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Wildfires generate substantial smoke containing fine particulate matter (PM2.5) that adversely impacts health. This study develops machine learning models integrating pre-wildfire factors like weather and fuel conditions with post-wildfire health impacts to provide a holistic understanding of smoke exposure risks. Various data-driven models including Support Vector Regression, Multi-layer Perceptron, and three tree-based ensemble algorithms (Random Forest, Extreme Gradient Boosting (XGBoost), and Natural Gradient Boosting (NGBoost)) are evaluated in this study. Ensemble models effectively predict PM2.5 levels based on temperature, humidity, wind, and fuel moisture, revealing the significant roles of radiation, temperature, and moisture. Further modelling links smoke exposure to deaths from chronic obstructive pulmonary disease (COPD) and lung cancer using age, sex, and pollution type as inputs. Ambient pollution is the primary driver of COPD mortality, while age has a greater influence on lung cancer deaths. This research advances atmospheric and health impact understanding, aiding forest fire prevention and management. [ABSTRACT FROM AUTHOR]

Background/Aim: Tracheobronchial adenoid cystic carcinoma (ACC) is a rare type of malignancy. Although complete resection is standard treatment for localized ACC, treatment for unresectable ACC has not been established. It is unclear whether concurrent chemoradiotherapy (CCRT) followed by immune checkpoint inhibitor (ICI) therapy is effective for ACC. Case Report: A 49-year-old man was admitted to our hospital for the treatment of dyspnea and thickening of the bronchial wall from the tracheal carina to the left main bronchus, as observed on a CT scan. Systemic examinations and transbronchial biopsy led to a diagnosis of locally advanced ACC. Although radiotherapy and chemotherapy are not regarded as very sensitive for ACC, a favorable response was obtained with CCRT. Following CCRT, he received ICI therapy with durvalumab for 1 year. The patient has remained in a stable condition 18 months after therapy, with no recurrence. Conclusion: ICI after CCRT might be a promising treatment option for unresectable tracheobronchial ACC. [ABSTRACT FROM AUTHOR]

BACKGROUND: Tracheobronchial foreign body (FB) aspiration (FBA) is a life-threatening emergency mostly observed in childhood and advanced age. With early diagnosis, the FB can be removed using bronchoscopic methods without causing irreversible damage. METHODS: This was a single-center, retrospective observational study. Subjects diagnosed with FBA via either bronchoscopic methods and/or radiological findings, having no medical history of aspirated FB, and who were detected to have aspirated FB for longer than 30 days were included in the study. Medical records and radiological and bronchoscopic findings of the subjects were investigated from the hospital information database system. RESULTS: Of the 255 patients with FBA, 17.6% (N 5 45) were diagnosed late. The mean age was 53 y; 28% were female, and 60% of the subjects had a history of ever smoking. The estimated residence time of the FB in the bronchial system was 22.8 months. The most common complaints were cough and shortness of breath. Fortytwo percent of the aspirated FBs were organic material. FB artifact could be observed in 6.7% of posteroanterior chest radiographs and 65% of thorax computed tomography (CT) scans. Rigid bronchoscopy had been primarily preferred as therapeutic interventional procedure. It was also found that the artifact most frequently resided in the right bronchial system and was most commonly found in the right lower lobe, while granulation tissue was formed in 85% of the subjects. CONCLUSIONS: The findings of the present study demonstrate that subjects tended to forget the FBA, leading to insidious respiratory system symptoms, with recurrent infections. In cases with an endobronchial mass lesion image on thorax CT, clinicians should consider the possibility of FBA. Delayed diagnosis of both organic and inorganic FB may cause granulation tissue. [ABSTRACT FROM AUTHOR]

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A congenital complete tracheal ring is an infrequent cause of tracheal stenosis. It is usually diagnosed in infants and young children, and adults diagnosed with complete tracheal rings are even rarer entities. There is limited literature regarding the adult complete tracheal ring. Down syndrome patients have a wide array of documented anatomic variations especially airway abnormalities such as laryngomalacia, tracheomalacia, tracheal bronchus and bronchomalacia and rare to have complete tracheal ring. Hence, we described a Down syndrome adult who remained asymptomatic until the recent onset of severe respiratory illness, which requires endotracheal intubation, leading to an unexpectedly difficult airway. A differential diagnosis of a complete tracheal ring should be considered when attending such cases of difficult intubation. [ABSTRACT FROM AUTHOR]

Introduction: Chevalier Jackson defined a foreign body as “an object or a substance that is foreign to its location” In human beings foreign bodies have always attracted the minds of the surgeon. Every attempt is made to take out the foreign body, even when it is harmless. Foreignbody ingestion and aspiration are common, especially in children. Taking into account the risk of infection and digestive perforation, it often requires an endoscopic removal under conditions of maximal safety and minimal trauma, especially for sharp-pointed objects. A positive history, detailed clinical examination and radiograph lead to a diagnosis. Materials and Methods: The sample size is calculated based on the previous year operation theatre records which gave an approximate data of how many patients with foreign body in the upper aero digestive tract were operated, which was around 30-35 and about 10-15 cases will be assessed in prospective arm. Hence the sample size for this study is kept at a maximum of 50 cases. All the patients presenting with foreign body in the upper aero digestive tract in the outpatient department, who satisfy the inclusion and exclusion criteria will be included in the study. Informed consent will be taken from each patient and the study will be explained to each one of them. Detailed clinical history of all these patients will be taken and relevant information regarding their presenting complaints and past illnesses will be recorded. Detailed clinical examination will be done and radiological investigation like x-Ray or CT scan as indicated. Based on the radiological investigations the surgical technique will be decided and the necessary surgical intervention will be performed as per the existing standards of care and protocols. Patient’s identity will be anonymized. Results: Out of 50 patients studied, maximum patients presented with esophageal foreign bodies i.e. 50% and airway foreign bodies are 32 % and nasal foreign bodies 18%. Patients presenting with foreign bodies in the upper aerodigestive tracts were predominantly males, constituting up to 60% of all patients. The most common type of foreign body found was metallic, around 56 %, coin(25%) being the most common. In children, mainly in the under 5 age group, coins were most common whereas in adults, fish-bones and mutton bones were most common. Most common site in esophagus is cricopharynx i.e.44%, followed by an area just below the cricopharynx i.e. 28% in overall distribution. Conclusion: In this study, foreign bodies were more common in children than in adults and in males than in females. Airway foreign bodies were more common in children and digestive tract foreign bodies were more common in adults. The most common age for throat and airway foreign bodies was in the 1st decade. Foreign bodies in the digestive tract were more commonly found in males and airway foreign bodies, in females. Rapid or careless eating was the most common causative factor for foreign body in the digestive tract, and carelessness on the part of caretaker was the cause in airway foreign bodies. In the digestive tract, Fish bone was the most common foreign body in adults and Coins in children. Groundnut was the most common foreign body in the airway. Majority of patients with foreign body, present within 1 day, but children with objects in the nose and bronchus have shown delayed presentation Food particles were the commonest nasal foreign bodies. [ABSTRACT FROM AUTHOR]

