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Bilateral mediastinal cysts with müllerian differentiation. 双侧纵隔囊肿伴有苗勒氏分化。
IF 9 1区 医学 Q1 RESPIRATORY SYSTEM Pub Date : 2024-07-16 DOI: 10.1136/thorax-2024-221708
Nuria Domedel Puig, Marta Cufí Quintana, Vanessa Escobedo Rodriguez, Manuela Iglesias Sentís, Miguel Gallego
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引用次数: 0
Reinforcing the benefits of children's physical activity on lung health. 加强儿童体育锻炼对肺部健康的益处。
IF 9 1区 医学 Q1 RESPIRATORY SYSTEM Pub Date : 2024-07-16 DOI: 10.1136/thorax-2024-221493
Gang Wang, Erik Melén
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引用次数: 0
Adaptive multi-interventional trial platform to improve patient care for fibrotic interstitial lung diseases. 适应性多干预试验平台,改善纤维化间质性肺病的患者护理。
IF 9 1区 医学 Q1 RESPIRATORY SYSTEM Pub Date : 2024-07-16 DOI: 10.1136/thorax-2023-221148
Leticia Kawano-Dourado, Tejaswini Kulkarni, Christopher J Ryerson, Pilar Rivera-Ortega, Bruno Guedes Baldi, Nazia Chaudhuri, Manuela Funke-Chambour, Anna-Maria Hoffmann-Vold, Kerri A Johannson, Yet Hong Khor, Sydney B Montesi, Lucilla Piccari, Helmut Prosch, María Molina-Molina, Jacobo Sellares Torres, Iazsmin Bauer-Ventura, Sujeet Rajan, Joseph Jacob, Duncan Richards, Lisa G Spencer, Barbara Wendelberger, Tom Jensen, Melanie Quintana, Michael Kreuter, Anthony C Gordon, Fernando J Martinez, Naftali Kaminski, Victoria Cornelius, Roger Lewis, Wendy Adams, Gisli Jenkins

Background: Fibrotic interstitial lung diseases (fILDs) are a heterogeneous group of lung diseases associated with significant morbidity and mortality. Despite a large increase in the number of clinical trials in the last 10 years, current regulatory-approved management approaches are limited to two therapies that prevent the progression of fibrosis. The drug development pipeline is long and there is an urgent need to accelerate this process. This manuscript introduces the concept and design of an innovative research approach to drug development in fILD: a global Randomised Embedded Multifactorial Adaptive Platform in fILD (REMAP-ILD).

Methods: Description of the REMAP-ILD concept and design: the specific terminology, design characteristics (multifactorial, adaptive features, statistical approach), target population, interventions, outcomes, mission and values, and organisational structure.

Results: The target population will be adult patients with fILD, and the primary outcome will be a disease progression model incorporating forced vital capacity and mortality over 12 months. Responsive adaptive randomisation, prespecified thresholds for success and futility will be used to assess the effectiveness and safety of interventions. REMAP-ILD embraces the core values of diversity, equity, and inclusion for patients and researchers, and prioritises an open-science approach to data sharing and dissemination of results.

Conclusion: By using an innovative and efficient adaptive multi-interventional trial platform design, we aim to accelerate and improve care for patients with fILD. Through worldwide collaboration, novel analytical methodology and pragmatic trial delivery, REMAP-ILD aims to overcome major limitations associated with conventional randomised controlled trial approaches to rapidly improve the care of people living with fILD.

