Therapeutic Advances in Respiratory Disease最新文献

{"title":"Advancing the understanding and treatment of lung pathologies associated with alpha 1 antitrypsin deficiency.","authors":"Alice M Turner, Joachim H Ficker, Andrea Vianello, Christian F Clarenbach, Sabina Janciauskiene, Joanna Chorostowska-Wynimko, Jan Stolk, Noel Gerard McElvaney","doi":"10.1177/17534666251318841","DOIUrl":"10.1177/17534666251318841","url":null,"abstract":"<p><p>Alpha 1 antitrypsin deficiency (AATD) is a genetic disorder that alters the functionality and/or serum levels of alpha 1 antitrypsin (AAT). Dysfunctional forms of AAT, or low levels of serum AAT, predispose affected individuals to pulmonary complications. When AATD-associated lung disease develops, the most common pulmonary pathology is emphysema. The development of emphysema and decline in lung function varies by AATD genotype and is accelerated by risk factors, such as smoking. To improve the understanding and treatment of AATD, emerging knowledge and unresolved questions need to be discussed. Here we focus on developments in the areas of disease pathogenesis, biomarkers, and clinical endpoints for trials in AATD, as well as barriers to treatment. The clinical impact of AATD on lung function is highly variable and highlights the complexity of AATD pathogenesis, in which multiple underlying processes are involved. Reduced levels of functional AAT disrupt the protease-antiprotease homeostasis, leading to a loss of neutrophil elastase inhibition and the breakdown of elastin within the lung interstitium. Inflammatory processes also play a critical role in the development of AATD-associated lung disease, which is not yet fully understood. Biomarkers associated with the disease and its complications may have an important role in helping to address AATD underdiagnosis and evaluating response to treatment. To improve access to treatment, the problem of underdiagnosis needs to be addressed and the provision of therapeutic options needs to become uniform. Patients should also be empowered to play a key role in the self-management of the disease. Advancing our understanding of the disease will ultimately improve the life expectancy and quality of life for patients affected by AATD.</p>","PeriodicalId":22884,"journal":{"name":"Therapeutic Advances in Respiratory Disease","volume":"19 ","pages":"17534666251318841"},"PeriodicalIF":3.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11843710/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143469205","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":"Retraction: \"Two-day versus seven-day course of levofloxacin in acute COPD exacerbation: a randomized controlled trial\".","authors":"","doi":"10.1177/17534666251362671","DOIUrl":"10.1177/17534666251362671","url":null,"abstract":"","PeriodicalId":22884,"journal":{"name":"Therapeutic Advances in Respiratory Disease","volume":"19 ","pages":"17534666251362671"},"PeriodicalIF":3.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12317233/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144754367","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":"Pulmonary arterial hypertension: sex-specific differences and outcomes.","authors":"Noura Alturaif, Umberto Attanasio, Valentina Mercurio","doi":"10.1177/17534666251350493","DOIUrl":"10.1177/17534666251350493","url":null,"abstract":"<p><p>Pulmonary arterial hypertension (PAH) is a progressive and life-threatening vascular disease characterized by increased pulmonary vascular resistance, leading to right ventricular failure and death. It has a higher prevalence in women than men, yet notable sex-based differences influence disease presentation, treatment response, and outcomes. This narrative review explores the distinct sex differences in PAH and their significant impact on prognosis. Data from major PAH clinical trials indicate that nearly 78.4% of participants are women. According to the REVEAL registry, the most common causes of PAH in women are connective tissue disease-associated PAH (CTD-PAH), idiopathic PAH (IPAH), and congenital heart disease-associated PAH (CHD-PAH). Women are often found to have better baseline right ventricular (RV) function and hemodynamics before treatment, as well as more favorable RV adaptation post-therapy. They also demonstrate a stronger response to endothelin receptor antagonists (ERA) and prostacyclins. Most notably, these factors contribute to better survival outcomes in women compared to men. In conclusion, significant sex-based differences exist in PAH, underscoring the need for personalized treatment approaches that consider sex-related factors. Future research should focus on optimizing therapeutic strategies to improve outcomes for both sexes.