Canadian respiratory journal最新文献

Background: Chronic obstructive pulmonary disease (COPD) is an increasing cause of morbidity and mortality worldwide, and acute exacerbations are the major health issues in COPD patients. In this study, we aimed to investigate the role of the delta neutrophil index (DNI) with other hematologic parameters in managing and guiding COPD patients admitted with acute exacerbations. Methods: In this retrospective study, COPD patients treated internally in pulmonology clinic, intensive care unit, and anesthesiology and reanimation unit with acute exacerbation between May 2021 and December 2023 were investigated. Records from daily visits were evaluated retrospectively. Patients were divided into two groups according to the causative organism: bacterial or nonbacterial. Results: Patients with cardiac failure were found to have significantly higher median DNI values (p : 0.026), whereas patients with other comorbidities that were not individually recorded have substantially lower median DNI values (p : 0.026). White blood cell (WBC), neutrophil, immature granulocyte values (both absolute value and percent), thrombocyte, platelet-lymphocyte ratio (PLR), neutrophil-lymphocyte ratio (NLR), C-reactive protein (CRP), procalcitonin, positive blood culture, positive systemic inflammatory response syndrome (SIRS) criteria, and sepsis were significantly higher in patients with bacterial acute exacerbation. Hospitalization duration was also significantly longer in the same group (p :  0.006). No statistically significant correlation was found between median DNI values and early mortality rate (within 28 days), readmission within 30 days and 6 months. Conclusion: In this study, we have shown that the serum procalcitonin level, WBC, NLR, and PLR measurement can be used to distinguish bacterial and nonbacterial COPD exacerbations. The DNI revealed no prognostic predictive value regarding early mortality, mechanic ventilation need, or readmission in 30 days and 6 months.

Background: Nonresolving or slowly resolving pneumonia (NRP) poses a diagnostic challenge because infectious and noninfectious etiologies often mimic community-acquired pneumonia on imaging. Endobronchial ultrasound-guided transbronchial lung biopsy (EBUS-TBLB) improves tissue acquisition for peripheral lesions, whereas metagenomic next-generation sequencing (mNGS) offers culture-independent pathogen detection. Whether their combination enhances etiological clarification of NRP remains uncertain. Methods: A total of 109 consecutive adults with NRP unresponsive to standard antimicrobial therapy were randomized to EBUS-TBLB alone (n = 66) or EBUS-TBLB + mNGS (n = 43). Baseline characteristics, diagnostic yield, and procedure-related complications were recorded. Diagnostic positivity, sensitivity for infectious agents, and safety profiles were compared using χ ² or Fisher's exact tests, with p < 0.05 considered significant. Results: Overall diagnostic yield increased from 50.0% with EBUS-TBLB to 72.1% with the combined approach (χ ² = 4.37, p < 0.05). mNGS significantly improved detection of bacterial/fungal pneumonia (0% vs. 13.9%; p < 0.05) and pulmonary tuberculosis (0% vs. 20.9%; p < 0.05). Malignancy remained the predominant diagnosis (57.8% of all cases); yields for most tumor subtypes were comparable between groups. Complication rates did not differ between the two groups: minor bleeding (19.7% vs. 23.3%), hypoxia (50.0% vs. 48.8%), pneumothorax (4.5% vs. 0%), and delayed recovery (4.5% vs. 7.0%) (p > 0.05). No severe adverse events occurred. Conclusions: EBUS-TBLB + mNGS represents a paradigm shift in the diagnosis of complex respiratory cases, integrating imaging with advanced genomics to enhance precision medicine. In practice, early implementation of the EBUS-TBLB + mNGS diagnostic protocol in patients with NRP can help exclude malignancy or confirm an infectious etiology.

A diffusely thickened or hard pleura is a special type of macroscopic appearance associated with benign or malignant conditions. Medical thoracoscopy (MT) is the gold standard for pleural pathology, but its diagnostic yield is imperfect. Although cryobiopsy may provide greater and deeper tissue, its impact on the diagnostic yield remains uncertain, and safety concerns persist. We evaluated the efficacy and safety of cryoprobe biopsy as a salvage technique following negative or inconclusive flexible forceps biopsy during MT under the guidance of rapid on-site evaluation (ROSE). This prospective study enrolled 280 patients with undiagnosed exudative pleural effusion who underwent MT. After the initial flexible forceps biopsy and ROSE, 37 patients with negative ROSE results underwent cryoprobe biopsy. A total of 37 (21 males and 16 females) patients, aged 56.43 ± 16.09 (range: 22-78) years with negative ROSE results, underwent cryoprobe biopsy. CB established a definitive histopathological diagnosis in 33/37 (89.2%) patients, which was significantly higher than that achieved with FFB, i.e., 21/37 (56.8%; p=0.002). CB resulted in significantly larger pleural specimens (9.86 ± 2.69 mm) in comparison to FFB (2.89 ± 1.15 mm, 95% confidence interval [CI]: 6.01-7.93; p < 0.001). Furthermore, CB was faster than FFB (median durations of 15 and 31 min, respectively; p < 0.001). CB had improved tissue quality for CGP testing in 20 NSCLC patients compared to FFB (18/20 versus 8/15, p=0.036). No significant complications were noted. Cryoprobe biopsy is a safe and effective salvage technique for patients with undiagnosed pleural effusion who show negative results on flexible forceps biopsy during MT. It provides larger, higher-quality specimens with a higher positivity rate, potentially avoiding the need for repeat procedures and facilitating timely diagnosis and treatment.

