Canadian respiratory journal最新文献

Objectives: Recommendations for programmatic components for lung cancer screening programs (LCSPs) have been published; however, adoption within LCSPs has not been mandated and implementation requires resources. We aimed to determine the presence of recommended structural and quality elements within LCSPs and determine barriers to performing LCS within a community-based, multistate healthcare network. Methods: We conducted a cross-sectional study using two structured interviews within a community-based healthcare network between 1 June 2018 and 31 July 2020. Two separate interviews were created, one delivered to LCSP navigators to determine the presence of recommended structural and quality elements within LCSPs and one delivered to imaging center administrators to determine barriers to LCS implementation. Results: Of the 22 LCSPs, 20 (91%) were decentralized and 2 (9%) centralized. Three (14%) utilized standardized shared decision-making tools and 13 (59%) a multidisciplinary nodule review. Of the 21 (95%) LCSPs who collected information for external purposes, 9 (43%) collected it manually. Ten (45%) utilized a standard procedure for smoking cessation, and 5 (23%) had Certified Tobacco Treatment Specialists. Of the 31 affiliated imaging sites not associated with a LCSP, 8 (26%) were performing LCS. While 19 (61%) sites had the resources to fulfill or maintain an increase in LCS orders, lack of resources was the predominant (11, 35%) barrier to implementing a LCSP. Conclusions: A wide variation in the structure, quality, and resource allocation was identified within the network of LCSPs. Further research identifying the implications this variation has on outcomes, operational cost, and experience may shed light on whether stringent program quality control is needed.

Background: Populations residing at high altitudes display distinct physiological adaptations that are essential for understanding respiratory diseases. However, there is limited research on how these adaptations affect the assessment and prognosis of community-acquired pneumonia (CAP). Methods: A prognostic validation nested within a retrospective cohort was conducted on subjects with pneumonia admitted to two high-complexity institutions in Colombia at different altitudes above sea level. The receiver operating characteristic (ROC) curves were calculated for SaO₂, PaO₂, SpO₂, A-a O₂ gradient, a-A index, PaO₂/FiO₂, SpO₂/FiO₂, and the CURB-65 score to predict 30-day mortality, requirement for invasive mechanical ventilation (IMV), and need for vasopressor support. Results: 3467 were selected for analysis, with 73.7% (2557/3467) residing at high altitudes and 26.2% (910/3467) at low altitudes. The CURB-65 score  ≥ 2 showed a performance in predicting mortality of 0.707 (95% CI: 0.653-0.761; p < 0.001) at low altitudes and 0.737 (95% CI: 0.709-0.765; p < 0.001) at high altitudes. The PaO₂/FiO₂ ≤ 300 showed a performance in predicting the need for IMV and vasopressor support of 0.734 (95% CI: 0.685-0.783; p < 0.001) and 0.724 (0.674-0.775; p < 0.001) at high altitudes, respectively. The SpO₂/FiO₂ ≤ 350 showed a performance in predicting the need for IMV of 0.679 (0.507-0.85; p < 0.001) at low altitudes. The A-a O₂ gradient ≥ 10 showed a performance in predicting the need for vasopressor support of 0.686 (95% CI: 0.537-0.835; p=0.06) at low altitudes. Conclusion: In patients with CAP at altitudes above 2500 m above sea level, PaO₂/FiO₂, SpO₂/FiO₂, and the A-a O₂ gradient show a greater predictive capacity for 30-day mortality, need for IMV, and vasopressor requirements. The CURB-65 score showed a good predictive performance.

We present the findings from an evaluation of 144 survivors who experienced post-COVID-19 complications or reinfection. The assessment was conducted at 1, 3, and 6 months following their discharge from an intensive post-COVID care center. The evaluation encompassed a comprehensive analysis of clinical life-critical indicators and mental health states. Based on lung CT scans, pneumonia was identified in 73% of the patients, categorized into four severity groups according to their health conditions: mild (26%), moderate (57%), severe (14%), and extremely severe (3%). Among the extremely severe cases, two patients succumbed to the illness. Self-reported fatigue during the acute phase was prevalent among 79% of participants, which increased to 91% at 1 month, decreased to 64% at 3 months, and further decreased to 56% at 6 months. The vital signs of patients, including systolic and diastolic blood pressure, oxygen saturation, body temperature, respiratory rate, and heart rate, gradually normalized over time. Anxiety and depression symptoms persisted in 17% and 21% of patients, respectively, up to the 6-month mark; even though during the acute phase, these figures were 15% and 13%. The limitations of this study include issues related to sample representation and the exclusion of hypertension data, which affect the overall balance of its findings. Trial Registration: ClinicalTrials.gov identifier: NCT04987853.

