CHEST pulmonary最新文献

英文中文

Pathogenic mutations conferring alpha-1 antitrypsin deficiency are accurately identified by a novel multiplexed molecular assay 新型多重分子测定法可准确识别α-1 抗胰蛋白酶缺乏症的致病突变

CHEST pulmonary

Pub Date : 2024-07-01 DOI: 10.1016/j.chpulm.2024.100076

E. Decurtis, S. Kuss-Duerkop, Iara M.P. Machado, Zoe P. Stewart, Matt Jackson, E. Hasenohr, Jessica L. Crumby, S.D. Groshong, C. Coeshott, R. Harbeck, James Woodrow, R. Sandhaus, Yongbao Wang

引用次数: 0

Interventions to improve quality of life and knowledge in Hypersensitivity Pneumonitis, a survey of clinician practices and perspectives. 改善过敏性肺炎患者生活质量和知识的干预措施，临床医生实践和观点调查。

CHEST pulmonary

Pub Date : 2024-07-01 DOI: 10.1016/j.chpulm.2024.100083

Kerri I. Aronson, N.M. Holbrook, A. Edgar, Michael Anderson, Jamuna K. Krishnan, R. Kaner, A. Podolanczuk, F.J. Martinez, Johnathan N. Tobin, M.M. Safford

引用次数: 0

Bronchoscopy without sedation in healthy volunteers: a viable approach for research 无需镇静剂即可对健康志愿者进行支气管镜检查：一种可行的研究方法

CHEST pulmonary

Pub Date : 2024-07-01 DOI: 10.1016/j.chpulm.2024.100075

Dean L Kellogg, Diego Maselli, Kevin Proud, Eusondia Arnett, Larry S. Schlesinger, Jay I. Peters

引用次数: 0

Long-term Efficacy of Dupilumab in Moderate-to-Severe Asthma Phenotyped by Blood Eosinophils and Exhaled Nitric Oxide 杜匹单抗对以血液嗜酸性粒细胞和呼出一氧化氮为表型的中重度哮喘的长期疗效

CHEST pulmonary

Pub Date : 2024-07-01 DOI: 10.1016/j.chpulm.2024.100072

Michael E. Wechsler, Ian D. Pavord, A. Papi, Kenneth R. Chapman, A. Altincatal, N. Pandit-Abid, J. Jacob-Nara, Paul J Rowe, Y. Deniz, E. Laws, B. Akinlade, Nikhil Amin, H. Staudinger, D. Lederer, M. Hardin

引用次数: 0

Sex Differences in Lung Function in Asthma Across the Ages 不同年龄段哮喘患者肺功能的性别差异

CHEST pulmonary

Pub Date : 2024-06-01 DOI: 10.1016/j.chpulm.2024.100047

Celine Chedraoui MD , Battoul Fakhry MD , Joelle Sleiman MD , Bo Hu PhD , Amy Attaway MD , Peter Bazeley MD , Hyun Jo Kim MS , Peng Zhang MD , Joe G. Zein MD, PhD

引用次数: 0

The Diagnostic Yield of Cone Beam CT Combined With Radial-Endobronchial Ultrasound for the Diagnosis of Peripheral Pulmonary Nodules 锥形束计算机断层扫描结合径向支气管内超声诊断周围肺结节的诊断率：系统回顾与元分析

CHEST pulmonary

Pub Date : 2024-06-01 DOI: 10.1016/j.chpulm.2024.100037

Michael V. Brown , Arash Badiei , Matthew Arnold , Hubertus Jersmann , Thomas Sullivan , David Fielding , Phan Nguyen

Background

Identification of peripheral pulmonary nodules (PPNs) is becoming increasingly common with modern imaging and lung cancer screening programs. Navigational bronchoscopy has been developed to augment the diagnostic yield of sampling these nodules. Cone beam CT (CBCT) scan is one navigational tool which can be used alongside the historical criterion standard of fluoroscopy and radial endobronchial ultrasound (r-EBUS).

