Background:Endobronchial carcinosarcoma is a rare and highly malignant tumor composed of both carcinomatous and sarcomatous elements. It typically affects middle-aged and elderly men, particularly those with a history of smoking. The prognosis is generally poor due to its high potential for early metastasis and local recurrence. This case report is unique due to the presentation of endobronchial carcinosarcoma, exhibiting a gloved finger sign, coarse calcifications, and high 18F-fluorodeoxyglucose (18F-FDG) uptake, along with an exceptionally favorable long-term survival after pneumonectomy (R0) without any neoadjuvant or adjuvant therapy. Case Description:A 48-year-old man with a 30-year history of chronic productive cough, a 1-month history of shortness of breath, and a significant smoking history presented to The First Affiliated Hospital of Guangzhou Medical University. Initial examinations revealed elevated neuron-specific enolase (NSE) and reduced partial pressure of oxygen. Computed tomography identified a branching tubular mass in the left upper lobe with a gloved finger sign and coarse calcifications. 18F-FDG positron emission tomography/computed tomography showed intense FDG uptake. Preoperative imaging showed atelectasis and pleural effusion. A bronchoscopic biopsy suggested carcinosarcoma, which was confirmed post-pneumonectomy. Pathological examination confirmed complete surgical resection (R0). Microscopic analysis revealed a mix of squamous cell carcinoma and sarcoma components, primarily osteosarcoma and chondrosarcoma. The patient has remained free of recurrence or metastasis for 7 years post-surgery, without any neoadjuvant or adjuvant therapy. Conclusions:This case illustrates that the gloved finger sign may reflect early bronchial obstruction and prompt clinical evaluation. Despite preoperative imaging suggestive of disease progression, the patient underwent R0 pneumonectomy and has remained recurrence-free for 7 years without receiving neoadjuvant or adjuvant therapy. Exceptional long-term survival after R0 resection alone may be possible in some certain patients.

Background:Whole-lung lavage (WLL) remains the gold standard for symptomatic pulmonary alveolar proteinosis (PAP). However, conventional protocols are resource-intensive, relying on manual chest percussion, frequent position changes, and active negative-pressure suctioning to accelerate effluent drainage. We evaluated a modified gravity-driven workflow designed to improve procedural efficiency by optimizing hydrodynamics and minimizing manual airway manipulation. Methods:In this single-center retrospective cohort study, we analyzed 112 WLL procedures performed in 88 patients between October 1, 2007, and April 30, 2024. Procedures were categorized into a classic workflow (n=60; utilizing manual percussion, postural changes, and active negative-pressure suction) or a modified gravity-driven workflow (n=52). The modified technique employed a saline reservoir elevated to 100 cm, fixed supine positioning, and passive gravity drainage through a three-way stopcock to maintain a closed circuit. Primary outcomes included lavage duration, anesthesia duration, and fluid recovery rate. Generalized estimating equations (GEE) were used to adjust for baseline confounders. Results:Baseline characteristics were balanced between groups. The modified technique demonstrated superior efficiency. Compared with the classic technique, the modified workflow significantly reduced the median lavage duration [135 (interquartile range (IQR), 116-160) vs. 240 min (IQR, 211-360 min); P<0.001] and total anesthesia duration (240 vs. 390 min; P<0.001). The fluid recovery rate was significantly higher in the modified group (95.0% vs. 92.0%; P<0.001). Both techniques showed improvement in oxygenation at discharge, and no statistically significant between-group differences were observed in oxygenation outcomes in this cohort. No statistically significant between-group differences were observed in recorded complications, including pneumothorax, pleural effusion, and hemodynamic instability. Conclusions:The gravity-driven modified WLL is an efficient technique. By utilizing increased hydrostatic pressure, this approach significantly reduces procedural time and improves fluid recovery. In this cohort, it was not associated with a detectable difference in short-term oxygenation outcomes or recorded complications.