Background: Pulmonary hypertension (PH) in patients undergoing lung transplantation (LT) for pulmonary fibrosis can impair lung function, reduce physical activity, and decrease survival. However, data on outcomes at 1 and 5 years of follow-up remain limited. Methods: In this prospective cohort study, pulmonary function, the 6-min walk test (6MWT), and the St. George's Respiratory Questionnaire (SGRQ) were assessed pretransplant, at hospital discharge, and at 3, 6, and 12 months posttransplant. Additionally, minimal clinically important differences (MCIDs) between patients with and without PH were evaluated. Survival rates were calculated using the Kaplan-Meier method and analyzed using the log-rank test. Results: The study included 39 patients undergoing LT for pulmonary fibrosis. Of these, 82% (32/39) had PH, with a median age of 52.6 years (SD: 10.2). In both the PH and non-PH groups, lung function, 6MWD, and SGRQ total scores showed progressive improvement from pre-LT to 1 year posttransplant. Patients without PH demonstrated MCID in 6MWT and SGRQ total scores from pre-LT through the 6- and 12-month follow-up. The overall 1-year survival rate was 84.6%, with an average survival of 10.51 months (95% CI: 9.29-11.73). The 5-year overall survival rate was 61.5%, with an average survival of 44.89 months (95% CI: 37.62-52.16). No statistically significant differences in survival were found based on sex (p=0.322 and 0.206), mean pulmonary artery pressure (mPAP) (p=0.232 and 0.486), age (p=0.375 and 0.959), or body mass index (BMI) (p=0.884 and 0.594) at 1 and 5 years. Conclusion: Survival at 1 and 5 years was lower in patients with PH. However, no significant differences in survival were observed based on sex, mPAP, age, or BMI. Statistically significant improvements in FVC, FEV1, 6MWT, and SGRQ total scores were observed both before and after LT, continuing through 1 year of follow-up. The 6MWT and SGRQ showed MCID both prior to surgery and during follow-up at 6 and 12 months, in both PH and non-PH patients.

Background: Patients with esophageal cancer (EC) who have undergone esophagectomy are at risk of developing hypoxemia and encountering postoperative complications. It is essential to ascertain whether the high-flow nasal cannula (HFNC) therapy offers superior clinical efficacy compared to conventional oxygen therapy (COT). Methods: Clinical data from 80 patients who experienced hypoxemia subsequent to radical esophagectomy were retrospectively collected at our institution spanning January 2020 to December 2022. The whole cohort was divided into two groups: the HFNC group and the COT group. Following oxygen administration, we evaluated the variations in arterial blood gas parameters and infection indices within each group, in addition to scrutinizing the occurrence of postoperative pulmonary complications. Results: The HFNC group was associated with a better oxygenation index (F _group=41.779, p < 0.001) and partial pressure of carbon dioxide (F _group=16.760, p < 0.001) compared with the COT group. Moreover, there were statistically significant differences in the reduction of C-reactive protein (F _group = 17.603, p < 0.001) and neutrophil count (F _group = 4.395, p=0.039) in the HFNC group compared with the COT group after 3 days of oxygen therapy. Notably, patients treated with HFNC exhibited a markedly reduced risk of developing postoperative complications, especially pneumonia (p=0.039). Conclusion: HFNC outperformed COT in enhancing oxygenation and reducing carbon dioxide levels and infection indices among patients with hypoxemia after radical resection of EC and also lowered the risk of postoperative pneumonia.

Objective: To evaluate the relationship between air pollution, meteorological factors, and eosinophils in the peripheral blood of allergic rhinitis (AR) patients. Methods: We conducted a retrospective study of medical records from the Ninth Medical Center of PLA General Hospital in Beijing. A review of medical records (1^st January 2014-31^th August 2022) of 1080 AR patients who underwent peripheral blood eosinophil count tests. Patients were stratified into elevated and normal eosinophil count groups. Daily meteorological data (mean temperature and relative humidity) and ambient pollutant levels (PM2.5, PM10, NO₂, SO₂, CO, and ozone [O₃]) were collected. The mean pollutant levels and meteorological factors on the day of eosinophil count measurement were calculated separately for each group. Linear regression was performed to analyze the association between eosinophil counts and both meteorological factors and pollutant levels among AR patients. Results: In 1080 AR patients, 11.85% had elevated eosinophil counts. Higher temperature (16.88 ± 9.09°C), humidity (57.75 ± 17.22%), and O₃ levels (116.54 ± 54.92 μg/m³) correlated significantly (p < 0.05) with elevated eosinophil counts. Linear regression confirmed positive associations between eosinophil count and temperature (β = 0.003), humidity (β = 0.001), and O₃ (β = 0.0004) (p < 0.05). Other pollutants showed no significant differences. Conclusion: Elevated eosinophil counts in AR patients correlated significantly with higher temperature, humidity, and O₃ levels. Linear regression confirmed positive associations between eosinophil count and these meteorological factors.

Pulmonary arterial hypertension (PAH) is a malignant cardiovascular disease with a complex etiology, in which several types of cells play important roles. Sex differences in disease susceptibility and survival have been observed in PAH patients, but few studies have analyzed the effect of changes in cell type and number on sex differences in PAH at the single-cell level. In this study, we performed a series of analyses on GSE169471 and GSE228644 datasets and found significant changes in the ratio of several types of cells in male PAH lung tissues. Surprisingly, we found that the ratio of macrophages in male PAH samples was 7 times higher than that in females. Consistently, the ratio of M1 macrophages was also significantly increased in male PAH samples. The different expression genes (DEGs) in macrophages were mainly involved in the ribosome pathway, which is closely related to cell proliferation. Inhibition of ribosomal protein L39 (RPL39), a core gene in the ribosome pathway, can inhibit macrophage proliferation and attenuate the sex differences in PAH. In conclusion, our study suggests that ribosome pathway-associated cell proliferation of macrophages might be associated with sex differences in PAH.

