BMC Pulmonary Medicine最新文献

{"title":"Randomized clinical trial of ventilator liberation with pressure support ventilation versus therapist-implement patient-specific weaning in prolonged weaning patients via tracheostomy.","authors":"Tamás Dolinay, Dale Jun, Swetha Gogineni, Lillian Hsu, Abigail Maller, B Corbett Walsh, Jeffrey Gornbein","doi":"10.1186/s12890-026-04341-9","DOIUrl":"https://doi.org/10.1186/s12890-026-04341-9","url":null,"abstract":"<p><strong>Background: </strong>Liberation from prolonged mechanical ventilation is challenging and its outcomes are poor. Patients who failed at least three spontaneous breathing trials, often referred to as prolonged weaning patients, are usually weaned with protocolized programs in specialized weaning units, but there are no standardized strategies to facilitate their ventilator liberation. The objective of this study was to compare the ventilator liberation rate of two common ventilator weaning programs.</p><p><strong>Methods: </strong>Tracheostomized patients with ongoing invasive mechanical ventilation for at least 21 day who were admitted to Barlow Respiratory Hospital for ventilator weaning were studied. Patients who passed spontaneous breathing trial on admission were excluded. In a prospective parallel group, non-blinded clinical study, patients were randomized to receive either the Pressure Support Ventilation (PSV) weaning program or the Therapist-Implemented Patient-Specific (TIPS) weaning program. Randomization was performed using a computer algorithm of block design. The primary outcome was ventilator liberation success. The secondary outcomes were hospital length of stay, physical recovery, discharge disposition and mortality. Significant hospital events were also compared between the groups.</p><p><strong>Results: </strong>N = 25 patients were studied in PSV and N = 26 in the TIPS group. Outcomes were reported for all patients. The liberation success rate at 30 days was 37.5% (standard error, SE = 9.9%) in the PSV and 46.2% (SE = 9.8%) in the TIPS group (p = 0.58, odds ratio, OR 1.42, RD 8.7%, 95% confidence interval, CI=-18.6-35.9). The liberation rate at discharge was 44% (SE = 9.9%) in the PSV group and 53.8% (SE = 9.8%) in the TIPS group (p = 0.54, OR:1.48, RD 9.8%, CI=-17.2-37.2%). The inpatient mortality was: PSV = 24% (SE 8.5%) and TIPS = 11.5% (SE 6.3%), p = 0.291, OR 0.413, RD=-12.5%, CI=-33.2-8.3%. We did not find a significant difference between the two ventilator weaning programs in any of our outcomes, but our study describes a very sick patient population. Continued weaning beyond 30 days had improved liberation success.</p><p><strong>Conclusions: </strong>Both weaning paths are equally beneficial for prolonged mechanical ventilation patients who undergo prolonged weaning.</p><p><strong>Trial registration: </strong>The trial was registered retroactively at ClinicalTrials.gov, NCT06976554.</p>","PeriodicalId":9148,"journal":{"name":"BMC Pulmonary Medicine","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147855779","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Timing of corticosteroid initiation and severe in-hospital outcomes in pediatric Mycoplasma pneumoniae pneumonia: a propensity score-matched cohort study.","authors":"Lei Yang, Hu Liu, Jiangang Leng, Jiali Tong","doi":"10.1186/s12890-026-04335-7","DOIUrl":"https://doi.org/10.1186/s12890-026-04335-7","url":null,"abstract":"<p><strong>Background: </strong>Among hospitalized children with Mycoplasma pneumoniae pneumonia (MPP) who received systemic corticosteroids, the association between treatment timing and subsequent in-hospital outcomes remains uncertain. We evaluated whether earlier initiation was associated with a more favorable hospital course.