Clinical Respiratory Journal最新文献

{"title":"Association Between Volatile Organic Compound Metabolites in Urine and Adult Lung Function: Evidence From NHANES 2011-2012.","authors":"Qian Liu, Yanpeng Fu, Yuchen Tao, Wenyu Chen, Yue Wang, Haiyan Yin, Qianqian Yang","doi":"10.1111/crj.70192","DOIUrl":"https://doi.org/10.1111/crj.70192","url":null,"abstract":"<p><strong>Objectives: </strong>Volatile organic compounds (VOCs) have been reported to be associated with adverse respiratory outcomes during daily exposure at low levels. However, the main contributors among the numerous VOCs and tobacco as the possible sources of VOCs in the general population have not been fully revealed. Here, we aimed to examine the association between urinary VOCs metabolites (UM-VOCs) mixtures and adult lung health.</p><p><strong>Methods: </strong>We used data from the National Health and Nutrition Examination Survey (NHANES) for the years 2011-2012 and aimed at 16 UM-VOCs. Initially, we used linear regression to evaluate the association between a single compound and lung health. Next, we utilized the BKMR model to assess the overall effect and attempt to understand the potential modifying effects of smoking.</p><p><strong>Results: </strong>Our linear regression analysis suggested that the majority of the UM-VOCs were inversely related to lung function. In multivariable linear regression models, each one-unit increase in natural log-transformed urinary concentrations (μg/mmol Cr) of AMCC, CYMA, MHBMA3, 3HPMA, AAMA, and MA was associated with an absolute decrease in 1 s/forced vital capacity (FEV1/FVC) ratio of 3.5, 1.6, 2.3, 3.0, 3.2, and 4.6 percentage points, respectively (all p < 0.05). Moreover, 3HPMA and HPMMA were positively correlated with wheeze symptom, while 2MHA and 3MHA + 4MHA were negatively correlated with fractional exhaled nitric oxide (FeNO), respectively. BKMR model results showed that UM-VOC mixtures exhibited a negative correlation with FEV1/FVC and FeNO. Urinary AMCC and CYMA were identified as the most important contributors to the decline in FEV1/FVC and FeNO, respectively. Subsequently, we found UM-VOCs of higher concentration in smokers, and stratified BKMR analyses revealed an effect modification by smoking status.</p><p><strong>Conclusions: </strong>Using BKMR, we found that higher concentrations of urinary metabolites of VOCs (UM-VOCs) were associated with lower FEV₁/FVC ratios and lower FeNO levels in a population-based study. This association was primarily observed among smokers, suggesting that tobacco smoke may be a significant contributor to VOC exposure.</p>","PeriodicalId":55247,"journal":{"name":"Clinical Respiratory Journal","volume":"20 5","pages":"e70192"},"PeriodicalIF":2.3,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13133596/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147823634","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploring the Role of Nocturnal Hypoxemia and Sleep Fragmentation in Memory Decline: Insights From Explainable Machine Learning Models.","authors":"Xin Li, Yingying Zhu, Fansu Meng, Kangan Lai, Yuling Liang, Huang Ting, Zhengnan Mai, Liang Li","doi":"10.1111/crj.70188","DOIUrl":"https://doi.org/10.1111/crj.70188","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;Sleep-disordered breathing (SDB) is linked to memory decline, but the exact relationship between sleep fragmentation, nocturnal hypoxemia, and cognitive impairment remains unclear.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;This study aimed to investigate the associations between micro-arousal burden, nocturnal oxygen desaturation, and memory decline in patients with moderate-to-severe OSA.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Data were retrieved from the clinical and overnight polysomnographic (PSG) records of adult patients evaluated for suspected SDB. The primary clinical endpoint was the presence and severity of memory decline, ascertained via a standardized Subjective Cognitive Decline (SCD) instrument. A multidimensional array of variables was systematically extracted, encompassing baseline demographic characteristics, cardiometabolic comorbidities, and high-resolution sleep architecture metrics, with a distinct emphasis on stage-specific micro-arousal burdens and the morphological profiles of nocturnal oxygen desaturation. Then, independent t tests and &lt;math&gt; &lt;semantics&gt; &lt;mrow&gt;&lt;msup&gt;&lt;mi&gt;x&lt;/mi&gt; &lt;mn&gt;2&lt;/mn&gt;&lt;/msup&gt; &lt;/mrow&gt; &lt;annotation&gt;$$ {x}^2 $$&lt;/annotation&gt;&lt;/semantics&gt; &lt;/math&gt; tests were initially utilized to characterize PSG disparities between the memory-normal and memory-decline groups. And interpretable machine learning algorithms, utilizing rigorously partitioned training and validation sets, were deployed to predict cognitive trajectories and elucidate the relative prognostic importance of specific sleep-related parameters.