Respirology最新文献

Background and objective: Image-guided thermal ablation (IGTA) has been increasingly used in patients with stage IA non-small cell lung cancer (NSCLC) without surgical contraindications, but its long-term outcomes compared to lobectomy remain unknown. This study aims to evaluate the long-term outcomes of IGTA versus lobectomy and explore which patients may benefit most from ablation.

Methods: After propensity score matching, a total of 290 patients with stage IA NSCLC between 2015 and 2023 were included. Progression-free survival (PFS) and overall survival (OS) were estimated using the Kaplan-Meier method. A Markov model was constructed to evaluate cost-effectiveness. Finally, a radiomics model based on preoperative computed tomography (CT) was developed to perform risk stratification.

Results: After matching, the median follow-up intervals were 34.8 months for the lobectomy group and 47.2 months for the ablation group. There were no significant differences between the groups in terms of 5-year PFS (hazard ratio [HR], 1.83; 95% CI, 0.86-3.92; p = 0.118) or OS (HR, 2.44; 95% CI, 0.87-6.63; p = 0.092). In low-income regions, lobectomy was not cost-effective in 99% of simulations. The CT-based radiomics model outperformed the traditional TNM model (AUC, 0.759 vs. 0.650; p < 0.01). Moreover, disease-free survival was significantly lower in the high-risk group than in the low-risk group (p = 0.009).

Conclusion: This study comprehensively evaluated IGTA versus lobectomy in terms of survival outcomes, cost-effectiveness, and prognostic prediction. The findings suggest that IGTA may be a safe and feasible alternative to conventional surgery for carefully selected patients.

Background and objective: Anti-melanoma differentiation-associated gene 5-positive dermatomyositis (MDA5 + DM) exhibits the worst prognosis among all subtypes of idiopathic inflammatory myopathies, with substantial heterogeneity in patient outcomes. This study aimed to investigate prognostic factors for MDA5 + DM and develop a scoring system to determine mortality risk.

Methods: This retrospective study included 621 patients with MDA5 + DM. Variables were selected using univariable Cox regression and LASSO regression. Predictive models for mortality risks were constructed using machine learning-based algorithms. A simplified scoring system was established based on the optimal model with thorough validation to ensure predictive accuracy.

Results: Seven variables emerged as key factors associated with mortality in MDA5 + DM and incorporated into the mortality risk prediction model: ferritin, lactate dehydrogenase, age at onset, CD8+ T-cell count, C-reactive protein, albumin, and lung computed tomography pattern of NSIP + OP. Among six models, the Cox proportional hazards model demonstrated superior discriminative ability and clinical utility and was translated into a simplified scoring system 'FLATCAN'. This model achieved a concordance index of 0.815 and time-dependent area under the receiver operating characteristic curves for predicting 3-, 6-, and 12-month mortality of 0.895, 0.855, and 0.850, respectively. Patients were effectively stratified into low-, intermediate-, and high-risk groups using the FLATCAN score. Further internal cross-validation, time-point splitting, and rapidly progressive interstitial lung disease-based splitting confirmed the FLATCAN score's robust predictive ability.

Conclusion: The FLATCAN score provides an easy-to-use tool for predicting mortality risk in patients with MDA5 + DM and may facilitate improved risk stratification-based patient management.

Background and objective: Health impacts of inhaling airborne microplastics have been actively investigated. Although microplastics have been detected in lung tissues and bronchoalveolar lavage fluids, their detection requires substantial effort and is technically challenging, with existing studies demonstrating various limitations. Bronchoalveolar lavage fluid is a less invasive sampling method than surgical lung biopsy. This study aimed to establish a detection method for microplastics from bronchoalveolar lavage fluid and evaluate the relevant health impacts.

Methods: Patients undergoing bronchoscopy for diffuse lung disease diagnosis were included. Microplastics were detected using Nile Red staining and fluorescence microscopy. Particle size, shape, and concentration were assessed through image analysis, and plastic types were identified via Raman spectroscopy. Correlations between microplastic findings and clinical laboratory data were evaluated.

Results: Microplastics were detected in the bronchoalveolar lavage fluid of all 30 patients. The median concentration of Nile Red-stained particles was 684.7 particles/mL, and over 80.0% of the particles were smaller than 10 μm, with 93.5% being particulate and 6.5% fibre. The most frequently identified microplastics were polyvinyl chloride, polystyrene, and polyethylene terephthalate. Microplastic concentration positively correlated with blood C-reactive protein levels (r_s = 0.39) and was higher in areas showing consolidation shadows (p = 0.024).

Conclusions: We established a method for detecting microplastics in bronchoalveolar lavage fluid. Microplastics were found in all patients, with a potential link to inflammation. In addition, Nile Red staining was applied for the first time to detect plastics in the lung and appeared to be useful for screening and quantification.

Background and objective: Bronchoalveolar lavage lymphocyte percentage (BLP) is considered a prognostic marker for interstitial lung diseases (ILDs) other than idiopathic pulmonary fibrosis (IPF). Its association with an early glucocorticoid response (EGR) has not been studied systematically. We aimed to assess the association of BLP and other factors with EGR.

Methods: We prospectively enrolled subjects with non-IPF ILDs and treated them with glucocorticoids. We defined EGR as a composite response in symptoms and pulmonary function tests 2 months after glucocorticoid initiation. Cases were those with EGR (responders), while non-responders (without EGR) formed the controls. The primary exposure was the BLP expressed on an ordinal scale: 0%-19%, 20%-29%, 30%-39%, ≥ 40%. Confounders included age, sex, body mass index, smoke exposure, %pred FVC, symptom duration, inflammatory and/or fibrotic phenotype on chest computed tomography. We also assessed factors associated with progressive disease at 6 months.

Results: We included 150 subjects (mean age, 51.2 years; 39% men); 73% had either hypersensitivity pneumonitis or connective tissue disease-related ILD. One hundred and thirty-one subjects (69 responders; 62 non-responders) followed up at 2 months. The BLP (adjusted odds ratio [aOR], 1.64; 95% confidence intervals [CI], 1.03-2.63; p = 0.04) and symptom duration (aOR, 0.60; 95% CI, 0.40-0.92; p = 0.02) were independently associated with EGR. A BLP < 20% (aOR, 4.37; 95% CI, 1.37-13.96; p = 0.01) and history of smoke exposure (aOR, 4.59; 95% CI, 1.25-16.91; p = 0.02) independently predicted progressive disease at 6 months.

Conclusion: Higher BLPs and shorter symptom duration were associated with EGR, while BLP < 20% and smoke exposure predicted progressive disease despite glucocorticoid treatment.