BMC Pulmonary Medicine最新文献

{"title":"Exploring the role of serum adiponectin and its holigomerization in fibrotic interstitial lung diseases: results from a cross-sectional study.","authors":"Ersilia Nigro, Vito D'Agnano, Raffaella Pagliaro, Marta Mallardo, Andrea Bianco, Carmine Picone, Adolfo Gallipoli D'Errico, Aurora Daniele, Fabio Perrotta","doi":"10.1186/s12890-025-03706-w","DOIUrl":"10.1186/s12890-025-03706-w","url":null,"abstract":"<p><p>Intestitial lung diseases (ILDs) include a group of inflammatory and fibrotic pulmonary disorders with different etiologies which in several patients might lead to a progressive reduction of respiratory capacities and chronic respiratory failure. Nowadays, biomarkers for predicting the ILD progression and response to therapies are lacking. Adiponectin, the most abundant peptide secreted by adipocytes, has emerged as a potential response biomarker in fibrotic progressive ILDs. The aim of this observational prospective single-center cross-sectional study is therefore to verify whether serum adiponectin levels were altered in patients with fibrotic ILDs (f-ILDs) and its correlation with clinical and pulmonary function data. Sixty-four f-ILDs patients - divided in three subgroups IPF, CTD-ILDs and other f-ILDs - and 45 healthy subjects were recruited. Serum adiponectin concentration were measured by enzyme-linked immunosorbent assay (ELISA). Pulmonary function tests and clinical data were systematically collected. The results showed that patients with f-ILDs have reduced circulating levels of serum adiponectin (12.5 [10.8-15.4] versus 19.3 [17.3-20.8] p < 0.001). No significant difference in adiponectin levels were observed in the different f-ILDs subgroups (p = 0.619). Adiponectin levels were not associated with progression of f-ILDs (p = 0.745). High molecular weight adiponectin isoform was highly reduced in patients with f-ILDs. In patients with CTD-ILDs - but not in other subgroups - adiponectin levels were associated with pulmonary function and GAP index. These resuls support a potential role of adiponectin as diagnostic and prognostic biomarker of f-ILDs.</p>","PeriodicalId":9148,"journal":{"name":"BMC Pulmonary Medicine","volume":"25 1","pages":"263"},"PeriodicalIF":2.6,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12105393/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144148937","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":"Can intraoperative improvement of radial endobronchial ultrasound imaging enhance the diagnostic yield in peripheral pulmonary lesions?","authors":"Kazuki Nishida, Takayasu Ito, Shingo Iwano, Shotaro Okachi, Shota Nakamura, Basile Chrétien, Toyofumi Fengshi Chen-Yoshikawa, Makoto Ishii","doi":"10.1186/s12890-025-03725-7","DOIUrl":"10.1186/s12890-025-03725-7","url":null,"abstract":"<p><strong>Background: </strong>Data regarding the diagnostic efficacy of radial endobronchial ultrasound (R-EBUS) findings obtained via transbronchial needle aspiration (TBNA)/biopsy (TBB) with endobronchial ultrasonography with a guide sheath (EBUS-GS) for peripheral pulmonary lesions (PPLs) are lacking. We evaluated whether intraoperative probe repositioning improves R-EBUS imaging and affects diagnostic yield and safety of EBUS-guided sampling for PPLs.</p><p><strong>Methods: </strong>We retrospectively studied 363 patients with PPLs who underwent TBNA/TBB (83 lesions) or TBB (280 lesions) using EBUS-GS. Based on the R-EBUS findings before and after these procedures, patients were categorized into three groups: the improved R-EBUS image (n = 52), unimproved R-EBUS image (n = 69), and initial within-lesion groups (n = 242). The impact of improved R-EBUS findings on diagnostic yield and complications was assessed using multivariable logistic regression, adjusting for lesion size, lesion location, and the presence of a bronchus leading to the lesion on CT. A separate exploratory random-forest model with SHAP analysis was used to explore factors associated with successful repositioning in lesions not initially \"within.