Respiratory investigation最新文献_第9页

Association between pleurodesis before immunotherapy and pneumonitis in non-small cell lung cancer 非小细胞肺癌免疫治疗前胸膜浸润与肺炎的关系

IF 2 Q2 RESPIRATORY SYSTEM

Respiratory investigation

Pub Date : 2025-09-25 DOI: 10.1016/j.resinv.2025.09.016

Megumi Mizutani , Yasutaka Ihara , Kenji Sawa , Akira Sugimoto , Hiroaki Nagamine , Yoshiya Matsumoto , Yoko Tani , Takako Oka , Hiroyasu Kaneda , Tsubasa Bito , Tomoya Kawaguchi , Ayumi Shintani

Background

Immune checkpoint inhibitors are important in the treatment of advanced non-small cell lung cancer, with pneumonitis being a prevalent complication. Pneumonitis is a recognized adverse event of pleurodesis in lung cancer patients with pleural effusion. However, the association between pleurodesis and pneumonitis in patients with immunotherapy remains unclear.

Methods

This retrospective cohort study used nationwide administrative claims data in Japan. Patients aged ≥18 years who underwent immunotherapy for newly diagnosed non-small cell lung cancer between December 2015 and January 2023 were included in the study. Patients who used talc or OK-432 within 60 days prior to immune checkpoint inhibitors treatment were defined as having undergone pleurodesis. The incidence rates of pneumonitis in patients with and without pleurodesis were compared using cumulative incidence functions against time, and by conducting a Fine–Gray analysis to account for death as a competing risk factor for pneumonitis incidence.

Results

Among the 16,538 patients with non-small cell lung cancer who received immune checkpoint inhibitors, 509 underwent pleurodesis. The incidence of pneumonitis was higher in patients who underwent pleurodesis than in those who did not. The sub-distribution hazard ratio quantified by Fine–Gray analysis was 1.168 (95 % confidence intercal, 1.062–1.286).

Conclusions

Pleurodesis before immunotherapy in patients with advanced non-small cell lung cancer was associated with an increased incidence of pneumonitis.

免疫检查点抑制剂在晚期非小细胞肺癌的治疗中很重要，肺炎是一种常见的并发症。肺炎是公认的胸腔积液肺癌患者胸腔积液的不良事件。然而，在接受免疫治疗的患者中，胸膜穿刺术和肺炎之间的关系尚不清楚。方法本回顾性队列研究使用日本全国行政索赔数据。在2015年12月至2023年1月期间接受新诊断的非小细胞肺癌免疫治疗的年龄≥18岁的患者纳入研究。在免疫检查点抑制剂治疗前60天内使用滑石粉或OK-432的患者被定义为经历了胸膜切除术。采用累积发病率随时间变化的函数，并通过细灰分析，将死亡作为肺炎发病率的竞争危险因素，比较有胸膜切除术和无胸膜切除术患者的肺炎发病率。结果在接受免疫检查点抑制剂治疗的16,538例非小细胞肺癌患者中，509例发生了胸膜切除术。胸膜切除术患者的肺炎发病率高于未行胸膜切除术的患者。细灰分析量化的亚分布风险比为1.168（95%可信区间为1.062 ~ 1.286）。结论晚期非小细胞肺癌患者免疫治疗前行脾脏切除术与肺炎发病率增高相关。

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引用次数: 0

Artificial intelligence for diagnosis in interstitial lung disease and digital ontology for unclassified interstitial lung disease 间质性肺疾病的人工智能诊断与未分类间质性肺疾病的数字本体

IF 2 Q2 RESPIRATORY SYSTEM

Respiratory investigation

Pub Date : 2025-09-24 DOI: 10.1016/j.resinv.2025.09.007

Tomohisa Baba , Tsubasa Goto , Yoshiro Kitamura , Tae Iwasawa , Koji Okudela , Tamiko Takemura , Akira Osawa , Takashi Ogura

Background

Multidisciplinary discussion (MDD) is the gold standard for diagnosis in interstitial lung disease (ILD). However, its inter-rater agreement is not satisfactory, and access to the MDD is limited due to a shortage of ILD experts. Therefore, artificial intelligence would be helpful for diagnosing ILD.

