Multidisciplinary Respiratory Medicine最新文献

Background: Many transcription factors may be involved in the pathogenesis of pulmonary fibrosis (PF). One such factor is PPARG. The PPARG agonist, pioglitazone (PG), has demonstrated general lung protective activity in animal models and is considered a promising therapeutic agent for fibrotic intervention. This study aimed to investigate the effect of PG on the expression of connective tissue remodeling genes in the lungs using bleomycin (BLM)-induced lung fibrosis (BIF).

Methods: The study was conducted on male BALB/c mice. PF was induced by pretreatment with bleomycin sulfate and cyclophosphamide. The mice were randomly divided into 3 groups: the first group was administered BLM at a dose of 0.15 U/kg in 50 µl of sterile saline (0.9% NaCl), and the second group was administered 50 µl of saline. The third group was not induced with pulmonary fibrosis and served as a control group. On the 4th day of the experiment, animals from the first and second groups were randomly divided into animals that received PG orally at a dose of 20 mg/kg or saline (40 µl) for 14 days. 4-hydroxyproline was determined in right lung tissue samples. Gene expression was determined using real-time PCR.

Results: PG administration to BIF mice resulted in a significant reduction and normalization of the total number of BAL cells, fibrosis score, mRNA expression of genes associated with connective tissue - Col1a1 (P=0.0466), Col3a1 (P=0.0053), Mmp2 (P=0.0006), Tgfb2 (P=0.0459), and Tgfb3 (P=0.0017), as well as mRNA of genes regulating lung connective tissue inflammation and fibrosis - Mrc1 (P=0.0263), Edn1 (P=0.0012), Pparg (P=0.0044), Nr1d1 (P=0.0053) and Fn1 (P=0.0125).

Conclusions: PPARG activation by PG alleviates BIF by decreasing collagen deposition, Col1a1 and Col3a1 mRNA expression, remodeling of lung tissue (decreasing Mmp2, Edn1, and Fn1 mRNA), and M2-specific profibrotic macrophage Mrc1 mRNA.

Background: The length of hospital stay (LoS) among COVID-19 patients is influenced by multiple factors. This study aimed to identify factors associated with LoS among deceased Cambodian patients with confirmed SARS-CoV-2 infection.

Methods: We analyzed a total of 106 deceased patients with confirmed SARS-CoV-2 infection reported between March 11 and May 1, 2021, and publicly shared on the Ministry of Health's Facebook page. A zero-inflated Poisson regression model was used to identify factors associated with LoS. Maximum likelihood estimates, and incidence rate ratios (IRRs) were calculated, and model goodness of fit was assessed.

Results: The mean LoS to death was 4.39 days (standard deviation, SD = 5.17). Factors associated with a shorter LoS included critical respiratory symptoms (p = .011), being dead on arrival (p < .0001), advanced age (p = .003), residence in a province (p = .004), presence of multiple chronic conditions (p = .0006), and receiving care at a non-designated COVID-19 treatment facility (p = .005). In contrast, each additional day between SARS-CoV-2 diagnosis and hospital admission was associated with an approximately 9% increase in LoS (95% CI 1.07, 1.10).

Conclusions: Despite substantial efforts by the Cambodian government to control the pandemic, many COVID-19 patients died shortly after hospital admission. The findings highlight important patient characteristics and underscore the need for improved patient education, strengthened healthcare infrastructure, and enhanced public preparedness for future pandemics.

Introduction: Clinical reasoning in medicine is a complex cognitive process that integrates sensory perception, interpretation, and abductive inference to develop diagnostic hypotheses. Despite the rise of artificial intelligence, the patient-clinician encounter remains rooted in semiotics and a probabilistic approach driven by Bayesian updating. In this context, medical knowledge is viewed as context-dependent and subject to continuous revision based on new clinical signs.

Main body: This paper identifies bedside ultrasonography as a transformative "epistemic mediator" that enhances traditional semiotics by uncovering subtle clinical signs often missed by conventional inspection, palpation, percussion, and auscultation. In managing respiratory diseases, ultrasound provides direct, contextualized data that refines the interpretation of findings such as dullness, altered fremitus, and crackles by linking them to specific anatomical correlates. Based on these principles, the AdET-CHEPHEUS initiative proposes a new paradigm for chest physical examination centered on three pillars: 1) Visual inspection; 2) Auscultation integrated with ultrasound; 3) Palpatory ultrasound evaluation Conclusion: By replacing traditional percussion with more informative and reproducible ultrasound-based methods, this model aligns modern technology with classical clinical epistemology. The integration of ultrasound into bedside reasoning represents a vital evolution in chest semiotics, preserving the human element of the diagnostic process while increasing accuracy.

Background: Alpha-1 antitrypsin deficiency is an autosomal, codominant disorder caused by mutations of the SERPINA1 gene. Several mutations have been described associated with the development of pulmonary and/or chronic liver diseases. We report a novel mutation Mangera, identified for the first time in an Italian patient originating from the city of Angera (Varese), Italy.

