Lung Volume Research Articles

Utility of Diaphragm Dome Height as a Marker of Operational Lung Volume Changes, Disease Burden and Exacerbations in Patients with Mild-to-Moderate COPD: An Observational Study Within the CanCOLD Cohort

BackgroundDynamic hyperinflation is central to dyspnoea, exercise limitation, and exacerbations in chronic obstructive pulmonary disease (COPD). While studied previously in moderate-severe COPD, the relevance of diaphragm dome height on clinically important outcomes has been under-investigated in mild-to-moderate COPD.MethodsCanadian Cohort Obstructive Lung Disease participants with spirometry-confirmed COPD, symptom-limited incremental cardiopulmonary exercise testing, and computed tomography image data were included. Base-to-apex left and right diaphragm dome height (DDH) was automatically segmented, with increased height implying less flattening and thus less hyperinflation. Dynamic hyperinflation was defined as ≥150 mL reduction in inspiratory capacity (IC) from rest to peak-exercise. Cross-sectional linear regression models were fitted between left and right DDH (predictor variables) with peak IC (ICpeak), peak workload (Wpeak), FEV1, and CAT score (outcome variables), and in longitudinal (Anderson-Gill) models with “symptom-based” and “event-based” exacerbations. Results are reported as parameter estimates or hazard ratios with 95%CIs per interquartile range dome height increment.ResultsAmong 304 participants (mean age 64.7±10.3, 41.8% female, 44.4% with mild COPD), each left and right DDH increment, respectively, was associated with ICpeak(0.21[0.13,0.29]L, 0.13[0.07,0.19]L), Wpeak(9.54[5.03,14.04]W, 6.04[2.45,9.62]W), FEV1(0.17[0.10,0.25]L, 0.08[0.02,0.14]L), and CAT score (−1.36[−2.39,−0.33], −0.82[−1.63,0.00]). Left DDH alone was associated with both symptom-based (HR: 0.82[0.74,0.91]) and event-based (0.83[0.73,0.95]) exacerbations. Of 167/304 participants with confirmed dynamic hyperinflation (ΔIC=−0.47±0.25 L), left DDH alone was associated with all outcomes (ICpeak, Wpeak, FEV1, CAT, and symptom-based/event-based exacerbations).ConclusionsLeft DDH appears to be a clinically important marker for operational lung volume changes, lung function, exercise performance, disease burden, and exacerbations in mild-to-moderate COPD.

Expanded Use of Vorasidenib in Non-Enhancing Recurrent CNS WHO Grade 3 Oligodendroglioma

Background/Objectives: Anaplastic oligodendrogliomas (AOs) are central nervous system (CNS) World Health Organization (WHO) grade 3 gliomas characterized by isocitrate dehydrogenase (IDH) mutation (m)IDH and 1p/19q codeletion. AOs are typically treated with surgery and chemoradiation. However, chemoradiation can cause detrimental late neurocognitive morbidities and an accelerated disease course. The recently regulatory-approved vorasidenib, a brain-penetrating oral inhibitor of IDH1/2, has altered the treatment paradigm for recurrent/residual non-enhancing surgically resected CNS WHO grade 2 mIDH gliomas. Though vorasidenib can delay the time to chemoradiation for grade 2 gliomas, the implications for vorasidenib in non-grade 2 mIDH gliomas are not well understood. Results: We present a case of a 71-year-old male with a grade 3 non-enhancing oligodendroglioma successfully treated with vorasidenib with an 11% reduction in residual tumor volume. Vorasidenib was well tolerated in our patient with a mild elevation in his liver transaminases that resolved following a brief interruption in treatment. Conclusions: Our case suggests that vorasidenib may impart therapeutic benefits in this setting. This case illustrates the need for further investigation into these less commonly addressed scenarios and treatment strategies that extend beyond current guidelines.

Can preoperative urodynamic studies predict de novo stress urinary incontinence following advanced pelvic organ prolapse surgery?

