Background Existing asthma biomarkers are insufficient for comprehensive disease assessment. Exhaled volatile organic compounds (VOCs) offer a paradigm-shifting opportunity as non-invasive biomarkers for comprehensive clinical assessment in asthma. This study pioneers a holistic approach by systematically exploring the utility of exhaled VOC profiles for differentiating asthmatic patients (APs) from healthy individuals (HCs), evaluating disease control status, classifying asthma phenotypes, and predicting treatment response. Furthermore, it unravels critical correlations between exhaled VOC profiles and clinical parameters, thereby laying the groundwork for unprecedented precision in asthma diagnosis and management. Methods This single-center, cross-sectional and cohort study recruited 147 APs and 50 HCs over a 6-month period, and exhaled breath samples were analyzed using gas chromatography-mass spectrometry (GC-MS). Univariate and multivariate analyses identified potential VOC markers for classification. Subsequently, correlation analyses were performed between VOC biomarkers and clinical characteristics. Results We identified 10, 10, 1, 4, and 8 potential exhaled VOC biomarkers for differentiating APs from HCs, assessing disease control status, predicting treatment response, classifying asthma phenotypes, and characterizing pre- and post-treatment changes, respectively. Additionally, four VOCs demonstrated a significant degree of correlation with pulmonary function and clinical inflammatory markers. Conclusion This study identified discriminatory exhaled breath VOCs between asthmatic patients and healthy controls, with distinct profiles also observed in controlled versus uncontrolled asthma. Notably, significant VOC variations were additionally detected in patients undergoing conventional inhaled corticosteroid (ICS) or biological monoclonal antibody therapy. Upon validation, these findings advocate for breath analysis as a non-invasive, readily implementable technique for identifying airway inflammatory phenotypes and assessing treatment eligibility in asthma.

Objective Standard spirometry often fails to capture regional functional heterogeneity in severe asthma. This study aimed to evaluate the differential effects of biological versus conventional therapy on small airway function and ventilation homogeneity, utilizing a combined strategy of longitudinal spirometry and cross-sectional electrical impedance tomography (EIT) assessment at the 6-month endpoint. Methods In this observational study, 111 patients with severe asthma were stratified into two groups based on their clinical treatment regimen: a conventional group (high-dose ICS/LABA, n = 79) and a biological group (add-on biologic therapy, n = 32). Spirometry was performed at baseline and after 6 months. Electrical impedance tomography (EIT) measurements were only conducted at the 6-month follow-up to quantify regional ventilation dynamics, utilizing parameters such as the regional expiratory time constant (τ), global inhomogeneity (GI) index, and regional obstruction ratio (rOR). Results Over the 6-month period, the biological group demonstrated superior improvements compared to the conventional group. Significant Time×Group interactions were observed for all large airway parameters, including FEV1( P Interaction =0.01), FVC( P Interaction =0.047) and the FEV1/FVC ratio ( P Interaction =0.02) and FEV1% pred ( P Interaction =0.01). Small airway function also improved significantly more in the Biological group (MEF50, P Interaction =0.02; MEF25, P Interaction =0.04). EIT assessment at the endpoint confirmed these physiological benefits, showing significantly greater ventilation homogeneity (lower GI T75 , P = 0.01), faster lung emptying (shorter τ, P < 0.01), and reduced regional obstruction (lower rOR, P = 0.01) in the biological group. Conclusion Biological treatments demonstrated superior efficacy in restoring large and small airway function and improving ventilation homogeneity, compared to conventional therapy. While global spirometry tracks overall airflow trends, EIT provides critical insights into regional lung mechanics. Integrating both modalities offers a more comprehensive approach to uncovering the potential physiological improvements in severe asthma management.

