Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 70
Filtrar
1.
ERJ Open Res ; 10(4)2024 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-39286056

RESUMO

Exhaled breath analysis, utilising VOCs, offers promise in identifying SSc-ILD patients, aiding targeted treatment. Further multicentric studies are crucial for validation and exploring longitudinal VOC changes for comprehensive disease management. https://bit.ly/4aKMYif.

2.
Sci Immunol ; 9(98): eado1227, 2024 Aug 02.
Artigo em Inglês | MEDLINE | ID: mdl-39093958

RESUMO

The lung is constantly exposed to airborne pathogens and particles that can cause alveolar damage. Hence, appropriate repair responses are essential for gas exchange and life. Here, we deciphered the spatiotemporal trajectory and function of an atypical population of macrophages after lung injury. Post-influenza A virus (IAV) infection, short-lived monocyte-derived Ly6G-expressing macrophages (Ly6G+ Macs) were recruited to the alveoli of lung perilesional areas. Ly6G+ Macs engulfed immune cells, exhibited a high metabolic potential, and clustered with alveolar type 2 epithelial cells (AT2s) in zones of active epithelial regeneration. Ly6G+ Macs were partially dependent on granulocyte-macrophage colony-stimulating factor and interleukin-4 receptor signaling and were essential for AT2-dependent alveolar regeneration. Similar macrophages were recruited in other models of injury and in the airspaces of lungs from patients with suspected pneumonia. This study identifies perilesional alveolar Ly6G+ Macs as a spatially restricted, short-lived macrophage subset promoting epithelial regeneration postinjury, thus representing an attractive therapeutic target for treating lung damage.


Assuntos
Antígenos Ly , Lesão Pulmonar , Macrófagos Alveolares , Camundongos Endogâmicos C57BL , Regeneração , Animais , Antígenos Ly/metabolismo , Antígenos Ly/imunologia , Camundongos , Regeneração/imunologia , Lesão Pulmonar/imunologia , Macrófagos Alveolares/imunologia , Masculino , Humanos , Feminino , Infecções por Orthomyxoviridae/imunologia , Alvéolos Pulmonares/imunologia , Vírus da Influenza A/imunologia , Vírus da Influenza A/fisiologia
3.
Medicine (Baltimore) ; 103(29): e39028, 2024 Jul 19.
Artigo em Inglês | MEDLINE | ID: mdl-39029011

RESUMO

Broncho-alveolar lavage (BAL) is indicated in cases of uncertain diagnosis but high suspicion of Sars-Cov-2 infection allowing to collect material for microbiological culture to define the presence of coinfection or super-infection. This prospective study investigated the correlation between chest computed tomography (CT) findings, Covid-19 Reporting and Data System score, and clinical outcomes in Coronavirus disease 2019 (Covid-19) patients who underwent BAL with the aim of predicting outcomes such as lung coinfection, respiratory failure, and hospitalization length based on chest CT abnormalities. Study population included 34 patients (range 38-90 years old; 20 males, 14 females) with a positive nucleic acid amplification test for Covid-19 infection, suitable BAL examination, and good quality chest CT scan in the absence of lung cancer history. Pulmonary coinfections were found in 20.6% of patients, predominantly caused by bacteria. Specific correlations were found between right middle lobe involvement and pulmonary co-infections. Severe lung injury (PaO2/FiO2 ratio of 100-200) was associated with substantial involvement of right middle, right upper, and left lower lobes. No significant correlation was found between chest CT findings and inflammatory markers (C-reactive protein, procalcitonin) or hospitalization length of stay. Specific chest CT patterns, especially in right middle lobe, could serve as indicators for the presence of co-infections and disease severity in noncritically ill Covid-19 patients, aiding clinicians in timely interventions and personalized treatment strategies.


