Lung Area Research Articles

Abstract 9: Histological characterization of two genetically engineered mouse models of non-small cell lung cancer

Abstract Non-small cell lung cancer (NSCLC) patients exhibit minimal symptoms until late-stage disease, resulting in approximately 80% of patients being diagnosed at advanced stages when the response to therapy is low. Effective pre-clinical models are needed to accurately reflect NSCLC disease progression and improve basic NSCLC research. This work characterizes two genetically engineered mouse models (GEMM) that reflect human NSCLC. These mouse lines utilize a cre recombinase system to induce the expression of two oncogenic mutations (KrasG12D, Trp53fl) in club cells or alveolar epithelial cells based on cell type-specific promoters (Scgb1a1, Sftpc), thereby inducing NSCLC in mice. Furthermore, these mice harbor tumor cell-specific transgenes (GFP, MetRS) for cancer tracking. The MetRS transgene allows tumor cells to incorporate azide-bearing methionine analogs (ANL) into newly synthesized proteins which can then be detected via fluorescent noncanonical amino acid tagging (FUNCAT). Cancer mutations were induced at 6 weeks of age and lung samples were collected for histological analysis at early, mid, and late time points. Histological analysis of the club cell model revealed that hyperplasias are most abundant at the early time point and develop into invasive carcinomas within the bronchioles and alveoli at later time points. Histological scoring of this model showed that tumor burden increased from 28% to 61% of the total lung area after 15 weeks. The alveolar cell model progressed rapidly and exhibited adenocarcinomas and squamous cell carcinomas throughout disease progression. Histological scoring of this model revealed that tumor burden rapidly increased from 55% to 89% of total lung area after 5 weeks. FUNCAT analysis demonstrated that the incorporation of ANL within tumor-bearing mice was cancer-cell-specific. These findings suggest that the GEMM models accurately represent human NSCLC based on their cellular profile, morphology, and localization within the lung. The results also confirm that the tumor cells, and not the normal cells/tissues, are able to incorporate ANL into their proteins via the MetRS transgene. These models have the potential to identify biomarkers of NSCLC progression to improve patient prognosis. *This work was performed under the auspices of the U.S. Department of Energy by Lawrence Livermore National Laboratory under Contract DE-AC52-07NA27344. LLNL-ABS-839507. Citation Format: Nicole F. Leon, David Baliu-Rodriguez, Deepa K. Murugesh, Aimy Sebastian, Gabriela G. Loots, Nicholas R. Hum. Histological characterization of two genetically engineered mouse models of non-small cell lung cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 9.

Primary Squamous Cell Lung Cancer With Frequent Episodes of Sustained Ventricular Tachycardia due to Myocardial Metastasis

Myocardial metastasis from lung cancer rarely occurs. We encountered a patient with squamous cell lung cancer who was diagnosed with myocardial metastasis before death and sustained ventricular tachycardia during the course of the disease. The patient was a 56-year-old woman. A tumor was noted in the apex area of the left lung and was diagnosed as stage IVA of squamous cell lung cancer after a detailed examination. She underwent concurrent chemoradiotherapy with weekly treatment of carboplatin + paclitaxel. A 12-lead electrocardiogram performed upon admission for additional chemotherapy showed negative T waves in leads III, aVF, and V1-4. Transthoracic echocardiography and computed tomography showed a tumor lesion in the right ventricular wall, which was diagnosed as myocardial metastasis from lung cancer. During the course of the disease, the patient had frequent episodes of sustained ventricular tachycardia, which were refractory to treatment with antiarrhythmic drugs. However, the sinus rhythm was restored with cardioversion. Subsequently, the patient received palliative treatment and eventually died 4 months after the diagnosis of cardiac metastasis and 3 weeks after the diagnosis of ventricular tachycardia. Myocardial metastasis might reflect poor prognosis due to serious arrhythmia or some other complications. Therefore, the early diagnosis and appropriate treatment of cardiac metastasis by chemotherapy, cardiac radiotherapy, or surgery, are necessary prior to the development of symptoms in tolerant cases. J Med Cases. 2023;14(4):111-117 doi: https://doi.org/10.14740/jmc4066

Use of Nanostructured Silica SBA-15 as an Oral Vaccine Adjuvant to Control Mycoplasma hyopneumoniae in Swine Production

