Clinical Respiratory Journal最新文献

Introduction

Thoracic SMARCA4-deficient undifferentiated tumors (SMARCA4-UT) are rare and aggressive epithelioid neoplasms characterized by the loss of the SMARCA4 gene. These tumors are typically diagnosed at advanced stages and exhibit a dismal prognosis. Currently, there are no standardized treatment protocols or approved targeted therapies.

Methods

We present a case series of nine patients diagnosed of thoracic SMARCA4-UT, detailing demographic, pathological, imaging, and treatment data. Moreover, a comprehensive literature review and genomic analysis of SMARCA4 mutations in lung cancer were also performed.

Results

The cohort comprised predominantly male smokers (mean age: 63.0 ± 9.6 years). All cases exhibited loss of BRG1 expression, with negative staining for TTF-1 and p40, while SMARCB1/INI-1 expression was preserved. Patients showed poor responses to conventional chemotherapy but demonstrated partial responsiveness to immunotherapy or targeted agents. Genomic analysis of SMARCA4 mutations in lung cancer demonstrates that SMARCA4 mutations, primarily located in the SNF2-related and helicase conserved C-terminal domains, are associated with a poorer prognosis in lung cancer.

Conclusion

Immunotherapy and targeted therapies show promise in managing thoracic SMARCA4-UT, warranting further investigation. Further exploring the genetic and molecular landscape of this tumor might reveal potential therapeutic targets.

Background

Traditional biometric systems are vulnerable to forgery, highlighting the need for secure alternatives. Electroencephalography (EEG) offers inherent advantages in liveness detection and antispoofing but typically requires external stimuli. We propose a novel paradigm leveraging intrinsic respiratory-evoked EEG signals for identity authentication, with potential applications in clinical settings where unobtrusive monitoring is critical.

Methods

We developed a 64-channel EEG acquisition system with synchronized respiratory event monitoring. Thirteen healthy volunteers performed four breathing patterns: oral, nasal, slow nasal, and rapid nasal breathing. A hybrid deep learning model was designed to optimize spatial–temporal feature extraction from EEG signals.

Results

The model achieved 98.3% accuracy in identity recognition using rapid nasal breathing-evoked EEG, outperforming traditional biometric methods. Nasal breathing patterns consistently yielded higher accuracy than oral breathing, with rapid nasal breathing showing the strongest discriminative power.

Conclusions

Respiratory-evoked EEG signals provide a viable, noninvasive biometric identifier. The high accuracy of rapid nasal breathing opens avenues for clinical integration, such as continuous patient authentication in respiratory monitoring devices or secure access to electronic health records.

Objective

Continuous positive airway pressure (CPAP) therapy for obstructive sleep apnea (OSA) results in a modest reduction in blood pressure. This study aimed to identify parameters from 24-h ambulatory blood pressure monitoring (ABPM) that are predictive of treatment response.

Methods

Treatment-naïve patients with OSA were prospectively recruited from the Centre for Sleep Medicine and Science at Beijing Anzhen Hospital between July 2023 and April 2025. All participants underwent 24-h ABPM assessments before and after 3-month CPAP therapy. Correlations between the baseline ABPM data and post-CPAP changes in blood pressure were analyzed. Multivariate analysis was used to determine whether specific baseline blood pressure cutoffs independently predicted a clinically significant reduction in blood pressure.

Results

Good CPAP adherence (median usage: 6.1 h/night and 6.0 days/week; residual apnea–hypopnea index: 1.7 events/h) was achieved among 51 recruited patients (92.2% male, median age 40.5 years). After 3 months of CPAP treatment, significant reductions were observed in nearly all blood pressure measurements. Baseline 24-h mean arterial pressure (MAP) was positively correlated with the reduction in all 24-h blood pressure measures, all nighttime blood pressure measures, and daytime MAP. Compared with patients with 24-h MAP < 96 mmHg, those with baseline 24-h MAP ≥ 96 mmHg experienced relatively high absolute and relative reductions in all blood pressure measures.

Conclusions

Baseline 24-h MAP effectively predicts blood pressure reduction following CPAP therapy in patients with OSA, demonstrating the clinical value of an ABPM-guided strategy for managing patients with comorbid OSA and hypertension.

Trial Registration: ChiCTR2300067728

Background

Preserved ratio impaired spirometry (PRISm) is associated with elevated cardiovascular disease (CVD) risk and progression to COPD, but the underlying mechanisms remain unclear. Frailty is known to worsen outcomes in COPD; however, its role in PRISm has not been well defined. This study examined factors associated with cardiovascular events and mortality in PRISm and developed risk models.

Methods

We analyzed 8882 adults (aged 20–79 years) from NHANES 2007–2012, identifying 763 (8.6%) with PRISm (FEV₁/FVC ≥ 0.70 and FEV₁ < 80% predicted). Frailty was assessed using the 23-item laboratory frailty index (FI-LAB; cut-off ≥ 0.23). The primary outcome was all-cause mortality, obtained from linked National Death Index records; the secondary outcome was major adverse cardiovascular events (MACEs: myocardial infarction, stroke, heart failure, or angina), assessed cross-sectionally. LASSO regression and multivariable logistic/Cox models were used to identify variables independently associated with the outcomes, and nomograms were constructed.

Results

PRISm participants had higher frailty prevalence (53.9% vs. 45.5%) and more MACEs (16.2% vs. 6.0%) than those with normal spirometry (both p < 0.0001). Frailty was independently associated with prevalent MACEs (adjusted OR = 18.87, p < 0.001) and was bidirectionally associated with PRISm (OR = 1.40, p < 0.001). Key factors independently associated with MACEs included frailty index, age, sex, anemia, and emphysema (AUC = 0.786). Over 9.9 years, mortality was higher in frail vs. non-frail PRISm individuals (15.2% vs. 7.0%; adjusted HR = 30.66). Frailty severity demonstrated a clear mortality gradient, and a mortality nomogram integrating age and frailty achieved an AUC of 0.81.

