Respiration最新文献

Introduction: Percutaneous cryoablation under imaging guidance is an effective therapeutic modality for pulmonary nodules, but the conventional technique relies on surgical complexity and physician experience. Computed tomography (CT)-guided robotic-assisted percutaneous puncture technique provides three-dimensional reconstruction, optimal needle trajectory planning, and monitoring of real-time respiratory motion, thereby enabling safe ablation of lung nodules. This study aimed to clinically evaluate the feasibility and safety of a robotic-assisted optical navigation system when utilized for CT-guided percutaneous cryoablation of pulmonary nodules.

Methods: Patients who underwent CT-guided percutaneous cryoablation via a robotic-assisted optical navigation system were prospectively enrolled in our study. The primary outcomes were the technical success rate and the technical efficacy rate, and the preoperative, intraoperative, and postoperative variables were recorded and analyzed for each patient.

Results: A total of 37 consecutive patients with a single nodule were ultimately enrolled in the present study. The technical success rate was 100%, and the technical efficacy rate of robotic-assisted cryoablation was 100% with no recurrence during the 1-month follow-up. The average number of needle adjustments per nodule was 0.82 ± 1.19 in this study, with a mean deviation of 3.47 ± 2.47 mm. The mean numbers of CT acquisitions and dose length product used during needle insertion were 3.44 ± 1.65 and 638.86 ± 434.44 mGy cm, respectively. The duration of needle placement was 15.95 ± 5.06 min, whereas the total procedural duration was 99.32 ± 32.00 min. Notably, the deviation was found to be significantly correlated with the lobar location and was more prominent in the lower lobe. However, no significant correlations were observed with the nodule type, size, distance to the pleura, chest wall thickness, needle trajectory length, decubitus position, or the pulmonary function status of the patient. Moreover, no significant changes were found in the pulmonary function of the patients before or after the treatment. No major grade ≥3 complications were observed. However, among the minor complications, there were 5 cases (13.51%) of immediate pneumothorax, 2 cases (5.41%) of delayed pneumothorax, and 1 case (2.70%) of hemorrhage.

Conclusion: The feasibility, safety, and preliminary effectiveness of robotic-assisted optical navigation system for CT-guided percutaneous cryoablation of pulmonary nodules were demonstrated; however, long-term efficacy and safety require further validation through multicenter, large-scale, prospective clinical studies with extended follow-up.

Background: Flexible bronchoscopy is an essential procedural skill to master for the management of respiratory illness. Bronchoscopy simulators hasten the attainment of competencies. Whether augmented reality (AR) offers advantages over virtual simulation (VR) during training is unknown. We tested this premise in novice bronchoscopists by assessing end-of-training performance after mastery learning on either simulator.

Methods: A single-centre, single-blinded, randomised control trial. Thirty bronchoscopists were randomised to a VR (n=15) or AR (n=15) simulator training group. Each had up to 2 hours to practice full (diagnostic completion /18 segments, DC), orderly (structured progress, SP) and timely (procedure time, PT) segmental navigation using pre-defined mastery learning protocols. Experts assessed recorded complete test bronchoscopies on 2 different endobronchial airway training models (BronchoBoy®, Koken). Cognitive Load during training was compared.

Results: The VR group outperformed the AR group in the first test (Bronchoboy), marginally for diagnostic completeness (DC) (median difference, p value) (1, p=0.0022) but not structured progress (SP) (1, 0.6887), procedure time (PT) (46 s, 0.8119) or mean intersegmental time (MIT) (2.15 s, 0.9760). In the second test (Koken), the AR group (trained on the Koken), was faster PT (-48 s, 0.0377) but no different from VR in DC, SP or MIT. The VR group trained for more time than AR (90+/-30min v 80+/-30 min, p=0.0468). The VR group had a significantly lower mental demand in training than AR (median difference, p value) (15 NASA-TLX points, P=0.023) but higher physical demand score (35 NASA-TLX points, P=0.004) Conclusion: Training by novices on VR or AR bronchoscopy simulators led to thorough, timely and moderately ordered test segmental navigation. VR training portended high and slightly more thorough navigation, with lower mental but higher physical demand and longer time spent training. Further comparative studies of VR and AR bronchoscopic skills training should seek preferential and predictive factors for optimal clinical proficiency. .

