BMC Pulmonary Medicine最新文献

Background: Prolonged exposure to hyperoxia can lead to hyperoxic acute lung injury (HALI) in preterm neonates. Vitamin D (VitD) stimulates lung maturation and acts as an anti-inflammatory agent. Our objective was to determine if VitD provides a dose-dependent protective effect against HALI by reducing inflammatory cytokine expression and improving alveolarization and lung function in neonatal mice.

Methods: C57BL/6 mouse neonates were randomized and placed in room air or hyperoxic (85% O₂) conditions for 6 days. Control, low (5 ng/neonate) and high (25 ng/neonate) doses of VitD were administered daily beginning at day 2 via oral gavage. Lung tissue was analyzed for edema, changes in pulmonary structure and function, and inflammatory cytokine expression.

Results: Neonatal mice treated with VitD in hyperoxic conditions had improved weight gain, reduced pulmonary edema and increased alveolar surface area compared to untreated pups in hyperoxia. No significant changes in cytokine expression were observed between untreated and VitD neonates. While changes in surfactant protein mRNA expression were impacted by hyperoxia and VitD administration, no significant changes in alveolar type II cell percentages were observed. At 3 weeks, mice in hyperoxia treated with VitD had greater lung compliance, diminished airway reactivity and improved weight gain.

Conclusions: High dose VitD significantly limited harmful effects of HALI. These results suggest that supplementation of VitD to neonatal mice during hyperoxia exposure provides both short-term and long-term protective benefits against HALI.

Objective: Mycoplasma pneumoniae is a major causative pathogen in community-acquired pneumonia. Respiratory viral coinfections in children with Mycoplasma pneumoniae pneumonia (MPP) are not uncommon and cause severe clinical manifestations. This study aims to investigate the impacts of viral coinfection in MPP patients and hopes to offer novel insights for discriminating between MPP and MPP coinfection.

Methods: This study recruited 748 children hospitalized for MP pneumonia between January 2021 and October 2023. Patients were classified into two groups: MPP coinfected with respiratory virus group and MPP group. All children underwent polymerase chain reaction testing for respiratory pathogens. Baseline clinical features and demographic data were obtained retrospectively through medical records.

Results: The retrospective study included 748 patients, with a viral coinfection rate of 38.75%. Patients in the MPP coinfected with respiratory virus group have a higher disease burden than those in the non-coinfection group. Our findings indicate that patients with Mycoplasma pneumonia co-infected with respiratory viruses had longer hospital stays and prolonged fever post-admission, as well as more severe conditions and a higher incidence of extrapulmonary complications. MPP coinfection was associated with the following factors: patients with extrapulmonary complications of gastroenteritis (OR = 4.474, 95%CI = 1.733-11.554, P = 0.002), longer hospital stay (OR = 1.109, 95%CI = 1.012-1.217, P = 0.027), longer days of fever after admission (OR = 1.215 95%CI = 1.006-1.469, P = 0.043), elevated white blood cell count (OR = 1.332 95%CI = 1.082-1.640, P = 0.007), decreased neutrophil count (OR = 0.768 95%CI = 0.602-0.981, P = 0.035), higher fibrinogen levels (OR = 1.652 95%CI = 1.138-2.398, P = 0.008), and raised lactate dehydrogenase levels (OR = 1.007 95%CI = 1.003-1.011, P = 0.001).

Conclusions: We determined the clinical significance of respiratory viral coinfection in children with MPP. Timely identification of MPP coinfection and provision of early and comprehensive therapeutic measures are vital in shortening the disease severity and improving prognosis.

Objective: Electrical impedance tomography (EIT) has been used to titrate positive end-expiratory pressure (PEEP). This study aims to develop a comprehensive view of the efficacy and long-term prognosis of EIT-guided PEEP compared to other conventional approaches in various clinical scenarios, including patients with acute respiratory distress syndrome (ARDS), hypoxemic acute respiratory failure (hARF) and patients undergoing surgery under general anesthesia.

