RATIONALE:Excess weight contributes to impaired physical function among individuals with chronic obstructive pulmonary disease (COPD) and sleep apnea. Self-directed lifestyle-based weight management programs are an accessible option to promote weight loss and improve physical function, but their effectiveness has not been clearly demonstrated. OBJECTIVE:To test whether a self-directed lifestyle program improves 6-minute walk test (6MWT) distance among individuals with COPD and comorbid sleep apnea. STUDY DESIGN AND METHODS:We performed a subset analysis of participants previously enrolled in the INSIGHT-COPD randomized clinical trial (low-intensity lifestyle intervention vs usual care) who self-reported a diagnosis of sleep apnea. Our primary outcome was between-group differences for change in 6MWT distance (minimally important difference [MID] 30 m). Secondary outcomes included between-group differences in weight (a loss of 3% defines meaningful reduction) and quality of life (SF-12 Physical Component Score [PCS], MID 3-3.5 points). We also tested whether sleep apnea modified the effect of the intervention across the entire INSIGHT-COPD population. MEASUREMENTS AND MAIN RESULTS:Among 285 participants with sleep apnea (141 randomly allocated to intervention, 144 to usual care), those randomized to intervention could walk further (difference in 6MWT distance of 25.5 m, 95% CI 8.2 m to 42.9 m; 23.4% vs 20.1% had a MID increase in 6MWT distance) and had a greater reduction in weight (difference in weight of -2.4 kg, 95% CI -3.9 to -0.9 kg; 36.2% vs 23.6% had a 3% reduction in weight) at 12 months. The intervention group also reported a greater physical-function-related quality of life (difference in SF-12 PCS of 1.78 pts, 95% CI 0.10 to 3.49) in comparison to usual care at 12 months. CONCLUSIONS:Among patients with COPD and sleep apnea, a self-directed video-based weight management program led to favorable changes in 6MWT distance compared to usual care, though this did not meet the threshold of a clinically important improvement. However, fewer participants in the intervention group saw a decline in 6MWT distance, and more achieved meaningful weight loss. To effectively improve function in this population, additional interventions beyond self-directed weight management will be necessary.Clinical trial registered with www.clinicaltrials.gov (NCT02634268).

The successful management of lung cancer patients requires timely and accurate disease diagnosis, through peripheral lesion analysis, and effective disease staging, through comprehensive central-chest lymph node staging. The state-of-the-art approach for performing follow-on diagnosis and staging procedures entails minimally invasive bronchoscopy. Because bronchoscopy is challenging, the medical device community has embarked on a massive ongoing effort to create assisted bronchoscopy systems. Unfortunately, current systems suffer from many drawbacks: they do not enable sufficiently accurate peripheral lesion diagnosis; they offer no guidance for nodal staging across both lungs; and they offer no guidance for supplemental devices typically needed during a procedure; they tend to subject a patient to significant radiation from supplemental imaging devices and demand long procedure times. As a step toward mitigating these drawbacks, we have devised two complementary turnkey subsystems for peripheral lesion analysis and central-chest lymph node staging, both of which had been previously tested in phantom, animal, and human feasibility studies. We now present a prospective patient study for the combined system for lung cancer diagnosis and staging within the context of the live clinical workflow. We also compare the results of this study to a historical controls patient cohort performed at our University's medical center. Results indicate that our guidance system has the potential to enable far faster peripheral lesion bronchoscopies and nodal staging bronchoscopies, in comparison to the historical cohort. Also, the guidance system can potentially enable more efficient and accurate use of radial endobronchial ultrasound for peripheral lesions, without needing to resort to a radiation-intensive confirmational imaging modality, while also enabling the examination of substantially more nodal sites. With a mean joint procedure time under 10 minutes, the system could help realize more efficient and effective lung cancer diagnosis/staging bronchoscopies.

