BMC Pulmonary Medicine最新文献

{"title":"Activity of Aztreonam-avibactam and other β-lactamase inhibitor combinations against Gram-negative bacteria isolated from patients hospitalized with pneumonia in United States medical centers (2020-2022).","authors":"Helio S Sader, Rodrigo E Mendes, S J Ryan Arends, Timothy B Doyle, Mariana Castanheira","doi":"10.1186/s12890-025-03500-8","DOIUrl":"10.1186/s12890-025-03500-8","url":null,"abstract":"<p><strong>Background: </strong>Initial antimicrobial therapy for pneumonia is frequently empirical and resistance to antimicrobial agents represents a great challenge to the treatment of patients hospitalized with pneumonia. We evaluated the frequency and antimicrobial susceptibility of Gram-negative bacteria causing pneumonia in US hospitals.</p><p><strong>Methods: </strong>Bacterial isolates were consecutively collected (1/patient) from patients hospitalized with pneumonia and the susceptibility of Gram-negative bacilli (3,911 Enterobacterales and 2,753 non-fermenters) was evaluated by broth microdilution in a monitoring laboratory. Isolates were collected in 69 medical centers in 2020-2022. Aztreonam-avibactam was tested with avibactam at fixed 4 mg/L and a pharmacokinetic/pharmacodynamic susceptible (S) breakpoint of ≤ 8 mg/L was applied for comparison. Carbapenem-resistant Enterobacterales (CRE; isolates with MIC values of > 2 mg/L for imipenem and/or meropenem) isolates were screened for carbapenemases by whole genome sequencing.</p><p><strong>Results: </strong>Gram-negative bacilli represented 71.1% of organisms. The most common Gram-negative species were Pseudomonas aeruginosa (22.4% of organisms), Klebsiella pneumoniae (8.8%), Escherichia coli (6.6%), Serratia marcescens (6.2%), Stenotrophomonas maltophilia (4.9%), and Enterobacter cloacae complex (4.8%). Aztreonam-avibactam inhibited 100.0% of Enterobacterales at ≤ 8 mg/L and 99.9% at ≤ 4 mg/L and showed potent activity against CRE (MIC_50/90, 0.25/1 mg/L). Ceftazidime-avibactam and meropenem-vaborbactam were active against 89.4% and 88.5% of CREs, respectively. Aztreonam-avibactam retained activity against Enterobacterales non-susceptible to ceftazidime-avibactam and/or meropenem-vaborbactam (n = 19; MIC_50/90, 0.25/4 mg/L). The most common carbapenemases were KPC (69.2% of CREs), NDM (9.6%), and SME (4.8%). A carbapenemase gene was not identified in 16.3% of CREs. Ceftazidime-avibactam and meropenem-vaborbactam were highly active against KPC and SME producers but showed limited activity against MBL producers. The most active comparators against CRE were tigecycline (95.2%S), amikacin (73.1%S), and gentamicin (60.6%S). Among Pseudomonas aeruginosa, 79.1% were inhibited at ≤ 8 mg/L of aztreonam-avibactam, 77.2% were meropenem susceptible, and 77.2% were piperacillin-tazobactam susceptible. Aztreonam-avibactam was highly active against S. maltophilia, inhibiting 99.5% of isolates at ≤ 8 mg/L.</p><p><strong>Conclusions: </strong>Aztreonam-avibactam displayed potent in vitro activity against a large collection of contemporary Gram-negative organisms isolated from patients hospitalized with pneumonia, including CRE isolates resistant to ceftazidime-avibactam and/or meropenem-vaborbactam. Results of surveillance programs are valuable for planning empiric antimicrobial therapy guidelines and infection control measures.</p>","PeriodicalId":9148,"journal":{"name":"BMC Pulmonary Medicine","volume":"25 1","pages":"38"},"PeriodicalIF":2.6,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11762134/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143036921","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploring practical experience with different treatments in NSCLC patients with MET-deregulated: a retrospective analysis from the real world.","authors":"Mengmeng Li, Jiuyan Huang, Ruyue Xing, Xinyang Du, Chunhua Wei, Huijuan Wang","doi":"10.1186/s12890-024-03437-4","DOIUrl":"10.1186/s12890-024-03437-4","url":null,"abstract":"<p><strong>Background: </strong>Mesenchymal to epithelial transition factor (MET) dysregulation in non-small-cell-lung-cancer (NSCLC) is understudied, with scant data on treatment outcomes.