CHEST pulmonary最新文献

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Concordance of a Web-based Lung Cancer Risk Self-Assessment Tool With Nursing Risk Assessment 基于网络的肺癌风险自我评估工具与护理风险评估的一致性

CHEST pulmonary

Pub Date : 2025-07-22 DOI: 10.1016/j.chpulm.2025.100197

Ifeoma Iloghalu MD , Kirk Graff PhD , Matthew Warkentin PhD , Huiming Yang MD , Alain Tremblay MDCM

Background

The Alberta Lung Cancer Screening Program implemented a web-based risk self-assessment tool using the Prostate, Lung, Colorectal, Ovarian Model 2012 (PLCOm2012) model. To determine the accuracy of individual self-risk assessments, this study compared user online entries with program nurse assessments.

Research Question

Is the web-based lung cancer risk self-assessment tool based on the PLCOm2012 model accurate in predicting lung cancer risk among Albertans aged 50 to 74 years when incorporated into an existing lung cancer screening program?

Study Design and Methods

This retrospective study used administrative data from the Alberta Lung Cancer Screening Program, which was designed to enroll 3,800 participants from September 2022 to September 2024. All self-referrals from the web tool with a risk score ≥ 1.5% were included up to July 2024. Concordance was assessed between web entries and matched nurse assessments and the impact of discordant lung cancer risks estimated.

Result

A total of 384 matched entries were analyzed. The mean age of the participants was 64 ± 6 years, and most were currently smoking (61%). The study revealed high (> 95%) concordance between web entries and nurse assessments; concordance for education, smoking intensity, and smoking duration were slightly lower (90%-92%). Although a discrepancy in at least 1 value was common (32%), this resulted in an eligible participant being re-categorized as ineligible only in 3.7% of cases. Overall, 65% of participants had concordant PLCOm2012 risk scores (within 0.1%). The differences in PLCOm2012 risk between web and nurse entries ranged from – 3% to 2.5%.

Interpretation

This study described the feasibility of implementing a web-based lung cancer risk self-assessment tool based on the PLCOm2012 model and found a high concordance of discrete data points between the web entries and nurse entries. However, at least 1 value was discordant in one-third of the participants, and this occasionally affected risk scores. Confirmation of lung cancer risk by a health care provider remains important prior to screening.

艾伯塔省肺癌筛查项目使用2012年前列腺、肺、结肠、卵巢模型（PLCOm2012）模型实施了基于网络的风险自我评估工具。为了确定个人自我风险评估的准确性，本研究比较了用户在线输入与程序护士评估。基于PLCOm2012模型的基于网络的肺癌风险自我评估工具与现有的肺癌筛查项目相结合，在预测50 - 74岁阿尔伯塔人肺癌风险方面是否准确？研究设计和方法这项回顾性研究使用了艾伯塔省肺癌筛查项目的行政数据，该项目旨在从2022年9月到2024年9月招募3800名参与者。截至2024年7月，所有来自网络工具的风险评分≥1.5%的自我转诊均被纳入。评估了网络条目与匹配护士评估之间的一致性，并评估了不一致肺癌风险的影响。结果共分析匹配条目384条。参与者的平均年龄为64±6岁，大多数正在吸烟（61%）。研究显示，网络条目与护士评估之间的一致性很高（> 95%）；教育程度、吸烟强度和吸烟时间的一致性略低（90%-92%）。尽管至少1个值的差异是常见的（32%），但这导致符合条件的参与者仅在3.7%的病例中被重新归类为不符合条件。总体而言，65%的参与者具有一致的PLCOm2012风险评分（在0.1%以内）。网络和护士在PLCOm2012风险方面的差异从- 3%到2.5%不等。本研究描述了基于PLCOm2012模型实施基于网络的肺癌风险自我评估工具的可行性，并发现网络条目和护士条目之间的离散数据点高度一致。然而，在三分之一的参与者中，至少有一个值是不一致的，这偶尔会影响风险评分。在筛查之前，由卫生保健提供者确认肺癌风险仍然很重要。