Introduction: We aimed to assess the predictivity of preoperative urodynamics (UDS) on de novo stress urinary incontinence (SUI) in patients having advanced pelvic organ prolapse (POP). Methods: Between January 2016 and June 2019, 133 patients with symptomatic POP at stage 3 or higher were included in the study. The presence of postoperative SUI symptoms after a minimum of six months of followup was considered the primary outcome. The results of all patients' preoperative UDS were compared to their postoperative SUI symptoms. In addition, patients were divided into two groups based on whether SUI was detected during preoperative UDS testing (Group 1) or not (Group 2). Results: Although preoperative measurements, such as bladder capacity and residual urine volume, were not different between groups, group 1 had lower maximal urethral closure pressures (p=0.001). Preoperative SUI symptoms had a sensitivity of 32.1% and a specificity of 91.4% for predicting de novo SUI. In patients with advanced POP, preoperative UDS had a sensitivity of 60.7% and a specificity of 87.6% for predicting de novo SUI. Conclusions: Urodynamic examination with a pessary can significantly predict the development of de novo SUI.

Clamping Catheter Versus Free Drainage for Patients With Neurogenic Bladder With Indwelling Urinary Catheter: A Meta-Analysis.

Background: In the clinical setting, individuals with neurogenic bladder dysfunction commonly utilize indwelling urinary catheters for urinary management. The comparative efficacy of catheter clamping versus continuous free drainage in this patient population is yet to be established. This meta-analysis aims to explore the efficacy and safety of catheter clamping versus natural drainage in patients with neurogenic bladder, to provide evidence to support the treatment and nursing care of these patients. Methods: Two researchers conducted a literature search in Clinicaltrials et al. databases for Randomized Controlled Trials (RCTs) comparing clamping of the catheter to free drainage in patients with neurogenic bladder who have indwelling urinary catheters. The RCT bias risk assessment tool recommended by the Cochrane Handbook was used for quality assessment. RevMan 5.3 software were used for meta-analysis. Results: A total of 8 RCTs involving 772 patients with neurogenic bladder were enrolled. Catheter clamping significantly increased the volume of first urination in patients [MD = 52.86, 95%CI (42.30, 63.41), p < .001]. The difference in time to first urination [SMD = 0.10, 95%CI (-0.68, 0.89), p = .80], residual urine volume [MD = -5.18, 95%CI (-17.27, 6.90), p = .40], incidence of urinary retention [MD = 1.07, 95%CI (0.30, 3.87), p = .92], the incidence of urinary tract infection [RR = 1.38, 95%CI (0.64, 2.97), p = .42] between the catheter clamping group and the natural drainage group were not statistically significant. The results of Egger's regression analysis indicated no evidence of statistical publication bias. Conclusion: In light of the existing body of evidence, the routine practice of catheter clamping in catheterized patients with neurogenic bladder is not recommended.

Effectiveness of Y-V-plasty for refractory bladder neck stenosis after transurethral prostate surgery.

To evaluate the surgical and patient-reported outcomes of YV-plasty in patients with refractory bladder neck stenosis (BNS) following transurethral prostate surgery. This retrospective study reviewed five patients who underwent YV-plasty for BNS between January 2021 and October 2023. The surgical procedure involved a midline lower abdominal incision to expose the bladder neck. A V-shaped incision was made in the anterior bladder wall to create a bladder flap. The bladder neck was then incised from the apex of the V-shape to the healthy urethra, forming a Y-shaped incision. Fibrotic tissue was excised, and the posterior side of the urethra and bladder were anastomosed. The bladder flap was mobilized and sutured to the healthy urethra using 4-0 PDS interrupted sutures. Follow-up assessments included uroflowmetry, postvoid residual urine volume measurement (PVR), and questionnaires on daily pad use and patient satisfaction. Success was defined as cystourethroscope passage through the anastomosis without resistance and no need for additional procedures. The median patient age was 69. All patients had a history of failed endoscopic treatments. The median follow-up was 13 months, with all considered successful. The median postoperative maximum flow rate was 26.6 mL/s, and the median PVR was 12 mL. Postoperatively, two (40%) were pad-free, and three (60%) used 1-2 pads daily. Three (60%) patients were 'very satisfied,' one (20%) 'satisfied,' while one (20%) was 'dissatisfied.' Y-V-plasty is an effective option for refractory BNS, improving urinary function and quality of life.

Surgical and patient-reported outcomes of staged urethroplasty for anterior urethral strictures: A comprehensive analysis.

