Respirology最新文献

{"title":"Few-Shot Lung Cancer Classification via Electronic Nose Using Large Language Models: A Multicentre Prospective Study.","authors":"Meng-Rui Lee, Chien-Chi Huang, Joyce Yue Sun, Chang-Ru Lin, Wen-Yuan Lin, Nai-Hui Chi, Kea-Tiong Tang, Jann-Yuan Wang, Chao-Chi Ho, Jin-Yuan Shih, Chong-Jen Yu","doi":"10.1002/resp.70266","DOIUrl":"10.1002/resp.70266","url":null,"abstract":"<p><strong>Background and objective: </strong>Electronic Nose (eNose) breathprints are promising non-invasive lung cancer diagnostic tools, but cross-site validation and adaptation remain barriers to clinical applications. It remains unknown whether a natural language processing-pretrained large language model (LLM) can enable few-shot, site-specific classification of lung cancer using eNose breathprints.</p><p><strong>Methods: </strong>We collected eNose breathprints of lung cancer and non-lung cancer patients from two medical centres in Taiwan. A GPT-2-backbone LLM with parameter-efficient adaptation was compared with convolutional neural networks (CNN) trained from scratch or pretrained on CIFAR-100. Few-shot protocols (2-6 shots per class) and full-data training were evaluated.</p><p><strong>Results: </strong>We collected 432 eNose breathprints from two sites (S1 and S2). With 6 labelled samples per class (6 shots), LLM achieved an area under the curve (AUC) of 0.79 (95% CI: 0.71-0.87), sensitivity of 0.74 (0.63-0.83), and specificity of 0.77 (0.67-0.87) on S1. On S2, it achieved an AUC of 0.76 (0.69-0.82), sensitivity of 0.77 (0.69-0.84), and specificity of 0.61 (0.51-0.70). LLM outperforms scratch CNN models (S1; AUC: 0.44, p = 0.0002) (S2; AUC: 0.63, p = 0.0198) and CNN pretrained on CIFAR-100 images (S1; AUC: 0.57, p = 0.0100) and (S2; AUC: 0.61, p = 0.0248). LLM or a CNN model trained on the source site fails to improve performance after transferring to the target site for fine-tuning; for the LLM, performance even deteriorates.</p><p><strong>Conclusion: </strong>Our study demonstrates the potential of pretrained LLMs for few-shot lung cancer classification in a real-world mixed clinical cohort, reducing dependence on large training datasets.</p>","PeriodicalId":21129,"journal":{"name":"Respirology","volume":" ","pages":"912-921"},"PeriodicalIF":7.2,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13535749/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147988710","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical and Inflammatory Phenotypes During Exacerbations Predict In-Hospital Adverse Outcomes in Asthma-COPD Overlap.","authors":"Lishan Yuan, Lei Wang, Yulai Yuan, Yilai Li, Li Zhang, Ying Liu, Lei Liu, Lingyun Lu, Min Feng, Gang Wang, Shuwen Zhang, Chongyang Zhao, Qin Wang, Deying Kang, Xin Zhang","doi":"10.1002/resp.70275","DOIUrl":"10.1002/resp.70275","url":null,"abstract":"<p><strong>Background and objectives: </strong>Exacerbations of asthma-chronic obstructive pulmonary disease overlap (EACO) are associated with high mortality, yet the acute-phase heterogeneity remains poorly characterized. This study aimed to identify distinct inflammatory phenotypes of EACO during hospitalization and evaluate their associations with clinical outcomes.</p><p><strong>Methods: </strong>A prospective two-centre cohort study enrolled 2444 EACO patients (training and validation cohort). Baseline inflammatory markers and clinical data were collected. Unsupervised k-means clustering identified inflammatory phenotypes, with sensitivity analysis excluding demographic variables. In-hospital clinical outcomes (ICU admission, invasive ventilation, in-hospital mortality) were assessed. Logistic regression and causal mediation analysis evaluated phenotype-outcome associations. A nomogram was developed and validated using receiver operating characteristic curves (AUC).</p><p><strong>Results: </strong>Three distinct phenotypes were identified: Cluster T1 (neutrophil-to-lymphocyte ratio [NLR]-elevated hypoeosinophilic systemic inflammatory), Cluster T2 (eosinophilic), and Cluster T3 (eosinophil-neutrophil balanced). Cluster T1 exhibited systemic hyperinflammation (elevated white blood cell count, neutrophils, NLR, C-reactive protein (CRP), procalcitonin (PCT), and interleukin-6 (IL-6)), and the highest composite adverse outcome rate (24.2%; p < 0.001). Logistic regression revealed absolute neutrophil count (β = 0.38, p < 0.001), D-dimer (β = 0.25, p < 0.001), and absolute lymphocyte count (β = -0.41, p < 0.001) as key outcome predictors, confirmed by causal mediation analysis. The nomogram showed robust predictive performance (AUC training = 0.775; validation = 0.766).</p><p><strong>Conclusion: </strong>Inflammatory phenotypes during EACO predict differential in-hospital outcomes, with neutrophil-dominant phenotypes conferring the highest risk. Early phenotype-based risk stratification using simple blood biomarkers may guide individualized EACO management.