The lung is an essential organ and is dark in Computed Tomography (CT) images because of air. Lung segmentation and correct lung region separation is a prerequisite for the development of computer-aided diagnostic algorithms and disease treatment planning. However, this remains a nontrivial problem because of lung anatomical structures. Here, we addressed this problem and proposed a reliable and robust solution that is based on a histogram-based fuzzy C-means (FCM) algorithm and morphological mathematical algorithms. There were 1632 high resolution CT slices with 1 mm thickness used from asthma patients with low dose; right and left lungs were classified using the proposed algorithm. We extracted right lung regions with 96.05% accuracy and left lung regions at 96.32%. The computation time is 1.3 s per slice.

Introduction: Image segmentation has importance role for medical image analysis. Because increasing image-processing methods can provide more reliable information for the best interpretation of diseases. Therefore correct segmentation of the pathological and anatomical structures has critical importance in medical images. Additionally, CT scan interpretation requires lots of time and energy because the large number scans are generated for each patient. Method: For this reasons, in this study a robust and reliable fast algorithm was proposed for the lung segmentation from low-dose HRCT images. The images have been recruited from asthma subjects before and after two months treatment with low-dose limited HRCT scan. HRCT scans were collected in full inspiration for all patients, who were performed with stable and mild moderate asthma. Fuzzy Cmeans method, which is based on image histogram, was used in this study. Algorithm was evaluated on 20 asthma patients. Conclusion: The accuracy is approximately 93.7% and it takes almost a second for each slice. In future studies we are planning to study airway segmentation and measure airway values before and after treatment.

Asthma is a chronic lung disease, which inflames and affects the airways, airway wall thickening, and lung density. In this study; we built up an automatic computerized method for the evaluation of the airway dimensions for asthma patients from low-dose 2D axial HRCT scans. Our proposed method concludes two frameworks. At first, right and left lung was eliminated from other structures. In the second step airway segmentation has been done using region growing and ellipse fitting method. Algorithm was evaluated on 10 mild asthma severity patients before and after drug using treatment and results were compared with respiratory function. We conclude that HRCT is a useful tool for airways evaluation in asthma patients. Because HRCT might be more sensitive for evaluate airway involvement, which is associated with airflow obstruction and diseases severity.

Obstructive sleep apnea (OSA) leads to upper respiratory tract obstruction, causing increased abdominal-gastric pressure and decreased lower esophageal sphincter (LES) pressure and thus gastroesophageal reflux (GER). Continuous positive airway pressure (CPAP) is known to be an effective method for OSA treatment, but its effect on GER is still controversial. There are a very few studies investigating CPAP and GER relationship and performed based on pre- and post-treatment objective parameters of GER in patients with OSA. The study investigated the effect of CPAP treatment in patients with moderate and severe OSA without GER complaints on pre- and post-treatment objective GER parameters. The study included 25 patients with respiratory disturbance indices >15 without reflux symptoms who had undergone polysomnography at sleep laboratory. Age, sex, body mass index (BMI), waist, and neck circumference of the patients were documented. DeMeester score, LES pressure, and polysomnography parameters were evaluated pre- and post-CPAP. The results were statistically evaluated, and p value <0.05 is considered significant. Out of 25 patients, 21 were male (84 %) and mean age was 49.2 ± 8.6 (range 31–66). At the pre-CPAP phase, mean sphincter pressure was 22.2 ± 1.2 (range 8–73), and mean DeMeester score was 18 ± 15.5 (range 0.2–57). At the post-CPAP, mean sphincter pressure was 22.9 ± 1.6 (range 9–95), and mean DeMeester score was 16.3 ± 14.8 (range 0.2–55). No significant difference (p > 0.05) was found comparing pre-CPAP and post-CPAP measurements. Objective criteria show that CPAP treatment does not cause reflux in patients with OSA. Unlike studies reported in the literature, this conclusion has been reached by pre- and post-CPAP assessments.

Background: Obstructive sleep apnea syndrome (OSAS) has a negative effect on peripheral nerve functions. There are few studies regarding this issue. The aim of the study is to investigate peripheral nerve functions via electromyography (EMG) in patients with OSAS. Methods: Respiratory Disturbance Index (RDI) was determined via polysomnography. There were 21 patients in the OSAS group (RDI≥5) and 10 individuals in the control group (RDI<5). Conventional sensory and motor conduction studies were performed on the upper and lower extremities via EMG. Results: The right median and ulnar sensory nerve action potential (SNAP) and the right tibial, left tibial, and left median compound muscle action potential (CMAP) amplitude measurements were significantly lower in the OSAS patients when compared to the control group (p<0.01). There was a significant negative correlation between the RDI and the right median and ulnar SNAP and right tibial CMAP amplitudes. There was a significant positive correlation between the average oxygen saturation and the right median, left median, and ulnar SNAP and the right tibial CMAP amplitude measurements. Conclusions: Results indicate that the axonal damage due to night desaturations increased in those with OSAS.