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引用次数: 0

A 40-Year-Old Woman With an Incidentally Found Semisolid Pulmonary Nodule 一位40岁女性偶然发现半实性肺结节

CHEST pulmonary

Pub Date : 2025-07-21 DOI: 10.1016/j.chpulm.2025.100195

Joseph V. Moran DO , Amar Mainra MD , Tian Sun MD , Eric R. Montgomery MD , Lauren A. Rome MD , Michael J. Walker MD

引用次数: 0

Tracheobronchial Wall Thickening in a Patient With Inflammatory Bowel Disease 炎症性肠病患者的气管支气管壁增厚

CHEST pulmonary

Pub Date : 2025-06-09 DOI: 10.1016/j.chpulm.2025.100186

Jonathan Tse MD , Kevyn Ramos Laguna MD , Shuman Liu MD, PhD , Evan Yung MD , Chongiin Kim MD , Patrick Chan MD

Case Presentation

A 43-year-old woman, born in Mexico, with a history of idiopathic thrombocytopenic purpura status after splenectomy and inflammatory bowel disease (IBD) favoring Crohn disease previously complicated by cytomegalovirus (CMV) colitis, presented with worsening abdominal and rectal pain. Over the past 6 months, she had 3 hospitalizations for biopsy-confirmed IBD flares, during which her immunosuppressive regimen was sequentially intensified from azathioprine and infliximab to high-dose corticosteroids and ultimately to upadacitinib for refractory disease.

病例介绍：一名43岁女性，出生在墨西哥，脾切除术后有特发性血小板减少性紫癜病史，炎症性肠病（IBD）倾向于克罗恩病，以前合并巨细胞病毒（CMV）结肠炎，表现为腹部和直肠疼痛加重。在过去的6个月里，她因活检证实的IBD发作而住院3次，在此期间，她的免疫抑制方案从硫唑嘌呤和英夫利昔单抗依次加强到大剂量皮质类固醇，并最终升级到阿达西替尼治疗顽固性疾病。

引用次数: 0

Feasibility of Assessing the Abnormal Pediatric Airway Using Rotational Optical Coherence Tomography 使用旋转光学相干断层扫描评估儿童气道异常的可行性

CHEST pulmonary

Pub Date : 2025-06-01 DOI: 10.1016/j.chpulm.2024.100120

Sune Rubak MD, PhD , Anne Katrine Bak Poulsen MD , Signe Thim MD , Nagarajan Muthialu MD , Thomas Kjærgaard MD, PhD , Emil Nielsen Holck MD, PhD

Background

Methods currently used to assess and diagnose abnormalities of pediatric airways have several limitations: CT scans involve a risk of ionizing radiation and diagnostic dynamic bronchoscopies have high interobserver variability. Advanced diagnostic methods for evaluating the dynamic airway are needed to enable newer interventions (eg, airway stenting) in select children. The study objective was to investigate the feasibility of optical coherence tomography (OCT) as a measuring method that facilitates accurate, quantifiable, and real-time cross-sectional imaging of the airway.

Research Question

Is bronchoscopy-guided quantitative OCT of the lower pediatric airway a feasible method and does it increase diagnostic possibilities?

Study Design and Methods

We evaluated a series of 10 children with severe persistent respiratory symptoms with a clinical indication for diagnostic dynamic bronchoscopy (DDB). Feasibility of OCT was defined as the ability to visualize and quantify airway stenoses and dynamic airway collapse in the pediatric airway without procedural complications. Furthermore, the study included a porcine model to calculate the correction constant for the OCT measurements in air in comparison with contrast fluid.

Results

Nine children aged 0 to 14 years were included. In total, 34 airway segments were OCT scanned. Results showed that OCT is a feasible method for visualizing and quantifying stenoses of the lower pediatric airway by measuring the mean and minimum lumen areas. The correction constant of OCT in air was 1.3 (interquartile range, 1.29-1.31) in comparison with contrast. Visual assessment of the minimum lumen area stenosis by dynamic bronchoscopy significantly varies in comparison with OCT assessment (18.416%; 95% CI, 8.93-27.91; P = .0018).