</p>","PeriodicalId":21129,"journal":{"name":"Respirology","volume":" ","pages":"882-892"},"PeriodicalIF":7.2,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13535756/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148309367","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"GLP-1-Based Therapy for Obstructive Sleep Apnoea.","authors":"Yizhong Zheng, Brendon J Yee","doi":"10.1002/resp.70282","DOIUrl":"10.1002/resp.70282","url":null,"abstract":"","PeriodicalId":21129,"journal":{"name":"Respirology","volume":" ","pages":"866-868"},"PeriodicalIF":7.2,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13535727/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148456538","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnostic Yield of EBUS Mediastinal Cryobiopsy Versus TBNA in Suspected Lymphoproliferative Disorders: A Prospective Multicentre Study.","authors":"Yaniv Dotan, Ayal Romem, Elad Guber, Michael Kassirer, Daphne Felus, Nimrod Urtreger, Ophir Freund, Hanna A Dawood, Boaz Tiran, Doron Cohn-Schwartz, Sarah Borsekofsky, Amir Bar-Shai, Evgeni Gershman","doi":"10.1002/resp.70274","DOIUrl":"10.1002/resp.70274","url":null,"abstract":"<p><strong>Background and objectives: </strong>The diagnosis of mediastinal lymphoproliferative disorders (LPDs) is often challenging and requires histopathological assessment from large tissue samples. As a result, new diagnostic techniques have been introduced alongside the commonly used endobronchial ultrasound-guided trans-bronchial needle aspiration (EBUS-TBNA). Among them, EBUS-guided transbronchial mediastinal cryobiopsy (EBUS-TBMC) has shown promising potential, although high-quality evidence remains limited. The aim of the study was to assess the diagnostic yield of EBUS-TBMC compared with EBUS-TBNA in patients with suspected mediastinal LPDs.</p><p><strong>Methods: </strong>This prospective multicentre study enrolled patients with suspected mediastinal LPDs undergoing bronchoscopy with EBUS for mediastinal lymph node sampling. All participants had either B symptoms or a history of LPD. All patients underwent EBUS-TBNA followed by EBUS-TBMC from the same mediastinal lymph node. Final diagnoses were confirmed after a 6-month follow-up.</p><p><strong>Results: </strong>Fifty-eight patients underwent EBUS, of whom 50 completed both EBUS-TBNA and EBUS-TBMC. There were eight cases of failed EBUS-TBMC who were not included in the analysis. The most frequent diagnoses were LPDs (54%) and sarcoidosis (30%). EBUS-TBNA and EBUS-TBMC had overall diagnostic yield of 52% and 80%, respectively. Among non-diagnostic EBUS-TBNA samples, 80% were diagnostic with EBUS-TBMC (odds ratio 4.89, 95% CI 1.76-13.6). For confirmed LPDs, diagnostic yield was 41% for EBUS-TBNA and 85% for EBUS-TBMC. No major complications during or following the EBUS-TBMC were observed.</p><p><strong>Conclusion: </strong>EBUS-TBMC was superior to EBUS-TBNA and achieved a high diagnostic yield in patients with suspected mediastinal LPDs.</p>","PeriodicalId":21129,"journal":{"name":"Respirology","volume":" ","pages":"903-911"},"PeriodicalIF":7.2,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13535719/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148265906","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Thinking Outside the Box (Lungs): Airway Mucus Plugs and Extrapulmonary Manifestations of Chronic Obstructive Pulmonary Disease.","authors":"Jose M Martinez-Manzano, Alejandro A Diaz","doi":"10.1002/resp.70283","DOIUrl":"10.1002/resp.70283","url":null,"abstract":"","PeriodicalId":21129,"journal":{"name":"Respirology","volume":" ","pages":"856-858"},"PeriodicalIF":7.2,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13401497/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148456684","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Not All Flares Are Equal: Stratifying Risk During Asthma/COPD Overlap Exacerbations.","authors":"Helen O'Brien, Alessandro N Franciosi","doi":"10.1002/resp.70287","DOIUrl":"10.1002/resp.70287","url":null,"abstract":"","PeriodicalId":21129,"journal":{"name":"Respirology","volume":" ","pages":"854-855"},"PeriodicalIF":7.2,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13535705/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148412768","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Few Labels, Many Breaths: Adapting Electronic Noses for Lung Cancer Detection.","authors":"Qingpeng Zhang","doi":"10.1002/resp.70292","DOIUrl":"10.1002/resp.70292","url":null,"abstract":"","PeriodicalId":21129,"journal":{"name":"Respirology","volume":" ","pages":"862-863"},"PeriodicalIF":7.2,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13535701/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148707542","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Primed to React: Neutrophil-To-Lymphocyte Ratio to Predict Severe Checkpoint Inhibitor Pneumonitis.","authors":"John A Mackintosh","doi":"10.1002/resp.70294","DOIUrl":"10.1002/resp.70294","url":null,"abstract":"","PeriodicalId":21129,"journal":{"name":"Respirology","volume":" ","pages":"864-865"},"PeriodicalIF":7.2,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13535728/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148707481","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Enhancing Asthma Management in Emergency Departments: New Approaches Are Vital for Effective Care.","authors":"Christopher C Price, Mariko S Koh, Fanny W Ko, Philip G Bardin, Paul Leong","doi":"10.1002/resp.70284","DOIUrl":"10.1002/resp.70284","url":null,"abstract":"","PeriodicalId":21129,"journal":{"name":"Respirology","volume":" ","pages":"869-872"},"PeriodicalIF":7.2,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13535734/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148397567","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transbronchial Mediastinal Cryobiopsy-Rising to the Challenge.","authors":"Jeffrey Shuen Kai Ng","doi":"10.1002/resp.70290","DOIUrl":"10.1002/resp.70290","url":null,"abstract":"","PeriodicalId":21129,"journal":{"name":"Respirology","volume":" ","pages":"859-861"},"PeriodicalIF":7.2,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13535730/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148707489","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}