BACKGROUND The burden of cannabis use disorder(CUD)in the context of its prevalence and subsequent cardiopulmonary outcomes among cancer patients with severe sepsis is unclear.AIM To address this knowledge gap,especia...BACKGROUND The burden of cannabis use disorder(CUD)in the context of its prevalence and subsequent cardiopulmonary outcomes among cancer patients with severe sepsis is unclear.AIM To address this knowledge gap,especially due to rising patterns of cannabis use and its emerging pharmacological role in cancer.METHODS By applying relevant International Classification of Diseases,Ninth and Tenth Revision,Clinical Modification codes to the National Inpatient Sample database between 2016-2020,we identified CUD(+)and CUD(-)arms among adult cancer admissions with severe sepsis.Comparing the two cohorts,we examined baseline demographic characteristics,epidemiological trends,major adverse cardiac and cerebrovascular events,respiratory failure,hospital cost,and length of stay.We used the Pearsonχ^(2) d test for categorical variables and the Mann-Whitney U test for continuous,non-normally distributed variables.Multivariable regression analysis was used to control for potential confounders.A P value≤0.05 was considered for statistical significance.RESULTS We identified a total of 743520 cancer patients admitted with severe sepsis,of which 4945 had CUD.Demographically,the CUD(+)cohort was more likely to be younger(median age=58 vs 69,P<0.001),male(67.9%vs 57.2%,P<0.001),black(23.7%vs 14.4%,P<0.001),Medicaid enrollees(35.2%vs 10.7%,P<0.001),in whom higher rates of substance use and depression were observed.CUD(+)patients also exhibited a higher prevalence of chronic pulmonary disease but lower rates of cardiovascular comorbidities.There was no significant difference in major adverse cardiac and cerebrovascular events between CUD(+)and CUD(-)cohorts on multivariable regression analysis.However,the CUD(+)cohort had lower all-cause mortality(adjusted odds ratio=0.83,95%confidence interval:0.7-0.97,P<0.001)and respiratory failure(adjusted odds ratio=0.8,95%confidence interval:0.69-0.92,P=0.002).Both groups had similar median length of stay,though CUD(+)patients were more likely to have higher hospital cost compared to CUD(-)patients(median=94574 dollars vs 86615 dollars,P<0.001).CONCLUSION CUD(+)cancer patients with severe sepsis,who tended to be younger,black,males with higher rates of substance use and depression had paradoxically significantly lower odds of all-cause in-hospital mortality and respiratory failure.Future research should aim to better elucidate the underlying mechanisms for these observations.展开更多
Exogenous lipoid pneumonia is a rare and under recognized pulmonary disorder caused by the inhalation or aspiration of fat-like substances.Nasal decongestants containing mineral oils or paraffin are emerging as overlo...Exogenous lipoid pneumonia is a rare and under recognized pulmonary disorder caused by the inhalation or aspiration of fat-like substances.Nasal decongestants containing mineral oils or paraffin are emerging as overlooked etiological agents.This review consolidates existing literature to delineate the clinical,radiological,and pathological features of exogenous lipoid pneumonia induced by nasal decongestants,highlight diagnostic challenges,and underscore the importance of thorough patient history in early diagnosis and management.This condition,while preventable,can result in serious pulmonary complications if not recog-nized early.It necessitates a multidisciplinary approach that incorporates careful history taking,high-resolution imaging,cytological assessment,and public health vigilance.展开更多
Introduction: Thoracentesis is a common pulmonary procedure;however, great variability still exists in provider practices. Standard of care methods ranges from vacuum assisted to manual aspiration to use of wall sucti...Introduction: Thoracentesis is a common pulmonary procedure;however, great variability still exists in provider practices. Standard of care methods ranges from vacuum assisted to manual aspiration to use of wall suctioning. Few studies have compared efficiency, safety or patient comfort between different methods of pleural fluid evacuation. We sought to investigate which of three standard of care methods implemented most frequently at our institution took the least amount of time to perform and caused the least symptoms and complications. Methods: We performed a single center, randomized controlled study to determine which method of thoracentesis (wall suctioning [N = 15], manual aspiration [N = 8], or vacuum drainage [N = 12]) was the most efficient in terms of procedural time and post-procedural symptoms. 35 patients undergoing therapeutic thoracentesis were randomized to the study. Procedural time was recorded from the onset of pleural fluid drainage and was measured at 500 mL, 750 mL, 1000 mL and at termination of drainage. Pain and dyspnea scores were assessed on a verbal numerical pain rating sale (NRS) and Modified Borg Dyspnea Scale (MBS). Scores were reported pre-procedure, after thoracentesis catheter placement before fluid removal, after termination of drainage prior to removal of catheter, immediately after catheter removal, 5 minutes post-procedure, and 24 hours post-procedure. Results: The differences in procedural time among groups were significant (p p p = 0.006 and p = 0.004;respectively. Discussion: This study comparing various methods of pleural fluid drainage reveals reduced procedural time with vacuum bottle drainage and suggests that vacuum bottle drainage in our study population was more efficient with less associated symptoms compared to the other two standard of care methods. These findings would benefit from further analysis in a larger, randomized study to corroborate our findings.展开更多
