堀口 智也

INTRODUCTION: Bronchoscopy is physically demanding, and studies of ergonomics and objective skill assessment require accurate, segment-resolved capture of the bronchoscopist's hand and head movements. However, existing motion capture approaches typically rely on specialized laboratory infrastructure or wearable sensor arrays, limiting their routine use. METHODS: A board-certified pulmonologist performed 10 systematic bronchoscopies across the 18 named segments using an airway simulator and a single-use bronchoscope. Procedures alternated between conditions without and with engagement of the bronchoscope's insertion-tube rotation mechanism. A custom visionOS application running on Apple Vision Pro captured bilateral hand and head poses at 30 Hz, with synchronized voice-cue annotations for each segment. RESULTS: All 180 expected segment insertions were recorded (94.4% via voice cues; 5.6% recovered through tracking-derived hold detection and excluded from per-insertion analyses). Intermittent tracking-freezing artifacts, in which a static pose was retained under a valid tracking flag, were detected by frame-to-frame immobility and excluded from the affected analyses. The mean per-insertion peak left-wrist rotation across all segments was 107.9° without and 72.6° with the rotation mechanism. The mean left-thumb path length within the wrist's local reference frame was 3.82 ± 0.48 m per bronchoscopy, and the estimated number of bronchoscope lever operation cycles was 64.8 ± 7.9 per procedure. CONCLUSION: In this proof-of-concept study, a single off-the-shelf head-mounted device enabled multi-channel capture of bronchoscopist kinematics during simulated bronchoscopy. This approach provides a practical methodological foundation for future studies on bronchoscopy ergonomics, skill assessment, and AI-driven training data generation.

Amivantamab, a bispecific antibody targeting epidermal growth factor receptor (EGFR) and mesenchymal-epithelial transition factor, has shown clinical efficacy in patients with EGFR-mutated non-small cell lung cancer. Although infusion-related reactions (IRRs) are common adverse events associated with this drug, cardiac events such as bradycardia have rarely been reported. We report the case of a 53-year-old Japanese man with advanced EGFR exon 19-deleted lung adenocarcinoma who was treated with amivantamab plus lazertinib as eighth-line therapy. On the first day, he experienced dyspnea, chills, and headache 30 min after amivantamab administration, so the infusion flow was reduced to 25 mL/h. After the symptoms resolved, the flow rate was set to 50 mL/h. On the second day, 2 h after initiating amivantamab infusion (700 mg) at 50 mL/h, his heart rate decreased to <50 beats per minute (bpm) and subsequently to <40 bpm. His blood pressure remained stable and he had no symptoms. The infusion was interrupted and intravenous methylprednisolone, chlorpheniramine, and atropine were administered. Bradycardia persisted for approximately 24 h but gradually resolved. On rechallenge with amivantamab 10 days later, bradycardia did not recur, suggesting that bradycardia is an IRR. Clinicians should be aware of this potential reaction and closely monitor cardiac rhythm during and after amivantamab infusion.

BACKGROUND: Patients with thoracic malignancy and interstitial pneumonia (IP) are often excluded from clinical trials, consequently lacking quantitative evidence of poorer prognosis and lower programmed death-ligand 1 (PD-L1) testing rates. METHODS: We evaluated the real-world impact of comorbid IP on biomarker adoption and survival in thoracic malignancy patients receiving first-line systemic therapy at a tertiary teaching hospital between 2016 and 2023. RESULTS: Among 1247 patients, 98 (7.5%) had comorbid IP. Multigene testing rates in IP patients were similar to those in non-IP patients. Only three actionable genomic alterations were found in the IP group, highlighting PD-L1 testing as the key element. PD-L1 testing was underutilized in the IP group (63.3%) compared with the non-IP group (75.1%). Immune checkpoint inhibitor (ICI) therapy was utilized in 12.2% of IP versus 29.3% in non-IP, despite comparable clinical situations. Comorbid IP predicted worse survival (hazard ratio: 1.789; 95% confidence interval: 1.373-2.331; p < 0.001). Although survival significantly improved in non-IP after 2020, no benefit was observed in IP. A multivariable model incorporating an IP × Period interaction confirmed comorbid IP remained a negative prognostic factor, highlighting recent advances have not bridged the survival disparity for this high-risk group. CONCLUSIONS: Despite recent progress, patients with comorbid IP experience limited clinical benefit, characterized by lower rates of PD-L1 testing, restricted use of immune checkpoint inhibitors, and absence of post-2020 survival gains. This large-scale and quantitative evidence demonstrates persistent disparities and their prognostic significance, reflecting the limited applicability of current immunotherapy-based strategies in this high-risk population.