There is a well-known relationship between sleep quality and body position during sleep in patients with obstructive sleep apnea (OSA). In this study, we aimed to investigate the effects of body position on sleep architecture and sleep quality in subjects without sleep apnea. One hundred and one subjects between 24 and 77 years of age, who had undergone polysomnography and had a respiratory disturbance index (RDI) below 5 were included in the study. Sleep stages and sleep parameters in the right, left, supine and prone positions were examined. Mean sleep duration in S2, S3 and rapid eye movement (REM) were 110, 39 and 20.7 min in supine position and 61, 28 and 17 min in right position, respectively. Mean RDI at supine position was higher than other positions. Mean minimal oxygen saturation at supine position was significantly lower than other positions. Maximal heart rate and mean arousal index were significantly higher in the supine position. Duration of sleep was highest in the right position in those older than 60 years. Subjects with 40–60 years age had higher duration of sleep in right and supine positions. Female subjects slept more in supine position whereas male ones slept more in right position. Stages of sleep may change according to position. Deteriorations in the parameters of sleep quality (RDI, lowest saturation, arousal index, heart rate) occur in individuals with RDI < 5 as well as in patients with OSA in the supine position.

INTRODUCTION:Ventilator-associated pneumonia (VAP) is an important cause of mortality and morbidity in critically ill patients. We sought to determine the prognostic value of procalcitonin (PCT) and C-reactive protein (CRP) kinetics in critically ill patients who developed VAP.METHODS:Patients who were admitted to the intensive care unit (ICU) and developed VAP were eligible. Patients were followed for 28 days after the pneumonia diagnosis and blood samples for PCT and CRP were collected on the day of the pneumonia diagnosis (D0), and days 3 (D3) and 7 (D7) after the diagnosis. Patients were grouped as survivors and non-survivors, and the mean PCT and CRP values and their kinetics were assessed.RESULTS:In total, 45 patients were enrolled. Of them, 22 (48.8%) died before day 28 after the pneumonia diagnosis. There was no significant difference between the survivor and non-survivor groups in terms of PCT on the day of pneumonia diagnosis or CRP levels at any point. However, the PCT levels days 3 and 7 were significantly higher in the non-survivor group than the survivor group. Whereas PCT levels decreased significantly from D0 to D7 in the survivor group, CRP did not. A PCT level above 1 ng/mL on day 3 was the strongest predictor of mortality, with an odds ratio of 22.6.CONCLUSION:Serum PCT was found to be a superior prognostic marker compared to CRP in terms of predicting mortality in critically ill patients who developed VAP. The PCT level on D3 was the strongest predictor of mortality in VAP.

BACKGROUND AND AIMS:Ankylosing spondylitis (AS) is a multisystem disorder with ocular, pulmonary, and cardiovascular involvement. The incidence of pulmonary involvement varies from 1 to 52%. Abnormal T-cell function-derived immune responses are involved in AS pathogenesis. Numerous genes such as CTLA4 and CD28 control T-cell functions. In this study, we aimed to address the relationship between CTLA4 and CD28 polymorphisms and lung involvement in Turkish patients with AS.METHODS:A cross-sectional evaluation of 80 healthy and 89 AS subjects with no active infection or malignancy was performed to determine the relationship between pulmonary involvement and CTLA4 and CD28 gene polymorphisms. All patients were assessed for clinical, radiological, and spirometric findings. Descriptive statistics, chi-square tests, and independent-sample t-tests were used for statistical analyses.RESULTS:All patients with the CD28 CC genotype (n = 4) had abnormal HRCT, but it was not significant (p = 0.47). All of the normal HRCT patients have CD 28 T alleles. In addition to this data ; 4 patients who have not any T alleles have abnormal HRCT finding. It was significant and was considered that T genotype have protective effect (p= 0,047) on radiologic involvement but no other association was found between CTLA4 and CD28 gene polymorphism with respect to pulmonary function tests (PFT), diffusion capacity, and clinical characteristics in the Turkish patients with AS.CONCLUSION:Our results suggest a possible association of CTLA4 and CD28 variants with AS pulmonary involvement. Furthermore, these results may lead to the development of new therapeutic agents to control more aggressive forms of the disease. However, further studies are needed in larger populations.

The objective of our study was to investigate the renal functions on admittance, chronic disease status, the diagnosis on admittance to the intensive care unit (ICU), need for mechanical ventilation and medication groups and their impact over mortality and renal replacement treatment (RRT) requirement in geriatric patients with and without known acute kidney injury (AKI) at the time of admittance.

