Pub Date : 2026-01-01DOI: 10.1016/j.resinv.2025.101356
Yoshio Nakano , Masahisa Nakamura , Iwao Gohma
Background
Empyema often requires surgery such as video-assisted thoracoscopic surgery (VATS). Minimally invasive nonvascular interventional radiology (IR) techniques, including hydrodissection and guidewire dissection, may be alternatives. We compared outcomes of IR and VATS for stage II–III empyema.
Methods
We retrospectively analyzed 45 patients with stage II–III empyema treated at a single center between April 2021 and October 2024 (IR, n = 23; VATS, n = 22). Primary treatment success was resolution without conversion to surgical management; repeat IR procedures were considered part of the IR strategy. Groups were compared using appropriate statistical tests (p < 0.05).
Results
The Primary treatment success was 87.0 % (20/23) in the IR group and 100 % (22/22) in the VATS group (p = 0.233). The overall clinical outcome, including cases that required subsequent surgery, was 95.6 % in the IR group and 100 % in the VATS group (p = 1). One patient in the IR group required three IR sessions, all performed through the same access site. While IR recipients were significantly older (median 78.0 versus [vs.] 71.5 years; p = 0.046) and had worse performance status (p = 0.015), there was no significant difference in hospital stay, drainage duration, or antibiotic therapy. Ninety-day mortality was 8.7 % (2/23) for IR and 0 % (0/22) for VATS (p = 0.49), with no procedure-related deaths.
Conclusion
In this cohort, no statistically significant difference in overall outcomes was observed between IR-based management and VATS for stage II–III empyema.
{"title":"Non-vascular interventional radiology techniques versus video-assisted thoracoscopic surgery in stage II–III empyema: a retrospective cohort study","authors":"Yoshio Nakano , Masahisa Nakamura , Iwao Gohma","doi":"10.1016/j.resinv.2025.101356","DOIUrl":"10.1016/j.resinv.2025.101356","url":null,"abstract":"<div><h3>Background</h3><div>Empyema often requires surgery such as video-assisted thoracoscopic surgery (VATS). Minimally invasive nonvascular interventional radiology (IR) techniques, including hydrodissection and guidewire dissection, may be alternatives. We compared outcomes of IR and VATS for stage II–III empyema.</div></div><div><h3>Methods</h3><div>We retrospectively analyzed 45 patients with stage II–III empyema treated at a single center between April 2021 and October 2024 (IR, n = 23; VATS, n = 22). Primary treatment success was resolution without conversion to surgical management; repeat IR procedures were considered part of the IR strategy. Groups were compared using appropriate statistical tests (p < 0.05).</div></div><div><h3>Results</h3><div>The Primary treatment success was 87.0 % (20/23) in the IR group and 100 % (22/22) in the VATS group (p = 0.233). The overall clinical outcome, including cases that required subsequent surgery, was 95.6 % in the IR group and 100 % in the VATS group (p = 1). One patient in the IR group required three IR sessions, all performed through the same access site. While IR recipients were significantly older (median 78.0 versus [vs.] 71.5 years; p = 0.046) and had worse performance status (p = 0.015), there was no significant difference in hospital stay, drainage duration, or antibiotic therapy. Ninety-day mortality was 8.7 % (2/23) for IR and 0 % (0/22) for VATS (p = 0.49), with no procedure-related deaths.</div></div><div><h3>Conclusion</h3><div>In this cohort, no statistically significant difference in overall outcomes was observed between IR-based management and VATS for stage II–III empyema.</div></div>","PeriodicalId":20934,"journal":{"name":"Respiratory investigation","volume":"64 1","pages":"Article 101356"},"PeriodicalIF":2.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145865196","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01DOI: 10.1016/j.resinv.2025.101359
Punchalee Kaenmuang , Fiammetta Danzo , Simon Bax , Richard J. Hewitt , Maria Kokosi , Vasileios Kouranos , Felix Chua , Peter M. George , Gisli Jenkins , Athol U. Wells , Carmel JW. Stock , Piersante Sestini , Elisabetta A. Renzoni
In fibrotic hypersensitivity pneumonitis, the relevance of bronchoalveolar lavage (BAL) lymphocytosis remains unclear. We investigated the relationship between BAL %lymphocytes, baseline pulmonary function tests (PFTs) and transplant-free survival. We retrospectively analysed 162 treatment-naïve patients (median age 64 years; 43 % male; 39 % ever-smokers) undergoing BAL within three months of PFTs. Mean FVC 79 %, DLCO 43 %, composite physiologic index (CPI) 48. Median BAL lymphocytes were 24 %(IQR 21–28). BAL %lymphocytes were associated with less severe disease, FVC [coefficient 0.28 (95 %C.I. 0.06–0.48), p = 0.01], FEV1 [0.20(0.0002–0.41), p = 0.05], and CPI [-0.11(-0.21 to −0.01, p = 0.04]. Although BAL% lymphocytes were not correlated with DLCO, significant opposite correlations were observed for its two components: positive with VA% [0.32 (0.18–0.45), p < 0.0005]; negative with KCO% [-0.37(-0.51 to −0.23), p < 0.0005]. In adjusted Cox regression models, BAL %lymphocytes, lower CPI, higher %FVC, %FEV1 and %DLCO were significantly associated with increased survival. These findings suggest BAL lymphocytosis reflects a pathophysiological pattern linked to better outcomes.