Research Question

What is the diagnostic yield and safety profile of combining CBCT scan with r-EBUS for the diagnosis of PPNs?

Study Design and Methods

Embase, PubMed, and Cochrane Central Register of Controlled Trials were searched in March 2023. Eligible studies used CBCT scan with r-EBUS as the primary navigation technique. The primary outcome, diagnostic yield, was analyzed using random effects meta-analysis. Additional subgroup analysis was based on the use of additional navigational technologies. Risk of bias was assessed using the Critical Appraisal Skills Programme tool for diagnostic studies. The Grading of Recommendations Assessment, Development, and Evaluation tool was used to assess the quality of outcomes.

Results

Fourteen studies (865 patients and 882 lesions) were included. The risk of bias was significant as assessed using the Critical Appraisal Skills Programme tool, which identified multiple confounders. The pooled diagnostic yield of combined CBCT scan and r-EBUS-guided biopsy for the diagnosis of PPNs was 80% (95% CI, 76%-84%). Subgroup analysis of diagnostic yield for CBCT scan and r-EBUS alone was 80% (95% CI, 76%-83%). The diagnostic yield of CBCT scan and r-EBUS combined with additional navigational technology (electromagnetic navigational bronchoscopy, virtual bronchoscopic navigation, and robotic-assisted bronchoscopy) was 80% (95% CI, 73%-87%). The quality of outcomes was assessed as low to very low using the Grading of Recommendations Assessment, Development, and Evaluation tool. There was a 2.01% pneumothorax rate and 1.08% bleeding rate. Although heterogeneously reported, the total radiation dose was between 19.59 and 85.9 Gy.cm², resulting in an approximate effective dose range of 3.1 to 13.8 mSv.

Interpretation

CBCT scan and r-EBUS for the diagnosis of PPNs has a high diagnostic yield and acceptable safety profile. Studies showed moderate heterogeneity with significant bias; hence, generalizability of the study is limited and further prospective trials are required.

Clinical Trial Registration

PROSPERO; No.: CRD42023410221; URL: https://www.crd.york.ac.uk/prospero/.

背景在现代影像学和肺癌筛查项目中，外周肺结节（PPN）的识别越来越普遍。为了提高这些结节取样的诊断率，人们开发了导航支气管镜。锥形束 CT（CBCT）扫描是一种导航工具，可与透视和径向支气管内超声（r-EBUS）这一历史标准同时使用。研究问题将 CBCT 扫描与 r-EBUS 结合用于诊断 PPNs 的诊断率和安全性如何？符合条件的研究将 CBCT 扫描和 r-EBUS 作为主要导航技术。采用随机效应荟萃分析法对主要结果（诊断率）进行了分析。另外还根据其他导航技术的使用情况进行了分组分析。偏倚风险采用诊断研究的 "批判性评估技能计划 "工具进行评估。结果纳入了14项研究（865名患者和882个病灶）。使用 "批判性评估技能计划 "工具对偏倚风险进行了评估，发现了多种混杂因素。CBCT扫描和r-EBUS引导活检对PPNs诊断的综合诊断率为80%（95% CI，76%-84%）。单独进行CBCT扫描和r-EBUS的亚组分析诊断率为80%（95% CI，76%-83%）。CBCT 扫描和 r-EBUS 结合其他导航技术（电磁导航支气管镜、虚拟支气管镜导航和机器人辅助支气管镜）的诊断率为 80%（95% CI，73%-87%）。采用建议分级评估、开发和评价工具，结果质量被评为低至很低。气胸发生率为 2.01%，出血发生率为 1.08%。尽管报道不一，但总辐射剂量在 19.59 至 85.9 Gy.cm2 之间，因此有效剂量范围约为 3.1 至 13.8 mSv。研究显示存在中度异质性和明显偏倚；因此，研究的推广性有限，需要进一步的前瞻性试验。临床试验注册PROSPERO；编号：CRD42023410221；网址：https://www.crd.york.ac.uk/prospero/.

