Background Chronic obstructive pulmonary disease (COPD) remains a leading cause of global mortality, driven by declining lung function and frequent exacerbations. Conventional pulmonary rehabilitation (PR) programs usually last 6–12 weeks, and evidence supporting long-term PR is limited. In addition, the role of negative-pressure ventilation (NPV) in the management of COPD remains unclear. Objectives This study investigated the clinical efficacy of a sequential long-term NPV and PR program in patients with COPD. Design A retrospective cohort study. Methods We analyzed 125 COPD patients treated between 2019 and 2023. The intervention group received 12 months of NPV preceding hospital-based PR with lower-limb exercise twice weekly (NPV-PR), while the comparison group received PR alone. Longitudinal outcomes included pulmonary function tests, 6-min walking distance (6-MWD), COPD Assessment Test (CAT) score, Modified Medical Research Council (mMRC) dyspnea score, and the number of acute exacerbations. Results The NPV-PR group showed significant within-group improvements in pulmonary function, marked by an increased change in forced vital capacity (ΔFVC%) and a significant reduction in residual volume (ΔRV). Despite a lower baseline 6-MWD, the NPV-PR cohort achieved 12-month walking distances comparable to the PR-alone group. Furthermore, CAT scores declined rapidly by 6 months in the NPV-PR group, suggesting NPV may accelerate symptom relief. Notably, the combined approach sustained long-term rehabilitation benefits, yielding significant reductions in mMRC dyspnea scores and the expected count of acute exacerbations. Conclusion Our findings suggest that integrating long-term NPV with extended PR may represent a novel strategy, potentially optimizing the long-term management and clinical trajectory of patients with symptomatic COPD.
Acute exacerbation of interstitial lung disease (AE-ILD) is a life-threatening clinical event associated with poor prognosis. Accurate outcome prediction is important for treatment planning and resource allocation. This review evaluates evidence on prognostic risk factors and clinical scoring systems and discusses the application of artificial intelligence (AI) into the key stages of model development for AE-ILD prognostication. Conventional prognostic approaches enable rapid risk stratification but have limited capacity to integrate heterogeneous data and account for clinical complexity. AI-driven approaches have been preliminarily applied to clinical and imaging data for prognostic assessment. However, direct AE-ILD-specific evidence is limited, and the incremental prognostic value of existing AI models over conventional approaches remains uncertain. Multimodal integration, independent external validation, and model interpretability remain major research gaps. Addressing these gaps through representative multicentre studies may enable AI to reinforce conventional prognostic assessment and promote more individualised risk stratification in AE-ILD.
Background During endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA), visible aspirated material may accumulate in the suction syringe but is typically discarded. Objective To assess whether cytological examination of suction-syringe aspirate improves the diagnostic performance of EBUS-TBNA. Design Prospective, single-center, paired-sample diagnostic study. Methods Pooled aspirated material was preserved in formalin and analyzed cytologically alongside routine EBUS-TBNA specimens. Diagnostic yield, adequacy, and accuracy were compared with/without syringe aspirate analysis. Results Among 355 screened patients, 151 (42.5%) had visible syringe aspirate and were included. Adding syringe aspirate increased diagnostic yield from 58.3% to 62.9% (+4.6%, p =0.016). Sample adequacy remained unchanged (98.7%). Accuracy for excluding malignancy improved from 85.4% to 88.1%, although not significantly (p=0.125). Concordance between TBNA and syringe samples was 87.9%. Seven diagnoses, including four malignancies, were established exclusively from syringe aspirate. Conclusion Cytological analysis of suction-syringe aspirate modestly but significantly enhances EBUS-TBNA diagnostic yield and should be considered in routine practice.
Background Idiopathic pulmonary fibrosis (IPF) is a chronic progressive interstitial lung disease with a high mortality rate. Reliable biomarker can enable clinicians to judge the development and prognosis of IPF. Objectives This study aimed to investigate the prognostic value of erythrocyte sedimentation rate (ESR) for predicting all-cause mortality in IPF. Design This retrospective cohort study enrolled patients hospitalized with IPF between January 1st, 2015 and May 31st, 2023. Methods Data was collected regarding patient demographics, laboratory analysis results, and the following pulmonary function parameters: the forced expiratory volume in one second percentage of predicted (FEV1 %pred), forced vital capacity percentage of predicted (FVC %pred), diffusing capacity divided by the alveolar volume (DLCO/VA), DLCO, DLCO %pred. All-cause mortality data were collected throughout the 18 months follow-up period. Results A total of 510 IPF patients recruited for the final analysis, 131 (25.7%) died during follow-up. IPF patients who died were older, had a higher white blood cell, lactic dehydrogenase, fibrinogen and ESR. In addition, IPF patients who died had a worse pulmonary function, as evidenced by lower FEV1 %pred, FVC %pred, DLCO %pred and DLCO/VA (P<0.05). Logistic regression analysis showed that ESR was an independent risk factor for IPF patients who died, with OR=1.024, 95% CI=1.002-1.048 (P<0.05). Based on the receiver operating characteristic curve, ESR could predict all-cause mortality in IPF patients, with an area under the curve of 0.645 and a 95% CI of 0.591-0.700 (P<0.05). The optimal ESR cut-off value was determined to be 21.5 mm/h. Cox regression analysis revealed that IPF patients with an ESR ≥ 21.5 mm/h had a significantly higher all-cause mortality risk, with a hazard ratio of 5.406 and a 95% CI of 1.177-24.825 (P<0.05). Conclusion ESR is a promising biomarker for predicting all-cause mortality in IPF patients.
Intrapleural enzyme therapy consisting of tissue plasminogen activator and DNase has become a standard approach to the medical management of pleural space infection. The primary risk of such a strategy is pleural hemorrhage, which is rare but well-described, and this complication normally requires surgical intervention since tissue bleeding cannot be treated with vascular embolization. In this report, we describe the novel and successful use of intrapleural tranexamic acid administered at the bedside through a chest tube to control hemothorax caused by tissue plasminogen activator instillation into the pleural space. The index patient, a 60-year-old man with coagulopathy due to liver cirrhosis, had developed a nosocomial empyema following complex spine surgery. His empyema was being managed medically with intrapleural enzyme therapy when the second instillation of this regimen produced a hemothorax. A single dose of 500 mg of tranexamic acid led to the cessation of bleeding without surgery and enabled the patient to ultimately leave the hospital without experiencing recurrent pleural hemorrhage. Although the administration of tranexamic acid via tube thoracostomy is not unprecedented, our report is the first to document its use in this manner to address hemothorax resulting from intrapleural enzyme therapy, introducing a non-invasive option for this challenging clinical scenario.