</p><p><strong>Methods: </strong>We conducted a retrospective propensity score-matched cohort study at a tertiary pediatric center in China between January 2023 and August 2025. Children aged 1-18 years with confirmed MPP who received systemic corticosteroids 3-14 days after symptom onset were included. Symptom onset was adjudicated by chart abstraction from caregiver-reported histories documented in the electronic medical record. All included patients received macrolide-based first-line antibiotics. Patients were grouped by corticosteroid initiation timing as early (3-7 days) or late (> 7 days). The propensity model used prespecified pre-treatment demographic, clinical-course, admission respiratory, inflammatory, radiographic, comorbidity, and resistance variables. The primary outcome was a severe composite endpoint; secondary outcomes included fever duration after corticosteroid initiation, hospital stay, oxygen therapy, ICU admission, pleural effusion, and antibiotic escalation. Exploratory analyses compared 3-5, 6-7, and > 7 days, with initiation day additionally modeled continuously for trend.</p><p><strong>Results: </strong>Among 902 eligible patients, 482 received early corticosteroids and 420 received late corticosteroids. After 1:1 matching, 299 pairs were analyzed; 183 early initiators and 121 late initiators were unmatched and excluded from the matched cohort. Early initiation was associated with lower odds of the severe composite outcome than late initiation (12.0% vs. 19.4%; OR 0.57, 95% CI 0.36-0.89; P = 0.018), less oxygen therapy (8.7% vs. 13.7%; OR 0.59, 95% CI 0.35-0.99), less antibiotic escalation (9.4% vs. 15.7%; OR 0.56, 95% CI 0.34-0.91; P = 0.019), shorter fever after corticosteroid initiation (3 [IQR 2-4] vs. 4 [3-5] days), and shorter hospitalization (7 [6-9] vs. 9 [7-11] days; both P < 0.001). In exploratory timing analyses, only initiation on days 3-5 was associated with lower odds of severe outcomes (OR 0.35, 95% CI 0.18-0.68), whereas initiation on days 6-7 was not (OR 0.83, 95% CI 0.48-1.43). Continuous modeling suggested a graded association between later initiation day and worse outcomes (P for trend = 0.021).</p><p><strong>Conclusion: </strong>Among corticosteroid-treated hospitalized children with MPP, earlier corticosteroid initiation-particularly on days 3-5 after symptom onset-was associated with a more favorable in-hospital course. Because residual confounding, potential collider bias, and time-dependent bias cannot be excluded, these findings should be interpreted as associative and require prospective confirmation.</p>","PeriodicalId":9148,"journal":{"name":"BMC Pulmonary Medicine","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147833634","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-term prognostic impact of clinical frailty scale on acute exacerbation of fibrotic interstitial lung disease: a retrospective cohort study.","authors":"Shoichiro Saito, Chigusa Shirakawa, Kanji Yamada, Jumpei Harada, Kyosuke Wakata, Tsuyoshi Sasada, Shohei Aoki, Yuya Nishida, Kentaro Iwata, Ryosuke Hirabayashi, Atsushi Nakagawa, Kazuma Nagata, Yuki Sato, Keisuke Tomii, Ryo Tachikawa","doi":"10.1186/s12890-026-04333-9","DOIUrl":"https://doi.org/10.1186/s12890-026-04333-9","url":null,"abstract":"<p><strong>Background: </strong>Acute exacerbations (AE) of fibrotic interstitial lung disease (fILD) are associated with a poor prognosis; however, the factors that predict long-term outcomes remain unclear. This study aimed to evaluate whether pre-admission frailty, as assessed using the Clinical Frailty Scale (CFS), predicts 1-year mortality and other relevant outcomes in patients with AE-fILD.</p><p><strong>Methods: </strong>This single-centre retrospective study included 125 patients hospitalised for AE-fILD between January 2017 and September 2023. Patients were categorised into low (score: 1-4) and high (score: 5-9) CFS groups based on their CFS scores. The primary outcome was 1-year mortality, and the secondary outcomes included in-hospital mortality, 90-day mortality, and home discharge. Prognostic associations were evaluated using Kaplan-Meier and multivariable Cox regression analyses, adjusted for age, lactate dehydrogenase levels, SpO₂/F_IO₂ ratio, and home oxygen therapy.</p><p><strong>Results: </strong>The median patient age was 78 years, and 41.6% of patients were included in the high CFS group. Kaplan-Meier analysis revealed a significantly lower 1-year survival in the high-CFS group (log-rank, p < 0.001). After adjustment, a high CFS score remained independently associated with increased 1-year mortality (adjusted hazard ratio, 2.20; 95% confidence interval, 1.31-3.68; p = 0.003). Higher in-hospital and 90-day mortality rates and lower home discharge rates were observed in the frail subgroup.