</p>","PeriodicalId":22884,"journal":{"name":"Therapeutic Advances in Respiratory Disease","volume":"19 ","pages":"17534666251350493"},"PeriodicalIF":3.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12181702/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144333921","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":"Underutilization of palliative care in advanced COPD and heart failure: associations, disparities, and the role of specialists.","authors":"Lior Zornitzki, Neta Sror, Amir Bar-Shai, Rotem Tellem, Shmuel Banai, Shir Frydman, Gil Bornstein, Ophir Freund","doi":"10.1177/17534666251364056","DOIUrl":"10.1177/17534666251364056","url":null,"abstract":"<p><strong>Background: </strong>Palliative care is essential for managing advanced chronic illnesses (ACI) but remains underused.</p><p><strong>Objectives: </strong>We aimed to evaluate the prevalence, associations, and outcomes of palliative care utilization (PCU) in patients with ACIs.</p><p><strong>Design: </strong>A prospective observational questionnaire-based study.</p><p><strong>Methods: </strong>The study included hospitalized patients with severe COPD (<i>n</i> = 53), advanced heart failure (HF; <i>n</i> = 56), or metastatic malignancy (<i>n</i> = 57). Participants were interviewed about their demographics, health status, PCU, and end-of-life decision-making.</p><p><strong>Results: </strong>A total of 166 subjects were included (median age: 77 years; 41% females), with a 1-year median of 2 hospital admissions. Subjects with COPD and HF had low rates of PCU compared to those with malignancy (6% and 11% vs 39%, <i>p</i> < 0.01). PCU occurred exclusively in patients who had visited a specialist (cardiologist, pulmonologist, or oncologist) before study inclusion. Patients with PCU were more aware of advance directives (71% vs 38%), signed advanced orders (23% vs 3%), and shared their end-of-life decisions with others (71% vs 29%). These differences remained significant after adjustment for prior specialist visits. Independent associations with PCU were self-identifying as non-religious (adjusted OR 3.41, 95% CI 1.2-9.9), above high-school education (AOR 2.84, 95% CI 1.1-7.3), and chronic pain (aOR 2.81, 95% CI 1.11-7.14), while COPD showed the opposite (aOR 0.25, 95% CI 0.07-0.96).</p><p><strong>Conclusion: </strong>Palliative care utilization is alarmingly low among patients with HF and COPD despite significant symptom burden. Specialists should advocate for PCU as their involvement could enhance end-of-life care planning, improve patient outcomes, and address current gaps in care.</p>","PeriodicalId":22884,"journal":{"name":"Therapeutic Advances in Respiratory Disease","volume":"19 ","pages":"17534666251364056"},"PeriodicalIF":3.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12344236/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144837789","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":"Next-generation radiomic sequencing in non-small cell lung cancer: an alternative model to predict mutations from [18F]FDG PET/CT.","authors":"Lavinia Monaco, Cinzia Crivellaro, Elisabetta De Bernardi, Francesca Bono, Gabriele Casati, Davide Seminati, Diego Luigi Cortinovis, Federica Elisei, Vincenzo L'Imperio, Claudio Landoni, Fabio Pagni, Elia Anna Turolla, Cristina Messa, Luca Guerra","doi":"10.1177/17534666251384433","DOIUrl":"10.1177/17534666251384433","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Non-small cell lung cancer (NSCLC) remains the most common cause of cancer-related mortality worldwide. The introduction of targeted therapies against oncogenic drivers, particularly EGFR and KRAS mutations, has significantly improved patient outcomes. However, next-generation sequencing (NGS), the current gold standard for molecular profiling, is not always accessible in routine clinical practice, emphasizing the need for noninvasive surrogate biomarkers. Radiomics has emerged as a promising imaging-based approach that extracts a large number of quantitative features from standard modalities such as [18F]FDG PET/CT. By capturing tumor heterogeneity and biological characteristics, radiomics can provide clinically relevant insights and holds potential for identifying predictive biomarkers. Recent studies suggest that CT radiomic features related to heterogeneity, texture, and shape may predict EGFR and KRAS mutation status, while the integration of metabolic parameters from [18F]FDG PET radiomics may further enhance predictive performance and offer a more comprehensive characterization of tumor biology.