Pulmonology最新文献

英文中文

Multidisciplinary virtual management of pulmonary nodules 肺结节的多学科虚拟管理。

IF 11.7 2区医学 Q1 Medicine

Pulmonology

Pub Date : 2024-05-01 DOI: 10.1016/j.pulmoe.2021.12.003

D. Polanco , J. González , E. Gracia-Lavedan , L. Pinilla , R. Plana , M. Molina , M. Pardina , F. Barbé

Introduction and objectives

Multidisciplinary nodule clinics provide high-quality care and favor adherence to guidelines. Virtual care has shown savings benefits along with patient satisfaction. Our aim is to describe the first year of operation of a multidisciplinary virtual lung nodule clinic, the population evaluated and issued decisions. Secondarily, among discharged patients, we aimed to analyze their follow-up prior to the existence of our consultation, evaluating its adherence to guidelines.

Materials and methods

Observational study including all patients evaluated at the Virtual Lung Nodule Clinic (VLNC) (March 2018- March 2019). Clinical and radiological data were recorded. Recommendations, based on 2017 Fleischner Society guidelines, were categorized into follow-up, discharge or referral to lung cancer consultation. Discharged patients were classified according to adherence to guidelines of their previous management, into adequate, prolonged and non-indicated follow-up.

Results

A total of 365 patients (58.9% men; median age 64.0 years) were included. Sixty-four percent had smoking history and 23% had chronic obstructive pulmonary disease (COPD). Most nodules were solid (87.4%) and multiple (57.5%). The median diameter was 6.00 mm. 43.8% of patients were discharged following first VLNC evaluation. Among them, 27.5% had received appropriate follow-up, but 66.9% had received poor management. Patients with prolonged follow-up (33.1%) were older (67.0 vs 60.5 years) and had larger nodules (6.00 mm vs 5.00). Non-indicated follow-up patients (33.8%) were more non-smokers (77.8% vs 31.8%) and presented smaller nodules (4.00 vs 5.00 mm).

Conclusions

During its first year of operation, the VLNC has evaluated a population with a relevant risk profile for lung cancer development, management of which should be cautious and adhere to guidelines. After the first VLNC assessment, approximately one-half of this population was discharged. It was noticeable that previous follow-up of discharged patients was found poorly adherent to guidelines, with a marked tendency to overmanagement.

导言和目标：多学科结节诊所可提供高质量的护理，并有利于遵守指南。虚拟医疗在提高患者满意度的同时，也显示出节约成本的优势。我们的目的是描述多学科虚拟肺结节门诊第一年的运行情况、评估人群和做出的决定。其次，在出院患者中，我们旨在分析他们在我们开展会诊之前的随访情况，评估其对指南的遵守情况：观察性研究，包括在虚拟肺结节诊所（VLNC）（2018 年 3 月至 2019 年 3 月）接受评估的所有患者。记录了临床和放射学数据。根据 2017 年弗莱施纳协会指南的建议，分为随访、出院或转诊至肺癌会诊。出院患者根据是否遵守之前的治疗指南，分为充分随访、延长随访和无指征随访：共纳入了 365 名患者（58.9% 为男性，中位年龄为 64.0 岁）。64%的患者有吸烟史，23%的患者患有慢性阻塞性肺病（COPD）。大多数结节为实性（87.4%）和多发性（57.5%）。中位直径为 6.00 毫米。43.8%的患者在首次VLNC评估后出院。其中，27.5%的患者接受了适当的后续治疗，但66.9%的患者治疗效果不佳。接受长期随访的患者（33.1%）年龄较大（67.0 岁对 60.5 岁），结节较大（6.00 毫米对 5.00 毫米）。未指定随访的患者（33.8%）多为非吸烟者（77.8% 对 31.8%），结节较小（4.00 毫米对 5.00 毫米）：VLNC运行一年来，评估了肺癌发病风险的相关人群，对他们的管理应谨慎，并遵守相关指南。在 VLNC 首次评估后，约有二分之一的患者出院。值得注意的是，以前对出院患者的随访发现，他们对指南的遵守情况很差，有明显的过度管理倾向。