Background:Chemotherapy-induced myelosuppression (CIM) is a frequent complication in lung cancer, leading to treatment delays, dose reductions, and increased healthcare utilization. Trilaciclib, a first-in-class CDK4/6 inhibitor with myeloprotective properties, has been approved for extensive-stage small-cell lung cancer (ES-SCLC), but real-world evidence in broader lung cancer populations is limited. This retrospective real-world study aimed to evaluate the myeloprotection effects of trilaciclib in lung cancer patients undergoing chemotherapy. Methods:We conducted a retrospective analysis of lung cancer patients who received chemotherapy at the First Affiliated Hospital of Air Force Medical University between January 2023 and June 2024. Patients were categorized into trilaciclib group and non-trilaciclib group. Baseline characteristics, myelosuppression grades, drug dosages for myelosuppression treatment, chemotherapy delays, hospitalizations, and alopecia were collected and analyzed. Inverse probability of treatment weighting (IPTW) was applied to adjust for baseline imbalances. Results:A total of 108 patients were included (54 per group). Overall myelosuppression incidence did not differ significantly (74.1% vs. 87%, P=0.09), but grade ≥3 myelosuppression was markedly reduced in the trilaciclib group [40% vs. 66%, IPTW-adjusted odds ratio (OR) =2.90, P=0.02]. The trilaciclib group required fewer therapeutic granulocyte colony-stimulating factor (G-CSF) doses [median 2 vs. 6, IPTW-adjusted rate ratio (RR) =1.74, P=0.02] and had a lower incidence of grade ≥3 alopecia (77.8% vs. 93.2%, P=0.04), but not significant after IPTW adjustment. Myelosuppression-related hospitalization was significantly reduced (13% vs. 50%, IPTW-adjusted OR =7.77, P<0.001), while chemotherapy delays and other supportive medication use were similar. Conclusions:In a real-world cohort of patients with locally advanced or metastatic lung cancer receiving chemotherapy, trilaciclib was associated with a lower incidence of severe myelosuppression, reduced G-CSF utilization, and fewer hospitalizations. These findings should be considered exploratory, and may support the potential role of trilaciclib as a myeloprotective strategy to optimize treatment continuity and reduce healthcare burden.

In recent years, alternating epidemics of multiple respiratory pathogens have appeared globally, with recurrent infections in some individuals. However, there is a lack of evidence from clinical studies on the effects of the initial pathogen on the incidence, severity, and regression of infections with the subsequent pathogen. This study involved college students as survey respondents during the successive outbreaks of Mycoplasma pneumoniae (MP) and influenza epidemics to obtain evidence regarding MP–influenza interference. MP and influenza epidemics occurred successively between September 2023 and February 2024. Internet-based questionnaires were administered to all freshmen enrolled in August 2023 at three closed-management public universities in northern China after the end of the first wave of the MP epidemic and the second wave of the influenza epidemic, respectively. The participants self-rated their perceived severity for 16 symptoms, and the scores were summed to obtain a combined symptom score for each individual. Multiple logistic and linear regression analyses were used to investigate the effect of previous MP infection on the incidence and severity of subsequent influenza infection. A total of 1803 cases of MP-like illness and 2111 cases of influenza-like illness (ILI) were observed among 5790 freshmen across two waves of respiratory infection outbreaks. Moreover, 709 and 1244 cases were voluntarily tested for pathogens at the university clinic, of which 549 (77.4

PurposeThis study aimed to evaluate the regional ventilation distributions in A-B-E phenotypes among patients with chronic obstructive pulmonary disease (COPD). The feasibility to better distinguish the phenotypes combining global spirometry and regional ventilation parameters derived from electrical impedance tomography (EIT) was explored.MethodsA cohort undergoing pulmonary function testing was prospectively enrolled. Regional spatial and temporal ventilation parameters were calculated with EIT. Principal component analysis was used to visualize phenotypic clustering, while multinomial logistic regression evaluated discriminatory performance. Feature importance was interpreted using SHapley Additive exPlanations (SHAP).ResultsThis study enrolled 88 COPD patients (Group A n = 36, Group B n = 21, Group E n = 31). Spirometry and EIT parameters revealed significant intergroup differences in FEV1%pred (P < 0.001), FEV1/FVC (P < 0.001), GI-FEV1 (regional distribution of FEV1%pred in functional EIT; P = 0.004), GI-FEV1/FVC (regional distribution of FEV1/FVC; P = 0.001) and expiratory time constant (P = 0.017). Group A demonstrated the best pulmonary function (FEV1%pred: 77.67 ± 20.40), while Group E showed the most pronounced flow limitation (longest time required to exhale 75% of FVC, T75). The multinomial model showed optimal discrimination for Group A (AUC: 0.827), while differentiation between Groups B and E was less satisfactory (AUC: 0.749). SHAP analysis identified FEV1%pred as the most significant predictor (|SHAP| = 0.477), with EIT-derived parameters GI-FEV1/FVC (|SHAP| = 0.203) and regional T75 (|SHAP| = 0.189) providing substantial incremental value.ConclusionCOPD phenotypes showed differences in global and regional flow limitations. The combination of global and regional information helped with distinguishing phenotypes.

