Pulmonary Medicine最新文献

Asthma diagnosis can be confirmed by observing significant bronchodilator response (BDR) through peak expiratory flow (PEF) at home or forced expiratory volume in 1 s (FEV₁) via spirometry in a clinical setting. We aimed to use the administration of salbutamol after a methacholine challenge test as a model of bronchodilation to study how accurately the change in PEF predicts improvement in lung function, as defined by an increase in FEV₁. We analyzed 869 adult patients who were administered salbutamol after a methacholine challenge. To compare relative changes in PEF and FEV₁ during bronchodilation, we used regression analysis and constructed a Bland and Altman plot. ROC analysis, sensitivity, specificity, positive and negative predictive values, and kappa coefficient assessed how precisely increases in PEF detected a 12% and 0.2-L improvement in FEV₁. The average relative increase in FEV₁ was significantly greater than that in PEF. The area under the curve in the ROC analysis was 0.844 for PEF change to detect a 12% and 0.2-L increase in FEV₁. The kappa values for changes in PEF and FEV₁ ranged from fair to moderate. BDR detected by the recommended 15% and 60 L/min cut-off for PEF identified less than half of true positives, while a 10% cut-off correctly identified close to 75% of them. PEF increase is not a reliable measure of BDR in comparison to FEV₁ increase, and a 10% improvement in PEF was the least inaccurate cut-off. Substituting the PEF meter with a handheld spirometer should be further investigated for asthma home monitoring.

Lung diseases, including pneumonia and COVID-19, are prevalent globally, necessitating early diagnosis for effective treatment. Medical imaging is widely regarded as an effective method for detecting lung diseases. Numerous researchers have dedicated their efforts to developing advanced detection techniques, significantly contributing to the prevention and management of these conditions. Despite advancements in imaging diagnostic methods, chest radiographs remain pivotal due to their cost-effectiveness and rapid results. This study proposes an automated system for detecting multiple lung diseases in x-ray and CT scans using a customized convolutional neural network (CNN) alongside pretrained models and an image enhancement approach. The dataset used comprises 6400 images sourced from Kaggle, categorized into three classes: pneumonia, COVID-19, and normal. To address dataset imbalance, data augmentation techniques were applied. The model includes preprocessing and classification stages, achieving high performance metrics: 96% precision, 95.33% recall, 95.66% F1-score, and 97.24% accuracy, highlighting its effectiveness compared to other deep learning models.

Background: Therapeutic drug monitoring (TDM) for vancomycin (VAN) in adult people with cystic fibrosis (pwCF) historically has utilized trough concentrations. Recent VAN TDM guidelines recommend area under the curve (AUC) monitoring to reduce the risk of acute kidney injury (AKI), despite limited evidence to support this practice in adult pwCF. Methods: This single-center, retrospective, observational cohort study included 143 adult pwCF admitted from July 1, 2017, to July 1, 2022, with an acute pulmonary exacerbation that received VAN for at least 72 h with available VAN plasma concentrations for TDM for AUC (n = 39) or trough monitoring (n = 104). Eligible patients with multiple hospital admissions during the study period were incorporated as separate encounters. The primary outcome was the incidence of AKI. Results: Receipt of concurrent nephrotoxins was more common in the AUC cohort than in the trough cohort (97% vs. 81%, p = 0.01), but the rate of AKI was similar (7.7% vs. 10.6%, p = 0.76). AUC monitoring was associated with earlier achievement of TDM goal (median 0 days (IQR 0-2) vs. 2 days (IQR 0-4), p < 0.01), lower total daily doses (34.8 mg/kg/day (IQR 27.6-49) vs. 57.5 mg/kg/day (IQR 43.9-68.6), p < 0.01), and fewer regimen changes (median 1 change (IQR 0-2) vs. 2 changes (IQR 1-3), p < 0.01). In patients with MRSA, pulmonary function recovery, readmission, and mortality were similar. Conclusion: In adult pwCF, the incidence of AKI was similar between AUC and trough monitoring cohorts; however, AUC monitoring achieved therapeutic targets sooner with fewer regimen modifications without significantly increasing the number of concentrations compared to trough monitoring.

