Pulmonary Malignancy Research Articles

BL-MOL-AR Project, Preliminary Results about Liquid Biopsy: Molecular Approach Experience and Research Activity in Oncological Settings.

Background Liquid biopsy is mainly used to identify tumor cells in pulmonary neoplasms. It is more often used in research than in clinical practice. The BL-MOL-AR study aims to investigate the efficacy of next-generation sequencing (NGS) and clinical interpretation of the circulating free DNA (cfDNA) levels. This study reports the preliminary results from the first samples analyzed from patients affected by various neoplasms: lung, intestinal, mammary, gastric, biliary, and cutaneous. Methods The Biopsia Liquida-Molecolare-Arezzo study aims to enroll cancer patients affected by various malignancies, including pulmonary, intestinal, advanced urothelial, biliary, breast, cutaneous, and gastric malignancies. Thirty-nine patients were included in this preliminary report. At time zero, a liquid biopsy is executed, and two types of NGS panels are performed, comprising 17 genes in panel 1, which is already used in the routine tissue setting, and 52 genes in panel 2. From the 7th month after enrollment, 10 sequential liquid biopsies are performed up to the 17th month. The variant allele frequency (%) and cfDNA levels (ng/mL) are measured in every plasmatic sample. Results The NGS results obtained by different panels are similar even though the number of mutations is more concordant for lung pathologies. There are no significant differences in the actionability levels of the identified variants. Most of the molecular profiles of liquid biopsies reflect tissue data. Conclusions Preliminary data from this study confirm the need to clarify the limitations and potential of liquid biopsy beyond the lung setting. Overall, parameters related to cfDNA levels and variant allele frequency could provide important indications for prognosis and disease monitoring.

Investigating the association of acute kidney injury (AKI) with COVID-19 mortality using data-mining scheme

COVID-19 has caused significant challenges in kidney research and disease management. Data mining techniques such as logistic regression (LR) and decision tree (DT) were used to model data. All analyses were performed using SPSS 25 and Python 3. The incidence of acute kidney injury (AKI) was 14.1% and the overall mortality risk was 13% among COVID-19 patients. The mortality was associated with, AKI, age, marital status, smoking status, heart failure, chronic obstructive pulmonary disease, malignancy, and SPO2 level using LR. The accuracy, sensitivity, specificity, and area under the curve of the DT (and LR) classifier were 70% (85%), 73% (75%), 78% (79%), and 77% (81%), respectively. Based on the DT model, the variable most significantly associated with COVID-19 mortality was AKI followed by age, high WBC count, BMI, and lymphocyte count. It was concluded that the incidence of AKI was high, and AKI was identified as one of the important factors that played an effective role in mortality due to COVID-19.

CPC05 A case of extensive hypertrophic lupus erythematosus responsive to topical steroids