Methods

We retrospectively analyzed data from 630 patients with ILD, including clinical information, CT images, and pathological results. The ILD classification into four clinicopathologic entities (i.e., idiopathic pulmonary fibrosis, non-specific interstitial pneumonia, hypersensitivity pneumonitis, connective tissue disease) consists of two stages: first, pneumonia pattern classification of CT images using a convolutional neural network (CNN) model; second, multimodal (clinical, radiological, and pathological) classification using a support vector machine (SVM). The performance of the classification algorithm was evaluated using 5-fold cross-validation.

Results

The mean accuracies of the CNN model and SVM were 62.4 % and 85.4 %, respectively. For multimodal classification using SVM, the overall accuracy was very high, especially with sensitivities for idiopathic pulmonary fibrosis and hypersensitivity pneumonitis exceeding 90 %. When pneumonia patterns from CT images, pathological results, or clinical information were not used, the SVM accuracy was 84.3 %, 70.3 % and 79.8 %, respectively, suggesting that pathological results contributed most to MDD diagnosis. When an unclassifiable interstitial pneumonia was input, the SVM output tended to align with the most likely diagnosis by the expert MDD team.

Conclusions

The algorithm based on multimodal information can assist in diagnosing interstitial lung disease and is suitable for ontology diagnosis. (242 words)

多学科讨论（MDD）是诊断间质性肺疾病（ILD）的金标准。然而，其内部协议并不令人满意，并且由于缺乏ILD专家，对MDD的访问受到限制。因此，人工智能将有助于诊断ILD。方法回顾性分析630例ILD患者的临床资料、CT图像和病理结果。将ILD分为四种临床病理实体（特发性肺纤维化、非特异性间质性肺炎、超敏性肺炎、结缔组织病）分为两个阶段：首先，使用卷积神经网络（CNN）模型对CT图像进行肺炎模式分类；第二，使用支持向量机（SVM）进行多模式（临床、放射和病理）分类。使用5倍交叉验证对分类算法的性能进行评估。结果CNN模型和SVM的平均准确率分别为62.4%和85.4%。对于SVM多模态分类，总体准确率非常高，特别是对特发性肺纤维化和超敏性肺炎的敏感性超过90%。在不使用CT图像、病理结果和临床信息的情况下，SVM的准确率分别为84.3%、70.3%和79.8%，表明病理结果对MDD的诊断贡献最大。当输入无法分类的间质性肺炎时，支持向量机的输出倾向于与MDD专家团队最可能的诊断一致。结论基于多模态信息的诊断算法能够辅助诊断间质性肺疾病，适合本体论诊断。(242字)

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引用次数: 0

Cluster analysis of seasonal KL-6 variations in interstitial lung diseases 间质性肺疾病患者KL-6季节性变异的聚类分析

IF 2 Q2 RESPIRATORY SYSTEM

Respiratory investigation

Pub Date : 2025-09-23 DOI: 10.1016/j.resinv.2025.09.018

Yuki Iijima , Tsukasa Okamoto , Shiro Sonoda , Tsuyoshi Shirai , Masahiro Ishizuka , Haruhiko Furusawa , Tomoya Tateishi , Tatsuhiko Anzai , Kunihiko Takahashi , Yasunari Miyazaki

Background

Serum Krebs von den Lungen-6 (KL-6) is a biomarker that reflects the pathophysiology and activity of interstitial lung disease (ILDs); however, its fluctuation patterns remain understudied.

Methods

This retrospective cohort study included 910 patients with ILD with at least one year of regular KL-6 measurements. Cluster analysis was performed to identify the distinct annual KL-6 fluctuation patterns. Patient demographics, disease distribution, and prognostic outcomes were compared across clusters.

Results

Four distinct clusters of KL-6 patterns were identified: minimal change (cluster 1, n = 722), decrease in summer (cluster 2, n = 74), increase in autumn (cluster 3, n = 21), and increase in winter (cluster 4, n = 93). Mean KL-6 value of the first year (p < 0.01), percent predicted forced vital capacity (p = 0.01), and diagnoses of idiopathic pulmonary fibrosis (p < 0.01), nonfibrotic hypersensitivity pneumonitis (p < 0.01), and fibrotic hypersensitivity pneumonitis (p = 0.04) were significantly associated with specific KL-6 fluctuation patterns. When seasonal trends were defined as belonging to the same cluster for two consecutive years, nonfibrotic hypersensitivity pneumonitis showed significant association with seasonal trends (p < 0.01). Multivariate analysis, adjusted for age and etiology, showed a trend for cluster 4 to have a poorer prognosis compared to cluster 1 (hazard ratio: 1.62, 95 % confidence interval: 0.93–2.80, p = 0.09).

