BMC Pulmonary Medicine最新文献

{"title":"Deep learning-based super-resolution ultrashort echo time MRI for pulmonary nodule detection and longitudinal assessment in emphysema.","authors":"Meng-Ting Duan, Hui Liu, Ning Zhang, Meng Li, Gao-Feng Shi, Hui Feng","doi":"10.1186/s12890-026-04468-9","DOIUrl":"10.1186/s12890-026-04468-9","url":null,"abstract":"<p><strong>Purpose: </strong>This study aimed to evaluate the performance of deep learning-based super-resolution ultrashort echo time magnetic resonance imaging (SR-UTE MRI) for the detection of pulmonary nodules and the reliability of longitudinal nodule size assessment compared with conventional ultrashort echo time (UTE) in patients with emphysema.</p><p><strong>Materials and methods: </strong>This prospective study included 127 patients with emphysema and pulmonary nodules who underwent chest low-dose computed tomography (LDCT) and UTE MRI. SR-UTE images were reconstructed using a deep learning-based algorithm. Pulmonary nodule detection performance, size measurement accuracy, and longitudinal reproducibility were assessed using LDCT as the reference standard. Patients were stratified according to CT-derived emphysema severity quantified by low-attenuation area percentage (LAA%). Objective image quality metrics, including signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), and Laplacian variance, were also evaluated.</p><p><strong>Results: </strong>SR-UTE demonstrated superior image quality compared with conventional UTE, with higher SNR and CNR in patients with severe emphysema (both p < 0.05). For nodules < 6 mm, SR-UTE achieved a higher detection rate than UTE (81.8% vs. 54.5%, p < 0.05), with greater improvement for ground-glass nodules in severe emphysema (66.7% vs. 33.3%). Both UTE and SR-UTE achieved 100% sensitivity for nodules > 8 mm. SR-UTE showed better agreement with CT for nodule size measurement, with higher intraclass correlation coefficients across emphysema subgroups (0.89-0.93 vs. 0.84-0.88 for UTE) and reduced measurement bias. In longitudinal analysis, SR-UTE more accurately reflected CT-derived nodule size changes and demonstrated higher reproducibility than UTE (ICC 0.90 vs. 0.82).</p><p><strong>Conclusion: </strong>SR-UTE improved the detection of small and subsolid pulmonary nodules and provided more reliable longitudinal size assessment than UTE in patients with emphysema. These findings support the potential role of SR-UTE MRI in MRI-based surveillance of pulmonary nodules.</p>","PeriodicalId":9148,"journal":{"name":"BMC Pulmonary Medicine","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13613646/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148387357","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":"Prognostic significance of nodal subclassification and adjuvant therapy in surgically treated T1-4N1-2M0 non-small cell lung cancer: a single-center retrospective study.","authors":"Bekir Elma, Ahmet Uluşan, Maruf Şanlı, Ahmet Ferudun Işık","doi":"10.1186/s12890-026-04473-y","DOIUrl":"10.1186/s12890-026-04473-y","url":null,"abstract":"<p><strong>Background: </strong>This study evaluated the prognostic significance of nodal subclassification in surgically treated patients with non-small cell lung cancer who had pathological N1-N2 disease, based on the ninth edition of the Tumor-Node-Metastasis classification.</p><p><strong>Methods: </strong>All patients with pathologically confirmed stage T1-4N1-2M0 non-small cell lung cancer who underwent anatomical lung resection with systematic mediastinal lymph node dissection were retrospectively reviewed. Patients who received preoperative therapy or had incomplete resections were excluded. Nodal involvement was classified as pathological N1, N2a, and N2b; N2 cases were divided into N2a1, N2a2, N2b1, and N2b2 according to skip and station status. In addition, single-zone and multi-zone metastases were evaluated to investigate the spatial distribution of mediastinal spread. Overall and recurrence-free survival were analyzed using Kaplan-Meier and multivariable Cox regression methods.</p><p><strong>Results: </strong>The median overall survival was 45, 30, and 19 months for the pathological N1, N2a, and N2b groups, respectively. Patients in the N2a2 subgroup demonstrated the most favorable survival, whereas those in the N2b2 subgroup had the poorest outcomes. Skip metastasis was not associated with any survival benefit, while multi-station and multi-zone involvement were related to worse long-term results. In multivariable analysis, multiple-station disease and postoperative complications were independent adverse factors, whereas younger age and administration of adjuvant chemotherapy were independently associated with improved survival.