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Background: Differences between virtual bronchoscopic navigation (VBN) systems and their impacts on the diagnostic yield of transbronchial biopsy (TBB) of peripheral pulmonary nodules (PPNs) remain unclear. Objectives: To compare the Synapse 3D system (Version 4.4, Fujifilm, Japan) and DirectPath system (Version 2.0, Olympus, Japan) in the VBN application of PPNs. Design: Retrospective study with self-paired design and exploratory study with retrospective cohort design. Methods: The study analyzed patients with PPNs using the Synapse 3D system (Group S) and DirectPath system (Group D) and compared differences between the two groups in bronchial tree reconstruction, navigation pathway planning, and VBN-assisted TBB of PPNs. Results: In all, 289 patients were analyzed ultimately. Bronchial tree reconstruction quality was better in Group S ( p 0.05). Conclusion: Synapse 3D system (Version 4.4) and DirectPath system (Version 2.0) had their own merits. Localization success rate and diagnostic yield of VBN-assisted TBB were of no statistical difference for these two VBN systems. Improvements in segmentation algorithms of VBN systems and using the most suitable chest CT scan data for them may be the breakthrough to improve the efficiency of VBN, especially for poor experienced interventional physicians.

Abstract Acquired bronchobiliary fistula (ABBF) is very rare among the complications that occur in patients with hepatocellular carcinoma (HCC) after treatment. Although surgery and drainage have been the main methods for treating ABBF for a long time, they are not entirely suitable for patients with refractory ABBF resulting from HCC therapy. In this study, we present four cases of ABBF caused by HCC treatment, who were treated using selective bronchial occlusion (SBO). Among the 4 patients with ABBF treated with SBO, 3 cases successfully blocked ABBF with SBO, and the treatment success rate was 75%. All successfully treated patients reported disappearance of symptoms of bilioptysis and cough was alleviated. No life‐threatening adverse reactions were reported following SBO intervention, and no deaths occurred. We believe that the use of video bronchoscopy to place a self‐made silicone plug in the bronchus to treat refractory ABBF is a feasible palliative treatment, which can significantly improve the condition of ABBF patients.

Introduction: Congenital bronchial atresia (CBA), as a rare developmental abnormality of the lung, is usually asymptomatic and is accidently discovered in most cases. Currently, no standardized guidelines for the treatment or management of CBA have been established. Case presentation: A 22-year-old male soldier was referred to Shanghai Changhai Hospital, The First Affiliated Hospital of Naval Medical University due to chest tightness and shortness of breath after repeated strenuous activities. Contrast-enhanced computed tomography (CT) revealed an 18mm × 11mm solitary, well-circumscribed, and solid nodule with no enhancement in the right upper lobe (RUL), and emphysematous changes distributed throughout the RUL. A flexible bronchoscopic examination showed extrinsic compression stenosis in the bronchial opening of the right middle lobe (RML). After three-dimensional (3D) reconstruction CT and a multidisciplinary consultation, a diagnosis of CBA in the anterior segment (B3) of RUL was established. Subsequently, thoracoscopic right upper lobectomy was performed and resulted in an improved respiratory capacity 6 months after surgery. To date, the patient has good quality of life without any complication. Conclusion: This study underscores the role of bronchoscopy, 3D reconstruction CT, and a multidisciplinary consultation in the diagnosis of CBA, and highlights that a thoracoscopic intervention should be considered in such case.

PurposeTo evaluate the operability and safety of bronchoscopic domestic one-way endobronchial valves (EBV) on animals.MethodsNine pigs were randomly assigned (2:1) to receive domestic one-way EBV (the experimental group, n = 6) and Zephyr® EBV (the control group, n = 3). Routine blood tests, arterial blood gases, and CT scans of the lungs were performed 1 day pre-procedure in addition to 1 week and 1 month post-procedure to assess changes in blood markers and lung volumes. At 1 month post-procedure, the animals were sacrificed, followed by removal of all valves via bronchoscopy. Pathological examinations of critical organs were subsequently performed.ResultsA total of 15 valves were placed in the experimental group and 6 valves were placed in the control group, without serious complications. Routine blood tests and arterial blood gas examinations at 1 day pre-procedure, 1 week post-procedure, and 1 month post-procedure did not differ significantly in both groups. No EBV displacement was noted under bronchoscopy, and the valve was smoothly removable by bronchoscope at 1 month post-procedure. At 1 week post-procedure, varying degrees of target lung lobe volume reduction were observed on lung CT in both groups. Lung volume reduction was achieved at 1 month post-procedure in both groups, without significant statistical difference. Although 3 cases in the experimental group and 1 case in the control group developed varying degrees of pneumonia, the inflammatory response did not increase over time during the experimental period. Pathological examination revealed no significant abnormal changes in the critical organs for both groups.ConclusionOur results demonstrate that domestic EBV is safe and reliable for endobronchial application in general-grade laboratory white pigs. The safety of domestic EBV is similar to that of Zephyr® EBV, with good ease of use and operability. This kind of domestic EBV can meet the safety evaluation requirements for animal testing.

