Yedikule Hospital for Chest Disease and Thoracic Surgery

Background Polysomnography (PSG) is resource-intensive but remains the gold standard for diagnosing Obstructive Sleep Apnea (OSA). We aimed to develop a screening tool to better allocate resources by identifying individuals at higher risk for OSA, overcoming limitations of current tools that may under-diagnose based on self-reported symptoms. Methods A total of 884 patients (490 diagnosed with OSA) were included, which was divided into the training, validation, and test sets. Using multivariate logistic regression analyses, we developed a scoring system incorporating male sex, age, sawtooth pattern, area under the inspiratory flow-volume curve (AreaFI), and neck circumference to objectively identify patients at higher risk of OSA. Sensitivity and specificity were evaluated using area under the curve (AUC) metrics. The M-APNE Score was compared to other non-symptom-based tools, the No-Apnea Score and the Symptomless Multivariable Apnea Prediction (sMVAP) model, using the Delong test. Results The M-APNE Score showed sensitivity rates of 79.3% in the training set, 70.8% in the test, and 80% in the validation set. ROC analysis for M-APNE score yielded AUCs of 0.82 in the training, 0.76 in the test, 0.82 in the validation set. The discriminative accuracy of M-APNE Score were found to be better than the No-Apnea Score (AUC = 0.82 vs. 0.76, p < 0.001) and the sMVAP (AUC = 0.82 vs. 0.75, p = 0.001) in the training set. Hosmer Lemeshow test indicated good calibration for M-Apne Score (p = 0.46). Conclusions The M-APNE Score is a robust and objective tool for OSA screening, potentially reducing classification errors and improving accuracy.

Background and aim Lung cancer is one of the significant comorbidities seen in patients with Idiopathic Pulmonary Fibrosis (IPF). However, there is limited data on non-IPF Pulmonary Fibrosis (PF) patients with lung cancer (LC). The present study aims to compare the characteristics and survival outcomes of patients diagnosed with LC in IPF and non-IPF PF. Methods The multicenter data records of IPF and non-IPF PF patients diagnosed with lung cancer between 2010-2022 were analyzed in this descriptive, cross-sectional, and retrospective study. Results Of the 251 patients involved in this study [164 IPF-LC, 87 non-IPF PF-LC], 89.6% were male, the mean age was 69±7.9 years and the smoking rate was 85.7%. Honeycomb pattern was more frequently observed in IPF-LC patients [62.8%,37.9%p<0.001], whereas ground-glass opacity [33.5%,59.8%p<0.001] and emphysema [37.8%,59.8%p<0.001] were more frequently seen in non-IPF PF-LC patients. The most commonly seen histological type was squamous cell carcinoma [42.7%,33.9%], followed by adenocarcinoma [28.2%; 32.2%]. [46.4%;47.2%] and their 5-year mortality rates were high [64.6%, 63.2%]. The median survival for both groups was 2±0.22 years [median 95% CI (1.55-2.44)]. The shortest survival time was observed in non-IPF PF-LC subgroup with unclassified PF [1±0.253 years median 95% CI (0.50-1.49) (p=0.030)]. Conclusions The majority of IPF and non-IPF PF LC patients were male, elderly, and had a high smoking rate. Squamous cell carcinoma was the most frequently seen histological type and they had short survival periods and high mortality rates. The survival period of unclassified non-IPF PF-LC patients was found to be the shortest.

