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Nosocomial pneumonia is defined as pneumonia occurring ≥ 48 h after hospital admission in a patient without severe immunosuppression. It can occur in spontaneously breathing patients or with noninvasive ventilation (NIV) and mechanically ventilated patients. In patients with suspected ventilator-associated pneumonia (VAP) (semi)quantitative cultures of tracheobronchial aspirates or bronchoalveolar lavage fluid should be perfomed. The initial empirical antimicrobial treatment is determined by the risk for multidrug-resistant pathogens (MDRP). The advantage of combination treatment increases with the prevalence of MDRPs. The antibiotic treatment should be adapted when the microbiological results are available. After 72 h a standardized re-evaluation including the response to treatment and also checking of the suspected diagnosis of pneumonia in a structured form is mandatory. Treatment failure can occur as a primary or secondary failure and in the case of primary progression necessitates another comprehensive diagnostic work-up before any further antibiotic treatment. [ABSTRACT FROM AUTHOR]

Background and Objective: Chest x‐ray (CXR) remains a core component of health monitoring guidelines for workers at risk of exposure to crystalline silica. There has however been a lack of evidence regarding the sensitivity of CXR to detect silicosis in artificial stone benchtop industry workers. Methods: Paired CXR and high‐resolution computed tomography (HRCT) images were acquired from 110 artificial stone benchtop industry workers. Blinded to the clinical diagnosis, each CXR and HRCT was independently read by two thoracic radiologists from a panel of seven, in accordance with International Labour Office (ILO) methodology for CXR and International Classification of HRCT for Occupational and Environmental Respiratory Diseases. Accuracy of screening positive (ILO major category 1, 2 or 3) and negative (ILO major category 0) CXRs were compared with identification of radiological features of silicosis on HRCT. Results: CXR was positive for silicosis in 27/110 (24.5%) workers and HRCT in 40/110 (36.4%). Of the 83 with a negative CXR (ILO category 0), 15 (18.1%) had silicosis on HRCT. All 11 workers with ILO category 2 or 3 CXRs had silicosis on HRCT. In 99 workers ILO category 0 or 1 CXRs, the sensitivity of screening positive CXR compared to silicosis identified by HRCT was 48% (95%CI 29–68) and specificity 97% (90–100). Conclusion: Compared to HRCT, sensitivity of CXR was low but specificity was high. Reliance on CXR for health monitoring would provide false reassurance for many workers, delay management and underestimate the prevalence of silicosis in the artificial stone benchtop industry. The use of CXR to screen artificial stone benchtop industry workers for silicosis has low sensitivity compared to HRCT chest, especially for early‐stage disease. Reliance on chest x‐ray for screening will fail to identify many workers with artificial stone silicosis and underestimate the prevalence of respiratory disease in this industry. [ABSTRACT FROM AUTHOR]

The article presents a neonatal case where cardiac tamponade developed as a complication of a peripherally inserted central catheter (PICC). Topics discussed include the potential risks associated with PICC placement, the management of pericardial effusion, and the importance of timely detection and intervention to prevent severe outcomes.

The article presents a case study of a 15-year-old girl with migratory joint pain, rash, and respiratory symptoms, ultimately diagnosed with granulomatosis with polyangiitis (GPA). Topics discussed include the diagnostic challenges of pulmonary hemorrhage, the role of Antineutrophil Cytoplasmic Antibody (ANCA)-associated vasculitides in such presentations, and the management strategies involving corticosteroids and immunosuppressants.

The present study evaluated 10-year atherosclerotic cardiovascular disease (ASCVD) risk using ASCVD and Systematic Coronary Risk Evaluation (SCORE2) risk models in combination with aortic arch calcification (AAC) to identify those at high risk for significant coronary artery disease (CAD) in patients undergoing coronary angiography. Of the 402 patients enrolled, 48 had normal coronary angiograms and served as group 1. The 131 patients with CAD with stenosis of <70% as group 2 and 223 patients with CAD with stenosis of ≥70% as group 3. ASCVD and SCORE2 risk scores, and the presence of AAC differed significantly among these groups. For prediction of significant CAD, the area under the curve (AUC) of ASCVD and SCORE2 risk scores in receiver operating characteristic (ROC) curve analysis were statistically similar ([AUC:.647, P <.001] and [AUC:.654, P <.001], respectively). When AAC was added to ASCVD risk and SCORE2, it increased their predictive value for significant CAD in the ROC curve analysis (P =.003, and P =.019, respectively). In addition, significant net reclassification improvement (NRI) values were obtained by adding AAC to ASCVD and SCORE2 risk models ([NRI =.10, P =.04], and [NRI =.19, P =.04], respectively). These results suggest that the predictive value of ASCVD and SCORE2 increases when AAC is combined. [ABSTRACT FROM AUTHOR]

Background: Isolated pulmonic valve endocarditis is a rare heart valve infection, and constitutes about 1% to 2% of all infective endocarditis cases. Modified Duke's criteria were used to diagnose culture negative pulmonic valve endocarditis. Case presentation: A 52-year-old male patient presented with generalized body swelling of 1 month duration associated with prolonged fever, malaise, fatigue, and lassitude. He had productive cough, dyspnea on mild exertion, and reddish discoloration of urine. Upon physical examination, blood pressure (BP) = 140/90 mmHg, pulse rate (PR) = 104 beats per minute, respiratory rate (RR) = 26 breaths per minute, temperature (T0) = 38.3°C, and Sp02 = 90% at ambient air. He had signs of bilateral pleural effusion. Cardiovascular examination revealed tachycardia, raised jugular venous pressure, murmurs of pulmonic regurgitation, and tricuspid regurgitation. There was grade 2 ascites and bilateral leg edema. On laboratory investigation, there were normochromic, normocytic anemia; raised ESR; positive Rheumatoid factor, elevated serum creatinine; and active urinary sediments on urinalysis. Two sets of blood culture were negative on days 1, 5, and 7. Chest-X-ray showed cardiomegaly with bilateral pleural effusion. ECG revealed sinus tachycardia with regular P-waves and QRS complexes. 2D Transthoracic echo showed vegetation on pulmonic valves, pulmonary valve lesions, dilated right atrium and right ventricle, and elevated right ventricular systolic pressure. Abdominal ultrasound revealed enlarged and echogenic kidneys, and ascites. Definitive diagnosis of PVE was made using modified Duke's criteria which was evidenced by 1 major (echo-proven vegetation on pulmonic valve), and 3 minors (suspected congenital pulmonic stenosis, fever, and immunologic phenomena [acute glomerulonephritis, positive rheumatoid factor]). The patient's clinical condition markedly improved after 2 weeks of intravenous antibiotics and loop diuretics, and discharged home after completing 6 weeks of parenteral antibiotics. Conclusion: Modified Duke's criteria could play a major role in the management decision about diagnosis and empiric treatment of infective endocarditis in the absence of positive bacterial cultures. [ABSTRACT FROM AUTHOR]

Radiological imaging is a globally prevalent diagnostic method, yet the free text contained in radiology reports is not frequently used for secondary purposes. Natural Language Processing can provide structured data retrieved from these reports. This paper provides a summary of the current state of research on Large Language Model (LLM) based approaches for information extraction (IE) from radiology reports. We conduct a scoping review that follows the PRISMA-ScR guideline. Queries of five databases were conducted on August 1st 2023. Among the 34 studies that met inclusion criteria, only pre-transformer and encoder-based models are described. External validation shows a general performance decrease, although LLMs might improve generalizability of IE approaches. Reports related to CT and MRI examinations, as well as thoracic reports, prevail. Most common challenges reported are missing validation on external data and augmentation of the described methods. Different reporting granularities affect the comparability and transparency of approaches. [ABSTRACT FROM AUTHOR]

