ABSTRACT BACKGROUND: Hyponatremia and respiratory failure are common in cancer patients, but their relationship among lung cancer patients remains unclear. This study aimed to determine the prevalence of hyponatremia and its association with respiratory failure on admission among lung cancer patients presenting to the emergency room (ER). METHODS: This cross-sectional study was conducted between July 1, 2023, and June 30, 2024, in the ER of Persahabatan Hospital. Adults with histopathologically confirmed or previously established, untreated lung cancer were consecutively enrolled. Hyponatremia was defined as serum sodium <135 mmol/L, and respiratory failure as PaO 2 <60 mmHg or PaCO 2 >45 mmHg. Associations were analyzed using bivariate analysis and simplified exploratory multivariable logistic regression. RESULTS: Among 101 patients, hyponatremia and respiratory failure occurred in 51.5% and 20.8%, respectively. Respiratory failure was more frequent with hyponatremia than without hyponatremia (34.6% vs. 6.1%; odds ratio [OR]: 8.12, 95% confidence interval [CI]: 2.21–29.79; P < 0.001). In the exploratory multivariable model, hyponatremia (adjusted OR [aOR] 6.05, 95% CI: 1.58–23.14; P = 0.009) and tuberculosis (aOR 8.05, 95% CI: 1.73–37.37; P = 0.008) remained associated with respiratory failure. The model showed acceptable discrimination (area under the curve: 0.769, 95% CI: 0.652–0.885), with sensitivity 85.7% (95% CI: 63.7%–97.0%), specificity 56.3% (95% CI: 44.7%–67.3%), positive predictive value 34.0% (95% CI: 21.5%–48.3%), and negative predictive value 93.8% (95% CI: 82.8%–98.7%). CONCLUSION: Among lung cancer patients, hyponatremia was prevalent and associated with respiratory failure at ER admission. These findings are exploratory and hypothesis-generating.
ABSTRACT Primary pulmonary artery angiosarcoma (PAAS) is an exceptionally rare and aggressive malignancy often misdiagnosed as pulmonary thromboembolism (PTE). PAAS typically exhibits aggressive biological behavior, with rapid local invasion, early recurrence, and distant metastasis, and the prognosis of PAAS remains extremely poor. We report the case of PAAS initially misdiagnosed with PTE, demonstrating its rapid postoperative recurrence within days after tumor resection and aggressive progression with pulmonary and systemic metastases. This case underscores the importance of avoiding misdiagnosis as PTE, which may delay definitive treatment and facilitate disease progression. It also highlights how rapidly residual tumor cells can proliferate and serves as a reminder to carefully consider the potential role of systemic therapy in PAAS management.
ABSTRACT Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) is treated with corticosteroids and immunosuppressive drugs such as rituximab, which is associated with an increased risk of opportunistic infections, including Pneumocystis pneumonia (PCP), particularly in nonhuman immunodeficiency virus (HIV) immunocompromised patients. We present a 62-year-old man with CIDP on rituximab maintenance and low-dose prednisone who presented with fever, dyspnea, and hypoxia. Notable laboratories included profound lymphopenia and elevated lactate dehydrogenase. Prior bronchoalveolar lavage (BAL) showed foamy macrophages, but all direct microbiological tests for Pneumocystis jirovecii , beta-D-glucan, and viral screen were negative. Chest computed tomography showed diffuse bilateral ground-glass opacities. Based on the constellation of risk factors, clinical presentation, and imaging, the patient met the EORTC/MSGERC 2021 criteria for possible PCP. Empiric treatment with intravenous trimethoprim–sulfamethoxazole (TMP-SMX) and corticosteroids led to rapid clinical and radiographic improvement. PCP should be considered in non-HIV immunocompromised patients receiving rituximab, even with negative beta-D-glucan and BAL microscopy. The rapid clinical response to TMP-SMX strongly supports the diagnosis.
