Respiration最新文献

Introduction: The aim of the study was to evaluate the value of quantitative CT (QCT) parameters, radiomics features, and deep learning (DL) features based on inspiratory and expiratory CT for the identification and severity staging of chronic obstructive pulmonary disease (COPD).

Methods: This retrospective analysis included 223 COPD patients and 59 healthy controls from the Guangzhou cohort. We stratified the participants into a training cohort and a testing cohort (7:3) and extracted DL features based on VGG-16 method, radiomics features based on pyradiomics package, and QCT parameters based on NeuLungCARE software. The logistic regression method was employed to construct models for the identification and severity staging of COPD. The Shenzhen cohort was used as the external validation cohort to assess the generalizability of the models.

Results: In the COPD identification models, model 5-B1 (the QCT combined with DL model in biphasic CT) showed the best predictive performance with AUC of 0.920 and 0.897 in testing cohort and external validation cohort, respectively. In the COPD severity staging models, the predictive performance of model 4-B2 (the model combining QCT with radiomics features in biphasic CT) and model 5-B2 (the model combining QCT with DL features in biphasic CT) was superior to that of the other models.

Conclusion: This biphasic CT-based multimodal approach integrating QCT, radiomics, or DL features offers a clinically valuable tool for COPD identification and severity staging.

Introduction: Skeletal muscle dysfunction, fatigue, and poor sleep quality are common in severe emphysema patients. Endobronchial valve (EBV) treatment is a bronchoscopic procedure which improves pulmonary function, quality of life, and exercise capacity in these patients. However, its potential beneficial effects on skeletal muscle function, fatigue, and sleep are unclear. Our aim was to investigate the effects of EBV treatment on these outcomes.

Methods: We conducted a prospective cohort study assessing the second parasternal intercostal muscle thickening fraction, and quadriceps muscle thickness and rectus femoris cross-sectional area (RF_CSA), both using ultrasound, limb muscle function using the 30-s sit-to-stand test, fatigue with the Checklist Individual Strength (CIS) fatigue subscale (score ≥36 indicating severe fatigue), and sleep quality with the Pittsburgh Sleep Quality Index (PSQI) at baseline and 6 months following EBV treatment.

Results: A total of 20 patients were included. At the 6-month follow-up, significant improvements were observed in pulmonary function, quadriceps thickness, and RF_CSA in the nondominant leg, as well as in limb muscle function. Intercostal thickening fraction did not change following treatment. Fatigue decreased significantly, reducing severe fatigue prevalence from 70% to 25%. Sleep quality was generally poor and remained unchanged.

Conclusion: Our results show that quadriceps muscle size and function, as well as fatigue, significantly improve following EBV treatment in severe emphysema patients. However, BLVR seems to have no impact on intercostal thickening fraction and patient-reported sleep quality. This study highlights the beneficial extrapulmonary effects of EBV treatment in patients with severe emphysema, further supporting its clinical use.

Introduction: Noninvasive ventilation (NIV) requires ongoing monitoring to ensure optimal therapeutic efficacy. The S3-noninvasive ventilation (S3-NIV) questionnaire was recently developed as a brief, repeatable, self-administered tool for the routine clinical evaluation of patients on long-term home NIV. This study aimed to produce an Arabic translation and cultural adaptation of the S3-NIV questionnaire and to assess its psychometric properties.

Methods: This was a descriptive, cross-sectional study involving patients with stable chronic respiratory disease treated with long-term home NIV. The Arabic version of the S3-NIV questionnaire was developed from the original French version through a standardized translation and back-translation process. The resulting instrument was evaluated for reliability and construct validity.

Results: A total of 150 patients were enrolled. The Arabic S3-NIV questionnaire demonstrated good internal consistency for the total score (Cronbach's alpha = 0.76; 95% CI: 0.69 to 0.83) and for the "respiratory symptoms" domain (Cronbach's alpha = 0.793; 95% CI: 0.728 to 0.858). The "sleep and side effects" domain showed lower reliability (Cronbach's alpha = 0.573; 95% CI: 0.266 to 0.880). Both the total score and the two subscale scores showed weak negative correlations with the Epworth Sleepiness Scale (ESS), modified Medical Research Council (mMRC) scale, pain visual analogue scale (VAS), and fatigue VAS. Exploratory factor analysis explained 54.6% of the total variance, supporting the internal structure of the Arabic version.