</p><p><strong>Conclusion: </strong>The ninth edition of the Tumor-Node-Metastasis classification provides a more accurate prognostic stratification for surgically treated patients with pathological N2 disease. Multi-station and multi-zone metastases represent more aggressive patterns, while carefully selected single-station N2a2 cases can achieve survival similar to N1 disease, supporting the clinical usefulness of refined nodal and zone-based subclassification.</p>","PeriodicalId":9148,"journal":{"name":"BMC Pulmonary Medicine","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13602630/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148381587","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":"Metagenomic next-generation sequencing-guided management of descending mediastinitis and empyema caused by Segatella baroniae: a case report.","authors":"Wang Du, Feng Pan, Pin Lan, Lutao Xie, Chunhui Zheng, Haohao Wu","doi":"10.1186/s12890-026-04465-y","DOIUrl":"10.1186/s12890-026-04465-y","url":null,"abstract":"<p><strong>Background: </strong>Deep neck infections can rapidly progress to descending mediastinitis and empyema, both of which are associated with high morbidity and mortality. Early diagnosis and timely intervention are essential but can be challenging, particularly in infections caused by rare anaerobic pathogens.</p><p><strong>Case presentation: </strong>We report a case of a 63-year-old man presenting with fever and neck pain. Computed tomography revealed extensive cervical emphysema and pneumomediastinum with a large right-sided empyema. The patient developed respiratory failure requiring endotracheal intubation. Endoscopic examination identified a retropharyngeal fistula, and thoracoscopic exploration confirmed communication between the mediastinum and pleural cavity. Combined cervical, mediastinal, and thoracic drainage was performed. Metagenomic next-generation sequencing identified Segatella baroniae as the predominant pathogen, guiding targeted antimicrobial therapy. The patient showed gradual clinical and radiological improvement and was discharged in good condition.</p><p><strong>Conclusion: </strong>This case highlights the importance of early recognition and aggressive surgical management in deep neck infections complicated by descending mediastinitis. Metagenomic next-generation sequencing may facilitate rapid pathogen identification and guide targeted therapy in complex anaerobic infections.</p>","PeriodicalId":9148,"journal":{"name":"BMC Pulmonary Medicine","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13613756/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148381646","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A study of excessive dynamic airway collapse in chronic obstructive pulmonary disease patients.","authors":"Esraa Samy Elsharkawy, Amira Abdelgalil Elkholy, Alaa Mohamed Reda, Mohamed Gamal Amer Elkholy","doi":"10.1186/s12890-026-04398-6","DOIUrl":"10.1186/s12890-026-04398-6","url":null,"abstract":"<p><strong>Background: </strong>Excessive dynamic airway collapse (EDAC) is defined as a pathological expiratory reduction of ≥ 50% in the cross-sectional area of the tracheobronchial lumen due to increased laxity of the posterior membranous wall while preserving the cartilaginous structure. EDAC frequently coexists with chronic obstructive pulmonary disease (COPD) and may contribute to persistent wheezing and dyspnea despite optimal medical therapy.</p><p><strong>Methods: </strong>This cross-sectional study included 75 stable COPD patients recruited from the outpatient clinic of the Chest Department, Faculty of Medicine, Tanta University Hospitals, between August 2024 and August 2025. All patients underwent detailed history taking, general and local clinical examination, spirometry, dynamic multidetector computed tomography (MDCT) of the chest, and fiberoptic bronchoscopy. Multivariate logistic regression analysis was performed to identify predictors of EDAC.