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Background: Pemetrexed (PEM) is the primary chemotherapy for non‐small cell lung cancer (NSCLC), showing potential for long‐term disease stability in certain cases. However, studies examining disease control with PEM therapy are lacking. This study aimed to pinpoint clinical traits in patients with NSCLC responding well to PEM therapy, predict factors influencing disease control, and suggest optimal treatment approaches. Methods: A retrospective analysis of patients with NSCLC treated with PEM was performed to compare patients who achieved disease control after treatment with those who did not. Results: Of 73 patients, 56 (76.7%) achieved disease control with PEM therapy. In the disease control group, a significantly higher proportion of patients exhibited good performance status (PS) and received PEM doses without reduction after the second cycle. Multivariate analysis identified bevacizumab (Bev) noncompliance, PEM dose reduction, and thyroid transcription factor‐1 (TTF‐1) negativity as significant independent risk factors for disease progression during PEM therapy. Additionally, overall survival was significantly longer in the disease control group (p < 0.001). Conclusions: Our findings indicated that maintaining the dose of PEM after the second treatment cycle in patients with NSCLC, along with concurrent use of Bev and the presence of TTF‐1 positivity, could enhance disease control rates and extend survival. [ABSTRACT FROM AUTHOR]

Background and Objectives: Cardiopulmonary and skeletal muscle impairment and poor physical activity are potential contributors to reduced functional capacity in cystic fibrosis (CF). The Glittre‐ADL test (TGlittre) has great potential for clinical use in adult CF adults, as it meets the need for a comprehensive assessment of physical function using tasks similar to activities of daily living. This study aimed to evaluate the performance of TGlittre in CF adults compared to the 6‐min walk test (6MWT) and, secondarily, to quantify the associations of their results with pulmonary function, muscle strength, and health‐related quality of life (HRQoL). Methods: This cross‐sectional study evaluated 34 CF adults and compared them with 34 subjects from a control group. The participants underwent the following assessments: functional capacity using TGlittre and 6MWT; spirometry; respiratory muscle strength; handgrip strength (HGS); and HRQoL using the Cystic Fibrosis Questionnaire‐Revised (CFQ‐R). Results: While CF patients showed a longer time to perform TGlittre compared to controls (134 (119–150) versus 107 (95–126) % of the predicted time p = 0.0002), no difference between these groups was observed in the 6MWT. When the second TGlittre was compared to the first TGlittre, there was a significant decrease in total time for both CF patients (p < 0.0001) and controls (p = 0.0001). TGlittre time correlated with 6MWT distance (6MWD) (rs = −0.641, p < 0.0001), HGS (rs = −0.364, p = 0.034), peripheral oxygen saturation at the end of the test (rs = −0.463, p = 0.006) and the "digestive symptoms" domain of CFQ‐R (rs = 0.376, p = 0.028). TGlittre time was shorter in patients who engaged in regular physical activity (3.10 (2.49–3.39) min versus 3.28 (2.95–3.53) min, p = 0.016). Conclusions: TGlittre is more effective than the 6MWT in detecting limitations during exercise. There is an important learning effect of TGlittre in adult CF patients. TGlittre time was correlated with 6MWD, HGS, oxygen saturation level, and the patient's level of physical activity. [ABSTRACT FROM AUTHOR]

Physiotherapy plays a major role in long-term management of COPD. The aim of this study was to evaluate the effects of a 4-week muscle energy technique programme on pulmonary function measures, functional endurance capacity, chest wall mobility and ADLs in patients with COPD. A parallel-group, randomised controlled trial was adopted. 108 participants with COPD were recruited and randomly assigned to the intervention or control group. The intervention group received MET interventions, three-times weekly for 4 consecutive weeks, while the control group continued with their standard medical treatment. The study is clinically registered (ClinicalTrials.gov Identifier: NCT04773860). Statistically significant improvements in pulmonary function (p < 0.001), chest measurements (p < 0.001) and ADLs (p < 0.001) were observed for participants in the intervention group when compared to baseline measures. Clinical but not statistically significant improvements in the 6MWT were also noted (p = 0.08), outcomes which were not observed in participants enrolled in the control group. This study concludes that METs can be used as an adjunct with other non-pharmacological treatments for patients with COPD to help manage their shortness of breath, improve their respiratory function and hence, as a result, improve their activities of daily living. [ABSTRACT FROM AUTHOR]

Background: The impact of mechanical ventilation on the survival of patients supported with veno-venous extracorporeal membrane oxygenation (V-V ECMO) due to severe acute respiratory distress syndrome (ARDS) remains still a focus of research Methods: Recent guidelines, randomized trials, and registry data underscore the importance of lung-protective ventilation during respiratory and cardiac support on ECMO. Results: This approach includes decreasing mechanical power delivery by reducing tidal volume and driving pressure as much as possible, using low or very low respiratory rate, and a personalized approach to positive-end expiratory pressure (PEEP) setting. Notably, the use of ECMO in awake and spontaneously breathing patients is increasing, especially as a bridging strategy to lung transplantation. During respiratory support in V-V ECMO, native lung function is of highest importance and adjustments of blood flow on ECMO, or ventilator settings significantly impact the gas exchange. These interactions are more complex in veno-arterial (V-A) ECMO configuration and cardiac support. The fraction on delivered oxygen in the sweep gas and sweep gas flow rate, blood flow per minute, and oxygenator efficiency have an impact on gas exchange on device side. On the patient side, native cardiac output, native lung function, carbon dioxide production (VCO2), and oxygen consumption (VO2) play a role. Avoiding pulmonary oedema includes left ventricle (LV) distension monitoring and prevention, pulse pressure >10 mm Hg and aortic valve opening assessment, higher PEEP adjustment, use of vasodilators, ECMO flow adjustment according to the ejection fraction, moderate use of inotropes, diuretics, or venting strategies as indicated and according to local expertise and resources Conclusion: Understanding the physiological principles of gas exchange during cardiac support on femoro-femoral V-A ECMO configuration and the interactions with native gas exchange and haemodynamics are essential for the safe applications of these techniques in clinical practice. Proning during ECMO remains to be discussed until further data is available from prospective, randomized trials implementing individualized PEEP titration during proning. [ABSTRACT FROM AUTHOR]

BACKGROUND: Since its first outbreak, coronavirus disease 2019 (COVID-19) has led to a great deal of published literature highlighting the short-term determinants of morbidity and mortality. Recently, several studies have reported radiological and functional sequelae from 3 months to 1 year among hospitalized COVID-19 survivors; however, long-term (more than 1 year) respiratory consequences in this population remain to be evaluated. OBJECTIVE: To assess the long-term radiological and pulmonary function outcomes of patients with COVID-19 2 years after resolution of the initial infection. METHODS: Hospitalized COVID-19 patients with moderate to severe disease who survived acute illness were included in this prospective and partially retrospective study. Clinical assessment, laboratory tests, high-resolution computed tomography scans, and pulmonary function tests (PFTs) were performed at baseline, followed by radiological and lung function assessments at 6 and 24 months. RESULTS: Among 106 enrolled participants (mean age 62 ± 13.5 years; males: 61), 44 (41.5%) and 27 (25.4%) underwent radiological assessment at 6 and 24 months, respectively. Overall, 22.6% (24) of patients had residual radiological abnormalities. Overt fibrosis was observed in 12.2% of patients. Computed tomography disease severity and extent diminished significantly at 6 (13 ± 6, P < 0.001) and 24 months (11 ± 6, P < 0.001) from baseline. PFTs were performed in 65 (61.3%), 22 (20.7%), and 34 (32%) patients at baseline, 6 and 24 months, respectively. Impaired diffusion capacity (median diffusion capacity for carbon monoxide: 60%, interquartile range [IQR]: 51--80), restrictive lung defect (mean total lung capacity: 73.4% ± 18% predicted), and reduced exercise tolerance (median 6-min walk distance: 360 m, IQR: 210--400) were the predominant features at baseline. With the exception of exercise tolerance, a statistically significant improvement was observed in lung function parameters at the extended follow-up (2 years). CONCLUSIONS: Hospitalized COVID-19 survivors are at increased risk of developing long-term pulmonary complications, including lung fibrosis. A protocol-based approach to the management of post-COVID-19 patients is mandatory to improve future outcomes. [ABSTRACT FROM AUTHOR]

This study aims to investigate the pulmonary functions and respiratory symptoms of workers in the neem oil extraction industry in Tamil Nadu, India, who are exposed to neem oil dust and chemicalsin their occupational environment. Fifty male workers from the exposed group and 50 male workers from the non-exposed group to neem dust and chemicals were investigated for this study. A modified respiratory assessment questionnaire based on the American Thoracic Society (ATS) standard and portable hand-held spirometry were used to assess their respiratory symptoms and pulmonary function. Respiratory symptoms such as coughing, sneezing, wheezing, and, nasal irritation are found to be higher in the exposed groups than in the controlled groups. The pulmonary function of exposed workers had doubled respiratory problems than the controlled groups, which indicates the impacts of dust and chemicals generated during neem oil extraction on workers' health. Forced expiratory volume in one second (FEV1)/forced vital capacity FVC)% was noted regarding the duration of exposure to neem oil dust (P < 0.001). Also, there was a high difference between the heavily exposed and the lightly exposed (P < 0.001). Hence, to mitigate these problems, the oil mill workers should be cautious and wear personal protection equipment during working hours, and it is recommended to have an exhaust ventilation system. [ABSTRACT FROM AUTHOR]

