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Thorax 07/15/2020 14:02
In October 2019, an Independent Review of Adult Screening Programmes in England was published, authored by Mike Richards.1 Two key recommendations were that targeted screening programmes should be given equal weight to population screening programmes and that there should be a single advisory body covering both population and targeted screening programmes.
Thorax 07/15/2020 14:02
Purpose. Acute respiratory failure (ARF) is a common cause of admission to intensive care units (ICUs). Mucoactive agents are medications that promote mucus clearance and are frequently administered in patients with ARF, despite a lack of evidence to underpin clinical decision making. The aim of this systematic review was to determine if the use of mucoactive agents in patients with ARF improves clinical outcomes. Methods. We searched electronic and grey literature (January 2020). Two reviewers independently screened, selected, extracted data and quality assessed studies. We included trials of adults receiving ventilatory support for ARF and involving at least one mucoactive agent compared with placebo or standard care. Outcomes included dura.
Thorax 07/15/2020 14:02
In 500 children aged ≤10 years after 13-valent pneumococcal conjugate vaccine (PCV)13 immunisation in different schedules, serotypes 19A-specific and 19F-specific immunoglobulin G (IgG) were predicted to persist above 0.35 µg/mL for ≥10 years in all groups, likely due to PCV13-induced memory with natural boosting from residual diseases and colonisation.
Thorax 07/15/2020 14:02
The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic represents an extraordinary medical challenge that has already had massive economic and societal impacts. In contrast to the severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS) coronavirus outbreaks, every respiratory physician and intensivist are likely to encounter patients infected with SARS-CoV-2 and need a good understanding of the management of the associated disease, COVID-19. We are facing the first wave of the SARS-CoV-2 pandemic, but the infectivity of the virus and the lack of population immunity suggest future waves are possible. For this article (summarised in table 1), we have used our recent clinical experience of COVID-
Thorax 07/15/2020 14:02
The past 5 years have seen an explosion of interest in the use of artificial intelligence (AI) and machine learning techniques in medicine. This has been driven by the development of deep neural networks (DNNs)—complex networks residing in silico but loosely modelled on the human brain—that can process complex input data such as a chest radiograph image and output a classification such as ‘normal’ or ‘abnormal’. DNNs are ‘trained’ using large banks of images or other input data that have been assigned the correct labels. DNNs have shown the potential to equal or even surpass the accuracy of human experts in pattern recognition tasks such as interpreting medical images or biosignals. Within respiratory medicine, the main applications of AI a.
Thorax 07/15/2020 14:02
Throughout the COVID-19 pandemic, UK politicians have claimed to "follow the science" – in some cases all the way from Durham to Barnard Castle... In this issue of Thorax the Triumvirate bring you the best science and follow it to some unexpected places: all the way from Manchester (community-based spirometry data) (see page 655) to the Antarctic (in the footsteps of Ernest Shackleton) (see page 693) . Following the science in the footsteps of Ernest Shackleton. One of the important, unanswered questions of the COVID-19 pandemic is: "How many people have had asymptomatic infection?" If past infection does confer some immunity, then a high rate of "silent" infection would mean higher levels of immunity in the population. This in turn might al.
Thorax 07/15/2020 14:02
Introduction. Individuals with chronic lung disease (eg, cystic fibrosis (CF)) often receive antimicrobial therapy including aminoglycosides resulting in ototoxicity. Extended high-frequency audiometry has increased sensitivity for ototoxicity detection, but diagnostic audiometry in a sound-booth is costly, time-consuming and requires a trained audiologist. This cross-sectional study analysed tablet-based audiometry (Shoebox MD) performed by non-audiologists in an outpatient setting, alongside home web-based audiometry (3D Tune-In) to screen for hearing loss in adults with CF. Methods. Hearing was analysed in 126 CF adults using validated questionnaires, a web self-hearing test (0.5 to 4 kHz), tablet (0.25 to 12 kHz) and sound-booth audiometr.