This study evaluated the positive predictive value (PPV) of artificial intelligence (AI) in detecting pneumothorax on chest radiographs (CXRs) and its affecting factors. Patients determined to have pneumothorax on CXR by a commercial AI software from March to December 2021 were included retrospectively. The PPV was evaluated according to the true-positive (TP) and false-positive (FP) diagnosis determined by radiologists. To know the factors that might influence the results, logistic regression with generalized estimating equation was used. Among a total of 87,658 CXRs, 308 CXRs with 331 pneumothoraces from 283 patients were finally included. The overall PPV of AI about pneumothorax was 41.1% (TF:FP = 136:195). The PA view (odds ratio [OR], 29.837; 95% confidence interval [CI], 15.062–59.107), high abnormality score (OR, 1.081; 95% CI, 1.066–1.097), large amount of pneumothorax (OR, 1.005; 95% CI, 1.003–1.007), presence of ipsilateral atelectasis (OR, 3.508; 95% CI, 1.509–8.156) and a small amount of ipsilateral pleural effusion (OR, 5.277; 95% CI, 2.55–10.919) had significant effects on the increasing PPV. Therefore, PPV for pneumothorax diagnosis using AI can vary based on patients' factors, image-acquisition protocols, and the presence of concurrent lesions on CXR. [ABSTRACT FROM AUTHOR]

Introduction: The cardiothoracic ratio (CTR) based on postero-anterior chest X-rays (P-A CXR) images is one of the most commonly used cardiac measurement methods and an indicator for initially evaluating cardiac diseases. However, the hearts are not readily observable on P-A CXR images compared to the lung fields. Therefore, radiologists often manually determine the CTR's right and left heart border points of the adjacent left and right lung fields to the heart based on P-A CXR images. Meanwhile, manual CTR measurement based on the P-A CXR image requires experienced radiologists and is timeconsuming and laborious. Methods: Based on the above, this article proposes a novel, fully automatic CTR calculation method based on lung fields abstracted from the P-A CXR images using convolutional neural networks (CNNs), overcoming the limitations to heart segmentation and avoiding errors in heart segmentation. First, the lung field mask images are abstracted from the P-A CXR images based on the pre-trained CNNs. Second, a novel localization method of the heart's right and left border points is proposed based on the two-dimensional projection morphology of the lung field mask images using graphics. Results: The results show that the mean distance errors at the x-axis direction of the CTR's four key points in the test sets T1 (21 × 512 × 512 static P-A CXR images) and T2 (13 × 512 × 512 dynamic P-A CXR images) based on various pre-trained CNNs are 4.1161 and 3.2116 pixels, respectively. In addition, the mean CTR errors on the test sets T1 and T2 based on four proposed models are 0.0208 and 0.0180, respectively. Discussion: Our proposed model achieves the equivalent performance of CTR calculation as the previous CardioNet model, overcomes heart segmentation, and takes less time. Therefore, our proposed method is practical and feasible and may become an effective tool for initially evaluating cardiac diseases. [ABSTRACT FROM AUTHOR]

Many researchers and medical practitioners have recently focused on the automatic detection of COVID-19 using chest X-Ray (CXR) images. In the past, several computer-aided diagnostic (CAD) schemes were developed to assist healthcare professionals. These CAD systems using CXR images can speed up the identification process. As a result, we have proposed an automatic diagnosis (CAD-CXR) system by using the haar-like feature and XgBoost classifier. To develop a CAD-CXR system, we have used a pre-processing step and Haar-Like feature descriptor to extract features from chest X-ray images. Afterward, many machine learning classifiers are employed to categorize the images into coronavirus-19 and normal. Feature extraction and classification techniques are evaluated based on detection performance. Several experiments are performed to compare the performance of the proposed method with other classifiers. Our work is evaluated by public datasets with three different train-test splits in terms of average accuracy, F1-score, recall, and precision metrics. Compared to state-of-the-art methods, the XgBoost classifier with the Haar-Like feature obtained excellent performance based on the accuracy of 97.5%, F1-score of 96%, recall of 96%, and precision of 97%. These experimental results conclude that the CAD-CXR system outperforms to detect most of the covid-19 cases. The proposed CAD-CXR approach can be utilized to effectively screen the COVID-19-infected patients using CXR images. [ABSTRACT FROM AUTHOR]

Background: Liver injuries such as metabolic-associated fatty liver disease, liver fibrosis, and steatosis are common in COVID-19 patients. Unenhanced CT can be used to diagnose the morphological traits of steatosis and cirrhosis. This study aims to provide a clear overview on the association between liver injuries and decreased hepatic CT attenuation values on chest CT images in patients with COVID-19. Main text: Measuring HU values can be used as an additional method to diagnose liver injuries, even though HU values alone cannot definitively diagnose specific liver diseases. Chest CT is a common imaging procedure for diagnosing pneumonia, and during this CT examination, the upper abdomen, including the liver and spleen, is incidentally captured on the CT scan. Therefore, the assessment of liver injuries in chest CT of patients with COVID-19 can be performed by measuring the HU value of the liver and spleen. In this review, we summarize all the currently available CT findings in liver injuries associated with decreased hepatic CT attenuation values. Conclusion: We found out that liver injuries such as hepatic steatosis and metabolic disease were more frequent in the COVID-19 patient, especially in severe and ICU patients. Compared to control group and COVID-19 patients with mild symptoms, the hepatic CT attenuation values and L/S ratios were lower in research group and severe COVID-19 patients. [ABSTRACT FROM AUTHOR]

Here we report a rare case of immunoglobulin G4 (IgG4)–related pleural disease diagnosed using a thoracoscopic pleural biopsy. A 66‐year‐old man was admitted to our hospital with right‐dominant bilateral pleural effusions and gradually worsening dyspnoea. Chest radiographs revealed right‐dominant pleural effusions, while chest computed tomography showed bilateral pleural effusions without parenchymal lesions. Although the bilateral pleural effusions were exudative with an increased number of lymphocytes, the definitive diagnosis was initially elusive. High IgG4 levels in the serum and pleural effusions were observed. A pathological evaluation of a right pleural biopsy specimen collected via video‐assisted thoracoscopic surgery showed fibrosis‐associated lymphoplasmacytic infiltration, 45–60 IgG4‐positive plasma cells per high‐power field, and an IgG4/immunoglobulin G ratio of 40%. Consequently, the patient was diagnosed with IgG4‐related pleural disease. The bilateral pleural effusions improved after corticosteroid therapy. [ABSTRACT FROM AUTHOR]

Peripheral benign lung tumors are often asymptomatic and incidentally detected on chest radiographs. Surgical intervention is recommended when feasible. Single-port thoracoscopic resection has emerged as a promising technique for treating various chest diseases, including lung tumors. This study aimed to assess the clinical efficacy of single-port thoracoscopic resection for benign lung tumors and its impact on respiratory function and inflammatory factors. A total of 128 eligible patients diagnosed with benign lung tumors were randomly assigned to either the observation group (undergoing single-port thoracoscopic resection) or the control group (undergoing conventional thoracic surgery). Surgical outcomes, complications, pulmonary and respiratory function, and inflammatory factors were compared between the two groups. The observation group showed significantly lower intraoperative bleeding, shorter hospitalization time, and lower complication rates compared to the control group. Patients in the observation group exhibited higher vital capacity (VC), forced vital capacity (FVC), and total lung capacity (TLC) levels at 1/2 week and 1 month after surgery. Additionally, forced expiratory volume in one second (FEV1) and maximum ventilation volume per minute (MVV) levels were higher in the observation group post-surgery, with a lower Borg score. Levels of C-reactive protein (CRP), precalcitonin (PCT), and tumor necrosis factor (TNF-α) were lower in the observation group postsurgery. Single-port thoracoscopic resection demonstrates favorable clinical efficacy for treating benign lung tumors, reducing bleeding, and shortening hospital stays. Furthermore, it improves lung and respiratory function while reducing inflammatory factors. This technique is safe, effective, and holds promise for wider application in managing benign lung tumors. [ABSTRACT FROM AUTHOR]

