Annals of Thoracic Medicine最新文献

Background: Standards of treatment for limited-stage small-cell lung cancer (SCLC) include chemoradiotherapy. The place of the surgery in this indication is still debated. The objective of this study was to evaluate the overall survival (OS) in patients who underwent surgery for an SCLC undiagnosed before resection in the University Hospital of Nancy, France. Secondarily, the impact of surgery on recurrence-free survival (RFS) was analyzed.

Methods: All the patients who underwent lung resection in the Department of Thoracic Surgery, from 1991 to 2018, and a diagnosis of SCLC after surgery were included. OS and RFS were analyzed according to the resection type, postoperative staging, and lymph node extension.

Results: Sixty-one patients were included. The median OS was higher in patients with lobectomy than those with pneumonectomy (26 [8.4-208.7] vs. 12 [3.4-27.6] months, P < 0.001) in stage I compared to other stages (58 [8.4-208.7] vs. 17 [3.4-83.5] months, P = 0.002), and N0-1 than N2 (25 [3.6-208.7] vs. 15 [3.4-83.5] months, P = 0.01). RFS was also significantly higher after lobectomy than after pneumonectomy (17 [1.6-184.9] vs. 8 [0.5-17.6], P < 0.001), stage I than stages II-III (35 [5-184.9] vs. 11 [0.5-42.4], P < 0.001) and N0-1 compared to N2 (25 [1.6-184.9] vs. 9 [0.5-16.5] months, P = 0.006). In multivariate analysis, the only independent factor influencing the OS was the pneumonectomy (hazard ratios = 3.19; 95% confidence interval [1.46-6.98], P = 0.004).

Conclusion: Surgical resection of stage I SCLC may lead to better OS and RFS. N1 patients should not automatically be excluded from surgery. Lobectomy with regional lymph node resection is the preferable choice of surgery.

Background: Pediatric obstructive sleep apnea (OSA) poses a significant health concern, affecting the well-being and quality of life of affected children. This study focuses on the translation, adaptation, and validation of the OSA-18 questionnaire for Arabic-speaking pediatric patients, aiming to contribute to the understanding of OSA and its implications on the quality of life in this population.

Methods: A study was conducted at Jordan University Hospital, involving 186 Arabic-speaking pediatric patients with suspected OSA. The OSA-18 questionnaire was translated and culturally adapted following the World Health Organization guidelines. Overnight polysomnography was conducted to assess OSA severity. Internal consistency, construct validity, convergent validity, and predictive/discriminant validity were analyzed.

Results: The study sample (68.8% of males, median age: 10.87) showed a median Apnea-Hypopnea Index (AHI) of 7.0, OSA-18 score of 46.5, and Pediatric Sleep Questionnaire (PSQ) score of 7.0. Internal consistency of OSA-18 was acceptable, except for the "physical symptoms" domain. Exploratory and confirmatory factor analyses revealed five factors corresponding to different OSA-18 domains. Convergent validity was supported by significant correlations between OSA-18 and PSQ scores. However, no correlation was found between OSA-18 scores and AHI. OSA severity was associated with higher PSQ scores but not with AHI.

Conclusion: This study provides valuable insights into pediatric OSA in Arabic-speaking children. While the translation and validation of the OSA-18 questionnaire demonstrated acceptable reliability and convergent validity, the lack of correlation between OSA-18 scores and AHI raises questions about the survey's ability to capture the full impact of OSA objectively. Future research should focus on developing more reliable diagnostic tools, especially in resource-limited settings.

Context: Early detection of lung cancer through screening can improve outcomes; yet public knowledge, attitudes, and practices regarding lung cancer screening in Saudi Arabia are limited.

Aims: The aim is to assess knowledge, attitudes, and practices toward lung cancer risk factors and screening, and understand the impact of demographic factors on these variables.

Settings and design: An observational cross-sectional study was conducted from October 2023 to March 2024, involving 708 participants.

