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Background: Bronchoscopy is essential for diagnosing and treating lung diseases, yet conventional techniques are limited by incomplete anatomical coverage, unstable image quality, high rates of missed lesions, and significant operator dependency. These challenges exacerbate disparities in healthcare quality, especially in regions with unevenly distributed medical resources.

Summary: This study conducts a systematic analysis of the potential for adapting deep learning technologies to the field of medical endoscopy. It specifically explores the application prospects of artificial intelligence (AI) for enhancing the quality control and diagnostic analysis of bronchoscopic images.

Key messages: The findings highlight AI's significant potential to innovate bronchoscopic image analysis. However, current research has limitations, particularly in the generalizability of models. Future work must focus on multicenter clinical validation to optimize model robustness and on developing real-time decision support systems to ultimately standardize bronchoscopic procedures and improve diagnostic efficiency.

Introduction: It is not known if pulse oximetry oxygen saturation measurements (SpO₂) are subject to even-number bias and boundary effects which have been reported for other physiological measurements.

Methods: We reviewed three large SpO₂ datasets from two countries for even-number bias: 3,351,981 continuous automated SpO₂ entries in Denmark (DK-continuous), 7,602,352 manual SpO₂ entries in Denmark (DK-manual), and 949,718 manual SpO₂ entries in the UK (UK-manual).

Results: Even-numbered SpO₂ entries were commoner than odd numbers in all three datasets. Even numbers accounted for 50.6% of DK-continuous entries (95% CI: 50.6-50.7), 57.5% of DK-manual entries (95% CI: 57.4-57.6), and 59.7% of UK-manual entries (95% CI: 59.6-59.8): DK-manual vs. DK-continuous, relative risk [RR]: 1.14, 95% CI: 1.13-1.14, p < 0.0001; UK-manual vs. DK-continuous RR 1.18, 95% CI: 1.18-1.18, p < 0.0001. The even-number bias was more pronounced in UK medical patients for whom 64.9% of SpO₂ entries had even numbers (UK-manual medical entries vs. DK-continuous medical entries RR 1.29, 95% CI: 1.29-1.30, p < 0.0001). The proportion of even SpO₂ numbers was particularly high (67.0%; 95% CI: 66.5-67.5%) for UK medical patients who were using supplemental oxygen.

Conclusions: We identified even-number bias in routine pulse oximetry entries in the UK and Denmark. The bias was substantially greater for manually collected data than for automated continuous data. The high degree of even-number bias in patients who were receiving supplemental oxygen suggests that the SpO₂ might be rounded to meet target saturation range or Early Warning Score boundaries. This bias could influence patient management and clinical outcomes.

Introduction: Prolonged weaning from invasive mechanical ventilation remains a major clinical challenge. While outcomes from certified weaning centers are increasingly documented, data on long-term survival and post-discharge trajectories are limited. This study evaluated both in-hospital weaning outcomes and long-term survival in patients treated at two specialized weaning centers in Germany.

Methods: We conducted a retrospective cohort study using the WeanNet registry, focusing on patients admitted for prolonged weaning between 2016 and 2020 at two centers (Greifswald and Hemer). After data cleaning, 718 patients (Greifswald: 337; Hemer: 381) were included. The 3-year follow-up was performed using structured outpatient assessments, clinical records, and telephone interviews.

Results: In-hospital mortality was markedly lower in both centers (Greifswald: 6.2%; Hemer: 3.4%) compared to national WeanNet data (13.4%). Among discharged patients, increased age, discharge with invasive ventilation (hazard ratio [HR] 2.60; 95% confidence interval [CI]: 1.99-3.39), and tracheostomy without ventilation (HR 1.90; 95% CI: 1.40-2.60) were significantly associated with higher 36-month mortality. Comorbidities such as left heart failure, thoracorestrictive disease, chronic kidney disease, oncologic disease, and diabetes were also linked to poorer outcomes.

Conclusion: Patients discharged with invasive ventilation or tracheostomy exhibit significantly reduced long-term survival, highlighting the urgent need for structured post-discharge care pathways. Regular re-evaluation of weaning potential and tracheostomy decannulation should be integrated into follow-up programs to improve outcomes in this vulnerable population.

Introduction: Intrapleural fibrinolytic therapy, involving the sequential administration of DNase and tissue plasminogen activator (tPA), is a key component in the management of pleural infections. This approach has been shown to reduce hospital length of stay and the need for surgical intervention. However, it remains unclear whether these agents are pharmaceutically compatible for concurrent administration. This study investigated the compatibility of DNase and tPA when mixed together.