Ankylosing spondylitis is a multisystemic disorder with ocular, pulmonary, and cardiovascular involvement. Data from AS patients who have amyloidosis, psoriasis suggest that immunologic or inflammatory mechanisms may be responsible for pathogenesis.Incidence of pulmonary involvement is 1 to 70%,but pathophysiology is still unknown.We aimed to address the relationship between CTLA4 and CD28 polymorphism in AS patients who have lung involvement.Enrolled were 80 controls and 89 AS patients diagnosed according to the Modified New York Criteria in the Physical Medicine and Rehabilitation Department of the Rheumatology Outpatient Clinic.CTLA4 and CD28 polymorphism analysis and clinical,radiological assessment were performed. We found a correlation between HRCT findings and CD 28 gene polymorphism,but no significant association was detected between CTLA4-318,CTLA4-49 and CD28 genotypes and the clinical characteristics of the patients. All patients with the CD28 CC genotype had abnormal HRCT to a statistically significant degree(p=0.047)but no other correlation was found between CTLA 4, CD28 gene polymorphism, and PFTs and clinical characteristics.

OBJECTIVEWe examined brain diffusion changes of patients with acromegaly. We searched whether there are differences in apparent diffusion coefficient (ADC) and fractional anisotropy (FA) values between remission and non-remission patients with acromegaly and investigated any effect of time of hormone exposure on diffusion metrics.METHODSThe values of FA and ADC were calculated in a total of 35 patients with acromegaly and 28 control subjects. Patients were subdivided into remission and non-remission groups. We looked at brain FA and ADC differences among the groups and looked for any relation between the diffusion changes and time of hormone exposure among the patients with acromegaly.RESULTSWe found decreased FA and increased ADC values in some of the growth hormone responsive areas. There were no significant brain diffusion changes between remission and non-remission groups. The most affected areas were the hypothalamus, parietal white matter and pre-motor cortex in patients with acromegaly. In terms of hormone exposure time among the patients with acromegaly, there was no effect of disease duration on brain microstructural changes.CONCLUSIONAll patients with acromegaly showed increased brain diffusion with no relation to disease duration and treatment status. We suggested that in patients with acromegaly, brain damage had already occurred in the subclinical period before symptom onset.ADVANCES IN KNOWLEDGEThis study contributes to the understanding of the mechanisms in acromegaly.

Chronic obstructive pulmonary disease (COPD) is a serious disease with morbidity and mortality due to delayed diagnosis until significant symptoms arise. We aimed to assess the utility of spirometry and COPD Assessment Test (CAT) in detecting undiagnosed COPD patients in a localized area.

Purpose. We investigated diffusion alterations in specific regions of the brain in morbid obese, obese, and nonobese OSA patients and searched whether there is a correlation between BMI and ADC values. Materials and Methods. DWIs of 65 patients with OSA were evaluated. The patients were classified according to BMI as morbid obese (n = 16), obese (n = 27), and nonobese (control, n = 22) groups. ADC measurements were performed from 24 different regions of the brain in each patient. The relationship of BMI with ADC values was searched. Results. The ADC values in hypothalamus, insular cortex, parietal cortex, caudate nucleus, frontal white matter, and posterior limb of internal capsule were all increased in obese patients (n = 43) compared to control group. The ADC values of midbrain, hypothalamus, orbitofrontal cortex, and parietal cortex were significantly increased in morbid obese compared to obese patients. In obese patients, the degree of BMI was positively correlated with ADC values of orbitofrontal cortex, parietal cortex, and hypothalamus. Conclusion. We observed increasing brain vasogenic edema with increasing BMI, suggesting that the main reason of brain diffusion alteration in patients with OSA could be obesity related.

Sarcoidosis is a multisystemic, granulomatous disease with particular involvement in the lungs and intrathoracic lymph nodes.The prevalence of pleural fluid occurs in 0-5% of the cases in the literature.Diagnosis depends on non-caseating granulomas in biopsy and the exclusion of other possible reasons.A 26year-old male admitted with cough and left sided chest pain.Physical examination was normal except a decrease in respiratory sounds at left hemithorax.Chest x-ray showed bilateral hilar enlargement, pleural fluid in the left hemithorax, and non-homogenous density in the left upper zone.Video-assisted thoracosopic surgery (VATS) was performed because the patient couldn't tolerate bronchoscopy.Histopathological examination of samples reported nonnecrotizing granulomatous inflammation.Methylprednisolone (0.5 mg/kg/day) was started.Regression of lymphadenopathies, pleural effusion and paranchymal opacities were present at the 5th month of therapy.This case emphasizes the possibility of sarcoidosis in patients with pleural effusion, even in places where tuberculosis prevalence is high.