Background: Chronic obstructive pulmonary disease (COPD) is a progressive lung disorder characterized by poorly reversible airway obstruction. COPD being an inflammatory disorder has been proposed to have an imbalance between proinflammatory and anti-inflammatory factors. Regulatory T cells (Tregs) being a negative regulator of immune response have been observed to play an important role in other inflammatory diseases as well as animal models of inflammation. Objective: This study is aimed at assessing the suppressive functions of circulatory Tregs and examining the inductive capacity of naive CD4+ T cells to generate induced Tregs. Methods: The study was conducted in 20 COPD patients (smokers n = 10; reformed smokers n = 10) and 20 age-matched healthy controls (smokers n = 10; nonsmokers n = 10). Peripheral blood mononuclear cells were isolated from blood using Ficoll density gradient separation. The suppressive functions were evaluated by assessing the proliferation of T responder cells (CD4+CD25-) in the presence of circulatory Tregs (CD4+CD25+) under polyclonal stimulation. In addition, cytokine-mediated suppression was assessed in the culture supernatants of the suppression assay. Inductive capacity was assessed by stimulating naive CD4+ T cells to generate iTregs in the presence of anti-CD3, IL-2, and TGF-β1. Results: The percent suppression of T responder cells by Tregs was significantly lower in COPD smokers (p = 0.03) and COPD reformed smokers (p = 0.04) as compared to control smokers. On the assessment of cytokine-mediated suppression, significantly reduced IL-2 in COPD S as compared to COPD RS (p < 0.05) and reduced IL-10 and TGFß1 in COPD S as compared to CNS (p < 0.05) and CS (p < 0.05) was observed in the culture supernatants of suppression assay. In addition, a significantly higher frequency of iTregs with phenotype CD4+CD25+CD45RA+CD127- was observed in COPD S as compared to COPD RS (p < 0.01). Discussion: Characteristics changes were observed in patients with COPD. The compromised Tregs function, despite the increase in systemic inflammation, suggests a potential role of these cells in the pathogenesis of the disease.

Background: Lung volume recruitment (LVR) is a stacked-breath assisted inflation technique in which consecutive insufflations are delivered, without exhaling in between, until the maximum tolerable inflation capacity is reached. Although LVR is recommended in some neuromuscular disease guidelines, there is little information detailing when and how allied health professionals (AHPs) prescribe LVR. Objective: This study is aimed at describing the use of LVR in practice across Brazil. Methods: A cross-sectional e-survey (Sep-Nov 2023) explored LVR practices among qualified clinical or home care AHPs in Brazil. It gathered participant data on geographical region, profession, and experience. It delved into LVR specifics: clinical population and indications for use, prescription (frequency, dosage, and interfaces), related side effects, outcomes assessed, and combined therapies. Results were presented descriptively. Results: One hundred two surveys (74 physical therapists (PTs) and 28 speech and language pathologists (SLPs)) from diverse locations were collected. LVR was predominantly prescribed for adults (57%), with the most common diagnosis being amyotrophic lateral sclerosis (84%). Changes in peak cough flow and vital capacity were the most common reasons for LVR prescription. Maximal insufflation capacity was reportedly measured by 58% of PTs and 22% of SLPs. Chest wall soreness and discomfort were the most common side effects, and many respondents did not provide warnings about potential side effects (42% PTs and 50% SLPs). The study highlighted common use of other respiratory therapy devices alongside LVR. Conclusion: LVR is available in routine clinical and home care settings in Brazil. There is a lack of standardization regarding indications, prescription, and outcome measures among PTs and SLPs in Brazil. Clear recommendations and guidelines are needed to standardize these parameters, enabling more objective data and facilitating comparisons between centers.

