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Controversies in the clinical management of chronic pulmonary aspergillosis. 慢性肺曲霉菌病临床治疗中的争议。
IF 2.3 Q2 RESPIRATORY SYSTEM Pub Date : 2024-10-01 DOI: 10.1183/20734735.0234-2023
Xinxin Hu, Kathryn Hulme, Liana Brien, Sonya Natasha Hutabarat, Zinta Harrington

Chronic pulmonary aspergillosis has a range of manifestations from indolent nodules to semi-invasive infection. Patients may be asymptomatic or have chronic symptoms such as cough and weight loss or present with life-threatening haemoptysis. The physician can choose from a range of available therapies including medical therapy with antifungals, minimally invasive therapy with intracavitary antifungal therapy and surgery involving open thoracotomy or video-assisted thoracoscopic surgery. The patients with the most severe forms of pulmonary infection may not be surgical candidates due to their underlying pulmonary condition. The management of haemoptysis can include tranexamic acid, bronchial artery embolisation, antifungals or surgery. There are few controlled studies to inform clinicians managing complex cases, so a multidisciplinary approach may be helpful.

慢性肺曲霉菌病有一系列表现,从无症状结节到半浸润性感染。患者可能没有症状,或有咳嗽、体重减轻等慢性症状,或出现危及生命的咯血。医生可以选择一系列可用的疗法,包括使用抗真菌药物的内科疗法、使用腔内抗真菌疗法的微创疗法以及涉及开胸手术或视频辅助胸腔镜手术的外科疗法。肺部感染最严重的患者可能因其潜在的肺部疾病而不适合手术治疗。治疗咯血的方法包括氨甲环酸、支气管动脉栓塞、抗真菌药物或手术。很少有对照研究可为临床医生处理复杂病例提供参考,因此采用多学科方法可能会有所帮助。
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引用次数: 0
Lung imaging methods: indications, strengths and limitations. 肺部成像方法:适应症、优势和局限性。
IF 2.3 Q2 RESPIRATORY SYSTEM Pub Date : 2024-10-01 DOI: 10.1183/20734735.0127-2023
Dávid László Tárnoki, Kinga Karlinger, Carole A Ridge, Fanni Júlia Kiss, Tamás Györke, Elzbieta Magdalena Grabczak, Ádám Domonkos Tárnoki

Imaging methods are fundamental tools to detect and diagnose lung diseases, monitor their treatment and detect possible complications. Each modality, starting from classical chest radiographs and computed tomography, as well as the ever more popular and easily available thoracic ultrasound, magnetic resonance imaging and nuclear medicine methods, and new techniques such as photon counting computed tomography, radiomics and application of artificial intelligence, has its strong and weak points, which we should be familiar with to properly choose between the methods and interpret their results. In this review, we present the indications, strengths and main limitations of methods for chest imaging.

成像方法是检测和诊断肺部疾病、监测治疗效果和检测可能出现的并发症的基本工具。从经典的胸片和计算机断层扫描开始,到日益普及和易于使用的胸部超声、磁共振成像和核医学方法,以及光子计数计算机断层扫描、放射组学和人工智能应用等新技术,每种方法都有其强项和弱点,我们应该熟悉这些强项和弱点,以便正确选择方法并解释其结果。在这篇综述中,我们将介绍胸部成像方法的适应症、优势和主要局限性。
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引用次数: 0
Pulmonary complications of bone marrow transplantation. 骨髓移植的肺部并发症。
IF 2.3 Q2 RESPIRATORY SYSTEM Pub Date : 2024-10-01 DOI: 10.1183/20734735.0043-2024
Helen O'Brien, John Murray, Nina Orfali, Ruairi J Fahy

Bone marrow transplantation, now often known as haematopoietic stem cell transplantation (HSCT), is a complex choreographed procedure used to treat both acquired and inherited disorders of the bone marrow. It has proven invaluable as therapy for haematological and immunological disorders, and more recently in the treatment of metabolic and enzyme disorders. As the number of performed transplants grows annually, and with patients enjoying improved survival, a knowledge of both early and late complications of HSCT is essential for respiratory trainees and physicians in practice. This article highlights the spectrum of respiratory complications, both infectious and non-infectious, the timeline of their likely occurrence, and the approaches used for diagnosis and treatment, keeping in mind that more than one entity may occur simultaneously. As respiratory issues are often a leading cause of short- and long-term morbidity, consideration of a combined haematology/respiratory clinic may prove useful in this patient population.

