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Imaging in the diagnosis and management of fibrosing interstitial lung diseases. 纤维化间质性肺疾病诊断和治疗中的成像技术。
IF 2 Q3 Medicine Pub Date : 2024-03-01 Epub Date: 2024-05-14 DOI: 10.1183/20734735.0006-2024
Christoph Lederer, Monika Storman, Adam Domonkos Tarnoki, David Laszlo Tarnoki, George A Margaritopoulos, Helmut Prosch

High-resolution computed tomography (HRCT) plays a pivotal role in the diagnosis and management of interstitial lung diseases (ILDs), particularly given the approval of antifibrotic agents for conditions like idiopathic pulmonary fibrosis and progressive pulmonary fibrosis. Diagnosing fibrotic pulmonary disorders through HRCT involves a detailed and methodical examination. The identification of specific lung tissue changes, including ground-glass opacities and reticulation, along with signs of fibrosis like honeycombing, traction bronchiectasis and lung volume loss, establishes clear HRCT patterns indicative of various ILDs. The reliability of these patterns in predicting pathological conditions depends largely on the clinical context. For instance, when a usual interstitial pneumonia pattern is present, the predictive value of this diagnosis is so high that a lung biopsy is considered to be redundant. This review intends to delineate the HRCT signs of fibrosis, elucidate the specific radiological patterns of fibrotic lung diseases, and identify the clinical circumstances under which these patterns emerge. Additionally, we introduce and discuss novel imaging techniques that hold promise for the diagnosis, screening and early detection of ILDs.

高分辨率计算机断层扫描(HRCT)在间质性肺疾病(ILDs)的诊断和治疗中发挥着举足轻重的作用,特别是鉴于抗纤维化药物已被批准用于特发性肺纤维化和进行性肺纤维化等疾病的治疗。通过 HRCT 诊断肺纤维化疾病需要进行详细而有条理的检查。通过识别特定的肺组织变化,包括磨玻璃不透明和网状结构,以及纤维化的迹象,如蜂窝、牵引性支气管扩张和肺容积减少,可以建立明确的 HRCT 模式,指示各种 ILD。这些模式预测病理状况的可靠性在很大程度上取决于临床环境。例如,当出现通常的间质性肺炎模式时,这种诊断的预测价值非常高,以至于肺活检被认为是多余的。本综述旨在描述纤维化的 HRCT 征象,阐明纤维化肺部疾病的特定放射学模式,并确定出现这些模式的临床情况。此外,我们还将介绍和讨论有望用于 ILD 诊断、筛查和早期检测的新型成像技术。
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引用次数: 0
Respiratory problems associated with liver disease in children. 与儿童肝病相关的呼吸系统问题。
IF 2 Q3 Medicine Pub Date : 2024-03-01 Epub Date: 2024-04-09 DOI: 10.1183/20734735.0150-2023
Jordache Ellis, Tassos Grammatikopoulos, James Cook, Akash Deep

Respiratory manifestations of chronic liver disease have a profound impact on patient clinical outcomes. Certain conditions within paediatric liver disease have an associated respiratory pathology. This overlap between liver and respiratory manifestations can result in complex challenges when managing patients and requires clinicians to be able to recognise when referral to specialists is required. While liver transplantation is at the centre of treatment, it opens up further potential for respiratory complications. It is established that these complications place patients at risk of longer stays in hospital and reduced survival. Additionally, late post-transplant complications can occur, including post-transplant lymphoproliferative disease and immunosuppression-induced interstitial lung disease. Although rare, it is important for clinicians to recognise these conditions to allow for prompt management. Finally, as liver disease progresses in children, respiratory complications can occur. Hepatopulmonary syndrome can occur in the context of portal hypertension, resulting in increased mortality and poorer quality of life for patients. Another consequence is portopulmonary hypertension, which can be associated with poor survival. Failure to recognise these complications in children may result in poorer outcomes and therefore it is vital that clinicians can establish when referral to a paediatric respiratory medicine specialist is required.

