Thorax最新文献

{"title":"Mucus clears from the trachea in a helix: a new twist to understanding airway diseases.","authors":"David Abelson, James Di Michiel, Clayton Frater, Mark Pearson, Robert Russo, Martin Wechselberger, Alice Cottee, Lucy Morgan","doi":"10.1136/thorax-2023-221052","DOIUrl":"10.1136/thorax-2023-221052","url":null,"abstract":"<p><strong>Background: </strong>Mucociliary clearance (MCC) is critical to lung health and is impaired in many diseases. The path of MCC may have an important impact on clearance but has never been rigorously studied. The objective of this study is to assess the three-dimensional path of human tracheal MCC in disease and health.</p><p><strong>Methods: </strong>Tracheal MCC was imaged in 12 ex-smokers, 3 non-smokers (1 opportunistically imaged during acute influenza and repeated after recovery) and 5 individuals with primary ciliary dyskinesia (PCD). Radiolabelled macroaggregated albumin droplets were injected into the trachea via the cricothyroid membrane. Droplet movement was tracked via scintigraphy, the path of movement mapped and helical and axial models of tracheal MCC were compared.</p><p><strong>Measurements and main results: </strong>In 5/5 participants with PCD and 1 healthy participant with acute influenza, radiolabelled albumin coated the trachea and did not move. In all others (15/15), mucus coalesced into globules. Globule movement was negligible in 3 ex-smokers, but in all others (12/15) ascended the trachea in a helical path. Median cephalad tracheal MCC was 2.7 mm/min ex-smokers vs 8.4 mm/min non-smokers (p=0.02) and correlated strongly to helical angle (r=0.92 (p=0.00002); median 18^o ex-smokers, 47^o non-smokers (p=0.036)), but not to actual speed on helical path (r=0.26 (p=0.46); median 13.6 mm/min ex-smokers vs 13.9 mm/min non-smokers (p=1.0)).</p><p><strong>Conclusion: </strong>For the first time, we show that human tracheal MCC is helical, and impairment in ex-smokers is often caused by flattened helical transit, not slower movement. Our methodology provides a simple method to map tracheal MCC and speed in vivo.</p>","PeriodicalId":23284,"journal":{"name":"Thorax","volume":" ","pages":"607-614"},"PeriodicalIF":10.0,"publicationDate":"2024-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139913572","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Actinomycosis mimicking metastatic lung malignancy.","authors":"Daniel Sims, Anthony Kerry, Kim Billingham","doi":"10.1136/thorax-2024-221556","DOIUrl":"10.1136/thorax-2024-221556","url":null,"abstract":"","PeriodicalId":23284,"journal":{"name":"Thorax","volume":" ","pages":"694-695"},"PeriodicalIF":9.0,"publicationDate":"2024-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140917301","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Challenging the gold standard: the limitations of molecular assays for detection of <i>Mycobacterium tuberculosis</i> heteroresistance.","authors":"Sarah N Danchuk, Ori E Solomon, Thomas Andreas Kohl, Viola Dreyer, Ivan Barilar, Christian Utpatel, Stefan Niemann, Dick van Soolingen, Richard Anthony, Jakko van Ingen, Joy S Michael, Marcel A Behr","doi":"10.1136/thorax-2023-220202","DOIUrl":"10.1136/thorax-2023-220202","url":null,"abstract":"<p><strong>Objectives: </strong>Heteroresistant infections are defined as infections in which a mixture of drug-resistant and drug-susceptible populations are present. In <i>Mycobacterium tuberculosis</i> (<i>M. tb</i>), heteroresistance poses a challenge in diagnosis and has been linked with poor treatment outcomes. We compared the analytical sensitivity of molecular methods, such as GeneXpert and whole genome sequencing (WGS) in detecting heteroresistance when compared with the 'gold standard' phenotypic assay: the agar proportion method (APM).</p><p><strong>Methods: </strong>Using two rounds of proficiency surveys with defined monoresistant BCG strains and mixtures of susceptible/resistant <i>M. tb</i>, we determined the limit of detection (LOD) of known resistance associated mutations.</p><p><strong>Results: </strong>The LOD for rifampin-R (RIF-R) detection was 1% using APM, 60% using GeneXpert MTB/RIF, 10% using GeneXpert MTB/RIF Ultra and 10% using WGS. While WGS could detect mutations beyond those associated with RIF resistance, the LOD for these other mutations was also 10%. Additionally, we observed instances where laboratories did not report resistance in the majority population, yet the mutations were present in the raw sequence data.