BRONCHIAL INFECTION AND temporal evolution OF bronchiectasis in patients with chronic obstructive pulmonary disease.
- 作者列表："Martinez-Garcia MA","de la Rosa-Carrillo D","Soler-Cataluña JJ","Catalan-Serra P","Ballester M","Roca Vanaclocha Y","Agramunt M","Ballestin J","Garcia-Ortega A","Oscullo G","Navarro-Soriano C","Agusti A
BACKGROUND:The prevalence of bronchiectasis (BE) is high in patients with chronic obstructive pulmonary disease (COPD). BE impacts their clinical course and prognosis. Yet, the temporal evolution of BE in these patients is unknown. This study seeks to assess the temporal evolution of BE in COPD patients. METHODS:In 2013 we reported a cohort of 201 COPD patients (GOLD II-IV) recruited between 2004 and 2007. Patients were followed up clinically, at least every 6 months, for a median of 102 (77-116.5) months. To investigate the temporal evolution of BE, in 2015 a second high-resolution computed tomography scan (HRCT) was obtained in survivors and compared with the one obtained at recruitment. RESULTS:Out of the 201 patients initially recruited, 99 (49.3%) died during follow-up. The second HRCT could be obtained in 77 patients (78% of survivors) and showed that: (1) in 27.3% of patients BE never developed, in 36.4% they remained stable, in 16.9% they increased in size and/or extension and in 19.5% new BE emerged; and, (2) the presence of chronic muco-purulent or purulent sputum (HR 2.8 [95%CI:1.3-5.8]), frequency of hospitalization episodes due to exacerbations of COPD (HR 1.2 [95%CI:1.1-1.5]) and number of any potentially pathogenic microorganism (PPM) isolations (HR 1.1 [95%CI:1.02-1.3]) were independent risk factors for the progression of existing BE or the emergence of new ones. CONCLUSIONS:The presence of chronic purulent sputum production, number of PPM isolated in sputum and number of hospitalizations due to exacerbations of COPD are independent, preventable and treatable risk factors of BE progression in patients with COPD.
背景: 在慢性阻塞性肺疾病 (COPD) 患者中，支气管扩张症 (BE) 的患病率较高。BE 影响其临床病程和预后。然而，BE 在这些患者中的时间演变尚不清楚。本研究旨在评估 COPD 患者 BE 的时间演变。 方法: 在 2013 中，我们报告了 201 和 2004年招募的 2007 例 COPD 患者 (GOLD II-IV) 队列。对患者进行临床随访，至少每 6 个月一次，中位随访时间为 102 (77-116.5) 个月。为了研究 BE 的时间演变，2015年在幸存者中获得了第二次高分辨率计算机断层扫描 (HRCT)，并与招募时获得的一次进行了比较。 结果: 在最初招募的 201 例患者中，99 例 (49.3%) 在随访期间死亡。77 例患者 (78% 的幸存者) 可获得第二次 HRCT，结果显示 :( 1) 27.3% 的患者从未发育，36.4% 的患者保持稳定, 在 16.9% 中，它们的大小和/或扩展增加，并在 19.5% 中出现新的 BE; 和，(2)存在慢性黏液脓性或脓性痰 (HR 2.8 [95% CI: 1.3-5.8]), COPD 急性加重导致的住院发作频率 (HR 1.2 [95% CI: 1.1-1.5]) 和任何潜在致病微生物的数量 (PPM) 隔离 (HR 1.1 [95% CI: 1.02-1.3])是现有 BE 进展或新 BE 出现的独立危险因素。 结论: 慢性脓性痰液的产生、痰液中分离的 PPM 数量和 COPD 急性加重导致的住院次数是独立的, COPD 患者 BE 进展的可预防和可治疗的危险因素。
METHODS:Background Dye localization is a useful method for the resection of unidentifiable small pulmonary lesions. This study compares the transbronchial route with augmented fluoroscopic bronchoscopy (AFB) and conventional transthoracic CT-guided methods for preoperative dye localization in thoracoscopic surgery. Methods Between April 2015 and March 2019, a total of 231 patients with small pulmonary lesions who received preoperative dye localization via AFB or percutaneous CT-guided technique were enrolled in the study. A propensity-matched analysis, incorporating preoperative variables, was used to compare localization and surgical outcomes between the two groups. Results After matching, a total of 90 patients in the AFB group ( N = 30) and CT-guided group ( N = 60) were selected for analysis. No significant difference was noted in the demographic data between both the groups. Dye localization was successfully performed in 29 patients (96.7%) and 57 patients (95%) with AFB and CT-guided method, respectively. The localization duration (24.1 ± 8.3 vs. 21.4 ± 12.5 min, p = 0.297) and equivalent dose of radiation exposure (3.1 ± 1.5 vs. 2.5 ± 2.0 mSv, p = 0.130) were comparable in both the groups. No major procedure-related complications occurred in either group; however, a higher rate of pneumothorax (0 vs. 16.7%, p = 0.029) and focal intrapulmonary hemorrhage (3.3 vs. 26.7%, p = 0.008) was noted in the CT-guided group. Conclusion AFB dye marking is an effective alternative for the preoperative localization of small pulmonary lesions, with a lower risk of procedure-related complications than the conventional CT-guided method.