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The final analytical sample comprised 884 participants with complete primary outcome data (memory-normal: N = 408; memory-decline: N = 476). Initial comparative analyses revealed the memory-decline group was older (50.24 vs. 45.95 years, p &lt; 0.001) with a significantly higher prevalence of cardiometabolic comorbidities, including hypertension (47.3% vs. 40.2%, p = 0.035) and diabetes (24.4% vs. 8.8%, p &lt; 0.001). Polysomnographically, this group exhibited a distinct hypopnea-predominant phenotype: despite a comparable overall AHI (45.82 vs. 48.64 events/h, p = 0.099) and global arousal index (26.98 vs. 28.85 events/h, p = 0.172), they demonstrated a significantly higher hypopnea count (122.25 vs. 110.40, p = 0.047) and prolonged awake time with SpO&lt;sub&gt;2&lt;/sub&gt; &lt; 95% (33.71 vs. 27.71 min, p = 0.015). Paradoxically, their nadir SpO&lt;sub&gt;2&lt;/sub&gt; was elevated (76.68% vs. 74.39%, p = 0.009), maximal obstructive events were shorter (51.42 s vs. 57.49 s, p &lt; 0.001), and obstructive desaturation events were fewer (180.33 vs. 219.70, p = 0.006), indicating a shift toward shallower, persistent desaturation morphologies. Furthermore, interpretable machine learning models, rigorously evaluated on the independent validation set, identified spontaneous NREM micro-arousals, total REM micro-arousals, and obstructive desaturation metrics as the highest-ranking predictive determinant","PeriodicalId":55247,"journal":{"name":"Clinical Respiratory Journal","volume":"20 5","pages":"e70188"},"PeriodicalIF":2.3,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147846331","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Serum Metabolomics Study Reveals a Diagnostic Model for Lung Cancer Brain Metastasis.","authors":"Hongxia Zhu, Yinuo Jin, Xin You, Qi Wang","doi":"10.1111/crj.70193","DOIUrl":"https://doi.org/10.1111/crj.70193","url":null,"abstract":"<p><p>Lung cancer remains the leading cause of cancer-related deaths worldwide, with brain metastasis being one of the most common complications in advanced-stage disease. The development of noninvasive and efficient early diagnostic methods is therefore of critical clinical importance. In this study, untargeted liquid chromatography-mass spectrometry (LC-MS) was employed to perform metabolomic profiling of 66 serum samples from patients with lung cancer brain metastasis, early-stage lung cancer, and healthy controls. A total of 719 metabolites were identified with high data reliability. Comparative analysis revealed 20 significantly upregulated and 12 significantly downregulated metabolites in the lung cancer brain metastasis group. These differentially expressed metabolites were primarily enriched in amino acid and energy metabolism pathways. This specific metabolic signature was highly associated with the brain metastatic state. Although not yet validated for clinical application, this profile demonstrated robust discriminatory power within the current cohort and serves as a potential set of risk-stratification biomarkers. These findings identify a distinct metabolic phenotype associated with brain metastasis, laying the critical groundwork for future research into noninvasive diagnostic strategies. Nevertheless, further validation within independent, longitudinal cohorts is required.</p>","PeriodicalId":55247,"journal":{"name":"Clinical Respiratory Journal","volume":"20 5","pages":"e70193"},"PeriodicalIF":2.3,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13142225/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147846513","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Stage III Lymph Node-Positive Non-Small-Cell Lung Cancer Patients With or Without Lymph Node Irradiation by Stereotactic Body Radiation Therapy: Propensity Score-Matched Analysis.","authors":"Zhen Jia, Fang Fang, Xiaofei Zhu, Yangsen Cao, Huojun Zhang","doi":"10.1111/crj.70191","DOIUrl":"https://doi.org/10.1111/crj.70191","url":null,"abstract":"<p><strong>Purpose: </strong>This study compared the local control (LC) and survival of patients with stage III lymph node-positive non-small-cell lung cancer (NSCLC) who received lymph node irradiation (LNs R+) and those who did not (LNs R-).</p><p><strong>Methods: </strong>We retrospectively reviewed patients with stage III LN-positive NSCLC who underwent stereotactic body radiotherapy (SBRT) with or without lymph node irradiation between January 2013 and December 2018. Using propensity score matching (PSM) analyses, we compared the rates of LC, progression-free survival (PFS), overall survival (OS), and acute/late toxicities between the two groups.