</p><p><strong>Conclusion: </strong>The gold standard APM detects minority resistant populations at a lower proportion than molecular tests. <i>Mycobacterium bovis</i> BCG strains with defined resistance and extracted DNA from <i>M. tb</i> provided concordant results and can serve in quality control of laboratories offering molecular testing for resistance. Further research is required to determine whether the higher LOD of molecular tests is associated with negative treatment outcomes.</p>","PeriodicalId":23284,"journal":{"name":"Thorax","volume":" ","pages":"670-675"},"PeriodicalIF":9.0,"publicationDate":"2024-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11187393/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139576526","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence of lung cysts in adolescents and adults with a germline <i>DICER1</i> pathogenic/likely pathogenic variant: a report from the National Institutes of Health and International Pleuropulmonary Blastoma/<i>DICER1</i> Registry.","authors":"Alexander T Nelson, Lauren M Vasta, Dave Watson, Jung Kim, Anne K Harris, Ana F Best, Laura A Harney, Ann G Carr, Nicole Frederickson, Louis P Dehner, Christian P Kratz, Kelly N Hagedorn, William A Mize, Alexander Ling, Yoav H Messinger, D Ashley Hill, Kris Ann P Schultz, Douglas R Stewart","doi":"10.1136/thorax-2023-221024","DOIUrl":"10.1136/thorax-2023-221024","url":null,"abstract":"<p><strong>Background: </strong>Pleuropulmonary blastoma (PPB), the hallmark tumour associated with <i>DICER1</i>-related tumour predisposition, is characterised by an age-related progression from a cystic lesion (type I) to a high-grade sarcoma with mixed cystic and solid features (type II) or purely solid lesion (type III). Not all cystic PPBs progress; type Ir (regressed), hypothesised to represent regressed or non-progressed type I PPB, is an air-filled, cystic lesion lacking a primitive sarcomatous component. This study aims to evaluate the prevalence of non-progressed lung cysts detected by CT scan in adolescents and adults with germline <i>DICER1</i> pathogenic/likely pathogenic (P/LP) variants.</p><p><strong>Methods: </strong>Individuals were enrolled in the National Cancer Institute Natural History of <i>DICER1</i> Syndrome study, the International PPB/<i>DICER1</i> Registry and/or the International Ovarian and Testicular Stromal Tumor Registry. Individuals with a germline <i>DICER1</i> P/LP variant with first chest CT at 12 years of age or older were selected for this analysis.</p><p><strong>Results: </strong>In the combined databases, 110 individuals with a germline <i>DICER1</i> P/LP variant who underwent first chest CT at or after the age of 12 were identified. Cystic lung lesions were identified in 38% (42/110) with a total of 72 cystic lesions detected. No demographic differences were noted between those with lung cysts and those without lung cysts. Five cysts were resected with four centrally reviewed as type Ir PPB.</p><p><strong>Conclusion: </strong>Lung cysts are common in adolescents and adults with germline <i>DICER1</i> variation. Further study is needed to understand the mechanism of non-progression or regression of lung cysts in childhood to guide judicious intervention.</p>","PeriodicalId":23284,"journal":{"name":"Thorax","volume":" ","pages":"644-651"},"PeriodicalIF":9.0,"publicationDate":"2024-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11179973/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140176608","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"To progress or not to progress: new insights into the evolution of pleuropulmonary blastomas come from studying lung cysts in adolescents and adults with <i>DICER1</i>-related tumour predisposition.","authors":"Eric Santoni-Rugiu","doi":"10.1136/thorax-2024-221459","DOIUrl":"10.1136/thorax-2024-221459","url":null,"abstract":"","PeriodicalId":23284,"journal":{"name":"Thorax","volume":" ","pages":"593-594"},"PeriodicalIF":9.0,"publicationDate":"2024-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140319272","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transbronchial cryoablation in peripheral lung parenchyma with a novel thin cryoprobe and initial clinical testing.","authors":"Chuanjia Gu, Haibin Yuan, Chi Yang, Fangfang Xie, Junxiang Chen, Lei Zhu, Yifeng Jiang, Jiayuan Sun","doi":"10.1136/thorax-2023-220227","DOIUrl":"10.1136/thorax-2023-220227","url":null,"abstract":"<p><strong>Background: </strong>Transbronchial cryoablation shows potential as a local therapy for inoperable peripheral lung cancer. However, its clinical application for peripheral pulmonary lesions has not been reported yet.