Mycoplasma hyopneumoniae is a difficult-to-control bacterium since commercial vaccines do not prevent colonization and excretion. The present study aimed to evaluate the performance of an orally administered vaccine composed of antigens extracted from Mycoplasma hyopneumoniae and incorporated into mesoporous silica (SBA-15), which has an adjuvant-carrier function, aiming to potentiate the action of the commercial intramuscular vaccine. A total of 60 piglets were divided into four groups (n = 15) submitted to different vaccination protocols as follows, Group 1: oral SBA15 + commercial vaccine at 24 days after weaning, G2: oral vaccine on the third day of life + vaccine commercial vaccine at 24 days, G3: commercial vaccine at 24 days, and G4: commercial vaccine + oral vaccine at 24 days. On the first day, the piglets were weighed and, from the third day onwards, submitted to blood collections for the detection and quantification of anti-Mycoplasma hyopneumoniae IgG. Nasal swabs were collected to monitor IgA by ELISA, and oropharyngeal swabs were used to assess the bacterial load by qPCR. Biological samples were collected periodically from the third day of life until the 73rd day. At 41 days of life, 15 individuals of the same age, experimentally challenged with an inoculum containing M. hyopneumoniae, were co-housed with the animals from groups (1 to 4) in a single pen to increase the infection pressure during the nursery period. At 73 days, all piglets were euthanized, and lungs were evaluated by collecting samples for estimation of bacterial load by qPCR. Quantitative data obtained from physical parameters and laboratory investigation were analyzed by performing parametric or non-parametric statistical tests. Results indicate that animals from G2 showed smaller affected lung areas compared to G3. Animals from G2 and G4 had a low prevalence of animals shedding M. hyopneumoniae at 61 days of age. Additionally, no correlation was observed between lung lesions and M. hyopneumoniae load in lung and BALF samples in animals that received the oral vaccine, while a strong correlation was observed in other groups. In the present study, evidence points to the effectiveness of the oral vaccine developed for controlling M. hyopneumoniae in pig production under field conditions.

Bone suppression of lateral chest x-rays with imperfect and limited dual-energy subtraction images.

Bone suppression is to suppress the superimposed bone components over the soft tissues within the lung area of Chest X-ray (CXR), which is potentially useful for the subsequent lung disease diagnosis for radiologists, as well as computer-aided systems. Despite bone suppression methods for frontal CXRs being well studied, it remains challenging for lateral CXRs due to the limited and imperfect DES dataset containing paired lateral CXR and soft-tissue/bone images and more complex anatomical structures in the lateral view. In this work, we propose a bone suppression method for lateral CXRs by leveraging a two-stage distillation learning strategy and a specific data correction method. Specifically, a primary model is first trained on a real DES dataset with limited samples. The bone-suppressed results on a relatively large lateral CXR dataset produced by the primary model are improved by a designed gradient correction method. Secondly, the corrected results serve as training samples to train the distillated model. By automatically learning knowledge from both the primary model and the extra correction procedure, our distillated model is expected to promote the performance of the primary model while omitting the tedious correction procedure. We adopt an ensemble model named MsDd-MAP for the primary and distillated models, which learns the complementary information of Multi-scale and Dual-domain (i.e., intensity and gradient) and fuses them in a maximum-a-posteriori (MAP) framework. Our method is evaluated on a two-exposure lateral DES dataset consisting of 46 subjects and a lateral CXR dataset consisting of 240 subjects. The experimental results suggest that our method is superior to other competing methods regarding the quantitative evaluation metrics. Furthermore, the subjective evaluation by three experienced radiologists also indicates that the distillated model can produce more visually appealing soft-tissue images than the primary model, even comparable to real DES imaging for lateral CXRs.

Factors Associated with the Peak Flow Variation Generated during Forced Manual Hyperinflation Technique

Manual hyperinflation is one of the most used respiratory physiotherapy techniques in critically ill patients and consists of administering a higher volume of gaseous fluid than the patient performed using a self-inflating balloon (AMBU). This technique was developed with the objective of removing bronchial secretion and re-expansion of atelectasis lung areas, thus improving pulmonary compliance and oxygenation in mechanically ventilated patients.