Interpretation

OCT demonstrated feasibility of providing quantitative assessments of clinical manifestations including cross-sectional imaging in the pediatric airway. The correction constant for optimal quantification was calculated and provided the possibility for precise interpretation of OCT measurements. Further studies are needed to investigate safety, accuracy, and efficacy of OCT in the lower pediatric airway.

目前用于评估和诊断儿童气道异常的方法有几个局限性：CT扫描涉及电离辐射的风险，诊断动态支气管镜在观察者之间具有很高的可变性。需要先进的诊断方法来评估动态气道，以便在选定的儿童中进行新的干预（例如气道支架置入术）。本研究的目的是探讨光学相干断层扫描（OCT）作为一种测量方法的可行性，这种方法可以促进气道准确、可量化和实时的横断面成像。支气管镜引导下小儿气道定量OCT是一种可行的方法吗？它是否增加了诊断的可能性？研究设计和方法我们评估了10例具有诊断性动态支气管镜（DDB）临床指征的严重持续性呼吸道症状的儿童。OCT的可行性被定义为能够可视化和量化儿童气道狭窄和动态气道塌陷而无手术并发症。此外，该研究还包括一个猪模型来计算空气中OCT测量的校正常数，并与对比液进行比较。结果纳入9例0 ~ 14岁儿童。共对34个气道段进行OCT扫描。结果表明，通过测量平均和最小管腔面积，OCT是一种可行的方法来可视化和量化儿童下气道狭窄。与对照相比，空气OCT的校正常数为1.3（四分位间距为1.29 ~ 1.31）。动态支气管镜对最小管腔面积狭窄的视觉评估与OCT评估相比差异显著(18.416%；95% ci, 8.93-27.91；P = .0018)。oct证明了对儿童气道的临床表现进行定量评估的可行性，包括横断面成像。计算了最佳定量的校正常数，并提供了精确解释OCT测量结果的可能性。需要进一步研究OCT在小儿下气道检查中的安全性、准确性和有效性。

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引用次数: 0

The Overlooked Epidemic 被忽视的流行病

CHEST pulmonary

Pub Date : 2025-06-01 DOI: 10.1016/j.chpulm.2025.100166

Sameer Khanijo MD

引用次数: 0

Bronchoscopic Lung Volume Reduction 支气管镜下肺减容

CHEST pulmonary

Pub Date : 2025-06-01 DOI: 10.1016/j.chpulm.2024.100117

Domingo J. Franco-Palacios MD , Rebecca Priebe NP , Jane Simanovski PhD, NP , Lisa L. Allenspach MD , Lisa Stagner DO , Lisa K. Waynick PA , Yichu Wang BS , Mei Lu BS , Shraddha Desai MD , Daniel Kapadia MD , Avi Cohen MD

Background

Many bronchoscopic lung volume reduction (BLVR) studies have excluded patients meeting the listing criteria for lung transplantation (LT).

Research Question

What are the outcomes of BLVR in a sicker group of patients with emphysema compared with patients not meeting the criteria for LT listing?

Study Design and Methods

This was a real-world retrospective study (June 2018 to December 2022) assessing the effect of BLVR in patients with severe emphysema considered for LT. FEV₁, FVC, diffusing capacity for carbon monoxide, symptoms, and 6-minute walk distance (6-MWD) were measured at baseline and 45 days and 6 months after BLVR.

Results

Of 76 fully evaluated patients (median age, 62 years; 60% female), 42 underwent BLVR (30 sicker patients met the criteria for LT listing). At baseline, patients that met the criteria for listing had shorter baseline 6-MWD (234.72 ± 68.86, P < .001), higher BODE Index score (6.79 ± 1.11, P = .001), and lower FEV₁ (617.5 ± 139.2 mL, P = .005). All patients treated with BLVR experienced a decrease in BODE Index and Borg dyspnea by scores −0.5 to −2 points, respectively. Diffusing capacity for carbon monoxide % predicted increased by 4.5%, FEV₁ increased by 115 mL, FVC increased by 450 mL, and 6-MWD increased by 20 meters. In the sicker group, FEV₁ at 45 days after BLVR increased by 180.8 ± 231 mL (FEV₁ % predicted 5.84 ± 5.66) compared with baseline; a persistent effect was seen at 6 months in 62% of patients with available data (18 of 30). Median hospital length of stay was 3.27 ± 3.07 days. Endobronchial valves were removed in 6 patients (3 in each group) due to complications. The pneumothorax rate was 24% (10 of 42; 5 in each group).

