首页 > 最新文献

Pneumon最新文献

英文 中文
Pulmonary sequestration and concomitant pectus excavatum in adulthood 成年期肺隔离与伴发漏斗胸
IF 0.7 Q4 Medicine Pub Date : 2022-05-17 DOI: 10.18332/pne/147972
J. Ribeiro, A. Costa, D. Alves, D. Cardoso, Z. Cruz, J. Silva, J. Reis, J. Maciel, P. Calvinho
1 Pulmonary sequestration (PS) is a rare congenital malformation with an incidence of 0.1%, representing 0.15–6.4% of all pulmonary malformations, with only 10% manifesting in adulthood1,2. It is characterized by a nonfunctioning pulmonary parenchyma vascularized by an aberrant artery branch from the systemic circulation1. These are classified into intralobar and extralobar, with intralobar being the most frequent. Concomitant congenital anomalies are associated with extralobar PS in 43% of cases, however in intralobar PS are only seen in 17%3. The combination of pulmonary sequestration with pectus excavatum is described in children, although the presentation in adulthood is rare. We present a case of intralobar PS that occurred in adulthood with concomitant pectus excavatum. A 39-year-old female non-smoker with past medical history of pectus excavatum was presented to the pulmonology outpatient department with dry cough and left pleuritic chest pain. Respiratory examination showed decreased breath sounds in the lower left hemithorax. Chest radiograph exposed a homogeneous opacity in the lower third of the left hemithorax. Chest Computed Tomography (CT) scan was performed and revealed a small collapse of the left lower lung associated with small pleural effusion. CT scan also determined the pectus severity index (PSI) as 2.9. Due to a suspicion of left pleural effusion, ultrasound-guided thoracentesis was scheduled. However, chest ultrasound excluded the presence of pleural effusion, exposing parenchymal consolidation and thoracentesis ended up not being performed. CT scan was repeated, this time with intravenous contrast, and showed an anomalous vessel originating from the distal thoracic aorta irrigating posterior and medial segment of left lower lobe, compatible with intralobar PS (Figures 1 A, B and C). Pulmonary function tests showed no significant ventilatory changes. Transthoracic echocardiogram was performed and showed a good global systolic function, without changes in segmental contractility or valvular abnormalities. The patient was referred to the thoracic surgery and was proposed Video-Assisted Thoracoscopic (VATS) left lower lobectomy with anomalous vessel lacquering (Figures 1 D and E). Although she had PSI lower than 3.25 and no cardiorespiratory function alteration or concerns about appearance, the possibility of pectus excavatum surgical correction was suggested, which the patient refused. The procedure was uneventful and the patient was discharged on 8th post-operative day; currently being under surveillance with resolution of symptoms. A total of 12 cases of PS associated with pectus excavatum were identified in English literature, all in pediatric age, 11 of those associated with intralobar subtype2-5. The causes of pectus excavatum include connective tissue disorders and neuromuscular diseases. In addition, it can also occur in response to an underlying lung condition4. The etiology is not clear, there are currently several
1肺隔离(Pulmonary sequestration, PS)是一种罕见的先天性畸形,发病率为0.1%,占所有肺部畸形的0.15-6.4%,仅10%在成年期表现出来1,2。其特征是无功能的肺实质被来自体循环的异常动脉分支血管化。这些疾病分为肺泡内和肺泡外,肺泡内是最常见的。伴随的先天性异常在43%的病例中与颞叶外的PS有关,而在颞叶内的PS仅占17%。肺隔离合并漏斗胸症在儿童中有报道,但在成人中很少见。我们提出了一例发生在成年伴发漏斗胸的肺叶内PS。一位39岁非吸烟女性,既往有漏斗胸病史,以干咳和左胸膜性胸痛就诊于肺科门诊。呼吸检查显示左下半胸呼吸音减少。胸片显示左半胸下三分之一处均匀混浊。胸部计算机断层扫描(CT)显示左下肺小塌陷伴少量胸腔积液。CT扫描也确定胸骨严重程度指数(PSI)为2.9。由于怀疑左侧胸腔积液,超声引导下进行胸腔穿刺。然而,胸部超声排除了胸腔积液的存在,暴露了实质实变和胸穿刺最终没有进行。再次进行CT扫描,这一次进行了静脉造影剂,显示一根源自远端胸主动脉的异常血管冲洗左下叶后段和内侧段,与瓣内PS相符(图1 A、B和C)。肺功能检查未见明显通气改变。经胸超声心动图显示整体收缩功能良好,无节段性收缩改变或瓣膜异常。患者转至胸外科,并建议采用视频辅助胸腔镜(VATS)左下肺叶切除伴血管异常漆化(图1 D和E)。尽管患者PSI低于3.25,且无心肺功能改变或外观问题,但建议行漏斗胸手术矫正的可能性,但患者拒绝。手术顺利,患者于术后第8天出院;目前正在接受监测,症状已得到缓解。英文文献中共发现12例PS合并漏斗胸,均为儿童年龄,其中11例合并漏斗内亚型2-5。漏斗胸的病因包括结缔组织紊乱和神经肌肉疾病。此外,它也可能发生在对潜在肺部疾病的反应中。病因尚不清楚,目前有几种假说。然而,考虑到它只与肺叶内PS有关,Iva和Watanabe4提示解剖和生理因素的结合,如隔离引起的通气力学的改变,导致了胚胎发育和出生后的胸部变形。
