Respiration最新文献

{"title":"Comparison of Mycobacterial Culture Yield from Pleural Tissue Using Pleuroscopic Cryobiopsy versus Forceps Biopsy in Patients with Tuberculous Pleurisy.","authors":"Che-Chia Chang, Li-Chung Chiu, Wei-Chun Lee, Shu-Yi Huang, Chih-Hao Chang, Fu-Tsai Chung, Shih-Hong Li, Meng-Heng Hsieh, Meng-Jer Hsieh, Shu-Min Lin, Horng-Chyuan Lin, Chih-Wei Wang, Chung-Shu Lee","doi":"10.1159/000551717","DOIUrl":"10.1159/000551717","url":null,"abstract":"<p><strong>Introduction: </strong>The diagnostic yield of mycobacterial culture from pleural tissue in tuberculous pleurisy is high and practical. However, the yield rates of mycobacterial culture from pleural tissue obtained through different pleural biopsy techniques via medical pleuroscopy remain unclear. This study aimed to compare the efficiency of mycobacterial culture from pleural tissue obtained by cryobiopsy and forceps biopsy during medical pleuroscopy for diagnosing tuberculous pleurisy.</p><p><strong>Methods: </strong>This retrospective study included 84 patients with tuberculous pleurisy who underwent mycobacterial culture testing using pleural tissue samples. Of these, 33 patients underwent pleuroscopic cryobiopsy and 51 underwent pleuroscopic forceps biopsy from April 2016 to December 2023 at two tertiary hospitals. Mycobacterial cultures from pleural tissue obtained by cryobiopsy and forceps biopsy were analyzed.</p><p><strong>Results: </strong>The average age of the participants was 67.1 years, with 67.9% being men. The sensitivity of Mycobacterium tuberculosis (MTB) cultures from pleural tissue was 54.5% (18/33) for cryobiopsy and 62.7% (32/51) for forceps biopsy (p = 0.455). The sensitivity of MTB culture was higher, up to 64.4% and 74.2%, in cases with pleural adhesion lesions and a combination of adhesion lesions and micronodules, respectively.</p><p><strong>Conclusion: </strong>There was no significant difference in the yield rate of MTB culture obtained by cryobiopsy or forceps biopsy in cases of undiagnosed pleural effusion during pleuroscopy. When tuberculous pleurisy is suspected, forceps biopsy may be the optimal method for obtaining mycobacterial cultures from pleural tissue.</p>","PeriodicalId":21048,"journal":{"name":"Respiration","volume":" ","pages":"1-10"},"PeriodicalIF":3.8,"publicationDate":"2026-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147532496","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":"Enhancing Cough Capacity: The Unseen Benefits of Active-Passive Lower Limb Training in Patients with Tracheostomy ‑ A Randomized Controlled Trial.","authors":"Ranran Xing, Lihua Jin, Yu Sun, Fei Yu, Yunhao Zhang, Xiaoyi Li, Liangjina Hu, Liqing Yao, Huai Huang","doi":"10.1159/000551647","DOIUrl":"10.1159/000551647","url":null,"abstract":"<p><strong>Introduction: </strong>Challenges associated with decannulation following tracheostomy frequently arise from diminished cough efficacy. Active-passive lower limb training is a rehabilitative strategy that is commonly employed but insufficiently studied in this context. This study aimed to assess the effectiveness of active-passive lower limb training in potentially enhancing diaphragm engagement, thereby improving cough capacity in tracheostomized patients with central nervous system injuries.</p><p><strong>Methods: </strong>A total of 36 patients were enrolled in this study and stratified into three groups (n = 12) for a 14-day intervention assessment. Utilizing a randomized crossover design combine with a control group. In intervention groups, participants were allocated to one of two intervention sequences: (1) the CA sequence, which involved an initial phase of active-passive lower limb training followed by an additional physiotherapy (PT) course; or (2) the AC sequence, which applied these interventions in the reverse order. A standard care control group (Con) was monitored for an equivalent duration. Assessments were conducted on days 1, 7, and 14. Primary and secondary outcomes included peak cough flow (PCF), Glasgow Coma Scale score, and ultrasound-derived measurements of cough-related respiratory muscle thickness.</p><p><strong>Results: </strong>All groups showed significantly improved PCF post-intervention (p = 0.011, 0.007, 0.007). Active-passive lower limb training led to a greater PCF increase compared to additional PT or standard care (p = 0.011). Both interventions increased parasternal intercostal muscle thickness (p < 0.05).