BACKGROUND: Impulse oscillometry (IOS) is a noninvasive technique that measures lung physiology independently of patient effort. In the present study, we aimed to investigate the utility of IOS parameters in comparison with pulmonary function testing (PFT) among hospitalized subjects, with emphasis on obstructive and small airway diseases. METHODS: Sixty-one subjects hospitalized either with unexplained dyspnea or for pre-surgery evaluation were included in the study. All subjects underwent PFTs and IOS test. The correlation between IOS results and PFTs was examined in different subgroups. The ability of IOS parameters to predict abnormal PFTs was evaluated using the area under the receiver operating characteristic (ROC) curve, and optimal cutoff values were calculated. RESULTS: IOS results were found to correlate with PFT values. Subgroup analysis revealed that these correlations were higher in younger (age < 70) and non-obese (body mass index < 25kg/m²) subjects. The resonant frequency was an independent predictor and had the best predictive ability for abnormal FEV1/FVC (area under the ROC curve 0.732 [95% CI 0.57-0.90], optimal cutoff 17 Hz, 87% sensitivity, 62% specificity) and abnormal forced expiratory flow during the middle half of the FVC maneuver (area under the ROC curve 0.667 [95% CI 0.53-0.81], optimal cutoff 15 Hz, 77% sensitivity, 54% specificity). Area of reactance and the difference in respiratory resistance at 5 Hz and 20 Hz also showed a good predictive ability for abnormal FEV1/FVC (area under the ROC curve 0.716 and 0.730, respectively). CONCLUSIONS: We found that the IOS performed well in diagnosing small airway and obstructive diseases among hospitalized subjects. IOS might serve as an alternative to standard PFTs in non-cooperative or dyspneic hospitalized patients. [ABSTRACT FROM AUTHOR]

The aim of this study was to develop and evaluate a proof-of-concept opensource individualized Patient Decision Aid (iPDA) with a group of patients, physicians, and computer scientists. The iPDA was developed based on the International Patient Decision Aid Standards (IPDAS). A previously published questionnaire was adapted and used to test the user-friendliness and content of the iPDA. The questionnaire contained 40 multiple-choice questions, and answers were given on a 5-point Likert Scale (1-5) ranging from "strongly disagree" to "strongly agree." In addition to the questionnaire, semi-structured interviews were conducted with patients. We performed a descriptive analysis of the responses. The iPDA was evaluated by 28 computer scientists, 21 physicians, and 13 patients. The results demonstrate that the iPDA was found valuable by 92% (patients), 96% (computer scientists), and 86% (physicians), while the treatment information was judged useful by 92%, 96%, and 95%, respectively. Additionally, the tool was thought to be motivating for patients to actively engage in their treatment by 92%, 93%, and 91% of the above respondents groups. More multimedia components and less text were suggested by the respondents as ways to improve the tool and user interface. In conclusion, we successfully developed and tested an iPDA for patients with stage I-II Non-Small Cell Lung Cancer (NSCLC). [ABSTRACT FROM AUTHOR]

Copyright of Journal of Clinical Nursing in Practice is the property of Journal of Clinical Nursing in Practice (Editorial Board, Shanghai Jiao Tong University Press) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Journal of Clinical Nursing in Practice is the property of Journal of Clinical Nursing in Practice (Editorial Board, Shanghai Jiao Tong University Press) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction: Live high-train high (LHTH) is suggested to improve performance, especially maximal aerobic capacity through the hypoxic adaptation responses. The present study aims to determine the impact of LHTH protocol on cardio-respiratory variables, lactate response, iron profile indices, and lung function capacities to the performance enhancement of middle-long distance (MLD) runners. Methods: Seven MLD runners were trained LHTH for six weeks at 8000ft altitude. Cardio-respiratory variables (V̇O2max, VO2/HR, VEmax, HR response), lactate response, iron profile indices (Hb, iron, UIBC, TIBC, transferrin, EPO, ferritin), and lung function parameters (FVC, FEV1, FEV1/FVC, PEF, and VC) were measured via standard protocols. Result: Hemoglobin (Hb, 7.8%), iron concentration (36.7%), and TIBC (8.2%) were found to be significantly increased after LHTH. On the other hand, V̇O2max (6.4%) and PEF (10.7%) were found to be significantly (p<0.05) increased after camp. But HRrest (1.8%), HRrec (5min and 10min with 2.3% and 4.7% respectively), and lactate peak (7.9%) significantly decreased after LHTH condition. Discussion: All participating athletes improved performances after LHTH (overall group improved by 1.7%, individual increase up to 2.6%). Specific training load with hypoxic stress at high altitude induces peripheral chemoreceptor activation and stimulates sympathetic drive to initiate adaptive cascade leading to V̇O2max improvement (improved group mean 6.4%, individually up to 16.7%) which might be supported by enhanced erythropoiesis, iron metabolism, Hb concentrations, peak expiratory flow, glycolytic enzyme activity, enhanced oxidative capacity, improved resting and recovery HR response and peak lactate tolerance. [ABSTRACT FROM AUTHOR]

Objective: To study how Pneumoperitoneum under Trendelenburg position for robot-assisted laparoscopic surgery impact the perioperative respiratory parameters, diagrammatic function, etc. Methods: Patients undergoing robot-assisted laparoscopic surgery in the Trendelenburg position and patients undergoing general surgery in the supine position were selected. The subjects were divided into two groups according to the type of surgery: robot-assisted surgery group and general surgery group. ① Respiratory parameters such as lung compliance, oxygenation index, and airway pressure were recorded at 5 min after intubation, 1 and 2 h after pneumoperitoneum. ② Diaphragm excursion (DE) and diaphragm thickening fraction (DTF) were recorded before entering the operating room (T1), immediately after extubation (T2), 10 min after extubation (T3), and upon leaving the postanesthesia care unit (T4). ③ Peripheral venous blood (5 ml) was collected before surgery and 30 min after extubation and was analyzed by enzyme-linked immunosorbent assay to determine the serum concentration of Clara cell secretory protein 16 (CC16) and surfactant protein D (SP-D). Result: ① Compared with the general surgery group (N = 42), the robot-assisted surgery group (N = 46) presented a significantly higher airway pressure and lower lung compliance during the surgery(P < 0.001). ② In the robot-assisted surgery group, the DE significantly decreased after surgery (P < 0.001), which persisted until patients were discharged from the PACU (P < 0.001), whereas the DTF only showed a transient decrease postoperatively (P < 0.001) and returned to its preoperative levels at discharge (P = 0.115). In the general surgery group, the DE showed a transient decrease after surgery(P = 0.011) which recovered to the preoperative levels at discharge (P = 1). No significant difference in the DTF was observed among T1, T2, T3, and T4. ③ Both the general and robot-assisted surgery reduced the postoperative serum levels of SP-D (P < 0.05), while the robot-assisted surgery increased the postoperative levels of CC16 (P < 0.001). Conclusion: Robot-assisted laparoscopic surgery significantly impairs postoperative diaphragm function, which does not recover to preoperative levels at PACU discharge. Elevated levels of serum CC16 after surgery suggest potential lung injury. The adverse effects may be attributed to the prolonged Trendelenburg position and pneumoperitoneum during laparoscopic surgery. [ABSTRACT FROM AUTHOR]

Background: Coronary artery disease (CAD) poses a substantial and increasing public health concern in India, particularly among individuals aged 20 and above. The postoperative phase following coronary artery bypass graft (CABG) surgery presents potential complications, notably impacting the pulmonary system. Emerging evidence suggests that the Buteyko breathing technique not only improves lung function but also positively influences the psychological well-being of CABG patients. This study seeks to assess the impact of the Buteyko breathing technique on pulmonary functions in individuals who have undergone off-pump CABG. Materials and methods: In this randomized controlled trial, patients undergoing off-pump CABG were allocated to either the Buteyko breathing technique group (n = 35) or the control group (n = 35). The intervention group received supervised Buteyko breathing technique sessions twice daily for 15 minutes, concurrently with cardiac rehabilitation from postoperative day (POD-2 to POD-7). The control group underwent phase I cardiac rehabilitation. Outcome measures, including pulmonary function test (PFT), chest expansion, and breath-holding tests were evaluated at baseline (POD-2) and conclusion (POD-7). Results: Statistical analyses were conducted with a significance level set at p < 0.05. Both the control and intervention groups exhibited statistically significant improvements in pulmonary function, chest expansion at three levels, and breath-holding time (p = 0.0001). However, the Buteyko breathing group demonstrated a more significant improvement compared with the control group. Conclusion: The integration of the Buteyko breathing technique into conventional physiotherapy proves to be a beneficial strategy, leading to improvements in pulmonary function, breath-holding duration, and chest expansion for individuals who underwent off-pump CABG surgery. [ABSTRACT FROM AUTHOR]