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引用次数: 0

How Is Life After Severe COVID-19? 严重 COVID-19 后的生活如何？心肺功能结果和生活质量

CHEST pulmonary

Pub Date : 2024-06-01 DOI: 10.1016/j.chpulm.2024.100056

Maurizio Bernasconi MD , Camelia Voinea MD , Luca Sardella MD , Alessandro Felice Chiesa MD , Marco Previsdomini MD , Andreas Perren MD , Claudia Gamondi MD , Adam Ogna MD

Background

Data on long-term outcomes of COVID-19-related ARDS are scarce and rely largely on patient-reported outcomes. This study aimed to study cardiopulmonary function combined with psychosocial sequelae in a cohort of patients with severe COVID-19 requiring ICU management and intubation, with a follow-up of 12 months.

Research Question

What are the functional and psychosocial sequelae 1 year after severe COVID-19 requiring ICU management and intubation?

Study Design and Methods

We studied a longitudinal cohort of 39 mechanically ventilated patients with COVID-19 from the early phase of the pandemic. Pulmonary function test results, cardiopulmonary exercise testing findings, and subjective health perception data from 6 and 12 months after ICU admission were collected.

Results

Twelve months after COVID-19, 19.3% of participants showed at least moderate alteration in pulmonary function test findings, and 35.7% of participants showed a pathologically reduced effort capacity by cardiopulmonary exercise testing. A considerable impact on daily activities was reported, with only 41.7% of participants being able to resume work entirely and 71% reporting a relevant health impairment resulting from residual respiratory symptoms. The health perception scores did not correlate significantly with the measured cardiopulmonary performance or lung function.

Interpretation

A persistent objective limitation in physical activity was observed in this population of unvaccinated patients from the early phase of the pandemic, studied for 12 months after recovery from COVID-19-related ARDS. Patients also reported a profound impact on functional autonomy, daily activities, professional life, and health perception. Despite being attributed primarily to residual respiratory symptoms, the observed health impairment is probably multifactorial, with physical and psychological factors playing a role. The prolonged course of the symptoms and the underlying complexity should be considered in future programs for the care of patients who have recovered from COVID-19.

背景有关 COVID-19 相关 ARDS 长期预后的数据很少，且主要依赖于患者报告的预后。本研究旨在对需要在重症监护室接受治疗和插管的重症 COVID-19 患者队列中的心肺功能和社会心理后遗症进行研究，随访 12 个月。研究问题在需要在重症监护室接受治疗和插管的重症 COVID-19 患者 1 年后，其功能和社会心理后遗症如何？结果在 COVID-19 发生 12 个月后，19.3% 的参与者的肺功能测试结果出现至少中度改变，35.7% 的参与者在心肺运动测试中显示出病理性的用力能力下降。据报告，患者的日常活动受到很大影响，只有 41.7% 的患者能够完全恢复工作，71% 的患者因残留呼吸道症状而健康受损。健康感知评分与测量的心肺功能或肺功能没有明显的相关性。解释：在大流行早期未接种疫苗的患者群体中，观察到体力活动持续受到客观限制。患者还报告说，功能自主性、日常活动、职业生活和健康感知都受到了严重影响。尽管主要归因于残留的呼吸道症状，但观察到的健康损害可能是多因素的，生理和心理因素都起了作用。在未来的 COVID-19 康复计划中，应考虑到症状的长期持续性和潜在的复杂性。

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引用次数: 0

Cone-Beam CT Scan-Guided Peripheral Bronchoscopy 锥形束 CT 引导下的周边支气管镜检查：我们成功了吗？

CHEST pulmonary

Pub Date : 2024-06-01 DOI: 10.1016/j.chpulm.2024.100045

Matthew Aboudara MD, FCCP, DAABIP , James Katsis MD, DAABIP

引用次数: 0

Who Drives Pulmonology Evidence Synthesis? 谁在推动肺病学证据综述？1997-2023 年肺科相关 Cochrane 综述作者的全球和性别多样性分析

CHEST pulmonary

Pub Date : 2024-06-01 DOI: 10.1016/j.chpulm.2024.100041

Vivek Bhat , Abhishek Kumar , Sharanya Kaushik , Shreyas Bellur , Harsimran Singh Walia , Manmeet Singh Ahluwalia , Harneet Kaur Walia MD