{"title":"BAL cells analysis and lung function parameters in fibrotic hypersensitivity pneumonitis at baseline and in relation to survival","authors":"Punchalee Kaenmuang , Fiammetta Danzo , Simon Bax , Richard J. Hewitt , Maria Kokosi , Vasileios Kouranos , Felix Chua , Peter M. George , Gisli Jenkins , Athol U. Wells , Carmel JW. Stock , Piersante Sestini , Elisabetta A. Renzoni","doi":"10.1016/j.resinv.2025.101359","DOIUrl":"10.1016/j.resinv.2025.101359","url":null,"abstract":"<div><div>In fibrotic hypersensitivity pneumonitis, the relevance of bronchoalveolar lavage (BAL) lymphocytosis remains unclear. We investigated the relationship between BAL %lymphocytes, baseline pulmonary function tests (PFTs) and transplant-free survival. We retrospectively analysed 162 treatment-naïve patients (median age 64 years; 43 % male; 39 % ever-smokers) undergoing BAL within three months of PFTs. Mean FVC 79 %, DLCO 43 %, composite physiologic index (CPI) 48. Median BAL lymphocytes were 24 %(IQR 21–28). BAL %lymphocytes were associated with less severe disease, FVC [coefficient 0.28 (95 %C.I. 0.06–0.48), p = 0.01], FEV<sub>1</sub> [0.20(0.0002–0.41), p = 0.05], and CPI [-0.11(-0.21 to −0.01, p = 0.04]. Although BAL% lymphocytes were not correlated with DLCO, significant opposite correlations were observed for its two components: positive with VA% [0.32 (0.18–0.45), p < 0.0005]; negative with KCO% [-0.37(-0.51 to −0.23), p < 0.0005<strong>].</strong> In adjusted Cox regression models, BAL %lymphocytes, lower CPI, higher %FVC, %FEV<sub>1</sub> and %DLCO were significantly associated with increased survival. These findings suggest BAL lymphocytosis reflects a pathophysiological pattern linked to better outcomes.</div></div>","PeriodicalId":20934,"journal":{"name":"Respiratory investigation","volume":"64 1","pages":"Article 101359"},"PeriodicalIF":2.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145883568","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Nontuberculous mycobacterial pulmonary disease (NTM-PD) is a chronic respiratory infection with a growing incidence and mortality globally. Although the clinical features, treatment, and prognosis of Mycobacterium avium-intracellulare (MAI) pulmonary disease have been extensively reported, evidence regarding non-MAI NTM-PD remains limited.
Methods
This retrospective cohort study included patients newly diagnosed with NTM-PD between 2010 and 2017 at 18 hospitals in Kyushu, Japan. Data on baseline characteristics, causative organisms, radiological findings, treatment regimens, and clinical outcomes were collected and analysed.
Results
In total, 1317 patients were enrolled. M. intracellulare (50.4 %), M. avium (40.5 %), M. abscessus complex (MABC) (2.4 %), and M. kansasii (2.4 %) were identified as the major causative organisms. Compared with patients with MAI, those with MABC exhibited a lower body mass index and a higher AFB sputum smear positivity rate. Patients with M. kansasii infection were predominantly male, frequently had underlying chronic obstructive pulmonary disease, and presented with cavitary lesions. Treatment initiation rates for MABC and M. kansasii were 71.9 % and 87.5 %, respectively. The response rate to the treatment in sputum mycobacterial evaluation was comparable between the two groups. However, the re-treatment rate was higher in the MABC group (30.4 % vs. 14.3 %). The 10-year mortality rates were 25.0 % and 15.6 % for MABC and M. kansasii, respectively.