Conclusion

KL-6 fluctuations were categorized into four seasonal patterns, which may provide insights for diagnosing ILD etiology and predicting the prognosis of patients with ILD.

血清Krebs von den Lungen-6 （KL-6）是反映间质性肺疾病（ILDs）病理生理和活动的生物标志物；然而，其波动模式仍未得到充分研究。方法本回顾性队列研究纳入910例ILD患者，患者至少有一年的定期KL-6测量。聚类分析表明，KL-6的年波动特征明显。患者人口统计、疾病分布和预后结果进行跨组比较。结果KL-6的变化最小（第1类，n = 722），夏季减少（第2类，n = 74），秋季增加（第3类，n = 21），冬季增加（第4类，n = 93）。第一年的平均KL-6值（p < 0.01）、预测强迫肺活量的百分比（p = 0.01）、特发性肺纤维化（p < 0.01）、非纤维化性过敏性肺炎（p < 0.01）和纤维化性过敏性肺炎（p = 0.04）的诊断与特定的KL-6波动模式显著相关。当季节性趋势被定义为连续两年属于同一群集时，非纤维化性超敏性肺炎与季节性趋势有显著相关性（p < 0.01）。经年龄和病因调整后的多因素分析显示，第4类患者预后较第1类患者差（风险比：1.62,95%可信区间：0.93-2.80,p = 0.09）。结论kl -6波动具有4种季节性特征，可为ILD的病因诊断和预后预测提供依据。

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引用次数: 0

Rethinking routine chest drainage in pneumothorax management: Outcomes from a nationwide Japanese database 重新思考常规胸腔引流在气胸治疗中的作用：来自日本全国数据库的结果

IF 2 Q2 RESPIRATORY SYSTEM

Respiratory investigation

Pub Date : 2025-09-23 DOI: 10.1016/j.resinv.2025.09.015

Yoshikane Yamauchi , Yukinori Sakao , Noriyoshi Sawabata , Toshiro Obuchi , Kenji Tsuboshima , Noriyuki Matsutani , Shouichi Okamoto , Hitoshi Igai , Akihiro Hayashi

Background

The optimal management of pneumothorax remains controversial, with evolving evidence challenging the conventional approach of routine chest drainage.

Methods

We analyzed data of 1773 patients (956 with primary spontaneous pneumothorax [PSP], 817 with secondary spontaneous pneumothorax [SSP]) from a nationwide Japanese database. Multivariate and propensity score matching analyses identified factors associated with drainage requirement and compared outcomes between drainage and non-drainage groups.

Results

Pneumothorax grade was the most significant determinant of chest drainage requirement in both PSP (moderate: odds ratio [OR] 12.5, severe: OR 22.6 vs. mild, p < 0.001) and SSP patients (moderate: OR 16.1, severe: OR 26.9 vs. mild, p < 0.001), with chronic obstructive pulmonary disease being an additional factor in SSP (OR 3.04). PSP patients without drainage had shorter hospital stays (median: 6.0 vs. 8.0 days, p < 0.001) and more frequently underwent surgery. SSP patients without drainage had lower ICU admission rates and shorter hospitalization (median: 11.0 vs. 14.0 days, p < 0.001). The benefits of non-drainage were observed across all pneumothorax grades in PSP, while in severe SSP, drainage was associated with better outcomes. After matching for pneumothorax grade, non-drainage PSP patients had shorter stays in both non-surgical (median: 2 vs. 6 days, p < 0.001) and surgical subgroups (median: 5 vs. 8 days, p < 0.001). Mortality rates were comparable between groups.

Conclusions

While pneumothorax grade remains the key determinant for chest drainage, carefully selected patients may be successfully managed without drainage, with shorter hospital stays without compromising outcomes. Refined criteria for non-drainage management could improve resource utilization and patient experience.