</p><p><strong>Conclusions: </strong>Active-passive lower limb training significantly improved cough capacity in tracheostomized patients with CNS injuries, being as effective as additional PT and potentially reducing staffing needs. This intervention is a promising approach to enhance cough effectiveness in tracheostomy patients.</p>","PeriodicalId":21048,"journal":{"name":"Respiration","volume":" ","pages":"1-12"},"PeriodicalIF":3.8,"publicationDate":"2026-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147514415","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":"Safety and Feasibility of the Lung Volume Reduction Reverser System in Patients with Severe Emphysema: A First-in-Human Pilot Study.","authors":"A Susanne Dittrich, Judith Maria Brock, Claus-Peter Heussel, Felix J F Herth, Ralf Eberhardt, Konstantina Kontogianni","doi":"10.1159/000551022","DOIUrl":"10.1159/000551022","url":null,"abstract":"<p><strong>Introduction: </strong>Endoscopic lung volume reduction with coils is a symptomatic treatment approach for patients with severe pulmonary emphysema and positive collateral ventilation. In this study, we evaluated the safety and feasibility of the new Lung Volume Reduction Reverser (LVR-R) system.</p><p><strong>Methods: </strong>Prospective, nonrandomized, exploratory, single-center, first-in-man study in 15 patients with chronic obstructive pulmonary disease (COPD) and severe emphysema. Most affected lung lobes were treated sequentially with the LVR-R coils from May 2019 to JUL 2022. Pulmonary function, 6-min walking distance (6-MWD), questionnaires and adverse events were recorded from baseline to 1-year post-procedure. Computer tomography was acquired at baseline and 6 months.</p><p><strong>Results: </strong>A total of 28 procedures were performed, in which 10 (n = 22, 78.6%), 9 (n = 2, 7.1%), or 8 (n = 4, 14.3%) LVR-R coils were implanted, predominantly in the upper lobes (n = 26/28, 92.86%). Two patients refused a second treatment, one of whom refused follow-ups. Adverse events at 3 months included severe pneumonia and/or COPD exacerbations (n = 7), ventilatory failure (n = 2) and 1 pneumothorax requiring thoracic drainage. Mild hemoptysis occurred in 18 and mild pneumonia and/or COPD exacerbations in 9 patients. Overall, neither FEV₁, residual volume, 6-MWD, CAT nor mMRC improved within 1-year (n.s. all). In 2 patients, response in FEV1 >500 mL occurred.</p><p><strong>Conclusion: </strong>In this severely diseased and small patient cohort, LVR-R implantation was technically feasible. The complication rate was similar to other coil studies and requires a careful pre-procedure benefit-risk evaluation. Two of fourteen bilaterally treated individuals demonstrated a notable improvement in lung function.</p>","PeriodicalId":21048,"journal":{"name":"Respiration","volume":" ","pages":"1-11"},"PeriodicalIF":3.8,"publicationDate":"2026-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147514441","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":"High-Frequency Chest Wall Oscillation in Critical Care: A Systematic Review.","authors":"Simone Ielo, Lorenzo Carriera, Roberto Barone, Pier-Valerio Mari, Angelo Coppola, Stefano Baglioni, Luca Richeldi, Raffaele Scala","doi":"10.1159/000551711","DOIUrl":"10.1159/000551711","url":null,"abstract":"<p><strong>Introduction: </strong>Airway secretion retention represents a major clinical challenge in critically ill patients, promoting gas exchange impairment and atelectasis, precipitating failure of noninvasive respiratory support, and prolonging invasive mechanical ventilation, with an associated increase in respiratory-related complications and mortality. High-frequency chest wall oscillation (HFCWO) is a noninvasive airway clearance technique widely used in chronic respiratory diseases, but its role in the intensive care unit (ICU) remains unclear. This systematic review aimed to evaluate the available evidence on the efficacy and safety of HFCWO in adult ICU patients.</p><p><strong>Methods: </strong>A systematic literature search was conducted in PubMed/MEDLINE, Embase, and Cochrane Library from inception to December 2025 in accordance with PRISMA guidelines. Studies evaluating HFCWO in adult ICU patients, including those receiving invasive or noninvasive respiratory support, were eligible. Primary outcomes included duration of mechanical ventilation, ICU length of stay, and mortality. Secondary outcomes included impact on secretion airway clearance and its radiographic/functional surrogates as well as safety and treatment tolerance.