背景:纤维化间质性肺病(fILDs)是一类异质性肺病,发病率和死亡率都很高。尽管过去 10 年中临床试验的数量大幅增加,但目前监管部门批准的治疗方法仅限于两种防止纤维化进展的疗法。药物开发管道漫长,迫切需要加快这一进程。本手稿介绍了一种创新性研究方法的概念和设计:fILD 全球随机嵌入式多因素自适应平台(REMAP-ILD):方法:描述 REMAP-ILD 的概念和设计:具体术语、设计特点(多因素、适应性特征、统计方法)、目标人群、干预措施、结果、使命和价值观以及组织结构:目标人群将是患有 fILD 的成年患者,主要结果将是一个疾病进展模型,其中包括 12 个月内的强迫生命容量和死亡率。将采用反应适应性随机化、预设成功和无效阈值来评估干预措施的有效性和安全性。REMAP-ILD秉承多样性、公平性以及对患者和研究人员包容的核心价值观,并优先采用开放科学的方法进行数据共享和结果传播:通过采用创新、高效的适应性多干预试验平台设计,我们旨在加快和改善对 fILD 患者的治疗。通过全球合作、新颖的分析方法和务实的试验实施,REMAP-ILD 旨在克服传统随机对照试验方法的主要局限性,迅速改善对 fILD 患者的治疗。
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引用次数: 0
Improvements of the shape and strength of the diaphragm after endoscopic lung volume reduction. 内窥镜肺容积缩小术后横膈膜形状和强度的改善。
IF 9 1区 医学 Q1 RESPIRATORY SYSTEM Pub Date : 2024-07-16 DOI: 10.1136/thorax-2024-221375
Olivier Taton, Pierre Alain Gevenois, Alain Van Muylem, Benjamin Bondue, Sébastien Van Laethem, Dimitri Leduc

Rationale: Endoscopic lung volume reduction improves lung function, quality of life and exercise capacity in severe emphysema patients. However, its effect on the diaphragm function is not well understood. We hypothesised that endoscopic lung volume reduction increases its strength by modifying its shape.

Objectives: To investigate changes in both diaphragm shape and strength induced by the insertion of endobronchial valves.

Methods: In 19 patients, both the diaphragm shape and strength were investigated respectively by 3D Slicer software applied on CT scans acquired at functional residual capacity and by transdiaphragmatic pressure measurements by bilateral magnetic stimulation of the phrenic nerves before and 3 months after unilateral valves insertion.

Measurements and main results: After lung volume reduction (median (IQR), 434 mL (-597 to -156], p<0.0001), diaphragm strength increased (transdiaphragmatic pressure: 3 cmH2O (2.3 to 4.2), p<0.0001). On the treated side, this increase was associated with an increase in the coronal (16 mm (13 to 24), p<0.0001) and sagittal (26 mm (21 to 30), p<0.0001) lengths as well as in the area of the zone of apposition (62 cm2 (3 to 100), p<0.0001) with a decrease in the coronal (8 mm (-12 to -4), p<0.0001) and sagittal (9 mm (-18 to -2), p=0.0029) radii of curvature.

Conclusions: Endoscopic lung volume reduction modifies the diaphragm shape by increasing its length and its zone of apposition and by decreasing its radius of curvature on the treated side, resulting in an increase in its strength.

Trial registration number: NCT05799352.

