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Background: Infant pulmonary function tests (iPFTs) in subjects with neuroendocrine cell hyperplasia of infancy (NEHI) have demonstrated substantial expiratory airflow obstruction and air trapping.Research Question: Can indices from iPFTs be used in the diagnosis of NEHI?Study Design and Methods: This is an observational case-control study evaluating iPFT results from a registry of patients assessed at the Hadassah Hebrew University Medical Center between 2008 and 2018. iPFTs results in infants with NEHI were compared to two disease control infant groups (infants evaluated for recurrent wheezing and infants evaluated due to prematurity) and a spirometry control group of infants with normal expiratory airflow, using the Kruskal-Wallis test. Receiver operating characteristic (ROC) curves were used to assess the diagnostic accuracy of iPFT indices.Results: We evaluated iPFT data in 481 infants (15, NEHI; 292, wheezing; 128, premature; and 46, spirometry control group). Infants with NEHI had significantly increased trapped air volumes (median functional residual capacity measured with infant whole-body plethysmography [FRCpleth] was 199% predicted; median ratio of residual volume to total lung capacity was 59% predicted) when compared with results in all evaluated groups of infants (P < .001), including multiple pairwise comparisons. Airflow limitation was demonstrated in infants with NEHI when compared with the infants in the spirometry control group but was similar to the two disease control groups. FRCpleth had the best discriminatory ability for NEHI diagnosis, with an FRCpleth ≥ 150% predicted demonstrating a ROC of 0.91 (95% CI, 0.82-1.00), sensitivity of 86.7% (95% CI, 59.5%-98.3%), and specificity of 95.5% (95% CI, 93.2%-97.3%).Interpretation: Findings on iPFTs of markedly increased air trapping, out of proportion to the degree of airflow limitation, are characteristic of infants with NEHI. iPFT results demonstrating an FRCpleth ≥ 150% predicted are highly specific for NEHI and may aid in early diagnosis. Further research is required to confirm these findings in a prospective cohort and to understand the pathophysiologic explanation for these findings. [ABSTRACT FROM AUTHOR]

At the 2020 "Luftschlösser" (castles in the air) conference, experts from a wide range of pneumological fields discussed technical innovations in pneumology, which can be seen in many different areas of the field, including e-health, screening, diagnostics, and therapy. They contribute to substantial advancements ranging from the innovative use of diagnostic tools to novel treatments for chronic lung diseases. Artificial intelligence enables broader screening, which can be expected to have beneficial effects on disease progression and overall prognosis. There is still a high demand for clinical trials to investigate the usefulness and risk-benefit ratio. Open questions remain especially about the quality and utility of medical apps in an inadequately regulated market. This article weighs the pros and cons of technical innovations in specific subspecialties of pneumology based on the lively exchange of ideas among various pneumological experts. [ABSTRACT FROM AUTHOR]

Le pyoderma gangrenosum (PG) est une affection rare, essentiellement dermatologique, dont l'atteinte pulmonaire inhabituelle et peu connue, constitue un défi diagnostique et thérapeutique. Un homme, âgé de 66 ans, suivi depuis 6 ans pour une gammapathie monoclonale IgA de signification indéterminée et un PG corticodépendant initialement cutané, avait une pneumonectomie pour une masse suspecte de néoplasie se révélant être une localisation pulmonaire du PG. Lors des pneumopathies successives parfois dyspnéisantes et excavées, plusieurs hypothèses, parfois associées, sont évoquées. Diverses explorations infectieuses et immunologiques, et diverses thérapeutiques anti-bactériennes/fongiques ou immunosuppressives sont conduites, pour finalement conclure à des récidives pulmonaires et/ou cutanées du PG. L'évolution à 14 mois semble finalement favorable sous tofacitinib. La reconnaissance de l'atteinte cutanée du PG, essentielle au diagnostic de son atteinte pulmonaire, en constitue probablement le miroir évolutif sous traitement. Seules des confrontations multidisciplinaires des cas rapportés permettront l'élaboration de recommandations diagnostiques et thérapeutiques. Pyoderma gangrenosum (PG) is a rare, mainly dermatological condition, whose unusual and little-known lung involvement presents a diagnostic and therapeutic challenge. A 66-year-old man, followed for 6 years for an IgA monoclonal gammopathy of undetermined significance and an initially cutaneous corticosteroid-dependent PG, received a pneumonectomy for a mass suspected of neoplasia, that turns out to be a PG pulmonary localisation. During successive pneumopathies, sometimes dyspneic and excavated, several hypotheses are discussed. Various infectious and immunological explorations, and various antibacterial/fungal or immunosuppressive therapies are conducted, to finally conclude to pulmonary and/or cutaneous recurrences of PG. The outcome at 14 months seems finally favourable with tofacitinib. The recognition of cutaneous involvement of PG, which is essential for the diagnosis of its lung involvement, is probably the mirror of its evolution under treatment. Only multidisciplinary confrontation of reported cases will allow the elaboration of diagnostic and therapeutic recommendations. [ABSTRACT FROM AUTHOR]

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Rationale: Real-life pharmacological treatment patterns of patients with interstitial lung diseases (ILD) remain elusive. Objectives: To determine how often and with what medications patients with ILD are treated in Canadian tertiary care clinics. Methods: All patients with ILD prospectively enrolled in the Canadian Registry for Pulmonary Fibrosis were included in this observational study. All first instances of medication for each patient were compiled. The time between the diagnosis of ILD and the first initiation of an ILD-related medication was compared across diagnostic categories. Cox proportional hazards models were used to identify variables associated with time-to-treatment initiation, stratified by diagnostic category. Results: Out of 2,652 patients, a total of 1,483 (56%) were treated with an ILD-related medication during the median follow up of 3.0 years (1.4-5.9), including 349/646 (54%) patients with idiopathic pulmonary fibrosis (IPF) who received an antifibrotic. Patients with IPF were treated earlier and in greater proportion than those with non-IPF ILD (P = 0.001). Male sex and lower lung function were associated with shorter time-to-treatment initiation in the full cohort. Conclusions: Overall, 56% of patients with ILD seen across seven Canadian specialized ILD clinics received pharmacological treatment over a median follow up of 3 years. Further studies are needed to assess longitudinal patterns of treatment and their influence on key outcomes. [ABSTRACT FROM AUTHOR]

Rationale: A central strategy of tuberculosis (TB) control in the United States is reducing the burden of latent TB infection (LTBI) through targeted testing and treatment of persons with untreated LTBI. Objectives: The objective of the study was to provide estimates of and risk factors for engagement in LTBI care in the overall U.S. population and among specific risk groups. Methods: We used nationally representative data from 7,080 participants in the 2011-2012 National Health and Nutrition Examination Survey. Engagement in LTBI care was assessed by estimating the proportion with a history of testing, diagnosis, treatment initiation, and treatment completion. Weighted methods were used to account for the complex survey design and to derive national estimates. Results: Only 1.4 million (10%) of an estimated 14.0 million individuals with an LTBI had previously completed treatment. Of the 12.6 million who did not complete LTBI treatment, 3.7 million (29%) had never been tested and 7.2 million (57%) received testing but had no history of diagnosis. High-risk groups showed low levels of engagement, including contacts of individuals with TB and persons born outside the United States. Conclusions: There is a reservoir of more than 12 million individuals in the United States who may be at risk for progression to TB disease and potential transmission. TB control programs and community providers should consider focused efforts to increase testing, diagnosis, and treatment for LTBI. [ABSTRACT FROM AUTHOR]

Aims: Surgical and bronchoscopic treatments are tried to reduce hyperinflation together with medical treatments in patients with chronic obstructive pulmonary disease (COPD) and emphysema. Therefore, bronchoscopic lung volume reduction (BLVR) procedures can improve the success of treatment and quality of life of patients. Methods: We investigated the efficacy and safety of BLVR treatment retrospectively. Demographic characteristics, modified Medical Research Council (mMRC) and COPD assessment test (CAT) questionnaires, 6-minute walking distance (6-MWD) and all pulmonary function tests of the patients, who were treated with BLVR, were examined. The values before the procedure and the values at the third and sixth months after the procedure were analyzed statistically. Results: Twenty-five patients were examined (one was female). Six patients (59±10.4 years, forced expiratory volume in 1 s (FEV1) 21.7±5.7% pred) were bronchoscopically treated with coils, with a median of 9.33 (range 8-11) coils per procedure. Nineteen patients (65.8±6 years, FEV1 26.9±9% pred) were treated with valves, with a median 3.52 (range 3-4) valves per patient. At 3 and 6 months, respectively, ΔCAT was -4.8±6 and -7.5±7.2 points, Δ6-MWD was +103.4±139 m and +160.8±149 m [endobronchial valve (EBV)], ΔFEV1 was +0.15±0.3 L and +0.21±0.3 L, ΔFVC was +0.44±0.7 L and +0.5±0.7 L, (all p<0.05), and ΔRV (residual volume) was -0.52±1.1 L and 0.32±1.5 L (p<0.05). Conclusions: In our study, BLVR (EBV and coil) treatments were used in patients with severe to very severe emphysema in COPD, in appropriate indications and in selected cases, and statistically significant well-being was observed in spirometric parameters in the first six months after the procedure. [ABSTRACT FROM AUTHOR]

