CHEST pulmonary最新文献

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Li X, Tang Y, Chen C, Wang P, Shen Y. CHEST Pulmonary. 2023;1(2):100011. 李霞，唐勇，陈晨，王鹏，沈勇。胸肺杂志。2023;1(2):100011。

CHEST pulmonary

Pub Date : 2025-06-01 DOI: 10.1016/j.chpulm.2025.100172

引用次数: 0

A 53-Year-Old Female With Dyspnea and Hemoptysis 53岁女性，呼吸困难，咯血

CHEST pulmonary

Pub Date : 2025-06-01 DOI: 10.1016/j.chpulm.2025.100168

Arsh Chowdhary MD , Hemali Rochlani MD , Daniel G. Fein MD , Berrin Ustun MD , Ali Sadoughi MD , Marc Vimolratana MD , Gerardo Eman MD

引用次数: 0

Evaluating the Effectiveness of ChatGPT and Google Gemini in Providing Lung Cancer Screening Recommendations for Vulnerable Communities 评估ChatGPT和谷歌Gemini为弱势群体提供肺癌筛查建议的有效性

CHEST pulmonary

Pub Date : 2025-06-01 DOI: 10.1016/j.chpulm.2025.100167

Caretia J. Washington BS , Joel Divaker MPH , Michael K. Gould MD, MS , Gerard A. Silvestri MD, MS , Tracy E. Crane PhD, RDN , Bruno Hochhegger MD, PhD , Shama D. Karanth PhD , Dejana Braithwaite PhD, MSc

引用次数: 0

A Novel Same Day Discharge Program After Pulmonary Wedge Resection 一种新的肺楔形切除术后当日出院方案

CHEST pulmonary

Pub Date : 2025-06-01 DOI: 10.1016/j.chpulm.2025.100148

David Sahai BSc , Richard C. Chaulk MD , Richard Malthaner MD , Mehdi Qiabi MD , Dalilah Fortin MD , Richard Inculet MD , Rahul Nayak MD

Background

The current practice for patients undergoing minimally invasive pulmonary wedge resection (MIS-PWR) is to remain in hospital with a chest tube (CT) in situ for at least 24 hours. There exists emerging evidence that patients typically do not encounter significant complications during this period. However, this has not been studied prospectively.

Research Question

Is it feasible and safe for patients to undergo early CT removal and same day discharge (SDD) after elective MIS-PWR?

Study Design and Methods

We conducted a nonrandomized prospective clinical trial in 2 phases to assess early CT removal and SDD after elective MIS-PWR. Phase 1 focused on the safety of early CT removal with patients undergoing removal at 4 hours postoperatively. Phase 2 evaluated both early CT removal and SDD. The primary outcomes were rate of successful early CT removal and the rate of successful SDD.

Results

In phase 1, a total of 51 patients were enrolled (intervention group: n = 31, control group: n = 20). In the intervention group, 22 (71%) had early removal of CT. Patients who underwent early CT removal in this phase had a significantly shorter median length of hospital stay in days (2.0 in control group vs 1.0 in intervention group; P = .0185) without significant differences in postoperative day 1 and 30 complications or return to the hospital. In phase 2, a total of 43 patients were enrolled (intervention group: n = 23, control group: n = 20). In the intervention group, 17 (74%) had early CT removal and 14 (61%) successfully underwent SDD. There were no significant differences noted in postoperative day 1 and 30 complications or early return to hospital. No patients required pleural reintervention after early CT removal.

Interpretation

Our results indicate that select patients undergoing MIS-PWR can safely undergo early CT removal and can be safely discharged on the day of surgery.