The opportunistic use of radiological examinations for disease detection can potentially enable timely management. We assessed if an index created by an AI software to quantify chest radiography (CXR) findings associated with heart failure (HF) could distinguish between patients who would develop HF or not within a year of the examination. Our multicenter retrospective study included patients who underwent CXR without an HF diagnosis. We included 1117 patients (age 67.6 ± 13 years; m:f 487:630) that underwent CXR. A total of 413 patients had the CXR image taken within one year of their HF diagnosis. The rest (n = 704) were patients without an HF diagnosis after the examination date. All CXR images were processed with the model (qXR-HF, Qure.AI) to obtain information on cardiac silhouette, pleural effusion, and the index. We calculated the accuracy, sensitivity, specificity, and area under the curve (AUC) of the index to distinguish patients who developed HF within a year of the CXR and those who did not. We report an AUC of 0.798 (95%CI 0.77–0.82), accuracy of 0.73, sensitivity of 0.81, and specificity of 0.68 for the overall AI performance. AI AUCs by lead time to diagnosis (<3 months: 0.85; 4–6 months: 0.82; 7–9 months: 0.75; 10–12 months: 0.71), accuracy (0.68–0.72), and specificity (0.68) remained stable. Our results support the ongoing investigation efforts for opportunistic screening in radiology. [ABSTRACT FROM AUTHOR]

Simple Summary: Lung cancer diagnosis often requires invasive procedures due to the lack of effective early detection methods, particularly the insufficient specificity of current screening approaches. This study aimed to develop and validate epigenetic biomarkers from bronchoalveolar lavage fluid (BALF) exosome specimens capable of discriminating between lung cancer and benign lung diseases suspected of lung malignancy. Our findings indicate that combinations of epigenetic biomarkers derived from BALF exosomes can effectively support the discrimination of these clinical conditions with high specificity. Benign lung diseases are common and often do not require specific treatment, but they pose challenges in the distinguishing of them from lung cancer during low-dose computed tomography (LDCT). This study presents a comprehensive methylation analysis using real-time PCR for minimally invasive diagnoses of lung cancer via employing BALF exosome DNA. A panel of seven epigenetic biomarkers was identified, exhibiting specific methylation patterns in lung cancer BALF exosome DNA. This panel achieved an area under the curve (AUC) of 0.97, with sensitivity and specificity rates of 88.24% and 97.14%, respectively. Each biomarker showed significantly higher mean methylation levels (MMLs) in both non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC) compared to non-cancer groups, with fold changes from 1.7 to 13.36. The MMLs of the biomarkers were found to be moderately elevated with increasing patient age and smoking history, regardless of sex. A strong correlation was found between the MMLs and NSCLC stage progression, with detection sensitivities of 79% for early stages and 92% for advanced stages. In the validation cohort, the model demonstrated an AUC of 0.95, with 94% sensitivity and specificity. Sensitivity for early-stage NSCLC detection improved from 88.00% to 92.00% when smoking history was included as an additional risk factor. [ABSTRACT FROM AUTHOR]

Introduction: Tuberculosis (TB) in children under 15 years often results in airway compression, with bronchus intermedius (BI) being the most common site. Endoscopic enucleations can be used to remove lymph nodes and establish an airway in severe cases. Both rigid and flexible bronchoscopy are suitable, with alligator forceps being preferred for its ability to extract tissue. Recent studies have also explored cryoprobe enucleation. Case Presentation: An HIV-positive boy with persistent symptoms after 9 months of TB treatment was diagnosed based on his mother's and sister's Xpert MTB/RIF positive status. He was started on 4-drug TB treatment, but the child remained clinically symptomatic with abnormal chest X-ray and unconfirmed TB. Bronchoscopy was performed, revealing complete obstruction of BI due to caseating granulomas causing collapse of the right middle and lower lobes. Cryotherapy was used to recanalize the airway, and follow-up bronchoscopy confirmed patent BI. Conclusion: While cryotherapy was effective in the restoration of airway patency in this case, there is a lack of knowledge about its use in children. [ABSTRACT FROM AUTHOR]

Background: Community-acquired pneumonia (CAP) is widely acknowledged as the leading cause of morbidity and mortality among children worldwide, particularly in developing nations. Children with congenital heart disorders (CHD) are more likely to have pneumonia and require repeated hospitalization. We aim to determine the most frequent microorganism responsible for pneumonia in children with and without CHD, as well as the frequency of bacteremia in such cases, and whether or not CHD raises the risk of bacteremia in children with pneumonia. Methods We conducted our prospective cohort study in Department of Pediatrics, Faculty of Medicine, Zagazig University on 50 children who divided equally into 2 groups; group I contained 25 children with pneumonia in patients with CHD, group II contained 25 non cardiac children with pneumonia. All underwent complete blood count (CBC), chest x ray (CXR), echocardiogram (ECHO), sputum culture, and blood culture. Results: Patients of CHD had significant more frequent previous hospital admissions by pneumonia. Among the children in group I, the blood culture results revealed no growth in 15 cases (60%), and klebsiella pneumoniae in 3 cases (12%), while in group I, the result revealed no growth in 11 cases (44%), klebsiella pneumoniae in 5 cases (20%) and there was no statistically significant difference between both groups. Conclusion: Klebsiella pneumoniae was the most prevalent pathogen responsible for pneumonia in children with and without CHD, and linezolid was the most sensitive antibiotic. In children who have pneumonia, CHD might attribute to higher risk of bacteremia, however, we couldn't prove that in our study. [ABSTRACT FROM AUTHOR]

Purpose: To compare the diagnostic performance of a thick-slab reconstruction obtained from an ultra-low-dose CT (termed thoracic tomogram) with standard-of-care low-dose CT (SOC-CT) for rapid interpretation and detection of pneumonia in hemato-oncology patients. Methods: Hemato-oncology patients with a working diagnosis of pneumonia underwent an SOC-CT followed by an ultra-low-dose CT, from which the thoracic tomogram (TT) was reconstructed. Three radiologists evaluated the TT and SOC-CT in the following categories: (I) infectious/inflammatory opacities, (II) small airways infectious/inflammatory changes, (III) atelectasis, (IV) pleural effusions, and (V) interstitial abnormalities. The TT interpretation time and radiation dose were recorded. Sensitivity, specificity, diagnostic accuracy, ROC, and AUC were calculated with the corresponding power analyses. The agreement between TT and SOC-CT was calculated by Correlation Coefficient for Repeated Measures (CCRM), and the Shrout-Fleiss intra-class correlations test was used to calculate interrater agreement. Results: Forty-seven patients (mean age 58.7 ± 14.9 years; 29 male) were prospectively enrolled. Sensitivity, specificity, accuracy, AUC, and Power for categories I/II/III/IV/V were: 94.9/99/97.9/0.971/100, 78/91.2/86.5/0.906/100, 88.6/100/97.2/0.941/100, 100/99.2/99.3/0.995/100, and 47.6/100/92.2/0.746/87.3. CCRM between TT and SOC-CT for the same categories were.97/.81/.92/.96/.62 with an interobserver agreement of.93/.88/.82/.96/.61. Mean interpretation time was 18.6 ± 5.4 seconds. The average effective radiation dose of TT was similar to a frontal and lateral chest X-ray (0.27 ± 0.08 vs 1.46 ± 0.64 mSv for SOC-CT; P <.01). Conclusion: Thoracic tomograms provide comparable diagnostic information to SOC-CT for the detection of pneumonia in immunocompromised patients at one-fifth of the radiation dose with high interobserver agreement. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to investigate whether deep-learning reconstruction (DLR) improves interobserver agreement in the evaluation of honeycombing for patients with interstitial lung disease (ILD) who underwent high-resolution computed tomography (CT) compared with hybrid iterative reconstruction (HIR). Methods: In this retrospective study, 35 consecutive patients suspected of ILD who underwent CT including the chest region were included. High-resolution CT images of the unilateral lung with DLR and HIR were reconstructed for the right and left lungs. A radiologist placed regions of interest on the lung and measured standard deviation of CT attenuation (i.e., quantitative image noise). In the qualitative image analyses, 5 blinded readers assessed the presence of honeycombing and reticulation, qualitative image noise, artifacts, and overall image quality using a 5-point scale (except for artifacts which was evaluated using a 3-point scale). Results: The quantitative and qualitative image noise in DLR was remarkably reduced compared to that in HIR (P <.001). Artifacts and overall DLR quality were significantly improved compared to those of HIR (P <.001 for 4 out of 5 readers). Interobserver agreement in the evaluations of honeycombing and reticulation for DLR (0.557 [0.450-0.693] and 0.525 [0.470-0.541], respectively) were higher than those for HIR (0.321 [0.211-0.520] and 0.470 [0.354-0.533], respectively). A statistically significant difference was found for honeycombing (P =.014). Conclusions: DLR improved interobserver agreement in the evaluation of honeycombing in patients with ILD on CT compared to HIR. [ABSTRACT FROM AUTHOR]

