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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 Pub Date : 2024-11-01 DOI: 10.1016/j.pulmoe.2024.04.007
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引用次数: 0
An extremely rare case of Langerhans cell hyperplasia in the thymus 一例极为罕见的胸腺朗格汉斯细胞增生症。
IF 10.4 2区 医学 Q1 RESPIRATORY SYSTEM Pub Date : 2024-11-01 DOI: 10.1016/j.pulmoe.2024.04.002
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引用次数: 0
Recommendations for the implementation of a national lung cancer screening program in Portugal—A consensus statement 关于在葡萄牙实施全国肺癌筛查计划的建议--共识声明。
IF 10.4 2区 医学 Q1 RESPIRATORY SYSTEM Pub Date : 2024-11-01 DOI: 10.1016/j.pulmoe.2024.04.003
Lung cancer (LC) is a leading cause of cancer-related mortality worldwide. Lung Cancer Screening (LCS) programs that use low-dose computed tomography (LDCT) have been shown to reduce LC mortality by up to 25 % and are considered cost-effective. The European Health Union has encouraged its Member States to explore the feasibility of LCS implementation in their respective countries.
The task force conducted a comprehensive literature review and engaged in extensive discussions to provide recommendations.
These recommendations encompass the essential components required to initiate pilot LCS programs following the guidelines established by the World Health Organization. They were tailored to align with the specific context of the Portuguese healthcare system. The document addresses critical aspects, including the eligible population, methods for issuing invitations, radiological prerequisites, procedures for reporting results, referral processes, diagnostic strategies, program implementation, and ongoing monitoring. Furthermore, the task force emphasized that pairing LCS with evidence-based smoking cessation should be the standard of care for a high-quality screening program. This document also identifies areas for further research.
These recommendations aim to guarantee that the implementation of a Portuguese LCS program ensures high-quality standards, consistency, and uniformity across centres.
肺癌(LC)是全球癌症相关死亡的主要原因。使用低剂量计算机断层扫描(LDCT)的肺癌筛查(LCS)计划已被证明可将肺癌死亡率降低 25%,并被认为具有成本效益。欧洲健康联盟鼓励其成员国探索在各自国家实施 LCS 的可行性。特别工作组进行了全面的文献综述和广泛的讨论,以提出建议。这些建议包含了按照世界卫生组织制定的指导方针启动试点 LCS 计划所需的基本组成部分。这些建议是根据葡萄牙医疗保健系统的具体情况量身定制的。文件涉及的关键方面包括符合条件的人群、发出邀请的方法、放射学先决条件、报告结果的程序、转诊流程、诊断策略、计划实施和持续监测。此外,特别工作组还强调,将 LCS 与循证戒烟相结合应成为高质量筛查项目的护理标准。本文件还指出了需要进一步研究的领域。这些建议旨在保证葡萄牙 LCS 项目的实施能确保各中心的高质量标准、一致性和统一性。
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引用次数: 0
Obstructive Sleep Apnoea (OSA) and early atherosclerosis: The role of microbiota and EVs 阻塞性睡眠呼吸暂停(OSA)与早期动脉粥样硬化:微生物群和 EVs 的作用
IF 10.4 2区 医学 Q1 RESPIRATORY SYSTEM Pub Date : 2024-11-01 DOI: 10.1016/j.pulmoe.2023.11.011
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引用次数: 0
Single breath nitrogen test as predictor of lung function decline and COPD over an 8-year follow-up 单次呼气含氮量测试作为肺功能下降和慢性阻塞性肺病的预测指标,随访 8 年。
IF 10.4 2区 医学 Q1 RESPIRATORY SYSTEM Pub Date : 2024-11-01 DOI: 10.1016/j.pulmoe.2022.09.001

Background

The single breath nitrogen (SBN2) test was proposed for early detection of “small airways disease” in the seventies. Few longitudinal studies have subsequently evaluated the relationships between SBN2 test measurements and lung function decline or COPD incidence.

Aim

This study evaluates whether SBN2 test abnormalities may be significant predictors of lung function decline and COPD incidence over an 8-year follow-up.