The detection and classification of pleural effusion present significant challenges in clinical practice, often contributing to delayed diagnoses and suboptimal patient outcomes. Recent advancements in artificial intelligence (AI) and machine learning (ML) techniques hold substantial promise for enhancing the accuracy and efficiency of pleural effusion diagnostics. This paper reviews the current landscape of AI applications in pleural effusion detection, synthesizing findings across diverse studies to illustrate the transformative potential of these technologies. We examine various ML models, including deep learning and ensemble methods, that leverage clinical, laboratory, and imaging data to improve diagnostic performance. Notably, models such as Light Gradient Boosting Machine (LGB) and XGBoost have achieved accuracy levels up to 96% and high AUC values (e.g., AUC = 0.883 for pleural effusion differentiation). This overview highlights the importance of integrating diverse diagnostic parameters to enhance pleural effusion diagnostic accuracy and outlines future research directions essential for optimizing patient management and outcomes.

Cancer distant metastasis is one of the main causes of cancer progression and difficulty in treatment (Rossi et al., 2020). This abstract aims to summarize the significance of tumor-stroma ratio (TSR) as a prognostic factor in the development of distant metastasis in squamous cell lung cancer (SQCLC) patients. The TSR has recently been recognized as a novel and independent prognostic parameter for a variety of solid tumor types (Lu et al., 2023). A total of 86 patients with SQCLC who had undergone surgery were included in the present study. Two independent observers visually identified TSR on hematoxylin and eosin (H&E)-stained pathological histologic sections. Patients were separated into two groups: stroma-rich, with a ratio of stroma as > 50%, and stroma-poor, with a ratio of stroma as ≤ 50%, which included a total of 36 and 50 patients, respectively. In the current study, the overall survival and no distant metastasis survival of patients in the stroma-poor group were improved compared with the stroma-rich group, and the overall risk of patients in the stroma-poor group was reduced compared with the stroma-rich group (p < 0.05). In the multivariable analyses, the TSR was recognized as an important prognostic indicator for overall survival (HR = 2.41; p < 0.001) and no distant metastasis survival (HR = 2.27; p < 0.001). The study revealed that in patients with SQCLC, stroma-rich tumors were associated with a shorter distant metastasis-free interval and poorer prognosis compared to stroma-poor tumors. These findings suggest that the TSR may serve as a novel prognostic indicator for predicting distant metastasis in SQCLC.

Objective: At present, there is a lack of studies on depression and the likelihood for mortality among those suffering from chronic obstructive pulmonary disease (COPD). This research explores the connection between depression and the risks of overall mortality as well as cardiovascular mortality in individuals with COPD. Methods: A total of 1336 COPD patients from seven cycles of the National Health and Nutrition Examination Survey (NHANES) conducted between 2005 and 2018 were selected. We created a multivariate Cox proportional hazards model and performed a subgroup analysis to investigate the connection between depression and both overall and cardiovascular mortality. Additionally, we used restricted cubic spline (RCS) curves to examine the relationship between depression and both overall and cardiovascular mortality to better reveal the association between the two. The Kaplan-Meier technique was employed to determine the likelihood of survival. Results: Over the course of a mean follow-up period of 91 months, 1336 COPD patients were studied, of which 340 patients experienced overall mortality, and 82 had cardiovascular-related deaths. Using RCSs, we found that depression was positively correlated with both all-cause and cardiovascular mortality in COPD patients. In the multivariable-adjusted model, individuals suffering from moderate to severe depression had a greater likelihood of overall and cardiovascular mortality compared to those without depression. The results were consistent in subgroup analyses based on age, gender, body mass index (BMI), and poverty income ratio (PIR), and there was no significant interaction between these traits and depression (p for interaction > 0.05). Conclusion: In COPD patients, depression is associated with higher risks of both cardiovascular and overall mortality. However, further validation of this finding is needed in large-scale prospective studies with sufficient follow-up time.

