Canadian respiratory journal最新文献

{"title":"High-Frequency Oscillatory Ventilation Combined With Inhaled Nitric Oxide for Persistent Pulmonary Hypertension of the Newborn: A Single-Center Randomized Clinical Trial.","authors":"Yanbo Wang, Qian Wu, Xin Zhang, Zhongyi Sun, Mingming Zhang, Xiao Liu, Bin Zhou","doi":"10.1155/carj/8717590","DOIUrl":"10.1155/carj/8717590","url":null,"abstract":"<p><strong>Background: </strong>Persistent pulmonary hypertension of the newborn (PPHN) may respond incompletely to inhaled nitric oxide (iNO) when poorly recruited lung limits delivery to ventilated alveoli. We evaluated whether high-frequency oscillatory ventilation (HFOV) combined with iNO improved clinical and physiologic outcomes compared with conventional mechanical ventilation (CMV) + iNO or HFOV alone.</p><p><strong>Methods: </strong>In this prospective, single-center, 3-arm, open-label randomized clinical trial, 138 neonates born at 34 weeks of gestation or later with echocardiographically confirmed PPHN and an oxygenation index of 25 or greater were randomized 1:1:1 to HFOV + iNO, CMV + iNO, or HFOV alone. The principal complete-case per-protocol analysis included 126 infants (42 per group) with ascertainable 120-day primary outcomes who completed the assigned strategy without a major protocol deviation. The possible influence of the 12 unavailable primary outcomes was evaluated in post hoc randomized-denominator extreme-case sensitivity analyses. The primary outcome was death or extracorporeal membrane oxygenation (ECMO) within 120 days.</p><p><strong>Results: </strong>In the complete-case per-protocol population, death or ECMO occurred in 3 of 42 infants (7.1%) assigned to HFOV + iNO, 11 of 42 (26.2%) assigned to CMV + iNO, and 14 of 42 (33.3%) assigned to HFOV alone (overall p = 0.012). For HFOV + iNO versus CMV + iNO, the risk ratio was 0.27 (95% CI, 0.08-0.91), and the risk difference was -19.0 percentage points (95% CI, -34.5 to -3.6; Holm-adjusted p = 0.038). For HFOV + iNO versus HFOV alone, the risk ratio was 0.21 (95% CI, 0.07-0.69) and the risk difference was -26.2 percentage points (95% CI, -42.4 to -9.9; Holm-adjusted p = 0.011). The mean oxygenation index at 72 h was 7.1 (SD, 2.8), 11.0 (SD, 3.8), and 15.9 (SD, 4.5), respectively (group-by-time interaction p < 0.001). The overall primary comparison remained significant under symmetric extreme-case assignments for the unavailable outcomes but not under the differential worst-case assumption for HFOV + iNO (p = 0.222).</p><p><strong>Conclusions: </strong>In the observed per-protocol population, HFOV + iNO was associated with fewer deaths or ECMO events and faster improvement in oxygenation and right-ventricular echocardiographic measures than either comparator. Because 12 randomized infants were excluded and the overall comparison was not robust to the differential worst-case missing-outcome assumption, confidence in the apparent treatment effect is limited. These findings are exploratory and hypothesis-generating, do not establish efficacy, and require confirmation in a prospectively registered multicenter trial with complete outcome ascertainment.</p>","PeriodicalId":9416,"journal":{"name":"Canadian respiratory journal","volume":"2026 1","pages":"e8717590"},"PeriodicalIF":2.1,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13617540/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149069246","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multiple Pulmonary Papillary Adenoma With Malignant Potential Accompanied by ERBIN-BRAF Gene Fusion and APC Mutation: A Case Report and Literature Review.","authors":"Ning Ao, Hui Wu, Wenping Li, Qiwen Zhao, Zhenyang Yu, Mingang Duan, Sixin Zhang, Li Jin, Mei Liu","doi":"10.1155/carj/3589904","DOIUrl":"10.1155/carj/3589904","url":null,"abstract":"<p><strong>Background: </strong>Pulmonary papillary adenoma is currently considered a benign tumor; however, a few cases have been reported in the past with potential for malignancy. Therefore, the histological nature of papillary adenomas remains controversial. This article presents a rare case of a multifocal papillary adenoma with uncertain malignant potential, featuring an ERBIN-BRAF gene fusion and an APC mutation, along with a literature review, to enhance understanding of this tumor.