One of the most important aspects of interventional pulmonology is to obtain tissue or liquid samples of the chest to diagnose a respiratory disease;however,it is still possible to obtain insufficient tissue or cytolo...One of the most important aspects of interventional pulmonology is to obtain tissue or liquid samples of the chest to diagnose a respiratory disease;however,it is still possible to obtain insufficient tissue or cytologic specimens.Indeed,methylation detection is an effective method by which to establish a diagnosis.This review focuses on the clinical application of short stature homeobox 2 and RAS-associated domain family 1 subtype A DNA methylation detection in interventional pulmonology,including bronchoscopic fluid biopsy,transbronchial needle aspiration,and pleural effusion.展开更多
Background: The purpose of this research was to identify significant changes to respiratory resistance resulting from anxiety inducing simulations presented through the medium of virtual reality (VR) goggles. The test...Background: The purpose of this research was to identify significant changes to respiratory resistance resulting from anxiety inducing simulations presented through the medium of virtual reality (VR) goggles. The tested hypothesis was that a virtual reality simulation would produce anxiety in the wearer, and, with it, a statistically significant change in subject respiratory resistance. It was also suggested that there may be a significant difference in the levels of respiratory resistance responses of males and females. The Oculus Rift DK2 VR goggles with video software designed for the Rift were used to induce anxiety in the wearers. Methods: Respiratory resistances in both inhalation and exhalation directions were measured with the Airflow Perturbation Device (APD), a medical instrument used noninvasively. Two groups of subjects were tested: the test group watched a simulation deemed to be anxiety inducing, and the Control group watched a simulation determined to be non-anxiety inducing. Anxiety levels and respiratory resistance were measured before and during the simulation with two anxiety measures, the State Trait Anxiety Inventory (STAI) and the Subjective Units of Distress Scale (SUDS). Results: Statistically significant increases in anxiety level and respiratory resistance were found in the Test group, but no significant differences in anxiety and respiratory resistance levels were found in the control group. Anxiety affected both breathing phases similarly. For the gender hypothesis, we found that one of the tests used to measure anxiety, (the SUDS difference) was statistically significant, while the other test and the difference in respiratory resistance were not statistically significant. Conclusion: Results from this experiment show that anxiety level can be a significant contributor to the physiological measurement of respiratory resistance, and this can have implications for pulmonary function test environments and the psychological conditions of the patients being tested.展开更多
Importance:Opportunities for pediatric residents to perform direct laryngoscopy and tracheal intubation(DLTI)are few and the success rate is low.Objective:We hypothesize that incorporation of video laryngoscope(McGrat...Importance:Opportunities for pediatric residents to perform direct laryngoscopy and tracheal intubation(DLTI)are few and the success rate is low.Objective:We hypothesize that incorporation of video laryngoscope(McGrath MAC)into pediatric residents DLTI simulation course will improve the simulated DLTI success rate.Methods:Residents were given 3 attempts at DLTI:(1)baseline using a conventional laryngoscope(CL);(2)using a video laryngoscope(VL);and(3)again using the CL.Residents were given up to 120 seconds to complete each DLTI attempt.Time to successful DLTI was collected.Residents recorded their best view(larynx,epiglottis,vocal cords)with each DLTI attempt.Results:Prior to the intervention,15/17(88.2%)and 16/17(94.1%)of the participants reported prior exposure to DLTI as'less than 10 total attempts'in simulated and live patients respectively.Seventeen pediatric residents performed 51 DLTI attempts(34 with a CL and 17 with the VL).Success rates for DLTI are as follows:Baseline with CL 11/17(64.7%),VL 12/17(70.6%),and last attempt with CL 13/17(76.5%)(P=0.15).Compared to the baseline,the use of VL resulted in a shorter but non-significant decrease in time to successful DLTI(Mean 34.2 sec[SD,22.0]vs.56.5 sec[SD,40.2];P=0.08).Repeat attempts at DLTI with the CL,however,were significantly shorter than baseline(Mean 20.3 sec[SD,12.8]vs.56.5 sec[SD,40.2];P=0.003).Using the VL,more residents could visualize the vocal cords compared to the baseline(14/17[82.3%]vs.9/17[52.9%];P=0.03).Interpretation:Repeated training is certainly a way to improve successful DLTI.Use of VL as a new teaching method led to greater visualization of the vocal cords,shortening operating time and raising self-confidence.展开更多