Conclusions
Initial treatment responses for MABC and M. kansasii were favourable. However, long-term outcomes for MABC remained poor, potentially owing to the limited availability of effective continuation-phase therapies. Further large-scale prospective studies are warranted to understand the clinical management and prognosis of non-MAI NTM-PD.
{"title":"Clinical features of Mycobacterium abscessus complex and Mycobacterium kansasii pulmonary disease in Kyushu, Japan","authors":"Kazuaki Takeda , Takahiro Takazono , Shotaro Ide , Masataka Yoshida , Naoki Iwanaga , Naoki Hosogaya , Yusei Tsukamoto , Satoshi Irifune , Takayuki Suyama , Asuka Umemura , Tomo Mihara , Akira Kondo , Tsutomu Kobayashi , Eisuke Sasaki , Toyomitsu Sawai , Yasuhito Higashiyama , Kohji Hashiguchi , Minako Hanaka , Toshihiko Ii , Kiyoyasu Fukushima , Hiroshi Mukae","doi":"10.1016/j.resinv.2025.101358","DOIUrl":"10.1016/j.resinv.2025.101358","url":null,"abstract":"<div><h3>Background</h3><div>Nontuberculous mycobacterial pulmonary disease (NTM-PD) is a chronic respiratory infection with a growing incidence and mortality globally. Although the clinical features, treatment, and prognosis of <em>Mycobacterium avium-intracellulare</em> (MAI) pulmonary disease have been extensively reported, evidence regarding non-MAI NTM-PD remains limited.</div></div><div><h3>Methods</h3><div>This retrospective cohort study included patients newly diagnosed with NTM-PD between 2010 and 2017 at 18 hospitals in Kyushu, Japan. Data on baseline characteristics, causative organisms, radiological findings, treatment regimens, and clinical outcomes were collected and analysed.</div></div><div><h3>Results</h3><div>In total, 1317 patients were enrolled. <em>M. intracellulare</em> (50.4 %), <em>M. avium</em> (40.5 %), <em>M. abscessus</em> complex (MABC) (2.4 %), and <em>M. kansasii</em> (2.4 %) were identified as the major causative organisms. Compared with patients with MAI, those with MABC exhibited a lower body mass index and a higher AFB sputum smear positivity rate. Patients with <em>M. kansasii</em> infection were predominantly male, frequently had underlying chronic obstructive pulmonary disease, and presented with cavitary lesions. Treatment initiation rates for MABC and <em>M. kansasii</em> were 71.9 % and 87.5 %, respectively. The response rate to the treatment in sputum mycobacterial evaluation was comparable between the two groups. However, the re-treatment rate was higher in the MABC group (30.4 % vs. 14.3 %). The 10-year mortality rates were 25.0 % and 15.6 % for MABC and <em>M. kansasii</em>, respectively.</div></div><div><h3>Conclusions</h3><div>Initial treatment responses for MABC and <em>M. kansasii</em> were favourable. However, long-term outcomes for MABC remained poor, potentially owing to the limited availability of effective continuation-phase therapies. Further large-scale prospective studies are warranted to understand the clinical management and prognosis of non-MAI NTM-PD.</div></div>","PeriodicalId":20934,"journal":{"name":"Respiratory investigation","volume":"64 1","pages":"Article 101358"},"PeriodicalIF":2.0,"publicationDate":"2025-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145839206","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-19DOI: 10.1016/j.resinv.2025.101355
Toshiyuki Yonezawa , Akiko Nakamura , Yuka Onda , Takuma Katano , Hiroto Murao , Masaya Fukami , Tomoyuki Ogisu , Kenji Baba , Satoru Ito
Background
Exophiala dermatitidis is a ubiquitous black fungus found in the environment, but the clinical characteristics of E. dermatitidis in respiratory diseases without cystic fibrosis (CF) remain unclear.
Methods
We retrospectively analyzed clinical data of non-CF patients who had E. dermatitidis isolated from respiratory specimens.