This case series explores the use of veno-venous extracorporeal membrane oxygenation (VV ECMO) as a bridge to diagnosis and treatment in patients with suspected lung adenocarcinoma and severe respiratory failure refractory to conventional mechanical ventilation. We present three cases where ECMO support was initiated to facilitate further diagnostic evaluations, including lung biopsy and bronchoalveolar lavage fluid liquid biopsy, enabling the identification of actionable mutations and guiding targeted therapies. Two patients achieved significant clinical improvement and were successfully weaned from ECMO, while one patient experienced an unfavorable outcome due to a combination of uncontrolled tumor progression and hospital-acquired pneumonia. Our findings suggest that ECMO, traditionally considered a relative contraindication in advanced cancer, can be a valuable temporary support in carefully selected patients, allowing time for diagnosis and targeted treatment initiation. Furthermore, our experience highlights the feasibility and safety of performing lung biopsies under ECMO with appropriate anticoagulation management. This study emphasizes the importance of individualized decision-making and a multidisciplinary approach when considering ECMO for lung cancer patients, carefully weighing the risks of infection and disease progression to optimize patient outcomes.

Background:The safety and efficacy of self-expandable metallic stent (SEMS) in the management of benign tracheobronchial stenosis (TBS) remain elusive. This study aimed to provide comprehensive insights into the efficacy and safety of SEMS in treating benign TBS. Methods:We conducted a meta-analysis to elucidate the safety and efficacy of the SEMS in benign TBS. Data on related trials were obtained by doing a literature search in PubMed, Cochrane Library, Web of Science and Embase. Random-effect models were used to calculate the efficacy and incidence of complication of SEMS treatment. Results:Data of 797 participants who received 1,236 SEMS during 26.0±13.5 months of follow-up period were included and analyzed. The main causes of benign TBS included tracheotomy (32.8%), anastomotic stenosis after transplantation or lobectomy (31.3%), tracheal intubation (18.1%), and other benign diseases (17.8%). The total effective rate of SEMS in the treatment of benign TBS was 56.4%, but varied from different etiologies: iatrogenic injury 41.5%, tuberculous infection 83.3%, autoimmune disease 46.2%, and external compression 75%, respectively. The average time of stents placement was 6.59±4.96 months, while the success rate of stent removal was 98.7%. The overall incidence of complications after stent implantation was 45%, including airway restenosis 16.7%, granulation tissue hyperplasia 27.9%, mucus retention 19%, stent migration 20.1%, and stent rupture 25.7%. Airway stent-related mortality was rarely occurred. Conclusions:SEMS could serve as a relatively effective and safe treatment for benign TBS with intensive observation and follow-up.

Introduction: Bronchopleural fistula (BPF) is associated with high morbidity and mortality rates in patients undergoing pulmonary resections. Surgery, bronchoscopy, and conservative management have their limitations for small fistulas. Platelet-rich plasma (PRP) has regenerative properties, which might be efficient in enhancing tissue recovery and repairing small BPF. This study aimed to investigate efficacy and safety of PRP on BPF. Methods: This is a pilot prospective cohort study. Patients whose fistulas smaller than 4 mm were enrolled in this study, treated with PRP under bronchoscopy and followed up at 2 weeks and 4-6 weeks after the last PRP treatment. The cure rate, improvement rate and ineffectiveness rate were investigated. The severity of respiratory symptoms was evaluated by modified Medical Research Council dyspnea scale (mMRC) and COPD Assessment Test (CAT). The recurrence of fistula, new infection and mortality rate were examined. Adverse events were documented to explore the safety profile of PRP therapy. Results: A total of 16 patients (mean age, 50.1 years) met the eligibility criteria. The median time from the first PRP treatment to the closure of the fistula was 12.0 (IQR 6.0, 21.5) days. Our findings indicate an effectiveness rate of 87.6%, with 68.8% of cure and 18.8% of improvement, along with significant improvement of respiratory symptoms evaluated by mMRC (P < 0.001) and CAT (P < 0.001). No recurrent of fistulas, newly developed infection, or death was observed. Adverse events of the procedure were most mild (82.6%) and temporary. Conclusions: PRP is a potential treatment for small BPF and is well tolerated. (c) 2024 SEPAR. Published by Elsevier Espana, S.L.U. All rights are reserved, including those for text and data mining, AI training, and similar technologies.

