Respiration最新文献

{"title":"Patent Foramen Ovale and Oxygenation in Patients with Cystic Fibrosis.","authors":"Haley Belt, Evbu O Enakpene, Judy L Jensen, Alice P Moe, Holly Carveth, Barbara C Cahill, Nathan Hatton, Theodore G Liou, Anwar Tandar","doi":"10.1159/000541892","DOIUrl":"10.1159/000541892","url":null,"abstract":"<p><strong>Introduction: </strong>Patent foramen ovale (PFO) affects about 25% of the population. We studied outcomes in cystic fibrosis (CF).</p><p><strong>Methods: </strong>We conducted a case-control study of patients with CF (PwCF) and age- and sex-matched controls who underwent agitated saline contrast (bubble) echocardiography, 1998-2020. We assessed PFO impacts using linear, logistic, quasi-Poisson, and Cox proportional hazards models.</p><p><strong>Result: </strong>Fifty-nine of 64 PwCF and 88 of 93 controls underwent bubble studies to investigate unexplained hypoxemia or dyspnea. PwCF had higher mean pulmonary artery pressure (PAP: 6.9 mm Hg, 95% confidence interval [CI] = 2.35-11.4), reduced tricuspid annular plane systolic excursion (TAPSE: -3.78 mm, CI = -5.64 to -1.93) and similar right ventricular diastolic sizes. Without hypoxemia, the PFO incidence was similar between PwCF and controls; with hypoxemia, PFO was more common in CF (odds ratio = 5.00, CI = 1.32-19.0). In CF, oxygen supplementation occurred at a percent-predicted forced expiratory volume in 1 s (FEV1%), 22.5 points higher with PFO. Adjusted for FEV1%, PFO was associated with 0.59 more prior-year pulmonary exacerbations (CI = 0.20-0.98) and shorter time to next exacerbation (hazard ratio = 1.86, CI = 1.06-3.26). Associations between PFO and hypoxemia or exacerbations were insensitive to PAP, TAPSE, and CF transmembrane regulator protein modulator treatments. PFO was not associated with CF time to death or lung transplantation (median 1.87 years) adjusted for age, sex, FEV1%, and prior-year exacerbation counts.</p><p><strong>Conclusion: </strong>PFO in CF is associated with hypoxemia at higher FEV1% and more pulmonary exacerbations but not survival.</p><p><strong>Introduction: </strong>Patent foramen ovale (PFO) affects about 25% of the population. We studied outcomes in cystic fibrosis (CF).</p><p><strong>Methods: </strong>We conducted a case-control study of patients with CF (PwCF) and age- and sex-matched controls who underwent agitated saline contrast (bubble) echocardiography, 1998-2020. We assessed PFO impacts using linear, logistic, quasi-Poisson, and Cox proportional hazards models.</p><p><strong>Result: </strong>Fifty-nine of 64 PwCF and 88 of 93 controls underwent bubble studies to investigate unexplained hypoxemia or dyspnea. PwCF had higher mean pulmonary artery pressure (PAP: 6.9 mm Hg, 95% confidence interval [CI] = 2.35-11.4), reduced tricuspid annular plane systolic excursion (TAPSE: -3.78 mm, CI = -5.64 to -1.93) and similar right ventricular diastolic sizes. Without hypoxemia, the PFO incidence was similar between PwCF and controls; with hypoxemia, PFO was more common in CF (odds ratio = 5.00, CI = 1.32-19.0). In CF, oxygen supplementation occurred at a percent-predicted forced expiratory volume in 1 s (FEV1%), 22.5 points higher with PFO. Adjusted for FEV1%, PFO was associated with 0.59 more prior-year pulmonary exacerbations (CI = 0.20-0.98) and short","PeriodicalId":21048,"journal":{"name":"Respiration","volume":" ","pages":"188-199"},"PeriodicalIF":3.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11885056/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142392888","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"GOLD-Grade Specific Disease Characterization and Phenotyping of COPD Using Quantitative Computed Tomography in the Nationwide COSYCONET Multicenter Trial in Germany.","authors":"Philip Konietzke, Oliver Weinheimer, Simon M F Triphan, Sebastian Nauck, Felix Wuennemann, Marilisa Konietzke, Bertram J Jobst, Rudolf A Jörres, Claus F Vogelmeier, Claus P Heussel, Hans-Ulrich Kauczor, Jürgen Biederer, Mark O Wielpütz","doi":"10.1159/000540781","DOIUrl":"10.1159/000540781","url":null,"abstract":"<p><strong>Introduction: </strong>The aim of this study was to apply quantitative computed tomography (QCT) for GOLD-grade specific disease characterization and phenotyping of air-trapping, emphysema, and airway abnormalities in patients with chronic obstructive pulmonary disease (COPD) from a nationwide cohort study.