Background: The diagnostic yield of radial endobronchial ultrasound (r-EBUS) for the diagnosis of peripheral pulmonary lesions (PPLs) varies between studies and is affected by multiple factors. We aimed to evaluate the efficacy and safety of r-EBUS, and to explore the factors influencing the diagnostic yield of r-EBUS in patients with PPLs. Methods: The PubMed, Web of Science, and EMBASE databases were searched to identify relevant studies that used r-EBUS for diagnosing PPLs from the date of inception to Dec 2022. Meta-analysis was conducted using Review Manager 5.4 and Stata 15.1. Results: An analysis of 46 studies with a total of 7252 PPLs was performed. The pooled diagnostic yield of r-EBUS was 73.4 % (95 % CI: 69.9%–76.7 %), with significant heterogeneity detected among studies (I2 = 90 %, P 2 cm in size, malignant in type, solid in appearance on computerized tomography (CT), present in bronchus sign, the within probe location, and the addition of rapid on-site evaluation (ROSE) were associated with increased diagnostic yield, whereas use of a guide sheath (GS), bronchoscopy type, and a multimodality approach failed to influence the outcome. The pooled incidence rates of overall complications, pneumothorax and moderate and severe bleeding were 3.1 % (95 % CI: 2.1%–4.3 %), 0.4 % (95 % CI: 0.1%–0.7 %) and 1.1 % (95 % CI: 0.5%–2.0 %), respectively. Conclusions: r-EBUS has an appreciable diagnostic yield and an excellent safety manifestation when used to deal with PPLs.

Abstract The Wnt pathway is frequently dysregulated in many cancers, underscoring it as a therapeutic target. Wnt inhibitors have uniformly failed in clinical trials. Here, we report a mechanism of WNT pathway activation through the Semaphorin 3 C neurodevelopmental program in glioma stem-like cells. Sema3C directs β-catenin nuclear accumulation in a Rac1-dependent process, leading to transactivation of Wnt target genes. Sema3C-driven Wnt signaling occurred despite suppression of Wnt ligand secretion, suggesting that Sema3C drives canonical Wnt signaling independent of Wnt ligand binding. In a mouse model of glioblastoma, combined depletion of Sema3C and β-catenin partner TCF1 extended animal survival more than single target inhibition alone. In human glioblastoma, Sema3C expression and Wnt pathway activation were highly concordant. Since Sema3C is frequently overexpressed in glioblastoma, Sema3C signaling may be a significant mechanism of resistance to upstream Wnt pathway inhibitors. Dual targeting of Sema3C and Wnt pathways may achieve clinically significant Wnt pathway inhibition.

Background: Low oxygen saturation (LOS) is a frequent occurrence for patients with post-tuberculosis tracheobronchial stenosis (PTTS) during bronchoscopic procedures. However, there are currently no systematic assessment tools to predict LOS risk in PTTS patients during bronchoscopy. Objectives: This study aimed to develop an effective preoperative predictive model to guide clinical practice. Design: Retrospective cohort study. Methods: Data was retrospectively collected from PTTS patients who underwent bronchoscopic interventions between January 2017 and December 2022. Among all patients included in this study, patients between January 2017 and December 2021 were used as training cohort for the logistic regression model, and patients between January 2022 and December 2022 were utilized as validation cohort for internal validation. We used consistency index (C-index), goodness-of-fit test and calibration plot to evaluate the model performance. Results: A total of 465 patients who met the inclusion criteria were enrolled in the study. The overall incidence of LOS was 26.0% (121/465). Comorbidity, degree of stenosis, bronchoscopist level, thermal ablation therapy, balloon dilation, and airway stenting, as independent risk factors for the presence of LOS, were used to construct the nomogram prediction model. The C-index of training cohort was 0.827 (95% CI, 0.786–0.869), whereas that of validation cohort was 0.836 (95% CI, 0.757–0.916), combining with the results of the calibration plot and goodness-of-fit test, demonstrating that this model had good predictive ability. Conclusion: The predictive model and derived nomogram with good predictive ability has been developed to preoperatively predict the risk of LOS in PTTS patients during bronchoscopy, allowing for individualized interventions for high-risk patients.

