Main Airways Research Articles

Effective factors on Migration to Kerman City and Immigrants’ Problems Using Analytical Hierarchy Process Model and Technique for Order of Preference by Similarity to Ideal Solution

Introduction: Marginal immigrants cause many problems in economic, social and cultural, physical ,and environmental aspects of cities. This study aims to investigate the factors affecting migration to Kerman city and the problems of marginalized immigrants using the analytical hierarchy process (AHP) and technique for order of preference by similarity to ideal solution (TOPSIS) models. Methods: This cross-sectional study was conducted in 2022, with a sample size of 147 households selected from Kerman suburban region. The data were collected by a standardized questionnaire measuring effective factors on the migration and the checklist of the immigrant problems. Results: The most important immigration factors were economic, social, geographical, political, educational and religious-cultural factors, respectively. Among 37 components studied, transferring the job of the family man as the family head, being on the main land, air and rail ways, having a special position at the international level, burying the family’s dead members in the desired city, and the education of the wife or one of the children of the family were the most important components. According to the results, more than 90% did not have access to public baths, sports facilities, government centers, private institutions, and parks, and recreational spaces. Conclusion: According to AHP model, economic factors ,and then social factors, were the most important reasons for migrating to the suburbs of Kerman. Therefore, it is suggested to create stable and long-term job opportunities , improve employment and business environment in the cities, and develop infrastructure to control migration to the city capitals.

AIRWAY OBSTRUCTION FROM INFECTION-RELATED TRACHEOBRONCHIAL PSEUDOMEMBRANES

AIRWAY OBSTRUCTION FROM INFECTION-RELATED TRACHEOBRONCHIAL PSEUDOMEMBRANES

Tracheobronchoplasty yields long-term anatomy, function, and quality of life improvement for patients with severe excessive central airway collapse

ObjectivesThis study examines the long-term anatomic and clinical effects of tracheobronchoplasty in severe excessive central airway collapse. MethodsIncluded patients underwent tracheobronchoplasty for excessive central airway collapse (2002-2016). The cross-sectional area of main airways on dynamic airway computed tomography was measured before and after tracheobronchoplasty. Expiratory collapse was calculated as the difference between inspiratory and expiratory cross-sectional area divided by inspiratory cross-sectional area ×100. The primary outcome was improvement in the percentage of expiratory collapse in years 1, 2, and 5 post-tracheobronchoplasty. Secondary outcomes included mean response profile for the 6-minute walk test, Cough-Specific Quality of Life Questionnaire, Karnofsky Performance Status score, and St George Respiratory Questionnaire. Repeated-measures analysis of variance was used for statistical analyses. ResultsThe cohort included 61 patients with complete radiological follow-up at years 1, 2, and 5 post-tracheobronchoplasty. A significant linear decrease in the percentage of expiratory collapsibility of the central airways after tracheobronchoplasty was present. Anatomic repair durability was preserved 5 years after tracheobronchoplasty, with decrease in percentage of expiratory airway collapse up to 40% and 30% at years 1 and 2, respectively. The St George Respiratory Questionnaire (74.7 vs 41.8%, P < .001) and Cough-Specific Quality of Life Questionnaire (78 vs 47, P < .001) demonstrated significant improvement at year 5 compared with baseline. Similar results were observed in the 6-minute walk test (1079 vs 1268 ft, P < .001) and Karnofsky score (57 vs 82, P < .001). ConclusionsTracheobronchoplasty has durable effects on airway anatomy, functional status, and quality of life in carefully selected patients with severe excessive central airway collapse.

A multichannel feature-based approach for longitudinal lung CT registration in the presence of radiation induced lung damage