BACKGROUND: Bronchoscopy is widely used to evaluate the source and cause of hemoptysis. Its diagnostic value is well established in patients with abnormal radiological findings; however, its utility in patients without such findings remains uncertain. METHODS: We retrospectively included adults with hemoptysis who underwent bronchoscopy between January 2019 and June 2023 and were followed up clinically and radiologically for at least 1 year. Computed tomography (CT) scans were reviewed and categorized as pathological or nonpathological; cases with pathological findings were further classified according to malignancy suspicion. The diagnostic yield of bronchoscopy was compared between groups. Receiver operating characteristic (ROC) analysis was used to derive an age cutoff; multivariable logistic regression identified independent predictors. RESULTS: A total of 380 patients were included (mean age 58.3 ± 14.6 years; 78.9% males). Bronchoscopy was diagnostic in 37.6% of cases. Diagnostic yield was significantly higher in patients over 50 years of age, in males, and in those with abnormal CT findings. In contrast, bronchoscopy was rarely diagnostic in patients younger than 50 years with normal CT. Logistic regression showed a 3.5-fold increase in diagnostic yield with age (odds ratio [OR]: 3.48, 95% confidence interval [CI] 1.27–9.53, P = 0.015) and 15.8-fold with CT findings suggestive of malignancy (OR: 15.81, 95% CI: 7.35–33.95, P < 0.001). CONCLUSION: Bronchoscopy provides meaningful diagnostic information in patients aged ≥50 years and/or with CT findings suspicious for malignancy, whereas its yield is limited in younger patients with normal CT. A selective approach may be appropriate in low-risk cases.
Difficult airway management remains a major challenge for paediatric anaesthesiologists. Our aim is to visualise the research hotspots of tracheal intubation for children using bibliometric analysis and clarify the development status of this research field. English articles on pediatric intubation (2009-2025, Web of Science) were analyzed. Only original and review studies included. Publication trends, countries, authors, journals, keywords, and citations were statistically analyzed and visualized. The study results showed that a total of 752 eligible articles were included, and the annual number of publications showed a fluctuating increase, reaching a peak of 64 in 2023. The United States ranked first in both the number of publications (265) and citations (5,935). The journal Pediatric Anesthesia had the largest number of publications (58) and also the highest local citations (13,878). The most cited author globally was Silbergleit (468 citations), and the author with the most publications was Nishisaki (27 articles). The institution with the most publications was the University of Pennsylvania. The top three high-frequency keywords were children (329 times, 17%), endotracheal intubation (183 times, 9%) and tracheal intubation (125 times, 6%), and the core research hotspots were intubation efficacy, safety and airway difficulties. Study analyzes 752 pediatric intubation articles (2009-2025), showing growing interest, peak in 2023. U.S. leads; China productive but less recognized. Focus on anesthesia, critical care; Nishisaki prominent. Shift from basic to personalized techniques, emphasizing safety, difficult airways. Lacks Global South input. Highlights trends, guides clinical priorities, informs research.
Previous studies have described an emerging deficiency of sleep medicine physicians in the United States (US). This study defines the training pipeline for sleep medicine physicians, including the annual number of applicants, training positions, and unfilled training positions. This was a cross-sectional analysis of all applicants for sleep medicine fellowship training in the US from 2012 to 2025. Annual match outcomes were calculated and trends analyzed with linear regression. From 2012 to 2025, growth in the annual number of applicants (103–249, 142% increase, P < 0.001) exceeded growth in the number of training positions (99–218, 120% increase, P < 0.001) for sleep medicine fellowship training. Accordingly, the annual applicant-to-training position ratio increased (1.04–1.14, P = 0.003) and the annual rate of unfilled training positions decreased (12.1% to 5.0%, P = 0.004) over the study period. The annual representation of US allopathic medical school graduates increased among incoming sleep medicine fellows (31.0% to 41.1%) while the annual representation of non-US allopathic medical school graduates decreased (69.0% to 58.9%), although this trend was not significant (P = 0.056). Match rates for US allopathic medical school graduates exceeded those for non-US allopathic medical school graduates (93.1% vs. 85.8%, P < 0.001). Growth in applicants for sleep medicine fellowship training has exceeded growth in training capacity, resulting in an increasing annual applicant-to-training position ratio. While interest appears to be increasing, surveillance of future match outcomes is warranted given anticipated deficiencies in the sleep medicine physician workforce.