Objective: The air content within the lungs directly influences the dielectric properties of lung tissue; however, previous studies were conducted under ex vivo conditions and without quantitatively controlling air volume. This study aims to develop an improved model using in vivo measurements to accurately characterize the dielectric properties of rabbit lung tissue across various tidal volumes. Methods: In this study, six sets of different tidal volumes (30, 40, 50, 60, 70, 80 mL) were set in the frequency band of 100 MHz~1 GHz to analyze the trend of the dielectric properties, and the dielectric parameters were systematically constructed under the conditions of different tidal volumes. Results: It was found that the conductivity and permittivity of rabbit lung tissue showed a decreasing trend with increasing tidal volume in the measuring frequency band. The traditional Cole–Cole model has limitations in simulating the dielectric properties of in vivo lung tissues. Therefore, by refining and optimizing the model, this study successfully reduced the average error between the measured data and the model fitting to less than 5%. Conclusions: This study lays the groundwork for investigating the relationship between total air volume within the lungs and their dielectric properties in vivo.

Objective:Preserved ratio impaired spirometry (PRISm) is a condition characterized by abnormal spirometry results despite a normal forced expiratory volume in the first second (FEV1)/forced vital capacity (FVC) ratio. We hypothesized that electrical impedance tomography (EIT) would detect regional decreases in lung function in subjects with PRISm. The study aimed to explore the regional lung function differences between subjects with preserved ratio impaired spirometry (PRISm) and healthy volunteers. Methods:In this observational study, subjects with respiratory symptoms visiting Xijing Hospital in May 2024 were rescreened for eligibility. Subjects meeting the PRISm criteria were included in the study. Electrical impedance tomography (EIT) and spirometry were conducted simultaneously. The same number of healthy subjects were studied, matching the gender, height, and weight in frequency. The regional lung function parameters were compared. A P-value of < 0.05 was considered statistically significant. Results:A total of 16 subjects with PRISm, and 16 healthy volunteers were included in the study and evaluated. Functional EIT images provided information about the location of the dysfunctional lung regions. All evaluated EIT-based parameters were worse in the subjects with PRISm. Statistically significant differences were found in the regional obstructive ratio (rOR) and the median of the regional time constant τmed (p < 0.05). EIT-based parameters did not correlate with spirometry-based parameters, except for spirometry FEV1/FVC, which showed correlations with rOR (r = -0.53, p = 0.03) and τmed (r = -0.62, p = 0.01) in subjects with PRISm. Both τmed and rOR values were quite low in healthy volunteers, whereas substantial changes were observed in subjects with PRISm. Conclusion:EIT-based regional lung function provides additional information to traditional spirometry, which visualizes and localizes regional lung function defects.