OBJECTIVE: Hypersensitivity pneumonitis (HP) is an inflammatory and/or fibrotic lung disease. The restrictive lung function with low diffusing capacity of carbon monoxide (DLCO) is common in interstitial lung diseases (ILD). There are limited data on pulmonary function test (PFT) in HP and its role for diagnosis is questionable. We analyzed the data of 152 HP patients for type of defect, lung volume, and DLCO. MATERIAL AND METHODS: The present study is a retrospective analysis of 152 patients at one of the tertiary chest institutes in India. All diagnosed cases with at least spirometry were included. PFT findings were classified and graded as obstructive, restrictive, and mixed patterns. The correlation of PFT was calculated with disease duration and 6MWT distance. RESULTS: The majority were female [106 (70%)], with a mean age of 47.8 ± 12.3 years. Spirometry with lung volume data were available for 97% patients. PFT was abnormal in 118 (80%) cases. Among the patterns of abnormality, the most common type was restrictive (74%) followed by mixed (15%) and obstructive (11%) with the majority in the severe to very severe grade. The mean total lung capacity (TLC) and residual volume (RV) were reduced, with the grade more severe when the pattern of abnormality was restrictive while the RV/TLC was higher suggestive of air tapping. DLCO data were available for 132 (87%) cases, with levels decreased in 67%. The severity of DLCO was highest when the pattern of abnormality was restrictive. One of the PFT parameters was abnormal in 137 (90%) cases, with isolated decreased DLCO levels seen in 16 (10%) cases. Forced vital capacity (FVC), TLC, and DLCO showed positive correlation with 6MWT distance (FVC r = .22, P = .02; TLC r = .28, P = .003; DLCO r = .30, P = .002). CONCLUSION: The PFT abnormality is seen in >80% of HP patients. All types of abnormality were seen, with the restrictive pattern being the most common. Isolated decreased DLCO levels were seen in 10% of cases. We advised to do full PFT for diagnosis and followup of HP. [ABSTRACT FROM AUTHOR]

Background: Structured light plethysmography (SLP) is a novel light-based method that captures chest wall movements to evaluate tidal breathing. Methods: Thirty-two children who underwent lung surgery were enrolled. Their clinical history was collected along with spirometry and SLP. Results: Median age of surgery was 9 months (interquartile range 4–30). Most frequent diagnosis was congenital pulmonary airway malformation (14/32), then pulmonary sequestration (9/32), tumor (5/32), and bronchogenic cyst (4/32). The most frequent surgical approach was lobectomy (59%), segmentectomy (38%), and complete resection (3%). More than 80% had surgery when younger than 3 years of age. Eight patients had short-term complications (pleural effusion was the most frequent), while long-term effects were reported in 15 patients (19% recurrent cough, 13% thoracic deformities, 13% airway infections, 9% wheezing, 6% reduced exercise tolerance, and 3% columnar deformities). Spirometry was normal in 9/22 patients. Nine patients had a restrictive pattern, while 4 showed a mild bronco-reactivity. Ten patients did not perform spirometry because of young age. SLP revealed the presence of obstructive pattern in 10% of patients (IE50 > 1.88) and showed a significant difference between the two hemithorax in 29% of patients. Discussion: SLP may be a new method to evaluate lung function, without collaboration and radiation exposure, in children who underwent lung resection, also in preschool age. [ABSTRACT FROM AUTHOR]

Background and Aim: The recent review of research conducted in the field of air pollution and sports shows that there is a serious impact of air pollutants as well as the new pollutant of dust particles, and it is imperative to pay attention to this issue. This research aims to investigate the effect of regular exercise on lung function and amino acid arginine-alanine in traffic police of the provinces affected by dust particles in Iran. Methods: Forty traffic police officers (age: 23.62 ± 6.4 years; body mass index: 27.44 ± 4.7 kg/m2) were voluntarily selected from the centers of Khuzestan, Ilam, and Kermanshah provinces and randomly assigned to two control and regular physical activity groups. Regular physical activity included: 30 sessions, circuit training three times a week including hanging from the chin up (20 seconds), jumping over obstacles (knee height) at a distance of one meter for a total of 540 cm, Sit-ups (30 seconds), chest press (70% 1RM-8 repetitions), leg press (70% 1RM -8 repetitions), back extension (15 repetitions), calf raise (70% 1RM -8 repetitions), zigzag jump (20 repetitions), six to ten reputation Illinois Agility Test with a 30-second rest interval. Before the study, 48 hours before the occurrence of dust particles, and after the study fat percentage, amino acids, WBC, and FEV1/FVC were measured. To examine the research data, we used the mean and standard deviation as well as repeated analysis of variance (P ≥0.05). Results: It was found that time (pre-test-May 12, 2023) had a significant effect on amino acids argininealanine, maximum oxygen consumption, body fat percentage, and FEV1/FVC in the training group (P <0.05). In the control group, there was no significant difference in the amino acid arginine-alanine, maximum oxygen consumption, body fat percentage, or FEV1/FVC (P >0.05). However, the effect of time was present in the control group only for white blood cells (P <0.001). In terms of body fat percentage, there was a significant difference between the control and exercise groups (P = 0.01), as well as maximum oxygen consumption (P = 0.01). Conclusion: This study has demonstrated that regular exercise training can improve lung function, aerobic fitness, body fat percentage, and levels of amino acids involved in the immune system, as well as increase muscle mass and anti-inflammatory effects that reduce dust particle damage in those exposed to dust particles. [ABSTRACT FROM AUTHOR]

Copyright of Fisioterapia Brasil is the property of Atlantica Editora and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Abstract Background Idiopathic pulmonary fibrosis (IPF) is a progressive disease with a poor prognosis. Pulmonary function tests (PFTs) aid in evaluating the disease status of IPF. The clinical significance of oscillometry measurements in interstitial lung diseases has recently been reported. Our previous study showed that respiratory reactance (Xrs) measured by oscillometry reflected disease severity and predicted subsequent lung capacity decline in patients with IPF. However, the direct impact of Xrs on survival needs to be determined, and there are currently no reference values in oscillometry to predict prognosis. Therefore, this study aimed to investigate the association between oscillometry measurements, particularly Xrs, and survival in patients with IPF and to determine the cutoff values of Xrs that predict 3-year survival. Methods We analyzed the relationship between the measured values of PFT and oscillometry derived from 178 patients with IPF. Univariate and multivariate Cox proportional hazards analyses were performed to investigate the relationships between clinical indices at the time of the first oscillometry and survival. We performed the time-dependent receiver operating characteristic (ROC) curve analysis to set the optimized cutoff values of Xrs for 3-year survival prediction. We examined the discriminating power of cutoff values of Xrs on survival using the Kaplan–Meier method and the log-rank test. Results Xrs components, especially in the inspiratory phase (In), significantly correlated with the PFT values. In the multivariate analyses, Xrs (all of reactance at 5 Hz [X5], resonant frequency [Fres], and low-frequency reactance area [ALX] in the inspiratory phase) had a significant impact on survival (X5, p = 0.003; Fres, p = 0.016; ALX, p = 0.003) independent of age, sex, and other prognostic factors derived from the univariate analysis. The area under the ROC curve was 0.765, 0.759, and 0.766 for X5 In, Fres In, and ALX In, with cutoff values determined at − 0.98, 10.67, and 5.32, respectively. We found significant differences in survival after dividing patients using each of the cutoff values of Xrs. Conclusions In patients with IPF, Xrs measured by oscillometry significantly impacted survival. We also determined the cutoff values of Xrs to discriminate patients with poor prognoses.

The article critiques Dr. Zavorsky's response to previous work on exercise-induced pulmonary diffusion limitation, emphasizing that capillary red cell transit time (CTT) plays a significant role in this phenomenon. It also discusses the need for more research on CTT heterogeneity, the relationship between CTT and diffusion limitation, and the limitations of current methods for evaluating these factors.