This study aimed to investigate the effect of Fuzheng Yiai Decoction (FZYA) on epidermal growth factor receptor-tyrosine kinase inhibitor (EGFR-TKI) drug resistance in lung adenosquamous carcinoma (ASC). The expression of thyroid transcription factor 1 (TTF1) and p63 in tumor cells was observed by immunofluorescence staining. Meanwhile, 25 nude mice successfully inoculated with the human lung ASC cell line NCI-H596 were randomly divided into five groups, namely, the model, gefitinib, low-, medium-, and high-dose FZYA with gefitinib groups. After four weeks of daily intragastric administration of the various treatments, the tumor weight and volume inhibition rates were calculated. The positive expression rate and protein expression of TTF1 and p63 in mouse tumor tissues were evaluated by immunohistochemistry and western blot assays. The results showed that the adenocarcinoma part and the squamous cell carcinoma part of the lung tissue were not either one or the other, and each had unique biological behavior patterns. In terms of the tumor volume and weight, gefitinib treatment along with FZYA reduced the acquired resistance of EGFR-TKIs in lung ASC, and its inhibitory effect was superior to EGFR-TKI (gefitinib) treatment alone. Moreover, it was discovered that FZYA inhibited the pedigree transformation among cancer subtypes due to EGFR-TKI treatment. In conclusion, the application of FZYA inhibited the pedigree transformation among lung cancer subtypes, thus increasing the tumor inhibitory effect and decreasing the EGFR-TKI drug resistance of tumor cells.

Background: Thymoma is a common malignancy with low incidence, and pleural metastases are common pattern of recurrence. It is necessary that the spatial location of pleural metastatic lesions be analyzed. This study aimed to analyze the spatial distribution patterns of pleural dissemination in patients with thymoma and evaluate the variables that influence the survival of pleural metastasis in this population. Methods: This retrospective study investigated hospital admissions of patients diagnosed with pleural metastasis from thymoma. The spatial distribution pattern and visualization of the pleural metastases were analyzed after establishing a coordinate system. We further analyzed the survival and influencing factors in patients with pleural metastases from thymoma. Results: The analysis included 56 patients with a cumulative count of 365 pleural metastases, with 351 metastases from Zones 1-5 finally included in the analysis. The spatial distribution of the 285 initially diagnosed pleural metastases was significantly concentrated in Zones 3 and 4 near the lateral half of the spine (56.5%), followed by Zone 5 (17.5%). Collectively, these two components accounted for 74.0% (211/285) of all initial metastatic lesions. The survival rates at 5 years for those who underwent surgery versus nonsurgical treatment were 68.3% and 37.1%, respectively (p=0.015). Univariate Cox regression analysis showed that surgical intervention reduced the risk of death by 61%. Conclusions: The distribution of pleural metastatic lesions exhibited a nonuniform pattern, primarily concentrated on the spinal aspect below the aortic arch of the costal pleura and the spinal aspect of the diaphragmatic pleura.

Background: Aspergillus has become the second most common causative agent of invasive fungal infections and is the leading cause of death from fungal infections. Methods: English-language publications ranging from 1975 to 2022 collected from the Web of Science Core Collection database were analyzed visually using VOSviewer, R package Bibliometrix, Scimago graphic, Gephi, Pajek, and Microsoft Excel 365. Literature search using the advanced search function in WoSCC with the search formula "TS=(Aspergillus)." The inclusion criteria were as follows: (1) article type = article; (2) time span = 1975-2022; (3) topic = "Medical Mycology"; (4) research field = "Respiratory System, Internal Medicine"; (5) language type = English. Results: As of February 21, 2023, studies of Aspergillus in respiratory medicine included 1065 articles with 41,308 cumulative citations. The United States ranked first in terms of the highest number of publications (n = 320). Udice French Research University was the institution with the highest number of publications (n = 40). The author with the highest number of publications was Denning (n = 32). Based on the CiteSpace analysis result, the keywords with the nature of a Burst Citation were "epidemiology," "chronic pulmonary aspergillosis," "galactomannan," "guideline," "sensitization," and "randomized trail." Besides the keywords, it was found that as of 2022, only the topics "allergic bronchopulmonary aspergillosis" and "invasive pulmonary aspergillosis" are still active with a large number of papers published, according to the results of the CiteSpace analysis of the cited literature. Conclusions: The bibliometric results indicated the current hot research hotspots of Aspergillus were as follows: (1) research directly related to Aspergillus (epidemiology, risk factors, early diagnosis methods, and methods of novel antifungal treatment, e.g., galactomannan); (2) studying coinfections of Aspergillus with other pathogens: For example, COVID-19 could focus on studying the immune status of patients with COVID-19-associated pulmonary aspergillosis (CAPA) to guide individualized immunotherapy and individualized management of patients with CAPA.