Pulmonary fibrosis model of mice induced by different administration methods of bleomycin

BackgroundIdiopathic pulmonary fibrosis (IPF) is a chronic, progressive disease of the lung. How to build a typical human mimicking animal model has been a challenge. Thus, to reveal the mechanism and to make it useful for IPF clinical treatment, a different type of mice model and inspection methods are used to evaluate which one is applicable for the study of IPF.Method69 Twelve-weeks-old C57BL/6 mice were divided into 3 type groups (n = 7 for each control group, n = 8 for each BLM-induced pulmonary fibrosis groups), as intraperitoneal injection, intratracheal administration, and intravenous administration of bleomycin (BLM) to initiate lung fibrosis. Changes of the lung function measured through mice Pulmonary function test (PFT). Morphological changes in mice were observed by PET/CT, Masson and Picro-Sirius staining, Transmission electron microscopy (TEM). Biochemical changes were tested by Enzyme-linked immunosorbent assay (Elisa).ResultsPET/CT of BLM-receiving mice showed an increase in fibrotic consolidations and an increase in non-aerated lung area in BLM-treated mice compared with that in controls. TGF-b1, TNF-a, IL-6, GM-CSF in BALF and serum. PAI-1, HYP in the lung tissue of mice were significantly different in each BLM groups than those in the controls. The results of Masson staining in mice indicate that the lung tissues of all BLM received groups, the intratracheal groups, the intravenous groups, and the intraperitoneal groups have a higher degree of pulmonary septal thickening and collagen fiber consolidation compare to saline control. Picro-Sirius staining results are consistent with the results of Masson staining. Compared with the saline control group, the ratio of Col 1/Col 3 was significantly increased in each BLM group. TEM results found that in BLM group, type I alveolar epithelial cells were degenerated. Exfoliated endothelial cells were swelling, and type II alveolar epithelial cells were proliferated, the shape of the nucleus was irregular, and some tooth-like protrusions were seen.ConclusionsWith three different methods of animal model construction, high dose of each show more compliable, and BLM can successfully induce animal models of pulmonary fibrosis, however, certain differences in the fibrosis formation sites of them three, and tail vein injection of BLM induced PF model is closer to the idiopathic pulmonary interstitial fibrosis.

A Feasibility Study of Functional Lung Volume Preservation during Stereotactic Body Radiotherapy Guided by Gallium-68 Perfusion PET/CT

The aim of this study was to assess the feasibility of sparing functional lung areas by integration of pulmonary functional mapping guided by 68Ga-perfusion PET/CT imaging in lung SBRT planification. Sixty patients that planned to receive SBRT for primary or secondary lung tumors were prospectively enrolled. Lung functional volumes were defined as the minimal volume containing 50% (FV50%), 70% (FV70%) and 90% (FV90%) of the total activity within the anatomical volume. All patients had a treatment planning carried out in 2 stages: an anatomical planning blinded to the PET results and then a functional planning respecting the standard constraints but also incorporating "lung functional volume" constraints. The mean lung dose (MLD) in functional volumes and the percentage of lung volumes receiving xGy (VxGy) within the lung functional volumes using both plans were calculated and compared. SBRT planning optimized to spare lung functional regions led to a significant reduction (p < 0.0001) of the MLD and V5 to V20 Gy in all functional volumes. Median relative difference of the MLD in the FV50%, FV70% and FV90% was -8.0% (-43.0 to 1.2%), -7.1% (-34.3 to 1.2%) and -5.7% (-22.3 to 4.4%), respectively. Median relative differences for VxGy ranged from -12.5% to -9.2% in the FV50%, -11.3% to -7.2% in the FV70% and -8.0% to -5.3% in the FV90%. This study shows the feasibility of significantly decreasing the doses delivered to the lung functional volumes using 68Ga-perfusion PET/CT while still respecting target volume coverage and doses to other organs at risk.

Lung and diaphragm ultrasound in noninvasive respiratory support: A real tool or fashion?