Background: Obstructive sleep apnea (OSA) commonly coexists with lung disease. However, the association between OSA components and lung function remains unclear. This study estimated STOP-BANG scores according to lung function using nationwide Korean data. Materials and Methods: Three thousand and two hundred eighty adults with available STOP-BANG scores and spirometry data were analyzed. Multivariate regression models were applied to estimate STOP-BANG scores according to lung function. Results: Approximately 28% of participants had abnormal lung function, and the characteristics were diverse. The significant factors associated with abnormal lung function included the STOP-BANG score. In multivariate regression analyses, individuals with abnormal lung function had significantly higher STOP-BANG scores than those with normal lung function (odds ratio: 1.19; 95% confidence interval: 1.10-1.29; P < 0.001), and this difference was remarkable in men. Conclusion: Our results suggest that screening and management of OSA components are warranted to prevent impaired lung function. [ABSTRACT FROM AUTHOR]

Context: Hypopressive exercise (HE) has been used as an alternative lumbo-pelvic injury prevention program and claimed to be a means of respiratory and flexibility improvement. However, the possible effects of HE on athletic populations and physical performance remain unclear. Objective: Examine the effects of a HE program on posterior back chain kinematics, thoracic mobility, pulmonary function, and lower lumbar pain in female basketball players over an 8-week training period. Design: Prospective (1) baseline, (2) midpoint (4 wk), and (3) after 8 weeks. Setting: Sports field. Participants: A total of 17 professional female basketball players (mean age 20.7 y, SD: 3.50; body mass index, 21.71, SD: 1.69). Intervention: Participants performed 8 HE weekly sessions of 30 minutes. Main outcome measures: Back chain kinematics was assessed with the sit and reach and finger to floor test, and back pain was assessed through numerical rating scale. Respiratory parameters were assessed by spirometry and through thoracic mobility. Results: The analysis of variance revealed significant differences between the 3 measurement periods for thoracic mobility (P > .01); forced expiratory volume in the first second (P < .05) while no statistical differences were found for the rest of spirometry outcomes. Significant differences were also revealed between baseline and after the intervention for the sit and reach test (P > .01), peak expiratory flow (P = .01), and forced expiratory volume in the first 25 seconds (P = .04). Also, significant differences between weeks were found in levels of lumbar pain (P = .003) and the finger to floor test (P = .002). Conclusions: These preliminary findings suggest that a HE program can improve posterior back chain and chest wall kinematics as well as lower lumbar pain levels. However, no gains seem to be observed for the majority of pulmonary variables except for peak expiratory flow and forced expiratory volume in the first seconds. [ABSTRACT FROM AUTHOR]

Purpose: Inspiratory muscle strength training (IMST) can improve exercise performance. Increased maximal inspiratory mouth pressure (MIP) could be beneficial for swimmers to enhance their performance. This study aimed to clarify the effect of high-intensity IMST for 6 weeks on MIP and swimming performance in highly trained competitive swimmers. Methods: Thirty male highly trained competitive swimmers were assigned to high-intensity IMST (HI; n = 10), moderate-intensity IMST (MOD; n = 10), and control (n = 10) groups. The 6-week IMST intervention comprised twice daily sessions for 6 d/wk at inspiratory pressure threshold loads equivalent to 75% MIP (HI) and 50% MIP (MOD). Before and after the intervention, MIP and swimming performance were assessed. Swimming performance was evaluated in free and controlled frequency breathing 100-m freestyle swimming time trials in a 25-m pool. For controlled frequency breathing, participants took 1 breath every 6 strokes. Results: The MIP values after 2 and 6 weeks of IMST in the HI and MOD groups were significantly higher than those before IMST (P =.0001). The magnitudes of the MIP increases after 6 weeks of IMST did not differ between the HI (13.4% [8.7%]) and MOD (13.1% [10.1%]) groups (P =.44). The 100-m freestyle swimming times under the controlled frequency condition were significantly shorter after IMST than those before IMST in both the HI (P =.046) and MOD (P =.042) groups. Conclusions: Inspiratory pressure threshold load equivalent to 50% MIP could be sufficient to improve MIP and swimming performance under the controlled frequency breathing condition in highly trained competitive swimmers. [ABSTRACT FROM AUTHOR]

Simple Summary: This manuscript provides a detailed analysis of the advancements in thoracic surgery. It traces the journey from the standard pneumonectomy to the precise approach of sublobar resections. The manuscript emphasizes the emergence and acceptance of advanced techniques such as robotic-assisted surgery. It also highlights the pivotal role of preserving organ functionality while ensuring oncological radicality, which is especially important when treating early-stage lung cancer. Through a comprehensive review of contemporary surgical methods and their clinical outcomes, this paper explains the delicate balance that modern thoracic surgeons must achieve between aggressive cancer removal and preserving the quality of life. It thereby contributes to the ongoing refinement of the field. This review chronicles the evolution of thoracic surgical interventions, from the standardized pneumonectomy to the precise approach of sublobar resections. It discusses the emergence and acceptance of minimally invasive and robot-assisted surgical techniques, highlighting their impact on improving outcomes beyond cancer and their influence on the surgical management of early-stage lung cancer. Evaluating historical developments alongside present methodologies, this review underscores the critical need for meticulous surgical planning and execution to optimize both oncological radicality and functional preservation. This evolution portrayed not only technical advancements but also a shift in the clinical approach towards tailored, organ-preserving methodologies, culminating in a contemporary framework promoting sublobar resections as the standard for specific patient profiles, signifying a new era of precision in thoracic surgery. [ABSTRACT FROM AUTHOR]

Simple Summary: This article examines the significance of liquid biopsies in the field of thoracic oncology, particularly regarding the diagnosis and treatment of malignancies. These blood-based biopsies, which utilize circulating tumor DNA (ctDNA), are presented as a less invasive method for both the diagnosis and monitoring of cancer cells and offer a dynamic means of tracking tumors, allowing for personalized treatment approaches and real-time information about the tumor's status throughout its natural history. The analysis of biomarkers through blood samples could therefore lessen the need for more invasive tissue biopsies. The article also addresses the valuable role circulating biomarker analyses play in allowing treatment plans to be modified according to the genetic changes observed in the tumor. The importance of adapting to genetic aberrations that may develop during treatment is highlighted, emphasizing the need for timely adjustments to ensure a therapy's effectiveness. In summary, the article underscores the potential of liquid biopsies to revolutionize thoracic cancer care by offering a minimally invasive and personalized approach to diagnosis and treatment, emphasizing the importance of their further advancement. Thoracic oncology continues to pose a great threat to human health as one of the most common forms of cancer. Liquid biopsies present a transformative approach to treating patients affected by these types of diseases by providing a less invasive genetic overview of the tumor, aiding in both diagnostic and treatment measures. The primary objective of this article is to examine the prospects of liquid biopsies in managing thoracic malignancies and to present barriers to their usage as demonstrated by Dr. Luis Raez. In examining why molecular diagnostics continue to be employed together with more traditional methods, this article presents the next steps in the clinical application of blood-based cancer screening. Future cancer diagnosis and treatment aim to prioritize circulating biomarker analyses based on their potential for the detection and monitoring of thoracic cancers. Liquid biopsies are favored thanks to their reduced invasiveness with respect to traditional treatments. The further study of clinical biomarkers and technological advancements are thus pivotal to enhance the clinical applicability of this method. In conclusion, this blood-based analysis offers a promising route by which the diagnosis, treatments, and outcomes of thoracic cancer can be improved. [ABSTRACT FROM AUTHOR]

Simple Summary: Epiregulin (EREG) is a member of the ErbB family of ligands that plays multiple roles in cellular processes, including cell proliferation, invasion, and angiogenesis. Accumulating evidence has indicated that EREG is involved in lung tumorigenesis and therapeutic resistance. It is becoming evident that EREG contributes to the epithelial–mesenchymal transition, cancer stemness, immune evasion, and resistance to anticancer drugs in several human cancers, including non-small cell lung cancer. In this review, we summarized the current understanding of EREG as an oncogene and discussed its oncogenic role in lung tumorigenesis and therapeutic resistance. Epidermal growth factor (EGF) signaling regulates multiple cellular processes and plays an essential role in tumorigenesis. Epiregulin (EREG), a member of the EGF family, binds to the epidermal growth factor receptor (EGFR) and ErbB4, and it stimulates EGFR-related downstream pathways. Increasing evidence indicates that both the aberrant expression and oncogenic function of EREG play pivotal roles in tumor development in many human cancers, including non-small cell lung cancer (NSCLC). EREG overexpression is induced by activating mutations in the EGFR, KRAS, and BRAF and contributes to the aggressive phenotypes of NSCLC with oncogenic drivers. Recent studies have elucidated the roles of EREG in a tumor microenvironment, including the epithelial–mesenchymal transition, angiogenesis, immune evasion, and resistance to anticancer therapy. In this review, we summarized the current understanding of EREG as an oncogene and discussed its oncogenic role in lung tumorigenesis and therapeutic resistance. [ABSTRACT FROM AUTHOR]

In healthy adults, airway-to-lung (i.e., dysanapsis) ratio is lower and dyspnoea during exercise at a given minute ventilation (V̇E) is higher in females than in males. We investigated the relationship between dysanapsis and sex on exertional dyspnoea in healthy adults. We hypothesized that females would have a smaller airway-to-lung ratio than males and that exertional dyspnoea would be associated with airway-to-lung ratio in males and females. We analyzed data from n = 100 healthy never-smokers aged ≥40 years enrolled in the Canadian Cohort Obstructive Lung Disease (CanCOLD) study who underwent pulmonary function testing, a chest computed tomography scan, and cardiopulmonary exercise testing. The luminal area of the trachea, right main bronchus, left main bronchus, right upper lobe, bronchus intermedius, left upper lobe, and left lower lobe were 22%–37% smaller (all p < 0.001) and the airway-to-lung ratio (i.e., average large conducting airway diameter relative to total lung capacity) was lower in females than in males (0.609 ± 0.070 vs. 0.674 ± 0.082; p < 0.001). During exercise, there was a significant effect of V̇E, sex, and their interaction on dyspnoea (all p < 0.05), indicating that dyspnoea increased as a function of V̇E to a greater extent in females than in males. However, after adjusting for age and total lung capacity, there were no significant associations between airway-to-lung ratio and measures of exertional dyspnoea, regardless of sex (all r < 0.34; all p > 0.05). Our findings suggest that sex differences in airway size do not contribute to sex differences in exertional dyspnoea. [ABSTRACT FROM AUTHOR]

