Kompass Pneumologie最新文献

{"title":"COPD, Bronchiektasen und neutrophile Inflammation: Den Einfluss von Atemwegsentzündungen, Infektionen und Rauchen bedenken","authors":"A. Gülsen","doi":"10.1159/000540064","DOIUrl":"https://doi.org/10.1159/000540064","url":null,"abstract":"Background: The causality of the relationship between bronchiectasis and chronic obstructive pulmonary disease (COPD) remains unclear. This study aims to investigate the potential causal relationship between them, with a specific focus on the role of airway inflammation, infections, smoking as the mediators in the development of COPD. Methods: We conducted a two-sample Mendelian randomization (MR) analysis to assess: (1) the causal impact of bronchiectasis on COPD, sex, smoking status, infections, eosinophil and neutrophil counts, as well as the causal impact of COPD on bronchiectasis; (2) the causal effect of smoking status, infections and neutrophil counts on COPD; and (3) the extent to which the smoking status, infections and neutrophil counts might mediate any influence of bronchiectasis on the development of COPD. Results: COPD was associated with a higher risk of bronchiectasis (OR 1.28 [95% CI 1.05, 1.56]). Bronchiectasis was associated with a higher risk of COPD (OR 1.08 [95% CI 1.04, 1.13]), higher levels of neutrophil (OR 1.01 [95% CI 1.00, 1.01]), higher risk of respiratory infections (OR 1.04 [95% CI 1.02, 1.06]) and lower risk of smoking. The causal associations of higher neutrophil cells, respiratory infections and smoking with higher COPD risk remained after performing sensitivity analyses that considered different models of horizontal pleiotropy, with OR 1.17, 1.69 and 95.13, respectively. The bronchiectasis-COPD effect was 0.99, 0.85 and 122.79 with genetic adjustment for neutrophils, respiratory infections and smoking. Conclusion: COPD and bronchiectasis are mutually causal. And increased neutrophil cell count and respiratory infections appears to mediate much of the effect of bronchiectasis on COPD.","PeriodicalId":402207,"journal":{"name":"Kompass Pneumologie","volume":" 9","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141832369","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}

{"title":"ILD: Monozytenverhältnis als ergänzender Biomarker für die Prognose","authors":"F. Drakopanagiotakis, A. Günther","doi":"10.1159/000540065","DOIUrl":"https://doi.org/10.1159/000540065","url":null,"abstract":"Background: The ILD-GAP scoring system is known to be useful in predicting prognosis in patients with interstitial lung disease (ILD). An elevated monocyte count was associated with increased risks of IPF poor prognosis. We examined whether the ILD-GAP scoring system combined with the monocyte ratio (ILD-GAPM) is superior to the conventional ILD-GAP model in predicting ILD prognosis. Methods: In patients with ILD treated between April 2013 and April 2017, we were retrospectively assessed the relationships between baseline clinical parameters, including age, sex, Charlson Comorbidity Index score (CCIS), ILD diagnosis, blood biomarkers, pulmonary function test results, and disease outcomes. In ILD patients were included idiopathic pulmonary fibrosis (IPF), idiopathic nonspecific interstitial pneumonia (iNSIP), collagen vascular disease-related interstitial pneumonia (CVD-IP), chronic hypersensitivity pneumonitis (CHP), and unclassifiable ILD (UC-ILD). We also assessed the ability to predict prognosis was compared between the ILD-GAP and ILD-GAPM models. Results: A total of 179 patients (mean age, 73 years) were assessed. All of them were taken pulmonary function test, including percentage predicted diffusion capacity for carbon monoxide. ILD patients included 56 IPF cases, 112 iNSIP and CVD-IP cases, 6 CHP cases and 5 UC-ILD cases. ILD-GAPM provided a greater area under the receiver-operating characteristic curve (0.747) than ILD-GAP (0.710) for predicting 3-year ILD-related events. Furthermore, the log-rank test showed that the Kaplan-Meier curves in ILD-GAPM were significantly different by stage (P = 0.015), but not by stage in ILD-GAP (P = 0.074). Conclusions: The ILD-GAPM model may be a more accurate predictor of prognosis for ILD patients than the ILD-GAP model.","PeriodicalId":402207,"journal":{"name":"Kompass Pneumologie","volume":" 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141832525","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}

