BMC Pulmonary Medicine最新文献

Background: In patients with primary osseous sacral/pelvic tumors, once pulmonary metastasis has occurred, their prognosis is worrying. It is therefore essential to construct a novel tool to achieve accurate prediction of the probability of pulmonary metastasis from primary osseous sacral/pelvic tumors.

Methods: This study retrospectively analyzed data from 407 patients with primary osseous sacral/pelvic tumors from the Surveillance, Epidemiology, and End Results database. Univariate and multivariate logistic regression analyses were used to identify risk factors. Construction of predictive models based on logistic regression algorithm in R software. The calibration, discrimination, and clinical utility of the models are validated in a validation cohort. The Kaplan-Meier survival curve and log-rank test were used to examine the pulmonary metastasis risk classification system for evaluation.

Results: The total cohort was randomly divided into a training cohort (287 patients) and a validation cohort (120 patients). Five independent risk factors were identified to develop a nomogram model to predict the probability of pulmonary metastasis in patients. The area under the receiver operating characteristic curve (0.860 for the training cohort and 0.895 for the validation cohort) showed that the model showed satisfactory discrimination in both validation cohorts. The calibration curve showed a high predictive accuracy of the model and the Hosmer-Lemeshow test indicated a good model fit (p > 0.05). The decision curve analysis showed that the nomogram is clinically useful and can provide a net benefit to patients within certain limits.

Conclusion: We have successfully developed a nomogram and risk classification system to accurately predict the probability of pulmonary metastasis from primary osseous sacral/pelvic tumors.

Background: Pulmonary hyalinizing granuloma (PHG) is a rare, benign pulmonary disease characterized by dense hyalinized collagen deposition. Diagnosis is often challenging because conventional transbronchial forceps biopsy frequently fails to obtain adequate tissue samples, necessitating surgical lung biopsy. While transbronchial cryobiopsy has been successfully employed in similar sclerotic diseases, its use in PHG has not been reported to date. Herein, we present a case of PHG diagnosed using transbronchial cryobiopsy.

Case presentation: A 61-year-old man was evaluated due to a 5-mm nodular lesion in the right lower pulmonary lobe incidentally detected on chest computed tomography performed as part of a routine health check-up. He was asymptomatic, and physical examination revealed no remarkable clinical findings. Over a 2-year follow-up, the lesion enlarged slightly to 6 mm. Bronchoscopy revealed a firm, whitish endobronchial tumor in the right B10 bronchus. Forceps biopsy was unsuccessful due to the lesion's hardness. Transbronchial cryobiopsy using a 1.7-mm cryoprobe successfully obtained a sufficient tissue sample. Histopathological examination showed dense hyalinized collagen bundles with lymphoplasmacytic infiltration, consistent with PHG. No immediate complications occurred. The lesion remained stable during 18 months of follow-up without intervention.

Conclusions: This case suggests that transbronchial cryobiopsy may be a useful, less-invasive option for diagnosing firm, fibrotic pulmonary lesions, including PHG, and may help reduce the need for surgical procedures in selected patients.

Background: The increasing use of low-dose CT (LDCT) screening has significantly enhanced the detection of pulmonary nodules, particularly in early-stage lung cancer. However, diagnosing peripheral pulmonary nodules (PPNs) presents unique challenges due to their distal location, rendering traditional methods like CT-guided biopsy less effective and associated with higher complication risks. Robotic-assisted bronchoscopy (RAB) has emerged as a promising minimally invasive technology that offers improved diagnostic accuracy and safety.

Methods: This review explores recent advancements in RAB technology for PPN diagnosis, focusing on the integration of multimodal imaging innovations. These include shape-sensing technology, electromagnetic navigation bronchoscopy (ENB), radial endobronchial ultrasound (rEBUS), cone-beam CT (CBCT), and needle-based confocal laser endomicroscopy (nCLE). Additionally, advanced biopsy techniques such as transbronchial cryobiopsy (TBCB) are discussed for their contributions to improving diagnostic yield.

Results: The integration of multimodal imaging technologies has significantly enhanced the precision of navigation and biopsy, reducing the risk of complications associated with traditional methods. Comparative studies show that RAB achieves similar or superior diagnostic outcomes compared to conventional approaches, with improved lesion targeting and tissue sampling. The use of techniques like TBCB has further improved the diagnostic yield and quality of tissue samples.

Conclusions: RAB represents a safer and more accurate alternative to conventional biopsy methods for diagnosing peripheral pulmonary nodules. The combined use of advanced imaging and biopsy techniques has solidified RAB's clinical utility, making it a promising tool for current and future developments in pulmonary nodule diagnosis.

Background: Pulmonary fibrosis is a chronic and progressive lung disease with limited therapeutic options. This study aimed to investigate the roles of the vagus nerve and nicotine in bleomycin-induced pulmonary fibrosis in rats.

