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1.
Dual-energy CT in pulmonary vascular disease.
Vlahos, I, Jacobsen, MC, Godoy, MC, Stefanidis, K, Layman, RR
The British journal of radiology. 2022;(1129):20210699
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Abstract
Dual-energy CT (DECT) imaging is a technique that extends the capabilities of CT beyond that of established densitometric evaluations. CT pulmonary angiography (CTPA) performed with dual-energy technique benefits from both the availability of low kVp CT data and also the concurrent ability to quantify iodine enhancement in the lung parenchyma. Parenchymal enhancement, presented as pulmonary perfused blood volume maps, may be considered as a surrogate of pulmonary perfusion. These distinct capabilities have led to new opportunities in the evaluation of pulmonary vascular diseases. Dual-energy CTPA offers the potential for improvements in pulmonary emboli detection, diagnostic confidence, and most notably severity stratification. Furthermore, the appreciated insights of pulmonary vascular physiology conferred by DECT have resulted in increased use for the assessment of pulmonary hypertension, with particular utility in the subset of patients with chronic thromboembolic pulmonary hypertension. With the increasing availability of dual energy-capable CT systems, dual energy CTPA is becoming a standard-of-care protocol for CTPA acquisition in acute PE. Furthermore, qualitative and quantitative pulmonary vascular DECT data heralds promise for the technique as a "one-stop shop" for diagnosis and surveillance assessment in patients with pulmonary hypertension. This review explores the current application, clinical value, and limitations of DECT imaging in acute and chronic pulmonary vascular conditions. It should be noted that certain manufacturers and investigators prefer alternative terms, such as spectral or multi-energy CT imaging. In this review, the term dual energy is utilised, although readers can consider these terms synonymous for purposes of the principles explained.
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Nutritional Risk Index: A Predictive Metric for Mortality After Lung Transplant.
Bigelow, B, Toci, G, Etchill, E, Krishnan, A, Merlo, C, Bush, EL
The Annals of thoracic surgery. 2021;(1):214-220
Abstract
BACKGROUND Malnourishment is associated with poor outcomes after lung transplantation. Validated screening tools for patients awaiting lung transplants are needed. We assessed the association of the Nutritional Risk Index (NRI) with outcomes after lung transplantation. METHODS We categorized adult patients (aged more than 18 years) undergoing incident lung transplantation in the Scientific Registry of Transplant Recipients between 2005 and 2018 (n = 13,392) according to NRI categories of malnutrition: none, 100 or greater; mild, 97.5 to 100 or less; moderate, 83.5 to 97.5 or less; and severe, less than 83.5. We used Cox models to characterize the association of NRI categories with all-cause mortality within 5 years, graft failure within 1 year, and length of stay. In a subset of patients (n = 11,634), we used logistic regression to assess the association of NRI with airway dehiscence, reintubation, and chest tube placement. RESULTS Of the 13,392 lung transplant recipients (mean age 55 years; 58.6% male) in the study, the most common indication for transplant was idiopathic pulmonary fibrosis (36.2%), followed by chronic obstructive pulmonary disease (27.3%), and cystic fibrosis (12.6%). Based on the NRI, 54.4% were non-malnourished, 12.4% mildly, 25.9% moderately, and 7.2% severely malnourished. Five-year mortality was higher among patients with severe malnutrition (44.6%) compared with patients who were non-malnourished (38.9%). Severe malnourishment remained significantly associated with higher mortality risk, with adjustment for covariates (hazard ratio 1.47; 95% confidence interval, 1.26 to 1.58). The length of stay was significantly longer among patients with severe malnutrition (median 15 days) compared with non-malnourished recipients (median 18 days). This difference persisted after adjustment for covariates (severe malnutrition hazard ratio 0.85; 95% confidence interval, 0.79 to 0.91). CONCLUSIONS The NRI before transplant is an independent predictor of postoperative mortality and morbidity among lung transplant patients.
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3.
Extraesophageal syndrome of gastroesophageal reflux: relationships with lung disease and transplantation outcome.