Quantifying parenchymal tissue changes in the lungs is imperative in furthering the study of radiation induced lung damage (RILD). Registering lung images from different time-points is a key step of this process. Traditional intensity-based registration approaches fail this task due to the considerable anatomical changes that occur between timepoints. This work proposes a novel method to successfully register longitudinal pre- and post-radiotherapy (RT) lung computed tomography (CT) scans that exhibit large changes due to RILD, by extracting consistent anatomical features from CT (lung boundaries, main airways, vessels) and using these features to optimise the registrations. Pre-RT and 12 month post-RT CT pairs from fifteen lung cancer patients were used for this study, all with varying degrees of RILD, ranging from mild parenchymal change to extensive consolidation and collapse. For each CT, signed distance transforms from segmentations of the lungs and main airways were generated, and the Frangi vesselness map was calculated. These were concatenated into multi-channel images and diffeomorphic multichannel registration was performed for each image pair using NiftyReg. Traditional intensity-based registrations were also performed for comparison purposes. For the evaluation, the pre- and post-registration landmark distance was calculated for all patients, using an average of 44 manually identified landmark pairs per patient. The mean (standard deviation) distance for all datasets decreased from 15.95 (8.09) mm pre-registration to 4.56 (5.70) mm post-registration, compared to 7.90 (8.97) mm for the intensity-based registrations. Qualitative improvements in image alignment were observed for all patient datasets. For four representative subjects, registrations were performed for three additional follow-up timepoints up to 48 months post-RT and similar accuracy was achieved. We have demonstrated that our novel multichannel registration method can successfully align longitudinal scans from RILD patients in the presence of large anatomical changes such as consolidation and atelectasis, outperforming the traditional registration approach both quantitatively and through thorough visual inspection.

USE OF LASER PHOTOCOAGULATION THROUGH ENDOBRONCHIAL APPROACH AS AN ALTERNATIVE TREATMENT FOR BRONCHIAL CARCINOID TUMOR.CASE REPORT

Abstract INTRODUCTION Bronchial carcinoid tumor constitutes less than 5% of lung tumors. Eighty-five percent are histologically typical, located in the main airways, generally benign with malignant potential. Clinically they present with persistent cough, respiratory infections and wheezing. Radiologically they manifest as a smooth border mass with calcifications in 25% and obstruction of the main bronchi with atelectasis. The definitive diagnosis is histopathological. According to current NCCN guidelines resection is the first line of treatment. MATERIAL AND METHODS Female, 37 years old, smoker, presents with dyspnea, dry cough and fever. Hypoxemia with absent VM in the left lung base. Chest RX/CT with increased density in LIL and hypercapillary nodule of 15x14mm in LMB that conditions stenosis of the lumen and atelectasis of the LSL. No adenopathies. Spirometry FVC 43% FEV1 44% FEV1/FVC 82%. Video/ecobronchoscopy with endobronchial lesion in LMB occupying 100% of the lumen cT1cN0.PA: carcinoid tumor. RESULTS In MDT, endobronchial approach with rigid bronchoscopy is decided, performing mechanical debridement in its entirety and laser photocoagulation with immediate bronchial repermeabilization. Spirometry FVC 67%; FEV1 66%; FEV1/FVC 98%. PA: typical carcinoid. Follow-up for 12 months with CT and bronchoscopy without evidence of recurrence. CONCLUSION According to Reuling, the endobronchial approach is a treatment alternative in intraluminal tumors &amp;lt;20 mm, regardless of their histologic grade; likewise, Van der Heijden proposes it as the first line of therapy; however, more prospective studies with long-term follow-up are needed. Follow-up with CT and bronchoscopy is recommended to rule out local recurrences.

Human pluripotent stem cell-derived lung organoids: Potential applications in development and disease modeling.

The pulmonary system is comprised of two main compartments, airways and alveolar space. Their tissue and cellular complexity ensure lung function and protection from external agents, for example, virus. Two-dimensional (2D) in vitro systems and animal models have been largely employed to elucidate the molecular mechanisms underlying human lung development, physiology, and pathogenesis. However, neither of these models accurately recapitulate the human lung environment and cellular crosstalk. More recently, human-derived three-dimensional (3D) models have been generated allowing for a deeper understanding of cell-to-cell communication. However, the availability and accessibility of primary human cell sources from which generate the 2D and 3D models may be limited. In the past few years, protocols have been developed to successfully employ human pluripotent stem cells (hPSCs) and differentiate them toward pulmonary fate in vitro. In the present review, we discuss the advantages and pitfalls of hPSC-derived lung 2D and 3D models, including the main characteristics and potentials for these models and their current and future applications for modeling development and diseases. Lung organoids currently represent the closest model to the human pulmonary system. We further focus on the applications of lung organoids for the study of human diseases such as pulmonary fibrosis, infectious diseases, and lung cancer. Finally, we discuss the present limitations and potential future applications of 3D lung organoids. This article is categorized under: Adult Stem Cells, Tissue Renewal, and Regeneration > Stem Cells and Disease Adult Stem Cells, Tissue Renewal, and Regeneration > Stem Cell Differentiation and Reversion.

