Pulmonology最新文献

英文中文

Late-onset endobronchial metastasis of oncocytic cell thyroid carcinoma 晚期发生的甲状腺细胞癌支气管内转移。

IF 10.4 2区医学 Q1 RESPIRATORY SYSTEM

Pulmonology

Pub Date : 2024-11-01 DOI: 10.1016/j.pulmoe.2024.02.005

引用次数: 0

Disseminated tuberculosis mimicking pleural mesothelioma in a polycythemia vera patient treated with ruxolitinib 一名接受鲁索利替尼治疗的红细胞增多症患者发生了模仿胸膜间皮瘤的播散性结核病。

IF 10.4 2区医学 Q1 RESPIRATORY SYSTEM

Pulmonology

Pub Date : 2024-11-01 DOI: 10.1016/j.pulmoe.2024.05.003

引用次数: 0

Prone position for acute respiratory distress syndrome and the hazards of meta-analysis 急性呼吸窘迫综合征的俯卧位和荟萃分析的危害。

IF 10.4 2区医学 Q1 RESPIRATORY SYSTEM

Pulmonology

Pub Date : 2024-11-01 DOI: 10.1016/j.pulmoe.2022.12.005

Background

Researchers have tried unsuccessfully for many years using randomized controlled trials to show the efficacy of prone ventilation in treating ARDS. These failed attempts were of use in designing the successful PROSEVA trial, published in 2013. However, the evidence provided by meta-analyses in support of prone ventilation for ARDS was too low to be conclusive. The present study shows that meta-analysis is indeed not the best approach for the assessment of evidence as to the efficacy of prone ventilation.

Methods

We performed a cumulative meta-analysis to prove that only the PROSEVA trial, due to its strong protective effect, has substantially impacted on the outcome.

We also replicated nine published meta-analyses including the PROSEVA trial. We performed leave-one-out analyses, removing one trial at a time from each meta-analysis, measuring p values for effect size, and also the Cochran's Q test for heterogeneity assessment. We represented these analyses in a scatter plot to identify outlier studies influencing heterogeneity or overall effect size. We used interaction tests to formally identify and evaluate differences with the PROSEVA trial.

Results

The positive effect of the PROSEVA trial accounted for most of the heterogeneity and for the reduction of overall effect size in the meta-analyses. The interaction tests we conducted on the nine meta-analyses formally confirmed the difference in the effectiveness of prone ventilation between the PROSEVA trial the other studies.

Conclusions

The clinical lack of homogeneity between the PROSEVA trial design and the other studies should have discouraged the use of meta-analysis. Statistical considerations support this hypothesis, suggesting that the PROSEVA trial is an independent source of evidence.

背景：多年来，研究人员一直尝试使用随机对照试验来证明俯卧位通气治疗 ARDS 的疗效，但均未成功。这些失败的尝试有助于设计 2013 年成功发表的 PROSEVA 试验。然而，支持俯卧位通气治疗 ARDS 的荟萃分析所提供的证据太少，无法得出结论。本研究表明，荟萃分析确实不是评估俯卧位通气疗效证据的最佳方法：我们进行了累积荟萃分析，证明只有 PROSEVA 试验因其强大的保护作用对结果产生了实质性影响。我们还复制了九项已发表的荟萃分析，其中包括 PROSEVA 试验。我们进行了剔除分析，每次从每项荟萃分析中剔除一项试验，测量效应大小的 p 值，并使用 Cochran's Q 检验进行异质性评估。我们用散点图表示这些分析，以识别影响异质性或总体效应大小的离群研究。我们使用交互检验来正式识别和评估与 PROSEVA 试验的差异：结果：PROSEVA 试验的积极效应解释了荟萃分析中的大部分异质性和总体效应大小的减少。我们对九项荟萃分析进行的交互检验正式证实了 PROSEVA 试验与其他研究之间俯卧位通气效果的差异：结论：PROSEVA 试验设计与其他研究在临床上缺乏同质性，这应阻碍荟萃分析的使用。统计方面的考虑支持了这一假设，表明 PROSEVA 试验是一个独立的证据来源。