Study Design and Methods

In this longitudinal study, 907 adults (20+ years old; 56% males) from the prospective Po River Delta epidemiological study underwent SBN2 test at baseline and spirometry testing at both baseline and follow-up 8-year apart. Multinomial and multiple regression models were used to assess associations of SBN2 indexes and rates of FEV1 decline or risk of COPD incidence over time, after adjusting for sex, height and baseline age, FEV1 and smoking status. COPD was defined according to either GOLD or ATS-ERS criteria.

Results

Among SBN2 indexes, only the slope of alveolar plateau (N2-slope) was significantly associated with rates of FEV1 decline (7.93 mL/year for a one-unit change in N2-slope, p<0.0001), and with an increased risk of developing COPD as defined by GOLD (RR 1.81, 95%CI 1.29-2.52, mild; RR 2.78, 95%CI 1.70-4.53, moderate or severe obstruction) and ATS-ERS criteria (RR 1.62, 95%CI 1.14-2.29, mild; RR 3.40, 95%CI 1.72-6.73, moderate or severe obstruction).

Conclusion

In this population-based study, N2-slope from SBN2 test is a significant predictor of lung function decline and COPD incidence over an 8-year follow-up, confirming the role of the “small airways disease” in the natural history of COPD.
背景:单次呼气含氮量(SBN2)测试在七十年代被提出用于早期检测 "小气道疾病"。目的:本研究评估了 SBN2 测试异常是否可能成为 8 年随访期间肺功能下降和慢性阻塞性肺病发病率的重要预测因素:在这项纵向研究中,来自波河三角洲前瞻性流行病学研究的 907 名成年人(20 岁以上;56% 为男性)在基线时接受了 SBN2 测试,并在基线和随访 8 年时接受了肺活量测试。在对性别、身高、基线年龄、FEV1 和吸烟状况进行调整后,采用多项式和多元回归模型评估 SBN2 指数与 FEV1 下降率或慢性阻塞性肺病发病风险的相关性。慢性阻塞性肺病是根据 GOLD 或 ATS-ERS 标准定义的:结果:在 SBN2 指数中,只有肺泡平台斜率(N2-斜率)与 FEV1 下降率显著相关(N2-斜率每变化一个单位,FEV1 下降率为 7.93 毫升/年,p):在这项基于人群的研究中,SBN2测试得出的N2-斜率是8年随访期间肺功能下降和慢性阻塞性肺病发病率的重要预测指标,证实了 "小气道疾病 "在慢性阻塞性肺病自然病史中的作用。
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引用次数: 0
Intensity of exercise in people with COPD enrolled in community-based physical activities 参加社区体育活动的COPD患者的运动强度。
IF 10.4 2区 医学 Q1 RESPIRATORY SYSTEM Pub Date : 2024-11-01 DOI: 10.1016/j.pulmoe.2023.11.001
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引用次数: 0
Unraveling the resurgence of pertussis: Insights into epidemiology and global health strategies 揭示百日咳卷土重来的原因:流行病学和全球健康战略的启示。
IF 10.4 2区 医学 Q1 RESPIRATORY SYSTEM Pub Date : 2024-11-01 DOI: 10.1016/j.pulmoe.2024.04.009
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引用次数: 0
Reliability and validity of the Chester step test in patients with interstitial lung disease 间质性肺病患者切斯特台阶试验的可靠性和有效性。
IF 10.4 2区 医学 Q1 RESPIRATORY SYSTEM Pub Date : 2024-11-01 DOI: 10.1016/j.pulmoe.2022.10.009

Background

The Chester Step Test (CST) is a simple and inexpensive field test, which requires minimal physical space to assess exercise capacity. Such characteristics make the CST suitable to be used in different settings, however, its measurement properties in patients with interstitial lung diseases (ILD) are unknown.

