Therapeutic Advances in Respiratory Disease最新文献

{"title":"Real-world antifibrotic treatment patterns in patients with idiopathic pulmonary fibrosis: retrospective analyses of two large healthcare administrative databases in the United States.","authors":"Ying Qiu, Julia Zhu, Pooja Chopra, Brandon Elpers, Christopher Dieyi, Clare Byrne, Jackson Tang, Ye Wang, Kousalya Govindaraj, Aryeh Fischer","doi":"10.1177/17534666241280704","DOIUrl":"10.1177/17534666241280704","url":null,"abstract":"<p><strong>Background: </strong>Real-world data on the use, healthcare resource utilization (HCRU), and associated costs of antifibrotic therapies in patients with idiopathic pulmonary fibrosis (IPF) are limited.</p><p><strong>Objectives: </strong>To assess the prevalence of antifibrotic treatment, characteristics of patients receiving treatment, discontinuation rates, and HCRU and costs associated with treatment.</p><p><strong>Design: </strong>This retrospective study analyzed de-identified longitudinal and cross-sectional data, respectively, from two US claims databases: Optum's de-identified Clinformatics^® Data Mart Database (CDM; commercial claims, Medicare Advantage) and the Veterans Health Administration (VHA) database. The study periods were October 1, 2013-March 31, 2019 and October 1, 2014-September 30, 2019, respectively. Eligible individuals were adults with ⩾1 diagnosis claim for IPF.</p><p><strong>Methods: </strong>Antifibrotic prevalence, patient demographics, treatment discontinuation rates, and HCRU and costs were determined separately for each cohort and described using summary statistics. Bivariate comparisons were analyzed using Chi-square and Student's <i>t</i>-tests for categorical and continuous variables, respectively.</p><p><strong>Results: </strong>Overall, 4223 and 4459 eligible patients were identified in the CDM and VHA databases, respectively. Prevalence of antifibrotic uptake was 9.2% and 29.1% and the rate of index treatment discontinuation was 47% and 66% during follow-up in the CDM and VHA cohorts, respectively. Antifibrotic-treated patients were significantly younger (<i>p</i> < 0.0001) with lower mean Charlson Comorbidity Index scores at baseline versus untreated patients in both cohorts. In the CDM cohort, the number of outpatient and pharmacy visits was significantly higher in treated versus untreated patients during follow-up (both <i>p</i> < 0.0001). A similar trend was observed for the VHA cohort. Total follow-up costs in both cohorts were significantly higher in treated versus untreated patients due to higher pharmacy costs (CDM; <i>p</i> < 0.0001) or higher outpatient and pharmacy costs (VHA; <i>p</i> < 0.0001).</p><p><strong>Conclusion: </strong>The low prevalence of antifibrotic usage in both cohorts, together with the high rate of antifibrotic discontinuation, and increased HCRU and costs in treated versus untreated patients, support the need for novel treatment options for IPF.</p><p><strong>Trial registration: </strong>Not applicable.</p>","PeriodicalId":22884,"journal":{"name":"Therapeutic Advances in Respiratory Disease","volume":"18 ","pages":"17534666241280704"},"PeriodicalIF":3.3,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11490954/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142475400","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":"Patient-reported experiences with refractory or unexplained chronic cough: a qualitative analysis.","authors":"Vishal Bali, Jonathan Schelfhout, Mandel R Sher, Anju Tripathi Peters, Gayatri B Patel, Margaret Mayorga, Diana Goss, Carla DeMuro Romano","doi":"10.1177/17534666241236025","DOIUrl":"10.1177/17534666241236025","url":null,"abstract":"<p><strong>Background: </strong>Chronic cough, defined as a cough lasting 8 or more weeks, affects up to 10% of adults. Refractory chronic cough (RCC) is a cough that is uncontrolled despite comprehensive investigation and treatment of comorbid conditions while unexplained chronic cough (UCC) is a cough with no identifiable cause despite extensive evaluation of comorbid conditions. RCC and UCC are often poorly controlled. Understanding individuals' lived experience of the symptoms and impacts of these conditions may guide therapeutic strategies.