Pulmonology最新文献

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How Artificial Intelligence is changing scientific publishing? Unrequested advices for young researchers II 人工智能如何改变科学出版？给年轻研究人员的不二建议 II.

IF 10.4 2区医学 Q1 RESPIRATORY SYSTEM

Pulmonology

Pub Date : 2024-09-01 DOI: 10.1016/j.pulmoe.2024.04.011

Stefano Mazzoleni , Nicolino Ambrosino

引用次数: 0

Comparison of cryobiopsy and forceps biopsy for the diagnosis of mediastinal lesions: A randomised clinical trial 冷冻活检与镊子活检在纵隔病变诊断中的比较：随机临床试验

IF 10.4 2区医学 Q1 RESPIRATORY SYSTEM

Pulmonology

Pub Date : 2024-09-01 DOI: 10.1016/j.pulmoe.2023.12.002

Introduction

Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is the standard approach for lung cancer staging. However, its diagnostic utility for other mediastinal diseases might be hampered by the limited tissue retrieved. Recent evidence suggests the novel sampling strategies of forceps biopsy and cryobiopsy as auxiliary techniques to EBUS-TBNA, considering their capacity for larger diagnostic samples.

Methods

This study determined the added value of forceps biopsy and cryobiopsy for the diagnosis of mediastinal diseases. Consecutive patients with mediastinal lesions of 1 cm or more in the short axis were enrolled. Following completion of needle aspiration, three forceps biopsies and one cryobiopsy were performed in a randomised pattern. Primary endpoints included diagnostic yield defined as the percentage of patients for whom mediastinal biopsy led to a definite diagnosis, and procedure-related complications.

Results

In total, 155 patients were recruited and randomly assigned. Supplementing EBUS-TBNA with either forceps biopsy or cryobiopsy increased diagnostic yield, with no significant difference between EBUS-TBNA plus forceps biopsy and EBUS-TBNA plus cryobiopsy (85.7 % versus 91.6 %, P = 0.106). Yet, samples obtained by additional cryobiopsies were more qualified for lung cancer molecular testing than those from forceps biopsies (100.0 % versus 89.5 %, P = 0.036). When compared directly, the overall diagnostic yield of cryobiopsy was superior to forceps biopsy (85.7 % versus 70.8 %, P = 0.001). Cryobiopsies produced greater samples in shorter procedural time than forceps biopsies. Two (1.3 %) cases of postprocedural pneumothorax were detected.

Conclusions

Transbronchial mediastinal cryobiopsy might be a promising complementary tool to supplement traditional needle biopsy for increased diagnostic yield and tissue harvesting.

Trial registration

ChiCTR2000030373

导言支气管内超声引导下经支气管针吸术（EBUS-TBNA）是肺癌分期的标准方法。然而，它对其他纵隔疾病的诊断效用可能会因提取的组织有限而受到影响。最近的证据表明，考虑到镊子活检和冷冻活检能获取更多的诊断样本，因此这两种新型取样策略可作为 EBUS-TBNA 的辅助技术。研究对象为纵隔短轴病变达 1 厘米或以上的连续患者。在完成针吸后，以随机模式进行了三次镊子活检和一次冷冻活检。主要终点包括诊断率（即通过纵隔活检获得明确诊断的患者比例）和手术相关并发症。EBUS-TBNA辅以镊子活检或冷冻活检可提高诊断率，EBUS-TBNA加镊子活检与EBUS-TBNA加冷冻活检之间无显著差异（85.7%对91.6%，P = 0.106）。然而，额外冷冻活检获得的样本比钳夹活检获得的样本更适合进行肺癌分子检测（100.0% 对 89.5%，P = 0.036）。如果直接比较，冷冻活检的总体诊断率要高于钳活检（85.7% 对 70.8%，P = 0.001）。冷冻活组织检查比钳取活检在更短的手术时间内获得更多样本。结论经支气管纵隔冷冻活检可能是一种很有前途的补充工具，可作为传统针活检的补充，以提高诊断率和组织采集率。