Objectives: Chronic lung disease is a recognized complication in children with HIV. Acute respiratory exacerbations (ARE) are common among this group and cause significant morbidity. Exhaled nitric oxide (eNO) is a known marker of local airway inflammation. We investigated the association between eNO and ARE, biomarkers of systemic inflammation, and the effect of azithromycin on eNO levels. Methods: Individuals aged 6–19 years with HIV‐associated chronic lung disease in Harare, Zimbabwe, were enrolled in a placebo‐controlled randomized trial investigating the effect of 48‐week azithromycin treatment on lung function and ARE. eNO levels and biomarkers were measured at inclusion and after treatment in a consecutively enrolled subset of participants. Linear regression and generalized linear models were used to study associations between eNO and ARE, biomarkers, and the effect of azithromycin on eNO levels. Results: In total, 172 participants were included in this sub‐study, 86 from the placebo group and 86 from the azithromycin group. Participants experiencing at least one ARE during follow‐up had significantly higher eNO levels at baseline than participants who did not (geometric mean ratio 1.13, 95% confidence interval [CI] 1.03–1.24, p = 0.015), adjusted for trial arm, age, sex and history of tuberculosis. Matrix metalloproteinase (MMP)‐3, ‐7, and ‐10 were significantly associated with higher baseline eNO levels. At 48 weeks, azithromycin treatment did not affect eNO levels (geometric mean ratio 0.86, 95% CI 0.72–1.03, p = 0.103). Conclusion: Higher baseline eNO levels were a risk factor for ARE. eNO was associated with proinflammatory biomarkers previously found to contribute to the development of chronic lung disease. The potential use of eNO as a marker of inflammation and risk factor for ARE in HIV‐associated chronic lung disease needs further investigation. [ABSTRACT FROM AUTHOR]

An understanding of the health inequities that surround the treatment and prevention of COPD is required to address the barriers that hinder improvement of care for underserved populations. This scoping review was conducted to identify the existing evidence of social factors that affect the health, health-care access, and health-care quality of patients with COPD within the United States, and to identify gaps in knowledge to help direct future research. We followed the guidelines from the Joanna Briggs Institute and Preferred Reporting Items for Systematic reviews and Meta Analyses Extension for Scoping Reviews. In July 2022, a literature search by using Ovid (Embase) and MEDLINE (PubMed) databases was conducted to identify articles on COPD, published between 2016 and 2021, written in English, and that investigated at least one health inequity as defined by the National Institutes of Health. All studies were screened for inclusion criteria and were extracted in a masked, duplicate manner. Each health inequity was investigated, extracted, and summarized. Thirty articles were screened in full text, and 19 were found to meet inclusion criteria. Common social factors investigated in the COPD literature included race/ethnicity, income, and education. Since the implementation of the National Institutes of Health's sex and gender minority category in 2016, only one study within our sample examined LGBTQ+ (lesbian, gay, bisexual, transgender, queer [or sometimes questioning], and others) patients with COPD. The least commonly investigated social factors that affect patients with COPD were rural/under-resourced (geography), sex and gender, and LGBTQ+ affiliation. In addition, occupational status was not investigated by any included studies in our sample. Our scoping review underlines the lack of research with regard to inequities that affect patients with COPD. We propose researching hormone replacement therapy's impact on lung function in transgender and nonbinary patients with COPD. Implementation science studies are suggested to enhance intervention for COPD medication adherence among racial/ethnic minority groups, given the intersectionalities of social factors that disproportionately affect this population. We, also recommend developing telemedicine pulmonary rehabilitation technology for rurally located patients with COPD. [ABSTRACT FROM AUTHOR]

The article discusses research which evaluated the changes in ventilation distribution with alterations in trunk inclination in subjects with acute respiratory distress syndrome (ARDS) using traditional respiratory mechanics and electrical impendance tomography (EIT). Cited are the effects of trunk inclination on lung aeration and gas exchange, three mechanisms that underlie the improvement in respiratory mechanics and gas exchange, and the deleterious effects of the supine-flat position.

Bone scan is a investigation which uses radionuclide phosphonate compound for whole skeletal survey. In this current study we have done the analysis of the role of bone scan in skeletal osteosarcoma at tertiary oncology care centre. This is a retrospective study conducted in a tertiary oncology centre from January 2022 to February 2023. A total of 92 patients with skeletal OGS were included in our study undergone 99 mTCcMDP whole body bone scan. 99 mTc MDP was prepared freshly every morning and dose for each patient were calculated as per EANM guidelines. Images were acquired 2–3 h of post injection. All images were acquired at GE infinia dual head machine with peak setting at 140Kev and LEAP collimator. Suspicious lesions on planer bone scan were correlated with SPECT fused with CT. All the bone scans were reviewed retrospectively by two independent nuclear medicine physicians. In this study group, 86 patients with biopsy proven skeletal OGS underwent 99 mTCcMDP bone scan of which 63 were males and 23 were females (2.7:1) with age of study group ranging from 7years to 48years. Patients referred for bone scan were retrospectively categorized in two groups, first group patients (52) were referred for initial staging of disease and second group of patients (34) were referred for follow-up or re-staging of the disease. Total 09 patients showed distant skeletal metastases on bone scan, out of which 05 were in initial staging group and 04 in follow up group. Osteosarcoma has propensity to metastasize to many sites in the body however most common site being lung followed by skeletal, nodal and rarely soft tissue metastasis. Bone scan enjoys a optimal sensitivity in case of osteosarcoma to detect skeletal metastasis but have low specificity. However being a cost effective and faster investigation makes it a wise investigation of choice in case of osteosarcoma for skeletal metastasis evaluation. [ABSTRACT FROM AUTHOR]

Background: To investigate the distribution pattern of V1+2d in the left superior pulmonary vein and its clinical significance. Methods: A retrospective analysis was conducted using three‐dimensional computed tomographic bronchography and angiography (3D‐CTBA) data from 500 lung cancer patients. Statistical analyses were performed to evaluate the incidence and drainage patterns of the three sub‐branches of V1+2d, namely V1+2d1, V1+2d2 and V1+2d3. Furthermore, clinical data from 10 patients' lesions involving V1+2d were reviewed to illustrate the impact of adjacency to V1+2d on the surgical approach. Results: The incidences of V1+2d1, V1+2d2 and V1+2d3 were 100%, 76.4% and 100% respectively. The relative interlobar distribution sizes of B3a and B1+2c and the left upper division (LUD) vein type influenced the incidence of V1+2d2 (p < 0.05; p < 0.001). V1+2d2 predominantly occurred in B3a = B1+2c and B1+2c > B3a patterns. V1+2d2 was entirely absent in the B3a > B1+2c pattern. V1+2d2 exhibited a higher incidence in both the central vein (CV) type and the noncentral vein (NCV) type when compared to the semi‐central vein (SCV) type (100% vs. 100% vs. 64.8%). The most prevalent venous drainage pattern was the three sub‐branches of V1+2d constituting a major trunk to drain (41.2%). All 10 cases with lesions involving V1+2d successfully underwent sublobar resection with no complications, and the surgical margin was ≥2 cm. Conclusions: The three sub‐branches of V1+2d exhibit a high incidence with diverse distribution patterns, yet a discernible pattern exists. For inter‐ or multi‐intersegmental nodules involving V1+2d, combined segmentectomy and subsegmentectomy or combined subsegmentectomy can ensure the safe margin. [ABSTRACT FROM AUTHOR]