Over the past few years, there has been an increase in lung and diaphragm ultrasound applications as a tool to evaluate the outcomes and settings of noninvasive respiratory supports. However, actual clinical practices in this field are yet to be known. The aim of this study was to investigate the current clinical utilization of ultrasound for noninvasive respiratory supports on an international level. The study employed an online survey consisting of 32 items, which was sent via email to intensivists, pulmonologists, emergency medicine physicians, and other specialists with expertise in using ultrasound and/or noninvasive respiratory supports. We collected 52 questionnaires. The ultrasound study of diaphragm dysfunction was well-known by the majority of respondents (57.7%). Diaphragm performance was used as a weaning failure predictor (48.5%), as a predictor of noninvasive ventilation failure (38.5%) and as a tool for the ventilator settings adjustment (30.8%). In patients with acute respiratory failure, 48.1% used ultrasound to assess the damaged lung area to set up ventilatory parameters, 34.6% to monitor it after noninvasive ventilation application, and 32.7% to match it with the ventilatory settings for adjustment purposes. When administering high flow nasal cannula - oxygen therapy, 42.3% of participants used ultrasound to evaluate lung involvement and assess flow parameters. Lung and diaphragm ultrasound is an established clinical practice to evaluate noninvasive respiratory supports outcomes and settings. Further studies are needed to evaluate the educational aspects to increase confidence and indications for its use.

A pan-cancer analysis shows immunoevasive characteristics in NRF2 hyperactive squamous malignancies

The NRF2 pathway is frequently activated in various cancer types, yet a comprehensive analysis of its effects across different malignancies is currently lacking. We developed a NRF2 activity metric and utilized it to conduct a pan-cancer analysis of oncogenic NRF2 signaling. We identified an immunoevasive phenotype where high NRF2 activity is associated with low interferon-gamma (IFNγ), HLA-I expression and T cell and macrophage infiltration in squamous malignancies of the lung, head and neck area, cervix and esophagus. Squamous NRF2 overactive tumors comprise a molecular phenotype with SOX2/TP63 amplification, TP53 mutation and CDKN2A loss. These immune cold NRF2 hyperactive diseases are associated with upregulation of immunomodulatory NAMPT, WNT5A, SPP1, SLC7A11, SLC2A1 and PD-L1. Based on our functional genomics analyses, these genes represent candidate NRF2 targets, suggesting direct modulation of the tumor immune milieu. Single-cell mRNA data shows that cancer cells of this subtype exhibit decreased expression of IFNγ responsive ligands, and increased expression of immunosuppressive ligands NAMPT, SPP1 and WNT5A that mediate signaling in intercellular crosstalk. In addition, we discovered that the negative relationship of NRF2 and immune cells are explained by stromal populations of lung squamous cell carcinoma, and this effect spans multiple squamous malignancies based on our molecular subtyping and deconvolution data.

Analysis on characteristic of stage Ⅰ occupational cement pneumoconiosis patients

Objective: To analyze the clinical and imaging characteristics of stage Ⅰ occupational cement pneumoconiosis patients. Methods: In October 2021, the data of patients with occupational cement pneumoconiosis diagnosed by the Third Hospital of Peking University from 2014 to 2020 were collected, and the data of the patients' initial exposure age, dust exposure duration, diagnosis age, incubation period, chest X-ray findings, lung function and other data were analyzed retrospectively. Spearman grade correlation was used for correlation analysis of grade count data. The influencing factors of lung function were analyzed by binary logistic regression. Results: A total of 107 patients were enrolled in the study. There were 80 male patients and 27 female patients. The inital exposure age was (26.2±7.7) years, the diagnosis age was (59.4±7.9) years, the dust exposure duration was (17.9±8.0) years, and the incubation period was (33.1±10.3) years. The initial dust exposure age and the dust exposure duration in female patients were less than those in men, and the incubation period was longer than that in men (P<0.05). The imaging analysis showed the small opacities as"pp"accounted for 54.2%. 82 patients (76.6%) had small opacities distributed in two lung areas. The lung areas distribution of small opacities in female patients was less than that in male patients (2.04±0.19 vs 2.41±0.69, P<0.001). There were 57 cases of normal pulmonary function, 41 cases of mild abnormality and 9 cases of moderate abnormality. The number of lung regions with small opacities on X-ray was the risk factor for abnormal lung function in cement pneumoconiosis patients (OR=2.491, 95%CI=1.197-5.183, P=0.015) . Conclusion: The patients with occupational cement pneumoconiosis had long dust exposure duration and incubation period, light imaging changes and pulmonary function damage. The abnormal lung function was related to the range of pulmonary involvement.

Microvascular lung vessels obstructive thromboinflammatory syndrome in patients with COVID-19: Insights from lung intravascular optical coherence tomography.

