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Breathe Podcast December 2023: Early career members' highlights from the ERS Congress. 呼吸播客 2023 年 12 月:早期职业会员在 ERS 大会上的精彩发言。
IF 2 Q3 Medicine Pub Date : 2023-12-01 Epub Date: 2023-12-19 DOI: 10.1183/20734735.E194-2023

As part of the December issue, Breathe presents a podcast of early career members' highlights from the ERS Congress. Chief Editor Brian Kent discusses highlights from the ERS Congress with Joana Cruz, Siyu Dai and Sarah Alami.

作为 12 月刊的一部分,《呼吸》播客播出了 ERS 大会上早期职业成员的精彩发言。主编布莱恩-肯特(Brian Kent)与乔安娜-克鲁兹(Joana Cruz)、戴思宇和莎拉-阿拉米(Sarah Alami)讨论了欧洲遥感学会大会的亮点。
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引用次数: 0
The tuberculous pleural effusion. 结核性胸腔积液
IF 2 Q3 Medicine Pub Date : 2023-12-01 Epub Date: 2023-12-19 DOI: 10.1183/20734735.0143-2023
Emma McNally, Clare Ross, Laura E Gleeson

Pleural tuberculosis (TB) is a common entity with similar epidemiological characteristics to pulmonary TB. It represents a spectrum of disease that can variably self-resolve or progress to TB empyema with severe sequelae such as chronic fibrothorax or empyema necessitans. Coexistence of and progression to pulmonary TB is high. Diagnosis is challenging, as pleural TB is paucibacillary in most cases, but every effort should be made to obtain microbiological diagnosis, especially where drug resistance is suspected. Much attention has been focussed on adjunctive investigations to support diagnosis, but clinicians must be aware that apparent diagnostic accuracy is affected both by the underlying TB prevalence in the population, and by the diagnostic standard against which the specified investigation is being evaluated. Pharmacological treatment of pleural TB is similar to that of pulmonary TB, but penetration of the pleural space may be suboptimal in complicated effusions. Evidence for routine drainage is limited, but evacuation of the pleural space is indicated in complicated disease.

Educational aims: To demonstrate that pleural TB incorporates a wide spectrum of disease, ranging from self-resolving lymphocytic effusions to severe TB empyema with serious sequelae.To emphasise the high coexistence of pulmonary TB with pleural TB, and the importance of obtaining sputum for culture (induced if necessary) in all cases.To explore the significant diagnostic challenges posed by pleural TB, and consequently the frequent lack of information about drug sensitivity prior to initiating treatment.To highlight the influence of underlying TB prevalence in the population on the diagnostic accuracy of adjunctive investigations for the diagnosis of pleural TB.To discuss concerns around penetration of anti-TB medications into the pleural space and how this can influence decisions around treatment duration in practice.

胸膜结核(TB)是一种常见病,其流行病学特征与肺结核相似。它代表了一种疾病谱,可自行消退或发展为结核性肺水肿,并伴有严重的后遗症,如慢性纤维胸腔或必要肺水肿。肺结核的并存率和进展率都很高。诊断具有挑战性,因为胸膜结核在大多数情况下是贫血性的,但应尽一切努力获得微生物学诊断,尤其是在怀疑有耐药性的情况下。辅助诊断的辅助检查受到了广泛关注,但临床医生必须意识到,表面诊断的准确性既受到人群中潜在结核病发病率的影响,也受到评估特定检查所依据的诊断标准的影响。胸膜结核的药物治疗与肺结核相似,但对于复杂的积液,穿透胸膜腔的效果可能并不理想。常规引流的证据有限,但在病情复杂的情况下,可对胸膜腔进行排空:强调肺结核与胸膜结核的高度共存性,以及在所有病例中获取痰液进行培养(必要时进行诱导培养)的重要性。探讨胸膜结核在诊断方面的重大挑战,以及因此而导致的在开始治疗前经常缺乏有关药物敏感性的信息。强调人群中潜在肺结核患病率对胸膜结核辅助检查诊断准确性的影响。讨论抗结核药物渗入胸膜腔的问题,以及这如何影响实际治疗中关于治疗时间的决定。
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引用次数: 0
Diagnosis and management of pleural infection. 胸膜感染的诊断和处理。
IF 2 Q3 Medicine Pub Date : 2023-12-01 Epub Date: 2024-01-16 DOI: 10.1183/20734735.0146-2023
Alguili Elsheikh, Malvika Bhatnagar, Najib M Rahman