Abstract Hypertrophic lupus erythematosus (HLE) is a rare variant of lupus erythematosus, occurring in 2% of cases of chronic cutaneous lupus erythematosus (CCLE). It is an exaggerated proliferative epithelial response manifesting as verrucous-appearing hypertrophic indurated lesions occurring on sun-exposed sites. We present a case of the development of extensive HLE in a patient with subacute cutaneous lupus erythematosus (SCLE) with underlying pulmonary malignancy. A 74-year-old woman with Sjögren syndrome presented to dermatology with a 2-month history of a rash affecting her face and décolletage. Laboratory studies illustrated elevated antinuclear and anti-Ro antibodies. Biopsy from her chest confirmed SCLE. Malignancy screening revealed T1aN0 pulmonary lepidic adenocarcinoma, which was successfully managed with a lower lobectomy. Hydroxychloroquine was initially trialled but required discontinuation following intolerable side-effects. Mepacrine was then initiated, which allowed clearance of the rash, alongside yellow discoloration of the skin. Six months later, she developed a raised pruritic rash on her arms, legs and buttocks, resistant to current management alongside a trial of mycophenolate mofetil. Examination revealed violaceous hypertrophic plaques affecting 40% of her body-­surface area. The differential included hypertrophic lichen planus, nodular prurigo and HLE. Repeat lesional biopsies highlighted a lichenoid inflammatory infiltrate with overlying scale, favouring HLE. Owing to patient choice, topical mometasone furoate 0.1% was used to manage cutaneous disease, with a reduction in lesion size. HLE is a distinct subset of CCLE, regarded as a separate entity to SCLE. Twenty per cent of patients with SCLE also exhibit other types of cutaneous lupus erythematosus (CLE) lesions. No cases in the literature describe progression from SCLE to CCLE, or HLE, in particular. Hallmarks of HLE include verrucous lesions, chronicity and treatment resistance. Early recognition and follow-up are essential as malignancy may arise in long-standing lesions. Lung adenocarcinomas and hypertrophic lupus are both associated with p53 mutations and decreased granzyme B expression. Mutated p53 results in constitutive cell proliferation and DNA damage can accumulate in cells. Granzyme B is a protease in cytotoxic T cells involved in immune-mediated cell lysis. Both processes result in the potential to produce exaggerated hyperproliferative lesions, such as those observed in HLE and the lepidic adenocarcinomas. HLE is a rare clinical entity that can be easily misdiagnosed clinically and histopathologically. Increased awareness of this condition is essential to highlight the variety of clinical presentations of uncommon variants of CLE, to ensure they are considered while approaching clinical diagnosis.

Diffuse pulmonary meningotheliomatosis.

Diffuse pulmonary meningotheliomatosis (DPM) is an ultra-rare pulmonary disease characterized by innumerable bilateral minute meningothelial-like nodules, sometimes presenting a characteristic 'cheerio-sign' on imaging. Most patients with DPM are asymptomatic and experience no disease progression. Although little is known about its nature, DPM may be associated with pulmonary malignancies, mostly lung adenocarcinoma.

Remotely operated robotic microscopy for rapid diagnosis of bronchoscopic cytology specimens.

Obtaining a diagnosis and treating pulmonary malignancies during the same anesthesia requires either an on-site pathologist or a system for remotely evaluating microscopic images. Cytology specimens are challenging to remotely assess given the need to navigate through dispersed and three-dimensional cell clusters. Remote navigation is possible using robotic telepathology, but data are limited on the ease of use of current systems, particularly for pulmonary cytology. Air dried modified Wright-Giemsa stained slides from 26 touch preparations of transbronchial biopsies and 27 smears of endobronchial ultrasound guided fine needle aspirations were scored for ease of adequacy assessment and ease of diagnosis on robotic (rmtConnect Microscope) and non-robotic telecytology platforms. Diagnostic classifications were compared between glass slides and the robotic and non-robotic telecytology assessments. Compared to non-robotic telecytology, robotic telecytology had a greater ease of adequacy assessment and non-inferior ease of diagnosis. The median time to diagnosis using robotic telecytology was 85 s (range 28-190 s). Diagnostic categories were concordant for 76% of cases in robotic versus non-robotic telecytology and 78% of cases in robotic telecytology versus glass slide diagnosis. Weighted Cohen's kappa scores for agreement in these comparisons were 0.84 and 0.72, respectively. Use of a remote-controlled robotic microscope improved the ease of adequacy assessment compared to non-robotic telecytology and enabled strongly concordant diagnoses to be expediently rendered. This study provides evidence that modern robotic telecytology is a feasible and user-friendly method of remotely and potentially intraoperatively rendering adequacy assessments and diagnoses on bronchoscopic cytology specimens.