Thorax 07/15/2020 14:02
An 18-year-old man presented to the emergency department of a community hospital with a cough, fever, night sweats and significant weight loss. He recently completed an antibiotic course for a lower respiratory-tract infection. Full blood count revealed a normal total white cell count with eosinophil count of 0.85 x 10 9 /L. C-reactive protein (CRP) was normal but erythrocyte sedimentation rate (ESR) was 100 mm/hour. Chest radiograph demonstrated bilateral perihilar reticulonodular opacification with peripheral sparing (figure 1A). Immunoglobulin E was mildly elevated at 175UI/mL; other immunoglobulin levels, viral and autoantibody panels were normal. High-resolution CT thorax revealed diffuse centrilobular and peribronchovascular ground-gl.
Thorax 07/15/2020 14:02
Introduction. Low-dose CT (LDCT) screening of high-risk smokers reduces lung cancer (LC) specific mortality. Determining screening eligibility using individualised risk may improve screening effectiveness and reduce harm. Here, we compare the performance of two risk prediction models (PLCO M2012 and Liverpool Lung Project model (LLP v2 )) and National Lung Screening Trial (NLST) eligibility criteria in a community-based screening programme. Methods. Ever-smokers aged 55–74, from deprived areas of Manchester, were invited to a Lung Health Check (LHC). Individuals at higher risk (PLCO M2012 score ≥1.51%) were offered annual LDCT screening over two rounds. LLP v2 score was calculated but not used for screening selection; ≥2.5% and ≥5% thresholds.
Thorax 07/15/2020 14:02
Detecting lung cancer using exhaled breath analysis. Volatile organic compounds (VOC) in the breath have been identified as potential biomarkers of lung cancer. Phillips and colleagues (J Breath Res 2019;13:036013) investigated whether a breath VOC biomarker of lung cancer could also predict pulmonary nodules on low-dose chest CT (LDCT). The study enrolled patients undergoing LDCT screening for lung cancer. The initial phase employed an unblinded analysis of the exhaled breath of 301 subjects. Analysis identified a mass ion biomarker, termed mass abnormalities in gaseous ions with imaging correlates (MAGIIC). Cross-referencing with a library of mass spectra, it appeared MAGIIC may be related to metabolic products of oxidative stress. Subsequ.
Thorax 07/15/2020 14:02
Case presentation. A 59-year-old man with a history of encephalopathy in bedridden state since childhood presented to our hospital with a left-sided enlarging chest wall mass of a 2-month duration. On physical examination, his vital signs were as follows: temperature, 35.8°C; pulse rate, 54/min; respiratory rate, 28/min; and blood pressure, 79/39 mm Hg. He displayed a tender, erythematous, fluctuant mass (9 x 8 cm) over the left anterior chest (figure 1A) and tenderness in the left upper quadrant. Moreover, poor dentition was noted. The laboratory studies showed leucocytosis (17.5 x 10 9 /L) with predominant neutrophil count (88%) and elevated C-reactive protein level (164.8 mg/L). Chest radiography revealed an opacification extending from l.
Thorax 07/15/2020 14:02
Cystic fibrosis (CF) is a condition characterised by chronic pulmonary infection and progressive lung damage with those affected requiring frequent course of antibiotics. Pseudomonas aeruginosa is by far the most common chronic pathogen in CF. While measures comprising regular screening for initial onset of P. aeruginosa infection, aggressive therapy for eradication of early carriage and stringent infection control precautions have extended the age of onset, the majority of patients still eventually develop chronic infection. An aminoglycoside combined with a β-lactam antibiotic is the first-line treatment option for patients with P. aeruginosa requiring intravenous antibiotics and therefore most patients with CF will be exposed to intraven.