Chan, WW, Ahuja, N, Fisichella, PM, Gavini, S, Rangan, V, Vela, MF
Annals of the New York Academy of Sciences. 2020;(1):95-105
Abstract
Gastroesophageal reflux disease (GERD) is prevalent and may be associated with both esophageal and extraesophageal syndromes, which include various pulmonary conditions. GERD may lead to pulmonary complications through the "reflux" (aspiration) or "reflex" (refluxate-triggered, vagally mediated airway spasm) mechanisms. While GERD may cause or worsen pulmonary disorders, changes in respiratory mechanics due to lung disease may also increase reflux. Typical esophageal symptoms are frequently absent and objective assessment with reflux monitoring is often needed for diagnosis. Impedance monitoring should be considered in addition to traditional pH study due to the involvement of both acidic and weakly acidic/nonacidic reflux. Antireflux therapy may improve outcomes of some pulmonary complications of GERD, although careful selection of a candidate is paramount to successful outcomes. Further research is needed to identify the optimal testing strategy and patient phenotypes that would benefit from antireflux therapy to improve pulmonary outcomes.
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Current and Future Applications of Thoracic Dual-Energy CT in Children: Pearls and Pitfalls of Technique and Interpretation.
Rapp, JB, Biko, DM, Barrera, CA, Kaplan, SL, Otero, HJ
Seminars in ultrasound, CT, and MR. 2020;(5):433-441
Abstract
Dual-energy computer tomography (DECT) technology has experienced rapid growth in recent years, now allowing for the collection of 2 CT data sets and opening the potential for functional data acquisition. Data from a single postcontrast phase are deconstructed and Iodine can be subtracted to create a virtual noncontrast image, or selectively represented as a contrast map that allows for the qualification and quantification of lung perfusion. Virtual monoenergetic images can also be used to reduce beam-hardening artifact from concentrated contrast or metal implants. In children, DECT is of particular interest because it has been shown to be dose neutral in most applications, dose-reducing in multiphase studies, and to increase the contrast to noise ratio in suboptimal studies. We review the basics of acquisition, postprocessing, and thoracic applications of DECT with a focus on pulmonary blood volumes as a surrogate for perfusion imaging. The discussed applications include pulmonary embolism, hypoplastic lung, pulmonary hypertension in bronchopulmonary dysplasia, and pediatric lung masses.
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[Pulmonary rehabilitation in the in-hospital and outpatient phases].
Carvajal Tello, N, Segura Ordoñez, A, Arias Balanta, AJ
Rehabilitacion. 2020;(3):191-199
Abstract
Pulmonary rehabilitation programmes aim to improve aerobic capacity and enhance quality of life in patients with chronic pulmonary disease, facilitating their participation and integration in different areas and activities of daily living, through the prescription and performance of physical exercise, as well as education on risk factors and healthy living. In multidisciplinary processes, various health professionals work together to support patients through the rehabilitation process, guiding lifestyle changes to improve their level of physical activity, nutritional factors, smoking cessation, diabetes management, medication adherence and weight loss, based on theories of behavioural change. The main objective of pulmonary rehabilitation programmes is to empower users in self-care and facilitate long-term management of chronic lung disease.
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Molecular Mechanisms of Ferroptosis and Its Role in Pulmonary Disease.
Tao, N, Li, K, Liu, J
Oxidative medicine and cellular longevity. 2020;:9547127
Abstract
Ferroptosis is a new mode of cell death that is characterized by the excessive accumulation of iron and lipid peroxides. It has unique morphological changes and disparate biochemical features and plays an intricate role in many pathophysiological processes. A great deal of researches confirms that ferroptosis can be regulated by numerous molecules through different mechanisms, supporting great potentials for novel pharmacological therapeutics. Recently, several studies reveal that ferroptosis is also closely associated with the initiation and development of respiratory disease. Understanding the specific mechanism, the molecular trait of ferroptosis and their relationship with pulmonary disease could provide significant references regarding effective treatment of these obstinate disease.
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Interaction of diet and drugs in lung disease.
Semen, KO, Yelisyeyeva, OP, Bast, A
Current opinion in pulmonary medicine. 2020;(4):359-362
Abstract
PURPOSE OF REVIEW The current review aims to seek attention for the interaction between drugs and nutrition. Traditionally, drugs and nutrition are regarded as separate categories. Nutrition is to maintain health and drugs are for curing disease. Dieticians deal with food and the medical doctor prescribes drugs. During the last decade, both categories are getting closer. RECENT FINDINGS Some drugs used in pulmonology lead to decrease in nutrients. Other drugs negatively affect taste. This is remarkable because the diseases for which these drugs are intended, benefit from nutrition. Gradually examples emerge that suggest that the action of drugs profit from certain dietary components. SUMMARY A closer look into the interaction between diet and drugs will eventually benefit the patient.
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Behaviour change techniques to optimise participation in physical activity or exercise in adolescents and young adults with chronic cardiorespiratory conditions: a systematic review.