We report a case of pulmonary cysticercosis manifesting as a mass lesion. Cysticercosis confined to lungs is a rare manifestation of human cysticercosis. The disease mainly affects the central nervous system, skeletal muscles, and eyes. Pulmonary involvement is rare and usually presents as bilateral pulmonary nodules. The diagnosis was made based on positive enzyme-linked immunosorbent assay (ELISA) for anticysticercal antibodies, and the patient was started on antiparasitic therapy along with steroids. Symptomatic and radiological improvement was seen. There is no previous case report of isolated pulmonary cysticercosis presenting as mass lesion. [ABSTRACT FROM AUTHOR]

Pulmonary hemorrhage (PH) is a pathology associated with significant morbidity and mortality, particularly among preterm infants in the NICU. The diagnosis is made when hemorrhagic secretions are aspirated from the trachea concurrent with respiratory decompensation that necessitates intubation or escalated support. The implementation of mechanical ventilation and widespread exogenous surfactant administration have significantly reduced respiratory morbidities. However, when PH develops, death remains the most common outcome. Treatment for PH remains primarily supportive; thus, a thorough understanding of underlying disease processes, manifestations, diagnostic testing, and current evidence is vital to enable early identification and proactive management to reduce morbidity and mortality. [ABSTRACT FROM AUTHOR]

Idiopathic pulmonary fibrosis (IPF) is characterized by the invariably progressive deposition of fibrotic tissue in the lungs and overall poor prognosis. TG2 (transglutaminase 2) is an enzyme that crosslinks glutamine and lysine residues and is involved in IPF pathogenesis. Despite the accumulating evidence implicating TG2 as a critical enzyme, the causative function and direct target of TG2 relating to this pathogenesis remain unelucidated. Here, we clarified the distributions of TG2 protein/activity and conducted quantitative proteomics analyses of possible substrates crosslinked by TG2 on unfixed lung sections in a mouse pulmonary fibrosis model. We identified 126 possible substrates as markedly TG2-dependently increased in fibrotic lung. Gene ontology analysis revealed that these identified proteins were mostly enriched in the lipid metabolic process, immune system process, and protein transport. In addition, these proteins were enriched in 21 pathways, including phagosome, lipid metabolism, several immune responses, and protein processing in endoplasmic reticulum. Furthermore, the network analyses screened out the six clusters and top 20 hub proteins with higher scores, which are related to endoplasmic reticulum stress and peroxisome proliferator-activated receptor signals. Several enriched pathways and categories were identified, some of which were the same terms based on transcription analysis in IPF. Our results provide novel pathological molecular networks driven by protein crosslinking via TG2, which can lead to the development of new therapeutic targets for IPF. [ABSTRACT FROM AUTHOR]

Objective: Interstitial lung disease (ILD) is a frequent complication of systemic sclerosis (SSc), and ILD screening, characterization, and monitoring are important for therapeutic decision-making and prognostication. Lung ultrasonography (US) is a potential alternative imaging modality for ILD detection. In this study, our objective was to develop and test a novel lung US examination technique and interpretation criteria for detecting SSc-ILD.Methods: Lung US acquisition was performed by collecting short US movies at 14 lung positions. Lung US interpretation criteria for SSc-ILD detection focused on visualized pleural changes. To assess the performance of our methodology for SSc-ILD detection, we prospectively enrolled SSc patients with high-resolution computed tomography (HRCT) imaging within 3 months of lung US. Lung US examinations were scored independently by 2 blinded readers (1 ultrasonographer and 1 nonultrasonographer). The sensitivity and specificity for SSc-ILD detection were assessed, and agreement was measured with Cohen's kappa statistic.Results: To test the performance of our lung US acquisition technique and interpretation criteria, 20 SSc patients were evaluated by lung US (278 lung zones) and HRCT. HRCT confirmed ILD in 9 patients (45%). Lung US was positive for SSc-ILD in 11 patients (55%) with a sensitivity of 100% and specificity of 82% versus HRCT, with perfect agreement between the 2 readers (κ = 1). Analysis by individual lung zones found excellent agreement between readers, with 93.8% concordance and κ = 0.82.Conclusion: We developed a novel lung US examination technique and interpretation criteria that are highly sensitive and specific for SSc-ILD detection in an SSc cohort, affording perfect agreement between ultrasonographer and nonultrasonographer readers. [ABSTRACT FROM AUTHOR]

Case Presentation: A 29-year-old woman who is a never smoker and has a medical history of systemic hypertension presented with a 3-week history of generalized fatigue and dry cough. She endorsed sicca symptoms of dry eyes and dry mouth. She denied breathlessness, fever, chills, night sweats, or weight loss. She had no heartburn, postnasal drip, joint pain, swelling, or skin lesions. She had no known lung disease or history of pneumothorax. Her family history was unremarkable. [ABSTRACT FROM AUTHOR]

An estimated 58 million people have survived tuberculosis since 2000, yet many of them will suffer from post-tuberculosis lung disease (PTLD). PTLD results from a complex interplay between organism, host, and environmental factors and affects long-term respiratory health. PTLD is an overlapping spectrum of disorders that affects large and small airways (bronchiectasis and obstructive lung disease), lung parenchyma, pulmonary vasculature, and pleura and may be complicated by co-infection and haemoptysis. People affected by PTLD have shortened life expectancy and increased risk of recurrent tuberculosis, but predictors of long-term outcomes are not known. No data are available on PTLD in children and on impact throughout the life course. Risk-factors for PTLD include multiple episodes of tuberculosis, drug-resistant tuberculosis, delays in diagnosis, and possibly smoking. Due to a lack of controlled trials in this population, no evidence-based recommendations for the investigation and management of PTLD are currently available. Empirical expert opinion advocates pulmonary rehabilitation, smoking cessation, and vaccinations (pneumococcal and influenza). Exacerbations in PTLD remain both poorly understood and under-recognised. Among people with PTLD, the probability of tuberculosis recurrence must be balanced against other causes of symptom worsening. Unnecessary courses of repeated empiric anti-tuberculosis chemotherapy should be avoided. PTLD is an important contributor to the global burden of chronic lung disease. Advocacy is needed to increase recognition for PTLD and its associated economic, social, and psychological consequences and to better understand how PTLD sequelae could be mitigated. Research is urgently needed to inform policy to guide clinical decision-making and preventative strategies for PTLD. [ABSTRACT FROM AUTHOR]

Purpose: We aimed to evaluate various diffusion and dynamic contrast-enhanced magnetic resonance imaging (DCE MRI) parameters in differentiating malignant from benign pulmonary lesions. Methods: We enrolled 31 (22 males) patients who had solid pulmonary lesion(s) >2 cm in our cross sectional study. Of these, 23 (74.2%) were found to be malignant on histopathology. Dynamic contrast-enhanced MRI was performed using 36 dynamic measurements (volumetric interpolated breath-hold examination). Diffusion-weighted MRI (DW MRI) performed at b value of 800 s/mm2. We measured different diffusion and perfusion parameters, for example, diffusion-weighted imaging (DWI) SI, mean apparent diffusion coefficient (ADC), minimum ADC, lesion-to-spinal cord ratio, DWI score, T2 score, Ktrans, Kep, and Ve. We stratified values of each parameter as high if it was >median of values observed in our data set and low if it was ≤median. Normally distributed data were compared by unpaired t test, whereas non-normal continuous data were compared by Kruskal Wallis-H test. We applied Wilson score method to calculate sensitivity, specificity, and predictive values of parameters that were statistically significant by type of lesion with reference to histopathological examination as gold standard. Results: Diffusion-weighted imaging SI, mean ADC, minimum ADC, DWI score and Ktrans values were found to be significantly different (P value <.05) by type of lesion. Ktrans was found to have the highest diagnostic accuracy (74.2%) among these parameters. Conclusion: Ktrans and mean ADC had similar sensitivity of 65.2%. However, Ktrans had highest diagnostic accuracy among various DWI and DCE MRI parameters in predicting malignancy in solid pulmonary lesions. In our study, we found a cutoff value 0.251 min−1 for Ktrans as 100% specific. [ABSTRACT FROM AUTHOR]