Methods: We prepared the following combinations of tPA (Actilyse, Boehringer Ingelheim B.V.) and DNase (Pulmozyme, Roche Nederland B.V.): undiluted (10 mg tPA + 5 mg DNase), diluted in 50 mL saline, and diluted in 500 mL saline. Control solutions containing only tPA, only DNase, or only saline were also prepared. Physical stability was assessed by visual inspection for particulate formation, haze, precipitation, color change, or gas evolution. Physical compatibility was evaluated by measuring pH at baseline, 2 h, and 4 h post-preparation, at both room temperature and 40°C. Incompatibility was defined as a mean absolute pH change greater than 1 unit over time.

Results: All tested solutions remained physically compatible across all time points, dilutions, and temperatures.

Conclusion: Our findings demonstrate that tPA and DNase are pharmaceutically compatible when mixed and diluted in normal saline. This supports the feasibility of concurrent intrapleural administration, which may reduce labor intensity, improve protocol adherence, and lower the risk of iatrogenic infections in patients with pleural infections.

Introduction: Gender disparities in long-term health-related quality of life (HRQOL) after pulmonary embolism (PE) are only rarely investigated. The present study aimed to explore gender disparities in HRQOL of patients with PE up to 4 years after hospital discharge.

Methods: Data from the German "Lungenembolie Augsburg (LEA)" cohort study were used. Baseline characteristics of adult hospitalized patients with PE were collected during their hospital stay. Participants completed postal questionnaires at 3 months, 6 months, and then yearly for 4 years after their PE. The Pulmonary Embolism Quality of Life Questionnaire (PEmb-QoL) and the European Quality of Life Questionnaire (EQ-5D-5L) were used to measure HRQOL. Multivariable linear mixed models were applied to determine the association between gender and HRQOL. Interaction effects between gender and various covariables were examined.

Results: In 569 participants (45% women, mean age 62.9 ± 14.5 years), significant interaction effects of gender with other covariables were found in most subscales of the PEmb-QoL and the EQ-5D-5L. Among patients without chronic obstructive pulmonary disease, women scored significantly worse in the subscales "limitations of activities of daily living" and "work-related problems." Among patients with obesity, women had significantly more limitations of activities of daily living than men. Among patients younger than 64 years, women had significantly more emotional complaints than men. The observed gender differences were restricted to the first 3 months after PE.

Conclusion: Gender disparities regarding HRQOL were observed in specific subgroups and mainly occurred in the first 3 months after PE.

Introduction: Continuous positive airway pressure (CPAP) is the standard treatment for obstructive sleep apnea (OSA), yet diagnostic and treatment models have historically overlooked sex-specific responses. This study aimed to examine sex differences in changes in sleep-related symptoms, cognitive functions, and quality of life (QOL) following CPAP initiation in individuals with OSA.

Methods: A prospective repeated-measures study was conducted at a sleep clinic. Adults diagnosed with OSA (apnea-hypopnea index ≥5) were assessed at four time points after CPAP initiation. Outcomes measures included Epworth Sleepiness Scale, Pittsburgh Sleep Quality Index, Mini-Mental State Examination, Hospital Anxiety and Depression Scale, and QOL. Generalized estimating equations were used for longitudinal analysis.

Results: Of 121 participants, 15.7% were female (mean age: 50.8 years). CPAP adherence did not differ by sex. At baseline, women reported significantly poorer sleep quality and physical functions. Adjusted analyses revealed women exhibited poorer sleep quality (β = 3.23, p < 0.00001) but better cognitive function (β = 0.70, p = 0.025) compared to men after receiving CPAP treatment. When examining sex differences over time, women showed progressive improvements in sleep quality (β = -1.12, p = 0.001), depressive symptoms (β = -0.90, p = 0.004), and the physical domain of QOL (β = 0.49, p = 0.019) throughout the treatment period.

Conclusion: CPAP therapy significantly improved sleep quality, depressive symptoms, cognitive function, and physical well-being in female patients with OSA. Implementing sex-specific treatment and support strategies may strengthen patient engagement, improve adherence, and optimize therapeutic outcomes.

Introduction: Chronic obstructive pulmonary disease (COPD) is the third cause of death in Spain. The ETHOS (NCT02465567) and IMPACT (NCT02164513) RCTs showed reduced exacerbations and all-cause mortality for single-inhaler triple therapy (SITT), but no studies have evaluated the potential impact on COPD outcomes of higher SITT adoption in Spain.