Results
Thirteen patients were enrolled in the study. E. dermatitidis was isolated from sputum aspirated by bronchoscopy (n = 6), sputum (n = 5), bronchoalveolar lavage fluid (n = 1), and empyema pus (n = 1). Preceding pulmonary comorbidities included bronchiectasis (n = 6), COPD (n = 4), nontuberculous Mycobacterium (NTM) infection (n = 3), lung cancer (n = 2), interstitial lung disease (ILD) (n = 2), and asthma (n = 2). Non-pulmonary immunosuppressive comorbidities included diabetes (n = 4), immunosuppressive drug use (n = 3), and malignancies treated with chemotherapy (n = 2). Six patients (46.2 %) were defined as “definite” infection and seven (53.8 %) were as “possible” infection. Levels of serum β-D-glucan (cut-off <20 pg/mL) were elevated in two of 10 patients. Chest CT showed various shadows such as bronchiectasis (n = 9), infiltrative shadow (n = 9), and mucoid impaction (n = 8). Among six patients who were treated with itraconazole (ITCZ), three patients improved, one was unchanged, and two worsened. Despite ITCZ therapy, one patient died due to exacerbation of ILD. In the non-treated group, two patients died due to advanced lung cancer. NTM was also detected with E. dermatitidis in three patients.
Conclusion
Our data suggest that E. dermatitidis may cause respiratory infections in patients with bronchiectasis or immunocompromised conditions. Further studies are needed to distinguish colonization from true infection of E. dermatitidis in the respiratory tract.
{"title":"Clinical characteristics of pulmonary infections caused by Exophiala dermatitidis","authors":"Toshiyuki Yonezawa , Akiko Nakamura , Yuka Onda , Takuma Katano , Hiroto Murao , Masaya Fukami , Tomoyuki Ogisu , Kenji Baba , Satoru Ito","doi":"10.1016/j.resinv.2025.101355","DOIUrl":"10.1016/j.resinv.2025.101355","url":null,"abstract":"<div><h3>Background</h3><div><em>Exophiala dermatitidis</em> is a ubiquitous black fungus found in the environment, but the clinical characteristics of <em>E. dermatitidis</em> in respiratory diseases without cystic fibrosis (CF) remain unclear.</div></div><div><h3>Methods</h3><div>We retrospectively analyzed clinical data of non-CF patients who had <em>E. dermatitidis</em> isolated from respiratory specimens.</div></div><div><h3>Results</h3><div>Thirteen patients were enrolled in the study. <em>E. dermatitidis</em> was isolated from sputum aspirated by bronchoscopy (n = 6), sputum (n = 5), bronchoalveolar lavage fluid (n = 1), and empyema pus (n = 1). Preceding pulmonary comorbidities included bronchiectasis (n = 6), COPD (n = 4), nontuberculous <em>Mycobacterium</em> (NTM) infection (n = 3), lung cancer (n = 2), interstitial lung disease (ILD) (n = 2), and asthma (n = 2). Non-pulmonary immunosuppressive comorbidities included diabetes (n = 4), immunosuppressive drug use (n = 3), and malignancies treated with chemotherapy (n = 2). Six patients (46.2 %) were defined as “definite” infection and seven (53.8 %) were as “possible” infection. Levels of serum β-D-glucan (cut-off <20 pg/mL) were elevated in two of 10 patients. Chest CT showed various shadows such as bronchiectasis (n = 9), infiltrative shadow (n = 9), and mucoid impaction (n = 8). Among six patients who were treated with itraconazole (ITCZ), three patients improved, one was unchanged, and two worsened. Despite ITCZ therapy, one patient died due to exacerbation of ILD. In the non-treated group, two patients died due to advanced lung cancer. NTM was also detected with <em>E. dermatitidis</em> in three patients.</div></div><div><h3>Conclusion</h3><div>Our data suggest that <em>E. dermatitidis</em> may cause respiratory infections in patients with bronchiectasis or immunocompromised conditions. Further studies are needed to distinguish colonization from true infection of <em>E. dermatitidis</em> in the respiratory tract.</div></div>","PeriodicalId":20934,"journal":{"name":"Respiratory investigation","volume":"64 1","pages":"Article 101355"},"PeriodicalIF":2.0,"publicationDate":"2025-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145786957","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
According to LACE analysis, patients diagnosed with p-Stage II-III non-small cell lung cancer (NSCLC) are usually indicated for adjuvant chemotherapy, including platinum doublets. We aimed to identify the risk of recurrence in NSCLC patients without lymph node metastasis.