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;To assess the putative role of [18F]FDG PET/CT radiomic features for the prediction of mutated NSCLC.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design: &lt;/strong&gt;This retrospective observational study included patients with histologically confirmed NSCLC, molecularly profiled by NGS and who underwent baseline [18F]FDG PET/CT scans at Fondazione IRCCS San Gerardo dei Tintori, Monza. Tumor segmentation and radiomic feature extraction were performed on PET images using Pyradiomics, generating 766 quantitative features. Feature selection for EGFR and KRAS mutation association was conducted via repeated random subsampling and LASSO logistic regression.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Data source and methods: &lt;/strong&gt;Patients' histological, clinical and PET/CT imaging data were obtained from the electronic clinical database and picture archiving and communication system of IRCCS Fondazione San Gerardo dei Tintori di Monza between January 2023 and December 2024. Data from 105 patients with biopsy-proven NSCLC and available NGS and [18F]FDG PET/CT scans were analyzed to identify radiomic features from PET images associated with specific mutations. Two different PET/CT scanners were used (Discovery IQ and Discovery MI, GE Healthcare), and radiomic features were extracted using IBSI-compliant algorithms, generating 766 features per tumor. Features correlated with mutations were selected using the Discovery MI dataset (55 patients) and subsequently evaluated on the independent Discovery IQ dataset (50 patients).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;No radiomic features were identified as associated with EGFR mutation in the Discovery MI dataset. Among the features correlated with KRAS mutation in the Discovery MI dataset, FBS_glcm_MCC-a measure of image texture complexity-was confirmed to be associated with KRAS mutation in the independe","PeriodicalId":22884,"journal":{"name":"Therapeutic Advances in Respiratory Disease","volume":"19 ","pages":"17534666251384433"},"PeriodicalIF":3.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12515289/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145259210","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":"Pulmonary nontuberculous mycobacterial infections among women with cystic fibrosis and non-cystic fibrosis bronchiectasis.","authors":"Jane E Gross, Morgan C Jones, Ashley Buige, D Rebecca Prevots, Shannon Kasperbauer","doi":"10.1177/17534666251323181","DOIUrl":"10.1177/17534666251323181","url":null,"abstract":"<p><p>Nontuberculous mycobacteria (NTM) are ubiquitous, opportunistic pathogens that can cause lung disease in people with non-cystic fibrosis bronchiectasis (NCFB) and cystic fibrosis (CF). The incidence of NTM pulmonary infections and lung disease has continued to increase worldwide over the last decade among both groups. Notably, women with NCFB NTM pulmonary disease (NTM-PD) bear a disproportionate burden with NTM rates increasing in this population as well as having consistently higher incidence of NTM-PD compared to men. In contrast, among people with CF, an overall increased risk among women has not been observed. In the United States, the majority of people with CF are taking highly effective cystic fibrosis transmembrane conductance regulator (CFTR) modulators, and these numbers are increasing worldwide. The long-term impact of CFTR modulator medications on NTM infections is not entirely understood. Guidelines for the screening, diagnosis, and management of NTM-PD exist for people with NCFB and CF, but do not consider unique implications relevant to women. This review highlights aspects of NTM-PD among women with NCFB and CF, including the epidemiology of NTM infection, special considerations for treatment, and unmet research needs relevant to women with NTM-PD.</p>","PeriodicalId":22884,"journal":{"name":"Therapeutic Advances in Respiratory Disease","volume":"19 ","pages":"17534666251323181"},"PeriodicalIF":3.