Pleural infection remains a medical challenge. Although closed tube drainage revolutionised treatment in the 19th century, pleural infection still poses a significant health burden with increasing incidence. Diagnosis presents challenges due to non-specific clinical presenting features. Imaging techniques such as chest radiographs, thoracic ultrasound and computed tomography scans aid diagnosis. Pleural fluid analysis, the gold standard, involves assessing gross appearance, biochemical markers and microbiology. Novel biomarkers such as suPAR (soluble urokinase plasminogen activator receptor) and PAI-1 (plasminogen activator inhibitor-1) show promise in diagnosis and prognosis, and microbiology demonstrates complex microbial diversity and is associated with outcomes. The management of pleural infection involves antibiotic therapy, chest drain insertion, intrapleural fibrinolytic therapy and surgery. Antibiotic therapy relies on empirical broad-spectrum antibiotics based on local policies, infection setting and resistance patterns. Chest drain insertion is the mainstay of management, and use of intrapleural fibrinolytics facilitates effective drainage. Surgical interventions such as video-assisted thoracoscopic surgery and decortication are considered in cases not responding to medical therapy. Risk stratification tools such as the RAPID (renal, age, purulence, infection source and dietary factors) score may help guide tailored management. The roles of other modalities such as local anaesthetic medical thoracoscopy and intrapleural antibiotics are debated. Ongoing research aims to improve outcomes by matching interventions with risk profile and to better understand the development of disease.

胸膜感染仍然是一项医学挑战。尽管 19 世纪的闭式管道引流术彻底改变了治疗方法,但胸膜感染仍对健康造成重大负担,且发病率不断上升。由于临床表现特征不具特异性,诊断面临挑战。胸片、胸部超声波和计算机断层扫描等成像技术有助于诊断。胸腔积液分析是金标准,包括评估大体外观、生化标志物和微生物学。suPAR(可溶性尿激酶纤溶酶原激活物受体)和PAI-1(纤溶酶原激活物抑制剂-1)等新型生物标志物在诊断和预后方面显示出前景,而微生物学则显示出复杂的微生物多样性并与预后相关。胸膜感染的治疗包括抗生素治疗、插入胸腔引流管、胸膜内纤维蛋白溶解治疗和手术。抗生素治疗主要根据当地政策、感染环境和耐药模式,采用经验性广谱抗生素。插入胸腔引流管是治疗的主要方法,使用胸膜内纤维蛋白溶解剂有助于有效引流。对于药物治疗无效的病例,可考虑采取外科干预措施,如视频辅助胸腔镜手术和去栓术。RAPID(肾脏、年龄、脓液、感染源和饮食因素)评分等风险分层工具可帮助指导有针对性的治疗。对局部麻醉胸腔镜和胸膜腔内抗生素等其他方式的作用还存在争议。正在进行的研究旨在通过将干预措施与风险状况相匹配来改善治疗效果,并更好地了解疾病的发展过程。
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引用次数: 0
Spontaneous pneumothorax or no pneumothorax at all? 自发性气胸还是没有气胸?
IF 2 Q3 Medicine Pub Date : 2023-09-01 DOI: 10.1183/20734735.0045-2023
Barrett J Burger, Matthew Pertzborn, Kevin Bielamowicz, Zena Ghazala

Care of a simple pneumothorax in a paediatric patient is often anything but simple, and a refractory and complex pneumothorax requires thoughtful and deliberate care https://bit.ly/3NFAk9S.

儿科患者单纯性气胸的护理通常并不简单,而难治性和复杂的气胸则需要周到和刻意的护理https://bit.ly/3NFAk9S。
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引用次数: 0
Regular (up to 10 puffs 4-hourly) inhaled salbutamol should be prescribed at discharge after an asthma attack: myth or maxim? 哮喘发作后出院时应开具定期(4小时最多10次)吸入沙丁胺醇的处方:神话还是格言?
IF 2 Q3 Medicine Pub Date : 2023-09-01 Epub Date: 2023-10-10 DOI: 10.1183/20734735.0054-2023
Sara Warraich, Andrew Bush, Mark L Levy, Louise Fleming

Over the past 20 years, the concept of asthma weaning plans on discharge after an attack has crept into common practice, although the precise origin of these plans is unclear. High use of short-acting β2-agonists (SABAs) may result in tolerance to their bronchodilator effects, thus diminishing their efficacy, particularly when they are most needed at the time of an acute attack. Furthermore, key warning signs of a deterioration in asthma control may be masked and the weaning plan may encourage the over-use and over-reliance on SABAs. Side-effects from over-use may also occur, including lactic acidosis, downregulation of the β2-adrenoreceptor, increased allergen response and pro-inflammatory effects. The need for asthma education at discharge, a personal asthma action plan and vigilance about prescribing and ensuring adherence to maintenance therapy are definitely important. However, the current authors conclude that the benefit of prescribing regular salbutamol (up to 10 puffs every 4 h) at discharge after an acute asthma attack is a myth, and a very dangerous one.