Background: Sialolipoma is a benign neoplasm composed of neoplastic adipose tissue and normal salivary gland parenchyma. It is commonly seen in the parotid gland. The occurrence of sialolipoma in the main bronchus is exceedingly rare. Case report: A 52-year-old diabetic and hypertensive gentleman presented with shortness of breath and cough for the last 3-4 months. Computed tomography bronchial angiography showed a soft tissue lesion in the right intermediate bronchus causing its complete obliteration and subsequent collapse of the right lower lobe. A rigid tracheobronchoscope revealed a polypoidal growth originating in the right intermediate bronchus. Histopathology revealed a sialolipoma. The patient was doing well on follow-up and no recurrence was noted to date. Conclusion: The bronchus as the primary site for sialolipoma is unusual and has to be kept in the differential while dealing with the slow-growing endobronchial tumor. [ABSTRACT FROM AUTHOR]

Abstract Background This study aimed to describe the trends in incidence, mortality, and burden of tracheal, bronchial and lung (TBL) cancer in Asia from 2010 through 2019 and compare with global and other continental data. Methods We collected TBL cancer data from the 2019 Global Burden of Disease (GBD) study from 2010 to 2019 in 49 countries and territories in Asia. For all locations, annual case data and age‐standardized rates (ASRs) were used to investigate the incidence, prevalence, mortality, and disability‐adjusted life‐years (DALYs) of TBL from 2010 to 2019. The relative difference (%) between years was used to show comparative variations of ASRs for the indicators studied. Results In 2019, more than 55% of TBL cancer cases and deaths occurred in Asian countries. A total of 57% of lung cancer patients lived in Asia and almost 60% of the global burden of lung cancer was imposed on Asian countries. From 2010 to 2019, incidences, deaths, prevalence cases, and DALYs number of TBL cancer increased over 1.34‐, 1.31‐, 1.31‐, and 1.26‐fold, in Asia. During this period, the age‐standardized incidence rate (ASIR), the age‐standardized death rate (ASDR), the age‐standardized prevalence rate (ASPR), and the age‐standardized DALYs rate (DALYs ASR) of TBL cancer decreased by 1, 3, 4, and 4%, respectively. While at the same time, the decreasing trend of these rates globally and in America and in Europe happened faster. In 2019, age‐specific incidence, death, prevalence, and DALY cases of TBL cancer were peaking at 65–74, 70–74, 65–69, and 65–69 years, respectively. In 2019, the highest ASIR, ASDR, and DALYs ASR of TBL cancer was observed in East Asia countries and the highest ASPR in high‐income Asia Pacific countries. Central Asia and high‐income Asia Pacific countries experienced a decreasing trend in ASIR and ASDR, and the South Asia countries experienced the highest increasing trend from 2010 to 2019. ASPR only decreased in Central Asia, and DALYs ASR only increased in South Asia. In 2019, among high sociodemographic index (SDI) Asian countries, Brunei Darussalam had the highest ASIR, ASDR, and DALYs ASR and the Republic of Korea had the highest ASPR. Among high‐middle SDIs, Turkey and Georgia; among middle SDIs, China and Armenia; among low‐middle SDIs, Mongolia and the Democratic People's Republic of Korea had the highest ASIR, ASDR, ASPR, and DALY ASR of TBL cancer. Among low SDI Asian countries, Pakistan had the highest ASIR, ASDR, ASPR, and DALY ASR of TBL cancer. Conclusion Most of the global burden of lung cancer occurs in Asian countries, and the decreasing trend of incidence, death, prevalence, and burden of this cancer in these countries is slower than in other regions. Therefore, the implementation of necessary measures in order to reduce the process of this cancer is considered urgent.

Key message Congenital anomalies of the large airways are occasionally asymptomatic and are incidentally discovered through radiography, often using computed tomography. Bronchoscopy can aid in the direct visual examination of the large airway abnormalities detected on radiography.

Sofia V Krylova, Sara Glickman, Ali Kalam, Katherine Chemakin, Joseph Yi, Linda Forrester, Priti Mishall, Adi Pinkas Department of Pathology, Albert Einstein College of Medicine, Bronx, NY, 10461, USACorrespondence: Adi Pinkas, Department of Pathology, Albert Einstein College of Medicine, 1300 Morris Park Avenue, F620S, Bronx, NY, 10461, USA, Email adi.pinkas@einsteinmed.eduAbstract: The thoracic cavity contains vital cardiovascular and pulmonary structures. Few congenital anatomical variations in the bronchial tree and pulmonary vasculature have been reported. Understanding such variants is crucial during surgical procedures that involve the thorax. During routine dissection of an 89-year-old male cadaver as part of a first-year anatomy course, an anomaly of the bronchial tree was discovered. The left lung hilum was notable for the pulmonary artery being posterior to the mainstem bronchus. The case report describes normal lung development and anatomy and the significance of this novel variation in which has not been previously described in the literature.Keywords: pulmonary artery, bronchus, lung, pulmonary vein, thoracic region

This paper summarized the nursing countermeasures of indwelling gastric tube insertion into left pulmonary bronchus in a patient with nasopharyngeal carcinoma. Disease, anatomical position, material of catheters and other issuers are influencing factors of insertion indwelling gastric tube into pulmonary bronchus. Nurses should take risk factor into consideration before catheter placement, and adopt standard methods to determine the position of catheter tip. (本文总结1例浅昏迷鼻咽癌患者留置胃管误入左肺支气管的护理经验。疾病、解剖位置、置管材料等均是导致置管误入气管的高危因素, 护士在执行胃管操作时应积极评估上述危险因素, 采取科学、规范的方法准确判断置管位置, 避免不良事件发生。)