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11898043/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143606366","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":"Quantitative chest computed tomography in chronic obstructive pulmonary disease: assessing the role of emphysema severity and its correlation with clinical characteristics, lung function, and plasma levels of VEGF and IL-1β.","authors":"Cong Nguyen Hai, Thanh Bui Duc, The Nguyen Minh, Loi Trinh Duc, Thang Tran Quyet","doi":"10.1177/17534666251332469","DOIUrl":"https://doi.org/10.1177/17534666251332469","url":null,"abstract":"<p><strong>Background: </strong>Quantitative computed tomography has emerged as a crucial tool for assessing the severity of emphysema in chronic obstructive pulmonary disease (COPD) patients. Vascular endothelial growth factor (VEGF) levels are significantly elevated in patients with chronic bronchitis but reduced in those with emphysema. Chronic inflammation is a key factor in the pathogenesis and progression of COPD, with cytokines such as Interleukin-1 beta playing a significant role.</p><p><strong>Objective: </strong>This study aimed to evaluate the characteristics of emphysema in patients with COPD using quantitative computed tomography (QCT) and to investigate the relationship between the extent of emphysema, clinical phenotypes, lung function, and plasma concentrations of VEGF and IL-1β in COPD patients.</p><p><strong>Design: </strong>A prospective cross-sectional study was conducted on 30 male patients with stable COPD at Military Hospital 175.</p><p><strong>Methods: </strong>The emphysema index (EI) was quantified using QCT of the chest and categorized into levels from 0 to 4. Data on acute exacerbation frequency, CAT scores, mMRC, pulmonary function indices, arterial blood gas measurements, and plasma concentrations of VEGF and IL-1β were collected and analyzed to determine their relationship with EI.</p><p><strong>Results: </strong>The study found an average EI of 12.8% ± 11.64%, with 96.7% of patients exhibiting a bronchitis-dominant phenotype. The severity of airflow obstruction, PaCO₂ levels, mMRC scores, and the number of exacerbations per year increased with the degree of emphysema. Conversely, FEV1% and the FEV1/FVC ratio significantly decreased with increasing emphysema severity. Plasma VEGF concentration was inversely correlated with the EI. In GOLD 3 and 4 stages, plasma VEGF levels decreased in proportion to emphysema severity, indicating that more advanced emphysema was associated with a more rapid decline in VEGF concentrations. Notably, when emphysema exceeded 25%, a significant reduction in both VEGF and IL-1β concentrations was observed.</p><p><strong>Conclusion: </strong>The EI determined by QCT is a valuable tool for identifying COPD phenotypes and assessing disease severity. It can also provide insights into the prognosis regarding the risk of exacerbations, clinical symptom burden, and lung function decline. The significant inverse correlation between plasma VEGF concentration and EI indicates that decreased VEGF levels may be a crucial factor in the pathogenesis of emphysema, suggesting a potential target for research on \"treatable\" factors in COPD management.</p><p><strong>Trial registration: </strong>The study was approved by an independent ethics committee (Ethics Committee of Military Hospital 175, No. 003/QĐ-IRB-VN01.055) and conducted in accordance with the Declaration of Helsinki and Guidelines for Good Clinical Practice.</p>","PeriodicalId":22884,"journal":{"name":"Therapeutic Advances in Respiratory Disease","volume":"19 ","pages":"17534666251332469"},"PeriodicalIF":3.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12041710/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144062292","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 correlation between the level of therapy adherence and inhalation technique in children with uncontrolled asthma using a smart inhaler: the IMAGINE study.","authors":"Esther Sportel, Boony Thio, Kris Movig, Job van der Palen, Marjolein Brusse","doi":"10.1177/17534666251346363","DOIUrl":"10.1177/17534666251346363","url":null,"abstract":"<p><strong>Background: </strong>Asthma is a chronic condition with a high health and social burden in children. Although many well-studied effective therapies are available, because of suboptimal adherence and inhalation technique, asthma in children remains frequently uncontrolled. It is often assumed that adherence and technique are highly correlated items, but this assumption has not been thoroughly validated.