过去20年 多年来,哮喘发作后出院时断奶计划的概念已经逐渐成为惯例,尽管这些计划的确切来源尚不清楚。大量使用短效β2-拮抗剂(SABAs)可能会导致对其支气管扩张作用的耐受性,从而降低其疗效,尤其是在急性发作时最需要的时候。此外,哮喘控制恶化的关键警告信号可能被掩盖,断奶计划可能会鼓励过度使用和过度依赖SABA。过量使用也可能产生副作用,包括乳酸酸中毒、β2-肾上腺素受体下调、过敏原反应增加和促炎作用。出院时进行哮喘教育的必要性、个人哮喘行动计划以及对处方的警惕性和确保坚持维持治疗的必要性无疑很重要。然而,目前的作者得出结论,定期服用沙丁胺醇(每4次最多10次 h) 急性哮喘发作后出院是一个神话,也是一个非常危险的神话。
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引用次数: 0
An interesting case of pulmonary infiltrates with eosinophilia: out of sight out of mind 肺浸润伴嗜酸性粒细胞增多的有趣病例:眼不见心不烦
Q3 Medicine Pub Date : 2023-09-01 DOI: 10.1183/20734735.0097-2023
Amit Panjwani, Mohamed Redha Salman, Umesh Nabar

Tweetable abstract

Tropical pulmonary eosinophilia should be considered in patients presenting with respiratory symptoms and hypereosinophilia, even in areas not endemic for filariasis. This awareness may prevent morbidity associated with its late or wrong diagnosis.https://bit.ly/3t8hHVc
在出现呼吸道症状和嗜酸性粒细胞增多的患者中,即使在丝虫病不流行的地区,也应考虑热带肺嗜酸性粒细胞增多。这种意识可以预防与晚期或错误诊断相关的发病率。https://bit.ly/3t8hHVc
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引用次数: 0
Ending the TB pandemic: the urgency of a new and improved TB vaccine and the World Health Organization's TB Vaccine Accelerator Council. 结束结核病大流行:新的和改进的结核病疫苗以及世界卫生组织结核病疫苗加速理事会的紧迫性。
IF 2 Q3 Medicine Pub Date : 2023-09-01 Epub Date: 2023-09-12 DOI: 10.1183/20734735.0036-2023
Victor Abiola Adepoju, Okechukwu Innocent Onyezue

We support the World Health Organization (WHO) recent decision to create a council to accelerate the development of a tuberculosis (TB) vaccine. With over 10 million new cases and 1.4 million deaths in 2020 alone, new and improved vaccines are urgently needed. Recent advancements in TB vaccine research offer hope, but a lack of funding, coordination and understanding of immune responses have impeded progress. A TB Vaccine Accelerator Council aims to bring together resources and expertise to overcome these obstacles and speed up development. Support and investment in research are crucial to ultimately eradicate TB and achieve the WHO goal of ending TB by 2035.