</p><p><strong>Results: </strong>EDAC was identified in 29 (38.7%) out of 75 COPD patients based on bronchoscopic assessment. Among these 29 patients, dynamic chest CT successfully diagnosed EDAC in 27 cases, resulting in 93.1% (95% CI: 77.2-99.2) sensitivity, 100% (95% CI: 92.3-100.0) specificity, and 97.3% (95% CI: 90.1-100.0) diagnostic accuracy. COPD patients with EDAC showed significantly higher BMI, mMRC, CAT scores, and exacerbation frequency compared with those without EDAC. Conversely, patients with COPD and EDAC showed significantly lower FEV1% predicted and FVC% predicted compared with those without EDAC. BMI, mMRC, and CAT score were independent predictors of EDAC.</p><p><strong>Conclusions: </strong>EDAC should be evaluated in all COPD patients who present with more symptoms despite optimal COPD management. Also, obesity in COPD patients represents a contributing factor for EDAC, which should be carefully evaluated and managed. Dynamic CT demonstrated good diagnostic performance in detecting EDAC when compared with bronchoscop.</p>","PeriodicalId":9148,"journal":{"name":"BMC Pulmonary Medicine","volume":"26 1","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13332589/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148381608","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":"Diagnostic value of biochemical ratios in the differential diagnosis of tuberculous and malignant pleural effusions.","authors":"Umut İlhan, Zeynep Güney, Ayşe Özçelik, Helin Su Kaya, Erdogan Cetinkaya, Mustafa Çörtük","doi":"10.1186/s12890-026-04421-w","DOIUrl":"10.1186/s12890-026-04421-w","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background and objective: &lt;/strong&gt;The differential diagnosis between tuberculous pleural effusion (TPE) and malignant pleural effusion (MPE) in patients with pleural effusion (PE) continues to pose significant clinical challenges. While conventional pleural fluid cytology has limited sensitivity, invasive diagnostic procedures are often costly or inaccessible, particularly in resource-limited settings. In this study, we investigated the diagnostic contribution of ratios derived from pleural fluid adenosine deaminase (ADA), total protein, serum lactate dehydrogenase (S-LDH), and pleural effusion lactate dehydrogenase (PE-LDH) levels in patients with histopathological confirmed pleural effusion etiology. Specifically, the diagnostic performance of biochemical and hematological parameters, particularly the ADA/serum protein, S-LDH/ADA and PE-LDH/ADA ratios were evaluated for their ability to discriminate between TPE and MPE.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This retrospective cross-sectional study was conducted among patients who underwent diagnostic evaluation and treatment for pleural effusion at a tertiary referral hospital between 1 November 2014 and 1 November 2024. A total of 1,003 patients with pleural effusion (397 TPE and 606 MPE: 409 primary, 133 metastatic, and 64 mesothelioma) were included, whose etiologies were determined using a composite reference standard based on clinical, radiological, microbiological, and histopathological findings, with multidisciplinary team (MDT) evaluation applied in selected cases where appropriate. Receiver operating characteristic (ROC) curve analyses were performed to determine diagnostic accuracy, sensitivity, specificity, and optimal cut-off values.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Patients with TPE were significantly younger than those with MPE (median age: 32 vs. 65 years, p &lt; .001). Overall, 62.9% of the study population were male. ADA levels were significantly higher in the TPE group, whereas S-LDH levels were higher in the malignant effusion group. When ratio-based parameters were evaluated, the S-LDH/ADA ratio was markedly higher in patients with malignant pleural effusion and emerged as the most powerful discriminatory marker, with an area under the curve (AUC) of 0.938, sensitivity of 89.5%, and specificity of 91.3%. The ADA/serum protein ratio also demonstrated high diagnostic accuracy for differentiating TPE, with an AUC of 0.929, sensitivity of 89.9%, and specificity of 93.3%. In multivariate analysis, the S-LDH/ADA ratio, ADA/serum protein ratio, and PE-LDH/ADA ratio remained independently associated with diagnostic discrimination between TPE and MPE.