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引用次数: 0

Transcutaneous capnometry-guided exercise in respiratory settings 呼吸环境下经皮血压引导的运动

IF 10.4 2区医学 Q1 RESPIRATORY SYSTEM

Pulmonology

Pub Date : 2024-09-01 DOI: 10.1016/j.pulmoe.2023.12.003

引用次数: 0

Bronchiectasis as long-term complication of acute fire smoke inhalation? 支气管扩张是急性火灾烟雾吸入的长期并发症吗？

IF 10.4 2区医学 Q1 RESPIRATORY SYSTEM

Pulmonology

Pub Date : 2024-09-01 DOI: 10.1016/j.pulmoe.2023.09.001

引用次数: 0

EBUS-guided cryobiopsy in the diagnosis of thoracic disorders EBUS 引导下的冷冻生物切片检查在胸腔疾病诊断中的应用

IF 10.4 2区医学 Q1 RESPIRATORY SYSTEM

Pulmonology

Pub Date : 2024-09-01 DOI: 10.1016/j.pulmoe.2023.11.008

Background

Endobronchial Ultrasound (EBUS) has emerged as a crucial tool for diagnosing intrathoracic disorders, particularly in the staging of lung cancer. However, its diagnostic capabilities in the context of benign and rare diseases remain a subject of debate.

Aim

to investigate the diagnostic yield and safety of EBUS-transbronchial mediastinal cryobiopsy (EBUS-TMC) in comparison to EBUS-transbronchial needle aspiration (TBNA) for a broad spectrum of intrathoracic diseases.

Methods

a single-centre retrospective observational study conducted on 48 patients who underwent both EBUS-TBNA and endobronchial ultrasound-transbronchial mediastinal cryobiopsy (EBUS-TMC) in the same procedure between August 2021 and October 2023.

Results

The overall diagnostic yield of EBUS-TMC surpassed that of EBUS-TBNA (95.8% vs 54.1 %), notably excelling in the diagnosis of sarcoidosis (92.8% vs 78.5 %), rare mediastinal disorders (100% vs 0 %), hyperplastic lymphadenopathy (100% vs 0 %), and lymphoproliferative disease (100% vs 0 %). No significant differences were observed in the diagnosis of NSCLC and SCLC. Samples obtained through EBUS-TMC facilitated the acquisition of NGS and immunohistochemical analyses more readily.

Conclusion

EBUS-TMC may contribute to the precise diagnosis and subtyping of mediastinal diseases, especially lymphomas and rare mediastinal tumors, thereby reducing the number of non-diagnostic procedures.

背景支气管内超声（EBUS）已成为诊断胸腔内疾病，尤其是肺癌分期的重要工具。目的研究 EBUS-经支气管纵隔冷冻活检术（EBUS-TMC）与 EBUS-经支气管针吸术（TBNA）相比，对多种胸腔内疾病的诊断率和安全性。方法对2021年8月至2023年10月期间同时接受EBUS-TBNA和支气管内超声-经支气管纵隔低温活检（EBUS-TMC）的48例患者进行了单中心回顾性观察研究。结果 EBUS-TMC 的总体诊断率超过了 EBUS-TBNA（95.8% vs 54.1%），尤其在诊断肉样瘤病（92.8% vs 78.5%）、罕见纵隔疾病（100% vs 0%）、增生性淋巴腺病（100% vs 0%）和淋巴增生性疾病（100% vs 0%）方面表现突出。在 NSCLC 和 SCLC 的诊断中未发现明显差异。结论EBUS-TMC有助于纵隔疾病，尤其是淋巴瘤和罕见纵隔肿瘤的精确诊断和亚型分类，从而减少非诊断性手术的数量。

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引用次数: 0

High altitudes and partial pressure of arterial oxygen in patients with chronic obstructive pulmonary disease - A systematic review and meta-analysis. 慢性阻塞性肺病患者的高海拔和动脉氧分压 - 系统回顾和荟萃分析。

IF 10.4 2区医学 Q1 RESPIRATORY SYSTEM

Pulmonology

Pub Date : 2024-07-18 DOI: 10.1016/j.pulmoe.2024.06.002

A Sevik, T Gaisl, A Forrer, L Graf, S Ulrich, K E Bloch, M Lichtblau, M Furian

Importance: Prior study in healthy subjects has shown a reduction of partial pressure of arterial oxygen (PaO₂) by -1.60 kPa/kilometre of altitude gain. However, the association of altitude-related change in PaO₂ and altitude-related adverse health effects (ARAHE) in patients with chronic obstructive pulmonary disease (COPD) remain unknown.