\"</p><p><strong>Results: </strong>The diagnostic yield in the improved R-EBUS group was significantly higher than that in the unimproved R-EBUS group (76.9% vs. 46.4%, p = 0.001). The regression model revealed that the improvement in intraoperative R-EBUS findings was associated with a high diagnostic yield (odds ratio: 3.55, 95% confidence interval, 1.57-8.06, p = 0.002). Machine learning analysis indicated that inner lesion location and radiographic visibility were the most influential predictors of successful repositioning. The complication rates were similar across all groups (total complications: 5.8% vs. 4.3% vs. 6.2%, p = 0.943).</p><p><strong>Conclusions: </strong>Improved R-EBUS findings during TBNA/TBB or TBB with EBUS-GS were associated with a high diagnostic yield without an increase in complications, even when the initial R-EBUS findings were inadequate. This suggests that repeated intraoperative probe repositioning can safely boost outcomes.</p>","PeriodicalId":9148,"journal":{"name":"BMC Pulmonary Medicine","volume":"25 1","pages":"261"},"PeriodicalIF":2.6,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12105327/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144149537","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":"Roflumilast reduces the number of lung adenocarcinomas, inflammation, and emphysema in a smoking-induced mouse model.","authors":"Kaori Sakurai, Shingo Nakayama, Shotaro Chubachi, Shiro Otake, Takashi Shimada, Hidehiro Irie, Akihiro Tsutsumi, Naofumi Kameyama, Ahmed E Hegab, Masayuki Shimoda, Junko Hamamoto, Hideki Terai, Hiroyuki Yasuda, Yae Kanai, Koichi Fukunaga","doi":"10.1186/s12890-025-03730-w","DOIUrl":"10.1186/s12890-025-03730-w","url":null,"abstract":"<p><strong>Background: </strong>The prognosis of lung cancer complicated by chronic obstructive pulmonary disease is poor, and effective prophylactic agents have not been established. Given that inflammation is a shared pathogenic mechanism of both diseases, we aimed to evaluate the efficacy of roflumilast, a novel anti-inflammatory drug, in preventing emphysema and lung cancer using a smoking-induced lung cancer mouse model.</p><p><strong>Methods: </strong>Male A/J mice were exposed to 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone, a potent carcinogen, and intermittent mainstream cigarette smoke for 20 weeks. Roflumilast or vehicle was administered via intragastric gavage once daily. Lung tissues were assessed for tumor nodules and emphysema, and bronchoalveolar lavage fluid was collected for cell counting. Emphysema severity and concentrations of inflammatory cytokines (IL-6, IL-1β, and TNF-α) were assessed. RAW 264.7 macrophage cells were used to assess cellular responses to cigarette smoke extract.</p><p><strong>Results: </strong>Roflumilast attenuated the increase in total cells and macrophages in bronchoalveolar lavage fluid induced by intermittent smoking exposure and significantly suppressed smoking-induced expressions of IL-6, IL-1β, and TNF-α. Roflumilast also reduced emphysematous changes and the number of lung tumors. In vitro, roflumilast attenuated cigarette smoke extract-induced expression of IL-6, IL-1β, and TNF-α in RAW 264.7 cells.</p><p><strong>Conclusions: </strong>This study highlights the potential use of roflumilast as a chemopreventive agent for patients with chronic obstructive pulmonary disease who are at risk of lung cancer and underscores its relevance for future clinical application and research on phosphodiesterase-4 inhibitors.</p>","PeriodicalId":9148,"journal":{"name":"BMC Pulmonary Medicine","volume":"25 1","pages":"262"},"PeriodicalIF":2.6,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12105171/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144148942","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":"Cryptogenic organizing pneumonia complicated by pulmonary embolism following glucocorticoid therapy: a case report.","authors":"Dong Liu, Luna Zhao, Xinxin Zhang, Ye Liu, Chao Wu","doi":"10.1186/s12890-025-03719-5","DOIUrl":"10.1186/s12890-025-03719-5","url":null,"abstract":"<p><strong>Background: </strong>Cryptogenic organizing pneumonia (COP), a rare interstitial lung disease, can mimic community-acquired pneumonia (CAP), often leading to delayed diagnosis. This case highlights the importance of recognizing COP in elderly patients and brings attention to pulmonary embolism (PE) as a potential but underrecognized complication associated with glucocorticosteroid therapy, providing novel insights into hypercoagulability risks during treatment.