Pulmonology最新文献

Background: Asbestos is still the leading cause of occupational cancer mortality worldwide. Asbestos-related lung cancer (LC) and malignant pleural mesothelioma (MPM) prognosis is still poor especially at advanced stage, so early diagnosis biomarkers are needed. MicroRNAs (miRNAs) have been proposed as potential early diagnostic biomarkers of asbestos-related LC and MPM.

Aim: To evaluate the role of miRNAs as diagnostic and prognostic biomarkers of asbestos-related LC and MPM by performing a literature systematic review and meta-analysis.

Methods: MEDLINE, EMBASE via Ovid, PUBMED and Cochrane library databases were systematically searched up to April 2023 to identify relevant articles. A grey literature search was also conducted using the Google Scholar platform. MeSH and free text terms for 'asbestos', 'occupational exposure', 'lung cancer', 'mesothelioma' and 'miRNAs' were used to search the literature. Our systematic review protocol was registered in the PROSPERO database. Study quality was assessed via the Newcastle-Ottawa Scale.

Results: From the search, 331 articles were retrieved, and, after applying our selection criteria, and exclusion of one study for poor quality, 27 studies were included in the review. Most of the studies were hospital-based case-control, conducted in Europe, and evaluated MPM among men only. MiRNAs expression was measured mainly in plasma or serum. MiR-126, miR-132-3p, and miR-103a-3p were the most promising diagnostic biomarkers for MPM, and we estimated a pooled area under the curve (AUC) of 85 %, 73 %, and 50 %, respectively. In relation to MPM prognosis, miR-197‑3p resulted associated with increased survival time. MiR-126, alone and combined with miR-222, was confirmed associated also to LC diagnosis, together with miR-1254 and miR-574-5p; no miRNA was found associated to LC prognosis.

Conclusion: Based on our systematic literature review there is suggestive evidence that the expression of specific miRNAs in the blood serum or plasma are associated with asbestos-related LC and MPM diagnosis and prognosis. Further large longitudinal studies are urgently needed to validate these findings and elucidate the underlying mechanisms given the potential important implications for patients' survival.

Background and objective: Traditionally, the diagnosis of acute rejection (AR) relies on invasive transbronchial biopsies (TBBs) to obtain histopathological samples. We aimed to evaluate the diagnostic yield of probe-based confocal laser endomicroscopy (pCLE) as a complementary and non-invasive tool for ACR screening, comparing its results with those obtained from TBBs.

Methods: Between January 2015 and April 2022, we conducted a retrospective study of all lung transplant recipients aged over 18 years at Toulouse University Hospital (France). All patients who underwent bronchoscopies with both TBBs and pCLE imaging were included. Two experienced interpreters (TV and MS) reviewed the pCLE images independently, blinded to all clinical information and pathology results.

Results: From 120 procedures in 85 patients, 34 abnormal histological samples were identified. Probe-based confocal laser endomicroscopy revealed significant associations between both alveolar (ALC) and perivascular (PVC) cellularities and abnormal histological samples (p<0.0001 and 0.003 respectively). Alveolar cellularity demonstrated a sensitivity (Se) of 85.3 %, specificity (Spe) of 43 %, positive predictive value (PPV) of 37.2 % and negative predictive value (NPV) of 88.1 %. For PVC, Se was 70.6 %, Spe 80.2 %, PPV 58.5 % and NPV 87.3 %. Intra-interpreter correlation (TV) was 88.3 % for the number of vessels (+/-1), 98.3 % for ALC and 90 % for PVC. Inter-interpreter correlation (TV and MS) was 80 % for vessels (+/-1), 97.5 % for ALC and 83.3 % for PVC.

Conclusion: Our study demonstrates the feasibility of incorporating pCLE into clinical practice, demonstrating good diagnostic yield and reproducible outcomes in the screening of AR in lung transplant recipients.

Background: The severe acute respiratory syndrome Coronarovirus-2 associated still causes a significant number of deaths and hospitalizations mainly by the development of respiratory failure. We aim to validate lung ultrasound score in order to predict mortality and the severity of the clinical course related to the need of respiratory support.

Methods: In this prospective multicenter hospital-based cohort study, all adult patients with diagnosis of SARS-CoV-2 infection, performed by real-time reverse transcription polymerase chain reaction were included. Upon admission, all patients underwent blood gas analysis and lung ultrasound by expert operators. The acquisition of ultrasound scan was performed on 12 peculiar anatomic landmarks of the chest. Lung ultrasound findings were classified according to a scoring method, ranging 0 to 3: Score 0: normal A-lines. Score 1: multiple separated B-lines. Score 2: coalescent B-lines, alteration of pleural line. Score 3: consolidation area.