Mucosal antigen-specific T cells are pivotal for pathogen clearance and immune modulation in respiratory infections. Dysregulated T cell responses exacerbate coronavirus disease 2019 severity, marked by cytokine storms and respiratory failure. Despite extensive description in peripheral blood, the characteristics of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-specific T cells in the lungs remain elusive. Here we conducted integrated single-cell profiling of SARS-CoV-2-specific T cells in 122 bronchoalveolar lavage fluid (BALF) and 280 blood samples from 159 patients, including 27 paired BALF and blood samples from 24 patients. SARS-CoV-2-specific T cells were robustly elicited in BALF irrespective of prior vaccination, correlating with diminished viral loads, lessened systemic inflammation and improved respiratory function. SARS-CoV-2-specific T cells in BALF exhibited profound activation, along with proliferative and multi-cytokine-producing capabilities and a glycolysis-driven metabolic signature, which were distinct from those observed in peripheral blood mononuclear cells. After viral clearance, these specific T cells maintained a polyfunctional tissue-resident memory phenotype, highlighting their critical roles in infection control and long-term protection. The authors show that SARS-CoV-2-specific T cells in the lung are key to fighting infection and persist after viral clearance, contributing to long-term immunity and protection.

Background: While many studies have been conducted on sugammadex sodium and neostigmine in patients undergoing general anesthesia, few have explored their effects in patients with interstitial lung diseases (ILDs). Material/Methods: Sixty-three patients who underwent transbronchial cryobiopsy under general anesthesia were enrolled in a prospective randomized study. The patients were randomly divided into 2 groups: neostigmine combined with atropine group (group C, n=32) and sugammadex group (group S, n=31). Induction and maintenance of anesthesia were the same in both groups. Patients received rocuronium during anesthesia. At the end of the procedure, when the T2 of the train-of-four stimulation technique (TOF) monitoring appeared, neostigmine 0.04 mg/kg combined with atropine 0.02 mg/kg was injected intravenously in group C, and sodium sugammadex 2 mg/kg was injected intravenously in group S. Time from administration of muscle relaxant antagonist to recovery of TOF ratio (TOFr) to 0.9 and extubation time were recorded. The residual rate of neuromuscular blockade at 1, 3, 5, 7, and 10 min after extubation was calculated. Results: Compared to group C, group S had a significantly shorter recovery time of TOFr to 0.9 (4.0[2.0] min vs 14.0[11.0] min, P<0.001) and extubation time (4.0[3.0] min vs 11.0[7.0] min, P<0.001). The residual rate of neuromuscular blockade was remarkably lower in group S than in group C at 3, 5, and 7 min after extubation (3.2% vs 31%, 0% vs 25%, 0% vs 6%, P<0.05). Conclusions: Sugammadex is more effective than neostigmine in reversing the muscle-relaxant effect of rocuronium bromide in patients with ILDs.

Pulmonary Mucormycosis is a fatal infectious disease with high mortality rate. The occurrence of Mucormycosis is commonly related to the fungal virulence and the host’s immunological defenses against pathogens. Mucormycosis infection and granulation tissue formation occurred in the upper airway was rarely reported. This patient was a 60-year-old male with diabetes mellitus, who was admitted to hospital due to progressive cough, sputum and dyspnea. High-resolution computed tomography (HRCT) and bronchoscopy revealed extensive tracheal mucosal necrosis, granulation tissue proliferation, and severe airway stenosis. The mucosal necrotic tissue was induced by the infection of Rhizopus Oryzae, confirmed by metagenomic next-generation sequencing (mNGS) in tissue biopsy. This patient was treated with the placement of a covered stent and local instillation of amphotericin B via bronchoscope. The tracheal mucosal necrosis was markedly alleviated, the symptoms of cough, shortness of breath, as well as exercise tolerance were significantly improved. The placement of airway stent and transbronchial microtube drip of amphotericin B could conduce to rapidly relieve the severe airway obstruction due to Mucormycosis infection.

Background:Post-intubation subglottic stenosis (PI-SGS) is a fatal disease which could result in partial or complete narrowing of the airway. Although airway stenting is commonly used as an alternative treatment for PI-SGS patients unsuitable for surgery, complications including stent migration and excessive granulation tissue formation are frequently encountered. Additionally, tracheotomy is necessary in patients undergoing T-tube placement. Therefore, it is necessary to further enhance the effectiveness of airway stenting in refractory PI-SGS. In this study, we aimed to evaluate the safety and effectiveness of utilizing short bronchial Dumon (BD) stents in managing refractory PI-SGS. Methods:PI-SGS patients who were not suitable for surgery and in whom previous interventional treatments had proven ineffective were enrolled. Short BD stents were inserted via rigid bronchoscopy under general anesthesia. Complications and outcomes were assessed by follow-ups. Results:Fourteen patients were included and successful stent insertion was achieved in all cases. The median diameter and length of stents was 12 (0.25) and 33.5 (5) mm, respectively. During the 6-month follow-up period, complications were reported in five patients. Granulation tissue formation was the most frequently observed complication (4 in 14 patients, 28.57%), followed by stent migration (2 in 14 patients, 14.29%). Out of the total participants, 11 patients (78.57%) demonstrated good tolerance to the stent, while 3 (21.43%) required stent removal. Among these three patients, two finally underwent subsequent T-tube insertion after the removal. Twelve patients (85.71%) avoided the tracheotomy and T-tube insertion. Conclusions:The utilization of short BD stents appears to be a safe and effective approach for managing refractory PI-SGS. The complications and tolerability are acceptable.