{"title":"Besondere klinische Aspekte bei der Diagnostik und Behandlung der akuten Lungenembolie","authors":"M. Pfeifer","doi":"10.1159/000540066","DOIUrl":"https://doi.org/10.1159/000540066","url":null,"abstract":"","PeriodicalId":402207,"journal":{"name":"Kompass Pneumologie","volume":"52 7","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141837363","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}

{"title":"MPE beim mutierten NSCLC: Intrapleurale Applikation von Bevacizumab stellt effektive Therapie dar","authors":"F. Stanzel","doi":"10.1159/000539751","DOIUrl":"https://doi.org/10.1159/000539751","url":null,"abstract":"Background: Several studies have indicated that intrapleural infusion of bevacizumab is an effective treatment for non-small cell lung cancer (NSCLC) with malignant pleural effusion (MPE). However, the impact of bevacizumab administered through an indwelling pleural catheter (IPC) on the prognosis of these patients is unknown. Methods: Consecutive advanced NSCLC patients with symptomatic MPE receiving an IPC alone or bevacizumab through an IPC were identified in a tertiary hospital. The patient characteristics and clinical outcomes were collected. Results: A total of 149 patients were included, and the median age was 60.3 years. Males and nonsmokers accounted for 48.3% and 65.8%, respectively. A total of 69.8% (104/149) of patients harbored actionable mutations, including 92 EGFR-activating mutations, 11 ALK fusions, and 1 ROS1 fusion. A total of 81.9% (122/149) of patients received IPC alone, and 18.1% (27/149) received bevacizumab through an IPC. The incidence of spontaneous pleurodesis during the first 6 months was greater in the bevacizumab-treated group than in the IPC-treated group in the subgroup with actionable mutations (64.3% vs. 46.9%, P = 0.28). The median overall survival (OS) in patients with actionable mutations treated with bevacizumab through an IPC was 42.2 months, which was significantly longer than the 26.7 months in patients who received an IPC alone (P = 0.045). However, the median OS did not differ between the two arms in the subgroup without actionable mutations (10.8 vs. 41.0 months, P = 0.24). No significant difference between the bevacizumab through an IPC group and the IPC group was detected in the number of participants who had adverse events, either in patients with actionable mutations (14.3% vs. 8.4%; P = 0.42) or in patients without actionable mutations (16.7% vs. 12.8%; P = 1.00).","PeriodicalId":402207,"journal":{"name":"Kompass Pneumologie","volume":"63 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141837759","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}

{"title":"Weaning von invasiver Beatmung: Multiresistente Bakterien beeinflussen den Erfolg","authors":"J. Knoch","doi":"10.1159/000539197","DOIUrl":"https://doi.org/10.1159/000539197","url":null,"abstract":"Background: Although multidrug-resistant bacteria (MDR) are common in patients undergoing prolonged weaning, there is little data on their impact on weaning and patient outcomes. Methods: This is a retrospective analysis of consecutive patients who underwent prolonged weaning and were at a university weaning centre from January 2018 to December 2020. The influence of MDR colonisation and infection on weaning success (category 3a and 3b), successful prolonged weaning from invasive mechanical ventilation (IMV) with or without the need for non-invasive ventilation (NIV) compared with category 3c (weaning failure 3cI or death 3cII) was investigated. The pathogen groups considered were: multidrug-resistant gram-negative bacteria (MDRGN), methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus spp. (VRE). Results: A total of 206 patients were studied, of whom 91 (44.2%) showed evidence of MDR bacteria (32% VRE, 1.5% MRSA and 16% MDRGN), with 25 patients also meeting the criteria for MDR infection. 70.9% of the 206 patients were successfully weaned from IMV, 8.7% died. In 72.2% of cases, nosocomial pneumonia and other infections were the main cause of death. Patients with evidence of MDR (infection and colonisation) had a higher incidence of weaning failure than those without evidence of MDR (48% vs. 34.8% vs. 21.7%). In multivariate analyses, MDR infection (OR 4.9, p = 0.004) was an independent risk factor for weaning failure, along with male sex (OR 2.3, p = 0.025), Charlson Comorbidity Index (OR 1.2, p = 0.027), pH (OR 2.7, p < 0.001) and duration of IMV before admission (OR 1.01, p < 0.001). In addition, MDR infection was the only independent risk factor for death (category 3cII), (OR 6.66, p = 0.007). Conclusion: Patients with MDR infection are significantly more likely to die during the weaning process. There is an urgent need to develop non-antibiotic approaches for the prevention and treatment of MDR infections as well as clinical research on antibiotic stewardship in prolonged weaning as well as in ICUs.","PeriodicalId":402207,"journal":{"name":"Kompass Pneumologie","volume":"81 6","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140978530","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}