慢性肝病的呼吸系统表现对患者的临床疗效影响深远。儿科肝病的某些病症与呼吸系统病理有关。肝脏和呼吸系统表现之间的这种重叠可能会给患者的管理带来复杂的挑战,并要求临床医生能够识别何时需要转诊给专科医生。虽然肝移植是治疗的核心,但它为呼吸系统并发症的发生提供了更多可能。已经证实,这些并发症会使患者面临住院时间延长和存活率降低的风险。此外,还可能出现移植后晚期并发症,包括移植后淋巴增生性疾病和免疫抑制引起的间质性肺病。虽然这种情况很少见,但临床医生必须认识到这些情况,以便及时处理。最后,随着儿童肝病的进展,可能会出现呼吸系统并发症。肝肺综合征可在门静脉高压的情况下发生,导致患者死亡率增加,生活质量下降。另一个后果是门静脉高压症,这可能与存活率低有关。如果不能识别儿童的这些并发症,可能会导致较差的预后,因此临床医生必须确定何时需要转诊至儿科呼吸内科专科医生。
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引用次数: 0
Eosinophilia and wheeze: thinking beyond asthma. 嗜酸性粒细胞增多症与喘息:超越哮喘的思考。
IF 2.3 Q2 RESPIRATORY SYSTEM Pub Date : 2024-03-01 Epub Date: 2024-03-12 DOI: 10.1183/20734735.0126-2023
Stephanie L Kuek, Colin Pettman, Melanie R Neeland, Joanne Harrison, Sam Mehr, Shivanthan Shanthikumar, Sean Beggs

Primary idiopathic hypereosinophilic syndrome is a rare condition that can cause end-organ damage in multiple systems. The advent of targeted monoclonal antibodies, such as mepolizumab, provides a safe and effective steroid-sparing treatment. https://bit.ly/4bgDP1u.

原发性特发性高嗜酸性粒细胞综合征是一种罕见病,可导致多个系统的终末器官损伤。靶向单克隆抗体(如mepolizumab)的出现提供了一种安全有效的节省类固醇的治疗方法。https://bit.ly/4bgDP1u。
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引用次数: 0
Patient experience: impact of environmental conditions on severe asthma. 患者体验:环境条件对严重哮喘的影响。
IF 2 Q3 Medicine Pub Date : 2023-12-01 Epub Date: 2023-12-19 DOI: 10.1183/20734735.0178-2023
Irantzu Muerza, Rory Harris

Climate change is a direct threat to the respiratory health of people with difficult-to-control severe asthma and directly affects the daily life of patients. https://bit.ly/49etd24.

气候变化直接威胁着难以控制的严重哮喘患者的呼吸健康,并直接影响患者的日常生活。https://bit.ly/49etd24。
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引用次数: 0
Medical treatment of pleural infection: antibiotic duration and corticosteroid usefulness. 胸膜感染的药物治疗:抗生素持续时间和皮质类固醇的作用。
IF 2 Q3 Medicine Pub Date : 2023-12-01 Epub Date: 2023-12-19 DOI: 10.1183/20734735.0134-2023
Vasileios Skouras, Foteini Chatzivasiloglou, Marianthi Iliopoulou, Theofani Rimpa

The data about the optimal duration of antibiotics and the usefulness of corticosteroids in the management of parapneumonic effusion and pleural infection are scarce. Two randomised controlled trials evaluating short antibiotic courses (ODAPE and SLIM) and another trial assessing the benefit from corticosteroid use (STOPPE) in this setting were recently published. The aim of this journal club is to present these trials and discuss their significance and limitations. ODAPE compared the efficacy and safety of a short (2 weeks) versus an extended (3 weeks) course of amoxicillin-clavulanate in community-acquired complicated parapneumonic effusions, while SLIM compared the efficacy and safety of short (14-21 days) versus longer (28-42 days) antibiotic courses in patients with community- or hospital-acquired pleural infection. STOPPE assessed the benefit from dexamethasone use in patients with community-acquired pneumonia and concomitant pleural effusion. Both ODAPE and SLIM found that shorter antibiotic courses produce less adverse events while being equally efficacious to the longer courses in a subgroup of patients, such as those with pleural infection that is stabilised with only medical treatment and does not require surgery. In contrast, STOPPE found no benefit from the use of dexamethasone in unselected patients with pneumonia and pleural effusion. Due to the significant limitations of these trials, further studies are required to confirm these findings.