</p><p><strong>Methods: </strong>As part of the COSYCONET multicenter study, standardized CT in ex- and inspiration, lung function assessment (FEV1/FVC), and clinical scores (BODE index) were prospectively acquired in 525 patients (192 women, 327 men, aged 65.7 ± 8.5 years) at risk for COPD and at GOLD1-4. QCT parameters such as total lung volume (TLV), emphysema index (EI), parametric response mapping (PRM) for emphysema (PRMEmph) and functional small airway disease (PRMfSAD), total airway volume (TAV), wall percentage (WP), and total diameter (TD) were computed using automated software.</p><p><strong>Results: </strong>TLV, EI, PRMfSAD, and PRMEmph increased incrementally with each GOLD grade (p < 0.001). Aggregated WP5-10 of subsegmental airways was higher from GOLD1 to GOLD3 and lower again at GOLD4 (p < 0.001), whereas TD5-10 was significantly dilated only in GOLD4 (p < 0.001). Fifty-eight patients were phenotyped as \"non-airway non-emphysema type,\" 202 as \"airway type,\" 96 as \"emphysema type,\" and 169 as \"mixed type.\" FEV1/FVC was best in \"non-airway non-emphysema type\" compared to other phenotypes, while \"mixed type\" had worst FEV1/FVC (p < 0.001). BODE index was 0.56 ± 0.72 in the \"non-airway non-emphysema type\" and highest with 2.55 ± 1.77 in \"mixed type\" (p < 0.001).</p><p><strong>Conclusion: </strong>QCT demonstrates increasing hyperinflation and emphysema depending on the GOLD grade, while airway wall thickening increases until GOLD3 and airway dilatation occur in GOLD4. QCT identifies four disease phenotypes with implications for lung function and prognosis.</p>","PeriodicalId":21048,"journal":{"name":"Respiration","volume":" ","pages":"133-150"},"PeriodicalIF":3.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142036822","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":"Impact of the COVID-19 Pandemic on Home Mechanical Ventilation in Germany: A Descriptive Observational Study.","authors":"Sarah Bettina Stanzel, Maximilian Wollsching-Strobel, Daniel Sebastian Majorski, Doreen Kroppen, Melanie Patricia Berger, Falk Schumacher, Johannes Fabian Holle, Maximilian Zimmermann, Wolfram Windisch","doi":"10.1159/000541083","DOIUrl":"10.1159/000541083","url":null,"abstract":"<p><strong>Introduction: </strong>Over the last decade, the number of patients receiving home mechanical ventilation (HMV) has increased significantly, which has led to a limited availability of specialist centres, not least due to the scarcity of healthcare professionals. This situation was exacerbated by the COVID-19 pandemic. It is therefore assumed that the repurposing of resources has led to an aggravated change in the healthcare structure in HMV.</p><p><strong>Methods: </strong>This descriptive observational study analysed the Operation and Procedure Classification Codes for patients receiving HMV from 2008 to 2022. The data were provided by the Federal Statistical Office of Germany. Data were additionally analysed with respect to geographical distribution and ventilation status.</p><p><strong>Results: </strong>A total of 737,770 datasets were analysed (mean age in 2020: 66.5 years). There was a steady increase in HMV initiations (+6%) and controls (+9%) per year before the pandemic (2008-2019). Patient admissions during the pandemic revealed a 28% decrease, with the largest decrease in invasive ventilation (IV) follow-up visits (2019: 3,053; 2020: 2,199; -39%), while the number of IV initiations remained stable. There was a 19% decrease in the number of non-IV initiations in 2020 (16,919 vs. 14,227) and a 32% decrease in the number of follow-ups (45,812 vs. 34,813) in comparison with 2019.</p><p><strong>Conclusion: </strong>The pandemic has led to a significant decline of inpatient admissions for patients receiving HMV. This decline was most pronounced in the first year of the pandemic. Control visits in particular did not reach the pre-pandemic level. This is an indication of the ongoing change in the healthcare landscape as a result of the pandemic.</p>","PeriodicalId":21048,"journal":{"name":"Respiration","volume":" ","pages":"77-84"},"PeriodicalIF":3.