Methods
Between 2009 and 2018, 187 patients underwent lung resection of one or more lobes and mediastinal lymph node dissection for p-Stage II-IIIA NSCLC. Among them, 112 were included after excluding those with a history of lung cancer, perioperative chemotherapy. Staging was based on 8th Edition of IASLC staging system. Multivariate analysis was performed to identify important prognostic factors for oncologic outcomes.
Results
Among the evaluated patients, 84 were male, and with a median age of 67 years. Seventy-one (51.4 %) patients were diagnosed with adenocarcinoma. The cancer stages were stage IIA in 34 patients, stage IIB in 57 patients, and stage IIIA in 21 patients. Multivariate analysis of disease-free survival revealed that vascular invasion (HR, 2.481; 95 %CI, 1.411–4.362, P < 0.01) and pathological T factor (HR, 1.819; 95 %CI, 1.226–2.699, P < 0.01) were the independent risk factors. Gray's test for equality of cumulative incidence functions revealed that the five-year cumulative incidence of recurrence was particularly high in patients with vascular invasion compared to that in patients without vascular invasion (21.5 % vs. 37.5 %, P = 0.03).
Conclusions
Vascular invasion is a significant predictor of lung cancer recurrence in patients with p-Stage II-IIIA NSCLC without lymph node metastasis. The patients without vascular invasion in this cohort had a favorable prognosis, with a 5-year recurrence rate of 21.5 %.
{"title":"The risk of recurrence in pathological stage II-IIIA non-small cell lung cancer without lymph node metastasis","authors":"Ryusuke Sumiya , Takeshi Matsunaga , Yukio Watanabe , Hisashi Tomita , Takuo Hayashi , Mariko Fukui , Aritoshi Hattori , Kazuya Takamochi , Kenji Suzuki","doi":"10.1016/j.resinv.2025.101349","DOIUrl":"10.1016/j.resinv.2025.101349","url":null,"abstract":"<div><h3>Background</h3><div>According to LACE analysis, patients diagnosed with p-Stage II-III non-small cell lung cancer (NSCLC) are usually indicated for adjuvant chemotherapy, including platinum doublets. We aimed to identify the risk of recurrence in NSCLC patients without lymph node metastasis.</div></div><div><h3>Methods</h3><div>Between 2009 and 2018, 187 patients underwent lung resection of one or more lobes and mediastinal lymph node dissection for p-Stage II-IIIA NSCLC. Among them, 112 were included after excluding those with a history of lung cancer, perioperative chemotherapy. Staging was based on 8th Edition of IASLC staging system. Multivariate analysis was performed to identify important prognostic factors for oncologic outcomes.</div></div><div><h3>Results</h3><div>Among the evaluated patients, 84 were male, and with a median age of 67 years. Seventy-one (51.4 %) patients were diagnosed with adenocarcinoma. The cancer stages were stage IIA in 34 patients, stage IIB in 57 patients, and stage IIIA in 21 patients. Multivariate analysis of disease-free survival revealed that vascular invasion (HR, 2.481; 95 %CI, 1.411–4.362, P < 0.01) and pathological T factor (HR, 1.819; 95 %CI, 1.226–2.699, P < 0.01) were the independent risk factors. Gray's test for equality of cumulative incidence functions revealed that the five-year cumulative incidence of recurrence was particularly high in patients with vascular invasion compared to that in patients without vascular invasion (21.5 % vs. 37.5 %, P = 0.03).</div></div><div><h3>Conclusions</h3><div>Vascular invasion is a significant predictor of lung cancer recurrence in patients with p-Stage II-IIIA NSCLC without lymph node metastasis. The patients without vascular invasion in this cohort had a favorable prognosis, with a 5-year recurrence rate of 21.5 %.</div></div>","PeriodicalId":20934,"journal":{"name":"Respiratory investigation","volume":"64 1","pages":"Article 101349"},"PeriodicalIF":2.0,"publicationDate":"2025-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145786956","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-17DOI: 10.1016/j.resinv.2025.101351
Kiminori Fujimoto
{"title":"Interstitial lung abnormality or interstitial lung disease; is that the question?","authors":"Kiminori Fujimoto","doi":"10.1016/j.resinv.2025.101351","DOIUrl":"10.1016/j.resinv.2025.101351","url":null,"abstract":"","PeriodicalId":20934,"journal":{"name":"Respiratory investigation","volume":"64 1","pages":"Article 101351"},"PeriodicalIF":2.0,"publicationDate":"2025-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145782709","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Intrapleural fibrinolytic therapy has emerged as a preferred treatment for empyema, helping to reduce the need for surgery and shorten hospital stays. However, fibrinolytic drugs may not be available in some regions due to distribution challenges. In such situations, intrapleural saline lavage can serve as an effective alternative treatment option. Evidence supporting the use of intrapleural saline lavage remains limited, primarily because previous studies have used low lavage volumes.