Interpretation

Improvement in lung function after BLVR was observed regardless of disease severity. BLVR might represent an alternative to LT for some patients.

许多支气管镜下肺减容（BLVR）研究排除了符合肺移植（LT）清单标准的患者。研究问题：与不符合LT清单标准的患者相比，病情较重的肺气肿患者进行BLVR的结果是什么？研究设计和方法这是一项真实世界的回顾性研究（2018年6月至2022年12月），评估BLVR对lt考虑的严重肺气肿患者的影响。在基线和BLVR后45天和6个月测量FEV1、FVC、一氧化碳弥散能力、症状和6分钟步行距离（6- mwd）。结果76例充分评估的患者(中位年龄62岁；60%为女性)，42例接受了BLVR（30例病情较重的患者符合LT列表标准）。基线时，符合清单标准的患者基线6-MWD较短(234.72±68.86,P <；.001)，较高的BODE指数评分（6.79±1.11,P = .001），较低的FEV1评分（617.5±139.2 mL, P = .005）。所有接受BLVR治疗的患者BODE指数和Borg呼吸困难分别下降了- 0.5到- 2分。预测一氧化碳扩散量增加4.5%，FEV1增加115 mL， FVC增加450 mL， 6-MWD增加20米。在病情较重的组，与基线相比，BLVR后45天FEV1增加了180.8±231 mL (FEV1 %预测为5.84±5.66)；在有可用数据的患者中，62%的患者（30人中有18人）在6个月后出现持续的效果。平均住院时间为3.27±3.07天。6例患者（每组3例）因并发症切除支气管内瓣膜。气胸发生率为24% (10 / 42；每组5人)。解释：无论疾病严重程度如何，BLVR术后肺功能均有改善。对于一些患者来说，BLVR可能是替代肝移植的一种方法。

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引用次数: 0

Cumulative Personal Radiation Exposure for a Single Pulmonary Proceduralist Over 1 Year 单个肺部手术医师1年以上个人累积辐射暴露

CHEST pulmonary

Pub Date : 2025-06-01 DOI: 10.1016/j.chpulm.2025.100161

Kim Styrvoky MD , Xinhui Duan PhD

引用次数: 0

Assessment of Risk Factors for Death in Older Adult Patients With TB in Japan 日本老年结核病患者死亡危险因素评估

CHEST pulmonary

Pub Date : 2025-06-01 DOI: 10.1016/j.chpulm.2025.100162

Seigo Miyoshi MD, PhD, Mayuko Semba MD, Miyuki Tanabe MD, Chika Sato MD, Akira Watanabe MD, PhD, Ryoji Ito MD, PhD, Mari Kubota, Masahiro Abe MD, PhD

Background

Previous studies have identified several risk factors for death because of TB, including advanced age, HIV coinfection, multidrug-resistant TB, malnutrition, low activities of daily living, and comorbidities. In Japan, the incidence of TB and TB-related deaths is consistently higher among older individuals. However, few studies have evaluated the risk factors for death in older adult patients with TB.

Research Question

What are the risk factors for death among older adults with TB?

Study Design and Methods

This prospective cohort study included data on consecutive older adult patients (aged ≥ 65 years) who were admitted for treatment of TB between October 2016 and April 2022. We collected data on patient characteristics, chest radiography findings, and laboratory data and assessed whether these parameters were associated with patient death. We also examined the risk factors associated with TB-related and TB-unrelated deaths as a subanalysis.

