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Thorax 08/13/2020 00:11
Domiciliary non-invasive ventilation (NIV) effectively reduces arterial carbon dioxide pressure (PaCO 2 ) in patients with stable hypercapnic chronic obstructive pulmonary disease, but a consistent percentage of them may remain hypercapnic. We hypothesised that extracorporeal CO 2 removal (ECCO 2 R) may lower their PaCO 2 . Ten patients hypercapnic despite ≥6 months of NIV underwent a 24-hour trial of ECCO 2 R. Six patients completed the ECCO 2 R-trial with a PaCO 2 drop ranging between 23% and 47%. Time to return to baseline after interruption ranged 48–96 hours. In four patients, mechanical events led to ECCO 2 R premature interruption, despite a decreased in PaCO 2 . This time window ‘free’ from hypercapnia might allow to propose the con.
Thorax 08/13/2020 00:11
To evaluate the effectiveness of the Centers for Disease Control and Prevention (CDC) recommended one- and two-layer cloth face covering against a three-ply surgical mask, we challenged the cloth covering against speaking, coughing and sneezing. The one-layer covering was made using ‘quick cut T-shirt face covering (no-sew method)’ and the two-layer covering was prepared using the sew method prescribed by CDC.1 To provide visual evidence of the efficacy of face coverings we used a tailored LED lighting system (GS Vitec MultiLED PT) along with a high-speed camera (nac MEMRECAM HX-7s) to capture the light scattered by droplets and aerosols expelled during speaking, coughing and sneezing while wearing different types of masks (figure 1 and ).
Thorax 08/13/2020 00:11
The Lung Screen Uptake Trial tested a novel invitation strategy to improve uptake and reduce socioeconomic and smoking-related inequalities in lung cancer screening (LCS) participation. It provides one of the first UK-based ‘real-world’ LCS cohorts. Of 2012 invited, 1058 (52.6%) attended a ‘lung health check’. 768/996 (77.1%) in the present analysis underwent a low-dose CT scan. 92 (11.9%) and 33 (4.3%) participants had indeterminate pulmonary nodules requiring 3-month and 12-month surveillance, respectively; 36 lung cancers (4.7%) were diagnosed (median follow-up: 1044 days). 72.2% of lung cancers were stage I/II and 79.4% of non-small cell lung cancer had curative-intent treatment.
Thorax 08/13/2020 00:11
The fibrosing IIPs are characterised by progressive scarring of the alveolar interstitium, which leads to significant morbidity and mortality. Idiopathic pulmonary fibrosis (IPF) is the most common and most severe form of IIP with a median survival of 3 years, limited treatment options and an increasing prevalence. The strongest and most replicated risk factor for IPF is the promoter variant located in a highly conserved region of the genome ~3 kilobases upstream of the airway mucin MUC5B transcription start site.1 The MUC5B variant rs35705950 has a regulatory role and is associated with increased RNA expression in whole lung tissue in IPF and controls.2 In mice, transgenic overexpression of Muc5b leads to increased lung fibrosis and decrea.
Thorax 08/13/2020 00:11
Introduction. Idiopathic pulmonary fibrosis (IPF) is a progressive fibrosing interstitial lung disease of unknown aetiology and cure. Recent studies have reported a dysregulation of exosomal microRNAs (miRs) in the IPF context. However, the impact of IPF-related exosomal miRs on the progression of pulmonary fibrosis is unknown. Methods. Two independent cohorts were enrolled at the ambulatory care polyclinic of Liège University. Exosomes from sputum were obtained from 19 patients with IPF and 23 healthy subjects (HSs) (cohort 1), and the ones from plasma derived from 14 patients with IPF and 14 HSs (cohort 2). Exosomal miR expression was performed by quantitative reverse transcription–PCR. The functional role of exosomal miRs was assessed in v.