</p><p><strong>Methods: </strong>We retrospectively examined 160 NSCLC patients: 125 with primary MET mutations (further classified into MET exon 14 (METex14) skipping mutations and primary MET amplifications) and 35 with secondary MET amplifications. Patients underwent varied treatments: Chemotherapy, Immune monotherapy, Crizotinib, or Savolitinib. Secondary MET amplification patients were grouped by treatment: Group A (Class Ib MET-TKI with third-generation EGFR-TKI), Group B (Crizotinib with first-generation EGFR-TKI), and Group C (Crizotinib alone). One hundred and thirty patients have completed the whole treatment process. Their data were included in the study's survival analysis (included 95 patients with primary MET mutations and 35 patients with secondary MET amplifications).</p><p><strong>Results: </strong>Among METex14 skipping mutations patients (n = 57), median progression free survival (PFS) was: Chemotherapy 7.64 m, Crizotinib 8.5 m, Savolitinib 9.3 m, and Immunotherapy 3.87 m. Targeted therapies and chemotherapy significantly outperformed Immunotherapy. Sub-group analysis indicated splice donor region mutations benefited more than those at the polypyrimidine tract (9.23 m vs. 4.03 m, P = 0.038). For primary MET amplifications (n = 38), PFS was: Chemotherapy 2.84 m, Crizotinib 3.80 m, Savolitinib 5.23 m, and Immunotherapy 3.30 m. Patients with copy number (CN) > 5 had longer PFS than CN ≤ 5 (5.17 m vs. 3.44 m, P = 0.039). In secondary MET amplifications (n = 35), Group A and B had similar PFS (6.77 m and 6.57 m) versus Group C (3.13 m). Dual-target therapy PFS showed no difference between CN ≤ 5 and CN > 5 (8.63 m vs. 6.27 m, P = 0.29).</p><p><strong>Conclusion: </strong>NSCLC patients with METex14 skipping mutations benefit more from targeted therapies, especially those with splice donor mutations. MET amplification patients benefit universally from targeted therapies; primary MET amplifications show higher benefits with increased copy numbers. For secondary MET amplifications post-EGFR-TKI resistance, dual-target therapy surpasses Crizotinib monotherapy, independent of MET copy number.</p>","PeriodicalId":9148,"journal":{"name":"BMC Pulmonary Medicine","volume":"25 1","pages":"35"},"PeriodicalIF":2.6,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11761713/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143036964","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between dietary intake of live microbes and chronic obstructive pulmonary disease: a cross-sectional study of NHANES 2007-2012.","authors":"Yifeng Xu, Zhaoqi Yan, Liangji Liu","doi":"10.1186/s12890-024-03453-4","DOIUrl":"10.1186/s12890-024-03453-4","url":null,"abstract":"<p><strong>Background: </strong>Diet plays a crucial role in intervening in the development of chronic obstructive pulmonary disease (COPD), yet previous studies have not investigated the impact of dietary intake of live microbes on COPD. This study aims to assess the relationship between the two.</p><p><strong>Methods: </strong>Participants from the National Health and Nutrition Examination Survey (NHANES) from 2007 to 2012 were selected. The exposure variable was the estimated intake of live microbes in the diet, categorized into low, medium, and high groups. The outcome variable was COPD. A multivariable logistic regression model was used to assess the relationship between estimated dietary intake of live microbes and the risk of COPD.</p><p><strong>Results: </strong>In the fully adjusted multiple logistic regression model, participants with moderate and high dietary intake of live microbes showed a negative association with the prevalence of COPD compared to those with low estimated intake, with reductions of 38% (OR, 0.62; 95% CI: 0.39-0.99, P < 0.05) and 44% (OR, 0.56; 95% CI: 0.34-0.92, P < 0.05) respectively. Additionally, subgroup analysis results remained stable with no observed interactions.</p><p><strong>Conclusion: </strong>Our study suggests a negative association between higher dietary live microbe intake and the risk of COPD among adults in the United States.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov Identifier NCT00005154 First Posted date 26/05/2000(retrospectively registered).