Introduction: Sex disparities in lung cancer risk assessment may lead to inequities in screening eligibility. Criteria based on smoking history and age can underrepresent women. Systemic inflammatory indexes derived from routine blood tests are potential biomarkers in cancer risk assessment. We investigated the association between systemic inflammatory indexes and lung cancer risk, stratified by sex, in a Danish cohort.

Methods: We conducted a population-based cohort study using data from the Lolland-Falster Health Study (LOFUS) linked to the Danish Pathology Data Bank (Patobank). Participants aged 40-74 years without a history of lung cancer were included. We calculated four systemic inflammatory indexes and assessed their association with lung cancer using logistic regression models adjusted for age, sex, and smoking status. Optimal cutoff points were determined using the Youden index. Bootstrapping was applied for internal validation.

Results: Among 10,887 participants with complete data, 58 (0.53%) were diagnosed with lung cancer during a maximum follow-up period of 6.6 years. High levels of all four inflammatory indexes were associated with increased lung cancer risk. Sex-stratified analyses revealed stronger associations between Neutrophil-to-Lymphocyte Ratio (NLR) and Systemic Immune Inflammatory Index (SII) and lung cancer in men, and between C-reactive protein to Albumin Ratio (CAR) and lung cancer in women. Model discrimination improved after adding inflammatory indexes.

Conclusion: Our findings support sex-specific lung cancer risk assessment and personalised screening strategies. Pre-diagnostic inflammatory indexes may serve as biomarkers to complement existing screening criteria. Further research is needed to validate their potential in improving lung cancer prediction models.

Bronchiectasis is a chronic, often progressive respiratory disease characterized by irreversible dilation of the bronchi. It is etiologically heterogeneous and frequently associated with a significant symptom burden, multiple complications, and reduced quality of life. In recent years, the global prevalence of bronchiectasis has increased markedly, placing a substantial economic burden on healthcare systems. These consensus-based guidelines are the first German-language guidelines focused on the management of bronchiectasis in adults. They underscore the critical role of thoracic imaging - particularly computed tomography - in diagnosing and distinguishing bronchiectasis and highlight the importance of identifying the underlying etiology in guiding treatment decisions. The guidelines provide comprehensive recommendations for both pharmacological and non-pharmacological treatment strategies. Non-drug interventions include smoking cessation, physiotherapy, physical training, pulmonary rehabilitation, non-invasive ventilation, thoracic surgery, and lung transplantation. Pharmacological therapies emphasize the long-term use of mucolytics, bronchodilators, anti-inflammatory agents, and antibiotics. In addition, the guidelines address the management of upper airway involvement, common comorbidities, and acute exacerbations. They also cover socio-medical issues, disability rights, and the role of patient education and self-management in optimizing care. Special life stages - such as transition from pediatric to adult care, family planning, pregnancy, parenthood, and palliative care - are also considered. The overarching goal is to promote comprehensive, consensus-driven, and patient-centered care that accounts for individual risks and needs.

Introduction: Fractional exhaled nitric oxide (FeNO) is a clinically utilized marker of Type 2 airway inflammation and is used to guide treatment in asthma.

Objectives: We aim to resolve the ongoing scientific debate, whether FeNO is affected by obesity-related changes in inflammation and airway architecture.

Methods: We assessed the association of FeNO levels with obesity markers and lung function parameters in 1205 respiratory-healthy adult participants (43.1% males) aged 18-82 years from the Austrian LEAD cohort with mean body mass index (BMI) of 26.4±4.7kg/m2. Sensitivity analyses were conducted in the respiratory-healthy obese subpopulation (n=230).

Results: Median FeNO levels were 16.0 (interquartile [IQR]: 12.0 - 23.0; 95th percentile: 34.0) ppb in the respiratory-healthy any-weight population, with higher levels reported in the respiratory-healthy obese (17.5 [IQR: 12.0 - 23.0] ppb; 95th percentile: 35.0 ppb) population. Unadjusted multiple regression analyses showed that BMI; indices of fat mass, visceral adipose tissue (VATI), appendicular lean mass; and residual volume (RV) %predicted were associated with higher FeNO levels in respiratory-healthy any-weight individuals. In obese respiratory-healthy individuals, only VATI showed statistically significant association with FeNO. After adjusting for the confounders as age, sex, and smoking status all assessed parameters lost their significance in the assessed populations except for residual volume- and total lung capacity Z-scores, although at low effect size.