BACKGROUND: Foreign bodies in the airway are a potentially fatal event associated with multiple complications. CLINICAL CASE: A 48-year-old male patient who was admitted to the intensive care unit of the Hospital de Traumatología y Ortopedia No. 21, Monterrey, Mexico, due to a car accident with a fracture of the left mandibular branch and detachment of a dental piece with location in the hypopharynx, with posterior displacement to the right bronchus in the context of an intubated patient with sedation, factors that contributed to the event of foreign body aspiration in the airway. It was successfully performed with timely flexible bronchoscopy, with subsequent successful extubation and prevention of associated complications. CONCLUSIONS: The importance of this case report lies in the peculiarity of the manifestation and the association of conditions that predispose this event, as well as the relevance in the diagnosis and treatment, since it is described that the timely performance of flexible bronchoscopy in the adult population is associated with a higher success rate. [ABSTRACT FROM AUTHOR]

Understanding the dimensions of the lower airway is critical for performing respiratory surgery, selecting and designing appropriate airway equipment, and removing aspirated foreign bodies via bronchoscopy, anaesthesia, and radiography. The purpose of this study was to analyse the trachea and bronchus morphologically in children and adults, as well as to standardise the data for these structures’ measurements. Various databases were reviewed for studies on lower airway dimensions. The criteria for inclusion and exclusion were established. Finally, it was agreed to look into 28 studies that took place between 1984 and 2021. The length of the trachea, its anterior-posterior (AP) and transverse dimensions, the lengths and transverse diameters of the right and left major bronchus, and the subcarinal angle were also investigated in the study. In studies where measurements were performed with different methods and procedures. It was revealed that age and gender were effective in the difference in lower respiratory tract dimensions. The mean values of all parameters were greater in adults than in children, the AP diameter of the trachea in adults was greater than the transverse diameter. In children, it was observed that the transverse diameter was larger than the AP diameter on average, the left main bronchus was longer than the right main bronchus, and the transverse diameter was smaller than the right main bronchus in most of the studies. The articles reviewed for this study revealed that measurements were done using a variety of different procedures and approaches, and the resulting data were inconsistent and could not be standardized. The data collected will be beneficial both conceptually and clinically; we believe that additional comparison research involving children and adults in bigger groups are necessary. [ABSTRACT FROM AUTHOR]

Background: This study aimed to describe the trends in incidence, mortality, and burden of tracheal, bronchial and lung (TBL) cancer in Asia from 2010 through 2019 and compare with global and other continental data. Methods: We collected TBL cancer data from the 2019 Global Burden of Disease (GBD) study from 2010 to 2019 in 49 countries and territories in Asia. For all locations, annual case data and age‐standardized rates (ASRs) were used to investigate the incidence, prevalence, mortality, and disability‐adjusted life‐years (DALYs) of TBL from 2010 to 2019. The relative difference (%) between years was used to show comparative variations of ASRs for the indicators studied. Results: In 2019, more than 55% of TBL cancer cases and deaths occurred in Asian countries. A total of 57% of lung cancer patients lived in Asia and almost 60% of the global burden of lung cancer was imposed on Asian countries. From 2010 to 2019, incidences, deaths, prevalence cases, and DALYs number of TBL cancer increased over 1.34‐, 1.31‐, 1.31‐, and 1.26‐fold, in Asia. During this period, the age‐standardized incidence rate (ASIR), the age‐standardized death rate (ASDR), the age‐standardized prevalence rate (ASPR), and the age‐standardized DALYs rate (DALYs ASR) of TBL cancer decreased by 1, 3, 4, and 4%, respectively. While at the same time, the decreasing trend of these rates globally and in America and in Europe happened faster. In 2019, age‐specific incidence, death, prevalence, and DALY cases of TBL cancer were peaking at 65–74, 70–74, 65–69, and 65–69 years, respectively. In 2019, the highest ASIR, ASDR, and DALYs ASR of TBL cancer was observed in East Asia countries and the highest ASPR in high‐income Asia Pacific countries. Central Asia and high‐income Asia Pacific countries experienced a decreasing trend in ASIR and ASDR, and the South Asia countries experienced the highest increasing trend from 2010 to 2019. ASPR only decreased in Central Asia, and DALYs ASR only increased in South Asia. In 2019, among high sociodemographic index (SDI) Asian countries, Brunei Darussalam had the highest ASIR, ASDR, and DALYs ASR and the Republic of Korea had the highest ASPR. Among high‐middle SDIs, Turkey and Georgia; among middle SDIs, China and Armenia; among low‐middle SDIs, Mongolia and the Democratic People's Republic of Korea had the highest ASIR, ASDR, ASPR, and DALY ASR of TBL cancer. Among low SDI Asian countries, Pakistan had the highest ASIR, ASDR, ASPR, and DALY ASR of TBL cancer. Conclusion: Most of the global burden of lung cancer occurs in Asian countries, and the decreasing trend of incidence, death, prevalence, and burden of this cancer in these countries is slower than in other regions. Therefore, the implementation of necessary measures in order to reduce the process of this cancer is considered urgent. [ABSTRACT FROM AUTHOR]

A brief insight of Rigid Bronchoscopy and methodology in current times in a tertiary care centre and a series of 3 recent unusual encounters of foreign body removed through rigid bronchoscopy. [ABSTRACT FROM AUTHOR]

Abstract Bronchoscopic TransParenchymal Nodule Access (BTPNA) technology is mainly used for sampling or ablative treatment of lung parenchymal lesions that cannot be reached by bronchoscopy and its appendages, generally for palliative treatment of some lung tumors. We used BTPNA to treat a 32‐year‐old young woman with pulmonary tuberculosis and successfully perforated her occluded left main bronchus. Her left atelectasis was recovered, and a silicone stent was inserted to preserve the shape of the left main bronchus.