</p><p><strong>Results: </strong>A limited number of studies met the inclusion criteria, mainly small randomized controlled trials and observational studies, characterized by substantial heterogeneity in patient populations, intervention protocols, and assessed outcomes. HFCWO effects on clinically meaningful primary endpoints, including duration of mechanical ventilation, length of ICU stay, and mortality, remain variable and inconclusive. Overall, HFCWO was well tolerated and appeared to enhance secretion clearance, with some studies reporting modest improvements in oxygenation and respiratory mechanics.</p><p><strong>Conclusions: </strong>Current evidence suggests that HFCWO is a safe and feasible airway clearance strategy in selected ICU patients with secretion burden and without proved effects on the main clinical outcomes. Lack of physiopathologically driven criteria for selection of patients more likely to respond to HFCWO either alone or integrated with other cough-assisting techniques may partially explain these scanty findings from the overall published studies. This precludes its routine use in clinical practice. Well-designed, adequately powered randomized trials are needed to define patient selection criteria, optimal timing, and the true clinical impact of HFCWO in the ICU setting.</p>","PeriodicalId":21048,"journal":{"name":"Respiration","volume":" ","pages":"1-13"},"PeriodicalIF":3.8,"publicationDate":"2026-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147514381","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":"Virtual Reality versus Augmented Reality Bronchoscopy Simulation-Based Training: A Randomised Controlled Trial to Compare Navigation Performance and Cognitive Load in Novice Bronchoscopists.","authors":"Aditi Naik, Kristoffer M Cold, Kaladerhan O Agbontaen, Lars Konge, Suveer Singh","doi":"10.1159/000551106","DOIUrl":"10.1159/000551106","url":null,"abstract":"<p><strong>Introduction: </strong>Flexible bronchoscopy is an essential procedural skill to master for the management of respiratory illness. Bronchoscopy simulators hasten the attainment of competencies. Whether augmented reality (AR) offers advantages over virtual reality (VR) during training is unknown. We tested this premise in novice bronchoscopists by assessing end-of-training performance after mastery learning on either simulator.</p><p><strong>Methods: </strong>This is a single-centre, single-blinded, randomised control trial. Thirty bronchoscopists were randomised to a VR (n = 15) or AR (n = 15) simulator training group. Each had up to 2 h to practice full (diagnostic completeness [DC]/18 segments), orderly (structured progress [SP]), and timely (procedure time [PT]) segmental navigation using pre-defined mastery learning protocols. Experts assessed recorded complete test bronchoscopies on 2 different endobronchial airway training models (BronchoBoy®, Koken). Cognitive load during training was compared.</p><p><strong>Results: </strong>The VR group outperformed the AR group in the first test (BronchoBoy), marginally for DC (median difference, p value) (1, p = 0.0022) but not SP (1, 0.6887), PT (46 s, 0.8119), or mean intersegmental time (MIT) (2.15 s, 0.9760). In the second test (Koken), the AR group (trained on the Koken) was faster PT (-48 s, 0.0377) but no different from VR in DC, SP, or MIT. The VR group trained for more time than AR (90+/-30 min vs. 80+/-30 min, p = 0.0468). The VR group had a significantly lower mental demand in training than AR (median difference, p value) (15 NASA-TLX points, p = 0.023) but higher physical demand score (35 NASA-TLX points, p = 0.004).</p><p><strong>Conclusion: </strong>Training by novices on VR or AR bronchoscopy simulators led to thorough, timely, and moderately ordered test segmental navigation. VR training portended high and slightly more thorough navigation, with lower mental but higher physical demand and longer time-spent-training. Further comparative studies of VR and AR bronchoscopic skills training should seek preferential and predictive factors for optimal clinical proficiency.