Validity of Lung Ultrasound: Is an Image Worth More Than a Thousand Sounds?

Introduction: There is debate as to whether lung-ultrasound (LUS) can replace lung-auscultation (LA) in the assessment of respiratory diseases. Methodology: The diagnostic validity, safety, and reliability of LA and LUS were analyzed in patients admitted in a pulmonary ward due to decompensated obstructive airway diseases, decompensated interstitial diseases, and pulmonary infections, in a prospective study. Standard formulas were used to calculate the diagnostic sensitivity, specificity, and accuracy. The interobserver agreement with respect to the LA and LUS findings was evaluated based on the Kappa coefficient (ᴋ). Results: A total of 115 patients were studied. LUS was more sensitive than the LA in evaluating pulmonary infections (93.59% vs. 77.02%; p = 0.001) and more specifically in the case of decompensated obstructive airway diseases (95.6% vs. 19.10%; p = 0.001). The diagnostic accuracy of LUS was also greater in the case of pulmonary infections (75.65% vs. 60.90%; p = 0.02). The sensitivity and specificity of the combination of LA and LUS was 95.95%, 50% in pulmonary infections, 76.19%, 100% in case of decompensated obstructive airway diseases, and (100%, 88.54%) in case of interstitial diseases. (ᴋ) was 0.71 for an A-pattern, 0.73 for pathological B‑lines, 0.94 for condensations, 0.89 for pleural-effusion, 0.63 for wheezes, 0.38 for rhonchi, 0.68 for fine crackles, 0.18 for coarse crackles, and 0.29 for a normal LA. Conclusions: There is a greater interobserver agreement in the interpretation of LUS-findings compared to that of LA-noises, their combined use improves diagnostic performance in all diseases examined.

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Multimorbidity clusters in patients with chronic obstructive airway diseases in the EpiChron Cohort

Scientific Reports ◽

10.1038/s41598-021-83964-w ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Jonás Carmona-Pírez ◽

Beatriz Poblador-Plou ◽

Ignatios Ioakeim-Skoufa ◽

Francisca González-Rubio ◽

Luis Andrés Gimeno-Feliú ◽

...

Keyword(s):

Substance Use ◽

Chronic Conditions ◽

Large Scale ◽

Mental Health Problems ◽

Epidemiological Studies ◽

Chronic Obstructive ◽

High Morbidity ◽

Airway Diseases ◽

Obstructive Sleep ◽

Obstructive Airway Diseases

AbstractChronic obstructive airway diseases such as chronic obstructive pulmonary disease (COPD), asthma, rhinitis, and obstructive sleep apnea (OSA) are amongst the most common treatable and preventable chronic conditions with high morbidity burden and mortality risk. We aimed to explore the existence of multimorbidity clusters in patients with such diseases and to estimate their prevalence and impact on mortality. We conducted an observational retrospective study in the EpiChron Cohort (Aragon, Spain), selecting all patients with a diagnosis of allergic rhinitis, asthma, COPD, and/or OSA. The study population was stratified by age (i.e., 15–44, 45–64, and ≥ 65 years) and gender. We performed cluster analysis, including all chronic conditions recorded in primary care electronic health records and hospital discharge reports. More than 75% of the patients had multimorbidity (co-existence of two or more chronic conditions). We identified associations of dermatologic diseases with musculoskeletal disorders and anxiety, cardiometabolic diseases with mental health problems, and substance use disorders with neurologic diseases and neoplasms, amongst others. The number and complexity of the multimorbidity clusters increased with age in both genders. The cluster with the highest likelihood of mortality was identified in men aged 45 to 64 years and included associations between substance use disorder, neurologic conditions, and cancer. Large-scale epidemiological studies like ours could be useful when planning healthcare interventions targeting patients with chronic obstructive airway diseases and multimorbidity.

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Clinicopathological predictors of postoperative upstaging to invasive ductal carcinoma (IDC) in patients preoperatively diagnosed with ductal carcinoma in situ (DCIS): a multi-institutional retrospective cohort study

Breast Cancer ◽

10.1007/s12282-021-01225-0 ◽

2021 ◽

Author(s):

Kiyo Tanaka ◽

Norikazu Masuda ◽

Naoki Hayashi ◽

Yasuaki Sagara ◽

Fumikata Hara ◽

...

