发病率为4.4/百万儿童(95% CI为3.44至5.56)。确诊时的中位年龄为3个月,其中16.9%为家族性。分别有 23.4% 和 76.9% 的患者进行了肺活检和基因分析。结论:这是一项大规模、系统性的流行病学调查:这项大规模、系统性的流行病学研究证实,chILD 的发病率和流行率高于之前的描述。为了开展国际研究,仍需努力优化病例收集并统一诊断和管理方法。
{"title":"Epidemiology of childhood interstitial lung disease in France: the RespiRare cohort.","authors":"Camille Fletcher, Alice Hadchouel, Caroline Thumerelle, Julie Mazenq, Manon Fleury, Harriet Corvol, Nouha Jedidi, Myriam Benhamida, Katia Bessaci, Tiphaine Bilhouee, Raphael Borie, Jacques Brouard, Aurélie Cantais, Annick Clement, Laurianne Coutier, Camille Cisterne, Pierrick Cros, Marie-Laure Dalphin, Christophe Delacourt, Eric Deneuville, Jean-Christophe Dubus, Carole Egron, Ralph Epaud, Michael Fayon, Aude Forgeron, Elsa Gachelin, François Galode, Isabelle Gertini, Lisa Giovannini-Chami, Pierre Gourdan, Tamazoust Guiddir, Audrey Herzog, Véronique Houdouin, Églantine Hullo, Pierre-Henri Jarreau, Guillame Labbé, Géraldine Labouret, Alice Ladaurade, Laurence Le Clainche Viala, Christophe Marguet, Alexandra Masson-Rouchaud, Caroline Perisson, Cinthia Rames, Philippe Reix, Marie-Catherine Renoux, Léa Roditis, Cyril Schweitzer, Aurélie Tatopoulos, Pascale Trioche-Eberschweiler, Françoise Troussier, Clémentine Vigier, Laurence Weiss, Marie Legendre, Camille Louvrier, Alix de Becdelievre, Aurore Coulomb, Chiara Sileo, Hubert Ducou le Pointe, Laureline Berteloot, Céline Delestrain, Nadia Nathan","doi":"10.1136/thorax-2023-221325","DOIUrl":"10.1136/thorax-2023-221325","url":null,"abstract":"<p><strong>Introduction: </strong>Interstitial lung disease in children (chILD) are rare and mostly severe lung diseases. Very few epidemiological data are available in limited series of patients. The aim of this study was to assess the prevalence and incidence of chILD in France.</p><p><strong>Methods: </strong>We performed within the RespiRare network a multicentre retrospective observational study in patients with chILD from 2000 to 2022 and a prospective evaluation of chILD's incidence between February 2022 and 2023.</p><p><strong>Results: </strong>chILD was reported in 790 patients in 42 centres. The estimated 2022 prevalence in France was 44 /million children (95% CI 40.76 to 47.46) and the computed incidence was 4.4 /million children (95% CI 3.44 to 5.56). The median age at diagnosis was 3 months with 16.9% of familial forms. Lung biopsy and genetic analyses were performed in 23.4% and 76.9%, respectively. The most frequent chILD aetiologies in the <2 years group were surfactant metabolism disorders (16.3%) and neuroendocrine cell hyperplasia of infancy (11.8%), and in the 2-18 years group diffuse alveolar haemorrhage (12.2%), connective tissue diseases (11.4%), hypersensitivity pneumonitis (8.8%) and sarcoidosis (8.8%). The management included mainly oxygen therapy (52%), corticosteroid pulses (56%), oral corticosteroids (44%), azithromycin (27.2%), enteral nutrition (26.9%), immunosuppressants (20.3%) and hydroxychloroquine (15.9%). The 5-year survival rate was 57.3% for the patients diagnosed before 2 years and 86% between 2 and 18 years.</p><p><strong>Conclusion: </strong>This large and systematic epidemiological study confirms a higher incidence and prevalence of chILD than previously described. In order to develop international studies, efforts are still needed to optimise the case collection and to harmonise diagnostic and management practices.</p>","PeriodicalId":23284,"journal":{"name":"Thorax","volume":" ","pages":"842-852"},"PeriodicalIF":9.0,"publicationDate":"2024-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141535396","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Antibiotic pharmacokinetics in infected pleural effusions. 感染性胸腔积液中的抗生素药代动力学。
IF 9 1区 医学 Q1 RESPIRATORY SYSTEM Pub Date : 2024-08-19 DOI: 10.1136/thorax-2023-220402
David T Arnold, Liam Read, Oliver Waddington, Fergus W Hamilton, Sonia Patole, Jessica Hughes, Alice Milne, Alan Noel, Mark Bayliss, Nicholas A Maskell, Alasdair MacGowan