</p><p><strong>Objectives: </strong>The primary objectives of this study were to assess respondents' perceptions of the key symptoms of RCC and UCC and the impacts of RCC and UCC and their symptoms on well-being, health-related quality of life, work productivity, and social relationships.</p><p><strong>Design: </strong>Qualitative study.</p><p><strong>Methods: </strong>This study enrolled 30 adults with physician-diagnosed RCC or UCC. Two trained qualitative researchers conducted individual, in-depth telephone interviews using a semi-structured interview guide. Interviews were audio-recorded, transcribed, coded, and systematically analyzed to identify content themes.</p><p><strong>Results: </strong>A total of 15 respondents with RCC and 15 with UCC were included in the study. Many respondents had RCC or UCC for a long duration (median 9 years, range: 0-24). Half of the respondents reported having a coughing episode at least once daily. Only 40% of respondents reported that medication had improved their symptoms. In over half of the respondents, RCC or UCC hindered communication, caused embarrassment, frustration, and worry, and lowered quality of life. Perceptions of meaningful treatment benefits in RCC or UCC varied widely across respondents.</p><p><strong>Conclusion: </strong>RCC and UCC remained poorly managed in many individuals and were associated with a wide range of symptoms and cough triggers that hindered daily activities and reduced emotional well-being. Understanding individuals' lived experiences may inform the development of RCC and UCC therapeutic strategies.</p>","PeriodicalId":22884,"journal":{"name":"Therapeutic Advances in Respiratory Disease","volume":"18 ","pages":"17534666241236025"},"PeriodicalIF":4.3,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10953008/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140159102","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":"Ability of the modified NUTRIC score to predict mortality in patients requiring short-term <i>versus</i> prolonged acute mechanical ventilation: a retrospective cohort study.","authors":"Wanho Yoo, Hyojin Jang, Hayoung Seong, Saerom Kim, Soo Han Kim, Eun-Jung Jo, Jung Seop Eom, Kwangha Lee","doi":"10.1177/17534666241232263","DOIUrl":"10.1177/17534666241232263","url":null,"abstract":"<p><strong>Background: </strong>The modified NUTRIC (nutritional risk in the critically ill) score has been reported to predict clinical outcomes in critically ill patients. However, the applicability of this score may differ between patients undergoing short-term mechanical ventilation (STMV, < 96 h) and those undergoing prolonged acute mechanical ventilation (PAMV, ⩾96 h), as PAMV patients typically experience significantly higher morbidity and mortality.</p><p><strong>Objective: </strong>This study aimed to investigate the predictive ability of modified NUTRIC score for predicting 28-day mortality in patients receiving STMV and PAMV.</p><p><strong>Design: </strong>Retrospective single-center cohort study.</p><p><strong>Methods: </strong>We enrolled patients who received mechanical ventilation (MV) on the day of admission to the intensive care unit (ICU) from 1 December 2015 to 30 November 2020. Modified NUTRIC scores were calculated based on the clinical data of each patient at ICU admission.</p><p><strong>Results: </strong>The study population comprised 464 patients, including 319 (68.8%) men with a mean age of 69.7 years. Among these patients, 132 (28.4%) received STMV and 332 (71.6%) received PAMV. The overall 28-day mortality rate was 26.7%, which was significantly higher in STMV patients than in PAMV patients (37.9% <i>versus</i> 22.3%, <i>p</i> < 0.001). Evaluation of the predictive performance of the modified NUTRIC score for 28-day mortality revealed areas under the receiver operating characteristic curves of 0.672 [95% confidence interval (CI): 0.627-0.714] for total patients, 0.819 (95% CI, 0.742-0.880) for STMV patients, and 0.595 (95% CI, 0.540-0.648) for PAMV patients. The best overall cutoff value was 5 in total, STMV, and PAMV patients. This cutoff value was a significant predictor of 28-day mortality based on the Cox proportional hazard model for total [hazards ratio (HR): 2.681; 95% CI: 1.683-4.269] and STMV (HR: 5.725; 95% CI: 2.057-15.931) patients, but not for PAMV patients.