Early detection of lung function impairment is crucial. However, the sensitivity of spirometry in detecting early lung function deterioration is limited. In this study, lungs of 3180 healthy participants scheduled for annual health check were screened. Electrical impedance tomography measurements were conducted in 130 participants with normal spirometry for concept establishment phase and 105 for validation phase. A follow-up CT examination was suggested for participants with abnormal regional time constant or tobacco consumption ≥10 pack-years. Using CT as reference, the sensitivity and specificity of electrical impedance tomography-based screening were 81.3% and 50.0%, respectively in the concept establishment phase. In the validation phase, the sensitivity and specificity were 77.9% and 50.0%. In this study we show that conventional spirometry may not capture early changes that occur at a regional level. The regional time constant based on electrical impedance tomography can be a promising tool for early screening of lung function impairment. Clinical trial registration: ChiCTR2300076673, www.chictr.org.cn . The study explores the possibility of using electrical impedance tomography (EIT) as an early screening method to identify lung function impairment in participants with normal spirometry results. It identifies EIT-based regional τ values can be a promising tool for early screening of lung function impairment.

Background: Kirsten rat sarcoma viral oncogene homolog (KRAS) mutation seemingly suffered less effective therapeutic regimens in the absence of widely-accepted targeted drugs compared with other mutation types in non-small cell lung cancer (NSCLC). However, whether these non-selective therapy schedules for KRAS mutation matters is still under debate. Correspondingly, we aimed to compare the long term expectancy of indicated therapeutic regimes and further explore the optimal schemes of KRAS mutated NSCLC in the absence of targeted drugs in this retrospective study cohort. Methods: We conducted a single-center retrospective analysis among 66 patients diagnosed with KRASmutant advanced NSCLC from November 2018 to December 2020. These enrolled cases were divided into different subgroups in light of mutant isotypes, pathological characteristics, and therapeutic regimes to uncover indicated long-term survival benefits. Additionally, clinical outcomes of treatment schedules and interventional lines to KRAS-mutant NSCLC were described in detail. Results: This cohort enrolled 8 patients with stage IIIB (12.1%) and 58 patients with stage IV (87.9%) with the median age 62 years, ranging from 32 to 91 years old. Genetically, G12C conducted as the most common KRAS mutation type, accounting for 30.3%. Pemetrexed combined with platinum chemotherapy seemed to be a priority (72.7%), and chemotherapy combined with immunotherapy became an alternative (15.2%) in clinic. Performing further analysis of long-term survival of patients receiving different treatment methods indicated that the median overall survival (mOS) in first-line therapy with antiangiogenesis or untreated was 13 and 12 months, respectively (P=0.79). In the first-line regimen, median survival was 17 months for patients who received combined immune checkpoint inhibitors and 12 months for those who did not (P=0.34). The mOS was 20 months for those who had used immune checkpoint inhibitors and 12 months for those who had not (P=0.11). Survival analysis results of NSCLC patients with different KRAS mutation types showed the median survival time of patients with G12C mutation type and patients without with nonG12C Conclusions: In the absence of KRAS targeted drugs, available treatment plans failed to benefit KRAS mutant sufferers regardless of isotypes, making the KRAS-targeted drugs urgent.

目的 观察稳定期不同分组慢性阻塞性肺疾病(COPD)患者的外周血细胞因子及炎性指标的表达情况,分析其与疾病严重程度的相关性,以期达到精准诊疗目的.方法 纳入COPD患者75例,依据GOLD指南将患者分为A、B、C、D组,其中A组为低风险、症状少(20例),B组为低风险、症状多(19例),C组为高风险、症状少(17例),D组为高风险、症状多(19例).收集患者基线资料、血常规、各类细胞因子指标.比较不同分组间COPD患者的炎性指标是否存在差异,并且分析炎性指标与综合评估疾病严重程度之间的关系.结果 A、B、C、D组COPD患者血常规中中性粒细胞/淋巴细胞比值(NLR)、血小板/淋巴细胞比值(PLR)、全身免疫炎症指数(SII)、全身炎症反应指数(SIRI)组间差异具有统计学意义(P＜0.05,P＜0.01),且随着病情严重程度的增加,NLR、PLR、SII、SIRI呈现上升的趋势;细胞因子IL-6组间差异具有统计学意义(P＜0.01),且随着病情严重程度的增加呈现上升的趋势;而IL-8在C组和B组、C组和D组患者间差异具有统计学意义(P＜0.01).COPD 患者 NLR、PLR、SII、SIRI、IL-6 与病情严重程度呈正相关(P＜0.05,P＜0.01);IL-1β、IL-6与肺功能一秒率、FEV1占预计值呈负相关(P＜0.05).结论 NLR、PLR、SII、SIRI、IL-6与COPD患者病情严重程度密切相关,而IL-1β、1L-6指标与COPD患者肺功能呈负相关.