背景：气胸的最佳治疗方法仍然存在争议，不断发展的证据挑战了常规胸腔引流的传统方法。方法分析来自日本全国数据库的1773例患者的资料，其中956例为原发性自发性气胸，817例为继发性自发性气胸。多变量和倾向评分匹配分析确定了与引流需求相关的因素，并比较了引流组和非引流组的结果。结果气胸分级是PSP（中度：比值比12.5，重度：比值比22.6 vs.轻度，p < 0.001）和SSP（中度：比值比16.1，重度：比值比26.9 vs.轻度，p < 0.001）患者胸腔引流需求的最重要决定因素，慢性阻塞性肺疾病是SSP的另一个因素（OR 3.04）。没有引流的PSP患者住院时间较短（中位数：6.0天vs 8.0天，p < 0.001），且更频繁地接受手术。无引流的SSP患者ICU住院率较低，住院时间较短（中位数：11.0天对14.0天，p < 0.001）。在所有级别的PSP气胸中均观察到不引流的益处，而在严重的SSP中，引流与更好的结果相关。在气胸分级匹配后，非引流PSP患者在非手术亚组（中位数：2天vs. 6天，p < 0.001）和手术亚组（中位数：5天vs. 8天，p < 0.001）的住院时间均较短。两组之间的死亡率具有可比性。结论虽然气胸分级仍然是胸腔引流的关键决定因素，但精心挑选的患者可以在不引流的情况下成功治疗，缩短住院时间而不影响预后。改进非引流管理标准可提高资源利用率和患者体验。

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引用次数: 0

Evaluation of inhalation device prescribing trends: A retrospective database study in Japan 评估吸入装置处方趋势：日本的回顾性数据库研究

IF 2 Q2 RESPIRATORY SYSTEM

Respiratory investigation

Pub Date : 2025-09-23 DOI: 10.1016/j.resinv.2025.09.011

Hiroyuki Ura , Noriko Matsuoka , Hiroyuki Furuya

Background

Inhalation therapy is crucial in treating obstructive lung diseases, including asthma and chronic obstructive pulmonary disease (COPD). Improper inhalation techniques are associated with poor asthma and COPD management, increased exacerbation risk, and overutilization of healthcare resource. However, comprehensive analyses of prescription trends across diverse inhalation devices are limited. Therefore, we aimed to investigate inhalation device prescription trends in Japan from 2016 to 2022 using data from the National Database of Health Insurance Claims and Specific Health Checkups Open Data Japan.

Methods

Temporal changes in prescription patterns were analyzed across different device types, therapeutic categories, and patient demographics.

Results

Our findings revealed major shifts toward combination therapies, particularly triple combination therapy (inhaled corticosteroid [ICS]/long-acting beta2-agonist [LABA]/long-acting muscarinic antagonist [LAMA]), in addition to the preference for newer devices, such as the Ellipta dry powder and Aerosphere pressurized metered-dose inhalers. Age- and sex-specific patterns emerged, with distinct preferences observed across demographic groups. The pediatric population primarily received ICS mono- and ICS/LABA combination therapies, while older adults showed increased use of the triple combination therapy. Sex disparities were particularly pronounced in the older population, with older male patients requiring LABA/LAMA and triple combination therapies more often than older female patients. An economic analysis revealed that while dry powder inhalers had the highest overall cost, the introduction of generic formulations markedly reduced expenditures.

Conclusions

The shift toward combination therapies and newer inhaler devices in Japan highlights the critical need for personalized treatment strategies that balance patient characteristics with economic factors.

背景：在治疗包括哮喘和慢性阻塞性肺疾病（COPD）在内的阻塞性肺疾病中，放射治疗是至关重要的。不恰当的吸入技术与哮喘和慢性阻塞性肺病管理不良、加重风险增加以及医疗资源的过度利用有关。然而，对不同吸入装置的处方趋势的综合分析是有限的。因此，我们的目的是利用日本国家健康保险索赔数据库和特定健康检查开放数据，调查2016年至2022年日本吸入装置处方趋势。方法分析不同器械类型、治疗类别和患者人口统计学中处方模式的变化。结果：除了对Ellipta干粉和Aerosphere加压式定量吸入器等新设备的偏好外，我们的研究结果还揭示了向联合治疗的主要转变，特别是三联治疗（吸入皮质类固醇[ICS]/长效β -受体激动剂[LABA]/长效毒瘤碱拮抗剂[LAMA]）。出现了年龄和性别特定的模式，在人口统计群体中观察到不同的偏好。儿科人群主要接受ICS单一和ICS/LABA联合治疗，而老年人使用三联疗法的情况有所增加。性别差异在老年人群中尤为明显，老年男性患者比老年女性患者更需要LABA/LAMA和三联疗法。一项经济分析显示，虽然干粉吸入器的总成本最高，但采用非专利配方显著减少了支出。结论：日本向联合治疗和新型吸入器设备的转变凸显了对个性化治疗策略的迫切需求，该策略应平衡患者特征和经济因素。

