Characteristics analysis of 157 cases of central airway stenosis due to tracheobronchial tuberculosis: A descriptive study

Application value of fibro-bronchoscopic cryosurgery combined with medication in the treatment of tracheobronchial tuberculosis

OBJECTIVE

To investigate the value of fibro-bronchoscopic cryosurgery combined with medication in the treatment of tracheobronchial tuberculosis (TBTB).

METHODS

This study was designed as a prospective, randomized clinical trial. 96 patients with newly diagnosed TBTB were collected and divided into the study group (n = 48) and the control group (n = 48). Specifically, conventional anti-tuberculosis therapy was given to the control group, with the study group undergoing fibro-bronchoscopic cryosurgery combined with topical administration. Afterward, the post-treatment response rate and adverse reaction indicators were collected for comparison.

RESULTS

After treatment for 6 months, the study group was superior to the control group in terms of clinical efficacy (P = 0.013), negative conversion rate of acid-fast bacilli (P = 0.014), and lesion recovery (P = 0.003); after treatment for 6 months, the study and control groups exhibited no significant differences in the response rate of inflammatory infiltration (P = 1.000) and granulation proliferation (P = 0.061). Additionally, the study group showed a higher response rate of ulcer necrosis (P = 0.041) and cicatricial stenosis (P = 0.029) than the control group, with no significant differences observed in the incidence of adverse reactions between the 2 groups (P = 0.584). Moreover, the clinical efficacy in the study group was higher than that in the control group after treatment for 12 months (P < 0.001).

CONCLUSION

The application of fibro-bronchoscopic cryosurgery combined with topical administration on the basis of conventional anti-TB treatment can improve the clinical efficacy of TBTB patients and shorten the duration of treatment without increasing the incidence of adverse reactions.

Comparative study of cryorecanalisation and cryoablation using flexible bronchoscopy for the treatment of endobronchial tuberculosis

To compare the efficacy and safety of cryorecanalisation and cryoablation using flexible bronchoscopy for the treatment of tumor-like endobronchial tuberculosis (EBTB). Patients with tumor-like EBTB (104) were randomly divided into a cryorecanalisation (54 patients) or cryoablation (50 patients) group to assess the differences in efficacy and complications between the treatments. The cryorecanalisation and cryoablation treatments' therapeutic efficacies were 81.5% and 48.0%, respectively (p = 0.000); in patients with less than moderate obstruction (≤ 50%), the therapeutic efficacies were 92.9% and 88.9%, respectively (p = 1.000). In patients with more than moderate obstruction (> 50%), cryorecanalisation and cryoablation's therapeutic efficacies were 77.5% and 25.0%, respectively (p = 0.000). The number of treatments in the cryorecanalisation and cryoablation groups were 2.46 ± 1.06 and 3.26 ± 0.75, respectively (p = 0.000). The main complication of the treatment protocol in both groups was bleeding, and the overall bleeding rate was 96.2% and 16.0% in the cryorecanalisation and cryoablation groups, respectively (p = 0.000). Cryorecanalisation via flexible bronchoscopy improved the outcome of patients with tumor-like EBTB and reduced the number of treatments required compared with cryoablation; however, it had a higher bleeding rate and the potential risk of severe bleeding.

Long-term outcomes of surgical reconstruction for post-tuberculosis tracheobronchial stenosis: a 7-year follow-up in a tuberculosis-endemic region

Background

Surgical reconstruction is often necessary for severe tracheobronchial stenosis resulting from tuberculosis (TB). However, the long-term efficacy of this approach remains unclear. This study investigated the safety and long-term outcomes of surgery for severe post-TB tracheobronchial stenosis.

Methods

We conducted a retrospective study of 48 patients with severe post-TB tracheobronchial stenosis who underwent surgical reconstruction between 2015 and 2018 in a TB-endemic region. Pre- and postoperative evaluations included Karnofsky performance status, modified Medical Research Council (mMRC) dyspnea scale, spirometry, chest computed tomography (CT) scan, and bronchoscopy. The primary outcome was intervention-requiring restenosis over the long term.