</p><p><strong>Results: </strong>We retrospectively analyzed 201 patients, of whom 52 received LN irradiation and 149 did not. The median LC and OS were 59.7 months (95% CI: 51.1-62.9 months) and 36.3 months (95% CI: 32.6-40.0 months), respectively. After the PSM analysis, 52 patients were included in each group. The median LC (30.6 months and not reached, HR 1.296, 95% CI: 0.733-2.294, p = 0.371) and OS (30.3 months and 31.6 months, HR 0.969, 95% CI: 0.628-1.496, p = 0.887) were similar between the LN R+ group and the LN R- group. Total tumor size, tumor location, and biologic equivalent dose (BED) were independently associated with LC (p < 0.05). The incidences of acute radiation esophagitis (p = 0.006) and late pulmonary interstitial fibrosis (p = 0.046) were significantly higher in the LN R+ group than in the LN R- group.</p><p><strong>Conclusions: </strong>SBRT is safe and effective in stage III LN-positive NSCLC patients. Omitting elective nodal irradiation achieves comparable survival to irradiating involved lymph nodes while significantly reducing toxicity. These findings support the development of novel combination strategies.</p>","PeriodicalId":55247,"journal":{"name":"Clinical Respiratory Journal","volume":"20 5","pages":"e70191"},"PeriodicalIF":2.3,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147857644","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk Factors for the Recurrence of Massive Hemoptysis Treated With Bronchial Artery Embolization: A Retrospective Study.","authors":"Tianhua Yue, Ling Li, Zhengyu Yue","doi":"10.1111/crj.70187","DOIUrl":"10.1111/crj.70187","url":null,"abstract":"<p><strong>Background: </strong>Bronchial artery embolization (BAE) is preferred for massive hemoptysis. However, the suboptimal short-term and long-term therapeutic outcomes have necessitated the initiation of this study. The aim of this study was to identify risk factors that influence the recurrence of massive hemoptysis after BAE and determine active prevention and control measures to reduce recurrence.</p><p><strong>Methods: </strong>Between January 2019 and November 2024, a total of 162 patients with massive hemoptysis underwent BAE, of whom 47 required re-embolization due to recurrence. Baseline data of patients, technical success, clinical success, recurrence, complications, and other relevant information were collected from outpatient and inpatient medical records and subsequently analyzed. The Cox regression analysis and Forest map were employed to analyze the risk factors associated with recurrence of massive hemoptysis after BAE.</p><p><strong>Results: </strong>Findings suggested that the technical success rate was (160/162) 98.76% and clinical success rate was (115/162) 70.99% during the 12-month follow-up. Mean recurrence-free time was 26 ± 3.43 days (95% CI: 19.28-32.72) among 47 patients who experienced recurrence following BAE. Multivariate Cox regression analysis showed that the risk factors for early recurrence of hemoptysis following BAE were the extent of destroyed lung (OR = 0.562 [95% CI: 0.325-0.973], p = 0.04), whether preoperative computed tomography angiography (CTA) (OR = 0.204 [95% CI: 0.083-0.499], p = 0.001), or technical factors (OR = 4.621 [95% CI: 1.936-11.028], p = 0.001), while the risk factor for late recurrence was the progression of underlying diseases (OR = 6.071 [95% CI: 1.968-18.731], p = 0.002). However, the overall risk factors for recurrent hemoptysis after BAE included the extent of destroyed lung (OR = 0.606 [95% CI: 0.404-0.91], p = 0.016), whether preoperative CTA (OR = 0.49 [95% CI: 0.266-0.905], p = 0.023), technical factors (OR = 2.176 [95% CI: 1.089-4.348], p = 0.028), and the progression of underlying diseases (OR = 1.958 [95% CI: 1.047-3.662], p = 0.035. There were no major complications related to BAE requiring immediate treatment, and only minor complications were observed.</p><p><strong>Conclusion: </strong>This study preliminarily concludes that the extent of destroyed lung, whether preoperative CTA, technical factors, and the progression of underlying diseases are independent risk factors associated with hemoptysis recurrence after BAE. Through comprehensive preoperative assessments, individualized embolization strategies, and proactive postoperative management of underlying diseases, the risk of recurrent hemoptysis can be significantly reduced.