Methods
We aimed to compare hospital stays, 30-day mortality rates, rates of referral to surgery, length of drainage, and adverse events between two groups of empyema patients: one receiving pleural lavage with urokinase administration; and the other receiving pleural lavage using 500 mL of saline. This was a single-center, prospective cohort study that analyzed patients contracting empyema with positive culture of pleural fluids admitted to our hospital between March 2021 and March 2023.
Results
The 33 patients comprised 18 in the urokinase group and 15 in the saline group. No significant differences were seen in 30-day mortality rate (p = 0.08) or referral for surgery (p = 0.618). Although the overall duration of hospital stay appeared comparable between the groups, competing risk analysis accounting for death as a competing event demonstrated a significant difference in time to discharge (p = 0.023), with a longer hospital stay observed in the saline group. Non-inferiority analysis showed significant differences between groups in additional drainage tubes.
Conclusions
No significant difference in surgical referrals or mortality was evident between intrapleural saline lavage and urokinase therapy. However, saline lavage in acute empyema may be less effective and result in longer hospital stays, even with larger volumes.
Trial registration
This study was performed using data from a prospective epidemiological study for patients with pneumonia (UMIN000004353).
{"title":"Effect of large-volume intrapleural saline lavage for empyema: a single-center, prospective cohort study","authors":"Masanori Kawataki , Akihiro Ito , Hiromasa Tachibana , Yosuke Nakanishi , Shotaro Ide , Akitsugu Furumoto , Hiroshi Mukae , Tadashi Ishida","doi":"10.1016/j.resinv.2025.101354","DOIUrl":"10.1016/j.resinv.2025.101354","url":null,"abstract":"<div><h3>Background</h3><div>Intrapleural fibrinolytic therapy has emerged as a preferred treatment for empyema, helping to reduce the need for surgery and shorten hospital stays. However, fibrinolytic drugs may not be available in some regions due to distribution challenges. In such situations, intrapleural saline lavage can serve as an effective alternative treatment option. Evidence supporting the use of intrapleural saline lavage remains limited, primarily because previous studies have used low lavage volumes.</div></div><div><h3>Methods</h3><div>We aimed to compare hospital stays, 30-day mortality rates, rates of referral to surgery, length of drainage, and adverse events between two groups of empyema patients: one receiving pleural lavage with urokinase administration; and the other receiving pleural lavage using 500 mL of saline. This was a single-center, prospective cohort study that analyzed patients contracting empyema with positive culture of pleural fluids admitted to our hospital between March 2021 and March 2023.</div></div><div><h3>Results</h3><div>The 33 patients comprised 18 in the urokinase group and 15 in the saline group. No significant differences were seen in 30-day mortality rate (p = 0.08) or referral for surgery (p = 0.618). Although the overall duration of hospital stay appeared comparable between the groups, competing risk analysis accounting for death as a competing event demonstrated a significant difference in time to discharge (p = 0.023), with a longer hospital stay observed in the saline group. Non-inferiority analysis showed significant differences between groups in additional drainage tubes.</div></div><div><h3>Conclusions</h3><div>No significant difference in surgical referrals or mortality was evident between intrapleural saline lavage and urokinase therapy. However, saline lavage in acute empyema may be less effective and result in longer hospital stays, even with larger volumes.</div></div><div><h3>Trial registration</h3><div>This study was performed using data from a prospective epidemiological study for patients with pneumonia (UMIN000004353).</div></div>","PeriodicalId":20934,"journal":{"name":"Respiratory investigation","volume":"64 1","pages":"Article 101354"},"PeriodicalIF":2.0,"publicationDate":"2025-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145775603","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Treprostinil has been approved for pulmonary hypertension associated with interstitial lung disease (PH-ILD) in Japan. This report aimed to evaluate long-term effects of inhaled treprostinil in Japanese patients with PH-ILD based on observation over 52 weeks.