Simple Summary: This study aimed to assess the impact of postoperative smoking cessation on lung function, quality of life (QOL), and long-term survival in non-small cell lung cancer (NSCLC) patients. Two matched groups were formed including patients who quit smoking postoperatively and patients who continued smoking. One year after surgery, both groups showed a similar reduction in FEV1. However, smoking cessation was linked to improved DLCO and QOL. Importantly, patients who quit smoking postoperatively demonstrated significantly superior overall survival rates. These findings highlight the positive association between postoperative smoking cessation, enhanced QOL, and increased long-term survival in NSCLC patients, providing motivation for the implementation of smoking cessation programs. Objectives: About 90% of all non-small cell lung cancer (NSCLC) cases are associated with inhalative tabacco smoking. Half of patients continue smoking during lung cancer therapy. We examined the effects of postoperative smoking cessation on lung function, quality of life (QOL) and long-term survival. Materials and Methods: In total, 641 patients, who underwent lobectomy between 2012 and 2019, were identified from our single institutional data base. Postoperatively, patients that actively smoked at the time of operation were offered a structured 'smoking cessation' program. For this retrospective analysis, two patient groups (total n = 90) were selected by pair matching. Group A (n = 60) had no postoperative tobacco smoking. Group B (n = 30) involved postoperative continued smoking. Lung function (FEV1, DLCO) and QOL ('SF-36′ questionnaire) were measured 12 months postoperatively. We compared long-term outcomes using Kaplan–Meier curves. Results: The mean age in group A was 62.6 ± 12.5 years and that in group B was 64.3 ± 9.7 years (p = 0.82); 64% and 62%, respectively, were male (p = 0.46). Preoperative smoking habits were similar ('pack years': group A, 47 ± 31; group B, 49 ± 27; p = 0.87). All relevant baseline characteristics we collected were similar (p > 0.05). One year after lobectomy, FEV1 was reduced by 15% in both groups (p = 0.98). Smoking cessation was significantly associated with improved DLCO (group A: 11 ± 16%; group B: −5 ± 14%; p <0.001) and QOL (vitality (VT): +10 vs. −10, p = 0.017; physical role function (RP): +8 vs. −17, p = 0.012; general health perceptions (GH): +12 vs. −5, p = 0.024). Patients who stopped smoking postoperatively had a significantly superior overall survival (median survival: 89.8 ± 6.8 [95% CI: 76.6–103.1] months vs. 73.9 ± 3.6 [95% CI: 66.9–80.9] months, p = 0.034; 3-year OS rate: 96.2% vs. 81.0%, p = 0.02; 5-year OS rate: 80.0% vs. 64.0%, p = 0.016). The hazard ratio (HR) was 2.31 [95% CI: 1.04–5.13] for postoperative smoking versus tobacco cessation. Conclusion: Postoperative smoking cessation is associated with improved quality of life and lung function testing. Notably, a significant increase in long-term survival rates among non-smoking NSCLC patients was observed. These findings could serve as motivation for patients to successfully complete a non-smoking program. [ABSTRACT FROM AUTHOR]

Background: Idiopathic pulmonary fibrosis (IPF) is a progressive disease with a poor prognosis. Pulmonary function tests (PFTs) aid in evaluating the disease status of IPF. The clinical significance of oscillometry measurements in interstitial lung diseases has recently been reported. Our previous study showed that respiratory reactance (Xrs) measured by oscillometry reflected disease severity and predicted subsequent lung capacity decline in patients with IPF. However, the direct impact of Xrs on survival needs to be determined, and there are currently no reference values in oscillometry to predict prognosis. Therefore, this study aimed to investigate the association between oscillometry measurements, particularly Xrs, and survival in patients with IPF and to determine the cutoff values of Xrs that predict 3-year survival. Methods: We analyzed the relationship between the measured values of PFT and oscillometry derived from 178 patients with IPF. Univariate and multivariate Cox proportional hazards analyses were performed to investigate the relationships between clinical indices at the time of the first oscillometry and survival. We performed the time-dependent receiver operating characteristic (ROC) curve analysis to set the optimized cutoff values of Xrs for 3-year survival prediction. We examined the discriminating power of cutoff values of Xrs on survival using the Kaplan–Meier method and the log-rank test. Results: Xrs components, especially in the inspiratory phase (In), significantly correlated with the PFT values. In the multivariate analyses, Xrs (all of reactance at 5 Hz [X5], resonant frequency [Fres], and low-frequency reactance area [ALX] in the inspiratory phase) had a significant impact on survival (X5, p = 0.003; Fres, p = 0.016; ALX, p = 0.003) independent of age, sex, and other prognostic factors derived from the univariate analysis. The area under the ROC curve was 0.765, 0.759, and 0.766 for X5 In, Fres In, and ALX In, with cutoff values determined at − 0.98, 10.67, and 5.32, respectively. We found significant differences in survival after dividing patients using each of the cutoff values of Xrs. Conclusions: In patients with IPF, Xrs measured by oscillometry significantly impacted survival. We also determined the cutoff values of Xrs to discriminate patients with poor prognoses. [ABSTRACT FROM AUTHOR]

Introduction: asthma is a chronic inflammatory disease, which in the case of a long-term and inadequate treatment can lead to a remodeling of the lower airways and weakening of lung functions. Asthma pathophysiology is still completely unknown, which to a certain extent can explain the absence of the desired response to the applied therapy. As of recently, the focus has been on the role of Vitamin D. Vitamin D is considered to induce mediation of the Th2 inflammatory response by increasing the effect of IL-4, IL-5 and IL-13 cytokines, which play a significant role in the pathophysiology of asthma. All the above, rightly raises the issue of the influence of Vitamin D in the pathophysiology of asthma. Aim: to determine the correlation between the degree of asthma control and the value of vitamin D in the peripheral blood. Materials and methods: the study included a total of 200 respondents aged 8 to 10, who, due to diagnosed asthma, were monitored through the Pulmonology Department of the Pediatric Clinic of the CCUS. The degree of asthma control was determined using the Asthma Control Test (ACT) designed for use with children, supplemented by auscultatory findings, spirometric measurements, and determination of FeNO. The level of vitamin D was determined in a peripheral blood sample. Conclusion: lower Vitamin D values were closely correlated with poorer asthma control. Higher vitamin D levels reduced the risk of poor asthma control, so that with each higher concentration unit, the risk was reduced by 10%. [ABSTRACT FROM AUTHOR]

INTRODUCTION Endothelial progenitor cells (EPCs) dysfunction is involved in the pathogenesis of chronic obstructive pulmonary disease (COPD). The transcription factor PU.1 is essential for the maintenance of stem/progenitor cell homeostasis. However, the role of PU.1 in COPD and its effects on EPC function and lunghoming, remain unclear. This study aimed to explore the protective activity of PU.1 and the underlying mechanisms in a cigarette smoke extract (CSE)-induced emphysema mouse model. METHODS C57BL/6 mice were treated with CSE to establish a murine emphysema model and injected with overexpressed PU.1 or negative control adeno-associated virus. Morphometry of lung slides, lung function, and apoptosis of lung tissues were evaluated. Immunofluorescence co-localization was used to analyze EPCs homing into the lung. Flow cytometry was performed to detect EPC count in lung tissues and bone marrow (BM). The angiogenic ability of BM-derived EPCs cultured in vitro was examined by tube formation assay. We determined the expression levels of PU.1, β-catenin, C-X-C motif ligand 12 (CXCL12), C-X-C motif receptor 4 (CXCR4), stem cell antigen-1 (Sca-1), and stemness genes. RESULTS CSE exposure significantly reduced the expression of PU.1 in mouse lung tissues, BM, and BM-derived EPCs. PU.1 overexpression attenuated CSE-induced emphysematous changes, lung function decline, and apoptosis. In emphysematous mice, PU.1 overexpression markedly reversed the decreased proportion of EPCs in BM and promoted the lung-homing of EPCs. The impaired angiogenic ability of BM-derived EPCs induced by CSE could be restored by the overexpression of PU.1. In addition, PU.1 upregulation evidently reversed the decreased expression of β-catenin, CXCL12, CXCR4, Scal-1, and stemness genes in mouse lung tissues, BM, and BM-derived EPCs after CSE exposure. CONCLUSIONS PU.1 alleviates the inhibitory effects of CSE on EPC function and lunghoming via activating the canonical Wnt/β-catenin pathway and CXCL12/CXCR4 axis. While further research is needed, our research may indicate a potential therapeutic target for COPD patients. [ABSTRACT FROM AUTHOR]

Background: To create a combined variable integrating both ventilation and perfusion as measured by preoperative dual‐energy computed tomography (DECT), compare the results with predicted postoperative (PPO) lung function as estimated using conventional methods, and assess agreement with actual postoperative lung function. Methods: A total of 33 patients with lung cancer who underwent curative surgery after DECT and perfusion scan were selected. Ventilation and perfusion values were generated from DECT data. In the "combined variable method," these two variables and clinical variables were linearly regressed to estimate PPO lung function. Six PPO lung function parameters (segment counting, perfusion scan, volume analysis, ventilation map, perfusion map, and combined variable) were compared with actual postoperative lung function using an intraclass correlation coefficient (ICC). Results: The segment counting method produced the highest ICC for forced vital capacity (FVC) at 0.93 (p < 0.05), while the segment counting and perfusion map methods produced the highest ICC for forced expiratory volume in 1 second (FEV1; both 0.89, p < 0.05). The highest ICC value when using the combined variable method was for FEV1/FVC (0.75, p < 0.05) and diffusing capacity of the lung for carbon monoxide (DLco; 0.80, p < 0.05) when using the perfusion map method. Overall, the perfusion map and ventilation map provided the best performance, followed by volume analysis, segment counting, perfusion scan, and the combined variable. Conclusions: Use of DECT image processing to predict postoperative lung function produced better agreement with actual postoperative lung function than conventional methods. The combined variable method produced ICC values of 0.8 or greater for FVC and FEV1. [ABSTRACT FROM AUTHOR]

