BMC Pulmonary Medicine最新文献

Background: Diffusing capacity for carbon monoxide (DLco) testing is widely used in adult respiratory medicine, but its role in pediatric care remains unclear. This study aimed to assess the diagnostic and clinical utility of DLco testing in children at a single tertiary center.

Methods: We conducted a retrospective analysis of DLco and spirometry data from all children who underwent pulmonary function testing at the University Children's Hospital Zurich between 2015 and 2025. Tests meeting ATS/ERS quality criteria (Grades A/B) and performed alongside same-day blood counts were included. Patients were categorized as undergoing initial diagnostic evaluation or follow-up monitoring.

Results: Out of 269 DLco tests from 202 patients (median age 13.4 years), 72 tests (26.7%) were excluded due to insufficient quality. The final cohort included 197 tests from 144 patients. Among 54 children undergoing DLco as part of initial assessment, none had abnormal values or changes in diagnosis or management. In the follow-up group (n = 90), 16 patients (8.1%) had DLco z-scores below the lower limit of normal, but these findings did not influence clinical decisions. No significant correlation was observed between DLco and FEV1 z-scores (p = 0.399). Longitudinal data from 31 patients showed no significant changes in DLco.

Conclusions: DLco testing in children is technically challenging, with a high proportion of tests failing quality standards. Abnormal results were rare and did not impact clinical management. These findings suggest limited routine utility for DLco in pediatric populations, underscoring the need for targeted indications and further prospective research.

Objectives: This study aimed to investigate the relationship between lung ultrasound morphology patterns-localized tissue-like patterns (TLP) and diffuse B-lines (DBP)-and patients' response to routine clinician-directed management in high-risk mechanically ventilated patients undergoing weaning.

Methods: In this retrospective study, 97 high-risk mechanically ventilated patients with a Lung Ultrasound Score (LUS) > 13 were stratified into TLP and DBP groups based on their lung ultrasound patterns. Lung reaeration was assessed using the Lung Recruitment Score (LRS) before and after the application of routine therapeutic measures. Primary outcomes included changes in LRS. Secondary outcomes included weaning failure rates, duration of mechanical ventilation, intensive care unit (ICU) mortality, and length of ICU stay.

Results: The study included 97 high-risk mechanically ventilated patients, of whom 49 had TLP and 48 had DBP on lung ultrasound. Upon ICU admission, the TLP group exhibited significantly higher global LUS compared to the DBP group (17.20 ± 2.01 vs. 14.21 ± 2.04, P < 0.001), with more pronounced differences observed in the posterior (9.65 ± 0.90 vs. 7.5 ± 0.58, P < 0.001) and lateral regions (4.94 ± 1.05 vs. 4.35 ± 1.24, P = 0.014). Following routine clinician-directed, the TLP group demonstrated more substantial improvement in global LRS compared to the DBP group (5.43 ± 3.42 vs. 4.04 ± 2.99, P = 0.036), indicating enhanced lung reaeration. Multivariate analysis identified Apache II score (OR = 1.105, P = 0.021) and global LRS (OR = 0.476, P = 0.003) as independent predictors of weaning failure. Among successfully weaned patients, those in the TLP group exhibited significantly higher LRS than those in the DBP group (6.71 ± 2.31 vs. 5.39 ± 2.26, P = 0.021), suggesting a more favorable response to interventions in the TLP group.

Conclusions: Patients with TLP demonstrated superior response to routine clinician-directed management and achieved comparable weaning outcomes to those with DBP, despite higher initial LUS. Lung morphology patterns and regional LRS assessments may assist in tailoring management strategies and predicting weaning outcomes in high-risk mechanically ventilated patients.

Background: Non-cystic fibrosis bronchiectasis (NCFB) is a chronic respiratory condition characterized by irreversible bronchial dilatation and persistent inflammation. Although inflammation plays a central role in disease progression, the upstream regulatory mechanisms remain incompletely understood. MicroRNA-155 (miR-155) is a well-recognized modulator of immune responses in chronic lung diseases, but its role in NCFB has not been previously elucidated.