</p><p><strong>Conclusion: </strong>The modified NUTRIC score is more effective in predicting 28-day mortality in patients undergoing STMV than in those undergoing PAMV.</p>","PeriodicalId":22884,"journal":{"name":"Therapeutic Advances in Respiratory Disease","volume":"18 ","pages":"17534666241232263"},"PeriodicalIF":4.3,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10898311/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139973588","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":"Optimal short-term outcomes in balloon pulmonary angioplasty: the minimum frequency of three sessions annually.","authors":"Xin Li, Tao Yang, Yi Zhang, Qing Zhao, Qixian Zeng, Qi Jin, Anqi Duan, Zhihua Huang, Meixi Hu, Sicheng Zhang, Luyang Gao, Changming Xiong, Qin Luo, Zhihui Zhao, Zhihong Liu","doi":"10.1177/17534666241232521","DOIUrl":"10.1177/17534666241232521","url":null,"abstract":"<p><strong>Background: </strong>Balloon pulmonary angioplasty (BPA) is typically performed in a sequential manner.</p><p><strong>Objectives: </strong>This study aimed to determine the lowest frequency of BPA for patients who could not reach treatment goals in a short period.</p><p><strong>Design: </strong>Retrospective cohort.</p><p><strong>Methods: </strong>We retrospectively enrolled 186 BPA-treated patients diagnosed with chronic thromboembolic pulmonary hypertension. According to the accumulative number of performed BPA sessions or treated pulmonary vessels or the ratio of the number of treated pulmonary vessels/the number of baseline lesions (T/P) prior to the initial occurrence of clinical outcome or censored date, we divided patients into different groups. The principal outcome was clinical worsening.</p><p><strong>Results: </strong>After stratifying patients by the number of performed BPA sessions, most baseline parameters were comparable among groups. During follow-up, 31 (16.7%) of 186 patients experienced clinical worsening. The 6-month cumulative clinical worsening-free survival rates of ⩾2 performed sessions group were significantly higher than that of 1 performed session group. The 12-month cumulative rates of clinical worsening-free survival exhibited a declining pattern in the subsequent sequence: ⩾3, 2, and 1 performed BPA sessions, and this trend persisted when follow-up time exceeded 12 months. The 6-, 12-, and 24-month cumulative clinical worsening-free survival rates were comparable between patients with 3 and ⩾4 performed BPA sessions. Similar results were also observed when stratifying patients by the accumulative number of treated pulmonary vessels (⩽8, 9-16, ⩾17) and T/P (⩽0.789, 0.790-1.263, ⩾1.264).</p><p><strong>Conclusion: </strong>To achieve optimal short-term outcomes, patients might need to undergo ⩾2 BPA sessions or have ⩾9 pulmonary vessels treated or have T/P ⩾0.790 within 6 months, and undergo ⩾3 BPA sessions or have ⩾17 pulmonary vessels treated or have T/P ⩾1.264 within 12 months.</p>","PeriodicalId":22884,"journal":{"name":"Therapeutic Advances in Respiratory Disease","volume":"18 ","pages":"17534666241232521"},"PeriodicalIF":4.3,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10898305/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139973589","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":"Dual-task performance and balance in patients with severe COPD: a cross-sectional study.","authors":"Crisan Alexandru Florian, Pescaru Camelia Corina, Maritescu Adelina, Carunta Vlad, Onofrei Roxana Ramona, Stoicescu Emil Robert, Oancea Cristian","doi":"10.1177/17534666241287302","DOIUrl":"10.1177/17534666241287302","url":null,"abstract":"<p><strong>Background: </strong>Chronic obstructive pulmonary disease (COPD) significantly impacts respiratory and motor function, balance, and cognition, leading to muscle weakness and impaired exercise capacity. The impairments often result in challenges with daily activities, particularly those requiring dual-tasking.