理由:内窥镜肺容积缩小术可改善严重肺气肿患者的肺功能、生活质量和运动能力。然而,其对膈肌功能的影响尚不十分清楚。我们假设内窥镜肺容积缩小术通过改变膈肌的形状来增加其强度:研究插入支气管内瓣膜后膈肌形状和强度的变化:在单侧瓣膜植入前和植入 3 个月后,通过应用 3D Slicer 软件对 CT 扫描获得的功能残余能力和通过双侧膈神经磁刺激测量的横膈膜压力分别对 19 例患者的横膈膜形状和强度进行了研究:肺容量缩小后(中位数(IQR),434 mL(-597 至 -156],p2O(2.3 至 4.2),p2(3 至 100),p结论:内窥镜肺容积缩小术通过增加膈肌的长度和贴合区以及减少治疗侧的曲率半径来改变膈肌的形状,从而增加膈肌的强度:NCT05799352.
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引用次数: 0
Journal club 期刊俱乐部
IF 1 1区 医学 Q1 Medicine Pub Date : 2024-07-01 DOI: 10.1136/thorax-2024-221967
Timothy J Davies
In 2015 the WHO set ambitious targets to tackle the global epidemic of Mycobacterium Tuberculosis (TB), including increased detection, reduced mortality, and decreased economic burden of disease, however, the WHO update from September 2023 reports that none are on track for their 2025 milestones (https://reliefweb.int/report/world/global-tuberculosis-report-2023). This situation is not new- globally all three of the 2020 milestones were missed despite some country specific successes. However, the pandemic has had a major impact, stalling, or outright reversing pre-pandemic progress. For example, overall incidence estimates had declined year-on-year between 2010 and 2020 from 11.4 million (95% CI, 8.94,14.10) to 10 million (95% CI, 9.40,10.70). However, in 2021 and 2022, global incidence estimates increased to 10.3 million (95% CI, 9.64,11.00) and 10.6 million (95% CI, 9.87,11.40) respectively. Similar trends were seen in mortality, although the initial increase was in 2020 with 1.37 million estimated deaths compared with 1.32 million in 2019, with the number returning back to pre-pandemic levels (1.30 million, 95% CI 1.18 to 1.43) in 2022. The timing discrepancy reflects the delayed onset of the disease post infection, compared with the more immediate effects of reduced access to treatment. Shockingly, they estimate that 500 000 excess TB deaths occurred compared with if pre-pandemic trends had been maintained. As it stands, the total reduction in incidence rate and TB deaths in 2022 compared with 2015 were 8.7% and 19% respectively, a long …
2015 年,世卫组织为应对结核分枝杆菌(TB)在全球的流行制定了雄心勃勃的目标,包括提高检测率、降低死亡率和减少疾病的经济负担。然而,世卫组织 2023 年 9 月的最新报告显示,没有一项目标能够如期实现 2025 年的里程碑 (https://reliefweb.int/report/world/global-tuberculosis-report-2023)。这种情况并不新鲜--在全球范围内,尽管一些国家取得了成功,但 2020 年的所有三个里程碑都未能实现。然而,大流行产生了重大影响,使大流行前取得的进展停滞不前,甚至完全逆转。例如,2010 年至 2020 年期间,总发病率估计值逐年下降,从 1140 万(95% CI,894,14.10)降至 1000 万(95% CI,940,10.70)。然而,2021年和2022年,全球发病率估计值分别增至1030万(95% CI,964,11.00)和1060万(95% CI,987,11.40)。死亡率也出现了类似的趋势,但最初的增长是在 2020 年,估计死亡人数为 137 万,而 2019 年为 132 万,到 2022 年,死亡人数将恢复到疫情流行前的水平(130 万,95% CI 118-143 例)。时间上的差异反映了感染后发病的延迟,而获得治疗的机会减少则会产生更直接的影响。令人震惊的是,他们估计,与大流行前的趋势相比,结核病死亡人数将多出 50 万。目前的情况是,与 2015 年相比,2022 年结核病发病率和死亡人数的总降幅分别为 8.7% 和 19%,这是一个漫长的过程......
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引用次数: 0
Sleep-disordered breathing in children and adults with intellectual disability: mind the gap! 智障儿童和成人的睡眠呼吸障碍:注意差距!
IF 1 1区 医学 Q1 RESPIRATORY SYSTEM Pub Date : 2024-06-27 DOI: 10.1136/thorax-2023-220032
Renata L Riha, Ankur Singh, Elizabeth A Hill, Hazel Evans, David O'Regan
Background In adults and children with intellectual disability (ID), sleep -disordered breathing (SDB) is thought to be common. However, large epidemiological studies are lacking, and there are few studies on optimal methods of investigation and even fewer randomised, controlled intervention trials of treatment. Method Peer-reviewed publications from various databases were examined in line with search terms relevant to ID and SDB spanning the years 200-2024. Results Findings suggest that, due to comorbid conditions, children and adults with ID may experience both an increased risk of SDB, as well as lower frequency of diagnosis. SDB can compromise the emotional, physical and mental health of individuals with ID. Appropriate treatment when tolerated leads to an improvement in health and well-being and several studies emphasized the importance of consistent follow-up of people with ID - something that is not universally occurring during childhood, in the transition to adulthood and during adulthood itself. As the most frequently occurring form of ID worldwide, we use Down syndrome as a specific example of how diagnosing and treating SDB can lead to improved outcomes. Conclusions This review highlights the importance of identifying SDB in this heterogenous population, recognising the multi-faceted, deleterious consequences of untreated SDB in people with ID, and presents some strategies that can be harnessed to improve diagnosis and management. Until further ID-specific research is available, we urge flexibility in the approach to people with ID and SDB based in guidelines and standard practice developed for the typically developing population.