Methods: This study enrolled 58 NCFB patients and 30 healthy controls. The expression of miR-155 in peripheral blood mononuclear cells (PBMC) was quantified using qRT-PCR. Serum levels of IL-1β, IL-6, IL-8, and TNF-α were assessed by ELISA. Correlations between miR-155 expression and inflammatory cytokines, clinical indices, and Pseudomonas aeruginosa colonization were evaluated. In vitro, BEAS-2B epithelial cells were transfected with miR-155 mimics or inhibitors, and cytokine production was measured following LPS stimulation.

Results: MiR-155 expression was significantly elevated in NCFB patients and positively correlated with IL-6, IL-8, TNF-α, and IL-1β levels (all p < 0.01). Higher miR-155 expression was also associated with increased disease burden, including elevated BSI scores and P. aeruginosa colonization. In vitro, miR-155 overexpression in BEAS-2B cells markedly enhanced pro-inflammatory cytokine secretion upon LPS stimulation, while inhibition of miR-155 suppressed cytokine release.

Conclusion: miR-155 is upregulated in NCFB and closely associated with systemic and airway inflammation. It actively promotes pro-inflammatory signaling in airway epithelial cells, suggesting a pathogenic role in sustaining chronic inflammation. These findings highlight miR-155 as a potential biomarker of disease activity and a candidate target for immune modulation in bronchiectasis.

Purpose: To develop and validate a risk stratification model for severe postoperative cancer-related fatigue (CRF) in elderly survivors following early-stage non-small cell lung cancer (NSCLC) resection.

Methods: Elderly survivors (age ≥ 70 years) following NSCLC surgery were recruited from two tertiary medical centers in Shenyang. Data collected from medical records and self-reported questionnaires were divided into training and validation sets (7:3 ratio). Risk factors were selected utilizing the least absolute shrinkage and selection operator (LASSO) and multivariable logistic regression analysis, and were subsequently integrated into a nomogram. Model performance was assessed using area under the curve (AUC), calibration curves with the Hosmer-Lemeshow (HL) test, decision curve analysis (DCA), and clinical impact curve (CIC).

Results: A total of 32.7% (212/649) participants reported experiencing severe CRF. Five crucial risk factors were identified: fear of disease progression (FoP), caregivers, social support, activities of daily living (ADL), and nutrition status. The nomogram exhibited strong discrimination, with an AUC of 0.864 (95% confidence interval [CI]: 0.828, 0.900) in the training and 0.845 (95% CI: 0.786, 0.903) in the validation sets. Calibration curves indicated a satisfactory agreement between predicted and actual outcomes (HL test: P > 0.05). DCA and CIC supported the nomogram's favorable clinical utility.

Conclusion: This validated nomogram serves as an effective tool for stratifying the risk of severe postoperative CRF in elderly patients with NSCLC, facilitating healthcare practitioners in identifying high-risk individuals and implementing early timely interventions.

Background: Postoperative chylothorax is a known but uncommon complication of lung cancer surgery. Progression to chylous pericardial effusion and tamponade is exceedingly rare but can be rapidly fatal if not recognized and treated promptly.