</p><p><strong>Conclusion: </strong>Preadmission frailty, as assessed using the CFS, independently predicts 1-year mortality and is associated with adverse outcomes in patients with AE-fILD. Incorporating a CFS-based frailty assessment may provide a simple and useful prognostic tool to inform clinical decision-making and promote patient-centred care.</p><p><strong>Trial registration: </strong>An independent ethics committee approved the study (Institutional Review Board of the Kobe City Medical Center General Hospital [number zn241009 date October 8, 2024]), which was performed in accordance with the Declaration of Helsinki and Guidelines for Good Clinical Practice.</p>","PeriodicalId":9148,"journal":{"name":"BMC Pulmonary Medicine","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147833511","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Somatic symptom disorder comorbidity in chronic cough: prevalence, clinical features, and neuroimaging characteristics.","authors":"Tongyangzi Zhang, Heng Wu, Haodong Bai, Yaxing Zhou, Yiqing Zhu, Wanzhen Li, Shengyuan Wang, Jashin In, Nadire Wubulikasimu, Xianghuai Xu, Li Yu","doi":"10.1186/s12890-026-04331-x","DOIUrl":"https://doi.org/10.1186/s12890-026-04331-x","url":null,"abstract":"<p><strong>Background: </strong>This study was aimed at exploring the prevalence of somatic symptom disorder (SSD) in patients with chronic cough and comparing SSD comorbid (SSD+) and non-comorbid (SSD-) groups, including sociodemographic, clinical, psychological, and neuroimaging characteristics.</p><p><strong>Methods: </strong>A total of 463 patients with chronic cough were enrolled. The structured clinical interview from the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders was used for SSD diagnosis. Clinical features, cough-related assessment and psychological assessment were used to compare the SSD+ and SSD- groups, while functional magnetic resonance imaging (fMRI) was performed in 24 patients (12 SSD+ and 12 SSD-) for neuroimaging comparisons.</p><p><strong>Results: </strong>SSD was diagnosed in 13.8% (64/463) of all enrolled patients. The prevalence of SSD was greater in patients with refractory chronic cough (27.7%) than those with non-refractory chronic cough (7.8%). The SSD+ group had higher levels of capsaicin cough sensitivity (P = 0.016), anxiety (P < 0.001), and depression (P < 0.001), and lower cough-related quality of life scores (P < 0.001), than the SSD- group. Binary logistic stepwise regression indicated that higher anxiety level, female sex, lower cough-related quality of life, and more doctor visits were predictors of SSD diagnosis. Notably, SSD- patients demonstrated enhanced regional neural activity synchronization in the right cerebellum and mid-cingulate cortex, whereas SSD+ patients exhibited diminished spontaneous neural activity in the lingual gyrus (voxel P < 0.001, cluster P < 0.05, FWE corrected).</p><p><strong>Conclusion: </strong>SSD was identified in 13.8% of chronic cough patients and in approximately 28% of those with refractory chronic cough. Comprehensive evaluation of psychological in chronic cough patients is essential for early identification and management of SSD comorbidity. Interdisciplinary collaboration, including psychosomatic medicine, may enhance diagnostic accuracy and treatment outcomes in this population.</p><p><strong>Trial registration: </strong>This study was registered in the Chinese Clinical Trials Register (http://www.chictr.org.cn/) (ChiCTR2400079808). Registration date: January 12, 2024.