Pulmonary amyloidosis is an extremely rare disease, often detected incidentally because of its asymptomatic nature and potential to result in fatal outcomes. In this study, we aimed to present the clinical and radiological features of patients diagnosed with pulmonary amyloidosis by biopsy. This descriptive study included 21 patients with pathologically diagnosed pulmonary amyloidosis. Pulmonary amyloidosis was classified as diffuse alveolar-septal amyloidosis (DASA), cystic amyloidosis (CPA), tracheobronchial amyloidosis (TBA), nodular amyloidosis (NPA), and extraparenchymal pulmonary amyloidosis (pleural and mediastinal lymph node). Clinical, bronchoscopic, and radiological specific characteristics were presented in detail to be used for differential diagnosis. The median age of the patients was 63 (40–83) years, and 14 (66.7%) were male. Twenty patients (95.2%) presented with at least 1 comorbidity. All patients diagnosed with tracheobronchial amyloidosis were symptomatic at presentation, whereas those diagnosed with NPA/extraparenchymal amyloidosis were often asymptomatic. The patients included 1 case of DASA, 1 case of CPA, 10 cases of NPA, 6 cases of TBA, and 3 cases of extraparenchymal amyloidosis involving the mediastinal lymph node and pleura. Sixteen patients (76.2%) were classified as localized amyloidosis, while 5 patients (23.8%) were classified as systemic amyloidosis following the diagnosis of multiple myeloma, monoclonal gammopathy of undetermined significance, systemic lupus erythematosus, Sjogren’s syndrome, and B-cell lymphoma. Bronchoscopic biopsies were sufficient for diagnosis, and notably, even transbronchial needle aspiration could be a useful diagnostic method. During the follow-up, we observed that the disease remained stable without progression. However, it is important to note that patients with concurrent malignancies experience fatal outcomes. In conclusion, it is crucial to distinguish pulmonary amyloidosis from other pulmonary diseases such as malignancies, infectious diseases, and interstitial lung diseases, which may have similar clinical and radiological findings. Bronchoscopic diagnostic methods are usually sufficient for the diagnosis. Although patients with pulmonary involvement mostly remain stable during long-term follow-up without progression, it is important to consider the risk of malignancy.

There is currently no effective treatment strategy for recurrent/metastatic adenoid cystic carcinoma (R/M ACC). Furthermore, recent single-agent and combination immunotherapy trials have failed in unselected ACC cohorts, unlike non-ACC salivary gland cancers. Genomic profiling revealed no actionable targets but NOTCH1 and KDM6A frameshift and CTCF splice site mutations (no MYB/L fusion) with a low tumor mutational burden (TMB), microsatellite stable (MSS) and negative programmed death ligand 1 (PD-L1) were observed. We recommended an anti-programmed cell death protein 1 (anti-PD-1) plus anti-Cytotoxic T-lymphocyte-associated protein 4 (anti-CTLA-4) combination based on TMB 2-fold greater-than-median TMB in ACC, tumor harboring multiple immunogenic frameshift or splice site mutations, and PD-L1 negativity. Accordingly, we achieved a complete response in a radiotherapy (RT) and chemotherapy (CT)-refractory patient with locally recurrent lacrimal gland (LG) ACC and lung metastasis following personalized immunotherapy in combination with integrative therapeutics. Therefore, it is crucial to assess not only conventional immune biomarkers but also patient-specific parameters, especially in “immune-cold” cancer types.

Lung diseases have profound effects on the aging population. We aimed to hypothesize and investigate the effect of remote pulmonary telerehabilitation and motor imagery (MI) and action observation (AO) methods on the clinical status of elderly chronic obstructive pulmonary disease (COPD) patients. Twenty-six patients were randomly assigned to pulmonary telerehabilitation (PtR) or cognitive telerehabilitation (CtR) groups. The programs were carried out 3 days a week for 8 weeks. The 6-min walk test (6MWT), modified Medical Research Council dyspnea score, blood lactate level (BLL), measurement of peripheral muscle strength (PMS), and electromyography activation levels of accessory respiratory muscles were the main outcomes. There was a statistically significant improvement (p < 0.05) in both groups in the 6MWT distance and in secondary results, except for BLL. Generally, in the mean muscle activity obtained from the electromyography measurement after the program, there were statistically significant increases in the PtR group and decreases in the CtR group (p < 0.05). There was a statistically significant increase in PMS in both groups. An active muscle-strengthening program has the same benefits as applying the muscle-strengthening program to the patient as MI and AO. CtR can be a powerful alternative rehabilitation method in respiratory patients who cannot tolerate active exercise programs.