Conclusion: Our results demonstrate no independent effect of obesity markers on FeNO levels after adjustments for age, sex, and smoking status.

Introduction: Clinicians often extend antibiotic therapy for refractory nontuberculous mycobacterial pulmonary disease (NTM-PD), despite potential side effects and the uncertain benefits of extended therapy. In this study, we present our real-world experience with prolonged antibiotic therapy in patients with treatment-refractory NTM-PD.

Methods: We reviewed adult patients with treatment-refractory NTM-PD treated at a tertiary referral center in South Korea between April 2003 and July 2024. Eligible patients did not achieve sustained culture conversion within 6 months and received macrolide-based therapy for at least 18 months. Patients were grouped into prolonged treatment (≥24 months) and shorter treatment (18-24 months) groups. The microbiological, radiographic, and clinical outcomes were analyzed.

Results: Among the 123 patients, 50 (40.7%) received prolonged therapy. Patients who underwent prolonged treatment had a more frequent history of tuberculosis (44.0% vs. 24.7%, P=0.040) and autoimmune diseases (14.0% vs. 1.4%, P=0.016), although the other baseline characteristics were similar. The use of clofazimine, intravenous aminoglycosides, and inhaled amikacin was significantly higher in the prolonged group, along with a higher incidence of anemia as a side effect (14.0% vs. 2.7%, P=0.030). Acquired macrolide resistance appeared to be more common in the prolonged group (14.0% vs. 6.8%), but the difference was not statistically significant (P=0.315). Over a median follow-up of 4.4 years, prolonged treatment was not associated with a lower risk of retreatment or all-cause mortality. The rates of microbiological cure, sputum smear conversion, radiographic progression, and weight change did not differ between groups.

Conclusion: Extending antibiotic therapy beyond 24 months in patients with treatment-refractory NTM-PD does not necessarily confer additional microbiological, radiographic, or survival benefits, and may increase the risk of adverse events. Therefore, prolonged therapy should be reserved for selected patients, with close monitoring for side effects and macrolide resistance.

Background Pulmonary rehabilitation (PR) is beneficial, yet outcome assessment remains inconsistent. A multidisciplinary D-A-CH working group reviewed evidence, introduced new measures, and explored emerging PR concepts. Summary The meeting emphasized patient-reported (PROMs) and clinician-reported (CROMs) outcome measures. A key focus was the minimal clinically important difference (MCID), a widely used metric which is applied inconsistently and is highly dependent on the baseline value. The 'performance score' (T2D = T2 + (T2 - T1)) takes baseline status (T1) into account by combining the discharge value (T2) with the improvement (T2 - T1) before and after treatment, based on the distribution. This simple descriptive approach results in a baseline-adjusted MCID estimator, with a planned multicenter study to validate its use in COPD rehabilitation. Further discussions addressed epistemic trust, crucial for patient adherence and interdisciplinary collaboration, with a study planned to assess its impact. Dysfunctional breathing (DB), often overlooked in PR, was highlighted, emphasizing the need for standardized diagnostic tools. The role of artificial intelligence (AI) in PR, including large language models, was explored, with surveys planned to evaluate patient and provider perceptions. Key Messages The T2D performance score offers a dynamic approach to assessing PR progress, addressing MCID limitations. Standardized methods for epistemic trust and DB diagnosis are essential for better recognition and management. AI integration in PR presents opportunities for personalized rehabilitation but requires further evaluation. The D-A-CH working group remains committed to advancing PR through evidence-based strategies and international collaboration.

Introduction: To explore the feasibility of an ultrasound radiomics machine learning model based on endobronchial ultrasound (EBUS) for differentiating pulmonary sarcoidosis from mediastinal lymph node tuberculosis.

Methods: Clinical characteristics and ultrasound image data from 100 patients diagnosed with pulmonary sarcoidosis and 70 patients diagnosed with mediastinal lymph node tuberculosis were collected. Statistical analysis was performed to compare clinical features, such as age, gender, smoking history, and lymph node size and so on, between the two groups. The least absolute shrinkage and selection operator (Lasso) was used to analyze the radiomics features extracted from EBUS-based ultrasound images. A support vector machine (SVM) algorithm was applied to establish an EBUS-based radiomics model, and clinical features with statistically significant were incorporated to optimize the model. A total of 170 lymph nodes were randomly divided into training group (n=119) and validation group (n=51), with the diagnostic performance of the model assessed using receiver operating characteristic (ROC) curves and the area under the curve (AUC), accuracy, sensitivity, and specificity.