Clinical Trial Registration

ClinicalTrials.gov; No.: NCT05067738; URL: www.clinicaltrials.gov

背景：目前接受微创肺楔形切除术（MIS-PWR）的患者的做法是在原位胸管（CT）下住院至少24小时。有新的证据表明，在此期间，患者通常不会遇到严重的并发症。然而，这还没有前瞻性的研究。选择性MIS-PWR术后患者早期CT切除和当日出院（SDD）是否可行和安全？研究设计和方法我们进行了一项非随机前瞻性临床试验，分为两个阶段来评估选择性MIS-PWR术后早期CT切除和SDD。第一阶段的重点是患者术后4小时进行早期CT切除的安全性。二期评估早期CT切除和SDD。主要结果是早期CT切除成功率和SDD成功率。结果第一阶段共纳入51例患者，其中干预组31例，对照组20例。干预组22例（71%）早期行CT切除。在该阶段接受早期CT切除的患者的中位住院天数（对照组2.0天vs干预组1.0天）显著缩短；P = 0.0185)，术后第1天和第30天的并发症或复诊率无显著差异。第二阶段共纳入43例患者（干预组23例，对照组20例）。干预组17例（74%）早期CT切除，14例（61%）成功行SDD。术后第1天、第30天并发症及早期返院率无显著差异。早期CT切除后无患者需要胸膜再干预。我们的研究结果表明，接受MIS-PWR的患者可以安全地进行早期CT切除，并可以在手术当天安全出院。临床试验注册网站clinicaltrials .gov；否。: NCT05067738;URL: www.clinicaltrials.gov

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引用次数: 0

60-Year-Old Man With Recurrent Hemoptysis, Pulmonary Nodules, and Mediastinal Lymphadenopathy 60岁男性，反复咯血，肺结节，纵隔淋巴结病

CHEST pulmonary

Pub Date : 2025-06-01 DOI: 10.1016/j.chpulm.2025.100141

Srikant Kashinath Malegaonkar MD, DM

Case Presentation

A 60-year-old man with type 2 diabetes mellitus sought treatment at our clinic with episodes of recurrent streaky hemoptysis (about 2 episodes per year for the last 3 years). These episodes resolved with oral antibiotics and empiric oral tranexamic acid given over a short duration of 2 to 3 days. The patient did not smoke and had no other notable medical history, except that one of his coworkers was receiving treatment for pulmonary TB.

病例介绍：一名60岁男性2型糖尿病患者因反复发作的条状咯血（近3年每年约2次）来我院就诊。这些发作通过口服抗生素和经用性口服氨甲环酸在2至3天的短时间内解决。患者不吸烟，除了他的一位同事正在接受肺结核治疗外，没有其他明显的病史。

引用次数: 0

Practice Patterns and Outcomes of Initial Anticoagulation Among Hospitalized Patients With Low- and Low-Intermediate-Risk Pulmonary Embolism 低危和中低危肺栓塞住院患者初始抗凝治疗的实践模式和结果

CHEST pulmonary

Pub Date : 2025-06-01 DOI: 10.1016/j.chpulm.2025.100151

Grace M. Ferri MD , Om A. Kothari MD , Sarika D. Gurnani MD , Anica C. Law MD, MS , Nicholas A. Bosch MD, MSc , Burton H. Shen MD

Background

Guidelines recommend treatment with direct oral anticoagulants (DOACs) over unfractionated heparin (UFH) or low-molecular-weight heparin (LMWH) among ambulatory patients, including patients in the emergency department, with pulmonary embolism (PE) at low risk for mortality; however, recent evidence suggests that patients with low-risk PE are usually admitted to the hospital from the emergency department rather than discharged on DOACs.

Research Question

Among hospitalized patients with low- and low-intermediate-risk PE, how do patterns in anticoagulation and outcomes vary between institutions?

Study Design and Methods

This multicenter retrospective cohort study used the PINC AI enhanced administrative database (2016-2022). Eligible adult patients were admitted to a general ward, had an International Classification of Diseases, 10th Revision, diagnosis code for PE present on admission, were initiated on anticoagulation (UFH, LMWH/fondaparinux, or a DOAC) on but not before day 1, and had troponin and brain natriuretic peptide below the upper limit of normal. Initial anticoagulation practices were summarized overall and by hospital. Regression modeling was used to determine associations between initial anticoagulation and median length of stay.

Results

Among 2,369 eligible patients, the percentage of patients initiated on UFH was 54%, initiated on LMWH/fondaparinux was 41%, and initiated on DOACs was 4%. Anticoagulation with DOACs decreased median length of stay by 0.62 days (95% CI, −1.04 to −0.20) compared with those who initially received UFH.