Methods

A cross-sectional study was conducted in patients with ILD. First, a CST-1 and a 6-minute walk test (6MWT) were performed. After 48-72 hours, a CST-2 was repeated. A 2nd rater was present in one of the sessions. Relative reliability was measured using intraclass correlation coefficient (ICC1,1 and ICC2,1). Absolute reliability was determined using standard error of measurement (SEM), minimal detectable change at 95% confidence interval (MDC95) and the Bland-Altman method. The values of SEM and MDC95 were also expressed as a percentage of the mean. Construct validity was explored using Spearman correlation coefficient (rs) between the number of steps taken in the best CST and the distance performed in the 6MWT.

Results

Sixty-six patients with ILD (65.5±12.9 years; 48.5%men; FVC 79.4±18.8pp; DLCO 49.0±18.3pp) participated in the study. Relative (ICC 0.95-1.0) and absolute reliability were excellent without evidence of systematic bias. The SEM and MDC95 were 11.8 (14.7%) and 32.6 steps (40.7%), respectively. The correlation between CST and 6MWT was significant, positive, and high (rs=0.85, p=0.001).

Conclusion

The CST is a reliable and valid test and might be especially useful to assess exercise capacity in patients with ILD in limited space environments.
背景:切斯特台阶试验(CST)是一种简单而廉价的现场试验,只需最小的物理空间即可评估运动能力。这些特点使切斯特台阶试验适合在不同环境中使用,但其在间质性肺病(ILD)患者中的测量特性尚不清楚:方法:对 ILD 患者进行了一项横断面研究。首先,进行 CST-1 和 6 分钟步行测试(6MWT)。48-72 小时后,重复 CST-2。在其中一次测试中,有第二位评分者在场。相对可靠性采用类内相关系数(ICC1,1 和 ICC2,1)进行测量。绝对信度采用标准测量误差(SEM)、95% 置信区间(MDC95)的最小可检测变化和布兰德-阿尔特曼法确定。SEM 和 MDC95 的值也以平均值的百分比表示。使用最佳 CST 的步数与 6MWT 的距离之间的斯皮尔曼相关系数(rs)探讨了结构有效性:66名 ILD 患者(65.5±12.9 岁;48.5% 男性;FVC 79.4±18.8pp;DLCO 49.0±18.3pp)参加了研究。相对信度(ICC 0.95-1.0)和绝对信度都非常好,没有系统性偏差的证据。SEM和MDC95分别为11.8步(14.7%)和32.6步(40.7%)。CST与6MWT之间的相关性显著、正且高(rs=0.85,P=0.001):CST是一项可靠有效的测试,尤其适用于评估ILD患者在有限空间环境中的运动能力。
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引用次数: 0
Chronic obstructive pulmonary disease exacerbations' management in Portuguese hospitals – EvaluateCOPDpt, a multicentre, observational, prospective study 葡萄牙医院对慢性阻塞性肺疾病加重的管理 - EvaluateCOPDpt,一项多中心、观察性、前瞻性研究。
IF 10.4 2区 医学 Q1 RESPIRATORY SYSTEM Pub Date : 2024-11-01 DOI: 10.1016/j.pulmoe.2022.07.007

Introduction and Objectives

In order to improve the quality of chronic obstructive pulmonary disease (COPD) patients' care, better knowledge of clinical practice and the factors associated with patient outcomes are needed. This study aimed to evaluate the relation between clinical practice and the outcomes of patients admitted for COPD exacerbations in Portuguese hospitals.

Materials and Methods

Observational, multicentre, prospective study with a 60-days follow-up period, in 11 hospitals, including patients aged ≥ 30 years, admitted to hospital for at least 24 hours due to an acute exacerbation of COPD. Demographic and clinical data were collected, including sex, age, smoking habits, hospitalisations, pulmonary function, comorbidities, COPD symptoms, and treatment. Sixty days after discharge, COPD exacerbations management, outcome measures, and readmission data were evaluated through a structured phone follow-up interview.