Objective: To provide an effect size estimate for the decline in PaO₂ with each kilometre of altitude gain and to identify ARAHE in relation to altitude in patients with COPD. www.crd.york.ac.uk/prospero: CRD42020217938.

Data sources: A systematic search of PubMed and Embase was performed from inception to May 30, 2023.

Study selection: Peer-reviewed and prospective studies in patients with COPD staying at altitudes >1500 m providing arterial blood gases within the first 3 days at the target altitude.

Data extraction and synthesis: Aggregate data (AD) on study characteristics were extracted, and individual patient data (IPD) were requested. Estimates were pooled using random-effects meta-analysis.

Main outcome and measures: Relative risk estimates and 95 % confidence intervals for the association between PaO₂ and altitude in patients with COPD.

Results: Thirteen studies were included in the AD analysis, of which 6 studies (222 patients, 45.2 % female) provided IPD, thus were included in the quantitative analysis. The estimated effect size of PaO₂ was -0.84 kPa [95 %CI, -0.92 to -0.76] per 1000 m of altitude gain (I²=65.0 %, P < 0.001). In multivariable regression analysis, COPD severity, baseline PaO₂, age and time spent at altitude were predictors for PaO₂ at altitude. Overall, 37.8 % of COPD patients experienced an ARAHE, whereas older age, female sex, COPD severity, baseline PaO_2, and target altitude were predictors for the occurrence of ARAHE (area under ROC curve: 0.9275, P < 0.001).

Conclusions and relevance: This meta-analysis, providing altitude-related decrease in PaO₂ and risk of ARAHE in patients with COPD ascending to altitudes >1500 m, revealed a lower altitude-related decrease in PaO₂ in COPD patients compared with healthy. However, these findings might improve patient care and facilitate decisions about initiating preventive measures against hypoxaemia and ARAHE in patients with COPD planning an altitude sojourn or intercontinental flight, i.e. supplemental oxygen or acetazolamide.

重要性：先前对健康受试者进行的研究表明，每上升一千米，动脉血氧分压（PaO2）就会降低-1.60千帕。然而，慢性阻塞性肺病（COPD）患者与海拔相关的血氧饱和度（PaO2）变化和与海拔相关的不良健康影响（ARAHE）之间的关系仍然未知：提供每上升一公里PaO2下降的效应大小估计值，并确定慢性阻塞性肺病患者与海拔相关的ARAHE。www.crd.york.ac.uk/prospero：CRD42020217938.Data sources：从开始到2023年5月30日，对PubMed和Embase进行了系统检索：同行评议的前瞻性研究，研究对象为在海拔高度大于 1500 米的地方居住的慢性阻塞性肺病患者，这些研究提供了患者在目标海拔高度最初 3 天内的动脉血气：提取有关研究特征的总体数据（AD），并要求提供单个患者数据（IPD）。采用随机效应荟萃分析法对估计值进行汇总：COPD 患者 PaO2 与海拔高度之间关系的相对风险估计值和 95 % 置信区间：13项研究被纳入AD分析，其中6项研究（222名患者，45.2%为女性）提供了IPD，因此被纳入定量分析。每上升 1000 米，PaO2 的估计效应大小为-0.84 kPa [95 %CI, -0.92 to -0.76]（I2=65.0 %, P < 0.001）。在多变量回归分析中，慢性阻塞性肺病严重程度、基线 PaO2、年龄和在高海拔地区停留的时间是预测高海拔地区 PaO2 的因素。总体而言，37.8% 的慢性阻塞性肺病患者经历过高原反应，而年龄较大、女性、慢性阻塞性肺病严重程度、基线 PaO2 和目标海拔高度是发生高原反应的预测因素（ROC 曲线下面积：0.9275，P <0.001）：该荟萃分析提供了 COPD 患者在海拔超过 1500 米时与海拔相关的 PaO2 下降和发生 ARAHE 的风险，结果显示 COPD 患者与健康人相比与海拔相关的 PaO2 下降较低。不过，这些发现可能会改善对患者的护理，并有助于对计划进行高原旅行或洲际飞行的慢性阻塞性肺病患者启动预防低氧血症和 ARAHE 的措施（即补充氧气或乙酰唑胺）做出决定。