Assuntos
COVID-19 , Tomografia Computadorizada por Raios X , Humanos , COVID-19/complicações , COVID-19/diagnóstico por imagem , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Adulto , Tomografia Computadorizada por Raios X/métodos , Idoso de 80 Anos ou mais , Estudos Prospectivos , Lavagem Broncoalveolar/métodos , SARS-CoV-2 , Coinfecção , Pulmão/diagnóstico por imagem , Unidades de Terapia Intensiva/estatística & dados numéricos
4.
Autoimmun Rev ; 23(6): 103582, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-39074630

RESUMO

BACKGROUND: The early detection and management of (progressive) interstitial lung disease in patients with connective tissue diseases requires the attention and skills of a multidisciplinary team. However, there are currently no well-established standards to guide the daily practice of physicians treating this heterogenous group of diseases. RESEARCH QUESTION: This paper aimed to identify gaps in scientific knowledge along the journey of patients with connective tissue disease-related interstitial lung disease and to provide tools for earlier identification of interstitial lung disease and progressive disease. STUDY DESIGN AND METHODS: The opinions of an international expert panel, which consisted of pulmonologists and rheumatologists were collected and interpreted in the light of peer-reviewed data. RESULTS: Interstitial lung disease is a common complication of connective tissue diseases, but prevalence estimates vary by subtype. Screening and monitoring by means of clinical examination, chest radiography, pulmonary function testing, and disease-specific biomarkers provide insight into the disease activity of patients presenting with connective tissue diseases in a routine setting. Multiple phenotypic and genotypic characteristics have been identified as predictors of the development and progression of interstitial lung disease. However, these risk factors differ between subtypes. To ensure earlier diagnosis of rapidly progressive phenotypes, a risk-based method is necessary for determining the need for HRCT and additional testing. INTERPRETATION: To reduce the underdiagnosis of CTD-ILDs in clinical practice, a standardized and systematic multidisciplinary risk-based approach is suggested. Collaboration across disciplines is essential for the management of CTD-ILD.


Assuntos
Doenças do Tecido Conjuntivo , Diagnóstico Precoce , Doenças Pulmonares Intersticiais , Doenças Pulmonares Intersticiais/diagnóstico , Doenças Pulmonares Intersticiais/etiologia , Doenças Pulmonares Intersticiais/complicações , Humanos , Doenças do Tecido Conjuntivo/diagnóstico , Doenças do Tecido Conjuntivo/complicações , Progressão da Doença , Guias de Prática Clínica como Assunto , Biomarcadores
5.
ERJ Open Res ; 10(2)2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-38529351

RESUMO

This article summarises a selection of scientific highlights in the field of interstitial lung diseases (ILDs) presented at the International Congress of the European Respiratory Society in 2023. Translational and clinical studies focused on the whole spectrum of ILDs, from (ultra)rare ILDs to sarcoidosis, ILDs associated with connective tissue disease and idiopathic pulmonary fibrosis. The main topics of the 2023 Congress presentations were improving the diagnostic process of ILDs, better prediction of disease course and investigation of novel treatment options.

6.
ERJ Open Res ; 10(1)2024 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-38410705

RESUMO

Pulmonary vascular diseases such as pulmonary embolism and pulmonary hypertension are important and frequently under-recognised conditions. This article provides an overview of key highlights in pulmonary vascular diseases from the European Respiratory Society International Congress 2023. This includes insights into disease modification in pulmonary arterial hypertension and novel therapies such as sotatercept and seralutinib. Exciting developments in our understanding of the mechanisms underpinning pulmonary hypertension associated with interstitial lung disease are also explored. A comprehensive overview of the complex relationship between acute pulmonary embolism and chronic thromboembolic pulmonary hypertension (CTEPH) is provided along with our current understanding of the molecular determinants of CTEPH. The importance of multidisciplinary and holistic care cannot be understated, and this article also addresses advances beyond medication, with a special focus on exercise training and rehabilitation.

7.
Front Med (Lausanne) ; 11: 1259570, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38371516

RESUMO

Diagnosing COVID-19 and treating its complications remains a challenge. This review reflects the perspective of some of the Dragon (IMI 2-call 21, #101005122) research consortium collaborators on the utility of bronchoalveolar lavage (BAL) in COVID-19. BAL has been proposed as a potentially useful diagnostic tool to increase COVID-19 diagnosis sensitivity. In both critically ill and non-critically ill COVID-19 patients, BAL has a relevant role in detecting other infections or supporting alternative diagnoses and can change management decisions in up to two-thirds of patients. BAL is used to guide steroid and immunosuppressive treatment and to narrow or discontinue antibiotic treatment, reducing the use of unnecessary broad antibiotics. Moreover, cellular analysis and novel multi-omics techniques on BAL are of critical importance for understanding the microenvironment and interaction between epithelial cells and immunity, revealing novel potential prognostic and therapeutic targets. The BAL technique has been described as safe for both patients and healthcare workers in more than a thousand procedures reported to date in the literature. Based on these preliminary studies, we recognize that BAL is a feasible procedure in COVID-19 known or suspected cases, useful to properly guide patient management, and has great potential for research.