Microvascular lung vessels obstructive thromboinflammatory syndrome has been proposed as a possible mechanism of respiratory failure in COVID-19 patients. However, it has only been observed in post-mortem studies and has never been documented in vivo, probably because of a lack of CT scan sensitivity in small pulmonary arteries. The aim of the present study was to assess the safety, tolerability, and diagnostic value of optical coherence tomography (OCT) for the assessment of patients with COVID-19 pneumonia for pulmonary microvascular thromboinflammatory syndrome. The COVID-OCT trial was a multicenter, open-label, prospective, interventional clinical study. Two cohorts of patients were included in the study and underwent pulmonary OCT evaluation. Cohort A consisted of patients with COVID-19 with a negative CT scan for pulmonary thrombosis and elevated thromboinflammatory markers (D-dimer > 10,000 ng/mL or 5,000 < D-dimer < 10,000 ng/mL and one of: C-reactive Protein > 100 mg/dL, IL-6 > 6 pg/mL, or ferritin > 900 ng/L). Cohort B consisted of patients with COVID-19 and a CT scan positive for pulmonary thrombosis. The primary endpoints of the study were: (i) to evaluate the overall safety of OCT investigation in patients with COVID-19 pneumonia, and (ii) to report on the potential value of OCT as a novel diagnostic tool for the diagnosis of microvascular pulmonary thrombosis in COVID-19 patients. A total of 13 patients were enrolled. The mean number of OCT runs performed in each patient was 6.1 ± 2.0, both in ground glass and healthy lung areas, achieving a good evaluation of the distal pulmonary arteries. Overall, OCT runs identified microvascular thrombosis in 8 patients (61.5%): 5 cases of red thrombus, 1 case of white thrombus, and 2 cases of mixed thrombus. In Cohort A, the minimal lumen area was 3.5 ± 4.6 mm2, with stenosis of 60.9 ± 35.9% of the area, and the mean length of thrombus-containing lesions was 5.4 ± 3.0 mm. In Cohort B, the percentage area obstruction was 92.6 ± 2.6, and the mean thrombus-containing lesion length was 14.1 ± 13.9 mm. No peri-procedural complications occurred in any of the 13 patients. OCT appears to be a safe and accurate method of evaluating the distal pulmonary arteries in hospitalized COVID-19 patients. Here, it enabled the first in vivo documentation of distal pulmonary arterial thrombosis in patients with elevated thromboinflammatory markers, even when their CT angiogram was negative for pulmonary thrombosis. ClinicalTrial.gov, identifier NCT04410549.

An Efficient Model for Lungs Nodule Classification Using Supervised Learning Technique.

Lung cancer has the highest death rate of any other cancer in the world. Detecting lung cancer early can increase a patient's survival rate. The corresponding work presents the method for improving the computer-aided detection (CAD) of nodules present in the lung area in computed tomography (CT) images. The main aim was to get an overview of the latest tools and technologies used: acquisition, storage, segmentation, classification, processing, and analysis of biomedical data. After the analysis, a model is proposed consisting of three main steps. In the first step, threshold values and component labeling of 3D components were used to segment the lung volume. In the second step, candidate nodules are identified and segmented with an optimal threshold value and rule-based trimming. It also selects 2D and 3D features from the candidate segmented node. In the final step, the selected features are used to train the SVM and classify the nodes and classify the non-nodes. To assess the performance of the proposed framework, experiments were performed on the LIDC data set. As a result, it was observed that the number of false positives in the nodule candidate was reduced to 4 FP per scan with a sensitivity of 95%.

Wilms Tumor 1-Driven Fibroblast Activation and Subpleural Thickening in Idiopathic Pulmonary Fibrosis.

Idiopathic pulmonary fibrosis (IPF) is a progressive fibrotic lung disease that is often fatal due to the formation of irreversible scar tissue in the distal areas of the lung. Although the pathological and radiological features of IPF lungs are well defined, the lack of insight into the fibrogenic role of fibroblasts that accumulate in distinct anatomical regions of the lungs is a critical knowledge gap. Fibrotic lesions have been shown to originate in the subpleural areas and extend into the lung parenchyma through processes of dysregulated fibroproliferation, migration, fibroblast-to-myofibroblast transformation, and extracellular matrix production. Identifying the molecular targets underlying subpleural thickening at the early and late stages of fibrosis could facilitate the development of new therapies to attenuate fibroblast activation and improve the survival of patients with IPF. Here, we discuss the key cellular and molecular events that contribute to (myo)fibroblast activation and subpleural thickening in IPF. In particular, we highlight the transcriptional programs involved in mesothelial to mesenchymal transformation and fibroblast dysfunction that can be targeted to alter the course of the progressive expansion of fibrotic lesions in the distal areas of IPF lungs.