To evaluate the efficacy of staged urethroplasty for complex anterior urethral strictures from both surgical and patient-reported outcome perspectives. This retrospective study included 100 patients who underwent staged urethroplasty for anterior urethral strictures between May 2011 and June 2023. Anatomical success was defined as the ability to pass cystourethroscopy without resistance and the patient's ability to void without additional interventions. Patient-reported outcomes were evaluated using validated questionnaires, including the urethral stricture surgery patient-reported outcome measure, sexual health inventory for men (SHIM), and EuroQol 5-dimension (EQ-5D), administered pre-and postoperatively. At a median follow-up of 53 months, the anatomical success rate was 89.0%. Seventeen (17.0%) required revision surgery between stages. Perioperative complications occurred in 13 (13.0%). Significant improvements were observed in maximum flow rate (p < 0.0001), postvoid residual volume (p = 0.0006), total lower urinary tract symptoms (LUTS) scores (p < 0.0001), LUTS-specific quality of life (QOL) score (p < 0.0001), EQ-5D index score (p < 0.0001), and EQ-5D visual analog scale score (p < 0.0001). SHIM scores showed no significant change (p = 0.59). Overall, 93.5% of patients reported being either "satisfied" or "very satisfied" with the outcomes. Staged urethroplasty demonstrates high anatomical success rates and significant improvements in urinary function and QOL without compromising erectile function. The high patient satisfaction rate supports its efficacy in treating complex anterior urethral strictures.

Inhaled ozone induces distinct alterations in pulmonary function in models of acute and episodic exposure in female mice.

Ozone is an urban air pollutant, known to cause lung injury and altered function. Using established models of acute (0.8 ppm, 3 h) and episodic (1.5 ppm, 2 h, 2 times/wk, 6 wk) inhalation exposure, we observed distinct structural changes in the lung; whereas acutely, ozone primarily disrupts the bronchiolar epithelial barrier, episodic exposure causes airway remodeling. Herein we examined how these responses altered pulmonary function. A SCIREQ small animal ventilator was used to assess lung function; impedance was used to conditionally model resistance and elastance. Episodic, but not acute ozone exposure reduced the inherent and frequency-dependent tissue recoil (elastance) of the lung. Episodic ozone also increased central and high-frequency resistance relative to air control after methacholine challenge, indicating airway hyperresponsiveness. Pressure-volume (PV) loops showed that episodic ozone increased maximum lung volume, while acute ozone decreased lung volume. Episodic ozone-induced functional changes were accompanied by increases in alveolar circularization; conversely, minimal histopathology was observed after acute exposure. However, acute ozone exposure caused increases in total phospholipids, total surfactant protein D (SP-D), and low molecular weight SP-D in bronchoalveolar lavage fluid. Episodic ozone exposure only increased total SP-D. These findings demonstrate that acute and episodic ozone exposure cause distinct alterations in surfactant composition and pulmonary function. Whereas loss in PV loop area following acute ozone exposure is likely driven by increases in SP-D and inflammation, emphysematous pathology and airway hyperresponsiveness after episodic ozone appears to be the result of alterations in lung structure.

Alkalinised lidocaine as an anaesthetic before onabotulinumtoxinA injections. a randomised trial.

To evaluate the effect of intravesical alkalinised lidocaine as an anaesthetic treatment on procedural pain during intradetrusor onabotulinumtoxinA (BTX-A) injections for overactive bladder. This single-centre, randomised, double-blind, placebo-controlled two period crossover trial was conducted on women scheduled for BTX-A injections at our outpatient urogynaecology clinic between September 2022 and May 2024. Patients were randomly assigned (1:1) to receive either alkalinised lidocaine or placebo during the first treatment period. Alkalinised lidocaine solution comprised lidocaine hydrochloride (20 mg/mL, 20 mL), sodium hydrogen carbonate (1 mmoL/mL, 10 mL), and sodium chloride (9 g/L, 10 mL). The matching placebo was sodium chloride (9 g/L, 40 mL). The primary outcome measure was procedural pain rated on a 100-mm visual analogue scale (VAS). Secondary outcomes included adverse effects such as post-void residual urine volumes requiring catheterisation, urinary tract infection, haematuria 1 week after treatment, and patient satisfaction measured on a 5-point scale. During the second treatment period, patients received the alternative intervention. We enrolled 50 patients, of which 41 were eligible for per-protocol analyses. The mean VAS score was significantly lower following intravesical alkalinised lidocaine (mean 21.3 mm, 95% confidence interval [CI] 14.7-27.8 mm) compared to placebo (mean 41.6 mm, 95% CI 35.0-48.1 mm) with a mean difference of -20.3 mm (95% CI -29.2 to -11.5 mm; P < 0.001). Adverse events and patient satisfaction did not significantly differ between the alkalinised lidocaine and placebo treatments (P = 0.825 and P = 0.138, respectively). Intravesical instillation of alkalinised lidocaine before BTX-A injections significantly reduced VAS pain scores compared to placebo (ClinicalTrials.gov identifier: NCT05415865).