Conclusion

Frailty is strongly and independently associated with cardiovascular morbidity and mortality. FI-LAB offers a practical tool for risk stratification and may help guide targeted preventive strategies.

Objective

It was found that the levels of antineutrophil cytoplasmic antibodies (ANCA) are elevated and linked to disease severity of bronchiolitis obliterans (BO) in children. This study aims to explore the mechanism of ANCA in the process of BO.

Methods

Plasma from BO patients (n = 40) and healthy controls (n = 11) was analyzed for ANCA and neutrophil extracellular traps (NETs) components. Plasma IgG from ANCA-positive BO children and normal controls were used to stimulate neutrophils, measuring reactive oxygen species (ROS) and NETs production. Small airway epithelial cells (SAECs) were exposed to NETs, assessing viability by CCK8 and cytokine release by ELISA. The IgG treated neutrophils were co-cultured with SAECs, and cytokines were measured by ELISA.

Results

The levels of ANCA and NETs components including dsDNA, neutrophil elastase (NE) and myeloperoxidase (MPO) in the plasma of BO children were significantly higher than those of healthy controls. ANCA-positive IgG induced neutrophils produce ROS and NETs. The cell viability of SAECs was significantly reduced upon treatment with NETs in a concentration-dependent manner. The levels of IL-8, IL-17, TNF-α, and TGF-β secreted by SAECs treated with NETs were increased significantly, and the degree of increase was positively correlated with the concentration of NETs. The co-culture of neutrophils stimulated by ANCA IgG with SAECs significantly increased the expression of cytokines including IL-8, IL-17, TNF-α, and TGF-β.

Conclusions

NETs induced by ANCA may exacerbate airway inflammation in children with BO.

Introduction

The objective of this study was to examine the development of chronic thromboembolic pulmonary disease (CTEPD) incidence, risk factors, and coexisting medical conditions following an episode of acute pulmonary embolism (PE).

Materials

This retrospective, cross-sectional study analyzed data from 722 patients diagnosed with PE. Group I (n = 663), consisting of individuals who did not develop CTEPD, and Group II (n = 59), comprising those who progressed to CTEPD. CTEPD were divided into two subgroups as chronic thromboembolic pulmonary hypertension (CTEPH, n = 23) and without pulmonary hypertension (PH) (n = 36). The groups were compared based on demographic features, comorbid conditions, risk factors, and initial systolic pulmonary artery pressure (sPAP) values.

Results

CTEPD was observed in 59 patients (8.2%). Chronic obstructive pulmonary disease, coronary artery disease, and elevated baseline sPAP demonstrated a significant association with CTEPD (p = 0.003, p = 0.041, and p = 0.024, respectively). Immobilization was found to be significantly more prevalent in Group I (p = 0.032). In the multivariate logistic regression analysis, each 1 mmHg increase in baseline sPAP was associated with a 1.04-fold elevation in the risk of CTEPD development (95% confidence interval [CI]: 1.02–1.05; p < 0.001). Additionally, a 1-year decrease in age was linked to a 1.03-fold increase in the probability of developing CTEPD (95% CI: 1.01–1.05; p = 0.003). No significant differences were found between patients with CTEPH and those with CTEPD without PH.

Conclusion

These findings highlight the important role of comorbid conditions in the development of CTEPD. It is important to optimize the clinical management of patients with such comorbidities to reduce the risk of CTEPD development.

Background

Although patients with bronchiectasis often have comorbidities, the impact of bronchiectasis on managing these is unknown. This study assessed the incremental burden of managing chronic obstructive pulmonary disease (COPD), asthma, and rheumatoid arthritis in patients with bronchiectasis.

Methods

This retrospective cohort study using Merative MarketScan US claims data included patients with a COPD, asthma, or rheumatoid arthritis diagnosis between January 2017 and December 2021. Within these cohorts, patients with a bronchiectasis diagnosis (excluding cystic fibrosis) were compared with nonbronchiectasis controls following 1:1 propensity score matching (1:2 for rheumatoid arthritis). Comorbid disease-specific inpatient, outpatient, and emergency room (ER) visits and direct medical costs were reported.

Results

After matching, 4291 patients with COPD, 2460 with asthma, and 566 with rheumatoid arthritis, all with bronchiectasis, and the corresponding controls, were included. For patients with COPD, proportions with COPD-related outpatient (66.5% vs. 56.8%), ER (7.5% vs. 5.8%), and inpatient visits (4.5% vs. 3.1%), as well as respiratory-related ($11 054 vs. $6961) and disease-specific ($1384 vs. $1107) costs were significantly higher in the bronchiectasis cohort (vs. control cohort). For patients with asthma, asthma-related outpatient visits (52.0% vs. 41.1%), respiratory-related ($10 327 vs. $5458), and disease-specific ($489 vs. $221) costs were significantly higher in the bronchiectasis cohort. For patients with rheumatoid arthritis, rheumatoid arthritis-specific PPPY outpatient (5.1 vs. 3.9) and specialist visits (3.5 vs. 2.5), and disease-specific ($4820 vs. $2592) costs were significantly higher in the bronchiectasis cohort (p < 0.05 for all comparisons).

Conclusions

Bronchiectasis is associated with higher comorbid disease-related healthcare resource utilization and costs and complicates the management of comorbid conditions.