Clinical Respiratory Journal最新文献

{"title":"Clinical Features of COVID-19 Associated Pulmonary Aspergillosis: A Multicenter, Retrospective Study","authors":"Yasheng Zhan,&nbsp;Guojun He,&nbsp;Cheng Zhong,&nbsp;Yake Yao,&nbsp;Jiangying Zhou,&nbsp;Tong Li,&nbsp;Hua Zhou","doi":"10.1111/crj.70048","DOIUrl":"10.1111/crj.70048","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>This study was conducted to further understand the clinical characteristics of COVID-19 associated pulmonary aspergillosis (CAPA).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>In this study, we conducted a multicenter retrospective survey, which included patients with COVID-19 from five hospitals in Zhejiang, China. A total of 197 patients with COVID-19 were included in the study. The detailed clinical data of seven patients with CAPA from COVID-19 onset to 28 days after CAPA were collected and analyzed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In the total of 197 patients, 36 were admitted to the intensive care unit (ICU), 13 received mechanical ventilation; among them, nine received extracorporeal membrane oxygenation (ECMO). All seven cases acquired CAPA in the ICU, six cases during MV, of which five cases received ECMO treatment at the same time, and one case had been off ventilation. The average duration from onset of COVID-19 to CAPA was 25.4 days, from ICU admission to CAPA was 23.4 days, and from MV to CAPA was 22.1 days. All seven patients were diagnosed with CAPA without neutropenia, four with lymphopenia, seven with decreased CD4+ T lymphocyte, and five with decreased CD8+ T lymphocyte. All cases received glucocorticoids before CAPA, with an average duration of 15 days and an average cumulative dose of 762.5 mg prednisolone. In addition, all patients suffered bacterial infections and received antibacterial agents before CAPA, with an average duration of 22.6 days. CAPA was diagnosed according to a positive culture of <i>Aspergillus fumigatus</i> in sputum or bronchoalveolar lavage fluid (BALF) and positive serum 1,3-β-<span>d</span>-glucan in all seven patients; serum galactomannan was positive in three cases. Rhizopus was cultured from BALF of one case during treatment of CAPA. All patients received antifungal therapy, and the 28-day survival rate was 100%.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The incidence of CAPA in patients with COVID-19 admitted to the ICU was 19.44%, all patients with CAPA had a history of chronic underlying diseases, and all had a history of high dose glucocorticoid. Patients with CAPA had no specific clinical symptoms and lung imaging manifestations, and diagnosis depended on Aspergillus culture and galactomannan detection. For patients with COVID-19 with these high-risk factors, <i>Aspergillus</i> culture and GM testing should be performed actively to avoid delaying the diagnosis of CAPA.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55247,"journal":{"name":"Clinical Respiratory Journal","volume":"19 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-01-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11769720/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143048827","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":"Significance of Combining Bronchoalveolar Lavage Fluid With Targeted Next-Generation Sequencing in the Pathogen Detection-Based Diagnosis of Pulmonary Infections","authors":"Jiangbo Liu,&nbsp;Bo Yang,&nbsp;Yu Wu,&nbsp;Guihong Yang,&nbsp;Xiaojiu Zha,&nbsp;Wei Jiang","doi":"10.1111/crj.70046","DOIUrl":"10.1111/crj.70046","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>In this study, we investigated the application value of bronchoalveolar lavage fluid (BALF) combined with targeted next-generation sequencing (tNGS) in the pathogen detection-based diagnosis of patients with lung infections.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Method</h3>\u0000 \u0000 <p>A retrospective analysis was conducted on patients who underwent tracheoscopy and conventional microbiological tests (CMTs) on BALF, coupled with metagenomic next-generation sequencing (mNGS) or tNGS. This investigation encompassed individuals with suspected lung infections at Tianjin First Central Hospital from March 2023 to July 2023. Diagnostic rates based on pathogens detected via tNGS were compared with CMTs within the tNGS group. Additionally, diagnostic rates obtained through tNGS were compared with mNGS between the two groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The data of a total of 169 patients (78 in