</p>","PeriodicalId":9148,"journal":{"name":"BMC Pulmonary Medicine","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147833636","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Relationship between the advanced lung cancer inflammation index (ALI) and all-cause and cause-specific mortality among patients with chronic obstructive pulmonary disease (COPD): a population-based study.","authors":"Zhuanbo Luo, Peixu Chen, Luting Chen, Hongying Ma, Chao Cao","doi":"10.1186/s12890-026-04324-w","DOIUrl":"https://doi.org/10.1186/s12890-026-04324-w","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Chronic obstructive pulmonary disease (COPD) is viewed as a significant health problem, and the prognosis of patients with this disease is strongly influenced by the inflammatory response and nutritional well-being of the body. The advanced lung cancer inflammation index (ALI) provides a complete measurement of these two factors. Although the ALI has promising applications, its relationship with the prognosis of COPD patients remains unexplored. This research sought to bridge this knowledge gap by investigating the connection between the ALI and the outcomes of COPD patients.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This study retrospectively investigated 2,884 COPD patients who were admitted to the respiratory department because of acute exacerbation. The study period extends from January 1, 2017, to December 31, 2022. All these COPD patients subsequently received follow-up, and the cause-specific and all-cause mortality of these patients was reported. Kaplan‒Meier analysis was employed to investigate the associations of the ALI with all-cause mortality and mortality resulting from specific causes among COPD patients. In addition, univariable and multivariable Cox proportional hazards models were used to explore this association in further detail after adjusting for various confounding variables. A restricted cubic spline (RCS) analysis was performed to assess the nonlinear relationships of the ALI with all-cause and cause-specific death rates among COPD patients. In addition, subgroup and sensitivity analyses were conducted to verify the validity of the findings.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;In total, 2,884 patients with COPD were recruited. A greater ALI was strongly associated with a lower risk of all-cause mortality and mortality resulting from respiratory and cardiovascular illnesses specifically among patients with COPD. The findings of the RCS analysis indicated a reverse J-shaped, nonlinear relationship between ALI and all-cause mortality among COPD patients, and an inflection point was identified at 95 (p for nonlinearity &lt;0.0001). The inflection point of the J-shaped pattern indicates the ALI that is associated with the lowest risk of mortality. For ALIs less than 95, an increase of 10 units in the ALI was associated with a 14% reduction in the possibility of all-cause mortality (HR: 0.86; 95% CI: 0.81-0.92; p for trend=0.01). However, when the ALI was greater than 95, a 10-unit increase in the ALI resulted in a 5% increase in the likelihood of all-cause mortality (HR: 1.05; 95% CI: 1.01-1.07; Ptrend=0.01). Similar J-shaped patterns were observed for deaths related to cardiovascular and respiratory illnesses, in which context the inflection points were 97 and 96, respectively. These findings were consistent across various medical history and demographic subgroups and remained stable during the sensitivity analysis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;This study revealed a unique relationship between a high ALI ","PeriodicalId":9148,"journal":{"name":"BMC Pulmonary Medicine","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147833544","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between the endothelial activation and stress index and 28-day all-cause mortality in critically ill patients with chronic obstructive pulmonary disease: a retrospective cohort study and predictive model establishment based on machine learning.","authors":"Jianyi Niu, Qiaoyun Huang, Yanqi Dong, Shanshan Zha, Zhenfeng He, Luqian Zhou, Rongchang Chen, Lili Guan","doi":"10.1186/s12890-026-04299-8","DOIUrl":"https://doi.org/10.1186/s12890-026-04299-8","url":null,"abstract":"<p><strong>Background: </strong>Chronic obstructive pulmonary disease (COPD) remains a major global health burden and is currently the third leading cause of death worldwide. Acute exacerbations accelerate disease progression and contribute substantially to mortality, underscoring the urgent need for reliable prognostic biomarkers. The endothelial activation and stress index (EASIX), a composite indicator of endothelial dysfunction, has demonstrated prognostic utility across diverse critical illnesses. However, its association with clinical outcomes in critically ill patients with COPD has not been clearly established.