Update on biomarkers for the stratification of indeterminate pulmonary nodules.
Lung cancer is the leading cause of cancer related deaths. Early detection and diagnosis are critical as survival decreases with advanced stages. Approximately 1.6 million nodules are incidentally detected every year on chest computed tomography in the United States. This number of nodules identified is likely much larger after accounting for screening detected nodules. Most of these nodules, whether incidentally or screening-detected, are benign. Despite this, many patients undergo unnecessary invasive procedures to rule out cancer as our current stratification approaches are suboptimal, particularly for intermediate probability nodules. Thus, non-invasive strategies are urgently needed. ⋯ Rapid technological advances and large network collaborative efforts will continue to drive the discovery and validation of many novel biomarkers, but ultimately, randomized clinical utility studies demonstrating improved patient outcomes will be required to bring biomarkers into clinical practice.
Effect of Hypertonic Saline on Lung Function as Add-On Treatment in People with Cystic Fibrosis Receiving Dornase-alfa: A Cystic Fibrosis Foundation Patient Registry Analysis.
Introduction of novel therapies for cystic fibrosis (CF), raises the question whether traditional treatments can be withdrawn. Nebulized hypertonic saline (HS) could potentially be discontinued in patients receiving Dornase alfa (DA). ⋯ In the pre-modulator era, CFF508del had no significant difference in lung function when nebulized HS was added to DA for 1-5 years.
Observation, aspiration, or tube-thoracostomy for primary spontaneous pneumothorax: A systematic review, meta-analysis and cost-utility analysis.
Primary spontaneous pneumothorax (PSP) has several commonly used management strategies: observation, aspiration, and chest tube (CT). Economic modelling of pooled data comparing techniques has not been performed. ⋯ Observation is the dominant choice compared to aspiration and CT for PSP. It should be considered as the first line therapy in appropriately selected patients.
Prospective Detection of Early Lung Cancer in COPD Patients in Regular Care by Electronic Nose Analysis of Exhaled Breath.
Patients with COPD are at high risk of developing lung cancer, but no validated predictive biomarkers have been reported to identify these patients. Molecular profiling of exhaled breath by electronic nose (eNose) technology may qualify for early detection of lung cancer in COPD patients. ⋯ Exhaled breath analysis by eNose identified COPD patients in whom lung cancer became clinically manifest within 2 years after inclusion. These results show eNose assessment may detect early stages of lung cancer in patients with COPD.
Pressure-dependent Pneumothorax and Air leak - Physiology and Clinical Implications.
Pressure-dependent pneumothorax is a common clinical event, often occurring after pleural drainage in patients with visceral pleural restriction, partial lung resection or lobar atelectasis from bronchoscopic lung volume reduction or an endobronchial obstruction. This type of pneumothorax and air leak is clinically inconsequential. Failure to appreciate the benign nature of such air leaks may result in unnecessary pleural procedures or prolonged hospital stays. ⋯ A pressure-dependent pneumothorax occurs during pleural drainage in patients with lung-thoracic cavity shape/size mismatch. It is caused by an air leak related to a pressure gradient between the subpleural lung parenchyma and the pleural space. Pressure-dependent pneumothorax and air leak do not need any further pleural interventions.