Abstract Background As one of the main causes ofchronic obstructive pulmonary disease (COPD), respiratory microbiome is of great significance to the disease progression. Meanwhile, pulmonary rehabilitation (PR), as an effective nonpharmacologicintervention for COPD, evaluation of the efficacy is limited to the improvement of symptoms and lung function, which is one-sided to a certain extent. Therefore, an individualized 2-week intensive PR programme was established in the present study for patients with COPD to investigate whether this short course of PR can have impact on respiratory microbiome in patients. Methods The patients with stable COPD who participated in this study underwent short-term, high-intensity and center-based PR programme, which included two major components: respiratory muscle training and vibration expectoration. Sputum samples were collected before and after the PR to detect alterations of respiratory microbiome by metagenomic sequencing. The main purpose was to observe changes of composition, function and resistance genes in respiratory microbiomebefore and after PR, and explore the relationship of respiratory microbiome with lung function and symptoms. Results After the 2-week intensive PR, the abundance of Firmicutes , Actinobacteria and Bacteroidetes decreased, while that of Proteobacteria increased at the phylum level; the abundance of Streptococcus and Prevotella decreased, while that of Neisseria increased at the genus level. Concomitantly, it was found that Firmicutes , Actinobacteria, Streptococcus and Prevotella were negatively correlated with lung function and positively correlated with CAT score, while Neisseria was positively correlated with lung function and negatively correlated with CAT score. Based on the Kyoto Encyclopedia of Genes and Genomes (KEGG) database, the functional abundance of most respiratory microbiome decreased after 2-week PR. Simultaneously, the species function abundance was negatively correlated with the lung function of COPD. In addition, the resistance gene fluctuated with the attribution of the species, and the macrolide resistance genes of COPD were significantly reduced after 2-week PR. Conclusions The short course of intensive PR can alter the composition, function and antibiotic resistance genes of respiratory microbiome in patients with COPD, which plays a role by promoting the self-regulation ability of patients. This study provides a novel, gentle and non-pharmacologic intervention for the regulation of microbiome in the future.

Background: Lung cancer is the leading source of cancer-caused disability-adjusted life years. Medical cost burden impacts the well-being of patients through reducing income, cutting daily expenses, curtailing leisure activities, and depleting exhausting savings. The COmprehensive Score for Financial Toxicity (COST) was created and validated by De Souza and colleagues. Our study intends to measure the financial burdens of cancer therapy and investigate the link between financial toxicity and health-related quality of life (HRQoL) in an advanced lung cancer population.Methods: Patients aged ≥ 18 years with confirmed stage III to IV lung cancer were eligible. The COST questionnaire verified by de Souza et al. was used to identify financial toxicity. Multivariable linear regression analysis with log transformation univariate analysis and Pearson correlations were used to perform the analysis.Results: The majority of the patients (90.8%, n = 138/152) had an annual income of $50,000 ($7,775). The cohort's insurance situation was as follows: 64.5% of the cohort had social insurance, 20.4% had commercial insurance, and 22.0% had both. Patients who were younger age (50–59, P < 0.001), employed but on sick leave, and had lower income reported increased levels of financial toxicity (P < 0.05). The risk factors for high financial toxicity: (i) younger age (50–59), (ii) <1 month of savings, and (iii) being employed but on sick leave. Increased financial toxicity is moderately correlated with a decrease in QoL.Conclusion: Poorer psychological status and specific demographics are linked to increased financial toxicity (lower COST). Financial toxicity has a modest relationship with HRQoL and may have a clear link with HRQoL measurements.