{"title":"Pulmonary sequestration and concomitant pectus excavatum in adulthood","authors":"J. Ribeiro, A. Costa, D. Alves, D. Cardoso, Z. Cruz, J. Silva, J. Reis, J. Maciel, P. Calvinho","doi":"10.18332/pne/147972","DOIUrl":"https://doi.org/10.18332/pne/147972","url":null,"abstract":"1 Pulmonary sequestration (PS) is a rare congenital malformation with an incidence of 0.1%, representing 0.15–6.4% of all pulmonary malformations, with only 10% manifesting in adulthood1,2. It is characterized by a nonfunctioning pulmonary parenchyma vascularized by an aberrant artery branch from the systemic circulation1. These are classified into intralobar and extralobar, with intralobar being the most frequent. Concomitant congenital anomalies are associated with extralobar PS in 43% of cases, however in intralobar PS are only seen in 17%3. The combination of pulmonary sequestration with pectus excavatum is described in children, although the presentation in adulthood is rare. We present a case of intralobar PS that occurred in adulthood with concomitant pectus excavatum. A 39-year-old female non-smoker with past medical history of pectus excavatum was presented to the pulmonology outpatient department with dry cough and left pleuritic chest pain. Respiratory examination showed decreased breath sounds in the lower left hemithorax. Chest radiograph exposed a homogeneous opacity in the lower third of the left hemithorax. Chest Computed Tomography (CT) scan was performed and revealed a small collapse of the left lower lung associated with small pleural effusion. CT scan also determined the pectus severity index (PSI) as 2.9. Due to a suspicion of left pleural effusion, ultrasound-guided thoracentesis was scheduled. However, chest ultrasound excluded the presence of pleural effusion, exposing parenchymal consolidation and thoracentesis ended up not being performed. CT scan was repeated, this time with intravenous contrast, and showed an anomalous vessel originating from the distal thoracic aorta irrigating posterior and medial segment of left lower lobe, compatible with intralobar PS (Figures 1 A, B and C). Pulmonary function tests showed no significant ventilatory changes. Transthoracic echocardiogram was performed and showed a good global systolic function, without changes in segmental contractility or valvular abnormalities. The patient was referred to the thoracic surgery and was proposed Video-Assisted Thoracoscopic (VATS) left lower lobectomy with anomalous vessel lacquering (Figures 1 D and E). Although she had PSI lower than 3.25 and no cardiorespiratory function alteration or concerns about appearance, the possibility of pectus excavatum surgical correction was suggested, which the patient refused. The procedure was uneventful and the patient was discharged on 8th post-operative day; currently being under surveillance with resolution of symptoms. A total of 12 cases of PS associated with pectus excavatum were identified in English literature, all in pediatric age, 11 of those associated with intralobar subtype2-5. The causes of pectus excavatum include connective tissue disorders and neuromuscular diseases. In addition, it can also occur in response to an underlying lung condition4. The etiology is not clear, there are currently several ","PeriodicalId":42353,"journal":{"name":"Pneumon","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2022-05-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76002268","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
The effect of an educational program for hookah use prevention among high school male students: Application of the prototype willingness model 高中男生预防水烟使用教育计划之效果:意愿原型模型之应用
IF 0.7 Q4 Medicine Pub Date : 2022-05-09 DOI: 10.18332/pne/147573
S. Bashirian, M. Barati, E. Ezati, Y. Mohammadi, H. Mostafaei
that determine the effect of an educational program for hookah use prevention among high school male students using the Prototype Willingness Model (PWM) in Kermanshah city, Iran. METHOD The present study was a randomized controlled trial study on 83 male adolescents in Kermanshah. We performed multi-stage random sampling. The data collection tool included a researcher-made questionnaire based on the Prototype Willingness Model. The intervention program consisted of 5 training sessions. We followed up the participants two months after the intervention, and analyzed data using SPSS Statistics 22.0. RESULTS In the present study, scores of all model constructs were significant between the two groups after the intervention, except for positive prototypes of non-hookah users (p<0.001). The greatest effect of the intervention was on reducing the positive attitude (-3.42±5.7) and reducing the willingness to use hookah (-3.35±5.1). After the intervention, the comparison of hookah use frequencies was significant among the participants in the experimental and control groups in the last month and now (p=0.03). CONCLUSIONS The research results indicate that the educational intervention based on the Prototype Willingness Model (PWM) was an appropriate educational strategy for reducing hookah use in male adolescents. determine the effect of an educational program based on hookah prevention among high school male students using the Prototype Willingness Model (PWM) in Kermanshah.