</p>","PeriodicalId":9148,"journal":{"name":"BMC Pulmonary Medicine","volume":"25 1","pages":"33"},"PeriodicalIF":2.6,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11760668/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143027880","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Autoimmune pulmonary alveolar proteinosis developed during treatment for systemic sclerosis: a case report.","authors":"Tomoki Kozono, Kentaro Tanaka, Tomoko Yagi, Kazuto Kamikawaji, Masaki Watanabe, Azusa Iwanaga, Minako Hamada, Yoshifusa Koreeda, Hiromasa Inoue, Ikkou Higashimoto","doi":"10.1186/s12890-025-03489-0","DOIUrl":"10.1186/s12890-025-03489-0","url":null,"abstract":"<p><strong>Background: </strong>Reports of autoimmune diseases coexisting with autoimmune pulmonary alveolar proteinosis (autoimmune PAP; APAP) are extremely rare. APAP coexisting with autoimmune diseases may often be misdiagnosed as connective tissue disease-associated interstitial lung disease (ILD). Here, we describe a rare case of a patient with systemic sclerosis who was diagnosed with APAP after the exacerbation of lung opacities during treatment with immunosuppressive agents.</p><p><strong>Case presentation: </strong>A 72-year-old woman was diagnosed with systemic sclerosis (SSc) at the age of 68, and initiated treatment with prednisolone (PSL). At the age of 70, she was diagnosed with ILD associated with SSc. Despite intravenous cyclophosphamide (IVCY), no improvement was observed. A significant elevation of Krebs von den Lungen-6 (KL-6) and a crazy-paving pattern on chest computed tomography (CT) are observed. Bronchoscopy showed milky white bronchoalveolar lavage fluid (BALF) and histology of periodic acid-Schiff (PAS) stain-positive eosinophilic granular material. Serum anti granulocyte-macrophage colony-stimulating factor (GM-CSF) antibodies were measured, and the result was positive, leading to the diagnosis of APAP.</p><p><strong>Conclusion: </strong>In patients with interstitial lung shadows who do not improve with immunosuppressive treatment, PAP is one of the differential diagnoses that should be considered. All physicians should be aware that the appropriate diagnosis of PAP and the measurement of serum anti-GM-CSF antibodies will critically affect patient outcomes.</p>","PeriodicalId":9148,"journal":{"name":"BMC Pulmonary Medicine","volume":"25 1","pages":"32"},"PeriodicalIF":2.6,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11753109/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143000088","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"NLRP3 is a BMI-independent mediator of stable COPD.","authors":"Yonca Gungor, Selin Ercan, Saliha Selin Özuygur Ermiş, Yiğit Kozalı, Gizem Kursunluoglu, Ceyda Sahan, Aylin Ozgen Alpaydin, Hulya Ayar Kayali","doi":"10.1186/s12890-024-03435-6","DOIUrl":"10.1186/s12890-024-03435-6","url":null,"abstract":"<p><strong>Purpose: </strong>The inflammatory response in animal models of chronic obstructive pulmonary disease (COPD) is activated by the NLR-family-pyrin-domain-containing-3 (NLRP3) inflammasome pathway, which is also known to play a role in obesity-related inflammation. The NLRP3/caspase-1/interleukin (IL)-1β pathway might be involved in the progression of COPD with increasing body mass index. To our knowledge, no previous studies have explored the role of NLRP3 inflammasome markers in linking COPD and obesity. Here, we aim to investigate this potential connection by examining levels of NLRP3, caspase-1, IL-1β, and IL-17A and to provide additional data on the expression of these molecules in relation to smoking status and COPD severity.</p><p><strong>Methods: </strong>A case‒control study was conducted between July 2020 and March 2023. Peripheral blood mononuclear cells were isolated, and total RNA was extracted for real-time quantitative polymerase chain reaction (qPCR) analysis to measure the expression levels of inflammasome molecules.</p><p><strong>Results: </strong>29 subjects who were diagnosed with stable COPD and 32 controls were included in the data analysis. NLRP3 and IL-17A but not caspase-1 or IL-1β expression was significantly greater in the COPD group than in the control group. We detected a significant increase in NLRP3 levels in the smoker COPD group (p = 0.009) and nonsmoker COPD group (p = 0.045) compared with those in the nonsmoker control group. There was no significant correlation between BMI and the inflammasome markers.</p><p><strong>Conclusion: </strong>As proinflammatory biomarkers, NLRP3 and IL-17A are prominent in stable COPD patients. Smoking may trigger NLRP3-mediated inflammation in stable COPD patients. The expression levels of NLRP3 inflammasome molecules did not differ in terms of disease severity or BMI.