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引用次数: 0

What do we know about macrolides immunomodulatory therapeutic potential in respiratory disease in 2023 我们对 2023 年大环内酯类药物在呼吸系统疾病中的免疫调节治疗潜力了解多少？

IF 10.4 2区医学 Q1 RESPIRATORY SYSTEM

Pulmonology

Pub Date : 2024-11-01 DOI: 10.1016/j.pulmoe.2024.02.001

引用次数: 0

Atypical surge of hospitalized and severe cases of pertussis: A single center 19-years study from China 百日咳住院重症病例的非典型激增：来自中国的一项为期 19 年的单一中心研究。

IF 10.4 2区医学 Q1 RESPIRATORY SYSTEM

Pulmonology

Pub Date : 2024-11-01 DOI: 10.1016/j.pulmoe.2024.06.006

Y. Hu , L. Wang , K. Yao , Q. Wang

引用次数: 0

Profile of emergency department overuse in hospitalized patients with pulmonary disease and its impact on mortality 住院肺病患者过度使用急诊室的概况及其对死亡率的影响。

IF 10.4 2区医学 Q1 RESPIRATORY SYSTEM

Pulmonology

Pub Date : 2024-11-01 DOI: 10.1016/j.pulmoe.2023.01.005

Introduction and objectives

Portugal is one of the countries with the highest number of visits to the emergency department (ED), 31% classified as “non-urgent” or “avoidable.” The objectives of our study were to evaluate the size and characteristics of patients with pulmonary disease who overuse the ED, and identify factors associated with mortality.

Materials and methods

A retrospective cohort study was conducted, based on the medical records of ED frequent users (ED-FU) with pulmonary disease who attended a university hospital center in the northern inner city of Lisbon from January 1 to December 31, 2019. To evaluate mortality, a follow-up until December 31, 2020 was performed.

Results

Over 5,567 (4.3%) patients were identified as ED-FU and 174 (0.14%) had pulmonary disease as the main clinical condition, accounting for 1,030 ED visits. 77.2% of ED visits were categorized as “urgent/very urgent.” A high mean age (67.8 years), male gender, social and economic vulnerability, high burden of chronic disease and comorbidities, with a high degree of dependency, characterized the profile of these patients. A high proportion (33.9%) of patients did not have a family physician assigned and this was the most important factor associated with mortality (p<0.001; OR: 24.394; CI 95%: 6.777–87.805). Advanced cancer disease and autonomy deficit were other clinical factors that most determined the prognosis.

Conclusions

Pulmonary ED-FU are a small group of ED-FU who constitute an aged and heterogeneous group with a high burden of chronic disease and disability. The lack of an assigned family physician was the most important factor associated with mortality, as well as advanced cancer disease and autonomy deficit.

导言和目标：葡萄牙是急诊科（ED）就诊人数最多的国家之一，其中 31% 被归类为 "非急诊 "或 "可避免"。我们的研究旨在评估过度使用急诊科的肺病患者的规模和特征，并确定与死亡率相关的因素：根据2019年1月1日至12月31日期间在里斯本北部内城一所大学医院中心就诊的经常使用急诊室的肺病患者（ED-FU）的病历，进行了一项回顾性队列研究。为了评估死亡率，我们进行了截至2020年12月31日的随访：超过5567名（4.3%）患者被确定为急诊室-FU，174名（0.14%）患者以肺部疾病为主要临床症状，占急诊室就诊人数的1,030。77.2%的急诊就诊被归类为 "紧急/非常紧急"。这些患者的特点是平均年龄高（67.8 岁）、性别为男性、社会和经济弱势、慢性病负担重、合并症多、依赖性强。没有指定家庭医生的患者比例很高（33.9%），这是与死亡率相关的最重要因素（p 结论：肺部急诊室-急诊科-急诊科医生是一小群急诊室-急诊科医生，他们是一个高龄、异质的群体，慢性病和残疾的负担很重。没有指定的家庭医生是与死亡率、晚期癌症疾病和自主能力缺失相关的最重要因素。