</p><p><strong>Case presentation: </strong>An 80-year-old woman from Xinjiang presented with a 4-week history of cough, dyspnea, and weight loss that was unresponsive to antibiotics. Chest Computed tomography (CT) revealed bilateral subpleural consolidations with air bronchograms. Bronchoscopy ruled out infection, and a multidisciplinary evaluation confirmed COP based on clinical, radiological, and pathological correlation. Oral prednisone at 0.75 mg/kg/day led to symptom resolution within 14 days. However, during steroid tapering (10% weekly reduction), she developed hypoxemia at 3 months. CT angiography revealed segmental PE, despite the absence of conventional thrombosis risk factors. Treatment with anticoagulation and continued glucocorticoid therapy resulted in full recovery after 6 months.</p><p><strong>Conclusions: </strong>Clinicians should consider COP in elderly patients with pneumonia unresponsive to antibiotics, confirm the diagnosis through biopsy, and remain vigilant for hypercoagulable states during glucocorticoid tapering. Anticoagulation should be tailored even in the absence of traditional thrombosis risk factors. The temporal association between steroid tapering and PE suggests that glucocorticoids may modulate endothelial function and coagulation pathways, highlighting the need for mechanistic studies to inform thromboembolic surveillance in COP management.</p>","PeriodicalId":9148,"journal":{"name":"BMC Pulmonary Medicine","volume":"25 1","pages":"259"},"PeriodicalIF":2.6,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12102873/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144132035","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":"Clinical characteristic of patients with COPD-A.","authors":"Jong Min Lee, Youlim Kim, Joon Young Choi, Seung Won Ra, Deog Kyeom Kim, Tae-Hyung Kim, Hyung Kyu Yoon, Kwang Ha Yoo, Ki-Suck Jung, Chin Kook Rhee","doi":"10.1186/s12890-025-03731-9","DOIUrl":"10.1186/s12890-025-03731-9","url":null,"abstract":"<p><strong>Background: </strong>The 2023 Global Initiative for Chronic Obstructive Lung Disease (GOLD) document proposed the COPD-A subtype as a condition of COPD with asthma. We examined the characteristics of COPD-A patients and analyzed them according to smoking history and inhaled corticosteroid (ICS) use.</p><p><strong>Methods: </strong>Patients in the COPD cohort with a history of asthma were included. The patients were divided into two groups according to their smoking history (< 10 vs. ≥10 pack-years) and their clinical characteristics were compared. The association between patients' ICS use and the occurrence for exacerbations during 1 year follow-up period was analyzed.</p><p><strong>Results: </strong>Of the 970 patients included in the analysis, the group with a smoking history less than 10 pack-years (n = 158) had a significantly higher BMI, FEV₁ (%), FEV₁/FVC (%), DLco, ESR, and prevalence of osteoporosis. Among 560 patients who were followed up for 1 year, the patients with ICS (n = 274) had a higher exacerbation rate than without ICS (n = 286) (54% vs. 44.1%, p = 0.018). However, in multivariable analysis, ICS use was not significantly associated with exacerbation. In subgroup analysis of patients with blood eosinophil count ≥ 300 cells/µl, ICS use showed a trend to reduce the risk for exacerbation (IRR = 0.907, p = 0.708). In patients with blood eosinophil count < 300 cells/µl, ICS use significantly increased the risk for exacerbation (IRR = 1.547, p = 0.005).</p><p><strong>Conclusions: </strong>COPD-A patients with a smoking history of less than 10 pack-years had better pulmonary function test results, BMI, ESR, and prevalence of osteoporosis. The use of ICS did not decrease exacerbations in COPD-A.