Strict control of iron homeostasis is critical for the maintenance of normal lung function. Iron accumulates in the lungs of patients with idiopathic pulmonary fibrosis (PF), but the characteristics of iron metabolism in the pathogenesis of PF and related targeting therapeutics are not well studied. In this study, we investigated the cellular and molecular characteristics of iron metabolism in fibrotic lungs and further explored the efficacy of clioquinol (CQ) for the treatment of PF as well as its functional mechanism. Iron aggregates accumulated in the lungs of patients with idiopathic PF, and FTL (ferritin light chain) transcripts were increased in their pulmonary fibroblasts. In the bleomycin (BLM)-induced PF (BLM-PF) mouse model, pulmonary iron accumulation is a very early and concomitant event of PF. Labile iron pool levels in both fibroblasts and macrophages from the BLM-PF model were elevated, and iron metabolism was dysregulated. CQ attenuated PF induced by BLM and FITC, and iron-saturated CQ did not alleviate BLMPF. Furthermore, CQ inhibited the activation of fibroblasts, including proliferation, fibrotic differentiation, proinflammatory cytokine secretion, and migration. In conclusion, our study demonstrated that CQ, acting as an iron chelator, attenuates experimental PF through inactivation of fibroblasts, providing support for targeting iron metabolism as a basis for PF treatment. [ABSTRACT FROM AUTHOR]

Rationale: Disease activity in idiopathic pulmonary fibrosis (IPF) remains highly variable, poorly understood, and difficult to predict. Objectives: To identify a predictor using short-term longitudinal changes in gene expression that forecasts future FVC decline and to characterize involved pathways and cell types. Methods: Seventy-four patients from COMET (Correlating Outcomes with Biochemical Markers to Estimate Time-Progression in IPF) cohort were dichotomized as progressors (≥10% FVC decline) or stable. Blood gene-expression changes within individuals were calculated between baseline and 4 months and regressed with future FVC status, allowing determination of expression variations, sample size, and statistical power. Pathway analyses were conducted to predict downstream effects and identify new targets. An FVC predictor for progression was constructed in COMET and validated using independent cohorts. Peripheral blood mononuclear single-cell RNA-sequencing data from healthy control subjects were used as references to characterize cell type compositions from bulk peripheral blood mononuclear RNA-sequencing data that were associated with FVC decline. Measurements and Main Results: The longitudinal model reduced gene-expression variations within stable and progressor groups, resulting in increased statistical power when compared with a cross-sectional model. The FVC predictor for progression anticipated patients with future FVC decline with 78% sensitivity and 86% specificity across independent IPF cohorts. Pattern recognition receptor pathways and mTOR pathways were downregulated and upregulated, respectively. Cellular deconvolution using single-cell RNA-sequencing data identified natural killer cells as significantly correlated with progression. Conclusions: Serial transcriptomic change predicts future FVC decline. An analysis of cell types involved in the progressor signature supports the novel involvement of natural killer cells in IPF progression. [ABSTRACT FROM AUTHOR]

Despite widespread use of antiretroviral therapy (ART), people with HIV (PWH) continue to suffer substantial morbidity and mortality from pulmonary diseases. We sought to evaluate the prevalence of pulmonary symptoms, evaluations, and diagnoses (both infectious and noninfectious) among PWH receiving care at one of the largest HIV clinics in the United States. All PWH seen at the Infectious Disease Program in Atlanta, Georgia, from July 2013 to June 2018 were included. Multivariable logistic regression was used to assess the odds of all-cause mortality. Among 8387 patients, median age was 48 years, 35% had documented smoking, 74% were male, and the 47% with ≥1 pulmonary symptom or diagnosis were older and had higher rates of smoking compared to those without any symptoms or diagnoses (p-values <0.0001). Percent on ART was 97% and 81% for individuals with and without symptoms or diagnoses, respectively (p-value <0.0001). Patients with an infectious diagnosis were more likely to have a diagnostic test ordered than those with a noninfectious diagnosis (p-value <0.0001). After adjustment for demographic and clinical risk factors, odds of death were 2.1 times greater [95% confidence interval (CI) = 1.3–3.5] among those with a pulmonary symptom or diagnosis compared to those without. Despite a high prevalence of pulmonary symptoms and diagnoses in this large cohort of PWH, many did not have a complete diagnostic evaluation, particularly those with noninfectious diagnoses. Greater awareness of evaluation and treatment of noninfectious pulmonary diseases among HIV care providers will be critical to improving long-term outcomes for PWH. [ABSTRACT FROM AUTHOR]

Background: Ultrasound is a portable and adaptable imaging modality used widely in the care of trauma patients. The initial exam, known as the "Focused Assessment in Trauma (FAST) exam focused on the evaluation for hemoperitoneum and hemopericardium. In recent years, the exam has expanded to include evaluate for thoracic pathology, including pneumothorax, and is now known as the "Extended Focused Assessment in Trauma" (E-FAST) exam. Methods: We reviewed after-action reviews (AAR) from the Joint Trauma System Prehospital Trauma Registry from 2013-2014 in which the use of an ultrasound exam was noted. Given the largely unstructured nature of the AARs, we selected relevant information from the free text available. Results: Our initial dataset contained 705 casualties, of which we identified 45 cases containing the key words with AAR data for review: 39 cases involved the use of the FAST exam, three explicitly described the use of pulmonary ultrasound and they were categorized as E-FAST exams, two cases described the use of point of care echo to evaluate for cardiac standstill, and two cases described the use of ultrasound to evaluate for vascular injury. Of those with vital signs documented, 25% (11) reported at least one episode of tachycardia (=120/min) and 16% (7) with at least one episode of systolic hypotension (<90mmHg). Of the 45 cases reviewed, six were recorded as equivocal, which we interpreted to indicate more training in either performance or interpretation of the exam was needed. Conclusions: Our findings suggest that training in both the FAST exam and E-FAST has the potential to improve patient care for military trauma patients. A performance improvement system would enable real-time confirmation of findings and feedback for training and quality improvement. [ABSTRACT FROM AUTHOR]

Background: Competence in ultrasonography is essential for pulmonary and critical care medicine (PCCM) fellows, but little is known about fellow-reported barriers to acquiring this crucial skill during fellowship training.Research Question: How do PCCM fellows acquire experience performing and interpreting ultrasonography during their training, what is their perspective on barriers to acquiring ultrasound expertise during fellowship, and what is their comfort with a range of ultrasound examinations?Study Design and Methods: A 20-item survey including questions about procedural training and acquisition of ultrasound skills during PCCM fellowship was developed. The survey instrument was sent to PCCM fellowship program directors to distribute to their fellows at program directors' discretion.Results: Four hundred seventy-five responses were received. The most common method of learning ultrasonography was performing it independently at the bedside. Fellows reported that the greatest barrier to acquiring ultrasound skills was the lack of trained faculty experts, followed by lack of a formal curriculum. Fellow comfort was greatest with thoracic ultrasound and least with advanced cardiac ultrasound.Interpretation: Significant barriers to ultrasound training during PCCM fellowship exist, and future educational efforts should address these barriers at both program and institutional levels. [ABSTRACT FROM AUTHOR]

Background: The LungVision system is a novel augmented‐fluoroscopy‐based real‐time navigation and guidance technology for bronchoscopy that can be integrated with any standard biopsy tool, including the cryoprobe, to enable real‐time visualization and localization of pulmonary nodules. Objectives: To evaluate the diagnostic yield and safety among patients undergoing peripheral pulmonary nodule biopsy with the LungVision system. Methods: This prospective, single‐center study was conducted at Rabin Medical Center in Israel. All patients that underwent peripheral pulmonary nodule biopsy with the LungVision system from January 2016 to August 2020 were included. All procedures were performed under moderate sedation. The primary outcome was tissue diagnosis by either identification of malignant cells or benign diagnosis. Secondary outcomes were safety and the added value of cryobiopsy. Results: Sixty‐three procedures were performed during the study period. Median lesion size (interquartile range) was 25.0 mm (18–28 mm). The diagnostic yield overall was 27/33 (81.8%) and for lesions smaller than 20 mm was 13/18 (72.2%). In nine cases the transbronchial cryobiopsy showed tissue with malignant cells that were not found in any other biopsy material taken with other sampling tools. One patient was treated with a chest tube for a pneumothorax. No other major complications were reported. Conclusions: The LungVision system showed good feasibility and safety for peripheral pulmonary nodule biopsy. The system is compatible with all biopsy tools, including the cryoprobe. Randomized controlled trials are needed to accurately ascertain its diagnostic yield. [ABSTRACT FROM AUTHOR]