Lobectomy for Suspected Lung Cancer Without Prior Diagnosis

BackgroundWe describe use, patients, and outcome of diagnostic lobectomy for suspected lung cancer without pathologic confirmation. MethodsA retrospective review of consecutive lobectomy or bilobectomy for suspected or confirmed primary pulmonary malignancy was conducted using our participant’s sample of The Society of Thoracic Surgeons database. Surgeons performed lobectomy based on clinical diagnosis or confirmation on a biopsy specimen. Lung cancer confirmed by biopsy specimen was compared with cases clinically suspected. Univariate and multivariate analyses identified variables associated with lobectomy without biopsy specimen confirmation. ResultsAmong 2651 lobectomies performed between 2006 and 2019 in 2617 patients, lung cancer was confirmed by preoperative biopsy specimen in 51.6% (1368 of 2651) or was clinically suspected before the operation in 48.4% (1283 of 2651). The intraoperative biopsy specimen in 585 of 1283 cases (45.6%) proved lung cancer before lobectomy, whereas lobectomy proceeded in 698 cases (54.4%) without a diagnosis. Final pathology proved lung cancer in 90% (628 of 698) without a diagnosis before lobectomy and nonmalignant disease in 10% (70 of 698). Nonneoplastic pathology included granulomas (30 of 70 [43%]), pneumonia (12 of 70 [17%]), bronchiectasis (7 of 70 [10%]), and other lesions (21 of 70 [30%]). Operative mortality was 0.94% (25 of 2651) for the cohort and 1.0% (7 of 698) for diagnostic lobectomy only. Multivariate analysis identified patient age, type of lobectomy (right middle lobe), and the intermediate study tercile as associated with diagnostic lobectomy. ConclusionsLobectomy for suspected lung cancer without diagnosis is common, represents practice variation, and infrequently (10% diagnostic, 2.6% all lobectomies) removes nonmalignant disease. Tissue confirmation before lobectomy is preferred, particularly when operative risk is increased. Diagnostic lobectomy is acceptable in carefully selected patients and lesions.

Tumor board tuesday and awareness of novel therapies and toxicities in solid tumor oncology.

11008 Background: Social media platforms, including Twitter, offer novel tools to accelerate discussion and learning that crosses national borders, flattens hierarchies, and enables collaborations not previously possible. Here, we report on a new initiative, Tumor Board Tuesday (TBT), which facilitates the presentation of cases with active discussion from thousands of stakeholders across the oncology community, highlighting new practice changes and precision oncology strategies. Herein, we sought to evaluate 1) the nature of participation by individuals and groups, as well as their scope of participation in TBT; 2) the impact of participation in TBT, including new collaborations forged, practice changes, increased knowledge of the use of novel agents, and their associate toxicities, as well as emerging clinical trials available to patients. Methods: TBT performed a survey designed to assess the demographics, experience, and opinions of platform users. This survey was collated with voluntary pre/post TBT presentation knowledge checks to assess knowledge acquisition. Results: Based on the survey of TBT participants (n = 38), participant gender is roughly balanced (48.4% women, 48.4% men; 3.2% prefer not to answer). 83.6% of respondents reside in the United States, 8% in Brazil, 5.4% in India, and 3% in Ireland. Interestingly, the majority of respondents identified Twitter as their primary source for oncologic and practice changing updates. Among self-identified oncologists, 12.9% identified as senior members of the field, 51.6% as mid-career, 16.1% as early career, and 12.9% as fellows/trainees. Despite the wide variation in career stage, 81.1% of respondents noted that they had become aware of a new treatment option or modality through TBT participation, which caused 78.4% to change or re-think their treatment approach. In addition, 75.7% of respondents noted that TBT had helped them to become more aware of novel agent toxicities, and 78.4% became aware of a clinical trial option because of TBT participation. Finally, 78.4% of respondents identified TBT as a tool that had helped grow professional connections and networks. On average, there were 56 respondents to knowledge-based questions within each TBT presentation. Analysis of responses to pre and post TBT questions focused on breast, GU, and pulmonary malignancies revealed a 12%, 13%, and 6% respective increase in correct answer choices. Conclusions: Social media, specifically, the use of the TBT platform engages oncology professionals across the career spectrum, enhances learning about novel therapies and corresponding toxicities, and broadens professional connections.

