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Background: Shape-sensing robotic-assisted bronchoscopy (ssRAB) combined with intraoperative imaging optimizes tool-lesion relationship during the sampling of focal pulmonary lesions. Nevertheless, confirmation of tool-in-lesion status is not equivalent to diagnostic sampling. This gap may be bridged by the addition of transbronchial cryobiopsy (TBCB) to traditional transbronchial needle aspiration (TBNA) and forceps biopsy (TBFB); however, the performance of TBCB, specifically with the 1.7-mm cryoprobe, has raised significant safety concerns.

Objective: Evaluate the safety of TBCB using the 1.7-mm cryoprobe, added into ssRAB-guided TBNA and TBFB, and performed via a protocolized approach in a cancer center patient population undergoing lung biopsy for focal parenchymal pulmonary lesions. Secondary endpoints included diagnostic yield, accuracy, and TBFB vs. TBCB tissue quality measures.

Methods: This prospective, single center, single arm study, enrolled patients referred for sampling of focal pulmonary parenchymal lesions. All procedures were performed with image-guided ssRAB with prophylactic balloon occlusion. The primary endpoint was a safety composite of grade ≥ 2 bleeding, grade ≥ 2 pneumothorax, or other biopsy-related grade ≥ 3 complication. Secondary endpoints included conservative diagnostic yield, diagnostic accuracy for malignancy, and biopsy specimen quality measures.

Results: Fifty-one participants were enrolled and underwent image-guided ssRAB. The primary severe adverse event rate was 0% (95% CI 0.0-7.9). The conservative diagnostic yield was 92% and the diagnostic accuracy for malignancy was 90%. TBCB was superior to forceps biopsy in measures of total specimen dimensions, diagnostic tissue area, and degree of crush artifact (P < 0.001 for all comparisons).

Conclusion: In cancer patients with localized parenchymal lung lesions, the incorporation of a rigorous safety protocol into image-guided ssRAB allows for the safe acquisition of high-quality peripheral lung TBCB specimen, utilizing the 1.7-mm cryoprobe.

Clinical trial registration: Clinicaltrials.gov identifier: NCT04548830.

Asthma is a heterogeneous condition characterized by chronic airway inflammation, airway hyperresponsiveness, and mucin hypersecretion. Obesity-related asthma is one phenotype of asthma with significant metabolic dysregulation. A complete understanding of obesity-related asthma remains elusive, but it is most often characterized by the absence of hallmark features of Type-2 (T2) high asthma, such as eosinophilia or elevated exhaled nitric oxide (NO) levels. Patients with obesity-related and T2 low asthma with or without type 2 diabetes mellitus (T2DM) experience worse clinical outcomes, including more severe acute exacerbations. Among the Food and Drug Administration (FDA) approved drug classes for T2DM, there is a growing interest in glucagon-like peptide 1 receptor agonists' (GLP-1RAs) ability to potentially exert effects in the airway. Previous studies found that individuals with T2DM and asthma who were prescribed GLP-1RAs, had decreased asthma exacerbations and improved lung function. However, there remains a gap in understanding GLP-1RAs mechanism of action in the lung and airways to improve pulmonary function. In this review we discuss the potential mechanisms by which GLP-1RAs may impact T2 low asthma and offer a therapeutic option for this highly prevalent disorder.

Right ventricular failure (RVF) is a complex clinical syndrome resulting from anatomical and physiological dysfunction of the right ventricle, marked by insufficient cardiac output state, elevated filling pressures, and elevated central venous pressures. Historically, acute RVF in the medical intensive care unit (MICU) has posed significant diagnostic and therapeutic challenges, often leading to poor patient outcomes and increased healthcare utilization. RVF is a pervasive and critically underdiagnosed condition in MICUs, often masked by nonspecific symptoms and overlooked in favor of left-sided pathology, despite its profound impact on patient outcomes and mortality. This difficulty stems from a limited understanding of its underlying mechanisms and a lack of high-quality evidence to guide management in critical care settings. Effective care for RVF demands early recognition, precise identification of the underlying etiology, and prompt, targeted interventions. Intensivists must possess comprehensive knowledge and a diverse skill set to navigate these complexities and address unforeseen complications. Over the past two decades, advancements in diagnostic and therapeutic technologies have transformed the approach to RVF, driving significant progress in the field. This review explores the historical evolution, pathophysiology, clinical presentation, and contemporary management strategies for RVF in the MICU.

Purpose: Cough hypersensitivity is characterized by exaggerated cough responses to mild stimuli, which is frequently associated with laryngeal abnormal sensation (LAS). However, the clinical characteristics of LAS and its prevalence in a non-clinical working population remain unclear. This study aimed to investigate the clinical characteristics and prevalence of LAS.

Methods: This cross-sectional study included 556 healthcare workers (aged 20-72) from Gamagori City Hospital, Japan. Participants completed the Newcastle Laryngeal Hypersensitivity Questionnaire (NLHQ), Hull Airway Reflux Questionnaire, and Leicester Cough Questionnaire (LCQ). LAS was defined as an NLHQ score < 17.1. Binary logistic regression was used to analyze LAS-associated factors.