To evaluate the organ at risk (OAR) dose and its characteristic variation with different clinically usable prescription doses (RxD) for breast and chest wall radiotherapy in patients with early-stage left-sided breast cancer. In total, 145 patients with early-stage breast cancers (T1N0M0-T2N0M0) on the left side were treated with radiotherapy after a modified radical mastectomy or breast conservation surgery, with a mean age of 45.1 ± 21.6 years. The patient received 4050 cGy of field-in-field (three-dimensional conformal radiotherapy) treatment limited to the breast or chest wall, excluding the supraclavicular node, axillary node and internal mammary chain, over 15 fractions. Additional plans of 5000 cGy/25 fractions, 4500 cGy/20 fractions and 2600 cGy/5 fractions were created with no or minor changes to the original plan. Mathematical modelling was used to study the distinctive change in the dose–volume characteristics for various OARs as a function of the RxD. OAR dosages, both absolute and normalised, were expressed in terms of the RxD. The mathematical (functional) relationship between OAR doses and different prescription levels was deduced by the least squares fit method. The left lung mean dose, V5Gy (%), V10Gy (%) and V20Gy (%) and the heart mean dose, V10Gy (%) and V20Gy (%) were evaluated. The dose–volume parameters showed a parabolic variation (x 2) with the RxD. Prescription normalised OAR doses showed a linear relationship with the RxD; relative dose increased with diminishing RxD. Normalised lung and heart mean doses exhibited saturation (linear relationship) with RxD variation. Paired sample t -test results between RxD versus all evaluated parameters were found to be statistically significant (P = 0.004). The Pearson correlation coefficient between different prescription levels for left lung mean dose (range 0.942–1.0), heart mean dose (range 1.0–1.0), left lung V5Gy (%) (range 0.987–1.0), left lung V10Gy (%) (range 0.991–0.999), heart V10Gy (%) (range 0.998–1.0). The functional form of absolute OAR dose–volume parameters versus RxD is parabolic and the RxD normalised OAR dose–volume parameter versus RxD is a straight line with a negative slope as RxD increases. This indicates an increase in the relative OAR dose–volume parameters if the RxD is reduced. This study is the first of its kind to compare the OAR doses as a function of clinically used degenerate prescription levels. These data will help to comprehend the OAR doses while adopting a new dose fractionation regimen and reviewing the radiotherapy treatment plans. • Evaluation of OAR doses as a function of different prescription doses. • Calculate the dosimetric limits of OAR doses for different prescriptions. • Include 50 Gy/25 fractions, 45 Gy/20 fractions, 40 Gy/15 fractions and 26 Gy/5 fractions prescriptions. • Calculate the mathematical formula for OAR dose versus prescription dose. • Gives an overall understanding of the OAR dose for the FAST-Forward regimen. [ABSTRACT FROM AUTHOR]

The article presents a study to compare the effectiveness of three positive end-expiratory pressure (PEEP) titration methods monitored through electrical impedance tomography (EIT) in monitoring patients with acute respiratory distress syndrome (ARDS) or COVID-19 patients. The data monitored in the study include oxygenation, respiratory compliance, and regional lung indexes. Also cited is the use of pressure-controlled ventilation in the study.

BACKGROUND: Patients receiving mechanical ventilation often require airway clearance and inhaled therapies. Intrapulmonary percussive ventilation (IPV) combines a high-frequency percussive ventilator with a jet nebulizer. Data on aerosol delivery efficiency of the device are scarce. We evaluated albuterol delivery efficiency while using an IPV in-line adapter under different conditions. METHODS: A pediatric lung model of invasive mechanical ventilation was used. The following independent variables were evaluated: lung condition (normal vs ARDS), ventilator mode (adaptive pressure ventilation vs pressure control), percent opening of adapter (0% vs 25% vs 50%), IPV driving pressure (25 psi vs 40 psi), IPV percussion setting (easy vs hard), and endotracheal tube (ETT) size (3.5 mm vs 5.5 mm). Albuterol delivery efficiency (mass captured in the filter expressed as percentage of loading dose) was selected as the dependent variable. Albuterol was captured on a filter at the tip of the ETT and quantified via spectrophotometry (276 nm). RESULTS: Albuterol delivery efficiency ranged from 0-2.89%. Median (interquartile range) and 95% CI around the median were 0.54% (0.37-1.00) and 0.50-0.63%, respectively. The coefficient of determination (R²) for the model including all variables was 0.363. The 2 main contributors were percent of adapter opening (R² 0.30) and IPV setting (R² 0.039). CONCLUSIONS: Albuterol delivery during invasive mechanical ventilation via in-line IPV in a pediatric lung model was inefficient. Alternative methods of delivering bronchodilators and other inhaled medications should be considered when IPV is used. [ABSTRACT FROM AUTHOR]

Background: Acupressure is a branch of complementary medicine that is non-pharmacological and non-invasive. We conducted this technique to see its effect on pulmonary function in Rafsanjan Sarcheshmeh Copper Complex workers. Materials and Methods: This study was a randomized controlled clinical trial conducted on 82 workers with abnormal spirometry results. Respondents were selected by convenient sampling and then randomly divided into the two groups of 41 people. In the intervention group, after acupressure training, the participants were asked to stimulate 2 points first on one side of the body and then on the other side. The Two points were LU7 and LU9. The pressure was applied using fingers for 2 minutes at each point, at a specific time, and for 5 days by the participants themselves. In the control group, acupressure was used at ineffective points that the samples did not know about. FVC, FEV1 indices, and six-minute walk test (6MWT) in both groups were measured and compared before and after the intervention. Results: No significant difference was observed between the control and intervention groups before the study based on FVC, FEV1 and 6MWT scors. There was also no difference in the control group before and after the study based on these indices. However, in the treatment group, the FEV1 and FEV1/FVC ratios significantly increased after the intervention (P<0.05). Conclusions: Acupressure can effectively improve the functional parameters of the lungs, especially in workers who suffer from pulmonary dysfunction due to occupational diseases. [ABSTRACT FROM AUTHOR]

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Background: Our aim was to evaluate the efficacy of transcutaneous electrical acupoint stimulation (TEAS) on oxidative stress induced by one-lung ventilation, lung function, and postoperative quality of recovery in patients with lung cancer. Methods: The participants (n = 80) were assigned to the sham group and TEAS group. TEAS on bilateral Feishu (BL13), Zusanli (ST36), and Hegu (L14) was performed 30 minutes before induction of anesthesia and continued until the end of the surgery. In the sham group, the same acupoints were selected without electrical stimulation. PaO2/FiO2, intrapulmonary shunt ratio (Qs/Qt), alveolar-arterial oxygen tension (A-aDO2), and respiratory index (RI) were calculated to evaluate lung function before one-lung ventilation (T0), 30 min after one-lung ventilation (T1), 1 h after one-lung ventilation (T2), and 10 min after resuming two-lung ventilation (T3). The levels of malondialdehyde (MDA) and superoxide dismutase (SOD) were detected to estimate oxidative stress at T0, T1, T2, and T3. Secondary outcomes included removal time of thoracic drainage tube, duration of intensive care unit (ICU) stay, length of postoperative hospitalization, the incidence of postoperative pulmonary complications, and the Quality of Recovery-15 (QoR-15) score on postoperative day 1 and 2. Results: TEAS significantly increased PaO2/FiO2 at T1 and T2, while Qs/Qt, A-aDO2, and RI decreased remarkably from T1 to T3 (P < 0.05). Meanwhile, TEAS obviously decreased MDA and increased SOD activity at T2 and T3 (P < 0.05). Furthermore, TEAS also markedly shortened the length of ICU stay and hospital stay after surgery, whereas the QoR-15 score on postoperative day 1 and 2 was significantly higher (P < 0.05). Conclusions: TEAS could reduce oxidative lung injury during one-lung ventilation, thereby protecting pulmonary function and effectively accelerating the early recovery of patients with lung cancer. Trial registration: Chinese Clinical Trial Registry (ChiCTR2000038243). [ABSTRACT FROM AUTHOR]

Simple Summary: Dynamic chest radiographs offer a distinct advantage over traditional chest radiographs by integrating motion and functional data, elevating their significance in clinical diagnostics. This study introduces a pioneering technique employing deep neural networks to simulate respiratory lung motion and extract local functional details from single-phase chest X-rays, thereby enhancing lung cancer clinical diagnostic capabilities. Our research establishes the viability of generating patient-specific respiratory motion profiles from single-phase chest radiographs. The evaluation of results from the network developed here underscores its substantial accuracy and fidelity, affirming its robustness in providing valuable supplementary insights into pulmonary function. In this study, we present an innovative approach that harnesses deep neural networks to simulate respiratory lung motion and extract local functional information from single-phase chest X-rays, thus providing valuable auxiliary data for early diagnosis of lung cancer. A novel radiograph motion simulation (RMS) network was developed by combining a U-Net and a long short-term memory (LSTM) network for image generation and sequential prediction. By utilizing a spatial transformer network to deform input images, our proposed network ensures accurate image generation. We conducted both qualitative and quantitative assessments to evaluate the effectiveness and accuracy of our proposed network. The simulated respiratory motion closely aligns with pulmonary biomechanics and reveals enhanced details of pulmonary diseases. The proposed network demonstrates precise prediction of respiratory motion in the test cases, achieving remarkable average Dice scores exceeding 0.96 across all phases. The maximum variation in lung length prediction was observed during the end-exhale phase, with average deviation of 4.76 mm (±6.64) for the left lung and 4.77 mm (±7.00) for the right lung. This research validates the feasibility of generating patient-specific respiratory motion profiles from single-phase chest radiographs. [ABSTRACT FROM AUTHOR]