Methods: The literature search was conducted in PubMed, Web of Science, Embase, and Cochrane Library, from inception to July 30, 2023 (ARDS/hARF) and October 5, 2023 (surgery). The Cochrane risk of bias assessment and the methodological index for non-randomized studies were used for quality appraisal. The main outcomes were PEEP level, PaO₂/FiO₂ ratio, lung/respiratory system compliance (C_L/C_rs), driving pressure (ΔP), in-hospital mortality, and postoperative pulmonary complications (PPCs) in surgical studies.

Results: Four randomized controlled trials (RCTs), one historical control study, and six before-after studies of ARDS/hARF, as well as eight surgical RCTs, were retrieved. Subgroup analysis has been carried out and analysis of before-after studies was performed separately. Diverse PEEP strategies were adopted in the included studies, such as low/high PEEP-FiO₂-table of ARDS-net, pressure-volume loop, and transpulmonary pressure. In ARDS/hARF studies, the EIT strategy did not result in considerably enhanced respiratory system mechanics, including comparable PaO₂/FiO₂ ratios, comparable ΔP, and increased C_L/C_rs. As for long-term prognosis, the rough overall meta-analysis showed decreased in-hospital mortality (risk ratio RR = 1.54, 95% CI = (1.09, 2.18), P = 0.01). In patients undergoing general anesthesia surgery, the EIT group demonstrated increased PaO₂/FiO₂ ratio, C_L/C_rs, and decreased ΔP versus the fixed 4 or 5 cmH₂O PEEP. In postoperative prognosis, incidence of PPCs was generally comparable between the two groups.

Conclusion: The EIT-derived PEEP setting strategy might be associated with potential benefits in respiratory outcomes and prognosis in ARDS/hARF and surgical patients. Current data is insufficient to provide solid evidence.

Background: Seropositive rheumatoid arthritis (RA) is associated with significant cardiovascular and pulmonary morbidity. However, screening for early detection of pulmonary involvement especially interstitial lung disease (ILD) is not established in RA.

Methods: We propose a non-invasive radiation-free approach to screen for interstitial lung involvement (ILI) by means of pulmonary function tests (PFT) and pleuro-pulmonary transthoracic ultrasound (LUS) with additional cardiopulmonary exercise tests (CPET) with ECG, and echocardiography. We included patients with confirmed diagnosis of seropositive RA according to ACR criteria, but without symptoms for or known cardiopulmonary disease. ILD was suspected when significant LUS abnormalities and additional PFT changes were present.

Results: We included 67 consecutive patients (78% female, mean age 61 ± 12 years, 48% active or previous smokers), who fulfilled the inclusion criteria and gave written informed consent. We found 48% of patients with suspected changes in PFT with a diffusion capacity (DLCOc-SB) ≤ 80%, among them 7% with forced vital capacity (FVC) ≤ 80%. In 40% of patients, we found noticeable changes in LUS, 24% with an ILD compatible pattern. In 16% of cases, LUS abnormalities and additional PFT changes were present, and ILI was suspected. Additional findings included obstructive lung disease (n = 11), subpleural consolidation (n = 6) including one confirmed lung cancer, minimal pleural effusion (n = 6), and ischemic cardiac disease (n = 2). None of the patients showed signs of pulmonary vascular involvement.

Conclusions: ILI was suspected in 16% of cases using a new radiation-free screening protocol in asymptomatic RA patients.

Trial registration: German Register of Clinical Studies (DRKS00028871).

Epidermal growth factor receptor (EGFR)-tyrosine kinase inhibitors (TKIs) have been the standard treatment for patients with sensitizing EGFR mutation. However, almost all patients eventually acquire resistance to EGFR-TKIs. Therefore, easily available parameters to estimate the outcome of lung adenocarcinoma patients treated with EGFR-TKIs are in urgent need. Lung adenocarcinoma patients harbored EGFR sensitive mutant and received EGFR-TKIs as first-line or second-line treatment were recruited in the study. X-tile software were utilized to determine the optimal cut-off value of Alkaline phosphatase (ALP), direct bilirubin (DB), total bile acid (TBA), and high-density lipoprotein-cholesterol (HDL-C). The prognostic value of ALP, DB, TBA, and HDL-C for Progression-free survival (PFS) in patients were evaluated by the Kaplan-Meier curve. We applied univariate and multivariate survival analysis to identify the independent predictor for PFS in patients with EGFR-mutant advanced lung adenocarcinoma and received EGFR-TKIs. A total of 131 lung adenocarcinoma patients with a median age of 58 years old were included in the final analysis. Patients with elevated level of DB and HDL-C showed a longer PFS, while high level of ALP and TBA indicated shorter PFS in response to EGFR-TKI treatment. The multivariate survival analyses revealed a significant association of prolonged PFS with increased DB, and decreased TBA. In conclusion, these findings suggest that DB and TBA were significant independent predictors of PFS in EGFR-TKI-treated patients with advanced lung adenocarcinoma.