</p>","PeriodicalId":9148,"journal":{"name":"BMC Pulmonary Medicine","volume":"25 1","pages":"31"},"PeriodicalIF":2.6,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11749553/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143000122","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development and validation of a nomogram for predicting cough variant asthma diagnosis.","authors":"Jiao Min, Xiaomiao Tang, Di Zhang, Jin Yang, Fei Li, Wei Lei","doi":"10.1186/s12890-025-03478-3","DOIUrl":"10.1186/s12890-025-03478-3","url":null,"abstract":"<p><strong>Background: </strong>Cough variant asthma (CVA) is a specific type of asthma characterized by chronic cough as the sole or predominant symptom. Accurate diagnosis is crucial for effective treatment, yet bronchial provocation test is not always feasible in clinical settings. To identify independent predictors of CVA diagnosis, we developed a nomogram for predicting CVA. Univariate and multivariate logistic regression analyses were employed to construct the model, and the accuracy and consistency of the prediction model were subsequently validated.</p><p><strong>Methods: </strong>We conducted a retrospective review of clinical data from 241 outpatients with chronic cough (≥ 8 weeks) who underwent bronchial provocation test at our hospital between January 2018 and December 2021. Patients were categorized into CVA group and Non-CVA group based on diagnostic criteria. Univariate analysis (chi-square and t-tests) was performed, followed by multivariate logistic regression to identify independent predictors. A nomogram was constructed using these predictors and validated using Bootstrap resampling (B = 200) to calculate the C-index. Additionally, receiver operating characteristic (ROC) curve analysis and decision curve analysis (DCA) were employed to assess the model's accuracy.</p><p><strong>Results: </strong>Of the 241 outpatients, 156 (64.7%) were diagnosed with CVA. Multivariate analysis identified several independent predictors of CVA, including cough triggered by cold air (OR = 12.493, P = 0.019), exposure to pungent odors (OR = 3.969, P = 0.002), cough phasing (OR = 4.515, P < 0.001), history of allergic rhinitis (OR = 3.231, P = 0.018), and the percentage of the predicted value of maximum mid-expiratory flow (MMEF%pred) (OR = 0.981, P = 0.039) were independent predictors of CVA. The nomogram demonstrated good discrimination (AUC = 0.829) and calibration, with a sensitivity of 75.3% and specificity of 77.6% at the optimal cutoff. The C-index was 0.920, indicating excellent model performance.</p><p><strong>Conclusions: </strong>We successfully developed and validated a user-friendly nomogram that accurately predicted CVA diagnosis based on clinical characteristics and pulmonary function test. This nomogram model could assist clinicians in diagnosing CVA, especially in patients without bronchial provocation test or with contraindications to bronchial provocation test.</p>","PeriodicalId":9148,"journal":{"name":"BMC Pulmonary Medicine","volume":"25 1","pages":"28"},"PeriodicalIF":2.6,"publicationDate":"2025-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11744963/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143000117","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Severe pneumonia due to concurrent Legionella pneumophila and Acinetobacter baumannii infections: a case report.","authors":"Xiaoming Yang, Zhongda Liu, Xiaojing Liu, Quan Li, Hui Huang, Yibo Wei, Tao Sun","doi":"10.1186/s12890-025-03481-8","DOIUrl":"10.1186/s12890-025-03481-8","url":null,"abstract":"<p><strong>Background: </strong>Legionella pneumophila is an uncommon pathogen causing community-acquired atypical pneumonia. Acinetobacter baumannii is a major pathogen responsible for hospital-acquired pneumonia, but it rarely causes serious infections in a community setting. Without prompt and appropriate treatments, infection from either of these two pathogens can cause a high mortality rate. Concurrent infection from both L. pneumophila and A. baumannii can cause serious outcomes, but it has rarely been reported previously.