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142140912","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":"And the Author Is … ChatGPT.","authors":"Felix J F Herth","doi":"10.1159/000542986","DOIUrl":"10.1159/000542986","url":null,"abstract":"","PeriodicalId":21048,"journal":{"name":"Respiration","volume":" ","pages":"229-230"},"PeriodicalIF":3.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142802096","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 Diagnostic and Therapeutic Odyssey in Pulmonary Arterial Hypertension: Insights from In-Depth Semi-Structured Interviews.","authors":"Emilia M Swietlik, Michaela Fay, Nicholas W Morrell","doi":"10.1159/000540556","DOIUrl":"10.1159/000540556","url":null,"abstract":"<p><strong>Introduction: </strong>Establishing a diagnosis is paramount in medical practice as it shapes patients' experiences and guides treatment. Patients grappling with rare diseases face a triple challenge: prolonged diagnostic journeys, limited responses to existing therapies, and the absence of effective monitoring tools. Genetic diagnosis often provides crucial diagnostic and prognostic information, opening up possibilities for genotype-targeted treatments and facilitating counselling and relative testing. The NIHR BioResource - Rare Diseases (NBR) Study and the Cohort Study in Idiopathic and Hereditary Pulmonary Arterial Hypertension (PAH Cohort study) aimed to enhance diagnosis and treatment for PAH, successfully identifying the genetic cause in 25% of idiopathic cases. However, the diagnostic and therapeutic odyssey in patients with PAH remains largely unexplored.</p><p><strong>Methods: </strong>Stakeholders from the NBR and PAH Cohort studies were recruited using purposive sampling. In-depth interviews and focus groups were recorded, transcribed, anonymised, and analysed thematically using MAXQDA software.</p><p><strong>Results: </strong>The study involved 53 interviews and focus groups with 63 participants, revealing key themes across five stages of the diagnostic odyssey: initial health concerns and interactions with general practitioners, experiences of misdiagnosis, relief upon receiving the correct diagnosis, and mixed emotions regarding genetic results and the challenges of living with the disease. Following the diagnosis, participants embarked on a therapeutic journey, facing various challenges, including the disease's impact on professional and social lives, the learning curve associated with understanding the disease, shifts in communication dynamics with healthcare providers, therapeutic hurdles, and insurance-related issues. Building on these insights, we identified areas of unmet needs, such as improved collaboration with primary care providers and local hospitals, the provision of psychological support and counselling, and the necessity for ongoing patient education in the ever-evolving realms of research and therapy.</p><p><strong>Conclusions: </strong>The study highlights the significant challenges encountered throughout the diagnostic and therapeutic journey in PAH. To enhance patient outcomes, it is crucial to raise awareness of the disease, establish clear diagnostic pathways, and seamlessly integrate genetic diagnostics into clinical practice. Streamlining the diagnostic process can be achieved by utilising existing clinical infrastructure to support research and fostering better communication within the NHS. Moreover, there is an urgent need for more effective therapies alongside less burdensome drug delivery methods.</p>","PeriodicalId":21048,"journal":{"name":"Respiration","volume":" ","pages":"26-39"},"PeriodicalIF":3.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142294147","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":"Prevalence, Clinical Features, and Outcomes of Young Patients with Idiopathic Pulmonary Fibrosis.","authors":"Jeewon Lee, Kyung Joo Kim, Jung Hyun Nam, Joon Young Choi, Chin Kook Rhee, Yong Suk Jo","doi":"10.1159/000541692","DOIUrl":"10.1159/000541692","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;Idiopathic pulmonary fibrosis (IPF) can occur at any age; however, studies on younger IPF patients are scarce because it primarily affects the elderly. This study aimed to investigate the clinical features and outcomes of younger IPF patients.