Case presentation: A 72-year-old man underwent right upper lobectomy with bronchus-sleeve resection and systematic mediastinal lymphadenectomy for squamous cell carcinoma. In the early postoperative course, a high-output chylothorax was diagnosed. On postoperative day (POD) 4, he developed paroxysmal atrial fibrillation with hemodynamic instability, requiring brief ICU admission for cardioversion. On POD 6, he suddenly deteriorated with obstructive shock with hypotension, tachycardia, pronounced mottled skin extending to the abdomen, and decreased level of consciousness. Bedside transthoracic echocardiography revealed a large pericardial effusion with tamponade physiology. Emergency pericardiocentesis drained 800 mL of milky fluid with high triglycerides, consistent with chylopericardium, and resulted in immediate hemodynamic stabilization. Interventional radiology attempted bilateral intranodal lymphangiography and thoracic duct embolization via lymphatic, venous and percutaneous routes; despite partial opacification of lymphatic channels, catheterization and embolization was unsuccessful. On POD 7, surgical re-thoracotomy with thoracic duct ligation above the diaphragm and lymphatic fistula closure was performed. The pericardial drain was removed on POD 8, echocardiography confirmed no recurrence, and the patient recovered uneventfully.

Discussion: Chylous pericardial tamponade is extremely rare but life-threatening. Previous reports describe a spectrum from successful conservative therapy to surgical interventions, with at least one fatal outcome despite drainage (Fukumoto et al. Surg Case Rep. 11:87; 2025). Our case highlights three points: (1) transthoracic echocardiography is indispensable for rapid diagnosis of tamponade in unstable postoperative patients; (2) interventional radiology, although attempted, was unsuccessful and should not delay definitive treatment; (3) surgical thoracic duct ligation and pericardial drainage remain the most reliable interventions.

Conclusion: Chylous pericardial tamponade should be considered in patients with postoperative chylothorax who deteriorate hemodynamically. Rapid echocardiography, emergency pericardial drainage, and timely surgical management are key to survival.

Background: Tropheryma whipplei is a Gram-positive aerobic bacillus belonging to the phylum Actinobacteria. It is the causative agent of Whipple's disease, a multi-systemic illness that can lead to pneumonia when the lungs are involved. Currently, there is no expert consensus regarding diagnostic criteria for T. whipplei pneumonia. Its clinical manifestations and imaging features lack specificity, often resulting in misdiagnosis or missed diagnosis.

Case presentation: A 69-year-old male presented with intermittent right-sided chest pain and coughing with expectoration. Initial chest imaging suggested a high probability of a malignant lung tumor. Following comprehensive examinations and treatments, the tumor diagnosis was excluded, and an infectious lesion was confirmed. Positron Emission Tomography/Computed Tomography (PET/CT) revealed a marked increase in ¹⁸F-fluorodeoxyglucose (¹⁸F-FDG) metabolism within the pulmonary lesion. This lesion obstructed the bronchial opening in the outer basal segment of the right lower lobe (RB9) of the lung. Bronchial mucosal biopsy specimens were obtained from this site using biopsy forceps, while lung lesion tissue samples were collected via endobronchial ultrasound (EBUS). Bronchoalveolar lavage fluid (BALF) was subsequently collected at the puncture site and subjected to targeted next-generation sequencing (tNGS), resulting in the detection of T. whipplei. Pathological examination of both biopsy tissues found no evidence of tumor cells. Furthermore, the tuberculosis bacillus infection was ruled out through pathogen testing. After 6 months of anti-infection treatment for T. whipplei, the original lung nodules had significantly shrunk and subsequently disappeared. We conducted a literature review of case reports with relatively complete data, summarizing and analyzing the clinical features, chest imaging manifestations, and diagnostic methods relating to lung infections caused by T. whipplei.

Conclusions: The symptoms of T. whipplei infection involving the lungs are indeed nonspecific, and pulmonary nodules are perhaps its most common imaging manifestation. The tNGS has improved the efficiency of pathogenic microorganism diagnosis. Where feasible, tNGS testing should be promptly implemented to avoid misdiagnosis or missed diagnosis. PET/CT can be used as a potential auxiliary diagnostic tool for pulmonary nodules associated with T. whipplei infection.

Background: Chronic thromboembolic pulmonary disease (CTEPD) includes both chronic thromboembolic pulmonary hypertension (CTEPH) and disease without pulmonary hypertension. Although the main cause of CTEPH is mostly due to thromboembolic events, other rare non-thrombotic etiologies may also contribute to chronic pulmonary artery obstruction. This case series presents a unique observation of foreign material embolization related to prior sclerotherapy procedures, confirmed histopathologically after pulmonary endarterectomy (PEA).