Results: Seven stable radiomics features with non-zero coefficients and four clinical features were selected as inputs for the model. The SVM model demonstrated great performance in both groups. In the training group, the ROC AUC of the SVM model was 0.909 (95% CI: 0.897-0.922), with an accuracy of 88.2%, sensitivity of 82.4%, and specificity of 92.6%. In the validation group, the ROC AUC was 0.917 (95% CI: 0.901-0.934), with an accuracy of 80.4%, sensitivity of 68.4%, and specificity of 87.5%.

Conclusion: The SVM model based on EBUS ultrasound radiomics and clinical data shows promising feasibility for differentiating pulmonary sarcoidosis from mediastinal lymph node tuberculosis. It exhibits significant potential in clinical practice and provides a new method for the early diagnosis of these conditions.

Introduction: Mechanical ventilation can induce lung injury and diaphragmatic dysfunction. Diaphragmatic activation via rapid bilateral anterolateral magnetic phrenic nerve stimulation (rBAMPS) may attenuate both conditions. Given a change in body position during mechanical ventilation alters patient prognosis, this study compared inspiratory responses and side-effects to rBAMPS in different body positions in healthy volunteers.

Methods: 17 healthy participants underwent three blocks of 1-s rBAMPS at 25Hz starting at 20% of maximal stimulator output with increases in 10% increments (until participant cessation or 100%) while lying semirecumbent, lying supine, and while seated. Esophageal and gastric balloon catheters were used to assess transdiaphragmatic pressure (Pdi). Tidal volume (VT) was calculated from flow recorded with a pneumatometer. Discomfort, pain, and paresthesia were assessed via numerical visual scales. Tolerability to rBAMPS was assessed as the highest stimulator output achieved in each position.

Results: Body position significantly affected both VT (P = 0.007) and Pdi,mean (P = 0.044). The semirecumbent position resulted in higher VT and Pdi,mean compared to the supine (+ 2.6 mLkg-1 ideal body weight [IBW]; + 2.5 cmH2O) and sitting (+ 1.7 mLkg-1 IBW; + 0.5 cmH2O) positions. The lowest stimulator output tolerability was observed in the sitting position, and the highest stimulator output tolerability in the semirecumbent position. However, differences in tolerability were not reflected in changes of any sensory rating.

Conclusion: rBAMPS could produce physiological resting breathing in semirecumbent, supine and sitting positions. The semirecumbent position may optimize the stimulus to the diaphragm, while the supine position may limit VT and lung overdistension.

Introduction: Accurate diagnosis of peripheral pulmonary lesions is crucial in respiratory medicine. Radial endobronchial ultrasound (R-EBUS), navigation technologies, and ultrathin bronchoscopes have progressively enhanced distal airway access. Mixed reality (MR) offers a hands-free method for visualizing and manipulating CT-derived three-dimensional (3D) anatomy within the operator's field of view. This retrospective study aimed to describe the technical feasibility and safety of intraprocedural MR-based holographic virtual bronchoscopy (VB) use.

Methods: This study included patients who underwent bronchoscopy for peripheral pulmonary lesions using an MR-based 3D holographic VB system. CT datasets were converted into 3D polygon models and displayed on a HoloLens 2 headset. Operators/assistants intraprocedurally referenced and manipulated the hologram while advancing the bronchoscope. Procedural variables, R-EBUS findings, biopsy techniques, diagnostic yield, and complications were evaluated.

Results: Eighteen patients were included. A direct bronchus sign was present in 12 lesions. The median bronchial generation that could be visualized on CT and 3D-VB was six, whereas bronchoscopy enabled advancement to a median of five generations. Radial EBUS demonstrated a within-lesion position in 13 cases. Biopsy techniques included forceps biopsy, cryobiopsy, and TBNA. The overall diagnostic yield was 72.2% (13/18), with malignant disease accounting for the majority of diagnoses. One patient developed mild pneumothorax, which resolved without drainage.

Conclusion: MR-based holographic VB enabled real-time, hands-free 3D anatomical referencing without interrupting the procedure. Further prospective studies are warranted to assess procedural benefits and potential integration with other bronchoscopic modalities and devices.