{"title":"Bronchoskopische Abklärung von Lungenherden: Gute Hustenkontrolle als Erfolgskriterium","authors":"M. Wagner","doi":"10.1159/000539196","DOIUrl":"https://doi.org/10.1159/000539196","url":null,"abstract":"Bronchoscopy is an invasive procedure, and patient coughing during examination has been reported to cause patient distress. This study aimed to clarify the relationship between cough severity and diagnostic yield of endobronchial ultrasonography with guide sheath transbronchial biopsy (EBUS-GS-TBB). Data of patients who underwent bronchoscopy at Kyorin University Hospital between April 2019 and March 2022 were retrospectively evaluated. Bronchoscopists assessed the cough severity upon completion of the procedure using a four-point cough scale. Cough severity was included as a predictive factor along with those reportedly involved in bronchoscopic diagnosis, and their impact on diagnostic yield was evaluated. Predictors of cough severity were also examined. A total of 275 patients were enrolled in this study. In the multivariate analysis, the diagnostic group (n = 213) had significantly more ‹within› radial endobronchial ultrasound findings (odds ratio [OR] 5.900, p < 0.001), a lower cough score (cough score per point; OR 0.455, p < 0.001), and fewer bronchial generations to target lesion(s) (OR 0.686, p < 0.001) than the non-diagnostic group (n = 62). The predictive factors for severe cough include the absence of virtual bronchoscopic navigation (VBN) and prolonged examination time. Decreased cough severity was a positive predictive factor for successful EBUS-GS-TBB, which may be controlled using VBN and awareness of the procedural duration.","PeriodicalId":402207,"journal":{"name":"Kompass Pneumologie","volume":"16 17","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141005204","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}

{"title":"Maschinelles Lernen zur Identifizierung von Risikofaktoren, die mit der Entwicklung von im Krankenhaus erworbener beatmungsassoziierter Pneumonie und Mortalität assoziiert sind: Implikationen für die Wahl der Antibiotikatherapie","authors":"Anthony Sophonsri, Mimi Lou, Pamela Ny, Emi Minejima, Paul Nieberg, Annie Wong-Beringer","doi":"10.1159/000538394","DOIUrl":"https://doi.org/10.1159/000538394","url":null,"abstract":"Hintergrund: Bei Patienten mit nosokomialer bakterieller Pneumonie ist die Mortalität am höchsten bei denjenigen, die so weit dekompensieren, dass eine mechanische Beatmung (vHABP) nötig wird, gefolgt von denen mit beatmungsassoziierter Pneumonie (VABP) und nicht beatmungsassoziierter, im Krankenhaus erworbener Pneumonie (nvHABP). Die Ziele dieser Studie waren die Identifizierung von Risikofaktoren, die mit der Entwicklung und der Mortalität von vHABP assoziiert sind, und die Bewertung der Antibiotikabehandlung. Methoden: Eine multizentrische retrospektive Kohortenstudie wurde bei erwachsenen hospitalisierten Patienten mit nosokomialer Pneumonie zwischen 2014 und 2019 durchgeführt. Die Gruppen wurden nach vHABP, nvHABP und VABP stratifiziert und hinsichtlich demografischer Daten, klinischer Merkmale, Behandlung und Ergebnissen verglichen. Mithilfe von maschinellem Lernen wurden multivariate Modelle erstellt, um Risikofaktoren für die Progression zur vHABP und die Mortalität durch Pneumonie für jede Kohorte zu identifizieren. Ergebnisse: 457 Patienten (32% nvHABP, 37% vHABP und 31% VABP) wurden untersucht. Die vHABP- und die nvHABP-Gruppe waren ähnlich alt (medianes Alter 66,4 Jahre), 77% wiesen mehrere Komorbiditäten auf, aber mehr vHABP-Patienten hatten eine Lebererkrankung (18,2% vs. 7,7%; p = 0,05) und eine Alkoholkonsumstörung (27% vs. 7,1%; p < 0,001) und waren in den vorausgehenden 30 Tagen im Krankenhaus gewesen (30,4% vs. 19,5%; p = 0,02). 70% der vHABP-Patienten benötigten am Tag der Diagnose eine sofortige Beatmung. Die Mortalität war in der vHABP-Gruppe am höchsten, gefolgt von der VABP- und der nvHABP-Gruppe (44,6% vs. 36% vs. 14,3%; p < 0,0001). Fast alle (96%) vHABP-Patienten hatten positive Kulturen, wobei Gram-negative Erreger 58,8% ausmachten und 33,0% resistent gegen β-Laktame mit breitem Wirkungsspektrum (ESBL), Ceftriaxon (17,5%), Fluorchinolone (20,6%) und Carbapeneme (12,4%) waren. Bis zur Hälfte der vHABP-Patienten mit ESBL-Enterobacteriaceae oder Pseudomonas aeruginosa erhielten keine wirksame empirische Therapie. Bei Patienten, bei denen eine wirksame Therapie erst nach dem Tag der Pneumoniediagnose begonnen wurde, war die Mortalität um mehr als 50% erhöht. Risikofaktoren, die mit der Entwicklung einer vHABP assoziiert waren, waren Alkoholkonsumstörung, APACHE-II-Score, eine Vasopressortherapie vor der Infektion und eine positive Kultur für ESBL-Enterobacteriales, während eine Krankenhausaufnahme in den letzten 30 Tagen, eine aktive maligne Erkrankung, die Isolierung von Ceftriaxon-resistenten Erregern oder P. aeruginosa und eine Vasopressortherapie Risikofaktoren für eine vHABP-assoziierte Mortalität waren.","PeriodicalId":402207,"journal":{"name":"Kompass Pneumologie","volume":"83 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141017985","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}