Rationale: Excess weight contributes to impaired physical function among individuals with chronic obstructive pulmonary disease (COPD) and comorbid sleep apnea. Self-directed lifestyle-based weight management programs are an accessible option to promote weight loss and improve physical function, but their effectiveness in this population is unclear. We sought to test whether a self-directed lifestyle program improves 6-minute walk test (6MWT) distance among individuals with COPD and comorbid sleep apnea. Methods: INSIGHT-COPD was a randomized trial to test whether a self-directed video-based lifestyle intervention would lead to better physical function in participants with excess weight and COPD. We performed a retrospective subset analysis restricted to participants with a self-reported clinician-diagnosis of sleep apnea. Our primary outcome was between-group differences for change in 6MWT distance, which we measured using a linear mixed effects model. We also assessed secondary outcomes including weight and SF-12 physical function related quality of life. Finally, we assessed whether participants met meaningful thresholds for improvement and decline in 6MWT distance (30m) and weight loss (5% total body weight) using generalized linear regression models for binary outcomes. Results: Among the 684 participants randomized in INSIGHT-COPD, 285 had self-reported sleep apnea (141 randomized to intervention, 144 to control). At 12 months, those randomized to intervention could walk further relative to those randomized to control (adjusted between group difference for 6MWT distance +25.5 m [95% CI 8.2-42.9 m] for individuals with OSA in the intervention group compared to the control group). We did not observe a between-group difference in the likelihood of achieving meaningful improvement in 6MWT distance, though fewer intervention participants experienced a meaningful decline in 6MWT (Figure). Intervention participants also experienced a greater reduction in weight, (adjusted between-group difference of -2.4 kg, 95% CI -3.9 to -0.9 kg) and were more likely to experience meaningful weight loss (Figure). Participants in the intervention arm also experienced greater improvements in physical-function related quality-of-life (adjusted between-group difference: SF-12 PCS 1.78 pts, 95% CI 0.10 to 3.49. Conclusions: Among individuals with COPD and self-reported sleep apnea, a self-directed video-based weight management intervention did not lead to clinically meaningful improvements in 6MWT distance relative to usual care. However, fewer participants experienced a meaningful reduction in 6MWT distance, and a greater proportion of participants in the intervention group experienced clinically meaningful weight loss. Additional interventions beyond self-directed weight management will be needed to meaningfully improve function among patients with COPD and comorbid sleep apnea.

Early detection of lung cancer is crucial as it significantly improves survival rates by facilitating timely and effective treatment. Lung cancer often begins as bronchial lesions developing along the airway walls. Bronchoscopy is the minimally invasive method of choice for detecting such lesions. Currently, three complementary bronchoscopic video modalities have been utilized for this purpose: white-light bronchoscopy (WLB), narrow-band imaging (NBI), and autofluorescence bronchoscopy (AFB). Unfortunately, current practice forces the clinician to manually examine each video source and later interactively correlate the results of these exams to make final lesion decisions. Because of the lack of effective tools for multimodal endoscopic video analysis, this proves to be an extremely time-consuming, error-prone process, making it impractical for common clinical use. To address this problem, we propose a multimodal video analysis and synchronization system that enables efficient analysis of multimodal bronchoscopic videos for early cancer lesion detection. The system provides methods for planning and guiding a straightforward multimodal airway exam through the major airways. Subsequent video processing methods then draw on deep-learning-based techniques to identify candidate single-mode bronchial lesions. Next, a synchronization/registration pipeline registers all bronchoscopic video data to a reference 3D airway tree model derived from a patient's X-ray computed tomography (CT) scan. This finally facilitates interactive graphical visualization and interaction with all processed multimodal data. Results with lung cancer patient studies indicate the system's promise for efficient, effective video analysis and lesion detection.