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We analyzed the National Korean Health Insurance Review and Assessment Service (HIRA) database from 2015 to 2021. Patients with IPF were identified using the International Classification of Diseases 10th Revision (ICD-10) codes and the Rare Intractable Diseases codes and were categorized into three age groups: &lt;50, ≥50 and &lt;65, and ≥65 years. The risk of acute exacerbation (AE) and mortality was analyzed.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Among 4,243 patients with IPF, 91 were under 50. These younger patients, who were predominantly female, exhibited less comorbidities and received more systemic steroids, whereas older group received more pirfenidone. Although AE risk increased with age, it was not statistically significant. Mortality and lung transplantation risks increased notably with age from the &lt;50 group to the ≥50 and &lt;65 group (hazard ratio [HR]: 1.52, 95% confidence interval [CI]: 0.93-2.49) and the ≥65 group (HR: 2.44, 95% CI: 1.51-3.93). These risks were influenced by factors such as age, comorbidities, previous AEs, and steroid use. Conversely, pirfenidone treatment reduced the risk.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;While younger IPF patients had a lower risk of mortality and lung transplantation, with no significant differences in the risk of AEs, they were less likely to receive antifibrotic therapy and more often treated with steroids, which may affect outcomes. Early, targeted treatment strategies, including antifibrotic use, are crucial for improving their prognosis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;Idiopathic pulmonary fibrosis (IPF) can occur at any age; however, studies on younger IPF patients are scarce because it primarily affects the elderly. This study aimed to investigate the clinical features and outcomes of younger IPF patients.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We analyzed the National Korean Health Insurance Review and Assessment Service (HIRA) database from 2015 to 2021. Patients with IPF were identified using the International Classification of Diseases 10th Revision (ICD-10) codes and the Rare Intractable Diseases codes and were categorized into three age groups: &lt;50, ≥50 and &lt;65, and ≥65 years. The risk of acute exacerbation (AE) and mortality was analyzed.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Among 4,243 patients with IPF, 91 were under 50. These younger patients, who were predominantly female, exhibited less comorbidities and received more systemic steroids, whereas older group received more pirfenidone. Although AE risk increased with age, it was not statistically significant. Mortality and lung transplantation risks increased notably with age from the &lt;50 group to the ≥50 and &lt;65 group (hazard ratio [HR]: 1.5","PeriodicalId":21048,"journal":{"name":"Respiration","volume":" ","pages":"176-187"},"PeriodicalIF":3.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11887994/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142606187","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Current Status and Future Directions of Research on Artificial Intelligence in Nasopharyngolaryngoscopy.","authors":"Cui Fan, Xiangwan Miao, Xingmei Sun, Yiming Zhong, Bin Liu, Mingliang Xiang, Bin Ye","doi":"10.1159/000542362","DOIUrl":"10.1159/000542362","url":null,"abstract":"<p><strong>Background: </strong>The nasopharyngolaryngoscopy (NPL) has emerged as a valuable tool for detecting early cases of head and neck cancers. However, misdiagnoses and missed diagnoses are still common phenomena. The expertise of examining physicians often serves as the primary limiting factor, leading to issues such as incomplete visualization, imprecise identification, and unclear vision. Over recent years, the application of artificial intelligence (AI) in medical imaging, particularly in the realm of gastrointestinal endoscopy, has instigated revolutionary changes in site quality control, lesion identification, and report generation. However, there remains a lack of standardized guidelines for the proper application of NPL across various countries.