8.
Respirology ; 29(4): 304-311, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38123492

RESUMO

BACKGROUND AND OBJECTIVE: Real-life data on suspected familial fibrosis, defined as the occurrence of the disease in a patient younger than 50 and/or having at least one relative affected by pulmonary fibrosis remain scarce. METHODS: The Belgian and Luxembourg IPF registry (PROOF-Next) is a multicentric prospective longitudinal and observational study set in Belgium and Luxembourg. We compared characteristics and clinical course of patients with suspected familial pulmonary fibrosis (FPF) and sporadic IPF. RESULTS: We included 618 patients in the analysis, of whom 76 (12%) fulfilled criteria for FPF. They were significantly younger than sIPF (median age (range) 65 (43-87), vs. 72 (51-98), p = 0.0001). Male gender proportion and smoking status did not differ between groups, but the number of pack-year among current and former smokers was lower in FPF (20 vs. 25, p = 0.02). Besides, 87% of FPF and 76% of sIPF were treated with antifibrotic (p = 0.047). Baseline pulmonary function tests were similar in both groups, as well as median time before progression and transplant-free survival. Finally, genetic testing, performed in a minority, led to the identification of 10 telomerase-related gene variants. CONCLUSION: Although younger and exposed to less tobacco, patients with FPF show an equally aggressive progression as observed in sporadic IPF patients. These results warrant early referral of FPF patients to expert centres for optimal management.


Assuntos
Fibrose Pulmonar Idiopática , Humanos , Masculino , Estudos Prospectivos , Fibrose Pulmonar Idiopática/epidemiologia , Fibrose Pulmonar Idiopática/genética , Fibrose Pulmonar Idiopática/tratamento farmacológico , Testes de Função Respiratória , Sistema de Registros , Progressão da Doença
9.
Rev Med Liege ; 78(11): 641-648, 2023 Nov.
Artigo em Francês | MEDLINE | ID: mdl-37955294

RESUMO

Rheumatoid arthritis is a chronic inflammatory systemic disease. Pulmonary manifestations are the most common extra-articular involvements and can impact all components of the respiratory system: parenchyma, pleura, vessels and airways, all complications that are briefly described in this article. Interstitial lung disease is the most common of these and is associated with significant morbidity and mortality. Its detection and monitoring are based on spirometry and thoracic imaging. Specific treatments are initiated in order to reduce the risk of disease flare up but may themselves in case of toxicity be associated with respiratory manifestations, either directly or by promoting infectious complications.


La polyarthrite rhumatoïde est une pathologie systémique inflammatoire chronique. Les manifestations pulmonaires représentent l'atteinte extra-articulaire la plus fréquente et peuvent affecter tous les composants du système respiratoire : le parenchyme, la plèvre, les vaisseaux et les voies aériennes, complications décrites brièvement dans cet article. La pneumopathie interstitielle diffuse en est la plus commune et associée à une morbi-mortalité importante. Son dépistage et son suivi reposent sur les épreuves fonctionnelles et l'imagerie thoracique. Des traitements spécifiques sont initiés afin de limiter au mieux l'évolution pulmonaire, mais peuvent eux-mêmes être associés à des manifestations respiratoires, soit directement, soit en favorisant des complications infectieuses.


Assuntos
Artrite Reumatoide , Doenças Pulmonares Intersticiais , Pneumopatias , Humanos , Pneumopatias/etiologia , Pneumopatias/complicações , Artrite Reumatoide/complicações , Doenças Pulmonares Intersticiais/diagnóstico , Doenças Pulmonares Intersticiais/etiologia , Doenças Pulmonares Intersticiais/terapia
12.
Rev Med Liege ; 78(7-8): 441-447, 2023 Jul.
Artigo em Francês | MEDLINE | ID: mdl-37560958