INTRODUCTION:Benign airway stenosis (BAS) is a severe pathologic condition. Complex stenosis has a high recurrence rate and requires repeated bronchoscopic interventions for achieving optimal control, leading to recurrent BAS (RBAS) due to intraluminal granulation. METHODS:This study explored the potential of autologous regenerative factor (ARF) for treating RBAS using a post-intubation tracheal stenosis canine model. Bronchoscopic follow-ups were conducted, and RNA-seq analysis of airway tissue was performed. A clinical study was also initiated involving 17 patients with recurrent airway stenosis. RESULTS:In the animal model, ARF demonstrated significant effectiveness in preventing further collapse of the injured airway, maintaining airway patency and promoting tissue regeneration. RNA-seq results showed differential gene expression, signifying alterations in cellular components and signaling pathways. The clinical study found that ARF treatment was well-tolerated by patients with no severe adverse events requiring hospitalization. ARF treatment yielded a high response rate, especially for post-intubation tracheal stenosis and idiopathic tracheal stenosis patients. CONCLUSION:The study concludes that ARF presents a promising, effective, and less-invasive method for treating RBAS. ARF has shown potential in prolonging the intermittent period and reducing treatment failure in patients with recurrent tracheal stenosis by facilitating tracheal mucosal wound repair and ameliorating tracheal fibrosis. This novel approach could significantly impact future clinical applications.