Methods: Male Sprague-Dawley rats were randomly assigned to five groups: Sham (SHAM; intratracheal [I.T.] saline), bleomycin (BLM; 2 mg/kg, I.T.), bleomycin with right cervical vagotomy (BLVR), bleomycin with nicotine (0.5 mg/kg/day, intraperitoneal [I.P.]) (BLNC), and bleomycin with vagotomy plus nicotine (BLVN).

Results: Twenty-four hours after bleomycin or saline administration, total white blood cell (WBC) counts and the neutrophil-to-lymphocyte ratio (NLR) increased in all groups, with the BLVR group exhibiting significantly higher values than the BLM, BLNC, and BLVN groups. On day 14, NLR in the BLVR group and WBC counts in the BLM and BLVR groups remained elevated. Lung malondialdehyde levels were higher in the BLM and BLVR groups compared with the BLNC and BLVN groups. During mechanical ventilation, peak expiratory pressures were higher in the BLM, BLVR, and BLNC groups than in the SHAM group, whereas the BLVN group showed values comparable to the SHAM group. Lung compliance was lowest in the BLVR group but was preserved in the BLVN group. Histopathological examination confirmed reduced lung injury in the BLVN group compared with the BLM and BLVR groups.

Conclusions: These findings highlight the anti-inflammatory role of the vagus nerve and suggest that nicotine-particularly in combination with vagotomy-may confer protective effects against early-stage pulmonary fibrosis by mitigating inflammation, oxidative stress, and pulmonary dysfunction.

Background: Post-tuberculosis lung disease (PTLD) is a major public health challenge in sub-Saharan Africa (SSA), where the burden of tuberculosis (TB) remains high. Only a few studies have reported the global burden of PTLD, and the associated factors of PTLD have been understudied. This systematic review and meta-analysis aimed to estimate the pooled prevalence and associated factors of PTLD in SSA.

Methods: This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines for systematic review and meta-analysis. We included studies reporting the prevalence and associated factors of PTLD among individuals with a history of pulmonary TB in SSA. A comprehensive literature search was conducted via PubMed, Embase, Google Scholar, and African Journal Online databases from February 25, 2025, to March 20, 2025. The pooled prevalence of PTLD was estimated using a random-effects model. Due to the lack of reports on adjusted odds ratios (aORs), the associated factors were analyzed using crude odds ratios (ORs).

Results: A total of 21 studies, consisting of 4,463 participants, were included. The overall pooled prevalence of PTLD in SSA was 43.26% (95% CI: 34.17%-52.34%). The key Factors significantly associated with PTLD included: female sex (OR: 1.57, 95% CI: 1.16, 2.11), smoking (OR: 1.64, 95% CI: 1.09, 2.46), Presence of cough (OR: 1.73, 95% CI: 1.03, 2.9) and fibrotic pattern (OR:3.94 (95% CI: 1.96, 7.92).

Conclusion: Nearly half of prior TB patients in SSA develop PTLD. Being female, smoking, fibrosis, and post-treatment cough were key factors associated with PTLD. To effectively manage PTLD in SSA, it is important to implement targeted interventions for high-risk groups, strengthen screening and chronic care services, enhance healthcare system capacity, ensure equity in health resources and integrate PTLD management into national TB control programs.

Rationale and objectives: Massive hemoptysis is a serious respiratory emergency. In most cases, the bleeding source is the bronchial circulation, and bronchial artery embolization (BAE) is considered the primary approach for treating massive hemoptysis. However, there is no standardized protocol regarding embolic agents. The aim of this study is to evaluate the efficacy and safety of BAE performed with n-butyl-2-cyanoacrylate (NBCA) in the treatment of massive hemoptysis.

Materials and methods: This single-center, retrospective study included patients who underwent BAE with NBCA for massive hemoptysis between January 2021 and December 2024. Demographic data and etiological factors were documented. BAE procedural details were thoroughly analyzed and recorded. Postprocedural complications, technical success, and clinical success rates (within 24 h and 1 month) were evaluated. Recurrence rates beyond 1 month were assessed.

Results: The study included 41 patients (33 male, 8 female). The most frequently identified etiologies were tuberculosis (28.5%), bronchiectasis (20%). The mean 24-hour hemoptysis volume was 535 ± 448.2 mL (range: 240-1200 mL). The most common DSA findings were bronchial artery hypertrophy/tortuosity (78.2%), hypervascularization (67.4%). BAE procedures most frequently targeted the right bronchial artery (57.14%). Embolization involved a single vessel in 75% of cases, two vessels in 17.5%, and three vessels in 7.5%. The mean NBCA/Lipiodol volume per vessel was 1.625 ± 0.66 mL (range: 0.5-2 mL). Technical success was achieved in 97.14% of cases. Clinical success rates were 100% within 24 h and 97.5% at 1-month follow-up. Over a median follow-up period of 13 months, no recurrence requiring repeat embolization was observed.