Pleural infection is usually treated with empirical broad-spectrum antibiotics, but limited data exist on their penetrance into the infected pleural space. We performed a pharmacokinetic study analysing the concentration of five intravenous antibiotics across 146 separate time points in 35 patients (amoxicillin, metronidazole, piperacillin-tazobactam, clindamycin and cotrimoxazole). All antibiotics tested, apart from co-trimoxazole, reach pleural fluid levels equivalent to levels within the blood and well above the relevant minimum inhibitory concentrations. The results demonstrate that concerns about the penetration of commonly used antibiotics, apart from co-trimoxazole, into the infected pleural space are unfounded.

胸膜感染通常采用经验性广谱抗生素进行治疗,但有关抗生素在受感染胸膜腔内渗透的数据却很有限。我们进行了一项药代动力学研究,分析了 35 名患者在 146 个不同时间点静脉注射五种抗生素(阿莫西林、甲硝唑、哌拉西林-他唑巴坦、克林霉素和复方新诺明)的浓度。除联合新诺明外,所有接受测试的抗生素在胸腔积液中的浓度水平都与血液中的浓度水平相当,并远高于相关的最低抑菌浓度。结果表明,除联合新诺明外,人们对常用抗生素渗入受感染胸膜腔的担忧是没有根据的。
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引用次数: 0
TB PCR in BAL and EBUS-TBNA samples for the diagnosis of pulmonary and mediastinal lymph node TB: retrospective TRiBE study. 用于肺和纵隔淋巴结结核诊断的 BAL 和 EBUS-TBNA 样本中的结核病 PCR:TRiBE 回顾性研究。
IF 9 1区 医学 Q1 RESPIRATORY SYSTEM Pub Date : 2024-08-19 DOI: 10.1136/thorax-2023-220647
Mirae Park, Kartik Kumar, Meg Coleman, Laura Martin, Georgina Russell, Pauline Scheelbeek, Ajit Lalvani, Giovanni Satta, Onn Min Kon

Introduction: The role of Xpert Ultra in bronchoalveolar lavage (BAL) and endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) samples for pulmonary and mediastinal lymph node tuberculosis (TB) remains unclear.

Methods: This was a retrospective observational service evaluation at a tertiary TB centre in a low-incidence setting. The diagnostic indices of Xpert Ultra, smear and culture (with cytology for EBUS-TBNA samples) were compared with culture positivity or a composite reference standard of clinical TB diagnosis. Trace readouts, a new category of results for Xpert Ultra indicating low bacillary load, were analysed in two ways as a true positive or true negative result. 282 BAL and 139 EBUS-TBNA samples were included in the analysis.