</p><p><strong>Methods: </strong>An improved cryoprobe with an 8-mm-long, 1.9-mm-wide cryotip was used. Initially, the safety and effectiveness of this cryoprobe were assessed in an in vivo porcine model. Transbronchial cryoablation with 2 or 3 freeze-thaw cycles (10 min or 15 min in each freezing time) was performed in 18 pigs under CT monitoring. Radiological and pathological examinations were performed to evaluate the extent of cryoablation. Subsequently, nine patients with stage IA peripheral lung cancer or metastases underwent transbronchial cryoablation with this cryoprobe under the guidance of navigation bronchoscopy and cone-beam CT. Technical success, safety and outcomes were assessed.</p><p><strong>Results: </strong>36 cryoablation procedures were performed successfully without any major complications in the porcine model. The extent of cryoablation increased with freezing time and the number of freeze-thaw cycles, which peaked at 24 hours and then gradually decreased. Pathological results showed a change from massive haemorrhage at 24 hours to fibrous hyperplasia with chronic inflammation after 4 weeks. In the clinical trial, 10 cryoablations were performed on 9 tumours with a technical success rate of 100%. One mild treatment-related complication occurred. Of the nine tumours, seven achieved complete ablation, while two exhibited incomplete ablation and subsequent local progression at 6 months.</p><p><strong>Conclusion: </strong>Our initial experience indicated that transbronchial cryoablation was a safe and feasible procedure for non-surgical peripheral stage IA lung cancer or pulmonary metastases.</p><p><strong>Trial registration number: </strong>ChiCTR2200061544.</p>","PeriodicalId":23284,"journal":{"name":"Thorax","volume":" ","pages":"633-643"},"PeriodicalIF":9.0,"publicationDate":"2024-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11187365/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139502829","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comprehensive analysis of environmental exposure to hazardous trace elements and lung function: a national cross-sectional study.","authors":"Yun-Jiang Yu, Tong Zheng, Jennifer L Perret, Yajing Han, Hongyan Li, Wenjie Meng, Dinh Bui, Qi-Zhen Wu, Chenyin Dong, Qiu-Ling Fang, Zhenchi Li, Hongxuan Kuang, Xiaowen Chen, Mingdeng Xiang, Xiaodi Qin, Shyamali C Dharmage, Guang-Hui Dong, Yang Zhou","doi":"10.1136/thorax-2022-219839","DOIUrl":"10.1136/thorax-2022-219839","url":null,"abstract":"<p><strong>Background: </strong>There is growing interest in the joint effects of hazardous trace elements (HTEs) on lung function deficits, but the data are limited. This is a critical research gap given increased global industrialisation.</p><p><strong>Methods: </strong>A national cross-sectional study including spirometry was performed among 2112 adults across 11 provinces in China between 2020 and 2021. A total of 27 HTEs were quantified from urine samples. Generalised linear models and quantile-based g-computation were used to explore the individual and joint effects of urinary HTEs on lung function, respectively.</p><p><strong>Results: </strong>Overall, there were negative associations between forced expiratory volume in 1 s (FEV₁) and urinary arsenic (As) (z-score coefficient, -0.150; 95% CI, -0.262 to -0.038 per 1 ln-unit increase), barium (Ba) (-0.148, 95% CI: -0.258 to -0.039), cadmium (Cd) (-0.132, 95% CI: -0.236 to -0.028), thallium (Tl) (-0.137, 95% CI: -0.257 to -0.018), strontium (Sr) (-0.147, 95% CI: -0.273 to -0.022) and lead (Pb) (-0.121, 95% CI: -0.219 to -0.023). Similar results were observed for forced vital capacity (FVC) with urinary As, Ba and Pb and FEV₁/FVC with titanium (Ti), As, Sr, Cd, Tl and Pb. We found borderline associations between the ln-quartile of joint HTEs and decreased FEV₁ (-20 mL, 95% CI: -48 to +8) and FVC (-14 mL, 95% CI: -49 to+2). Ba and Ti were assigned the largest negative weights for FEV₁ and FVC within the model, respectively.</p><p><strong>Conclusion: </strong>Our study investigating a wide range of HTEs in a highly polluted setting suggests that higher urinary HTE concentrations are associated with lower lung function, especially for emerging Ti and Ba, which need to be monitored or regulated to improve lung health.