</p><p><strong>Case presentation: </strong>A 45-year-old male presented to our hospital with a productive cough and fever after staying in a local hotel. His chest computed tomography (CT) scan showed bilateral lower-lobe infiltration and left pleural effusion. Empirical antibiotics, including piperacillin-tazobactam, levofloxacin, meropenem, and doxycycline, were administered to him to treat community-acquired pneumonia. However, his condition deteriorated very rapidly, and he required endotracheal intubation and mechanical ventilation for respiratory support. Finally, metagenomic next-generation sequencing (mNGS) of his bronchoalveolar lavage fluid identified L. pneumophila and A. baumannii. The sputum culture demonstrated multidrug-resistant A. baumannii. He was diagnosed with pneumonia by concurrent infections from both L. pneumophila and A. baumannii. After careful consideration of the antibiotic susceptibility results and the antibacterial mechanism of each antibiotic, we switched the antibiotics to omadacycline and cefoperazone/sulbactam. His clinical symptoms gradually subsided. The repeat chest CT image showed no infiltration or pleural effusion.</p><p><strong>Conclusions: </strong>Community-acquired pneumonia can be caused by concurrent infections of both L. pneumophila and A. baumannii. Close clinical monitoring, early pathogen detection and antibiotic susceptability tests, and appropriate antibiotic regimen adjustments should be applied to these patients who failed initial antibiotic treatments.</p>","PeriodicalId":9148,"journal":{"name":"BMC Pulmonary Medicine","volume":"25 1","pages":"29"},"PeriodicalIF":2.6,"publicationDate":"2025-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11749207/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143000170","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The superiority of veno-arterial over veno-venous extracorporeal membrane oxygenation for operative support of lung transplantation.","authors":"Sen Lu, Pin Wang, Xiao-Qin Zhang, Gang Feng, Hong-Li He, Yue Chen, Xiao-Bo Huang, Chun Pan, Jing-Chao Luo","doi":"10.1186/s12890-025-03483-6","DOIUrl":"10.1186/s12890-025-03483-6","url":null,"abstract":"<p><strong>Background: </strong>Veno-arterial (V-A) and veno-venous (V-V) extracorporeal membrane oxygenation (ECMO) are crucial support modalities during lung transplantation, yet their comparative effectiveness remains unclear.</p><p><strong>Methods: </strong>We conducted an 8-year retrospective analysis of 62 lung transplant recipients who received intraoperative ECMO (29 V-A, 33 V-V). Baseline characteristics, surgical parameters, and clinical outcomes were compared. To address potential selection bias, we employed entropy weighted inverse probability of treatment weighting (IPTW-EW).</p><p><strong>Results: </strong>After IPTW-EW adjustment, V-A ECMO was associated with superior hemodynamic and respiratory parameters, including lower systolic pulmonary artery pressure (30 vs. 37 mmHg, p = 0.007), higher arterial oxygen partial pressure (119 vs. 78 mmHg, p = 0.002), and less severe pulmonary edema (Grade 1: 50% vs. 3%, Grade 2: 45% vs. 38%, Grade 3: 5% vs. 59%, p < 0.001). Notably, V-A ECMO demonstrated significantly lower 28-day (5% vs. 29%, p = 0.017) and hospital mortalities (21% vs. 69%, p = 0.035).</p><p><strong>Conclusions: </strong>V-A ECMO provides superior pulmonary circulation unloading and is associated with improved survival outcomes compared to V-V ECMO in lung transplantation, suggesting its preferential use when clinically appropriate.</p>","PeriodicalId":9148,"journal":{"name":"BMC Pulmonary Medicine","volume":"25 1","pages":"30"},"PeriodicalIF":2.6,"publicationDate":"2025-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11748553/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142999344","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative the impact intraoperative phrenic nerve sacrifice on prognosis patients with thymoma.","authors":"Hongyun Ruan, Xuehui Shang, Dongjie Yan, Bin Liu, Fangchao Liu, Zhi Yang","doi":"10.1186/s12890-025-03498-z","DOIUrl":"10.1186/s12890-025-03498-z","url":null,"abstract":"<p><strong>Objectives: </strong>Complete removal of the tumor and surrounding tissue is the most important prognostic factor such as survival after surgery. When the tumor invades the phrenic nerve, the impact of intraoperative phrenic nerve sacrifice on the short- and long-term prognosis of patients is not clear. This study aims to explore the differences in prognosis between patients with malignant thymoma with and without phrenic nerve sacrifice during surgery, as well as analyze related factors.</p><p><strong>Methods: </strong>A total of 209 patients who underwent thymoma resection in the Department of Thoracic Surgery at our hospital from February 2006 to November 2022 were collected for retrospective analysis. The groups were divided into two according to the presence or absence of intraoperative phrenic nerve sacrifice. A comparative analysis was conducted on postoperative complications, long-term survival recurrence between the two groups. Cox regression was used to analyze the factors related to the differences in short- and long-term prognosis between two groups.