The aim of the study was investigate the effect of corticosteroid use on the need for invasive procedure like tube thoracostomy with underwater seal drainage (TT-UWSD) and Video Assisted Thoracoscopic Surgery (VATS) in adult patients diagnosed with parapneumonic effussion in the exudative phase. A retrospective cohort study was performed in a chest diseases hospital. A total of 65 patients were included in the study. While 30 patients received only medical treatment, 35 patients underwent invasive procedures. Data on characteristics, vital signs, and laboratory parameters were recorded from electronic medical records. Univariate and multivariate logistic regression analyses were performed to identify corticosteroid and other predictors of the need for invasive procedures. The outcomes of the multivariate regression analysis revealed that an longer duration of symptoms (OR = 1.10, 95% CI: 1.01-1.21, P < .033) and the presence of dyspnea (OR = 5.44, 95% CI: 1.26-23.50, P < .023) independently associated with an increased need for invasive procedures, while corticosteroid treatment (OR = 0.15, 95% CI: 0.02-0.81, P < .028) was observed to be associated with a reduced necessity for invasive procedures. Treatment with metilprednisolone, together with the absence of dyspnea and shorter symptom duration may independently decrease the need for invasive procedure in patients with parapneumonic pleural effusion in the exudative phase. Abbreviations: AUC = area under the ROC curve, CI = confidence interval, CRP = C-reactive protein, Dl = deciliter, INR = international normalized ratio, IQR = interquartile range, LDH = lactate dehydrogenase, OR = odds ratio, pH = power of hydrogen, PPE = parapneumonic effusion, ROC = receiver operating characteristic, TT-UWSD = tube thoracostomy with underwater seal drainage, VATS = Video Assisted Thoracoscopic Surgery.

Background Chronic obstructive pulmonary disease (COPD) is a common, preventable, and treatable disease. Despite optimal medical therapy and pulmonary rehabilitation, bronchoscopic and surgical lung volume reduction may still be necessary. Identifying the target lobe is crucial for the success of these treatments. This study aims to compare the role of quantitative planar lung perfusion scintigraphy (QPLPS) with quantitative lung computed tomography (StratX®), which is used in identifying the target lobe before the Zephyr® endobronchial valve (EBV) placement in patients with the emphysematous phenotype of advanced COPD. Methods A single-center retrospective cross-sectional study was performed in the Department of Pulmonology at the University of Health Sciences Turkey, Yedikule Chest Diseases and Thoracic Surgery Education and Research Hospital between June 2019 and June 2022. The study included 46 patients with the emphysematous phenotype of advanced COPD, who were all candidates for Zephyr® EBV therapy. The target lobes were assessed using the QPLPS and StratX® and the agreement between the methods was analyzed by the Kappa statistic method. Additionally, demographic characteristics, respiratory function tests, distributions of emphysema, and 6-minute walk test results of patients were recorded. Results The median age was 67 (42–80) years and 42 (91.3%) were male. In QPLPS, the perfusion percentages were 7.47%±3.31%, 9.59%±2.67%, and 13.32%±2.59% for the 1st, 2nd and 3rd target lobes, respectively while in StratX®, the voxel densities were 68.28%±9.16%, 63.79%±7.42%, and 60.69%±5.35%. In StratX®, the fissure integrity (FI) at the target lobe was 76.25%±21.18%, 84.68%±17.67%, and 86.19%±13.19%, respectively. There was a significant agreement between the methods in identifying the first, second, and third target lobes in all patients (Kappa coefficient: 0.897, 0.700, and 0.522), and also in identifying the first and second target lobes in patients with heterogeneous (Kappa coefficient: 0.879, and 0.735), and homogeneous subgroups (Kappa coefficient: 0.919, and 0.672). Conclusions There is an agreement between QPLPS and StratX® in identifying the target lobe in patients with severe emphysema, including those with homogeneous diseases. However, StratX® may be preferred, considering that it also predicts FI.