Plastic bronchitis is a rare disease characterized by chronic cough, dyspnea, airway obstruction, and expectorating rubber-like secretions.This entity is mostly seen in children predominantly in association with an underlying congenital heart disease.We present an adult case who was treated for asthma for two years and finally diagnosed with plastic bronchitis via bronchoscopy.

Mucormycosis is an opportunistic fungal infection that is rare but has a fatal course, occurs especially in patients with immunodeficiency, and is caused by fungi in the Zygomycetes class. Since the infection is generally caused by inhalation of spores, mostly the paranasal sinuses and lungs are affected. Diabetes mellitus and hematologic malignancies are the most common underlying diseases. It usually initiates like bacterial pneumonia, and its clinical and radiologic findings are nonspecific. Thus, a high index of suspicion is necessary. Combined medical and surgical treatment methods are recommended. We aimed to present a case of pulmonary mucormycosis with a course of endobronchial involvement.

Cardiac involvement in sarcoidosis has been associated with poor prognosis. We evaluated myocardial contractility quantitatively in a cohort of pulmonary sarcoidosis (PS) patients with and without cardiac involvement. We also studied markers of fibrosis (tenascin-C [Tn-C] and galectin-3 [Gl-3]) as diagnostic tools for PS and cardiac sarcoidosis (CS).

BACKGROUND:Vaspin and lipocalin-2 are less-known recent members of adipocytokine family. There are ongoing studies investigating the role of vaspin ve lipocalin-2 in metabolic syndrome (MS). Obstructive sleep apnea syndrome (OSAS) is independently associated with an increased prevalence of MS. We aimed to measure the levels of vaspin and lipocalin-2 which are secreted from adipocytes in patients with severe OSAS and examine the relationship between these two adipocytokines and OSAS.METHODS:THE STUDY CONSISTED OF TWO GROUPS: severe OSAS patients with an apnea-hypopnea index (AHI) of >30/h (OSAS group, 34 subjects) and age-matched healthy volunteers with a AHI <5/h (control group, 25 subjects) Serum levels of vaspin and lipocalin-2 in these two groups were compared.RESULTS:Serum levels of vaspin were significantly lower in OSAS group; patients with severe OSAS compared with control group; healthy volunteers (OSAS group: 0.69±0.5 vs. control group: 1.24±1.13; P=0.034). The difference between the two groups in terms of serum levels of lipocalin-2 has not reached statistical significance (OSAS group: 61.6±18.2 vs. control group: 68.5±20.1; P=0.17).CONCLUSIONS:We found that serum vaspin levels were significantly lower in patients with severe OSAS compared with healthy controls. Lipocalin-2 levels were similar. The decrease in serum vaspin levels in severe OSAS patients may be important in diagnosis and follow-up of these patients.

INTRODUCTION:Very little known with the differences of fractional exhaled nitric oxide (FENO) according to genders and the published data is controversial. We aimed to investigate whether the FENO levels differ according to gender in healthy subjects. METHOD: Sixtyfive male and 65 female subjects within 18-65 years old never smoked and have no chronic air way disease were included. FENO, bodypletsymography and spirometry were performed.RESULTS:Distribution of FENO levels and other parameters according to gender is shown Table-1. FENO, BMI, Body surface area(BSA), weight, height, FVC, FEV1, TLC, PEF were significantly higher in males. Age, gender, BSA were associated with FENO in univariate lineer regression analysis. In models with multiple linear regression analysis; age, gender and BSA were associated with FENO. CONCLUSION:The difference between males and females should be kept in mind when evaluating the FENO levels.

OBJECTIVES: Obesity is a chronic disease that impacts all age groups worldwide and leads to serious health problems, such as obstructive sleep apnea syndrome (OSAS). Bariatric surgery is a treatment option for patients with both OSAS and obesity who fail to lose weight. The efficacy of bariatric surgery in morbidly obese patients with OSAS was evaluated.MATERIAL AND METHODS: Twenty-six patients for whom obesity surgery was planned were enrolled. All subjects underwent overnight polysomnography (PSG) preoperatively and postoperatively within 8.35 (+/- 2.31) months. OSAS symptoms and sleep parameters were evaluated.RESULTS: Symptoms were evaluated preoperatively and postoperatively in patients with (17, 65.4%) and without (9, 34.6%) OSAS. PSG results and sleep parameters were evaluated preoperatively and postoperatively in patients with OSAS (17/ 26) and those who completed the follow-up. All sleep parameter values for respiratory disturbance index (RDI), rapid eye movement (REM) RDI, non-REM RDI, apnea index (AI), and 3% oxyhemoglobin desaturation index were improved significantly (p<0.05).CONCLUSION: Bariatric surgery may be another treatment option for morbidly obese patients with OSAS that is to be used together with other treatments, such as non-invasive mechanical ventilation.