Respiration最新文献

{"title":"Pulmonary hypertension associated with lung disease - an expert review from the Cologne Conference.","authors":"Silvia Ulrich, Katrin Milger, Michael Halank, Hans Klose, Tobias J Lange, Hanno H Leuchte, Esther Nossent, Hans-Jürgen Seyfarth, Oksana Shlobin, Dirk Skowasch, Michael Dreher, Juergen Behr","doi":"10.1159/res/aepag019","DOIUrl":"https://doi.org/10.1159/res/aepag019","url":null,"abstract":"<p><p>Pulmonary hypertension associated with chronic lung disease (PH_lung) is a frequent complication of chronic obstructive pulmonary disease, interstitial lung disease, and other parenchymal lung disorders, and is associated with impaired exercise capacity, reduced quality of life and poor survival. Despite increasing recognition of its clinical importance, major challenges remain regarding early diagnosis, hemodynamic classification, and optimal treatment. Following the 7th World Symposium on Pulmonary Hypertension, a panel of experts reviewed from Germany and International collaborators summarized recent evidence and discussed unresolved issues relevant to everyday clinical practice. This review summarizes current concepts of the diagnosis and management of PH_lung, with particular emphasis on multimodal screening strategies integrating pulmonary function testing, biomarkers, echocardiography, cardiopulmonary exercise testing, and thoracic imaging to improve patient selection for right heart catheterization. We discuss practical aspects of hemodynamic assessment, overlapping phenotypes, including connective tissue disease, sarcoidosis, and the emerging pulmonary vascular \"lung phenotype\", and current evidence supporting targeted therapies with emphasis on patients' pathways in real-world settings. While inhaled treprostinil has become the first approved treatment for pulmonary hypertension associated with interstitial lung disease in several countries, no pulmonary hypertension-specific therapy is currently recommended routinely for COPD-associated PH, highlighting the need for careful patient phenotyping and individualized management in expert centres. The review further addresses indications for lung transplantation and outlines future research priorities. Earlier recognition, multidisciplinary collaboration, and continued translational and clinical research are essential to improve outcomes in this highly vulnerable patient population.</p>","PeriodicalId":21048,"journal":{"name":"Respiration","volume":" ","pages":"1"},"PeriodicalIF":2.6,"publicationDate":"2026-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149216668","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnostic Performance and Safety Profile of Shape-sensing Robotic-assisted Bronchoscopy in Peripheral Pulmonary Lesions: A Systematic Review and Meta-Analysis.","authors":"Xianya Hu, Lechen Wang, Jingyu Shi, Sebastian Fernandez-Bussy, Dan Liu","doi":"10.1159/res/aepag020","DOIUrl":"https://doi.org/10.1159/res/aepag020","url":null,"abstract":"<p><strong>Introduction: </strong>Shape-sensing robotic-assisted bronchoscopy (ssRAB) has emerged as a promising modality for diagnosing peripheral pulmonary lesions (PPLs). This meta-analysis evaluated its diagnostic performance and safety profile.</p><p><strong>Methods: </strong>PubMed, Embase, and Cochrane Library were searched from inception to December 2025. Study quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies-3. Random-effects model was used to estimate the pooled diagnostic yield, sensitivity for malignancy, and complication, with rates (%) and 95% confidence intervals (CI) when the I2 index exceeded 50%. Cumulative meta-analysis was performed to assess the temporal stability and evidence saturation of the pooled diagnostic yield. Publication bias was evaluated using funnel plots and Egger's test.</p><p><strong>Results: </strong>A total of 3678 lesions from 18 studies were included. Notably, diagnostic yield varied significantly by outcome definition, with pooled diagnostic yield of 82.5% (95% CI: 78.3%-86.0%) under strict definition versus 88.1% (95% CI: 82.8%-92.0%) under intermediate definition (P=0.036). The pooled sensitivity for malignancy of 90.0% (95% CI: 86.4%-92.8%). Cumulative meta-analysis showed stabilized diagnostic performance after approximately 1,500 lesions for the strict definition and 500 lesions for intermediate definition. Moreover, safety profile was favorable, with pooled rates of pneumothorax 1.8% (95% CI:1.3%-2.3%), chest tube placement 1.1% (95% CI: 0.7%-1.5%), and severe bleeding 0.0% (95% CI: 0.0%-0.3%). Subgroup analyses showed consistent performance across study designs, region, and nodule characteristics. Diagnostic yield was significantly influenced by publication year, and lesion size (P<0.05).