BACKGROUND: Malignant pleural effusion (MPE) occurs in approximately 15% of cancer patients and is associated with poor prognosis, with a median survival of 3–12 months. Expected survival is a key factor in treatment decision-making. This study aimed to identify clinical and laboratory parameters affecting survival in patients with MPE and to evaluate the prognostic performance of the LENT, PROMISE, AL, and Eastern Cooperative Oncology Group Performance Status (ECOG-PS) scores in predicting mortality. METHODS: This retrospective study included 161 patients pathologically diagnosed with MPE at a tertiary care center between January 2010 and December 2024. Overall survival was defined as the time from MPE diagnosis to death. LENT, PROMISE, AL, and ECOG-PS scores were calculated at diagnosis. Three-month mortality was the primary endpoint. RESULTS: The median overall survival was 93 days, and the 3-month survival rate was 50.1%. Univariate analysis showed that body mass index ≥25 kg/m2, gastrointestinal tract malignancies, presence of extrapleural metastases, elevated leukocyte, neutrophil, and platelet counts, an increased neutrophil-to-lymphocyte ratio, and higher pleural fluid lactate dehydrogenase levels were significantly associated with mortality. ECOG-PS, LENT, and PROMISE scores were significant predictors of both 3-month and overall mortality. In multivariate analysis, ECOG-PS was the strongest independent predictor of 3-month mortality (hazard ratio [HR]: 46.63; 95% confidence interval [CI]: 14.23–152.83), followed by LENT (HR: 4.66; 95% CI: 2.77–7.85) and PROMISE (HR: 2.39; 95% CI: 1.41–4.03). ECOG-PS also remained the strongest predictor of overall mortality. CONCLUSION: ECOG-PS, together with LENT and PROMISE scores, are effective and clinically applicable tools for predicting early and overall mortality in patients with MPE.
BACKGROUND: The association between chronic obstructive pulmonary disease (COPD) with type 2 inflammation and comorbidities and functional outcomes remains incompletely defined. We aimed to compare clinical characteristics, comorbidities, and exacerbation risk between COPD patients with and without type 2 inflammation. METHODS: This was a retrospective observational study. Patients with spirometry-confirmed COPD between January 2020 and July 2025 were included. Patients were stratified by serum eosinophil count into type 2 inflammation COPD (≥300 cells/μL) and nontype 2 inflammation COPD (<300 cells/μL). Demographics, comorbidities, pulmonary function, and exacerbation history were assessed. Logistic regression identified independent predictors of exacerbation. RESULTS: The total number of patients were 270 (mean age: 70 years; 91.5% of males). Among them, 54.8% had type 2 inflammation COPD. Those with type 2 inflammation had more comorbidities (mean 3 vs. 2; P = 0.001), higher prevalence of ischemic heart disease (31.1%; P = 0.042), and increased exacerbation frequency (mean 2 vs. 1 per year; P = 0.006). Predictors of exacerbation included older age (odds ratio [OR] 1.02, 95% confidence interval [CI] 1.00–1.04), high eosinophilic count (OR 1.002, 95% CI 1.001–1.003), number of exacerbations in the past 12 months (OR 1.04, 95% CI 1.01–1.06), elevated right ventricular pressure (OR 1.06, 95% CI 1.03–1.10), lower postbronchodilator FEV1 (OR 1.03, 95% CI 1.01–1.05) and multiple comorbidities (OR 1.18, 95% CI 1.05–1.34). CONCLUSION: COPD with type 2 inflammation is associated with a higher prevalence of ischemic heart disease and a higher prevalence and higher risk of exacerbation compared with nontype 2 inflammation. Serum eosinophil count is a valuable biomarker for phenotyping and risk stratification.
BACKGROUND: Small-cell lung cancer (SCLC) is a highly aggressive malignancy with a poor prognosis. 18F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) plays a critical role in staging, as elevated FDG uptake is associated with tumor aggressiveness and metabolic activity. Although radiometabolic parameters such as maximum standardized uptake value (SUVmax), metabolic tumor volume (MTV), and total lesion glycolysis (TLG) have been proposed as prognostic markers, existing data remain inconsistent. This study aimed to investigate the association between these parameters and disease stage and overall survival (OS) in SCLC patients. METHODS: Patients diagnosed with lung cancer between May 2022 and June 2023 were retrospectively reviewed and divided into two groups: those with SCLC (Group 1) and those with non-SCLC (Group 2). Demographic, clinical, radiological (thoracic CT), and radiometabolic (PET/CT) features, treatment history, staging, and mortality data (based on the national death registry) were collected. RESULTS: A total of 111 patients (mean age: 65.2 years) were included, of whom 65 (58.6%) had SCLC. In the SCLC group, 55 (85.9%) had extensive-stage disease and 9 (14.1%) had limited-stage disease. Mean SUVmax, MTV, and TLG values were significantly higher in extensive-stage disease (12.5, 87.2, and 624.2, respectively) than in limited-stage disease (7.1, 7.0, and 37.0) (P < 0.05). Median OS was 12.5 months. Cutoff values for poor prognosis were identified as SUVmax ≥10, MTV ≥40, and TLG ≥170, with significantly shorter OS observed above these thresholds (P < 0.05). While SUVmax alone was not an independent predictor of survival (P > 0.05), MTV and TLG were identified as significant prognostic indicators in multivariate analysis (P < 0.05). CONCLUSION: In SCLC, higher SUVmax values are associated with advanced disease stage. However, MTV and TLG may serve as more reliable independent prognostic biomarkers for survival.