Quality of life outcomes in tracheobronchomalacia surgery.

Tracheobronchomalacia (TBM) is an obstructive airway disease characterized by laxity and redundancy of the posterior membrane of the main airways leading to dynamic airway collapse during exhalation. The gold standard for diagnosis is dynamic computed tomography (DCT) scan and dynamic flexible bronchoscopy (DFB). Patients with complete or near-complete collapse (>90% reduction in cross-sectional area) of the airway are possible candidates for surgical management. Central airway stabilization by tracheobronchoplasty (TBP) effectively corrects malacic airways and has demonstrated significant improvement in objective functional measures, which is often but not uniformly accompanied by equal improvement in health-related quality of life (HRQOL) metrics. This article reviews HRQOL instruments used to report outcomes after TBM surgery.

Anesthetic management of pulmonary surgery in newborns and infants.

The main congenital pulmonary airways malformations in newborns and infants requiring surgery are cystic adenoid malformation, congenital lobar emphysema and bronchogenic cyst. The surgical treatment preferably via thoracoscopy is recommended within the first year of life to avoid the risk of pneumopathy. A monopulmonary ventilation is then required by the surgeon to operate the diseased lung. The anesthetic management of intraoperative mono-pulmonary ventilation in newborns and infants is always challenging for the anesthesiologist. The main objective of this study was to describe anesthetic protocol for thoracoscopy and variations of monitored parameters during a mono-pulmonary ventilation procedure in newborns and infants.

Initial airflow obstruction in new cases of pulmonary tuberculosis: Complication, comorbidity or missed?

Tuberculosis (TB) may have a similar spirometry findings as a chronic obstructive pulmonary disease but the prevalence of TB-induced airflow obstruction (AO) is still unknown. ObjectivesTo measure frequency of AO in new TB cases at the beginning of treatment and to evaluate factors associated with obstructive abnormalities following TB diagnosis. Materials and Methods317 patients that have no history of prior AO were recruited into the study with a median age of 39.0 years (IQR, 30.0–49.0). AO was defined using the FEV1/F(VC)<LLN. ResultsAO was detected in 29.97% (95/317) new TB cases. These patients had a more severe clinical manifestation of TB with a greater likelihood of cough, OR=5.47 (95%CI 1.90–15.70) and wheezing, OR=10.51 (95%CI 5.72–19.27), p<0.001. The frequency of AO was positively associated with bronchoscopic evidence of narrowing of the main airways. Furthermore, from multiple logistic regression analysis we would assume that higher FEV1 value in TB patients with AO was related to greater BMI and inversely associated with older age, female sex and radiographic extent (p<0.05). ConclusionsObstructive pattern on spirometry frequently occurs in new TB cases without previously detected AO. This category of patients should be targeted for detailed follow-up, particularly, in high TB burden countries.

P1.04-002 Positive Airway Pressure-Enhanced CT to Improve Virtual Bronchoscopic Navigation

A main weakness of virtual bronchoscopic navigation (VBN) is unsuccessful segmentation of distal branches approaching peripheral pulmonary nodules (PPN). CT scan acquisition protocol is pivotal for segmentation covering the utmost periphery. We hypothesize that application of continuous positive airway pressure (CPAP) during CT acquisition could improve visualization and segmentation of peripheral bronchi. The purpose of the present pilot study is to compare quality of segmentations under 4 CT acquisition modes: inspiration (INSP), expiration (EXP) and both with CPAP (INSP-CPAP and EXP-CPAP). In 10 patients 320-detector row CT scans with slice thickness of 0.5 mm were performed in the 4 modes. In first 5 patients a pressure ranging 6-10 cmH2O was applied for 3 min immediately before CT acquisition (CPAP6-10). In following 5 a pressure of 10 cmH2O was applied, followed by 3 min of expiratory maneuvers and non-CPAP acquisitions (CPAP10). Segmentations were obtained and measurements manually calculated with a VBN system (LungPoint, Broncus Technologies, Inc., Mountain View, CA, USA). Comparisons for the inspiratory and expiratory models were made upon main airways area (proximal trachea, distal trachea and main bronchi) and distance of the path to the nodule (DIST-PN). Also, 2 random bronchi per lobe were selected and the number of bifurcations (BIF) and distance (DIST) from carina to the very end of the selected bronchi were manually counted and median calculated. Statistical analyses with R-3.2.3. See table 1. A tendency towards enlargement and improved segmentation of airways is seen with the use of CPAP in both levels of pressure. However, the power of this pilot study is limited and larger studies might be encouraged. Funded by La MaratóTV3-20133510, FIS PI09/90917, DPI2015-65286-R, 2014-SGR-1470, PROD-2014-00065, FUCAP and SEPAR.