</p><p><strong>Case description: </strong>The patient sought medical consultation due to symptoms of cough and sputum production. Imaging showed a high-density, lobulated nodule in the posterior basal segment of the left lower lobe, surrounded by multiple smaller nodules. Postpulmonary lobectomy, histopathological examination revealed a large nodule composed of a single papillary structure, with the papillary surface covered by a single layer of cuboidal or low-columnar epithelium. Local areas showed transition to surrounding alveolar epithelium, and well-formed glands were observed in the proliferative fibrous tissue, with local stromal fibrosis. Some tumor cells in the surrounding small nodules grew in a lepidic fashion, with cellular morphology similar to that of the large nodule. Immunohistochemical staining showed that tumor cells were positive for TTF-1, CK, CK7, and Napsin A, with a few cells expressing P53 and a Ki-67 index of approximately 8%. Next-generation sequencing (NGS) identified an APC gene mutation (Exon 16, p.E1306∗) and an ERBIN exon3-BRAF exon11 fusion. Given that BRAF alterations have been implicated in lung carcinogenesis, a similar BRAF-mediated tumorigenic pathway may be active in this tumor; therefore, complete resection of the adenoma may be indicated. The tumor's multifocal distribution and molecular alterations suggest that this case represents a papillary adenoma with uncertain malignant potential.</p><p><strong>Conclusions: </strong>Currently, there is no established standard treatment for such tumors, and the tumor in this case underwent pulmonary lobectomy. Future studies should accumulate more cases to clarify the prognosis and treatment guidelines for this type of tumor.</p>","PeriodicalId":9416,"journal":{"name":"Canadian respiratory journal","volume":"2026 1","pages":"e3589904"},"PeriodicalIF":2.1,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13651789/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149134981","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Continuous Positive Airway Pressure Effects on Pulmonary Hemodynamics and Left Ventricular Function in Obstructive Sleep Apnea and Obesity Hypoventilation Syndrome: A Systematic Review and Meta-Analysis.","authors":"Jing Li, Jing Zhao, Pan-Pan Pang, Wei-Jie Zhai, Ya-Kun Wang, Xiao-Ying Zhang, Yu-Qing Wei","doi":"10.1155/carj/3020878","DOIUrl":"10.1155/carj/3020878","url":null,"abstract":"<p><strong>Background: </strong>Obstructive sleep apnea (OSA) and obesity hypoventilation syndrome (OHS) are strongly linked to pulmonary hypertension and left ventricular abnormalities, driving cardiovascular issues. OHS, with daytime hypercapnia, affects 10%-20% of OSA patients. Continuous positive airway pressure (CPAP) is the first-line therapy, but its cardiac effects are inconsistent.</p><p><strong>Methods: </strong>We conducted a systematic review and meta-analysis adhering to the PRISMA 2020 statement. Risk of bias was assessed using RoB 2 (RCTs) and the Newcastle-Ottawa Scale (NOS; cohort studies). Continuous outcomes were pooled as mean differences (MDs) with 95% CIs using random-effects models (restricted maximum likelihood) with Hartung-Knapp adjustment.</p><p><strong>Results: </strong>Eight studies (574 participants; 2 RCTs, 6 cohorts) were included, showing that CPAP significantly reduced pulmonary arterial pressure (MD = -2.32 mmHg, 95% CI: -3.88 to -0.76, p = 0.004) versus controls. Secondary analyses indicated improved left ventricular diastolic function (early-to-late diastolic mitral inflow velocity [E/A] ratio: MD = 0.29, 95% CI: 0.09 to 0.48, p = 0.004). No significant effects on left ventricular mass index (LVMi) (MD = -2.31 percentage points, 95% CI: -6.38 to 1.77, p = 0.27) or left ventricular ejection fraction (LVEF) (MD = 0.53 percentage points, 95% CI: -1.49 to 2.55, p = 0.61) were found. Sensitivity analyses confirmed robustness. Funnel plot analysis suggested potential publication bias for pulmonary artery systolic pressure (PASP)/mean pulmonary artery pressure (mPAP), E/A ratio, and LVEF, while LVMi showed low bias.</p><p><strong>Conclusions: </strong>In adults with OSA or OHS, CPAP reduces pulmonary arterial pressure and improves LV diastolic function, but it does not significantly alter LVMi or ejection fraction. These findings support CPAP as a key intervention to mitigate pulmonary hemodynamic burden and diastolic dysfunction in this high-risk population, while its potential to reverse structural cardiac remodeling requires further study.