Objective To investigate the relationship between solid pulmonary nodules with maximum diameter≤2 cm and the bronchi in order to provide more valuable clues to differentiate benign and malignant solid pulmonary nodules. Methods The clinical and CT data of 776 patients with solid pulmonary nodule at a maximum diameter of not larger than 2 cm confirmed by pathology in our hospital from January 2014 to January 2021 were analyzed retrospectively. According to pathological types, the patients were divided into malignant nodule group(n=340) and benign nodule group(n=436), and those with benign nodules were further assigned into inflammatory nodule subgroup(n=299) and benign tumor subgroup(n=137). Bronchogram sign on CT images were classified into 4 types according to the relationship between pulmonary nodules and bronchi. The incidence and types of different bronchogram sign on CT images were compared between malignant nodule group and benign nodule group, and between inflammatory nodule subgroup and benign tumor subgroup. The diagnostic performance of bronchogram sign on CT images to differentiate benign and malignant solid pulmonary nodules was evaluated. Results ① The incidence of bronchogram sign on CT images was higher in the malignant nodule group than the benign nodule group(65.9% vs 31.4%, P < 0.001). Types Ⅰ and Ⅱ signs were more common in the benign nodule group, while Types Ⅲ and Ⅳ signs were more common in the malignant nodule group(all P < 0.01). The sensitivity, specificity, and accuracy of bronchogram sign on CT images was 82.1%, 56.2%, and 72.3%, respectively in differentiation of benign and malignant solid pulmonary nodules. ②The incidence of bronchogram sign on CT images was statistically higher in the inflammatory nodule subgroup than the benign tumor subgroup(39.1% vs 14.6%, P < 0.001). Type Ⅳ was more common in inflammatory nodule subgroup(P < 0.05). However, no significant differences were observed in the other 3 types between the 2 subgroups (all P > 0.05). Conclusion Bronchogram sign on CT images is valuable in differentiation of benign and malignant solid pulmonary nodules measuring ≤2 cm in diameter. Irregular air bronchogram sign or truncation of bronchus in the margin of nodule is highly suggestive of malignancy.

The purpose of this study is to evaluate changes in the trachea and bronchi using 3-dimensional reconstruction images obtained from the initial and follow-up computed tomography (CT) scans of COVID-19 patients. A hundred COVID-19 patients over the age of 18 were included in our study. CT images were transferred to Mimics software, and a 3-dimensional reconstruction of the trachea and bronchi was performed. The initial and follow-up CT images of COVID-19 patients were graded as none (grade 0), mild (grade 1), moderate (grade 2), and severe (grade 3) according to the total lung severity score. The patients were divided into progression and regression groups according to the grade increase/decrease between the initial and follow-up CTs. Moreover, the patients were divided into groups as 0-2 weeks, 2-4 weeks, 4-12 weeks, and over 12 weeks according to the duration between the initial and follow-up CTs. The mean cross-sectional area, circumference, and diameter measurements of the right upper lobar bronchus, intermediate bronchus, middle lobar bronchus, and left lower lobar bronchus decreased in the follow-up CTs of the progression group. This decrease was not found to be statistically significant. In the follow-up CTs of the regression group, the left upper lobar bronchus and left lower lobar bronchus measurements increased but not statistically significant. Upon comparing the onset of the disease and the follow-up period, statistically significant changes did not occur in the trachea, main bronchus, and lobar bronchus of COVID-19 patients. [ABSTRACT FROM AUTHOR]

Background: Studies demonstrated that age-related cellular and functional changes of airway significantly contribute to the pathogenesis of many airway diseases. However, our understanding on the age-related molecular alterations of human airway remains inadequate. Methods: Airway (trachea and bronchus) brushing specimens were collected from 14 healthy, female non-smokers with ages ranging from 20 to 60 years. Bulk RNA sequencing was performed on all the specimens (n = 28). Airway cell types and their relative proportions were estimated using CIBERSORTx. The cell type proportions were compared between the younger (age 20-40) and elder group (age 40-60) in the trachea and bronchus respectively. The linear association between cell type proportion and age was assessed using the Pearson correlation coefficient. Differentially expressed genes (DEGs) between the two age groups were identified using DESeq2. Three kinds of enrichment analysis of the age-related DEGs were performed, including Gene ontology (GO) enrichment, Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment, and disease enrichment analysis. Results: Sixteen and thirteen cell types were separately identified in tracheal and bronchial brushings, with the airway epithelial cells (including suprabasal, submucosal gland (SMG) goblet, serous, secretory, multiciliated, cycling. basal, basal cells) accounting for 85.1% in the trachea and 92.5% in the bronchus. The lymphatic cell and NK cells had a higher abundance ratio in the trachea, compared with the bronchus. The proportion of basal cells was negatively related to age both in the trachea and bronchus. Thirty-one and fifty-two age-related DEGs (p < 0.1) were identified in the trachea and bronchus, respectively. Among them, five common DEGs (CXCL2, CXCL8, TCIM, P4HA3, AQP10) were identified. Pathway enrichment analysis showed both tracheal and bronchial age-related DEGs were primarily involved in immune regulatory signaling pathways (TNF, NF-kappa B, IL-17 et al.). Disease enrichment analysis suggested that tracheal age-related DEGs significantly related to asthmatic pulmonary eosinophilia, and chronic airflow obstruction et al., and that bronchial age-related DEGs were enriched in airflow obstruction, bronchiectasis, pulmonary emphysema, and low respiratory tract infection et al. Conclusion: We found the proportion of basal cells decreased with age in both the trachea and bronchus, suggesting a weakening of their self-renew ability with age. We identified transcriptomic signature genes associated with the early aging process of the human trachea and bronchus, and provided evidence to support that changes in their immune regulatory function may play critical roles in age-related airway diseases. [ABSTRACT FROM AUTHOR]

Background: Isolated tracheobronchial mucormycosis (ITBM) is an uncommonly reported entity. Herein, we report a case of ITBM following coronavirus disease 2019 (COVID‐19) and perform a systematic review of the literature. Case description and systematic review: A 45‐year‐old gentleman with poorly controlled diabetes mellitus presented with cough, streaky haemoptysis, and hoarseness of voice 2 weeks after mild COVID‐19 illness. Computed tomography and flexible bronchoscopy suggested the presence of a tracheal mass, which was spontaneously expectorated. Histopathological examination of the mass confirmed invasive ITBM. The patient had complete clinical and radiological resolution with glycaemic control, posaconazole, and inhaled amphotericin B (8 weeks). Our systematic review of the literature identified 25 additional cases of isolated airway invasive mucormycosis. The median age of the 26 subjects (58.3% men) was 46 years. Diabetes mellitus (79.2%) was the most common risk factor. Uncommon conditions such as anastomosis site mucormycosis (in two lung transplant recipients), post‐viral illness (post‐COVID‐19 [n = 3], and influenza [n = 1]), and post‐intubation mucormycosis (n = 1) were noted in a few. Three patients died before treatment initiation. Systemic antifungals were used in most patients (commonly amphotericin B). Inhalation (5/26; 19.2%) or bronchoscopic instillation (1/26; 3.8%) of amphotericin B and surgery (6/26; 23.1%) were performed in some patients. The case‐fatality rate was 50%, primarily attributed to massive haemoptysis. Conclusion: Isolated tracheobronchial mucormycosis is a rare disease. Bronchoscopy helps in early diagnosis. Management with antifungals and control of risk factors is required since surgery may not be feasible. [ABSTRACT FROM AUTHOR]