This paper presents a backpropagation neural network (BPNN) approach based on the sparse autoencoder (SAE) for short-term water demand forecasting. In this method, the SAE is used as a feature learning method to extract useful information from hourly water demand data in an unsupervised manner. After that, the extracted information is employed to optimize the initial weights and thresholds of the BPNN. In addition, to enhance the effectiveness of the proposed method, data reconstruction is implemented to create suitable samples for the BPNN, and the early stopping method is employed to overcome the BPNN overfitting problem. Data collected from a real-world water distribution system are used to verify the effectiveness of the proposed method, and a comparison with the BPNN and other BPNN-based methods which integrate the BPNN with particle swarm optimization (PSO) and the mind evolutionary algorithm (MEA), respectively, is conducted. The results show that the proposed method can achieve fairly accurate and stable forecasts with a 2.31% mean absolute percentage error (MAPE) and 320 m3/h root mean squared error (RMSE). Compared with the BPNN, PSO–BPNN and MEA–BPNN models, the proposed method gains MAPE improvements of 5.80, 3.33 and 3.89%, respectively. In terms of the RMSE, promising improvements (i.e., 5.27, 2.73 and 3.33%, respectively) can be obtained. HIGHLIGHTS To enhance the performance of the BPNN, the SAE is introduced to extract useful features in an unsupervised manner.; An effective framework which integrates the BPNN with the SAE and early stopping technique is proposed for water demand forecasting.; The proposed method is verified by comparing with the BPNN and similar methods which integrate the BPNN with PSO and the MEA, respectively.;

BackgroundTransbronchial lung biopsy guided by radial probe endobronchial ultrasonography with a guide sheath (EBUS-GS-TBLB) is becoming a significant approach for diagnosing peripheral pulmonary lesions (PPLs). We aimed to explore the clinical value of the resistance of the probe to pass through the lesion in the diagnosis of PPLs when performing EBUS-GS-TBLB, and to determine the optimum number of EBUS-GS-TBLB.MethodsWe performed a prospective, single-center study of 126 consecutive patients who underwent EBUS-GS-TBLB for solid and positive-bronchus-sign PPLs where the probe was located within the lesion from September 2019 to May 2022. The classification of probe resistance for each lesion was carried out by two bronchoscopists independently, and the final result depended on the bronchoscopist responsible for the procedures. The primary endpoint was the diagnostic yield according with the resistance pattern. The secondary endpoints were the optimum number of EBUS-GS-TBLB and factors affecting diagnostic yield. Procedural complications were also recorded.ResultsThe total diagnostic yield of EBUS-GS-TBLB was 77.8%, including 83.8% malignant and 67.4% benign diseases (P=0.033). Probe resistance type II displayed the highest diagnostic yield (87.5%), followed by type III (81.0%) and type I (61.1%). A significant difference between the diagnostic yield of malignant and benign diseases was detected in type II (P = 0.008), whereas others did not. Although most of the malignant PPLs with a definitive diagnosis using EBUS-GS-TBLB in type II or type III could be diagnosed in the first biopsy, the fourth biopsy contributed the most sufficient biopsy samples. In contrast, considerably limited tissue specimens could be obtained for each biopsy in type I. The inter-observer agreement of the two blinded bronchoscopists for the classification of probe resistance was excellent (κ = 0.84).ConclusionThe probe resistance is a useful predictive factor for successful EBUS-GS-TBLB diagnosis of solid and positive-bronchus-sign PPLs where the probe was located within the lesion. Four serial biopsies are appropriate for both probe resistance type II and type III, and additional diagnostic procedures are needed for type I.

Abstract Background The insertion of self-expandable metallic stents (SEMS) for post-tuberculosis tracheobronchial stenosis (PTTS) was controversial. This study aimed to evaluate the efficacy and safety of SEMS for treating PTTS, and developed a scoring system for predicting the occurrence of restenosis after stenting in PTTS patients. Methods We conducted a retrospective review of 87 patients who were diagnosed with PTTS and experienced SEMS insertion between January 2000 and December 2017. All procedures were performed via flexible bronchoscopy under conscious sedation and local anesthesia. Results A total of 85 SEMS were successfully placed in 77 patients. Comparing with pre-stenting, there were significant improvements in the lumen diameters of the stenotic segment, mMRC scale and lung function after short-term SEMS placement. During the long-term (average 163.32 months) follow-up, 48 patients (62.3%) did not develop restenosis after stenting; the other 29 patients (37.7%) developed and eventually, 12 remained under interventional therapies and 11 had bronchial atresia. Multivariate Cox regression analysis revealed that the difference value between SEMS length and the stenosis-segment length, stenosis type, and the number of pre-stenting thermal ablation were independently related to restenosis occurrence and were subsequently used to establish the Restenosis Score. The model’s development group (0.83, 95% CI 0.74–0.92) and external validation set (0.94, 95% CI 0.77–1.00) showed excellent discrimination. Conclusion SEMS placement could serve as a safe and effective treatment option for most patients with PTTS. Further, we built a prediction model depending on the independent predictors of restenosis occurrence, the Restenosis Score. This validated tool might provide a decision support and a better management for PTTS patients who underwent SEMS implantation.