</p><p><strong>Objective: </strong>This trial evaluates the correlation between adherence and inhalation technique and the association of patient-related factors with these two important parameters.</p><p><strong>Design: </strong>Observational phase I of the IMproving Adherence by Guiding INhalation via Electronic monitoring (IMAGINE) study, a three-phased Randomized Controlled Trial (RCT) in children with uncontrolled asthma.</p><p><strong>Methods: </strong>The observational phase I of the IMAGINE study was designed to determine the correlation between adherence and inhalation technique in pediatric subjects with uncontrolled asthma. During this observational study phase, adherence and inhalation technique were measured with a smart add-on device called Respiro^© (Amiko, London). Patient-related factors were assessed either at baseline (e.g. characteristics of the patient), or during the study period (e.g. number of emergency room (ER) visits and daily salbutamol intake).</p><p><strong>Results: </strong>Of the 34 enrolled subjects, 6-18 years old, suffering from moderate to severe uncontrolled asthma, 32 successfully completed phase I. No significant correlation between adherence and inhalation technique was observed (<i>r</i> = -0.21; <i>p</i> = 0.234). Twenty-one percent of children had both good adherence and good inhalation technique. Children with good adherence had more often ⩾1 ER visits during follow-up, while poor inhalation technique was associated with younger age and lower height at baseline, and a higher daily salbutamol dosage intake and ⩾1 ER admission during follow-up.</p><p><strong>Conclusion: </strong>Our findings demonstrated no correlation between therapy adherence and inhalation technique, suggesting that these should be regarded as distinct and frequent pitfalls of inhaled medication use.We observed that inhalation technique was significantly associated with ER visits, rescue medication use, age, and height, while good adherence correlated with ER visits. Recognizing these factors allows pediatricians to identify risk profiles for poor inhalation technique and poor adherence, enabling more targeted and personalized interventions.<i>Trial registration:</i> NL-OMON25807.</p>","PeriodicalId":22884,"journal":{"name":"Therapeutic Advances in Respiratory Disease","volume":"19 ","pages":"17534666251346363"},"PeriodicalIF":3.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12144389/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144235259","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":"A novel decision tree algorithm model based on chest CT parameters to predict the risk of recurrence and metastasis in surgically resected stage I synchronous multiple primary lung cancer.","authors":"Shuangjiang Li, Guona Chen, Wenbiao Zhang, Huiyun Ma, Baocong Liu, Li Xu, Qiong Li","doi":"10.1177/17534666251325443","DOIUrl":"10.1177/17534666251325443","url":null,"abstract":"<p><strong>Background: </strong>Chest computed tomography (CT) may provide evidence to forecast unexpected recurrence and metastasis following radical surgery for stage I synchronous multiple primary lung cancer (SMPLC).</p><p><strong>Objective: </strong>This study aims to develop and validate a novel CT-based multi-parametric decision tree algorithm (CT-DTA) model capable of accurate risk assessment.</p><p><strong>Design: </strong>A multicenter retrospective cohort study.</p><p><strong>Methods: </strong>There were 209 patients with pathological stage I SMPLC from three tertiary centers included. We initially screened all of the CT-derived imaging parameters in the training cohort (130 patients from Center A) and then selected those showing statistical significance to construct a DTA model. The discriminative strength of the CT-DTA model for postoperative recurrence and metastasis was then validated in the validation cohort (79 patients from Centers B and C). Moreover, the performance of the CT-DTA model was further evaluated across different subgroups of the entire cohort.