Bronchoscopic TransParenchymal Nodule Access (BTPNA) technology is mainly used for sampling or ablative treatment of lung parenchymal lesions that cannot be reached by bronchoscopy and its appendages, generally for palliative treatment of some lung tumors. We used BTPNA to treat a 32‐year‐old young woman with pulmonary tuberculosis and successfully perforated her occluded left main bronchus. Her left atelectasis was recovered, and a silicone stent was inserted to preserve the shape of the left main bronchus. [ABSTRACT FROM AUTHOR]

Objective To investigate the mechanism of cordycepin (Cor) in the inhibition of epithelial-mesenchymal transition in asthmatic rats. Methods Rats were randomly divided into 4 groups (n=10): control group, ovalbumin (OVA) group, OVA+10 mg/kg Cor group, OVA+50 mg/kg Cor group. After 7 days of treatment, the cell counting in bronchoalveolar lavage fluid (BALF) was measured; hematoxylin-eosin (HE) staining was used to evaluate airway inflammation and airway remodeling. Masson's trichrome staining was used to detect epithelial collagen deposition. Human bronchial epithelioid cells 16HBE were divided into 3 groups: control group, TGF-β1 group and TGF-β1+Cor group. Immuno-fluorescence staining was used to detect the expression of c-Jun in the cells. Cell proliferation and migration were examined by cell counting kit-8 (CCK-8) and Transwell. The protein expression of E-cadherin, N-cadherin, α-SMA, vimentin, Smad3, p-Smad3, ERK1/2 and p-ERK1/2 was detected by immuno-histochemical staining or Western blot. Results With comparison with specific control groups, the following results were recorded. The collagen fiber area and cell count of OVA group increased significantly(P＜0.05). The collagen fiber area and cell count of OVA+10 mg/kg Cor group and OVA+50 mg/kg Cor group both decreased (P＜0.05). E-cadherin staining degree and protein expression of OVA group decreased, while the staining degree of α-SMA increased and the protein expression of N-cadherin, α-SMA and vimentin increased (P＜0.05); E-cadherin staining degree and protein expression of OVA+10 mg/kg Cor group and OVA+50 mg/kg Cor group increased, while the staining degree of α-SMA decreased and the protein expression of N-cadherin, α-SMA and vimentin decreased (P＜0.05). Compared with control group, the cell viability and the number of migrating cells in the TGF-β1 group increased (P＜0.05); compared with the TGF-β1 group, the cell viability and the number of migrating cells in the TGF-β1+Cor group were both decreased (P＜0.05). The expression level of E-cadherin protein in TGF-β1 group decreased, while the protein expression of N-cadherin, α-SMA, vimentin, p-Smad3 and p-ERK1/2 increased (P＜0.05). The E-cadherin protein expression level of TGF-β1+Cor group increased, while the N-cadherin, α-SMA, vimentin, p-Smad3 and p-ERK1/2 protein expression levels decreased (P＜0.05). The relative fluorescence intensity of c-Jun in TGF-β1 group increased (P＜0.05); The relative fluorescence intensity of c-Jun in TGF-β1+Cor group decreased (P＜0.05). Conclusions Cordycepin inhibits EMT in asthma by inhibiting Smad3 and ERK1/2 signaling pathway and c-Jun.

Sialadenoma papilliferum (SP) is a rare salivary gland tumor mostly reported in the oral cavity. Here we describe a bronchial SP in the left upper lobe bronchus of a 10-year-old boy. At bronchoscopy, a well-circumscribed polypoid lesion protruding into the bronchial lumen was identified. The tumor was excised, but eventually, the patient had to undergo a sleeve resection after 2 recurrences. Pathology revealed a papillocystic lesion with exophytic and endophytic components. The cells lining the exophytic surface and papillary structures were columnar and squamous, and the cells lining endophytic cystic and papillary structures were cuboidal to columnar, all of which were diffusely reactive with antibodies to SOX10 protein. The presence of basal cells was demonstrated by p63 immunoreactivity. The cells failed to immunohistochemically express BRAF V600E. Fluorescence in situ hybridization analysis revealed no MAML2 or RET gene rearrangement. The patient is alive 24 years after resection with no additional recurrences. Bronchial SP needs to be recognized and distinguished from other benign and malignant salivary gland and pulmonary neoplasms so that patients can receive appropriate treatment and follow-up. [ABSTRACT FROM AUTHOR]

This study deals with the development of a computer tomography (CT) system for automatic segmentation and quantitative analysis of the pulmonary bronchus. It includes three parts. Part I employed an adaptive median and four neighbors low pass filters to eliminate the noise of CT. Then, k-means clustering was used to segment the lung region in the CT data. In Part II, the pulmonary airway was segmented. The three-grade segmentation was employed to divide all pixels in the lung region into three uncertain grades, including air, blood vessels, and tissues, and uncertain portions. The airway wall was reformed using a border pixel weight mask. Afterwards, the seed was calculated automatically with the front-end image masking the aggregation position of the lung region as the input of the region growing to obtain the initial airway. Afterwards, the micro bronchi with different radii were detected using morphological grayscale reconstruction to modify the initial airway. Part III adopted skeletonization to simplify the pulmonary airway, keeping the length and extension direction information. The information was recorded in a linked list with the world coordinates based on the patients' carina, defined by the directions of the carina to the top end of the trachea and right and left main bronchi. The whole set of bronchi was recognized by matching the target bronchus direction and world coordinates using hierarchical classification. The proposed system could detect the location of the pulmonary airway and detect 11 generations' bronchi with a bronchus recognition capability of 98.33%. Meanwhile, 20 airway parameters' measurement and 3D printing verification have been processed. The diameter, length, volume, angle, and cross-sectional area of the main trachea and the right and left bronchi, the cross-sectional area of the junction, the left bronchus length, and the right bronchus length have been calculated for clinical practice guidelines. The system proposed in this study simultaneously maintained the advantages of automation and high accuracy and contributed to clinical diagnosis. [ABSTRACT FROM AUTHOR]