P2.05-020 Survival Outcomes in Stage 1 NSCLC Following Stereotactic Ablative Radiotherapy or Conventional Radiotherapy: Topic: Clinical Outcome

Stereotactic ablative radiotherapy (SABR) is a radiotherapy technique using ultra-hypofractionated treatment to deliver a high biological dose to early stage lung cancers. It is believed that SABR is more effective than conventional fractionated external beam radiotherapy (EBRT), however definitive evidence of superior survival outcomes from controlled trial comparisons is lacking. Across the UK access to SABR is not been uniform, with only certain centers delivering the technique. Before the introduction of a routine lung SABR service in 2013, patients from Northern Ireland were referred to English Centers to have SABR. We compare the outcomes of those patients who had SABR to those who had conventional fractionated radiotherapy for early stage lung cancer. Using our institutional electronic database, which includes all patients who had radiotherapy in the treatment of lung cancer, we identified those patients who had received SABR or who were eligible to receive it based on UK consortium guidelines (tumor size <= 4cm, tumor > 2cm from main airways, performance status 0-3). The time period of 2009 to 2015 inclusive was chosen as SABR treatment was funded from this time point onwards. Patient baseline demographics, lung function, tumor size, the reason for the treatment received, details of the treatment received (e.g. dose, use of respiratory compensation, IGRT and Type B planning algorithm) and survival outcomes were recorded for each patient. Between 2009 and 2015, eighty patients received SABR and an additional 63 were eligible to have SABR but received conventional EBRT (62 patients received 55Gy in 20 fractions and 1 patient received 66Gy in 33 fractions). The main reason for eligible patients not receiving SABR was that the patient did not want to travel or was not fit to travel to another country to have treatment with SABR (43% of all non-SABR patients). The 2-year overall survival for those receiving SABR was 68% versus 43% for those receiving conventional radiotherapy (HR 2.3 (95% CI 1.4 – 3.8), p=0.0007). Both disease free survival and metastasis free survival rates were superior in the SABR group. On univariate analysis of the various patient and treatment factors, only tumor size remained significant between the groups. In this cohort of patients there is evidence of improved local control, disease free survival and overall survival for SABR compared to conventional fractionated radiotherapy. SABR should be available in all radiotherapy centers for the treatment of early stage lung cancer.

Alternate solutions for mine ventilation network to keep a pre-assigned fixed quantity in a working place

In underground constructions, a good ventilation design not only delivers fresh air to establish good working environment, but also provides a scientific and reliable basis to prevent disasters. In emergency cases, unexpected closure of the main airways may occur, providing the workers with alternative airways is substantial. This is important not only to sustain personnel lives, but also to prevent the mine ventilation system from damage. In this research, alternate solutions were introduced in case of failure in the underground construction to keep a pre-assigned fixed quantity in a working place for mine ventilation network. Eight different collapse scenarios were proposed to study their effect on the air quantity distribution among the branches in the ventilation circuit. From these scenarios, it is found that providing a sufficient air quantity in the working places could be achieved through modification of the network topology and adjusting the values of the regulators pressure. It is also indicated that the distance between the collapse and working places has a great effect on the amount of air delivered to it. A reduction in the power consumption could be done by re-arrange the installed regulators and decreasing the number of nodes and branches inside the network. A relationship representing the effect of changing the network topology on the total network power consumption was deduced through regression analysis. It is found that the total network power is quadratic dependent on the number of regulators and number of branches while it is directly dependent on the regulator power.