</p><p><strong>Conclusion: </strong>ssRAB was associated with favorable, definition-dependent diagnostic yield (82.5%-88.1%) with exceptional safety, supporting ssRAB as an attractive first-line minimally invasive diagnostic option in appropriately selected patients, especially for small nodules (<2cm) and patients at elevated procedural risk.</p>","PeriodicalId":21048,"journal":{"name":"Respiration","volume":" ","pages":"1"},"PeriodicalIF":2.6,"publicationDate":"2026-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149169866","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploring Maximality Criteria of Cardiopulmonary Exercise Testing in Healthy Subjects and Patients with Chronic Respiratory Disease: A Practical Clinical Framework.","authors":"Michaël Staes, Iwein Gyselinck, Maud Lormans, Marieke Wuyts, Thierry Troosters, Maarten De Vos, Wim Janssens","doi":"10.1159/res/aepag004","DOIUrl":"10.1159/res/aepag004","url":null,"abstract":"<p><strong>Background: </strong>Incremental cardiopulmonary exercise testing (CPET) is used to assess exercise capacity and identify mechanisms of exercise limitation. Identification of test maximality is essential for correct interpretation, yet no consensus exists on the defining criteria. This study evaluated the performance of different <mml:math id=\"m1\" xmlns:mml=\"http://www.w3.org/1998/Math/MathML\"><mml:mrow><mml:mover accent=\"true\"><mml:mi mathvariant=\"normal\">V</mml:mi><mml:mo>˙</mml:mo></mml:mover><mml:msub><mml:mi mathvariant=\"normal\">O</mml:mi><mml:mn>2</mml:mn></mml:msub></mml:mrow></mml:math> plateau definitions and the contribution of secondary maximality criteria in patients with chronic respiratory disease and healthy controls.</p><p><strong>Methods: </strong>We retrospectively analyzed 395 CPETs (84 healthy, 135 chronic obstructive pulmonary disease, 99 interstitial lung disease, 77 pulmonary hypertension), comparing consensus-based visual identification of a <mml:math id=\"m2\" xmlns:mml=\"http://www.w3.org/1998/Math/MathML\"><mml:mrow><mml:mover accent=\"true\"><mml:mi mathvariant=\"normal\">V</mml:mi><mml:mo>˙</mml:mo></mml:mover><mml:msub><mml:mi mathvariant=\"normal\">O</mml:mi><mml:mn>2</mml:mn></mml:msub></mml:mrow></mml:math> plateau by three pulmonologists with three commonly used plateau definitions. Additionally, five secondary maximality criteria were evaluated, using strict and liberal thresholds.</p><p><strong>Results: </strong>The relative <mml:math id=\"m3\" xmlns:mml=\"http://www.w3.org/1998/Math/MathML\"><mml:mrow><mml:mover accent=\"true\"><mml:mi mathvariant=\"normal\">V</mml:mi><mml:mo>˙</mml:mo></mml:mover><mml:msub><mml:mi mathvariant=\"normal\">O</mml:mi><mml:mn>2</mml:mn></mml:msub></mml:mrow></mml:math> plateau definition showed strong agreement with visual assessment (κ = 0.75-0.93), while absolute thresholds were discordant (κ = 0.02-0.31). Overlap between maximality criteria was high in healthy individuals but low in disease groups, suggesting that evaluating multiple criteria in parallel is necessary. However, combining more than 2 secondary criteria in healthy subjects and more than 3 in patients on top of <mml:math id=\"m4\" xmlns:mml=\"http://www.w3.org/1998/Math/MathML\"><mml:mrow><mml:mover accent=\"true\"><mml:mi mathvariant=\"normal\">V</mml:mi><mml:mo>˙</mml:mo></mml:mover><mml:msub><mml:mi mathvariant=\"normal\">O</mml:mi><mml:mn>2</mml:mn></mml:msub></mml:mrow></mml:math> plateau provided minimal additive value.</p><p><strong>Conclusion: </strong>CPET maximality assessment depends strongly on the criteria applied, potentially altering CPET interpretation and clinical decision-making.</p>","PeriodicalId":21048,"journal":{"name":"Respiration","volume":" ","pages":"1"},"PeriodicalIF":2.6,"publicationDate":"2026-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149169707","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Survival in patients with activity-related dyspnea. A retrospective cohort study.","authors":"Carmen Wick, Helga Preiss, Michael Furian, Kay von Grünigen, Stéphanie Saxer, Julian Müller, Simon R Schneider, Malcolm Kohler, Silvia Ulrich, Mona Lichtblau","doi":"10.1159/res/aepag022","DOIUrl":"https://doi.org/10.1159/res/aepag022","url":null,"abstract":"<p><strong>Introduction: </strong>In an aging and multimorbid population, activity-related dyspnea is frequent. The aim was to study the prognostic relevance of patient-reported dyspnea, independent of the underlying diseases.