Case presentation: This case report describes a 64-year-old Italian male, a lifelong non-smoker, diagnosed with severe alpha-1 antitrypsin deficiency (AATD) as composed heterozygous with S allele and a novel mutation named Mangera. The patient presented with exertional dyspnea and had reduced serum AAT levels (0.54 g/L). Pulmonary function tests indicated mild airway obstruction with preserved diffusion capacity, and chest CT scans revealed early centrilobular emphysema and fibrotic changes. Genetic analysis was performed, finding a previously unreported mutation. Despite the severe AAT deficiency, the patient exhibited no significant clinical, radiological, or functional deterioration. Given the absence of disease progression, augmentation therapy was deferred in favor of ongoing annual monitoring.

Conclusions: This case report highlights the necessity of referring patients to specialized centers equipped with the expertise and tools required for precise diagnosis. Furthermore, the identification of the Mangera mutation expands the spectrum of known SERPINA1 variants associated with severe AATD, emphasizing the ongoing need for vigilance and thorough investigation in cases of suspected deficiency.

The Italian National Congress of Imaging in Pulmonology, held in Milan on November 21st, provided a unique educational platform exploring the evolving role of thoracic imaging in respiratory medicine. Organized by the Italian Respiratory Society (SIP-IRS) Imaging Study Group, the congress brought together over 160 participants, including pulmonologists, radiologists, interventional specialists, and early-career professionals, reflecting the essential role of multidisciplinary collaboration in modern respiratory care. Topics included functional imaging approaches to small airway disease in COPD and asthma, multimodal imaging in lung transplantation, the role of CT angiography for haemoptysis management, and radiomics applications for quantifying emphysema patterns and fibrotic changes. The role of imaging in guiding inhaled and biological therapies was explored, alongside a lively debate on thoracic ultrasound for interstitial lung disease screening. Advanced sessions covered medical thoracoscopy techniques, quantitative ultrasound and artificial intelligence in pleural diseases, shape-sensing robotic-assisted bronchoscopy for peripheral nodules, expanding cryobiopsy applications, and imaging's role in monitoring progressive pulmonary fibrosis therapeutics. A distinctive feature was the first "Images in Pulmonology" contest, won by a remarkable case simultaneously depicting lung cancer and new life. This meeting report summarizes key congress highlights and underscores the importance of fostering multidisciplinary collaboration and structured imaging education to bridge the gap between technological capabilities and clinical expertise in respiratory medicine.

Chronic Obstructive Pulmonary Disease (COPD) is a leading cause of global morbidity and mortality, with significant burden in Italy. Prevalence estimates vary by data source: Health Search data indicate a prevalence of 2.7% among adults, whereas population-based analyses report higher estimates of approximately 5.6%. Triple therapy combining a long-acting muscarinic antagonist (LAMA), a long-acting beta2-agonist (LABA), and an inhaled corticosteroid (ICS) has been shown to improve lung function, reduce exacerbations, and potentially decrease mortality in moderate-to-severe COPD. Fixed-dose Single-Inhaler Triple Therapy (SITT) provides practical advantages over Multiple-Inhaler Triple Therapy (MITT), including improved treatment adherence, fewer inhaler technique errors, and comparable safety. This expert opinion review summarizes evidence from randomized controlled trials and real-world studies supporting the clinical, practical, and economic benefits of SITT. While access to SITT in Italy is influenced by regulatory frameworks, optimizing prescription practices and aligning treatment strategies with clinical evidence could enhance continuity of care and patient outcomes. The paper highlights strategies to improve COPD management, reduce treatment discontinuation, and ensure equitable access to effective therapies.

In recent decades lung ultrasound (LUS) has emerged as an invaluable bedside imaging tool for the evaluation of respiratory conditions such as pneumonia, bronchiolitis, pneumothorax, and pleural effusion in pediatric age, thanks to the thin chest wall and absence of rib ossification. Despite its growing application, optimizing technique and interpretation remains crucial for reliable diagnostic performance. The present educational paper provides practical tips and tricks to enhance the accuracy, efficiency, and clinical value of LUS in pediatric patients, focusing on probe selection, patient positioning, scanning technique, common artifacts, and interpretation pitfalls.

Background: Tracheostomy is a commonly performed procedure in patients requiring prolonged mechanical ventilation (MV) in Intensive Care Units (ICUs), including COVID-19-related ARDS. However, limited data exist on the timing and predictors of decannulation.

Aim: To compare time to decannulation between COVID-19 and non-COVID-19 ARDS patients and to identify predictive factors.

Methods: A retrospective study including 96 COVID-19 ARDS and 32 non-COVID-19 ARDS tracheostomized patients admitted to step-down units after ICU stay from March 2020 to May 2021. Clinical, demographic data and comorbidities were analysed as well as predictors for decannulation delay.

Results: Timing of decannulation was similar between the two groups. Multivariate analysis identified limb weakness assessed by the Medical Research Council (MRC) scale, duration of steroids therapy, clinical complications, PaO2/FiO2 ratio and smoking history as independent predictors of decannulation timing.

Conclusions: COVID-19 did not affect timing of decannulation compared to non-COVID-19 ARDS. ICU-acquired weakness, assessed through the MRC scale, was the strongest predictor of delayed decannulation.

Pisa, Italy, November 6th-8th Every year, the Accademia di Ecografia Toracia (AdET), an Italian association focused on highlighting the scien-tific relevance of thoracic ultrasound (TUS) in clinical practice, presents the projects of its researchers from across Italy and beyond, in a National Congress where the results from AdET projects are shared and debated. Hereby we report the abstracts of the works submitted for publication.