Research on interventional pulmonological therapy for asthma via bronchoscopy could only be done through large animal experiments or clinical trials. However, the absence of large animal models of asthma and the heterogeneity among asthma patients have hindered researchers from thoroughly exploring its therapeutic mechanisms. The current use of large animal asthma models is limited by lengthy modeling time, high cost, low success rate, and atypical asthma clinical signs, rendering them impractical.1 Toluene diisocyanate (TDI)-induced asthma, a common form of occupational asthma, displays characteristic features including hyperresponsiveness, airway inflammation, and remodeling, having a propensity to progress to severe asthma.2 Based on these considerations, we aimed to establish a canine model exhibiting typical asthmatic features by exposing the animals to TDI via aerosol inhalation. A total of eight adult beagles were treated with 0.3% TDI on the dorsum of both ears once per week (200 μL/ear) 2 weeks before airway challenge. TDI challenge was subsequently conducted twice per week for 8 weeks. The beagles were placed in a transparent rectangular chamber (60 cm × 75 cm × 60 cm) and exposed to TDI aerosol produced by compressed air nebulization (NE-C28; Omron, Tokyo, Japan) for 2 h per session (Figure S1). The concentration of TDI in the airway challenge reagents was gradually increased from 3% to 5% over time. Detail method was shown in supplementary material. All 8 beagles received 8 weeks of TDI challenge and exhibited pronounced asthma clinical signs, including wheeze, cough, and breathlessness. Blood and bronchoalveolar lavage fluid samples indicated that a mixed granulocytic inflammation characterized by neutrophils systemically and in the lungs, accompanied by significant increase in total immunoglobulin E, immunoglobulin G, interleukin-13, and interleukin-17 levels (Figure 1). Airway hyperresponsiveness was assessed by changes in airway resistance in response to methacholine at different concentrations. After 8 weeks of TDI exposure, there was a significant increase in airway resistance at each concentration of methacholine tested (Figure S2). The application of optical coherence tomography (OCT) provides a non-invasive method to evaluate the airway structure, airway mucus retention and mucosal thickening. A trend toward increasing airway wall area in airway segments of different sizes were shown by OCT after 8 weeks of modeling (Figure S2). In terms of histopathology analysis, the asthma model beagles presented with a significant airway remodeling, including goblet cell metaplasia, infiltration of inflammatory cells and significant thickened airway smooth muscle. As the markers of cholinergic nerve tension increase and airway neuronal remodeling, immunohistochemistry showed the high expression of muscarinic 3 (M3) receptor and protein gene product 9.5 (PGP9.5) (Figure 2). Additionally, we randomly selected four modeling beagles to perform clinically standard bronchial thermoplasty (BT) using the Alair system. After three sections of BT treatment, the canines exhibited significant ablation of airway smooth muscle, resulting in decreased airway hyperresponsiveness. (Figure S3). The decrease in M3 receptor and PGP9.5 expression indicated that this model could reflect the denervation effect of BT3 (Figure 2). Therefore, our study demonstrates that the TDI-induced beagle model exhibited typical manifestations of severe asthma and effectively reflected the efficacy of respiratory intervention therapy, suggesting its potential as a valid candidate for experiment research in this field. The latest research in interventional pulmonological therapy for severe asthma, such as targeted denervation or cryoablation, typically involves experiments conducted on healthy animals or directly recruits severe asthma patients for clinical studies, with symptom scores as the primary endpoints.4, 5 However, both types of studies failed to explore the mechanisms behind interventional respiratory therapies, thus leaving them as effective treatments without understanding the underlying reasons. Establishing a rapid severe asthma large animal model with typical clinical signs allows us to analyze the therapeutic effects of interventional pulmonological therapy from a perspective that closely mirrors clinical reality.6 It also allows researchers to delve deeper into its specific mechanisms of action, further clarifying its appropriate patient population and go further for the novel therapeutic strategy. All authors had full access to the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Conceptualization: DC, ZS, YL, SL; Project administration: DC, ZS, YL, SL; Methodology: DC, ZS, YL, KC, SL; Data curation: DC, YL, ZZ, ZG, LY, JL; Formal analysis: DC, ZS, YL, YC, KC, CZ, XC, CT; Funding acquisition: YL, SL; Resources: YL, SL; Supervision: SL; Validation: DC, ZS, YL, SL; Visualization: DC, ZS, YL, SL; Roles/Writing—original draft: DC, ZS, YL, SL. The authors have nothing to report. Shi-Yue Li reports grants from National Natural Science Foundation of China (grant number 81770017); Yu-Long Luo reports grants from Basic Research Foundation of Guangzhou (202102020916) and Plan on Enhancing Scientific Research in Guangzhou Medical University. The funders of the study had no role in study design, data collection, data analysis, data interpretation, or writing of the report. The authors have no conflicts of interest to declare. The data used and analysed during the current study are available from the corresponding author on reasonable request. Data S1. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.

Background: A few studies have reported the medium-sized and small airway morphological abnormalities of bronchiolitis. Whether spirometry or impulse oscillometry (IOS) is correlated with airway remodeling of bronchiolitis remains unclear. Objectives: Aiming to demonstrate the airway morphological abnormalities of bronchiolitis obliterans (BO) and diffuse panbronchiolitis (DPB) assessed by endobronchial optical coherence tomography (EB-OCT), and elucidate whether spirometric and IOS parameters have correlation with the airway remodeling of bronchiolitis. Methods: We recruited 18 patients with bronchiolitis (BO, n = 9; DPB, n = 9) and 17 control subjects. Assessments of clinical features, St. George’s respiratory questionnaire (SGRQ), chest computed tomography (CT), spirometry, IOS, and EB-OCT were performed in all enrolled subjects. The correlation between EB-OCT and lung function parameters was studied and analyzed. Results: The magnitude of abnormalities of spirometric and IOS parameters was significantly greater in patients with bronchiolitis than that in control subjects ( p < 0.05). Patients with BO had notably lower forced expiratory volume in 1 s (FEV 1 ), forced vital capacity (FVC), FEV 1 /FVC, maximal mid-expiratory flow (MMEF)% pred and higher resonant frequency (Fres), and area of reactance (AX) than those with DPB ( p < 0.05). The EB-OCT measurement among patients with bronchiolitis and between the bronchus in the left and the right lung demonstrated a heterogeneous distribution of airway calibers, presenting a high intra- and inter-individual variability. Patients with bronchiolitis had notably greater airway wall area ( p < 0.05) compared with control, while BO presented greater magnitude of airway abnormalities than DPB. Fres and the difference in airway resistance at 5 and 20 Hz (R 5 –R 20 ) correlated negatively with medium-sized and small airway inner area, and correlated positively with airway wall area ( p < 0.05), whose correlation coefficients were higher than those of spirometric parameters. Conclusion: Bronchiolitis, BO and DPB, manifested a heterogeneous distribution of airway calibers with significant intra- and inter-individual variability. IOS parameters, rather than spirometry, correlated better with medium-sized and small airway remodeling in bronchiolitis assessed by EB-OCT measurement.

