BMC Pulmonary Medicine最新文献

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.

Background: Current clinical guidelines support use of parenteral prostacyclin therapy for patients with pulmonary arterial hypertension (PAH) at intermediate risk. The objective of this study was to assess parenteral prostacyclin therapy use among patients at intermediate risk according to the Comparative, Prospective Registry of Newly Initiated Therapies for Pulmonary Hypertension (COMPERA) 2.0 four-strata risk assessment model.

Methods: This was a retrospective chart review and cross-sectional online survey of healthcare professionals (HCPs). Included patients were classified as intermediate-low or intermediate-high risk per COMPERA 2.0 between 2016 and 2020 (index visit), initiated on a parenteral prostacyclin any time following intermediate risk assessment, and had World Health Organization (WHO) Functional Class (FC), 6-minute walk distance (6MWD), and B-type natriuretic peptide/N-terminal pro B-type natriuretic peptide (BNP/NT-proBNP) assessments at index and first comprehensive follow-up visits (follow-up).

Results: A total of 139 HCPs (53% community-based, 47% Pulmonary Hypertension Care Center-based) participated in the survey and provided 350 patient records; among these, mean age (SD) was 54.1 (15.3) years and 52% were female. Median (IQR) time from parenteral prostacyclin initiation to follow-up was 3.0 months (2.0, 7.0). At parenteral prostacyclin initiation for the 280 patient records with available COMPERA 2.0 assessments, 62% of patients were intermediate-high risk, 33% were intermediate-low risk and 3% were low risk, improving to 38%, 53%, and 8%, respectively, at follow-up.

Conclusions: Improvements were seen for the individual COMPERA 2.0 risk calculator parameters and for several other clinical parameters. Findings from this study substantiate recent guidelines suggesting earlier use of this treatment in intermediate-risk patients with PAH.

Clinical trial number: Not applicable.

Background: In patients with severe acute respiratory distress syndrome (ARDS), prolonged and inappropriate use of prone position ventilation (PPV) is a known risk factor for mortality. Hence, it is critical to monitor patients' response to PPV and accurately differentiate responders from non-responders at an early stage. The study aimed to investigate the relationship between oxygenation improvement after three rounds of PPV and survival rate in patients with pulmonary ARDS. Additionally, we sought to identify the earliest turning point for escalation from PPV to extracorporeal membrane oxygenation.

Methods: We performed a retrospective observational study from 2015 to 2023. We included adult patients who received invasive mechanical ventilation, underwent at least three periods of at least 6 h of PPV after admission to the Intensive Care Unit, and meet the ARDS criteria. The study collected data on each PPV session, including changes in PaCO₂, PaO₂, pH, FiO₂, PaO₂:FiO₂ ratio, and clinical outcomes.

Results: A total of 104 patients were enrolled in the study. The change in PaCO₂ from baseline to the third PPV session (P3) had the highest area under the receiver operating characteristic curve (AUC) of 0.70 (95% CI 0.60-0.80; p < 0.001) for predicting hospital mortality, with an optimal cut-off point of 3.15 (sensitivity 75.9%, specificity 56.0%). The percentage change in PaO₂:FiO₂ ratio from baseline to P3 also had significant AUC of 0.71 (95% CI 0.61-0.81; p < 0.001) for predicting hospital mortality, with an optimal cut-off value of 99.465 (sensitivity 79.6%, specificity 62.0%). PaCO₂ responders were defined as those with an increase in PaCO₂ of ≤ 3.15% from baseline to P3, while PaO₂:FiO₂ responders were defined as those with an increase in PaO₂:FiO₂ ratio of ≥ 99.465% from baseline to P3. In the multivariable Cox analysis, PaO₂:FiO₂ responders had a significantly lower 60-day mortality risk (hazard ratio 0.369; 95% CI 0.171-0.798; p = 0.011).

Conclusions: The percentage change in PaO₂:FiO₂ ratio from baseline to P3 was a significant predictor of outcomes. The model fit and prediction accuracy were improved by including the variable of PaCO₂ responders.

Introduction: Nasal high flow (NHF) is a popular technique to provide support in respiratory failure in different conditions. Recently published bench studies have hypothesized that airway pressure can be increased by using different cannula sizes and corresponding prongs resulting in a range of prong-nare ratios. We conducted this study to verify these experimental findings in clinical practice.

Methods: We characterized prong size and flow rate dependent changes in ventilation parameters and changes in hypercapnia in an interventional clinical setting. Outcome parameters included changes in mean airway pressure, tidal volume (TV), respiratory rate (RR), minute volume (MV) and decrease in pCO₂. The ventilatory parameters were determined at 20, 30, 40 and 50 l/min with 3 different prong sizes. 20 and 40 l/min and the 3 different prong sizes were used to document the changes in pCO2.

Results: In this study we demonstrate changes in ventilation with increasing flow rates of NHF. A significant increase in mean airway pressure was seen with every 10 l/min increase in flow rate. Respiratory rate and minute volume (using large prongs) changed significantly with larger increases in flow rate, while tidal volume was not significantly altered. When the flow rate was increased by 20 l/min (i.e. from 20 l/min to 40 l/min) capillary pCO₂ decreased significantly. None of the measured values were significantly altered by the prong size used.

Conclusion: In summary, we presented strong indications that different prong sizes have no influence on essential respiratory parameters or the elimination of pCO₂ when using NHF in COPD patients.

Background and aims: Interstitial lung diseases (ILDs), encompassing both pediatric and adult cases, present a diverse spectrum of chronic conditions with variable prognosis. Despite limited therapeutic options beyond antifibrotic drugs and immunosuppressants, accurate diagnosis is challenging, often necessitating invasive procedures that may not be feasible for certain patients. Drawn against this background, experts across pediatric and adult ILD fields have joined forces in the RARE-ILD initiative to pioneer novel non-invasive diagnostic algorithms and biomarkers. Collaborating with the RARE-ILD consortium, the eurILDreg aims to comprehensively describe different ILDs, analyze genetically defined forms across age groups, create innovative diagnostic and therapeutic biomarkers, and employ artificial intelligence for data analysis.

Methods: The foundation of eurILDreg is built on a comprehensive parameter list developed and adopted by clinical experts, encompassing over 1,800 distinct parameters related to patient history, clinical examinations, diagnosis, lung function and biospecimen collection. This robust dataset is further enriched with daily assessments captured through the patientMpower app, including handheld spirometry and exercise tests, conducted on approximately 350 patients over the course of a year. This approach involves app-based daily assessments of quality of life, symptom tracking, handheld spirometry, saturation measurement, and the 1-min sit-to-stand test (1-STST). Additionally, pediatric data from the ChILD-EU registry will be integrated into the RARE-ILD Data Warehouse, with the ultimate goal of including a total of 4.000 ILD patients and over 100.000 biospecimen.

Discussion: The collaborative efforts within the consortium are poised to streamline research endeavors significantly, promising to advance patient-centered care, foster innovation, and shape the future landscape of interstitial lung disease research and healthcare practices.

Trial registration: EurILDreg is registered in the German Clinical Trials Register (DRKS 00028968, 26.07.2022), and eurIPFreg is registered in ClinicalTrials.gov (NCT02951416).