Reality check for precision oncology in squamous cell lung cancer.

e21221 Background: Squamous cell lung cancer (SqCLC) is the second most common type of pulmonary malignancy after lung adenocarcinoma. Therapeutic advances in Precision Oncology have significantly improved outcomes in subsets of patients with lung adenocarcinoma. However, a significantly different mutational landscape has limited the success of Precision Oncology in SqCLC. Still, NCCN guidelines recommend considering molecular testing in SqCLC, preferably with broad-based molecular profiling like next-generation sequencing (NGS), aiming to identify candidates for FDA-approved targeted therapy. We aim to evaluate the percentage of SqCLC potentially eligible for targeted therapy using NGS by analyzing data from The Cancer Genome Atlas (TCGA). Methods: We filtered cases with a SqCLC diagnosis from the TCGA database. These cases were screened for DNA/RNA alterations in the 9 NCCN-guidelines recommended genes, including EGFR/ALK/ROS1/BRAF/MET/RET/HER2/NTRK/KRAS. Each unique alteration in the genes mentioned above was then analyzed in the oncoKB database to predict clinical benefit with level 1 and 2A evidence from FDA-approved targeted therapy. We then calculated the percentage of patients with SqCLC tested with NGS who could assess approved matched targeted therapy. Results: We identified 501 unique cases of SqCLC diagnosis in the TCGA. In the 9 NCCN-recommended actionable genes, 206 alterations were detected. We reviewed the clinical implication and utility of each of these alterations in the OncoKB database, and only 5 alterations were consistent with level 1/2A clinical benefit from a matched targeted therapy. These included 2 cases with L861Q and one each with EGFR L858R, EGFR E746_A750 exon 19 deletion, and G222C missense in the ERBB2 gene. Conclusions: The percentage of squamous cell cases which are potential candidates for FDA-approved targeted therapy was relatively low, 0.1% (5/501). While next-generation sequencing will not affect the standard of care treatment options for most SqCLC patients, clinicians can use this information to counsel patients for enrollment in clinical trials. [Table: see text]

ROC CURVE ANALYSIS OF DIFFERENT HYBRID FEATURE DESCRIPTORS USING MULTI CLASSIFIERS

Tremendous success of machine learning algorithms at pattern recognition creates interest in new inventions. Machine learning in an era of big data is that significant hierarchical relationships within the data can be discovered algorithmically than other handcraft like features. In this study, Convolutional Neural Network (CNN) is used as feature descriptors in pulmonary malignancy prediction. Various feature descriptors such as Histogram of Oriented Gradient (HOG), Extended Histogram of Oriented Gradient (EXHOG) and Linear Binary Pattern (LBP) descriptors are analyzed with classifiers such as Random Forest (RF), Decision Tree (DT), K-Nearest Neighbour (KNN) and Support Vector Machine (SVM) for Computed Tomography (CT) The phenotype features of pulmonary nodules are important cues for identification. The nodule solidity is an important cue for white blob area identification. The method is analyzed in Lung Image Database Consortium (LIDC) dataset. Receivers Operating Characteristics (ROC) curves show the graphical summaries of detectors performance. It is proved that CNN based feature extraction with SVM classifier works well in pulmonary malignancy prediction.

Pulmonary artery sarcoma: an unexpected settler in the right ventricular outflow tract

Pulmonary artery sarcoma (PAS) is a sporadic malignant tumor that mainly originates from the pulmonary arteries. However, PAS may also involve the right ventricular outflow tract (RVOT) and lead to obstruction, syncope, or sudden death. Early diagnosis and complete surgical resection are essential to prolong survival and improve the quality of life of patients with PAS. Herein, we report a case of a young female patient admitted for pulmonary malignancy and acute pulmonary embolism. The patient had a mass in the RVOT, which was detected by transthoracic echocardiography. Computed tomography and magnetic resonance imaging revealed the invasion depth and extent of the lesions. Surgical resection improved hemodynamics, while pathological and immunohistochemical tests confirmed the diagnosis of a pulmonary artery sarcoma. Local recurrence was detected in the adjacent tissues about two months after the surgery. Given the potential risk of reoperation, the patient was suggested to undergo conservative treatment.