RESUMO

Dermatomyositis is a rare disease of unknown etiology characterized by a severe inflammatory myopathy associated with a cutaneous syndrome. Dermatomyositis is associated with multisystemic disorders mostly represented by cardiac, pulmonary and articular involvements, which are particularly associated with a bad prognosis. We report a case of a 50-year-old patient suffering from dermatomyositis associated with an interstitial lung disease with a particularly fast and pejorative clinical evolution. The anti-Melanoma Differentiation-Associated gene 5 (anti-MDA5) antibodies are frequently associated with a severe and rapidly progressive lung disease without myositis named «amyopathic dermatomyositis¼. High blood levels of anti-MDA5 were found in our patient. Despite maximal immunosuppressive treatment and supportive care, he died 3 months after the diagnosis. Patients may present different antibodies that correspond to distinct clinical phenotypes of dermatomyositis. The anti-MDA5 is known to be a marker of clinically amyopathic dermatomyositis (CADM) associated with a rapidly progressive interstitial lung disease. Moreover, blood level of anti-MDA5 antibody predicts the response to treatment and survival in CADM.


La dermatomyosite est une maladie rare, d'étiologie inconnue, caractérisée par une myopathie inflammatoire associée à un syndrome cutané typique. Outre l'atteinte musculaire et cutanée, la dermatomyosite peut se manifester par des atteintes organiques, notamment pulmonaires, cardiaques et articulaires qui contribuent à la sévérité de la maladie. Nous rapportons le cas d'un patient âgé de 50 ans atteint d'une dermatomyosite compliquée d'une pneumopathie interstitielle d'évolution clinique particulièrement rapide et péjorative. Le patient présentait des anticorps anti-MDA5 (anti-Melanoma Differentiation-Associated gene 5), anticorps associés assez fréquemment à une atteinte pulmonaire sévère et rapidement progressive, ainsi qu'à une présentation particulière de la maladie appelée «dermatomyosite amyopathique¼. Malgré un traitement immunosuppresseur intensif, l'état pulmonaire du patient s'est rapidement aggravé, entraînant son décès par insuffisance respiratoire trois mois après le diagnostic. Cette histoire clinique illustre le fait que les patients atteints de dermatomyosite peuvent présenter différents anticorps qui correspondent à des phénotypes cliniques distincts. L'association entre anticorps anti-MDA5 et la pathologie pulmonaire interstitielle justifie qu'un screening des anticorps anti-MDA5 soit réalisé chez les patients porteurs d'une dermatomyosite. De plus, le titrage sanguin des anti-MDA5 est un facteur pronostique de la réponse au traitement et de la survie.


Assuntos
Dermatomiosite , Doenças Pulmonares Intersticiais , Miosite , Masculino , Humanos , Dermatomiosite/complicações , Dermatomiosite/diagnóstico , Dermatomiosite/tratamento farmacológico , Autoanticorpos/uso terapêutico , Helicase IFIH1 Induzida por Interferon , Miosite/complicações , Doenças Pulmonares Intersticiais/etiologia , Doenças Pulmonares Intersticiais/complicações
13.
Rev Med Liege ; 78(5-6): 299-304, 2023 May.
Artigo em Francês | MEDLINE | ID: mdl-37350206

RESUMO

Some individuals who have been infected with SARS-CoV-2 can experience long-term effects from their infection, known as post-COVID conditions, post-acute sequelae of COVID-19 or long COVID. Different underlying mechanisms can lead to long COVID, none of which are mutually exclusive. Lingering symptoms can persist years after SARS-CoV-2 infection, including fatigue, muscle weakness, tachycardia, dyspnea and various neurological symptoms. The symptomatology is partly similar to that reported by people with chronic fatigue syndrome and other unwell studied long-lasting diseases that may occur after other infections. People who have experienced more severe COVID-19 illness are at higher risk of developing long COVID, although anyone who was infected can experience post-COVID conditions. Importantly, unvaccinated individuals are more likely to develop long COVID. Here we review the current knowledge and discuss key findings regarding the epidemiology and physiopathology of long COVID. We briefly review current diagnostic and treatment options that remain so far largely insufficient.


Certains individus infectés par le SARS-CoV-2 peuvent présenter des symptômes à long terme, évoluant parfois durant plusieurs années. Il est alors question d'affection post-COVID-19 ou COVID long. Les symptômes sont très polymorphes, fluctuants, et comprennent, notamment, une fatigue intense, des douleurs articulaires et musculaires, de la dyspnée, de la tachycardie, ainsi qu'une constellation de plaintes neurologiques. Cette symptomatologie est, en partie, similaire à celle du syndrome de fatigue chronique et est retrouvée également après d'autres types d'infections. Les mécanismes à l'origine du COVID long sont probablement multiples et encore mal connus. Si le COVID long peut toucher tout individu infecté par le SARS-CoV-2, certains groupes sont plus à risque, notamment les personnes non vaccinées ou les individus ayant présenté une infection sévère. Dans cet article, nous résumons les connaissances actuelles et mettons en lumière les découvertes clés quant à l'épidémiologie et aux mécanismes physiopathologiques du COVID long. Nous discutons aussi des critères diagnostiques et des options thérapeutiques qui sont, à ce jour, largement insuffisantes.