the tNGS group and 91 in the mNGS group) were collected, and 145 patients (67 in the tNGS group and 78 in the mNGS group) were finally diagnosed with lung infections. The comprehensive positive pathogen detection-based diagnosis rate for tNGS was 86.6%, with a single-pathogen lung infection diagnosis rate of 85.7% and a mixed-pathogen pulmonary infection diagnosis rate of 88.0%. In contrast, the overall positive pathogen detection-based diagnosis rate for CMTs was 38.8%, comprising a single-pathogen pulmonary infection diagnosis rate of 28.6% and a mixed-pathogen pulmonary infection diagnosis rate of 20.0%. The difference in positive diagnosis rate was deemed statistically significant (<i>p</i> &lt; 0.05). In the mNGS group, the overall pathogen detection-based diagnosis rate was 89.7%, with a single-pathogen pulmonary infection diagnosis rate of 84.9%, and a 100% diagnosis rate for mixed-pathogen pulmonary infections. There was no statistically significant difference in the positive diagnosis rate when compared with the tNGS group (<i>p &gt;</i> 0.05).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>In patients with pulmonary infections, the diagnosis rate based on BALF pathogen detection using tNGS exceeded that of CMTs, showing no statistically significant difference compared to mNGS.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55247,"journal":{"name":"Clinical Respiratory Journal","volume":"19 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11747687/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143015650","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":"Effect of Refined Nursing on Wound Complications After Thoracoscopic Surgery for Lung Cancer","authors":"Yanxia Dong,&nbsp;Guangqin Ma,&nbsp;Shuaishuai Wu,&nbsp;Shuling Zhang","doi":"10.1111/crj.70039","DOIUrl":"10.1111/crj.70039","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Lung cancer thoracoscopic postoperative wound complications bring great pain and inconvenience to patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>To provide clinical nurses with a more scientific and effective nursing plan, this study evaluated the effect of refined nursing on wound complications after thoracoscopic surgery for lung cancer. Two-hundred thirty patients undergoing thoracoscopic radical resection for lung cancer were randomly divided into two groups according to the random number table method. The study group received refined nursing intervention (115 cases), and the control group received routine nursing intervention (115 cases). The effects of the two groups' nursing modes on the wound complications (pleural effusion, incision infection, lung leakage, and wound bleeding) after thoracoscopic surgery for lung cancer were compared.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>According to the study results, the study group experienced a shorter intraoperative blood loss, lower extubation time, shorter hospital stay, and lower wound complication rate than the control group (<i>p</i> &lt; 0.05). Compared to the control group, the study group had significantly lower Hamilton Anxiety Scale (HAMA), Hamilton Depression Scale (HAMD) and visual analog scale (VAS) scores, and higher the short form 36 health survey questionnaire (SF-36) scores (<i>p</i> &lt; 0.05).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Compared with the control group, the implementation of refined nursing intervention for patients with thoracoscopic radical resection of lung cancer has fewer postoperative wound complications and can improve patients' nursing satisfaction and quality of life, which is worthy of clinical promotion and application.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55247,"journal":{"name":"Clinical Respiratory Journal","volume":"19 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11744364/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143016900","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":"Bronchiectasis Exacerbation Increases the Risk of Adverse Renal Outcomes—Results From a Large Territory-Wide Cohort Study","authors":"Wang Chun Kwok,&nbsp;Chung Ki Tsui,&nbsp;Leung Sze Him Isaac,&nbsp;Chun Ka Emmanuel Wong,&nbsp;Terence Chi Chun Tam,&nbsp;James Chung Man Ho,&nbsp;Desmond Yat Hin Yap","doi":"10.1111/crj.70029","DOIUrl":"10.1111/crj.70029","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Bronchiectasis exacerbation (BE) is associated with unfavorable sequelae in other organs such as the cardiovascular system; data regarding its impact on adverse term renal outcomes, however, is lacking.