背景 在智障(ID)成人和儿童中,睡眠呼吸障碍(SDB)被认为很常见。然而,目前尚缺乏大规模的流行病学研究,有关最佳调查方法的研究也很少,而有关治疗的随机对照干预试验更是少之又少。方法 根据与 ID 和 SDB 相关的检索词,对各种数据库中 200-2024 年间的同行评审出版物进行了研究。结果 研究结果表明,由于合并症的存在,患有智障的儿童和成人患 SDB 的风险可能会增加,但诊断的频率却较低。SDB 会损害智障人士的情绪、身体和心理健康。一些研究强调了对智障人士进行持续跟踪随访的重要性--在儿童期、向成年过渡期间以及成年期,这种做法并不普遍。唐氏综合征是全球最常见的智障形式,我们以唐氏综合征为例,说明诊断和治疗 SDB 可如何改善治疗效果。结论 本综述强调了在这一异质人群中识别 SDB 的重要性,认识到了未经治疗的 SDB 对智障人士造成的多方面有害后果,并介绍了一些可用于改善诊断和管理的策略。在开展针对智障人士的进一步研究之前,我们呼吁根据为发育正常人群制定的指南和标准做法,灵活处理智障人士和 SDB 患者的问题。
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引用次数: 0
Long-term impact of ivacaftor on mortality rate and health outcomes in people with cystic fibrosis 伊伐卡夫多对囊性纤维化患者死亡率和健康状况的长期影响
IF 1 1区 医学 Q1 RESPIRATORY SYSTEM Pub Date : 2024-06-27 DOI: 10.1136/thorax-2023-220558
Christian A Merlo, Teja Thorat, Maral DerSarkissian, Lisa J McGarry, Catherine Nguyen, Yuqian M Gu, Joe Healy, Jaime L Rubin, M Alan Brookhart
Background Ivacaftor (IVA) has been shown to improve lung function and other clinical outcomes in people with cystic fibrosis (CF). A decade of real-world IVA availability has enabled the examination of long-term outcomes with this treatment. This retrospective, longitudinal cohort study investigated the impact of IVA on mortality rate and health outcomes among people with CF in the US. Methods Data from the US CF Foundation Patient Registry from January 2010 to December 2019 were analysed. The IVA-treated cohort included people with a CF transmembrane conductance regulator ( CFTR ) gating mutation (excluding R117H ); age-matched comparator cohort included people with a F508del and a minimal function CFTR mutation who had no prior CFTR modulator treatment. Baseline characteristics were balanced between cohorts using standardised mortality ratio weighting generated from propensity scores. Outcomes of interest were overall survival, lung transplant, percent predicted forced expiratory volume in 1 s (ppFEV1), body mass index (BMI), pulmonary exacerbations (PEx), outpatient visits and hospitalisations. Findings Over a maximum follow-up of 7.9 years, the IVA-treated cohort (N=736) had lower rates of mortality (hazard ratio [HR] (95% CI): 0.22 (0.09 to 0.45)), lung transplant (HR: 0.11 (95% CI 0.02 to 0.28)), PEx (rate ratio: 0.49 (95% CI 0.42 to 0.55)) and all-cause hospitalisations (rate ratio: 0.50 (95% CI 0.43 to 0.56)) as well as better lung function (mean difference in ppFEV1: 8.46 (95% CI 7.34 to 9.75)) and higher BMI/BMI z -scores (mean difference 1.20 (95% CI 0.92 to 1.71) kg/m2 and 0.27 (95% CI 0.25 to 0.40), respectively) than the comparator cohort (N=733). Interpretation Our analysis suggests that IVA provides sustained clinical benefits in people with CF over a follow-up period of approximately 8 years. These findings reinforce the existing real-world evidence that IVA can slow disease progression and decrease the healthcare burden of CF over the long term. Data are available on reasonable request. The data supporting the findings of this study are available from the US CFFPR at . The US CFFPR collects and manages its own data and maintains processes for researchers to request summarised data. Restrictions may apply to the availability of these data, which were used under the licence agreement for this study.
背景 伊伐卡夫托(IVA)已被证明可改善囊性纤维化(CF)患者的肺功能和其他临床疗效。十年来,IVA在现实世界中的应用使人们能够对这种治疗方法的长期疗效进行研究。这项回顾性纵向队列研究调查了 IVA 对美国 CF 患者死亡率和健康状况的影响。方法 对美国 CF 基金会患者登记处 2010 年 1 月至 2019 年 12 月的数据进行了分析。IVA治疗队列包括具有CF跨膜传导调节器(CFTR)门控突变(不包括R117H)的患者;年龄匹配的比较队列包括具有F508del和最小功能CFTR突变且之前未接受过CFTR调节剂治疗的患者。利用倾向评分生成的标准化死亡率加权法对各队列的基线特征进行了平衡。研究结果包括总生存率、肺移植、1 s内预测用力呼气容积百分比(ppFEV1)、体重指数(BMI)、肺部恶化(PEx)、门诊就诊次数和住院次数。研究结果 在最长 7.9 年的随访中,IVA 治疗组群(N=736)的死亡率(危险比(HR)(95% CI):0.22(0.09 至 0.45))、肺移植率(HR:0.11(95% CI 0.02 至 0.28))、PEx(比率:0.49(95% CI 0.42 至 0.55))和全因住院率(比率:0.50(95% CI 0.43 至 0.56))以及肺功能(ppFEV1 平均差异:8.46(95% CI 7.34 至 9.75))和 BMI/BMI z 分数(平均差异分别为 1.20(95% CI 0.92 至 1.71)kg/m2 和 0.27(95% CI 0.25 至 0.40))均优于参照队列(N=733)。解释 我们的分析表明,IVA 可在约 8 年的随访期内为 CF 患者带来持续的临床益处。这些研究结果加强了现有的实际证据,即 IVA 可以长期延缓疾病进展并减轻 CF 的医疗负担。如有合理要求,可提供相关数据。支持本研究结果的数据可从美国CFFPR获取,网址为 。美国 CFFPR 收集和管理自己的数据,并为研究人员申请汇总数据提供程序。根据本研究的许可协议,这些数据的提供可能会受到限制。
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引用次数: 0
A structural and metabolic framework for classifying pre-clinical tuberculosis infection phenotypes using 18F-FDG PET-CT: a prospective cohort analysis following M. tuberculosis exposure. 利用 18F-FDG PET-CT 对临床前结核感染表型进行分类的结构和代谢框架:结核杆菌暴露后的前瞻性队列分析。
IF 9 1区 医学 Q1 Medicine Pub Date : 2024-06-24 DOI: 10.1136/thorax-2024-221470
Jee Whang Kim, Sonam Vadera, Meedya Sharifpour, Amrita Bajaj, Anver Kamil, Pranabashis Haldar