</p>","PeriodicalId":55247,"journal":{"name":"Clinical Respiratory Journal","volume":"20 5","pages":"e70187"},"PeriodicalIF":2.3,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13120837/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147789925","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dynamic Parameters within the First 72 H of ICU Admission Predict Extubation Failure and 28-Day Mortality in Severe Pneumonia-Induced ARDS: A Retrospective Cohort Study.","authors":"Chen Wang, Yalong Liu, Wenqing Xu, Hanhan Hong","doi":"10.1111/crj.70189","DOIUrl":"https://doi.org/10.1111/crj.70189","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate dynamic parameter changes within 72 h of intensive care unit (ICU) admission for predicting extubation failure and 28-day mortality in patients with severe pneumonia-induced acute respiratory distress syndrome (ARDS).</p><p><strong>Methods: </strong>This retrospective cohort study enrolled 424 adults with severe pneumonia-induced ARDS receiving invasive ventilation ≥ 48 h during January 2023-August 2025. We collected clinical data and calculated 72-h changes (Δ) in key parameters: physiological stress [maximum respiratory rate (RR), mean heart rate (HR)] and disease progression [ΔPaO₂/FiO₂, Δ blood lactate (BLA), Δ procalcitonin (PCT), Δ Sequential Organ Failure Assessment (SOFA)]. Outcomes were extubation failure (first spontaneous breathing trial failure or reintubation ≤ 48 h) and 28-day mortality. Multivariable logistic and Cox regression models were built, with discrimination assessed by ROC curves.</p><p><strong>Results: </strong>Extubation failure and 28-day mortality rates were 23.82% (101/424) and 29.48% (125/424), respectively. For extubation failure, independent risk factors included older age, higher APACHE II score at admission, immunosuppression, higher maximum RR, higher mean HR, and increased ΔBLA, ΔPCT, and ΔSOFA (protective factor: increased ΔPaO₂/FiO₂) (p < 0.05). The prediction model had an AUC of 0.912 (95% CI, 0.883-0.941). For 28-day mortality, independent risk factors were higher APACHE II score at admission, higher maximum RR, increased ΔBLA, and increased ΔSOFA (p < 0.05), with a time-dependent AUC of 0.755 (95% CI, 0.729-0.781). A significant association was observed between extubation failure and 28-day mortality, with a markedly higher mortality rate in patients with extubation failure compared to those with successful extubation (81.19% vs. 13.31%, p < 0.001).</p><p><strong>Conclusion: </strong>Dynamic parameters within 72 h of ICU admission are predictors of extubation failure and 28-day mortality in severe pneumonia-induced ARDS, offering a tool for early risk stratification. Extubation failure was also strongly associated with increased short-term mortality, underscoring its clinical significance as an adverse outcome during the disease course.</p>","PeriodicalId":55247,"journal":{"name":"Clinical Respiratory Journal","volume":"20 5","pages":"e70189"},"PeriodicalIF":2.3,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13106213/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147789928","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Growth Differentiation Factor-15 Could Predict Decreased Hemoglobin in Tuberculosis Treated With Linezolid-Containing Regimen.","authors":"Amaylia Oehadian, Prayudi Santoso, Delita Prihatni, Andini Kartikasari, Ida Parwati, Diah Handayani, Thomas Handoyo, Noorwati Sutandiyo, Bachti Alisjahbana, Dick Menzies, Rovina Ruslami","doi":"10.1111/crj.70195","DOIUrl":"https://doi.org/10.1111/crj.70195","url":null,"abstract":"<p><strong>Background: </strong>Linezolid effectively treats rifampicin-resistant tuberculosis (RR-TB) but can cause significant hematological toxicities linked to mitochondrial dysfunction in hematopoietic stem cells. Growth differentiation factor-15 (GDF-15) has been identified as a potential biomarker of this dysfunction. This study aimed to determine whether baseline GDF-15 levels can predict myelosuppression in RR-TB patients treated with linezolid.</p><p><strong>Methods: </strong>The study included patients with RR-TB from three referral hospitals who were treated with a linezolid-containing regimen for at least 4 weeks. Hematological parameters and GDF-15 levels were measured at baseline as well as at the 2nd and 4th-8th weeks of treatment.</p><p><strong>Results: </strong>Ninety-seven subjects were included in this study. By the 2nd week of linezolid treatment, GDF-15 levels significantly increased from a baseline of 635.58 (407.31-1583.65) to 708.96 (378.09-2408.89)pg/ml (p = 0.003). By weeks 4-8, 65% of patients developed myelosuppression. A correlation was found between baseline GDF-15 levels and hemoglobin reduction at weeks 4-8 (r = 0.4, p < 0.001). Baseline GDF-15 levels > 950 pg/mL identified patients with more than a 25% reduction in hemoglobin (AUC 0.756, 95% CI 0.659-0.838).