</p>","PeriodicalId":9416,"journal":{"name":"Canadian respiratory journal","volume":"2026 1","pages":"e3020878"},"PeriodicalIF":2.1,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13655973/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149164717","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Influence of the COVID-19 Pandemic on the Prevalence of Depression Among US Adults.","authors":"Jixiang Liu, Yichong Wang, Ning Ding, Shengsheng Zhang","doi":"10.1155/carj/2846550","DOIUrl":"10.1155/carj/2846550","url":null,"abstract":"<p><strong>Background: </strong>The prevalence of depressive symptoms increased significantly in the early stages of the COVID-19 pandemic and remained elevated even as lockdown policies were eased. Therefore, a thorough evaluation of the pandemic's long-term effects on depressive disorders is critical.</p><p><strong>Methods: </strong>A repeated cross-sectional study was conducted using data from the National Health Interview Survey collected before (2017-2018) and during the later stage of the COVID-19 pandemic (August 2021-August 2023). χ² tests were conducted to compare the characteristics between nondepressed and depressed adults. Weighted multivariable logistic regression models were employed to estimate the associations between social and physical factors with depressive symptoms.</p><p><strong>Results: </strong>The prevalence of depressive symptoms in the later stages of the COVID-19 pandemic (12.7%) was significantly higher than prepandemic levels (9.1%). Specifically, the incidence rates for mild, moderate, moderately severe, and severe depressive symptoms increased by 1.24-fold, 1.44-fold, 1.38-fold, and 1.71-fold, respectively, compared to prepandemic levels. Higher risk of developing depressive disorders persisted among those who were widowed/divorced/separated, never married, and with lower education or income. Prepandemic protective factors such as lower systemic inflammatory response index, no smoking or drinking, and no hypertension history became less effective. Males and females aged 20-40 exhibited the highest probability of developing depressive symptoms in the later stage of the pandemic.</p><p><strong>Limitations: </strong>The cross-sectional design prevents inference of causality.</p><p><strong>Conclusions: </strong>The persistence of mental health disparities highlights the need for sustained efforts from the government, mental healthcare organizations, and healthcare providers to support vulnerable groups even beyond the pandemic.</p>","PeriodicalId":9416,"journal":{"name":"Canadian respiratory journal","volume":"2026 1","pages":"e2846550"},"PeriodicalIF":2.1,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13070868/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147670004","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Quantitative CT Patterns and Functional Loss Related to Welding Fume Exposure, While Handling the Confounding Effect of Cigarette Smoking.","authors":"Merve Demirci Atik, Abdullah Taylan, Aylin Çifci, Ahmet Naci Emecen, Naciye Sinem Gezer, Alp Ergör, Eyüp Sabri Uçan","doi":"10.1155/carj/2406824","DOIUrl":"10.1155/carj/2406824","url":null,"abstract":"<p><strong>Introduction: </strong>Ill-defined centrilobular nodules, the most common radiological sign of welding fume (WF) exposure, are also frequently seen in smoking-related respiratory bronchiolitis due to their common pathophysiological features. Thus, smoking is often a confounding factor in the diagnosis of welder's pneumoconiosis. This study aimed to investigate the quantitative computed tomography (QCT) patterns associated with WF exposure, while accounting for the effects of cigarette smoking. Additionally, the relationship between WF exposures and pulmonary function tests (PFTs) was also evaluated as the secondary outcome.</p><p><strong>Methods: </strong>This study involved 136 male employees, comprising 66 welders and 70 controls. The WF exposure index was retrospectively estimated by using a semiquantitative exposure assessment, and cigarette pack-years were noted. Two radiologists, blinded to exposure information, performed QCT analysis, an objective and reproducible method. PFT results were also compared.</p><p><strong>Results: </strong>A significant decrease in the histogram's skewness and kurtosis was observed with WF exposure, in contrast to the effects of smoking. In multivariate analysis, the percentage of voxels in the range of -949 to -850 HU decreased with WF exposure (p = 0.037), whereas the percentage of voxels greater than -750 HU increased significantly. Each incremental WF exposure index was associated with a 0.39% decrease in predicted FEV1% (forced expiratory volume in the first second) when adjusted for smoking.