Pleuropulmonary blastoma type I presenting as a tension pneumothorax: a case report and review of the literature.

Pleuropulmonary blastoma (PPB) is a very rare, aggressive, embryonal pulmonary malignancy that mostly affects children under the age of 5 years. According to the histological features, three subtypes of PPB have been recognized: type I (purely cystic), type II (grossly visible cystic and solid elements), and type III (purely solid). The authors report a case of a 10-month-old male infant with type I PPB, who was clinically misdiagnosed with pneumothorax, that he presented complaining of shortening of breath, fever, and cough. Radiographs of the patient showed right pneumothorax, so he had managed accordingly in another centre without improvement. Then Computed Tomography showed a huge right upper lobe sepated pneumocyst, which was treated surgically and the diagnosis was confirmed by combining the imaging and the histopathological examination as PPB type I. PPB is a relatively rare tumour, and it is important to put PPB with their subtypes within the differential diagnoses of any pulmonary lesion in children below the age of 5 or 6 years, as the early diagnosis will help to give early management. Hence, the patient may have a better outcome.

Proposal to Screen for Zinc and Selenium in Patients with IgA Deficiency

The increase in life expectancy can be a consequence of the world’s socioeconomic, sanitary and nutritional conditions. Some studies have demonstrated that individuals with a satisfactory diet variety score present a lower risk of malnutrition and better health status. Zinc and selenium are important micronutrients that play a role in many biochemical and physiological processes of the immune system. Deficient individuals can present both innate and adaptive immunity abnormalities and increased susceptibility to infections. Primary immunodeficiency diseases, also known as inborn errors of immunity, are genetic disorders classically characterized by an increased susceptibility to infection and/or dysregulation of a specific immunologic pathway. IgA deficiency (IgAD) is the most common primary antibody deficiency. This disease is defined as serum IgA levels lower than 7 mg/dL and normal IgG and IgM levels in individuals older than four years. Although many patients are asymptomatic, selected patients suffer from different clinical complications, such as pulmonary infections, allergies, autoimmune diseases, gastrointestinal disorders and malignancy. Knowing the nutritional status as well as the risk of zinc and selenium deficiency could be helpful for the management of IgAD patients. Objectives: to investigate the anthropometric, biochemical, and nutritional profiles and the status of zinc and selenium in patients with IgAD. Methods: in this descriptive study, we screened 16 IgAD patients for anthropometric and dietary data, biochemical evaluation and determination of plasma and erythrocyte levels of zinc and selenium. Results: dietary intake of zinc and selenium was adequate in 75% and 86% of the patients, respectively. These results were consistent with the plasma levels (adequate levels of zinc in all patients and selenium in 50% of children, 25% of adolescents and 100% of adults). However, erythrocyte levels were low for both micronutrients (deficiency for both in 100% of children, 75% of adolescents and 25% of adults). Conclusion: our results highlight the elevated prevalence of erythrocyte zinc and selenium deficiency in patients with IgAD, and the need for investigation of these micronutrients in their follow-up.

Glaucoma and Systemic Disease.

Glaucoma is the leading cause of irreversible blindness in the world. Due to its potential to cause permanent vision loss, it is important to understand how systemic conditions and their respective treatments can be associated with or increase the risk for developing glaucoma. In this review, we examined the literature for up-to-date discussions and provided commentary on glaucoma, its pathophysiology, and associated risk factors. We discuss systemic diseases and the impact, risk, and mechanism for developing glaucoma, including pharmacologically induced glaucoma; inflammatory and auto-immune conditions; infectious, dermatologic, cardiovascular, pulmonary, renal, urologic, neurologic, psychiatric and systemic malignancies: intraocular tumors; as well as pediatric, and genetic conditions. The goal of our discussion of systemic conditions including their commonality, mechanisms, treatments, and associations with developing glaucoma is to emphasize the importance of ocular examinations and follow-up with the multidisciplinary teams involved in the care of each patient to prevent unnecessary vision-loss.