在伊朗克尔曼沙阿市,使用原型意愿模型(PWM)确定了一项防止高中男生使用水烟的教育计划的效果。方法本研究采用随机对照试验方法,对克尔曼沙阿83名男性青少年进行研究。我们进行了多阶段随机抽样。数据收集工具包括基于原型意愿模型的问卷调查。干预方案包括5个训练环节。我们在干预后两个月对参与者进行随访,并使用SPSS统计软件22.0对数据进行分析。结果在本研究中,除非水烟使用者的阳性原型外,两组干预后所有模型建构的得分均显著(p<0.001)。干预效果最大的是减少积极态度(-3.42±5.7)和减少使用水烟的意愿(-3.35±5.1)。干预后,试验组与对照组的水烟使用频率上月及今比较,差异有统计学意义(p=0.03)。结论基于原型意愿模型(PWM)的教育干预是减少男性青少年水烟使用的有效教育策略。利用原型意愿模型(PWM)在Kermanshah地区确定基于水烟预防的高中男生教育方案的效果。
{"title":"The effect of an educational program for hookah use prevention among high school male students: Application of the prototype willingness model","authors":"S. Bashirian, M. Barati, E. Ezati, Y. Mohammadi, H. Mostafaei","doi":"10.18332/pne/147573","DOIUrl":"https://doi.org/10.18332/pne/147573","url":null,"abstract":"that determine the effect of an educational program for hookah use prevention among high school male students using the Prototype Willingness Model (PWM) in Kermanshah city, Iran. METHOD The present study was a randomized controlled trial study on 83 male adolescents in Kermanshah. We performed multi-stage random sampling. The data collection tool included a researcher-made questionnaire based on the Prototype Willingness Model. The intervention program consisted of 5 training sessions. We followed up the participants two months after the intervention, and analyzed data using SPSS Statistics 22.0. RESULTS In the present study, scores of all model constructs were significant between the two groups after the intervention, except for positive prototypes of non-hookah users (p<0.001). The greatest effect of the intervention was on reducing the positive attitude (-3.42±5.7) and reducing the willingness to use hookah (-3.35±5.1). After the intervention, the comparison of hookah use frequencies was significant among the participants in the experimental and control groups in the last month and now (p=0.03). CONCLUSIONS The research results indicate that the educational intervention based on the Prototype Willingness Model (PWM) was an appropriate educational strategy for reducing hookah use in male adolescents. determine the effect of an educational program based on hookah prevention among high school male students using the Prototype Willingness Model (PWM) in Kermanshah.","PeriodicalId":42353,"journal":{"name":"Pneumon","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2022-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80954341","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 1
The new triple combination in CFTR modulators: A new era in the management of cystic fibrosis CFTR调节剂的新三重组合:囊性纤维化治疗的新时代
IF 0.7 Q4 Medicine Pub Date : 2022-05-09 DOI: 10.18332/pne/147170
K. Manika, F. Diamantea
{"title":"The new triple combination in CFTR modulators: A new era in the management of cystic fibrosis","authors":"K. Manika, F. Diamantea","doi":"10.18332/pne/147170","DOIUrl":"https://doi.org/10.18332/pne/147170","url":null,"abstract":"","PeriodicalId":42353,"journal":{"name":"Pneumon","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2022-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75945312","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Application of a home-based exercise program combined with tele-rehabilitation in previously hospitalized patients with COVID-19: A feasibility, single-cohort interventional study 基于家庭的锻炼计划结合远程康复在先前住院的COVID-19患者中的应用:一项可行性、单队列干预研究
IF 0.7 Q4 Medicine Pub Date : 2022-04-19 DOI: 10.18332/pne/146521
E. Kortianou, Dimitrios Tsimouris, A. Mavronasou, S. Lekkas, Nikolaos Kazatzis, Z. Apostolara, Maria Isakoglou, Georgia Dimakou, Z. Barmparessou, S. Tsikrika, V. Sakka, Angelos Liontos, M. Christaki, H. Milionis, I. Kalomenidis
INTRODUCTION Telehealth for COVID-19 patients is still limited. We aimed to assess the clinical effects of a home-based tele-rehabilitation exercise program following hospital discharge during the first lockdown in Greece, April to July 2020. METHODS A pre-and post-intervention design was applied in two stages. Firstly, patients were instructed to use a specially designed for COVID-19, e-book during four tele-health sessions. Afterwards, a 2-month home-based program consisted of self-practice exercise and one-hour supervised tele-rehabilitation exercise sessions every 10 days, was delivered. At baseline and at the end of the program, participants were interviewed about their physical, psychological status and quality of life (QoL) during the post-hospitalization period. The IPAQ-Gr, the HADS and the SF-36 questionnaires were used, respectively, and the participants were functionally assessed via teleconferences, using the 60 sec Sit to Stand Test (60secSTS), the Short Physical Performance Battery (SPPB) and the 3 min Step Test (3MST). RESULTS Seventy-four patients, median age 52.5 (IQR: 43–61) years were included at the first stage. From those, only 22 patients, mean ± SD age 50.1 ± 13.2 years completed the 2-month exercise program. The training program was well tolerated by all 22 patients. The mean number of unsupervised exercise sessions was 18.4 ± 3.5. No adverse effects were observed either during initial and follow-up assessment via tele-communication or during home-exercise sessions. Training improved significantly (p<0.001) lower limb muscle performance [median (IQR) 60secSTS: 22 (20–26) to 31 (25–36)], anxiety [median (IQR) HADS: 9 (6–13) to 4.3 (3.2–9.6)], depression [median (IQR) HADS: 5 (3–8) to 1.8 (0.9–3.7)], QoL [mean ± SD SF-36pcs: 37.5 ± 10.3 to 52.1 ± 6, and mean ± SD SF-36mcs: 42.9 ± 11.6 to 45.5 ± 12.3]. CONCLUSIONS Tele-rehabilitation may be feasible and may improve physical and psychological status of COVID-19 patients after hospital discharge. © 2022 Kortianou E. et al.