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引用次数: 0

Treatment of obstructive sleep apnea syndrome (OSAS) with mandibular advancement devices-A statement of the Portuguese society of pulmonology, the Portuguese society of stomatology and dental medicine, the Portuguese dental association, and the Portuguese society of temporomandibular disorders, orofacial pain and sleep. 使用下颌前突矫正器治疗阻塞性睡眠呼吸暂停综合症（OSAS）--葡萄牙肺病学会、葡萄牙口腔医学和牙科医学会、葡萄牙牙科协会以及葡萄牙颞下颌紊乱、口腔疼痛和睡眠学会的声明。

IF 10.4 2区医学 Q1 RESPIRATORY SYSTEM

Pulmonology

Pub Date : 2024-07-13 DOI: 10.1016/j.pulmoe.2024.05.006

Susana Sousa, Sílvia Correia, André Mariz de Almeida, Gabriela Videira, Ricardo Dias, Susana Falardo Ramos, Júlio Fonseca

With the purpose of establishing a consensus around clinical orientations for professionals involved in managing patients with sleep breathing disorders (SBD), an interdisciplinary group of scientific societies involved in this field discussed and reviewed all the published international guidelines from the American Dental Association, American Academy of Sleep Medicine, American Academy of Dental Sleep Medicine and the European counterparts. Treatment of SBD is multidisciplinary and should be made in concert with the patient, the sleep physician, and the qualified dentist to solve the individual, social, and economic burden of the disease,. This consensus document represents the current thinking of a team of Portuguese experts on managing patients with SBD based on the available evidence.

为了就参与管理睡眠呼吸障碍（SBD）患者的专业人员的临床方向达成共识，一个由该领域相关科学协会组成的跨学科小组讨论并审查了美国牙科协会、美国睡眠医学学会、美国牙科睡眠医学学会以及欧洲同行发布的所有国际指南。SBD 的治疗是多学科的，应与患者、睡眠医师和合格的牙医共同合作，以解决该疾病对个人、社会和经济造成的负担。本共识文件代表了葡萄牙专家团队根据现有证据对管理 SBD 患者的最新想法。

引用次数: 0

Application and internal validation of lung ultrasound score in COVID-19 setting: Correspondence. 肺部超声评分在 COVID-19 环境中的应用和内部验证：通讯

IF 10.4 2区医学 Q1 RESPIRATORY SYSTEM

Pulmonology

Pub Date : 2024-07-12 DOI: 10.1016/j.pulmoe.2024.06.001

H Daungsupawong, V Wiwanitkit

引用次数: 0

Application and internal validation of lung ultrasound score in COVID-19 setting: The ECOVITA observational study. Authors' reply. 肺部超声评分在 COVID-19 环境中的应用和内部验证：ECOVITA 观察性研究。作者回复。

IF 10.4 2区医学 Q1 RESPIRATORY SYSTEM

Pulmonology

Pub Date : 2024-07-12 DOI: 10.1016/j.pulmoe.2024.06.004

L Rinaldi, F Perrotta

引用次数: 0

Methicilin-susceptible Staphylococcus aureus clonal complex 398: An unusual agent of necrotizing pneumonia 甲氧西林敏感金黄色葡萄球菌克隆复合体398:一种罕见的坏死性肺炎病原体。

IF 10.4 2区医学 Q1 RESPIRATORY SYSTEM

Pulmonology

Pub Date : 2024-07-01 DOI: 10.1016/j.pulmoe.2023.10.003

C. Nobre , P. Moniz , N.A. Faria

引用次数: 0

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