Abstract 5394: Detecting pulmonary malignancy against benign nodules using non-invasive cfDNA fragmentomics assay

Abstract Background: Early screening using Low-Dose Computed Tomography (LDCT) can reduce mortality by non-small-cell-lung cancer (NSCLC), which contributed the most cancer-related death worldwide. Yet ~25% of the “suspicious” nodules identified by LDCT are confirmed to be benign through resection surgery, which adds to patients’ discomfort and the burden of the healthcare system. In this prospective study, we set to develop a non-invasive liquid biopsy assay for distinguishing pulmonary malignancy from benign lung nodules using cfDNA fragmentomic profiling. Methods: An independent training cohort, which consisted of 193 patients with malignant nodule and 44 patients with benign nodule, was used to construct a machine learning model. Base models employing 4 different fragmentomics profiles were optimized using an automated machine learning (autoML) approach before being ensemble stacked to create the final predictive model. An independent validation cohort included 96 malignant nodules and 22 benign nodules, as well as an external test cohort containing 58 malignant nodules and 41 benign nodules, were used to assess the performance of the ensemble stacked model. Results: Our machine learning models showed excellent performances in detecting patients with malignant nodules. The AUCs reached 0.857 (0.782 - 0.932) and 0.860 (95% CI: 0.788 - 0.933) in the independent validation cohort and the external test cohort, respectively. The validation cohort achieved an excellent 68.2% specificity (95% CI: 45.1-86.1%) at the targeted 90% sensitivity (89.6%, 95% CI: 81.7-94.9%). An equivalently good performance was observed while applying the cutoff to the external cohort, which reached a specificity of 63.4% (95% CI: 46.9-77.9%) at 89.7% sensitivity (95% CI: 78.8-96.1%). Subgroup analysis for the independent validation cohort showed that the sensitivities for detecting various subgroups of nodule size (< 1cm: 91.7%; 1 - 3cm: 88.1%; > 3cm: 100%; Unknown: 100%) and smoking history (Yes: 88.2%; No: 89.9%) all remained high among the lung cancer group. Additionally, the specificities for successfully identifying the benign nodules among different subgroups decrease as the size increase (< 1cm: 80.0%, 1 - 3cm: 66.7%, > 3cm: 33.3%). Conclusions: Our cfDNA fragmentomics assay can provide a non-invasive approach to distinguish malignant nodules from the radiographically suspicious but pathologically benign nodules. Citation Format: Shun Xu, Ji Luo, Wanxiangfu Tang, Hua Bao, Jiajun Wang, Shuang Chang, Haimeng Tang, Zifang Zou, Xiaoxi Fan, Yang Liu, Changrui Jiang, Xue Wu, Yang Shao. Detecting pulmonary malignancy against benign nodules using non-invasive cfDNA fragmentomics assay. [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 5394.

Congenital pleuropulmonary blastoma in a newborn with a variant of uncertain significance in DICER1 evaluated by RNA-sequencing