</p><p><strong>Objectives: </strong>The study investigated whether patients with severe COPD would exhibit more significant cognitive and motor performance decline during dual tasks compared to healthy controls.</p><p><strong>Design: </strong>This study employed a cross-sectional design to compare cognitive and motor performance in dual tasks between patients with severe COPD and healthy controls.</p><p><strong>Methods: </strong>We included 44 patients with severe COPD and 43 healthy individuals. Participants underwent various tests, including pulmonary function tests, six-minute walking tests, dual Timed Up and Go tests (TUG), dual single-leg stance tests (SLS), Berg Balance Scale assessments, and Falls Efficacy Scale International evaluations (FES-I).</p><p><strong>Results: </strong>The COPD group had significantly lower scores in the Berg Balance Scale (BBS; 44.79 ± 4.70 vs 52.67 ± 2.16, <i>p</i> < 0.0001) and longer times for the TUG test (12.44 s; [11.44, 13.50] vs 9.14 s; [7.91, 10.11], <i>p</i> < 0.0001) and shorter times for the SLS test (14.15 s; [12.31, 15.65] vs 26.20 s; [23.45, 30.88], <i>p</i> < 0.0001), indicating poorer functional mobility and balance. Furthermore, dual-task interference (DTI) outcomes revealed poorer performance in the COPD group (<i>p</i> < 0.0001). The fear of falling (FES-I) was increased in the COPD group. There was a significant positive correlation between DTI TUG and FES-I (<i>r</i> = 0.35, <i>p</i> = 0.01) and a negative correlation between DTI SLS and BBS (<i>r</i> = -0.41, <i>p</i> = 0.005) in the COPD group.</p><p><strong>Conclusion: </strong>The study reveals significant impairments in DTI and balance among patients with severe COPD. Patients with severe COPD performed worse in tests involving dual tasks. They had poorer balance overall compared to healthy controls, with longer times for the dual Timed Up and Go test and shorter times for the SLS test, indicating a higher susceptibility to DTI and a greater fear of falling.</p>","PeriodicalId":22884,"journal":{"name":"Therapeutic Advances in Respiratory Disease","volume":"18 ","pages":"17534666241287302"},"PeriodicalIF":3.3,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11632881/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142802198","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":"Comparative effectiveness and safety of triple therapy and non-triple therapy interventions for COPD: an overview of systematic reviews.","authors":"Shujuan Zhang, Jun Wang, Xuanlin Li, Hailong Zhang","doi":"10.1177/17534666241259634","DOIUrl":"10.1177/17534666241259634","url":null,"abstract":"<p><strong>Background: </strong>Some systematic reviews (SRs) on triple therapy (consisting of long-acting β₂-agonist, long-acting muscarinic antagonist, and inhaled corticosteroid, LABA/LAMA/ICS) for chronic obstructive pulmonary disease (COPD) have reported conflicting results. As the number of syntheses increases, the task of identifying and interpreting evidence becomes increasingly complex and demanding.</p><p><strong>Objectives: </strong>To provide a comprehensive overview of the efficacy and safety of triple therapy for COPD.</p><p><strong>Design: </strong>Overview of SRs.</p><p><strong>Methods: </strong>Two independent reviewers conducted comprehensive searches in PubMed, Embase, Web of Science, and the Cochrane Library to identify relevant SRs that compared triple therapy with any non-triple therapy for COPD, from the inception of these databases until 1 June 2023. The AMSTAR 2 and GRADE tools were utilized to assess the quality of the included studies and the evidence for each outcome.