Current estimates indicate that 50 million people are infected with food-borne trematodes. This is a significant public health problem but still a neglected tropical disease because the burden of disease is in rural areas where health care is limited. Traditional ingestion of raw or poorly cooked food contaminated by unrestrained defecation maintains the cycle of disease, and school-age children bear the predominant burden. Clinical patterns of infection, current means of diagnosis, treatment and treatment failure are reviewed in sections on intestinal flukes, liver flukes and lung flukes. New therapeutic approaches are emphasized. [ABSTRACT FROM AUTHOR]

Aim: To investigate the effect of social support on psychological distress among Chinese lung cancer patients and clarify the mediating role of self‐esteem. Design: A cross‐sectional descriptive correlational survey of 441 Chinese lung cancer patients was designed. Methods: Self‐esteem was supposed to play a mediating role in the association between social support and psychological distress. We collected demographic information, the Distress Thermometer, Multidimensional Scale of Perceived Social Support and Rosenberg Self‐Esteem Scale. Results: Our revised model demonstrated an acceptable fit to the data (χ2 = 37.489, comparative fit index (CFI) = 0.965, Tucker‐Lewis index (TLI) = 0.926, root mean square error of approximation [RMSEA] = 0.099). Social support had a direct effect on self‐esteem and psychological distress, and self‐esteem had also a direct effect on psychological distress. Meanwhile, self‐esteem also partially mediated the relationship between social support and psychological distress among Chinese lung cancer patients. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 50-year-old female with a history of hydatidiform mole. Topics include getting treatment with uterine flushing and chemotherapy with 5-fluorouracil; and showing pancytopenia, oral mucosal hemorrhage, fluctuating consciousness, and multiple organ dysfunction syndrome involving the liver and gastrointestinal tract.

Rationale: Elexacaftor/tezacaftor/ivacaftor (ELX/TEZ/IVA) was shown to be efficacious and safe in patients ≥12 years of age with cystic fibrosis and at least one F508del-CFTR (cystic fibrosis transmembrane conductance regulator) allele, but it has not been evaluated in children <12 years of age. Objectives: To assess the safety, pharmacokinetics, and efficacy of ELX/TEZ/IVA in children 6 through 11 years of age with F508del-minimal function or F508del-F508del genotypes. Methods: In this 24-week open-label phase 3 study, children (N = 66) weighing <30 kg received 50% of the ELX/TEZ/IVA adult daily dose (ELX 100 mg once daily, TEZ 50 mg once daily, and IVA 75 mg every 12 h) whereas children weighing ⩾30 kg received the full adult daily dose (ELX 200 mg once daily, TEZ 100 mg once daily, and IVA 150 mg every 12 h). Measurements and Main Results: The primary endpoint was safety and tolerability. The safety and pharmacokinetic profiles of ELX/TEZ/IVA were generally consistent with those observed in older patients. The most commonly reported adverse events included cough, headache, and pyrexia; in most of the children who had adverse events, these were mild or moderate in severity. Through Week 24, ELX/TEZ/IVA treatment improved the percentage of predicted FEV1 (10.2 percentage points; 95% confidence interval [CI], 7.9 to 12.6), Cystic Fibrosis Questionnaire-Revised respiratory domain score (7.0 points; 95% CI, 4.7 to 9.2), lung clearance index2.5 (-1.71 units; 95% CI, -2.11 to -1.30), and sweat chloride (-60.9 mmol/L; 95% CI, -63.7 to -58.2); body mass index-for-age z-score increased over the 24-week treatment period when compared with the pretreatment baseline. Conclusions: Our results show ELX/TEZ/IVA is safe and efficacious in children 6 through 11 years of age with at least one F508del-CFTR allele, supporting its use in this patient population. Clinical trial registered with www.clinicaltrials.gov (NCT03691779). [ABSTRACT FROM AUTHOR]

Background: Cavitary peripheral pulmonary lesions (PPLs) are often diagnosed via transthoracic needle biopsy. However, today, radial probe endobronchial ultrasound (RP‐EBUS) is widely used to diagnose PPLs. The efficacy and safety of RP‐EBUS‐guided transbronchial lung biopsy (RP‐EBUS‐TBLB) used to diagnose cavitary PPLs remain poorly known. We investigated the utility of RP‐EBUS‐TBLB using a guide sheath (GS) without fluoroscopy to diagnose PPLs. Methods: Of 743 RP‐EBUS procedures conducted to diagnose PPLs performed at our institution from January 2019 to October 2020, we analyzed 77 cavitary PPLs. TBLB was performed using RP‐EBUS with a GS without fluoroscopy. The diagnostic accuracy and complications were assessed. All lung lesions with a definitive diagnosis were included in analyses. Results: The overall diagnostic accuracy was 85.7% (66/77). Of malignant lesions (n = 34), 29 (85.3%) were diagnosed successfully. Of benign lesions (n = 43), 37 (86.0%) were diagnosed successfully. In multivariate analyses, a thicker cavity wall (≥10 mm, odds ratio [OR] 14.22, 95% confidence interval [CI] 2.58–78.35, p = 0.002) and EBUS imaging with the probe within the lesion (OR 12.02, 95% CI 1.91–75.53, p = 0.008) independently affected diagnostic success. The likelihood of success increased with increasing thickness of the cavity wall (p < 0.001, test for trend). The specimens obtained for molecular confirmation of malignancy were satisfactory. There were four cases of infection (5.2%) and three cases of pneumothorax (3.9%). Conclusions: RP‐EBUS‐TBLB of cavitary PPLs affords high diagnostic accuracy with acceptable complication rates. [ABSTRACT FROM AUTHOR]

B-cell activation is increasingly linked to numerous fibrotic lung diseases, and it is well known that aggregates of lymphocytes form in the lung of many of these patients. Activation of B-cells by pattern recognition receptors (PRRs) drives the release of inflammatory cytokines, chemokines, and metalloproteases important in the pathophysiology of pulmonary fibrosis. However, the specific mechanisms of B-cell activation in patients with idiopathic pulmonary fibrosis (IPF) are poorly understood. Herein, we have demonstrated that B-cell activation by microbial antigens contributes to the inflammatory and profibrotic milieu seen in patients with IPF. B-cell stimulation by CpG and b-glucan via PRRs resulted in activation of mTOR-dependent and independent pathways. Moreover, we showed that the B-cell-secreted inflammatory milieu is specific to the inducing antigen and causes differential fibroblast migration and activation. B-cell responses to infectious agents and subsequent B-cell-mediated fibroblast activation are modifiable by antifibrotics, but each seems to exert a specific and different effect. These results suggest that, upon PRR activation by microbial antigens, B-cells can contribute to the inflammatory and fibrotic changes seen in patients with IPF, and antifibrotics are able to at least partially reverse these responses. [ABSTRACT FROM AUTHOR]

Idiopathic pulmonary fibrosis (IPF) is a progressive fibrotic interstitial lung disease with underlying mechanisms that have been primarily investigated in mice after intratracheal instillation of a single dose of bleomycin. However, the model has significant limitations, including transient fibrosis that spontaneously resolves and its failure to fully recapitulate the epithelial remodeling in the lungs of patients with IPF. Thus, there remains an unmet need for a preclinical model with features that more closely resemble the human disease. Repetitive intratracheal instillation of bleomycin has previously been shown to recapitulate some of these features, but the instillation procedure is complex, and the long-term consequences on epithelial remodeling and fibrosis persistence and progression remain poorly understood. Here, we developed a simplified repetitive bleomycin instillation strategy consisting of three bi-weekly instillations that leads to persistent and progressive pulmonary fibrosis. Lung histology demonstrates increased collagen deposition, fibroblast accumulation, loss of type I and type II alveolar epithelial cells within fibrotic areas, bronchiolization of the lung parenchyma with CCSP1cells, remodeling of the distal lung into cysts reminiscent of simple honeycombing, and accumulation of hyperplastic transitional KRT81 epithelial cells. Micro-computed tomographic imaging demonstrated significant traction bronchiectasis and subpleural fibrosis. Thus, the simplified repetitive bleomycin instillation strategy leads to progressive fibrosis and recapitulates the histological and radiographic characteristics of IPF. Compared with the single bleomycin instillation model, we suggest that the simplified repetitive instillation model may be better suited to address mechanistic questions about IPF pathogenesis and preclinical studies of antifibrotic drug candidates. [ABSTRACT FROM AUTHOR]