BackgroundPleuropulmonary blastoma (PPB) is a rare mesenchymal malignancy of the lung and is the most common pulmonary malignancy in infants and children. Cystic PPB, the earliest form of PPB occurring from birth to approximately two years of age, is often mistaken for a congenital pulmonary airway malformation, as the two entities can be difficult to distinguish on imaging and pathology. Diagnosis of PPB should prompt workup for DICER1 syndrome, an autosomal dominant tumor predisposition syndrome. We report a newborn with a congenital PPB presenting with tachypnea and hypoxia, who was found to have variant of uncertain clinical significance (VUS) in DICER1.Case presentationA term female infant developed respiratory distress shortly after birth. Initial imaging was concerning for a congenital pulmonary airway malformation versus congenital diaphragmatic hernia, and she was transferred to a quaternary neonatal intensive care unit for management and workup. Chest CT angiography demonstrated a macrocytic multicystic lesion within the right lower lobe without systemic arterial supply. The pediatric surgery team was consulted, and the neonate underwent right lower lobectomy. Pathology revealed a type I PPB. Oncology and genetics consultants recommended observation without chemotherapy and single gene sequencing of DICER1, which identified a germline VUS in DICER1 predicted to alter splicing. RNA-sequencing from blood demonstrated that the variant resulted in an in-frame deletion of 29 amino acids in a majority of transcripts from the affected allele. Due to the patient’s young age at presentation and high clinical suspicion for DICER1 syndrome, tumor surveillance was initiated. Renal and pelvic ultrasonography were unremarkable.ConclusionWe present the case of a term neonate with respiratory distress and cystic lung mass, found to have a type I PPB with a germline VUS in DICER1 that likely increased her risk of DICER1-related tumors. Nearly 70% of patients with PPB demonstrate germline mutations in DICER1. Review of RNA sequencing data demonstrates the difficulty in classifying splice variants such as this. Penetrance is low, and many patients with pathogenic DICER1 variants do not develop a malignancy. Best practice surgical and oncologic recommendations include an individualized approach and tumor board discussion. This case highlights the importance of a multidisciplinary team approach and the utility of international registries for patients with rare diagnoses.

Possible Causes of Hypertrophic Osteoarthropathy in the La Ferrassie 1 Neanderthal.

For over a century, researchers have been perplexed by the unique osteological findings on La Ferrassie 1 (LF1), one of the most complete Neanderthal remains ever found. In 1997, Fennel and Trinkaus proposed that LF1 suffered from hypertrophic osteoarthropathy (HOA), likely secondary to chronic thoracic infection or pulmonary malignancy. This disease process can have many etiologies, and no study has fully explored the possible origin of LF1's HOA. Ultimately, it is most likely that LF1's HOA etiology arose from one of the many infectious diseases that prehistoric Neanderthals were exposed to, specifically a chronic pulmonary RNA virus.

Impact of comorbidities on hospitalised Syrian patients with COVID-19: a retrospective study

ObjectivesThis study aims to compare the clinical manifestations, laboratory findings, outcomes and overall survival time of patients with COVID-19 with and without comorbidities.DesignRetrospective design.SettingThis study was undertaken at two hospitals...

Symptom severity trajectories and distresses in patients undergoing video-assisted thoracoscopic lung resection from surgery to the first post-discharge clinic visit.

This study aimed to characterize patients' symptom severity trajectories and distresses from video-assisted thoracoscopic lung resection to the first post-discharge clinic visit. Seventy-five patients undergoing thoracoscopic lung resection for diagnosed or suspected pulmonary malignancy prospectively recorded daily symptom severity on a 0-10 numeric scale using the MD Anderson Symptom Inventory until the first post-discharge clinic visit. The causes of postoperative distresses were surveyed, and symptom severity trajectories were analyzed using joinpoint regression. A rebound was defined as a statistically significant positive slope after a statistically significant negative slope. Symptom recovery was defined as symptom severity of ≤3 in two contiguous measurements. The accuracy of pain severity on days 1-5 for predicting pain recovery was determined using area under the receiver operating characteristic curves. We applied Cox proportional hazards models for multivariate analyses of the potential predictors of early pain recovery. The median age was 70 years, and females accounted for 48%. The median interval from surgery to the first post-discharge clinic visit was 20 days. Trajectories of several core symptoms including pain showed a rebound from day 3 or 4. Specifically, pain severity in patients with unrecovered pain had been higher than those with recovered pain since day 4. Pain severity on day 4 showed the highest area under the curve of 0.723 for predicting pain recovery (P = 0.001). Multivariate analysis identified pain severity of ≤1 on day 4 as an independent predictor of early pain recovery (hazard ratio, 2.86; P = 0.0027). Duration of symptom was the leading cause of postoperative distress. Several core symptoms after thoracoscopic lung resection showed a rebound in the trajectory. Specifically, a rebound in pain trajectory may be associated with unrecovered pain; pain severity on day 4 may predict early pain recovery. Further clarification of symptom severity trajectories is essential for patient-centered care.