{"title":"Geplante Pneumektomie bei zerstörter Lunge: Leitliniengerechte präoperative Evaluierung durchführen","authors":"K. Hekmat","doi":"10.1159/000538287","DOIUrl":"https://doi.org/10.1159/000538287","url":null,"abstract":"Background: Clinical guidelines recommend a preoperative forced expiratory volume in one second (FEV1) of > 2 L as an indication for left or right pneumonectomy. This study compares the safety and long-term prognosis of pneumonectomy for destroyed lung (DL) patients with FEV1 ≤ 2 L or > 2 L. Methods: A total of 123 DL patients who underwent pneumonectomy between November 2002 and February 2023 at the Department of Thoracic Surgery, Beijing Chest Hospital were included. Patients were sorted into two groups: the FEV1 > 2 L group (n = 30) or the FEV1 ≤ 2 L group (n = 96). Clinical characteristics and rates of mortality, complications within 30 days after surgery, long-term mortality, occurrence of residual lung infection/tuberculosis (TB), bronchopleural fistula/empyema, readmission by last follow-up visit, and modified Medical Research Council (mMRC) dyspnea scores were compared between groups. Results: A total of 96.7% (119/123) of patients were successfully discharged, with 75.6% (93/123) in the FEV1 ≤ 2 L group. As compared to the FEV1 > 2 L group, the FEV1 ≤ 2 L group exhibited significantly lower proportions of males, patients with smoking histories, patients with lung cavities as revealed by chest imaging findings, and patients with lower forced vital capacity as a percentage of predicted values (FVC%pred) (P values of 0.001, 0.027, and 0.023, 0.003, respectively). No significant intergroup differences were observed in rates of mortality within 30 days after surgery, incidence of postoperative complications, long-term mortality, occurrence of residual lung infection/TB, bronchopleural fistula/empyema, mMRC ≥ 1 at the last follow-up visit, and postoperative readmission (P > 0.05).","PeriodicalId":402207,"journal":{"name":"Kompass Pneumologie","volume":"17 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140250922","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}

{"title":"RET-Inhibitor: Phase-III-Studie bestätigt Effektivität","authors":"Wochen Selpercatinib Weiblich, Erstlinie Selpercatinib","doi":"10.1159/000535549","DOIUrl":"https://doi.org/10.1159/000535549","url":null,"abstract":"","PeriodicalId":402207,"journal":{"name":"Kompass Pneumologie","volume":"1 3","pages":"328 - 329"},"PeriodicalIF":0.0,"publicationDate":"2023-12-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139002470","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}

{"title":"Schweres Asthma – Klinische Remission ist ein erreichbares Ziel","authors":"","doi":"10.1159/000535548","DOIUrl":"https://doi.org/10.1159/000535548","url":null,"abstract":"","PeriodicalId":402207,"journal":{"name":"Kompass Pneumologie","volume":"8 9","pages":"330 - 331"},"PeriodicalIF":0.0,"publicationDate":"2023-12-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139002618","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}