Respiration最新文献

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: 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: 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: 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.

Bronchoscopic ablation is a promising minimally invasive treatment for peripheral lung tumours, avoiding the high complications associated with percutaneous approaches. However, existing ablation catheters are mostly incompatible with ultrathin bronchoscope (UTB), potentially limiting access to subpleural lesions. We report a case of successful bronchoscopic ablation using a novel 1.4 mm radiofrequency (RF) catheter delivered through a UTB. A 53-year-old woman with oligometastatic gastroesophageal adenocarcinoma underwent bronchoscopic ablation for a 12 mm apical right upper lobe metastasis. The UTB was navigated to the 8th airway generation under direct bronchoscopic vision, and the flexible RF catheter was smoothly inserted through the UTB's 1.7 mm working channel. Real-time cone-beam CT confirmed accurate catheter positioning, ensuring safe ablation without pleural puncture. A total of 26 kJ of energy was delivered over 513 seconds. The patient recovered without complications and was discharged 48 hours post-procedure. The RF catheter's small diameter and high flexibility allow UTB to remain precise and manoeuvrable in the peripheral airway. As peripheral bronchoscopy evolves beyond diagnostics, integrating miniaturized therapeutic tools such as the 1.4mm RF catheter will be crucial in expanding its clinical utility. Further results from ongoing clinical trials are highly anticipated to validate the long-term feasibility and safety of this technique.

Endobronchial valve implantation to accomplish bronchoscopic lung volume reduction (BLVR) has been shown to improve pulmonary function, functional status, and dyspnea in patients with advanced emphysema complicated by hyperinflation without interlobar collateral ventilation. Patient selection and periprocedural management are largely derived from clinical trial inclusion criteria and limited to expert opinion. No consensus recommendations are available to guide practical aspects of BLVR. An international group of experts were invited to participate and were surveyed broadly regarding their BLVR-related practices, from which specific topics were selected by the group, followed by literature review on these topics. Recommendations regarding selected topics were formulated over three voting rounds using a modified Delphi technique requiring at least 80% consensus agreement. A total of 21 recommendations reached consensus and are detailed herein. One recommendation failed to reach consensus, and two other topics were found to have insufficient evidence to make specific recommendations. These consensus recommendations offer guidance on practical aspects of patient selection and periprocedural management topics related to BLVR with endobronchial valves and highlight gaps in current knowledge requiring further research.

Background:  Airway fibrostenosis, a severe complication of tracheobronchial tuberculosis (TBTB), causes respiratory morbidity including atelectasis, pneumonia, and respiratory failure. Early risk prediction remains challenging due to the lack of validated assessment tools.

Methods:  This retrospective cohort study analyzed TBTB patients undergoing bronchoscopic interventions between January 2021 and June 2024 with 6-month follow-up. A Cox regression model was developed in all 305 patients, internally validated with 1,000 bootstrap resamples. Performance was evaluated via C-index, ROC-AUC, calibration, and decision curve analysis. Kaplan-Meier analysis was used to stratify groups, with log-rank tests assessing differences.

Results:  Airway fibrostenosis incidence was 60.33% (184/305). Eight independent predictors were identified: symptom duration, affected lung lobes, diabetes, multiple TBTB types, bronchoscopic intervention frequency, initial sputum acid-fast bacilli smear grade, neutrophil-to-lymphocyte ratio, and CD8+ T-cell count. The nomogram demonstrated strong discrimination (C-index 0.77, 95%CI 0.75-0.81) with increasing predictive accuracy over time: 6-week AUC 0.773 (0.708-0.838), 8-week 0.792 (0.740-0.844), 12-week 0.830 (0.782-0.878), and 16-week 0.883 (0.842-0.923). High-risk patients exhibited a significantly higher probability of developing airway fibrostenosis compared to low-risk patients (P<0.001). Calibration and decision curve analyses confirmed clinical utility.

Conclusions:  This validated nomogram effectively predicts airway fibrostenosis risk in TBTB patients, enabling early identification of high-risk individuals for targeted interventions.