Pulmonary fibrosis (PF) is a terminal-stage lung change in interstitial lung disease. It is characterized by proliferation of fibroblasts and deposition of a large amount of extracellular matrix, accompanied by inflammatory damage and structural destruction, caused by various reasons. The prognosis of PF is poor, and the average survival time after diagnosis is 2.5-3.5 years. The pathogenesis of PF is not yet fully understood. Its main mechanisms are diverse and include damage to alveolar epithelial cells, aggregation and activation of inflammatory cells and chemokines, proliferation of fibroblasts, transformation of myofibroblasts, production and deposition of large amounts of collagen, autophagy, epithelial-mesenchymal transition (EMT), mitochondrial quality-control disorders, microRNA, and circular RNA. The diagnosis of PF is mainly based on the comprehensive evaluation of clinical manifestations, imaging characteristics, and histopathological examination. Medical and family history to determine all potential causes of PF. For PF of unknown etiology, one can refer to the Official Clinical Practice Guideline of idiopathic pulmonary fibrosis (IPF) for definitive diagnosis. In terms of treatment, modern medications such as pirfenidone and nintedanib can inhibit the progression of PF to some extent and improve lung function. However, there is no drug that can significantly improve PF, except for lung transplantation. In addition, many patients are forced to stop taking medication due to adverse reactions in clinical practice. Therefore, to better control the progression of disease, some new drugs have been developed based on the pathogenesis of PF. However, there is still controversy over their efficacy and widespread clinical application in PF, and the evidence is limited. The results of in vitro and in vivo experiments, as well as randomized clinical trials, indicate that traditional Chinese medicine (TCM) can improve PF by intervening in multiple pathways and targets. This study combines the pathogenesis and diagnosis of PF, focusing on the intervention mechanism and targets of TCM in the treatment of PF, so as to provide more options for clinical treatment and provide scientific basis for a new approach to better management of PF.

Venous thromboembolism (VTE) is widespread and poses significant risks of illness and death, making it a vital public health issue. Obstructive sleep apnea (OSA), which is the most prevalent sleep disorder, is connected to an increased possibility of cardiovascular diseases and VTE. The length of VTE treatment hinges mainly on the frequency of its recurrence in patients. Our data about VTE and its recurrence in OSA patients are limited. In this review, we aim to investigate the risk of VTE recurrence in OSA patients and evaluate the role of continuous positive airway pressure (CPAP) therapy in mitigating this risk. A literature search gathered information about VTE pathogenesis and its potential recurrence mechanism in OSA. The recurrent episodes of partial or complete obstruction of the upper airway in OSA lead to intermittent lack of oxygen. Hypoxemia acts as a central cornerstone of VTE incidence in OSA patients, leads to activating all the vertices of Virchow's triad, and creates the appropriate condition for the developmental and even recurrence of VTE. Intermittent hypoxia causes an increase in the inflammatory state and coagulation activity, leading to oxidative stress and endothelial dysfunction. Furthermore, it results in heightened viscosity and venous stasis. The results of previous studies on VTE recurrence in OSA patients are conflicting. Even though the use of CPAP leads to diminished proinflammatory cytokines and oxidative stress indicators, there is currently insufficient clinical evidence to support that this therapy can prevent recurrent VTE in patients with OSA. Further investigation is necessary to gain a better comprehension of the probability and frequency of relapse of VTE in OSA patients, as the present research has generated inconclusive outcomes.

Bronchiolitis obliterans is a rare form of chronic obstructive lung disease, with postinfectious bronchiolitis obliterans being particularly prevalent in pediatric populations. The pathogenic investigations of pediatric postinfectious bronchiolitis obliterans predominantly center on adenovirus and Mycoplasma pneumoniae. Following the illness, children's lung function is impacted to varying extents; however, a definitive diagnosis relies on lung biopsy, which is not conducive to early detection and timely intervention. Consequently, there remains a need for novel research methodologies. This article synthesizes the 2023 China Reformulation of the Expert Consensus on the Diagnosis and Treatment of Bronchiolitis Obliterans in Children along with recent studies, providing a comprehensive overview of early diagnosis, treatment modalities, and preventive strategies for postinfectious bronchiolitis obliterans in children. Additionally, it outlines future research directions aimed at enhancing pediatricians' understanding of this complex disease.

Introduction: The Canadian Cystic Fibrosis Registry (CCFR) was developed in the 1970s and has longitudinal demographic and clinical data on persons living with cystic fibrosis (CF) attending accredited clinics in Canada. We aimed to validate the data collection and identify potential limitations of the CCFR. Methods: Of 40 accredited CF clinics in Canada invited and based on an a priori sample size calculation, eight clinics were included. 15% of each CF clinic's population in 2019 were randomly selected. Data variables were selected based on their importance to care, epidemiologic trends, and data related to demography, clinic visits, and hospitalizations. The accuracy of the registry data was compared to the medical records as the gold standard. Each data element was categorized as correct, incorrect, or not able to be validated. The accuracy rate was calculated as the percent correct out of all records validated. Results: A total of 4382 individuals had data entered into the CCFR in 2019. The validation cohort consisted of 208 individuals from 8 clinics, which were representative across location, size of clinic (small/medium/large), and type of clinic (adult, pediatric, and combined). The 208 individuals were 52% male and 95% White, and with a median age of 26.3 years (IQR: 15.2-36.6). Approximately 95% of CCFR data on clinical measurements, infections, treatments, and hospitalizations validated were accurate as compared to the medical record. For demography, sex and date of birth had 100% accuracy. Conclusion: Our validation of the CCFR demonstrated high accuracy for clinical and demographic variables used in clinical research.