Lung Cancer Detection Using Neural Net

Abstract: Leukemia is a sort of blood threatening development which happens due touncommon development in WBCs (white platelets) in bone marrow of human body. Leukemia can be appointed serious leukemia and progressing leukemia, affected severely and causes malignant growth. In the vast majority of the cases early in which serious leukemia turns out to be astoundingly fast however steady leukemia creates slowly .Among all kinds of kinds of developments, cell breakdown in the lungs is the most overwhelming contamination having the most critical passing rate. Dealt with tomography investigates are utilized for ID of lung hurt as it gives unmistakable image of harmful development in the body and tracks its development. Picture dealing with systems are utilized generally in clinical fields for beginning stage affirmation of cell breakdown in the lungs. The calculation for cell breakdown in the lungs disclosure is proposed utilizing strategies, for example, focus disconnecting for picture pre-dealing with followed by division of lung area of interest utilizing numerical morphological endeavors. Mathematical parts are dealt with from the eliminated district of interest and used to bundle CT channel pictures into typical and abnormal by utilizing support vector machine. Further both the sorts have two sub arrangements lymphocytic and myeloid. In this paper, we will explore different picture dealing with and Man-made intelligence procedures used for request of leukemia area and endeavor to focus in on advantages and limitations of different similar investigates to summarize an result which will be valuable for various experts.

Effect of recruitment manoeuvres under lung ultrasound-guidance and positive end-expiratory pressure on postoperative atelectasis and hypoxemia in major open upper abdominal surgery: A randomized controlled trial

BackgroundPostoperative pulmonary complications (PPCs) especially atelectasis and hypoxemia are common during abdominal surgery. Studies on the effect of either recruitment manoeuvres (RMs) or positive end-expiratory pressure (PEEP) on PPCs are controversial. The objective of this study is to evaluate the effect of perioperative lung ultrasound (LUS)-guided RMs combined with PEEP on the reduction of postoperative atelectasis and hypoxemia in major open upper abdominal surgery. MethodsIn this randomized controlled trial, 122 adult patients undergoing major open upper abdominal surgery were allocated into three groups: control (C) group (n = 42); PEEP (P) group (n = 40); RMs combined with PEEP (RP) group (n = 40). All patients were scheduled for general anaesthesia using the lung-protective ventilation (LPV) strategy. The levels of PEEP in the three groups were 0 cmH2O, 5 cmH2O and 5 cmH2O. LUS examination was carried out at 3 predetermined time points in each group: 5 min after intubation (T1), at the end of surgery (T2) and 15 min after extubation (T3). Patients with atelectasis on the sonogram in the RP group received LUS-guided RMs at point T2. LUS scores were used to estimate the severity of aeration loss. The P/F ratio (PaO2/FiO2) at 15min after extubation was used to assess the incidence of postoperative hypoxemia. Primary outcomes were the incidences of postoperative atelectasis and hypoxemia (PaO2/FiO2 < 300 mmHg). The secondary outcome was the distribution of LUS scores in each lung area. ResultsFrom July 2021 to December 2021, 122 consecutive patients were enrolled. No typical atelectasis was observed 5 min after intubation. The incidence of atelectasis was 52.4%, 50.0% and 42.5% in the C group, P group and RP group at the end of surgery, respectively. The rate of atelectasis in the C group, P group and RP group (after RMs) was 52.4%, 50.0% and 17.5%, respectively, 15 min after extubation (P < 0.01). The frequency of postoperative hypoxemia was 27.5%, 15.0% and 5.0% in the C group, P group and RP group, respectively (P < 0.017). The increased LUS scores mainly occurred in the superoposterior and inferoposterior quadrants at the end of surgery. Only in the RP group demonstrated a decreased LUS score in the posteriorquadrants after extubation. ConclusionsIn patients undergoing major open upper abdominal surgery, an intraoperative mechanical ventilation strategy without PEEP or with PEEP alone did not reduce PPCs. However, PEEP of 5 cmH2O combined with LUS-guided RMs proved feasible and beneficial to decrease the occurrence of postoperative atelectasis and hypoxemia in major open upper abdominal surgeries.