</p><p><strong>Results: </strong>Eighteen SRs encompassing 30 original studies and involving 47,340 participants were analyzed. The overall AMSTAR 2 rating revealed that 3 SRs were of low quality, 13 SRs were of critically low quality, and 2 SRs were of high quality. No high-certainty evidence revealed a significant advantage of triple therapy in improving lung function or reducing acute exacerbations. However, all evidence, including one high certainty, supported the benefits of improving quality of life. Regarding all-cause mortality, no significant difference was found when compared to LAMA or ICS/LABA; however, high-certainty evidence confirmed its effectiveness when compared with LABA/LAMA. Notably, high-certainty evidence indicated that triple therapy was associated with a significant increase in the risk of pneumonia compared to LABA/LAMA.</p><p><strong>Conclusion: </strong>Triple therapy demonstrated notable benefits in improving lung function, reducing exacerbations, improving quality of life, and reducing all-cause mortality. However, it is important to note that it may also significantly increase the risk of pneumonia.</p><p><strong>Trial registration: </strong>This overview protocol was prospectively registered with PROSPERO (No. CRD42023431548).</p>","PeriodicalId":22884,"journal":{"name":"Therapeutic Advances in Respiratory Disease","volume":"18 ","pages":"17534666241259634"},"PeriodicalIF":3.3,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11179455/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141321695","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":"Association between muscular atrophy and mortality risk in patients with COPD: a systematic review.","authors":"Wenyan Li, Ying Wu, Xun Yang, Jing Zhu, Mei Feng, Rong Deng, Cui Yang, Chengcheng Sun","doi":"10.1177/17534666241304626","DOIUrl":"10.1177/17534666241304626","url":null,"abstract":"<p><strong>Background: </strong>Muscular atrophy often can be seen at the end of stage in many chronic diseases. It will also negatively influence patients' outcomes. Different studies showed that the association between muscular atrophy and mortality in patients with chronic obstructive pulmonary disease (COPD) was unclear. This study will continue to assess the influence of muscular atrophy on mortality in patients with COPD.</p><p><strong>Objectives: </strong>To systematically evaluate the association between muscular atrophy and death in patients with COPD.</p><p><strong>Design: </strong>Systematic review.</p><p><strong>Methods and data sources: </strong>A systematic review and meta-analysis was conducted. Databases including PubMed, Web of Science, Embase, the Cochrane Library, the China Biomedical Literature Service System, China Biomedical Literature Service System (CINAHL), China National Knowledge Infrastructure, the Wanfang database, and the WeiPu (VIP) were systematically searched for cohort studies on muscular atrophy and COPD from inception to July 1st, 2023. Two reviewers independently review, assess, and extract data from the included studies. Meta-analysis was performed using RevMan 5.4 software.</p><p><strong>Results: </strong>Thirteen cohort studies were ultimately included, involving 10,528 patients with COPD. There were seven cohort studies included in the meta-analysis, including 3,458 COPD patients. The meta-analysis showed that patients with COPD combined with muscular atrophy had a higher mortality risk (HR = 2.20, 95%CI (1.74, 2.79), <i>p</i> < 0.00001). At the same time, patients with COPD who had muscular atrophy may had longer hospital stays.</p><p><strong>Conclusion: </strong>Muscular atrophy is associated with the mortality and disease prognosis of patients with COPD. The conclusion needs to be supported and validated by more high-quality studies given the limitation of the number of articles included in this study.</p><p><strong>Trial registration: </strong>This systematic review protocol was prospectively registered with PROSPERO (No. CRD42024589435).