Assuntos
COVID-19 , Síndrome de Fadiga Crônica , Humanos , Síndrome de COVID-19 Pós-Aguda , Síndrome de Fadiga Crônica/diagnóstico , Síndrome de Fadiga Crônica/epidemiologia , Síndrome de Fadiga Crônica/etiologia , COVID-19/complicações , SARS-CoV-2 , Dor
14.
Sci Rep ; 13(1): 7198, 2023 05 03.
Artigo em Inglês | MEDLINE | ID: mdl-37137947

RESUMO

The paper deals with the evaluation of the performance of an existing and previously validated CT based radiomic signature, developed in oropharyngeal cancer to predict human papillomavirus (HPV) status, in the context of anal cancer. For the validation in anal cancer, a dataset of 59 patients coming from two different centers was collected. The primary endpoint was HPV status according to p16 immunohistochemistry. Predefined statistical tests were performed to evaluate the performance of the model. The AUC obtained here in anal cancer is 0.68 [95% CI (0.32-1.00)] with F1 score of 0.78. This signature is TRIPOD level 4 (57%) with an RQS of 61%. This study provides proof of concept that this radiomic signature has the potential to identify a clinically relevant molecular phenotype (i.e., the HPV-ness) across multiple cancers and demonstrates potential for this radiomic signature as a CT imaging biomarker of p16 status.


Assuntos
Neoplasias do Ânus , Neoplasias Orofaríngeas , Infecções por Papillomavirus , Humanos , Papillomavirus Humano , Prognóstico , Neoplasias do Ânus/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Estudos Retrospectivos
15.
PLoS One ; 18(5): e0285121, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37130128

RESUMO

BACKGROUND: Recently, artificial intelligence (AI)-based applications for chest imaging have emerged as potential tools to assist clinicians in the diagnosis and management of patients with coronavirus disease 2019 (COVID-19). OBJECTIVES: To develop a deep learning-based clinical decision support system for automatic diagnosis of COVID-19 on chest CT scans. Secondarily, to develop a complementary segmentation tool to assess the extent of lung involvement and measure disease severity. METHODS: The Imaging COVID-19 AI initiative was formed to conduct a retrospective multicentre cohort study including 20 institutions from seven different European countries. Patients with suspected or known COVID-19 who underwent a chest CT were included. The dataset was split on the institution-level to allow external evaluation. Data annotation was performed by 34 radiologists/radiology residents and included quality control measures. A multi-class classification model was created using a custom 3D convolutional neural network. For the segmentation task, a UNET-like architecture with a backbone Residual Network (ResNet-34) was selected. RESULTS: A total of 2,802 CT scans were included (2,667 unique patients, mean [standard deviation] age = 64.6 [16.2] years, male/female ratio 1.3:1). The distribution of classes (COVID-19/Other type of pulmonary infection/No imaging signs of infection) was 1,490 (53.2%), 402 (14.3%), and 910 (32.5%), respectively. On the external test dataset, the diagnostic multiclassification model yielded high micro-average and macro-average AUC values (0.93 and 0.91, respectively). The model provided the likelihood of COVID-19 vs other cases with a sensitivity of 87% and a specificity of 94%. The segmentation performance was moderate with Dice similarity coefficient (DSC) of 0.59. An imaging analysis pipeline was developed that returned a quantitative report to the user. CONCLUSION: We developed a deep learning-based clinical decision support system that could become an efficient concurrent reading tool to assist clinicians, utilising a newly created European dataset including more than 2,800 CT scans.