Methods: We used literature-based data on patient characteristics, incidence, COPD severity changes, treatment distributions/transitions, mortality, exacerbations, and medical costs, to inform a stochastic simulation of the Spanish COPD population for 2025-2034 under two scenarios: "status quo" and "increased SITT," in which higher SITT use is driven by airflow limitation, exacerbation history (as per 2025 GOLD report), and SITT replacing multiple-inhaler triple therapy. Additionally, we present results separately for the subset of patients that met the criteria for SITT use, referred to as "flagged population."

Results: In our 10-year simulation, increased SITT use in the flagged population could lead to 51,000 deaths avoided resulting in a 14.6% reduction in mortality rates and extended patient life by 1.2 years per COPD-flagged patient. Additionally, increased SITT use in the flagged population reduced severe and moderate exacerbations by 62,000 (an 11.5% reduction) and 366,000 (an 11.6% reduction), respectively, resulting in total medical savings of EUR 384 million.

Conclusion: Based on our simulation, increased use of SITT in the Spanish COPD population, consistent with the most recent 2025 GOLD report recommendations, could reduce mortality and exacerbations and their corresponding medical costs. Increasing SITT utilization in patients with COPD may constitute a long-term strategy with relevant clinical and economic benefits.

Introduction: Iriscope, a novel ultra-thin video probe designed to be inserted through the bronchoscope working channel enables direct visualization of peripheral lung lesions. However, its diagnostic value in comparison or in combination with established bronchoscopic guidance techniques remains unclear. This study aims to evaluate the added benefit of combining Iriscope with radial endobronchial ultrasonography (R-EBUS) compared to R-EBUS alone for the diagnosis of peripheral lung lesions sized 20-50 mm.

Methods: 81 patients were randomized into two groups: bronchoscopy guided by R-EBUS or bronchoscopy guided by both Iriscope and R-EBUS. Fluoroscopic guidance and forceps biopsy were used in both groups. In the combined group, the Iriscope was used first, followed by insertion of the ultrasound probe through the working channel for lesion visualization. Biopsies were taken in case of abnormal lesion visualized by R-EBUS. The primary outcome was diagnostic yield. Secondary outcomes included yield stratified by lesion size, presence of bronchus sign, and lesion visualization on fluoroscopy.

Results: The diagnostic yield was higher in the combined group (32/40, 80%) compared to R-EBUS alone (23/41, 55%, p = 0.036). The improved yield in the combined approach was consistent regardless of lesion size, bronchus sign presence, or fluoroscopic visualization.

Conclusion: Combining Iriscope with R-EBUS significantly improves diagnostic yield compared to R-EBUS alone in patients with peripheral lung lesions sized 20-50 mm.

Introduction: Talc pleurodesis is a widely used intervention for recurrent pneumothorax and pleural effusion, particularly in nonsurgical candidates. However, some patients experience immediate failure or recurrence and require additional intervention. The safety and effectiveness of repeated talc administration remain unclear. This study investigated repeat-dose talc pleurodesis to determine its safety and efficacy in the management of initial failures and recurrence.

Methods: This retrospective study (January 2019-September 2024) analyzed hospitalized patients undergoing talc slurry pleurodesis. Data included demographics, comorbidities, indication, and number of talc doses for successful pleurodesis. The primary outcome was pleurodesis success after repeat dosing. Analyses used chi-square tests, Cox regression for recurrence risk, and Kaplan-Meier estimates for recurrence-free survival.

Results: Among 103 patients who underwent bedside talc slurry pleurodesis for pneumothorax (n = 70) or pleural effusion (n = 33), 80 (77.7%) achieved successful pleurodesis with a single 4 g dose (pneumothorax = 56; effusion = 24). Of the 23 patients with immediate pleurodesis failure, 16 (69.6%) achieved success following repeat-dose pleurodesis (pneumothorax = 7; effusion = 9), while 7 required alternative interventions. Recurrence after discharge occurred in 17 (21.3%) of the single-dose group (pneumothorax = 11; effusion = 6) compared with 1 (6.3%) in the repeat-dose group. Among 18 recurrence cases overall, 9 underwent repeat pleurodesis, with 8 (88.9%) achieving success.

Conclusion: Repeat-dose talc pleurodesis may represent a reasonable management approach for patients experiencing immediate failure or recurrence after an initial successful pleurodesis with minimal complications. Further research is needed to optimize protocols and improve outcomes for patients undergoing pleurodesis.