对COVID-19患者的远程医疗仍然有限。我们的目的是评估2020年4月至7月希腊第一次封锁期间出院后家庭远程康复锻炼计划的临床效果。方法采用干预前和干预后两阶段设计。首先,在四次远程医疗会议期间,指导患者使用专门为COVID-19设计的电子书。之后,进行了为期2个月的家庭项目,包括自我练习和每10天进行一次一小时的远程康复训练。在基线和项目结束时,参与者接受了关于他们在住院后期间的身体、心理状态和生活质量(QoL)的访谈。分别使用IPAQ-Gr、HADS和SF-36问卷,并通过电话会议,使用60秒坐立测试(60secSTS)、短物理性能电池(SPPB)和3分钟步距测试(3MST)对参与者进行功能评估。结果一期纳入74例患者,中位年龄52.5岁(IQR: 43-61)。其中,只有22名患者(平均±SD年龄50.1±13.2岁)完成了2个月的锻炼计划。所有22名患者对该培训计划耐受良好。无监督运动的平均次数为18.4±3.5次。在通过远程通信进行的初始和后续评估或在家庭锻炼期间均未观察到不良反应。训练显著改善下肢肌肉表现(p<0.001)[中位数(IQR) 60secSTS: 22(20-26)至31(25-36)],焦虑[中位数(IQR) HADS: 9(6 - 13)至4.3(3.2-9.6)],抑郁[中位数(IQR) HADS: 5(3-8)至1.8(0.9-3.7)],生活质量[平均±SD SF-36pcs: 37.5±10.3至52.1±6,平均±SD SF-36mcs: 42.9±11.6至45.5±12.3]。结论远程康复是可行的,可改善COVID-19患者出院后的身心状况。©2022 Kortianou et al。
{"title":"Application of a home-based exercise program combined with tele-rehabilitation in previously hospitalized patients with COVID-19: A feasibility, single-cohort interventional study","authors":"E. Kortianou, Dimitrios Tsimouris, A. Mavronasou, S. Lekkas, Nikolaos Kazatzis, Z. Apostolara, Maria Isakoglou, Georgia Dimakou, Z. Barmparessou, S. Tsikrika, V. Sakka, Angelos Liontos, M. Christaki, H. Milionis, I. Kalomenidis","doi":"10.18332/pne/146521","DOIUrl":"https://doi.org/10.18332/pne/146521","url":null,"abstract":"INTRODUCTION Telehealth for COVID-19 patients is still limited. We aimed to assess the clinical effects of a home-based tele-rehabilitation exercise program following hospital discharge during the first lockdown in Greece, April to July 2020. METHODS A pre-and post-intervention design was applied in two stages. Firstly, patients were instructed to use a specially designed for COVID-19, e-book during four tele-health sessions. Afterwards, a 2-month home-based program consisted of self-practice exercise and one-hour supervised tele-rehabilitation exercise sessions every 10 days, was delivered. At baseline and at the end of the program, participants were interviewed about their physical, psychological status and quality of life (QoL) during the post-hospitalization period. The IPAQ-Gr, the HADS and the SF-36 questionnaires were used, respectively, and the participants were functionally assessed via teleconferences, using the 60 sec Sit to Stand Test (60secSTS), the Short Physical Performance Battery (SPPB) and the 3 min Step Test (3MST). RESULTS Seventy-four patients, median age 52.5 (IQR: 43–61) years were included at the first stage. From those, only 22 patients, mean ± SD age 50.1 ± 13.2 years completed the 2-month exercise program. The training program was well tolerated by all 22 patients. The mean number of unsupervised exercise sessions was 18.4 ± 3.5. No adverse effects were observed either during initial and follow-up assessment via tele-communication or during home-exercise sessions. Training improved significantly (p<0.001) lower limb muscle performance [median (IQR) 60secSTS: 22 (20–26) to 31 (25–36)], anxiety [median (IQR) HADS: 9 (6–13) to 4.3 (3.2–9.6)], depression [median (IQR) HADS: 5 (3–8) to 1.8 (0.9–3.7)], QoL [mean ± SD SF-36pcs: 37.5 ± 10.3 to 52.1 ± 6, and mean ± SD SF-36mcs: 42.9 ± 11.6 to 45.5 ± 12.3]. CONCLUSIONS Tele-rehabilitation may be feasible and may improve physical and psychological status of COVID-19 patients after hospital discharge. © 2022 Kortianou E. et al.","PeriodicalId":42353,"journal":{"name":"Pneumon","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2022-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90732363","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 9
A late mediastinal complication of EBUS-TBNA: Case report and review of the literature EBUS-TBNA晚期纵隔并发症一例报告及文献复习
IF 0.7 Q4 Medicine Pub Date : 2022-04-19 DOI: 10.18332/pne/147125
E. Koukaki, N. Anagnostopoulos, Vasiliki Panou, Alexandra Kapsi, P. Bakakos, G. Stratakos
Minimally invasive procedures such as bronchoscopy are preferred to mediastinoscopy, given that the target is reachable being adjacent to the airways. Direct visualization of the puncture site is also preferable. Thus, indication for bronchoscopy was clear and the patient was scheduled ABSTRACT Mediastinal bleeding and development of hematoma (hemomediastinum) can rarely occur after TBNA (transbronchial needle aspiration). We report on a case of a 74-year-old man who developed a late post EBUS-TBNA (endobronchial ultrasound guided transbronchial needle aspiration) mediastinal hematoma attributed to supra-normal INR due to antibiotic treatment and anticoagulants following bronchoscopy. To the best of our knowledge, in the current literature there are only a few cases of mediastinal bleeding following transbronchial or transesophageal puncture and most are not related with coagulation abnormalities. This is the second case reported with late onset mediastinal hematoma post EBUS-TBNA and the first to be attributed to combined amoxycillin treatment and coumarin anticoagulants.