</p><p><strong>Methods: </strong>In this retrospective cohort study, data of critically ill patients with COPD were extracted from the Medical Information Mart for Intensive Care (MIMIC) database. Participants were stratified into tertiles based on EASIX values, and intergroup differences in clinical characteristics were analyzed. The relationship between EASIX and 28-day all-cause mortality was examined using Kaplan-Meier survival analysis, Cox proportional hazards regression, and restricted cubic spline modeling. The Boruta algorithm was applied to assess the relative importance of candidate predictors, and prognostic models were subsequently developed using six machine learning algorithms.</p><p><strong>Results: </strong>A total of 4,590 patients met the inclusion criteria. The incidence of 28-day ICU mortality increased progressively across higher EASIX tertiles (p < 0.001). EASIX was independently associated with 28-day ICU all-cause mortality, with both unadjusted and fully adjusted Cox models confirming this relationship (unadjusted HR = 1.21, p < 0.001; adjusted HR = 1.082, p < 0.001). Subgroup analyses demonstrated that the association between elevated EASIX and mortality risk remained consistent across demographic and comorbidity categories (p for interaction > 0.05 for all). The Boruta algorithm identified EASIX as one of the most important predictors of 28-day mortality. Among the six machine learning models evaluated, the XGBoost algorithm yielded the highest discriminative (AUC = 0.823), calibration and clinical application.</p><p><strong>Conclusions: </strong>EASIX serves as an independent prognostic marker for 28-day all-cause mortality in critically ill COPD patients. Furthermore, the EASIX-based machine learning model demonstrated strong predictive accuracy, supporting its potential as a valuable clinical tool or early risk stratification and decision-making in intensive care settings.</p>","PeriodicalId":9148,"journal":{"name":"BMC Pulmonary Medicine","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147833229","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rare transformation from small cell lung cancer to lung squamous cell carcinoma: a case report.","authors":"Hongxi Hong, Jiaxin Chi, Chunxia He, Lanting Tao, Liwen Zhang, Liuning Li","doi":"10.1186/s12890-026-04262-7","DOIUrl":"https://doi.org/10.1186/s12890-026-04262-7","url":null,"abstract":"<p><strong>Background: </strong>Despite the evolution of treatment for extensive-stage small cell lung cancer (ES-SCLC) and advanced non-small cell lung cancer (NSCLC), drug resistance remains a major clinical challenge. Histological transformation is one of the key mechanisms. Previous studies mostly reported transformation from NSCLC to SCLC. Here we reported a patient with lung squamous cell carcinoma transformation from SCLC after multiple lines of treatment.</p><p><strong>Case description: </strong>A 60-year-old male patient was diagnosed with ES-SCLC (cT4N3M1a) in October 2022. In addition to first-line chemotherapy, immunochemotherapy with or without anti-angiogenic agent was used in the subsequent treatment lines. Given the elevation of squamous cell carcinoma markers during third-line treatment, the patient underwent the second biopsy. The pathological examination showed transformation from SCLC to lung squamous cell carcinoma, which was confirmed by the third biopsy. Finally, the patient died due to ‌acute massive cerebral infarction on November 30, 2025, which was unrelated to treatment or cancer.</p><p><strong>Conclusions: </strong>This rare case highlights the importance of re-biopsy during the disease course, especially for patients with poor response. We hope that this case can provide reference for physicians in clinical practice.