</p>","PeriodicalId":9148,"journal":{"name":"BMC Pulmonary Medicine","volume":"25 1","pages":"260"},"PeriodicalIF":2.6,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12102872/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144132009","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of blood eosinophil counts with pulmonary and extrapulmonary comorbidities in patients with chronic obstructive pulmonary disease: data from NHANES 2013-2018.","authors":"Hong Chen, Xiaobo Hu, Chenyun He, Yanmei Wen, Chunlan Ma, Yongsheng Wang","doi":"10.1186/s12890-025-03734-6","DOIUrl":"10.1186/s12890-025-03734-6","url":null,"abstract":"<p><strong>Background: </strong>Chronic obstructive pulmonary disease (COPD) involves systemic inflammation and is often accompanied by comorbidities. Blood eosinophil count (BEC) is a key marker of airway inflammation, used for patient stratification and treatment guidance. However, the association between BEC (< 300 vs. ≥ 300 cells/µL) and pulmonary or extrapulmonary comorbidities in COPD remains unclear.</p><p><strong>Methods: </strong>This study analyzed COPD patients from the 2013-2018 National Health and Nutrition Examination Survey (NHANES). Weighted multivariable logistic regression models examined associations between BEC and comorbidities, adjusting for potential confounders. Associations were quantified using odds ratios (ORs) and 95% confidence intervals (CIs).</p><p><strong>Results: </strong>A total of 614 COPD patients were included (395 with BEC < 300 cells/µL, 219 with BEC ≥ 300 cells/µL). Patients with BEC ≥ 300 cells/µL had a higher prevalence of extrapulmonary comorbidities than those with BEC < 300 cells/µL (85.35% vs. 71.48%). Adjusted analysis showed that BEC ≥ 300 cells/µL was significantly associated with increased odds of any extrapulmonary comorbidity (OR = 2.03, 95% CI: 1.19-3.44, p = 0.009), congestive heart failure (OR = 1.69, 95% CI: 1.02-2.82, p = 0.043), and renal dysfunction (OR = 1.95, 95% CI: 1.01-3.79, p = 0.048), but not with pulmonary comorbidities. Sensitivity analyses using 3- and 4-level BEC categories revealed consistent trends, with higher BEC levels significantly associated with greater prevalence of at least one extrapulmonary comorbidity.</p><p><strong>Conclusions: </strong>In COPD, higher BEC (≥ 300 cells/µL) is significantly associated with extrapulmonary comorbidities, particularly congestive heart failure and renal dysfunction, but not pulmonary comorbidities.</p>","PeriodicalId":9148,"journal":{"name":"BMC Pulmonary Medicine","volume":"25 1","pages":"256"},"PeriodicalIF":2.6,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12101006/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144131992","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":"Distance travelled in the six-minute walk test in patients with chronic obstructive pulmonary disease as a predictor of mortality.","authors":"Izadora Moraes Dourado, Cássia da Luz Goulart, Aldair Darlan Santos-de-Araújo, Renan Shida Marinho, Adriana Sanches Garcia-Araujo, Meliza Goi Roscani, Renata Trimer, Andrea Lucia Gonçalves da Silva, Renata Gonçalves Mendes, Audrey Borghi-Silva","doi":"10.1186/s12890-025-03721-x","DOIUrl":"10.1186/s12890-025-03721-x","url":null,"abstract":"<p><strong>Background: </strong>Exercise intolerance in patients with COPD has significant implications for quality of life, hospitalization rates, and survival.</p><p><strong>Objective: </strong>To assess functional capacity using the six-minute walk test (6MWT) by categorizing the distance walked in six minutes (6MWD) into tertiles and to assess the impact of this functional capacity on predictors of survival over a 24-month follow-up in patients with Chronic Obstructive Pulmonary Disease (COPD).</p><p><strong>Methods: </strong>This prospective cohort study followed 118 patients with COPD for 24 months. Participants were stratified based on the 6MWD: Group 1 (mean distance 590-424 m); Group 2 (mean distance 423-337 m); and Group 3 (mean distance < 336 m). Symptoms and disease severity were assessed using CAT scores. Kaplan-Meier was used to determine the association between 6MWD and all-cause mortality.</p><p><strong>Results: </strong>The 6MWD, stratified by functional performance, was a significant predictor of survival in patients with COPD, despite heterogeneity in disease severity between groups. The 6MWD, stratified by functional performance, was a significant predictor of survival in patients with COPD, despite heterogeneity in disease severity between groups. Furthermore, in regression analysis for mortality, it was identified for 6MWD (CI 0.994; p = 0.043) and peripheral oxygen saturation (SpO₂) (CI 0.735; p < 0.001). Kaplan-Meier survival analysis revealed that patients who walked less than 336 m in the 6MWD had the lowest probability of survival at 24 months (log-rank p < 0.05).