Inflammatory myofibroblastic tumors (IMTs) are rare benign mesenchymal tumors that present diagnostic challenges due to their diverse clinical and radiological manifestations. We present a case of a 19-year-old female with a history of intermittent hemoptysis. Imaging studies suggested a mediobasal lung lesion, prompting further evaluation. Bronchoscopy revealed vascular changes, and PET imaging indicated high metabolic activity. A left lower lobectomy was performed for diagnostic and therapeutic purposes, confirming the diagnosis of IMT characterized by spindle cell proliferation and inflammatory infiltrates. Surgical resection remains the cornerstone treatment, offering favorable outcomes with rare recurrence. Follow-up underscores the importance of monitoring and assessing prognostic factors to optimize patient management.

Objective This study aimed to establish normative values for maximum inspiratory pressure and maximal expiratory pressure in the Turkish population while creating specific equations to calculate these values. Material and Methods The study involved 219 healthy adults, with a minimum of 50 individuals in specific age ranges: 20–29, 30–39, 40–49, and 50–60 years. Each age group comprised at least 25 males and 25 females. Participants were required to be free from health conditions influencing respiratory muscle strength and non-smokers. Measurements of maximum inspiratory pressure and maximal expiratory pressure were recorded for all participants. Results As a result of the regression analysis performed for the maximum inspiratory pressure values, the model P value was < .001, and the R ² value was found to be 0.261. The equation obtained as a result of the model was: 82.583 − 3.218 × gender − 0.093 × age + 9.534 × height + 0.343 × weight. As a result of the regression analysis performed for maximal expiratory pressure values, the model P value was <.001, and the R2 value was found to be 0.285. The equation obtained as a result of the model was: 157.165 − 35.522 × gender − 0.271 × age–42.036 × height + 0.787 × weight. Conclusions The newly developed equations offer valuable tools for evaluating respiratory muscle strength in the Turkish population. These results confirm the importance of using maximum inspiratory pressure and maximal expiratory pressure to monitor changes in each patient, while also emphasizing the necessity of reliable reference equations.

Background Mortality predictors in obstructive sleep apnea (OSA) patients yet to be comprehensively understood, especially within large cohorts undergoing long-term follow-up. We aimed to determine the independent predictors of mortality in OSA patients. Methods In our retrospective cohort study, 3,541 patients were included and survival data was obtained from electronic medical records. Demographic characteristics, anthropometric measurements, comorbidities, laboratory tests, and polysomnography parameters were analyzed for the survived and deceased patient groups. Univariate and multivariate Cox regression analyses were performed to determine independent predictors of all-cause mortality in patients followed for at least 5 years. Results Among all patients, 2,551 (72%) patients were male, with a mean age of 49.7 years. 231 (6.5%) patients had died. Deceased patients were significantly older and had higher waist-to-hip ratio and Epworth Sleepiness Scale (p < 0.001, p < 0.001, p = 0.003). OSA (nonpositional and not-rapid eye movement-related), periodic limb movements in sleep and Comorbidities of Sleep Apnea Score ≥ 1 were found to be associated with increased mortality (p < 0.001). Systemic immune-inflammation index was also significantly higher in the deceased group (p < 0.001). Higher oxygen desaturation index (ODI) and apnea-hypopnea index (AHI) were associated with increased mortality (p < 0.001). Due to the high correlation between ODI and AHI, two separate multivariate Cox regression models were created. While AHI lost its significance in the multivariate analysis, ODI remained significantly higher in the deceased patient group (HR = 1.007, 1.001–1.013, p = 0.01). Conclusion ODI, as the only polysomnography parameter, emerged as an independent predictor of mortality in OSA patients.