BACKGROUND:Accurate assessment of lung volumes is essential for diagnosing ventilatory defects and managing pulmonary diseases such as interstitial lung diseases (ILDs) and chronic obstructive pulmonary disease (COPD). Although body plethysmography is the standard method, it can be limited by patient tolerance and complexity. Helium dilution method (HDM) is a portable and cost-effective alternative, while chest computed tomography (CT) offers noninvasive volume assessment through imaging. This study aimed to evaluate the agreement and potential interchangeability between TLC values measured by CT (TLCCT) segmentation and the TLCHDM in patients with ILD and COPD. MATERIALS AND METHODS:In this retrospective study, patients who underwent HDM and chest CT were evaluated. Based on pulmonary function tests (PFTs), patients were grouped as having restrictive or obstructive ventilatory defects. TLCCT and HDM were compared using Bland-Altman analysis to assess agreement and bias. RESULTS:The study included 213 patients. In the overall cohort, TLCCT was slightly lower than TLCHDM (mean difference = -0.32 L, 95% confidence interval [CI] -0.50 to -0.14 L, P = 0.0007). In subgroup analyses, the mean bias was -0.67 L (95% CI -0.84 to -0.51 L, P < 0.001) for ILD and +0.78 L (95% CI 0.35-1.21 L, P = 0.0007) for COPD, indicating underestimation and overestimation by CT, respectively. The overall 95% limits of agreement ranged from -3.0 to +2.25 L. CONCLUSION:Both HDM and CT provide valuable lung volume data. CT may serve as a reliable alternative in patients unable to undergo PFTs. Prospective studies are warranted to confirm clinical utility.
BACKGROUND:Endobronchial Ultrasound with Transbronchial Needle Aspiration (EBUS-TBNA) is a well-established tool in evaluating the diverse etiologies of mediastinal lymphadenopathy. The objectives of our study included the estimation of overall, diagnostic yield in different primary tumors, and identification of the factors influencing yield. METHODS:This is a 3-year retrospective analytical study on patients with mediastinal lymph nodes who underwent EBUS-TBNA from January 2022 to December 2024 at Sultan Qaboos Comprehensive Cancer Care and Research Center, Muscat, Oman. The study included only patients with complete pathological and medical records. RESULTS:Out of the 113 EBUS-TBNA done during the study period, 111 patients were included. The mean age was 60.32 ± 14.69 years. One hundred and sixty-nine nodes were sampled with 861 sampling passes for diagnostic, staging, and molecular in 71.2%, 25.2%, and 3.6%, respectively. A single station was sampled in 67.6%, with station 7 the most common (64.9%). The overall diagnostic yield was 85.6%. Yield varied significantly by primary site (P < 0.001); 100% in gastrointestinal, 88.6% in lung, and 81.3% in breast cancers, with malignancy diagnosed in 2 (22.2%), 29 (65.9%), and 9 (56.3%), respectively. The cytological diagnosis was reactive lymphadenopathy (27.0%), nonsmall cell lung carcinoma (21.6%), carcinoma not otherwise specified (13.5%), and granulomatous inflammation (13.5%). All type 3 nodes (11; 50%) were malignant, and all type 1 node (5; 22.7%) were benign in the 22 elastographies on patients with lung cancer (P < 0.001). No major complications were encountered. CONCLUSIONS:EBUS-TBNA has a high diagnostic yield in mediastinal lymphadenopathy. It should be considered as the primary invasive tool for both diagnostic and staging assessment of mediastinal nodes. However, its limitations are noticeable in suspected lymphoma and molecular analysis, noting that this conclusion is limited by the small sample size.