METHODS:Background The use of artificial intelligence, including machine learning, is increasing in medicine. Use of machine learning is rising in the prediction of patient outcomes. Machine learning may also be able to enhance and augment anesthesia clinical procedures such as airway management. In this study, we sought to develop a machine learning algorithm that could classify vocal cords and tracheal airway anatomy real-time during video laryngoscopy or bronchoscopy as well as compare the performance of three novel convolutional networks for detecting vocal cords and tracheal rings. Methods Following institutional approval, a clinical dataset of 775 video laryngoscopy and bronchoscopy videos was used. The dataset was divided into two categories for use for training and testing. We used three convolutional neural networks (CNNs): ResNet, Inception and MobileNet. Backpropagation and a mean squared error loss function were used to assess accuracy as well as minimize bias and variance. Following training, we assessed transferability using the generalization error of the CNN, sensitivity and specificity, average confidence error, outliers, overall confidence percentage, and frames per second for live video feeds. After the training was complete, 22 models using 0 to 25,000 steps were generated and compared. Results The overall confidence of classification for the vocal cords and tracheal rings for ResNet, Inception and MobileNet CNNs were as follows: 0.84, 0.78, and 0.64 for vocal cords, respectively, and 0.69, 0.72, 0.54 for tracheal rings, respectively. Transfer learning following additional training resulted in improved accuracy of ResNet and Inception for identifying the vocal cords (with a confidence of 0.96 and 0.93 respectively). The two best performing CNNs, ResNet and Inception, achieved a specificity of 0.985 and 0.971, respectively, and a sensitivity of 0.865 and 0.892, respectively. Inception was able to process the live video feeds at 10 FPS while ResNet processed at 5 FPS. Both were able to pass a feasibility test of identifying vocal cords and tracheal rings in a video feed. Conclusions We report the development and evaluation of a CNN that can identify and classify airway anatomy in real time. This neural network demonstrates high performance. The availability of artificial intelligence may improve airway management and bronchoscopy by helping to identify key anatomy real time. Thus, potentially improving performance and outcomes during these procedures. Further, this technology may theoretically be extended to the settings of airway pathology or airway management in the hands of experienced providers. The researchers in this study are exploring the performance of this neural network in clinical trials.
METHODS:BACKGROUND:The optimal mode of delivering topical anesthesia during flexible bronchoscopy remains unknown. This article compares the efficacy and safety of nebulized lignocaine, lignocaine oropharyngeal spray, or their combination. METHODS:Consecutive subjects were randomized 1:1:1 to receive nebulized lignocaine (2.5 mL of 4% solution, group A), oropharyngeal spray (10 actuations of 10% lignocaine, group B), or nebulization (2.5 mL, 4% lignocaine) and two actuations of 10% lignocaine spray (group C). The primary outcome was the subject-rated severity of cough according to a visual analog scale. The secondary outcomes included bronchoscopist-rated severity of cough and overall procedural satisfaction on a visual analog scale, total lignocaine dose, subject's willingness to undergo a repeat procedure, adverse reactions to lignocaine, and others. RESULTS:A total of 1,050 subjects (median age, 51 years; 64.8% men) were included. The median (interquartile range) score for subject-rated cough severity was significantly lower in group B compared to group C or group A (4 [1-10] vs 11 [4-24] vs 13 [5-30], respectively; P < .001). The bronchoscopist-rated severity of cough was also the least (P < .001), and the overall satisfaction was highest in group B (P < .001). The cumulative lignocaine dose administered was the least in group B (P < .001). A significantly higher proportion of subjects (P < .001) were willing to undergo a repeat bronchoscopy in group B (73.7%) than in groups A (49.1%) and C (59.4%). No lignocaine-related adverse events were observed. CONCLUSIONS:Ten actuations of 10% lignocaine oropharyngeal spray were superior to nebulized lignocaine or their combination for topical anesthesia during diagnostic flexible bronchoscopy. TRIAL REGISTRY:ClinicalTrials.gov; No.: NCT03109392; URL: www.clinicaltrials.gov.