我们支持世界卫生组织(世界卫生组织)最近决定成立一个理事会,以加快结核病疫苗的开发。超过10 新增病例万例,新增病例1.4例 仅在2020年就有数百万人死亡,迫切需要新的和改进的疫苗。结核病疫苗研究的最新进展带来了希望,但缺乏资金、协调和对免疫反应的了解阻碍了进展。结核病疫苗加速委员会旨在汇集资源和专业知识,克服这些障碍,加快发展。对研究的支持和投资对于最终根除结核病和实现世界卫生组织到2035年结束结核病的目标至关重要。
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引用次数: 1
Lung functional imaging 肺功能成像
Q3 Medicine Pub Date : 2023-09-01 DOI: 10.1183/20734735.0272-2022
Sam Bayat, Jim Wild, Tilo Winkler
Pulmonary functional imaging modalities such as computed tomography, magnetic resonance imaging and nuclear imaging can quantitatively assess regional lung functional parameters and their distributions. These include ventilation, perfusion, gas exchange at the microvascular level and biomechanical properties, among other variables. This review describes the rationale, strengths and limitations of the various imaging modalities employed for lung functional imaging. It also aims to explain some of the most commonly measured parameters of regional lung function. A brief review of evidence on the role and utility of lung functional imaging in early diagnosis, accurate lung functional characterisation, disease phenotyping and advancing the understanding of disease mechanisms in major respiratory disorders is provided.
肺功能成像方式,如计算机断层扫描、磁共振成像和核成像,可以定量评估局部肺功能参数及其分布。这些包括通气、灌注、微血管水平的气体交换和生物力学特性等变量。这篇综述描述了用于肺功能成像的各种成像方式的基本原理、优势和局限性。它还旨在解释一些最常用的测量参数的区域肺功能。简要回顾肺功能成像在早期诊断、准确的肺功能特征、疾病表型和促进对主要呼吸系统疾病的疾病机制的理解方面的作用和应用的证据。
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引用次数: 0
When should we involve interventional radiology in the management of acute pulmonary embolism? 我们应该在什么时候介入放射学介入治疗急性肺栓塞?
IF 2.3 Q2 RESPIRATORY SYSTEM Pub Date : 2023-09-01 Epub Date: 2023-09-12 DOI: 10.1183/20734735.0085-2023
María Barca-Hernando, Luis Jara-Palomares

Pulmonary embolism (PE) is a common disease associated with high morbidity and mortality. Currently, guidelines recommend systemic thrombolysis in patients with haemodynamic instability (high-risk PE) or patients with intermediate-high-risk PE with haemodynamic deterioration. Nevertheless, more than half of high-risk PE patients do not receive systemic thrombolysis due to a perceived increased risk of bleeding. In these cases, percutaneous catheter-directed therapy (CDT) or surgical embolectomy should be considered. CDT has emerged and appears to be an effective alternative in treating PE, with a hypothetical lower risk of bleeding than systemic thrombolysis, acting directly in the thrombus with a much lower dose of thrombolytic drug or even without thrombolytic therapy. CDT techniques include catheter-directed clot aspiration or fragmentation, mechanical embolectomy, local thrombolysis, and combined pharmaco-mechanical approaches. A few observational prospective studies have demonstrated that CDT improves right ventricular function with a low rate of haemorrhage. Nevertheless, the evidence from randomised controlled trials is scarce. Here we review different scenarios where CDT may be useful and trials ongoing in this field. These results may change the upcoming guidelines for management and treatment of PE, establishing CDT as a recommended treatment in patients with acute intermediate-high-risk PE.

肺栓塞(PE)是一种常见的疾病,发病率和死亡率都很高。目前,指南建议对血液动力学不稳定(高危PE)患者或伴有血液动力学恶化的中高危PE患者进行全身溶栓治疗。然而,超过一半的高危PE患者由于出血风险增加而没有接受全身溶栓治疗。在这些情况下,应考虑经皮导管导向治疗(CDT)或手术栓塞。CDT已经出现,并且似乎是治疗PE的一种有效替代方案,假设出血风险比全身溶栓低,直接作用于血栓,使用剂量低得多的溶栓药物,甚至不进行溶栓治疗。CDT技术包括导管引导的血栓抽吸或碎片化、机械栓子切除术、局部溶栓和药物-机械联合方法。一些观察性前瞻性研究表明,CDT可改善右心室功能,出血率较低。然而,来自随机对照试验的证据很少。在这里,我们回顾了CDT可能有用的不同场景以及该领域正在进行的试验。这些结果可能会改变即将出台的PE管理和治疗指南,将CDT确定为急性中高危PE患者的推荐治疗方法。
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引用次数: 0
The changing face of the modern respiratory clinician. 现代呼吸科临床医生不断变化的面貌。
IF 2.3 Q2 RESPIRATORY SYSTEM Pub Date : 2023-09-01 Epub Date: 2023-09-12 DOI: 10.1183/20734735.0147-2023
Brian D Kent

This issue of Breathe examines both the integral role multidisciplinary care has in managing respiratory disease, and the changing faces of the respiratory clinicians providing that care. https://bit.ly/47MsW5R.

《呼吸》杂志探讨了多学科护理在管理呼吸系统疾病中的整体作用,以及提供护理的呼吸系统临床医生不断变化的面貌。https://bit.ly/47MsW5R.
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引用次数: 0
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Breathe
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