BMC Pulmonary Medicine最新文献

Background: Chronic Obstructive Pulmonary Disease (COPD) is a major cause of mortality, with underdiagnosis being a significant global issue. While spirometry is the diagnostic gold standard, it is impractical for widespread screening. This necessitates the use of validated questionnaires for initial risk stratification, though their performance varies across populations.

Objective: To compare the diagnostic accuracy of six COPD screening questionnaires (CDQ, CAPTURE, LFQ, COPD-PS, COPD-SQ, and SCSQ) against post-bronchodilator spirometry in a hospital-facilitated community screening Iranian population.

Methods: A hospital-facilitated community screening cross-sectional study was conducted on 294 patients aged ≥ 40 years recruited from primary care settings. All participants completed the six questionnaires and underwent spirometry. The area under the receiver operating characteristic curve (AUC), sensitivity, specificity, and cut-off points that yielded the best balance in our cohort were calculated for each questionnaire, using a post-bronchodilator FEV1/FVC < 0.70 as the gold standard for COPD diagnosis.

Results: The prevalence of spirometry-confirmed COPD was 20.4%. All questionnaires showed strong negative correlations with FEV1/FVC ratios (ρ range: -0.58 to -0.70; p < 0.001). The LFQ demonstrated the highest overall accuracy (AUC = 0.768), followed by the SCSQ (AUC = 0.766) and COPD-PS (AUC = 0.755). At established screening cut-offs, all tools showed high sensitivity (89.7% to 96.7%) for ruling out disease, albeit with low specificity (22.2% to 28.9%). A significant difference in AUC values was found between the questionnaires (χ² [5] = 35.16, p < 0.0001).

Conclusion: The LFQ, SCSQ, and COPD-PS questionnaires demonstrated the highest diagnostic accuracy for COPD screening in this hospital-facilitated community screening cohort. Their high sensitivity shows potential as effective "rule-out" instruments for identifying high-risk individuals in primary care settings who should be referred for confirmatory spirometry. Future validation in a pure primary care setting is recommended.

Background: Metagenomic next-generation sequencing (mNGS) plays a critical role in the rapid detection of infectious pathogens. We aimed to analyze the clinical characteristics of Pneumocystis jirovecii infection in children without HIV infection and to evaluate the performance of mNGS in distinguishing P. jirovecii colonization from true infection.

Methods: A multicenter, retrospective analysis was conducted on critically ill, non-HIV-infected pediatric patients who tested positive for P. jirovecii via mNGS analysis of bronchoalveolar lavage fluid (BALF). Group differences were assessed using Mann-Whitney U-tests (for continuous data) and chi-square tests (for categorical data). Discriminatory performance was evaluated by calculating the area under the receiver operating characteristic curve.

Results: A total of 59 HIV-negative children (age range: 2 months to 14 years) from four children's hospitals were included and classified into two groups based on P. jirovecii status: P. jirovecii pneumonia (PCP; n = 51) and P. jirovecii colonization (PCC; n = 8). Compared with the PCC group, the PCP group had significantly higher serum C-reactive protein levels and median P. jirovecii read counts in mNGS (both P < 0.05). The optimal threshold value for discriminating P. jirovecii infection from colonization appeared to be 556 reads (sensitivity, 77.6%; specificity, 100.0%). Eighteen patients (35.3%) in the PCP group died. Compared with survivors, these patients were significantly younger, had lower T-cell subset counts (CD3⁺, CD4⁺, and CD8⁺), and a higher prevalence of primary immunodeficiency (all P < 0.05).

Conclusions: BALF mNGS analysis may have utility for differentiating between colonization and infection by P. jirovecii, warranting further investigation.

Introduction: Postoperative pulmonary air leaks is one of the most significant complications, which prolongs hospitalization and increases mortality. The sclerosant interleukin-2 (IL-2) has been widely used in China to reduce postoperative air leaks. However, the optimal suction pressure on digital drainage systems when combined with IL-2 treatment remains elusive among thoracic surgeons. This study aimed to determine the optimal suction pressure provided by digital drainage system, together with IL-2 therapy, for effectively sealing air leaks, and to identify the key factors influencing the healing of air leakage.

Methods: A retrospective analysis involving 94 patients was conducted. The collected information included patient demographics, IL-2 treatment regimens, the average suction pressure applied during the IL-2 therapy period, and air leak duration. The suction pressures were categorized into low (1 ≤ pressure < 5 cmH₂O), medium (5 ≤ pressure < 9 cmH₂O) and high (9 ≤ pressure ≤ 12 cmH₂O) pressure groups. Univariate and multivariate analyses were employed to evaluate the impact of various variables on the time required for air leak sealing. The variables assessed included age, gender, diagnosis, pulmonary complications, resection site, surgery type, operative time, intraoperative blood loss, and suction pressure during IL-2 treatments.

Results: The analysis revealed that suction pressure was a statistically significant determinant of air leak duration (P = 0.036). In multivariate analysis, high suction pressure was independently associated with a longer air leak time by approximately 2.84 days (95% CI: -5.16, -0.52, P = 0.017) and 2.21 days (95% CI: -4.08, -0.35, P = 0.021) compared to low and medium pressure, respectively. Subgroup analysis showed no significant interaction between suction pressure and patient/surgical characteristics, indicating the benefit of lower suction was consistent across the cohort. The number of IL-2 treatments was also a strong predictor of air leak duration (P < 0.001), reflecting the need for repeated therapy in persistent leaks.

Conclusions: Patients receiving IL-2 therapy benefited more from mild suction pressures (low or medium) compared to high suction pressure, resulting in shorter air leak durations across a range of patient and surgical characteristics. These findings support the use of low-to-medium suction (1-9 cmH₂O) as part of the standard management protocol when IL-2 pleurodesis is employed.