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Mashup Score: 23Cardiac MRI in the assessment of chronic thromboembolic pulmonary hypertension and response to treatment - 13 hour(s) ago
Chronic thromboembolic pulmonary disease (CTEPD) arises in patients with prior pulmonary embolism who do not clear the obstructive material from the pulmonary circulation and may experience persistently raised pulmonary pressures (chronic thromboembolic pulmonary hypertension, CTEPH) and right heart failure. CTEPH affects between 1% and 9% of patients following a single episode of pulmonary embolism.1 The diagnosis of CTEPD requires characteristic radiological appearances, at least 3 months of anticoagulation therapy, and the diagnosis of concomitant pulmonary hypertension requires mean pulmonary artery pressure (mPAP)>20 mm Hg and pulmonary vascular resistance (PVR)>2 Wood units with a pulmonary capillary wedge pressure≤15 mm Hg.2 3 The literature included in this review is based on the previous threshold of mPAP>25 mm Hg for the diagnosis of CTEPH4 Surgical pulmonary endarterectomy (PEA) has offered a breakthrough by improving the 3-year survival to 89% vs 70% with medical management
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Mashup Score: 18Unilateral pleural effusion with pulmonary hypertension in sarcoidosis: do not forget the pulmonary veins! - 16 hour(s) ago
A 64-year-old woman presented with exertional dyspnoea and ankle oedema. She had lung biopsy-confirmed sarcoidosis 6 years previously, having initially responded to prednisolone, with clinical stability for several years. Pulmonary function tests (PFTs) showed forced expiratory volume in 1 s, 2 litres; forced vital capacity, 2.5 litres; and carbon monoxide transfer factor, 4.03 (49.2% predicted). Chest radiography showed Scadding stage 4 sarcoidosis with prominent hila and coarse reticulation throughout both lungs. CT showed stable fibrotic features and ground-glass opacification, new right lower lobe interlobular septal thickening and right-sided pleural effusion (figure 1A). Echocardiography suggested severe pulmonary hypertension (PH) (estimated right ventricular (RV) systolic pressure 68 mm Hg) with RV dilatation, with confirmed precapillary haemodynamics on right heart catheterisation. Cardiac MRI revealed abnormal remodelling of the RV (without evidence of cardiac sarcoidosis); c
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Mashup Score: 8Symptom-related screening programme for early detection of chronic thromboembolic pulmonary hypertension after acute pulmonary embolism: the SYSPPE study - 22 hour(s) ago
Background Chronic thromboembolic pulmonary hypertension (CTEPH) is the most severe long-term complication of acute pulmonary embolism (PE). We aimed to evaluate the impact of a symptom screening programme to detect CTEPH in PE survivors. Methods This was a multicentre cohort study of patients diagnosed with acute symptomatic PE between January 2017 and December 2018 in 16 centres in Spain. Patients were contacted by phone 2 years after the index PE diagnosis. Those with dyspnoea corresponding to a New York Heart Association (NYHA)/WHO scale≥II, visited the outpatient clinic for echocardiography and further diagnostic tests including right heart catheterisation (RHC). The primary outcome was the new diagnosis of CTEPH confirmed by RHC. Results Out of 1077 patients with acute PE, 646 were included in the symptom screening. At 2 years, 21.8% (n=141) reported dyspnoea NYHA/WHO scale≥II. Before symptom screening protocol, five patients were diagnosed with CTEPH following routine care. In p
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Mashup Score: 26Lung function trajectories from school age to adulthood and their relationship with markers of cardiovascular disease risk - 3 day(s) ago
Rationale Lung function in early adulthood is associated with subsequent adverse health outcomes. Objectives To ascertain whether stable and reproducible lung function trajectories can be derived in different populations and investigate their association with objective measures of cardiovascular structure and function. Methods Using latent profile modelling, we studied three population-based birth cohorts with repeat spirometry data from childhood into early adulthood to identify trajectories of forced expiratory volume in 1 s (FEV1)/forced vital capacity (FVC). We used multinomial logistic regression models to investigate early-life predictors of the derived trajectories. We then ascertained the extent of the association between the derived FEV1/FVC trajectories and blood pressure and echocardiographic markers of increased cardiovascular risk and stroke in ~3200 participants at age 24 years in one of our cohorts. Results We identified four FEV1/FVC trajectories with strikingly similar
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Mashup Score: 7Singing for lung health in COPD: a multicentre randomised controlled trial of online delivery - 3 day(s) ago
Background Singing for lung health (SLH) is an arts-based breathing control and movement intervention for people with long-term respiratory conditions, intended to improve symptoms and quality of life. Online, remotely delivered programmes might improve accessibility; however, no previous studies have assessed the effectiveness of this approach. Methods We conducted an assessor-blind randomised controlled trial comparing the impact of 12 weeks of once-weekly online SLH sessions against usual care on health-related quality of life, assessed using the RAND 36-Item Short Form Health Survey (SF-36) Mental Health Composite (MHC) and Physical Health Composite (PHC) scores. Results We enrolled 115 people with stable chronic obstructive pulmonary disease (COPD), median (IQR) age 69 (62–74), 56.5% females, 80% prior pulmonary rehabilitation, Medical Research Council dyspnoea scale 4 (3–4), forced expiratory volume in 1 s % predicted 49 (35–63). 50 participants in each arm completed the study. T
Source: bmjopenrespres.bmj.comCategories: General Medicine News, PulmonologyTweet