文摘BACKGROUND The burden of cannabis use disorder(CUD)in the context of its prevalence and subsequent cardiopulmonary outcomes among cancer patients with severe sepsis is unclear.AIM To address this knowledge gap,especially due to rising patterns of cannabis use and its emerging pharmacological role in cancer.METHODS By applying relevant International Classification of Diseases,Ninth and Tenth Revision,Clinical Modification codes to the National Inpatient Sample database between 2016-2020,we identified CUD(+)and CUD(-)arms among adult cancer admissions with severe sepsis.Comparing the two cohorts,we examined baseline demographic characteristics,epidemiological trends,major adverse cardiac and cerebrovascular events,respiratory failure,hospital cost,and length of stay.We used the Pearsonχ^(2) d test for categorical variables and the Mann-Whitney U test for continuous,non-normally distributed variables.Multivariable regression analysis was used to control for potential confounders.A P value≤0.05 was considered for statistical significance.RESULTS We identified a total of 743520 cancer patients admitted with severe sepsis,of which 4945 had CUD.Demographically,the CUD(+)cohort was more likely to be younger(median age=58 vs 69,P<0.001),male(67.9%vs 57.2%,P<0.001),black(23.7%vs 14.4%,P<0.001),Medicaid enrollees(35.2%vs 10.7%,P<0.001),in whom higher rates of substance use and depression were observed.CUD(+)patients also exhibited a higher prevalence of chronic pulmonary disease but lower rates of cardiovascular comorbidities.There was no significant difference in major adverse cardiac and cerebrovascular events between CUD(+)and CUD(-)cohorts on multivariable regression analysis.However,the CUD(+)cohort had lower all-cause mortality(adjusted odds ratio=0.83,95%confidence interval:0.7-0.97,P<0.001)and respiratory failure(adjusted odds ratio=0.8,95%confidence interval:0.69-0.92,P=0.002).Both groups had similar median length of stay,though CUD(+)patients were more likely to have higher hospital cost compared to CUD(-)patients(median=94574 dollars vs 86615 dollars,P<0.001).CONCLUSION CUD(+)cancer patients with severe sepsis,who tended to be younger,black,males with higher rates of substance use and depression had paradoxically significantly lower odds of all-cause in-hospital mortality and respiratory failure.Future research should aim to better elucidate the underlying mechanisms for these observations.
文摘Exogenous lipoid pneumonia is a rare and under recognized pulmonary disorder caused by the inhalation or aspiration of fat-like substances.Nasal decongestants containing mineral oils or paraffin are emerging as overlooked etiological agents.This review consolidates existing literature to delineate the clinical,radiological,and pathological features of exogenous lipoid pneumonia induced by nasal decongestants,highlight diagnostic challenges,and underscore the importance of thorough patient history in early diagnosis and management.This condition,while preventable,can result in serious pulmonary complications if not recog-nized early.It necessitates a multidisciplinary approach that incorporates careful history taking,high-resolution imaging,cytological assessment,and public health vigilance.
文摘Introduction: Thoracentesis is a common pulmonary procedure;however, great variability still exists in provider practices. Standard of care methods ranges from vacuum assisted to manual aspiration to use of wall suctioning. Few studies have compared efficiency, safety or patient comfort between different methods of pleural fluid evacuation. We sought to investigate which of three standard of care methods implemented most frequently at our institution took the least amount of time to perform and caused the least symptoms and complications. Methods: We performed a single center, randomized controlled study to determine which method of thoracentesis (wall suctioning [N = 15], manual aspiration [N = 8], or vacuum drainage [N = 12]) was the most efficient in terms of procedural time and post-procedural symptoms. 35 patients undergoing therapeutic thoracentesis were randomized to the study. Procedural time was recorded from the onset of pleural fluid drainage and was measured at 500 mL, 750 mL, 1000 mL and at termination of drainage. Pain and dyspnea scores were assessed on a verbal numerical pain rating sale (NRS) and Modified Borg Dyspnea Scale (MBS). Scores were reported pre-procedure, after thoracentesis catheter placement before fluid removal, after termination of drainage prior to removal of catheter, immediately after catheter removal, 5 minutes post-procedure, and 24 hours post-procedure. Results: The differences in procedural time among groups were significant (p p p = 0.006 and p = 0.004;respectively. Discussion: This study comparing various methods of pleural fluid drainage reveals reduced procedural time with vacuum bottle drainage and suggests that vacuum bottle drainage in our study population was more efficient with less associated symptoms compared to the other two standard of care methods. These findings would benefit from further analysis in a larger, randomized study to corroborate our findings.