Stability and reproducibility comparisons between deep inspiration breath-hold techniques for left-sided breast cancer patients: A prospective study.

Deep inspiration breath-hold (DIBH) is crucial in reducing the lung and cardiac dose for treatment of left-sided breast cancer. We compared the stability and reproducibility of two DIBH techniques: Active Breathing Coordinator (ABC) and VisionRT (VRT). We examined intra- and inter-fraction positional variation of the left lung. Eight left-sided breast cancer patients were monitored with electronic portal imaging during breath-hold (BH) at every fraction. For each patient, half of the fractions were treated using ABC and the other half with VRT, with an equal amount starting with either ABC or VRT. The lung in each portal image was delineated, and the variation of its area was evaluated. Intrafraction stability was evaluated as the mean coefficient of variation (CV) of the lung area for the supraclavicular (SCV) and left lateral (LLat) field over the course of treatment. Reproducibility was the CV for the first image of each fraction. Daily session time and total imaging monitor units (MU) used in patient positioning were recorded. The mean intrafraction stability across all patients for the LLat field was 1.3±0.7% and 1.5±0.9% for VRT and ABC, respectively. Similarly, this was 1.5±0.7% and 1.6±0.8% for VRT and ABC, respectively, for the SCV field. The mean interfraction reproducibility for the LLat field was 11.0±3.4% and 14.9±6.0% for VRT and ABC, respectively. Similarly, this was 13.0±2.5% and 14.8±9% for VRT and ABC, respectively, for the SCV. No difference was observed in the number of verification images required for either technique. The stability and reproducibility were found to be comparable between ABC and VRT. ABC can have larger interfractional variation with less feedback to the treating therapist compared to VRT as shown in the increase in geometric misses at the matchline.

Distribution of Aeration and Pulmonary Blood Volume in Healthy, ARDS and COVID-19 Lungs: A Dual-Energy Computed Tomography Retrospective Cohort Study

Few reports have studied lung aeration and perfusion in normal lungs, COVID-19, and ARDS from other causes (NC-ARDS) using dual-energy computed tomography pulmonary angiograms (DE-CTPA). To describe lung aeration and blood-volume distribution using DE-CTPAs of patients with NC-ARDS, COVID-19, and controls with a normal DE-CTPA ("healthy lungs"). We hypothesized that each of these conditions has unique ranges of aeration and pulmonary blood volumes. This retrospective, single-center study of DE-CTPAs included patients with COVID-19, NC-ARDS (Berlin criteria), and controls. Patients with macroscopic pulmonary embolisms were excluded. The outcomes studied were the (1) lung blood-volume in areas with different aeration levels (normal, ground glass opacities [GGO], consolidated lung) and (2) aeration/blood-volume ratios. Included were 20 patients with COVID-19 (10 milds, 10 moderate-severe), six with NC-ARDS, and 12 healthy-controls. Lung aeration was lowest in patients with severe COVID-19 24% (IQR13%-31%) followed by those with NC-ARDS 40%(IQR21%-46%). Blood-volume in GGO was lowest in patients with COVID-19 [moderate-severe:-28.6 (IQR-33.1-23.2); mild: -30.1 (IQR-33.3-23.4)] and highest in normally aerated areas in NC-ARDS -37.4 (IQR-52.5-30.2-) and moderate-severe COVID-19 -33.5(IQR-44.2-28.5). The median aeration/blood-volume ratio was lowest in severe COVID-19 but some values overlapped with those observed among patients with NC-ARDS. Severe COVID-19 disease is associated with low total aerated lung volume and blood-volume in areas with GGO and overall aeration/blood volume ratios, and with high blood volume in normal lung areas. In this hypothesis-generating study, these findings were most pronounced in severe COVID disease. Larger studies are needed to confirm these preliminary findings.

Repeatability, Reproducibility, and Concurrent Validity of a Stethoscope and Health App System for the Quantification of Breath Rate in Healthy Adults: Repeatability and Validity Study.