Objectives To examine changes in cardiovascular disease (CVD) risk factors, lung function and clinical laboratory markers among people who smoke who used e-cigarettes to reduce their cigarette smoking.Design Four-arm, parallel-group, double-blind, randomised placebo-controlled trial.Setting Two sites—Virginia Commonwealth University (Richmond, Virginia, USA) and Penn State University, College of Medicine (Hershey, Pennsylvania, USA).Participants Adults (n=520) aged 21–65 years who smoked at least 10 cigarettes per day, had an expired-air carbon monoxide reading of >9 parts per million at baseline and were interested in reducing their cigarette consumption.Interventions E-cigarettes with 0, 8 or 36 mg/mL nicotine liquid concentration or a cigarette substitute.Primary outcome measures CVD risk factors (blood lipids, C-reactive protein, blood pressure, heart rate, waist-to-hip ratio, body mass index and INTERHEART risk score), lung function (spirometry indices, and pulmonary symptoms and functional state using the Clinical Chronic Obstructive Pulmonary Disorder Questionnaire), and other clinical laboratory markers (complete blood count and complete metabolic panel).Results At 6 months, the use of nicotine e-cigarettes caused no significant between-group differences for most measures. However, participants randomised to the 36 mg/mL e-cigarette condition had significantly higher levels of high-density lipoprotein (HDL) (p=0.003 unadjusted, p=0.002 adjusted) and lower levels of low-density lipoprotein (LDL) (p=0.044 adjusted) and cholesterol/HDL ratio (p=0.034 unadjusted, p=0.026 adjusted) compared with the cigarette substitute condition. Also, those in the 36 mg/mL e-cigarette condition had higher HDL levels than those in the 0 mg/mL condition (p=0.016 unadjusted, p=0.019 adjusted).Conclusions Participants randomised to the highest nicotine e-cigarette condition showed modest improvements in some measures of blood lipids (eg, increased HDL, and reduced LDL and cholesterol/HDL ratio) as compared with a non-aerosol cigarette substitute among individuals attempting to reduce their cigarette smoking. Future studies of e-cigarettes for smoking cessation would benefit from including these measures to further explore the results found in this study.Trial registration number NCT02342795.

Introduction:Few people undertake residential testing for radon, despite its known impact on lung cancer risk. Motivated by new parents' interest in residential hazards, the Pennsylvania Department of Environmental Protection's Newborn Radon Testing Project distributes free radon testing vouchers to new parents. Impacts on radon testing are unknown. Methods:The authors evaluated the Newborn Radon Testing Project (2002-2023) utilizing the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework. Data came from project records as well as Pennsylvania Department of Health Birth Statistics. The authors analyzed outcomes according to Reach, Effectiveness, Adoption, Implementation, and Maintenance. Results:Among 3,093,704 babies delivered in Pennsylvania hospitals from 2002 to 2023, 24,165 (0.78%) parents requested radon testing kits through the project (Reach). Of these, 11,556 (47.7%) completed the kits, and 41.8% had radon above 4 picocuries per liter, including 18.2% with very elevated radon (>10.0 picocuries per liter) (Effectiveness). Among eligible hospitals, 87 of 107 (81%) partnered with the project (Adoption), and average program costs were $14,507 per year or $29 per analyzed kit (Implementation). Conclusions:The Newborn Radon Testing Project holds promise for identifying homes with elevated indoor radon levels. Efforts are needed to increase participation and monitor remediation among new parents.

BACKGROUND:Individuals with Ehlers-Danlos Syndromes (EDS) and Generalized Hypermobility Spectrum Disorder (G-HSD) experience musculoskeletal joint instability, cardiopulmonary manifestations, and functional limitations with online exercise resources commonly utilized. This study characterizes and assesses the content, quality, and readability of websites addressing exercise training for individuals with EDS/G-HSD. METHODS:The first 350 English websites were Googled using search terms "Ehlers-Danlos Syndrome and exercise" and "Ehlers-Danlos Syndrome and physical activity," targeting educational/instructional sites on exercise training for adults with EDS/G-HSD. Content was assessed using scientific consensus criteria, quality using Modified DISCERN, Global Quality Scale (GQS), and the Patient Education Materials Assessment Tool (PEMAT), and readability using Flesch-Kincaid Grade Level (FKGL) and Flesh-Reading Ease Scores (FRES). RESULTS:78/350 unique websites were included, most from industry organizations (37%) and personal commentary (24%). The mean content score was moderate 13.8 ± 4.4/25. The content most discussed included: short/long-term benefits of muscle strength, resistance training, and generalized exercise safety considerations. Median modified DISCERN and GQS scores were 4/5 IQR [3-4] and 3/5[2.3-4], respectively. Mean PEMAT understandability and actionability scores were 85% ± 12% and 69% ± 23%, respectively. Average FKGL was 11.0 ± 2.7 and FRES was 43.6 ± 7.2. Moderate-strong Spearman correlations were observed between total content scores and GQS (rho = 0.76) and DISCERN (rho = 0.52), p < 0.001 for both. CONCLUSION:Website content varied, most addressing general safety recommendations and multiple training modalities. While quality was moderate-to-good, future resources should focus on simplified language, actionable guidance, and visual aids. Incorporating practical examples of daily activities, injury prevention strategies, broader benefits like cardiovascular health, and psychological support can empower safe and confident exercise training.