OBJECTIVE:Electrical impedance tomography (EIT) is a bedside tool for lung ventilation and perfusion assessment. However, the ability for long-term monitoring diminished due to interferences from clinical interventions and motion artifacts. The purpose of this study is to investigate the feasibility of the discrete wavelet transform (DWT) to detect and remove the common types of motion artifacts in thoracic EIT.METHODS:Baseline drifting, step-like and spike-like interferences were simulated to mimic three common types of motion artifacts. The discrete wavelet decomposition was employed to characterize those motion artifacts in different frequency levels with different wavelet coefficients, and those motion artifacts were then attenuated by suppressing the relevant wavelet coefficients. Further validation was conducted in two patients when motion artifacts were introduced through pulsating mattress and deliberate body movements. The db8 wavelet was used to decompose the contaminated signals into several sublevels.RESULTS:In the simulation study, it was shown that, after being processed by DWT, the signal consistency improved by 92.98% for baseline drifting, 97.83% for the step-like artifact, and 62.83% for the spike-like artifact; the signal similarity improved by 77.49% for baseline drifting, 73.47% for the step-like artifact, and 2.35% for the spike-like artifact. Results from patient data demonstrated the EIT image errors decreased by 89.24% (baseline drifting), 88.45% (step-like artifact), and 97.80% (spike-like artifact), respectively; the data correlations between EIT images without artifacts and the processed were all > 0.95.CONCLUSION:This study found that DWT is a universal and effective tool to detect and remove these motion artifacts.

In order to identify, distinguish, and clarify the biological function of microbiome in various organs of the human body, the US National Institutes of Health launched the human microbiome program in 2007.After more than 10 years of promotion, this project improved people′s understanding of the relationship between microbiome and the body significantly, including respiratory tract, and broke the fallacy of the " lower respiratory tract is sterile" . Under normal circumstances, microbial community benefits from the interaction between the microorganism and the host.Chronic airway disease, a common chronic disease, represented by chronic obstructive pulmonary disease and asthma is the most common and most serious chronic disease in China.This paper lists the characteristics of microbiome in the respiratory tract and the lung in the background of various chronic respiratory diseases, and the importance of host respiratory tract microbiome interaction is expounded.Furthermore, we discussed the possibility of developing new therapeutic drugs and methods for the chronic respiratory diseases by regulating lung microbiome.

1 临床资料 患者男性,61岁,主诉"反复咳嗽、咳痰10余年,加重8月余"于2019年4月入住我科.既往史:患者既往体质一般,有煤尘接触史(环卫工人)11年,脱离接触已8年;吸烟20余年,300包/年,已戒烟5年;无其他器官系统疾病.

BackgroundAlthough asthma and chronic obstructive pulmonary disease (COPD) are two well-defined and distinct diseases, some patients present combined clinical features of both asthma and COPD, particularly in smokers and the elderly, a condition termed as asthma-COPD overlap (ACO). However, the definition of ACO is yet to be established and clinical guidelines to identify and manage ACO remain controversial. Therefore, in this study, inflammatory biomarkers were established to distinguish asthma, ACO, and COPD, and their relationship with the severity of patients’ symptoms and pulmonary function were explored.Materials and methodsA total of 178 patients, diagnosed with asthma (n = 38), ACO (n = 44), and COPD (n = 96) between January 2021 to June 2022, were enrolled in this study. The patients’ pulmonary function was examined and routine blood samples were taken for the analysis of inflammatory indexes. Logistic regression analysis was used to establish inflammatory biomarkers for distinguishing asthma, ACO, and COPD; linear regression analysis was used to analyze the relationship between inflammatory indexes and symptom severity and pulmonary function.ResultThe results showed that, compared with ACO, the higher the indexes of platelet, neutrophil-lymphocyte ratio (NLR) and eosinophil-basophil ratio (EBR), the more likely the possibility of asthma and COPD in patients, while the higher the eosinophils, the less likely the possibility of asthma and COPD. Hemoglobin and lymphocyte-monocyte ratio (LMR) were negatively correlated with the severity of patients’ symptoms, while platelet-lymphocyte ratio (PLR) was negatively correlated with forced expiratory volume in the 1 s/forced vital capacity (FEV1/FVC) and FEV1 percent predicted (% pred), and EBR was positively correlated with FEV1% pred.ConclusionInflammatory indexes are biomarkers for distinguishing asthma, ACO, and COPD, which are of clinical significance in therapeutic strategies and prognosis evaluation.