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引用次数: 0

Lung cancer and breast metastasis: A rare and atypical presentation 癌症和乳腺转移：一种罕见和非典型的表现。

IF 11.7 2区医学 Q1 Medicine

Pulmonology

Pub Date : 2024-05-01 DOI: 10.1016/j.pulmoe.2023.08.001

H. Guedes , A. Barroso , D. João , A. Furtado , T. Costa

引用次数: 0

Pulmonary capillary hemangiomatosis/veno-occlusive disease diagnosed by transbronchial cryobiopsy 经支气管冷冻活检诊断的肺毛细血管血管瘤病/静脉闭塞性疾病。

IF 11.7 2区医学 Q1 Medicine

Pulmonology

Pub Date : 2024-05-01 DOI: 10.1016/j.pulmoe.2023.08.009

Venerino Poletti , Davide Femia , Simone Petrarulo , Alessandro Marinelli , Claudia Ravaglia , Sara Piciucchi

引用次数: 0

Differential immunohistochemical expression of hTERT in lung cancer patients with and without idiopathic pulmonary fibrosis 有特发性肺纤维化和无特发性肺纤维化的肺癌患者中 hTERT 的免疫组化表达差异。

IF 11.7 2区医学 Q1 Medicine

Pulmonology

Pub Date : 2024-05-01 DOI: 10.1016/j.pulmoe.2021.12.001

G. Gomatou , C. Masaoutis , I. Vamvakaris , E. Kotteas , E. Bouros , V. Tzilas , D. Bouros

Background

Human telomerase reverse transcriptase (hTERT) is the catalytic subunit of telomerase enzyme, which adds nucleotides to telomeres and counteracts their length shortening. The development of a telomere maintenance mechanism represents a hallmark of cancer. On the other hand, idiopathic pulmonary fibrosis (IPF) is associated with mutations in telomerase genes and shorter telomeres. IPF is frequently complicated with lung cancer.

Aim

To investigate the expression of hTERT in lung cancer with co-existing IPF and to compare with lung cancer without fibrosis.

Methods

Diagnostic lung cancerous biopsies were retrieved from 18 patients with lung cancer and concomitant IPF, as well as 18 age and gender matched controls with lung cancer without pulmonary fibrosis. The expression of hTERT was studied with immunohistochemistry. ImajeJ software was used to quantitate subcellular stain intensity. Immunohistochemical investigation of two senescence-associated markers, p16 and p21, was also performed in all 36 cases.

Results

Both groups highly expressed hTERT, without significant difference (100% vs 95%, p = 0.521). Evaluation of p16 and p21 immunostaining revealed negative to minimal immunoreactivity in both groups. hTERT localization exhibited higher median nuclear intensity in the group of lung cancer with IPF (0.62 vs 0.45, p = 0.016), while cytoplasmic intensity did not differ significantly (0.17 vs 0.15, p = 0.463). Higher median nuclear intensity was also correlated with small cell lung cancer subtype in the whole study sample (0.69 vs 0.45, p = 0.09).

Conclusion

hTERT is highly expressed in lung cancer with concomitant IPF, but with differential localization compared to lung cancer without IPF, implying differences in pathogenicity and requiring further investigation.

背景：人类端粒酶逆转录酶（hTERT）是端粒酶的催化亚基，它能为端粒添加核苷酸，抵消端粒长度的缩短。端粒维持机制的发展是癌症的标志。另一方面，特发性肺纤维化（IPF）与端粒酶基因突变和端粒缩短有关。目的：研究 hTERT 在合并有 IPF 的肺癌中的表达，并与无纤维化的肺癌进行比较：方法：从18例肺癌并发IPF患者以及18例年龄和性别匹配的无肺纤维化的肺癌对照组中提取诊断性肺癌活检组织。用免疫组化方法研究了 hTERT 的表达。使用 ImajeJ 软件对亚细胞染色强度进行量化。此外，还对所有 36 个病例的两个衰老相关标记物 p16 和 p21 进行了免疫组化检测：结果：两组病例均高表达 hTERT，无显著差异（100% vs 95%，p = 0.521）。两组患者的 p16 和 p21 免疫染色均为阴性或极弱。hTERT 定位在 IPF 肺癌组的中位核强度更高（0.62 vs 0.45，p = 0.016），而胞质强度无显著差异（0.17 vs 0.15，p = 0.463）。结论：hTERT在伴有IPF的肺癌中高表达，但与无IPF的肺癌相比，其定位不同，这意味着致病性不同，需要进一步研究。