Tracheobronchopathia osteoplastica (TO), is an underreported affliction characterized by squamous metaplasia and heterotopic bone formation in trachea and bronchi. Here the authors apply functional, as well as genome-wide transcriptional and epigenetic profiling to identify airway basal cells dysfunction underlying TO.

A hybrid model based on the mind evolutionary algorithm is proposed to predict hourly water demand. In the hybrid model, hourly water demand data are first reconstructed to generate appropriate samples so as to represent the characteristics of time series effectively. Then, the mind evolutionary algorithm is integrated into a back propagation neural network (BPNN) to improve prediction performance. To investigate the application potential of the proposed model in hourly water demand forecasting, real hourly water demand data were applied to evaluate its prediction performance. In addition, the performance of the proposed model was compared with a traditional BPNN model and another hybrid model where the genetic algorithm (GA) is used as an optimization algorithm for BPNN. The results show that the proposed model has a satisfactory prediction performance in hourly water demand forecasting. On the whole, the proposed model outperforms all other models involved in the comparisons in both prediction accuracy and stability. These findings suggest that the proposed model can be a novel and effective tool for hourly water demand forecasting. HIGHLIGHTS A unified framework is developed to select input variables for an hourly water demand forecasting model.; Mind evolutionary algorithm, a novel and powerful optimization algorithm, is used to obtain the optimal initial weights and thresholds for the back propagation neural network.; A hybrid model coupling mind evolutionary algorithm and back propagation neural network is proposed to predict hourly water demand.;

The capacitance characteristics of magnetorheological fluids (MRFs) were studied experimentally based on simulation analysis. The nonlinear relationship between the capacitance of MRFs and electric field frequency was measured by the self-made circuit device. The effects of magnetic induction intensity and particle volume fraction on the capacitance characteristics of MRFs were investigated. The results show that the nonlinear dependence of the capacitance of an MRF on frequency induced by the effect of tunnel current decreases with the increase in frequency. The capacitance of an MRF is directly related to the particle structures. The capacitance of the MRF with a chain particle structure is greater than that of the MRF with a random particle distribution. The smaller the clearance between the adjacent particles, the greater the capacitance of the MRF. The network particle structure and particle contact will reduce the capacitance of an MRF. The capacitance of an MRF increases with the increment of external magnetic field. The capacitance of an MRF with higher particle volume fraction is smaller than that of an MRF with lower particle volume fraction.

Background and Objectives: Interstitial lung diseases have always been an issue for pulmonary and rheumatology physicians. Computed tomography scans with a high-resolution protocol and bronchoalveolar lavage have been used along with biochemical blood tests to reach a diagnosis. Materials and Methods: We included 80 patients in total. First, all patients had their diagnosis with computed tomography of the thorax, serological/ immunological blood tests and bronchoalveolar lavage. However; after 3 months, all were divided into 2 groups: those who had bronchoalveolar lavage again and those who had cryobiopsy instead of bronchoalveolar lavage (40/40). Positron emission-computed tomography was also performed upon the first and second diagnosis. The patients’ follow-up was 4 years from diagnosis. Results: Patients suffered most from chronic obstructive pulmonary disease (56, 70%), while lung cancer was rarely encountered in the sample (7, 9.75%). Age distribution ranged between 53 and 68 years with a mean value of 60 years. The computed tomography findings revealed 25 patients with typical diagnosis (35.2%), 17 with interstitial pulmonary fibrosis (23.9%) and 11 with probable diagnosis (11%). The cryobiopsy technique led to a new diagnosis in 28 patients (35% of the total sample). Patients who had a new diagnosis with cryobiopsy had a mean survival time of 710 days (Conclusions: Cryobiopsy is a safe tool for patients with interstitial lung disease and can assist in the diagnosis of interstitial lung diseases. The survival of patients was increased in the cryobiopsy group versus only bronchoalveolar lavage for disease diagnosis.