Methods: A validated questionnaire from a previous Malaysian study, translated into Arabic, was distributed to participants.

Statistical analysis used: Descriptive statistics, Shapiro-Wilk test, one-way analysis of variance, Tukey's test, and logistic regression were used.

Results: Most participants (95.9%) recognized smoking as a major risk factor. Common misconceptions included viewing lung cancer as infectious (84.0%) or affecting only men (14.4%). Nonetheless, 66.4% expressed willingness for future screening. Younger participants (18-40 years) and those with higher education demonstrated better knowledge scores (mean score: 11.33 ± 2.97 for ages 18-40; 11.42 ± 2.88 for those with master's or doctorate degrees), with significant differences based on age (P = 0.007) and education level (P = 0.025). No significant differences were observed based on gender, region of residence, or monthly family income.

Conclusions: There is a positive inclination toward lung cancer screening among the Saudi public, but there are significant knowledge gaps, particularly regarding nonsmoking-related risk factors and misconceptions, suggesting a need for enhanced public education and screening programs.

Background: Sleep-disordered breathing (SDB) is characterized by upper airway dysfunction and is linked to severe health issues. Individuals with SDB have distinct craniofacial morphology for which orthodontists are most suitable for the management due to their dental expertise.

Aim: This study aims to discern key differences in dental parameters between individuals with and without SDB.

Methods: The present study is a cross-sectional observational study conducted for 12 months. Out of 70 participants, 35 were placed in the SDB group as per the Berlin questionnaire (BQ) and 35 in the control aged 18-22 years. Criteria excluded individuals with preexisting illnesses, missing teeth, tonsillectomy, orthodontic or jaw surgeries, cleft lip/palate, or craniofacial anomalies. Dental assessments included interdental width, palatal vault depth and shape, molar relation, overjet, and overbite. In addition, self-perceived orthodontic treatment needs were evaluated as a secondary measure.

Results: In the SDB group, interdental distances were significantly reduced in the canine, first premolars, second premolars, and molar regions by 2, 3, 4, and 1.8 mm, respectively. A noticeable V-shaped arch was observed. Overjet and overbite increased by 42.85% and 31.42%, respectively, with Class 1 malocclusion more prevalent than Class 2. The Berlin questionnaire identified 54.3% as high-risk SDB. The Index of Orthodontic Treatment Need-Esthetic Component (IOTN-AC) revealed that 68.6% of snoring participants required orthodontic treatment.

Conclusion: Individuals with SDB exhibit a constricted maxilla and reduced interdental measurements, indicating a moderate risk. The Berlin questionnaire proves valuable in assessing SDB severity. Moreover, individuals displaying signs of SDB often present a high prevalence of orthodontic treatment needs, as indicated by the IOTN-AC.

Aims: Primary spontaneous pneumothorax (PSP) is a sudden pleural disease predominantly affecting healthy adolescents and young adults, making it a prevalent thoracic disorder within this demographic. This study evaluated the necessity of preoperative chest tube insertion for PSP patients and reassessed current clinical practices.

Methods: We conducted a retrospective analysis of medical records for individuals aged 14-30 years diagnosed with PSP who underwent video-assisted thoracoscopic surgery (VATS) at Wonju Severance Christian Hospital from January 2016 to December 2022. Patients were categorized retrospectively into two groups based on their initial treatment: Those who had a chest tube inserted and those who did not. We collected and compared clinical data, including demographics, treatment specifics, and outcomes.

Results: The study included 128 PSP cases. There was no difference in preoperative clinical data between the two groups, and there were no differences in operation time, number of wedge resections, and number of mechanical pleurodesis. However, the use of single-port surgery was significantly higher in the nonchest tube group (P = 0.001). The nonchest tube group had a significantly shorter hospital stay (P < 0.001), attributed to the absence of preoperative chest tube insertions. There were no significant differences in postoperative complications or recurrence rates between the groups.

