Respiration最新文献

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.

Introduction: Body weight (BW) loss is common in interstitial lung disease (ILD) patients and correlated with poor prognosis. This study aimed to verify whether multidisciplinary interventions combining pulmonary rehabilitation and nutritional management affect BW loss and prognosis in ILD.

Methods: We retrospectively examined changes in body composition including BW in ILD patients who were admitted to our hospital for the comprehensive pulmonary rehabilitation program. These parameters were measured 6 months before, at the beginning, and 6 months after the program. We investigated the program's impact on BW loss and its association with survival.

Results: Of the 169 program participants, 40 ILD patients with tracked BW trends were enrolled. A significant BW loss was observed during 6 months before the program (p < 0.001); however, the intervention successfully halted further BW loss (p = 0.116). Patients on antifibrotic medications also showed similar BW trends. Notably, patients with pleuroparenchymal fibroelastosis showed a significant BW loss before the program (-1.8 kg, p < 0.001) but exhibited BW gain following the intervention (+1.0 kg, p = 0.475). Regarding the survival, BW loss halted group (effective group) had a significantly longer survival (log rank, p = 0.022). In multivariate analysis, BW loss >5% was identified as a prognostic indicator. This program successfully halted BW loss and increased survival.

Conclusion: Multidisciplinary rehabilitation effectively managed BW, leading to better survival in ILD. In particular, there is currently no treatment for pleuroparenchymal fibroelastosis, and multidisciplinary rehabilitation offers a promising treatment option.

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.

Background: Lung cancer remains the leading cause of cancer-related mortality worldwide. Although surgical resection and stereotactic body radiation therapy are standard treatment options for early-stage disease, both are limited by procedural morbidity and ineligibility among high-risk patients. Similarly, percutaneous approach with image-guided ablation is associated with pneumothorax and pleural injury. Advances in navigation, imaging, and device design have enabled endoscopic ablation to emerge as a minimally invasive technique capable of targeting peripheral and central lesions under real-time image guidance.

Summary: Endoscopic ablation techniques, comprising radiofrequency, microwave, laser, vapor, cryoablation, photodynamic therapy, pulsed-electric field ablation, and intralesional chemotherapy, enable precise bronchoscopic delivery of localized therapy. Early feasibility, safety, and clinical data demonstrate high technical success, favorable short-term safety, and potential immunologic synergy when combined with systemic therapy. Nonetheless, several challenges remain, including limited access to subsegmental lesions, variability in ablation margins, and lack of long-term outcomes. Despite these limitations, ongoing advances in device design, navigation, and imaging, such as robotic-assisted bronchoscopy and cone-beam computed tomography, are enhancing the procedural precision and therapeutic reach. This review synthesizes current evidence on endoscopic ablation, focusing on emerging technologies, clinical applications, and key research gaps.

Key messages: Endoscopic ablation represents a promising, lung-sparing treatment for lung malignancies. Ongoing technological advances in navigation, imaging, and integration are enhancing its applicability in local tumor control. Large, prospective trials are required to validate oncologic efficacy, optimize procedural parameters, and establish endoscopic ablation's role within multimodal lung cancer management.

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.

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.