Background: Manual measurement of endobronchial optical coherence tomography (EB-OCT) images means a heavy workload in the clinical practice, which can also introduce bias if the subjective opinions of doctors are involved. Objective: We aim to develop a convolutional neural network (CNN)-based EB-OCT image analysis algorithm to automatically identify and measure EB-OCT parameters of airway morphology. Methods: The ResUNet, MultiResUNet, and Siamese network were used for analyzing airway inner area (Ai), airway wall area (Aw), airway wall area percentage (Aw%), and airway bifurcate segmentation obtained from EB-OCT imaging, respectively. The accuracy of the automatic segmentations was verified by comparing with manual measurements. Results: Thirty-three patients who were diagnosed with asthma (n = 13), chronic obstructive pulmonary disease (COPD, n = 13), and normal airway (n = 7) were enrolled. EB-OCT was performed in RB9 segment (lateral basal segment of the right lower lobe), and a total of 17,820 OCT images were collected for CNN training, validation, and testing. After training, the Ai, Aw, and airway bifurcate were readily identified in both normal airway and airways of asthma and COPD. The ResUNet and the MultiResUNet resulted in a mean dice similarity coefficient of 0.97 and 0.95 for Ai and Aw segmentation. The accuracy Siamese network in identifying airway bifurcate was 96.6%. Bland-Altman analysis indicated there was a negligible bias between manual and CNN measurements for Ai (bias = -0.02 to 0.01, 95% CI = -0.12 to 0.14) and Aw% (bias = -0.06 to 0.12, 95% CI = -1.98 to 2.14). Conclusion: EB-OCT imaging in conjunction with ResUNet, MultiResUNet, and Siamese network could automatically measure normal and diseased airway structure with an accurate performance.

Rationale: Sustained activation of lung fibroblasts and the resulting oversynthesis of the extracellular matrix are detrimental events for patients with interstitial lung diseases (ILDs). Lung biopsy is a primary evaluation technique for the fibrotic status of ILDs, and is also a major risk factor for triggering acute deterioration. Fibroblast activation protein (FAP) is a long-known surface biomarker of activated fibroblasts, but its expression pattern and diagnostic implications in ILDs are poorly defined. Objectives: The present study aims to comprehensively investigate whether the expression intensity of FAP could be used as a potential readout to estimate or measure the amounts of activated fibroblasts in ILD lungs quantitatively. Methods: FAP expression in human primary lung fibroblasts as well as in clinical lung specimens was first tested using multiple experimental methods, including real-time quantitative PCR (qPCR), Western blot, immunofluorescence staining, deep learning measurement of whole slide immunohistochemistry, as well as single-cell sequencing. In addition, FAP-targeted positron emission tomography/computed tomography imaging PET/CT was applied to various types of patients with ILD, and the correlation between the uptake of FAP tracer and pulmonary function parameters was analyzed. Measurements and Main Results: Here, it was revealed, for the first time, FAP expression was upregulated significantly in the early phase of lung fibroblast activation event in response to a low dose of profibrotic cytokine. Single-cell sequencing data further indicate that nearly all FAP-positive cells in ILD lungs were collagen-producing fibroblasts. Immunohistochemical analysis validated that FAP expression level was closely correlated with the abundance of fibroblastic foci on human lung biopsy sections from patients with ILDs. We found that the total standard uptake value (SUV) of FAP inhibitor (FAPI) PET (SUVtotal) was significantly related to lung function decline in patients with ILD. Conclusions: Our results strongly support that in vitro and in vivo detection of FAP can assess the profibrotic activity of ILDs, which may aid in early diagnosis and the selection of an appropriate therapeutic window.