骨髓移植,现在通常称为造血干细胞移植(HSCT),是一种复杂的程序,用于治疗获得性和遗传性骨髓疾病。事实证明,造血干细胞移植在治疗血液病和免疫病,以及最近在治疗代谢病和酶疾病方面具有重要价值。随着移植数量的逐年增加和患者存活率的提高,了解造血干细胞移植的早期和晚期并发症对于呼吸科受训人员和执业医师来说至关重要。本文重点介绍了感染性和非感染性呼吸系统并发症的范围、可能发生的时间以及用于诊断和治疗的方法,同时提醒大家可能会同时出现多种并发症。由于呼吸系统问题往往是短期和长期发病的主要原因,因此考虑设立血液/呼吸系统联合门诊可能会对这类患者有所帮助。
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引用次数: 0
Large-scale education in respiratory medicine: content versus delivery. 呼吸内科的大规模教育:内容与实施。
IF 2.3 Q2 RESPIRATORY SYSTEM Pub Date : 2024-10-01 DOI: 10.1183/20734735.0218-2023
Emer Kelly, Richard W Costello

The respiratory literature, both written and in online formats, is growing exponentially. Capturing quality content, to meet the learning needs of those working in all fields of respiratory medicine and delivering it in a palatable, accessible format is challenging but paramount. In this article we discuss ways to determine the information content and review different methods of delivering this content to those who need it.

呼吸系统文献,包括书面文献和网络文献,都在急剧增长。如何获取高质量的内容,满足呼吸医学各领域工作者的学习需求,并以易于理解和使用的形式提供这些内容,是一项具有挑战性但又至关重要的工作。在本文中,我们将讨论确定信息内容的方法,并评述向需要者提供这些内容的不同方法。
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引用次数: 0
Spatial lung imaging in clinical and translational settings. 临床和转化环境中的空间肺部成像。
IF 2.3 Q2 RESPIRATORY SYSTEM Pub Date : 2024-10-01 DOI: 10.1183/20734735.0224-2023
Irma Mahmutovic Persson, Gracijela Bozovic, Gunilla Westergren-Thorsson, Sara Rolandsson Enes

For many severe lung diseases, non-invasive biomarkers from imaging could improve early detection of lung injury or disease onset, establish a diagnosis, or help follow-up disease progression and treatment strategies. Imaging of the thorax and lung is challenging due to its size, respiration movement, transferred cardiac pulsation, vast density range and gravitation sensitivity. However, there is extensive ongoing research in this fast-evolving field. Recent improvements in spatial imaging have allowed us to study the three-dimensional structure of the lung, providing both spatial architecture and transcriptomic information at single-cell resolution. This fast progression, however, comes with several challenges, including significant image file storage and network capacity issues, increased costs, data processing and analysis, the role of artificial intelligence and machine learning, and mechanisms to combine several modalities. In this review, we provide an overview of advances and current issues in the field of spatial lung imaging.

对于许多严重的肺部疾病,成像中的非侵入性生物标志物可以改善肺部损伤或疾病发作的早期检测,确定诊断,或帮助跟踪疾病进展和治疗策略。由于胸部和肺部的大小、呼吸运动、心脏搏动的转移、密度范围大以及重力敏感性等原因,胸部和肺部的成像具有挑战性。然而,这一快速发展的领域正在进行广泛的研究。空间成像技术的最新进展使我们能够研究肺的三维结构,提供单细胞分辨率的空间结构和转录组信息。然而,这种快速发展也带来了一些挑战,包括重要的图像文件存储和网络容量问题、成本增加、数据处理和分析、人工智能和机器学习的作用以及结合多种模式的机制。在本综述中,我们将概述空间肺成像领域的进展和当前问题。
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引用次数: 0
Steroids in severe community-acquired pneumonia. 在严重社区获得性肺炎中使用类固醇。
IF 2.3 Q2 RESPIRATORY SYSTEM Pub Date : 2024-10-01 DOI: 10.1183/20734735.0081-2024
Sachin Ananth, Alexander G Mathioudakis, Jan Hansel