Results: LAS was present in 9.5% of participants. The LAS-positive group had significantly higher prevalence of asthma (13.2% vs. 3.4%, P = 0.005), chronic rhinosinusitis (7.5% vs. 1.0%, P = 0.006), and gastroesophageal reflux disease (GERD; 11.3% vs. 1.2%, P < 0.001). Cough prevalence was significantly higher in the LAS( +) group (45.2% vs. 9.5%, P < 0.001), and quality of life was impaired, as indicated by lower LCQ scores. Multivariate analysis revealed that asthma (OR = 5.092, P = 0.002), GERD (OR = 12.397, P < 0.001), and mood swings (OR = 2.957, P = 0.003) were independent risk factors for LAS.

Conclusion: LAS markedly affects symptoms like cough and impairs quality of life, and is independently associated with asthma, GERD, and mood swings. It may reflect a sensory phenomenon of vagal hypersensitivity that could contribute to the pathophysiology of such chronic conditions.

Viral pneumonia causes significant morbidity and mortality worldwide. However, there is limited ability to predict outcomes and treatment responses. We analyzed data from a recently published placebo-controlled trial of inhaled high molecular weight hyaluronan (HMWHA) in 146 patients with severe COVID-19 pneumonia, to determine whether admission cytokines and demographic information is associated with disease outcomes and response to HMWHA treatment. We found that serum levels of CXCL10 are strongly associated with both endpoints. Our data thus identify CXCL10 as a possible predictor of viral pneumonia outcome and response to anti-inflammatory treatment.

Background: Antimicrobial-resistant pathogens such as Pseudomonas aeruginosa (P. aeruginosa) represent a significant challenge to patients with respiratory diseases including Cystic Fibrosis (CF) and chronic obstructive pulmonary disease (COPD), where treatment of such infections is exacerbated by a shortage of new and effective antibiotic classes. One novel approach utilises 'antibiotic enhancers' that potentiate the antimicrobial activity of existing antibiotics. HT61, a small quinolone-derived compound, potentiates the activity of the aminoglycosides tobramycin and gentamicin against Staphylococcus aureus and P. aeruginosa. In this study, we have investigated synergism between tobramycin and HT61 using a panel of tobramycin-sensitive and -resistant clinical isolates of P. aeruginosa from CF patients.

Methods: Microdilution methods and chequerboard analysis were used to evaluate antimicrobial synergy of drug combinations against 63 isolates. Bacterial time-kill assays and biofilm eradication assays were then used to further characterise antimicrobial synergy against 13 selected isolates.

Results: 74% of isolates (47/63) demonstrated evidence of either positive interactions (29/63) determined by a Fractional Inhibitory Concentration Index (FICI) ≤ 1.0, or synergy (18/63) determined by an FICI value of ≤ 0.5. Using a sub-selection of these isolates, clear augmentation of tobramycin's antimicrobial activity was observed in both time-kill assays and biofilm eradication assays regardless of FICI classification with significant reductions observed in combination therapies vs monotherapies.

Conclusions: The expansion of previous studies highlighting the potentiating capabilities of HT61 on/with antibiotics in vivo across a further 63 clinical isolates of P. aeruginosa in a laboratory setting further highlights the potential therapeutic benefits of HT61-tobramycin combinations in respiratory diseases associated with drug-resistant P. aeruginosa.

Background: Chronic obstructive pulmonary disease (COPD) is a progressive disease characterized by chronic airway inflammation and remodeling. Fibrinogen gamma chain (FGG) has been implicated in the pathogenesis of multiple inflammatory and fibrotic conditions. However, the role and mechanisms of FGG in COPD remain unclear.

Methods: FGG expression in lung tissues and plasma of COPD patients and CS-exposed mice was assessed. To investigate its functional role in cigarette smoke extract (CSE)-induced inflammation and epithelial-mesenchymal transition (EMT), we employed FGG knockdown (KD) and recombinant human FGG (rFGG) protein treatment in BEAS-2B cells and in a murine COPD model. To elucidate the related mechanisms in CSE-induced airway inflammation and EMT, BEAS-2B cells were treated with PF573228 (10 µM, a FAK inhibitor) or SB431542 (10 µM, a TGF-β type I receptor inhibitor).

Results: FGG was up-regulated in both the lung tissue and plasma of COPD patients. Plasma FGG levels were negatively correlated with lung function in COPD patients. Similarly, elevated FGG expression was verified in CS-exposed mice and CSE-induced BEAS-2B cells. Both in vitro (FGG-KD in BEAS-2B) and in vivo (mouse model) experiments demonstrated that inhibition of FGG expression attenuated CSE-induced inflammatory cytokine release and EMT. Treatment with PF573228 or SB431542 inhibited airway inflammation and EMT, implicating the focal adhesion and TGF-β/Smad2 pathways.

Conclusions: FGG contributes to airway inflammation and remodeling in COPD. Cigarette smoke enhances FGG expression and secretion in bronchial epithelium. Increased FGG promotes the release of inflammatory cytokines and EMT through the focal adhesion and TGF-β/Smad2 pathways.