Introduction/Rationale: Familial pulmonary fibrosis (FPF) represents a subset of idiopathic pulmonary fibrosis cases, but the genetic basis for only a fraction of FPF patients has been determined. We report genetic analyses and phenotypes of a multigenerational cohort with early onset FPF. We further describe an unanticipated skin abnormality not previously reported and strictly linked to affected individuals. Methods: Clinical diagnosis and phenotyping included longitudinal chest computerized tomography, serial pulmonary function testing, thoracic lung biopsies, bronchoalveolar lavage and skin biopsies. Microarray analysis and genome sequencing were used to generate polymorphic profiles of the cohort. Skin punch biopsies were obtained from visually normal skin 4-6 cm below the midclavicular line and processed for histology, immunohistochemistry and isolation of fibroblasts for cell culture. Results: Affected family members displayed atypical parenchymal features as early as age 21, including ground-glass opacities, nodules and early cystic changes suggesting surfactant dysfunction. Progressive fibrosis and respiratory failure led to lung transplantation at age 32, 39 and 46 for three family members with a fourth referred for transplant evaluation at age 32. A fifth family member had mild interstitial changes detected at age 57 concurrent with a diagnosis of lung cancer. Additionally, several family members from previous generations died of FPF. Genetic analysis identified genomic regions on chromosomes 7, 10 and 17 that segregate only to affected family members as well as a rare variant in the SFTPA2 gene present in the affected members but also in several unaffected members. Variants in SFTPA2 have been previously linked to FPF. The variant causes a V187M substitution in the globular domain of the encoded Surfactant Protein A2 (SP-A2). Family members with early onset FPF showed an unusual separation of the skin epidermis, abnormal deposition of elastin as evidenced by pentachrome staining, poor growth of fibroblasts in vitro, and lack of SP-A staining in epithelial cells. Family members with the V187M substitution but without clinical fibrosis did not show the abnormal skin phenotypeConclusion: These results implicate a variant in SFTPA2 as contributing to FPF and suggest other genomic regions may collaborate with this variant to cause disease. We further observed strict linkage of the pulmonary disease in this family with a novel extrapulmonary skin phenotype consisting of epidermal detachment. Further investigation of the role that the specific genetic domains play in the pathogenesis of these abnormalities may lead to new strategies for early identification and intervention.

PurposeLung cancer remains the leading cause of cancer death. This has brought about a critical need for managing peripheral regions of interest (ROIs) in the lungs, be it for cancer diagnosis, staging, or treatment. The state-of-the-art approach for assessing peripheral ROIs involves bronchoscopy. To perform the procedure, the physician first navigates the bronchoscope to a preplanned airway, aided by an assisted bronchoscopy system. They then confirm an ROI's specific location and perform the requisite clinical task. Many ROIs, however, are extraluminal and invisible to the bronchoscope's field of view. For such ROIs, current practice dictates using a supplemental imaging method, such as fluoroscopy, cone-beam computed tomography (CT), or radial endobronchial ultrasound (R-EBUS), to gather additional ROI location information. Unfortunately, fluoroscopy and cone-beam CT require substantial radiation and lengthen procedure time. As an alternative, R-EBUS is a safer real-time option involving no radiation. Regrettably, existing assisted bronchoscopy systems offer no guidance for R-EBUS confirmation, forcing the physician to resort to an unguided guess-and-check approach for R-EBUS probe placement—an approach that can produce R-EBUS placement errors exceeding 30 deg, an error that can result in missing many ROIs. Thus, because of physician skill variations, biopsy success rates using R-EBUS for ROI confirmation have varied greatly from 31% to 80%. This situation obliges the physician to turn to a radiation-based modality to gather sufficient information for ROI confirmation. We propose a two-phase registration method that provides guidance for R-EBUS probe placement.ApproachAfter the physician navigates the bronchoscope to the airway near a target ROI, the two-phase registration method begins by registering a virtual bronchoscope to the real bronchoscope. A virtual 3D R-EBUS probe model is then registered to the real R-EBUS probe shape depicted in the bronchoscopic video using an iterative region-based alignment method drawing on a level-set-based optimization. This synchronizes the guidance system to the target ROI site. The physician can now perform the R-EBUS scan to confirm the ROI.ResultsWe validated the method's efficacy for localizing extraluminal ROIs with a series of three studies. First, for a controlled phantom study, we observed that the mean accumulated position and direction errors (accounting for both registration phases) were 1.94 mm and 3.74 deg (equivalent to 1.30 mm position error for a 20 mm biopsy needle), respectively. Next, for a live animal study, these errors were 2.81 mm and 4.79 deg (2.41 mm biopsy needle error), respectively. For 100% of the ROIs considered in these two studies, the method enabled visualization of an ROI via R-EBUS in under 3 min per ROI. Finally, initial operating-room tests on lung cancer patients indicated the method's efficacy, functionality, efficiency, and safety under standard clinical conditions.ConclusionsThe method offers a quick, low-cost, radiation-free approach for examining peripheral extraluminal ROIs using R-EBUS. Although our studies focused on R-EBUS as the supplemental working channel instrument, the proposed method has general applicability to any clinical bronchoscopic task requiring a working channel instrument. Thus, the method has the potential to improve the efficiency and efficacy of bronchoscopic procedures for lung cancer patients.