Sawyer, A, Lewthwaite, H, Gucciardi, DF, Hill, K, Jenkins, S, Cavalheri, V
Internal medicine journal. 2019;(10):1209-1220
Abstract
Participation in regular physical activity decreases the risk of developing cardiometabolic disease. However, the proportion of people who participate in the recommended amount of physical activity is low, with common barriers including competing interests and inclement weather. In people with chronic cardiorespiratory conditions, participation in physical activity is reduced further by disease-specific barriers, time burden of treatment and unpleasant symptoms during physical activity. Addressing these barriers during adolescence and early adulthood may promote greater physical activity participation into older age. The aim of this review was to classify interventions aimed at optimising participation in physical activity as 'promising' or 'not promising' in people aged 15-45 years with chronic cardiorespiratory conditions and categorise the behaviour change techniques (BCT) within these interventions. Nine databases and registries were searched (October 2017) for studies that reported objective measures of physical activity before and after an intervention period. Interventions were classified as 'promising' if a between-group difference in physical activity was demonstrated. Michie et al.'s (2013) v1 Taxonomy was used to unpack the BCT within interventions. Across the six included studies (n = 396 participants), 19 (20%) of 93 BCT were described. The interventions of three studies were classified as 'promising'. The most commonly used BCT comprised goal setting, action planning and social support. Five BCT were solely used in 'promising' interventions. Our review demonstrated that only 20% of BCT have been utilised, and those BCT that were used only in 'promising' physical activity interventions in adolescents and adults with chronic cardiorespiratory conditions were isolated.
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9.
Deep Learning Applications in Chest Radiography and Computed Tomography: Current State of the Art.
Lee, SM, Seo, JB, Yun, J, Cho, YH, Vogel-Claussen, J, Schiebler, ML, Gefter, WB, van Beek, EJR, Goo, JM, Lee, KS, et al
Journal of thoracic imaging. 2019;(2):75-85
Abstract
Deep learning is a genre of machine learning that allows computational models to learn representations of data with multiple levels of abstraction using numerous processing layers. A distinctive feature of deep learning, compared with conventional machine learning methods, is that it can generate appropriate models for tasks directly from the raw data, removing the need for human-led feature extraction. Medical images are particularly suited for deep learning applications. Deep learning techniques have already demonstrated high performance in the detection of diabetic retinopathy on fundoscopic images and metastatic breast cancer cells on pathologic images. In radiology, deep learning has the opportunity to provide improved accuracy of image interpretation and diagnosis. Many groups are exploring the possibility of using deep learning-based applications to solve unmet clinical needs. In chest imaging, there has been a large effort to develop and apply computer-aided detection systems for the detection of lung nodules on chest radiographs and chest computed tomography. The essential limitation to computer-aided detection is an inability to learn from new information. To overcome these deficiencies, many groups have turned to deep learning approaches with promising results. In addition to nodule detection, interstitial lung disease recognition, lesion segmentation, diagnosis and patient outcomes have been addressed by deep learning approaches. The purpose of this review article was to cover the current state of the art for deep learning approaches and its limitations, and some of the potential impact on the field of radiology, with specific reference to chest imaging.
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10.
ERS statement on standardisation of cardiopulmonary exercise testing in chronic lung diseases.
Radtke, T, Crook, S, Kaltsakas, G, Louvaris, Z, Berton, D, Urquhart, DS, Kampouras, A, Rabinovich, RA, Verges, S, Kontopidis, D, et al
European respiratory review : an official journal of the European Respiratory Society. 2019;(154)
Abstract
The objective of this document was to standardise published cardiopulmonary exercise testing (CPET) protocols for improved interpretation in clinical settings and multicentre research projects. This document: 1) summarises the protocols and procedures used in published studies focusing on incremental CPET in chronic lung conditions; 2) presents standard incremental protocols for CPET on a stationary cycle ergometer and a treadmill; and 3) provides patients' perspectives on CPET obtained through an online survey supported by the European Lung Foundation. We systematically reviewed published studies obtained from EMBASE, Medline, Scopus, Web of Science and the Cochrane Library from inception to January 2017. Of 7914 identified studies, 595 studies with 26 523 subjects were included. The literature supports a test protocol with a resting phase lasting at least 3 min, a 3-min unloaded phase, and an 8- to 12-min incremental phase with work rate increased linearly at least every minute, followed by a recovery phase of at least 2-3 min. Patients responding to the survey (n=295) perceived CPET as highly beneficial for their diagnostic assessment and informed the Task Force consensus. Future research should focus on the individualised estimation of optimal work rate increments across different lung diseases, and the collection of robust normative data.