Annals of Thoracic Medicine最新文献

Background: We developed an artificial intelligence (AI) model to predict the severity of obstructive sleep apnea syndrome (OSAS).

Methods: We used data from 750 inpatients at a research hospital between 2021 and 2023. The dataset comprises 20 attributes, including demographic information, medical history, anthropometric measurements, and polysomnography (PSG) data. The target attribute was the apnea-hypopnea Index (AHI), from which OSAS severity was determined. Data preprocessing included min-max scaling for normalization and the Synthetic Minority Over-sampling Technique algorithm to address the class imbalance, increasing the dataset size to 1250. We invented and further developed a multilayer artificial neural network (ANN) model to predict OSAS severity and evaluated its performance using k-fold cross-validation. We also performed an information gain analysis to rank the features by importance.

Results: The ANN model accurately predicted OSAS severity (area under the receiver operating characteristic curve: 0.966, CA: 0.880). Information gain analysis revealed strong associations between OSAS severity and the Epworth Sleepiness Scale, lowest nighttime oxygen saturation, percentage of sleep time with oxygen saturation between 80% and 90% during the night, and neck thickness. These identified features represent important risk factors for early OSAS diagnosis and treatment.

Conclusion: Our findings suggest that AI-based models can effectively predict OSAS severity. This research may contribute to the development of next-generation diagnostic tools for OSAS diagnosis and risk assessment. AI can readily determine OSAS severity from overnight pulse oximetry recordings, combined with other risk factors, in patients with suspected OSAS.

Background: Repair of long-segment tracheal defects remains a challenge worldwide. In this study, we proposed a new strategy for tracheal reconstruction and verified the feasibility of this strategy in a canine model of tracheal defects.

Methods: An external airway splint was designed and fabricated using three-dimensional (3D) printing. The skin flap was rotated as a tube and suspended by an external airway splint to construct tracheal substitutes. In vitro, the tracheal substitutes were tested under a negative pressure gradient (-10 mmHg, -20 mmHg, and -30 mmHg). In vivo, nine canines conducted long-segment tracheal resection (5 cm) and reconstructed. Quality of life was evaluated using the Westley clinical croup scale, and radiography was performed to evaluate the patency of the trachea.

Results: Three kinds of "C" shape external splint with different opening distances (5 mm, 10 mm, and 15 mm) were designed and fabricated. In vivo, with a C5 mm tracheal substitute, all canines' tracheal lumen recovered patency postoperation and canines can move normally immediately. The median survival time of all canines was 41 days. Radiography showed that the degree of patency was more than 40% at 4 weeks postoperatively. The main reason for tracheal obstruction was the growth of fur rather than granulation tissue. Histological examination indicated that the skin flaps had excellent viability, with extensive vascularization.

Conclusion: The "C" shape external airway splint could prevent the skin flap from collapsing without the need for an internal tracheal stent, indicating that 3D printed C-shape external airway splint composite skin flap may be a promising method for tracheal reconstruction.

Background: Midwakh smoking is the second most widely used form of smoking in the United Arab Emirates predominantly among adults. Despite high prevalence, there is a lack of scientific data on plasma nicotine after a single midwakh session and its effect on cardiopulmonary function. This study assessed the acute effects of midwakh smoking on plasma nicotine levels and cardiopulmonary function after a single session.

Methods: Among 211 midwakh smokers who visited the Sleep Disorders Specialized Clinic, 9 (nine) agreed to participate in the study. Blood samples were collected before and after smoking (5 min) to determine the nicotine and cotinine levels using mass spectroscopy. Anthropometric data, smoking details, physiological parameters, heart rate variability (HRV), spirometry, and forced oscillation technique were measured pre- and post-smoking.

Results: The mean age of the participants was 35.2 (10.2) years, and they started midwakh smoking at 20.33 (8.5) years. Plasma nicotine levels significantly increased from 14.67 (9.73) to 28.18 (12.92) ng/ml from baseline to postsmoking (P = 0.004). Plasma cotinine levels significantly decreased from 303.06 (141.87) to 281.16 (119.37) ng/ml (P < 0.001). Significant changes were observed in all physiological parameters (P < 0.001) pre-vs. postsmoking. HRV parameters including parasympathetic and sympathetic indices, showed pre- and post-smoking (P < 0.001). There were also significant changes in FVC, FEV1, and FEF _(25-75); P < 0.001, parameters pre- and postsmoking.

Conclusion: This study involving a small sample demonstrates changes in blood nicotine and cotinine levels and differences in cardiopulmonary function among midwakh smokers; however, findings should be interpreted with caution due to limited generalizability.