</p><p><strong>Conclusion: </strong>We identified functional losses and distinct QCT patterns associated with exposure to WF and cigarette smoke, both of which may cause chronic lung inflammation. These findings may offer valuable insights for further research.</p>","PeriodicalId":9416,"journal":{"name":"Canadian respiratory journal","volume":"2026 1","pages":"e2406824"},"PeriodicalIF":2.1,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13147207/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147833729","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Postpartum Venous Thromboembolism: Altitudinal Gradients, Decadal Trends, and PE-Specific Risk Profiling in Highland Populations.","authors":"Jianbo Yu, Lobsang Chodron, Tenzin Chodron, Jo'nga Cering, Peiliang Gao, Xiaoxiao Zheng, Fang-E Shi, Zhenzhong Yang, Lobsang Cering, Guiying Dong","doi":"10.1155/carj/3703610","DOIUrl":"10.1155/carj/3703610","url":null,"abstract":"<p><strong>Background: </strong>This study primarily analyzed differences in venous thromboembolism (VTE) characteristics across altitudes and their temporal trends during the puerperium. Additionally, it identified independent risk factors for postpartum pulmonary embolism (PE).</p><p><strong>Methods: </strong>This retrospective study reviewed all postpartum VTE cases at People's Hospital of Xizang Autonomous Region between 2015 and 2024.</p><p><strong>Results: </strong>This cohort study of 172 postpartum women (median age 31 [IQR 26-36]) compared high-altitude (HA, n = 109) and very high-altitude (VHA, n = 63) groups. PE proportion was significantly higher in VHA vs. HA ( p = 0.033). VHA subjects also showed significant elevated preterm delivery (p = 0.033) and ≥ 3 deliveries (p < 0.001). Joinpoint regression (2015-2024) revealed biphasic trends: significant early-phase escalations in VTE (APC = 18.05%) and deep vein thrombosis (DVT) (APC = 19.66%) during 2015-2022 (p < 0.05), followed by clinically relevant (though statistically nonsignificant) late-phase reductions. PE proportion demonstrated a significant overall increase (APC = 18.77%, p < 0.05). In multivariate analysis, four independent predictors significantly increased PE risk: altitude gradient (OR 1.035, p < 0.001), multiparity (OR 2.548, p = 0.004), hypertension or eclampsia (OR 1.797, p = 0.001), and structural heart disease (OR 1.988, p < 0.001).</p><p><strong>Conclusion: </strong>This decade-long analysis (2015-2024) revealed significant altitudinal gradients in postpartum VTE. Clinically significant escalation of postpartum VTE burden in high-altitude populations warrants urgent intervention. Integrated multiparity management and enhanced comorbidity control are critical future initiatives for resolving key perinatal thrombotic risk bottlenecks.</p>","PeriodicalId":9416,"journal":{"name":"Canadian respiratory journal","volume":"2026 1","pages":"e3703610"},"PeriodicalIF":2.1,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13311318/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148343916","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development of a Bedside Decision Tree for Postexacerbation Risk Stratification: Translating Neuroimmune Biomarker Dynamics Into Clinical Practice.","authors":"Cheng Chen, Shanshan Liu, Jian Dong","doi":"10.1155/carj/3591021","DOIUrl":"10.1155/carj/3591021","url":null,"abstract":"<p><strong>Background: </strong>The acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is characterized by systemic inflammatory response and neuroimmune dysregulation. The dynamic changes of certain key neuroimmune biomarkers during the course of AECOPD and their impact on long-term patient outcomes have not been thoroughly studied.</p><p><strong>Objective: </strong>This study aims to develop a bedside clinical decision tree based on neuroimmune biomarker dynamics to stratify post-AECOPD patient risk and guide personalized discharge planning.</p><p><strong>Methods: </strong>This prospective observational study included 273 patients hospitalized due to AECOPD. Serum levels of brain-derived neurotrophic factor (BDNF), programmed cell death protein 1 (PD-1), matrix metalloproteinase-9 (MMP-9), and inflammatory cytokines (IL-1β, IL-6, IL-10, and TNF-α) were measured within 24 h of admission (T1) and within 48 h after clinical stability at discharge (T2). Unsupervised clustering analysis was performed based on the dynamic changes in biomarkers, and multivariable logistic regression was used to assess their association with 90-day clinical outcomes (acute exacerbation, readmission). Additionally, a biomarker-based decision tree model was developed, and its performance was compared with traditional clinical assessment methods.