Rationale: Lung ultrasound is useful in critically ill patients with acute respiratory failure. Given its characteristics, it could also be useful in extremely preterm infants with evolving chronic respiratory failure, as we lack accurate imaging tools to monitor them. Objectives: To verify if lung ultrasound can monitor lung aeration and function and has good reliability to predict bronchopulmonary dysplasia in extremely preterm neonates. Methods: A multicenter, international, prospective, longitudinal, cohort, diagnostic accuracy study consecutively enrolling inborn neonates with gestational age 30+6 weeks or younger. Lung ultrasound was performed on the 1, 7, 14, and 28 days of life, and lung ultrasound scores were calculated and correlated with simultaneous blood gases and work of breathing score. Gestational age-adjusted lung ultrasound scores were created, verified in multivariate models, and subjected to receiver operator characteristics (ROC) analyses to predict bronchopulmonary dysplasia at 36 weeks postmenstrual age. Measurements and Main Results: Mean lung ultrasound scores are different between infants developing (n = 72) or not developing (n = 75) bronchopulmonary dysplasia (P < 0.001 at any time point). Lung ultrasound scores significantly correlate with oxygenation metrics and work of breathing at any time point (P always < 0.0001). Gestational age-adjusted lung ultrasound scores significantly predict bronchopulmonary dysplasia at 7 (area under ROC curve, 0.826-0.833; P < 0.0001) and 14 (area under ROC curve, 0.834-0.858; P < 0.0001) days of life. Bronchopulmonary dysplasia severity and gestational age-adjusted lung ultrasound scores are significantly correlated at 7 and 14 days (P always < 0.0001). Conclusions: Lung ultrasound scores allow monitoring of lung aeration and function in extremely preterm infants. Gestational age-adjusted scores significantly predict the occurrence of bronchopulmonary dysplasia, starting from the seventh day of life. [ABSTRACT FROM AUTHOR]

Rationale: Chronic obstructive pulmonary disease (COPD) is associated with abnormal skeletal muscle morphology and function. Objectives: To test the hypothesis that in vivo diaphragm muscle morphology assessed by computed tomography (CT) imaging would be associated with COPD severity, exacerbations, health status, and exercise capacity. Methods: The COPD Morphometry Study is a cross-sectional study that enrolled a clinical sample of smokers with COPD. Spirometry was performed and COPD severity was defined according to guidelines. Three-dimensional left hemidiaphragm morphology was segmented from contiguous axial CT images acquired at maximal inspiration, yielding quantitative measures of diaphragm CT density in Hounsfield units, dome height, and muscle volume. Exacerbations prompting pharmacotherapy or hospitalization in the preceding 12 months and St. George's Respiratory Questionnaire for COPD were assessed. Incremental symptom-limited cycle ergometry quantified peak oxygen uptake ([Formula: see text]o2Peak). Associations were adjusted for age, sex, body height, body mass index, and smoking status. Results: Among 65 smokers with COPD (75% male; [mean ± standard deviation (SD)] 56 ± 26 pack-years; forced expiratory volume in 1 second [FEV1] percentage predicted 55 ± 23%), mean diaphragm CT density was 3.1 ± 10 Hounsfield units, dome height was 5.2 ± 1.3 cm, and muscle volume was 57 ± 24 cm3. A 1-SD decrement in the diaphragm CT density was associated with 8.3% lower FEV1, 3.27-fold higher odds of exacerbation history, 9.7-point higher score on the St. George's Respiratory Questionnaire for COPD, and 2.5 ml/kg/min lower [Formula: see text]o2Peak. A 1-SD decrement in dome height was associated with 11% lower FEV1 and 1.3 ml/kg/min lower [Formula: see text]o2Peak. There were no associations with diaphragm volume observed. Conclusions: CT-assessed diaphragm morphology was associated with COPD severity, exacerbations, impaired health status, and exercise intolerance. The mechanisms and functional impact of lower diaphragm CT density merit investigation. [ABSTRACT FROM AUTHOR]

Background: Idiopathic pulmonary hemosiderosis (IPH) encompasses a rare and agnogenic group of diffuse alveolar capillary hemorrhagic diseases. Corticosteroid treatment is the globally preferred therapeutic strategy for IPH; however, it can cause immunodeficiency. Nocardia infection often occurs in immunocompromised patients and primarily involves the pleura and lungs. Herein, we describe a case of pediatric pulmonary Nocardia infection after the corticosteroid treatment of IPH.Case Presentation: A 7-year-old girl presented with chief complaints of pale complexion persisting for 1 year and a cough for 20 days. Abundant hemosiderin-laden macrophages were detected in the gastric juice, which supported the diagnosis of IPH. Uninterrupted doses of corticosteroids were administered during the last hospitalization. After nearly 2 months of corticosteroids therapy, the patient began to cough and produce a purulent sputum. Next-generation sequencing of the bronchoalveolar lavage fluid revealed Nocardia abscessus (N. abscessus) DNA. Linezolid was administered with good response, and the patient was discharged after 18 days of hospitalization. Her symptoms and pulmonary lesions had recovered, and the IPH appeared to be well-controlled with low dose of corticosteroids in follow-up.Conclusions: Nocardia infection should be considered in the differential diagnoses for IPH patients receiving corticosteroid therapy, especially in patients with poor response to conventional empirical antibiotic therapy. Next-generation sequencing of bronchoalveolar lavage fluid may be used to quickly identify the Nocardia. Sulfonamides or linezolid are effective for pediatric pulmonary Nocardia infection. [ABSTRACT FROM AUTHOR]

Background: Although cardiac autonomic modulation has been studied in several respiratory diseases, the evidence is limited on lung transplantation, particularly on its acute and chronic effects. Thus, we aimed to evaluate cardiac autonomic modulation before and after bilateral lung transplantation (BLT) through a prospective study on patients enrolled while awaiting transplant.Methods: Twenty-two patients on the waiting list for lung transplantation (11 women, age 33 [24-51] years) were enrolled in a prospective study at Ospedale Maggiore Policlinico Hospital in Milan, Italy. To evaluate cardiac autonomic modulation, ten minutes ECG and respiration were recorded at different time points before (T0) and 15 days (T1) and 6 months (T2) after bilateral lung transplantation. As to the analysis of cardiac autonomic modulation, heart rate variability (HRV) was assessed using spectral and symbolic analysis. Entropy-derived measures were used to evaluate complexity of cardiac autonomic modulation. Comparisons of autonomic indices at different time points were performed.Results: BLT reduced HRV total power, HRV complexity and vagal modulation, while it increased sympathetic modulation in the acute phase (T1) compared to baseline (T0). The HRV alterations remained stable after 6 months (T2).Conclusion: BLT reduced global variability and complexity of cardiac autonomic modulation in acute phases, and these alterations remain stable after 6 months from surgery. After BLT, a sympathetic predominance and a vagal withdrawal could be a characteristic autonomic pattern in this population. [ABSTRACT FROM AUTHOR]