</p><p><strong>Conclusion: </strong>The 6MWD is a robust predictor of mortality over a 2-year period in patients with COPD, reflecting a broad spectrum of disease severity. Poorer 6MWD performance is associated with increased desaturation, impaired heart rate recovery, and greater symptom burden during exercise, as indicated by CAT scores.</p><p><strong>Clinical trial number: </strong>Not applicable.</p>","PeriodicalId":9148,"journal":{"name":"BMC Pulmonary Medicine","volume":"25 1","pages":"258"},"PeriodicalIF":2.6,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12102868/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144132052","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between CRP-Albumin-Lymphocyte (CALLY) index and Asthma-COPD overlap: analysis of NHANES 2015-2018 data.","authors":"Shasha Fu, Zongcun Chen, Hongchuan Wu","doi":"10.1186/s12890-025-03705-x","DOIUrl":"10.1186/s12890-025-03705-x","url":null,"abstract":"<p><strong>Background: </strong>The CRP-Albumin-Lymphocyte (CALLY) index, a novel inflammatory biomarker combining serum albumin, lymphocyte count, and C-reactive protein (CRP), has been proposed for clinical use. This study aimed to investigate the association between CALLY index and Asthma-COPD Overlap (ACO) in the general US population.</p><p><strong>Methods: </strong>We analyzed data from 6,797 participants aged ≥ 40 years from the 2015-2018 National Health and Nutrition Examination Survey (NHANES). Participants were categorized into quartiles based on natural logarithmic transformed (ln) CALLY index. ACO was defined as self-reported physician-diagnosed asthma and COPD. Logistic regression models were used to examine the association between ln CALLY and ACO, adjusting for potential confounders across three models. Generalized additive models, subgroup analyses, and receiver operating characteristic (ROC) curve analysis were also performed.</p><p><strong>Results: </strong>The prevalence of ACO across the four CALLY quartiles was 5.56%, 1.89%, 1.54%, and 0.66%. In the fully adjusted model, for each 1-unit increase in ln CALLY, the risk of ACO decreased by 43% (OR = 0.57, 95% CI: 0.44-0.73, P = 0.001). Compared with Q1, the risk of ACO in Q2, Q3, and Q4 was reduced by 63% (OR = 0.37), 66% (OR = 0.34), and 87% (OR = 0.13), respectively (P for trend = 0.003). Generalized additive models showed a non-linear negative relationship (P < 0.001). Subgroup analysis revealed that the association remained consistent across different sexes, age groups, races, smoking status, and disease statuses (arthritis, DM, and hypertension). ROC curve analysis indicated moderate predictive ability of ln CALLY for ACO (AUC = 0.675, 95% CI: 0.636-0.714), with an optimal cutoff value of 8.007 (sensitivity 0.669, specificity 0.598).</p><p><strong>Conclusion: </strong>Higher CALLY index is independently associated with lower risk of ACO, suggesting its potential value as a biomarker for ACO risk assessment in clinical practice. By integrating inflammation, immune, and nutritional status evaluation, the CALLY index offers a novel perspective for early identification of high-risk individuals in clinical practice.</p>","PeriodicalId":9148,"journal":{"name":"BMC Pulmonary Medicine","volume":"25 1","pages":"257"},"PeriodicalIF":2.6,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12102915/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144131886","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":"Nocturnal desaturation in patients with non-operable chronic thromboembolic pulmonary hypertension.","authors":"Yu Taniguchi, Miki Sakamoto, Hiroyuki Fujii, Keisuke Miwa, Yasunori Tsuboi, Kenichi Yanaka, Noriaki Emoto, Hiromasa Otake","doi":"10.1186/s12890-025-03712-y","DOIUrl":"10.1186/s12890-025-03712-y","url":null,"abstract":"<p><strong>Background: </strong>Nocturnal desaturation is occasionally observed in patients with chronic thromboembolic pulmonary hypertension (CTEPH) despite the absence of parenchymal lung disease; however, the underlying mechanism remains unclear. This study aimed to clarify the clinical features of nocturnal desaturation in patients with CTEPH.