The effectiveness and clinical significance of respiratory muscle training for chronic obstructive pulmonary disease (COPD) patients remain controversial. Our aim is to systematically review and conduct a meta analysis on the impact of respiratory muscle training on the clinical outcomes of patients with COPD. We systematically searched electronic databases (PubMed, Web of Science, Cochrane Library, and Embase) for randomized controlled trials evaluating the effects of respiratory muscle training on clinical outcomes in COPD patients. We utilized fixed or random effects models to assess the impact of respiratory muscle training on the 6 min walk test (6MWT), dyspnea, pulmonary function, respiratory muscle strength, and quality of life (QOL). Thirteen studies met the inclusion criteria for this review, involving 1178 COPD patients, of whom 588 completed respiratory muscle training. Meta analysis results indicated that respiratory muscle training significantly improved 6MWT (mean difference [MD]: 17.99; 95% confidence interval [CI]: 3.73, 32.26), dyspnea (standardized MD [SMD]: -0.81; 95% CI: -1.28, -0.34), forced expiratory volume in 1 s (FEV1; MD: 0.09; 95% CI: 0.02, 0.17), forced vital capacity (FVC; MD: 0.13; 95% CI: 0.03, 0.23), maximum inspiratory pressure (MD: 14.43; 95% CI: 8.71, 20.14), maximal expiratory pressure (MD: 15.06; 95% CI: 5.69, 24.43), and QOL (SMD: -0.77; 95% CI: -1.43, -0.11). However, no significant effect of respiratory muscle training on FEV1 /FVC was found (MD: 1.22; 95% CI: -1.61, 4.06). Respiratory muscle training is a positive intervention for improving exercise tolerance, pulmonary function, respiratory muscle strength, and QOL in COPD patients. Further high quality studies are needed to validate the findings of this review.

Aortic dissection is a life-threatening condition that often presents with acute chest pain; Misdiagnosis can lead to delayed management and potentially fatal outcomes. This case report aims to highlight a rare instance involving a 40-year-old male patient who initially sought care at a spine clinic for his severe mid-back pain (MBP). His condition had worsened over the past 24 h, ultimately leading to a diagnosis of Stanford type B aortic dissection. The initial evaluation included physical examination and imaging studies focused on the musculoskeletal origin of the pain. However, as the patient's pain persisted despite conservative management, further investigations were pursued. Computed tomography angiography of the thoracic aorta revealed a Stanford type B aortic dissection that encompasses the ascending aorta and extends into the abdominal aorta. It involved the true lumen and resulted in significant compression of the spinal cord at the thoracic level, explaining the patient's MBP. This case underscores the importance of exploring various diagnostic options and collaborating with other specialists.

Community-acquired pneumonia (CAP) is a major cause of morbidity and mortality in children and adults. The burden is especially high among older adults and those with comorbidities. It is also the leading cause of hospital admissions during the annual Islamic pilgrimage (Hajj). CAP is a heterogeneous illness, varying in both etiology and clinical course across different patients. The Saudi Thoracic Society (STS) has developed evidence-based guidelines for the diagnosis, management, and prevention of CAP in both adult and pediatric populations in Saudi Arabia. This is the first guideline of its kind to combine both patient populations in one guideline. Although data on various aspects of CAP - especially within Saudi Arabia - remain limited, the task force based its recommendations on the best available evidence and a structured voting process to answer preset clinical questions. Main highlights from the guidelines include that routine complete blood count may assist in guiding management, particularly in severe disease, while acute-phase reactants (C-reactive protein, procalcitonin) are not recommended at initial diagnosis but may be useful if patients fail to improve. Blood cultures and sputum Gram stain/culture should not be routinely performed, except in severe or deteriorating cases or in hospitalized patients. Respiratory testing for viral pathogens and atypical bacteria is suggested when clinically indicated, especially during outbreaks or in high-risk groups. Chest radiography is recommended in adults and hospitalized children. Short-course antibiotic therapy is favored for improving patients, with early transition from intravenous to oral therapy when hospitalized. Macrolides are preferred over fluoroquinolones in outpatients, while combination beta-lactam plus macrolide therapy is recommended for inpatients. Preventive measures, particularly vaccination, are strongly endorsed. Special considerations apply to elderly, pregnant, chronic obstructive pulmonary disease, and immunocompromised patients. Corticosteroids may benefit select severe cases but are not recommended routinely. These guidelines are intended primarily for general practitioners, emergency physicians, pediatricians, and internal medicine specialists. To enhance accessibility and implementation, STS has simplified the guidelines and provided an executive summary of the key recommendations.

Background: Asthma and chronic obstructive pulmonary disease (COPD) contribute significantly to the global respiratory disease burden, with treatment adherence and nocturnal symptom control remaining key challenges. The Tulobuterol Transdermal Patch (Tuloplast™) provides continuous 24-h drug release, potentially improving adherence and symptom management. This Phase-IV clinical study evaluated its safety, tolerability, and efficacy in patients with asthma and COPD.

Methods: This multicentric, open-label Phase-IV trial enrolled 300 patients (189 asthma, 111 COPD) across seven Indian centers. Patients received Tuloplast™ in age-appropriate doses for 4-6 weeks. Primary endpoints included safety and tolerability, assessed by adverse events, global ratings, and rescue medication use. Efficacy (secondary endpoint) was evaluated through symptom severity (GINA/GOLD criteria) and pulmonary function (peak expiratory flow [PEF], forced expiratory volume in 1 second [FEV₁], forced vital capacity [FVC]), with statistical significance determined using paired t-tests.