Background: Silicosis and coal worker's pneumoconiosis primarily result from exposure to silica and coal dust. Despite similar exposure levels, individuals exhibit varying responses. This study aimed to address these gaps to explore the genetic factors influencing the development, severity, and associated complications.

Methods: A systematic literature search was performed across four databases-PubMed, Embase, Web of Science, and Cochrane Library-until July, 2023. Qualitative and quantitative analyses were applied to identify candidate genes.

Results: This study involved 83 articles and encompassed 545 individual studies, reviewing a total of 378 gene loci. After rigorous evaluation, we selected 8 candidate genes (TNFα-308, TNFα-238, GSTT1, IL-1α + 4845, IL-1β-511, IL-1β + 3953, IL-1RA + 2018, and IL-6-174) for meta-analysis. The analysis revealed that allele A of TNFα-308, allele A of TNFα-238, and allele C of IL-1RA + 2018 were identified as risk factors for the development of diseases.

Conclusions: This study established associations between specific genetic polymorphisms (TNFα-308, TNFα-238, and IL-1RA + 2018) and susceptibility to silicosis and coal worker's pneumoconiosis.

Background: Ectopic thyroid tissue is a developmental disorder and is extraordinarily rare to occur in the central airway. To our knowledge, nearly few reports of primary ectopic thyroid carcinoma in the central airway with a normal eutopic thyroid gland have been published to date. This is the second case about malignant central airway obstruction caused by primary ectopic thyroid carcinoma.

Case presentation: 65-year-old male was admitted to hospital for coughing accompanied by wheezing that recent exacerbated at night.The chest computed tomography scan revealed a soft tissue-density mass within the central trachea.The mass was removed and pathological analysis showed that it was ectopic thyroid carcinoma surprisingly. The goitrous thyroid gland was found in its expected location.

Conclusion: Ectopic thyroid carcinoma should be considered in the differential diagnosis of a pathological mass located in central airway.

Background: Immune checkpoint inhibitor-related pneumonitis (CIP) stands out as a particularly severe adverse event caused by immune checkpoint inhibitors, with a substantial real-world incidence ranging from 13 to 19%. While systemic corticosteroids represent the standard treatment for CIP, therapeutic options become limited in cases where patients do not respond to corticosteroid therapy. Such patients are classified as having steroid-resistant CIP, often associated with a poor prognosis. This case study provides insight into the symptoms, diagnostic process, and treatment approach for steroid-resistant CIP. Notably, successful management is demonstrated through the utilization of cyclosporine, highlighting its potential mechanisms of action in effectively treating steroid-resistant CIP.

Case description: We present the case of a 53-year-old male with stage IV. A non-small cell lung cancer (NSCLC), who experienced elevated fever, cough, and dyspnea subsequent to immunotherapy treatment. Based on his medical history, clinical manifestations, and radiological findings, the patient was diagnosed with CIP. Initial administration of led to improvement, but during the subsequent tapering of corticosteroid therapy, a resurgence of CIP occurred, resulting in respiratory failure. Consequently, we arrived at the diagnosis of steroid-resistant CIP, prompting the implementation of a combination therapy with cyclosporine and corticosteroids to establish stable disease control. Upon systematic reduction of corticosteroid dosage, the patient maintained a favorable response with no recurrence.