Conclusions: In young PSP patients, proceeding directly to VATS without prior chest tube insertion in stable individuals does not lead to serious complications or negatively affect outcomes. This approach may offer an effective alternative for PSP management.

Adult recurrence of infantile myofibromatosis is exceptional. Here, we report the case of a 23-year-old woman with a late recurrence of infantile myofibromatosis revealed by spontaneous pneumothorax. The chest computed tomography scan found both cavitary and nodular bilateral pulmonary lesions. In infancy, she had multicentric myofibromatosis with digestive, cutaneous, and bone involvement, spontaneously regressive before the age of 15 months. Histological analysis of lung samples showed identical findings as from the cutaneous biopsy performed in infancy, confirming the recurrence of infantile myofibromatosis as pulmonary metastasis. New biopsy and long-term follow-up are highly recommended in the management of such cases.

Background: Aging has been shown to have an impact on sleep patterns, necessitating a deep dive into understanding the complex relationship between aging and sleep disorders. This study aimed to assess the prevalence of sleep disorders among elderly people and identify the associations between different factors and sleep disorders in this age group.

Methods: This study was conducted at nursing homes in Jeddah. The target populations were those aged 65 years and older (geriatric group) and those aged younger than 65 years (nongeriatric group). Validated questionnaires, including the Athens Insomnia Scale, Berlin Questionnaire, Epworth Sleepiness Scale, International restless legs syndrome (RLS) Study Group, and Pittsburgh Sleep Quality Index, were used to assess different sleep disorders.

Results: A total of 313 participants were recruited in the geriatric (n = 153) and nongeriatric (n = 160) groups. Compared with the nongeriatric group, the geriatric group had greater risks of obstructive sleep apnea (OSA) (70.6%) and RLS (40.5%) (P < 0.001). Both groups had a notable prevalence of poor sleep quality (86.6%). Although insomnia was found to be common, there was no significant difference in the prevalence of insomnia between the two groups. In addition, insomnia (odds ratio [OR] = 3.04, confidence interval [CI]: 1.06-8.86, P = 0.037), OSA (OR = 3.17, CI: 1.06-9.41, P = 0.038), and high body mass index (OR = 1.76, CI: 1.63-2.9, P = 0.003) were significantly associated with poor sleep quality.

Conclusion: This study revealed that sleep disorders, particularly OSA and RLS, are common in the elderly population in Saudi Arabia.

Background: This narrative review aims to explore the current state and future perspective of artificial intelligence (AI) in respiratory care. The objective is to provide insights into the potential impact of AI in this field.

Methods: A comprehensive analysis of relevant literature and research studies was conducted to examine the applications of AI in respiratory care and identify areas of advancement. The analysis included studies on remote monitoring, early detection, smart ventilation systems, and collaborative decision-making.

Results: The obtained results highlight the transformative potential of AI in respiratory care. AI algorithms have shown promising capabilities in enabling tailored treatment plans based on patient-specific data. Remote monitoring using AI-powered devices allows for real-time feedback to health-care providers, enhancing patient care. AI algorithms have also demonstrated the ability to detect respiratory conditions at an early stage, leading to timely interventions and improved outcomes. Moreover, AI can optimize mechanical ventilation through continuous monitoring, enhancing patient comfort and reducing complications. Collaborative AI systems have the potential to augment the expertise of health-care professionals, leading to more accurate diagnoses and effective treatment strategies.

Conclusion: By improving diagnosis, AI has the potential to revolutionize respiratory care, treatment planning, and patient monitoring. While challenges and ethical considerations remain, the transformative impact of AI in this domain cannot be overstated. By leveraging the advancements and insights from this narrative review, health-care professionals and researchers can continue to harness the power of AI to improve patient outcomes and enhance respiratory care practices.

Improvements: Based on the findings, future research should focus on refining AI algorithms to enhance their accuracy, reliability, and interpretability. In addition, attention should be given to addressing ethical considerations, ensuring data privacy, and establishing regulatory frameworks to govern the responsible implementation of AI in respiratory care.