</p>","PeriodicalId":9148,"journal":{"name":"BMC Pulmonary Medicine","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147833501","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Safety of flexible bronchoscopy in elderly patients.","authors":"Stephanie Spiegel, Ralf-Harto Hübner, Dirk Schürmann, Konrad Neumann, Eva Pappe, Thomas Sgarbossa, Martin Witzenrath, Jacopo Saccomanno","doi":"10.1186/s12890-026-04326-8","DOIUrl":"10.1186/s12890-026-04326-8","url":null,"abstract":"<p><strong>Background: </strong>Flexible bronchoscopy is an indispensable tool in respiratory medicine. In the context of an aging society and increasing life expectancy, the number of elderly, often multimorbid patients is growing. This raises important questions regarding the safety of flexible bronchoscopy in this population.</p><p><strong>Methods: </strong>In this retrospective study 1841 flexible bronchoscopies performed at two sites of Charité Universitätsmedizin Berlin in the years 2022 and 2023 were assessed and classified into two age groups: patients ≥ 70 years (elderly group) and patients < 70 years (non-elderly group). Safety was assessed by the occurrence of complications, and in a GEE-analysis potential risk factors of complications were identified.</p><p><strong>Results: </strong>In total, 466 bronchoscopies in the elderly group and 1375 bronchoscopies in the non-elderly group were assessed. Bronchoscopies in the elderly group were performed more frequently under endotracheal intubation than in the non-elderly group (81.8% vs. 70.0%; p < 0.001). The overall complication rate was 2.3% with no significant differences between bronchoscopies of the elderly (1.7%) and non-elderly group (2.5%; p = 0.345). The most common complications were pneumothorax (0.9%) in the elderly group and hypoxia (0.8%) in the non-elderly group. Transbronchial forceps biopsy (p < 0.001; OR = 3.99) and endobronchial valve implantation (p = 0.002; OR = 6.44) were significantly associated with an increased risk of complications independent of age.</p><p><strong>Discussion: </strong>In our study, flexible bronchoscopy proved to be a safe procedure with low complication rates in elderly and non-elderly patients. Age was also not associated with an increased risk of complications. Invasive interventions such as transbronchial forceps biopsies and endobronchial valve implantations were identified as risk factors independent of age. This underscores the importance of individualized risk minimizing strategies, in particular for complex and invasive procedures.</p>","PeriodicalId":9148,"journal":{"name":"BMC Pulmonary Medicine","volume":"26 1","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13151341/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147833609","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":"Derivation and validation of a clinical prediction model incorporating the pleural fluid ADA-to-LDH ratio for differentiating tuberculous from malignant pleural effusions: a multi-center study.","authors":"Zhiyu Pan, Sha Tao, Haoyu Sheng, Xiuliang Xu, Zhixin Lin, Fen Huang, Fang Liu, Yajuan Wang, Yihui Sun, Yingchun Sun, Wei Qian, Jianghua Yang","doi":"10.1186/s12890-026-04332-w","DOIUrl":"https://doi.org/10.1186/s12890-026-04332-w","url":null,"abstract":"<p><strong>Background: </strong>Accurate discrimination between tuberculous (TPE) and malignant pleural effusion (MPE) is a major clinical challenge. Most existing models rely on non-routine laboratory tests and lack rigorous multicenter external validation.</p><p><strong>Objective: </strong>To develop and validate a clinical prediction model integrating the pleural fluid adenosine deaminase to lactate dehydrogenase ratio (ADA/LDH) and routine indicators for TPE vs. MPE differentiation.</p><p><strong>Methods: </strong>In this multicenter retrospective study conducted between January 2023 and December 2025, patients from five hospitals in Anhui Province, China, were divided into a training cohort (n = 290), an internal validation cohort (n = 72), and an external validation cohort (n = 93). Predictors were screened via univariable analysis and backward stepwise regression based on the Akaike Information Criterion (AIC). The optimal ADA/LDH cutoff was identified as 5.83% using restricted cubic splines (RCS) and simplified to 6.0% for clinical practicability without compromising model performance. A Firth penalized logistic regression model was constructed to mitigate data separation caused by the strong predictive effect of the ADA/LDH ratio.