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A territory-wide retrospective cohort study was conducted in Hong Kong between 1/1/1993 and 31/12/2017. All patients with bronchiectasis followed in the public healthcare system in 2017 were classified as “Exacerbators” or “Non-Exacerbators,” and their adverse renal outcomes (renal progression [decrease in eGFR by 30 mL/min lasted for more than 12 months during follow up], acute kidney injury [AKI], and annual rate of eGFR decline) in the ensuing 7 years were compared. Results were also analyzed in the 1:1 propensity score matched (PSM) cohort.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 7929 patients (1074 “Exacerbators” group and 6855 “Non-exacerbators”) were followed for 6.2 ± 1.6 years. A total of 1570 patients (19.8%) had renal progression, and 935 (11.8%) patients developed AKI. “Exacerbators” showed significantly increased risk of renal progression (adjusted odds ratio [aOR] 1. 27 [95% CI 1.08–1.50, <i>p</i> = 0.003]), more rapid eGFR decline (−3.67 [−1.74 to −6.54] vs. −3.03 [−1.56 to −5.12] mL/min/1.73 m²/year, <i>p</i> = 0.004) and AKI (aOR 1.99; 95% CI 1.44–2.73, <i>p</i> &lt; 0.001) than the “Non-exacerbators.” Annual number of BE was associated with renal progression (aOR 1.45; 95% CI 1.22–1.72, <i>p</i> &lt; 0.001) and AKI (aOR 2.00; 95% CI 1.38–2.91, <i>p</i> &lt; 0.001). Results were consistent in the analysis with the PSM cohort.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Renal progression and AKI are common among patients with bronchiectasis, and BE is an independent risk factor for adverse renal outcomes.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55247,"journal":{"name":"Clinical Respiratory Journal","volume":"19 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11724331/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142967463","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":"Study Protocol of the Korean EGFR Registry: A Multicenter Prospective and Retrospective Cohort Study in Nonsmall Cell Lung Cancer Patients With EGFR Mutation","authors":"Chang Dong Yeo,&nbsp;Dong Won Park,&nbsp;Seong Hoon Yoon,&nbsp;Eun Young Kim,&nbsp;Jeong Eun Lee,&nbsp;Shin Yup Lee,&nbsp;Chang-Min Choi,&nbsp;In-Jae Oh,&nbsp;Do Jin Kim,&nbsp;Jeong Seon Ryu,&nbsp;Jae Cheol Lee,&nbsp;Young-Chul Kim,&nbsp;Tae Won Jang,&nbsp;Kye Young Lee,&nbsp;Seung Hun Jang,&nbsp;Seung Joon Kim,&nbsp;for the Korean EGFR Registry Investigators","doi":"10.1111/crj.70043","DOIUrl":"10.1111/crj.70043","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>The provision of treatment for epidermal growth factor receptor (EGFR)-mutated nonsmall cell lung cancer (NSCLC) patients has increased in Korea. However, multicenter studies on the clinicopathologic dataset and treatment outcomes, using a large-scale dataset, have not been conducted. The current study is a prospective and retrospective multicenter observational cohort study that registers all stages of EGFR-mutated NSCLC patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The Korean EGFR Registry was designed to enroll 2000 patients with all stages of EGFR-mutated NSCLC from 40 university hospitals across Korea. This study, encompassing both retrospective and prospective cohorts, aims to analyze clinical characteristics, treatment modalities, and outcomes in these patients. Data collection will include patient demographics, smoking history, quality of life assessments, pathological data, and treatment outcomes, with follow-up until December 2026. The primary endpoint is disease-free survival in patients who have undergone radical therapy (surgery and radiotherapy) or progression-free survival in those receiving targeted therapy (first, second, and subsequent lines), chemotherapy (first and subsequent lines), combination therapy, and palliative/maintenance therapy according to stages of EGFR-mutated NSCLC. The study will explore the diagnostic methods for EGFR mutations, clinical outcomes based on treatment modalities, and metastatic patterns in EGFR-mutated NSCLC patients. Moreover, it will investigate various aspects, including the safety and efficacy of a new third-generation EGFR tyrosine kinase inhibitor (TKI), lazertinib, approved for both first- and second-line treatments.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>This study is expected to provide valuable insights into the epidemiology, risk factors, progression, and treatment outcomes of EGFR-mutated NSCLC in Korea. The Korean EGFR Registry will contribute significantly to the understanding of the complex dynamics of EGFR-mutated NSCLC, aiding in the development of more effective and personalized treatment strategies.