Results

Multivariate Cox proportional hazards analysis showed that performance status (hazard ratio [HR], 1.434; 95% CI, 1.051-1.956; P = .023), corticosteroid use (HR, 2.679; 95% CI, 1.374-5.221; P = .004), and serum albumin levels (HR, 0.434; 95% CI, 0.235-0.804; P = .008) were significantly correlated with all-cause mortality. Subanalyses demonstrated that performance status was significantly correlated with TB-related death (HR, 2.048; 95% CI, 1.459-2.874; P < 0.001), whereas advanced age (HR, 1.073; 95% CI, 1.008-1.142; P = .027), corticosteroid use (HR, 4.131; 95% CI, 1.783-9.575; P < .001), and serum albumin levels (HR, 0.435; 95% CI, 0.225-0.842; P = .014) were significantly correlated with TB-unrelated deaths.

Interpretation

The evaluation of daily activity, physical ability, immune status, and nutritional status is considered an important factor directly related to prognosis in the treatment of TB in older adults. Large-scale prospective studies should be conducted in the future.

以往的研究已经确定了结核病导致死亡的几个危险因素，包括高龄、艾滋病合并感染、耐多药结核病、营养不良、日常生活活动不足和合并症。在日本，老年人中结核病和结核病相关死亡的发病率一直较高。然而，很少有研究评估老年结核病患者死亡的危险因素。研究问题：老年结核病患者死亡的危险因素是什么？研究设计和方法本前瞻性队列研究纳入了2016年10月至2022年4月期间入院治疗结核病的连续老年成人患者（年龄≥65岁）的数据。我们收集了患者特征、胸片检查结果和实验室数据，并评估了这些参数是否与患者死亡相关。作为亚分析，我们还检查了与结核病相关和非结核病死亡相关的危险因素。结果多因素Cox比例风险分析显示，工作状态(风险比[HR]， 1.434；95% ci, 1.051-1.956；P = 0.023)，皮质类固醇使用(HR, 2.679；95% ci, 1.374-5.221；P = 0.004)，血清白蛋白水平(HR, 0.434；95% ci, 0.235-0.804；P = 0.008)与全因死亡率显著相关。亚分析显示，运动状态与结核病相关死亡显著相关(HR, 2.048；95% ci, 1.459-2.874；P & lt;0.001)，而高龄患者(HR, 1.073；95% ci, 1.008-1.142；P = 0.027)，皮质类固醇使用(HR, 4.131；95% ci, 1.783-9.575；P & lt;.001)，血清白蛋白水平(HR, 0.435；95% ci, 0.225-0.842；P = 0.014)与结核病无关的死亡显著相关。在老年人结核病治疗中，日常活动、身体能力、免疫状态和营养状况的评估被认为是直接关系到预后的重要因素。未来应进行大规模的前瞻性研究。

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引用次数: 0

Canary in the Coalmine? 煤矿里的金丝雀？

CHEST pulmonary

Pub Date : 2025-06-01 DOI: 10.1016/j.chpulm.2025.100155

William J. Healy MD , Younghoon Kwon MD

引用次数: 0

Dyspnea and Right-Sided Heart Failure in a Patient With a History of Pneumonectomy 有全肺切除术史患者的呼吸困难和右侧心力衰竭

CHEST pulmonary

Pub Date : 2025-06-01 DOI: 10.1016/j.chpulm.2025.100149

Shelsey W. Johnson MD , Melanie C. Kwan MD , Sarah A.M. Cuddy MD , Aaron B. Waxman MD, PhD , Lida P. Hariri MD, PhD , William M. Oldham MD, PhD

Case Presentation

A 67-year-old man who never smoked was evaluated in the emergency department for 3 months of progressive dyspnea, lower extremity edema, and 20lb weight gain. Eighteen months before this, he had presented with hemoptysis and was ultimately found to have squamous cell lung cancer invading the left pulmonary artery without lymph node involvement, stage pT4N0M0, for which he underwent left pneumonectomy. His medical history was additionally notable for paroxysmal atrial fibrillation and factor V Leiden mutation (anticoagulated on apixaban). Social history was notable for work as a grocer in a supermarket; the patient denied history of asbestos exposure and had no known TB exposure or prior infection. The patient was admitted to general cardiology where he was afebrile, in atrial fibrillation with rapid ventricular response to 127 beats/min with associated hypotension (80/55 mm Hg); his oxygen saturation was 95% on room air. Physical examination was most notable for jugular venous distension and bilateral edema to the thigh. Electrocardiogram did not demonstrate ischemia. Laboratory evaluation demonstrated a creatinine level of 1.10 mg/dL, elevated from his recent baseline level of 0.52 mg/dL. Lactic acid was normal. His cardiac biomarkers were abnormal with an elevated N-terminal pro-B-type natriuretic peptide value (3,682 pg/mL) and high sensitivity troponin T (43 ng/L). Both WBC count and hemoglobin values were normal as were his thyroid hormone levels. IV diuretic and antiarrhythmic therapies were initiated with furosemide and amiodarone, respectively.