</p>","PeriodicalId":22884,"journal":{"name":"Therapeutic Advances in Respiratory Disease","volume":"18 ","pages":"17534666241304626"},"PeriodicalIF":3.3,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11672470/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142882941","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":"Endobronchial ultrasound-guided transbronchial needle aspiration validated with video-assisted mediastinoscopic lymphadenectomy in the mediastinal restaging of patients with stage IIIA non-small cell lung cancer after induction therapy.","authors":"Bruno García-Cabo, Nina Reig, Ramón Rami-Porta, Sergi Call, Lluís Esteban, Bienvenido Barreiro, Efraín Reyes, Carme Obiols, Juan Manuel Ochoa, Xavier Morlius, Xavier Tarroch, Mireia Serra, José Sanz-Santos","doi":"10.1177/17534666241301284","DOIUrl":"10.1177/17534666241301284","url":null,"abstract":"<p><strong>Background: </strong>The role of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) validated with video-assisted mediastinoscopic lymphadenectomy (VAMLA) for mediastinal restaging of patients with non-small cell lung cancer (NSCLC) after induction therapy has never been described.</p><p><strong>Objective: </strong>To report on our experience in this clinical setting.</p><p><strong>Design: </strong>Retrospective analysis of a prospectively built database.</p><p><strong>Methods: </strong>Patients with stage IIIA (N2) NSCLC who underwent EBUS-TBNA for mediastinal restaging after induction therapy were included. The sensitivity, specificity, negative predictive value (NPV), positive predictive value (PPV), and diagnostic accuracy of EBUS-TBNA and VAMLA for mediastinal restaging were calculated. The number of patients needed to undergo confirmatory VAMLA (NNT) after a negative EBUS-TBNA for mediastinal restaging to avoid a case of pathologic (p) N2 disease after resection was also calculated.</p><p><strong>Results: </strong>Forty-six patients underwent EBUS-TBNA which was positive in 12 patients and negative in 34. Patients with a negative EBUS-TBNA underwent VAMLA which was positive in seven cases. Of the other 27 patients with a negative VAMLA, 26 underwent resection that did not show N2 disease. The sensitivity, specificity, NPV, PPV, and diagnostic accuracy of EBUS-TBNA for restaging were 63.1%, 100%, 79.4%, 100%, and 84.7%, respectively. The sensitivity, specificity, NPV, PPV, and diagnostic accuracy of confirmatory VAMLA after EBUS-TBNA was 100%. The NNT confirmatory VAMLA after a negative EBUS-TBNA to avoid a case of pN2 disease at resection was five patients.</p><p><strong>Conclusion: </strong>EBUS-TBNA must remain as the first-choice test for invasive mediastinal restaging. However, the results of our study in terms of sensitivity and NPV, even considering the small size of our population, suggest that negative results of EBUS-TBNA should be interpreted with caution and surgical exploration of the mediastinum (specially VAMLA, if available) should be considered in these patients.</p>","PeriodicalId":22884,"journal":{"name":"Therapeutic Advances in Respiratory Disease","volume":"18 ","pages":"17534666241301284"},"PeriodicalIF":3.3,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11603456/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142740561","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":"Pleural fluid carbohydrate antigen 72-4 and malignant pleural effusion: a diagnostic test accuracy study.","authors":"Xi-Shan Cao, Li Yan, Ting-Wang Jiang, Jin-Hong Huang, Hong Chen, José M Porcel, Wen-Qi Zheng, Zhi-De Hu","doi":"10.1177/17534666231222333","DOIUrl":"10.1177/17534666231222333","url":null,"abstract":"<p><strong>Background: </strong>The prognosis of malignant pleural effusion (MPE) is poor. A timely and accurate diagnosis is the prerequisite for managing MPE patients. Carbohydrate antigen 72-4 (CA72-4) is a diagnostic tool for MPE.</p><p><strong>Objective: </strong>We aimed to evaluate the diagnostic accuracy of pleural fluid CA72-4 for MPE.</p><p><strong>Design: </strong>A prospective, preregistered, and double-blind diagnostic test accuracy study.