Results: BAL: sensitivity with 95% CI against culture-confirmed pulmonary TB from BAL samples for Xpert Ultra (trace as positive) was 0.91 (0.82 to 0.98), Xpert Ultra (trace as negative) was 0.76 (0.69 to 0.83), smear was 0.38 (p=0.0009) and culture was 1.00 (0.91 to 1.00). Specificities for all the tests were ≥0.99 (0.98 to 1.00). The addition of smear to Xpert Ultra did not improve the diagnostic accuracy.EBUS-TBNA: sensitivity against culture-confirmed TB from EBUS-TBNA samples for Xpert Ultra (trace as positive) was 0.71 (0.63 to 0.78), Xpert Ultra (trace as negative) was 0.59 (0.54 to 0.63), smear was 0.12 (p=0.002), culture was 1.00 (0.89 to 1.00), cytology was 0.87 (0.76 to 0.98) and rapid on-site evaluation of cytology (ROSE) was 0.92 (0.78 to 1.00). Specificities were 0.99 (0.97 to 1.00), 0.99 (0.97 to 1.00), 1.00 (0.98 to 1.00), 1.00 (0.98 to 1.00), 0.67 (0.67 to 0.68) and 0.42, respectively.

Conclusion: Xpert Ultra had a significantly higher sensitivity compared with smear in both BAL and EBUS-TBNA samples. Xpert Ultra had a lower sensitivity compared with culture but comparable specificity with results being available within <24 hours. Trace readings in our low-incidence setting were associated with culture positivity in all BAL samples.

简介:Xpert Ultra 在支气管肺泡灌洗(BAL)和支气管内超声引导下经支气管针吸(EBUS-TBNA)样本检测肺结核和纵隔淋巴结结核(TB)中的作用尚不明确:这是一项在低发病率地区的三级结核病中心进行的回顾性观察服务评估。将 Xpert Ultra、涂片和培养(EBUS-TBNA 样本需进行细胞学检查)的诊断指标与培养阳性或临床结核病诊断的综合参考标准进行了比较。痕量读数是 Xpert Ultra 的一种新结果类别,表示结核菌载量较低,有两种分析方法,即真阳性或真阴性结果。分析包括 282 份 BAL 和 139 份 EBUS-TBNA 样本:BAL:Xpert Ultra(微量为阳性)对培养证实的肺结核的敏感性(95% CI)为 0.91(0.82 至 0.98),Xpert Ultra(微量为阴性)为 0.76(0.69 至 0.83),涂片为 0.38(p=0.0009),培养为 1.00(0.91 至 1.00)。所有检测的特异性均≥0.99(0.98 至 1.00)。EBUS-TBNA:Xpert Ultra(以微量为阳性)对 EBUS-TBNA 样本中经培养确诊的结核病的敏感性为 0.71(0.63 至 0.78),Xpert Ultra(以微量为阳性)对 EBUS-TBNA 样本中经培养确诊的结核病的敏感性为 0.73(0.91 至 1.00)。78),Xpert Ultra(微量为阴性)为 0.59(0.54 至 0.63),涂片为 0.12(P=0.002),培养为 1.00(0.89 至 1.00),细胞学为 0.87(0.76 至 0.98),细胞学快速现场评估(ROSE)为 0.92(0.78 至 1.00)。特异性分别为 0.99(0.97 至 1.00)、0.99(0.97 至 1.00)、1.00(0.98 至 1.00)、1.00(0.98 至 1.00)、0.67(0.67 至 0.68)和 0.42:结论:在 BAL 和 EBUS-TBNA 样本中,Xpert Ultra 的灵敏度明显高于涂片。与培养相比,Xpert Ultra 的灵敏度较低,但特异性不相上下,可在以下时间内得到结果
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引用次数: 0
Risk of hypersensitivity pneumonitis and other interstitial lung diseases following organic dust exposure. 接触有机粉尘后患超敏性肺炎和其他间质性肺病的风险。
IF 9 1区 医学 Q1 RESPIRATORY SYSTEM Pub Date : 2024-08-19 DOI: 10.1136/thorax-2023-221275
Inge Brosbøl Iversen, Jesper Medom Vestergaard, Ioannis Basinas, Johan Ohlander, Susan Peters, Elisabeth Bendstrup, Jens Peter Ellekilde Bonde, Vivi Schlünssen, Finn Rasmussen, Zara Ann Stokholm, Michael Brun Andersen, Hans Kromhout, Henrik Albert Kolstad

Background: Organic dust is associated with hypersensitivity pneumonitis, and associations with other types of interstitial lung disease (ILD) have been suggested. We examined the association between occupational organic dust exposure and hypersensitivity pneumonitis and other ILDs in a cohort study.