The german guideline on non-invasive ventilation offers comprehensive recommendations for the treatment of chronic respiratory failure in various underlying conditions, such as COPD, thoraco-restrictive diseases, obesity-hypoventilation syndrome, and neuromuscular diseases. The aim of the guideline is to improve the treatment of patients with chronic respiratory insufficiency using non-invasive ventilation and to make the indications and therapy recommendations accessible to all involved in the treatment process. It is based on the latest scientific evidence and replaces the previous guideline from 2017. This revised guideline provides detailed recommendations on the application of non-invasive ventilation, ventilation settings, and the subsequent follow-up of treatment. In addition to the updated evidence, important new features of this guideline include new recommendations on patient care and numerous detailed treatment pathways that make the guideline more user-friendly. Furthermore, a completely revised section is dedicated to ethical issues and offers recommendations for end-of-life care. This guideline is an important tool for physicians and other healthcare professionals to optimize the care of patients with chronic respiratory failure.

Introduction: Training-induced adaptations of the oxidative capacity have been shown to be blunted in alpha-1 antitrypsin deficiency (AATD)-related chronic obstructive pulmonary disease (COPD). To improve training outcomes in AATD, this study was aimed to compare the effects of two exercise training programmes with different training intensities.

Methods: Thirty patients with AATD (genotype PiZZ) and COPD III-IV were randomly assigned to either high-intensity (HIT) or moderate-intensity training (MIT), each consisting of endurance, strength, and squat training for a duration of 3 weeks. 6-Min walk distance (6MWD) was used as the primary outcome.

Results: Twenty-five subjects augmented with alpha-1 antitrypsin (HIT: n = 12, FEV1 41.3 ± 17.4%pred., MIT: n = 13, FEV1 45.9 ± 15.5%pred.) completed the study. In HIT and MIT, 6MWD (+37 ± 43 m vs. +32 ± 28 m, p = 0.741), 1-min sit-to-stand test (5.6 ± 4.9 repetitions vs. 5.6 ± 4.5 repetitions, p = 0.766), exercise-induced BORG dyspnoea (-1.4 ± 1.7 pts vs. -1.5 ± 2.4 pts, p = 0.952), and all CRQ domains have improved after training without between-group differences. When considering only subgroups of (probably) anxious or depressive patients (Hospital Anxiety and Depression Scale [HADS] ≥8 pts), only HIT induced a significant reduction of anxiety (-4.8 pts, 95% CI [2.1-7.5]) or depression symptoms (-5.0 pts, 95% CI [2.8-7.3]).

Conclusion: Although HIT and MIT were equally effective by improving exercise capacity, quality of life, and dyspnoea in homozygous AATD, HIT may show advantages over MIT, if anxiety or depression symptoms were present. The goal should be personalized training based on the patient's personal preference in order to achieve long-term adherence.

Introduction: Cone beam computed tomography-guided navigation bronchoscopy (CBCT-NB) with augmented fluoroscopy (AF) guidance represents a minimally invasive endobronchial technique for diagnosing small, peripheral pulmonary lesions. This approach is characterized by its high diagnostic accuracy and low complication risk. Current pilot trials are exploring the application of localized therapies using this innovative approach. This report aims to provide a detailed procedural guide for performing CBCT-NB with AF guidance as the only tool for navigation and image guided biopsy.

Methods: We outline the procedural steps involved in the CBCT-NB procedure for diagnosing peripheral pulmonary lesions, supported by specific intra-procedural clinical video footage. The steps include (1) preprocedural considerations, (2) a detailed procedural workflow encompassing navigation to the target lesion, (3) position confirmation and tissue acquisition, and (4) postprocedural follow-up.

Conclusion: CBCT-NB with AF guidance is a safe and precise stand-alone navigation modality that offers high-resolution real-time 3D imaging, enhancing the diagnosis and potential treatment of peripheral pulmonary nodules.

Introduction: Cone beam computed tomography-guided navigation bronchoscopy (CBCT-NB) with augmented fluoroscopy (AF) guidance represents a minimally invasive endobronchial technique for diagnosing small, peripheral pulmonary lesions. This approach is characterized by its high diagnostic accuracy and low complication risk. Current pilot trials are exploring the application of localized therapies using this innovative approach. This report aims to provide a detailed procedural guide for performing CBCT-NB with AF guidance as the only tool for navigation and image guided biopsy.

Methods: We outline the procedural steps involved in the CBCT-NB procedure for diagnosing peripheral pulmonary lesions, supported by specific intra-procedural clinical video footage. The steps include (1) preprocedural considerations, (2) a detailed procedural workflow encompassing navigation to the target lesion, (3) position confirmation and tissue acquisition, and (4) postprocedural follow-up.

Conclusion: CBCT-NB with AF guidance is a safe and precise stand-alone navigation modality that offers high-resolution real-time 3D imaging, enhancing the diagnosis and potential treatment of peripheral pulmonary nodules.