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Mashup Score: 2
The uniquely lethal nature of the tobacco industry’s products,1 the industry’s environmental impact2 and its incompatibility with human rights3 make the takeover of Vectura, a pharmaceutical company focused on inhaler technology, by tobacco giant Philip Morris International (PMI), extremely unwelcome. The idea that a company which, based on its market share and the global death toll, kills more than a million people every year4 should be allowed to expand into the delivery of healthcare has been widely condemned, including by the British Thoracic Society (BTS) (box 1), the European Respiratory Society5 and the US COPD Foundation, as well as the American Lung Association and American Thoracic Society who referred to the move as ‘reprehensible’.6 Box 1 ### British Thoracic Society Statement on Philip Morris International’s takeover of Vectura Vectura, a company that for over 20 years has worked to treat lung disease, is now part of the tobacco industry. This is inappropriate, unethical a
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Mashup Score: 4Comprehensive analysis of environmental exposure to hazardous trace elements and lung function: a national cross-sectional study - 7 day(s) ago
Background There is growing interest in the joint effects of hazardous trace elements (HTEs) on lung function deficits, but the data are limited. This is a critical research gap given increased global industrialisation. Methods A national cross-sectional study including spirometry was performed among 2112 adults across 11 provinces in China between 2020 and 2021. A total of 27 HTEs were quantified from urine samples. Generalised linear models and quantile-based g-computation were used to explore the individual and joint effects of urinary HTEs on lung function, respectively. Results Overall, there were negative associations between forced expiratory volume in 1 s (FEV1) and urinary arsenic (As) (z-score coefficient, −0.150; 95% CI, −0.262 to –0.038 per 1 ln-unit increase), barium (Ba) (−0.148, 95% CI: −0.258 to –0.039), cadmium (Cd) (−0.132, 95% CI: −0.236 to –0.028), thallium (Tl) (−0.137, 95% CI: −0.257 to –0.018), strontium (Sr) (−0.147, 95% CI: −0.273 to –0.022) and lead (Pb) (−0.1
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Mashup Score: 3Toxic metals and lung health: silent poisons? - 7 day(s) ago
Lady Astor: ‘Sir, if you were my husband , I would put arsenic in your tea!’ Churchill: ‘If I were your husband , I would drink it!’ This apocryphal joke is a reminder that arsenic is a potentially fatal poison. The phrase ‘mad as a hatter’ stems from the historical use of mercury by hatmakers, which could have neurotoxic consequences. Ironically, both these metals were also used therapeutically in the past to treat various diseases including syphilis. Arsenic and mercury, along with lead and cadmium, are often referred to as ‘heavy metals’, although it has been suggested that this term is misleading and should be replaced.1 These four toxic metal pollutants, which have no essential biological function, are established threats to human health,2 especially in low-income and middle-income countries (LMICs) where exposure levels are high. Occupational exposure aside, general population sources of exposure to these toxic metals broadly include the air, soil, food and water. Rapid industria
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Mashup Score: 59Rheumatoid arthritis and idiopathic pulmonary fibrosis: a bidirectional Mendelian randomisation study - 8 day(s) ago
Background A usual interstitial pneumonia (UIP) pattern of lung injury is a key feature of idiopathic pulmonary fibrosis (IPF) and is also observed in up to 40% of individuals with rheumatoid arthritis (RA)-associated interstitial lung disease (RA-ILD). The RA-UIP phenotype could result from either a causal relationship of RA on UIP or vice versa, or from a simple co-occurrence of RA and IPF due to shared demographic, genetic or environmental risk factors. Methods We used two-sample bidirectional Mendelian randomisation (MR) to test the hypothesis of a causal effect of RA on UIP and of UIP on RA, using variants from genome-wide association studies (GWAS) of RA (separately for seropositive (18 019 cases and 991 604 controls) and seronegative (8515 cases and 1 015 471 controls) RA) and of IPF (4125 cases and 20 464 controls) as genetic instruments. Sensitivity analyses were conducted to assess the robustness of the results to violations of the MR assumptions. Findings IPF showed a signif
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Mashup Score: 47Environmental pollutants exposure-derived extracellular vesicles: crucial players in respiratory disorders - 9 day(s) ago
Background Individual exposure to environmental pollutants, as one of the most influential drivers of respiratory disorders, has received considerable attention due to its preventability and controllability. Considering that the extracellular vesicle (EV) was an emerging intercellular communication medium, recent studies have highlighted the crucial role of environmental pollutants derived EVs (EPE-EVs) in respiratory disorders. Methods PubMed and Web of Science were searched from January 2018 to December 2023 for publications with key words of environmental pollutants, respiratory disorders and EVs. Results Environmental pollutants could disrupt airway intercellular communication by indirectly stimulating airway barrier cells to secrete endogenous EVs, or directly transmitting exogenous EVs, mainly by biological pollutants. Mechanistically, EPE-EVs transferred specific contents to modulate biological functions of recipient cells, to induce respiratory inflammation and impair tissue an
Source: thorax.bmj.comCategories: General Medicine News, PulmonologyTweet
State of the art review: Cardiac MRI in the assessment of chronic thromboembolic pulmonary hypertension and response to treatment. https://t.co/7yJCG6Wr9E @jweirmccall https://t.co/wPem1b09FY