</p><p><strong>Results: </strong>Three distinct biomarker response patterns were identified: \"Coordinated Improvement \" (60.0%), \"Inflammatory Rebound\" (27.8%), and \"Poor Neuro-repair\" (12.1%). Among them, the \"Poor Neuro-repair\" phenotype was the strongest independent predictor of acute exacerbation events at 90 days (adjusted OR 3.42, 95% CI 1.78-6.57, p < 0.001). The dynamic change in BDNF (ΔBDNF) showed predictive value for acute exacerbation events (AUC 0.84). The biomarker-based decision tree model classified patients into four risk levels, with significant differences in the 30-day event incidence (ranging from 3.6% to 68.4%). Its predictive accuracy (AUC 0.87) was markedly superior to that of clinical judgment (AUC 0.74) and the GOLD standard (AUC 0.68).</p><p><strong>Conclusions: </strong>The biomarker response patterns after acute exacerbation, particularly the \"Poor Neuro-repair\" phenotype and its dynamic changes in BDNF, are closely associated with short-term clinical outcomes. The decision tree model developed based on this information provides a preliminary approach for risk stratification and discharge planning in AECOPD patients, demonstrating superior efficacy compared to traditional clinical assessment methods.</p>","PeriodicalId":9416,"journal":{"name":"Canadian respiratory journal","volume":"2026 1","pages":"e3591021"},"PeriodicalIF":2.1,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13420269/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148618506","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Validity of Alfred Step Test Exercise Protocol (A-STEP) as a Surrogate VO_2Max Cardiopulmonary Exercise Test (CPET) to Cycle Ergometry in Adults With Cystic Fibrosis.","authors":"Brenda Button, Mahesh Dharmakumara, Lisa Wilson, Nic Parry, Faizel Hartley, Brigitte Borg, Dominic T Keating","doi":"10.1155/carj/9062245","DOIUrl":"10.1155/carj/9062245","url":null,"abstract":"<p><strong>Background: </strong>The Alfred Step Test Exercise Protocol (A-STEP) and feasibility study were previously published. The aim here was to determine the validity of the A-STEP compared to cycle ergometry (CPET) in adults with CF.</p><p><strong>Methods: </strong>The A-STEP and CPET were carried out in random order 2 weeks apart. A wearable, portable metabolic system was used to measure breath-by-breath and minute-by-minute sampling of O₂, CO₂, heart rate, and VO₂. The main outcome measures were VO_2max and HRmax.</p><p><strong>Results: </strong>Seven stable-state adults (3 male) on CFTR modulator therapy with a mean (SD) and range of age 38.2 (13.4) 26-64 years; height 169.9 (10.9) 149.7-185.3 cm; BMI 22.8 (2.10) 19.5-28 kg/m²; FEV1 79.4 (18.9) 38.0-106.0; and FVC 95.1 (16.7) 63.0-114.0 percent predicted (pp) completed both A-STEP and CPET. The VO_2Max had high correlation and good agreement between the A-STEP 31.3 (5.9) and CPET 29.8 (6.2) mL/min/kg, r = 0.88. The HR_MAX was strongly correlated with the A-STEP 174 (17) bpm and 95.7 (7.4) pp versus 168 (15) bpm and 92.4 (5.3) pp with r = 0.92 and 0.86, respectively. The SpO_2Nadir for A-STEP was 91.0 (4.0) and CPET 92.0 (3.3), r = 0.82. The VO₂ at the anaerobic threshold (VO_2@AT) occurred significantly earlier for the CPET at 1021 (260) versus A-STEP 1361 (234) mL/minute, p < 0.05. The VE_Max for CPET was 84.1 (18.8) and A-STEP 73.5 (15.8) L/minute, p < 0.05. The AWESCORE also ensured baseline stability. The number of levels completed during the A-STEP was 10.7 (12.9) ranging from 9 to 15.</p><p><strong>Conclusion: </strong>The A-STEP may be a portable, valid surrogate to cardiopulmonary exercise testing using cycle ergometry.</p>","PeriodicalId":9416,"journal":{"name":"Canadian respiratory journal","volume":"2026 1","pages":"e9062245"},"PeriodicalIF":2.1,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13140811/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147484702","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Characteristics of Mycoplasma pneumoniae Pneumonia in Children and Risk Factors for Progression to Severe Disease.","authors":"Chao Fu, Xiang He, Chengcheng Li, Shirong Luo, Yunrong Li","doi":"10.1155/carj/5938199","DOIUrl":"10.1155/carj/5938199","url":null,"abstract":"<p><strong>Objective: </strong>To understand the clinical characteristics of severe and nonsevere Mycoplasma pneumoniae pneumonia (MPP) in children and analyze the risk factors for severe Mycoplasma pneumoniae pneumonia (SMPP), providing a basis for early clinical diagnosis and treatment of SMPP.