</p>","PeriodicalId":21048,"journal":{"name":"Respiration","volume":" ","pages":"1-10"},"PeriodicalIF":2.6,"publicationDate":"2026-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13221171/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147491663","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":"Towards Personalised Screening for Lung Cancer: A Sex-Stratified Approach in a Danish Cohort Integrating Pre-Diagnostic Systemic Inflammatory Indexes with Smoking Status and Age.","authors":"María Del Pilar Fernández Montejo, Uffe Bodtger, Randi Jepsen, Søren Lophaven, Ioannis Fotopoulos, Oluf Dimitri Røe, Zaigham Saghir","doi":"10.1159/000551648","DOIUrl":"10.1159/000551648","url":null,"abstract":"<p><strong>Introduction: </strong>Sex disparities in lung cancer risk assessment may lead to inequities in screening eligibility. Criteria based on smoking history and age can underrepresent women. Systemic inflammatory indexes derived from routine blood tests are potential biomarkers in cancer risk assessment. We investigated the association between systemic inflammatory indexes and lung cancer risk, stratified by sex, in a Danish cohort.</p><p><strong>Methods: </strong>We conducted a population-based cohort study using data from the Lolland-Falster Health Study (LOFUS) linked to the Danish Pathology Data Bank (Patobank). Participants aged 40-74 years without a history of lung cancer were included. We calculated four systemic inflammatory indexes and assessed their association with lung cancer using logistic regression models adjusted for age, sex, and smoking status. Optimal cut-off points were determined using the Youden index. Bootstrapping was applied for internal validation.</p><p><strong>Results: </strong>Among 10,887 participants with complete data, 58 (0.53%) were diagnosed with lung cancer during a maximum follow-up period of 6.6 years. High levels of all four inflammatory indexes were associated with increased lung cancer risk. Sex-stratified analyses revealed stronger associations between Neutrophil-to-Lymphocyte Ratio (NLR) and Systemic Immune Inflammatory Index (SII) and lung cancer in men, and between C-reactive protein to albumin ratio (CAR) and lung cancer in women. Model discrimination improved after adding inflammatory indexes.</p><p><strong>Conclusion: </strong>Our findings support sex-specific lung cancer risk assessment and personalised screening strategies. Pre-diagnostic inflammatory indexes may serve as biomarkers to complement existing screening criteria. Further research is needed to validate their potential in improving lung cancer prediction models.</p>","PeriodicalId":21048,"journal":{"name":"Respiration","volume":" ","pages":"1-14"},"PeriodicalIF":2.6,"publicationDate":"2026-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13252921/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147491694","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":"Management of Adult Bronchiectasis: Consensus-Based Guidelines of the German Respiratory Society.","authors":"Felix C Ringshausen, Ingo Baumann, Andrés de Roux, Sabine Dettmer, Roland Diel, Monika Eichinger, Santiago Ewig, Holger Flick, Leif Gunnar Hanitsch, Thomas Hillmann, Rembert Koczulla, Michael Köhler, Assen Koitschev, Christian Kugler, Thomas Nüsslein, Sebastian R Ott, Isabell Pink, Mathias Pletz, Gernot Rohde, Ludwig Sedlacek, Hortense Slevogt, Urte Sommerwerck, Sivagurunathan Sutharsan, Sönke von Weihe, Tobias Welte, Michael Wilken, Pontus Mertsch, Jessica Rademacher","doi":"10.1159/000551643","DOIUrl":"10.1159/000551643","url":null,"abstract":"<p><p>Bronchiectasis is a chronic, often progressive respiratory disease characterized by irreversible dilation of the bronchi. It is etiologically heterogeneous and frequently associated with a significant symptom burden, multiple complications, and reduced quality of life. In recent years, the global prevalence of bronchiectasis has increased markedly, placing a substantial economic burden on healthcare systems. These consensus-based guidelines are the first German-language guidelines focused on the management of bronchiectasis in adults. They underscore the critical role of thoracic imaging - particularly computed tomography - in diagnosing and distinguishing bronchiectasis and highlight the importance of identifying the underlying etiology in guiding treatment decisions. The guidelines provide comprehensive recommendations for both pharmacological and non-pharmacological treatment