Polyamine Content of Enteral Nutrition Formulas: Effect of Daily Intake on the Feeding Tolerance of Patients During the First Week in the Intensive Care Unit

Enteral nutrition (EN) formulas are necessary for critically ill patients to meet their metabolic requirements. Polyamines (putrescine, spermidine, and spermine) are crucial dietary components, with spermidine being particularly interesting due to its multiple proposed benefits. The requirements for and intake of polyamines have yet to be investigated in adult patients hospitalised in intensive care units (ICUs) who are exclusively fed via commercial EN formulas. The aim of this study was to determine the polyamine content and other biogenic amines of EN formulas and the total intake and gastric residual volume (GRV) in adult ICU patients during their first seven days of hospitalisation. The amines were analysed in 16 EN formulas using high-performance liquid chromatography (HPLC). The clinical data of eight patients of both sexes aged 47 to 77 admitted to the ICU were analysed. Differences existed among the analysed EN formulas. The N-acetyl putrescine content was higher than that of the remaining amines. The daily intake of polyamines in the ICU was less than 100 μmol (the dietary intake is above 400 μmol). An inverse correlation existed between total daily polyamine intake and daily GRV, without effects from other biogenic amines being analysed. Polyamine intake in critically ill patients receiving EN is low and could impact these patients’ feeding tolerance. These findings underscore the need for further research to explore the clinical implications of increasing the polyamine content of EN formulas.

Efficacy analysis of acupuncture and rehabilitation for traumatic spinal cord injury.

This study investigates the role and efficacy of acupuncture combined with rehabilitation therapy during the recovery phase of patients with traumatic spinal cord injury. Patients hospitalized in the acupuncture department of our center between December 1, 2019, and December 1, 2021, were enrolled. Participants were divided into an observation group (acupuncture and rehabilitation therapy) and a control group (rehabilitation therapy alone) based on their treatment sequence. Initially, 15 patients were allocated to each group; however, 3 patients in the observation group and 4 in the control group withdrew, leaving 11 and 12 patients in the respective groups. The observation group received combined acupuncture and rehabilitation therapy, while the control group received conventional rehabilitation therapy. Outcomes were evaluated using the American Spinal Injury Association score and classification, urodynamic data, SF-36 scale, Functional Independence Measure, and Barthel Index, analyzed through data mining techniques. Posttreatment assessments revealed significant improvements in residual urine volume and detrusor pressure in the observation group (P < .05), whereas no significant changes were noted in the control group (P > .05). Both groups demonstrated improved motor function after treatment (P < .05), with the observation group showing significantly greater improvement (P < .05). Quality of life evaluations indicated substantial enhancement in physical pain, energy levels, general health, social functioning, perceived health changes, and mental health in both groups (P < .05). Acupuncture combined with rehabilitation therapy offers significant clinical benefits for patients with traumatic spinal cord injury. This approach effectively alleviates urinary and bowel dysfunction, accelerates motor function recovery, and improves overall quality of life, making it a valuable treatment option worthy of wider adoption.

Current approaches in the diagnosis and treatment of organizing pneumonia

Organizing pneumonia (OP), is a rare yet well-defined form of interstitial lung disease. The condition can be idiopathic, termed cryptogenic organizing pneumonia (COP), or secondary to various causes, including infections, connective tissue diseases, medications, and malignancies. OP typically presents with nonspecific symptoms such as cough, dyspnea, fever, and weight loss, often mimicking other respiratory conditions like pneumonia or interstitial lung diseases. Radiological findings are varied but commonly include bilateral, patchy consolidations or ground-glass opacities with preserved lung volumes. Diagnosis often requires high-resolution computed tomography (HRCT) and may be confirmed by lung biopsy when clinical and imaging findings are inconclusive. Laboratory studies and bronchoalveolar lavage can aid in excluding alternative diagnoses. Glucocorticoids remain the mainstay of treatment, with most patients responding well to therapy. This review explores current advances in the diagnosis, differential diagnosis, and management of OP, emphasizing the importance of a multidisciplinary approach to optimize patient outcomes.

Scoliosis Progression after Lung Transplantation: Scoliosis after lung transplantation.