微创手术如支气管镜检查优于纵隔镜检查,因为目标靠近气道。穿刺部位的直接可视化也是可取的。经支气管针吸术后很少发生纵隔出血和血肿(纵隔出血)。我们报告一例74岁男性患者,在支气管镜检查后,由于抗生素和抗凝剂治疗导致INR超正常,导致EBUS-TBNA(支气管超声引导下经支气管针吸)纵隔血肿。据我们所知,在目前的文献中,只有少数病例经支气管或经食管穿刺后纵隔出血,大多数与凝血异常无关。这是第二例报道的EBUS-TBNA后迟发性纵隔血肿病例,也是第一例归因于阿莫西林联合香豆素抗凝治疗的病例。
{"title":"A late mediastinal complication of EBUS-TBNA: Case report and review of the literature","authors":"E. Koukaki, N. Anagnostopoulos, Vasiliki Panou, Alexandra Kapsi, P. Bakakos, G. Stratakos","doi":"10.18332/pne/147125","DOIUrl":"https://doi.org/10.18332/pne/147125","url":null,"abstract":"Minimally invasive procedures such as bronchoscopy are preferred to mediastinoscopy, given that the target is reachable being adjacent to the airways. Direct visualization of the puncture site is also preferable. Thus, indication for bronchoscopy was clear and the patient was scheduled ABSTRACT Mediastinal bleeding and development of hematoma (hemomediastinum) can rarely occur after TBNA (transbronchial needle aspiration). We report on a case of a 74-year-old man who developed a late post EBUS-TBNA (endobronchial ultrasound guided transbronchial needle aspiration) mediastinal hematoma attributed to supra-normal INR due to antibiotic treatment and anticoagulants following bronchoscopy. To the best of our knowledge, in the current literature there are only a few cases of mediastinal bleeding following transbronchial or transesophageal puncture and most are not related with coagulation abnormalities. This is the second case reported with late onset mediastinal hematoma post EBUS-TBNA and the first to be attributed to combined amoxycillin treatment and coumarin anticoagulants.","PeriodicalId":42353,"journal":{"name":"Pneumon","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2022-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85493487","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 1
Tracheal diverticula in cases of bronchial asthma 支气管哮喘病例中的气管憩室
IF 0.7 Q4 Medicine Pub Date : 2022-04-19 DOI: 10.18332/pne/146642
Nihdi Girdhar, Komaldeep Kaur, Aditi Gupta, J. K, V. Chopra
CT scan showed bilateral tractional and cystic bronchiectasis, AP diameter of trachea was around 2.9 cm and a few paratracheal cysts were seen with one communicating with the trachea. A tracheal diverticulum with extroflexion of mucosa and no cartilaginous defect was also seen (Figure 1). For further evaluation, bronchoscopy was done that ABSTRACT Tracheal diverticulum (TD) is an outpouching of the tracheal wall and usually projects to the right side of thoracic inlet. It belongs to a larger group of paratracheal air collections (PTACs). It can be congenital or acquired, single or multiple. It is usually asymptomatic but can lead to symptoms such as chronic cough and repeated upper respiratory tract infections. Chronic cough can also cause increased intraluminal pressure which can then lead to development of diverticulum. Here we present two cases of bronchial asthma who had chronic cough and were later found to have tracheal diverticulum.
CT示双侧牵引性支气管囊性扩张,气管AP直径约2.9 cm,见少量气管旁囊肿,其中1个与气管相通。气管憩室粘膜外翻,无软骨缺损(图1)。为了进一步评估,我们进行了支气管镜检查,气管憩室(TD)是气管壁的外翻,通常突出到胸腔入口右侧。它属于更大的一组气管旁空气收集(PTACs)。它可以是先天性的或后天的,单一的或多重的。它通常无症状,但可导致慢性咳嗽和反复上呼吸道感染等症状。慢性咳嗽也会引起腔内压力增加,从而导致憩室的发展。我们在此报告两例慢性咳嗽的支气管哮喘患者,后来发现有气管憩室。
{"title":"Tracheal diverticula in cases of bronchial asthma","authors":"Nihdi Girdhar, Komaldeep Kaur, Aditi Gupta, J. K, V. Chopra","doi":"10.18332/pne/146642","DOIUrl":"https://doi.org/10.18332/pne/146642","url":null,"abstract":"CT scan showed bilateral tractional and cystic bronchiectasis, AP diameter of trachea was around 2.9 cm and a few paratracheal cysts were seen with one communicating with the trachea. A tracheal diverticulum with extroflexion of mucosa and no cartilaginous defect was also seen (Figure 1). For further evaluation, bronchoscopy was done that ABSTRACT Tracheal diverticulum (TD) is an outpouching of the tracheal wall and usually projects to the right side of thoracic inlet. It belongs to a larger group of paratracheal air collections (PTACs). It can be congenital or acquired, single or multiple. It is usually asymptomatic but can lead to symptoms such as chronic cough and repeated upper respiratory tract infections. Chronic cough can also cause increased intraluminal pressure which can then lead to development of diverticulum. Here we present two cases of bronchial asthma who had chronic cough and were later found to have tracheal diverticulum.","PeriodicalId":42353,"journal":{"name":"Pneumon","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2022-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81893039","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Original clinical presentation of SARS-CoV-2 induced CNS impairment: A clinical case of cerebellarsyndrome SARS-CoV-2致中枢神经系统损伤的原始临床表现:小脑综合征1例
IF 0.7 Q4 Medicine Pub Date : 2022-04-06 DOI: 10.18332/pne/146179
Farissi Youssef, H. Mohamed, H. Sanaa
SARS-CoV-2 is a new virus that emerged in China in December 2019, rapidly becoming a global pandemic. We report here the case of a 23-year-old man presenting with an acute dry cough associated with neurological disorders in a feverish setting. One day after being admitted to hospital, the patient presented with vertigo and asthenia. His neurological examination showed difficult standing with cerebellar walking and dysmetria. Brain MRI as well as cytochemical examination of the CSF showed normal results. The detection of SARS-CoV-2 by PCR was positive at the nasopharyngeal level and negative at the level of the CSF. The patient was treated with hydroxychloroquine, azithromycin and methylprednisolone. A good improvement was noted during his hospitalization. The cerebellar neurological involvement associated with SARS-CoV-2 was retained given the clinical and epidemiological context and taking into consideration the mechanism of neurological involvement in COVID-19 which can be direct or indirect. © 2022 Youssef F. et al.