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55247,"journal":{"name":"Clinical Respiratory Journal","volume":"19 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-01-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/crj.70043","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142933342","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":"New Insights on Continuous Renal Replacement Therapy for Acute Respiratory Distress Syndrome: A Systematic Review and Meta-Analysis","authors":"Siyao Zeng,&nbsp;Shanpeng Cui,&nbsp;Yue Li,&nbsp;Zhipeng Yao,&nbsp;Yunlong Li,&nbsp;Yang Cao,&nbsp;Lianghe Wen,&nbsp;Ming Li,&nbsp;Junbo Zheng,&nbsp;Hongliang Wang","doi":"10.1111/crj.70045","DOIUrl":"10.1111/crj.70045","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>In recent times, the applications of continuous renal replacement therapy (CRRT) beyond kidney-related conditions have been progressively increasing, and its implementation in randomized controlled trials (RCTs) specifically for acute respiratory distress syndrome (ARDS) has been documented. This meta-analysis compiles all existing RCTs to assess whether CRRT benefits ARDS.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We searched 12 databases in English and Chinese and two clinical trial centers up to November 28, 2023. The main outcome indicator is the mortality rate. Secondary outcome indicators include incidence of ventilator-associated pneumonia (VAP), ICU length of stay, mechanical ventilation time, oxygenation index (OI) at 24 h (h), OI at 48 h, OI at 72 h, OI at 7 days (d), partial pressure of oxygen (PaO₂) at 72 h, Acute Physiology and Chronic Health Evaluation II (APACHE II) score at 24 h, APACHE II score at 48 h, APACHE II score at 72 h, APACHE II score at 7 d, extravascular lung water indexes (EVLWI) at 72 h, TNF-α at 24 h, TNF-α at 7 d, IL-6 at 24 h, IL-6 at 48 h, IL-6 at 72 h, and IL-6 at 7 d. Statistical measures utilized include risk ratios (RR), weighted mean difference (WMD), and 95% confidence intervals (95% CI).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We summarized 36 studies, including 2123 patients. It was found that for ARDS, using CRRT in addition to conventional therapy can reduce the mortality rate (<i>I</i>² = 0%; RR: 0.40; 95% CI: 0.30–0.53; <i>p</i> &lt; 0.01), the incidence of VAP (<i>I</i>² = 0%; RR: 0.44; 95% CI: 0.33–0.59; <i>p</i> &lt; 0.01), ICU length of stay, mechanical ventilation time, and EVLWI at 72 h, as well as APACHE II score, TNF-α, and IL-6 at various time points. Additionally, it can increase OI during different time intervals and PaO₂ at 72 h.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Low-quality evidence suggests that compared with conventional therapy alone, the use of CRRT may be associated with a lower mortality rate, the incidence of VAP, ICU length of stay, mechanical ventilation time, EVLWI, APACHE II score, TNF-α, and IL-6 and may be related to better respiratory function. CRRT may be beneficial for ARDS patients. Future multicenter, well-designed, high-quality RCTs are needed to substantiate these findings.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55247,"journal":{"name":"Clinical Respiratory Journal","volume":"19 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11695202/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142923858","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":"Liver Function Biomarkers and Lung Cancer Risk: A Prospective Cohort Study in the UK Biobank","authors":"Xiangyu Sun,&nbsp;Zeqin Guo,&nbsp;Yanpei Zhang,&nbsp;Zhuangzhuang Liu,&nbsp;Jingrong Xiong,&nbsp;Mingliang Cai,&nbsp;Jiale Tan,&nbsp;Yan Lin,&nbsp;Zihang Yu,&nbsp;Kunheng Du,&nbsp;Enli Lu,&nbsp;Xiaolin Xia","doi":"10.1111/crj.70042","DOIUrl":"10.1111/crj.70042","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>As the primary organ of metabolism and detoxification, the liver may contribute to the pathogenesis of lung cancer. We aimed to illuminate the intricate link between liver function biomarkers and lung cancer risk, as well as delineate the role of smoking behavior within this association.