To ensure the safety of ships and bridges at the same time during collisions, a new type of bridge pier protection system is proposed, in which one is composed of corrugated steel plates, bolts, and corrugated steel pipes (CSP), and the other is composed of ordinary steel plates, bolts, and corrugated steel pipes (OSP). To study their anticollision performance, a pendulum impact test and numerical simulation were carried out. Comparing the test results with the simulation results, it was shown that the simulation results are basically consistent with the test results. Then, the influence curves of the impact velocity, specimen thickness, weight, and frequency are analysed to evaluate the anticollision performance of CSP/OSP and optimize their structure. When the impact energy is low, the peak values of the lateral impact force and lateral displacement of the column equipped with OSP are all smaller than those of the column equipped with CSP. When the impact energy is high, the peak values of the lateral impact force and lateral displacement of the column equipped with OSP are larger than those of the column equipped with CSP. However, under the same impact energy, the total energy peak value of the CSP specimen is larger than that of the OSP specimen. Results can provide a certain numerical analysis basis for the structural design and research of new types of corrugated steel protection system for bridge pier.

A new type of corrugated steel protection system (CSP) for the bridge pier is proposed to improve the impact resistance of the bridge pier and reduce the loss caused by the collision of the ship against the pier. A new bolt numerical simulation method and finite element model establishment method are proposed and verified by the impact test. The results show that the new method can effectively simulate the mechanical behavior of bolts and CSP. Parameters analysis was carried out subsequently by the verified finite element model which showed that the energy absorbing ability of CSP increases with corrugated steel pipe wall thickness and its weight decreases. It is concluded that CSP (2.0 mm) is the optimal structural type, and compared with the existing FRP Fender System. The results show that the energy absorbing ability of CSP (2.0 mm) is strong, and its final absorbed energy can reach 86.13% of the total energy of the model structural system (7.22 MJ).

The preferential sites of Cr in the μ -Co _7 W _6 phase and its influence on electronic properties were studied by first-principles calculations based on density functional theory. The calculation results of the formation energy and defect formation energy show that the stability of the system is enhanced when Cr occupies the Co site, which indicates that Cr tends to occupy the Co site of the system. By calculating the density of states, the Hamilton population of crystal orbital, the electron location function and the Bader charge distribution, the reason why Cr preferentially occupied the Co sites is further explained. This is primarily owing to the hybridization of the d-d orbitals of the Cr atom to its adjacent atoms.

Introduction: Local treatment of the airways and lung parenchyma has been used in clinical practice for several years for a variety of diseases. Methods: A variety of endoscopic tools for local treatment exist, especially for treating malignancies. Using these endoscopic tools, one can administer drugs specifically designed for the airways. Discussion: This article presents all locally administered treatment options and provides useful insights for future local endoscopically applied treatments.

Introduction: Aerosolised drugs have been approved for several diseases such as cystic fibrosis and diabetes. Moreover; there are already drugs for pulmonary hypertension in aerosol form already on the market. Materials and methods: Two drugs for pulmonary hypertension (Tadalafil and Macitentan) were milled and transformed from tablets to powder. Three different jet-nebulizers with seven different residual cups were combined. Moreover, we used 3 different ultrasound nebulizers with two different release methods. Results: The drug and residual cup designs produce alone or jointly different MMAD diameters. The three large (10 mls) residual cups with the jet-nebulisers produced the smallest aerosol droplets. Both ultrasound nebulisers are capable of producing optimal size aerosol droplets ≤5 μm mmad. Conclusions: These two drugs can be easily administered as aerosol and an vivo clinical study will prove the safety for the airways.

The additive strategy has become an effective method for reducing the defect density of perovskite solar cells (PSCs). Herein, a simple and low-cost small molecule material Na-dithienylethene (NaDTE) was designed and synthesized to enhance the power conversion efficiency (PCE) and stability of (FAPbI3)0.93(MAPbBr3)0.07 PSCs. The addition of NaDTE facilitated the growth of perovskite crystals, increased the grain size of perovskite films, and enhanced their optical absorption. The S group of NaDTE is beneficial to promote the chemical bonding of lead cations in perovskite. Under-coordinated lead ions in the perovskite were passivated by -C=O groups within the NaDTE unit, thereby dramatically reducing the defect density. Additionally, NaDTE adjusted the energy levels of the perovskite to better match with those of the hole transport layer (Spiro-OMETAD) and improved hole transport rates. After NaDTE doping, the PCE of the device increased to 23.12%, which was 12% higher than that of the control PSCs (20.64%). Ultimately, the non-encapsulated devices retained 90% of their initial efficiency after over 1000 hours of storage. This study indicates a promising pathway for achieving highly stable and low-cost perovskite films. [ABSTRACT FROM AUTHOR]