Apps for smartphones that can measure the breathing rate easily can be downloaded. The aim of this study was to demonstrate agreement in measuring breath rates between the stethoscope and Breath Counter health app. We performed a repeatability study with 56 healthy volunteers. The patient's demographic data and breathing rates per minute were collected. Breathing rates were measured via two methods: (1) using a stethoscope placed in the upper area of the right lung and (2) a Breath Counter app developed by Vadion on a Samsung Fold smartphone. This study demonstrated high repeatability and validity with respect to the breathing rate parameter of healthy adults using the aforementioned 2 systems. Intrasession repeatability measure using the intraclass correlation coefficient was >0.962, indicating excellent repeatability. Moreover, the intraclass correlation coefficient between methods was 0.793, indicating good repeatability, and coefficients of variation of method errors values were 1.83% with very low values in terms of other repeatability parameters. We found significant correlation coefficients and no systematic differences between the app and stethoscope methods. The app method may be attractive to individuals who require repeatability in a recreational setting.

Lung and Infection CT-Scan-Based Segmentation with 3D UNet Architecture and Its Modification.

COVID-19 is the disease that has spread over the world since December 2019. This disease has a negative impact on individuals, governments, and even the global economy, which has caused the WHO to declare COVID-19 as a PHEIC (Public Health Emergency of International Concern). Until now, there has been no medicine that can completely cure COVID-19. Therefore, to prevent the spread and reduce the negative impact of COVID-19, an accurate and fast test is needed. The use of chest radiography imaging technology, such as CXR and CT-scan, plays a significant role in the diagnosis of COVID-19. In this study, CT-scan segmentation will be carried out using the 3D version of the most recommended segmentation algorithm for bio-medical images, namely 3D UNet, and three other architectures from the 3D UNet modifications, namely 3D ResUNet, 3D VGGUNet, and 3D DenseUNet. These four architectures will be used in two cases of segmentation: binary-class segmentation, where each architecture will segment the lung area from a CT scan; and multi-class segmentation, where each architecture will segment the lung and infection area from a CT scan. Before entering the model, the dataset is preprocessed first by applying a minmax scaler to scale the pixel value to a range of zero to one, and the CLAHE method is also applied to eliminate intensity in homogeneity and noise from the data. Of the four models tested in this study, surprisingly, the original 3D UNet produced the most satisfactory results compared to the other three architectures, although it requires more iterations to obtain the maximum results. For the binary-class segmentation case, 3D UNet produced IoU scores, Dice scores, and accuracy of 94.32%, 97.05%, and 99.37%, respectively. For the case of multi-class segmentation, 3D UNet produced IoU scores, Dice scores, and accuracy of 81.58%, 88.61%, and 98.78%, respectively. The use of 3D segmentation architecture will be very helpful for medical personnel because, apart from helping the process of diagnosing someone with COVID-19, they can also find out the severity of the disease through 3D infection projections.

3-D Visualization for Lung Covid-19 Infection Based on U-Net CNN Segmentation

Covid-19 is still the attention of researchers in medical image analysis. Following the initial respiratory diagnosis, a CT-scan examination will be performed. Segmentation of infection within the lung area is needed as the next step after the examination. In recent years, image segmentation has been carried out with the help of Deep Learning. U-Net CNN is one of the Deep Learning-based architectures widely used in medical image segmentation. Our research aims to support radiologists in visualizing Covid-19 infection in 3D based on CNN’s U-Net segmentation. It results in two types of visualization: 3D bitmap and 3D Mesh. 3D visualization can contribute to seeing the extent of infection and calculating the predicted percentage of Covid-19 infection volume in the patient’s lungs. The dataset for training model CNN is relatively small, consisting of 20 CT scans of Zenodo’s Covid-19 patients, divided into 17 patients, 2808 images (80%) for training, and three patients, 712 images (20%) for testing. The segmentation evaluation metrics used are DICE, Precision, and Accuracy, while the evaluation metrics for 3D volume are Relative Volume Difference (RVD) and Volumetric Similarity (VS). Finally, the prediction of the percentage of infection volume to the patient’s lung volume is given. The evaluation results were satisfactory, obtaining 95% DICE scores for lung image segmentation and 75% for infection segmentation. The predicted 3D visualization volume also scored higher than 90% for both lung volume and infection. Furthermore, for calculating the prediction of infection volume against lung volume, we achieved a maximum difference of 3% from the ground truth value.