Interpretation

Our results showed that hospitalized patients with low- and low-intermediate-risk PE generally do not receive initial DOACs. However, use of initial DOAC therapy was associated with shorter hospital length of stay compared with other initial anticoagulation strategies.

背景：指南推荐在死亡率低的肺栓塞（PE）患者中，包括急诊科患者，直接口服抗凝剂（DOACs）而不是未分级肝素（UFH）或低分子量肝素（LMWH）治疗；然而，最近的证据表明，低风险PE患者通常从急诊科入院，而不是在DOACs出院。在低风险和中低风险PE住院患者中，不同机构的抗凝模式和结果有何不同？研究设计与方法本多中心回顾性队列研究使用PINC AI增强型管理数据库（2016-2022）。符合条件的成年患者入住普通病房，入院时有国际疾病分类第10版PE诊断代码，在但不早于第1天开始抗凝治疗（UFH，低分子肝素/氟达肝素或DOAC），肌钙蛋白和脑钠肽低于正常上限。对初步抗凝措施进行了总体和各医院的总结。回归模型用于确定初始抗凝治疗与中位住院时间之间的关系。结果在2369例符合条件的患者中，开始使用UFH的比例为54%，开始使用低分子肝素/fondaparinux的比例为41%，开始使用DOACs的比例为4%。与最初接受UFH治疗的患者相比，DOACs抗凝治疗使患者的中位住院时间缩短了0.62天（95% CI, - 1.04至- 0.20）。我们的研究结果显示，低风险和中低风险PE住院患者通常不接受初始doac治疗。然而，与其他初始抗凝策略相比，使用初始DOAC治疗可缩短住院时间。

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引用次数: 0

Telehealth Rehabilitation Using Videoconferencing 使用视频会议的远程医疗康复

CHEST pulmonary

Pub Date : 2025-06-01 DOI: 10.1016/j.chpulm.2024.100111

Abebaw Mengistu Yohannes PhD , George Marty Solomon

引用次数: 0

A 65-Year-Old Woman With Massive Hemoptysis After COVID-19 Infection 65岁女性感染COVID-19后大咯血1例

CHEST pulmonary

Pub Date : 2025-06-01 DOI: 10.1016/j.chpulm.2025.100152

Lissette Orozco MD , Bruno DiGiovine MD

Case Presentation

A 65-year-old woman presented with a 7-day history of generalized weakness, cough, and hemoptysis described as streaks of blood during the first 2 days, and as half a cup to a cup of bright red blood with clots thereafter. Seven weeks earlier she was hospitalized with COVID-19 pneumonia for which she received supplemental oxygen with high flow nasal cannula, remdesivir, dexamethasone, and tocilizumab.

Her medical history included stage 3a chronic kidney disease, multinodular goiter, hypertension, and type II diabetes mellitus. She denied recent use of anticoagulants or nonsteroidal antiinflammatory drugs. She denied any recent trauma including pulmonary contusion. The patient did not have any history of rash, hematuria, or known autoimmune disease preceding this episode of hemoptysis.

The patient had previous tobacco use with a 20 pack-year history and quit 7 years ago. She did not use alcohol or other recreational drugs. Family history was notable for breast cancer in her mother. She had no history of recent travel or exposure to sick contacts.

病例表现：一名65岁女性，有7天全身性虚弱、咳嗽和咯血病史，前2天有条状血，此后半杯至一杯鲜红色血并有血块。七周前，她因COVID-19肺炎住院，接受高流量鼻插管补充氧、瑞德西韦、地塞米松和托珠单抗。病史包括3a期慢性肾病、多结节性甲状腺肿、高血压和II型糖尿病。她否认最近使用过抗凝血剂或非甾体类抗炎药。她否认最近有外伤包括肺挫伤。在咯血发作前，患者没有任何皮疹、血尿史或已知的自身免疫性疾病。患者既往吸烟20包年，7年前戒烟。她没有使用酒精或其他娱乐性药物。她的母亲有明显的乳腺癌家族史。她没有近期旅行史或与患病接触者接触史。