Background: Pneumothorax is a common acute presentation in healthcare settings. A chest radiograph (CXR) is often necessary to make the diagnosis, and minimizing the time between presentation and diagnosis is critical to deliver optimal treatment. Deep learning (DL) algorithms have been developed to rapidly identify pathologic findings on various imaging modalities. Purpose: The purpose of this systematic review and meta-analysis was to evaluate the overall performance of studies utilizing DL algorithms to detect pneumothorax on CXR. Methods: A study protocol was created and registered a priori (PROSPERO CRD42023391375). The search strategy included studies published up until January 10, 2023. Inclusion criteria were studies that used adult patients, utilized computer-aided detection of pneumothorax on CXR, dataset was evaluated by a qualified physician, and sufficient data was present to create a 2 × 2 contingency table. Risk of bias was assessed using the QUADAS-2 tool. Bivariate random effects meta-analyses and meta-regression modeling were performed. Results: Twenty-three studies were selected, including 34 011 patients and 34 075 CXRs. The pooled sensitivity and specificity were 87% (95% confidence interval, 81%, 92%) and 95% (95% confidence interval, 92%, 97%), respectively. The study design, use of an institutional/public data set and risk of bias had no significant effect on the sensitivity and specificity of pneumothorax detection. Conclusions: The relatively high sensitivity and specificity of pneumothorax detection by deep-learning showcases the vast potential for implementation in clinical settings to both augment the workflow of radiologists and assist in more rapid diagnoses and subsequent patient treatment. [ABSTRACT FROM AUTHOR]

A 61‐year‐old man presented to our hospital with a chief complaint of chronic cough. He was diagnosed with lung squamous cell carcinoma at clinical stage cT2aN3M1a. He received chemotherapy up to the fourth line, but both the primary tumor and lymph node metastases increased in size. Nivolumab, administered as the fifth line, resulted in a complete response (CR) that continued for 2 years and 8 months. Treatment was stopped due to the appearance of common terminology criteria for adverse events grade 1 pneumonitis. He was followed up without treatment for 3 years and 8 months, but a left supraclavicular fossa lymph node metastasis appeared. Retreatment with nivolumab was initiated, and the patient achieved CR again. One year and 6 months after retreatment, CR was maintained with nivolumab. This case represents a rare instance in which nivolumab yielded a significant response after a prolonged immune checkpoint inhibitor (ICI)‐free interval. Our experience has shown that the long‐term response to ICIs may deteriorate in the future. Therefore, retreatment with ICIs may be effective when the initial therapy is successful. [ABSTRACT FROM AUTHOR]

Sickle cell disease (SCD) is an autosomal recessive disorder altering the shape of red blood cells, causing harmful obstructions in blood vessels, therefore altering normal blood flow. SCD can escalate quickly into acute chest syndrome (ACS), a life-threatening complication that requires immediate care. This article discusses the pathophysiology, assessment, diagnosis, and treatment of ACS, as well as nursing care and patient education. [ABSTRACT FROM AUTHOR]

Background: In 2022, fewer than half of persons with tuberculosis (TB) had access to molecular diagnostic tests for TB due to their high costs. Studies have found that the use of artificial intelligence (AI) software for chest X-ray (CXR) interpretation and sputum specimen pooling can each reduce the cost of testing. We modeled the combination of both strategies to estimate potential savings in consumables that could be used to expand access to molecular diagnostics. Methods: We obtained Xpert testing and positivity data segmented into deciles by AI probability scores for TB from the community- and healthcare facility-based active case finding conducted in Bangladesh, Nigeria, Viet Nam, and Zambia. AI scores in the model were based on CAD4TB version 7 (Zambia) and qXR (all other countries). We modeled four ordinal screening and testing approaches involving AI-aided CXR interpretation to indicate individual and pooled testing. Setting a false negative rate of 5%, for each approach we calculated additional and cumulative savings over the baseline of universal Xpert testing, as well as the theoretical expansion in diagnostic coverage. Results: In each country, the optimal screening and testing approach was to use AI to rule out testing in deciles with low AI scores and to guide pooled vs individual testing in persons with moderate and high AI scores, respectively. This approach yielded cumulative savings in Xpert tests over baseline ranging from 50.8% in Zambia to 57.5% in Nigeria and 61.5% in Bangladesh and Viet Nam. Using these savings, diagnostic coverage theoretically could be expanded by 34% to 160% across the different approaches and countries. Conclusions: Using AI software data generated during CXR interpretation to inform a differentiated pooled testing strategy may optimize TB diagnostic test use, and could extend molecular tests to more people who need them. The optimal AI thresholds and pooled testing strategy varied across countries, which suggests that bespoke screening and testing approaches may be needed for differing populations and settings. [ABSTRACT FROM AUTHOR]

Objective: We provide evidence‐based recommendations regarding screening for interstitial lung disease (ILD) and the monitoring for ILD progression in people with systemic autoimmune rheumatic diseases (SARDs), specifically rheumatoid arthritis, systemic sclerosis, idiopathic inflammatory myopathies, mixed connective tissue disease, and Sjögren disease. Methods: We developed clinically relevant population, intervention, comparator, and outcomes questions related to screening and monitoring for ILD in patients with SARDs. A systematic literature review was performed, and the available evidence was rated using the Grading of Recommendations, Assessment, Development, and Evaluation methodology. A Voting Panel of interdisciplinary clinician experts and patients achieved consensus on the direction and strength of each recommendation. Results: Fifteen recommendations were developed. For screening people with these SARDs at risk for ILD, we conditionally recommend pulmonary function tests (PFTs) and high‐resolution computed tomography of the chest (HRCT chest); conditionally recommend against screening with 6‐minute walk test distance (6MWD), chest radiography, ambulatory desaturation testing, or bronchoscopy; and strongly recommend against screening with surgical lung biopsy. We conditionally recommend monitoring ILD with PFTs, HRCT chest, and ambulatory desaturation testing and conditionally recommend against monitoring with 6MWD, chest radiography, or bronchoscopy. We provide guidance on ILD risk factors and suggestions on frequency of testing to evaluate for the development of ILD in people with SARDs. Conclusion: This clinical practice guideline presents the first recommendations endorsed by the American College of Rheumatology and American College of Chest Physicians for the screening and monitoring of ILD in people with SARDs. [ABSTRACT FROM AUTHOR]

Primary pulmonary enteric adenocarcinoma (P-PEAC) is an unusual subtype of invasive lung adenocarcinoma. The significance of such tumor lies in its similar histopathological and immunohistochemical characteristics to colorectal adenocarcinoma. Therefore, a detailed investigation is crucial to establish a definitive diagnosis. This paper reports a case of a 51-year-old Saudi female, diagnosed with a rare variant of lung carcinoma, P-PEAC. [ABSTRACT FROM AUTHOR]

Despite periodic changes in the clinical definition of ARDS, imaging of the lung remains a central component of its diagnostic identification. Several imaging modalities are available to the clinician to establish a diagnosis of the syndrome, monitor its clinical course, or assess the impact of treatment and management strategies. Each imaging modality provides unique insight into ARDS from structural and/or functional perspectives. This review will highlight several methods for lung imaging in ARDS, emphasizing basic operational and physical principles for the respiratory therapist. Advantages and disadvantages of each modality will be discussed in the context of their utility for clinical management and decision-making. [ABSTRACT FROM AUTHOR]