Results

196 patients were included (85.7% male, mean age 71.2 years), the majority admitted through the emergency service. Ex-smokers and current smokers accounted for 51% and 36%, respectively. On admission, 72.4% were on LAMA, 54.6% on LABA, and 45.5% were on LABA/LAMA. Inhaled corticosteroids (ICS) were used in 37.3% and systemic steroids (SCS) in 10.3%. 35.7 % had had at least one exacerbation, with hospitalisation, in the previous year. There was no spirometry data for 23.2%. On hospitalisation, 98.5% of patients were treated with oxygen and 38.3% with non-invasive ventilation. Additionally, 93.4% used SCS and 60.2% ICS. Antibiotics were administered to 85.2%. 95.4% of patients were discharged; 9 died, 5 of whom had a COPD-related death. The median length of stay was 12 days for discharged patients and 33 days for patients who died. At discharge, 79.1% were prescribed with LAMA, 63.6% SCS, 61.5% LABA and 55.6% LAMA+LABA. 26,2% were prescribed with ICS+LABA+LAMA. At follow-up, 44.4% had a scheduled medical appointment within the 60 days after being discharged, and 28.3% were later readmitted due to exacerbation, of whom 52.8% were hospitalised.

Conclusions

The severity of COPD, particularly in exacerbations, is directly related to impaired lung function and quality of life, mortality, and significant health system costs. Knowledge about COPD exacerbations' management in acute hospital admissions in Portugal may help stimulate a national discussion and review of existing data to engage clinicians, policymakers, managers, and patients, raising awareness and promoting action on COPD.
导言和目标:为了提高慢性阻塞性肺病(COPD)患者的治疗质量,需要更好地了解临床实践以及与患者治疗效果相关的因素。本研究旨在评估葡萄牙医院的临床实践与慢性阻塞性肺病加重患者的治疗效果之间的关系:观察性、多中心、前瞻性研究,随访期60天,在11家医院进行,包括年龄≥30岁、因慢性阻塞性肺疾病急性加重住院至少24小时的患者。研究人员收集了人口统计学和临床数据,包括性别、年龄、吸烟习惯、住院情况、肺功能、合并症、慢性阻塞性肺病症状和治疗情况。出院 60 天后,通过结构化电话随访对慢性阻塞性肺疾病加重的管理、结果测量和再入院数据进行评估:共纳入了 196 名患者(85.7% 为男性,平均年龄 71.2 岁),其中大部分患者是通过急诊服务入院的。曾经吸烟者和目前吸烟者分别占 51% 和 36%。入院时,72.4%的患者使用LAMA,54.6%使用LABA,45.5%使用LABA/LAMA。37.3%的患者使用吸入性皮质类固醇(ICS),10.3%的患者使用全身性类固醇(SCS)。35.7%的患者在过去一年中至少出现过一次病情加重并住院治疗。23.2%的患者没有肺活量数据。住院期间,98.5% 的患者接受了氧气治疗,38.3% 接受了无创通气治疗。此外,93.4%的患者使用了SCS,60.2%的患者使用了ICS。85.2%的患者使用了抗生素。95.4%的患者出院;9人死亡,其中5人死于慢性阻塞性肺病。出院患者的中位住院时间为 12 天,死亡患者的中位住院时间为 33 天。出院时,79.1%的患者接受了LAMA治疗,63.6%接受了SCS治疗,61.5%接受了LABA治疗,55.6%接受了LAMA+LABA治疗。26.2%的患者接受了 ICS+LABA+LAMA 治疗。在随访中,44.4%的患者在出院后60天内进行了预约就诊,28.3%的患者后来因病情加重再次入院,其中52.8%的患者住院治疗:结论:慢性阻塞性肺病的严重程度,尤其是病情加重的程度,与肺功能受损、生活质量下降、死亡率和医疗系统的重大成本直接相关。了解葡萄牙急性入院患者慢性阻塞性肺疾病加重的管理情况有助于促进全国性讨论和对现有数据的审查,让临床医生、政策制定者、管理者和患者参与进来,提高对慢性阻塞性肺疾病的认识并促进相关行动。
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引用次数: 0
Chronic cough in patients with obstructive sleep apnoea: A prospective cohort study 阻塞性睡眠呼吸暂停患者的慢性咳嗽:前瞻性队列研究
IF 10.4 2区 医学 Q1 RESPIRATORY SYSTEM Pub Date : 2024-11-01 DOI: 10.1016/j.pulmoe.2024.04.010
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引用次数: 0
期刊
Pulmonology
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