Background: Tracheobronchopathia osteochondroplastica (TO) is a rare idiopathic disease with a stable course that involves the mucous membrane of the tracheobronchial tree. Most cases present no specific symptoms, and there are currently no established guidelines for diagnosis and treatment. In this report, we discuss a single case of a patient with TO who was diagnosed based on clinical imaging and histopathology. Case Summary: A patient with a history of smoking and alcohol consumption, but no specific clinical symptoms, was diagnosed with TO after undergoing fiber-optic bronchoscopy. Nodular processes with smooth surface mucosa and detached bronchial mucosa were observed. The presence of TO was confirmed by pathological examination. Conclusion: The diagnosis of TO is difficult, and early fiber-optic bronchoscopy and pathological examination should be performed to facilitate the diagnosis. [ABSTRACT FROM AUTHOR]

A foreign body in the bronchus due to a ballistic projectile is very uncommon. A 45-year-old man presented to the hospital after being accidentally shot. The initial radiographic assessment found a bullet in his left thoracic cavity. With the help of an X-ray, an urgent left posterolateral thoracotomy was conducted, but no foreign body was found. The foreign body had migrated to the contralateral chest cavity, as determined by the C-arm. On the following day, a thorax computed tomography scan was conducted, and it was discovered that the foreign body had already migrated to the right lower bronchus. A right thoracotomy was then performed to remove the foreign body. He was moved to the intensive care unit and discharged with a stable condition. In conclusion, migration of a foreign body in the bronchus is rare. A thorough strategy is required to prevent the object from migrating even further. [ABSTRACT FROM AUTHOR]

Tracheal bronchus (TB) is a very rare condition, which is often associated with some other pathologies. This study was designed to characterize the morphology of tracheal bronchus and associated pathologies in Vietnamese individuals using multidetector-row computed tomography (MDCT). From August 2016 to February 2021, 16, 64-, and 128-detector-row computed tomography scanners were used to perform chest scans of 3663 patients, of whom 32 had tracheal bronchus and associated pathologies. The prevalence of tracheal bronchus was 0.9%, of which 0.6% were male and 0.3% were female. We found that one patient had bilateral tracheal bronchus (3.1%) and 31 patients (96.9%) had right-sided tracheal bronchus. Most patients (75.1%) had type II tracheal bronchus, whereas 15.6% and 6.2% had type III and type I tracheal bronchus, respectively. The average distance from the tracheal bronchus to the carina was 6.6 ± 6.4 mm. The average diameter of the tracheal bronchus was 4.4 ± 2.2 mm; the group with 2-4-mm tracheal bronchus accounted for the highest proportion (46.9%). Associated pathologies included congenital heart diseases (i.e., valvular heart disease, tetralogy of Fallot, cyanotic congenital heart disease-APSO, and aortic coarctation) (43.7%), stenosis of the bilateral pulmonary arteries (15.6%), absent left pulmonary artery (6.2%), stenosis of the right pulmonary artery (3.1%), anomalous pulmonary venous connection (3.1%), stenosis of the trachea (3.1%), stenosis of the left main bronchus (3.1%), bronchogenic cyst (3.1%), and bronchial atresia (3.1%), and the remaining 12.5% had no abnormalities. tracheal bronchus is a very rare abnormality among Vietnamese and is often accompanied by other pathologies. MDCT with a high spatial resolution and a good tissue contrast, along with contrast agent and appropriate scanning protocols, is efficient in detecting tracheal bronchus and associated pathologies. [ABSTRACT FROM AUTHOR]

Background: Trachea, bronchus, and lung (TBL) cancer has demonstrated a discernible feminization and a tendency towards younger onset in recent decades. Therefore, our objective is to examine the most recent patterns in the worldwide prevalence of TBL among women of reproductive age on a global, regional, and national scale., Methods: To assess the prevalence trends of TBL in women of reproductive age, we calculated the estimated annual percentage change (EAPC), age-standardized incidence rate (ASIR), age-standardized death rate (ASDR), and disability-adjusted life years (DALYs) for 204 countries and territories from 1990 to 2019. These calculations were based on the Global Burden of Disease (GBD) 2019 database., Results: From 1990 to 2019, there was a global increase in the absolute number of incidence cases, deaths, and DALYs of TBL in women of reproductive age. However, the ASIR, ASDR, and age-standardized DALY rates were decreasing over this period, with EAPC of -0.77 (95 % confidence interval [CI]: -1.03 to -0.51), -1.08 (95 % CI: -1.34 to -0.82), and -1.10 (95 % CI: -1.36 to -0.84), respectively. This trend was observed even in regions with higher Socio-Demographic Index (SDI). East Asia consistently had the highest ASIR, ASDR, and age-standardized DALY rate, but there was a decreasing trend. Conversely, Eastern Sub-Saharan Africa displayed an increasing burden pattern. When examining countries individually, Monaco, Greenland, and Palau had the highest ASIR. Moreover, in most countries, the ASIR for TBL increased with age, particularly among women aged 35-49 years., Conclusions: Despite a global decline in ASIR, ASDR, and age-standardized DALY rates for TBL in women of reproductive age over the past three decades, there is still a troubling increase observed in low- and low-middle SDI regions. It is crucial to implement effective preventive and curative measures in these regions in order to address this concerning trend., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Neuroendocrine lung tumours are a group of different tumours that have similar morphological, immunohistochemical and molecular characteristics, and represents 1-2 % of all malignant lung tumours. Tumorlet carcinoids represent the nodular proliferation of hyperplastic neuroendocrine cells that is smaller than 5 mm in size. In this study, we reported the unusual finding of tumour carcinoid and endobronchial hamartoma in the same bronchus. A 49-year-old male patient with symptoms of prolonged severe cough and fever, and was treated for pneumonia. Since he did not adequately respond to antibiotic therapy lung CT scan was performed which showed middle lobe bronchus obstruction. Bronchoscopy revealed a lobulated whitish tumour which was biopsied and histopathological diagnosis was hamartoma. Tumour could not be completely removed during bronchoscopy, it was decided to surgically remove it. On serial section, during gross examination in the same bronchus, an oval yellowish area with a diameter of 3 mm was found along the bronchial wall. According to gross and histomorphological characteristics and immunophenotype of tumour cells, the diagnosis of tumour carcinoid was set. Diagnosis of carcinoids of the tumorlet type is usually an accidental finding and it can be seen on CT in the form of subcentimeter, single or multiple, nodular changes. Considering that the clinical picture is nonspecific, they should always be kept in mind as a possible differential diagnosis. [ABSTRACT FROM AUTHOR]