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引用次数: 0

Issue 4-Impact of air pollution on COVID-19 mortality and morbidity: An epidemiological and mechanistic review. 第 4 期-空气污染对 COVID-19 死亡率和发病率的影响：流行病学和机理综述。

IF 11.7 2区医学 Q1 Medicine

Pulmonology

Pub Date : 2024-05-01 DOI: 10.1016/j.pulmoe.2024.04.005

Hasan Bayram, N. Konyalilar, Muge Akpinar Elci, Hadi Rajabi, G. Tuşe Aksoy, Deniz Mortazavi, Ö. Kayalar, Öner Dikensoy, Luis Taborda-Barata, Giovanni Viegi

引用次数: 0

Main bronchus fistula: An open window to the lung parenchyma 主支气管瘘：通往肺实质的开放窗口

IF 11.7 2区医学 Q1 Medicine

Pulmonology

Pub Date : 2024-05-01 DOI: 10.1016/j.pulmoe.2023.07.007

N. Faria, M. Sucena, J. Gomes

引用次数: 0

COPD phenotypes by computed tomography and ventilatory response to exercise 计算机断层扫描的慢性阻塞性肺病表型和运动时的通气反应。

IF 11.7 2区医学 Q1 Medicine

Pulmonology

Pub Date : 2024-05-01 DOI: 10.1016/j.pulmoe.2022.01.002

S. Rodrigues Sousa, J. Nunes Caldeira, C. Rodrigues

Introduction

Computed tomographic (CT) phenotypic patterns of chronic obstructive pulmonary disease (COPD) identify different clinical features of disease. The impact of these variables on the physiological response to exercise has been the focus of a great deal of research as it allows more individualized clinical approaches. The aim of our study was to evaluate the relationships between CT phenotyping of subjects with COPD and the ventilatory response during cardiopulmonary exercise testing (CPET).

Methods

Subjects with COPD were classified into four phenotypes based on CT metrics of emphysema (low attenuation area less than a threshold of -950 Hounsfield [%LAA-950]) and airwall thickness (bronchial wall area percentage [%WA]).

Results

Eighty COPD patients (78.8% males, median age 65±11.3 years) were enrolled in the study. Based on CT phenotype, 25 (31.3%) patients were classified as normal, 27 (33.8%) air dominant, 17 (21.3%) emphysema dominant and 11 (13.8%) mixed type. The emphysema and mixed phenotypes showed the highest ventilatory equivalent for carbon dioxide (V_E/VCO₂) and V_E/VCO₂ slope (p<0,05). In all phenotypes, %LAA was positive correlated with V_E/VCO₂ and V_E/VCO₂ slope (r = 0.437, p = 0.006 and r = 0.503, p<0.001, respectively). %WA also showed a positive correlation with V_E/VCO₂ and V_E/VCO₂ slope (r = 0.541, p<0.001 and r = 0.299, p = 0.033, respectively). In multivariate regression models, after adjustment for age, BMI, sex and FEV1, %LAA was the only independent predictor of V_E/VCO₂ and V_E/VCO₂ slope (β 0.343, SE 0.147, 95% CI 0.009/0.610, p = 0.044 and β 0.496, SE 0.081, 95% CI 0.130/0.455, p = 0.001, respectively).

Conclusion

Emphysema (%LAA) and airways metrics (%WA) had strong relationships with the different characteristics of ventilatory response to exercise in subjects with mild to moderate COPD. In particular, %LAA seemed to play an important role as an independent predictor of V_E/VCO₂ and V_E/VCO₂ slope. These results suggested that CT phenotyping may help predicting ventilatory response to exercise in subjects with COPD.

