Pulmonology最新文献

Approximately 400 million people live at high altitudes worldwide, yet reference equations for spirometry in these populations are inadequately documented. This study aims to develop reference equations for spirometry and assess their applicability to residents at altitudes ranging from 2,100 to 4,700 metres above sea level. This extensive cross-sectional study encompassed healthy non-smokers aged 15 years or older living at Xinjiang and Tibet autonomous region, which covered eight high-altitude areas by a multistage stratified sampling procedure. All individuals underwent pre- and post-bronchodilator measurement. We used the Lambda-Mu-Sigma (LMS) method to establish reference equations for various spirometry parameters. We assessed model fit using mean absolute error (MAE), mean absolute percentage error (MAPE), and residual values (standard deviation), relative to established benchmarks such as GLI, ECSC, and NHANES III, to evaluate the applicability of our equations to high-altitude residents. Between June 2015 and August 2016, 3174 healthy subjects were included. The reference equations utilise age and height as independent variables, with improved accuracy achieved through spline functions. Our spirometry reference equations demonstrate minimal MAE, MAPE, and residual values (standard deviation) for most of the analysed spirometry parameters, stratified by gender. Our spirometry reference equations are more applicable to residents of high-altitude regions.

Background: This systematic review assesses the current available evidence across the WHO European region on the effectiveness and cost-effectiveness of the different approaches used for TB screening and also explores the facilitators and barriers that migrants face during screening programmes.

Methods: We conducted an extensive, comprehensive, and systematic literature search across multiple databases, including MEDLINE, Cochrane, Scopus, and ISI Web of Knowledge, without any restrictions on publication date or language. In addition, we reviewed grey literature and reports. The data were meticulously analysed with a focus on screening of TB active disease and infection effectiveness indicators, and cost-effectiveness economic analyses as a primary objective and the comprehension of barriers and facilitators of screening as a secondary objective.

Findings: Our review included 43 studies covering over 8 million migrants from 11 countries. The findings demonstrate that while screening uptake was high, coverage varied, and completion rates for preventive treatments were low. Economic analyses supported the high cost-effectiveness of the screening programmes, particularly when integrating both active TB and TBI screening strategies.

Interpretation: This review underscores the cost-effectiveness and public health importance of TB screening in migrant populations within Europe. However, the disparities in screening practices highlight the urgent need for standardisation at the European level.

Background: High-flow nasal cannula (HFNC) is widely used in acute exacerbations of chronic obstructive pulmonary disease (AECOPD) treatment, but the optimal initial flow settings remain unclear. Research question Which initial HFNC flow rate provides the most effective and safe clinical outcomes for patients with AECOPD? Study design.

Methods: We searched 7 databases for studies published before January 2025. Network meta-analysis was conducted using R software (version 4.2.3) within a Bayesian framework. The primary outcome was intubation rate, and secondary outcomes included short-term mortality, PaCO₂, pH, PaO₂/FiO₂, and length of hospital stay.

Results: The analysis included 40 RCTs with 3597 patients. HFNC showed no significant difference from NIV in intubation rates. HFNC_Low (20 to 30 L/min) significantly reduced PaCO₂, improved pH, and lowered incidence of nasal and facial injuries. HFNC_Mod (30 to 50 L/min) significantly shortened hospital stay. SUCRA rankings indicated HFNC_Low as most effective for PaCO₂, pH, and injury prevention, while HFNC_Mod ranked highest for reducing hospital stay.

Conclusions: HFNC_Low demonstrates superior efficacy in lowering PaCO₂ levels, the incidence of nasal and facial injuries, and improving pH. Although HFNC_Mod may reduce hospital stay, low-flow settings are recommended as the preferred initial strategy for AECOPD.