</p><p><strong>Methods: </strong>This retrospective cohort study included patients undergoing CPET for evaluation of activity-related dyspnea who had simultaneous assessment of Dyspnea severity by the New York Heart Association (NYHA) functional class (I-III) or the modified Medical Research Council (mMRC) scale (0-3) which was harmonized into a unified dyspnea severity score (1: NYHA I and/or mMRC 0; 2: NYHA II and/or mMRC 1; 3: NYHA III and/or mMRC 2-3) for analysis. Survival analysis (Kaplan-Meier analysis, Cox proportional hazards model) was adjusted for age, sex, smoking status, exercise-induced desaturation, and number of cardiac and/or pulmonary diagnoses.</p><p><strong>Results: </strong>1,061 patients (56% female, 58 years, BMI 26.3 kg/m2) were included of whom 48% had ≥2 cardiac/pulmonary diseases. The 1/3/5-year survival for dyspnea score 1 was 99/96/94%, for dyspnea score 2 98/93/89% and for dyspnea score 3 95/87/79% (p<0·001 for overall-group comparisons). Increasing age and male sex were independently associated with worse survival, while exercise-desaturation, smoking status, and the number of cardiac/pulmonary diagnoses were not. The combination of dyspnea score 3 and exercise-induced desaturation or ≥2 cardiac/pulmonary diagnoses each had a 5-year survival of 73%.</p><p><strong>Conclusion: </strong>Activity-related dyspnea in cardiac/pulmonary diseases is independently associated with worse survival irrespective of the number of underlying diagnoses. These findings suggest that activity-related dyspnea may serve as a clinically relevant prognostic marker. Further validation in prospective cohorts is required.</p>","PeriodicalId":21048,"journal":{"name":"Respiration","volume":" ","pages":"1"},"PeriodicalIF":2.6,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149138053","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Emerging respiratory infectious diseases: Clinical aspects for rapid identification and management.","authors":"Thierry Rolling, Thomas Theo Brehm, Florian Krammer, Marylyn Addo, Stefan Schmiedel, Helmut Salzer","doi":"10.1159/res/aepag021","DOIUrl":"https://doi.org/10.1159/res/aepag021","url":null,"abstract":"<p><p>Emerging respiratory infectious diseases increasingly arise at the human-animal-environment interface and challenge clinicians with rapidly evolving diagnostic, therapeutic, and infection-control decisions. This narrative review summarizes clinically relevant viral and bacterial pathogens that may present as severe respiratory disease, but are easily mistaken for common community-acquired infections during early illness. We focus on zoonotic influenza A viruses, including contemporary H5N1, Middle East respiratory syndrome coronavirus (MERS-CoV), hantaviruses, Nipah virus, and inhalational bacterial threats such as anthrax, pneumonic plague, tularemia, and melioidosis. These infections may progress from non-specific symptoms to severe pneumonia, acute respiratory distress syndrome, shock, neurological complications, disseminated infection, or death. Timely recognition depends on careful assessment of travel, occupational and recreational exposures, animal contact, outbreak signals, and pathogen-specific syndromic clues. Multiplex molecular diagnostics can support early triage and exclusion of common pathogens, but targeted PCR, culture, serology, sequencing, and reference laboratory confirmation remain essential. Management requires prompt supportive care, appropriate isolation, public health notification, and pathogen-directed antimicrobial, antiviral, antitoxin, or prophylactic strategies where available. By integrating clinical presentation, diagnostics, treatment, vaccines, and One Health considerations, this review aims to translate knowledge on emerging infections into practical bedside preparedness.