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We investigated the associations of seven liver function biomarkers levels (alkaline phosphatase [ALP], alanine transaminase [ALT], total bilirubin [TBIL], albumin [ALB], gamma-glutamyltransferase [GGT], aspartate transaminase [AST], and total protein [TP]) with lung cancer risk across the UK Biobank (<i>N</i> = 337 499) through restricted cubic splines and Cox proportional hazards models. Moreover, Mendelian randomization (MR) was utilized to evaluate the causal effect of smoking behavior on these biomarkers. Then a lung cancer risk prediction model was developed among smokers by backward stepwise logistic regression.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>During a median follow-up of 13.3 years, 3003 lung cancer cases were identified. We found ALP levels positively associated with lung cancer risk, whereas ALT, TBIL, ALB, and AST were inversely correlated; TP exhibited a U-shaped association, whereas GGT displayed a mirrored J-shaped relationship. These associations were amplified among smokers. MR analysis indicated that smoking behavior could increase ALP (odds ratio [OR]: 1.05) and GGT (OR: 1.15) levels while decreasing TBIL (OR: 0.92), ALB (OR: 0.92), and TP (OR: 0.96) levels. The lung cancer risk model incorporating these biomarkers in smokers demonstrated robust discrimination.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Our finding provides perspectives and evidences towards the intricate crosstalk between the hepatic and pulmonary systems, as well as the processes through which tobacco catalyzes lung carcinogenesis.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55247,"journal":{"name":"Clinical Respiratory Journal","volume":"18 12","pages":""},"PeriodicalIF":1.9,"publicationDate":"2024-12-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11669495/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142900568","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":"Prediction of Optimal Positive Airway Pressure in Chinese Patients With Obstructive Sleep Apnea","authors":"Feng Pang,&nbsp;Wenmin Deng,&nbsp;Jingyan Huang,&nbsp;Yu Guo,&nbsp;Minmin Lin,&nbsp;Xiangmin Zhang,&nbsp;Jie Liu","doi":"10.1111/crj.70047","DOIUrl":"10.1111/crj.70047","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>Positive airway pressure (PAP) is the primary treatment for obstructive sleep apnea (OSA). This study aims to predict the optimal PAP pressure in Chinese OSA patients by their polysomnography (PSG) variables and demographic characteristics.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Patients with an apnea–hypopnea index (AHI) ≥ 15 times/h who received PAP therapy (residual AHI &lt; 5 times/h) and underwent PSG were included in this study. Sex, age, body mass index (BMI), Epworth Sleepiness Scale (ESS), AHI, supine AHI, lowest oxygen saturation (LSaO₂), percentage of total sleep time spent with SaO₂ &lt; 90% (CT90), and PAP pressure were recorded. PAP pressure and other variables were analyzed using univariate correlation and multivariate linear stepwise regression analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 167 patients were enrolled, with 122 in the study group and 45 in the validation group. Univariate correlation analysis revealed a significant correlation between PAP pressure and age, BMI, ESS, AHI, supine AHI, LSaO₂, and CT90. The multivariate linear regression analysis showed that PAP pressure was correlated with gender (<i>b</i> = 1.142, <i>p</i> = 0.032), age (<i>b</i> = −0.039, <i>p</i> = 0.005), AHI (<i>b</i> = 0.047, <i>p</i> = 0.000), and CT90 (<i>b</i> = 0.037, p = 0.000). The final PAP pressure prediction equation was PAPpre (cmH₂O) = 8.548 + 1.142 × sex −0.039 × age + 0.047 × AHI + 0.037 × CT90 (<i>R</i>² = 0.553) (male is defined as 0 and female as 1). This model accounts for 55.3% of the optimal pressure variance, and the area under the ROC curve of PAP prediction pressure is 0.7419.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>PSG variables can be used to predict PAP pressure in Chinese OSA patients, but for some individuals, the prediction model is not very good. PAP is correlated with age, BMI, ESS, AHI, supine AHI, LSaO₂, and percentage of total sleep time spent with SaO₂ &lt; 90% (CT90), which can be used to predict the optimal PAP pressure.