SARS-CoV-2是2019年12月在中国出现的一种新病毒,迅速成为全球大流行。我们在这里报告的情况下,一个23岁的男子提出急性干咳与神经系统疾病在发烧设置。入院一天后,患者出现眩晕和乏力。神经学检查显示站立困难,伴有小脑行走和节律障碍。脑MRI及脑脊液细胞化学检查结果正常。PCR检测的SARS-CoV-2在鼻咽水平呈阳性,在脑脊液水平呈阴性。患者给予羟氯喹、阿奇霉素和甲基强的松龙治疗。他在住院期间有了很好的好转。考虑到临床和流行病学背景,并考虑到COVID-19神经系统受累的直接或间接机制,保留了与SARS-CoV-2相关的小脑神经系统受累。©2022 Youssef F. et al。
{"title":"Original clinical presentation of SARS-CoV-2 induced CNS impairment: A clinical case of cerebellar\u0000syndrome","authors":"Farissi Youssef, H. Mohamed, H. Sanaa","doi":"10.18332/pne/146179","DOIUrl":"https://doi.org/10.18332/pne/146179","url":null,"abstract":"SARS-CoV-2 is a new virus that emerged in China in December 2019, rapidly becoming a global pandemic. We report here the case of a 23-year-old man presenting with an acute dry cough associated with neurological disorders in a feverish setting. One day after being admitted to hospital, the patient presented with vertigo and asthenia. His neurological examination showed difficult standing with cerebellar walking and dysmetria. Brain MRI as well as cytochemical examination of the CSF showed normal results. The detection of SARS-CoV-2 by PCR was positive at the nasopharyngeal level and negative at the level of the CSF. The patient was treated with hydroxychloroquine, azithromycin and methylprednisolone. A good improvement was noted during his hospitalization. The cerebellar neurological involvement associated with SARS-CoV-2 was retained given the clinical and epidemiological context and taking into consideration the mechanism of neurological involvement in COVID-19 which can be direct or indirect. © 2022 Youssef F. et al.","PeriodicalId":42353,"journal":{"name":"Pneumon","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2022-04-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81867293","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Lifestyle choices of smokers: Data from the Greek National Health Survey 吸烟者的生活方式选择:来自希腊国家健康调查的数据
IF 0.7 Q4 Medicine Pub Date : 2022-04-06 DOI: 10.18332/pne/147114
M. Kapetanstrataki, V. Evangelopoulou, P. Behrakis, A. Tzortzi
levels, with it being more intense when higher amounts of cigarettes and coffee were consumed 19 . Furthermore, in a study by Anyfanti et al. 20 researchers observed that smoking prior to exercise increased myocardial stress and dysregulated baroreceptor sensitivity, while more recent studies have mainly focused on the estimation of smoking prevalence 3,21-24 as well as smoking cessation 25,26 at a national or local level. To the authors knowledge, there is a lack of studies ABSTRACT INTRODUCTION Smoking is a documented health risk factor while successful cessation is challenging. The aim of the current study was to identify lifestyle characteristics of smokers that could aid the cessation process. METHODS Data derive from the most recent Health Survey conducted by the Hellenic Statistical Authority in 2019. In the survey were included 8125 participants aged ≥15 years . Chi-squared tests and ordered logistic regression models were used to assess differences between groups. Analysis was performed in Stata 14. RESULTS Smoking prevalence was 29%, with 25% daily and 4% occasional smokers. Lifestyle choices differed between smokers and non-smokers; alcohol use was observed more in smokers, and especially in younger ages. Weekly consumption of fruit/vegetables/freshly squeezed juices was observed more in non-smokers compared to smokers, while soda drinks consumption was observed more in smokers than non-smokers and especially males. Physical exercise was observed in a low proportion in both smokers and non-smokers, while health monitoring was not associated with smoking after adjusting for descriptive characteristics of participants. CONCLUSIONS Greece unhealthy dietary habits, consume a high engage rarely in physical activity. Even the Therefore, specific choices of each should be incorporated in the particular cessation plan.
当摄入更多的香烟和咖啡时,这种情况会更加强烈。此外,在Anyfanti等人的一项研究中,20研究人员观察到,运动前吸烟会增加心肌应激和压力感受器敏感性失调,而最近的研究主要集中在国家或地方水平上对吸烟率的估计3,21-24以及戒烟25,26。摘要介绍吸烟是一个有文献记载的健康风险因素,而成功戒烟是具有挑战性的。当前研究的目的是确定有助于戒烟过程的吸烟者的生活方式特征。方法数据来自希腊统计局于2019年进行的最新健康调查。调查纳入8125名年龄≥15岁的参与者。使用卡方检验和有序逻辑回归模型来评估组间差异。在Stata 14中进行分析。结果吸烟率为29%,每日吸烟率为25%,偶尔吸烟者为4%。吸烟者和非吸烟者的生活方式选择不同;在吸烟者中观察到更多的酒精使用,尤其是在年轻人中。非吸烟者每周摄入的水果/蔬菜/鲜榨果汁比吸烟者多,而吸烟者摄入的苏打饮料比不吸烟者多,尤其是男性。在吸烟者和非吸烟者中,体育锻炼的比例都很低,而在调整了参与者的描述性特征后,健康监测与吸烟无关。结论希腊人饮食习惯不健康,消费高,很少从事体育活动。因此,每个人的具体选择都应纳入特定的戒烟计划。
{"title":"Lifestyle choices of smokers: Data from the Greek National Health Survey","authors":"M. Kapetanstrataki, V. Evangelopoulou, P. Behrakis, A. Tzortzi","doi":"10.18332/pne/147114","DOIUrl":"https://doi.org/10.18332/pne/147114","url":null,"abstract":"levels, with it being more intense when higher amounts of cigarettes and coffee were consumed 19 . Furthermore, in a study by Anyfanti et al. 20 researchers observed that smoking prior to exercise increased myocardial stress and dysregulated baroreceptor sensitivity, while more recent studies have mainly focused on the estimation of smoking prevalence 3,21-24 as well as smoking cessation 25,26 at a national or local level. To the authors knowledge, there is a lack of studies ABSTRACT INTRODUCTION Smoking is a documented health risk factor while successful cessation is challenging. The aim of the current study was to identify lifestyle characteristics of smokers that could aid the cessation process. METHODS Data derive from the most recent Health Survey conducted by the Hellenic Statistical Authority in 2019. In the survey were included 8125 participants aged ≥15 years . Chi-squared tests and ordered logistic regression models were used to assess differences between groups. Analysis was performed in Stata 14. RESULTS Smoking prevalence was 29%, with 25% daily and 4% occasional smokers. Lifestyle choices differed between smokers and non-smokers; alcohol use was observed more in smokers, and especially in younger ages. Weekly consumption of fruit/vegetables/freshly squeezed juices was observed more in non-smokers compared to smokers, while soda drinks consumption was observed more in smokers than non-smokers and especially males. Physical exercise was observed in a low proportion in both smokers and non-smokers, while health monitoring was not associated with smoking after adjusting for descriptive characteristics of participants. CONCLUSIONS Greece unhealthy dietary habits, consume a high engage rarely in physical activity. Even the Therefore, specific choices of each should be incorporated in the particular cessation plan.","PeriodicalId":42353,"journal":{"name":"Pneumon","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2022-04-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81507559","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 1
Disease management knowledge is poor in Greek patients with chronic obstructive pulmonary diseasebefore entering pulmonary rehabilitation: A qualitative study 希腊慢性阻塞性肺病患者进入肺部康复前疾病管理知识贫乏:一项定性研究
IF 0.7 Q4 Medicine Pub Date : 2022-03-11 DOI: 10.18332/pne/145455
Maria Siafaka, E. Kortianou, A. Mavronasou, Nikoleta Rovina, N. Koulouris
{"title":"Disease management knowledge is poor in Greek patients with chronic obstructive pulmonary disease\u0000before entering pulmonary rehabilitation: A qualitative study","authors":"Maria Siafaka, E. Kortianou, A. Mavronasou, Nikoleta Rovina, N. Koulouris","doi":"10.18332/pne/145455","DOIUrl":"https://doi.org/10.18332/pne/145455","url":null,"abstract":"","PeriodicalId":42353,"journal":{"name":"Pneumon","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2022-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80269742","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Small hospitals in battle against COVID-19: A single-center cohort study 抗击COVID-19的小医院:一项单中心队列研究
IF 0.7 Q4 Medicine Pub Date : 2022-03-09 DOI: 10.18332/pne/145336
Antonios Patrinos, D. Komninos, Andreas Kartsonakis, Dimitris Serpanos, Niki Tsolka, Leonidas Stellas, D. Dimitropoulou
INTRODUCTION In Greece, higher morbidity and mortality due to COVID-19 pandemic were recorded during the third pandemic wave. Only a small percentage of the population was fully vaccinated at the beginning of the third pandemic wave. Our effort was multi-level, from the emergency room department to the ward. The aim of this article is to communicate a single secondary center’s experience during the third pandemic wave in Greece. METHODS A retrospective cohort study was conducted at the regional Agios Andreas General Hospital of Patra, Greece, including 360 hospitalized COVID-19 patients. A standard of care protocol was applied in all cases and its outcomes are examined. RESULTS The median age of the patients was 64.2 years (IQR: 18–100) and the median duration of hospitalization was 8 days. The overall case fatality rate was 8.1%. Of the 360 patients, 12 (3.3%) needed to be intubated. Most of the hospitalized patients (n=316;87.8%) were treated with nasal canula or Venturi mask. Twenty-six patients (7.2%) were supported with HFNC and 18 (5%) received any available type of non-invasive mechanical ventilation. CONCLUSIONS An articulate protocol and coordinated collaboration among specialists were the cornerstone of proper, immediate, and individualized treatment. The international recommendations in force at that time proved to be efficient in reducing progress to SRF and intubation. Full vaccination of the medical staff ensured long and dedicated presence in the patients’ rooms.
