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Background: Single-use flexible bronchoscopes (SUFBs) have been gaining popularity owing to their portability and reports of infections related to reusable flexible bronchoscopes (RFBs). Hence, a need has arisen to compare the costs of using each type. This study sets out to assess the per-use cost of an RFB as a point of direct comparison to that of SUFBs in a single healthcare delivery unit.

Methods: This is a prospective, observational study in which we followed 25 RFBs throughout their use cycle. We applied a micro-costing approach that encompassed scope capital, servicing, staffing, and reprocessing costs to derive the per-use cost for RFBs. A sensitivity analysis provided data regarding how the per-use cost varies with bronchoscope fleet size and procedure volume. The per-use cost of RFBs was compared with the price of SUFBs.

Results: The per-use cost of RFBs was $198.26 to $202.40, and SUFBs were $300.00 to $400.00 each in the endoscopy unit. The RFB cost was primarily attributed to scope capital and servicing costs but was highly variable across procedural volume and scope fleet size. Sensitivity analysis showed that as case volume increases, the per-use cost drops in a nonlinear fashion, and as scope fleet increases, the per-use price increases accordingly. In high-volume units (>900 annual procedures), RFBs are the more cost-effective option, whereas in low-volume units (<400 annual procedures) cost favors SUFBs. For medium-volume units (400-900 annual procedures), SUFBs and RFBs are largely comparable in cost.

Conclusion: SUFBs offer cost savings in low-volume units, whereas high-volume units may favor RFBs. The additional implications of environmental impact and risk of nosocomial infection need be considered.

Introduction: Several post hoc analyses of clinical trials and observational studies have noticed that women may be at a higher risk of exacerbations than men among patients with chronic obstructive pulmonary disease (COPD), although the findings remain conflicting. These studies, however, did not consider the impact of mainstay treatments over longitudinal follow-up. We examined whether the risk of acute exacerbations differed between women and men in patients with COPD treated with long-acting bronchodilators.

Methods: This population-based study included 2 cohorts of patients with COPD who initiated a single long-acting bronchodilator (mono-bronchodilator cohort) or a dual combination of long-acting bronchodilators (dual-bronchodilator cohort) identified from a nationwide Taiwanese claims database (2017-2022). In each cohort, Cox regression models were executed to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) of moderate-to-severe exacerbations comparing women to men after 1:10 variable-ratio propensity score (PS) matching.

Results: There were 51,945 patients (9,643 women and 42,302 men) in the mono-bronchodilator cohort and 88,271 patients (15,418 women and 72,853 men) in the dual-bronchodilator cohort after PS matching. The HR of moderate-to-severe exacerbations comparing women to men was 0.86 (95% CI, 0.80-0.92) and 0.88 (95% CI, 0.84-0.92) for each cohort, respectively. Results were consistent when analyzing moderate and severe exacerbations separately and did not change materially across prespecified subgroup and sensitivity analyses.

Conclusion: The present study including two sizable COPD cohorts of Asian patients suggests that women may have a lower risk of exacerbations than men when regularly receiving long-acting bronchodilators. The findings highlight the importance of considering maintenance treatments when evaluating sex differences in the risk of acute exacerbations.

Introduction: There are limited data on the prevalence and treatment of low bone density in young lung transplant recipients (LTRs), even though osteoporosis is common in patients with end-stage lung disease and transplant recipients. This study aimed to assess bone health in young LTRs.

Methods: We retrospectively reviewed medical records for LTRs aged 18-50 at transplant. Outcomes included posttransplant low bone density (Z score < -2), osteoporotic fractures, and treatment data.

Results: Among 150 LTRs (45% female, mean age 38 ± 9 years), with a median follow-up of 6.2 years, 103 (69%) underwent bone density scans; 82 occurred within the first year posttransplant. Of these, 19 (23%) showed low bone density within the first year. Posttransplant osteoporotic fractures occurred in 34 patients (23%), including femoral neck (32%) and vertebral fractures (29%) as first events. Eleven patients (32%) experienced multiple fractures. Pretransplant fracture history significantly predicted posttransplant fractures (HR 6.720, 95% CI: 1.572-28.724). Osteoporosis treatment was given to 41 patients (27%), primarily with bisphosphonates (93% as first line). Of those treated, 49% remained fracture free during follow-up.

Conclusion: Young LTRs face high rates of low bone density and fractures, including serious and recurrent fractures. These findings underscore the need for early screening and intervention to reduce osteoporosis-related morbidity in this vulnerable population.

Introduction: The physiological basis for dyspnea, a hallmark of post-COVID syndrome (PCS), remains poorly understood.