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Biochemical ratios particularly the S-LDH/ADA and PE-ADA/serum protein ratios are reliable, minimally invasive diagnostic tools for distinguishing TPE from MPE. These ratios are especially useful in guiding clinical decision-making in settings where access to invasive diagnostic procedures is limite","PeriodicalId":9148,"journal":{"name":"BMC Pulmonary Medicine","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13599273/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148381583","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":"Anemia burden in tuberculosis patients across Southeast Asia: a systematic review and meta-analysis.","authors":"Vaibhavkumar N Shrivastav, Hari Krishna Akurathi, Hardikkumar Kalariya, Dhruv Savaj","doi":"10.1186/s12890-026-04404-x","DOIUrl":"10.1186/s12890-026-04404-x","url":null,"abstract":"<p><strong>Background: </strong>Anemia represents a significant comorbidity in tuberculosis (TB) patients, affecting treatment outcomes and mortality. Despite Southeast Asia accounting for 46% of global TB cases, no comprehensive regional synthesis of anemia burden exists, limiting evidence-based policy development.</p><p><strong>Objectives: </strong>This systematic review and meta-analysis aimed to estimate the pooled prevalence of anemia among tuberculosis patients across Southeast Asia and to examine variations in prevalence by geographic, demographic, and clinical characteristics.</p><p><strong>Methods: </strong>We searched PubMed, Embase, Scopus, and Web of Science for observational studies published from 2000 onwards that reported anemia prevalence in drug-susceptible TB patients from Southeast Asian countries. Random-effects meta-analysis was performed to calculate pooled prevalence estimates with 95% confidence intervals. Subgroup analyses were conducted by country, HIV co-infection status, treatment status, study setting, COVID-19 period, and World Bank income classification. Publication bias was assessed using Egger's and Begg's tests.</p><p><strong>Results: </strong>Twenty-one studies comprising 6,090 TB patients from five Southeast Asian countries were included. The pooled prevalence of anemia was 72% (95% CI: 68%-76%), with substantial heterogeneity (I²=89.9%). These regional prevalence estimates are higher than the global pooled estimate of 53.9% reported by Barzegari et al. (2019), reflecting the distinct epidemiological context of Southeast Asia. Subgroup analysis revealed significantly higher prevalence in HIV-positive patients (88%, 95% CI: 78%-94%) compared to HIV-negative patients (70%, 95% CI: 65%-74%). Studies conducted during COVID-19 showed elevated prevalence (84%, 95% CI: 75%-90%) compared to pre-COVID (72%, 95% CI: 70%-73%) and post-COVID periods (72%, 95% CI: 68%-83%, p = 0.03). Lower-middle income countries showed higher prevalence (73%, 95% CI: 69%-77%) than upper-middle income countries (67%, 95% CI: 63%-70%). No significant publication bias was detected (Egger's p = 0.721, Begg's p = 0.537).</p><p><strong>Conclusions: </strong>This first regional synthesis demonstrates that anemia affects three-quarters of TB patients in Southeast Asia, with significant variation by HIV status, income level, and pandemic period. Unlike previous global estimates (53.9%), our region-specific findings (72%) and documentation of COVID-19 impact (84% during pandemic) provide actionable evidence for Southeast Asian TB programs to integrate anemia screening and management, particularly for vulnerable populations during health system disruptions.</p>","PeriodicalId":9148,"journal":{"name":"BMC Pulmonary Medicine","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13617783/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148374259","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":"Serum desmosine served as a biomarker for severity and prognosis in COVID-19 patients.","authors":"Xu-Dong Zhao, Jiao-Jiao Zha, Rui-Xiang Yang, Qi-Yuan He, Ya-Lin Jiang, Lin Fu, Tao-Tao Ma, Xin-Ming Wang","doi":"10.1186/s12890-026-04460-3","DOIUrl":"10.1186/s12890-026-04460-3","url":null,"abstract":"<p><strong>Background: </strong>Desmosine exerts a vital role as a cross-linking molecule integrate into a three-dimensional elastin network. After degradation of mature elastin, desmosine is released and enters into the circulatory system. The purpose was to estimate the association between serum desmosine level and Coronavirus disease 2019 (COVID-19) patients.</p><p><strong>Methods: </strong>All 333 COVID-19 patients were enrolled and regarded as the training cohort, and 150 cases were used for completely independent validation cohort. Serum specimens were collected on the day of admission. The level of serum desmosine was determined by enzyme-linked immunosorbent assay (ELISA).