There is conflicting evidence regarding the use of steroids in severe community-acquired pneumonia (CAP), with previous randomised controlled trials limited by small sample sizes. ESCAPe and CAPE COD are two recently published large trials on steroids in severe CAP. ESCAPe assessed the initiation of methylprednisolone within 72-96 h of hospital admission, while CAPE COD studied the use of hydrocortisone within 24 h of the development of severe CAP. ESCAPe did not show any differences in all-cause 60-day mortality or any of its secondary outcomes. CAPE COD showed that hydrocortisone improved all-cause 28-day mortality and reduced the risk of intubation or vasopressor-dependent shock. Important differences between the trials included the steroid regimens used, timing of steroid administration and baseline characteristics, with more diabetic patients included in ESCAPe. The results of CAPE COD support the initiation of hydrocortisone within 24 h of developing severe CAP, but more research is needed to evaluate long-term outcomes and optimum dosing regimens for steroids in severe CAP.

关于类固醇在重症社区获得性肺炎(CAP)中的应用,目前存在相互矛盾的证据,以往的随机对照试验因样本量较小而受到限制。ESCAPe和CAPE COD是最近发表的两项关于类固醇治疗重症CAP的大型试验。ESCAPe对入院后72-96小时内开始使用甲基强的松龙进行了评估,而CAPE COD则对重症CAP发生后24小时内使用氢化可的松进行了研究。ESCAPe在全因60天死亡率或任何次要结果方面均未显示出任何差异。CAPE COD 显示,氢化可的松改善了 28 天内的全因死亡率,并降低了插管或血管加压休克的风险。两项试验之间的重要差异包括使用的类固醇方案、类固醇给药时间和基线特征,ESCAPe 纳入了更多的糖尿病患者。CAPE COD 的结果支持在发生严重 CAP 的 24 小时内开始使用氢化可的松,但还需要更多的研究来评估严重 CAP 的长期疗效和类固醇的最佳给药方案。
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引用次数: 0
Stage III NSCLC treatment options: too many choices. III 期 NSCLC 治疗方案:选择太多。
IF 2.3 Q2 RESPIRATORY SYSTEM Pub Date : 2024-10-01 DOI: 10.1183/20734735.0047-2024
Oke Dimas Asmara, Georgia Hardavella, Sara Ramella, René Horsleben Petersen, Ilona Tietzova, E Christiaan Boerma, Eric Daniel Tenda, Asmaa Bouterfas, Marjolein A Heuvelmans, Wouter H van Geffen

Stage III nonsmall cell lung cancer (NSCLC) represents a wide range of tumour (T1 to T4) and nodal (N0 to N3) components, requiring variable management and a multidisciplinary approach. Recent advancements in minimally invasive techniques, molecular biology and novel drug discoveries have accelerated the refinement of stage III NSCLC management. The latest developments in staging include the forthcoming update of the nodal component in the 9th TNM (tumour-node-metastasis) edition, which emphasises the critical role for endobronchial ultrasonography in mediastinal staging. Recent treatment developments include the use of immunotherapy and targeted molecular therapy in both the neoadjuvant and adjuvant setting, either in combination with other modalities or used alone as consolidation. Surgical and radiotherapy advancements have further enhanced patient outcomes. These developments have significantly improved the prognosis for patients with stage III NSCLC. Fast-changing recommendations have also brought about a challenge, with clinicians facing a number of options to choose from. Therefore, a multimodal approach by a multidisciplinary team has become even more crucial in managing stage III NSCLC.

III 期非小细胞肺癌(NSCLC)的肿瘤(T1 至 T4)和结节(N0 至 N3)成分范围很广,需要不同的管理和多学科方法。微创技术、分子生物学和新药发现的最新进展加速了对 III 期 NSCLC 管理的完善。分期方面的最新进展包括即将更新的第9版TNM(肿瘤-结节-转移)中的结节部分,其中强调了支气管内超声造影在纵隔分期中的关键作用。近期的治疗进展包括在新辅助治疗和辅助治疗中使用免疫疗法和靶向分子疗法,既可与其他方式联合使用,也可作为巩固治疗单独使用。手术和放疗的进步进一步提高了患者的治疗效果。这些进展大大改善了 III 期 NSCLC 患者的预后。快速变化的建议也带来了挑战,临床医生面临着多种选择。因此,多学科团队采用多模式方法治疗 III 期 NSCLC 变得更加重要。
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引用次数: 0
Stage IV nonsmall cell lung cancer treatment: oligometastatic disease and disease progression, untangling the knot. IV 期非小细胞肺癌治疗:寡转移疾病与疾病进展,解开心结。
IF 2.3 Q2 RESPIRATORY SYSTEM Pub Date : 2024-08-27 eCollection Date: 2024-06-01 DOI: 10.1183/20734735.0039-2024
Tuğbanur Tezvergil, Ismini Kourouni, Adrien E Costantini, Diego Kauffmann-Guerrero, Torsten Gerriet Blum, Thierry Berghmans