Keyword(s):

Invasive Ductal Carcinoma ◽

Ductal Carcinoma In Situ ◽

Tumor Size ◽

Medical Records ◽

Carcinoma In Situ ◽

Ductal Carcinoma ◽

Palpable Mass ◽

Combined Use ◽

A Prospective Study

Abstract Background We conducted a prospective study with the intention to omit surgery for patients with ductal carcinoma in situ (DCIS) of the breast. We aimed to identify clinicopathological predictors of postoperative upstaging to invasive ductal carcinoma (IDC) in patients preoperatively diagnosed with DCIS. Patients and methods We retrospectively analyzed patients with DCIS diagnosed through biopsy between April 1, 2010 and December 31, 2014, from 16 institutions. Clinical, radiological, and histological variables were collected from medical records. Results We identified 2,293 patients diagnosed with DCIS through biopsy, including 1,663 DCIS (72.5%) cases and 630 IDC (27.5%) cases. In multivariate analysis, the presence of a palpable mass (odds ratio [OR] 1.8; 95% confidence interval [CI] 1.2–2.6), mammography findings (≥ category 4; OR 1.8; 95% CI 1.2–2.6), mass formations on ultrasonography (OR 1.8; 95% CI 1.2–2.5), and tumor size on MRI (> 20 mm; OR 1.7; 95% CI 1.2–2.4) were independent predictors of IDC. Among patients with a tumor size on MRI of ≤ 20 mm, the possibility of postoperative upstaging to IDC was 22.1%. Among the 258 patients with non-palpable mass, nuclear grade 1/2, and positive for estrogen receptor, the possibility was 18.1%, even if the upper limit of the tumor size on MRI was raised to ≤ 40 mm. Conclusion We identified four independent predictive factors of upstaging to IDC after surgery among patients with DCIS diagnosed by biopsy. The combined use of various predictors of IDC reduces the possibility of postoperative upstaging to IDC, even if the tumor size on MRI is larger than 20 mm.

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Lung ultrasound training and evaluation for proficiency among physicians in a low-resource setting

The Ultrasound Journal ◽

10.1186/s13089-021-00236-4 ◽

2021 ◽

Vol 13 (1) ◽

Author(s):

Darlene R. House ◽

Yogendra Amatya ◽

Benjamin Nti ◽

Frances M. Russell

Keyword(s):

Lung Ultrasound ◽

Cumulative Sum Analysis ◽

Resource Setting ◽

Individual Zone ◽

Low Resource Setting ◽

Hands On ◽

Level Of Training ◽

A Prospective Study ◽

Training Physicians ◽

Study Physician

Abstract Background Lung ultrasound (LUS) is helpful for the evaluation of patients with dyspnea in the emergency department (ED). However, it remains unclear how much training and how many LUS examinations are needed for ED physicians to obtain proficiency. The objective of this study was to determine the threshold number of LUS physicians need to perform to achieve proficiency for interpreting LUS on ED patients with dyspnea. Methods A prospective study was performed at Patan Hospital in Nepal, evaluating proficiency of physicians novice to LUS. After eight hours of didactics and hands-on training, physicians independently performed and interpreted ultrasounds on patients presenting to the ED with dyspnea. An expert sonographer blinded to patient data and LUS interpretation reviewed images and provided an expert interpretation. Interobserver agreement was performed between the study physician and expert physician interpretation. Cumulative sum analysis was used to determine the number of scans required to attain an acceptable level of training. Results Nineteen physicians were included in the study, submitting 330 LUS examinations with 3288 lung zones. Eighteen physicians (95%) reached proficiency. Physicians reached proficiency for interpreting LUS accurately when compared to an expert after 4.4 (SD 2.2) LUS studies for individual zone interpretation and 4.8 (SD 2.3) studies for overall interpretation, respectively. Conclusions Following 1 day of training, the majority of physicians novice to LUS achieved proficiency with interpretation of lung ultrasound after less than five ultrasound examinations performed independently.

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Development of an integral assessment approach of health status in patients with obstructive airway diseases: the CORONA study [Corrigendum]

International Journal of Chronic Obstructive Pulmonary Disease ◽

10.2147/copd.s101722 ◽

2016 ◽

pp. 191

Author(s):

E van den Akker ◽

Alex J van 't Hul ◽

Niels H. Chavannes ◽

Alie van Bruggen ◽

Maureen PMH Rutten-van Mölken ◽

...