Before the SARS-CoV-2 Omicron variant emergence, shell disorder models (SDM) suggested that an attenuated precursor from pangolins may have entered humans in 2017 or earlier. This was based on a shell disorder analysis of SARS-CoV-1/2 and pangolin-Cov-2017. The SDM suggests that Omicron is attenuated with almost identical N (inner shell) disorder as pangolin-CoV-2017 (N-PID (percentage of intrinsic disorder): 44.8% vs. 44.9%—lower than other variants). The outer shell disorder (M-PID) of Omicron is lower than that of other variants and pangolin-CoV-2017 (5.4% vs. 5.9%). COVID-19-related CoVs have the lowest M-PIDs (hardest outer shell) among all CoVs. This is likely to be responsible for the higher contagiousness of SARS-CoV-2 and Omicron, since hard outer shell protects the virion from salivary/mucosal antimicrobial enzymes. Phylogenetic study using M reveals that Omicron branched off from an ancestor of the Wuhan-Hu-1 strain closely related to pangolin-CoVs. M, being evolutionarily conserved in COVID-19, is most ideal for COVID-19 phylogenetic study. Omicron may have been hiding among burrowing animals (e.g., pangolins) that provide optimal evolutionary environments for attenuation and increase shell hardness, which is essential for fecal–oral–respiratory transmission via buried feces. Incoming data support SDM e.g., the presence of fewer infectious particles in the lungs than in the bronchi upon infection. [ABSTRACT FROM AUTHOR]

ObjectivesOccupational exposure to carcinogens is associated with trachea, bronchus, and lung (TBL) cancer. The objective of this study was to provide global and regional estimates of the burden of TBL cancer associated with occupational carcinogens (OCs) between 1990 and 2019.MethodsAge-standardized mortality rates (ASMR) and age-standardized disability-adjusted life years (DALYs) rates (ASDR) of TBL cancer related to exposure to OCs at the global and regional levels were extracted for 1990–2019 from the Global Burden of Disease 2019. Joinpoint regression was used to analyze trends in the ASMR and ASDR of TBL cancer burden related to OCs, and the annual percent change and the average annual percent change (AAPC) were recorded.ResultsThe mortality from TBL cancer related to exposure to OCs increased globally. The ASMR and ASDR decreased in both sexes and in men between 1990 and 2019. The AAPC of ASMR and ASDR decreased in men between 1990 and 2019, but increased in women. Asbestos accounted for the highest death number and beryllium accounted for the lowest; diesel engine exhaust caused the largest percentage change in death number (145.3%), in ASDR (14.9%), and in all ages DALY rates (57.6%). Asbestos accounted for the largest death number in high social development index (SDI) countries, whereas low-middle SDI countries had the largest percent change (321.4%). Asbestos was associated with decreased ASDR in high SDI countries and increased ASDR in low-middle SDI countries, and similar changes were observed for other OCs.ConclusionsThe overall mortality and DALYs of TBL cancer burden related to OCs showed a decreasing trend between 1990 and 2019, whereas death number increased. Asbestos accounted for the highest death number. TBL cancer burden related to OCs decreased to different degrees in high, low, low-middle, and middle SDI countries, which showed variable levels of TBL cancer burden related to exposure to OCs (except asbestos).

Bronchial papillomas are benign tumors, which can be divided into different subtypes based on the cellular features. So far, no bronchial papilloma with basaloid cell features has been reported. We report a bronchial basaloid papillary tumor in a 67-year-old woman. Tumor recurrence and malignant transformation were observed after a long-term follow-up. The clinical, histological, immunohistochemical, and genetic features were reappraised. The primary tumor was characterized by papillary growth pattern and basaloid neoplastic cells, only a small amount of neoplastic cells showed mature characteristics. The tumor originated from respiratory epithelium and had a low proliferation index by Ki-67. Keratin (KRT) 5/6 and KRT7 showed patchy or partial positivity. Myoepithelial markers were negative. P63 was diffusely positive, but it was negative in the small amount of tumor cells with mature characteristics. The common genetic alterations (EGFR, KRAS, BRAF V600E, HER2, and ALK) of lung cancers were not detected. However, tumor recurrence was observed in the mediastinum and esophagus 12 years after surgery. The recurrent tumor had a morphology overlapping with that of the primary tumor; however, it displayed significantly malignant characteristics. The recurrent tumor was not related to high-risk HPV. A high variant allele frequency was observed in tumor suppressor gene BRCA1, TP53, oncogene GNA11, and KIT, which were all missense mutations. Considering the bland features of the primary tumor and the fact of tumor recurrence and undisputed malignant transformation, the basaloid papillary tumor was considered a tumor with uncertain malignant potential. [ABSTRACT FROM AUTHOR]

Teaching Point: The pulmonary artery sling can be suspected on frontal chest radiography, not only by ancillary findings like lobe/lung emphysema or persisting atelectasis, but also blurring of the distal trachea or carina.

Pulmonary schwannoma is a rare neoplasm that arises from peripheral nerve sheath, Schwann cells, in the lungs and mostly remains asymptomatic for months. This report presents a seven-year-old female patient with an occasional cough and fever. She was hospitalized due to the lack of response to outpatient treatments, including antibiotics and antifebrile. A biopsy was taken from the mass by bronchoscopy, and the pathology report indicated the presence of a low-grade spindle cell, Verocay body, and Antoni B areas. Based on the pathologic findings, immunohistochemical (IHC) analysis was requested. The results indicated diffusely positive for S-100 protein, and accordingly, the diagnosis of schwannoma was confirmed. Thoracotomy and lobectomy were performed. Tracheobronchial schwannoma can be treated with surgical resection or bronchoscopy. [ABSTRACT FROM AUTHOR]