Methods: From a prospectively maintained database of 1,105 patients undergoing PEA between 2011 and 2025, four patients (three women and one man; median age 32.5 years, range: 28-41) with a history of sclerotherapy were identified. All underwent sclerotherapy for varicose vein treatment. They were referred for surgery with a preoperative diagnosis of CTEPD, with or without pulmonary hypertension. The final diagnosis was confirmed by histopathological examination of surgical specimens.

Results: All four patients had segmental or lobar perfusion defects and vascular obstruction consistent with organized embolic material. Preoperative mean pulmonary artery pressure (mPAP) was 24.3 ± 7.4 mmHg, and mean pulmonary vascular resistance (mPVR) was 219.3 ± 104.6 dyn·s/cm⁻⁵. Although the surgery was challenging because of difficulty establishing dissection plane, no perioperative morbidity or mortality occurred. Postoperative hemodynamic improvement was observed, with mPAP reduced to 16.3 ± 1.5 and mean PVR to 119.3 ± 45.8 dyn·s/cm⁻⁵ (p > 0.05). The mean six-minute walk test distance increased from 381.5 ± 63.2 m preoperatively to 470.0 ± 66.8 m after surgery (p > 0.05). Histopathological analysis confirmed the presence of sclerotherapy-related foreign material in all cases. All patients had unilateral lobar obstruction. During a median follow-up of 50 months, no mortality or recurrence of symptoms or pulmonary hypertension was observed.

Conclusions: This report is the first case series to document a direct histopathological link between sclerotherapy and chronic pulmonary artery obstruction. These findings emphasize the need to consider iatrogenic etiologies in patients with unexplained pulmonary vascular disease and support the diagnostic and therapeutic value of PEA in selected cases.

Background: Malignant pleural mesothelioma is a rare disease with a poor prognosis; distinguishing it from non-specific pleurisy is essential for determining an appropriate treatment strategy. We aimed to evaluate the diagnostic utility and safety of full-thickness biopsy performed during semi-rigid pleuroscopy under local anaesthesia to differentiate between malignant pleural mesothelioma and non-specific pleurisy.

Methods: Consecutive patients who attempted full-thickness biopsy using a cryoprobe or an insulated-tip diathermic knife during semi-rigid pleuroscopy between April 2019 and October 2023 were retrospectively enrolled. The diagnostic utility of full-thickness biopsy for distinguishing malignant pleural mesothelioma from non-specific pleurisy was assessed based on diagnostic accuracy, specimen quality, and procedural safety.

Results: Among the 64 patients who underwent full-thickness biopsy, 28 diagnosed with malignant pleural mesothelioma or non-specific pleurisy were included in this study. With the exception of one malignant pleural mesothelioma case diagnosed by surgical biopsy, 13 malignant pleural mesothelioma and 14 non-specific pleurisy cases were histologically diagnosed through full-thickness biopsy, with clinical courses supporting these diagnoses. The median full-thickness biopsy specimen size was 18.8 mm² (range: 0.6-364.2 mm²), and in 25 cases (89.3%), full-thickness pleura was pathologically confirmed. Full-thickness biopsy demonstrated a sensitivity of 92.9%, specificity of 100%, positive predictive value of 100%, negative predictive value of 93.3%, and an overall diagnostic accuracy of 96.4%. No severe complications were reported with the procedures.

Conclusion: Full-thickness biopsy during semi-rigid pleuroscopy provides high diagnostic accuracy and safety for differentiating malignant pleural mesothelioma from non-specific pleurisy, while yielding high-quality pleural tissue specimens.