Keyword(s):

Health Status ◽

Airway Diseases ◽

Assessment Approach ◽

Integral Assessment ◽

Obstructive Airway Diseases

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Respiratory Disorders, 5. Oral Drugs for Obstructive Airway Diseases (R03)

Ullmann's Encyclopedia of Industrial Chemistry ◽

10.1002/14356007.w23_w04 ◽

2018 ◽

pp. 1-6

Author(s):

Bernhard Kutscher

Keyword(s):

Oral Drugs ◽

Respiratory Disorders ◽

Airway Diseases ◽

Obstructive Airway Diseases

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Hepcidin and MELD-XI score as markers of multiple organ failure in patients with heart failure with preserved and reduced ejection fraction

CARDIOVASCULAR THERAPY AND PREVENTION ◽

10.15829/1728-8800-2020-2529 ◽

2020 ◽

Vol 19 (3) ◽

pp. 2529

Author(s):

V. I. Podzolkov ◽

N. A. Dragomiretskaya ◽

S. K. Stolbova ◽

A. V. Tolmacheva

Keyword(s):

Heart Failure ◽

Body Mass Index ◽

Ejection Fraction ◽

Cardiac Arrhythmias ◽

Multiple Organ ◽

Left Ventricular ◽

Chronic Obstructive ◽

Hepcidin Level ◽

Airway Diseases ◽

Obstructive Airway Diseases

Data on the changes in hepcidin levels in heart failure (HF) patients are contradictory and do not give an answer about its effect on the progression of multiple organ failure. Since the model of end-stage liver disease excluding INR (MELD-XI) reflects the severity of liver and kidney dysfunction, these markers have been suggested to be associated with decompensated HF.Aim. To assess the MELD-XI score and serum hepcidin levels in patients with decompensated HF with different values of left ventricular ejection fraction (EF).Material and methods. The study included 68 patients (29 women, 39 men; mean age 72,3±11,7 years) hospitalized due to decompensated HF. Patients were divided into three groups: reduced (HFrEF) (n=20), mid-range (HFmrEF) (n=23), and preserved EF (HFpEF) (n=24)). Upon admission, along with standard diagnostic tests, all patients were examined for hepcidin-25 levels by enzyme-linked immunosorbent assay. MELD-XI score was calculated. Statistical processing was carried out using the software package Statistica 8.0.Results. Hepcidin levels in the HFrEF group (31,63 ng/ml [22,0; 71,6]) were significantly higher than in the HFmrEF (23,89 ng/ml [21,1; 27,9]) (p<0,05) and HFpEF (26,91 ng/ml [18,6; 31,1]) (p<0,05) groups. In HFpEF, there was a correlation of hepcidin level with body mass index (r=0,47, p<0,05) and chronic obstructive airway diseases (r=0,44, p<0,05). A correlation of hepcidin level with significant cardiac arrhythmias (r=0,61, p<0,05) was revealed in HFmrEF patients. MELD-XI score were significantly increased from 9,44±3,96 for HFpEF and 11,53±3,82 for HFmrEF to 14,3±4,3 for HFrEF (p<0,005). We also revealed correlation of MELD-XI score with hepcidin levels (r=0,3, p<0,05) and EF (r=-0,43, p<0,0003). Patients with a MELD-XI score of >10,4 were more likely to have NYHA class III-IV HF, HFrEF and significantly higher levels of hepcidin (p<0,05 for all) These patients were also more likely to have chronic kidney disease (p<0,05).Conclusion. Hepcidin level and MELD-XI score in patients with decompensated HF are inversely related to left ventricular EF. There is a direct relationship between hepcidin levels and other clinical parameters: body mass index, the presence of chronic obstructive airway diseases and cardiac arrhythmias.

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Association between regular arrangement of collecting venules and Helicobacter pylori status in routine endoscopy

BMC Gastroenterology ◽

10.1186/s12876-021-01960-w ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Cong Yuan ◽

Xue-Mei Lin ◽

Yan Ou ◽

Lin Cai ◽

Qian Cheng ◽

...

Keyword(s):

