Az interdiszciplináris rehabilitáció hatása spondylitis ankylopoeticában szenvedő betegekben

Absztrakt Bevezetés: A légzőszervi manifesztációval kapcsolatos komplex pulmonalis vizsgálat spondylitis ankylopoeticában szenvedő betegekben hozzájárulhat a megfelelő rehabilitációs program kialakításához. Célkitűzés: A légzésfunkciós, terhelés-élettani változók és a rehabilitációt követő életminőség-változás közötti kapcsolat vizsgálata. Módszer: A vizsgálatba 5 fő Seyfried II. stádiumú és 11 fő Seyfried III. stádiumú beteget vontak be, akik spinalis fizioterápiás, ultrahangos, masszázs- és parafinpakolásos kezelésben részesültek, személyenként 15 alkalommal, majd 8 héten keresztül, heti 3 alkalommal nagy intenzitású kerékpár-kondicionálás történt. A rehabilitáció előtt és után Bath Ankylosing Spondylitis Disease Activity Index és Bath Ankylosing Spondylitis Functional Index felvételére került sor. A rehabilitációt követően elvégezték a légzésfunkciós paraméterek és a terhelés-élettani változók vizsgálatát. Eredmények: Mindkét index jelentős, kezelés utáni változást mutatott az eredeti eredményekhez képest (p<0,05). Ezek a funkcionális mutatók összefüggést mutattak a nyugalmi légzésfunkciós és a terhelés-élettani változókkal (p<0,05). Következtetések: A vizsgálat alapján lehetséges, hogy az előzetes pulmonalis felmérés a spondylitis ankylopoetica kezelésére irányuló hatékonyabb program kidolgozásának alapjául szolgálhat. Orv. Hetil., 2016, 157(28), 1126–1132

Post-COVID changes in lung function 6 months after veno-venous extracorporeal membrane oxygenation: a prospective observational clinical trial

BackgroundSevere coronavirus disease 2019 (COVID-19) may require veno-venous extracorporeal membrane oxygenation (V-V ECMO). While V-V ECMO is offered in severe lung injury to COVID-19, long-term respiratory follow-up in these patients is missing. Therefore, we aimed at providing comprehensive data on the long-term respiratory effects of COVID-19 requiring V-V ECMO support during the acute phase of infection.MethodsIn prospective observational cohort study design, patients with severe COVID-19 receiving invasive mechanical ventilation and V-V ECMO (COVID group, n = 9) and healthy matched controls (n = 9) were evaluated 6 months after hospital discharge. Respiratory system resistance at 5 and 19 Hz (R5, R19), and the area under the reactance curve (AX5) was evaluated using oscillometry characterizing total and central airway resistances, and tissue elasticity, respectively. R5 and R19 difference (R5–R19) reflecting small airway function was also calculated. Forced expired volume in seconds (FEV1), forced expiratory vital capacity (FVC), functional residual capacity (FRC), carbon monoxide diffusion capacity (DLCO) and transfer coefficient (KCO) were measured.ResultsThe COVID group had a higher AX5 and R5–R19 than the healthy matched control group. However, there was no significant difference in terms of R5 or R19. The COVID group had a lower FEV1 and FVC on spirometry than the healthy matched control group. Further, the COVID group had a lower FRC on plethysmography than the healthy matched control group. Meanwhile, the COVID group had a lower DLCO than healthy matched control group. Nevertheless, its KCO was within the normal range.ConclusionSevere acute COVID-19 requiring V-V ECMO persistently impairs small airway function and reduces respiratory tissue elasticity, primarily attributed to lung restriction. These findings also suggest that even severe pulmonary pathologies of acute COVID-19 can manifest in a moderate but still persistent lung function impairment 6 months after hospital discharge.Trial registrationNCT05812196

Erlotinib as single agent first line treatment in locally advanced or metastatic activating EGFR mutation-positive lung adenocarcinoma (CEETAC): an open-label, non-randomized, multicenter, phase IV clinical trial

BACKGROUND: Erlotinib is approved for the first line treatment of epidermal growth factor receptor (EGFR) mutation-positive non-small cell lung cancer. Since the number of prospective studies in Caucasian patients treated in routine clinical setting is limited we conducted a multicenter, phase IV clinical trial to determine the efficacy and safety of erlotinib and to demonstrate the feasibility of the validated standardized companion diagnostic method of EGFR mutation detection. METHODS: 651 chemonaive, cytologically or histologically verified advanced stage lung adenocarcinoma patients from Hungary, Turkey and Latvia were screened for exon19 microdeletions and exon21 L858R EGFR mutations using the companion diagnostic EGFR test. EGFR mutation-positive, locally advanced or metastatic lung adenocarcinoma patients received as first line treatment erlotinib at 150 mg/day. The primary endpoint was progression-free survival (PFS). RESULTS: 62 EGFR mutation-positive patients (9.5% of screened) were included in the safety/intent-to-treat cohort. Median PFS was 12.8 months (95%CI, 9.9-15.8), objective response rate and one-year survival was 66.1% and 82.5%, respectively. Most frequent treatment related adverse events were diarrhoea and rash. Eastern Oncology Cooperative Group Performance Status (ECOG PS), smoking status and M1a/M1b disease stage were significant prognosticators of PFS (p = 0.017, p = 0.045 and p = 0.002, respectively). There was no significant difference in PFS between the subgroups stratified by gender, age or exon19 vs exon21 mutation. CONCLUSIONS: Our study confirmed the efficacy and safety of first line erlotinib monotherapy in Caucasian patients with locally advanced or metastatic lung adenocarcinoma carrying activating EGFR mutations based on the screening with the approved companion diagnostic procedure. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01609543