DIAGNOSTIC ACCURACIES OF HRCT CHEST IN COMPARISON WITH RT-PCR IN DIAGNOSIS OF CORONAVIRUS DISEASE (COVID-19) IN A TERTIARY CARE HOSPITAL.

Objective:-To compare the diagnostic accuracies of HRCTchest and RT-PCR results in diagnosis of coronavirus disease (COVID-19) in a tertiary care hospital in Kolar. Methodology This was a prospective study approved by Ethical Review Committee of R L JALAPPA Hospital. From Dec 2021 to May 2022, a total of 48 CT chest were performed in this hospital. Patients aged above 18 years, irrespective of gender, who were clinically suspected of COVID-19 with at least one RT-PCR test and HRCT chest done, individuals with close contact history and admitted patients were included. Patients with interval of more than seven days between HRCT chest acquisition and rst PCR sampling, patients with pulmonary and extra pulmonary lung malignancy, chest trauma, previous chest surgery were excluded. For those patients with negative rst PCR but suspicious clinical symptoms suggesting COVID-19, a second PCR was conducted within 3 days after the rst, the result of which was taken as diagnostic gold standard. For patients with only a single RT-PCR test, the test result was taken as the diagnostic gold standard Results:- Sensitivity of HRCTin diagnosing Covid 19 was 86.49%, Specicity of HRCT in diagnosing Covid 19 was 27.27%, Positive Predictive Value of HRCT in diagnosing Covid 19 was 80.00%, Negative Predictive Value of HRCT in diagnosing Covid 19 was 37.50% and Accuracy of HRCT in diagnosing Covid 19 was 72.92%

Management of hemoptysis with bronchial artery embolization: Benign versus malignant indications

Objectives: The purpose of this study is to compare the role of bronchial artery embolization (BAE) in hemoptysis due to malignant and non-malignant etiologies. Material and Methods: Data from patients who underwent BAE at a tertiary care center from October 2002 to 2018 were retrospectively reviewed. Variables evaluated include procedural indication, technical success, clinical success, re-embolization, intensive care unit (ICU) admission, length of stay, and thirty-day readmission. Categorical and continuous variables were analyzed using Pearson’s Chi-squared and two sample t-tests, respectively. Post-procedure survival and re-embolization were analyzed using Kaplan–Meier curves and Cox proportional hazard models. Results: 114 BAE procedures from 93 unique patients with hemoptysis were identified, with 29.8% of procedures being performed for hemoptysis secondary to malignancy and 70.2% for benign causes. The technical and clinical success rates of the procedure were similar between benign and malignant etiologies (benign/malignant: 92.5% vs. 91.2% and 82.5% vs. 73.5%, respectively). There were no statistically significant differences in rates of need for re-embolization, ICU admission, 30-day readmission, mean hospital length of stay, or mortality between benign and malignant groups. Clinically successful embolization was protective against death (HR = 0.19, P < 0.001) and re-embolization (HR = 0.04, P = 0.001), while higher American Society of Anesthesiologists’ (ASA) score, female sex, and primary pulmonary malignancy were associated with risk of death. Conclusion: While patients with a malignant cause of hemoptysis had an increased risk of mortality and decreased survival time, BAE for malignant hemoptysis is effective with outcomes comparable to that for benign hemoptysis as indicated by high clinical and technical success rates and low rates of re-embolization.