Conclusion: The Arabic version of the S3-NIV questionnaire demonstrates acceptable reliability and construct validity, particularly for the assessment of respiratory symptoms. It is a suitable tool for routine clinical use in Arabic-speaking patients receiving home NIV, although further refinement of the "sleep and side effects" subscale is recommended.

Introduction: Although calcified mediastinal lymph nodes are often clinically silent, they can eventually compress vital structures, such as the trachea or bronchi, necessitating intervention. Traditional surgical resection can be risky for certain patients. We present a pioneering case in which endobronchial ultrasound (EBUS)-guided transbronchial resection effectively relieved bronchial obstruction caused by calcified lymph nodes.

Case presentation: A 59-year-old male with a history of treated tuberculosis presented with a 4-month history of persistent cough, sputum, and dyspnea. Imaging revealed calcified mediastinal lymph nodes compressing the right intermediate bronchus, with mucus plug formation and obstructive pneumonia. After attending a team consultation in which the risks were reviewed, the patient declined surgery. Hence, an EBUS-guided transbronchial resection was performed under general anesthesia. Two calcified lymph nodes were resected using a high-frequency needle knife and forceps under real-time ultrasound guidance. No perioperative complications occurred. The patient's respiratory symptoms resolved, and follow-up bronchoscopy at 4 months showed a fully healed airway without restenosis.

Conclusion: This case highlights the feasibility and safety of EBUS-guided transbronchial resection as a minimally invasive treatment for symptomatic mediastinal lymph node calcification. EBUS may potentially be a viable alternative for patients in whom thoracic surgery is contraindicated or declined.

Introduction: Radial endobronchial ultrasound (rEBUS)-guided transbronchial biopsy (TBB) is the most used technique for the diagnosis of peripheral pulmonary lesions. However, the TBB cannot be performed under simultaneous ultrasound guidance as the rEBUS probe has to be removed prior to the biopsy. To provide an endobronchial imaging-based guided TBB, the safety and feasibility of cryobiopsy under simultaneous probe-based confocal laser endomicroscopy (pCLE) control is analyzed for the first time in this prospective pilot study.

Methods: Fifteen patients with a pulmonary lesion suspicious for malignancy were enrolled in this prospective pilot trial from September 2023 to December 2024 at the Division of Pulmonology, Department of Internal Medicine II, Medical University of Vienna, Austria. After identifying the lesion by the rEBUS, a cryoprobe and an AQ Flex™ probe were inserted simultaneously under fluoroscopic guidance. Based on the pCLE images, the position of the cryoprobe was optimized and TBB were performed. The safety and feasibility were evaluated.

Results: In 11 patients in whom the pulmonary lesions were identified by rEBUS, a transbronchial cryobiopsy could be performed under simultaneous pCLE guidance without any complications. The cryoprobe and the AQ Flex™ probe could be inserted easily in parallel into the lesion in all cases. Overall, the agreement between the "tool-in-lesion" signal based on CLE images and the proof of malignancy was found to be 82%.

Conclusion: A transbronchial cryobiopsy under simultaneous pCLE guidance using an AQ Flex™ probe for peripheral pulmonary lesions is feasible and safe. Further studies are needed to evaluate the additional benefit of CLE imaging.

Background: The TNM staging system is the cornerstone of lung cancer classification, providing a framework for prognosis and treatment planning in a universal nomenclature. The 9th edition of the TNM classification, released by the International Association for the Study of Lung Cancer (IASLC) and went into effect in January 2025, introduces refinements to lymph node (N) staging. Lymph node staging is performed minimally invasively using bronchoscopy with endobronchial ultrasound (EBUS). This article explores the latest updates on lymph node staging by EBUS and their implications for lung cancer management from the perspective of bronchoscopy.