文摘One of the most important aspects of interventional pulmonology is to obtain tissue or liquid samples of the chest to diagnose a respiratory disease;however,it is still possible to obtain insufficient tissue or cytologic specimens.Indeed,methylation detection is an effective method by which to establish a diagnosis.This review focuses on the clinical application of short stature homeobox 2 and RAS-associated domain family 1 subtype A DNA methylation detection in interventional pulmonology,including bronchoscopic fluid biopsy,transbronchial needle aspiration,and pleural effusion.
文摘Background: The purpose of this research was to identify significant changes to respiratory resistance resulting from anxiety inducing simulations presented through the medium of virtual reality (VR) goggles. The tested hypothesis was that a virtual reality simulation would produce anxiety in the wearer, and, with it, a statistically significant change in subject respiratory resistance. It was also suggested that there may be a significant difference in the levels of respiratory resistance responses of males and females. The Oculus Rift DK2 VR goggles with video software designed for the Rift were used to induce anxiety in the wearers. Methods: Respiratory resistances in both inhalation and exhalation directions were measured with the Airflow Perturbation Device (APD), a medical instrument used noninvasively. Two groups of subjects were tested: the test group watched a simulation deemed to be anxiety inducing, and the Control group watched a simulation determined to be non-anxiety inducing. Anxiety levels and respiratory resistance were measured before and during the simulation with two anxiety measures, the State Trait Anxiety Inventory (STAI) and the Subjective Units of Distress Scale (SUDS). Results: Statistically significant increases in anxiety level and respiratory resistance were found in the Test group, but no significant differences in anxiety and respiratory resistance levels were found in the control group. Anxiety affected both breathing phases similarly. For the gender hypothesis, we found that one of the tests used to measure anxiety, (the SUDS difference) was statistically significant, while the other test and the difference in respiratory resistance were not statistically significant. Conclusion: Results from this experiment show that anxiety level can be a significant contributor to the physiological measurement of respiratory resistance, and this can have implications for pulmonary function test environments and the psychological conditions of the patients being tested.
文摘Importance:Opportunities for pediatric residents to perform direct laryngoscopy and tracheal intubation(DLTI)are few and the success rate is low.Objective:We hypothesize that incorporation of video laryngoscope(McGrath MAC)into pediatric residents DLTI simulation course will improve the simulated DLTI success rate.Methods:Residents were given 3 attempts at DLTI:(1)baseline using a conventional laryngoscope(CL);(2)using a video laryngoscope(VL);and(3)again using the CL.Residents were given up to 120 seconds to complete each DLTI attempt.Time to successful DLTI was collected.Residents recorded their best view(larynx,epiglottis,vocal cords)with each DLTI attempt.Results:Prior to the intervention,15/17(88.2%)and 16/17(94.1%)of the participants reported prior exposure to DLTI as'less than 10 total attempts'in simulated and live patients respectively.Seventeen pediatric residents performed 51 DLTI attempts(34 with a CL and 17 with the VL).Success rates for DLTI are as follows:Baseline with CL 11/17(64.7%),VL 12/17(70.6%),and last attempt with CL 13/17(76.5%)(P=0.15).Compared to the baseline,the use of VL resulted in a shorter but non-significant decrease in time to successful DLTI(Mean 34.2 sec[SD,22.0]vs.56.5 sec[SD,40.2];P=0.08).Repeat attempts at DLTI with the CL,however,were significantly shorter than baseline(Mean 20.3 sec[SD,12.8]vs.56.5 sec[SD,40.2];P=0.003).Using the VL,more residents could visualize the vocal cords compared to the baseline(14/17[82.3%]vs.9/17[52.9%];P=0.03).Interpretation:Repeated training is certainly a way to improve successful DLTI.Use of VL as a new teaching method led to greater visualization of the vocal cords,shortening operating time and raising self-confidence.
