Respirology最新文献

Background and objective: The impact of lipid abnormalities on right heart function and outcomes in pre-capillary pulmonary hypertension (precPH) remains unclear. This study investigates how lipid profile alterations influence right heart function, strain, and prognosis in precPH patients.

Methods: From June 2013 to December 2023, 394 precPH patients were prospectively enrolled. Clinical data, cardiac MRI-derived right heart systolic function, and strain parameters were compared among groups based on lipid profiles. The optimal cut-off values of lipid profiles were determined using the maximally selected rank statistics. Prognostic analyses were conducted using Cox regression and Kaplan-Meier survival methods.

Results: During a median follow-up of 36 months, 18.8% of patients died. Low-density lipoprotein cholesterol (LDL-C) < 1.93 mmol/L and high-density lipoprotein cholesterol (HDL-C) < 0.82 mmol/L were associated with increased mortality risks (2.51-fold and 2.65-fold, respectively). Multivariate analysis confirmed decreased LDL-C (HR 1.853, 95% CI 1.102-3.115, p = 0.02) and decreased HDL-C (HR 2.019, 95% CI 1.131-3.603, p = 0.02) as independent prognostic indicators. A decrease in either cholesterol subtype predicted worse outcomes (Log-rank p = 0.003). Incorporation of LDL-C and HDL-C enhanced prognostic accuracy of the ESC model (χ²: 50.8 to 60.5, p = 0.007; 50.8 to 66.0, p < 0.001) and ESC-CMR model (χ²: 59.3 to 66.0, p = 0.04; 59.3 to 72.7, p = 0.001). HDL-C < 0.82 mmol/L was associated with impaired right ventricular global longitudinal strain (p < 0.001), RV free wall strain (p < 0.001), and right atrial phasic strain (all p < 0.05).

Conclusions: Decreased HDL-C and LDL-C levels independently predict increased mortality in precPH patients. Notably, low HDL-C significantly associates with impaired right heart function and strain.

Trial registration: Chinese Clinical Trial Registry (https://www.

Clinicaltrials: gov; ID: ChiCTR1800019314 and ChiCTR1900025518).

Background and objective: Peripheral blood cell counts are useful biomarkers in COPD, but may not fully reflect disease activity. The Sysmex XN-Series haematology analyser offers advanced measurements of immune cell populations, providing information about the number and activation status of peripheral blood cells. We hypothesized that assessing immune cell activation status, in addition to cell counts, could provide complementary insights into the clinical heterogeneity of severe COPD.

Methods: For this study, 499 extensively characterised patients with severe COPD were included from the Groningen Severe COPD cohort. A total of 24 Sysmex-derived systemic blood parameters were selected for analysis. Clustering of blood cell population data was performed using Self-Organising Maps.

Results: The cell population parameters showed various associations with clinical characteristics, such as emphysema severity and lung function. Four clusters were identified based on their inflammatory profiles, each showing distinct clinical characteristics: the 'normal cell counts, resting pattern' cluster (n = 156) showed high emphysema severity scores and RV/TLC ratios; the 'normal cell counts, activated pattern' cluster (n = 241) was associated with few exacerbations; the 'elevated cell counts, activated pattern' cluster (n = 97) displayed high inflammatory cell counts and activity along with high exacerbation rates; and the small 'low-eosinophilic' cluster (n = 5) was characterised by inactive circulating eosinophils.

Conclusion: Cell population data can be used to identify distinct inflammatory profiles with clinical relevance in severe COPD. Cell population data provide information beyond absolute cell counts, supporting the added value of including activation markers in COPD phenotyping.

Trial registration: NCT04023409 at clinicaltrials.gov.

Background and objective: Nocturnal pulse oximetry (NPO) is a simple and inexpensive assessment tool that has previously been shown to correlate with prognosis and timing of non-invasive ventilation (NIV) initiation in people living with motor neuron disease (plwMND). However, the optimal number of nights for measuring NPO has not been defined for this population, with other respiratory conditions exhibiting both low and high night-to-night variability in NPO parameters. This study aims to determine the inter-night variability in NPO data over three nights in plwMND.