BackgroundThere is increasing incidence of pulmonary nodules due to the promotion and popularization of low-dose computed tomography (LDCT) screening for potential populations with suspected lung cancer. However, a high rate of false-positive and concern of radiation-related cancer risk of repeated CT scanning remains a major obstacle to its wide application. Here, we aimed to investigate the clinical value of a non-invasive and simple test, named the seven autoantibodies (7-AABs) assay (P53, PGP9.5, SOX2, GAGE7, GUB4-5, MAGEA1, and CAGE), in distinguishing malignant pulmonary diseases from benign ones in routine clinical practice, and construct a neural network diagnostic model with the development of machine learning methods. MethodA total of 933 patients with lung diseases and 744 with lung nodules were identified. The serum levels of the 7-AABs were tested by an enzyme-linked Immunosorbent assay (ELISA). The primary goal was to assess the sensitivity and specificity of the 7-AABs panel in the detection of lung cancer. ROC curves were used to estimate the diagnosis potential of the 7-AABs in different groups. Next, we constructed a machine learning model based on the 7-AABs and imaging features to evaluate the diagnostic efficacy in lung nodules. ResultsThe serum levels of all 7-AABs in the malignant lung diseases group were significantly higher than that in the benign group. The sensitivity and specificity of the 7-AABs panel test were 60.7% and 81.5% in the whole group, and 59.7% and 81.1% in cases with early lung nodules. Comparing to the 7-AABs panel test alone, the neural network model improved the AUC from 0.748 to 0.96 in patients with pulmonary nodules. ConclusionThe 7-AABs panel may be a promising method for early detection of lung cancer, and we constructed a new diagnostic model with better efficiency to distinguish malignant lung nodules from benign nodules which could be used in clinical practice.

Abstract BackgroundPulmonary rehabilitation (PR) is a widely recognized nonpharmacologic therapy for chronic obstructive pulmonary disease (COPD), but most of the current studies on whether PR can benefit COPD patients are based on the evaluation of symptoms and pulmonary function, which is limited to a certain extent. Therefore, based on the current study, this study evaluated the effects of individualized PR on the regional lung function in patients with stable COPD.MethodsThe patients with stable COPD were treated with PR for 2 weeks. The symptoms, global and regional lung function changes before and after 2-week program were evaluated using surveys, spirometry and electrical impedance tomography (EIT). The spatial coefficient of variation (CV) of regional spirometry parameters were calculated to quantified spatial heterogeneity of lung function. Temporal inhomogeneity was determined by the regional expiration time.ResultsAfter 2 weeks of intervention, the COPD assessment test score (CAT, 15.6±6.17 vs 11.1±5.85, P = 0.001), global spirometry forced expiratory volume in the first second (FEV1; 1.13±0.62 L vs 1.24±0.65 L, P = 0.006) and FEV1 % pred (43.3±21.34 % vs 48.3±24.22 %, P = 0.001) were improved. The CV for regional FEV1 / FVC (0.28±0.19 vs 0.17±0.06, P=0.012) differed significantly. Regional lung ventilation was more homogeneous and regional expiration time was shorter after PR.ConclusionThis study suggested that both spatial and temporal regional ventilation in COPD improved after the 2-week PR.