Rationale: Transbronchial lung cryobiopsy (TBLC) is an emerging technique for interstitial lung disease diagnosis. Good histopathologic agreement between TBLC and surgical lung biopsy (SLB) was demonstrated in the COLDICE (Cryobiopsy versus Open Lung Biopsy in the Diagnosis of Interstitial Lung Disease Alliance) study; however, diagnostic confidence was frequently lower for TBLC than SLB. Objectives: To characterize specific features of TBLC predictive of usual interstitial pneumonia (UIP) in corresponding SLB and to identify clinical indices predictive of biopsy concordance. Methods: The COLDICE study was a prospective, multicenter study investigating diagnostic agreement between TBLC and SLB. The participants underwent both procedures with blinded pathologist analysis of specimens, applying international guideline criteria. The TBLC features predictive of UIP in the paired SLB and predictive features of overall concordance were analyzed. Measurements and Main Results: A total of 65 patients (66.1 ± 9.3 yr; FVC, 84.7 ± 14.2%; DlCO, 63.4 ± 13.8%) participated in the COLDICE study. UIP was identified in 33/65 (50.8%) SLB, and 81.5% were concordant with corresponding TBLC (κ, 0.61; 95% confidence interval [CI], 0.38-0.77). The UIP guideline criteria of "predominantly subpleural or paraseptal fibrosis" was infrequently reported in TBLC (8/33, 24.2%), whereas "patchy fibrosis," "fibroblast foci," and the "absence of alternative diagnostic features" were frequently observed in TBLC. The combination of these three features strongly predicted UIP in paired SLB (odds ratio [OR], 23.4; 95% CI, 6.36-86.1; P < 0.0001). Increased numbers of TBLC samples predicted histopathologic concordance with SLB (OR, 1.8; 95% CI, 1.08-3.01; P = 0.03). The predictors of discordance included older age, family history, and radiologic asymmetry. Conclusions: Subpleural and/or paraseptal fibrosis were not essential for diagnosing UIP in TBLC, provided that other guideline criteria features were present. The diagnostic accuracy of TBLC was strengthened when increased numbers of samples were taken. Clinical trial registered with www.anzctr.org.au (ACTRN12615000718549). [ABSTRACT FROM AUTHOR]

Rationale: Tissue-resident memory T cells (TRM) play a critical role in the defense against inhaled pathogens. The isolation and study of human lung tissue-resident memory T cells and lung-resident macrophages (MLR) are limited by experimental constraints. Objectives: To characterize the spatial and functional relationship between MLR and human lung tissue-resident memory T cells using ex vivo lung perfusion (EVLP). Methods: TRM and MLR were isolated using EVLP and intraperfusate-labeled CD45 antibody. Cells isolated after 6 hours of EVLP were analyzed using spectral flow cytometry. Spatial relationships between CD3+ and CD68+ cells were explored with multiplexed immunohistochemistry. Functional relationships were determined by using coculture and T-cell-receptor complex signal transduction. Measurements and Main Results: Lungs from 8 research-consenting organ donors underwent EVLP for 6 hours. We show that human lung TRM and MLR colocalize within the human lung, preferentially around the airways. Furthermore, we found that human lung CD8+ TRM are composed of two functionally distinct populations on the basis of PD1 (programed cell death receptor 1) and ZNF683 (HOBIT) protein expression. We show that MLR provide costimulatory signaling to PD1hi CD4+ and CD8+ lung TRM,, augmenting the effector cytokine production and degranulation of TRM. Conclusions: EVLP provides an innovative technique to study resident immune populations in humans. Human MLR colocalize with and provide costimulation signaling to TRM, augmenting their effector function. [ABSTRACT FROM AUTHOR]

Rationale: The physiological basis of lung protection and the impact of positive end-expiratory pressure (PEEP) during pronation in acute respiratory distress syndrome are not fully elucidated. Objectives: To compare pleural pressure (Ppl) gradient, ventilation distribution, and regional compliance between dependent and nondependent lungs, and investigate the effect of PEEP during supination and pronation. Methods: We used a two-hit model of lung injury (saline lavage and high-volume ventilation) in 14 mechanically ventilated pigs and studied supine and prone positions. Global and regional lung mechanics including Ppl and distribution of ventilation (electrical impedance tomography) were analyzed across PEEP steps from 20 to 3 cm H2O. Two pigs underwent computed tomography scans: tidal recruitment and hyperinflation were calculated. Measurements and Main Results: Pronation improved oxygenation, increased Ppl, thus decreasing transpulmonary pressure for any PEEP, and reduced the dorsal-ventral pleural pressure gradient at PEEP < 10 cm H2O. The distribution of ventilation was homogenized between dependent and nondependent while prone and was less dependent on the PEEP level than while supine. The highest regional compliance was achieved at different PEEP levels in dependent and nondependent regions in supine position (15 and 8 cm H2O), but for similar values in prone position (13 and 12 cm H2O). Tidal recruitment was more evenly distributed (dependent and nondependent), hyperinflation lower, and lungs cephalocaudally longer in the prone position. Conclusions: In this lung injury model, pronation reduces the vertical pleural pressure gradient and homogenizes regional ventilation and compliance between the dependent and nondependent regions. Homogenization is much less dependent on the PEEP level in prone than in supine positon. [ABSTRACT FROM AUTHOR]

Background: Transbronchial lung biopsy (TBLB) in the diagnosis of lymphangioleiomyomatosis (LAM) is not a common approach, although TBLB is often performed in diffuse lung diseases. We aimed to examine the diagnostic value and safety of TBLB in LAM patients based on the data collected in our center.Methods: We reviewed LAM patients registered in our LAM Clinic from December 8, 2006, to December 31, 2019. All patients with definite or probable diagnosis of LAM who had been examined using TBLB were included. All available pathology slides were reviewed by an experienced LAM pathologist. All complications were reviewed by the medical records and confirmed using telephone interviews.Results: The pathology results of 86 patients (including 74 definite LAM and 12 probable LAM) were available. The positive rate of TBLB in LAM patients was 49/86 (57.0%). The positive rates of SMA, HMB-45, ER, and PR in LAM patients were 97.6%, 93%, 84.6%, and 78.4% respectively. The positive rate of TBLB was 40%, 60% and 60.8% in patients with CT Grade I, Grade II, and Grade III respectively, and the difference was not significant. Patients who had 3-4 or 5-6 biopsied specimens had a higher rate of diagnosis than those with 1-2 biopsied specimens. Four patients (5.6%) reported pneumothorax. No major hemoptysis was reported.Conclusions: TBLB is a feasible and safe procedure for obtaining a pathological diagnosis of LAM. Taking more than 2 samples during the biopsy procedure increased the rate of diagnosis. [ABSTRACT FROM AUTHOR]

The National Heart, Lung, and Blood Institute and the Cardiovascular Medical Research and Education Fund held a workshop on the application of pulmonary vascular disease omics data to the understanding, prevention, and treatment of pulmonary vascular disease. Experts in pulmonary vascular disease, omics, and data analytics met to identify knowledge gaps and formulate ideas for future research priorities in pulmonary vascular disease in line with National Heart, Lung, and Blood Institute Strategic Vision goals. The group identified opportunities to develop analytic approaches to multiomic datasets, to identify molecular pathways in pulmonary vascular disease pathobiology, and to link novel phenotypes to meaningful clinical outcomes. The committee suggested support for interdisciplinary research teams to develop and validate analytic methods, a national effort to coordinate biosamples and data, a consortium of preclinical investigators to expedite target evaluation and drug development, longitudinal assessment of molecular biomarkers in clinical trials, and a task force to develop a master clinical trials protocol for pulmonary vascular disease. [ABSTRACT FROM AUTHOR]

Aim: Bleomycin, etoposide, and cisplatin (BEP) regimen is the standard treatment for germ-cell tumors (GCTs). Bleomycin-induced pulmonary toxicity (BPT) is fatal and dose-limiting toxicity associated with this regimen. In this study, we aimed to identify the frequency and risk factors of BPT in South Indian GCT patients receiving BEP regimen.Patients and Methods: The study was carried out in the Department of Medical Oncology, Regional Cancer Centre at a tertiary care hospital in South India. All the patients with GCT (testicular and ovarian) who were receiving BEP regimen from December 2014 to May 2018 were included in the study. BPT was defined as the presence of radiological features and/or clinical symptoms during or post-treatment.Results: BPT was observed in 11 (27%) patients of 41 analyzed patients. Five (12%) patients developed BPT during treatment whereas six (15%) patients developed BPT post-treatment. Cumulative bleomycin dose ≥240 mg (relative risk 3.8, confidence interval: 1.2-12.2,P =0.02) was found to increase the risk of BPT. Three-year overall survival in patients with and without toxicity was 82% and 93%, respectively.Conclusions: The frequency of BPT in the study population is 27%, and cumulative bleomycin dose ≥240 mg has been found to be associated with increased risk of developing BPT. BPT does not negatively impact survival outcome in GCT patients receiving BEP regimen. [ABSTRACT FROM AUTHOR]

The article presents question and answer related to the context of systemic lupus erythematosus pulmonary complications have frequently observed in 7–31% of children with varying frequencies.