{"title":"Evaluation of inhalation device prescribing trends: A retrospective database study in Japan","authors":"Hiroyuki Ura , Noriko Matsuoka , Hiroyuki Furuya","doi":"10.1016/j.resinv.2025.09.011","DOIUrl":"10.1016/j.resinv.2025.09.011","url":null,"abstract":"<div><h3>Background</h3><div>Inhalation therapy is crucial in treating obstructive lung diseases, including asthma and chronic obstructive pulmonary disease (COPD). Improper inhalation techniques are associated with poor asthma and COPD management, increased exacerbation risk, and overutilization of healthcare resource. However, comprehensive analyses of prescription trends across diverse inhalation devices are limited. Therefore, we aimed to investigate inhalation device prescription trends in Japan from 2016 to 2022 using data from the National Database of Health Insurance Claims and Specific Health Checkups Open Data Japan.</div></div><div><h3>Methods</h3><div>Temporal changes in prescription patterns were analyzed across different device types, therapeutic categories, and patient demographics.</div></div><div><h3>Results</h3><div>Our findings revealed major shifts toward combination therapies, particularly triple combination therapy (inhaled corticosteroid [ICS]/long-acting beta2-agonist [LABA]/long-acting muscarinic antagonist [LAMA]), in addition to the preference for newer devices, such as the Ellipta dry powder and Aerosphere pressurized metered-dose inhalers. Age- and sex-specific patterns emerged, with distinct preferences observed across demographic groups. The pediatric population primarily received ICS mono- and ICS/LABA combination therapies, while older adults showed increased use of the triple combination therapy. Sex disparities were particularly pronounced in the older population, with older male patients requiring LABA/LAMA and triple combination therapies more often than older female patients. An economic analysis revealed that while dry powder inhalers had the highest overall cost, the introduction of generic formulations markedly reduced expenditures.</div></div><div><h3>Conclusions</h3><div>The shift toward combination therapies and newer inhaler devices in Japan highlights the critical need for personalized treatment strategies that balance patient characteristics with economic factors.</div></div>","PeriodicalId":20934,"journal":{"name":"Respiratory investigation","volume":"63 6","pages":"Pages 1164-1173"},"PeriodicalIF":2.0,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145118668","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}

引用次数: 0

Geographic variation in bronchoscopy use across Japan: A nationwide analysis using administrative claims data 日本支气管镜使用的地理差异：一项使用行政索赔数据的全国性分析

IF 2 Q2 RESPIRATORY SYSTEM

Respiratory investigation

Pub Date : 2025-09-23 DOI: 10.1016/j.resinv.2025.09.017

Tomohiro Akaba , Ken Arimura , Keiko Kan-o , Miki Kubo , Mitsuko Kondo , Musashi Ueda , Osamitsu Yagi , Atsushi Kurokawa , Naoko Kawashima , Yutaro Horie , Yuno Shiota , Etsuko Tagaya

Bronchoscopy is a widely used diagnostic procedure in respiratory medicine. Despite recent advances in techniques and an ongoing aging population, detailed information regarding current bronchoscopy procedural patterns and practice settings remains limited for Japan. We analyzed bronchoscopic procedure volumes and settings across 47 Japanese prefectures over the 2023 fiscal year, using NDB Open Data. A total of 177,317 procedures were performed, with a nationwide rate of 142.6 per 100,000 population. Of these, 78.8 % were conducted during inpatient care. The procedural rate and proportion of inpatient cases varied substantially by prefecture. No significant correlation was observed between population aging rate and procedure volume, but a moderate positive correlation was identified between procedure volume and the density of board-certified respiratory specialists (Spearman's ρ = 0.517, p < 0.001). This nationwide analysis highlights the substantial regional variations in bronchoscopy practices across Japan and suggests a possible role of specialist distribution in determining access to the procedure.