Results: One thousand and seven patients were included in statistical analysis (male 62.4 %, mean age 66.3). Oxygen support was needed in 811 (80.5 %) patients. The median ultrasound score was 24 and the risk of having more invasive respiratory support increased in relation to higher values score computed. Lung ultrasound score showed negative strong correlation (rho: -0.71) with the P/F ratio and a significant association with in-hospital mortality (OR 1.11, 95 %CI 1.07-1.14; p < 0.001), even after adjustment with the following variables (age, sex, P/F ratio, SpO2, lactate, hypertension, chronic renal failure, diabetes, and obesity).

Conclusions: The novelty of this research corroborates and validates the 12-field lung ultrasound score as tool for predicting mortality and severity clinical course in COVID-19 patients. Baseline lung ultrasound score was associated with in-hospital mortality and requirement of intensive respiratory support and predict the risk of IOT among COVID-19 patients.

Background and research question: Some participants inevitably fail spirometry testing and we aimed to assess the prevalence, risk factors, chronic respiratory symptoms, health status, and all-cause mortality outcomes associated with failed spirometry.

Methods: Using NHANES 2007-2012 data, we categorized participants into three groups: those with failed spirometry (FS-participants), those with qualified spirometry without COPD (QS-non-COPD), and those with qualified spirometry and COPD (QS-COPD). We assessed the prevalence and risk factors associated with FS-participants and compared clinical implications among the three groups.

Results: The prevalence of FS-participants was 4.8%. Key risk factors included older age, being male, non-Hispanic Black ethnicity, lower socioeconomic status, self-reported emphysema, and increased frailty. After adjustment, FS-participants had higher odds of shortness of breath, wheezing, and dry cough at night (all P values < 0.05). They also faced a greater risk of all-cause mortality (HR: 1.51, 95% CI: 1.22 to 1.86; p < 0.001) compared to the QS-non-COPD group, a risk similar to that of the QS-COPD group (HR: 1.05, 95% CI: 0.82 to 1.27; p = 0.675).

Conclusion: Failed spirometry is common among adults and correlates with increased respiratory symptoms and higher all-cause mortality risk, indicating the need for targeted attention.

Background: Endobronchial ultrasound-transbronchial needle aspiration (EBUS-TBNA) is used to diagnose and stage Non-Small Cell Lung Cancer (NSCLC), where the supernatant is discarded.

Research question: Can DNA/RNA extracted directly from formaldehyde-preserved EBUS-TBNA supernatant, provide sufficient and reliable molecular profiling in NSCLC?

Study design and methods: This prospective study included patients with advanced NSCLC (stage III-IV) undergoing EBUS-TBNA to compare DNA/RNA quantification, NGS feasibility and molecular findings between the supernatant phase (Sp) and the cell pellet (Cp).

Results: The median DNA and RNA concentrations were significantly higher in Sp than Cp, with Sp showing 29.9 ng/µL DNA and 52.12 ng/µL RNA versus 9.58 ng/µL and 13.6 ng/µL in Cp (Wilcoxon signed rank test, p = 0.012 and p = 0.005). MP in Cp identified 16 mutations (7 actionable), while Sp detected 19 mutations, including two additional actionable mutations. Concordance between Cp and Sp was 87%, with identical mutations in 13 cases and discrepancies in two cases.

Conclusions: Sp obtained from EBUS-TBNA is a rich source of tumour DNA and RNA, with high feasibility for NGS. There is strong concordance of NGS results between Cp and Sp, supporting Sp as a complementary/alternative source for molecular profiling in NSCLC, potentially reducing the need for additional biopsies.

Background: Traditionally, Venturi-based flow generators have been preferred over mechanical ventilators to provide continuous positive airway pressure (CPAP) through the helmet (h-CPAP). Recently, modern turbine-driven ventilators (TDVs) showed to be safe and effective in delivering h-CPAP. We aimed to compare the pressure stability during h-CPAP delivered by Venturi devices and TDVs and assess the impact of High Efficiency Particulate Air (HEPA) filters on their performance.

Methods: We performed a bench study using an artificial lung simulator set in a restrictive respiratory condition, simulating two different levels of patient effort (high and low) with and without the interposition of the HEPA filter. We calculated the average of minimal (Pmin), maximal (Pmax) and mean (Pmean) airway pressure and the time product measured on the airway pressure curve (PTPinsp). We defined the pressure swing (Pswing) as Pmax - Pmin and pressure drop (Pdrop) as End Expiratory Pressure - Pmin.

Results: Pswing across CPAP levels varied widely among all the tested devices. During "low effort", no difference in Pswing and Pdrop was found between Venturi devices and TDVs; during high effort, Pswing (p<0.001) and Pdrop (p<0.001) were significantly higher in TDVs compared to Venturi devices, but the PTPinsp was lower (1.50 SD 0.54 vs 1.67 SD 0.55, p<0.001). HEPA filter addition almost doubled Pswing and PTPinsp (p<0.001) but left unaltered the differences among Venturi and TDVs systems in favor of the latter (p<0.001).

Conclusions: TDVs performed better than Venturi systems in delivering a stable positive pressure level during h-CPAP in a bench setting.