</p><p><strong>Results: </strong>29.6% of patients developed phrenic nerve sacrifice during thymoma surgery. Compared to patients without phrenic nerve sacrifice, the long-term survival rate was lower (P = 0.031). The independent risk factors for reduced long-term survival were intraoperative phrenic nerve sacrifice, secondary postoperative complications, and modified Masaoka staging III/IV.</p><p><strong>Conclusion: </strong>Our data show that nearly one-third of patients develop phrenic nerve sacrifice during complete resection of thymoma. Phrenic nerve sacrifice has significant impact on short-term complications and long-term survival. Secondary postoperative complications and modified Masaoka staging III/IV are also risk factors for reduced long-term survival.</p>","PeriodicalId":9148,"journal":{"name":"BMC Pulmonary Medicine","volume":"25 1","pages":"27"},"PeriodicalIF":2.6,"publicationDate":"2025-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11742804/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143000095","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The incremental value of aspartate aminotransferase/alanine aminotransferase ratio combined with CURB-65 in predicting treatment outcomes in hospitalized adult community-acquired pneumonia patients with type 2 diabetes mellitus.","authors":"Huamei Zhou, Xuelei Zhu, Yi Zhang, Wenjuan Xu, Shiqun Li","doi":"10.1186/s12890-025-03488-1","DOIUrl":"10.1186/s12890-025-03488-1","url":null,"abstract":"<p><strong>Background: </strong>The features of community-acquired pneumonia (CAP) patients with type 2 diabetes mellitus (T2DM) differ from those without. This study aims to spot a routinely tested parameter with discriminative, predictive and prognostic value to enhance CURB-65's prognostic accuracy in CAP patients with T2DM.</p><p><strong>Methods: </strong>We retrospectively studied consecutive CAP patients from 2020 to 2021, comparing laboratory parameters between patients with and without T2DM. Receiver operating characteristic (ROC) curve analysis, univariate and multivariate logistic regression were used to identify key parameters. The area under the ROC curve (AUC), Fagan's nomogram, net reclassification improvement (NRI), and integrated discrimination improvement (IDI) evaluated the added predictive accuracy.</p><p><strong>Results: </strong>A total of 720 patients were included, comprising 180 diabetic CAP patients and 540 non-diabetic controls after matching for age, gender, and comorbidities through propensity score matching. In diabetic CAP patients, the aspartate aminotransferase/alanine aminotransferase (AST/ALT) ratio showed the highest AUC (0.676, 95% CI, 0.575-0.776) among laboratory parameters with different distributions between the groups. AST/ALT was also identified as an independent predictor of poor treatment outcome (OR = 3.672, 95% CI, 1.455-9.268, p = 0.006). Adding AST/ALT to CURB-65 slightly increased the AUC, but remarkably enhanced NRI and IDI (AUC, 0.756 vs. 0.782, p = 0.017; continuous NRI, 0.635, 95% CI, 0.304-0.966, p < 0.001; categorical NRI, 0.175, 95% CI, 0.044-0.307, p = 0.009; IDI, 0.043, 95% CI, 0.006-0.080, p = 0.021). An AST/ALT ratio of ≥ 1.625 conferred a 74% post-test probability of poor treatment outcome, while < 1.625 predicted 21%. AST/ALT also predicted outcomes for all the CAP patients enrolled (OR = 1.771, 95% CI, 1.231-2.549, p = 0.002). Predictive accuracy improved after incorporating AST/ALP into CURB-65 in these population (AUC, 0.615 vs. 0.645, p = 0.038; continuous NRI, 0.357, 95% CI, 0.196-0.517, p < 0.001; categorical NRI, 0.264, 95% CI, 0.151-0.376, p < 0.001; IDI, 0.019, 95% CI, 0.008-0.029, p < 0.001).</p><p><strong>Conclusions: </strong>AST/ALT was identified as a discriminative, predictive and prognostic factor for CAP patients with T2DM. The integration of AST/ALT into CURB-65 enhanced outcome prediction for both diabetic and non-diabetic CAP patients.</p>","PeriodicalId":9148,"journal":{"name":"BMC Pulmonary Medicine","volume":"25 1","pages":"26"},"PeriodicalIF":2.6,"publicationDate":"2025-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11742778/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143000183","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}