Introduction: Hydatid disease of the male breast has not been documented in literature to date. Case report: We present a case of a 46-year old male patient who presented with a painful breast lump for 1 year. On imaging, it was suspicious for hydatid disease of the breast and was successfully diagnosed preoperatively on fine-needle aspiration cytology and histopathology as hydatid disease of the breast. Discussion: Incidence of hydatid disease of the breast contributes to a minute number of total cases of hydatid disease. Male breast hydatid disease was unknown prior to this report. We did find similarities in the imaging features of our case and the ones described for female breasts. On ultrasonography, we found it analogous to the 'water-lily' sign which has been described in hepatic hydatic cysts. Conclusion: Keeping hydatid disease as a differential in the setting of a suspicious breast mass even in a male patient proved to be rewarding as it negated the need for further cross-sectional imaging and a definitive diagnosis could be sought based on the fine-needle aspiration cytology and histopathological findings. [ABSTRACT FROM AUTHOR]

Rosai Dorfman disease (RDD) is a rare non-Langerhans histiocytic disorder, which belongs to the R group of the 2016 revised histiocytic classification. It's characterized by the accumulation of activated histiocytes in the sinusoids of lymph nodes and/or extranodal tissues. Herein, we report a 7-year-old female who was initially suspected to have a lymphoma but was later identified as having RDD. She presented with a history of fever, night sweats, and weight loss, and on physical examination had bilateral cervical lymphadenopathy. Histologic examination of the biopsied cervical lymph nodes showed distended sinuses with S100 and CD68 immunoreactive histiocytes demonstrating emperipolesis, confirming a diagnosis of RDD. The condition is known to be self-limiting. However, evidence from literature and our case management shows that medical therapy can hasten remission in pediatric cases. [ABSTRACT FROM AUTHOR]

Background: Antimicrobial stewardship (AMS) for ventilator-associated pneumonia (VAP) or ventilated hospital-acquired pneumonia (vHAP) in extended-spectrum β-lactamase-producing Enterobacterales (ESBL-E) carriers is challenging. BioFire® FilmArray® Pneumonia plus Panel (mPCR) can detect bacteria and antibiotic resistance genes, including blaCTX-M, the most common ESBL-encoding gene. Methods: This monocentric, prospective study was conducted on a group of ESBL-E carriers from March 2020 to August 2022. The primary objective was to evaluate the concordance between the results of mPCR and conventional culture performed on respiratory samples of ESBL-E carriers to investigate suspected VAP/vHAP. The secondary objective was to appraise the impact of performing or not mPCR on initial antibiotic therapy adequacy in ESBL-E carriers with confirmed VAP/vHAP. Results: Over the study period, 294 patients with ESBL-E carriage were admitted to the ICU, of who 168 (57%) were mechanically ventilated. (i) Diagnostic performance of mPCR was evaluated in suspected 41 episodes of VAP/vHAP: blaCTX-M gene was detected in 15/41 (37%) episodes, where 9/15 (60%) were confirmed ESBL-E-induced pneumonia. The culture and blaCTX-M were concordant in 35/41 (85%) episodes, and in all episodes where blaCTX-M was negative (n = 26), the culture never detected ESBL-E. (ii) The impact of mPCR on initial antibiotic therapy adequacy was assessed in 95 episodes of confirmed VAP/vHAP (22 episodes were tested with mPCR and 73 without); 47 (49%) episodes were ESBL-E-induced, and 24 (25%) were carbapenem-resistant bacteria-induced. The use of mPCR was significantly associated with higher prescription of adequate empirical antibiotic therapy in the multivariable logistic regression (adjusted odds ratio (aOR) (95% CI) of 7.5 (2.1–35.9), p = 0.004), propensity-weighting (aOR of 5.9 (1.6–22.1), p = 0.008), and matching-cohort models (aOR of 5.8 (1.5–22.1), p = 0.01). Conclusion: mPCR blaCTX-M showed an excellent diagnostic value to rule out the diagnosis of ESBL-E related pneumonia in ESBL-E carriers with suspected VAP/vHAP. In addition, in patients with confirmed VAP/vHAP, a mPCR-based antibiotic therapy was associated with an increased prescription of adequate empirical antibiotic therapy. Performing mPCR on respiratory samples seems to be a promising tool in ESBL-E carriers with suspected vHAP/VAP. However, if mPCR is used in very low pre-test clinical probability of pneumonia, due to the high sensitivity and the rate of overdiagnosed pneumonia, the risk of overconsumption of carbapenem may prevail. Further studies are warranted. [ABSTRACT FROM AUTHOR]

Background: The reversed halo, also known as the atoll sign, is a distinct sign with ring-shaped consolidation and central lucency. The reversed halo sign, initially emerging in cryptogenic organizing pneumonia, has been observed in various pulmonary diseases, including pulmonary embolism. The presence of this sign in the subpleural, posterior basal parts of the lower lobes, predominantly when solitary, should raise the possibility of other causes, such as pulmonary infarction. Case presentation: We present a case of acute pulmonary embolism with pulmonary infarction discovered on a CT pulmonary angiogram in our emergency department, where the pulmonary infarction appears as a reverse halo sign with a reticulonodular pattern. The reticular nodular pattern in the halo sign is not typical of a pulmonary infarct presenting with a reverse halo sign. Conclusions: To our knowledge, this is the first case of pulmonary infarction in acute pulmonary embolism with the appearance of a reverse halo sign with a reticulonodular pattern. [ABSTRACT FROM AUTHOR]

Severe pneumonia results in high morbidity and mortality despite advanced treatments. This study investigates thoracic muscle mass from chest CT scans as a biomarker for predicting clinical outcomes in ICU patients with severe pneumonia. Analyzing electronic medical records and chest CT scans of 778 ICU patients with severe community-acquired pneumonia from January 2016 to December 2021, AI-enhanced 3D segmentation was used to assess thoracic muscle mass. Patients were categorized into clusters based on muscle mass profiles derived from CT scans, and their effects on clinical outcomes such as extubation success and in-hospital mortality were assessed. The study identified three clusters, showing that higher muscle mass (Cluster 1) correlated with lower in-hospital mortality (8% vs. 29% in Cluster 3) and improved clinical outcomes like extubation success. The model integrating muscle mass metrics outperformed conventional scores, with an AUC of 0.844 for predicting extubation success and 0.696 for predicting mortality. These findings highlight the strong predictive capacity of muscle mass evaluation over indices such as APACHE II and SOFA. Using AI to analyze thoracic muscle mass via chest CT provides a promising prognostic approach in severe pneumonia, advocating for its integration into clinical practice for better outcome predictions and personalized patient management. [ABSTRACT FROM AUTHOR]

Background: Intestinal necrosis in uremic patients has been reported but is rare. Case presentation: A 56-year-old male patient who underwent long-term regular haemodialysis was admitted to the hospital due to involuntary shaking of the limbs and nonsense speech. The patient's symptoms improved after continuous blood purification under heparin anticoagulation, rehydration, sedation, and correction of electrolyte disturbances. However, the patient experienced a sudden onset of abdominal pain and a rapid decrease in blood pressure; high-dose norepinephrine were required to maintain his blood pressure. A plain abdominal radiograph performed at bedside showed intestinal dilation. Colonoscopy revealed inflammation and oedema of the entire colon, with purulent secretions and multiple areas of patchy necrosis. The cause of intestinal ischaemia was not clear. Conclusions: Although rare, previous causes of uremic colitis have been reported. As the patient developed abdominal pain before the onset of shock and the necrosis was seen on colonoscopy, we suspect that this is a case of fulminant uremic colitis. [ABSTRACT FROM AUTHOR]