Methods: In this analysis of the prospective, multicenter, population-based, longitudinal COVIDOM study, we studied 936 previously healthy adults assessed ≥6 months after a mostly mild, PCR-confirmed SARS-CoV-2 infection. Participants underwent comprehensive pulmonary function testing including spirometry, body plethysmography, diffusing capacity for carbon monoxide, and airwave oscillometry. Dyspnea was assessed by questionnaires (mMRC ≥1/MDP-A1 domain ≥1). We performed cross-sectional and longitudinal analyses for lung function in relation to both dyspnea and a previously defined PCS severity score (PCS-S).

Results: Between 11/2020 and 05/2023, we examined 936 previously healthy COVIDOM participants (median age 37 [IQR 28-51], 56% female). Dyspnea prevalence increased significantly with PCS severity (low PCS-S: 19.3%; intermediate PCS-S: 53.8%; high PCS-S: 81.8%; p < 0.001). Women suffered more frequently from dyspnea and PCS. Small airway dysfunction (SAD), as indicated by abnormal R5-20 Hz or AX5 Hz measures, tended to be more frequent in participants with high PCS severity and dyspnea compared to those with low PCS and no dyspnea (37% vs. 25%, p = 0.058) with corresponding R5-20 Hz of 0.03 [0.01-0.07] vs. 0.01 [0-0.03] kPa·L-1·s-1 (p < 0.01). Longitudinally, however, none of the baseline or follow-up lung function parameters, including measures of SAD, differed between participants with persistent dyspnea and those who became asymptomatic.

Conclusion: Oscillometry-derived R5-R20 Hz differed significantly between dyspneic PCS patients and controls. The high frequency of SAD and the absence of longitudinal improvement might indicate the potential clinical relevance of SAD assessment, despite its only numeric differences between PCS severity groups.

Introduction: Shape-sensing robotic-assisted bronchoscopy (ssRAB) is a novel technique for the diagnosis of peripheral pulmonary lesions (PPLs). There are no prior studies who have assessed the learning curve using learning curve cumulative summation (LC-CUSUM) and cumulative summation (CUSUM) analyses with diagnostic yield (DY) as the main endpoint.

Methods: We performed a single-center analysis of the learning curve of ssRAB combined with cone beam computed tomography (CBCT) procedures for the diagnosis of PPL performed by two bronchoscopists experienced with 3D imaging-guided bronchoscopy techniques using (1) an LC-CUSUM followed by CUSUM analysis, (2) a CUSUM analysis, with strict DY as endpoint. We will compare these methods.

Results: A total of 131 patients with a median lesion size of 12 mm (9-18 mm) were navigated by two bronchoscopists. In the first method, the LC-CUSUM analysis indicated that both bronchoscopists were statistically declared proficient after 43 and 42 procedures, with subsequent CUSUM analysis confirming sustained performance thereafter. In the second method, CUSUM analysis revealed that both bronchoscopists were deemed in control during all procedures.

Conclusion: The CBCT-enhanced ssRAB performance of bronchoscopists experienced with CBCT-guided navigation bronchoscopy was in control from the start. LC-CUSUM and CUSUM are useful tools for assessing the learning curve and procedural performance. While CUSUM indicated that performance of the experienced bronchoscopists were in control from the start, LC-CUSUM inherently assumes initial non-proficiency leading to a larger number of procedures required to establish proficiency with statistical certainty. In the diagnosis of PPL, there will always be variability in performance, which may be attributable to patient-specific characteristics.

Introduction: Lung transplantation (LT) remains the gold standard treatment for patients with end-stage lung disease, but persistent organ shortage challenges equitable organ allocation. While post-transplant survival has been well characterized in the USA, data from corresponding cohorts remain limited. This study analyzed 3-year survival outcomes among German LT recipients and explored a simplified donor-recipient hazard score with a particular focus on rescue allocation.

Methods: We retrospectively analyzed 999 patients who underwent LT in Germany between 2006 and 2016 using data from the German Transplant Registry. Univariate and multivariate analyses were performed to identify survival predictors. A simplified hazard score was developed using Cox regression and validated with C-index and Brier scores.

Results: Rescue allocation was applied in 42.3% of cases and was independently associated with improved survival (HR: 0.64, 95% CI: 0.49-0.85, p = 0.002). Additional factors associated for mortality included donor smoking (HR: 1.37, p = 0.03), lung allocation score (LAS) >55 (HR: 1.85, p < 0.001), total lung capacity ratio ≤0.86 (HR: 1.45, p = 0.03), and donor age >55 (HR: 1.24, p = 0.11). A simplified hazard score was derived from these variables, with absence of rescue allocation contributing one point. Three-year survival declined to 56% (95% CI: 49-64%) when more than two risk factors were present.