</p><p><strong>Summary: </strong>In this paper, we set our sights on reviewing the current clinical applications and summarizing the primary shortcomings of NPL. In addition, we encapsulate the progress of AI application within gastrointestinal endoscopy and NPL. Drawing from real-world clinical practice, we propose future directions and prospects for AI research in NPL. We firmly believe that the pace of clinical application of AI in NPL will accelerate significantly in the near future.</p><p><strong>Key messages: </strong>Incomplete examination coverage, failure to detect and diagnose lesions, and poor image quality happens in the current use of NPL. Currently, NPL examinations lack third-party supervision and quality control. AI application has achieved great advancements in gastrointestinal endoscopy concerning endoscopic quality control, lesion identification, and standardized reporting. While AI-related research in NPL is still in its nascent stages, it shows substantial potential for clinical application and endoscopic training. The interaction of AI into NPL examinations is potential and inevitable in the era of big data.</p>","PeriodicalId":21048,"journal":{"name":"Respiration","volume":" ","pages":"255-263"},"PeriodicalIF":3.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142771899","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":"Successful Bronchoscopic Lung Volume Reduction with New Lung Tensioning Device Coil: A Case Report.","authors":"Jonas Herth, Jasmin Wani, Daniel Franzen","doi":"10.1159/000540286","DOIUrl":"10.1159/000540286","url":null,"abstract":"<p><strong>Introduction: </strong>Bronchoscopic lung volume reduction (BLVR) using endobronchial coil treatment is a widely studied therapeutic option in patients with end-stage chronic obstructive pulmonary disease (COPD) and pulmonary emphysema. However, patient responses were inconsistent, and, from 2020, production discontinuation rendered the treatment unavailable. In the meantime, a next-generation lung tensioning coil (FreeFlow Coil 4; FreeFlow Medical, Inc., Fremont, CA, USA) has been developed by the inventor of the lung volume reduction coil implant technology. This case study presents the first documented successful BLVR using FreeFlow Coils 4.</p><p><strong>Case presentation: </strong>A 68-year-old male patient with COPD, classified as Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage 3, and homogenous emphysema with incomplete interlobar fissures was treated using the new developed FreeFlow Coil 4 in both upper lobes. Apart from a suspected coil-associated opacity, no adverse events occurred. At the 18-week follow-up, a significant improvement in lung function and quality of life was observed, as measured by forced expiratory volume in 1 s (+150 mL), residual volume (-0.50 L), 6-min walking distance (+75 m), and the total score of the St. George's Respiratory Questionnaire (SGRQ) (-35 points).</p><p><strong>Conclusion: </strong>BLVR with FreeFlow Coils 4 has shown promising outcomes, significantly improving both pulmonary function and quality of life in 1 patient. However, larger studies and randomized controlled trials are imperative to investigate the efficacy and safety profile of the new coil system.</p>","PeriodicalId":21048,"journal":{"name":"Respiration","volume":" ","pages":"72-76"},"PeriodicalIF":3.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141760651","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":"Poor Correlation between Diaphragm Ultrasound and Invasive Gold Standard Technique Derived Respiratory Muscle Strength Assessment in Patients after Hospitalisation for COVID-19.","authors":"Janina Friedrich, Binaya Regmi, Benedikt Jörn, Mehdi Senol, Alberto Giannoni, Matthias Boentert, Florian Kahles, Ayham Daher, Michael Dreher, Jens Spiesshoefer","doi":"10.1159/000541632","DOIUrl":"10.1159/000541632","url":null,"abstract":"<p><strong>Introduction: </strong>Individuals who survive acute coronavirus disease 2019 (COVID-19) might experience diaphragm muscle weakness. Diaphragm ultrasound may be an easy-to-obtain bedside tool for determining diaphragm function. However, twitch transdiaphragmatic pressure (twPdi) following magnetic stimulation (MS) of the phrenic nerves is the gold standard for non-volitional assessment of diaphragm strength. This study investigated whether diaphragm thickening ratio (DTR) measured on diaphragm ultrasound reflects diaphragm strength as measured by twPdi following MS of the phrenic nerves or other (volitional) invasively obtained pressure values and could therefore be used to accurately diagnose diaphragm weakness.