Conclusions: This marks the first instance of effectively managing steroid-resistant CIP through the combined use of cyclosporine and corticosteroids. Presently, cases of steroid-resistant CIP remain infrequent, necessitating vigilant and meticulous monitoring within clinical settings. Notably, there exists no distinct guideline specifying a singular agent for rescuing patients unresponsive to corticosteroid therapy. Therefore, cyclosporine emerges as a promising and efficacious treatment alternative for individuals unresponsive to corticosteroid intervention in the context of CIP.

Background: This study was to examine the association between treatment with angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) and the risk of developing ventilator-associated pneumonia (VAP) among patients receiving mechanical ventilation (MV) in the intensive care unit (ICU).

Methods: Utilizing a retrospective cohort approach, the data were extracted from the Medical Information Mart for Intensive Care IV database. VAP diagnoses were ascertained through the international classification of disease codes recorded in the database. Both univariate and multivariable logistic regression analyses were conducted to assess the association between ACEI or ARB use and VAP. Subgroup analyses were performed to evaluate the impact of comorbidities (AKI, renal failure, diabetes, hypertension, and sepsis), simplified acute physiology score II (SAPS II), as well as the use of vasopressors and antibiotics on this association. Odds ratios (ORs) with 95% confidence intervals (CIs) were used as the evaluation metrics.

Results: The study comprised 8,888 patients, with 897 (10.09%) experiencing VAP. The analysis revealed that patients on ACEI or ARB therapy had a lower risk of developing VAP (OR: 0.79, 95% CI: 0.62-0.99, P = 0.047). Subgroup analyses revealed that the protective effect was observed in patients with AKI (OR: 0.70, 95% CI: 0.52-0.94, P = 0.020), renal failure (OR: 0.14, 95% CI: 0.02-0.84, P = 0.032), and diabetes (OR: 0.64, 95% CI: 0.43-0.94, P = 0.024), as well as in those receiving vasopressors (OR: 0.67, 95% CI: 0.49-0.92, P = 0.012), and antibiotics (OR: 0.74, 95% CI: 0.57-0.96, P = 0.021). No significant difference in VAP development was observed between patients treated with ACEI versus ARB (OR: 0.84, 95% CI: 0.49-1.47, P = 0.547).

Conclusion: This study's findings suggest a substantial association between the use of ACEIs or ARBs and reduced development of VAP, particularly among patients with specific comorbidities and those on vasopressor and antibiotic therapy. This study may educate the ICU team on the potential benefits of ACEIs and ARBs in preventing VAP, emphasizing the importance of considering these medications in the overall treatment plan.

Objective: The objective of this study is to explore the factors that influence anxiety in elderly hospitalized pulmonary tuberculosis patients using propensity score matching (PSM) methods.

Methods: We retrospectively analyzed the clinical data of elderly patients with pulmonary tuberculosis admitted to the tuberculosis Department of Lishui Hospital of Traditional Chinese Medicine from January 2021 to October 2023. The patients were then divided into anxiety and non-anxiety groups based on their GAD-7 scores. Propensity score matching was used to match the baseline data of the two groups, followed by multivariate logistic regression analysis to identify the influencing factors of anxiety in elderly hospitalized pulmonary tuberculosis patients.

Results: The study included 795 elderly hospitalized patients with pulmonary tuberculosis, with 599 classified as carefree and 196 as anxious (32.72%). Using the propensity score matching method, we successfully matched 185 pairs of patients. After matching, there were no statistically significant differences in gender, age, occupation, or other aspects between the two groups of patients (all P > 0.05). Multivariate logistic regression analysis revealed that chronic comorbidities (OR = 2.36, 95% CI: 1.54-3.61), lack of daily social interaction (OR = 1.79, 95% CI: 1.15-2.76), tuberculosis recurrence (OR = 2.08, 95% CI: 1.35-3.21), and lack of daily behavioral ability (OR = 1.99, 95% CI: 1.23-3.23) were influencing factors for anxiety in elderly hospitalized pulmonary tuberculosis patients (P < 0.05).

Conclusion: After controlling for confounding factors through PSM, we found that chronic comorbidities, lack of daily social interaction, tuberculosis recurrence, and lack of daily behavioral ability are influencing factors for anxiety in elderly pulmonary tuberculosis inpatients. This suggests a need for clinical intervention.

Clinical trial number: Not applicable.