Commentary on: Hassan M, et al. The Short versus Long Antibiotic Course for Pleural Infection Management (SLIM) randomised controlled open-label trial. ERJ Open Res 2023; 9: 00635-2022.Porcel JM, et al. Two vs. three weeks of treatment with amoxicillin-clavulanate for stabilized community-acquired complicated parapneumonic effusions. A preliminary non-inferiority, double-blind, randomized, controlled trial. Pleura Peritoneum 2020; 5: 20190027.Fitzgerald DB, et al. Steroid Therapy and Outcome of Parapneumonic Pleural Effusions (STOPPE): a pilot randomized clinical trial. Am J Respir Crit Care Med 2022; 205: 1093-1101.

有关抗生素的最佳疗程以及皮质类固醇在治疗气胸和胸膜感染中的作用的数据很少。最近发表了两项评估短期抗生素疗程的随机对照试验(ODAPE 和 SLIM)和另一项评估在这种情况下使用皮质类固醇的益处的试验(STOPPE)。本期刊俱乐部旨在介绍这些试验,并讨论其意义和局限性。ODAPE比较了社区获得性并发症性肺旁积液患者使用阿莫西林-克拉维酸短程(2周)和长程(3周)治疗的疗效和安全性,而SLIM则比较了社区或医院获得性胸膜感染患者使用抗生素短程(14-21天)和长程(28-42天)治疗的疗效和安全性。STOPPE 评估了社区获得性肺炎合并胸腔积液患者使用地塞米松的益处。ODAPE和SLIM均发现,对于某些亚组患者,如仅接受药物治疗即可稳定病情且无需手术的胸膜感染患者,使用较短疗程的抗生素与使用较长疗程的抗生素相比,不良反应较少,疗效相当。与此相反,STOPPE 发现,在未经筛选的肺炎和胸腔积液患者中使用地塞米松并无益处。由于这些试验存在很大的局限性,还需要进一步的研究来证实这些发现:Hassan M, et al.胸膜感染管理的短抗生素疗程与长抗生素疗程(SLIM)随机对照开放标签试验。ERJ Open Res 2023; 9: 00635-2022.Porcel JM, et al.一项初步的非劣效、双盲、随机对照试验。Pleura Peritoneum 2020; 5: 20190027.Fitzgerald DB, et al. Steroid Therapy and Outcome of Parapneumonic Pleural Effusions (STOPPE): a pilot randomized clinical trial.Am J Respir Crit Care Med 2022; 205:1093-1101.
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引用次数: 0
The role of the clinical pharmacist in the respiratory or sleep multidisciplinary team. 临床药剂师在呼吸或睡眠多学科团队中的作用。
IF 2 Q3 Medicine Pub Date : 2023-12-01 Epub Date: 2023-12-19 DOI: 10.1183/20734735.0123-2023
Jessica Clements, Elaine Bowman, Rowan Tolhurst, Maeve Savage, Alicia Piwko, Christabelle Chen, Elaine Lyons, Nixon Leung, Sarah Mulholland, Gráinne d'Ancona

The role of the pharmacist has evolved significantly, not least over the last 20 years. It delivers a skilled profession with a vital role in medicines optimisation and the management of patients with a respiratory or sleep disorder. While pharmacists are capable of acting as independent practitioners delivering direct patient care, this article explores their contribution to multidisciplinary teams within asthma, COPD, cystic fibrosis, tuberculosis, interstitial lung disease and sleep medicine. Having identified patient cohorts needing specialist medicines support, notably those with poor medicines adherence or specific medicines-related needs (for example during adolescence, or women who are pregnant or breastfeeding), these pharmacists work within primary, secondary and specialist tertiary care. The aim of this review is to share and inspire innovative models of working to include more pharmacists in respiratory and sleep medicine.