Methods: The study population included all residents of Denmark born in 1956 or later with at least 1 year of gainful employment since 1976. Incident cases of hypersensitivity pneumonitis and other ILDs were identified in the Danish National Patient Register 1994-2015. Job exposure matrices were used to assign individual annual levels of exposure to organic dust, endotoxin and wood dust from 1976 to 2015. We analysed exposure-response relations by different exposure metrics using a discrete-time hazard model.

Results: For organic dust, we observed increasing risk with increasing cumulative exposure with incidence rate ratios (IRR) per 10 unit-years of 1.19 (95% CI 1.12 to 1.27) for hypersensitivity pneumonitis and 1.04 (95% CI 1.02 to 1.06) for other ILDs. We found increasing risk with increasing cumulative endotoxin exposure for hypersensitivity pneumonitis and other ILDs with IRRs per 5000 endotoxin units/m3-years of 1.55 (95% CI 1.38 to 1.73) and 1.09 (95% CI 1.00 to 1.19), respectively. For both exposures, risk also increased with increasing duration of exposure and recent exposure. No increased risks were observed for wood dust exposure.

Conclusion: Exposure-response relations were observed between organic dust and endotoxin exposure and hypersensitivity pneumonitis and other ILDs, with lower risk estimates for the latter. The findings indicate that organic dust should be considered a possible cause of any ILD.

Trial registration number: j.no.: 1-16-02-196-17.

背景:有机粉尘与超敏性肺炎有关,也有人认为有机粉尘与其他类型的间质性肺病(ILD)有关。我们在一项队列研究中考察了职业性有机粉尘暴露与超敏性肺炎和其他间质性肺病之间的关系:研究对象包括所有 1956 年或以后出生、1976 年以来至少从事过一年有酬工作的丹麦居民。超敏性肺炎和其他 ILD 的发病病例在 1994-2015 年丹麦全国患者登记册中进行了确认。1976 年至 2015 年期间,我们使用工作暴露矩阵来确定个人每年暴露于有机粉尘、内毒素和木屑的水平。我们使用离散时间危害模型,根据不同的暴露指标分析了暴露-反应关系:对于有机粉尘,我们观察到随着累积暴露量的增加,风险也在增加,超敏性肺炎的每 10 单位年发病率比(IRR)为 1.19(95% CI 1.12 至 1.27),其他 ILD 为 1.04(95% CI 1.02 至 1.06)。我们发现,随着内毒素累积暴露量的增加,超敏性肺炎和其他 ILD 的风险也会增加,每 5000 个内毒素单位/立方米-年的 IRR 分别为 1.55(95% CI 1.38 至 1.73)和 1.09(95% CI 1.00 至 1.19)。对于这两种接触,风险也随着接触时间的延长和近期接触的增加而增加。木屑接触的风险没有增加:结论:有机粉尘和内毒素暴露与超敏性肺炎和其他 ILD 之间存在暴露-反应关系,后者的风险估计值较低。研究结果表明,有机粉尘应被视为任何 ILD 的可能诱因。
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引用次数: 0
Cause or consequence in idiopathic pulmonary fibrosis: using genetic data to back the right horse. 特发性肺纤维化的原因或结果:利用基因数据来支持正确的马。
IF 9 1区 医学 Q1 RESPIRATORY SYSTEM Pub Date : 2024-08-19 DOI: 10.1136/thorax-2024-222011
Louise V Wain
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引用次数: 0
Rectal organoid morphometric analysis (ROMA)-re: optimising measurements automatically. 直肠器官形态分析(ROMA):自动重新优化测量。
IF 9 1区 医学 Q1 RESPIRATORY SYSTEM Pub Date : 2024-08-19 DOI: 10.1136/thorax-2024-221829
Shafagh Waters, Peter G Middleton
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引用次数: 0
期刊
Thorax
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