引用次数: 0

Association of Short-Term Increases in Ambient Fine Particulate Matter With Hospitalization for Asthma or COPD During Wildfire Season and Other Time Periods 野火季节和其他时间段环境细颗粒物的短期增加与哮喘或慢性阻塞性肺病住院治疗的关系

CHEST pulmonary

Pub Date : 2024-06-01 DOI: 10.1016/j.chpulm.2024.100053

Benjamin D. Horne PhD, MStat, MPH , Mary M. Johnson MD, PhD , Denitza P. Blagev MD , Francois Haddad MD , Kirk U. Knowlton MD , Daniel Bride MS , Tami L. Bair BS , Elizabeth A. Joy MD, MPH , Kari C. Nadeau MD, PhD

Background

Short-term increases in air pollution are associated with poor asthma and COPD outcomes. Short-term elevations in fine particulate matter (PM_2.5) due to wildfire smoke are becoming more common.

Research Question

Are short-term increases in PM_2.5 and ozone in wildfire season and in winter inversion season associated with a composite of emergency or inpatient hospitalization for asthma and COPD?

Study Design and Methods

Case-crossover analyses evaluated 63,976 and 18,514 patients hospitalized for primary discharge diagnoses of asthma and COPD, respectively, between January 1999 and March 2022. Patients resided on Utah’s Wasatch Front where PM_2.5 and ozone were measured by Environmental Protection Agency-based monitors. ORs were calculated using Poisson regression adjusted for weather variables.

Results

Asthma risk increased on the same day that PM_2.5 increased during wildfire season (OR, 1.057 per +10 μg/m³; 95% CI, 1.019-1.097; P = .003) and winter inversions (OR, 1.023 per +10 μg/m³; 95% CI, 1.010-1.037; P = .0004). Risk decreased after 1 week, but during wildfire season risk rebounded at a 4-week lag (OR, 1.098 per +10 μg/m³; 95% CI, 1.033-1.167). Asthma risk for adults during wildfire season was highest in the first 3 days after PM_2.5 increases, but for children, the highest risk was delayed by 3 to 4 weeks. PM_2.5 exposure was weakly associated with COPD hospitalization. Ozone exposure was not associated with elevated risks.

Interpretation

In a large urban population, short-term increases in PM_2.5 during wildfire season were associated with asthma hospitalization, and the effect sizes were greater than for PM_2.5 during inversion season.

背景空气污染的短期增加与哮喘和慢性阻塞性肺病的不良后果有关。研究问题在野火季节和冬季反常季节，PM2.5 和臭氧的短期增加是否与哮喘和慢性阻塞性肺病的急诊或住院综合情况有关？研究设计和方法病例交叉分析评估了 1999 年 1 月至 2022 年 3 月期间因主要出院诊断为哮喘和慢性阻塞性肺病而住院的 63,976 名和 18,514 名患者。患者居住在犹他州的瓦萨奇前线，那里的 PM2.5 和臭氧由环境保护局的监测仪测量。结果在野火季节（OR，1.057 per +10 μg/m3；95% CI，1.019-1.097；P = .003）和冬季逆转（OR，1.023 per +10 μg/m3；95% CI，1.010-1.037；P = .0004）期间，PM2.5升高的同一天，哮喘风险也升高（OR，1.057 per +10 μg/m3；95% CI，1.019-1.097；P = .003）。风险在 1 周后下降，但在野火季节，风险在滞后 4 周后反弹（OR，1.098 per +10 μg/m3；95% CI，1.033-1.167）。在野火季节，成人在PM2.5升高后的头3天内患哮喘的风险最高，但对儿童来说，最高风险延迟了3至4周。PM2.5暴露与慢性阻塞性肺病的住院治疗关系不大。在一个大型城市人群中，野火季节PM2.5的短期增加与哮喘住院治疗有关，其效应大小大于反转季节PM2.5的效应大小。

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