药剂师的角色发生了重大变化,尤其是在过去 20 年中。药剂师是一门技术娴熟的职业,在药物优化和呼吸或睡眠障碍患者管理方面发挥着至关重要的作用。虽然药剂师能够作为独立的执业医师直接为患者提供护理,但本文探讨了药剂师在哮喘、慢性阻塞性肺病、囊性纤维化、肺结核、间质性肺病和睡眠医学多学科团队中的贡献。这些药剂师确定了需要专科药物支持的患者群体,特别是那些用药依从性差或有特殊药物相关需求的患者(如青春期、孕妇或哺乳期妇女),他们在初级、二级和专科三级医疗机构工作。本综述旨在分享和启发创新的工作模式,让更多的药剂师参与到呼吸与睡眠医学的工作中来。
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引用次数: 0
Why and how should children be protected from the deluge of vaping related media and marketing overexposure? 为什么以及如何保护儿童免受大量与吸烟有关的媒体和营销过度曝光的影响?
IF 2 Q3 Medicine Pub Date : 2023-12-01 Epub Date: 2023-12-19 DOI: 10.1183/20734735.0141-2023
David White, Andrew Bush, Alan R Smyth, Jayesh Mahendra Bhatt

E-cigarettes are products delivering nicotine via inhalation and are devised to mimic tobacco smoking. While they were initially introduced as a device putatively to aid with smoking cessation, their use is now far broader than that. Use by children is significantly increasing. There is growing evidence of the potential harms of vaping. E-liquids used for e-cigarettes contain a wide range of harmful substances, and the clinical consequences of this are now being increasingly demonstrated, such as the rise in cases of e-cigarette- or vaping-associated lung injury. In addition, early use may result in long-term nicotine addiction. Vaping companies utilise marketing methods that distinctly target young people, and weak legislation in the UK allows them free rein to expose children to vaping. In this review we demonstrate why children must be protected from vaping. We must have stringent legislation to prevent easy access to e-cigarettes, including banning the convenience and affordability disposable vapes provide, and prevent marketing that does not warn about the potential health effects. The Australia approach of prescription or pharmacy only access for smoking cessation should be considered to limit exposure of children and minimise use by nonsmokers.

电子烟是一种通过吸入提供尼古丁的产品,其设计目的是模仿吸烟。虽然电子烟最初是作为帮助戒烟的设备推出的,但现在其使用范围远不止于此。儿童的使用率正在大幅上升。越来越多的证据表明电子烟具有潜在危害。电子烟使用的电子液体中含有多种有害物质,其临床后果也日益显现,如电子烟或电子烟相关肺损伤病例的增加。此外,早期使用可能会导致尼古丁长期上瘾。电子烟公司利用明显针对年轻人的营销方法,而英国薄弱的立法又允许他们随意让儿童接触电子烟。在这篇评论中,我们说明了为什么必须保护儿童免受吸食电子烟的危害。我们必须制定严格的法律,防止儿童轻易接触到电子烟,包括禁止使用方便、价格低廉的一次性电子烟,防止不警告潜在健康影响的营销方式。应考虑澳大利亚的做法,即戒烟只能凭处方或药房购买,以限制儿童接触电子烟,并尽量减少非吸烟者使用电子烟。
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引用次数: 0
A pleural based mass in a post-partum woman. 一名产后妇女的胸膜肿块。
IF 2 Q3 Medicine Pub Date : 2023-12-01 Epub Date: 2024-02-13 DOI: 10.1183/20734735.0156-2023
Padraic C Ridge, Daphne Chen-Maxwell, Caroline Brodie, Anne Marie Quinn, John Bruzzi, David Breen

Can you diagnose this case of a 27-year-old female who presented 1-week post-partum with an incidental finding of intrathoracic masses and probable hilar lymphadenopathy? https://bit.ly/3S3ejVK.

该病例是一名 27 岁的女性,在产后一周偶然发现胸内肿块和可能的肺部淋巴结病,您能否对该病例做出诊断?https://bit.ly/3S3ejVK。
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引用次数: 0
microRNAs in exhaled breath condensate for diagnosis of lung cancer in a resource-limited setting: a concise review. 在资源有限的环境中,用于诊断肺癌的呼出气体冷凝物中的 microRNAs:简明综述。
IF 2 Q3 Medicine Pub Date : 2023-12-01 Epub Date: 2024-02-13 DOI: 10.1183/20734735.0125-2023
Divyanjali Rai, Bijay Pattnaik, Sunil Bangaru, Jaya Tak, Jyoti Kumari, Umashankar Verma, Rohit Vadala, Geetika Yadav, Rupinder Singh Dhaliwal, Sunil Kumar, Rakesh Kumar, Deepali Jain, Kalpana Luthra, Kunzang Chosdol, Jayanth Kumar Palanichamy, Maroof Ahmad Khan, Addagalla Surendranath, Saurabh Mittal, Pawan Tiwari, Vijay Hadda, Karan Madan, Anurag Agrawal, Randeep Guleria, Anant Mohan