Background Transbronchial lung forceps biopsy (TBFB) is recommended before a surgical lung biopsy (SLB) when a definitive diagnosis of lymphangioleiomyomatosis (LAM) is required for patients without any additional confirmatory features. Transbronchial lung cryobiopsy (TBCB) has been suggested as replacement test in patients considered eligible to undergo SLB for the diagnosis of interstitial lung diseases. The efficacy and safety of TBCB were compared with that of TBFB and SLB in the diagnosis of LAM. Methods A retrospective analysis was conducted on 207 consecutive patients suspected with LAM in the First Affiliated Hospital of Guangzhou Medical University from 2005 to 2020. Results The difference in diagnostic rate of patients suspected with LAM between TBCB (20/30, 66.7%) and TBFB (70/106, 66.0%) groups was not significant ( p = 0.949). One patient performed TBCB with negative pathological results could be diagnosed exclusively after SLB. LAM diagnosis was confirmed by surgical pathological findings in 3 TBFB-negative patients. More patients with minimal cystic profusion were diagnosed with LAM by TBCB (5/19, 26.3%) and SLB (11/39, 28.2%) than by TBFB (3/61, 4.9%) (TBCB vs TBFB: p = 0.04, SLB vs TBFB, p < 0.001). The difference between the severity of cystic lung disease in patients diagnosed with LAM through TBCB and SLB was not significant ( p > 0.05). One pneumothorax, 8 mild bleeding and 1 moderate bleeding were observed in TBCB. One pneumothorax, 15 mild bleeding and 1 moderate bleeding occurred after TBFB. Conclusion Compared to TBFB, TBCB is safe and effective in diagnosing LAM at a higher diagnostic rate in patients with minimal cystic profusion.

Background Endobronchial ultrasonography-guided transbronchial needle aspiration biopsy (EBUS-TBNA) has been used for more than 10 years in China. Its clinical application and diagnostic value in different diseases with large sample was lack of report. Methods A retrospective analysis was performed about the application and diagnostic value of EBUS-TBNA in different disease of patients in Respiratory Intervention Center of Guangzhou Institute of Respiratory Health from January 2012 to July 2020. Results A total 5758 patients were included with 182 patients excluded for lack of information. Finally, data of 5576 patients (3798 males and 1778 females) were analyzed. For anesthetize, most patients were undergoing general anesthesia of intravenous with spontaneous breathing (69.4%), followed by general anesthesia of intravenous and inhalation with tracheal intubation and mechanical ventilation (17.9%) and conscious sedation and analgesia (12.8%). Lymph nodes were the main sites of biopsy obtained (76.4%). Tumors accounted for the highest proportion of disease (66.4%), followed by infection diseases (9.9%), sarcoidosis (3.9%), lymphoma (1.1%), and others (18.7%). The sensitivity of EBUS-TBNA for diagnosis of tumor was 89.7%, and 40.8% for infection diseases. There were significant differences in the puncture site and proportions of diseases between male and females (both p < 0.05). Higher diagnostic value was found in male patients (p < 0.05). Conclusion EBUS-TBNA has good diagnostic value for different mediastinal and central pulmonary space-occupying lesions diseases, with highest sensitivity for tumors. Higher diagnostic value was found in male patients.

Disseminated infection caused by Streptococcus constellatus was seldom occurred. We reported a case of Streptococcus constellatus infection, presenting as multiple pulmonary cavities, thoracic wall abscess and vertebral destruction. The 37-year-old male had recurrent fever, chest wall swelling and pain, and lower limb numbness, he had weak physical condition and previously suffered from poorly controlled diabetes and severe periodontal disease for 3 years. Definite diagnosis of Streptococcus constellatus infection was made by metagenomic next‑generation sequencing (mNGS) in abscess drainage fluid. Systemic antibiotics and thoracic wall drainage were given, and the pulmonary cavity and the thoracic intermuscular abscess were significantly decreased. Few to no study reported the disseminated infection (pulmonary cavities, thoracic wall abscess and vertebral destruction) caused by Streptococcus constellatus. This case report highlighted the importance of mNGS for accurate diagnosis, as well as the timely drainage and antibiotics for effective treatment of Streptococcus constellatus infection.