Background: The efficacy of anti‐CTLA‐4 antibody (ipilimumab) plus anti‐programmed cell death 1 antibody (nivolumab) in treating advanced non‐small cell lung cancer (NSCLC) is impeded by an elevated risk of severe immune‐related adverse events. However, our understanding of associations among pre‐existing fibrosis, emphysematous changes, and objective indicators as predictive factors is limited for severe pneumonitis in NSCLC patients receiving this combination therapy. Thus, we retrospectively investigated these associations, including overall tumor burden, before treatment initiation in the Japanese population. Methods: We focused on patients (n = 76) with pre‐existing interstitial lung disease (ILD) to identify predictors of severe pneumonitis. Variables included age, sex, smoking status, programmed cell death ligand 1 expression, overall tumor burden, chest computed tomography‐confirmed fibrosis, serum markers, and respiratory function test results. Results: Severe pneumonitis was more frequent in patients with squamous cell carcinoma, fibrosis, low diffusing capacity for carbon monoxide (%DLCO), and high surfactant protein D (SP‐D) level. Notably, squamous cell carcinoma, baseline %DLCO, and SP‐D level were significant risk factors. Our findings revealed the nonsignificance of tumor burden (≥85 mm) in predicting severe pneumonitis, emphasizing the importance of pre‐existing ILD. Conversely, in cases without pre‐existing fibrosis, severe pneumonitis was not associated with %DLCO or SP‐D level (93.2% vs. 91.9%, and 63.3 vs. 40.9 ng/mL, respectively) and was more common in patients with a large overall tumor burden (97.5 vs. 70.0 mm). Conclusion: Vigilant monitoring and early intervention are crucial for patients with squamous cell carcinoma, high SP‐D level, or low %DLCO undergoing ipilimumab plus nivolumab therapy. [ABSTRACT FROM AUTHOR]

Background: Multiple supernumerary teeth, combined with numerous impacted teeth, can lead to various malocclusions, posing significant treatment challenges. While certain genes associated with syndromic cases of multiple supernumerary and impacted teeth have been identified, the etiologies of non-syndromic cases still largely remain elusive. Case presentation: Here, we report a treatment of a 12-year-old boy who presented with 10 supernumerary teeth and 6 impacted teeth, accompanied by a genetic analysis to explore the underlying etiology. During the treatment, fifteen teeth were extracted, and various skilled techniques, including the closed-eruption technique and the application of by-pass arches, were utilized. Post-treatment, traction was successful for all the impacted teeth, without any tooth mobility or reduction in gingival height. Space closure, well-aligned teeth, and excellent functional occlusion were achieved. Furthermore, comprehensive genetic analysis was conducted through whole-exome sequencing on the patient and his parents, which revealed a potential link between the patient's numerous supernumerary teeth and abnormal mineralization. Notably, the p.Ser496Pro variant in the TCF7L2 gene was identified as a potential candidate variant in this patient. Conclusions: Overall, our findings not only report the treatment of a rare case involving multiple supernumerary and impacted teeth but also offer valuable insights into the molecular basis of supernumerary teeth. [ABSTRACT FROM AUTHOR]

The incidence of lung cancer brain metastasis combined with hemorrhagic cerebral venous sinus thrombosis (CVST) is very rare, and the understanding and treatment experience of this case is insufficient. We reported a case of lung cancer brain metastasis accompanied by venous sinus thrombosis, and describe the diagnosis and treatment plan for colleagues to learn from experience and lessons. Key points: 1. The incidence of lung cancer brain metastasis combined with hemorrhagic CVST is very rare, and the understanding and treatment experience of this case is insufficient. 2. The clinical manifestations of metastatic tumors and CVST in patients are not specific, and the evolution of the medical history should be inquired in detail, with careful physical examination and imaging review. 3. CVST should be considered in patients with risk factors. The incidence of hemorrhagic CVST is relatively rare, and due to atypical symptoms and imaging manifestations, it is easy to miss and misdiagnose. 4. The responsible lesion should be determined based on the evolution of the medical history, the treatment of the responsible lesion should be prioritized, symptoms should be relieved in a timely manner and the optimal treatment time should be strived for. [ABSTRACT FROM AUTHOR]

Chest X-rays (CXR) are widely used to facilitate the diagnosis and treatment of critically ill and emergency patients in clinical practice. Accurate hemi-diaphragm detection based on postero-anterior (P-A) CXR images is crucial for the diaphragm function assessment of critically ill and emergency patients to provide precision healthcare for these vulnerable populations.Therefore, an effective and accurate hemi-diaphragm detection method for P-A CXR images is urgently developed to assess these vulnerable populations’ diaphragm function.Based on the above, this paper proposes an effective hemi-diaphragm detection method for P-A CXR images based on the convolutional neural network (CNN) and graphics. First, we develop a robust and standard CNN model of pathological lungs trained by human P-A CXR images of normal and abnormal cases with multiple lung diseases to extract lung fields from P-A CXR images. Second, we propose a novel localization method of the cardiophrenic angle based on the two-dimensional projection morphology of the left and right lungs by graphics for detecting the hemi-diaphragm.The mean errors of the four key hemi-diaphragm points in the lung field mask images abstracted from static P-A CXR images based on five different segmentation models are 9.05, 7.19, 7.92, 7.27, and 6.73 pixels, respectively. Besides, the results also show that the mean errors of these four key hemi-diaphragm points in the lung field mask images abstracted from dynamic P-A CXR images based on these segmentation models are 5.50, 7.07, 4.43, 4.74, and 6.24 pixels,respectively.Our proposed hemi-diaphragm detection method can effectively perform hemi-diaphragm detection and may become an effective tool to assess these vulnerable populations’ diaphragm function for precision healthcare. [ABSTRACT FROM AUTHOR]

Middle lobe torsion (MLT) is an unusual complication in lung surgery that is usually associated with upper lobe lobectomy and rarely develops postlower lobectomy. In the case of MLT, urgent surgical intervention is required to decrease the risk of mortality and morbidity, and diagnosis is challenging due to the nonspecific symptoms of MLT. In this article, we present a case of a recurring lung abscess treated by the right lower lobectomy, complicated by the right MLT and to our knowledge MLT consider rarest complication postright lower lobectomy. [ABSTRACT FROM AUTHOR]

In this research, we introduce a network that can identify pneumonia, COVID-19, and tuberculosis using X-ray images of patients' chests. The study emphasizes tuberculosis, COVID-19, and healthy lung conditions, discussing how advanced neural networks, like VGG16 and ResNet50, can improve the detection of lung issues from images. To prepare the images for the model's input requirements, we enhanced them through data augmentation techniques for training purposes. We evaluated the model's performance by analyzing the precision, recall, and F1 scores across training, validation, and testing datasets. The results show that the ResNet50 model outperformed VGG16 with accuracy and resilience. It displayed superior ROC AUC values in both validation and test scenarios. Particularly impressive were ResNet50's precision and recall rates, nearing 0.99 for all conditions in the test set. On the hand, VGG16 also performed well during testing—detecting tuberculosis with a precision of 0.99 and a recall of 0.93. Our study highlights the performance of our deep learning method by showcasing the effectiveness of ResNet50 over traditional approaches like VGG16. This progress utilizes methods to enhance classification accuracy by augmenting data and balancing them. This positions our approach as an advancement in using state-of-the-art deep learning applications in imaging. By enhancing the accuracy and reliability of diagnosing ailments such as COVID-19 and tuberculosis, our models have the potential to transform care and treatment strategies, highlighting their role in clinical diagnostics. [ABSTRACT FROM AUTHOR]

Background and Objectives: Small chest drains are used in many centers as the default drainage strategy for various pleural effusions. This can lead to drain overuse, which may be harmful. This study aimed to reduce chest drain overuse. Methods: We studied consecutive pleural procedures performed in the radiology department before (August 1, 2015, to July 31, 2016) and after intervention (September 1, 2019, to January 31, 2020). Chest drains were deemed indicated or not based on criteria established by a local interdisciplinary work group. The intervention consisted of a pleural drainage order set embedded in electronic medical records. It included indications for chest drain insertion, prespecified drain sizes for each indication, fluid analyses, and postprocedure radiography orders. Overall chest drain use and proportion of nonindicated drains were the outcomes of interest. Results: We reviewed a total of 288 procedures (pre-intervention) and 155 procedures (post-intervention) (thoracentesis and drains). Orderset implementation led to a reduction in drain use (86.5% vs 54.8% of all procedures, P < .001) and reduction in drain insertions in the absence of an indication (from 45.4% to 29.4% of drains, P = .01). The need for repeat procedures did not increase after order-set implementation (22.0% pre vs 17.7% post, P = .40). Complication rates and length of hospital stay did not differ significantly after the intervention. More pleural infections were treated with drain sizes of 12Fr and greater (31 vs 70%, P < .001) after order-set deployment, and direct procedural costs were reduced by 27 CAN$ per procedure. Conclusion: Implementation of a pleural drainage order-set reduced chest drain use, improved procedure selection according to clinical needs, and reduced direct procedural costs. In institutions where small chest drains are used as the default drainage strategy for pleural effusions, this order set can reduce chest drain overuse. [ABSTRACT FROM AUTHOR]