Background: The administration technique for inhaled drug delivery during invasive ventilation remains debated. This study aimed to compare in vivo and in vitro the deposition of a radiolabeled aerosol generated through four configurations during invasive ventilation, including setups optimizing drug delivery. Methods: Thirty-one intubated postoperative neurosurgery patients with healthy lungs were randomly assigned to four configurations of aerosol delivery using a vibrating-mesh nebulizer and specific ventilator settings: (1) a specific circuit for aerosol therapy (SCAT) with the nebulizer placed at 30 cm of the wye, (2) a heated-humidified circuit switched off 30 min before the nebulization or (3) left on with the nebulizer at the inlet of the heated-humidifier, (4) a conventional circuit with the nebulizer placed between the heat and moisture exchanger filter and the endotracheal tube. Aerosol deposition was analyzed using planar scintigraphy. Results: A two to three times greater lung delivery was measured in the SCAT group, reaching 19.7% (14.0–24.5) of the nominal dose in comparison to the three other groups (p < 0.01). Around 50 to 60% of lung doses reached the outer region of both lungs in all groups. Drug doses in inner and outer lung regions were significantly increased in the SCAT group (p < 0.01), except for the outer right lung region in the fourth group due to preferential drug trickling from the endotracheal tube and the trachea to the right bronchi. Similar lung delivery was observed whether the heated humidifier was switched off or left on. Inhaled doses measured in vitro correlated with lung doses (R = 0.768, p < 0.001). Conclusion: Optimizing the administration technique enables a significant increase in inhaled drug delivery to the lungs, including peripheral airways. Before adapting mechanical ventilation, studies are required to continue this optimization and to assess its impact on drug delivery and patient outcome in comparison to more usual settings. [ABSTRACT FROM AUTHOR]

Background: Lung isolation is a technique used in a multitude of surgeries to ensure single-lung ventilation with collapse of the contralateral lung, as to achieve improved access and visualization of relevant anatomical structures. Despite being accepted and having favorable outcomes, bronchial blockers (BBs) are not to this day the main device of choice among anaesthesiologists. Methods: In this retrospective and descriptive study, we analyzed the safety and efficacy of a BB in all types of thoracic surgeries in our centre between 2015 and 2022, excluding patients with massive hemoptysis or empyema, or who had undergone a prior pneumonectomy. Results: One hundred and thirty-four patients were intervened due to lung cancer (67.9%), respiratory disease (23.9%), and non-respiratory disease (8.2%) undergoing lung surgeries (65.7%), pleural and mediastinal surgeries (29.9%), chest wall surgeries (3.0%) and other surgeries (1.5%). In most cases, lung collapse was considered excellent (63.9%) or good (33.1%) with only 4 cases (3.0%) of poor lung collapse. More than 90% of patients did not present intraoperative or immediate postoperative complications. No statistically significant differences were found between lung collapse and the demographic, clinical or BB-related variables (p > 0.05). However, we found a significatively higher proportion of excellent lung collapses in VATS surgeries and lateral decubitus positioning, as well as a significatively less proportion of poor lung collapses (p < 0.05). Moreover, there was a significantly higher proportion of excellent lung collapses when the BB was placed in the left bronchus (p < 0.05). Conclusions: With these results, in our experience BBs constitute an effective alternative, capable of achieving pulmonary collapse in all kinds of thoracic procedures with satisfactory safety rates due to their minimal complications. [ABSTRACT FROM AUTHOR]

Objective: Right ventricular (RV) dilatation and dysfunction are usually present in heart transplant (HTx) patients and worsened with residual pulmonary hypertension (PH). We aimed to determine the ability of different echocardiographic modalities to evaluate RV function in comparison with cardiac magnetic resonance (CMR) and their relations with pulmonary hemodynamics in HTx patients. Methods: A total of 62 data sets [echocardiographic, hemodynamic, and CMR] were acquired from 35 HTx patients. Comprehensive echocardiography, including two‐dimensional (2D) transthoracic echocardiography, speckle tracking echocardiography, and three‐dimensional (3D) echocardiography, was performed. Mean pulmonary artery pressure (mPAP) was obtained invasively from right heart catheterization. The correlations between all echocardiographic parameters and CMR imaging data and the differences between patients with and without residual PH were evaluated. Results: Diastolic and systolic RV volumes and RV ejection fraction (RVEF) by 3D echocardiography correlated strongly with CMR‐derived volumes and RVEF (r =.91, r =.79, r =.64; p <.0001 for each, respectively). Among other parameters, RV fractional area change (r =.439; p <.001) and RV free wall longitudinal strain (RVFW‐LS) (r = −.34; p <.05) correlated moderately with CMR‐RVEF, whereas tricuspid annulus S' velocity (r =.29; p <.05) and tricuspid annular systolic plane excursion (r =.27; p <.05) correlated weakly with CMR‐RVEF. Additionally, 3D‐RVEF and RVFW‐LS were significantly decreased in studies with mPAP ≥ 20 mm Hg in comparison to those with mPAP < 20 mm Hg (47.7 ± 3.7 vs. 50.9 ± 5.3, p =.04 and −15.5 ± 3.1 vs. −17.5 ± 3, p =.03, respectively). Conclusion: The best method for the evaluation of RV function in HTx recipients is 3D echocardiography. Besides, the subclinical impact of residual PH on RV function can be best determined by RVFW‐LS and 3D‐RVEF in these patients. [ABSTRACT FROM AUTHOR]

Nearly 40 yr ago, Professor Dempsey delivered the 1985 ACSM Joseph B. Wolffe Memorial Lecture titled: "Is the lung built for exercise?" Since then, much experimental work has been directed at enhancing our understanding of the functional capacity of the respiratory system by applying complex methodologies to the study of exercise. This review summarizes a symposium entitled: "Revisiting 'Is the lung built for exercise?'" presented at the 2022 American College of Sports Medicine annual meeting, highlighting the progress made in the last three-plus decades and acknowledging new research questions that have arisen. We have chosen to subdivide our topic into four areas of active study: (i) the adaptability of lung structure to exercise training, (ii) the utilization of airway imaging to better understand how airway anatomy relates to exercising lung mechanics, (iii) measurement techniques of pulmonary gas exchange and their importance, and (iv) the interactions of the respiratory and cardiovascular systemduring exercise. Each of the four sections highlights gaps in our knowledge of the exercising lung. Addressing these areas that would benefit from further study will help us comprehend the intricacies of the lung that allow it to meet and adapt to the acute and chronic demands of exercise in health, aging, and disease. [ABSTRACT FROM AUTHOR]

Background: The aim of this evidence-based practice project was to determine if a digital air leak detection device could speed the identification of chest tube air leak cessation in patients after pulmonary lobectomy. Staff members assessing air leaks have varying levels of expertise, and the digital device is a limited resource in the study institution. A chest tube management algorithm is necessary to standardize care and determine which patients are most likely to benefit. Implementation: Twenty-five consecutive patients who underwent pulmonary lobectomy during the study period and continued to have a chest tube air leak on postoperative day 3 were monitored with digital air leak detection devices. The Mann-Whitney U test was used to compare chest tube duration and hospital length of stay between patients with digital devices and 259 patients who had traditional analog air leak detection devices (historical data from the departmental database over the previous 2 years). Evaluation: Median chest tube duration and hospital stay were 1 day less in patients with digital devices than in those with traditional analog devices (P =.01 and P =.004, respectively), with a cost savings of $2659 per hospital day. Reductions in chest tube duration and length of stay aided in the development of a chest tube management algorithm. Conclusions: Critical care nurses are valued team members who treat patients after lung resections. Digital air leak detection devices can help them assess air leaks more accurately, benefiting the patients in their care. [ABSTRACT FROM AUTHOR]

Introduction: Endobronchial valve (EBV) treatment has been shown to be beneficial for patients with severe emphysema. The forced expiratory volume in 1 s (FEV1) was found to be significantly higher compared to baseline for up to 3 years after treatment although the magnitude of improvement gradually decreases over time. So far, it has not been investigated whether this treatment decelerates the decline in lung function. Therefore, our aim was to investigate the lung function decline before and after EBV treatment. Methods: We included patients who were treated with EBVs in our hospital, of whom pre-treatment spirometry results were available (at least 4 measurements within at least 2 years before treatment) and who had an annual FEV1 measurement up to 3 years after treatment. Results: In total, 45 patients were included (73% female, FEV1: 28 ± 7% of predicted, residual volume: 232 ± 32% of predicted) who had a mean pre-treatment FEV1 decline of −64 mL/year. Mean FEV1 "decline" after treatment was +13 mL/year, since FEV1 was still above the baseline level at 3-year follow-up. However, the FEV1 decline between 1 and 3 years of follow-up was not significantly different compared to the pre-treatment decline (−73 mL/year, p = 0.179). Conclusions: Our results show that the EBV treatment does not influence the progression of disease in terms of lung function decline. However, the treatment does improve the FEV1 up to a level that is still comparable 3 years after treatment with the baseline level. [ABSTRACT FROM AUTHOR]