Thorax 08/13/2020 00:11
Long-term nocturnal non-invasive ventilation (NIV) is increasingly being applied in patients with chronic obstructive pulmonary disease (COPD) with chronic hypercapnic respiratory failure. Studies that have shown improvement in clinical and patient-related outcome measures have used a mode of ventilation aimed at a substantial reduction in carbon dioxide (CO 2 ) levels.1 Therefore, it might be suggested that CO 2 reduction is a causal factor for improvement in clinical outcomes such as improvement in symptoms, health-related quality of life (HRQoL) and survival. In line with this theory, in the linked paper, Pisani et al present a proof-of-concept study of extracorporeal CO 2 removal (ECCO 2 R) in patients with COPD with chronic hypercapnia.
Thorax 08/13/2020 00:11
Background. Accurate antibody tests are essential to monitor the SARS-CoV-2 pandemic. Lateral flow immunoassays (LFIAs) can deliver testing at scale. However, reported performance varies, and sensitivity analyses have generally been conducted on serum from hospitalised patients. For use in community testing, evaluation of finger-prick self-tests, in non-hospitalised individuals, is required. Methods. Sensitivity analysis was conducted on 276 non-hospitalised participants. All had tested positive for SARS-CoV-2 by reverse transcription PCR and were ≥21 days from symptom onset. In phase I, we evaluated five LFIAs in clinic (with finger prick) and laboratory (with blood and sera) in comparison to (1) PCR-confirmed infection and (2) presence of S.
Thorax 08/13/2020 00:11
Congenital pulmonary airway malformations (CPAMs) are rare lung abnormalities that result in cyst formation and are associated with respiratory distress in infants and malignant potential in adults. The pathogenesis of CPAMs remains unknown but data suggest disruption of the normal proximo-distal programme of airway branching and differentiation. Here, we demonstrate that adult human CPAM are lined with epithelium that retains SOX-2 and thyroid transcription factor-1 immunohistochemical markers, characteristic of the developing lung. However, RALDH-1, another key marker, is absent. This suggests a more complex aetiology for CPAM than complete focal arrest of lung development and may provide insight to the associated risk of malignancy.
Thorax 08/13/2020 00:11
A 65-year-old obese male, with no other comorbidities, was admitted to our intensive care unit for acute respiratory failure due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. The patient was mechanically ventilated (intermittent positive pressure ventilation autoflow mode with tidal volume of 6 mL/kg, positive end expiratory pressure (PEEP) 12 cmH 2 O, respiratory rate 20 breaths/min and fractional inspired oxygen (FiO 2 ) to the lowest level to maintain arterial pO 2 in a range of 55–60 mm Hg) for 7 days before his condition abruptly worsened. He became haemodynamically unstable with changes in the cardiac electrical activity and hypotension unresponsive to catecholamines. An initial plain chest X-ray revealed
Thorax 08/13/2020 00:11
Pregnancy in women with lymphangioleiomyomatosis (LAM) has been associated with increased complications and worsening lung function although objective data to advise patients are not available. We assessed lung function and CT scans before and after pregnancy in 16 women with LAM. During the pregnancy, pneumothorax was frequent and mean forced expiratory volume in 1 s (FEV 1 ) fell from 77%±19% prepregnancy to 64%±25% predicted and DL CO from 66±26 to 57±26 (both p <0.01). After pregnancy, rates of FEV 1 decline were high and 10 patients required sirolimus. Women with LAM, especially with moderate or advanced disease should be counselled regarding adverse events and loss of lung function during the pregnancy.
Thorax 08/13/2020 00:11
Background. Idiopathic pulmonary fibrosis (IPF) is a chronic and progressive lung disease which presents a grave prognosis for diagnosed patients. Nintedanib (a triple tyrosine kinase inhibitor) and pirfenidone (unclear mechanism of action) are the only approved therapies for IPF, but have limited efficacy. The pathogenic mechanisms of this disease are not fully elucidated; however, a role for mast cells (MCs) has been postulated. Objectives. The aim of this work was to investigate a role for MCs in IPF and to understand whether nintedanib or pirfenidone could impact MC function. Methods and results. MCs were significantly elevated in human IPF lung and negatively correlated with baseline lung function (FVC). Importantly, MCs were positively a.
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.

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