BACKGROUND:Bronchoscopic lung volume reduction (BLVR) offers several advantages over lung volume reduction surgery, such as faster recovery, fewer complications, and reduced infection risk; however, it also carries a risk of pneumothorax (PTX). This risk has led to the routine practice of admitting patients for observation to the intensive care unit (ICU) across various hospitals. However, the impact of care level, whether in the ICU or general ward, on length of stay (LOS) and postprocedural complications in BLVR patients remains unknown. This study aims to determine whether acuity of care affects LOS and postprocedural complication rates in patients who underwent BLVR. METHODS:We retrospectively reviewed 240 patients' electronic medical records, calculated median LOS, and compared factors that influence LOS in patients admitted to the pulmonary ward (PW) and the ICU. RESULTS:Our data revealed no statistically significant difference between the median LOS between patients who were admitted to the PW (median 3 days, 95% confidence interval [CI]: 3-5) versus the ICU (median 3 days, 95% CI: 3-5). Postprocedural complications, including PTX, respiratory failure, arrhythmias requiring intervention, rates of valve removal during admission, and time from identification of PTX to chest tube placement, were similar between PW and ICU. CONCLUSIONS:With structured nursing education, monitoring post-BLVR patients in a nonhigh-acuity setting appears to be a safe alternative to ICU admission in facilities that perform BLVR.
BACKGROUND:Primary spontaneous pneumothorax (PSP) is the spontaneous accumulation of air in the pleural space without any obvious reason. Although PSP typically occurs in young, thin, healthy males, the chest anthropometrics in PSP remain insufficiently explored. We aim to evaluate the chest anthropometrics and smoking habits of patients with PSP compared to healthy volunteers. METHODS:Fifty-eight adult male participants (38 PSP patients and 20 healthy volunteers) aged between 18 and 30 years were included. The study focused on thoracic anthropometric measurements, including body mass index (BMI), height, weight, circumference, sagittal, transverse diameters, and chest height. Smoking habits and place of residence were also assessed. RESULTS:Significant differences were observed between PSP patients and healthy controls in terms of weight (70.1 ± 9.7 kg vs. 78.1 ± 12.4 kg, P = 0.009) and BMI (20.9 ± 2.0 vs. 23.5 ± 3.9, P = 0.010). In addition, significant differences in thoracic sagittal diameter during inhalation (22.3 ± 2.1 cm vs. 24.0 ± 2.5 cm, P = 0.007) and exhalation (19.9 ± 2.0 cm vs. 21.4 ± 2.5 cm, P = 0.016) and transverse diameter during inhalation (30.7 ± 2.0 cm vs. 32.0 ± 2.5 cm, P = 0.037) were noted. Multivariable logistic regression analysis revealed that height, weight, and chest circumference on exhalation significantly influence PSP. CONCLUSION:PSP patients exhibit distinct thoracic anthropometric characteristics compared to healthy individuals. Although no statistically significant relationship between smoking and PSP incidence was established, a notable trend suggests that smoking may increase the risk, highlighting the need for further research on this potential association.
BACKGROUND:The absence of objective and quantitative criteria of pediatric asthma is a persistent barrier in the early diagnosis and assessment of severity. Alterations in major airway structures in individuals with asthma may indicate the severity of the disease. This study was conducted to determine the correlation between the morphologic characteristics of the respiratory tract with the degrees of the severity of asthma among the children under 3 years old. METHODS:A retrospective analysis of low-dose computed tomography (CT) data was performed to determine the potential predictive value of morphologic characteristics of big airways in determining the response to pharmacologic treatment in children with asthma <3 years of age. The analysis was performed using a machine learning approach. RESULTS:Two hundred and forty-four children with asthma were diagnosed with moderate (n = 164) and severe (n = 80) asthma by observing the drug treatment responses. When comparing across groups, patients with severe asthma displayed a greater degree of uneven wall thickness and ellipticity in the airways. This finding indicates that there are subtle alterations in the morphologic structure of big airways in children with severe asthma. In addition, the airway morphologic data were utilized to accurately classify moderate and severe cases, achieving an area under the receiver operating characteristic curve of 0.83 and an accuracy of 0.79. CONCLUSION:The morphologic characteristics of the respiratory tract are closely related to the degrees of the severity of asthma among the children under 3 years old.