Background:The Pulmonary Fibrosis Foundation Care Center Network (PFF-CCN) provides expertise in the diagnosis and management of interstitial lung diseases (ILDs); however, most centers are in urban areas. Little is known about access to ILD care for patients living in rural areas. Research Question:What are the perspectives of PFF-CCN providers on the accessibility and provision of ILD care for rural patients? Study Design and Methods:A mixed methods survey designed by the Pulmonary Fibrosis Foundation Rural Health Outreach Committee was distributed with weekly reminders to all 68 PFF-CCN sites between November 2021 and February 2022 through REDCap. The survey included 21 closed-ended questions that were analyzed using descriptive statistics and 3 open-ended questions that underwent thematic analysis. Before coding, free text responses were reviewed, and nearly all were sorted into 1 of 2 groups: barriers or facilitators to ILD care. Responses were then coded inductively and sorted into categories, followed by themes drawn from the data. Only 1 survey per PFF-CCN site was analyzed. Results:A total of 68 PFF-CCN sites (providers) completed the survey (100% response rate). Of these, 57% of providers perceived that rural patients often experience delays in diagnosis compared with their urban counterparts, and 47% perceived they often have delays in ILD treatment. The following 3 themes emerged as barriers to ILD care for rural patients: poor access to care (73% of all coded barriers), limited resources (23%), and patient preferences and concerns (3%). Three themes emerged as facilitators to ILD care: local collaboration (49% of all coded facilitators), telemedicine (30%), and patient-centered care (21%). Interpretation:PFF-CCN providers identified several important barriers and facilitators to care for rural patients with ILD occurring at the patient, provider, and health care system levels.

The formation of bronchial lesions along the airway walls (mucosa) is known to be a potential indicator of early lung cancer. White-light bronchoscopy (WLB) has long been the standard minimally invasive modality for identifying bronchial lesions. To do this, the physician performs a procedure known as bronchoscopy, examining the major airways to interactively locate suspect lesion sites. Unfortunately, past clinical studies have established that such an exam demands a time-consuming, careful inspection of the lengthy incoming WLB video stream. Because suspect lesions are typically distinguished from normal background regions by subtle differences, many lesions are easily missed in the video stream, resulting in lesion detection rates as low as 29% in past clinical studies. The recent introduction of high-definition (HD) WLB offers the potential for more detailed airway wall imaging, thereby offering a potentially more informative data source for identifying lesions. Nevertheless, the physician still must rely on interactive inspection to identify lesions. We consider deep learning approaches for automating the process of analyzing WLB video. In particular, we develop an HD WLB ground truth dataset and apply this dataset to a series of deep learning models to the problem of automatic bronchial lesion detection and segmentation. In our study, the best model achieved 97% detection accuracy and a Dice score of 0.54 for lesion segmentation.