Cough suppression disorders spectrum

Volitional cough suppression, identified exclusively in females, is an unusual causal mechanism for instances of lobar atalectasis and bronchiectasis. It is a postulated mechanism for the genesis of Lady Windermere Syndrome.

Vertebral Body Tumor Biopsy

Endobronchial ultrasound has become routinely utilized to improve sampling of mediastinal and hilar lymph nodes in the evaluation of suspected lung cancer. In addition, unconventional uses of this technology have also been occasionally reported, such as to drain a bronchogenic cyst. We present a case where endobronchial ultrasonography allowed for a safe approach to the biopsy of a vertebral body tumor. The case further illustrates how this technology may allow the bronchoscopist to diagnose metastatic disease, which may not reside within the lung or be directly attached to the main airways.

A three-stage method for the 3D reconstruction of the tracheobronchial tree from CT scans

This paper proposes a method for segmenting the airways from CT scans of the chest to obtain a 3D model that can be used in the virtual bronchoscopy for the exploration and the planning of paths to the lesions. The method is composed of 3 stages: a gross segmentation that reconstructs the main airway tree using adaptive region growing, a finer segmentation that identifies any potential airway region based on a 2D process that enhances bronchi walls using local information, and a final process to connect any isolated bronchus to the main airways using a morphologic reconstruction process and a path planning technique. The paper includes two examples for the evaluation and discussion of the proposal.

Current State-of-the-Art Therapy for Advanced Squamous Cell Lung Cancer

Squamous cell carcinoma (SCC) represents the second most common histologic subtype of lung cancer (preceded only by adenocarcinoma). SSC of the lung is prevalently diagnosed in smokers and has been described as a preferentially centrally located tumor in which the main airways are commonly involved. Clinically, it presents with predominant locoregional signs and symptoms, but in recent years an increasing frequency of peripheral SCC of the lung has been reported. Pathologic diagnosis can be easily made through light microscopy and immunohistochemistry. The treatment approach for early-stage disease does not differ from that of other histologic subtypes of non-small cell lung cancer; in locally advanced unresectable or metastatic disease, doublet chemotherapy regimens (including cisplatin or carboplatin and a third-generation agent such as gemcitabine, taxanes, or vinorelbine) remain the cornerstone of front-line systemic treatment. Conversely, a single agent, mainly docetaxel, is the preferred treatment in second-line treatment. In unselected patient populations, targeted therapies have been extensively tested in combination with cytotoxic chemotherapy with disappointing results because of increased toxicity or lack of improvement in efficacy outcomes. Genomic alterations in SCC of the lung have not been comprehensively characterized, and no molecularly targeted therapies have been specifically developed for the treatment of this disease, but recently immune checkpoints have emerged as new therapeutic agent.

Can computed tomography classifications of chronic obstructive pulmonary disease be identified using Bayesian networks and clinical data?

Diagnosis and classification of chronic obstructive pulmonary disease (COPD) may be seen as difficult. Causal reasoning can be used to relate clinical measurements with radiological representation of COPD phenotypes airways disease and emphysema. In this paper a causal probabilistic network was constructed that uses clinically available measurements to classify patients suffering from COPD into the main phenotypes airways disease and emphysema. The network grades the severity of disease and for emphysematous COPD, the type of bullae and its location central or peripheral. In four patient cases the network was shown to reach the same conclusion as was gained from the patients’ High Resolution Computed Tomography (HRCT) scans. These were: airways disease, emphysema with central small bullae, emphysema with central large bullae, and emphysema with peripheral bullae. The approach may be promising in targeting HRCT in COPD patients, assessing phenotypes of the disease and monitoring its progression using clinical data.

Current State-of-the-Art Therapy for Advanced Squamous Cell Lung Cancer

Squamous cell carcinoma (SCC) represents the second most common histologic subtype of lung cancer (preceded only by adenocarcinoma). SSC of the lung is prevalently diagnosed in smokers and has been described as a preferentially centrally located tumor in which the main airways are commonly involved. Clinically, it presents with predominant locoregional signs and symptoms, but in recent years an increasing frequency of peripheral SCC of the lung has been reported. Pathologic diagnosis can be easily made through light microscopy and immunohistochemistry. The treatment approach for early-stage disease does not differ from that of other histologic subtypes of non–small cell lung cancer; in locally advanced unresectable or metastatic disease, doublet chemotherapy regimens (including cisplatin or carboplatin and a third-generation agent such as gemcitabine, taxanes, or vinorelbine) remain the cornerstone of front-line systemic treatment. Conversely, a single agent, mainly docetaxel, is the preferred treatment in second-line treatment. In unselected patient populations, targeted therapies have been extensively tested in combination with cytotoxic chemotherapy with disappointing results because of increased toxicity or lack of improvement in efficacy outcomes. Genomic alterations in SCC of the lung have not been comprehensively characterized, and no molecularly targeted therapies have been specifically developed for the treatment of this disease, but recently immune checkpoints have emerged as new therapeutic agent.

Effect of Bronchodilators on Bronchial Gland Cell Proliferation After Inhalation and Burn Injury in Sheep

The objective of this study is to measure the temporal changes in bronchial submucosal gland (SMG) cell proliferation in sheep after smoke inhalation and burn (S+B) injury, and to assess the effect of bronchodilators on the proliferative response. Archived main bronchial airways from sheep after S+B injury were immunostained for Ki67, and the percentage of ciliated duct and SMG cells expressing nuclear localization of Ki67 was determined for uninjured sheep and in sheep 24, 48, 72, and 96 hours after injury. A semiquantitative measure of lining epithelial exfoliation was made for each tissue. Bronchial tissues from sheep at 48 hours after S+B injury that had been nebulized with albuterol or tiotropium bromide (tiotropium) were examined to assess the effect of bronchodilators on the proliferative response. At 48 through 96 hours after injury, both ciliated duct and SMG cell proliferation were significantly increased compared with that of uninjured animals and animals 24 hours after injury, P <.05. A small increase in proliferation was seen in the SMG cells of albuterol-treated sheep compared with nebulized saline controls, P = .048. SMG cells of tiotropium-treated animals showed a significant increase in Ki67 nuclear staining compared with their study controls, P = .001. Extensive injury to the lining epithelium is associated with a proliferative response in both ciliated duct and SMG cells 24 hours after injury. The increase in proliferation in sheep treated with bronchodilators suggests that therapies for inhalation injury modify the glandular proliferative response. Further study to assess the ability of bronchodilators to enhance epithelial repair is warranted.

Intraabdominal and Thoracic Pressures in Critically Ill Patients with Suspected Intraabdominal Hypertension

ObjectiveTo study the correlation between intraabdominal and intrathoracic pressures in patients with suspected intraabdominal hypertension. DesignA prospective, observational cohort study. SettingPolyvalent intensive care unit of a University hospital. PatientsTwenty-seven medical-surgical patients dependent upon controlled mechanical ventilation due to acute respiratory failure and with several risk factors for intraabdominal hypertension (IAH). Main variablesIntraabdominal (IAP), esophageal (Peso) and airways pressures were measured under static (st) and dynamic (dyn) conditions. Respiratory system (Crs), lung (Clu) and chest wall compliance (Ccw) were calculated. ResultsIn 10 patients IAP>12mmHg (IAH, IAPst, 14±2 [12–21] mmHg), while in the rest the pressure proved normal (n=17; IAPst, 8±2 [3–11] mmHg). Pesost was 11±5 (2–27) and Pesodyn 7±4 (2–24) cmH2O. Depending on the presence or absence of IAH, Pesost was 9±4 vs 7±3cmH2O (P=.2) and Pesodyn 6±2 vs 4±3cmH2O (P=.3), respectively. The correlation between Pesost and dyn with IAPst was 0.5 (P=.003) and 0.4 (P=.03), respectively. The compliance components were decreased (Crs, 31±8; Clu, 52±22 and Ccw, 105±50ml/cmH2O); Ccw was significantly lower in patients with IAH (81±31 vs 118±55ml/cmH2O; P=.02). The correlation coefficient between IAPst and Ccw was −0.7 (P<.001), and −0.5 (P=.002) with respect to Crs. ConclusionsA stiffer chest wall was observed in patients with IAH. In patients with risk factors for IAH, pressures in these compartments were highly variable.