Objectives: To characterize the clinical features and identify determinants of mortality in patients with dermatomyositis (DM)-associated interstitial lung disease (ILD) who are positive for anti-melanoma differentiation-associated gene 5 (MDA5) antibodies, and to develop a prognostic prediction model.

Methods: Patients with DM-ILD were retrospectively analyzed. Mortality and baseline features were compared between antibody-positive and antibody-negative groups. In the antibody-positive subgroup, Kaplan-Meier survival curves were generated, and clinical characteristics were compared between survivors and non-survivors. Prognostic factors were identified by elastic-net Cox regression, and a nomogram was constructed. Model performance was evaluated using C-index, calibration, and decision curve analysis (DCA).

Results: Among 147 patients with DM-ILD, the 6-month mortality was significantly higher in the anti-MDA5-positive group compared with the antibody-negative group (35.2% vs. 3.9%). In the antibody-positive subgroup, the mean follow-up time was 21.60 ± 14.93 days for non-survivors and 160.26 ± 52.91 days for survivors (P < 0.001). Kaplan-Meier analysis showed no significant difference in survival when stratified by year of diagnosis before and after 2020 (Log rank P = 0.298; HR, 0.653; 95% CI, 0.288-1.478). Elastic-net Cox regression identified rapidly progressive ILD (RP-ILD), serum albumin (ALB), C-reactive protein (CRP), ferritin, and neutrophil-to-lymphocyte ratio (NLR) as independent predictors of mortality in anti-MDA positive patients. A nomogram incorporating these variables was developed, and the final model demonstrated good discrimination (optimism-corrected concordance index 0.902) and calibration.

Conclusion: Anti-MDA5 antibody positivity was strongly associated with higher short-term mortality in DM-ILD. The proposed nomogram, integrating RP-ILD, ALB, CRP, ferritin, and NLR, showed robust predictive accuracy and may aid individualized risk stratification. External validation is warranted.

Background: Asthma exacerbations are acute episodes associated with worsening symptoms and lung function decline. In children, diagnosis and monitoring rely largely on clinical judgment and measures of large airway function, which may overlook peripheral airway involvement. Tests of small airway function, such as forced expiratory flow between 25% and 75% of vital capacity (FEF25-75) and impulse oscillometry (IOS), may offer additional physiological insights. The aim of this systematic review is to evaluate the evidence supporting the use of small airway tests during pediatric asthma exacerbations.

Main body: The protocol was registered on PROSPERO, and this systematic review followed established methodology. Electronic databases searched included MEDLINE (Ovid), EMBASE (Ovid), CINAHL (EBSCOhost), and CENTRAL (Cochrane Library). The search strategy combined subject headings and keywords relating to asthma exacerbations and small airway function (e.g.,'asthma exacerbation', 'small airway dysfunction', 'impulse oscillometry'). Eligible studies included observational studies and randomised controlled trials assessing small airway tests during paediatric asthma exacerbations (aged <18 years). Risk of bias was assessed using appropriate validated tools according to study design. Thirty-five studies met inclusion criteria. Thirty-one studies reported FEF25-75; four studies reported IOS parameters, including one that also included multiple-breath washout (MBW). Most studies found that small airway indices were impaired during exacerbations and improved after treatment. In many cases, FEF25-75 and IOS parameters (R5-R20, AX) showed greater relative change than forced expiratory volume in one second (FEV1), and small airways dysfunction persisted longer despite clinical recovery. All IOS studies achieved high feasibility in acute settings. No study evaluated whether small airway tests could be used to direct clinical management.

Conclusion: Physiological tests of small airway function appear feasible during acute paediatric asthma exacerbations and may detect abnormalities not captured by FEV1. However, no included studies evaluated whether incorporating these indices altered management or improved outcomes. While these tests show promise for future diagnostic or monitoring use, further validation in larger cohorts is needed before routine implementation.

Systematic review registration: PROSPERO 2025 CRD42025623062. Available from: https://www.crd.york.ac.uk/PROSPERO/view/CRD42025623062 .