Little is known about differences in interstitial lung disease (ILD) diagnosis by geographic location. The aim of this study is to evaluate differences in cross-sectional ILD diagnosis between patients in urban and rural areas. Methods: This is a retrospective analysis of participants (n = 1992) in the Pulmonary Fibrosis Foundation (PFF) Patient Registry. Diagnoses were grouped as follows: idiopathic pulmonary fibrosis (IPF); idiopathic interstitial pneumonia other than IPF (IIP, non-IPF); connective tissue disease-associated ILD (CTD-ILD); fibrotic hypersensitivity pneumonitis (fibrotic HP); exposure-related ILD; and other ILDs. Patient-reported zip codes were mapped to county Federal Information Processing Series (FIPS) codes using data from U.S. Department of Housing and Urban Development (HUD). Frequencies of ILD diagnoses were compared between urban and rural groups using two-sample Z-test with 0.05 significance level. County-level variables including occupation and fuel use were then compared by ILD diagnosis using analysis of variance (ANOVA) with 0.05 significance level. Results: Median age at consent was 69 years, 63 % were male, and 89.5 % were white. By county classification, 12 % resided in a rural area. Rates of IPF, IIP (non-IPF), and CTD-ILD diagnosis were similar between urban and rural residents, however rates of fibrotic HP and exposure-related ILD were higher among rural residents. Residence in a county with coal fuel use or wood fuel use was higher among those with exposure-related ILD (p < 0.0001 and p = 0.0001, respectively). Conclusion: ILD diagnoses differ in urban versus rural ILD patients, with fibrotic HP and exposure-related ILD being significantly more prevalent among residents in rural areas. Type of fuel use also was associated with fibrotic HP and exposure-related ILD.

Early detection of lung cancer allows for more effective treatment and helps increase the likelihood of patient survival. This fact has inspired the search for biomarkers that can help indicate disease development and cancer risk. One important minimally invasive method for identifying potential biomarkers entails performing an airway exam using bronchoscopy. More specifically, autofluorescence bronchoscopy (AFB) is notable for its high sensitivity in detecting candidate early cancer lesions along the airway wall. The task of performing an AFB airway exam to identify such lesions, however, proves to be very tedious, error prone and overly dependent on physician skill. This is due to the lack of sufficient tools to facilitate efficient, accurate analysis of the airway exam's video stream. We propose an integrated interactive system for autofluorescence bronchoscopy. The system takes a patient's three-dimensional (3D) chest computed tomography (CT) scan and a live bronchoscopy video stream as inputs and provides the following capabilities: 1) guidance assistance for performing the airway exam; 2) automatic video analysis to produce real-time detection and segmentation of candidate lesions; 3) subsequent lesion tracking over the video sequence to identify key frames that denote the most representative locations of detected lesions; 4) visualization and interaction tools to view lesion detection outcomes and to make final lesion confirmation decisions; 5) graphical tools for showing a detected lesion's precise anatomical location within the 3D airway tree. Through these capabilities, the system has the capacity to deliver a comprehensive assessment of suspect lesions throughout an AFB airway exam. Utilizing the exam videos and CT scans from lung cancer patients, we demonstrate the potential of our system for real-time, systematic analysis of a patient's major airways.

Background Our simulations previously predicted focal areas of gaseous pollutant dose delivered to the airway mucosa of a patient with idiopathic pulmonary fibrosis (IPF). We hypothesize a relation between these dose predictions and clinically meaningful endpoints in IPF which link toxicant-driven epithelial injury and disrepair to IPF etiology and pathogenesis. Objective To determine associations between patient-specific modeling of tracheal geometry, computer simulations of toxicant dose, and lung histopathology in patients with IPF. Methods The first three conducting airway generations of ten patients diagnosed with IPF were reconstructed from their high-resolution CT chest scans. We quantified geometric abnormalities of the reconstructed tracheas based on their curvature and eccentricity (cross-sectional flattening), and performed three-dimensional computer simulations to predict the average and upper values (i.e. hotspots) of reactive toxicant dose to the underlying mucosa. Distal biopsy tissue samples were characterized by epithelial cell phenotype, extent of fibrosis, and histopathologic severity scores. Non-parametric correlation analysis examined associations between these descriptors. Results Computed values for curvature and eccentricity of IPF-deformed trachea varied widely among patients and correlated with more subjective rankings of tracheal deformation, and with predicted toxicant dose. Overall histopathologic severity was positively correlated with tracheal deformation and upper decile toxicant uptake. Tracheal curvature was significantly correlated with fibroblastic foci. Conclusions These results demonstrate an association of tracheal curvature with predicted toxicant dose and with histopathologic indicators in distal tissue. This suggests that these measures may be predictors of risk for acute IPF exacerbations, subsequent clinical deterioration, and disease progression.