Stage IV nonsmall cell lung cancer (NSCLC) is a heterogeneous group of patients for whom systemic therapy is decided based on tumour-biological cancer features (histology, PD-L1 expression, genomic alteration, metastatic sites) and patient characteristics (performance status, comorbidities). In most instances, some kind of systemic treatment is proposed, for which immunotherapy-based or targeted therapies are considered the standards of care in 2024. Oligometastatic NSCLC represents a specific concept during the biological spectrum from localised to metastatic disease in which only a limited number of metastatic sites can be documented. Based on this assumption, prospective and a few randomised phase II studies have been performed, which suggested that adding a local ablative treatment to the systemic one can be a new option for selected stage IV NSCLC. The European Organisation for Research and Treatment of Cancer (EORTC) and the European Society for Radiotherapy and Oncology (ESTRO) supported efforts to define oligometastatic NSCLC to unify the semantics within the thoracic oncology community. This article summarises the currently available data and emphasises the questions and perspectives in oligometastatic disease NSCLC in European patient cohorts.

IV期非小细胞肺癌(NSCLC)是一个异质性患者群体,根据肿瘤生物学特征(组织学、PD-L1表达、基因组改变、转移部位)和患者特征(表现状态、合并症)决定是否对其进行全身治疗。在大多数情况下,建议采用某种系统性治疗方法,基于免疫疗法或靶向疗法被认为是2024年的治疗标准。寡转移性 NSCLC 代表了从局部疾病到转移性疾病这一生物学过程中的一个特定概念,在这一过程中,只有数量有限的转移部位可以被记录下来。基于这一假设,前瞻性研究和一些随机II期研究表明,在全身治疗的基础上增加局部消融治疗,可以成为部分IV期NSCLC患者的新选择。欧洲癌症研究与治疗组织(EORTC)和欧洲放射治疗与肿瘤学会(ESTRO)支持对少转移 NSCLC 进行定义,以统一胸部肿瘤学界的语义。本文总结了目前可用的数据,并强调了欧洲患者队列中寡转移性 NSCLC 疾病的问题和前景。
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引用次数: 0
Stage I and II nonsmall cell lung cancer treatment options. I 期和 II 期非小细胞肺癌治疗方案。
IF 2.3 Q2 RESPIRATORY SYSTEM Pub Date : 2024-08-27 eCollection Date: 2024-06-01 DOI: 10.1183/20734735.0219-2023
Georgia Hardavella, Dimitrios E Magouliotis, Roberto Chalela, Adam Januszewski, Fabio Dennstaedt, Paul Martin Putora, Alfred So, Angshu Bhowmik

Chest radiography, computed tomography (CT) and positron emission tomography (PET)-CT are required for staging nonsmall cell lung cancers. Stage I cancers may be up to 4 cm in maximal diameter, with stage IA tumours being up to 3 cm and stage IB up to 4 cm. A lung cancer becomes stage II if the tumour is between 4 and ≤5 cm (stage IIA), or it spreads to ipsilateral peribronchial or hilar lymph nodes (stage IIB). Stage IA tumours should be surgically resected, ideally using minimally invasive methods. Lobectomy is usually performed, although some studies have shown good outcomes for sublobar resections. If surgery is not possible, stereotactic body radiotherapy is a good alternative. This involves delivering a few high-dose radiation treatments at very high precision. For stage IB to IIB disease, combinations of surgery, chemotherapy or immunotherapy and radiotherapy are used. There is evidence that neoadjuvant treatment (immunotherapy with nivolumab and chemotherapy for stage IB and II) optimises outcomes. Adjuvant chemotherapy with a platinum-based doublet (typically cisplatin+vinorelbine) should be offered for resected stage IIB tumours and considered for resected IIA tumours. Adjuvant pembrolizumab is used for stage IB-IIIA following resection and adjuvant platinum-based chemotherapy. Osimertinib may be used for resected stage IB to IIIA cancers which have relevant mutations (epidermal growth factor receptor exon 19 deletions or exon 21 (L858R) substitution). There are no fixed guidelines for follow-up, but most centres recommend 6-monthly CT scanning for the first 2-3 years after definitive treatment, followed by annual scans.