</p><p><strong>Conclusion: </strong>Baseline GDF-15 levels were correlated with hemoglobin changes during the 4th-8th weeks of linezolid treatment. These levels can predict myelosuppression, particularly hemoglobin changes, in patients with RR-TB undergoing long-term linezolid therapy.</p>","PeriodicalId":55247,"journal":{"name":"Clinical Respiratory Journal","volume":"20 5","pages":"e70195"},"PeriodicalIF":2.3,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147846336","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnostic and Clinical Value of Targeted Next-Generation Sequencing for Pediatric Respiratory Infections in Northern China","authors":"Lixiang Wang,&nbsp;Xue Yang,&nbsp;Lexia Yang,&nbsp;Ke Yin,&nbsp;Hui Zhong","doi":"10.1111/crj.70185","DOIUrl":"10.1111/crj.70185","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Pediatric patients are particularly susceptible to respiratory tract infections (RTIs) due to ongoing maturation of pulmonary and immune function, highlighting the need for rapid and accurate pathogen identification. Although targeted next-generation sequencing (tNGS) is increasingly applied in infectious disease diagnostics, its real-world clinical utility in pediatric RTIs remains underexplored.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a retrospective study of 940 hospitalized children with RTIs in northern China between April and December 2023. All patients underwent tNGS alongside conventional microbiological tests (CMTs), including PCR, culture, and serology. Diagnostic performance metrics—including sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV)—were calculated. The clinical impact of tNGS was assessed by examining treatment adjustments, turnaround time (TAT), and patient outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>tNGS demonstrated superior diagnostic performance compared with CMTs: sensitivity 91.38% versus 29.68%, specificity 91.03% versus 90.17%, PPV 97.68% versus 77.78%, and NPV 73.39% versus 54.60%. tNGS identified a broader spectrum of pathogens, including RNA viruses and low-abundance organisms frequently missed by CMTs, and detected polymicrobial infections in 17.77% of cases versus 1.17% by CMTs. Based on tNGS, treatment was escalated in 35.32% and de-escalated in 29.04% of patients, with over 90% of adjustments made within 48 h, facilitated by a mean TAT of 28.5 h. Clinical improvement was observed in most adjusted cases. Pathogen distribution showed age- and season-specific patterns, underscoring the need for context-informed diagnostics and therapy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>tNGS enhances pathogen detection accuracy in pediatric RTIs, enables timely and appropriate treatment modifications, and supports antimicrobial stewardship. Its high sensitivity, rapid TAT, and capacity to identify co-infections reinforce its clinical utility in guiding optimized management of pediatric respiratory infections.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55247,"journal":{"name":"Clinical Respiratory Journal","volume":"20 4","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13070711/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147678775","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Temporal and Partial Reversal of Airflow Limitation in Patients With COPD Treated With Single-Inhaler Long-Acting Dual Bronchodilators.","authors":"Yimeng Lu, Yanan Zhou, Liping Xue, Hao Tian, Junjie Han, Yanping Yang, Yunxin Guo, Weipeng Jiang, Cuicui Chen, Linlin Wang, Yuanlin Song","doi":"10.1111/crj.70173","DOIUrl":"10.1111/crj.70173","url":null,"abstract":"<p><strong>Introduction: </strong>Chronic obstructive pulmonary disease (COPD) is characterized by irreversible airflow limitation. While single-inhaler long-acting dual bronchodilators (LADBs) effectively relieve symptoms and improve lung function, their long-term impact on spirometry outcomes and the potential for meaningful changes in key diagnostic indices in a real-world setting remain underexplored.</p><p><strong>Methods: </strong>This was a single-country (China), single-center, retrospective, noninterventional, real-world study that included 182 patients treated with LADBs (indacaterol/glycopyrronium [IND/GLY] or umeclidinium/vilanterol [UMEC/VI]). The primary outcomes were changes in trough FEV1 and FEV1/FVC from baseline. Secondary outcomes were changes in other spirometry parameters. An exploratory post hoc analysis explored the reversal of FEV1/FVC, defined as a posttreatment trough FEV1/FVC ratio that exceeded 70%.