Background: Radiotherapy is a widely used treatment method in oncology, applied by delivering high-energy particles or waves to the tumor tissue. Although tumor cells are targeted with radiotherapy, it can cause acute or long-term damage to healthy tissues. Therefore, the preservation of healthy tissues has been an important subject of various scientific researches. Melatonin has been shown to have a radioprotective effect on many tissues and organs such as liver, parotid gland, brain, and testicles. This study aimed to evaluate the protective effect of melatonin against the radiation at various doses and rates administered to the lung tissue of healthy mice. Methods: This study was a randomized case-control study conducted with 80 rats comprising 10 groups with eight animals per group. Of the 10 groups, first is the control group, which is not given any melatonin, and second is the group that does not receive RT, which is given only melatonin, and the other eight groups are RT groups, four with melatonin and four without melatonin. Results: There was no statistical difference in terms of histopathological findings in the lung tissue between the second group, which did not receive radiotherapy and received only melatonin, and the control group. Lung damage due to radiotherapy was statistically significantly higher in the groups that did not receive melatonin compared to the groups that received melatonin. Conclusions: This study revealed that melatonin has a protective effect against the cytotoxic damage of RT in rats receiving RT.

Introduction Alpha-1 antitrypsin (AAT) deficiency, characterized by reduced synthesis of a serine protease inhibitor in liver cells, has been recognized to contribute to the development of emphysema and liver disease. Additional clinical manifestations encompassing respiratory disorders and dermatological issues have also been documented. Case A 56-year-old male patient presented with dyspnea. Despite being a non-smoker, he had a diagnosis of chronic obstructive pulmonary disease (COPD) five years ago. Utilizing inhaled corticosteroids (ICSs) - long-acting β2-agonists (LABAs)- long-acting muscarinic antagonists (LAMAs) inhalers, the patient's medical treatment had ceased for the past four months due to inhaler depletion. High-resolution thoracic computed tomography unveiled bilateral emphysematous regions, predominantly located in the lower pulmonary lobes. In light of the absence of smoking history, the suspicion of AAT deficiency was raised, prompting the assessment of serum AAT levels. Subsequent analysis indicated diminished AAT levels, prompting the collection of a dried blood sample for genetic evaluation. Genomic DNA amplification was performed using polymerase chain reaction (PCR), succeeded by allele-specific hybridization via Luminex XMAP Technology. This analysis disclosed a Q0amersfoort (Exon 2 Y160TAC > Ter TAG) (+/+) variant linked with AAT deficiency, originating from a frame-shift mutation that triggers a null (Q0amersfoort) stop codon. Conclusion The presentation of COPD-related emphysema in a non-smoker underscores the necessity to consider AAT deficiency in the differential diagnosis.

Objectives The burden of metastatic lymph node (LN) stations might reflect a distinct N subcategory with a more aggressive biology and behaviour than the traditional N classification. Methods Between 2008 and 2018, we analyzed 1236 patients with pN1/2 lung cancer. Survival was analyzed based on LN station metastasis, determining the optimal threshold for the number of metastatic LN stations that provided additional prognostic information. N prognostic subgrouping was performed using thresholds for the number of metastatic LN stations with the maximum chi-square log-rank value, and validated at each pT-stage. Results Survival showed stepwise statistical deterioration with an increase in the number of metastatic LN stations., Threshold values for the number of metastatic LN stations were determined and N prognostic subgroupswas created as sN-alpha; one LN station metastases (n = 632), sN-beta; two-three LN stations metastases (n = 505), and sN-gamma; ≥4 LN stations metastasis (n = 99). The 5-year survival rate was 57.7% for sN-alpha, 39.2% for sN-beta, and 12.7% for sN-gamma (chi-square log rank = 97.906, p < 0.001). A clear tendency of survival deterioration was observed from sN-alpha to sN-gamma in the same pT stage, except for pT4 stage. Multivariate analysis showed that age (p < 0.001), sex (p = 0.002), tumour histology (p < 0.001), IASLC-proposed N subclassification (p < 0.001), and sN prognostic subgroups (p < 0.001) were independent risk factors for survival. Conclusion The burden of metastatic LN stations is an independent prognostic factor for survival in patients with lung cancer. It could provide additional prognostic information to the N classification.