病例介绍：一名从不吸烟的67岁男性，因3个月进行性呼吸困难、下肢水肿和体重增加20lb而在急诊科接受评估。在此之前18个月，他曾出现咯血，最终被发现患有侵犯左肺动脉的鳞状细胞肺癌，未累及淋巴结，pT4N0M0期，为此他接受了左侧全肺切除术。他的病史还包括阵发性心房颤动和因子V Leiden突变（阿哌沙班抗凝）。在社会历史上，他曾在超市当过杂货商；患者否认有石棉接触史，也没有已知的结核接触史或既往感染史。患者在普通心脏病科住院，他发热，心房颤动，心室反应快速至127次/分，伴有低血压（80/55 mm Hg）；他的血氧饱和度在室内空气中为95%。体格检查以颈静脉扩张和双侧大腿水肿最为显著。心电图未显示缺血。实验室评估显示肌酐水平为1.10 mg/dL，高于最近的基线水平0.52 mg/dL。乳酸正常。他的心脏生物标志物异常，n端前b型利钠肽值升高（3,682 pg/mL）和高敏感性肌钙蛋白T （43 ng/L）。白细胞计数和血红蛋白值正常，甲状腺激素水平正常。静脉利尿剂和抗心律失常治疗分别开始使用速尿和胺碘酮。

{"title":"Dyspnea and Right-Sided Heart Failure in a Patient With a History of Pneumonectomy","authors":"Shelsey W. Johnson MD , Melanie C. Kwan MD , Sarah A.M. Cuddy MD , Aaron B. Waxman MD, PhD , Lida P. Hariri MD, PhD , William M. Oldham MD, PhD","doi":"10.1016/j.chpulm.2025.100149","DOIUrl":"10.1016/j.chpulm.2025.100149","url":null,"abstract":"<div><h3>Case Presentation</h3><div>A 67-year-old man who never smoked was evaluated in the emergency department for 3 months of progressive dyspnea, lower extremity edema, and 20lb weight gain. Eighteen months before this, he had presented with hemoptysis and was ultimately found to have squamous cell lung cancer invading the left pulmonary artery without lymph node involvement, stage pT4N0M0, for which he underwent left pneumonectomy. His medical history was additionally notable for paroxysmal atrial fibrillation and factor V Leiden mutation (anticoagulated on apixaban). Social history was notable for work as a grocer in a supermarket; the patient denied history of asbestos exposure and had no known TB exposure or prior infection. The patient was admitted to general cardiology where he was afebrile, in atrial fibrillation with rapid ventricular response to 127 beats/min with associated hypotension (80/55 mm Hg); his oxygen saturation was 95% on room air. Physical examination was most notable for jugular venous distension and bilateral edema to the thigh. Electrocardiogram did not demonstrate ischemia. Laboratory evaluation demonstrated a creatinine level of 1.10 mg/dL, elevated from his recent baseline level of 0.52 mg/dL. Lactic acid was normal. His cardiac biomarkers were abnormal with an elevated N-terminal pro-B-type natriuretic peptide value (3,682 pg/mL) and high sensitivity troponin T (43 ng/L). Both WBC count and hemoglobin values were normal as were his thyroid hormone levels. IV diuretic and antiarrhythmic therapies were initiated with furosemide and amiodarone, respectively.</div></div>","PeriodicalId":94286,"journal":{"name":"CHEST pulmonary","volume":"3 2","pages":"Article 100149"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144279504","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

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