Results: Only one patient (0.3%) reported an adverse event (mild swelling), with no serious safety concerns. At Day 28, 51.9% of asthma patients and 79.3% of COPD patients rated tolerability as "good," while 43.9% and 12.6%, respectively, rated it "excellent." Significant reductions in symptom severity were observed in asthma (P < 0.0001) and COPD patients (P < 0.0001), particularly for nocturnal symptoms (-74.88% for COPD, and -82.79% and -77.29% for pediatric and adolescent patients, respectively). Pulmonary function parameters (PEF, FEV₁, FVC) improved significantly in both groups (P < 0.0001).

Conclusion: Tuloplast™ demonstrated excellent safety, tolerability, and efficacy in improving symptom control and lung function. Its once-daily application enhances adherence, making it a promising alternative for asthma and COPD management.

Background: Incentive spirometry (IS) is a cost-effective, easy-to-use, and accessible device used peri-postoperative period for prevention or management of complications via maintaining maximum inhalation and open collapsed alveoli and resolving atelectasis. Although early pulmonary rehabilitation (PR) is known to reduce the length of stay (LOS), it is controversial whether the addition of IS provides a further contribution. This study aimed to investigate whether using IS in addition to early PR in patients with chronic obstructive pulmonary disease (COPD) exacerbation reduces LOS and whether it is a safe technique by assessing hemodynamic responses.

Methods: One hundred thirty patients with acute exacerbation of COPD (AECOPD) during hospitalization were randomized to an early PR group and an additional IS group (PR + IS). LOS (days), pre-, and postsession hemodynamic responses were recorded.

Results: The LOS was significantly lower in the PR + IS (5.34 days) group than in the PR group (7.17 days) (P = 0.026). Changes in respiratory rate (breaths/min) and oxygen saturation (%) were within the well-tolerated interval in both groups and there was a statistically significant difference in the PR + IS group (P < 0.001). Other hemodynamic changes were also within well-tolerated intervals, with no statistically significant differences between the groups (P > 0.05).

Conclusion: The usage of IS in addition to early PR in patients with AECOPD reduced LOS by approximately 1 day compared to PR alone. Furthermore, no significant signs of intolerance were observed, suggesting that IS was well-tolerated, similar to PR alone.

Background: For the early detection and prevention of lung cancer, it is critical to know how smokers are aware of warning signs, symptoms, and risk factors for this disease.

Methods: A cross-sectional study was conducted in Saudi Arabia to evaluate the smokers' awareness of lung cancer's signs, symptoms, and risk factors.

Results: Only 54% of smokers recruited (n = 1317) were aware of lung cancer symptoms with 56% of smokers expressing low confidence in recognizing them. The commonly missed symptoms include persistent shoulder pain (38%), prolonged cough (49%), and finger shape changes (49%). Around 73% were aware of lung cancer risk factors and the top known risk factors were smoking (75%), radon gas (65%), and air pollution (57%). Male and light smokers had higher knowledge scores of lung cancer signs and symptoms compared to female and heavy smokers (7.82 ± 4.0 vs. 6.34 ±2.9, P < 0.001, and 7.66 ± 3.9 vs 6.98 ± 4.0, P = 0.023, respectively). Furthermore, male and light smokers had significantly greater lung cancer awareness of risk factors than female and heavy smokers (P < 0.001). A significant positive correlation exists between the identifying signs and symptoms and knowing lung cancer risk factors (r = 0.71, P < 0.001).

Conclusion: Heavy smokers are more likely to be unaware of lung cancer warning signs, symptoms, and risk factors than light smokers. Over 55% of smokers lacked confidence in recognizing lung cancer symptoms. Public health measures should address the specific needs of heavy and light smokers, including tailored health education initiatives considering regional and social support differences.

Background: Spirometry is one of the basic methods used in the diagnosis, treatment, and follow-up of respiratory disease. Spirometric test results that do not comply with international standards may be misinterpreted and lead to misdiagnosis and treatment. We aimed to assess the tests of patients that meet the "American Thoracic Society/European Respiratory Society (ATS/ERS) 2019" recommendations, to identify the most common errors, and to explore patient characteristics possibly associated with failure to reach these standards.

Methods: A total of 1000 spirometries performed between January and December 2023 were randomly selected retrospectively. Spirometric maneuvers were evaluated for meeting the acceptability criteria of the ATS/ERS 2019 guidelines.

Results: The acceptability spirometry rate was 62.5%. The most frequently unmet criterion was failure to meet any of the three ends of forced expiration at 20.7%. There was no significant difference between male and female in terms of the acceptability of maneuvers. The 45-59 and 60-74 age groups were statistically more significant than the younger and older. Smoking, diagnosis of chronic obstructive pulmonary disease, and number of spirometry practices were significantly associated with conformity to test acceptability criteria. The forced expiratory volume in 1 second (FEV1) divided by the forced vital capacity, FEV1, and forced expiratory times had a statistically significant independent effect on the acceptability of spirometric maneuvers.

Conclusion: Nearly one-third of the tests performed by an experienced technician in a tertiary care hospital did not meet the acceptability criteria. Our study shows the importance of the learnability of maneuvers through repeated spirometry experiences.