strategies. Non-drug interventions include smoking cessation, physiotherapy, physical training, pulmonary rehabilitation, noninvasive ventilation, thoracic surgery, and lung transplantation. Pharmacological therapies emphasize the long-term use of mucolytics, bronchodilators, anti-inflammatory agents, and antibiotics. In addition, the guidelines address the management of upper airway involvement, common comorbidities, and acute exacerbations. They also cover sociomedical issues, disability rights, and the role of patient education and self-management in optimizing care. Special life stages - such as transition from pediatric to adult care, family planning, pregnancy, parenthood, and palliative care - are also considered. The overarching goal was to promote comprehensive, consensus-driven, and patient-centered care that accounts for individual risks and needs.</p>","PeriodicalId":21048,"journal":{"name":"Respiration","volume":" ","pages":"1-73"},"PeriodicalIF":2.6,"publicationDate":"2026-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13278716/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147491647","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":"Determinants of Fractional Exhaled Nitric Oxide in a Population-Based Cohort: The Role of Lung Volumes and Body Composition.","authors":"Charmaine J M Lim, Oliver Helk, Florian Krach, Alina Ofenheimer, Tobias L Mraz, Frits M E Franssen, Emiel F M Wouters, Robab Breyer-Kohansal, Marie-Kathrin Breyer","doi":"10.1159/000551192","DOIUrl":"10.1159/000551192","url":null,"abstract":"<p><strong>Introduction: </strong>Fractional exhaled nitric oxide (FeNO) is a clinically utilised marker of type 2 airway inflammation and is used to guide treatment in asthma. We aimed to resolve the ongoing scientific debate, whether FeNO is affected by obesity-related changes in inflammation and airway architecture.</p><p><strong>Methods: </strong>We assessed the association of FeNO levels with obesity markers and lung function parameters in 1,205 respiratory-healthy adult participants (43.1% males) aged 18-82 years from the Austrian LEAD cohort with mean body mass index (BMI) of 26.4 ± 4.7 kg/m2. Sensitivity analyses were conducted in the respiratory-healthy obese subpopulation (n = 230).</p><p><strong>Results: </strong>Median FeNO levels were 16.0 (interquartile range [IQR]: 12.0-23.0; 95th percentile: 34.0) ppb in the respiratory-healthy any-weight population, with higher levels reported in the respiratory-healthy obese (17.5 [IQR: 12.0-23.0] ppb; 95th percentile: 35.0 ppb) population. Unadjusted multiple regression analyses showed that BMI; fat mass index, visceral adipose tissue index (VATI), and appendicular lean mass index; and residual volume (RV) %predicted were associated with higher FeNO levels in respiratory-healthy any-weight individuals. In obese respiratory-healthy individuals, only VATI showed statistically significant association with FeNO. After adjusting for the confounders such as age, sex, and smoking status, all assessed parameters lost their significance in the assessed populations except for RV- and total lung capacity Z-scores, although at low effect size.</p><p><strong>Conclusion: </strong>Our results demonstrate no independent effect of obesity markers on FeNO levels after adjustments for age, sex, and smoking status.</p>","PeriodicalId":21048,"journal":{"name":"Respiration","volume":" ","pages":"1-16"},"PeriodicalIF":3.8,"publicationDate":"2026-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147491645","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 Montafon Proposal: New Insights and Emerging Concepts in Pulmonary Rehabilitation.","authors":"Peter Alter, Swantje Beyer, Michael J Fischer, Rainer Gloeckl, Vincent Grote, Andreas R Koczulla, Astrid Lampe, Judith Löffler Ragg, Andreas Erwin Mühlbacher, Stephanie Saxer, Tessa Schneeberger, Thomas Sigrist, Marc Spielmanns, Claus Franz Vogelmeier, Florence Boulmé, Karin Vonbank, Ralf Harun Zwick","doi":"10.1159/000551191","DOIUrl":"10.1159/000551191","url":null,"abstract":"<p><strong>Background: </strong>Pulmonary rehabilitation (PR) is beneficial, yet outcome assessment remains inconsistent. A multidisciplinary D-A-CH working group reviewed evidence, introduced new measures, and explored emerging PR concepts.