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引用次数: 0

Predictors of lung entrapment in malignant pleural effusion 恶性胸腔积液肺夹层的预测因素。

IF 10.4 2区医学 Q1 RESPIRATORY SYSTEM

Pulmonology

Pub Date : 2024-11-01 DOI: 10.1016/j.pulmoe.2022.08.001

Introduction

Malignant pleural effusion (MPE) is a common complication in advanced stages of malignancy and is associated with poor prognosis. Non-expandable lung (NEL) often occurs and its presence influences the MPE approach. Our main objective was to assess risk factors for malignant NEL.

Methods

Patients diagnosed with pathologically confirmed MPE between January 2012 and December 2018 in our institution were retrospectively analyzed. Demographic and clinical data of patients were reviewed and compared according to the presence or absence of NEL. A univariate and multivariate binary logistic regression analysis were used to determine predictors of the development of NEL.

Results

Of 365 patients included, 68 (18.6%) had NEL. After multivariate analysis, we found that loculated MPE (OR 8.63, 95%CI 4.30-17.33, p<0.001), complete hemithorax opacification (OR 2.81, 95%CI 1.17-6.76, p<0.021), lung cancer (OR 2.09, 95%CI 1.01-4.31, p=0.047) and higher effusion-serum LDH ratio (OR 1.09, 95%CI 1.00-1.17, p=0.039) were independent predictors of malignant NEL. There were no significant differences compared with expandable lung group regarding time from primary malignancy diagnosis to MPE diagnosis (3.0, IQR 0.0-75.8 vs 2.0, IQR 0.0-75.5 weeks, p=0.942) or MPE symptoms onset to MPE diagnosis (4.0, IQR 1.0-9.0 vs 3.0, IQR 1.0-9.0 weeks, p=0.497). Patients with NEL had a higher number of therapeutic pleural drainages (3.0, IQR 2.0-6.0 vs 2.0, IQR 1.0-3.0; p<0.001) and longer hospital stay (32.5, IQR 15.5-46.3 vs 21.0, IQR 11.0-36.0, p=0.007), measured in hospitalization days until the end of life, than patients with expandable lung. The rate of recurrence of pleural effusion was not significantly different between groups (p=0.291). Overall survival (OS) was 3.0 (95%CI, 2.3-3.7) months, regardless of lung expandability (p=0.923).

Conclusion

Loculated MPE, complete hemithorax opacification, lung cancer and a higher effusion-serum LDH ratio were found to be independent predictors for NEL. These patients underwent thoracocenteses more frequently and had longer hospitalization days, although without significant impact in the OS.

简介恶性胸腔积液（MPE）是恶性肿瘤晚期的常见并发症，与预后不良有关。肺不张（NEL）经常发生，它的存在会影响 MPE 的治疗方法。我们的主要目的是评估恶性 NEL 的风险因素：回顾性分析了 2012 年 1 月至 2018 年 12 月期间在我院确诊为病理证实 MPE 的患者。回顾患者的人口统计学和临床数据，并根据是否存在 NEL 进行比较。采用单变量和多变量二元逻辑回归分析来确定NEL发生的预测因素：在纳入的 365 名患者中，68 人（18.6%）患有 NEL。经过多变量分析，我们发现定位性 MPE（OR 8.63，95%CI 4.30-17.33，p发现定位性 MPE、全血胸不透明、肺癌和较高的渗出液-血清 LDH 比值是 NEL 的独立预测因素。这些患者接受胸腔穿刺的次数更多，住院天数更长，但对手术安全性没有显著影响。

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引用次数: 0

Associations of serum sclerostin levels with body composition, pulmonary function, and exacerbations in COPD patients 慢性阻塞性肺病患者血清硬骨素水平与身体组成、肺功能和病情恶化的关系。

IF 10.4 2区医学 Q1 RESPIRATORY SYSTEM

Pulmonology

Pub Date : 2024-11-01 DOI: 10.1016/j.pulmoe.2022.06.003

Background

In COPD, the bronchial epithelium shows a pathologically activated Wnt pathway. Sclerostin (SOST) is a secreted glycoprotein that is associated with bone metabolism and blocks the Wnt pathway. We hypothesized that low sclerostin levels might be associated with lung function and COPD exacerbations in patients.