Lung cancer is one of the common cancers globally with high mortality and poor prognosis. Most cases of lung cancer are diagnosed at an advanced stage due to limited diagnostic resources. Screening modalities, such as sputum cytology and annual chest radiographs, have not proved sensitive enough to impact mortality. In recent years, annual low-dose computed tomography has emerged as a potential screening tool for early lung cancer detection, but it may not be a feasible option for developing countries. In this context, exhaled breath condensate (EBC) analysis has been evaluated recently as a noninvasive tool for lung cancer diagnosis. The breath biomarkers also have the advantage of differentiating various types and stages of lung cancer. Recent studies have focused more on microRNAs (miRNAs) as they play a key role in tumourigenesis by regulating the cell cycle, metastasis and angiogenesis. In this review, we have consolidated the current published literature suggesting the utility of miRNAs in EBC for the detection of lung cancer.

肺癌是全球常见的癌症之一,死亡率高,预后差。由于诊断资源有限,大多数肺癌病例在晚期才被确诊。事实证明,痰细胞学检查和年度胸片检查等筛查方式的灵敏度不足以影响死亡率。近年来,年度低剂量计算机断层扫描已成为早期肺癌检测的一种潜在筛查工具,但对于发展中国家来说,这可能不是一个可行的选择。在这种情况下,最近对呼出气体冷凝物(EBC)分析进行了评估,将其作为诊断肺癌的一种无创工具。呼气生物标记物还具有区分肺癌不同类型和分期的优势。最近的研究更多地关注微RNA(miRNA),因为它们通过调节细胞周期、转移和血管生成在肿瘤发生过程中发挥着关键作用。在这篇综述中,我们整合了目前已发表的文献,这些文献表明 miRNAs 在 EBC 检测肺癌中的作用。
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引用次数: 0
Unveiling the power of neutral and inclusive language in tuberculosis prevention and care. 在结核病预防和护理工作中发挥中性和包容性语言的力量。
IF 2 Q3 Medicine Pub Date : 2023-12-01 Epub Date: 2024-02-13 DOI: 10.1183/20734735.0157-2023
Pedro Barbosa, Mariana Vieira, João Pedro Ramos, Raquel Duarte

Language plays a crucial role in shaping discourses and responses related to disease, particularly tuberculosis (TB). Stigmatising language and attitudes surrounding TB can lead to discrimination and marginalisation of affected individuals, creating barriers to seeking proper diagnosis and treatment. The terminology used to describe TB-affected individuals can be disempowering and criminalising, reinforcing an "othering" of those affected. To combat this, engaging with TB-affected communities is essential to co-construct a neutral and inclusive vocabulary that respects the dignity of individuals and fosters empathy and support. Thus, an inclusive language approach empowers affected individuals as active participants in their health management, encouraging open communication and the development of support networks. By adopting a neutral and inclusive language system, healthcare providers and communities can work together to remove unnoticed hurdles and align with the World Health Organization's TB care and prevention goals.

语言在形成与疾病,尤其是结核病(TB)有关的论述和应对措施方面发挥着至关重要的作用。围绕肺结核的污名化语言和态度会导致对患者的歧视和边缘化,为寻求适当的诊断和治疗制造障碍。用于描述受结核病影响的个人的术语可能会削弱他们的能力并使他们成为罪犯,从而强化了对受影响者的 "另类化"。为了解决这一问题,必须与受结核病影响的社区合作,共同构建一个尊重个人尊严、促进共鸣和支持的中立、包容的词汇。因此,包容性语言方法赋予受影响的个人权力,使其成为健康管理的积极参与者,鼓励开放式交流和发展支持网络。通过采用中性和包容性的语言系统,医疗服务提供者和社区可以共同努力,消除未被注意到的障碍,并与世界卫生组织的结核病护理和预防目标保持一致。
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引用次数: 0
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Breathe
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