</p>","PeriodicalId":21048,"journal":{"name":"Respiration","volume":" ","pages":"1"},"PeriodicalIF":2.6,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149128537","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Secondary pleuroparenchymal fibroelastosis shows worse pre-transplant lung function but comparable post-transplant outcomes to idiopathic pleuroparenchymal fibroelastosis.","authors":"Takafumi Yamaya, Miho Yamaguchi, Yoshihisa Hiraishi, Takaki Akamine, Gouji Toyokawa, Mitsuaki Kawashima, Chihiro Konoeda, Masaaki Sato","doi":"10.1159/res/aepag018","DOIUrl":"https://doi.org/10.1159/res/aepag018","url":null,"abstract":"<p><strong>Introduction: </strong>Pleuroparenchymal fibroelastosis (PPFE) can be idiopathic (iPPFE) or secondary. Although lung transplantation has been established for advanced PPFE, the clinical characteristics and transplantation outcomes of secondary PPFE remain poorly defined. In this study, we evaluated the parameters of secondary PPFE and iPPFE.</p><p><strong>Methods: </strong>We retrospectively evaluated patients with PPFE who underwent lung transplantation at our institution. The clinical characteristics, transplant outcomes, and longitudinal changes in body mass index (BMI), percent predicted forced vital capacity (%FVC), and the anteroposterior-to-transverse diameter (APDT/TDT) ratio, an indicator of flat chest, were analyzed using linear mixed-effects models.</p><p><strong>Results: </strong>Forty-one patients were included (26 with iPPFE and 15 with secondary PPFE). The underlying cause of secondary PPFE included post-hematopoietic stem cell transplantation in eight patients (53.3%). At baseline, the %FVC (p = 0.017) and APDT/TDT (p = 0.018) were significantly lower in the secondary PPFE group, whereas the BMI did not differ significantly between groups (p = 0.239). Improvements in %FVC tended to be smaller in secondary PPFE at 1 year (estimate -9.61; p = 0.070) and 2 years (estimate -10.37; p = 0.067) after transplantation. Longitudinal analysis demonstrated a significant increase in APDT/TDT over time in both groups, whereas the BMI remained stable with no significant group-time interaction. The 5-year overall survival rates were 71.3% and 71.1% in the iPPFE and secondary PPFE groups, respectively, with no significant differences in overall survival (p = 0.624). The 5-year chronic lung allograft dysfunction-free survival rates were 63.7% and 53.9%, respectively, with no significant intergroup difference (p = 0.487). In a Cox proportional-hazards model, the hazard ratio for overall survival in the secondary PPFE group compared with the iPPFE group was 1.40 (95% CI 0.36-5.41; p = 0.625), and for CLAD-free survival was 1.53 (95% CI 0.46-5.06; p = 0.490).</p><p><strong>Conclusion: </strong>Despite severe preoperative restrictive dysfunction and thoracic deformity, patients with secondary PPFE demonstrated post-transplant functional recovery and long-term transplantation outcomes that did not differ significantly from those with iPPFE, although this comparison was limited by the small number of patients with secondary PPFE and should be interpreted with caution.</p>","PeriodicalId":21048,"journal":{"name":"Respiration","volume":" ","pages":"1"},"PeriodicalIF":2.6,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149114068","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Benign Biopsy Paradox: False Reassurance and Diagnostic Overreach in Peripheral Pulmonary Lesions.","authors":"Ales Rozman, Pallav L Shah","doi":"10.1159/res/aepag016","DOIUrl":"https://doi.org/10.1159/res/aepag016","url":null,"abstract":"<p><strong>Background: </strong>Peripheral pulmonary lesions are increasingly detected through widespread computed tomography use, incidental imaging, and low-dose CT lung cancer screening programs. Diagnostic techniques have advanced substantially, including radial endobronchial ultrasound (rEBUS), virtual and electromagnetic navigation bronchoscopy, ultrathin bronchoscopy, cryobiopsy, cone-beam CT (CBCT), augmented fluoroscopy, and robotic-assisted bronchoscopy. Despite this rapid technological evolution, the interpretation of benign or non-malignant biopsy results remains one of the most consequential and underappreciated clinical challenges in pulmonary medicine.