引用次数: 0

Mind the Gap 注意缝隙

CHEST pulmonary

Pub Date : 2025-06-01 DOI: 10.1016/j.chpulm.2025.100135

Nitish Behary Paray MBChB MRCP , Vasilis Kouranos PhD , Raheel Ahmed MBBS MRCP

引用次数: 0

Receipt of Weight Management Services Among Patients With OSA and Obesity 阻塞性睡眠呼吸暂停和肥胖患者体重管理服务的接受情况

CHEST pulmonary

Pub Date : 2025-06-01 DOI: 10.1016/j.chpulm.2025.100156

Aristotle G. Leonhard MD , Jennifer McDowell MS , Katherine D. Hoerster PhD, MPH , Sophia Hayes MD, MS , Fernando Picazo MD, MS , Jason M. Castaneda MD , Kevin Josey PhD , Matthew Griffith MD , Jun Ma MD, PhD , Kevin I. Duan MD, MS , Laura C. Feemster MD, MS , David H. Au MD, MS , Lucas M. Donovan MD, MS

Background

Obesity is the single greatest driver of OSA severity, and clinical practice guidelines recommend weight management services for all patients with OSA and obesity.

Research Question

How often do patients with obesity and newly diagnosed OSA receive weight management services as part of the initial management strategy for OSA? What are the patient- and site-level predictors of receipt of these services?

Study Design and Methods

National electronic health record data from the Veterans Health Administration were used to identify patients with a BMI ≥ 30 kg/m² and a new sleep study diagnostic of OSA. Patients with prior sleep studies, positive airway pressure therapy, or weight management services prior to OSA diagnosis were excluded. The primary study outcome was the receipt of new weight management services in the first 3 to 12 months following diagnosis of OSA. A mixed-effects logistic regression analysis was performed evaluating for patient- and site-level predictors of the receipt of weight management care.

Results

Among 152,976 patients included in our analysis, 15,304 (10.0%) received a weight management service following OSA diagnosis. Of these, 14,146 (9.2%) received a lifestyle-based weight management intervention, 1,790 (1.2%) received a weight management medication, and 29 (0.2%) underwent bariatric surgery. Female sex, Black race, higher BMI, comorbidity burden, and nonrural location were associated with greater receipt of weight management services. The odds of receiving weight management services were also greater among patients cared for at sites that reported greater proportions of patients receiving weight management care in the prior year.

Interpretation

A new OSA diagnosis is an opportunity to consider new treatments. Despite existing guidelines and the availability of services, our results show that patients with OSA and obesity rarely receive weight management care following diagnosis. New strategies are needed to overcome existing barriers to effective weight management care in patients newly diagnosed with OSA.

背景：肥胖是OSA严重程度的最大驱动因素，临床实践指南建议对所有OSA合并肥胖患者进行体重管理。研究问题：作为OSA初始治疗策略的一部分，肥胖和新诊断的OSA患者接受体重管理服务的频率是多少？病人和医院接受这些服务的预测指标是什么？研究设计和方法使用退伍军人健康管理局的国家电子健康记录数据来识别BMI≥30 kg/m2和新的睡眠研究诊断为OSA的患者。排除OSA诊断前有睡眠研究、气道正压治疗或体重管理服务的患者。主要研究结果是在OSA诊断后的前3至12个月内接受新的体重管理服务。采用混合效应logistic回归分析评估患者和医院接受体重管理护理的预测因素。结果152976例患者中，15304例（10.0%）在OSA诊断后接受了体重管理服务。其中，14146人（9.2%）接受了基于生活方式的体重管理干预，1790人（1.2%）接受了体重管理药物治疗，29人（0.2%）接受了减肥手术。女性、黑人、较高的BMI、合并症负担和非农村地区与接受体重管理服务的比例较高相关。在报告前一年接受体重管理护理的患者比例较大的地点接受体重管理服务的患者的几率也较大。新的OSA诊断是考虑新的治疗方法的机会。尽管现有的指南和服务的可用性，我们的研究结果表明，阻塞性睡眠呼吸暂停和肥胖患者很少在诊断后接受体重管理护理。需要新的策略来克服现有的障碍，对新诊断的OSA患者进行有效的体重管理护理。

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