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55247,"journal":{"name":"Clinical Respiratory Journal","volume":"18 12","pages":""},"PeriodicalIF":1.9,"publicationDate":"2024-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11666474/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142883675","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":"Explainable Machine Learning Predictions for the Benefit From Chemotherapy in Advanced Non-Small Cell Lung Cancer Without Available Targeted Mutations","authors":"Zhao Shuang,&nbsp;Xiong Xingyu,&nbsp;Cheng Yue,&nbsp;Yu Mingjing","doi":"10.1111/crj.70044","DOIUrl":"10.1111/crj.70044","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Non-small cell lung cancer (NSCLC) is a global health challenge. Chemotherapy remains the standard therapy for advanced NSCLC without mutations, but drug resistance often reduces effectiveness. Developing more effective methods to predict and monitor chemotherapy benefits early is crucial.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We carried out a retrospective cohort study of NSCLC patients without targeted mutations who received chemotherapy at West China Hospital from 2009 to 2013. We identified variables associated with chemotherapy outcomes and built four predictive models by machine learning. Shapley additive explanations (SHAP) interpreted the best model's predictions. The Kaplan–Meier method assessed key variables' impact on 5-year overall survival.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The study enrolled 461 NSCLC patients. Eight variables were selected for the model: differentiation, surgery history, neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), total bilirubin (TBIL), total protein (TP), alanine aminotransferase (ALT), and lactate dehydrogenase (LDH). The extreme gradient boosting (Xgboost) model exhibited superior discriminatory ability in predicting complete response (CR) probabilities to chemotherapy, with an AUC of 0.78. SHAP plots showed surgery history and high differentiation were related to CR benefits from chemotherapy. Absence of surgery, higher NLR, higher PLR, and higher LDH were all independent prognostic factors for poor survivals in NSCLC patients without mutations receiving chemotherapy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>By machine learning, we developed a predictive model to assess chemotherapy benefits in NSCLC patients without targeted mutations, utilizing eight readily available and non-invasive clinical indicators. Demonstrating satisfactory predictive performance and clinical practicability, this model may help clinicians identify patients' tendency to benefit from chemotherapy, potentially improving their prognosis.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55247,"journal":{"name":"Clinical Respiratory Journal","volume":"18 12","pages":""},"PeriodicalIF":1.9,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/crj.70044","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142856830","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":"Concomitant ALK Fusion and TP53/EGFR Mutation Lead to Adverse Prognostic Outcome","authors":"Mingyuan Du,&nbsp;Cuiwei Liu,&nbsp;Leichong Chen,&nbsp;Zhenyu Li,&nbsp;Sijia Zhang,&nbsp;Rui Meng","doi":"10.1111/crj.70041","DOIUrl":"10.1111/crj.70041","url":null,"abstract":"<p>Lung cancer treatment has evolved at the molecular level. Detecting the presence of driver genes in lung cancer fundamentally alters the choice of therapeutic regimens and the outcome of this disease. ALK fusion mutation is one of the most important mutations in nonsmall cell lung cancer (NSCLC). Also, it often has other coexisting mutation types. TP53 is the most common coexisting mutation type, whereas the EGFR/ALK coexisting mutation type is extremely rare. There is still no definite conclusion about the impact of the multimutation and best treatment options for NSCLC patients with advanced multimutation. In this study, we report three cases of NSCLC with ALK fusion mutations as well as ALK combined with TP53 mutations and ALK combined with EGFR mutations. Combining cases from our oncology center and previous literature, we found that NSCLC patients with coexisting ALK fusion mutations and other mutations have poorer response to targeted therapy and poorer prognosis, and we also compared the efficacy rates of various types of coexisting mutations for different treatment regimens. Therefore, this review can help to evaluate the prognosis of NSCLC patients with coexisting mutations and the efficacy of targeted therapies and to find more favorable treatment options for patients with this type of coexisting mutations.</p>","PeriodicalId":55247,"journal":{"name":"Clinical Respiratory Journal","volume":"18 12","pages":""},"PeriodicalIF":1.9,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/crj.70041","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142839976","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}