</p><p><strong>Summary: </strong>A benign biopsy result from a peripheral pulmonary lesion must not be interpreted as a single, unambiguous entity. Specific benign diagnoses, nonspecific benign findings, atypia, suspicious results, and nondiagnostic samples each carry a distinct residual probability of malignancy and different implications for subsequent management. Recent consensus recommendations mandate a strict definition of diagnostic yield, in which only specific malignant diagnoses and specific benign diagnoses sufficient to inform patient care are counted as truly diagnostic. Follow-up data are essential for calculating diagnostic accuracy, sensitivity for malignancy, negative predictive value, and false-negative rates - but should not retroactively reclassify nonspecific or nondiagnostic index results as diagnostic. We propose that the diagnostic process be understood as a chain: tool/access → navigation → position confirmation → sampling → pathology → final clinic-radiologic diagnosis. Failure at any link may create a diagnostic gap and produce a falsely reassuring result. Newer technologies address different links: robotic bronchoscopy primarily narrows the access and stability gap, while CBCT and augmented fluoroscopy primarily narrow the position confirmation gap. Neither technology - alone or combined - closes the sampling, pathology, or clinical concordance gaps.</p>","PeriodicalId":21048,"journal":{"name":"Respiration","volume":" ","pages":"1"},"PeriodicalIF":2.6,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149114024","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sustained but Attenuated Weight Gain following Pulmonary Rehabilitation in COPD: Evidence for a Gap in Post-Discharge Nutritional Care.","authors":"Alvaro Blazquez-Bujeda, Kirsten Grossmann, Sabine Spielmanns, Patrick Heeb, Nena Lale, David Prins, Stefan Bachmann, Marc Spielmanns","doi":"10.1159/res/aepag017","DOIUrl":"https://doi.org/10.1159/res/aepag017","url":null,"abstract":"<p><strong>Background: </strong>Malnutrition is common in patients with chronic obstructive pulmonary disease (COPD) and is associated with adverse clinical outcomes. Pulmonary rehabilitation (PR) improves nutritional status in the short term, but evidence on sustainability remains limited.</p><p><strong>Objectives: </strong>To assess longitudinal changes in body weight following PR and to explore the role of oral nutritional supplementation (ONS) and post-discharge nutritional care.</p><p><strong>Methods: </strong>A multicenter study was conducted combining retrospective analysis with prospective follow-up. Patients with COPD stages 2-4 undergoing inpatient PR were included. Patients with BMI ≥25 kg/m² and incomplete PR were excluded. Body weight was assessed on admission, discharge, and follow-up.</p><p><strong>Secondary outcomes: </strong>6-minute walk test (6MWT), nutritional care variables following discharge. Linear mixed models were used to analyze weight trajectories.</p><p><strong>Results: </strong>75 patients were included. Body weight increased during PR and remained higher at follow-up (57.7 kg on admission, 59.5 kg at discharge, and 60.6 kg at follow-up; p<0.001). Patients receiving ONS had lower baseline BMI, without a differential effect on weight trajectories. Nutritional counselling declined following discharge (21% at follow-up). In a logistic regression analysis, lower BMI at discharge was associated with a higher likelihood of post-discharge nutritional counselling (OR 0.72 per kg/m² increase, 95% CI 0.57-0.91, p=0.007).</p><p><strong>Conclusions: </strong>PR was associated with an increase in body weight that persisted after discharge, although the magnitude of weight gain attenuated over time. The marked decline in post-discharge nutritional counselling highlights a potential gap in continuity of nutritional care. Future studies should evaluate whether structured long-term nutritional follow-up can improve nutritional outcomes after PR.</p>","PeriodicalId":21048,"journal":{"name":"Respiration","volume":" ","pages":"1"},"PeriodicalIF":2.6,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149081950","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Breathprint of Pulmonary Sarcoidosis: Development of a Non-Invasive Diagnostic Tool.","authors":"Noriane Sievi, Jonas Herth, Diego M Baur, Kai Fricke, Maurice Roeder, Felix Schmidt, Silvia Ulrich, Christian F Clarenbach, Malcolm Kohler","doi":"10.1159/res/aepag015","DOIUrl":"https://doi.org/10.1159/res/aepag015","url":null,"abstract":"<p><strong>Background: </strong>Sarcoidosis is a systemic inflammatory disease of unknown origin, primarily affecting the lungs and lymphatic system. Diagnosis relies on clinical assessment, histological confirmation of non-necrotizing granulomas, and exclusion of other conditions. However, current diagnostic methods are invasive and costly, making them unsuitable for disease monitoring. Existing biomarkers lack accuracy and clinical utility.