对非小细胞肺癌进行分期需要进行胸部放射摄影、计算机断层扫描(CT)和正电子发射断层扫描(PET)-CT。I 期癌症最大直径可达 4 厘米,IA 期肿瘤最大直径可达 3 厘米,IB 期肿瘤最大直径可达 4 厘米。如果肿瘤在4厘米到≤5厘米之间(IIA期),或扩散到同侧支气管周围或肺门淋巴结(IIB期),则肺癌进入II期。IA期肿瘤应手术切除,最好采用微创方法。通常采用肺叶切除术,但也有研究表明肺叶下切除术效果良好。如果无法进行手术,立体定向体放射治疗也是一种不错的选择。这包括以非常高的精度进行几次大剂量放射治疗。对于 IB 期至 IIB 期疾病,可采用手术、化疗或免疫疗法和放疗相结合的方法。有证据表明,新辅助治疗(IB 期和 II 期患者采用 nivolumab 免疫疗法和化疗)可优化疗效。应为切除的IIB期肿瘤提供铂类双联化疗(通常为顺铂+维诺瑞宾),并考虑为切除的IIA期肿瘤提供铂类双联化疗。IB-IIIA期肿瘤在切除术和铂类辅助化疗后,可使用pembrolizumab辅助治疗。奥希替尼可用于存在相关突变(表皮生长因子受体第19外显子缺失或第21外显子(L858R)置换)的IB至IIIA期切除肿瘤。目前还没有固定的随访指南,但大多数中心建议在明确治疗后的最初 2-3 年内每 6 个月进行一次 CT 扫描,之后每年扫描一次。
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引用次数: 0
Exploring the efficacy and advancements of medical pleurodesis: a comprehensive review of current research. 探索胸膜腔穿刺术的疗效和进展:当前研究的全面回顾。
IF 2.3 Q2 RESPIRATORY SYSTEM Pub Date : 2024-08-27 eCollection Date: 2024-06-01 DOI: 10.1183/20734735.0002-2024
Nadia Castaldo, Alberto Fantin, Michelangelo Palou-Schwartzbaum, Giovanni Viterale, Ernesto Crisafulli, Giulia Sartori, Avinash Aujayeb, Filippo Patrucco, Vincenzo Patruno

This narrative review aims to provide an overview of medical pleurodesis techniques, and their indications and potential adverse effects. Pleurodesis is a procedure performed with the aim of obliterating the pleural space. It has indications in the management of both malignant and benign pleural effusions and pneumothorax. Various nonsurgical techniques exist to perform pleurodesis. The scope of this work is to review the different nonsurgical techniques and their indications. This narrative review was performed checking scientific databases for medical literature, focusing especially on the data derived from randomised controlled trials. Pleurodesis is an effective method to manage pleural effusions and pneumothorax, and minimally invasive techniques are now frequently used with good results. Further research is needed to assess the efficacy of new treatments and the possibility of using different techniques in association.

这篇叙述性综述旨在概述医学胸膜腔穿刺技术及其适应症和潜在不良反应。胸膜腔穿刺术是一种旨在阻塞胸膜腔的手术。它适用于恶性和良性胸腔积液和气胸的治疗。胸膜腔穿刺术有多种非手术技术。本研究旨在回顾不同的非手术疗法及其适应症。这篇叙述性综述通过科学数据库检索医学文献,尤其关注随机对照试验中获得的数据。胸膜腔穿刺术是治疗胸腔积液和气胸的有效方法,目前微创技术已被广泛应用,并取得了良好的效果。我们需要进一步开展研究,以评估新疗法的疗效以及联合使用不同技术的可能性。
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引用次数: 0
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