Objective To explore the expression of CD4+ effector memory T cells (CD4+TEM) in peripheral blood of acute ischemic stroke patients with pulmonary infection, and to analyze the value of CD4+TEM combined with interleukin-6 (IL-6) and hypersensitive C-reactive protein (hs-CRP) in the diagnosis of pulmonary infection in patients with acute ischemic stroke. Methods Totally 54 confirmed acute ischemic stroke patients with pulmonary infection who were treated in the Department of Neurology at The Affiliated Hospital of Xuzhou Medical University from June 2018 to December 2019 were chosen as the infection group, meanwhile, 55 acute ischemic stroke patients without pulmonary infection were assigned as the control group. The clinical characters and the expression levels of CD4+TEM cells were compared in the 2 groups. Univariate and multivariate Logistic regression analysis were used to screen the risk factors of pulmonary infection in patients with acute ischemic stroke, and receiver operating characteristic (ROC) curve was further conducted to evaluate the diagnostic value of the percentage of CD4+TEM, IL-6, hs-CRP and combined detection in pulmonary infection patients with acute ischemic stroke. Results Multivariate Logistic regression analysis showed that the increased percentage of CD4+TEM cells (OR = 1.153, 95%CI: 1.069-1.244; P = 0.000), IL-6 (OR = 1.351, 95%CI: 1.046-1.747; P = 0.021) and hs-CRP (OR = 1.087, 95%CI: 1.008-1.172; P = 0.021) were important risk factors for pulmonary infection with acute ischemic stroke. When the percentage of CD4+TEM cells, IL-6 and hs-CRP were used as predictors of pulmonary infection with acute ischemic stroke alone, the area under the ROC curve were 0.906 (95%CI: 0.850-0.961), 0.799 (95%CI: 0.714-0.885) and 0.831 (95%CI: 0.754-0.908) respectively. When the percentage of CD4+TEM cells were combined with IL-6 and hs-CRP, the area under the curve increased to 0.943 (95%CI: 0.904-0.982). Conclusions The percentage of CD4+TEM cells combined with IL-6 and hs-CRP has better diagnostic value for pulmonary infection with acute ischemic stroke, and can be used as biomarkers for early prediction of pulmonary infection with acute ischemic stroke. [ABSTRACT FROM AUTHOR]

Introduction: Bronchopneumonia involves acute inflammation of the bronchi with inflamed patches in nearby lung lobules. It is usually bacterial, but can also be due to a viral or fungal infection. Common pathogens include Staphylococcus aureus, Klebsiella pneumoniae, Haemophilus influenzae, Streptococcus pneumoniae, Pseudomonas aeruginosa, and Escherichia coli, with rare cases involving viruses like SARS-Cov-2 or bacteria like Actinomyces. Case Report: This report describes two male patients, both 67 years old, who died shortly after the admission to the Emergency Room in Târnăveni, Mureş. Notably, both patients received different clinical diagnoses than those determined during the forensic autopsy. One patient, admitted for hypothermia, was initially diagnosed with a fatal heart attack leading to the drop in body temperature. In contrast, the other patient's cause of death was presumed to be a heart attack and further investigations raised suspicions of a neoplastic lung tumor. During the autopsy for the first patient, the macroscopic diagnosis provided no relevant information except for a pancreatic tumor. The microscopic examination revealed the presence of a massive confluent bronchopneumonia associated with an acute pulmonary edema and acute pancreatitis instead of a neoplasm. In the second case, at the macroscopical examination, a massive pulmonary tumor associated with pneumonia were seen. The microscopic analysis revealed an abscessed bronchopneumonia with bacterial colonies suggestive for Actinomyces infection. Discussions : Overlooking complex medical conditions like bronchopneumonia may lead to misdiagnosis during clinical evaluation. It is important to allow enough time per patient to complete the anamnesis and the physical examination. Further investigations such as blood tests and radiological imaging may offer clues for a better presumptive diagnosis and provide enough data to discuss the differential one. Moreover, the histopathology examination completes clinical assessments by offering insights into the underlying pathology. Forensic autopsy is equally important because it uncovers the true cause of death and corrects diagnostic errors. Conclusions: These contrasting clinical presentations underscore the challenges in accurately diagnosing and managing complex medical conditions, emphasizing the critical importance of comprehensive evaluations and thorough post-mortem analyses in elucidating the underlying pathology. [ABSTRACT FROM AUTHOR]

Introduction: In the realm of neonatology, tiny warriors born with incredibly low birth weights (ELBW & ILBW) stand apart, needing specialized care and attention. ELBW represents a birth weight below 1000 grams, while ILBW refers to newborns weighing under 500 grams. These infants are often exposed to a variety of challenges associated with extreme prematurity, from respiratory dysfunction to developmental hurdles. Expert management of ELBW and ILBW requires a united front of neonatologists, pediatricians, specialized nursing staff, and other medical professionals. Case Report: Patient C.T. was born naturally with a cranial presentation at a level 2 maternity hospital, weighing 450 grams, with a cranial circumference of 20 cm and a length of 32 cm. The APGAR score was 4/1 min and 6/5 min. Immediately after birth, the patient was transferred to a level 3 unit with hypothermia and moderate respiratory distress. In the first 5-6 days the patient weighed 380g. This newborn was diagnosed with all prematurity pathologies: Newborn Respiratory Distress Syndrome, chronic lung disease, specific perinatal period infection with unspecified germ, extreme immaturity at 22/23 weeks, ELBW newborn, neonatal infection with Serratia Marcescens, metabolic acidosis of the newborn, non-traumatic intraventricular hemorrhage grade 3, prematurity anemia, neonatal jaundice, and carbohydrate metabolism disorders. The therapeutic approach included placement in a heated incubator, monitoring, oxygen therapy under non-invasive ventilator support type nCPAP, hydroelectrolytic rebalancing, initiation of antibiotic therapy according to results, surfactant administration, administration of Phytonadione for hemorrhagic disease prophylaxis, caffeine citrate for respiratory system stimulation, treatment with Dexamethasone for bronchopulmonary dysplasia, phototherapy, administration of erythrocyte mass, and administration of vitamins. Discussions : This case stands out as one of the uncommon occurrences of ILBW, where it required 110 days for a premature weighing 450 grams at birth to stabilize and eradicate the factors that would have been impossible without the NICU intervention. The patient's progress has been incredibly positive, reaching a weight of 2400g by day 110, with ventilation levels exceeding 94%. Thanks to targeted treatment for Staphylococcus Aureus MSSA, prematurity infections have been effectively eradicated. Hematological analyses have shown all parameters to be within healthy ranges, with no adverse reactions observed during the treatment of anemia. Conclusions: The patient is now free from any prematurity related conditions, suggesting remarkable improvement. This positive outcome rises the possibility of normalization of ILBW infant. Despite presenting the full spectrum of prematurity complications, the favorable evolutions of this newborn gives hope for more successful outcomes. [ABSTRACT FROM AUTHOR]

• A structure-aware hybrid-fusion learning (SA-HFL) end-to-end network is proposed for high-resolution conductivity distribution reconstruction. • Utilizing distinct loss functions and specialized branches, the SA-HFL extracts both object structural details and conductivity distribution features from measurement voltages to reconstruct the conductivity distribution. • The SA-HFL exhibits excellent robustness against both measurement noise and modeling errors. • Simulations, water tank experiments, and human body experiments validate the superior performance of the proposed SA-HFL in EIT reconstruction tasks. Electrical impedance tomography (EIT) has gained considerable attention in the medical field for the diagnosis of lung-related diseases, owing to its non-invasive and real-time characteristics. However, due to the ill-posedness and underdetermined nature of the inverse problem in EIT, suboptimal reconstruction performance and reduced robustness against the measurement noise and modeling errors are common issues. This study aims to mine the deep feature information from measurement voltages, acquired from the EIT sensor, to reconstruct the high-resolution conductivity distribution and enhance the robustness against the measurement noise and modeling errors using the deep learning method. A novel data-driven method named the structure-aware hybrid-fusion learning (SA-HFL) is proposed. SA-HFL is composed of three main components: a segmentation branch, a conductivity reconstruction branch, and a feature fusion module. These branches work in tandem to extract different feature information from the measurement voltage, which is then fused to reconstruct the conductivity distribution. The unique aspect of this network is its ability to utilize different features extracted from various branches to accomplish reconstruction objectives. To supervise the training of the network, we generated regular-shaped and lung-shaped EIT datasets through numerical calculations. The simulations and three experiments demonstrate that the proposed SA-HFL exhibits superior performance in qualitative and quantitative analyses, compared with five cutting-edge deep learning networks and the optical image-guided group sparsity (IGGS) method. The evaluation metrics, relative error (RE), mean structural similarity index (MSSIM), and peak signal-to-noise ratio (PSNR), are improved by implementing the SA-HFL method. For the regular-shaped dataset, the values are 0.119 (RE), 0.9882 (MSSIM), and 31.03 (PSNR). For the lung-shaped dataset, the values are 0.257 (RE), 0.9151 (MSSIM), and 18.67 (PSNR). Furthermore, the proposed network can be executed with appropriate parameters and efficient floating-point operations per second (FLOPs), concerning network complexity and inference speed. The reconstruction results indicate that fusing feature information from different branches enhances the accuracy of conductivity reconstruction in the EIT inverse problem. Moreover, the study shows that fusing different modalities of information to reconstruct the EIT conductivity distribution may be a future development direction. [ABSTRACT FROM AUTHOR]