</p><p><strong>Methods: </strong>We prospectively enrolled participants with undiagnosed pleural effusions from two centers in China (Hohhot and Changshu). CA72-4 concentration in pleural fluid was measured by electrochemiluminescence. Its diagnostic accuracy for MPE was evaluated by a receiver operating characteristic (ROC) curve. The net benefit of CA72-4 was determined by a decision curve analysis (DCA).</p><p><strong>Results: </strong>In all, 153 participants were enrolled in the Hohhot cohort, and 58 were enrolled in the Changshu cohort. In both cohorts, MPE patients had significantly higher CA72-4 levels than benign pleural effusion (BPE) patients. At a cutoff value of 8 U/mL, pleural fluid CA72-4 had a sensitivity, specificity, and area under the ROC curve (AUC) of 0.46, 1.00, and 0.79, respectively, in the Hohhot cohort. In the Changshu cohort, CA72-4 had a sensitivity, specificity, and AUC of 0.27, 0.94, and 0.86, respectively. DCA revealed the relatively high net benefit of CA72-4 determination. In patients with negative cytology, the AUC of CA72-4 was 0.67.</p><p><strong>Conclusion: </strong>Pleural fluid CA72-4 helps differentiate MPE and BPE in patients with undiagnosed pleural effusions.</p>","PeriodicalId":22884,"journal":{"name":"Therapeutic Advances in Respiratory Disease","volume":"18 ","pages":"17534666231222333"},"PeriodicalIF":4.3,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10775747/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139378304","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":"The significance of dynamic monitoring plasma TMAO level in pulmonary arterial hypertension - a cohort study.","authors":"Yicheng Yang, Xin Li, Peizhi Wang, Songren Shu, Bingyang Liu, Yanru Liang, Beilan Yang, Zhihui Zhao, Qin Luo, Zhihong Liu, Lemin Zheng, Qixian Zeng, Changming Xiong","doi":"10.1177/17534666231224692","DOIUrl":"10.1177/17534666231224692","url":null,"abstract":"<p><strong>Background: </strong>Gut microbiota assumes an essential role in the development and progression of pulmonary arterial hypertension (PAH). Trimethylamine N-oxide (TMAO), a gut microbiota-dependent metabolite, is correlated with the prognosis of patients with PAH. However, the correlation between changes in TMAO (ΔTMAO) and the prognosis of PAH remains elusive.</p><p><strong>Objectives: </strong>To investigate the association between ΔTMAO and prognosis of PAH, and explore whether dynamic assessment of TMAO level was superior to measurement at a single time point in predicting prognosis.</p><p><strong>Design: </strong>Single-center cohort study.</p><p><strong>Methods: </strong>Consecutive patients diagnosed with PAH and had at least two TMAO measurements taken from May 2019 to June 2020 were eligible. The outcome events of this study were defined as adverse clinical events.</p><p><strong>Results: </strong>A total of 117 patients with PAH who had two TMAO measurements and follow-up were included in this study. Patients with ΔTMAO ⩾1.082 μmol/L had over four times increased risk of adverse clinical events than their counterparts after adjusting for confounders [hazard ratio (HR) 4.050, 95% confidence interval (CI): 1.468-11.174; <i>p</i> = 0.007]. Patients with constant high TMAO levels at both time points had the highest risk of adverse clinical events compared with patients with constant low TMAO levels (HR 3.717, 95% CI: 1.627-8.492; <i>p</i> = 0.002). ΔTMAO was also associated with changes in parameters reflecting PAH severity (<i>p</i> < 0.05).</p><p><strong>Conclusion: </strong>Changes in TMAO were independently correlated with prognosis in patients with PAH, irrespective of baseline level of TMAO. ΔTMAO also correlated with alteration in disease severity. Repeated assessment of TMAO level contributes to better identification of patients with increased risk of adverse clinical events.</p>","PeriodicalId":22884,"journal":{"name":"Therapeutic Advances in Respiratory Disease","volume":"18 ","pages":"17534666231224692"},"PeriodicalIF":4.3,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10785727/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139418105","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}