</p>","PeriodicalId":23284,"journal":{"name":"Thorax","volume":" ","pages":"615-623"},"PeriodicalIF":10.0,"publicationDate":"2024-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139933033","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lung allocation: a vexed, complex multifaceted challenge","authors":"Andrew Fisher, Jasvir Parmar","doi":"10.1136/thorax-2024-221747","DOIUrl":"https://doi.org/10.1136/thorax-2024-221747","url":null,"abstract":"We read with interest the paper from Roussel et al .1 In this study, the authors examine the outcomes for lung transplant recipients who were allocated donor organs in two very different healthcare systems. Their findings raise the complex and vexed question of what the fairest system for the allocation donor lungs is, especially for those candidates identified as being at the highest risk of waiting list mortality. There are a myriad of different allocation systems in operation across the world, which highlights the complex interplay between medical need, the ethical, legal and societal issues that shape national organ allocation policies.2 3 The paper examines two large national databases over a 10-year period to compare lung transplant outcomes in the French and US systems. The French national lung allocation programme is similar to the UK lung allocation …","PeriodicalId":23284,"journal":{"name":"Thorax","volume":"47 1","pages":""},"PeriodicalIF":10.0,"publicationDate":"2024-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141235974","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction: British Thoracic Society Winter Meeting 2023","authors":"BMJ Publishing Group Ltd and British Thoracic Society","doi":"10.1136/thorax-2023-btsabstracts-corr1","DOIUrl":"https://doi.org/10.1136/thorax-2023-btsabstracts-corr1","url":null,"abstract":"Abstract withdrawn as it was not presented at the Meeting S45 - Forced Oscillometry Technique in Children with Preschool Wheeze: Feasibility and Relationship to Clinical Parameters P89 - The burden and impact of NTM-LD and perspectives on care, UK data from a European patient survey (ENPADE) P97 - CPET’s utility in understanding unexplained exertional dyspnoea in military personnel. Amendments to author list M7 – Improving the use of Treatment Escalation Plans in the care of respiratory inpatients in a large tertiary centre. R Meharry, K Hamilton. Queen Elizabeth University Hospital, Glasgow, UK. Amendment to text in abstract P43 – …","PeriodicalId":23284,"journal":{"name":"Thorax","volume":"40 1","pages":""},"PeriodicalIF":10.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141074272","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Journal club","authors":"Neda Akhtar Hasan","doi":"10.1136/thorax-2024-221678","DOIUrl":"https://doi.org/10.1136/thorax-2024-221678","url":null,"abstract":"IPF is a progressive fibrotic lung disease with a median survival of 3–5 years post-diagnosis. Fifty cases are diagnosed per 100 000 people in the UK. The incidence has been rising over the last two decades, with no cure at present. Furthermore, considerable heterogeneity exists within the disease course, making management and prognostication challenging. Kraven et al (DOI: 10.1136/thoraxjnl-2021–218563) have identified 3 IPF endotypes, termed clusters, that exhibit statistically significant differences in the GAP index (gender-age-physiology index), mortality and gas transfer (DLCO). 220 patients were identified from three pooled, publicly available blood transcriptomic datasets found on the Gene Expression Omnibus, where intermittently, data such as force vital capacity (FVC) was missing. Cluster one heavily displayed genes correlating to electron transport, cellular respiration and TGFβ. Cluster two demonstrated genes related to DNA repair, cell cycle, and apoptosis. Cluster three expressed genes corresponding to immune responses. Cluster 2 patients had the most favourable outcomes, achieving higher DLCO values, and lower GAP scores. Cluster one had the highest GAP score. Cluster three had the poorest prognosis, being 3.59 times more likely to die than patients in cluster 2. Following this discovery phase, the authors created a validated …","PeriodicalId":23284,"journal":{"name":"Thorax","volume":"220 1","pages":""},"PeriodicalIF":10.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141074136","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}