Methods

We studied 139 outpatients with stable COPD and normal kidney function. We assessed the serum levels of SOST and bone metabolism parameters, body composition, clinical characteristics and lung function at baseline. We followed the patients prospectively for 12 months after enrolment. Moderate exacerbations and hospital admissions were recorded during follow-up.

Results

The serum SOST levels were 23.98±7.6 pmol/l (men: 25.5±7.7 pmol/l, women: 20.3±5.9 pmol/l (p < 0.001)). SOST showed correlations with age (r = 0.36), FFMI (r = 0.38), FEV1 (r = 0.27), DLCO (r = 0.39), 6MWD (r = 0.19) and CAT (r = -0.24). In multivariate linear regression analysis, only age (beta=0.264) and FFMI (beta=1.241) remained significant. SOST showed a significant negative correlation with serum phosphorus (r = -0.29). Cox proportional risk analysis indicated that patients in the lower tertile of SOST levels were at higher risk of moderate COPD exacerbation (HR 2.015, CI95% 1.136–3.577, p = 0.017) and hospital admission due to COPD (HR 5.142, CI95% 1.380–19.158, p = 0.015) than the rest of the patients.

Conclusions

SOST levels are associated with body composition and lung function in patients with COPD. Furthermore, lower SOST levels predict a higher risk of exacerbations and hospitalization.

背景：慢性阻塞性肺病患者的支气管上皮会出现病理激活的 Wnt 通路。硬骨素（SOST）是一种分泌性糖蛋白，与骨代谢有关，能阻断 Wnt 通路。我们假设，硬骨素水平低可能与患者的肺功能和慢性阻塞性肺疾病恶化有关：我们研究了 139 名病情稳定、肾功能正常的慢性阻塞性肺疾病门诊患者。方法：我们对 139 名病情稳定、肾功能正常的慢性阻塞性肺疾病门诊患者进行了研究，评估了他们的血清 SOST 水平、骨代谢参数、身体组成、临床特征和基线肺功能。在入组后，我们对患者进行了为期 12 个月的前瞻性随访。随访期间记录了中度病情加重和入院情况：结果：血清 SOST 水平为 23.98±7.6 pmol/l（男性：25.5±7.7 pmol/l，女性：20.3±5.9 pmol/l（p 结论：SOST 水平与身体成分有关：SOST水平与慢性阻塞性肺病患者的身体组成和肺功能有关。此外，较低的 SOST 水平预示着较高的病情加重和住院风险。

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引用次数: 0

The Brompton breathing pattern assessment tool (BPAT): Portuguese translation and cultural adaptation 布朗普顿呼吸模式评估工具（BPAT）：葡萄牙语翻译和文化适应。

IF 10.4 2区医学 Q1 RESPIRATORY SYSTEM

Pulmonology

Pub Date : 2024-11-01 DOI: 10.1016/j.pulmoe.2024.01.006

引用次数: 0

Malignant pulmonary epithelioid hemangioendothelioma masquerading as lung adenocarcinoma: A possible radiological and pathological diagnostic pitfall 伪装成肺腺癌的恶性肺上皮样血管内皮瘤：一个可能的放射学和病理学诊断陷阱。

IF 10.4 2区医学 Q1 RESPIRATORY SYSTEM

Pulmonology

Pub Date : 2024-11-01 DOI: 10.1016/j.pulmoe.2024.04.007

引用次数: 0

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全部化学•材料生命科学医学物理工程技术环境•农林材料科学地球科学法学管理学化学环境科学与生态学计算机科学教育学经济学农林科学人文科学生物学数学物理与天体物理心理学综合性期刊其他工业工程理学历史学农学文学信息工程

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Pulmonology

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