BACKGROUND:The long-term efficacy of the Dumon stent in the treatment of benign airway stenosis is unclear.OBJECTIVE:The objective of this study was to evaluate the long-term efficacy and safety of the Dumon stent in patients with benign airway stenosis.METHODS:We retrospectively reviewed patients with benign airway stenosis who were treated with a Dumon stent at the First Affiliated Hospital of Guangzhou Medical University between March 2014 and October 2021. We included patients with successful removal of silicone stents after implantation. The clinical data and information on bronchoscopic interventional procedures and related complications were collected and analyzed.RESULTS:Ninety-nine patients with benign airway stenosis were included. The stent was placed mainly in the trachea (44.4%) and left main bronchus (43.4%). The main type of stenosis was post-tuberculosis bronchial stenosis (57.6%). The overall cure rate was 60.6%. Stent-related complications included retention of secretions (70.7%), granuloma formation (67.7%), stent angulation (21.2%), and stent migration (12.1%). The stent was less effective for left main bronchus stenosis (p = 0.012). Multivariate logistic regression analysis identified that stent placement for more than 13 months, a stent-intervention number of ⩽ 1 predicted a favorable outcome.CONCLUSION:The efficacy and safety of the Dumon stent for benign airway stenosis need improvement. The stent is less effective for left main bronchus stenosis; regular follow-up is required in such cases. Stent placement for > 13 months and no more than once stent intervention within a 6-month period were associated with a favorable outcome.

Background: The effects of bronchial thermoplasty (BT) on smooth muscle (SM) and nerves in small airways are unclear. Methods: We recruited 15 patients with severe refractory asthma, who received BT treatment. Endobronchial optical-coherence tomography (EB-OCT) was performed at baseline, 3 weeks' follow-up and 2 years' follow-up to evaluate the effect of BT on airway structure. In addition, we divided 12 healthy beagles into a sham group and a BT group, the latter receiving BT on large airways (inner diameter >3 mm) of the lower lobe. The dogs' lung lobes were resected to evaluate histological and neuronal changes of the treated large airways and untreated small airways 12 weeks after BT. Results: Patients receiving BT treatment had significant improvement in Asthma Control Questionnaire (ACQ) scores and significant reduction in asthma exacerbations. EB-OCT results demonstrated a notable increase in inner-airway area (Ai) and decrease in airway wall area percentage (Aw%) in both large (3rdto 6th-generation) and small (7th-to 9th-generation) airways. Furthermore, the animal study showed a significant reduction in the amount of SM in BT-treated large airways but not in untreated small airways. Protein gene product 9.5 (PGP9.5)epositive nerves and muscarinic receptor 3 (M3 receptor) expression in large and small airways were both markedly decreased throughout the airway wall 12 weeks after BT treatment. Conclusions: BT significantly reduced nerves, but not SM, in small airways, which might shed light on the mechanism of lung denervation by BT. Copyright (c) 2021, Japanese Society of Allergology. Production and hosting by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Abstract Background A feasible and economical bronchoscopic navigation method in guiding peripheral pulmonary nodule biopsy is lacking. Objective To investigate the utility of hierarchical clock-scale hand-drawn mapping for bronchoscopic navigation in peripheral pulmonary nodules. Methods We developed a hierarchical clock-scale hand-drawn mapping for bronchoscopic navigation in peripheral pulmonary nodules. Patients with peripheral pulmonary nodules were recruited and assigned to two groups in this retrospective study, subjects in VBN group received conventional bronchoscopy in conjunction with virtual bronchoscopic navigation (VBN) and radial probe endobronchial ultrasound (RP-EBUS) for biopsy (VBN group), while HBN group underwent ultrathin bronchoscopy and RP-EBUS under the guidance of hand-drawn bronchoscopic navigation (HBN). The demographic characteristics, procedural time, operating cost and diagnostic yield were compared between these two groups. Results Forty-eight patients with peripheral pulmonary nodule were enrolled in HBN group, while 42 in VBN group. There were no significant differences between VBN and HBN groups in terms of age, gender, lesion size, location and radiographic type. The time of planning pathway (1.32 vs. 9.79 min, P < 0.001) and total operation (23.63 vs. 28.02 min, P = 0.002), as well as operating cost (758.31 ± 125.21 vs.1327.70 ± 116.25 USD, P < 0.001) were markedly less in HBN group, compared with those in VBN group. The pathological diagnostic efficiency of benign and malignant disease in HBN group appeared similar with those in VBN group, irrespective of the size of pulmonary lesion (larger or smaller than 20 mm). The total diagnostic yield of HBN had no marked difference from that of VBN (75.00% vs. 61.90%, P = 0.25). Conclusions Hierarchical clock-scale hand-drawn mapping for bronchoscopic navigation could serve as a feasible and economical method for guiding peripheral pulmonary nodule biopsy, providing a comparable diagnostic yield in comparison with virtual bronchoscopic navigation.