Thorax 07/15/2020 14:02
Cruise ships, with their unique enclosed environment, have provided valuable insights into the dynamics of viral transmission during the COVID-19 pandemic. On the Diamond Princess cruise ship in Yokohama, Japan, approximately 21% of those on board tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), with 51.7% of these representing asymptomatic infections at the time of testing.1 In this month’s edition of Thorax , Ing et al describe an outbreak on a cruise ship departing Argentina for the Antarctic peninsula with 223 members, all of whom were screened with temperature and symptom check prior to embarkation in mid-March 2020. At day 8, the first member developed symptoms. Despite immediate imposition of cabin is.
Thorax 07/15/2020 14:02
We describe what we believe is the first instance of complete COVID-19 testing of all passengers and crew on an isolated cruise ship during the current COVID-19 pandemic. Of the 217 passengers and crew on board, 128 tested positive for COVID-19 on reverse transcription–PCR (59%). Of the COVID-19-positive patients, 19% (24) were symptomatic; 6.2% (8) required medical evacuation; 3.1% (4) were intubated and ventilated; and the mortality was 0.8% (1). The majority of COVID-19-positive patients were asymptomatic (81%, 104 patients). We conclude that the prevalence of COVID-19 on affected cruise ships is likely to be significantly underestimated, and strategies are needed to assess and monitor all passengers to prevent community transmission aft.
Thorax 07/10/2020 12:59
Background. Thoracic surgery is the optimal treatment for early-stage lung cancer, but there is a high risk of postoperative morbidity. Therefore, it is necessary to evaluate patients’ preoperative general condition and cardiorespiratory capacity to determine the risk of postoperative complications. The objective of this study was to assess whether the stair-climbing test could be used in the preoperative evaluation of lung resection patients to predict postoperative morbidity following thoracic surgery. Methods. We performed a systematic review and a meta-analysis on the association between stair-climbing test result and morbidity/mortality after thoracic surgery. We analysed all articles published until May 2020 in the following databases:
Thorax 07/10/2020 12:59
Patient selection has contributed significantly to improve the incidence of postoperative complications after anatomical lung resection. Stair-climbing test is one of the low technology alternatives available, sometimes underused, to improve this selection. In the current issue, Boujibar and colleagues1 present the first systematic review and meta-analysis assessing stair-climbing test as a tool to predict postoperative complications after lung resection and to determine which patients require further high-technology cardiopulmonary evaluation. Boujibar and colleagues describe the first systematic review and meta-analysis, which addresses the role of the stair-climbing test in predicting the incidence of postoperative complications after ma.
Thorax 07/06/2020 14:40
Background. A variety of maintenance inhaler therapies are available to treat asthma and COPD. Patient-centric treatment choices require understanding patient preferences for the alternative therapies. Methods. A self-completed web-based discrete choice experiment was conducted to elicit patient preferences for inhaler device and medication attributes. Selection of attributes was informed by patient focus groups and literature review. Results. The discrete choice experiment was completed by 810 patients with asthma and 1147 patients with COPD. Patients with asthma most valued decreasing the onset of action from 30 to 5 min, followed by reducing yearly exacerbations from 3 to 1. Patients with COPD most and equally valued decreasing the onset of.
Thorax 07/06/2020 14:40
Patient confidence in their inhaler regimen is essential in the management of asthma and COPD. Inhaler misuse is associated with poorer symptom control, more frequent use of oral corticosteroids and antibiotics for rescue, and more frequent hospitalisations in both COPD and asthma.1 Device designs have expanded to allow for ease of use; each device has its benefits and drawbacks. Metered dose inhalers (MDIs) are pressurised and therefore less reliant on inspiratory effort. Breath-actuated MDIs, while more expensive and limited in range of agents, help to minimise timing errors. Dry powder inhalers also require less coordination but may be less effective with higher degrees of airflow obstruction. Soft mist inhalers offer extremely low resis.
Thorax 06/26/2020 10:07
Bu et al 1 report their findings from using data collected by an established longitudinal study of older people (the English Longitudinal Study of Ageing, ELSA), linked to administrative information, to analyse loneliness, social disengagement and isolation as risk factors for hospital admissions related to respiratory disease.

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