Double-lumen endobronchial tube (DLT) intubation is more challenging than single-lumen tube intubation is, and the rigid video stylet (RVS) is one of the tools that has emerged to deal with this demanding intubation procedure. We evaluated whether the UE^® RVS can shorten the DLT intubation time and improve the first-attempt intubation success rate compared with that of Macintosh laryngoscope (ML). A total of 130 participants scheduled to undergo thoracoscopic pulmonary surgeries were enrolled. They were randomized to receive either ML- or RVS-assisted DLT intubation. The primary outcomes were the intubation time and first-attempt intubation success rate. The secondary outcomes were the overall intubation success rate, mean arterial pressure, postoperative sore throat (POST), and postoperative hoarseness at 1 h and 24 h. Compared with the ML group, the intubation time was significantly shorter in the RVS group (p < 0.001; 30.82 ± 10.61 vs. 39.62 ± 6.54 s), however, the first-attempt success rate was significantly lower (p = 0.048; 83.08% vs. 95.16%). The POST at 1 h was less severe in the RVS group (p = 0.021). No significant differences were found for the other indicators. Among the patients with normal airways, the UE^® RVS can achieve faster DLT intubation and decrease the severity of a POST at 1 h, although it was associated with a lower first-attempt intubation success rate.

Objective: We explored whether the inverse association between smoking and sarcoidosis observed in observational studies may involve nicotine-related mechanisms. Methods: Genetic summary statistics were sourced from the largest available genome-wide association studies, covering smoking initiation, age of onset, daily cigarette consumption (CigDay), smoking cessation, lifetime smoking exposure, and nicotine metabolite ratio (NMR). Multivariable Mendelian randomization (MVMR) estimated the association of genetically predicted NMR with sarcoidosis risk after adjusting for CigDay, with univariable MR (UVMR) as supportive evidence. Results: Higher NMR was associated with higher sarcoidosis risk after adjusting for CigDay (OR = 1.08, 95% CI: 1.01–1.16, p = 0.018). UVMR showed that current smokers had lower risk than former smokers (OR = 0.44, 95% CI: 0.25–0.76, p = 0.003), whereas associations for current and former smoking versus never smoking, and for nicotine metabolites, were null. Conclusions: This exploratory MR study provides hypothesis-generating evidence that genetically predicted faster nicotine metabolism may be associated with higher sarcoidosis risk, compatible with a possible role of nicotine-related mechanisms but not establishing a causal effect or a clinical effect of nicotine. These results should not justify smoking, which remains strongly harmful. Future studies should investigate the immune regulatory pathways through which nicotine metabolism may influence sarcoidosis pathogenesis.

Background: Combined pulmonary fibrosis and emphysema (CPFE) is a syndrome with distinct clinical features and pathogenetic considerations. Limited data exists regarding the correlation between CPFE and prognosis. In this study, we assessed the prognostic implications of CPFE, as well as the radiological and functional change over time in patients with fibrotic interstitial lung diseases (fILDs). Methods: A single-center, retrospective cohort study was conducted diagnosed with fILDs between December 2016 and March 2023, who underwent pulmonary function testing at the time of diagnosis and one year after diagnosis. Patient demographics, radiological features, and clinical outcomes were all collected. The prognosis of fILDs patients with CPFE was investigated. Results: Of the 376 patients with fILDs, 102 patients were diagnosed CPFE. Patients with CPFE were more common in male (89.2% vs. 45.7%, p<0.001). CPFE patients were significantly more cases with GAP stage Ⅲ (11.8% vs. 6.8%, p<0.001), and CT scores were also higher. CPFE patients had higher forced vital capacity (FVC) but worse diffusing capacity for carbon monoxide (DLco) than those without CPFE. In multivariate Cox analysis, age, GAP stage, honeycombing and forced expiratory volume in one second (FEV₁) were the independent predictors of mortality. Kaplan–Meier curves revealed that the survival time of CPFE patients was lower than that of non-CPFE patients, with 37.5 months (interquartile range (IQR): 26-48.75) and 43.5 months (IQR: 30–53.25), respectively. Honeycombing on CT significantly influences the prognosis of both groups. Conclusions: CPFE at baseline was associated with worse prognosis compared to fILDs occurring without CPFE.