</p><p><strong>Summary: </strong>The meeting emphasized patient-reported and clinician-reported outcome measures. A key focus was the minimal clinically important difference (MCID), a widely used metric which is applied inconsistently and is highly dependent on the baseline value. The \"performance score\" (T2D = T2 + (T2-T1)) takes baseline status (T1) into account by combining the discharge value (T2) with the improvement (T2-T1) before and after treatment, based on the distribution. This simple descriptive approach results in a baseline-adjusted MCID estimator, with a planned multicenter study to validate its use in chronic obstructive pulmonary disease rehabilitation. Further discussions addressed epistemic trust, crucial for patient adherence and interdisciplinary collaboration, with a study planned to assess its impact. Dysfunctional breathing (DB), often overlooked in PR, was highlighted, emphasizing the need for standardized diagnostic tools. The role of artificial intelligence (AI) in PR, including large language models, was explored, with surveys planned to evaluate patient and provider perceptions.</p><p><strong>Key messages: </strong>The T2D performance score offers a dynamic approach to assessing PR progress, addressing MCID limitations. Standardized methods for epistemic trust and DB diagnosis are essential for better recognition and management. AI integration in PR presents opportunities for personalized rehabilitation but requires further evaluation. The D-A-CH working group remains committed to advancing PR through evidence-based strategies and international collaboration.</p>","PeriodicalId":21048,"journal":{"name":"Respiration","volume":" ","pages":"1-9"},"PeriodicalIF":3.8,"publicationDate":"2026-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147475116","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":"Value of Endobronchial Ultrasound-Derived Radiomics in Differentiating Pulmonary Sarcoidosis from Mediastinal Lymph Node Tuberculosis.","authors":"Quncheng Zhang, Mengyu Zhao, Feifei Wen, Xiangnan Li, Huizhen Yang, Haiyang Liu, Felix J F Herth, Wenjia Hu, Xiaoju Zhang","doi":"10.1159/000551556","DOIUrl":"10.1159/000551556","url":null,"abstract":"<p><strong>Introduction: </strong>The aim of the study was to explore the feasibility of an ultrasound radiomics machine-learning model based on endobronchial ultrasound (EBUS) for differentiating pulmonary sarcoidosis from mediastinal lymph node tuberculosis.</p><p><strong>Methods: </strong>Clinical characteristics and ultrasound images from 100 patients diagnosed with pulmonary sarcoidosis and 70 diagnosed with mediastinal lymph node tuberculosis were collected. Statistical analysis was performed to compare clinical features, such as age, sex, smoking history, and lymph node size, between the two groups. The least absolute shrinkage and selection operator was used to analyze the radiomics features extracted from EBUS-based ultrasound images. A support vector machine (SVM) algorithm was applied to establish an EBUS-based radiomics model, and statistically significant clinical features were incorporated to optimize the model. A total of 170 lymph nodes were randomly divided into the training (n = 119) and validation (n = 51) groups, and the diagnostic performance of the model was assessed using receiver operating characteristic (ROC) curves, area under the curve (AUC), accuracy, sensitivity, and specificity.</p><p><strong>Results: </strong>Seven stable radiomics features with nonzero coefficients and four clinical features were selected as model inputs. The SVM model demonstrated great performance in both groups. In the training group, the ROC AUC of the SVM model was 0.909 (95% CI: 0.897-0.922), with 88.2% accuracy, 82.4% sensitivity, and 92.6% specificity. In the validation group, the ROC AUC was 0.917 (95% CI: 0.901-0.934), with 80.4% accuracy, 68.4% sensitivity, and 87.5% specificity.</p><p><strong>Conclusion: </strong>The SVM model based on EBUS radiomics and clinical data shows preliminary feasibility for differentiating pulmonary sarcoidosis from mediastinal lymph node tuberculosis. It may be used as an auxiliary tool in clinical practice and provides a potentially useful approach for the early diagnosis of these conditions.</p>","PeriodicalId":21048,"journal":{"name":"Respiration","volume":" ","pages":"1-12"},"PeriodicalIF":3.8,"publicationDate":"2026-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147475073","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}