Scoliosis is a potential postoperative complication of various pediatric cardiothoracic conditions. To investigate the incidence of scoliosis in pediatric lung transplant patients and explore the factors associated with its development. Retrospective observational study PATIENT SAMPLE: 330 consecutive lung transplant recipients at a single institution between April 2002 and June 2022. The incidence of scoliosis METHODS: After excluding 45 patients with <1 year of follow-up, 285 patients were analyzed: 43 pediatric (≤17 years) and 242 adult (>18 years) patients. Data on baseline demographics, Cobb angle measurements pre- and post-transplant, and lung volumes at 1-year post-transplant in pediatric patients were collected. The prevalence of scoliosis was compared between pediatric and adult patients. Additionally, the impact of lung volume differences (right minus left) on scoliosis progression was assessed. Pediatric (n=43) and adult (n=242) patients had a mean age of 10.3 and 44.9 years, respectively. Scoliosis was significantly more prevalent in pediatric patients, with 30.2% having a Cobb angle >10° and 13.9% having a Cobb angle >20°, compared to 11.5% and 1.6% in adults, respectively. Pediatric patients with Cobb angles >20° exhibited significant lung volume differences 1-year post-transplant. Lung volume disparities increased the risk of scoliosis progression, particularly in patients with unilateral lung collapse. Pediatric lung transplant recipients have a higher incidence of significant scoliosis than adult recipients. Post-transplant lung volume disparities, especially in cases of unilateral lung collapse, may contribute to scoliosis progression. Routine spinal assessments are necessary for managing scoliosis in pediatric lung transplant patients to prevent curvature progression and ensure long-term musculoskeletal health.

Comparing multi-texture fibrosis analysis versus binary opacity-based abnormality detection for quantitative assessment of idiopathic pulmonary fibrosis

Automated tools for quantification of idiopathic pulmonary fibrosis (IPF) can aid in ensuring reproducibility, however their complexity and costs can differ substantially. In this retrospective study, two automated tools were compared in 45 patients with biopsy proven (12/45) and imaging-based (33/45) IPF diagnosis (mean age 74 ± 9 years, 37 male) for quantification of pulmonary fibrosis in CT. First, a tool that identifies multiple characteristic lung texture features was applied to measure multi-texture fibrotic lung (MTFL) by combining the amount of ground glass, reticulation, and honeycombing. Opacity-based fibrotic lung (OFL) was measured by a second tool that performs a simpler binary classification of tissue into either normal or opacified lung and was originally developed for quantifying pneumonia. Differences in quantification of MTFL and OFL were assessed by Mann-Whitney U-test and Pearson correlation (r). Also, correlation with spirometry parameters (percent predicted total lung capacity (TLC), percent predicted vital capacity (VC), percent predicted forced expiratory volume in 1 s (FEV1), diffusing capacity of the lungs for carbon monoxide (DLCO), partial pressure of oxygen (PO2) and carbon dioxide (PCO2)) were assessed by r. The prognostic values for 3-year patient survival of OFL, LSS and MTFL were investigated by multivariable Cox-proportional-hazards (CPH) models including sex, age and TLC and including sex, age and VC. Also, Kaplan-Meier analysis with log rank test between subgroups separated by median OFL and MTFL were conducted. No significant difference between OFL and MTFL was observed (median and interquartile range: OFL = 29% [20-38%], MTFL = 31% [19-45%]; P = 0.44). For OFL significant correlation was observed to MTFL (r = 0.93, P < 0.01) and VC (r=-0.50, P = 0.03). For MTFL no significant correlation to spirometry parameters was found. The total time for one analysis was lower for the automated MTFL (MTFL: 313 ± 25s vs. OFL: 612 ± 61s, P < 0.001). Both analyses were significant predictors in the multivariable CPH analysis including TLC (hazard-ratios: MTFL 1.03 [1.01–1.06], P = 0.02; OFL 1.03 [1.00-1.06], P = 0.03). No parameter was a significant predictor in the CPH models including VC (hazard-ratios: MTFL 1.01 [0.98–1.04], P = 1; OFL 1.01 [0.97–1.05], P = 1). OFL showed significance in Kaplan-Meier analysis (MTFL: P = 0.17; OFL: P = 0.03). Using a simple opacity-based quantification of pulmonary fibrosis in IPF patients displayed similar results and prognostic value compared to a more complex multi-texture based analysis.