Computer Tomography (CT) is currently being adapted for visualization of COVID-19 lung damage. Manual classification and characterization of COVID-19 may be biased depending on the expert's opinion. Artificial Intelligence has recently penetrated COVID-19, especially deep learning paradigms. There are nine kinds of classification systems in this study, namely one deep learning-based CNN, five kinds of transfer learning (TL) systems namely VGG16, DenseNet121, DenseNet169, DenseNet201 and MobileNet, three kinds of machine-learning (ML) systems, namely artificial neural network (ANN), decision tree (DT), and random forest (RF) that have been designed for classification of COVID-19 segmented CT lung against Controls. Three kinds of characterization systems were developed namely (a) Block imaging for COVID-19 severity index (CSI); (b) Bispectrum analysis; and (c) Block Entropy. A cohort of Italian patients with 30 controls (990 slices) and 30 COVID-19 patients (705 slices) was used to test the performance of three types of classifiers. Using K10 protocol (90% training and 10% testing), the best accuracy and AUC was for DCNN and RF pairs were 99.41 ± 5.12%, 0.991 (p < 0.0001), and 99.41 ± 0.62%, 0.988 (p < 0.0001), respectively, followed by other ML and TL classifiers. We show that diagnostics odds ratio (DOR) was higher for DL compared to ML, and both, Bispecturm and Block Entropy shows higher values for COVID-19 patients. CSI shows an association with Ground Glass Opacities (0.9146, p < 0.0001). Our hypothesis holds true that deep learning shows superior performance compared to machine learning models. Block imaging is a powerful novel approach for pinpointing COVID-19 severity and is clinically validated. [ABSTRACT FROM AUTHOR]

Postoperative complications are becoming more and more important than the risk given in preoperative pulmonary evaluation due to the increase in patients requiring surgical intervention. Patients undergoing craniotomy are routinely evaluated preoperatively, but the role of these evaluations in predicting outcomes has not been adequately studied. We aimed to investigate the effect of preoperative pulmonary risk assessment and the type of operation performed on postoperative complications and mortality concerning the presence of chronic disease in patients undergoing cranial surgery in the light of the literature. Preoperative pulmonary consultation data and postoperative pulmonary consultations, if any, of cranial surgery patients who were operated on in the neurosurgery clinic of a tertiary hospital were retrospectively analyzed. 85 (43.8%) of the surgical patients were male and 109 (56.2%) were female, and the average age of 194 people was 74 (35-90). 83 (42.7%) of the patients had at least one chronic disease. Considering the preoperative pulmonary risks, 72 (37.1%) patients were given medium risk. Statistically, the mortality rate was higher in those with ICU beds. Atelectasis in 10 (5.15%) patients, pneumonia in 7 (3.608%) patients, embolism in 3 (1.5%) patients, respiratory failure in 3 (1.5%) and bronchospasm in 2 (1%) patients, respectively. Postoperative pulmonary complications developed in 25 (12.9%) patients. Prediction of respiratory complications with effective preoperative pulmonary evaluation is important in terms of decreasing morbidity and mortality and decreasing the length of hospital stay. Since most of the complications are seen in patients given high risk in the preoperative period, close follow-up of high-risk patients in the postoperative period is important. [ABSTRACT FROM AUTHOR]

Significant changes have been made on audio-based technologies over years in several different fields. Healthcare is no exception. One of such avenues is health screening based on respiratory sounds. In this paper, we developed a tool to detect respiratory sounds that come from respiratory infection carrying patients. Linear Predictive Cepstral Coefficient (LPCC)-based features were used to characterize such audio clips. With Multilayer Perceptron (MLP)-based classifier, in our experiment, we achieved the highest possible accuracy of 99.22% that was tested on a publicly available respiratory sounds dataset (ICBHI17) (Rocha et al. Physiol. Meas. 40(3):035,001 20) of size 6800+ clips. In addition to other popular machine learning classifiers, our results outperformed common works that exist in the literature. [ABSTRACT FROM AUTHOR]

Background: Pulmonary disease is a potentially serious yet underdiagnosed complication of Sjögren's syndrome, the second most common autoimmune rheumatic disease. Approximately 16% of patients with Sjögren's demonstrate pulmonary involvement with higher mortality and lower quality of life.Research Question: Clinical practice guidelines for pulmonary manifestations of Sjögren's were developed by the Sjögren's Foundation after identifying a critical need for early diagnosis and improved quality and consistency of care.Study Design and Methods: A rigorous and transparent methodology was followed according to American College of Rheumatology guidelines. The Pulmonary Topic Review Group (TRG) developed clinical questions in the PICO (Patient, Intervention, Comparison, Outcome) format and selected literature search parameters. Each article was reviewed by a minimum of two TRG members for eligibility and assessment of quality of evidence and strength of recommendation. Guidelines were then drafted based on available evidence, expert opinion, and clinical importance. Draft recommendations with a clinical rationale and data extraction tables were submitted to a Consensus Expert Panel for consideration and approval, with at least 75% agreement required for individual recommendations to be included in the final version.Results: The literature search revealed 1,192 articles, of which 150 qualified for consideration in guideline development. Of the original 85 PICO questions posed by the TRG, 52 recommendations were generated. These were then reviewed by the Consensus Expert Panel and 52 recommendations were finalized, with a mean agreement of 97.71% (range, 79%-100%). The recommendations span topics of evaluating Sjögren's patients for pulmonary manifestations and assessing, managing, and treating upper and lower airway disease, interstitial lung disease, and lymphoproliferative disease.Interpretation: Clinical practice guidelines for pulmonary manifestations in Sjögren's will improve early identification, evaluation, and uniformity of care by primary care physicians, rheumatologists, and pulmonologists. Additionally, opportunities for future research are identified. [ABSTRACT FROM AUTHOR]

Background: Cervical mediastinoscopy is useful for diagnosing lung and mediastinal disease. Ultrasound is a safe real‐time diagnostic tool widely employed in many surgical fields. Ultrasound was used in cervical mediastinoscopy in our cohort with satisfactory results. This study investigated the safety, feasibility, and availability of video‐assisted mediastinoscopy (VAM) combined with ultrasound for mediastinal lymph node biopsy. Methods: A total of 87 cases involving cervical mediastinal lymph node biopsy performed from November 2015 to May 2020, with complete clinical and pathological information, were retrospectively analyzed in the Department of Thoracic Surgery at Beijing Chaoyang Hospital. The cohort was divided into two groups: ultrasound‐guided biopsy under video‐assisted mediastinoscopy (UVAM) (44 cases) and routine VAM (43 cases). Operation time, biopsy number and nodal stations, postoperative complications, pathological conditions, and surgical difficulty were compared between the two nodal stations. Results: UVAM was significantly shorter and more lymph node specimens were obtained than with VAM. There was one case of fatal bleeding and two cases of right recurrent laryngeal nerve injury in the VAM group, and no postoperative complications in the UVAM group. Conclusions: When used with cervical VAM, ultrasound guidance assists physicians assess the space between lymph nodes, surrounding tissues, and large vessels systematically, making biopsy safer and easier, improving lymph node sampling, and decreasing postoperative complications. Furthermore, surgeons can easily learn and master this method. Key points: Significant findings of the study: Ultrasound was used in combination with cervical mediastinoscopy and the results showed that ultrasound guidance makes biopsy in patients safer and easier, improves lymph node sampling, and decreases postoperative complications. What this study adds: Surgeons can easily learn and master this method. [ABSTRACT FROM AUTHOR]