</p><p><strong>Results: </strong>Serum desmosine level on the day of admission gradually increased with elevating severity scores among COVID-19 patients. Spearman correlation analysis unveiled the close relationships between serum desmosine level and clinical parameters, such as liver function, renal function, myocardial enzymes, and inflammatory cytokines. The training cohort and external validation cohort revealed that serum desmosine level was positively associated with severity scores by multivariable linear regression analyses. Multivariable logistic regression models found that higher serum desmosine concentration on admission elevated the risks of mechanical ventilation, vasoactive agent use, ICU admission, and death during hospitalization. A receiver operating characteristic (ROC) curve analysis demonstrated the excellent discrimination for the poor prognosis of serum desmosine concentration by the training set and validation set.</p><p><strong>Conclusions: </strong>Baseline serum desmosine level was positively associated with disease severity scores and worse clinical outcomes among COVID-19 patients during hospitalization, substantializing that serum desmosine might serve as a biomarker for discriminating the severity and prognosis in COVID-19 patients.</p>","PeriodicalId":9148,"journal":{"name":"BMC Pulmonary Medicine","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13587329/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148367125","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":"Flow rate dependence of salbutamol dose with various valved holding chambers in vitro.","authors":"Ville Vartiainen, Lauri Lehtimäki, Mikael Csonka, Péter Csonka","doi":"10.1186/s12890-026-04456-z","DOIUrl":"10.1186/s12890-026-04456-z","url":null,"abstract":"<p><strong>Background: </strong>Inhalation is the primary administration route for managing airway diseases like asthma and COPD. Presently, treatment protocols for management of acute obstruction in emergency care involve using either pressurized metered dose inhalers (pMDI), often with holding chambers (HC), or nebulizers. The aim of this work was to assess the impact of different inhalation patterns and specifically peak inspiratory flow rate (PIF) on drug delivery, as well as to provide a head-to-head comparison between different (HC) in combination with a salbutamol pMDI.</p><p><strong>Methods: </strong>For the comparison we chose two reusable (Vortex and OptiChamber Diamond) and two disposable (DispoZABLE and LiteAire) HCs. The HCs were connected to an anatomical throat model, Next Generation Impactor, and breathing simulator and the deposited drug content was measured with high performance liquid chromatography. In the used inhalation patterns the PIFs were 15 l/min, 30 l/min, 60 l/min, and 80 l/min.</p><p><strong>Results: </strong>All HCs decreased throat deposition by at least 80%, but throat deposition increased with higher PIF. There was some flow-dependency also in fine particle dose (FPD) but the direction of the dependency varied between the HCs.</p><p><strong>Conclusions: </strong>The performance of disposable devices in terms of flow dependency and throat deposition was similar to reusable ones.</p>","PeriodicalId":9148,"journal":{"name":"BMC Pulmonary Medicine","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13587319/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148359441","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":"Airway structural involvement detected by quantitative computed tomography in controlled and uncontrolled asthma.","authors":"Letícia Pereira Lima, Izabela Maria Elias Silva, Lucas Botelho Azevedo, Ana Júlia Abbud Chierice, Elcio Oliveira Vianna, Marcel Koenigkam Santos, Marcelo Bezerra de Menezes","doi":"10.1186/s12890-026-04453-2","DOIUrl":"10.1186/s12890-026-04453-2","url":null,"abstract":"<p><strong>Background: </strong>Structural airway changes (airway remodeling) are traditionally associated with severe and uncontrolled asthma. The extent to which they are present in asthmatics with different clinical control statuses is unknown. Quantitative computed tomography (qCT) is an underused tool for assessing airway morphology and remodeling. In this study, we aimed to compare airway morphology between individuals with severe uncontrolled asthma (SA), controlled asthma (CA), and non-asthmatic controls (C) using qCT. We also sought correlations between qCT metrics and spirometric measurements.