Methods
Inhaled treprostinil was administered via a nebulizer from 18 μg (three breaths, four times daily) to 72 μg (12 breaths, four times daily) at minimum 3-day intervals. World Health Organization (WHO) functional class, clinical worsening, adverse events, pulmonary function and ILD-related biomarkers were evaluated throughout the trial.
Results
Among 20 patients, 16 and 13 completed the 52-week and 100-week observation periods, respectively. Eleven patients continued on the trial until transitioning to a commercially available product. The reasons of discontinuation in nine patients were adverse events in six patients (including four adverse drug reactions (ADRs)), withdrawal of consent in two patients, and lung transplantation in one patient. The median observation period was 107.5 weeks (interquartile range, 61.4–128.8 weeks) in 20 patients. Among 13 patients observed until week 100, WHO functional class was maintained in 69.2 % (9/13), and improved from class III to class II in 30.8 % (4/13). The main ADRs included cough, malaise, and blood pressure decreased. At the final measurement timepoint in each patient, 70.0 % (14/20) and 83.3 % (15/18) maintained had no absolute decline of forced vital capacity ≥5 % and diffusing capacity for carbon monoxide ≥10 %, respectively.
Conclusion
Considering its long-term clinical benefits and tolerability, inhaled treprostinil is a promising treatment option for patients with PH-ILD.
Trial registration
Japan Registry of Clinical Trials (jRCT), jRCT2051210016. (first registered: May 7, 2021).
{"title":"Long-term effects of inhaled treprostinil in Japanese patients with pulmonary hypertension associated with interstitial lung disease","authors":"Yasuhiro Kondoh , Takashi Ogura , Osamu Nishiyama , Hideyuki Kinoshita , Takeshi Ogo , Nobuhiro Tanabe , Shun Minatsuki , Kazuhiko Nakayama , Yu Taniguchi , Kenta Takahashi , Takashi Orido , Seiichiro Sakao","doi":"10.1016/j.resinv.2025.101340","DOIUrl":"10.1016/j.resinv.2025.101340","url":null,"abstract":"<div><h3>Background</h3><div>Treprostinil has been approved for pulmonary hypertension associated with interstitial lung disease (PH-ILD) in Japan. This report aimed to evaluate long-term effects of inhaled treprostinil in Japanese patients with PH-ILD based on observation over 52 weeks.</div></div><div><h3>Methods</h3><div>Inhaled treprostinil was administered via a nebulizer from 18 μg (three breaths, four times daily) to 72 μg (12 breaths, four times daily) at minimum 3-day intervals. World Health Organization (WHO) functional class, clinical worsening, adverse events, pulmonary function and ILD-related biomarkers were evaluated throughout the trial.</div></div><div><h3>Results</h3><div>Among 20 patients, 16 and 13 completed the 52-week and 100-week observation periods, respectively. Eleven patients continued on the trial until transitioning to a commercially available product. The reasons of discontinuation in nine patients were adverse events in six patients (including four adverse drug reactions (ADRs)), withdrawal of consent in two patients, and lung transplantation in one patient. The median observation period was 107.5 weeks (interquartile range, 61.4–128.8 weeks) in 20 patients. Among 13 patients observed until week 100, WHO functional class was maintained in 69.2 % (9/13), and improved from class III to class II in 30.8 % (4/13). The main ADRs included cough, malaise, and blood pressure decreased. At the final measurement timepoint in each patient, 70.0 % (14/20) and 83.3 % (15/18) maintained had no absolute decline of forced vital capacity ≥5 % and diffusing capacity for carbon monoxide ≥10 %, respectively.</div></div><div><h3>Conclusion</h3><div>Considering its long-term clinical benefits and tolerability, inhaled treprostinil is a promising treatment option for patients with PH-ILD.</div></div><div><h3>Trial registration</h3><div>Japan Registry of Clinical Trials (jRCT), jRCT2051210016. (first registered: May 7, 2021).</div></div>","PeriodicalId":20934,"journal":{"name":"Respiratory investigation","volume":"64 1","pages":"Article 101340"},"PeriodicalIF":2.0,"publicationDate":"2025-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145769039","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Fibrotic idiopathic interstitial pneumonias (IIPs) are progressive lung diseases with variable prognoses. Oscillometry, a non-invasive method for assessing respiratory impedance, has emerged as a potential tool for disease stratification. However, the association between standardized respiratory reactance (Xrs) measured by oscillometry and clinical outcomes in IIPs, including those other than idiopathic pulmonary fibrosis, remains unclear. Therefore, we investigated this association.