Efficacy of Open Reduction and Internal Fixation Assisted by Handheld Ultrasound Combined with 3D Printing Technology in Treating Multiple Rib Fractures

AIM: This study aimed to explore the efficacy of open reduction and internal fixation assisted by handheld ultrasound combined with three-dimensional (3D) printing technology in treating multiple rib fractures. METHODS: We retrospectively analyzed the clinical data from 84 patients affected with multiple rib fractures admitted to our hospital between August 2022 and April 2024. After excluding four cases, 80 cases were included in this study. Based on the method of preoperative rib fracture localization, patients were divided into three groups: group A (n = 30), group B (n = 26), and group C (n = 24). Group A received 3D reconstruction of ribs on chest Computed Tomography (CT), group B adopted the examination of handheld ultrasound and 3D reconstruction of ribs on chest CT, and group C received handheld ultrasound, 3D reconstruction of ribs on chest CT, and 3D printing technology. The operation-related indicators (such as incision length, exposure time of surgical field, intraoperative blood loss), pulmonary function [total lung capacity (TLC), forced vital capacity (FVC), forced expiratory volume in one second/forced vital capacity (FEV1/FVC), residual volume (RV)], quality of life, degree of pain, and incidence of complications were compared among the three groups. RESULTS: Before surgery, there were no significant differences in pulmonary function, quality of life, and degree of pain among the three groups (p &gt; 0.05). However, after surgery, significant differences in the pairwise comparison of TLC, FVC, FEV1/FVC and RV were observed among the three groups (p &lt; 0.001), with group C indicating the highest levels of observational indicators and group A exhibiting the lowest levels. Furthermore, a significant difference was observed in the pairwise comparison of incision length, exposure time of surgical field, and intraoperative blood loss among the three groups (p &lt; 0.001). Group C had the shortest incision length, the lowest exposure time in the surgical field, and the least intraoperative blood loss, while those in group A were the opposite. After surgery, a significant difference was found in the pairwise comparison of the quality of life and degree of pain among the three groups (p &lt; 0.001). Group C had the highest quality of life and the lowest degree of pain, while Group A had the opposite results. Additionally, there was no significant difference in the incidence of complications among the three groups (p &gt; 0.05). CONCLUSIONS: The open reduction and internal fixation assisted by handheld ultrasound combined with 3D printing technology revealed effective curative outcomes in treating multiple rib fractures. This method promotes the formulation of an accurate and personalized surgical plan and seems to have high clinical significance.

Ultrasound-guided Transperineal Prostate Thermal Ablation (TPTA) for Benign Prostatic Hyperplasia: Feasibility of an Outpatient Procedure using Radiofrequency Ablation.

To evaluate the feasibility, safety, and short-term (3-month) results of transperineal prostate thermal ablation (TPTA) as a minimally invasive outpatient treatment for benign prostatic hyperplasia (BPH). A prospective nonrandomized study of 25 patients with lower urinary tract symptoms secondary to BPH seeking care at 2 interventional radiology centers between March and July 2024. TPTA was performed using a 17G radiofrequency needle with a 10-mm active tip under unconscious sedation combined with bilateral perineal and periprostatic nerve blocks. The primary outcome measure was technical success, defined as successful bilateral ablation of the prostate transition zone. Secondary outcome measures included changes of international prostate symptom score (IPSS), quality of life (QoL), prostate volume, intravesical prostatic protrusion (IPP), prostate-specific antigen (PSA), post-void residual volume (PVR), maximum urinary flow rate (Qmax), and need for BPH medical therapy at 3months relative to baseline. All procedures were technically successful (100%). The median patient age was 69.4years (IQR 54-74), and all were discharged within 3h of the end of the procedure. Sixteen patients (64.0%) were discharged without a urinary catheter, and 6 patients (24.0%) reported mild complications. At 3-month follow-up, there were significant reductions in IPSS (79.1%), QoL score (70.3%), prostate volume (36.9%), IPP (70.8%), PSA (54.7%), and PVR (51.1%), whereas Qmax increased significantly (102.3%). Twenty-four patients (96.0%) reported discontinuation of medical therapy after TPTA. Ultrasound-guided TPTA using radiofrequency ablation is feasible and safe in the outpatient setting, with significant clinical improvements after 3months of the procedure. Level 3 [non-randomized prospective cohort study].

Cyclophosphamide is not associated with clinically relevant late pulmonary dysfunction in Dutch survivors of childhood cancer - the DCCSS-LATER 2 PULM sub-study.