Results

The mean patient age was 30.6±9.9 years, with 91.7% females. Airway fibrosis was the predominant lesion (93.8%), affecting the bronchi (93.8%) and trachea (6.2%). All the patients underwent resection and anastomosis, and 56.2% required lobectomy. Postoperative complications occurred in 13 patients (27.1%), with prolonged air leaks being the most prevalent (12.5%). All complications resolved with conservative management. Significant improvements in performance status, dyspnea, and lung function were observed postoperatively and sustained for over 5 years. Within a median follow-up of 69 months, five cases of intervention-requiring restenosis occurred within the first year. The freedom from restenosis rate was 90% from 1 year onwards.

Conclusions

Surgical reconstruction is safe and effective in treating severe post-TB tracheobronchial stenosis. Larger studies are required to validate these findings.

Assessing the risk of concurrent mycoplasma pneumoniae pneumonia in children with tracheobronchial tuberculosis: retrospective study

Objective

This study aimed to create a predictive model based on machine learning to identify the risk for tracheobronchial tuberculosis (TBTB) occurring alongside Mycoplasma pneumoniae pneumonia in pediatric patients.

Methods

Clinical data from 212 pediatric patients were examined in this retrospective analysis. This cohort included 42 individuals diagnosed with TBTB and Mycoplasma pneumoniae pneumonia (combined group) and 170 patients diagnosed with lobar pneumonia alone (pneumonia group). Three predictive models, namely XGBoost, decision tree, and logistic regression, were constructed, and their performances were assessed using the receiver's operating characteristic (ROC) curve, precision-recall curve (PR), and decision curve analysis (DCA). The dataset was divided into a 7:3 ratio to test the first and second groups, utilizing them to validate the XGBoost model and to construct the nomogram model.

Results

The XGBoost highlighted eight significant signatures, while the decision tree and logistic regression models identified six and five signatures, respectively. The ROC analysis revealed an area under the curve (AUC) of 0.996 for XGBoost, significantly outperforming the other models (p < 0.05). Similarly, the PR curve demonstrated the superior predictive capability of XGBoost. DCA further confirmed that XGBoost offered the highest AIC (43.226), the highest average net benefit (0.764), and the best model fit. Validation efforts confirmed the robustness of the findings, with the validation groups 1 and 2 showing ROC and PR curves with AUC of 0.997, indicating a high net benefit. The nomogram model was shown to possess significant clinical value.

Conclusion

Compared to machine learning approaches, the XGBoost model demonstrated superior predictive efficacy in identifying pediatric patients at risk of concurrent TBTB and Mycoplasma pneumoniae pneumonia. The model's identification of critical signatures provides valuable insights into the pathogenesis of these conditions.

Endobronchial optical coherence tomography helps to estimate the cartilage damage of the central airway in TBTB patients

Purpose

At present, there are few examination methods used to evaluate tracheobronchial cartilage damage. In our study, we explored whether endobronchial optical coherence tomography (EB-OCT) can be used to estimate central airway cartilage damage in tracheobronchial tuberculosis (TBTB) patients.

Methods

In our study, we used the OCTICS Imaging system to perform EB-OCT scanning for TBTB patients. The thickness of the central airway wall and cartilage was measured by the OCTICS software system workstation.

Results

There were 102 TBTB patients included in our study cohort. Their EB-OCT images of the central airway cartilage showed that abnormal cartilage manifests as thinning of the cartilage, cartilage damage, cartilage destruction, and even cartilage deficiency. The cartilage morphology becomes irregular and discontinuous. Some parts of the cartilage become brighter in grayscale. The intima of the cartilage is thickened and discontinuous, and the boundary with submucosa and mucosa is unclear.

Conclusion

Our study conducted EB-OCT examination of the central airway cartilage of TBTB patients in vivo for the first time. EB-OCT helps to estimate the cartilage damage of the central airway in TBTB patients to some extent.