Tuberculosis (TB) control efforts are limited by ineffective characterisation of tuberculosis infection (TBI) -a heterogeneous spectrum of pre-clinical infection states, invisible to tools of routine clinical screening, that are associated with variable risk of progression to TB disease. In this prospective study, we use positron emission tomography-CT (PET-CT) as a high-resolution imaging modality to characterise and classify structural and metabolic features observed in 16 asymptomatic household TB contacts with normal chest radiographs. We identify four feature patterns that associate with distinct clinical and microbiological outcomes, supporting potential utility of PET-CT for objective classification of TBI phenotypes.

结核病(TB)控制工作因结核病感染(TBI)特征描述不清而受到限制--TBI 是临床前感染状态的一个异质性谱系,常规临床筛查工具无法发现,与结核病进展的不同风险相关。在这项前瞻性研究中,我们使用正电子发射断层扫描-计算机断层扫描(PET-CT)作为一种高分辨率成像模式,对 16 名胸片正常的无症状家庭结核病接触者的结构和代谢特征进行描述和分类。我们确定了与不同临床和微生物学结果相关的四种特征模式,支持 PET-CT 用于结核病表型客观分类的潜在用途。
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引用次数: 0
Mucus clears from the trachea in a helix: a new twist to understanding airway diseases. 粘液以螺旋状从气管中清除:了解气道疾病的新转折。
IF 1 1区 医学 Q1 Medicine Pub Date : 2024-06-14 DOI: 10.1136/thorax-2023-221052
David Abelson, James Di Michiel, Clayton Frater, Mark Pearson, Robert Russo, Martin Wechselberger, Alice Cottee, Lucy Morgan

Background: Mucociliary clearance (MCC) is critical to lung health and is impaired in many diseases. The path of MCC may have an important impact on clearance but has never been rigorously studied. The objective of this study is to assess the three-dimensional path of human tracheal MCC in disease and health.