简介：慢性阻塞性肺病（COPD）的计算机断层扫描（CT）表型模式可确定疾病的不同临床特征。这些变量对运动生理反应的影响一直是大量研究的焦点，因为它可以使临床方法更加个体化。我们的研究旨在评估慢性阻塞性肺病受试者的 CT 表型与心肺运动测试（CPET）期间通气反应之间的关系：根据肺气肿（低衰减面积小于-950 Hounsfield[%LAA-950]阈值）和气壁厚度（支气管壁面积百分比[%WA]）的 CT 指标，将慢性阻塞性肺病受试者分为四种表型：80 名慢性阻塞性肺病患者（78.8% 为男性，中位年龄为 65±11.3 岁）参加了研究。根据 CT 表型，25 例（31.3%）患者被归类为正常型，27 例（33.8%）为空气优势型，17 例（21.3%）为肺气肿优势型，11 例（13.8%）为混合型。肺气肿和混合表型的二氧化碳通气当量（VE/VCO2）和 VE/VCO2 斜率（pE/VCO2 和 VE/VCO2 斜率（r = 0.437，p = 0.006 和 r = 0.503, pE/VCO2 and VE/VCO2 slope (r = 0.541, pE/VCO2 and VE/VCO2 slope (β 0.343, SE 0.147, 95% CI 0.009/0.610, p = 0.044 and β 0.496, SE 0.081, 95% CI 0.130/0.455, p = 0.001, respectively).结论：肺气肿（%LAA）和气道指标（%WA）与轻度至中度慢性阻塞性肺疾病患者运动时通气反应的不同特征有密切关系。尤其是，肺气肿%LAA似乎是VE/VCO2和VE/VCO2斜率的独立预测因子。这些结果表明，CT 表型可能有助于预测慢性阻塞性肺病患者运动时的通气反应。

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引用次数: 0

Personalised follow-up and management schema for patients with screen-detected pulmonary nodules: A dynamic modelling study. 筛查出肺部结节患者的个性化随访和管理方案：动态建模研究

IF 11.7 2区医学 Q1 Medicine

Pulmonology

Pub Date : 2024-04-01 DOI: 10.1016/j.pulmoe.2024.02.010

Z. Wang, F. Xue, X. Sui, W. Han, W. Song, J. Jiang

引用次数: 0

Association between lung function and dyspnoea and its variation in the multinational Burden of Obstructive Lung Disease (BOLD) study. 多国阻塞性肺病负担（BOLD）研究中肺功能与呼吸困难之间的关系及其变化。

IF 11.7 2区医学 Q1 Medicine

Pulmonology

Pub Date : 2024-04-01 DOI: 10.1016/j.pulmoe.2024.03.005

A. Müller, E.F. Wouters, P. Koul, T. Welte, I. Harrabi, A. Rashid, L. Loh, M. Al Ghobain, A. Elsony, R. Ahmed, J. Potts, K. Mortimer, F. Rodrigues, S. N. Paraguas, S. Juvekar, D. Agarwal, D. Obaseki, T. Gislason, T. Seemungal, A. A. Nafees, C. Jenkins, H.B. Dias, F. Franssen, M. Studnicka, C. Janson, H. Cherkaski, M. El Biaze, P. A. Mahesh, J. Cardoso, P. Burney, S. Hartl, D. Janssen, A. Amaral

引用次数: 0

Low tumor interleukin-1β expression predicts a limited effect of adjuvant platinum-based chemotherapy for patients with completely resected lung adenocarcinoma: An identification and validation study. 肿瘤白细胞介素-1β低表达预示完全切除肺腺癌患者铂类辅助化疗效果有限：一项鉴定和验证研究。

IF 11.7 2区医学 Q1 Medicine

Pulmonology

Pub Date : 2024-04-01 DOI: 10.1016/j.pulmoe.2024.03.003

S. Safi, J. Krzykalla, H. Hoffmann, A. Benner, H. Bischoff, M. Eichhorn, M. Kriegsmann, I. Poschke, F. Stögbauer, L. Umansky, C. Mogler, W. Weichert, H. Winter, P. Beckhove, T. Muley

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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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