Summary: The 9th edition of the TNM classification includes the subdivision of N2 lymph nodes into N2a single-station and N2b multiple-station involvement, but not the subdivision of N1 lymph nodes. This has implications not only for treatment but also for the number of lymph nodes sampled by EBUS. As there is no strict hierarchy of N2 lymph nodes, this poses challenges to the order in which N2 lymph nodes should be sampled. The development of a new thin EBUS device will enable sampling of peripheral N1 lymph nodes. This could influence future TNM classifications, given that there are pathological but not clinical differences in survival between purely peripheral and hilar N1 involvement.

Key messages: With respect to occult lymph node disease, EBUS remains fundamental in staging lung cancer. New technical developments will also enable sampling of peripheral N1 lymph nodes.

Introduction: Excessive dynamic airway collapse (EDAC) is a condition characterized by excessive narrowing of the trachea and bronchi during exhalation, leading to respiratory symptoms. While bronchoscopic tracheobronchoplasty using laser-based thermal ablation has been reported in clinical practice, the lack of preclinical studies, including animal models, limits a comprehensive understanding of its safety and efficacy. This study compares laser and argon plasma coagulation (APC) thermal ablation in a Bama miniature pig model to assess their effects on airway histopathology and healing.

Methods: Twelve Bama miniature pigs underwent noncontact laser ablation and precise APC ablation of the membranous trachea via flexible bronchoscopy under different parameter settings. The animals were euthanized either immediately post-procedure or at 28 days. Histopathological changes were assessed using HE and Masson's trichrome staining. The remaining animals were closely monitored for 28 days postoperatively for infection, hemoptysis, and respiratory distress. Bronchoscopic evaluations were conducted on days 7, 14, 21, and 28 to assess tracheal healing.

Results: All 12 procedures were successfully completed without major intraoperative complications. Acute histopathological changes included necrosis and sloughing of the mucosal and submucosal layers. Between postoperative days 7 and 14, varying degrees of cough and dyspnea were observed. By day 28, histopathological analysis showed significant collagen fiber proliferation in the submucosal layer, with collagen layer thickness directly proportional to APC power and inversely proportional to laser power.

Conclusion: When the injury depth is limited to the submucosal layer of the tracheal membranous part by setting reasonable technical parameters, laser and precise APC can induce fibrous tissue hyperplasia and collagen deposition. However, precise APC is safer and more feasible, and further research is still needed to improve the surgical parameters and evaluate long-term clinical results.

Introduction: Osteoprotegerin (OPG), a decoy receptor for receptor activator of NF-κB ligand (RANKL), serves as a biomarker for liver fibrosis severity. Our recent findings show OPG production in fibrotic lung tissue, though its specific cellular source and role in pulmonary fibrosis are unknown. We hypothesized that OPG is produced by fibroblasts and serves as a marker for pulmonary fibrosis progression.

Methods: We examined OPG expression in human and mouse control and fibrotic lung tissue and used primary human lung fibroblasts and murine precision-cut lung slices to study OPG production. Serum from idiopathic pulmonary fibrosis (IPF) patients and controls was analyzed to investigate correlations between OPG levels and disease status, as measured by lung function.

Results: OPG-protein levels were significantly higher in murine and human fibrotic lung tissue compared to control. OPG-protein levels in fibrotic mouse lung tissue correlated positively with collagen deposition. OPG-mRNA and protein production increased in mouse lung slices upon TGFβ stimulation. Isolated lung fibroblasts from IPF patients produced more OPG-protein than controls. Serum OPG levels in IPF patients negatively correlated with diffusing capacity to carbon monoxide. Serum OPG levels above 1,243 pg/mL were linked to disease progression in IPF patients.

Conclusion: OPG is produced by fibroblasts in lung tissue, associates with fibrosis, and may be a potential prognostic biomarker for IPF progression. Validation in a larger cohort is necessary to further explore OPG's role in pulmonary fibrosis and its potential for assessing fibrotic lung disease prognosis in individual patients.