Methods: We conducted a retrospective analysis of 132 studies in which plwMND underwent three consecutive nights of NPO. Intraclass correlation coefficients (ICC) were used to assess the reliability of key NPO parameters, including mean percentage of total recording time with oxygen saturation (SpO₂) < 90% (T90), oxygen desaturation index (ODI), basal SpO₂ and nadir SpO₂. The proportion of plwMND meeting NIV criteria based on single-night versus multi-night assessments was also compared.

Results: Excellent reliability was observed for T90 (ICC(1) = 0.940) and ODI (ICC(1) = 0.901), while basal SpO₂ (ICC(1) = 0.845) and nadir SpO₂ (ICC(1) = 0.768) demonstrated good reliability. However, relying on a single-night NPO assessment failed to identify 12% of plwMND who met NIV criteria when evaluated over three nights.

Conclusion: Despite good to excellent inter-night variability of NPO data in plwMND, multi-night NPO monitoring improves the accuracy of identifying plwMND requiring NIV. These findings support the need for multi-night assessments to enhance clinical decision-making in MND management.

Background and objective: The role of perioperative radiotherapy in squamous cell lung cancer patients with pathologic N2 remains unclear. The purpose of this study was to explore the effectiveness of preoperative radiotherapy (PRRT) and postoperative radiotherapy (PORT) on survival.

Methods: Patients with pathologic N2 stage III squamous cell lung cancer who received PRRT combined with preoperative systemic therapy (PRST) or PORT combined with postoperative systemic therapy (POST) were identified in the Surveillance, Epidemiology, and End Results database from 2000 through 2021. Propensity score matching (PSM) was used for the matching of patients (1:1 ratio). Overall survival (OS) was compared among the different groups by using Kaplan-Meier analysis.

Results: A total of 2132 patients were included and 344 patients were excluded. After PSM, 105 patients received PRST combined with PRRT while 105 patients received PRST alone; 446 patients received POST combined with PORT while 446 patients received POST alone. For PRST combined with/without PRRT, median OS for radiotherapy was 80 months (95% confidence interval [CI], 60 to 121), which was significantly longer than that without radiotherapy (40 months [95% CI, 30 to 70]; p = 0.016); and the hazard ratio for radiotherapy was 0.65 (95% CI, 0.46 to 0.92) compared with no radiotherapy. For POST combined with/without PORT, there was no significant difference between radiotherapy and no radiotherapy for median OS (34 months [95% CI, 30 to 42] for radiotherapy versus 41 months [95% CI, 34 to 51] for no radiotherapy; p = 0.17).

Conclusion: Our results revealed that PRST combined with PRRT significantly improved OS.

Background and objectives: General anaesthesia with intubation is the standard technique for video-assisted thoracic surgery (VATS). However, non-intubated VATS (NIVATS) is emerging as a less invasive alternative, particularly for lung biopsies in patients with interstitial lung disease (ILD) and impaired respiratory function. This study aims to investigate the benefits of non-intubated surgery on postoperative respiratory function and to compare operative outcomes between intubated VATS (IVATS) and NIVATS.

Methods: We conducted a single-centre retrospective study of patients who underwent lung biopsy for ILD diagnosis via VATS between January 2020 and September 2023 at Montpellier University Hospital. Primary outcomes included the variation in pulmonary function tests after surgery (FEV₁, FVC, DLCO). Secondly, this study compares clinical postoperative outcomes and diagnostic yield between the two groups.

Results: The study included 61 patients, with 42% (n = 26) undergoing NIVATS. The NIVATS group showed a significantly smaller decrease in postoperative FEV₁ and FVC compared to the IVATS group (p = 0.001 for both variables). Additionally, NIVATS was associated with shorter operating room time (247 min vs. 288 min, p = 0.013), reduced hospital stay duration (47.5 h vs. 65.2 h, p = 0.018), and decreased need for additional analgesics (3% vs. 15%, p = 0.001). Diagnostic yield was at least similar to IVATS. There were no significant differences in DLCO or chest tube duration between the two groups.

Conclusions: NIVATS offers better preservation of respiratory function, a good diagnostic yield, and improved overall outcomes following surgical lung biopsy in patients with ILD and could be a preferred technique for diagnosis.