</p><p><strong>Results: </strong>Single-inhaler LADB therapy significantly improved lung function, including FEV1, FVC, FEV1/FVC, RV, and parameters of small airway function. The least-square mean change in trough FEV1 and FEV1/FVC post-treatment was 0.154 L [95% CI: 0.09, 0.218] and 1.929% [95% CI: 0.694, 3.164], respectively, at 24 weeks. Posttreatment FEV1 exhibited a characteristic pattern: an initial increase, followed by a peak, a subsequent slight decline, and eventual stabilization. Patients with lower GOLD grades experienced greater improvement in key spirometry parameters. Notably, 21 patients (11.5%) achieved a reversal of the FEV1/FVC ratio to over 70%. Exploratory logistic regression showed that a better baseline lung function, especially FEV1/FVC ratio, was associated with an increased likelihood of achieving this threshold (OR = 1.52 [95% CI: 1.29, 1.89]).</p><p><strong>Conclusion: </strong>This study demonstrated significant and sustained improvements in lung function in this real-world cohort of COPD patients managed with LABA/LAMA monotherapy. A subset of patients achieved a posttreatment FEV1/FVC ratio above 70%, indicating a potentially meaningful change in airflow limitation after LADB therapy.</p>","PeriodicalId":55247,"journal":{"name":"Clinical Respiratory Journal","volume":"20 4","pages":"e70173"},"PeriodicalIF":2.3,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13096688/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147730811","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Features and Predictive Risk Factors for Prognosis in Invasive Pulmonary Aspergillosis and Pulmonary Mucormycosis.","authors":"Yu Bai, Ming Wei, Jun Liu, Xi Chen, Li Gu, Yinqun Guo","doi":"10.1111/crj.70186","DOIUrl":"10.1111/crj.70186","url":null,"abstract":"<p><strong>Background: </strong>Invasive pulmonary aspergillosis (IPA) and pulmonary mucormycosis (PM) stand as the most prevalent invasive mold pulmonary infections. The incidence of IPA and PM has progressively increased. Untimely or inappropriate intervention amplifies mortality rates in patients affected by IPA and PM. There exist numerous commonalities between the two with regard to the population susceptible to the disease and imaging characteristics. This renders it challenging to differentiate them in certain clinical practices, resulting in issues such as the inappropriate selection of treatment plans. Early and expeditious differential diagnosis of invasive pulmonary mold infections and prompt identification of severe cases are critical challenges in clinical practice.</p><p><strong>Methods: </strong>A retrospective cohort study encompassed IPA and PM patients admitted to Beijing Chao-Yang Hospital from 2017 to 2022. Patients in the cohort were categorized into PM and IPA groups. A comprehensive analysis of clinical characteristics, laboratory parameters, and chest radiology findings was conducted. Subsequently, a comparative assessment of the prognosis between the two patient groups was carried out. All patients with invasive pulmonary mold infection were classified based on prognosis, and independent risk factors for poor prognosis were identified. Subsequent to these findings, exploration of novel disease assessment tools was undertaken, and their diagnostic efficacy was evaluated.</p><p><strong>Results: </strong>In comparison to IPA, PM patients exhibited a younger age profile, with a higher incidence of diabetes and solid organ transplantation. PM occurrences postinfluenza infection were less frequent than IPA. Radiologically, consolidation and bronchial lumen stenosis were more prevalent in PM patients. Additionally, the diagnosis of PM patients relied more on pathological confirmation. No significant disparities were noted regarding ICU stays, mechanical ventilation ratios, and 90-day mortality between PM and IPA. Postinfluenza infection and the neutrophil-to-lymphocyte ratio (NLR) were identified as independent risk factors for ICU stays in PM/IPA patients. Postinfluenza infection and elevated hemoglobin A1c (HbA1c) levels were independent risk factors for mechanical ventilation. NLR, HbA1c levels, and postinfluenza infection collectively enhanced the predictive capacity of existing assessment tools for adverse outcomes in PM/IPA patients.</p><p><strong>Conclusions: </strong>PM patients exhibit distinctions from IPA in certain clinical characteristics, laboratory parameters, and chest radiology findings. Nevertheless, both PM and IPA patients experienced higher 90-day mortality and ICU utilization. The combination of NLR and HbA1c with existing disease assessment tools proves effective in prognosticating the disease, particularly during influenza epidemic seasons.</p>","PeriodicalId":55247,"journal":{"name":"Clinical Respiratory Journal","volume":"20 4","pages":"e70186"},"PeriodicalIF":2.3,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13092352/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147724681","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}