</p><p><strong>Results: </strong>The final model included three statistically significant variables: pleural fluid ADA/LDH ratio (≥ 6.0% vs. < 6.0%), age, and sex. An ADA/LDH ratio ≥ 6.0% was the strongest independent predictor (OR = 13.32, 95% CI 6.51-27.28, P < 0.001). The model demonstrated excellent and stable discriminative ability with AUCs of 0.901 (training cohort), 0.893 (internal validation cohort), and 0.916 (external validation cohort). Calibration was good across all cohorts (Brier scores: 0.1235, 0.1249, 0.1159, respectively). Decision curve analysis demonstrated that the model provided numerically higher net benefit than the \"treat all\" and \"treat none\" strategies across the clinically relevant threshold range of 0%-90%.</p><p><strong>Conclusion: </strong>This multicenter study developed and validated a robust Firth penalized prediction model centered on the pleural fluid ADA/LDH ratio. The model demonstrates excellent discriminative ability, good calibration, and potential clinical utility for differentiating TPE from MPE in TB-endemic regions of China.</p>","PeriodicalId":9148,"journal":{"name":"BMC Pulmonary Medicine","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147833223","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Serum Vanin-1: a potential diagnostic biomarker linked to oxidative stress imbalance in asthma.","authors":"Wei Li, Yun Liu, Xiangli Feng, Xiaoli Feng, Xiuyuan Wei, Yuanyuan Wu","doi":"10.1186/s12890-026-04319-7","DOIUrl":"https://doi.org/10.1186/s12890-026-04319-7","url":null,"abstract":"<p><strong>Background: </strong>Asthma is a heterogeneous disease, underscoring the urgent need for reliable diagnostic biomarkers. Vanin-1, a well-recognized sensor of oxidative stress, has been implicated in various inflammatory disorders; however, its diagnostic value in asthma remains to be fully elucidated. This study aimed to evaluate serum Vanin-1 levels in asthmatic patients and explore their correlations with systemic oxidative stress biomarkers-malondialdehyde (MDA) and glutathione (GSH)-as well as inflammatory cytokines, pulmonary function parameters, and to assess its diagnostic potential.</p><p><strong>Methods: </strong>A case-control study was conducted, enrolling 169 participants: 129 asthmatic patients and 40 age- and sex-matched healthy controls. Serum concentrations of Vanin-1, MDA, GSH, cytokines (IL-4, IL-13, IL-17, IFN-γ), and total IgE were measured. Pulmonary function tests were also performed. Statistical correlations were analyzed using Spearman's rank test, and diagnostic efficacy was evaluated using receiver operating characteristic (ROC) curves.</p><p><strong>Results: </strong>Compared with healthy controls, asthmatic patients exhibited significantly elevated serum levels of Vanin-1 (7.54 ± 1.62 ng/mL vs. 4.59 ± 1.30 ng/mL, P < 0.001) and MDA [0.11 (0.09, 0.12) nmol/mg protein vs. 0.08 (0.06, 0.10) nmol/mg protein, P < 0.001], but markedly reduced GSH [1.44 (1.16, 1.57) nmol/mg protein vs. 2.06 (1.65, 2.37) nmol/mg protein, P < 0.001]. Vanin-1 level was positively correlated with MDA (ρ = 0.342, P < 0.001) and negatively correlated with GSH (ρ = - 0.329, P < 0.001). No significant correlations were observed between Vanin-1 and IL-4, IL-13, IL-17, IFN-γ, eosinophil counts, or pulmonary function indices. ROC analysis demonstrated that Vanin-1 had robust diagnostic utility, with an area under the curve (AUC) of 0.884 (95% CI: 0.832-0.936, P < 0.001). At an optimal cutoff of 6.12 ng/mL, the sensitivity and specificity were 69.0% and 92.5%, respectively.</p><p><strong>Conclusion: </strong>Serum Vanin-1 is significantly elevated in asthmatic patients and is closely associated with an oxidative stress imbalance. It may serve as a potential biomarker for distinguishing asthma patients from healthy individuals.</p>","PeriodicalId":9148,"journal":{"name":"BMC Pulmonary Medicine","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147833577","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}