支气管镜检查是一种在呼吸医学中广泛应用的诊断方法。尽管最近技术的进步和持续的人口老龄化，日本目前关于支气管镜检查程序模式和实践环境的详细信息仍然有限。我们使用NDB开放数据分析了2023财年日本47个县的支气管镜手术数量和设置。累计手术177317例，全国每10万人中手术142.6例。其中78.8%是在住院期间进行的。住院病例的手术率和比例因州而异。人口老龄化率与手术量之间无显著相关，但手术量与委员会认证的呼吸专家密度之间存在中度正相关（Spearman’s ρ = 0.517, p < 0.001）。这项全国性的分析强调了日本各地支气管镜检查实践的重大地区差异，并提出了专家分布在决定手术可及性方面的可能作用。

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引用次数: 0

Recent advances in lung function standard value prediction equations: Comparison with the Global Lung Initiative prediction equation based on GAMLSS 肺功能标准值预测方程的最新进展：与基于GAMLSS的Global lung Initiative预测方程的比较

IF 2 Q2 RESPIRATORY SYSTEM

Respiratory investigation

Pub Date : 2025-09-20 DOI: 10.1016/j.resinv.2025.09.010

Toshitaka Shomura, Yosuke Wada, Masayuki Hanaoka

To accurately interpret lung function test (LFTs) results, it is necessary to appropriately select the lung function reference value prediction equation implemented in the measuring equipment of each medical institution.

The American Thoracic Society (ATS) and European Respiratory Society (ERS) task force, known as the Global Lung Function Initiative (GLI), recommends the use of a lung function standard value prediction equation that can calculate continuous standard values across a wide age range. Generalized additive models for location, scale, and shape (GAMLSS) are statistical techniques used to create accurate percentiles for a wide age range. This prediction equation was created using the lambda, mu, and sigma (LMS) method, a subtype of a statistical method known as generalized additive models for location, scale, and shape (GAMLSS). Lung function equations created using the LMS method can be used to calculate the z-score, which can contribute to a more accurate interpretation of the results. As for the contents of this review, an overview of the development of equations for predicting lung function using GAMLSS, such as spirometry, diffusion capacity, and static lung volume, is provided in the first portion of this review. The second section of this review compiles the statistical knowledge required to develop lung function reference-value prediction algorithms based on GAMLSS. This section briefly explains how to calculate the z-score and provides advice on addressing ethnic diversity in the lung function standard value prediction equations.

为了准确地解释肺功能试验（LFTs）结果，有必要适当选择各医疗机构测量设备中实施的肺功能参考值预测方程。美国胸科学会（ATS）和欧洲呼吸学会（ERS）工作组，即全球肺功能倡议（GLI），建议使用肺功能标准值预测方程，该方程可以计算大年龄范围内的连续标准值。广义加性模型的位置，规模和形状（GAMLSS）是统计技术，用于创建准确的百分位数为广泛的年龄范围。这个预测方程是使用lambda， mu, and sigma （LMS）方法创建的，LMS是一种称为位置，规模和形状广义加性模型（GAMLSS）的统计方法的子类型。使用LMS方法创建的肺功能方程可用于计算z分数，这有助于更准确地解释结果。关于本综述的内容，本文第一部分概述了利用GAMLSS预测肺功能的方程的发展，如肺活量测定法、扩散能力和静态肺体积。本综述的第二部分汇编了基于GAMLSS开发肺功能参考值预测算法所需的统计知识。本节简要解释了如何计算z分数，并提供了在肺功能标准值预测方程中解决种族多样性的建议。

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引用次数: 0

The prognosis of lung transplant candidates with progressive pulmonary fibrosis 进行性肺纤维化肺移植候选者的预后。

IF 2 Q2 RESPIRATORY SYSTEM

Respiratory investigation

Pub Date : 2025-09-19 DOI: 10.1016/j.resinv.2025.09.009

Takafumi Yamaya , Tatsuya Muraoka , Miho Yamaguchi , Mitsuaki Kawashima , Chihiro Konoeda , Masaaki Sato

Background

Interstitial lung disease with progressive fibrosis is now defined as progressive pulmonary fibrosis (PPF), and often requires lung transplantation. However, the prognosis of lung transplant candidates with PPF is unclear.