Narrow-band imaging (NBI), a relatively new bronchoscopy technology, offers superior visualization of vascular details in lesion areas along the airway walls compared to standard white light bronchoscopy. This empowers physicians to detect suspect lesions and characterize their underlying vascular structures for further indications of cancerous activity. Unfortunately, the bronchoscopic video stream suffers from blurring artifacts due to device and patient motions, resulting in low-resolution visualization of lesion areas. To address this problem, we present an image enhancement method for NBI bronchoscopy to improve: 1) visualization of vascular structures; 2) lesion detection; and 3) vessel segmentation. We adapted Real-ESRGAN, a single-image super-resolution network, to enhance bronchoscopic images in real-time. This involved a transfer learning approach to fine-tune a pre-trained model using our public NBI bronchial lesion database. The results, derived from bronchoscopic airway exam videos of 10 lung cancer patients, demonstrate significant improvement in the visual quality of super-resolved frames, particularly in vascular regions. Our quantitative analysis further shows enhanced vessel segmentation and lesion detection accuracy, with increased confidence scores. This method offers a practical, real-time solution for improving the diagnostic utility of NBI bronchoscopy by providing clearer, more detailed images. Thus, we integrated the method into an NBI video analysis system for aiding in the early detection and characterization of bronchial lesions.

Idiopathic Pulmonary Fibrosis (IPF) is a chronic, progressive disease of unknown origin. Establishing the epidemiology of IPF has been challenging due to diagnostic complexity, poor survival, low prevalence, and heterogeneity of ascertainment methodologies. This research aimed to estimate the rates of IPF in central and western Pennsylvania and to pilot the use of capture recapture (CR) methods to estimate the disease incidence. We identified adults ≥ 30 years old diagnosed with IPF (by ICD-9/10 coding) between 2013 to 2021 from two health systems (UPMC Health System and Penn State Health) participating in the PaTH Clinical Research Network. We extracted information on patients’ sex, race, date of birth and 3-digit zip code from electronic health records (EHR). Incidence rate of IPF among Pennsylvania residents was calculated using three case definitions (broad and two restricted) and piloted the use of CR in estimating IPF incidence. IPF incidence rates were 8.42, 6.95 and 4.4 per 100,000 person-years for the unrestricted (n = 3148), partially restricted (n = 2598) and fully restricted (n = 1661) samples, respectively. Low case overlap between two sites resulted in a highly inflated estimate of IPF incidence, using the CR methodology. The rate of IPF in central and western Pennsylvania was similar to previously published statistics. The application of CR to IPF epidemiology could be further investigated in health systems with greater overlap of patients utilizing more than one system.

ABSTRACT Introduction The health effects of dual use of electronic cigarettes (e-cigarettes) and combustible cigarettes are unclear. We report on differences in cardiovascular disease (CVD) risk factors, lung function, and clinical laboratory markers among people who smoke used e-cigarettes to reduce their cigarette smoking in a randomized placebo-controlled trial. Methods Participants (n=520) who regularly smoked cigarettes were randomized to 1 of 4 conditions (e-cigarette device paired with liquid containing 0, 8, or 36 mg/mL of nicotine or a cigarette-substitute [CS]) and encouraged to reduce their smoking over 6 months. Group differences were assessed between the e-cigarettes and CS conditions at baseline and 6-month using one-way ANOVA and linear mixed-effects model. Multi-testing adjustment was not applied as the analysis was exploratory in nature. Primary outcomes were: CVD risk (i.e., blood lipids, C-reactive protein, blood pressure, heart rate, waist-to-hip ratio, body mass index, and INTERHEART risk score), lung function (i.e., spirometry indices and clinical COPD questionnaire), and other clinical laboratory markers (i.e., complete blood count and complete metabolic panel). Results At 6-month, use of nicotine e-cigarettes caused no significant differences from control groups for most measures. However, participants randomized to 36 mg/mL e-cigarettes had significantly higher levels of high-density lipoprotein (HDL) (p=0.003 in unadjusted analysis,p=0.002 in adjusted analysis), and lower levels of low-density lipoprotein (LDL) (p=0.044 in adjusted analysis) and cholesterol/HDL ratio (p=0.034 in unadjusted analysis,p=0.026 in adjusted analysis) as compared to CS. Also, those in the 36 mg/mL e-cigarette condition had higher levels of HDL as compared to those in 0 mg/mL condition (p=0.016 in unadjusted analysis,p=0.019 in adjusted analysis). Conclusions Those randomized to the highest nicotine e-cigarettes had small improvement in some measures of blood lipids (e.g., increased HDL, and reduced LDL and cholesterol/HDL ratio) as compared to a non-aerosol CS among individuals attempting to reduce their cigarette smoking. Future studies of e-cigarettes for smoking cessation would benefit from including these measures to further explore the results found in this study. Trial Registration ClinicalTrials.gov,NCT02342795. Strengths and limitations of this study The use of a randomized double-blind placebo-controlled trial design with two nicotine concentrations and a relatively long follow-up period (6 months). Use of an additional randomized control group who did not use an electronic cigarette device, but were given a “cigarette substitute” product with no aerosol but similar behavioral requirements. Participants had to be daily cigarette smokers with no plans to quit smoking, but an interest in reducing, and were recruited from two U.S. sites. The results may only be generalizable to similar populations. These were exploratory analyses of a comprehensive group of commonly used clinical markers, rather than hypothesis-driven primary outcomes. These results therefore provide a preliminary assessment of effects that may inform future studies.