Assuntos
COVID-19 , Aprendizado Profundo , Humanos , Feminino , Masculino , Pessoa de Meia-Idade , COVID-19/diagnóstico por imagem , Inteligência Artificial , Pulmão/diagnóstico por imagem , Teste para COVID-19 , Estudos de Coortes , SARS-CoV-2 , Tomografia Computadorizada por Raios X/métodos
16.
Respir Res ; 24(1): 112, 2023 Apr 15.
Artigo em Inglês | MEDLINE | ID: mdl-37061683

RESUMO

BACKGROUND: Pulmonary fibrosis is an emerging complication of SARS-CoV-2 infection. In this study, we speculate that patients with COVID-19 and idiopathic pulmonary fibrosis (IPF) may share aberrant expressed microRNAs (miRNAs) associated to the progression of lung fibrosis. OBJECTIVE: To identify miRNAs presenting similar alteration in COVID-19 and IPF, and describe their impact on fibrogenesis. METHODS: A systematic review of the literature published between 2010 and January 2022 (PROSPERO, CRD42022341016) was conducted using the key words (COVID-19 OR SARS-CoV-2) AND (microRNA OR miRNA) or (idiopathic pulmonary fibrosis OR IPF) AND (microRNA OR miRNA) in Title/Abstract. RESULTS: Of the 1988 references considered, 70 original articles were appropriate for data extraction: 27 studies focused on miRNAs in COVID-19, and 43 on miRNAs in IPF. 34 miRNAs were overlapping in COVID-19 and IPF, 7 miRNAs presenting an upregulation (miR-19a-3p, miR-200c-3p, miR-21-5p, miR-145-5p, miR-199a-5p, miR-23b and miR-424) and 9 miRNAs a downregulation (miR-17-5p, miR-20a-5p, miR-92a-3p, miR-141-3p, miR-16-5p, miR-142-5p, miR-486-5p, miR-708-3p and miR-150-5p). CONCLUSION: Several studies reported elevated levels of profibrotic miRNAs in COVID-19 context. In addition, the balance of antifibrotic miRNAs responsible of the modulation of fibrotic processes is impaired in COVID-19. This evidence suggests that the deregulation of fibrotic-related miRNAs participates in the development of fibrotic lesions in the lung of post-COVID-19 patients.


Assuntos
COVID-19 , Fibrose Pulmonar Idiopática , MicroRNAs , Humanos , MicroRNAs/genética , COVID-19/genética , COVID-19/patologia , SARS-CoV-2/genética , Fibrose Pulmonar Idiopática/genética , Fibrose Pulmonar Idiopática/patologia , Pulmão/patologia
17.
Cancers (Basel) ; 15(7)2023 Mar 25.
Artigo em Inglês | MEDLINE | ID: mdl-37046629

RESUMO

The aim of our study was to determine the potential role of CT-based radiomics in predicting treatment response and survival in patients with advanced NSCLC treated with immune checkpoint inhibitors. We retrospectively included 188 patients with NSCLC treated with PD-1/PD-L1 inhibitors from two independent centers. Radiomics analysis was performed on pre-treatment contrast-enhanced CT. A delta-radiomics analysis was also conducted on a subset of 160 patients who underwent a follow-up contrast-enhanced CT after 2 to 4 treatment cycles. Linear and random forest (RF) models were tested to predict response at 6 months and overall survival. Models based on clinical parameters only and combined clinical and radiomics models were also tested and compared to the radiomics and delta-radiomics models. The RF delta-radiomics model showed the best performance for response prediction with an AUC of 0.8 (95% CI: 0.65-0.95) on the external test dataset. The Cox regression delta-radiomics model was the most accurate at predicting survival with a concordance index of 0.68 (95% CI: 0.56-0.80) (p = 0.02). The baseline CT radiomics signatures did not show any significant results for treatment response prediction or survival. In conclusion, our results demonstrated the ability of a CT-based delta-radiomics signature to identify early on patients with NSCLC who were more likely to benefit from immunotherapy.

18.
Front Med (Lausanne) ; 10: 1063012, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-36968825

RESUMO

Objectives: In our study, we explored the specific subgroup of patients with rheumatoid arthritis (RA) suffering from obstructive lung disease (OLD) and its impact on morbi-mortality. Methods: Our retrospective study included 309 patients suffering from RA with either obstructive (O-RA) or non-obstructive patterns (non-O-RA). OLD was defined based on the Tiffeneau index at the first available pulmonary functional test (PFT). Survival was then calculated and represented by a Kaplan-Meier curve. The comparison between the populations considered was performed by the Log-Rank test. Results: Out of the 309 RA patients, 102 (33%) had airway obstruction. The overall survival time was significantly lower in the O-RA group than in the non-O-RA group (n = 207) (p < 0.001). The median survival time was 11.75 years in the O-RA group and higher than 16 years in the non-O-RA group. Multivariate analysis identified OLD as an independent risk factor for mortality (HR 2.20; 95% CI 1.21-4.00, p < 0.01). Conclusion: Airway obstruction can be an independent risk factor of mortality in RA and should be considered as an early marker of poor prognosis. Further prospective longitudinal studies are required in order to determine the best clinical management for O-RA patients.