在希腊,在第三波大流行期间,COVID-19大流行导致的发病率和死亡率有所上升。在第三波大流行开始时,只有一小部分人口充分接种了疫苗。我们的努力是多层次的,从急诊室到病房。这篇文章的目的是传达一个单一的二级中心的经验,在希腊的第三波大流行。方法在希腊帕特拉Agios Andreas总医院进行回顾性队列研究,纳入360例住院的COVID-19患者。所有病例均采用标准护理方案,并对其结果进行检查。结果患者中位年龄为64.2岁(IQR: 18-100),中位住院时间为8 d。总病死率为8.1%。360例患者中有12例(3.3%)需要插管。大多数住院患者(316例,87.8%)采用鼻导管或文丘里面罩治疗。26例患者(7.2%)接受HFNC支持,18例(5%)接受任何可用的无创机械通气。结论:明确的方案和专家之间的协调合作是正确、及时和个性化治疗的基石。当时有效的国际建议证明在减少SRF和插管进展方面是有效的。医务人员的全面疫苗接种确保了他们在病人的病房里长时间和专注地工作。
{"title":"Small hospitals in battle against COVID-19: A single-center cohort study","authors":"Antonios Patrinos, D. Komninos, Andreas Kartsonakis, Dimitris Serpanos, Niki Tsolka, Leonidas Stellas, D. Dimitropoulou","doi":"10.18332/pne/145336","DOIUrl":"https://doi.org/10.18332/pne/145336","url":null,"abstract":"INTRODUCTION In Greece, higher morbidity and mortality due to COVID-19 pandemic were recorded during the third pandemic wave. Only a small percentage of the population was fully vaccinated at the beginning of the third pandemic wave. Our effort was multi-level, from the emergency room department to the ward. The aim of this article is to communicate a single secondary center’s experience during the third pandemic wave in Greece. METHODS A retrospective cohort study was conducted at the regional Agios Andreas General Hospital of Patra, Greece, including 360 hospitalized COVID-19 patients. A standard of care protocol was applied in all cases and its outcomes are examined. RESULTS The median age of the patients was 64.2 years (IQR: 18–100) and the median duration of hospitalization was 8 days. The overall case fatality rate was 8.1%. Of the 360 patients, 12 (3.3%) needed to be intubated. Most of the hospitalized patients (n=316;87.8%) were treated with nasal canula or Venturi mask. Twenty-six patients (7.2%) were supported with HFNC and 18 (5%) received any available type of non-invasive mechanical ventilation. CONCLUSIONS An articulate protocol and coordinated collaboration among specialists were the cornerstone of proper, immediate, and individualized treatment. The international recommendations in force at that time proved to be efficient in reducing progress to SRF and intubation. Full vaccination of the medical staff ensured long and dedicated presence in the patients’ rooms.","PeriodicalId":42353,"journal":{"name":"Pneumon","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2022-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89255581","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 2
期刊
Pneumon
全部 Acc. Chem. Res. ACS Applied Bio Materials ACS Appl. Electron. Mater. ACS Appl. Energy Mater. ACS Appl. Mater. Interfaces ACS Appl. Nano Mater. ACS Appl. Polym. Mater. ACS BIOMATER-SCI ENG ACS Catal. ACS Cent. Sci. ACS Chem. Biol. ACS Chemical Health & Safety ACS Chem. Neurosci. ACS Comb. Sci. ACS Earth Space Chem. ACS Energy Lett. ACS Infect. Dis. ACS Macro Lett. ACS Mater. Lett. ACS Med. Chem. Lett. ACS Nano ACS Omega ACS Photonics ACS Sens. ACS Sustainable Chem. Eng. ACS Synth. Biol. Anal. Chem. BIOCHEMISTRY-US Bioconjugate Chem. BIOMACROMOLECULES Chem. Res. Toxicol. Chem. Rev. Chem. Mater. CRYST GROWTH DES ENERG FUEL Environ. Sci. Technol. Environ. Sci. Technol. Lett. Eur. J. Inorg. Chem. IND ENG CHEM RES Inorg. Chem. J. Agric. Food. Chem. J. Chem. Eng. Data J. Chem. Educ. J. Chem. Inf. Model. J. Chem. Theory Comput. J. Med. Chem. J. Nat. Prod. J PROTEOME RES J. Am. Chem. Soc. LANGMUIR MACROMOLECULES Mol. Pharmaceutics Nano Lett. Org. Lett. ORG PROCESS RES DEV ORGANOMETALLICS J. Org. Chem. J. Phys. Chem. J. Phys. Chem. A J. Phys. Chem. B J. Phys. Chem. C J. Phys. Chem. Lett. Analyst Anal. Methods Biomater. Sci. Catal. Sci. Technol. Chem. Commun. Chem. Soc. Rev. CHEM EDUC RES PRACT CRYSTENGCOMM Dalton Trans. Energy Environ. Sci. ENVIRON SCI-NANO ENVIRON SCI-PROC IMP ENVIRON SCI-WAT RES Faraday Discuss. Food Funct. Green Chem. Inorg. Chem. Front. Integr. Biol. J. Anal. At. Spectrom. J. Mater. Chem. A J. Mater. Chem. B J. Mater. Chem. C Lab Chip Mater. Chem. Front. Mater. Horiz. MEDCHEMCOMM Metallomics Mol. Biosyst. Mol. Syst. Des. Eng. Nanoscale Nanoscale Horiz. Nat. Prod. Rep. New J. Chem. Org. Biomol. Chem. Org. Chem. Front. PHOTOCH PHOTOBIO SCI PCCP Polym. Chem.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
0
微信
客服QQ
Book学术公众号 扫码关注我们
反馈
×
意见反馈
请填写您的意见或建议
请填写您的手机或邮箱
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
现在去查看 取消
×
提示
确定
Book学术官方微信
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术
文献互助 智能选刊 最新文献 互助须知 联系我们:info@booksci.cn
Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。
Copyright © 2023 Book学术 All rights reserved.
ghs 京公网安备 11010802042870号 京ICP备2023020795号-1