Objective: To find out the pattern of foreign bodies inhaled or ingested in a series of patients. Study Design: Case series. Place and Duration of Study: Ear, Nose and Throat (ENT) department, Pak Emirates Military Hospital (PEMH) Rawalpindi, Jan 2016 to Dec 2016. Methodology: A total of 46 cases of foreign body upper aero digestive tract who presented in the ENT Department, PEMH Rawalpindi in 2016 were included in this study. Twenty eight cases were of foreign body esophagus and 18 were of foreign body airway. The age, gender, duration of foreign body lodgment, types of foreign body’s physical signs and symptoms were recorded. Relevant radiographic studies were performed. Results: Out of 46 patients of foreign body aero digestive tract 33 were males and 13 were females. The overall frequency of foreign bodies’ upper aero digestive tract was 46 (0.14%) with 28 (0.08%) being foreign bodies esophagus and 18 (0.06%) foreign bodies airway. In 50% cases of bronchial foreign bodies were in age group 0-3 years. The most frequent foreign body in the esophagus was coin in 13(46.4%) followed by chicken bone 5 (17.8%) and fish bone 3 (10.7%). Peanuts, peas, and beans were predominant component of the airway foreign bodies constituting 6 (33.3%), 3 (16.6%) and 3 (16.6%) respective of the total. Most frequent sites of impaction of the foreign body were cervical esophagus 16 (34%), right main bronchus 11 (23.9%) and left main bronchus 3 (6.5%). Conclusion: Foreign body aero digestive tract is an uncommon but potentially life threatening presentation in ENT practice. Prompt management includes high index of suspicion and investigation to reach definitive diagnosis followed by intervention.

Abstract Foreign body ingestion should be considered as an important differential in a child with difficult asthma. We report an 11‐year‐old male child with foreign body aspiration who initially was diagnosed and treated as difficult asthma. Later on, he was diagnosed to have a foreign body in the right bronchus, which was successfully removed by flexible bronchoscopy.

Abstract Background Paediatric cases of pleomorphic adenoma of the bronchus are rare in clinical practice, despite pleomorphic adenoma being the most common histological form of salivary gland neoplasm. To date, no such cases have been reported in China. Case presentation We report a case of pleomorphic adenoma of the bronchus in a 10-year-old child with no obvious positive signs on examination. Chest-enhanced computed tomography and bronchoscopy showed a large white mass in the right principal bronchus. The patient was treated by bronchial mass resection. Biopsy confirmed the diagnosis of pleomorphic adenoma. Conclusions We not only describe a rare benign bronchial tumour in children but also demonstrate the successful use of surgery as a radical cure for pleomorphic adenoma.

Teaching Point: The pulmonary artery sling can be suspected on frontal chest radiography, not only by ancillary findings like lobe/lung emphysema or persisting atelectasis, but also blurring of the distal trachea or carina. [ABSTRACT FROM AUTHOR]

Bronchial chondromas are very rare pulmonary benign tumors. Despite their rarity, clinicians should be aware of the possibility of endobronchial tumors in patients with unexplained respiratory symptoms. Treatment modalities for the complete excision of the tumor should be initiated to prevent further complications based on the individual tumor situation. [ABSTRACT FROM AUTHOR]

Abstract Background Incidence of foreign body aspiration has been noticed predominantly in age group ranging from 12 months-3 years. Foreign body in the trachea is a medical emergency as presentation is in respiratory distress. Obstruction of only one main or distal bronchus, leads to severe cough, choking sensation and breathlessness. Without early intervention, it can lead to collapse, consolidation and pneumonia of the affected lung. Methods We retrospectively analyzed 37 pediatric case records who presented from January 2014–December 2018 with foreign body aspiration. Our primary aim was to assess the parameters responsible for early and late diagnosis of foreign body aspiration. We concluded with a diagnostic algorithm for management of foreign body aspiration on the basis of this outcome. Results Around 32.5% came with a history of aspiration, 43% were referred from the primary centers with a suspicion for the same and the rest came to our tertiary care hospital directly. Those who presented within a week came with complaints of wet cough, wheeze and tachypnea. Furthermore, those who came in after a week had a dry cough and fever as their main complaint. Majority of ingested foreign bodies was a vegetative type (80%) as compared to the non –vegetative. Conclusion Unlike adults, foreign body aspiration in children is most commonly diagnosed on history, suspicion and clinical findings. Chest x ray has been the primary investigation of choice but in the majority of the cases it was normal with subtle changes. Early diagnosis is the key to avoid complication.

Abstract Rationale Smoking-related chronic obstructive pulmonary disease (COPD) is associated with dysregulated production of mucus. Mucins (MUC) are important both for mucus secretion and epithelial defense. We have examined the distribution of MUC1 and MUC4 in the airway epithelial cells of never-smokers and smokers with and without COPD. Methods Mucosal biopsies and bronchial wash samples were obtained by bronchoscopy from age- and sex-matched COPD-patients (n = 38; GOLD I-II/A-B), healthy never-smokers (n = 40) and current smokers with normal lung function (n = 40) from the Karolinska COSMIC cohort (NCT02627872). Cell-specific expressions of MUC1, MUC4 and regulating factors, i.e., epithelial growth factor receptor (EGFR) 1 and 2, were analyzed by immunohistochemistry. Soluble MUC1 was measured by quantitative immunodetection on slot blot. Results The levels of cell-bound MUC1 expression in basal cells and in soluble MUC1 in bronchial wash were increased in smokers, regardless of airway obstruction. Patients with chronic bronchitis had higher MUC1 expression. The expression of MUC4 in cells with goblet cell phenotype was increased in smokers. The expression of EGFR2, but not that of EGFR1, was higher in never-smokers than in smokers. Conclusions Smoking history and the presence of chronic bronchitis, regardless of airway obstruction, affect both cellular and soluble MUC1 in human airways. Therefore, MUC1 may be a novel marker for smoking- associated airway disease.

This research aimed to attest the effect of Kepok banana (Musa acuminata) peel extract on the histopathology of bronchus and pulmonary veins in male mice (Mus musculus) exposed by cigarette smoke. The 24 experimental male mice were divided into six groups with each treatment having four replicate. All the groups, except K- as a control group, was treated with cigarette smoke for 14 days. After that, K- and K+ was treated with CMC-Na 1%, KO was treated with ascorbic acid 13 mg/kgBW, P1 was treated with Kepok banana peel extract 14 mg/kgBW, P2 was treated with Kepok banana peel extract 28 mg/kgBW, and P3 was treated with Kepok banana peel extract 56 mg/kgBW for 14 days. The data of the thickness of bronchial epithelium and the diameter of pulmonary veins were analyzed using ANOVA (Analysis of Varience) with significance p