Respirology最新文献

Background and objective: Diagnosing pulmonary ground-glass nodules (GGNs) on chest CT imaging remains challenging in clinical practice. Moreover, different stages of GGNs may require different clinical treatments. Hence, we sought to predict the progressive state of pulmonary GGNs (absorption or persistence) for accurate clinical treatment and decision-making.

Methods: We retrospectively enrolled 672 patients (absorption group: 299; control group: 373) from two medical centres from January 2017 to March 2023. Clinical information and radiomic features extracted from regions of interest of all patients on chest CT imaging were collected. All patients were randomly divided into training and test sets at a ratio of 7:3. Three models were constructed-Rad-score (Model 1), clinical factor (Model 2), and clinical factors and Rad-score (Model 3)-to identify GGN progression. In the test dataset, two radiologists (with over 8 years of experience in chest imaging) evaluated the models' performance. Receiver operating characteristic curves, accuracy, sensitivity, and specificity were analysed.

Results: In the test set, the area under the curve (AUC) of Model 1 and Model 2 was 0.907 [0.868-0.946] and 0.918 [0.88-0.955], respectively. Model 3 achieved the best predictive performance, with an AUC of 0.959 [0.936-0.982], an accuracy of 0.881, a sensitivity of 0.902, and a specificity of 0.856. The intraclass correlation coefficient of Model 3 (0.86) showed better performance than radiologists (0.83 and 0.71).

Conclusion: We developed and validated a radiomics-based machine-learning method that achieved good performance in predicting the progressive state of GGNs on initial computed tomography. The model may improve follow-up management of GGNs.

Background and objective: Lobectomy is the primary treatment for early-stage non-small cell lung cancer. However, pulmonary function declines postoperatively, presenting a significant challenge. This study investigated pulmonary function following lobectomy and compared these changes with predicted lung function based on the traditional segmental method, focusing on resected lobe-specific variability.

Methods: This prospective cohort study included 419 patients who underwent lobectomies for NSCLC. Pulmonary function tests measuring forced vital capacity (FVC), forced expiratory volume in one second (FEV₁), and diffusion capacity for carbon monoxide (DLCO) were conducted preoperatively and at 1, 3, 6, and 12 months postoperatively. We compared the observed pulmonary function values to the predicted postoperative (PPO) values based on the traditional segmental method and analysed lobe-specific differences using mixed-effects models.

Results: Left upper and right lower lobectomies demonstrated observed pulmonary function values similar to their PPOs as early as 2 weeks postoperatively. However, the other lobes declined significantly, with an approximately 25% reduction in FVC, FEV1, and DLCO, regardless of the number of segments in the lobe. Three months postoperatively, observed pulmonary function values exceeded PPO values across all lobes. Surgical approach (open vs. video-assisted thoracoscopic surgery), right upper lobectomy in the reference to right lower lobectomy, and postoperative decreased physical activity were significant factors related to the non-recovery of lung function to their PPOs at 6 months after surgery.

Conclusion: Postoperative pulmonary function recovery varied significantly by resected lobe, with most lobes showing better recovery than predicted postoperative values. Accurate outcome prediction requires accounting for lobe-specific characteristics and compensatory mechanisms.

Background and objective: Interstitial lung diseases (ILDs) are rare and severe respiratory conditions that may ultimately result in pulmonary fibrosis (PF). The objective of this study was to present the results of molecular diagnosis of early-onset ILD (from neonates to young adults < 50 years) in a reference genetic diagnostic laboratory.

Methods: DNAs from 699 index cases and 190 relatives were studied over 6 years by Sanger and/or targeted next generation sequencing of surfactant-related genes and other genes involved in early-onset ILD.

Results: Pathogenic/likely pathogenic variants were evidenced for 62 patients (8.9%). The genes most frequently involved were SFTPA2 (13/62), followed by ABCA3 (12/62) and SFTPC (10/62). Among index cases for whom precise clinical data were available (n = 542), indications associated with a high molecular diagnostic yield were pulmonary alveolar proteinosis (61.5%, 8/13; p < 0.0007); family history of ILD/PF and lung cancer (36.8%, 7/19; p = 0.0132) and newborns > 32 weeks gestation with neonatal respiratory distress (14.8%, 9/61). The proportion of positive molecular investigations culminated in two age groups over the lifespan: 23.3% (7/30) in children aged 1 to 10 years, and 18.3% (15/82) in adults aged 30 to 40 years. Over the 6-year period, 190 relatives were subjected to testing in order to perform segregation studies (n = 123) and/or predictive testing (n = 79).

Conclusion: This study highlights the specific patient's characteristics associated with a high or low molecular diagnostic yield in clinical practice. Furthermore, it emphasises the importance of establishing a molecular diagnosis in order to provide genetic counselling to the family.

Background and objective: Paediatric obstructive sleep apnea (OSA) has a distinct pathophysiology and management from that of adults, yet endotypic traits in this population remain underreported. Understanding how these traits vary by age and sex could provide insights into respiratory system development. This study aims to examine the association of age and sex with endotypic traits in children and adolescents with OSA.

Methods: Between April 2020 and September 2024, we prospectively enrolled 88 patients aged ≤ 18 years who were referred to a single clinical sleep center in Taiwan for in-laboratory diagnostic polysomnography. Patients with an apnea-hypopnea index (AHI) ≥ 1 h^-1 were included. Endotypic traits were estimated using polysomnographic signals. Linear regression analysis was performed to assess the associations of endotypic traits with AHI, age, and sex.

Results: Poor compensation, worse collapsibility, and high loop gain were associated with higher AHI, with compensation explaining the largest variance (12.85%) among all endotypic traits. Patients older than 12 years exhibited a more compromised upper airway (V _min: 64.3 vs. 71.4% eupnea) and higher loop gain (LG₁: 0.45 vs. 0.34) than younger patients, independent of AHI. No significant sex differences in endotypic traits were observed.

Conclusions: In addition to upper airway collapsibility, inadequate compensatory activity of the dilator muscles significantly contributed to higher AHI in paediatric patients with OSA. The age-related decrease in upper airway patency may result from the interplay between upper airway and craniofacial development.