BACKGROUND:Chronic obstructive pulmonary disease (COPD) exacerbations significantly affect morbidity, mortality, and healthcare costs. The Lancet Commission proposed a severity classification for COPD exacerbations, but its validation has not been performed. This study aims to assess the relationship between exacerbation severity scores, as defined by the Lancet Commission, and patient outcomes, including morbidity and mortality. METHODS:A retrospective, single-center study analyzed 240 hospitalized patients with COPD exacerbations from January 2023 to January 2024. Patients were categorized into three severity groups based on the Lancet exacerbation severity scores. Clinical and laboratory parameters, duration of hospitalization, intensive care unit (ICU) admissions, ventilatory support, and 30-day mortality rates were compared. RESULTS:Our study found that patients with the highest severity scores had significantly lower hemoglobin and hematocrit levels, higher pCO2 and urea levels, and longer hospital stays. The rates of noninvasive mechanical ventilation use, ICU admission, and mortality were notably higher in this group. In addition, hypoalbuminemia, anemia, lymphopenia, and elevated blood urea were linked to 30-day mortality in patients experiencing exacerbation. The receiver operating characteristic analysis showed an albumin cutoff of ≤33.3 g/L as predictive of mortality, with a sensitivity of 51.3% and specificity of 80.5%. CONCLUSION:This study is the first to the Lancet Commission's severity classification in COPD exacerbations. Results indicate that this scoring system can effectively identify patients at high risk for poor outcomes. Future prospective studies are necessary to refine severity assessment criteria and incorporate biochemical markers for improved prognostication and management of COPD exacerbations.
Acute respiratory distress syndrome (ARDS) is a severe clinical condition with high mortality, and effective adjunctive therapies remain limited. In recent years, continuous renal replacement therapy (CRRT) and ulinastatin have both been applied in ARDS management, but the clinical value of their combined use is still unclear. Therefore, we conducted a systematic review and meta-analysis to evaluate the efficacy of CRRT combined with ulinastatin compared with CRRT alone in patients with ARDS. A comprehensive search of 11 English and Chinese databases was performed from inception to August 29, 2025. Randomized controlled trials enrolling adult patients with ARDS and comparing CRRT plus ulinastatin versus CRRT alone were included. Mortality was the primary outcome, and secondary outcomes included intensive care unit (ICU) length of stay, mechanical ventilation time (MVT), Acute Physiology and Chronic Health Evaluation II (APACHE II) score at 7 days, oxygenation index (OI) at 7 days, and partial pressure of oxygen (PaO₂) at 7 days. Five studies involving 384 patients met the inclusion criteria. Pooled analysis showed that combination therapy significantly reduced mortality (risk ratio [RR] = 0.37, 95% confidence interval [CI] 0.23–0.60), ICU length of stay, MVT, and APACHE II scores at 7 days, and significantly improved OI and PaO₂ at 7 days compared with CRRT alone. Overall, current evidence of limited quality suggests that CRRT combined with ulinastatin may improve short-term clinical outcomes in patients with ARDS. Future rigorous, large-scale, multicenter randomized controlled trials are essential to verify these findings.
BACKGROUND: The adherence of asthma patients remains an urgent issue that needs to be addressed, and there is still a lack of tools for the rapid identification of nonadherence. METHODS: A number of factors associated with increased risk of nonadherence were compared with adherence assessed using the Medication Adherence Report Scale for Asthma (MARS-A). Among them was the tool for recognizing asthma nonadherence (TRAN), which is the ratio between the patient's perceived overall health measured using a 0-100 visual analog scale and their asthma control test score. The development set used data from a multicenter, prospective cohort study in asthma. The TRAN was then validated in a further test set of asthma patients. RESULTS: Data from 518 participants who completed 3-month follow-up formed the development set. TRAN was the best predictor of nonadherence as defined by MARS-A (odds ratio = 9.14; 95% confidence interval [CI]: 4.16, 20.10; P < 0.01) in univariate logistic regression analysis. Its area under the curve (AUC) for identifying nonadherent patients was 0.810 (95% CI: 0.753, 0.866), at a cutoff score of 1.08, its sensitivity was 82.0%, specificity was 84.4%, positive predictive value (PPV) was 55.8%, and negative predictive value (NPV) was 95.1%. In the validation group (n = 175), the AUC was 0.75 with PPV and NPV at 56.4% and 90.8%, respectively. CONCLUSION: The TRAN is a simple method for the initial screening of asthma patients for potential nonadherence.