Purpose: Early detection of cancer is crucial for lung cancer patients, as it determines disease prognosis. Lung cancer typically starts as bronchial lesions along the airway walls. Recent research has indicated that narrow-band imaging (NBI) bronchoscopy enables more effective bronchial lesion detection than other bronchoscopic modalities. Unfortunately, NBI video can be hard to interpret because physicians currently are forced to perform a time-consuming subjective visual search to detect bronchial lesions in a long airway-exam video. As a result, NBI bronchoscopy is not regularly used in practice. To alleviate this problem, we propose an automatic two-stage real-time method for bronchial lesion detection in NBI video and perform a first-of-its-kind pilot study of the method using NBI airway exam video collected at our institution. Approach: Given a patient's NBI video, the first method stage entails a deep-learning-based object detection network coupled with a multiframe abnormality measure to locate candidate lesions on each video frame. The second method stage then draws upon a Siamese network and a Kalman filter to track candidate lesions over multiple frames to arrive at final lesion decisions. Results: Tests drawing on 23 patient NBI airway exam videos indicate that the method can process an incoming video stream at a real-time frame rate, thereby making the method viable for real-time inspection during a live bronchoscopic airway exam. Furthermore, our studies showed a 93% sensitivity and 86% specificity for lesion detection; this compares favorably to a sensitivity and specificity of 80% and 84% achieved over a series of recent pooled clinical studies using the current time-consuming subjective clinical approach. Conclusion: The method shows potential for robust lesion detection in NBI video at a real-time frame rate. Therefore, it could help enable more common use of NBI bronchoscopy for bronchial lesion detection. (c) 2024 Society of Photo-Optical Instrumentation Engineers (SPIE)

For patients at risk of developing either lung cancer or colorectal cancer, the identification of suspect lesions in endoscopic video is an important procedure. The physician performs an endoscopic exam by navigating an endoscope through the organ of interest, be it the lungs or intestinal tract, and performs a visual inspection of the endoscopic video stream to identify lesions. Unfortunately, this entails a tedious, error-prone search over a lengthy video sequence. We propose a deep learning architecture that enables the real-time detection and segmentation of lesion regions from endoscopic video, with our experiments focused on autofluorescence bronchoscopy (AFB) for the lungs and colonoscopy for the intestinal tract. Our architecture, dubbed ESFPNet, draws on a pretrained Mix Transformer (MiT) encoder and a decoder structure that incorporates a new Efficient Stage-Wise Feature Pyramid (ESFP) to promote accurate lesion segmentation. In comparison to existing deep learning models, the ESFPNet model gave superior lesion segmentation performance for an AFB dataset. It also produced superior segmentation results for three widely used public colonoscopy databases and nearly the best results for two other public colonoscopy databases. In addition, the lightweight ESFPNet architecture requires fewer model parameters and less computation than other competing models, enabling the real-time analysis of input video frames. Overall, these studies point to the combined superior analysis performance and architectural efficiency of the ESFPNet for endoscopic video analysis. Lastly, additional experiments with the public colonoscopy databases demonstrate the learning ability and generalizability of ESFPNet, implying that the model could be effective for region segmentation in other domains.