Methods

We retrospectively investigated fibrotic ILD patients who were candidates for lung transplantation. Based on the clinical data, we classified the patients into idiopathic pulmonary fibrosis (IPF), PPF, and non-PPF groups. We investigated the patient characteristics, transplant-free survival (TFS), and cumulative waiting list mortality in each group.

Results

In total, 194 patients were included in the study: 51 IPF patients, 121 PPF patients, and 22 non-PPF patients, respectively. PPF patients tended to show a lower forced vital capacity (47.0 ± 16.2 %) and a shorter 6-min walk distance than IPF patients [310 (233–400) m]. The TFS of PPF patients was shorter than that of non-PPF patients and comparable to that of IPF patients (p < 0.001, 0.132, respectively). A similar trend was observed for cumulative waiting list mortality (p = 0.001, 0.062, respectively). Pleuroparenchymal fibroelastosis (PPFE) patients exhibited worse waiting list mortality than IPF patients (p = 0.019). Multivariate analysis revealed no statistically significant risk factors for mortality in the PPF group.

Conclusions

Among lung transplant candidates, PPF patients exhibited worse TFS and waiting list mortality than non-PPF patients, and were comparable to IPF patients. In addition, PPFE patients demonstrated significantly higher mortality rates than IPF patients. Early lung transplantation should be considered for PPF patients, especially PPFE patients.

背景：间质性肺疾病伴进行性纤维化现在被定义为进行性肺纤维化（PPF），通常需要肺移植。然而，肺移植候选人PPF的预后尚不清楚。方法：我们回顾性调查了适合肺移植的纤维化ILD患者。根据临床资料，我们将患者分为特发性肺纤维化（IPF）组、PPF组和非PPF组。我们调查了每组患者的特征、无移植生存（TFS）和累积等待名单死亡率。结果：共纳入194例患者：IPF患者51例，PPF患者121例，非PPF患者22例。与IPF患者相比，PPF患者的强迫肺活量（47.0±16.2%）更低，6分钟步行距离更短[310 (233-400)m]。PPF患者的TFS比非PPF患者短，与IPF患者相当(p结论：在肺移植候选者中，PPF患者的TFS和等待名单死亡率比非PPF患者差，与IPF患者相当。此外，PPFE患者的死亡率明显高于IPF患者。对于PPF患者，尤其是PPFE患者应考虑早期肺移植。

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引用次数: 0

Impact of Pseudomonas aeruginosa on the outcomes after lung transplantation: a single-center study 铜绿假单胞菌对肺移植后预后的影响：单中心研究。

IF 2 Q2 RESPIRATORY SYSTEM

Respiratory investigation

Pub Date : 2025-09-18 DOI: 10.1016/j.resinv.2025.09.002

Takashi Kanou, Hideki Nagata, Kenji Kimura, Eriko Fukui, Toru Kimura, Naoko Ose, Yasushi Shintani

Background

Lung transplantation (LTX) is an established treatment for end-stage pulmonary diseases. However, infections, particularly those caused by Pseudomonas aeruginosa, remain a major challenge, contributing to morbidity, mortality, and complications such as acute cellular rejection (ACR). This study aimed to investigate the relationship between the postoperative detection of P. aeruginosa in respiratory samples and post-LTX outcomes, including the incidence of ACR and overall survival.

Methods

We retrospectively analyzed 63 patients who underwent cadaveric LTX at our institution between 1999 and 2021. Patient characteristics, perioperative factors, and microbiological data were collected, and the association of P. aeruginosa detection within three months post-LTX with ACR and survival outcomes was analyzed. ACR was diagnosed by surveillance bronchoscopy and histological assessment.

Results

P. aeruginosa was detected in the respiratory samples of 21 patients (33 %) within three months post-LTX. Patients with the history of P. aeruginosa detection after LTX exhibited a significantly higher incidence of ACR (p = 0.02) and poorer 5-year overall survival rates (p = 0.03). A multivariate analysis confirmed that P. aeruginosa detection and older recipient age were independent risk factors for poor survival.

Conclusions

The detection of P. aeruginosa in respiratory samples was associated with an increased risk of ACR and poorer overall survival following LTX. These findings underscore the importance of vigilant monitoring for P. aeruginosa detection and development of targeted antimicrobial strategies to improve post-transplant outcomes. Further studies are warranted to explore the mechanisms linking P. aeruginosa to adverse outcomes and evaluate the efficacy of novel therapeutic interventions.