Treatment for childhood cancer may increase the risk of long-term pulmonary complications and dysfunction. Pulmonary surveillance is recommended after established pulmonary toxic exposures, including bleomycin, busulfan, carmustine (BCNU), lomustine (CCNU), radiotherapy to a field exposing the lungs, and pulmonary surgery. However, the role of cyclophosphamide as a pulmonary toxic agent is debated. To establish whether cyclophosphamide is associated with late pulmonary dysfunction among survivors of childhood cancer. In this multicenter Dutch Childhood Cancer Survivor Study (DCCSS)-LATER 2 PULM sub-study, we included 828 survivors with a median follow-up of 26.6 years, treated with cyclophosphamide and/or established pulmonary toxic treatment, or neither. Pulmonary function tests were used to measure the primary outcomes of diffusion impairment (diffusing capacity for carbon monoxide (DLCO) z-score), restriction (total lung capacity (TLC) z-score), and obstruction (forced expiratory volume in the first second/forced vital capacity (FEV1/FVC) z-score. Secondary outcomes comprised chronic cough, recurrent respiratory tract infections, shortness of breath, and supplemental oxygen need. Diffusion and restrictive abnormalities were highly prevalent among those treated with established pulmonary toxic treatment, with cyclophosphamide (41.0% and 50.4%, respectively) and without (34.3% and 41.9%, respectively), and occurred less frequently in survivors treated with cyclophosphamide only (12.9% and 7.3%, respectively) or in survivor controls (9.9% and 12.4%, respectively). In multivariable analyses, cyclophosphamide did not have a clinically relevant effect on the primary or secondary outcomes. This study suggests that cyclophosphamide is not associated with clinically relevant pulmonary dysfunction in long-term childhood cancer survivors.

Effect of residual lung expansion on pulmonary function after lobectomy.

Pulmonary function after lobectomy is often higher than what is predicted. This occurrence could be related to postoperative expansion of the residual lung. The study aim was to determine if residual lung expansion affects pulmonary function after lobectomy. The participants in this retrospective study were 142 patients who had undergone lobectomy via video-assisted thoracic surgery. Computed tomography and pulmonary function tests were performed preoperatively and 1year postoperatively. Three-dimensional computed tomography volumetry was performed to assess lung volumes preoperatively and postoperatively, and the predicted postoperative forced expiratory volume in 1s was calculated. The residual lung expansion ratio was defined as the postoperative-to-preoperative residual lung volume ratio, and the postoperative forced expiratory volume in 1s ratio was defined as the measured-to-predicted postoperative forced expiratory volume in 1s ratio. The effect of the residual lung expansion ratio on the postoperative forced expiratory volume in 1s ratio as well as the factors affecting the postoperative forced expiratory volume in 1s ratio were evaluated. The median residual lung expansion ratio was 1.17 (interquartile range: 1.10-1.24), and the median postoperative forced expiratory volume in 1s ratio was 1.13 (interquartile range: 1.04-1.21). The residual lung expansion ratio significantly affected postoperative forced expiratory volume in 1s ratio (p < 0.001). After lobectomy, better residual lung expansion was associated with improved postoperative pulmonary function.

GOLD grade-specific characterization of COPD in the COSYCONET multi-center trial: comparison of semiquantitative MRI and quantitative CT.

We hypothesized that semiquantitative visual scoring of lung MRI is suitable for GOLD-grade specific characterization of parenchymal and airway disease in COPD and that MRI scores correlate with quantitative CT (QCT) and pulmonary function test (PFT) parameters. Five hundred ninety-eight subjects from the COSYCONET study (median age = 67 (60-72)) at risk for COPD or with GOLD1-4 underwent PFT, same-day paired inspiratory/expiratory CT, and structural and contrast-enhanced MRI. QCT assessed total lung volume (TLV), emphysema, and air trapping by parametric response mapping (PRMEmph, PRMfSAD) and airway disease by wall percentage (WP). MRI was analyzed using a semiquantitative visual scoring system for parenchymal defects, perfusion defects, and airway abnormalities. Descriptive statistics, Spearman correlations, and ANOVA analyses were performed. TLV, PRMEmph, and MRI scores for parenchymal and perfusion defects were all higher with each GOLD grade, reflecting the extension of emphysema (all p < 0.001). Airway analysis showed the same trends with higher WP and higher MRI large airway disease scores in GOLD3 and lower WP and MRI scores in GOLD4 (p = 0.236 and p < 0.001). Regional heterogeneity was less evident on MRI, while PRMEmph and MRI perfusion defect scores were higher in the upper lobes, and WP and MRI large airway disease scores were higher in the lower lobes. MRI parenchymal and perfusion scores correlated moderately with PRMEmph (r = 0.61 and r = 0.60) and moderately with FEV1/FVC (r = -0.56). Multi-center semiquantitative MRI assessments of parenchymal and airway disease in COPD matched GOLD grade-specific imaging features on QCT and detected regional disease heterogeneity. MRI parenchymal disease scores were correlated with QCT and lung function parameters. Question Do MRI-based scores correlate with QCT and PFT parameters for GOLD-grade specific disease characterization of COPD? Findings MRI can visualize the parenchymal and airway disease features of COPD. Clinical relevance Lung MRI is suitable for GOLD-grade specific disease characterization of COPD and may serve as a radiation-free imaging modality in scientific and clinical settings, given careful consideration of its potential and limitations.