Lung cancer (LC) remains one of the leading causes of cancer-related mortality worldwide. With recent technological advances, artificial intelligence (AI) has begun to play a crucial role in improving diagnostic and treatment methods. It is crucial to understand how AI has integrated into LC research and to identify the main areas of focus. The aim of the study was to provide an updated insight into the role of AI in LC research, analyzing evolving topics, geographical distribution, and contributions to journals. The study explores research trends in AI applied to LC through a novel approach combining latent Dirichlet allocation (LDA) topic modeling with the HJ-Biplot statistical technique. A growing interest in AI applications in LC oncology was observed, reflected in a significant increase in publications, especially after 2017, coinciding with the availability of computing resources. Frontiers in Oncology leads in publishing AI-related LC research, reflecting rigorous investigation in the field. Geographically, China and the United States lead in contributions, attributed to significant investment in R&D and corporate sector involvement. LDA analysis highlights key research areas such as pulmonary nodule detection, patient prognosis prediction, and clinical decision support systems, demonstrating the impact of AI in improving LC outcomes. DL and AI emerge as prominent trends, focusing on radiomics and feature selection, promising better decision-making in LC care. The increase in AI-driven research covers various topics, including data analysis methodologies, tumor characterization, and predictive methods, indicating a concerted effort to advance LC research. HJ-Biplot visualization reveals thematic clustering, illustrating temporal and geographical associations and highlighting the influence of high-impact journals and countries with advanced research capabilities. This multivariate approach offers insights into global collaboration dynamics and specialization, emphasizing the evolving role of AI in LC research and diagnosis.

Venous thromboembolism is responsible for a significant burden of disease worldwide. Despite the publication of multiple international guidelines, anecdotal evidence suggests significant clinical variation exists in the diagnostic and management pathways of pulmonary embolism (PE). We conducted a retrospective cohort study using electronic medical records to examine clinical variation in patients admitted to a tertiary referral center in Australia with a diagnosis of PE between November 2018 and January 2020. Three hundred cases met the inclusion criteria; we found variation in rates of compression ultrasonography, acute investigation of the right ventricle, and planning of repeat imaging at specialist follow-up. Guidelines do not address the use of compression ultrasonography in already diagnosed PE, are conflicting in their recommendation for acute investigation of the right ventricle, and recommend repeat imaging only if there are persistent symptoms at the time of specialist follow-up. The variations we found in this study may in part be due to physician preference or due to the paucity of evidence for some of these diagnostic practices. Robust future studies are required to guide the use of these investigations in PE.

Background/Objective: Respiratory syncytial virus (RSV) is a major cause of bronchiolitis in infants and young children. Bronchiolitis, an acute inflammation of the lower respiratory tract, can lead to pneumonia, respiratory failure, and death. We aimed to compare the incidence and severity of RSV infection in children aged 0-60 months before and during the coronavirus disease 2019 (COVID-19) pandemic. Methods: A retrospective chart review was conducted on patients aged 0-60 months who tested positive for RSV between May 1, 2018, and May 31, 2022, in a community hospital in Queens County, New York City, United States. Comparisons were made between seasons 2018-2019 and 2019-2020 as before, and seasons 2020-2021 and 2021-2022 as during the COVID-19 pandemic. Severity of RSV infection was assessed using the Bronchiolitis Severity Score (BSS). Data were analyzed using R software, a p value of < 0.05 was considered statistically significant. Results: The incidence of RSV infection in seasons 2018-2019 and 2019-2020 peaked from mid-October to February, whereas the first season during the COVID-19 pandemic (2020-2021) was truncated with a very low incidence of RSV infection, and season 2021-2022 peaked from September to January, with the highest incidence (37%) and lower frequency of RSV infection at any given point. Patients during the season 2021-2022 were older (H [2, 196.6] = 12.5, p < 0.001, 95% CI = [5.4, 25.6]) and had milder illness (H [2, 187.5] = 7.5, p < 0.01, 95% CI = [2.1, 19.2]). Conclusions: We observed a lower incidence of RSV infection and a lower rate of hospitalization for RSV during the COVID-19 pandemic. The second RSV season during the COVID-19 pandemic began earlier, lasted longer, and had a lower frequency. Older children with milder illnesses were affected most during this season. RSV epidemiology and disease burden were impacted by the COVID-19 pandemic and could have significant ramifications for its prevention and control strategies.