Background Pulmonary rehabilitation (PR) is a widely recognized nonpharmacologic therapy for chronic obstructive pulmonary disease (COPD), but most of the current studies on whether PR can benefit COPD patients are based on the evaluation of symptoms and pulmonary function, which is limited to a certain extent. Because COPD is characterized by potential regional lung changes in morphology and pathophysiology, this study was designed to evaluate the effects of individualized PR on regional lung function in patients with stable COPD. Methods In this study, patients with stable COPD who met the criteria were included, and they were treated with PR for 2 weeks using the respiratory rehabilitation training instrument. The symptoms, and global and regional lung function before and after 2 weeks of PR treatment were evaluated using surveys, spirometry, and electrical impedance tomography (EIT), respectively. The spatial coefficient of variation (CV) of regional spirometry parameters were calculated to quantify spatial heterogeneity of lung function. Temporal inhomogeneity was determined by the regional expiration time. Results A total of 34 participants were recruited in this study, of whom 24 completed the PR. After 2 weeks of intervention, the modified Medical Research Council (mMRC) dyspnea scale and the COPD assessment test (CAT) score was significantly lower compared to those measured before the treatment (2.3±1.17 vs. 2.1±0.93, P=0.034; and 15.0±7.18 vs. 10.9±6.06, P<0.001, respectively). Global spirometry forced vital capacity (FVC), forced expiratory volume in the first second (FEV1), FEV1 predicted percentage (%pred), and peak expiratory flow (PEF) were significantly better than they were pre-rehabilitation (2.1±0.86 vs. 2.3±0.90 L, P=0.018; 1.2±0.65 vs. 1.4±0.66 L, P=0.001; 46.8%±23.16% vs. 51.4%±24.41%, P<0.001; and 3.1±1.80 vs. 3.8±2.23 L/s, P=0.005, respectively). In addition, the CV for regional FEV1/FVC was significantly decreased after the PR treatment (0.26±0.161 vs. 0.17±0.077, P=0.002). Regional lung ventilation was more homogeneous and regional expiration time was shorter after 2 weeks of the PR treatment. Conclusions Two weeks of PR treatment can improve both spatial and temporal regional ventilation in COPD. In addition, EIT may be useful in developing individualized PR treatment program to improve regional lung function in COPD.

Rationale: Endobronchial ultrasound (EBUS) combined with a guide sheath (GS) as an instrument for confirming the proximity of the bronchoscope and its relationship to the lesion can increase the diagnostic yield when conducting transbronchial lung biopsy of peripheral pulmonary nodules (PPNs). A novel electromagnetic navigational bronchoscopy (ENB) system comprising a thinner locatable sensor probe as a guidance instrument was developed to be suitable for a thin bronchoscope with a working channel 2 mm in diameter. The diagnostic efficacy of EBUS-GS with or without this ENB system has not been confirmed. Objectives: To compare the diagnostic value and safety of EBUS-GS with or without the ENB system for diagnosing PPNs. Methods: A prospective, multicenter, randomized controlled clinical trial was designed and conducted at three centers. Patients with PPNs suspected to be malignant were enrolled and randomly assigned to the ENB-EBUS-GS group or the EBUS-GS group. The primary endpoint was the diagnostic yield in each group. The secondary endpoint was the procedural time and other factors affecting diagnostic yield. The safety endpoint was procedural complications. Results: Four hundred participants were enrolled from July 2018 to October 2019, and 385 patients were analyzed, 193 in the ENB-EBUS-GS group and 192 in the EBUS-GS group. The mean nodule size was 21.7 +/- 5.3 mm. The diagnostic yields were 82.9% (95% confidence interval [CI], 77.6-88.2%) in the ENB-EBUS-GS group and 73.4% (95% CI, 67.2-79.7%) in the EBUS-GS group. The difference between the two groups was 9.5% (95% CI, 2.6-16.3%), with an adjusted difference of 9.0% (95% CI, 2.3-15.8%) after adjusting for the stratification factors and center. The time to find lesions in the ENB-EBUS-GS group was shorter than in the EBUS-GS group (213.2 +/- 145.6 vs. 264.8 +/- 189.5 s; P = 0.003). Intraoperative hemorrhage occurred 3.6% of subjects in the ENB-EBUS-GS group and 3.1% in the EBUS-GS group, without significant differences between the two groups. Conclusions: The novel ENB system combined with EBUS-GS demonstrated improved ability to locate PPNs, achieving a high diagnostic yield for PPNs compared with EBUS-GS alone in a safe and efficient procedure.