Methods
We retrospectively analyzed 101 patients with fibrotic IIPs treated at Shizuoka General Hospital from 2017 to 2022. Fibrosis was defined by high-resolution computed tomography findings of honeycombing, traction bronchiectasis, or subpleural reticulation. Patients were categorized into high-Xrs or low-Xrs groups based on whether Xrs parameters (X5, Fres, or AX) exceeded 1.64 standard deviations above Japanese standard values. The primary outcome was mortality. Cox proportional hazards analysis identified prognostic factors.
Results
Among 101 patients, 25 (24.8 %) were classified as high-Xrs. Median overall survival was significantly shorter in the high-Xrs group (21.1 months; 95 % CI, 13.2–43.3) compared to the low-Xrs group (78.7 months; 95 % CI, 56.8–not reached). A subgroup analysis of IPF and non-IPF patients showed significant survival differences between the high-Xrs and low-Xrs groups. Multivariate analysis identified low %FVC and high-Xrs classification as independent predictors of mortality.
Conclusions
High respiratory reactance measured by oscillometry was independently associated with impaired lung function and poor prognosis in patients with fibrotic IIPs. Oscillometry may be a valuable tool for risk stratification and prognostic assessment in this patient population.
{"title":"Oscillometrically assessed higher respiratory reactance is associated with impaired lung function and poorer prognosis in patients with fibrotic idiopathic interstitial pneumonias","authors":"Yuya Yamamoto , Taisuke Akamatsu , Keita Hirai , Toshihiro Shirai","doi":"10.1016/j.resinv.2025.101352","DOIUrl":"10.1016/j.resinv.2025.101352","url":null,"abstract":"<div><h3>Background</h3><div>Fibrotic idiopathic interstitial pneumonias (IIPs) are progressive lung diseases with variable prognoses. Oscillometry, a non-invasive method for assessing respiratory impedance, has emerged as a potential tool for disease stratification. However, the association between standardized respiratory reactance (Xrs) measured by oscillometry and clinical outcomes in IIPs, including those other than idiopathic pulmonary fibrosis, remains unclear. Therefore, we investigated this association.</div></div><div><h3>Methods</h3><div>We retrospectively analyzed 101 patients with fibrotic IIPs treated at Shizuoka General Hospital from 2017 to 2022. Fibrosis was defined by high-resolution computed tomography findings of honeycombing, traction bronchiectasis, or subpleural reticulation. Patients were categorized into high-Xrs or low-Xrs groups based on whether Xrs parameters (X5, Fres, or AX) exceeded 1.64 standard deviations above Japanese standard values. The primary outcome was mortality. Cox proportional hazards analysis identified prognostic factors.</div></div><div><h3>Results</h3><div>Among 101 patients, 25 (24.8 %) were classified as high-Xrs. Median overall survival was significantly shorter in the high-Xrs group (21.1 months; 95 % CI, 13.2–43.3) compared to the low-Xrs group (78.7 months; 95 % CI, 56.8–not reached). A subgroup analysis of IPF and non-IPF patients showed significant survival differences between the high-Xrs and low-Xrs groups. Multivariate analysis identified low %FVC and high-Xrs classification as independent predictors of mortality.</div></div><div><h3>Conclusions</h3><div>High respiratory reactance measured by oscillometry was independently associated with impaired lung function and poor prognosis in patients with fibrotic IIPs. Oscillometry may be a valuable tool for risk stratification and prognostic assessment in this patient population.</div></div>","PeriodicalId":20934,"journal":{"name":"Respiratory investigation","volume":"64 1","pages":"Article 101352"},"PeriodicalIF":2.0,"publicationDate":"2025-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145736941","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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