Conclusion: Our study demonstrates that BAE using NBCA/Lipiodol is an effective and safe method for treating massive hemoptysis, with high technical and clinical success rates. When carefully administered by experienced specialists, NBCA/Lipiodol may be considered as a potential primary embolic agent for BAE.

Background and objectives: This meta-analysis aimed to identify risk factors for ventilator-associated pneumonia (VAP) in patients with Acute exacerbations of Chronic obstructive pulmonary disease (AECOPD).

Methods: We systematically searched PubMed, Web of Science, CINAHL, Cochrane Library, Embase, CNKI, and other databases for studies investigating risk factors for VAP in patients experiencing AECOPD. The search encompassed records from database inception up to July 2, 2025. The quality of the studies was assessed using the Newcastle-Ottawa Scale. Meta-analysis was performed using Stata 18.0.

Results: A total of 16 articles were included, encompassing 3,664 subjects and 16 risk factors. Meta-analysis results showed that, Age (OR: 2.49, 95%CI : 1.49, 4.17; P < 0.001), Smoking history (OR: 2.70, 95%CI : 1.65, 4.44; P < 0.001), Acute physiology and chronic health evaluation composite score (APACHE Ⅱ) score (OR: 3.03, 95%CI : 1.98, 4.65; P < 0.001), Sequential organ failure assessment (SOFA) score (OR: 2.75, 95%CI : 1.90, 3.99; P < 0.001), Diabetes (OR: 2.11, 95%CI : 1.38, 3.24; P = 0.001), Underlying Diseases (OR: 3.42, 95%CI : 1.85, 6.32; P < 0.001), Duration of mechanical ventilation (OR: 4.53, 95%CI : 2.68, 7.65; P < 0.001), Tracheal intubation (OR: 4.21, 95%CI : 1.85, 9.57; P = 0.001), Indwelling gastric tube (OR: 3.31, 95%CI : 1.38, 7.95; P = 0.008), Total parenteral nutrition (OR: 1.86, 95%CI : 1.29, 2.70; P = 0.001), Combined antibiotics (OR: 2.79, 95%CI : 1.32, 5.93; P = 0.007), Tracheotomy (OR: 2.92, 95%CI : 2.04, 4.17; P < 0.001), History of mechanical ventilation within one year (OR: 2.92, 95%CI : 2.04, 4.17; P = 0.005), Use acid suppressants (OR: 2.10, 95%CI : 1.49, 2.97; P < 0.001) were associated with the development of VAP in AECOPD patients.

Conclusions: This study identified 14 risk factors associated with the risk of VAP in AECOPD patients. This finding is helpful for early identification of high-risk patients, which is of great value for reducing mortality and improving the clinical prognosis of patients with mechanical ventilation.

Background: Asthma is a chronic respiratory disease characterized by airway inflammation, leading to varying degrees of respiratory difficulties. Effective disease management depends on consistent medication adherence, which remains a significant challenge in Saudi Arabia.

Objective: This study aims to assess the level of adherence to asthma medications among patients in Al-Ahsa, Saudi Arabia, and identify factors contributing to non-adherence.

Methods: A cross-sectional study was conducted between may and July 2024, targeting asthma patients aged 18 years and older in Al-Ahsa. Participants were selected using a stratified random sampling technique from various geographic stria. Data were collected through structured phone interviews utilizing a validated questionnaire designed to assess adherence to medication refills. Descriptive statistics, chi-square tests, and multivariable logistic regression were used to identify factors associated with medication non-adherence.

Results: Only 39.3% of participants were adherent to their prescribed asthma medications, while 60.7% were non-adherent. Common reasons for non-adherence included stopping medications when feeling better (36.9%) and stopping medication due to side effects (20.4%). Female gender (p = 0.021), higher income (p = 0.034), being married (p = 0.049), urban residence (p = 0.001), and receiving medication support (p < 0.001) were significantly associated with higher adherence. Multivariable regression showed that younger age (OR = 0.97; 95% CI: 0.95-0.98), male gender (OR = 1.76; 95% CI: 1.16-2.69), lower income (OR = 0.85; 95% CI: 0.75-0.97), and lack of medication support (OR = 0.06; 95% CI: 0.04-0.10) were independently associated with non-adherence.

Conclusion: Medication non-adherence is prevalent among asthma patients in Al-Ahsa and is influenced by demographic, socioeconomic, and healthcare-related factors. Interventions targeting support systems, education, and access may enhance adherence and improve asthma outcomes in this population.