背景：肺移植（LTX）是终末期肺部疾病的一种成熟治疗方法。然而，感染，特别是由铜绿假单胞菌引起的感染，仍然是一个主要的挑战，导致发病率、死亡率和急性细胞排斥反应（ACR）等并发症。本研究旨在探讨呼吸样本中P. aeruginosa的术后检测与ltx术后预后的关系，包括ACR的发生率和总生存率。方法：我们回顾性分析了1999年至2021年间在我院接受尸体LTX治疗的63例患者。收集患者特征、围手术期因素和微生物学数据，分析ltx术后3个月内铜绿假单胞菌检测与ACR和生存结果的关系。经支气管镜监测和组织学检查诊断为ACR。结果：21例患者（33%）在ltx术后3个月内的呼吸道样本中检出铜绿假单胞菌。LTX术后有铜绿假单胞菌检测史的患者ACR发生率显著增高（p = 0.02）， 5年总生存率较差（p = 0.03）。多因素分析证实铜绿假单胞菌检测和受体年龄较大是生存率差的独立危险因素。结论：呼吸道样本中铜绿假单胞菌的检测与LTX后ACR风险增加和总生存率降低相关。这些发现强调了警惕监测铜绿假单胞菌检测和开发靶向抗菌策略以改善移植后预后的重要性。进一步的研究需要探索铜绿假单胞菌与不良后果的联系机制，并评估新的治疗干预措施的疗效。

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引用次数: 0

Turbidity of whole lung lavage fluid in patients with autoimmune pulmonary alveolar proteinosis: Association between turbidity and pulmonary function 自身免疫性肺泡蛋白沉积症患者全肺灌洗液浊度：浊度与肺功能的关系

IF 2 Q2 RESPIRATORY SYSTEM

Respiratory investigation

Pub Date : 2025-09-18 DOI: 10.1016/j.resinv.2025.09.008

Takuma Katano , Satoru Ito , Masaya Fukami , Hiroyuki Tanaka , Eisuke Fujishiro , Hiroto Murao , Hitomi Amano , Shiori Nishizaki , Tomoyuki Ogisu , Toshiyuki Yonezawa , Etsuro Yamaguchi

Background

Whole lung lavage (WLL) under general anesthesia has been the standard therapeutic strategy for patients with severe autoimmune pulmonary alveolar proteinosis (APAP). However, the criteria for termination of WLL have not yet been standardized.

Methods

We retrospectively examined clinical data of APAP patients who underwent WLL. The turbidity of effluent was measured by nephelometry.

Results

Fourteen patients and totally 26 sets of WLLs were enrolled in the study. The turbidity of the effluent decreased with repeated instillation and drainage as the effluent became visibly clear. In most cases (88.5 % of right lung lavage and 65.4 % of left lung lavage), the turbidity fell below 100 nephelometric turbidity units, the value that has been proposed by the Japanese Respiratory Society Guidelines for pulmonary alveolar proteinosis in 2022 for considering termination of the WLL. The maximum turbidity of the effluent in the first WLL was significantly correlated with % of predicted values of diffusing capacity of the lungs of carbon monoxide before the WLL. The changes in turbidity, differences between the maximum and minimum turbidity, were significantly correlated with changes in % of predicted values of forced vital capacity.

Conclusions

Assessment of turbidity may serve as a supplementary indicator of termination and effectiveness of WLL.

背景：全麻下全肺灌洗（WLL）已成为严重自身免疫性肺泡蛋白沉积症（APAP）患者的标准治疗策略。然而，终止井馀水的标准尚未标准化。方法：回顾性分析APAP患者行WLL的临床资料。用浊度法测定出水浊度。结果：14例患者共26套wll纳入研究。随着反复注入和排水，出水的浊度降低，出水变得明显清澈。在大多数情况下（88.5%的右肺灌洗和65.4%的左肺灌洗），浊度低于100浊度单位，这是日本呼吸学会在2022年提出的肺泡蛋白沉积症指南中提出的考虑终止WLL的值。第一次生化试验出水最大浊度与生化试验前肺一氧化碳扩散能力预测值的%显著相关。浊度的变化，最大浊度和最小浊度之间的差异，与强迫肺活量预测值百分比的变化显著相关。结论：浊度评价可作为WLL终止和有效性的补充指标。

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