Methods: Tracheal MCC was imaged in 12 ex-smokers, 3 non-smokers (1 opportunistically imaged during acute influenza and repeated after recovery) and 5 individuals with primary ciliary dyskinesia (PCD). Radiolabelled macroaggregated albumin droplets were injected into the trachea via the cricothyroid membrane. Droplet movement was tracked via scintigraphy, the path of movement mapped and helical and axial models of tracheal MCC were compared.

Measurements and main results: In 5/5 participants with PCD and 1 healthy participant with acute influenza, radiolabelled albumin coated the trachea and did not move. In all others (15/15), mucus coalesced into globules. Globule movement was negligible in 3 ex-smokers, but in all others (12/15) ascended the trachea in a helical path. Median cephalad tracheal MCC was 2.7 mm/min ex-smokers vs 8.4 mm/min non-smokers (p=0.02) and correlated strongly to helical angle (r=0.92 (p=0.00002); median 18o ex-smokers, 47o non-smokers (p=0.036)), but not to actual speed on helical path (r=0.26 (p=0.46); median 13.6 mm/min ex-smokers vs 13.9 mm/min non-smokers (p=1.0)).

Conclusion: For the first time, we show that human tracheal MCC is helical, and impairment in ex-smokers is often caused by flattened helical transit, not slower movement. Our methodology provides a simple method to map tracheal MCC and speed in vivo.

背景:黏膜纤毛清除(MCC)对肺部健康至关重要,在许多疾病中都会受损。MCC 的路径可能对清除有重要影响,但从未进行过严格研究。本研究的目的是评估人体气管 MCC 在疾病和健康状态下的三维路径:方法:对 12 名戒烟者、3 名非吸烟者(其中 1 人在急性流感期间进行了机会性成像,并在康复后进行了重复成像)和 5 名原发性睫状肌运动障碍(PCD)患者的气管 MCC 进行了成像。放射性标记的大聚合白蛋白液滴经环甲膜注入气管。通过闪烁扫描跟踪液滴运动,绘制运动路径图,并比较气管 MCC 的螺旋模型和轴向模型:在 5/5 名患有 PCD 的参与者和 1 名患有急性流感的健康参与者中,放射性标记的白蛋白覆盖了气管且没有移动。在其他所有参与者(15/15)中,粘液凝聚成球。3 名戒烟者的球状物移动可以忽略不计,但其他所有戒烟者(12/15)的球状物都以螺旋路径上升到气管。头侧气管 MCC 中位数为 2.7 毫米/分钟(戒烟者)和 8.4 毫米/分钟(非吸烟者)(p=0.02),与螺旋角密切相关(r=0.92(p=0.00002);前吸烟者的中位数为18o,非吸烟者为47o(p=0.036)),但与螺旋路径上的实际速度无关(r=0.26(p=0.46);前吸烟者的中位数为13.6毫米/分钟,非吸烟者为13.9毫米/分钟(p=1.0)):我们首次证明了人类气管 MCC 是螺旋形的,戒烟者的功能障碍通常是由扁平的螺旋运动而不是运动减慢造成的。我们的方法提供了一种绘制气管 MCC 和体内速度图的简单方法。
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引用次数: 0
Actinomycosis mimicking metastatic lung malignancy. 模仿转移性肺部恶性肿瘤的放线菌病。
IF 9 1区 医学 Q1 RESPIRATORY SYSTEM Pub Date : 2024-06-14 DOI: 10.1136/thorax-2024-221556
Daniel Sims, Anthony Kerry, Kim Billingham
{"title":"Actinomycosis mimicking metastatic lung malignancy.","authors":"Daniel Sims, Anthony Kerry, Kim Billingham","doi":"10.1136/thorax-2024-221556","DOIUrl":"10.1136/thorax-2024-221556","url":null,"abstract":"","PeriodicalId":23284,"journal":{"name":"Thorax","volume":null,"pages":null},"PeriodicalIF":9.0,"publicationDate":"2024-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140917301","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
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