</p><p><strong>Methods: </strong>A retrospective analysis was conducted on 146 children with MPP admitted to pediatric wards 1-4 of Zunyi First People's Hospital from August 2024 to June 2025. According to the severity of their condition, the patients were divided into a severe group (n = 49) and a nonsevere group (n = 97). Clinical manifestations, imaging data, and laboratory indicators were compared between the two groups, and logistic regression analysis was used to summarize the risk factors for pediatric SMPP.</p><p><strong>Results: </strong>(1) The duration of fever and cough was significantly longer in the severe MPP group than in the nonsevere group (p < 0.05). Compared with those in the nonsevere group, instances of prematurity, intrauterine infection at birth, pulmonary consolidation, pleural effusion, high fever, wheezing, and difficulty breathing were significantly more frequent in the severe group (p < 0.05). (2) Laboratory indicators, such as C-reactive protein levels, lactate dehydrogenase levels, D-dimer levels, ferritin levels, the neutrophil ratio, and serum amyloid A levels, were significantly greater in the severe group than in the nonsevere group (p < 0.05). (3) The risk factors for SMPP included prematurity (OR = 4.747; 95% CI: 1.259 ∼ 17.891; p = 0.021), pulmonary consolidation (OR = 5.277; 95% CI: 1.372 ∼ 20.301; p = 0.016), high fever (OR = 25.597; 95% CI: 6.760 ∼ 96.926; p < 0.001), wheezing (OR = 6.913; 95% CI: 1.837 ∼ 26.017; p = 0.004), and difficulty breathing (OR = 5.990; 95% CI: 1.451 ∼ 24.722; p = 0.013).</p><p><strong>Conclusion: </strong>Children with SMPP have prolonged fever and cough, more severe clinical symptoms, and significantly elevated inflammation-related laboratory indicators. Prematurity, pulmonary consolidation, high fever, wheezing, and difficulty breathing are easily accessible baseline warning indicators for early identification of children at high risk of progression to SMPP. Strengthening early recognition and timely intervention in patients presenting with these factors may help optimize clinical management and improve outcomes.</p>","PeriodicalId":9416,"journal":{"name":"Canadian respiratory journal","volume":"2026 1","pages":"e5938199"},"PeriodicalIF":2.1,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13579244/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148975972","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Noninvasive Ventilation in Pediatric Bronchiolitis: Variables Related to Weaning Readiness and Approach.","authors":"Rheanna Bulten, Gregory Hansen, Tanya Holt","doi":"10.1155/carj/2042835","DOIUrl":"https://doi.org/10.1155/carj/2042835","url":null,"abstract":"<p><strong>Background: </strong>There is a lack of evidence related to weaning noninvasive ventilation in bronchiolitis. The purpose of this study was to identify variables related to NIV weaning readiness and approach in bronchiolitis.</p><p><strong>Methods: </strong>A retrospective cohort study of 74 children less than two years of age with bronchiolitis, requiring NIV and admitted to a pediatric intensive care unit (PICU) from 2022 to 2023. Demographic variables, clinical metrics, NIV mode, and weaning metrics were collected.</p><p><strong>Results: </strong>Mean total duration of NIV therapy was 40 h with weans lasting 13 h. Duration for children on CPAP alone was shorter (26 h) than for children on combination of BiPAP and CPAP (45 h, 95% CI 4.258 to 33.742, p = 0.0123). Wean times were also shorter for children on CPAP alone (mean 5 h) than children on BiPAP and CPAP (mean 16 h) (95% CI 1.899 to 20.101, p = 0.0185). Patients were more likely to have a \"complex wean,\" defined as escalation and de-escalation between multiple settings, with BiPAP (44.6%) than with CPAP (18.8%). RR at first wean was a significant predictor of NIV weaning duration (p = 0.007).</p><p><strong>Conclusion: </strong>There is a need for NIV weaning guidelines. RR may be an important predictor of NIV weaning readiness and approach. A \"complex wean\" may be a potential outcome variable for weaning NIV in children with bronchiolitis. This study may be used to inform future research and guidelines for weaning NIV in children with bronchiolitis.</p>","PeriodicalId":9416,"journal":{"name":"Canadian respiratory journal","volume":"2026 1","pages":"e2042835"},"PeriodicalIF":2.1,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13494516/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148788558","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}