</p><p><strong>Methods: </strong>One year after discharge, 50 individuals (14 female, age 58 ± 12 years) who had been hospitalised and treated for moderate-severe COVID-19 underwent standard spirometry and diaphragm ultrasound. TwPdi following cervical MS of the phrenic nerve and volitional inspiratory manoeuvres (Sniff and Mueller manoeuvre) were measured using oesophageal and gastric balloon catheters after transnasal placement.</p><p><strong>Results: </strong>At follow-up, no clinically meaningful restrictive lung function impairment was evident on spirometry. On diaphragm ultrasound, diaphragm dysfunction, i.e., an impaired DTR was detected in 24% (12/50) of participants. An objective diagnosis of diaphragm dysfunction, defined as twPdi <16 cm H2O, was made in 60% (30/50) of participants. The measurement results of the two methods did not agree, given that there were many false-negative but also false-positive results, so diaphragm ultrasound diagnosed in parts other patients with diaphragm dysfunction than twPdi. Diaphragm ultrasound had a sensitivity of 26.67% and a specificity of 80.0% in the detection of diaphragm dysfunction (positive predictive value 66.67%, negative predictive value 42.10%).</p><p><strong>Conclusion: </strong>Diagnosis of diaphragm weakness in individuals who have recovered from COVID-19 cannot be made accurately on diaphragm ultrasound (via DTR) but requires twPdi as the gold standard for assessment of diaphragm strength.</p>","PeriodicalId":21048,"journal":{"name":"Respiration","volume":" ","pages":"231-239"},"PeriodicalIF":3.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142576812","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 Impact of Balloon Use during Endobronchial Ultrasound: A Randomized Pilot Study.","authors":"Taha Huseini, Andrew DeMaio, Lonny Yarmus, Clare Pollock, Amit Katz, Basil Nasir, Adnan Majid, Stephan Soder, Moishe Liberman","doi":"10.1159/000542448","DOIUrl":"10.1159/000542448","url":null,"abstract":"<p><strong>Introduction: </strong>During endobronchial ultrasound transbronchial needle aspiration (EBUS-TBNA), a saline-filled balloon placed over the tip of the bronchoscope is used to improve coupling of the ultrasound transducer to the airway wall. However, it is unknown whether it objectively improves image quality or affects procedural outcomes. Our aim was to establish whether the use of a balloon during EBUS impacts image quality, diagnostic yield, procedure duration or complications.</p><p><strong>Methods: </strong>A pilot randomized control trial of patients undergoing EBUS-TBNA of mediastinal lymph nodes was performed at a single academic center. Patients were randomized to use a saline-filled balloon (versus no balloon use) during EBUS-TBNA of the right lower paratracheal lymph node (station 4R). The EBUS videos were recorded and scored on a 4-point Likert scale by three blinded external reviewers. The primary outcome of this study was ultrasound image quality. Secondary outcomes included diagnostic yield, procedure duration, and complications.</p><p><strong>Results: </strong>Forty-six patients were randomized. In the balloon group, 61% of patients had an image quality score of \"excellent\" or \"good,\" compared to 47% in the no balloon group (p = 0.009). There was no significant difference in diagnostic yield, procedure duration, or complications between the groups.</p><p><strong>Conclusion: </strong>Inflation of the balloon during EBUS-TBNA at the right lower paratracheal lymph node improves ultrasound image quality but does not impact diagnostic yield, procedure duration, or safety. This study provides a framework for additional studies with complete nodal assessment to determine if balloon use has a clinically meaningful benefit to procedural outcomes.</p>","PeriodicalId":21048,"journal":{"name":"Respiration","volume":" ","pages":"272-280"},"PeriodicalIF":3.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142668806","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}