With increasing evidence of meaningful clinical benefit in patients with advanced emphysema, bronchoscopic lung volume reduction (BLVR) using endobronchial valves (EBVs) was included in the Global Initiative for Chronic Obstructive Lung Disease report, as well as US Food and Drug Administration approval. However, bilateral BLVR using an EBV has been rarely reported. We report a case of successful and safe bilateral BLVR with staged EBV insertion. A 65-year-old male was diagnosed with chronic obstructive pulmonary disease 5 years prior and has severe heterogeneous emphysema mainly situated in the right upper lobe and left lower lobe (LLL) with giant bullae in the right middle lobe. First, we successfully inserted an EBV into the right middle bronchus, and the bullae decreased dramatically in size. After 6 months of initial valve implantation, we inserted five additional valves into the left lower bronchi of the patient. About 3 years after the secondary EBV insertion, this patient experienced hemoptysis and aggravation of dyspnea. In bronchoscopy, EBV inserted into LB6 was displaced with the formation of granulation tissue, so the EBV was removed. Later, LB6 was fully obstructed by granulation tissue. Then, we inserted an additional EBV into the LLL basal segmental bronchus, and complete atelectasis of the LLL occurred. The patient's pulmonary function, symptoms, and quality of life were further improved. BLVR can serve as a good alternative treatment for appropriately selected patients, and the procedure can be repeated on the contralateral side of the lung. It is important to recognize granulation tissue formation and deal with them appropriately.
BACKGROUND: Existing evidence suggests that regular physical activity is associated with improved outcomes in asthma. However, the impact of exercise on TH2 inflammation in patients with mild and well-controlled asthma is not well understood. This study aimed to determine if a short bout of exercise, alters serum inflammatory cytokines in obese and nonobese patients with well-controlled asthma. METHODS: Participants were categorized into three groups: normal-weight asthma (NW-A), asthma with obesity (O-A), and a control group of obesity without asthma (O-Ctrl). Serum cytokines were measured before and at the peak of a cardiopulmonary exercise and tested using a cycle ergometer. RESULTS: A total of 43 participants were included: NW-A (n = 15), O-A (n = 12), and O-Ctrl (n = 16). At baseline, the O-A group exhibited elevated levels of interleukin-5 (IL-5), IL-6, and leptin compared to the other groups. The NW-A group had higher baseline levels of IL-13 compared to the O-A group, but tumor necrosis factor-α levels were not significantly different among the groups. At peak exercise, both the O-A and NW-A groups showed reductions in plasma concentrations of IL-5, IL-6, and leptin. The O-A group showed a statistically significant increase in IL-13 levels at maximum exercise intensity, while the NW-A group did not exhibit a significant change. CONCLUSION: A short bout of exercise modifies the inflammatory cytokine profile in all participants, with the most significant changes observed in the O-A group. Future studies on exercise training should include inflammatory cytokine measurements to validate these findings and further explore the unique inflammatory responses in obese asthmatic patients.
BACKGROUND: This study aimed to investigate the impact of parenchymal infarction (PI) on the progression of pulmonary thromboembolism (PTE). METHODS: This retrospective, multicenter study evaluated patients diagnosed as having PTE via thoracic computed tomography angiography (CTA). Patients were divided into two groups, those with PI (Group 1) and those without PI (Group 2), based on CTA parenchymal windows. Clinical, demographic, radiologic, and laboratory characteristics, prognostic scores (Pulmonary embolism severity ındex [PESI]), early mortality evaluations, and 30-day mortality outcomes were recorded and compared between the groups, adhering to the European Society of Cardiology PTE guidelines. RESULTS: The study included 455 patients (mean age: 63.2 ± 16.8 years; 244 women [53.6%], 211 men [46.4%]). Group 1 consisted of 160 patients (35.2%), and Group 2 included 295 patients (64.8%). The mean age in Group 1 was 59 years, with a comorbidity rate of 70%. In Group 2, these were 65 years and 87%. Fever and C-reactive protein levels were significantly higher in Group 1 (P < 0.05). PESI scores and 30-day mortality rates were not statistically significant between the groups (P > 0.05). However, hemodynamic instability and high-risk PTE rates were significantly higher in Group 1 (P < 0.05). CONCLUSION: PI, observed in approximately one-third of PTE patients, may influence certain parameters affecting the prognosis of PTE.