</p><p><strong>Methods: </strong>Data of 163 patients with CTEPH who underwent balloon pulmonary angioplasty (BPA) between March 2011 and December 2022 were retrospectively analyzed. We evaluated their hemodynamics using right heart catheterization, arterial blood gas examination, respiratory function tests, nocturnal oximetry, and cardiopulmonary exercise testing, which were routinely performed at baseline and after BPA.</p><p><strong>Results: </strong>A higher ratio of dead space to tidal volume (VD/VT) (p < 0.001) and higher alveolar-arterial oxygen difference (A-aDO2) (p = 0.026) at baseline were associated with greater nocturnal desaturation in the multivariable linear analysis. After BPA, nearly normal hemodynamics was achieved (mean pulmonary arterial pressure: 37.5 ± 10.0 to 20.2 ± 4.9 mmHg, p < 0.01). Nocturnal desaturation also improved from - 13.3 ± 5.8% at baseline to -10.3 ± 5.4% after BPA (p < 0.01). Improvement in VD/VT correlated well with improvement in nocturnal desaturation after BPA (p < 0.001, R² linear = 0.18).</p><p><strong>Conclusions: </strong>Nocturnal desaturation often coexists with CTEPH. VD/VT, a marker of physiologic dead-space fraction, A-aDO2, a marker of ventilation-perfusion mismatch, and lung diffusing capacity were strongly associated. Nocturnal desaturation improved slightly after BPA, which was associated with a decrease in the physiological dead- space fraction. Our study emphasizes the importance of including nocturnal oximetry in routine evaluations and continuation of nocturnal oxygen therapy, if necessary, in patients with CTEPH.</p>","PeriodicalId":9148,"journal":{"name":"BMC Pulmonary Medicine","volume":"25 1","pages":"254"},"PeriodicalIF":2.6,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12096539/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144126706","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":"Machine learning prediction model with shap interpretation for chronic bronchitis risk assessment based on heavy metal exposure: a nationally representative study.","authors":"Tiansheng Xia, Kaiyu Han","doi":"10.1186/s12890-025-03724-8","DOIUrl":"10.1186/s12890-025-03724-8","url":null,"abstract":"<p><strong>Background: </strong>Chronic bronchitis (CB), as a core precursor of Chronic Obstructive Pulmonary Disease (COPD), is crucial for global disease burden prevention and control. Although the association between heavy metal exposure and respiratory damage has been preliminarily demonstrated, traditional linear models are difficult to resolve the nonlinear interactions and dose-response heterogeneity. The aim of this study was to construct the first heavy metal exposure-chronic bronchitis risk prediction model by integrating exposureomics data through machine learning (ML).</p><p><strong>Methods: </strong>Weighted logistic regression was used to assess the association of 14 blood and urine heavy metals with CB based on nationally representative samples from the 2005-2015 National Health and Nutrition Examination Survey (NHANES). The Boruta algorithm was further applied to screen the characteristic variables and construct 10 ML models. The best model was selected by four evaluation metrics: accuracy, specificity, sensitivity, and area under the ROC curve (AUC), and the best model was visually interpreted using Shapley's additive interpretation (SHAP).</p><p><strong>Results: </strong>The multifactorial logistic regression model showed that urinary cadmium (OR = 1.53, 95% CI = 1.17-1.98) versus blood cadmium (OR = 1.36, 1.13-1.65) was an independent risk factor for CB. The CatBoost model had the best predictive performance (AUC = 0.805), with smoking as the most significant predictor, followed by blood cadmium concentration and gender.</p><p><strong>Conclusion: </strong>In this research, the first risk prediction diagnostic model for heavy metal-chronic bronchitis was developed, in which CatBoost model had the best performance, and it provides a referenceable prediction model for the screening of high-risk groups.</p>","PeriodicalId":9148,"journal":{"name":"BMC Pulmonary Medicine","volume":"25 1","pages":"252"},"PeriodicalIF":2.6,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12096596/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144126704","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}