</p><p><strong>Results: </strong>Five key imaging parameters measured on chest thin-section CT, including consolidation tumor ratio (CTR), long-axis diameter of the lesion, number of pure solid nodules, presence of spiculation and pleural indentation, constituted a CT-DTA model with nine leaf nodes, and CTR was the leading risk contributor of them. The CT-DTA model achieved a satisfactory predictive accuracy indicated by an area under the curve of more than 0.80 in both the training cohort and validation cohort. Meanwhile, this CT-DTA model was also exhaustively demonstrated to play as the only independent risk factor for postoperative recurrence and metastasis. Its promising predictive performance still remained stable across nearly all of the subgroups stratified by clinicopathological characteristics.</p><p><strong>Conclusion: </strong>This CT-DTA model could serve as a noninvasive, user-friendly, and practicable risk prediction tool to aid treatment decision-making in operable stage I SMPLC.</p>","PeriodicalId":22884,"journal":{"name":"Therapeutic Advances in Respiratory Disease","volume":"19 ","pages":"17534666251325443"},"PeriodicalIF":3.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11907625/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143626138","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":"Intrapleural tissue plasminogen activator and deoxyribonuclease in complex pleural effusion and empyema, clinical outcomes, and predictors.","authors":"Yub Raj Sedhai, Priyanka Bhat, Roshan Acharya, Nada Qaiser Qureshi, Fawaz Mohammed, Irfan Waheed, Tahir Muhammad Abdullah Khan, Muhammad Altaf Ahmed, Nisarfathima Kazimuddin, Akinchan Kafle, Rodney T Steff, Karan Singh","doi":"10.1177/17534666251343711","DOIUrl":"10.1177/17534666251343711","url":null,"abstract":"<p><strong>Background: </strong>Complex pleural effusion and empyema (CPPE) is treated with intrapleural fibrinolytic therapy (IPFT) using tissue plasminogen activator (tPA) and deoxyribonuclease (DNase) We present our single-center retrospective observational data using a simplified regimen of coadministering six divided doses of tPA and DNase over the course of 3 days.</p><p><strong>Objective: </strong>To study the safety, utility, and clinical outcomes of IPFT.</p><p><strong>Design: </strong>This is a single-center retrospective study of patients who received co-administration tPA/DNase for CPPE over a period of 5 years. The primary outcome was successful treatment without the need for surgery. Secondary outcomes were bleeding risk, post-procedural pain, treatment complications, and all-cause mortality at 30 days and 6 months. We have tested the clinical role RAPID score (Renal function measured as urea, Age, fluid Purulence, Infection source, Dietary status measured as albumin) to predict treatment success, and all-cause mortality at 6 months.</p><p><strong>Results: </strong>A total of (<i>n</i> = 55) patients were included in the study. The mean age of the population studied was 67 (Interquartile range 57-74), including 47.3% male and 52.7% Female. 92.7% of the population studied was Caucasian. Comorbidities including chronic obstructive pulmonary disease, congestive heart failure, and Diabetes mellitus were present in 41.8%, 41.8%, and 43.6.% respectively. Patients were treated with tube thoracostomy with 14 French percutaneous pigtail catheters in 47 (85.5%) or 28-32 French chest tubes in 8 (14.5%) patients. Twenty-nine percent (16) of patients had acceptable clinical and radiographic improvement and did not require additional surgical or radiological intervention. Seventy-one percent (39) of patients required additional surgical drainage; video-assisted thoracoscopic surgery in 37, and open thoracotomy in 2 patients. The discriminating ability of the RAPID score for treatment success after IPFT was found to be poor (AUC: 0.601, 95% CI: 0.429-0.773, <i>p</i> = 0.24). All-cause mortality at 6 months was 23.6% (13) of patients. The predictive ability of the RAPID score for mortality at 6 months was found to be poor (AUC: 0.640, 95% CI: 0.478-0.802, <i>p</i> = 0.13). The optimal cutoff for the RAPID score for mortality was ⩾4, with 84.6% sensitivity and 46.3% specificity.</p><p><strong>Conclusion: </strong>Results of our single-center study suggest that IPFT can be safely adopted by small and mid-sized clinical centers, as the risk of bleeding is low. The results of coadministering tPA and DNase are safe, and it reduces the need for surgical intervention in nearly one-third of patients.</p>","PeriodicalId":22884,"journal":{"name":"Therapeutic Advances in Respiratory Disease","volume":"19 ","pages":"17534666251343711"},"PeriodicalIF":3.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12126679/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144182286","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}