Introduction: Ropeginterferon alfa-2b is a novel mono-pegylated proline-interferon. This clinical study aimed to evaluate its antiviral efficacy of ropeginterferon alfa-2b against SARS-CoV-2 infection. Methods: This is a multicenter, randomized, open-label study. Adult patients with confirmed SARS-CoV-2 infection with initial cycle threshold (Ct) value < 30 and symptom onset within 4 days were enrolled. Eligible patients were randomized in a 2:1 ratio to receive a single 250-µg dose of ropeginterferon alfa-2b subcutaneously plus standard of care (SOC) or to receive SOC alone. The primary endpoint was the proportion of patients with a negative RT-PCR result for SARS-CoV-2 or discharged from the hospital before Day 8. Change in clinical status based on the World Health Organization (WHO) clinical progression scale and pulmonary infiltrations through chest radiograph were also evaluated. Results: A total of 132 patients were enrolled and treated with study medication. Higher percentages of patients who achieved Ct ≥ 30 or were discharged from the hospital were observed on Day 8 and every other time point of assessment, i.e., Days 5, 11, 15, and 22, in the ropeginterferon alfa-2b group compared to the SOC alone group. However, the difference was statistically significant on Day 11 but not on Day 8. The primary endpoint was not met. The ropeginterferon alfa-2b group showed a higher improvement rate in lung infiltration on Day 5 (27.6% vs. 0.0%, p = 0.0087) and a higher improvement rate in WHO clinical progression scores on Day 8 (69.4% vs. 35.3%, p = 0.03) than those in the SOC group. No ropeginterferon alfa-2b-related serious adverse event was observed. Conclusion: Our data show that ropeginterferon alfa-2b with SOC shortened the duration of SARS-CoV-2 shedding compared with SOC alone. In addition, ropeginterferon alfa-2b as an additional therapy could be beneficial by improving lung infiltration. [ABSTRACT FROM AUTHOR]

Objectives: Lung cancer is one of the most common malignant tumors threatening human life and health. At present, low‐dose computed tomography (LDCT) screening for the high‐risk population to achieve early diagnosis and treatment of lung cancer has become the first choice recommended by many authoritative international medical organizations. To further optimize the lung cancer screening method, we conducted a real‐world study of LDCT lung cancer screening in a large sample of a healthy physical examination population, comparing differences in lung nodules and lung cancer detection between thin and thick‐slice LDCT scanning. Methods: A total of 29 296 subjects who underwent low‐dose thick‐slice CT scanning (5 mm thickness) from January 2015 to December 2015 and 28 058 subjects who underwent low‐dose thin‐slice CT scanning (1 mm thickness) from January 2018 to December 2018 in West China Hospital were included. The positive detection rate, detection rate of lung cancer, pathological stage of lung cancer, and mortality rate of lung cancer were analyzed and compared between the two groups. Results: The positive rate of LDCT screening in the thin‐slice scanning group was significantly higher than that in the thick‐slice scanning group (20.1% vs. 14.4%, p < 0.001). In addition, the lung cancer detection rate in the thin‐slice LDCT screening positive group was significantly higher than that in the thick‐slice scanning group (78.0% vs. 52.9%, p < 0.001). Conclusions: The screening positive rate of low‐dose thin‐slice CT scanning is higher and more early‐stage lung cancer (IA1 stage) can be detected in the screen‐positive group. [ABSTRACT FROM AUTHOR]

Objective To describe the frequency of progressive pulmonary fibrosis (PPF) in an incident cohort of systemic sclerosis (SSc)-related interstitial lung disease (ILD) and its impact on survival. Methods Incident ILD was defined as the new development of characteristic fibrotic changes on chest HRCT scan. PPF was defined as per the 2022 American Thoracic Society. Determinants of PPF were identified using generalised estimating equations. Impact on survival was analysed using accelerated failure time regression modelling. Results Of our incident SSc-ILD cases, 38.8% (n  = 180) experienced PPF within a 12-month period after ILD diagnosis. Determinants of PPF included older age (OR 1.02, 95%CI 1.00–1.03, P  = 0.011), dcSSc (OR 1.54, 95% CI 1.06–2.25, P  = 0.024) and SSc-specific antibodies (anticentomere antibody OR 0.51, 95%CI 0.29–0.91, P  = 0.021 and anti-Scl-70 antibody OR 1.46, 95%CI 1.01–2.09, P  = 0.043). Raised CRP was numerically associated with PPF but did not reach statistical significance (OR 1.29, 95%CI 0.99–1.68, P  = 0.064) nor did GORD or dysphagia (OR 1.18, 95%CI 0.57–2.42, P  = 0.658 and OR 1.17, 95%CI 0.57–2.40, P  = 0.664, respectively). The presence of PPF significantly impacted survival in SSc-ILD (hazard ratio 2.66, 95%CI 1.59–4.41, P  < 0.001). Conclusions PPF occurred in a third of our incident SSc-ILD cohort; however, its occurrence was significantly associated with mortality indicating an at-risk group who may be suitable for earlier introduction of immunosuppressive and/or antifibrotic therapy. [ABSTRACT FROM AUTHOR]

Objectives Pulmonary arterial hypertension associated with systemic sclerosis (PAH-SSc) sometimes accompanies pulmonary veno-occlusive disease (PVOD). We aimed to reveal the relationship between clinical signs of PVOD and severity of pulmonary vasculopathy in SSc. Methods This study included 52 consecutive SSc patients who had pulmonary haemodynamic abnormalities [mean pulmonary arterial pressure (mPAP) >20 mmHg, pulmonary vascular resistance >2 WU or pulmonary artery wedge pressure (PAWP) >15 mmHg]. A chest CT scan was evaluated in all patients. Patients were divided into two groups, the 0–1 group and the 2–3 group, according to the number of chest CT signs for PVOD, including mediastinal lymph node enlargement, thickened interlobular septal wall and ground glass opacity. Pulmonary haemodynamics, echocardiography and MRI-based cardiac function, pulmonary function and serum biomarkers were compared between the two groups. Results Mediastinal lymph node enlargement, thickened interlobular septal wall and ground glass opacity were observed in 11 (21%), 32 (62%) and 11 (21%) patients, respectively. The 2–3 group (n  = 15) had higher mPAP (P  = 0.02) but lower diffusing capacity of carbon monoxide (DLCO)/alveolar volume (P  = 0.02) compared with the 0–1 group (n  = 37). Other parameters, including PAWP, cardiac output, left ventricular ejection fraction, left atrial diameter, forced vital capacity, brain natriuretic peptide and Krebs von den Lunge-6 were not different between the two groups. Conclusions The CT signs for PVOD had a positive correlation with mPAP but a negative correlation with DLCO in SSc patients, indicating that PAH-SSc may reflect a spectrum of pulmonary vascular disease that ranges from the pulmonary artery to the vein. [ABSTRACT FROM AUTHOR]