Conclusion: This study identifies key donor and recipient factors associated with 3-year survival after LT in Germany. Rescue allocation was frequently applied and unexpectedly associated with improved survival outcomes in this cohort. The hazard score, showing moderate discrimination (C-index = 0.62), should be regarded as an exploratory clinical decision support tool requiring external validation. These findings highlight the complexity of organ allocation under the current LAS system and underscore the need for ongoing evaluation of LAS policies in settings of organ shortage.

Introduction: Early identification and treatment are vital for managing central airway carcinomas, with endobronchial treatment recommended for patients who are unsuitable for or refuse surgery. Hybrid argon plasma coagulation (Hybrid-APC) is an innovative technique whose value in treating superficial mucosal lung cancer remains underreported. This prospective single-arm study aimed to evaluate the efficacy and safety of Hybrid-APC in adult patients with superficial mucosal lung cancer.

Methods: Eligible patients diagnosed with superficial mucosal lung cancer were treated with Hybrid-APC under general anaesthesia. The primary endpoint was the complete remission rate at 3 months post-procedure. The secondary endpoints included total procedure time, injected water cushion rate, progression-free survival, overall survival, and possible complications.

Results: From December 2018 to November 2021, 15 patients were initially enrolled. Fourteen patients underwent Hybrid-APC treatment, and 10 patients eventually completed the primary endpoint at 3 months of follow-up. Pathological biopsies at 3 months showed no malignant tumour cells in 9 patients, indicating a complete remission rate of 90%. All Hybrid-APC ablations were successfully completed. The median total procedure time was 31.5 min (range, 14-60 min) with minor complications. The successful injected water cushion rate was 100%. The 3-year progression-free survival and overall survival estimates were 70% (95% CI: 32.9%-89.2%) and 90% (95% CI: 47.3%-98.5%), respectively.

Conclusion: Hybrid-APC appeared to be safe and efficient for superficial mucosal lung cancer, providing patients unfit for or refusing surgery with a promising alternative to surgical treatment.

In the article "National Registry for Home Mechanical Ventilation in Children from Turkey" [Respiration. 2025;104(6):377-387. https://doi.org/10.1159/000543343] by Neval Metin Çakar et al., the authors noticed an error in reference #12, which was inserted erroneously during citation formatting. It incorrectly refers to an unrelated article, while it should have only indicated the abbreviation spinal muscular atrophy (SMA) within the text.The corrected sentence should read as follows:"This group comprised of 54.3% (n = 150) with spinal muscular atrophy (SMA) type 1, 29.1% (n = 81) with other neuromuscular diseases, 9% (n = 26) with Duchenne muscular dystrophy (DMD), and 7% (n = 19) with SMA-2."The original online article has been updated to reflect this.

Introduction: Sedation during flexible bronchoscopy can be administered by a second physician, an anesthesiologist or as nurse-administered sedation (NAS). Propofol is often administered by non-anesthesiologists. It is unclear whether complications differ with various sedation protocols.

Methods: We searched PubMed for clinical trials of sedation during bronchoscopy and conducted a systematic review of complications (death ≤24 h post-procedure or intensive care unit (ICU) admission/predefined cardiopulmonary escalation [CPE]). Outcomes were analyzed according to the staff administering sedation, complexity of procedure, for propofol-containing regimes, and the ASA physical status classification of the patient.

Results: This analysis (120 articles, 39,475 procedures) showed a mortality rate of 0.01% for sedation bronchoscopy. ICU admission rate was 0.12%, and CPE was reported in 0.57%. Significantly higher CPE was recorded for anesthesiologists compared to NAS and second physicians (1.16% vs. 0.65% vs. 0.07%, respectively, p < 0.001) with higher ICU admission for NAS compared to anesthesiologists and second physicians (0.35% vs. 0.00% vs. 0.03%, respectively, p < 0.001). Endobronchial ultrasound did not increase complication rates. Admission to ICU and CPE remained <1% in propofol-containing regimes, although complications were slightly lower without propofol. Comparison of lower risk ASA 1-2 studies compared to studies with ASA 1-3 showed no significant difference in outcome.

Conclusion: Sedation bronchoscopy is a safe procedure. The staff administering sedation may react differently to periprocedural respiratory and cardiovascular events. Propofol application is not associated with a clinically relevant increase in complication rate. There is no evidence that ASA status is a predictor of individual risk at bronchoscopy.