Real-time lung extraction from synthesized x-rays improves pulmonary image-guided radiotherapy.

&#xD;Lung tumors can be obscured in X-rays, preventing accurate and robust localization. To improve lung conspicuity for image-guided procedures, we isolate the lungs in the anterior-posterior (AP) X-rays using a lung extraction network (LeX-net) that virtually removes overlapping thoracic structures, including ribs, diaphragm, liver, heart, and trachea.&#xD;Approach:&#xD;73,965 thoracic 3DCTs and 106 thoracic 4DCTs were included. The 3D lung volume was extracted using an open-source lung volume segmentation model. AP digitally reconstructed radiographs (DRRs) of the full anatomy CT and extracted lungs were computed as the input and reference to train a network (LeX-net) to generate lung-extracted DRRs (LeX-net DRRs) from full anatomy DRRs, which adopted a Swin-UNet model with conditional GAN. Subsequently, the trained LeX-net on 3DCT was applied to 4DCT-derived DRRs. Lung tumor tracking was then performed on DRRs using a template-matching method on a holdoff 4DCT test set of 79 patients whose gross tumor volumes were smaller than 20 cm3.&#xD;Main results:&#xD;LeX-net successfully isolated the lungs in DRRs, achieving an SSIM of 0.9581 ± 0.0151 and a PSNR of 30.78 ± 2.50 on the testing set of 3DCT-derived DRRs. Its performance declined slightly when applied to the 4DCT but maintained useable lung-only 2D views. On the challenging test set including cases of organ overlap, high tumor mobility, and small tumor size, the individual tumor tracking error for LeX-net DRRs was 0.97 ± 0.86 mm, significantly lower than that of 3.13 ± 5.82 mm using the full anatomy DRRs. LeX-net improved success rates of using 5 mm, 3 mm, and 1 mm tracking windows from 88.1%, 80.0%, and 58.7% to 98.1%, 94.2%, and 73.8%, respectively.&#xD;Significance:&#xD;LeX-net removes overlapping anatomies and enhances visualization of the lungs in X-rays. The model trained using 3DCTs is generalizable to 4DCT-derived DRRs, achieving significantly improved tumor tracking outcome.&#xD.

Association Between Lung Parenchymal Attenuation in Computed Tomography and Airflow Limitation in Adults with Cystic Fibrosis.

Objectives: To determine the association between airflow limitation and the quantification of lung attenuation in computed tomography (CT) in adult patients with cystic fibrosis (CF). Methods: A cross-sectional study in a single center between January 2013 and December 2018 in adult patients with stable CF. We collected clinical data and the results of spirometry and plethysmography. A chest CT at inspiration and expiration, using a specific software that automatically measured the lung attenuation, was performed. Results: In total, 73 patients (63% males) were included. The mean age was 31.6 ± 12.3 years and the FEV1 was 67.8 ± 25.9% pred. An airflow limitation was found in 63%, the mean residual volume was 159.9% pred, and air trapping was observed in 50 (87.7%) of the patients. The patients with airflow limitations showed a higher bulla index and a percentage of lung voxels in the range of emphysema. The FEV1 and the FEV1/FVC correlated with the percentage of the lungs at a high attenuation value (HAV), the range of emphysema, and the bulla index at inspiration, as well as the mean lung density at expiration and the inspiratory-expiratory variation of the mean lung density (MLDi-e). Finally, in the multivariate model, the MLDi-e and the HAV at inspiration were associated with airflow limitations. Conclusions: The measurements obtained from the automated quantification of lung parenchymal attenuation predicts airflow limitation in CF.