</p><p><strong>Objective: </strong>To evaluate exhaled breath analysis as a non-invasive, real-time diagnostic and monitoring tool for pulmonary sarcoidosis, by identifying disease-specific metabolic signatures. METHODS Exhaled breath samples were collected from patients with pulmonary sarcoidosis, matched controls without lung disease, and patients with pulmonary fibrosis. Patients with sarcoidosis were further stratified into active and inactive disease states. Molecular breath profiles were compared using t-test and prediction models were developed based on ReliefF feature selection and Naïve Bayes algorithms.</p><p><strong>Results: </strong>39 patients with pulmonary sarcoidosis, 39 matched controls, and 25 patients with pulmonary fibrosis were included. Sarcoidosis could be discriminated from matched controls with a repeated cross-validated ROC-AUC of 0.76, with the main metabolic changes in fatty acid and cysteine metabolism. Active sarcoidosis was discriminated from inactive disease with a repeated cross-validated ROC-AUC of 0.77, with linoleate metabolism playing a central role.</p><p><strong>Conclusion: </strong>Exhaled breath analysis shows potential to distinguish patients with pulmonary sarcoidosis from matched controls and patients with pulmonary fibrosis, and to differentiate between active and inactive sarcoidosis. Metabolic signatures, particularly involving fatty acid and linoleate metabolism, support its potential as a non-invasive, real-time tool for diagnosis and monitoring of pulmonary sarcoidosis, pending validation in larger cohorts.</p>","PeriodicalId":21048,"journal":{"name":"Respiration","volume":" ","pages":"1"},"PeriodicalIF":2.6,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149025947","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Motion Capture of Bronchoscopist Kinematics Using a Spatial Computing Device: A Methodological Proof-of-Concept Study.","authors":"Shotaro Okachi, Tomoya Horiguchi, Yasuhiro Goto, Michitaka Fujiwara, Kazuyoshi Imaizumi, Naozumi Hashimoto","doi":"10.1159/res/aepag014","DOIUrl":"10.1159/res/aepag014","url":null,"abstract":"<p><strong>Introduction: </strong>Bronchoscopy is physically demanding, and studies of ergonomics and objective skill assessment require accurate, segment-resolved capture of the bronchoscopist's hand and head movements. However, existing motion capture approaches typically rely on specialized laboratory infrastructure or wearable sensor arrays, limiting their routine use.</p><p><strong>Methods: </strong>A board-certified pulmonologist performed 10 systematic bronchoscopies across the 18 named segments using an airway simulator and a single-use bronchoscope. Procedures alternated between conditions without and with engagement of the bronchoscope's insertion-tube rotation mechanism. A custom visionOS application running on Apple Vision Pro captured bilateral hand and head poses at 30 Hz, with synchronized voice-cue annotations for each segment.</p><p><strong>Results: </strong>All 180 expected segment insertions were recorded (94.4% via voice cues; 5.6% recovered through tracking-derived hold detection and excluded from per-insertion analyses). Intermittent tracking-freezing artifacts, in which a static pose was retained under a valid tracking flag, were detected by frame-to-frame immobility and excluded from the affected analyses. The mean per-insertion peak left-wrist rotation across all segments was 107.9° without and 72.6° with the rotation mechanism. The mean left-thumb path length within the wrist's local reference frame was 3.82 ± 0.48 m per bronchoscopy, and the estimated number of bronchoscope lever operation cycles was 64.8 ± 7.9 per procedure.</p><p><strong>Conclusion: </strong>In this proof-of-concept study, a single off-the-shelf head-mounted device enabled multichannel capture of bronchoscopist kinematics during simulated bronchoscopy. This approach provides a practical methodological foundation for future studies on bronchoscopy ergonomics, skill assessment, and AI-driven training data generation.</p>","PeriodicalId":21048,"journal":{"name":"Respiration","volume":" ","pages":"1"},"PeriodicalIF":2.6,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149017846","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}