19.
Rev Med Liege ; 78(2): 99-106, 2023 Feb.
Artigo em Francês | MEDLINE | ID: mdl-36799327

RESUMO

Pulmonary hypertension (PH) is a common clinical condition linked to chronic cardiopulmonary illnesses. It must be distinguished from pulmonary arterial hypertension (PAH), a rare disease characterized by a specific involvement of the pulmonary arterial bed. An early diagnosis and accurate classification by a multidisciplinary team are necessary for a multimodal and individualized therapy approach. This article aims to provide a summary of the most recent ESC/ERS recommendations published in 2022.


L'hypertension pulmonaire (HTP) est une entité clinique fréquemment retrouvée chez les patients atteints d'affections cardio-pulmonaires chroniques. Elle est à différentier de l'hypertension artérielle pulmonaire (HTAP) qui est, quant à elle, une maladie rare caractérisée par une atteinte spécifique du lit artériel pulmonaire. Une identification précoce et une classification correcte, en équipe pluridisciplinaire, sont primordiales pour une prise en charge thérapeutique multimodale et personnalisée. Cet article a pour but de résumer, de façon pratique, les dernières recommandations des sociétés européennes de cardiologie (ESC) et de pneumologie (ERS) publiées en 2022.


Assuntos
Hipertensão Pulmonar , Hipertensão Arterial Pulmonar , Humanos , Hipertensão Pulmonar/diagnóstico , Hipertensão Pulmonar/terapia , Diagnóstico Precoce , Medição de Risco
20.
Crit Care Explor ; 5(1): e0850, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36699242

RESUMO

At present, it is not clear if critically ill COVID-19 survivors have different needs in terms of follow-up compared with other critically ill survivors, and thus if duplicated post-ICU trajectories are mandatory. OBJECTIVES: To compare the post-intensive care syndrome (PICS) of COVID-19 acute respiratory distress syndrome and non-COVID-19 (NC) survivors referred to a follow-up clinic at 3 months (M3) after ICU discharge. DESIGN SETTING AND PARTICIPANTS: Adults who survived an ICU stay greater than or equal to 7 days and attended the M3 consultation were included in this observational study performed in a post-ICU follow-up clinic of a single tertiary hospital. MAIN OUTCOMES AND MEASURES: Patients underwent a standardized assessment, addressing health-related quality of life (3-level version of EQ-5D), sleep disorders (Pittsburgh Sleep Quality Index [PSQI]), physical status (Barthel index, handgrip and quadriceps strengths), mental health disorders (Hospital Anxiety and Depression Scale and Impact of Event Scale-Revised [IES-R]), and cognitive impairment (Montreal Cognitive Assessment [MoCA]). RESULTS: A total of 143 survivors (86 COVID and 57 NC) attended the M3 consultation. Their median age and severity scores were similar. NC patients had a shorter ICU stay (10 d [8-17.2 d]) compared with COVID group (18 d [10.8-30 d]) (p = 0.001). M3 outcomes were similar in the two groups, except for a higher PSQI (p = 0.038) in the COVID group (6 [3-9.5]) versus NC group (4 [2-7]), and a slightly lower Barthel index in the NC group (100 [100-100]) than in the COVID group (100 [85-100]) (p = 0.026). However, the proportion of patients with abnormal values at each score was similar in the two groups. Health-related quality of life was similar in the two groups. The three MoCA (≥ 26), IES-R (<33), and Barthel (=100) were normal in 58 of 143 patients (40.6%). In contrast, 68.5% (98/143) had not returned to their baseline level of daily activities. CONCLUSIONS AND RELEVANCE: In our follow-up clinic at 3 months after discharge, the proportion of patients presenting alterations in the main PICS domains was similar whether they survived a COVID-19 or another critical illness, despite longer ICU stay in COVID group. Cognition and sleep were the two most affected PICS domains.

SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA