Pulmonary Conditions Research Articles

Development and Implementation of a Pediatric Pulmonary-Focused Active Learning Curriculum.

During the pediatric pulmonary rotation, trainees reported that while the clinical experience was robust, they desired more structured didactic sessions. Self-paced online modules can be an alternative but equally effective teaching tool. Multiple studies demonstrate the benefits of e-learning in medical education. Four interactive, case-based, e-learning modules on asthma, chronic cough, tracheostomy, and obstructive sleep apnea were created and piloted to pediatric residents and medical students in the pediatric pulmonology elective at the University of California, San Francisco and Oakland campus. Modules incorporated videos with experts, images, and multiple-choice questions to enhance learning. The modules were distributed via email on their first day of the rotation and were completed virtually by the trainees during their rotation. Progress was evaluated from December 2021 to July 2022 using pre- and postcourse questions assessing knowledge acquisition and decision-making skills. A total of 22 participants took part in the elective and completed the modules to varying degrees. This group included six fourth-year medical students and three first-year, five second-year, and eight third-year pediatric residents. Data showed an improvement in posttest scores across all four modules, ranging from 9% to 21%, with a large improvement in the obstructive sleep apnea module and a small improvement in the chronic cough module. Trainees reported that the modules supplemented and increased their knowledge base. Knowledge about managing common pulmonary conditions is critical for general pediatricians. Self-paced online modules are well accepted by trainees and are effective in improving knowledge and medical decision-making.

Machine learning-based model for predicting the occurrence and mortality of nonpulmonary sepsis-associated ARDS

Objective: The objective was to establish a machine learning-based model for predicting the occurrence and mortality of nonpulmonary sepsis-associated ARDS. Methods: 80% of sepsis patients selected randomly from the MIMIC-IV database, without prior pulmonary conditions and with nonpulmonary infection sites, were used to construct prediction models through machine learning techniques (including K-nearest neighbour, extreme gradient boosting, support vector machine, deep neural network, and decision tree methods). The remaining 20% of patients were utilized to validate the model’s accuracy. Additionally, local data were employed for further model validation. Results: A total of 11,409 patients were included, with the most common type of infection being bloodstream infection. A total of 7,632 (66.9%) patients developed nonpulmonary sepsis-associated ARDS (NPS-ARDS). Patients with NPS-ARDS had significantly longer ICU stays (6.2 ± 5.2 days vs. 4.4 ± 3.7 days, p < 0.01) and higher 28-day mortality rates (19.5% vs. 14.9%, p < 0.01). Both internal and external validation demonstrated that the model constructed with the extreme gradient boosting method had high accuracy. In the internal validation, the model predicted NPS-ARDS and mortality in such patients with accuracies of 77.5% and 71.8%, respectively. In the external validation, the model predicted NPS-ARDS and mortality in these patients with accuracies of 78.0% and 81.4%, respectively. Conclusion: The model established via the extreme gradient boosting method can predict the occurrence and mortality of nonpulmonary sepsis-associated ARDS to a certain extent.

Enhancing Lung Ultrasound Diagnostics: A Clinical Study on an Artificial Intelligence Tool for the Detection and Quantification of A-Lines and B-Lines.

Background/Objective: A-lines and B-lines are key ultrasound markers that differentiate normal from abnormal lung conditions. A-lines are horizontal lines usually seen in normal aerated lungs, while B-lines are linear vertical artifacts associated with lung abnormalities such as pulmonary edema, infection, and COVID-19, where a higher number of B-lines indicates more severe pathology. This paper aimed to evaluate the effectiveness of a newly released lung ultrasound AI tool (ExoLungAI) in the detection of A-lines and quantification/detection of B-lines to help clinicians in assessing pulmonary conditions. Methods: The algorithm is evaluated on 692 lung ultrasound scans collected from 48 patients (65% males, aged: 55 ± 12.9) following their admission to an Intensive Care Unit (ICU) for COVID-19 symptoms, including respiratory failure, pneumonia, and other complications. Results: ExoLungAI achieved a sensitivity of 91% and specificity of 81% for A-line detection. For B-line detection, it attained a sensitivity of 84% and specificity of 86%. In quantifying B-lines, the algorithm achieved a weighted kappa score of 0.77 (95% CI 0.74 to 0.80) and an ICC of 0.87 (95% CI 0.85 to 0.89), showing substantial agreement between the ground truth and predicted B-line counts. Conclusions: ExoLungAI demonstrates a reliable performance in A-line detection and B-line detection/quantification. This automated tool has greater objectivity, consistency, and efficiency compared to manual methods. Many healthcare professionals including intensivists, radiologists, sonographers, medical trainers, and nurse practitioners can benefit from such a tool, as it assists the diagnostic capabilities of lung ultrasound and delivers rapid responses.

Viability and diagnostic potential of tissues obtained through cryobiopsy

BackgroundTransbronchial lung cryobiopsy is primarily used for diagnosing interstitial lung diseases and tumors, providing larger tissue samples with reduced tissue crushing than traditional biopsies. However, freezing during cryobiopsy may damage cells, potentially affecting diagnostic methods that require live cells, such as flow cytometry (FCM). We aimed to determine the extent of freezing-related cell damage in cryobiopsies using cells cultured in vitro. MethodsTo investigate the relationship between freezing duration and sample volume, Jurkat cells underwent freezing for durations ranging from 2 to 6 s, with 1-s intervals, using either 1-mm- or 1.7-mm cryoprobes. FCM was conducted to assess both cell viability (2, 4, and 6 s) and cell-surface molecule expression (3 and 6 s) over varying freezing times. Additionally, we describe a clinical case involving a 70-year-old man suspected of malignant lymphoma, in which tissue samples were obtained via both forceps biopsy and cryobiopsy methods to compare the pathological and cytological features between the methods. ResultsHarvested cell count increased with freezing duration, with a notable increase in viable cell percentage. Moreover, cells distant from the cryoprobe exhibited higher survival rates under milder freezing conditions. FCM revealed significantly higher marker expression levels in viable cryobiopsy samples than in non-viable samples. The clinical case demonstrated that cryobiopsy yields a significant proportion of live cells (>90%), with cytological findings consistent with those of non-frozen samples. ConclusionsCryobiopsy may be beneficial for histopathological diagnosis, providing sufficient viable cells for FCM, and can be used for diagnosing malignant lymphomas and other pulmonary conditions.

Fungal lung disease.

Fungal lung disease encompasses a wide spectrum of organisms and associated clinical conditions, presenting a significant global health challenge. The type and severity of disease are determined by underlying host immunity and infecting fungal strain. The most common group of diseases are associated with the filamentous fungus Aspergillus species and include allergic bronchopulmonary aspergillosis, sensitisation, aspergilloma and chronic and invasive pulmonary aspergillosis. Fungal lung disease remains epidemiologically heterogenous and is influenced by geography, environment and host comorbidities. Diagnostic modalities continue to evolve and now include novel molecular assays and biomarkers; however, persisting challenges include achieving rapid and accurate diagnosis, particularly in resource-limited settings, and in differentiating fungal infection from other pulmonary conditions. Treatment strategies for fungal lung diseases rely mainly on antifungal agents but the emergence of drug-resistant strains poses a substantial global threat and adds complexity to existing therapeutic challenges. Emerging antifungal agents and increasing insight into the lung mycobiome may offer fresh and personalised approaches to diagnosis and treatment. Innovative methodologies are required to mitigate drug resistance and the adverse effects of treatment. This state-of-the-art review describes the current landscape of fungal lung disease, highlighting key clinical insights, current challenges and emerging approaches for its diagnosis and treatment.

Comprehensive strategies for preoperative pulmonary risk evaluation and management.

Postoperative pulmonary complications (PPCs) significantly increase morbidity and mortality in surgical patients, particularly those with pulmonary conditions. The incidence of PPCs varies widely, influenced by surgery type, patient age, smoking status, and comorbidities like chronic obstructive pulmonary disease (COPD) and congestive heart failure. Preoperative pulmonary function tests and chest radiographs, while critical for lung resection surgery, should be selectively used based on individual risk factors. Effective risk stratification models, including ASA classification, Arozullah Respiratory Failure Index, Gupta Calculators, and ARISCAT model, aid in predicting PPCs. Key strategies to reduce PPCs involve preoperative optimization of pulmonary conditions, smoking cessation, and respiratory rehabilitation. In COPD and asthma patients, maintaining optimal disease control through inhaled therapies, systemic corticosteroids, and preoperative respiratory exercises is crucial. Anemia and hypoalbuminemia are notable predictors of PPCs, warranting careful management. The type and duration of anesthesia significantly impact PPC risk, with regional anesthesia preferred over general anesthesia when feasible. Comprehensive preoperative evaluation and tailored interventions are essential to improve surgical outcomes and reduce PPC incidence. Further study involving domestic patients is needed to refine national guidelines for managing patients at risk of PPCs.

High-Flow Nasal Oxygen in Patients with Acute Hypercapnic Respiratory Failure: A Narrative Review of the Physiological Rationale and Clinical Evidence.

Acute hypercapnic respiratory failure is a life-threatening condition caused by alveolar hypoventilation. It is mostly caused by an acute exacerbation of chronic obstructive pulmonary disease or conditions yielding muscle dysfunction. Noninvasive ventilation through a facemask is the cornerstone first-line strategy to support hypercapnic patients with acidemia, and current guidelines strongly recommend this intervention to improve survival and long-term clinical outcomes. Because of its benefits related to carbon dioxide washout from the upper airways and the enhanced comfort, high-flow nasal oxygen has been proposed as a respiratory support strategy in patients with hypercapnic respiratory failure, both as an alternative to and in combination with noninvasive ventilation. When compared to noninvasive ventilation as a first-line intervention, high-flow nasal oxygen shows a higher rate of failure. Hence, if not contraindicated, the use of noninvasive ventilation should be preferred. After the resolution of acidemia with noninvasive ventilation, high-flow nasal oxygen showed promising physiological effects compared to conventional oxygen. During weaning from mechanical ventilation in patients with or at risk of developing hypercapnia, high-flow nasal oxygen showed encouraging results, especially when applied alternating with sessions of noninvasive ventilation. Optimal settings of high-flow nasal oxygen in hypercapnic patients include the use of a smaller-size cannula, flows ranging between 30 and 40 L/min, and FiO2 adjusted to obtain SpO2 between 88% and 92%. Specific interfaces, such as asymmetric cannulas, may further enhance the benefits of a high flow in terms of carbon dioxide clearance. In this narrative review, we provide an updated overview of the physiological rationale and clinical evidence concerning the use of high-flow nasal oxygen in patients with acute hypercapnic respiratory failure.

The Mechanism and Inflammatory Markers Involved in the Potential Use of N-acetylcysteine in Chronic Pain Management.

N-acetylcysteine (NAC) has established use as an antidote for acetaminophen overdose and treatment for pulmonary conditions and nephropathy. It plays a role in regulating oxidative stress and interacting with various cytokines including IL-1β, TNFα, IL-8, IL-6, IL-10, and NF-κB p65. The overexpression of reactive oxygen species (ROS) is believed to contribute to chronic pain states by inducing inflammation and accelerating disease progression, favoring pain persistence in neuropathic and musculoskeletal pain conditions. Through a comprehensive review, we aim to explore the mechanisms and inflammatory pathways through which NAC may manage neuropathic and musculoskeletal pain. Evidence suggests NAC can attenuate neuropathic and musculoskeletal pain through mechanisms such as inhibiting matrix metalloproteinases (MMPs), reducing reactive oxygen species (ROS), and enhancing glutamate transport. Additionally, NAC may synergize with opioids and other pain medications, potentially reducing opioid consumption and enhancing overall pain management. Further research is needed to fully elucidate its therapeutic potential and optimize its use in pain management. As an adjuvant therapy, NAC shows potential for chronic pain management, offering significant benefits for public health.

Efficacy and Safety of Intrapleural Fibrinolytic Therapy in Empyema Thoracis: A Meta-Analysis of Clinical Outcomes

Background: Empyema thoracis is a severe pulmonary condition characterized by pus accumulation in the pleural space. Intrapleural fibrinolytic therapy is used adjunctively to break down loculations and facilitate lung re-expansion. This meta-analysis evaluated the efficacy and safety of this treatment in adults with empyema thoracis. Methods: A systematic search of PubMed, Embase, and Cochrane Central Register of Controlled Trials was conducted (January 2013 - December 2023) for randomized controlled trials (RCTs) comparing intrapleural fibrinolytics with placebo or no fibrinolytic therapy in adults with empyema. Primary outcomes were treatment success (radiographic improvement and/or clinical resolution), duration of hospital stay, and mortality. Secondary outcomes included major bleeding and bronchopleural fistula. Data were pooled using a random-effects model, and risk ratios (RR) or mean differences (MD) with 95% confidence intervals (CI) were calculated. Results: Six RCTs (n=623 patients) met the inclusion criteria. Intrapleural fibrinolytic therapy showed a significantly higher treatment success rate than the control (RR 1.42, 95% CI 1.18-1.72, p=0.001) and significantly reduced hospital stay (MD -2.84 days, 95% CI -3.36 to -2.33, p&lt;0.001). No significant difference in mortality was found (RR 0.95, 95% CI 0.46-1.93, p=0.93). The incidence of major bleeding and bronchopleural fistula was similar between the groups. Conclusion: Intrapleural fibrinolytic therapy significantly improves treatment success and reduces hospital stays without increasing mortality or major complications. These findings support its use as an adjunctive therapy for drainage in managing empyema thoracis in adults.

Clinical and Electrocardiographic Predictors of Cardiac Resynchronization Therapy Response That Correlate with the 6 min Walking Test.

Background: Cardiac resynchronization therapy is an essential treatment for heart failure patients. Candidates typically have cardiomyopathy accompanied by delayed electrical activation in the left ventricular lateral wall, causing uncoordinated contractions and worsening heart failure. Heart failure severity can be assessed with functional tests: the cardiopulmonary test, which is a maximal exercise test, remains the gold standard, but the 6 min walk test has emerged as an easier, faster, and more comfortable alternative to be used by clinicians to adjust treatment protocols for cardiovascular and pulmonary conditions. Methods: This is a prospective observational study that included 69 patients from a single healthcare facility, and the purpose was to determine if the 6 min walk test results could be associated with changes in various electrocardiographic, clinical, functional, and demographic parameters. All the parameters and the 6 min walk distance were recorded at four key time moments: before the procedure and after 6, 9, and 12 months. The electrocardiographic parameters were obtained from the patients' electrocardiograms recorded in the four key moments and included variables such as QRS area, duration, percentage of biventricular pacing, and many others, while the functional variables included the monitored intraprocedural systolic blood pressure and the end-systolic left ventricular volume. We also aimed to check if clinical conditions such as diabetes and chronic kidney disease and demographic variables such as age or sex have any impact. Results and Conclusions: All this research was performed in order to identify which parameters hold a predictive value and can serve as future criteria for better patient selection and for defining a proper resynchronization outcome. The study shows that parameters such as diabetes and QRS duration have an impact over the 6 min walk distance. Also, newer variables such as the QRS area and the R/S ratio may represent a direction worth studying in order to predict the outcomes of cardiac resynchronization therapy.

Adaptation of Aortic Bioprosthetic Valves for Pulmonary Position: Comparative Analysis of Transcatheter and Surgical Valves.

Pulmonary valve dysfunction is common in congenital heart disease, often leading to interventions like right ventricular outflow tract reconstruction. Transcatheter pulmonary valve replacement (TPVR) has emerged as a successful alternative to surgery, showcasing promising outcomes for managing postoperative RVOT complications. The study aimed to compare two bioprosthetic valves-Carpentier Edwards Perimount Magna Ease surgical valve and Edwards SAPIEN 3 transcatheter valve-originally designed for aortic use but adapted for pulmonary applications. The hemodynamic characteristics of a 26-mm SAPIEN 3 and a 25-mm Magna Ease were assessed in a pulse duplicator under both pulmonary and aortic conditions. Furthermore, detailed structural analyses of the leaflets were conducted using computational simulations under these conditions. The results highlighted significant differences in the hydrodynamic and structural characteristics of these two bioprosthetic valves when exposed to pulmonary versus aortic conditions. The study enhances our understanding of the biomechanics involved in surgical and transcatheter pulmonary valve replacement.

Correlation between elderly patients with COPD and the impact on immunity in tuberculosis patients: A retrospective study.

The prevalence of chronic obstructive pulmonary disease (COPD) and tuberculosis (TB) is increasing globally, yet their comprehensive impact on the immune system remains underexplored. This study aimed to provide a thorough assessment of the immune status of patients with COPD and tuberculosis (TB-COPD), including their pulmonary conditions, immune cell responses, and changes in lymphocyte subpopulations. A total of 151 patients with TB-COPD patients were included, and clinical data were compared between the TB-COPD group and a group of TB patients without COPD (TB-NCOPD). Lung imaging findings and peripheral blood immune cell levels were compared between the 2 groups. Flow cytometry was used to analyze the absolute counts of lymphocyte subpopulations. The incidence of pulmonary lobe lesions and cavitation in the TB-COPD group aged 70 years or older was significantly higher than that in the control group. At the immune cell level, patients with TB-COPD showed a significant reduction in total lymphocytes, CD4+ T lymphocytes and CD4+/CD8+ ratio. Regardless of COPD status, the CD4+ T cell count in the CMV-infected group was significantly lower than that in the uninfected group (P < .05). Additionally, the CD4+/CD8+ ratio in the COPD + TB CMV + group was significantly lower than that in the uninfected group. Analysis of lymphocyte subpopulations revealed a decrease in the counts of CD4+ T lymphocytes in patients with TB-COPD, potentially associated with the chronic inflammatory state induced by COPD. The one-month treatment outcomes showed that the improvement rate in the control group was 70.58%, which was significantly higher than the 38.92% in the COPD + TB group (P < .001). We observed a significant increase in the number of pulmonary cavity patients in the TB-COPD group, suggesting that COPD may be a potential risk factor for the formation of pulmonary cavities in patients with TB. At the immune cell level, TB-COPD patients showed a notable decrease in lymphocytes and CD4+ T lymphocytes, implying that COPD combined with pulmonary TB may significantly affect the immune system, leading to a reduction in the counts of key immune cells.

Hypoxia and aging: molecular mechanisms, diseases, and therapeutic targets.

Aging is a complex biological process characterized by the gradual decline of cellular functions, increased susceptibility to diseases, and impaired stress responses. Hypoxia, defined as reduced oxygen availability, is a critical factor that influences aging through molecular pathways involving hypoxia-inducible factors (HIFs), oxidative stress, inflammation, and epigenetic modifications. This review explores the interconnected roles of hypoxia in aging, highlighting how hypoxic conditions exacerbate cellular damage, promote senescence, and contribute to age-related pathologies, including cardiovascular diseases, neurodegenerative disorders, cancer, metabolic dysfunctions, and pulmonary conditions. By examining the molecular mechanisms linking hypoxia to aging, we identify key pathways that serve as potential therapeutic targets. Emerging interventions such as HIF modulators, antioxidants, senolytics, and lifestyle modifications hold promise in mitigating the adverse effects of hypoxia on aging tissues. However, challenges such as the heterogeneity of aging, lack of reliable biomarkers, and safety concerns regarding hypoxia-targeted therapies remain. This review emphasizes the need for personalized approaches and advanced technologies to develop effective antiaging interventions. By integrating current knowledge, this review provides a comprehensive framework that underscores the importance of targeting hypoxia-induced pathways to enhance healthy aging and reduce the burden of age-related diseases.

Tumefactive Pulmonary amyloidosis in an elderly male: A Diagnostic Dilemma

Abstract Introduction/Objective Tumefactive pulmonary amyloidosis is a rare variant of pulmonary amyloidosis characterized by the extracellular deposition of abnormal protein fibrils in the lung parenchyma, forming tumor-like masses called amyloidomas. Although most cases are clinically silent, it may present with findings that mimic a wide range of respiratory conditions (eg. primary or metastatic malignant nodules, granulomatous disease, multiple pulmonary hamartomas etc), thereby necessitating a comprehensive and broad-based approach to differential diagnosis. Methods/Case Report We present a case of an 88-year-old male with a history of smoking and multiple comorbidities. He presented with numerous bilateral pulmonary nodules identified on a CT scan, concerning for malignancy. A biopsy from a left upper lobe lesion revealed necrotic tissue and was non-diagnostic. A PET scan to assess for metastatic disease was unremarkable, and demonstrated mild hypermetabolic activity, confined to the lungs, with standardized uptake values (SUV) ranging from 4.3 to a maximum SUV of 8.9. A subsequent right lung biopsy was positive for amyloid, confirmed by Congo red staining. A Mass spectrometry analysis further identified the amyloid as AL type. Serum, and urine protein electrophoresis with immunofixation were negative for M protein and the serum free light chain assay was normal as well. Significantly, the bone marrow biopsy also yielded normal results, and the patient was diagnosed with a localized form of AL amyloidosis. Results (if a Case Study enter NA) NA Conclusion This case highlights how tumefactive pulmonary amyloidosis poses a diagnostic challenge due to its rarity and resemblance to malignancy on imaging. Careful histopathological examination, including immunohistochemical stains and amyloid typing, was pivotal in establishing the correct diagnosis and underscores the essential role of pathology and laboratory medicine in differentiating rare pulmonary conditions, along with the need for a multidisciplinary approach in complex diagnostic scenarios.

Interstitial lung abnormality in COPD is inversely associated with the comorbidity of lung cancer

BackgroundInterstitial lung abnormality (ILA) has been recognized as a pertinent factor in the development and prognosis of various pulmonary conditions. However, its correlation with co-morbidities remains understudied. The current study endeavors to elucidate the association between ILA and both clinical features and co-morbidities in patients with chronic obstructive pulmonary disease (COPD).MethodsA retrospective cohort comprising 1131 hospitalized patients diagnosed with COPD was examined in this observational study. Patients were dichotomously classified based on the presence or absence of ILA, and subsequent analyses scrutinized disparities in demographic, clinical, and laboratory profiles, alongside co-morbid conditions, between the two subgroups.ResultsOf the 1131 COPD patients, 165 (14.6%) exhibited ILA. No statistically significant differences were discerned between COPD patients with and without ILA concerning demographic, clinical, or laboratory parameters, except for levels of circulating fibrinogen and procalcitonin. Nevertheless, a notable discrepancy emerged in the prevalence of multiple co-morbidities. Relative to COPD patients devoid of ILA, those presenting with ILA manifested a diminished prevalence of lung cancer (OR = 0.50, 95% CI: 0.30–0.83, p = 0.006), particularly of the lung adenocarcinoma (OR = 0.32, 95% CI: 0.15–0.71, p = 0.005). Additionally, the presence of ILA in COPD was positively associated with heart failure (OR = 1.75, 95% CI: 1.04-3.00, p = 0.040) and cancers other than lung cancer (OR = 2.27, 95% CI: 1.16–4.39, p = 0.012).ConclusionThese findings demonstrate that the presence of ILA is associated with co-morbidities of COPD, particularly lung cancer.

Effect of prednisone on woodsmoke-induced sputum inflammation in healthy volunteers: A randomized, placebo-controlled pilot study

Inhalation of biomass smoke is associated with adverse respiratory effects in those with chronic pulmonary conditions. There are few published data regarding the effects of anti-inflammatory interventions on these outcomes. Our aim was to assess the effects of postexposure prednisone on woodsmoke (WS)-induced sputum neutrophilia. We carried out a randomized, placebo-controlled, crossover pilot study assessing the effect of a postexposure dose of 60 mg prednisone on induced sputum inflammation after controlled exposure to WS (500 μg/m3 for 2 hours) in healthy adults who had been identified in a separate screening protocol as being "PMN responsive" to WS. Secondary end points were sputum cytokine level and mucociliary clearance as measured by γ-scintigraphy. A total of 11 subjects yielded complete data for the primary analysis. At 24 hours after WS exposure, there was a significant increase in sputum percentage of PMNs (%PMN) versus at baseline after placebo (median= 42% [IQR= 31%-53%]) (P= .02) but not after prednisone (median= 32% [IQR= 18%-40%]) (P= .09). Prednisone reduced Δ%PMN at 24 hours, but this difference did not reach statistical significance. However, for the 8 of 11 subjects who were PMN responsive after placebo, prednisone reduced Δ%PMN significantly (P= .05). Prednisone had no significant effects on sputum levels of IL-1β, IL-6, IL-8, or TNF-α. WS exposure tended to reduce mucociliary clearance in the placebo arm but not in the prednisone arm. Prednisone taken immediately after exposure to WS mitigated short-term increase in sputum %PMN among healthy volunteers selected for their underlying inflammatory responsiveness to WS. Our data support future studies assessing anti-inflammatory interventions and the role of mucus clearance in WS-induced respiratory health effects.

Pulmonary and Cardiac Smoking-Related History Improves Abstinence Rates in an Urban, Socioeconomically Disadvantaged Patient Population.

Tobacco use continues to take the lives of many, and targeted interventions can counter this health burden. One possible target population is patients who have had a smoking-related diagnosis, as they may have a greater drive to quit. To assess whether patients with previous cardiac or pulmonary conditions directly attributable to smoking have greater rates of abstinence post-discharge from hospitalization in the CHART-NY trial. CHART-NY was a randomized comparative effectiveness trial comparing a more intensive versus a less intensive smoking cessation intervention after hospital discharge. We divided the 1618 CHART-NY participants into a smoking-related history group of 597 and a nonsmoking-related history group of 1021 based on cardiac or pulmonary conditions in a retrospective chart review. We conducted chi-squared analyses on baseline characteristics. Using follow-up survey data, we conducted chi-squared analyses on abstinence outcomes and made logistic regression models for the predictive value of smoking-related conditions on abstinence. A total of 1059 and 1084 participants in CHART-NY who completed both 2- and 6-month follow-up surveys respectively. Self-reported 30-day abstinence at 2- and 6-month follow-up and survey data for baseline characteristics. Those abstinent at 6-month follow-up were more likely to have a smoking-attributable history (OR = 1.40, 95% CI 1.09-1.81). When stratified based on intervention, only the intensive counseling group was significant (OR = 1.53, 95% CI 1.08-2.17). The regression model using a smoking-related comorbidity score was significant at 6months (OR = 1.29, p = 0.03), and the multivariate logistic regression model analyzing each smoking-related condition separately demonstrated significance for myocardial infarction at 6months (OR = 1.66, p = 0.03). People who smoke who have experienced smoking-related conditions may be more likely to benefit from smoking cessation interventions, especially intensive telephone-based counseling. Multiple conditions had an additive effect in predicting long-term abstinence after intervention, and myocardial infarction had the greatest predictive value.

Hypoxic Preconditioned Tibetan Mesenchymal Stem Cell-derived Exosomes Ameliorate Pulmonary Vascular Remodeling in Hypoxic Pulmonary Hypertension Rats

BackgroundPulmonary hypertension associated with hypoxia frequently manifests in a range of long-standing lung disorders. A strategy to augment the therapeutic efficacy of mesenchymal stem cells (MSCs) involves subjecting them to hypoxic preconditioning, which bolsters the emission of exosomes exhibiting enhanced bioactivities through paracrine mechanisms. The objective of this research is to explore the healing impact of preconditioning with hypoxia on MSC-extracted exosomes in relation to vascular structural changes within the lungs of rodents afflicted by hypoxia-induced pulmonary arterial hypertension. Methods and ResultsThis research entailed the successful isolation, cultivation of mesenchymal stem cells from Tibetan umbilical cords, alongside the extraction of their exosomes. Our results highlight that exosomes derived from hypoxia-conditioned Tibetan cord mesenchymal stem cells (H-Tibetan-exo) demonstrated superior efficacy in suppressing pulmonary vascular structural changes compared to those from normoxic conditions (N-Tibetan-exo) in a rat model of hypoxia-induced pulmonary hypertension (HPH).In an effort to replicate pulmonary hypertension conditions within a laboratory setting, we subjected rat pulmonary arterial smooth muscle cells (rPASMCs) to a low oxygen environment. Our findings revealed that exosomes derived from high-altitude Tibetans (H-Tibetan-exo) showed a superior capacity in suppressing the growth of rPASMCs compared to those obtained from normoxic Tibetans (N-Tibetan-exo). Additionally, the Transwell assay revealed a more significant inhibition of rPASMCs migration by H-Tibetan-exo. The investigation of PI3K-AKT-mTOR pathway protein expression through western blot analysis revealed that under hypoxic conditions, there was an elevation in the phosphorylation status of these proteins in both cellular and tissue settings. Furthermore, the H-Tibetan-exo exhibited more effective inhibition of rPASMCs proliferation and a more significant downregulation of PI3K-AKT-mTOR pathway protein phosphorylation levels compared to the N-Tibetan-exo. ConclusionsH-Tibetan-exo significantly ameliorates pulmonary vascular remodeling in hypoxic pulmonary hypertension more effectively than N-Tibetan-exo. The enhancement observed could be linked to reduced activity of the PI3K-AKT-mTOR pathway. This discovery sheds fresh light on managing hypoxic pulmonary hypertension, highlighting the potential therapeutic benefits of H-Tibetan-exo in mitigating its development.

A pilot metabolomics study across the continuum of interstitial lung disease fibrosis severity.

Interstitial lung diseases (ILDs) include a variety of inflammatory and fibrotic pulmonary conditions. This study employs high-resolution metabolomics (HRM) to explore plasma metabolites and pathways across ILD phenotypes, including non-fibrotic ILD, idiopathic pulmonary fibrosis (IPF), and non-IPF fibrotic ILD. The study used 80 plasma samples for HRM, and involved linear trend and group-wise analyses of metabolites altered in ILD phenotypes. We utilized limma one-way ANOVA and mummichog algorithms to identify differences in metabolites and pathways across ILD groups. Then, we focused on metabolites within critical pathways, indicated by high pathway overlap sizes and low p-values, for further analysis. Targeted HRM identified putrescine, hydroxyproline, prolyl-hydroxyproline, aspartate, and glutamate with significant linear increases in more fibrotic ILD phenotypes, suggesting their role in ILD fibrogenesis. Untargeted HRM highlighted pathway alterations in lysine, vitamin D3, tyrosine, and urea cycle metabolism, all associated with pulmonary fibrosis. In addition, methylparaben level had a significantly increasing linear trend and was higher in the IPF than fibrotic and non-ILD groups. This study highlights the importance of specific amino acids, metabolic pathways, and xenobiotics in the progression of pulmonary fibrosis.

Controversies in the clinical management of chronic pulmonary aspergillosis.

Chronic pulmonary aspergillosis has a range of manifestations from indolent nodules to semi-invasive infection. Patients may be asymptomatic or have chronic symptoms such as cough and weight loss or present with life-threatening haemoptysis. The physician can choose from a range of available therapies including medical therapy with antifungals, minimally invasive therapy with intracavitary antifungal therapy and surgery involving open thoracotomy or video-assisted thoracoscopic surgery. The patients with the most severe forms of pulmonary infection may not be surgical candidates due to their underlying pulmonary condition. The management of haemoptysis can include tranexamic acid, bronchial artery embolisation, antifungals or surgery. There are few controlled studies to inform clinicians managing complex cases, so a multidisciplinary approach may be helpful.