Background: Chronic obstructive pulmonary disease (COPD) is characterized by important extrapulmonary alterations that could affect the performance in dual task (DT) (motor and cognitive tasks executed simultaneously), which is defined as DT interference (DTI). Objective: To compare the performance of DT between individuals with COPD and healthy control subjects (HCSs). Methods: The literature search was conducted in seven databases (Medline, Scopus, Web of Science, PEDro, SciELO, LILACS, and Google Scholar) up to December 2023, including studies published in English, Spanish, or Portuguese. Studies with individuals diagnosed with COPD older than 60 years, who were evaluated with any DT assessment, and compared with HCS were included. The quality of the studies was evaluated using the risk of bias in nonrandomized studies of interventions (ROBINS-I). The meta-analysis was performed with JAMOVI software 5.4. The study protocol was registered on PROSPERO (CRD42023435212). Results: From a total of 128 articles, 5 observational studies were selected in this review, involving 252 individuals aged between 60 and 80 years, from France, Italy, Canada, Turkey, and Belgium. Notable DTI was observed in individuals with COPD compared to HCS (standard mean difference [SMD] = 0.91; 95% confidence interval (CI) 0.06-1.75, p = 0.04). Individuals with COPD had impaired gait speed, balance control, muscle strength, and cognitive interference during DT compared to HCS. DT assessment protocols included different combination of motor and cognitive tasks, using functional test, gait analysis, and muscle strength paired with countdown and verbal fluency tasks. Studies presented low (n = 2), moderate (n = 1), and serious (n = 2) overall risk of bias. Conclusion: Older adults diagnosed with COPD exhibited a significant DTI compared to HCSs, which is characterized by poorer physical and cognitive performance during DT execution. These findings highlight the importance of incorporating DT assessments into clinical practice for individuals with COPD.

The risks and benefits of bedaquiline (BDQ) for treatment of drug-resistant tuberculosis (DR-TB) have not been firmly established. We aimed to assess the safety and efficacy of BDQ-containing regimens for the treatment of DR-TB as evidenced in available randomized controlled trials (RCTs). In this systematic review and meta-analysis, five databases (i.e., ClinicalTrials.gov, Cochrane CENTRAL, PubMed, ScienceDirect, and SinoMed) were searched. RCTs among DR-TB patients that had a control arm were eligible. The safety endpoints were all-cause mortality and serious adverse effects (SAEs). Efficacy outcomes were sputum culture conversion rate at 8-12 weeks and 24-26 weeks, treatment success, and time to culture conversion. A total of 476 records were screened; 18 met the eligibility criteria. The pooled analysis included 2520 participants (55.8% received BDQ-containing regimens, n = 1408). Pooled safety outcomes showed no significant reduction in all-cause mortality (relative risk [RR] [95%confidence interval (CI)] = 0.94 [0.41-2.20]) or SAEs (RR [95%CI] = 0.91 [0.67-1.23]) in the BDQ-regimen group. Pooled efficacy outcomes showed significantly superior culture conversion rates at 8-12 weeks (RR [95%CI] = 1.35 [1.10-1.65]) and 24-26 weeks (RR [95%CI] = 1.25 [1.15-1.36]), more treatment success (RR [95%CI] = 1.30 [1.17-1.44]), and a 17-day reduction in the time to culture conversion (standardized mean difference [SMD] [95%CI] = -17.46 [-34.82 to -0.11]) in the BDQ-regimen group (reference: non-BDQ regimen). Overall, BDQ regimens showed significant treatment effect against DR-TB but did not reduce mortality or SAEs.