</p><p><strong>Methods: </strong>In this cross-sectional observational study, we recruited asthmatics (SA, CA) and non-asthmatic controls (C) aged 18-65 between March 2016 and February 2018. All subjects underwent spirometry and high-resolution chest computed tomography (CT). Quantitative CT analysis was performed using an automated software (YACTA v2.7). Airway metrics included total airway count (TAC), airway wall thickness (WT), relative wall thickness (Wall%), lumen area (LA) and mean maximal attenuation of airway walls. We compared groups using ANOVA and investigated correlations between spirometry and qCT metrics through Pearson coefficients.</p><p><strong>Results: </strong>Seventy-six individuals were included (SA n = 27, CA n = 28, C n = 21). Severe uncontrolled asthmatics were taking more intense asthma treatment and had lower forced expiratory volume in the first second (FEV1) compared with CA and C groups (FEV1%predicted: 55.37 + 12.64 × 91.21 + 9.74 × 104.93 + 15.7, respectively; p = 0.0001). Wall% (49.4 + 3.38 × 48.3 + 4.51 × 45.3 + 3.71; p = 0.001) and WT were higher in both asthma groups compared with controls (2.06 + 0.28 × 1.89 + 0.34 × 1.62 + 0.27; p = 0.0001; mm; 3rd bronchial generation); TAC was progressively greater from SA to CA and C groups (27.22 + 17.29 × 43,61 + 20,11 × 57,23 + 16,82; p = 0.0001). Lumen area (bronchial 3rd generation, in mm2) was lower in SA than in CA and C (52.95 + 17.29 × 65.78 + 14.53 × 66.92 + 13.57; p = 0.002). Forced expiratory volume in the first second correlated positively with TAC (r = 0.67) and negatively with Wall% (r=-0.59).</p><p><strong>Conclusions: </strong>Our findings defy the usual outlook of morphological airway involvement only in severe asthma. Further studies are needed to explore the nature of structural involvement in CA, while we showed the usefulness of qCT in evaluating seldom-assessed elements of asthma pathophysiology.</p>","PeriodicalId":9148,"journal":{"name":"BMC Pulmonary Medicine","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13591855/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148367057","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":"Digital twins in pulmonary medicine: a scoping review of applications, benefits, and challenges.","authors":"Raoof Nopour","doi":"10.1186/s12890-026-04466-x","DOIUrl":"10.1186/s12890-026-04466-x","url":null,"abstract":"<p><strong>Background and aim: </strong>Digital twins, a newly emerging technology, are increasingly used in pulmonary medicine across various aspects of prognosis, diagnosis, and therapy. Cognition and awareness of the applications, benefits, and challenges of digital twins in pulmonary medicine are paramount in shaping future efforts by healthcare stakeholders. This study aims to map the existing literature and conduct a narrative synthesis of these determinants to provide an in-depth understanding of this topic.</p><p><strong>Methods: </strong>This scoping review was carried out in accordance with PRISMA-ScR. Web of Science, PubMed, Scopus, Google Scholar, and IEEE Xplore were searched from their inception until January 30, 2026, in conjunction with a manual search. The English papers, original research papers, and conference papers were considered. A validated data extraction form was utilized to obtain relevant data from the existing literature. The results were presented in tables, figures, descriptive statistics, and narrative synthesis.</p><p><strong>Results: </strong>Eight studies met the inclusion criteria. A total of 41 applications, 37 benefits, and 28 challenges of digital twins in pulmonary medicine were identified. Applications are primarily focused on clinical monitoring, decision support and modeling, mechanistic modeling, technical/data and AI integration, intervention simulation, and disease management.</p><p><strong>Conclusion: </strong>This review provides a comprehensive overview of the current applications, benefits, and challenges of digital twins in pulmonary medicine. Mapping the existing evidence highlights the growing role of digital twins in patient monitoring, personalized care, and clinical decision support. The findings also identify critical barriers to the development of digital twins in this field. These insights can guide researchers, clinicians, healthcare organizations, and policymakers in prioritizing future research, developing implementation strategies, and supporting the safe integration of digital twins into pulmonary care.</p>","PeriodicalId":9148,"journal":{"name":"BMC Pulmonary Medicine","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13587457/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148359492","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}