Context.--Respiratory infections complicate lung transplantation and increase the risk of allograft dysfunction. Allograft lungs may have different susceptibilities to infection than native lungs, potentially leading to different disease severity in lungs of single lung transplant recipients (SLTRs). Objective.--To study whether infections affect allograft and native lungs differently in SLTRs but similarly in double LTRs (DLTRs). Design.--Using an institutional database of LTRs, medical records were searched, chest computed tomography studies were systematically reviewed, and histopathologic features were recorded per lung lobe and graded semiquantitatively. A multilobar-histopathology score (MLHS) including histopathologic data from each lung and a bilateral ratio (MLHSratio) comparing histopathologies between both lungs were calculated in SLTRs and compared to DLTRs. Results.--Six SLTRs died of infection involving the lungs. All allografts showed multifocal histopathologic evidence of infection, but at least 1 lobe of the native lung was uninvolved. In 4 of 5 DLTRs, histopathologic evidence of infection was seen in all lung lobes. On computed tomography, multifocal ground-glass and/or nodular opacities were found in a bilateral distribution in all DLTRs but in only 2 of 6 SLTRs. In SLTRs, the MLHSAllograft was higher than MLHSNative (P ¼ .02). The MLHSratio values of SLTR and DLTR were significantly different (P, .001). Conclusions.--Allograft and native lungs appear to harbor different susceptibilities to infections. The results are important for the management of LTRs. [ABSTRACT FROM AUTHOR]

Objectives: To develop and validate a deep learning-based prognostic model in patients with idiopathic pulmonary fibrosis (IPF) using chest radiographs. Methods: To develop a deep learning-based prognostic model using chest radiographs (DLPM), the patients diagnosed with IPF during 2011–2021 were retrospectively collected and were divided into training (n = 1007), validation (n = 117), and internal test (n = 187) datasets. Up to 10 consecutive radiographs were included for each patient. For external testing, three cohorts from independent institutions were collected (n = 152, 141, and 207). The discrimination performance of DLPM was evaluated using areas under the time-dependent receiver operating characteristic curves (TD-AUCs) for 3-year survival and compared with that of forced vital capacity (FVC). Multivariable Cox regression was performed to investigate whether the DLPM was an independent prognostic factor from FVC. We devised a modified gender-age-physiology (GAP) index (GAP-CR), by replacing DLCO with DLPM. Results: DLPM showed similar-to-higher performance at predicting 3-year survival than FVC in three external test cohorts (TD-AUC: 0.83 [95% CI: 0.76–0.90] vs. 0.68 [0.59–0.77], p < 0.001; 0.76 [0.68–0.85] vs. 0.70 [0.60–0.80], p = 0.21; 0.79 [0.72–0.86] vs. 0.76 [0.69–0.83], p = 0.41). DLPM worked as an independent prognostic factor from FVC in all three cohorts (ps < 0.001). The GAP-CR index showed a higher 3-year TD-AUC than the original GAP index in two of the three external test cohorts (TD-AUC: 0.85 [0.80–0.91] vs. 0.79 [0.72–0.86], p = 0.02; 0.72 [0.64–0.80] vs. 0.69 [0.61–0.78], p = 0.56; 0.76 [0.69–0.83] vs. 0.68 [0.60–0.76], p = 0.01). Conclusions: A deep learning model successfully predicted survival in patients with IPF from chest radiographs, comparable to and independent of FVC. Clinical relevance statement: Deep learning-based prognostication from chest radiographs offers comparable-to-higher prognostic performance than forced vital capacity. Key Points: • A deep learning-based prognostic model for idiopathic pulmonary fibrosis was developed using 6063 radiographs. • The prognostic performance of the model was comparable-to-higher than forced vital capacity, and was independent from FVC in all three external test cohorts. • A modified gender-age-physiology index replacing diffusing capacity for carbon monoxide with the deep learning model showed higher performance than the original index in two external test cohorts. [ABSTRACT FROM AUTHOR]

Chest radiographs (CXRs) are still of crucial importance in primary diagnostics, but their interpretation poses difficulties at times. Can a convolutional neural network-based artificial intelligence (AI) system that interprets CXRs add value in an emergency unit setting? A total of 563 CXRs acquired in the emergency unit of a major university hospital were retrospectively assessed twice by three board-certified radiologists, three radiology residents, and three emergency unit-experienced nonradiology residents (NRRs). They used a two-step reading process: (1) without AI support; and (2) with AI support providing additional images with AI overlays. Suspicion of four suspected pathologies (pleural effusion, pneumothorax, consolidations suspicious for pneumonia, and nodules) was reported on a five-point confidence scale. Confidence scores of the board-certified radiologists were converted into four binary reference standards of different sensitivities. Performance by radiology residents and NRRs without AI support/with AI support were statistically compared by using receiver-operating characteristics (ROCs), Youden statistics, and operating point metrics derived from fitted ROC curves. NRRs could significantly improve performance, sensitivity, and accuracy with AI support in all four pathologies tested. In the most sensitive reference standard (reference standard IV), NRR consensus improved the area under the ROC curve (mean, 95% CI) in the detection of the time-critical pathology pneumothorax from 0.846 (0.785-0.907) without AI support to 0.974 (0.947-1.000) with AI support (P <.001), which represented a gain of 30% in sensitivity and 2% in accuracy (while maintaining an optimized specificity). The most pronounced effect was observed in nodule detection, with NRR with AI support improving sensitivity by 53% and accuracy by 7% (area under the ROC curve without AI support, 0.723 [0.661-0.785]; with AI support, 0.890 [0.848-0.931]; P <.001). Radiology residents had smaller, mostly nonsignificant gains in performance, sensitivity, and accuracy with AI support. We found that in an emergency unit setting without 24/7 radiology coverage, the presented AI solution features an excellent clinical support tool to nonradiologists, similar to a second reader, and allows for a more accurate primary diagnosis and thus earlier therapy initiation. [ABSTRACT FROM AUTHOR]

The article focuses on the role of multi-angle chest radiograph in diagnosing esophageal aluminum coin ingestion, highlighting the importance of adding a lateral chest radiograph to detect such foreign bodies. Topics include the radiographic appearances of aluminum coins depending on the direction of the radiograph and the significance of careful examination to confirm the diagnosis and determine the location of the ingested coin.

The article focuses on the case of a previously healthy 3-year-old presenting with unsteady gait, nystagmus, and lower extremity weakness, highlighting the importance of thorough physical examination and the differential diagnosis process. Topics include the clinical presentation, diagnostic evaluation, and management of acute neurological symptoms in pediatric patients, emphasizing the need for prompt recognition and intervention in cases of acute neurological deterioration.

Background: Understanding the factors that contribute to diagnostic errors is critical if we are to correct or prevent them. Some scholars influenced by the default interventionist dual‐process theory of cognition (dual‐process theory) emphasise a narrow focus on individual clinician's faulty reasoning as a significant contributor. In this paper, we examine the validity of claims that dual process theory is a key to error reduction. Methods: We examined the relationship between a clinical experience (staff and resident physicians) and viewing time on accuracy for categorising chest X‐rays (CXRs) and electrocardiograms (ECGs). In two studies, participants categorised images as normal or abnormal, presented at viewing times of 175, 250, 500 and 1000 ms, to encourage System 1 processing. Study 2 extended viewing times to 1, 5, 10 and 20 s to allow time for System 2 processing and a diagnosis. Descriptives and repeated measures analysis of variance were used to analyse the proportion of true and false positive rates (TP and FP) as well as correct diagnoses. Results: In Study 1, physicians were able to detect abnormal CXRs (0.78) and ECGs (0.67) with relatively high accuracy. The effect of experience was found for ECGs only, as staff physicians (0.71, 95% CI = 0.66–0.75) had higher ECG TP than resident physicians (0.63, 95% CI = 0.58–0.68) in Study 1, and staff had lower ECG FP (0.10, 95% CI = 0.03–0.18) than resident physicians (0.27, 95% CI = 0.20–0.33) in Study 2. In other comparisons, experience was equivocal for ECG FPs and CXR TPs and FPs. In Study 2, overall diagnostic accuracy was similar for both ECGs and CXRs, (0.74). There were small interactions between experience and time for TP in ECGs and FP in CXRs, which are discussed further in the discussion and offer insights into the relationship between processing and experience. Conclusion: Overall, our findings raise concerns about the practical application of models that link processing type to diagnostic error, or to specific diagnostic error reduction strategies. Recommendations to employ self‐directed strategies to slow down, take a diagnostic time out, or reflect, are reported as not being reliable means for reducing diagnostic error; in fact, these strategies may increase error. [ABSTRACT FROM AUTHOR]