Helicobacter Pylori ◽

Predictive Value ◽

Underlying Mechanism ◽

High Definition ◽

Regular Arrangement ◽

Gastric Corpus ◽

H Pylori ◽

Sensitivity Specificity ◽

A Prospective Study ◽

Positive Pattern

Abstract Background The sensitivity of regular arrangement of collecting venules (RAC)-positive pattern for predicting Helicobacter pylori (H. pylori)-negative status greatly altered from 93.8 to 48.0% in recent two decades of various studies, while the reason behind it remained obscure. The aim of this study was to investigate the value of RAC as an endoscopic feature for judging H. pylori status in routine endoscopy and reviewed the underlying mechanism. Methods A prospective study with high-definition non-magnifying endoscopy was performed. RAC-positive and RAC-negative patients were classified according to the collecting venules morphology of the lesser curvature in gastric corpus. Gastric biopsy specimens were obtained from the lesser and greater curvature of corpus with normal RAC-positive or abnormal RAC-negative mucosal patterns. Helicobacter pylori status was established by hematoxylin and eosin staining and immunohistochemistry. Results 41 RAC-positive and 124 RAC-negative patients were enrolled from June 2020 to September 2020. The prevalence of H. pylori infection in patients with RAC-positive pattern and RAC-negative pattern was 7.3% (3/41) and 71.0% (88/124), respectively. Among all 124 RAC-negative patients, 36 (29.0%) patients were H. pylori-negative status. Ten patients (32.3%) demonstrated RAC-positive pattern in 31 H. pylori-eradicated cases. The sensitivity, specificity, positive predictive value, and negative predictive value of RAC-positive pattern for predicting H. pylori-negative status were 51.4% (95% CI, 0.395–0.630), 96.7% (95% CI, 0.900–0.991), 92.7% (95% CI, 0.790–0.981), and 71.0% (95% CI, 0.620–0.786), respectively. Conclusions RAC presence can accurately rule out H. pylori infection of gastric corpus, and H. pylori-positive status cannot be predicted only by RAC absence in routine endoscopy. Trial registration The present study is a non-interventional trial.

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Role of the nitric oxide–soluble guanylyl cyclase pathway in obstructive airway diseases

Pulmonary Pharmacology & Therapeutics ◽

10.1016/j.pupt.2014.07.004 ◽

2014 ◽

Vol 29 (1) ◽

pp. 1-6 ◽

Cited By ~ 31

Author(s):

Lisa L. Dupont ◽

Constantinos Glynos ◽

Ken R. Bracke ◽

Peter Brouckaert ◽

Guy G. Brusselle

Keyword(s):

Nitric Oxide ◽

Guanylyl Cyclase ◽

Soluble Guanylyl Cyclase ◽

Airway Diseases ◽

Obstructive Airway Diseases

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MRI may be able to identify the origin of neuroendocrine tumor liver metastases

Neuroendocrinology ◽

10.1159/000513015 ◽

2020 ◽

Author(s):

Maxime Barat ◽

Philippe Soyer ◽

Fatima Al Sharhan ◽

Benoit Terris ◽

Ammar Oudjit ◽

...

Keyword(s):

Multivariate Analysis ◽

Neuroendocrine Tumors ◽

Interobserver Agreement ◽

Validation Cohort ◽

Univariate Analysis ◽

Intraclass Correlation ◽

Hepatic Metastases ◽

Resonance Imaging ◽

Magnetic Resonance Imaging Mri ◽

Sensitivity Specificity

Objectives: To discriminate hepatic metastases from pancreatic neuroendocrine tumors (pNET) and hepatic metastases from midgut neuroendocrine tumors (mNET) with magnetic resonance imaging (MRI). Methods: MRI examinations of 24 patients with hepatic metastases from pNET were quantitatively and qualitatively assessed by two blinded readers and compared to those obtained in 23 patients with hepatic metastases from mNET. Inter-reader agreement was calculated with kappa and intraclass correlation coefficient (ICC). Sensitivity, specificity and accuracy of each variable for the diagnosis of hepatic metastasis from pNET were calculated. Associations between variables and primary tumor (i.e., pNET vs. mNET) were assessed at univariate and multivariate analysis. A nomogram was developed and validated using an external cohort of 20 patients with pNET and 20 patients with mNET. Results: Interobserver agreement was strong to perfect (k=0.893-1) for qualitative criteria and excellent for quantitative variables (ICC: 0.9817-0.9996). At univariate analysis, homogeneity on T1-weighted images was the most discriminating variable for the diagnosis of pNET (OR, 6.417; P=0.013) with greatest sensitivity (88%; 21/24; 95% CI: 68-97%). At multivariate analysis, tumor homogeneity on T1-weighted images (P=0.007; OR, 17.607; 95%CI: 2.179–142.295) and target sign on DW images (P=0.007; OR, 19.869; 95%CI: 2.305–171.276) were independently associated with pNET. Nomogram yielded a corrected AUC of 0.894 (95%CI: 0.796–0.992) for the diagnosis of pNET in the training cohort and 0.805 (95%CI: 0.662–0.948) in the validation cohort. Conclusions: MRI provides qualitative features that can help discriminate between hepatic metastases from pNET and those from mNET.

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