Background Interstitial lung disease (ILD) encompasses a wide variety of parenchymal lung pathologies with different clinical, histological, radiological and serological features. In terms of diagnosis and the proper selection of treatment, the key point is to know the underlying ethiology, Rheumatic diseases are a systemic inflammatory group of diseases that affect all organs and systems, including the lung. Although such diseases show up by different symptoms such as arthritis, pleuritis, photosensitivity, constitutional symptoms, raynoud’s phenomenon, sicca, musculoskeletal weakness present the diseases, from months to years ago before these symptoms disease may show-up itself by isolated pulmonary involment. Objectives In this study, we aimed to identify both underlying rheumatological diseases and interstitial pneumania with autoimmune features (IPAF) in newly diagnosed ILD patients and thus to increase awareness. Methods Data of 215 patients with newly diagnosed ILD who were evaluated by a pulmonologist and referred to the rheumatology clinic were included in the study. All patients evaluated by both pulmonologist and rheumatologist with history, physical examination, blood tests, pulmonary function tests, serological tests, high-resolution computed tomography (HRCT) and biopsies, if needed. Results Within this study, ILD diagnosed patients includes 90 woman and 125 men with and average age of 62 were evaluated (SD: 11.27). 22 of 215 (10.2 %) patients were diagnosed with specific rheumatologic disease (2.7% rheumatoid arthritis, 1.86 % sjogren syndrome, 2.3% microscopic polyangiitis, 0.9 % systemic sclerosis, 0.4% granulomatosis with polyangiitis, 0.4% systemic lupus erythematosus 1.4 % idiopathic inflammatory myopathies).Rheumatological assesments showed that in 42,3% of them interstitial pneumania with autoimmune features (IPAF) were detected. As a result of our study we have also diagnosed non-specific interstitial pneumonia (NSIP) in 67.9% patients where 48,6% of them were cellular NSIP and rest of the patients were fibroting NSIP. Steroid treatment was started to the 53.8% of patient diagnosed by IPAF and 69.3% of these patients received non-steroid maintenance therapy. Conclusion In terms of the understanding ethiology of ILD, it is important to add routine rheumatology evaluations in patients with newly diagnosed. The determination and treatment of rheumatological disease that cause ILD will prevent the possible complications in further times caused by rheumatologic diseases. We believe that a multidisciplinary approach may be important in diagnostic studies of IPAF in order to increase diagnostic confidence. If ILD is cause due to rhemautological pathology, it should be evaluated for immunsupresive treatment rather than the follow-up or antifibrotic treatments. REFERENCES: NIL • Download figure • Open in new tab • Download powerpoint • Download figure • Open in new tab • Download powerpoint Acknowledgements NIL Disclosure of Interests None declared

Objective Lung cancer, the most common cause of cancer-related death, is diagnosed mostly in advanced stages, and 5-year survival is approximately 5.8%. It is critical to identify reliable prognostic factors to optimize treatment responses, guide therapeutic strategies and pave the way to new research. In this study, we aimed to investigate the strongest prognostic factors for advanced non-small cell lung cancer (NSCLC). Methods We retrospectively analyzed 278 patients with NSCLC. We evaluated the association between potential prognostic factors and overall survival (OS) times using Kaplan–Meier analysis and Cox regression analysis. Results The median OS in all patients was 15.3 months. In univariate analysis, gender, histologic type, performance status, immunotherapy, radiotherapy, hemoglobin level, serum albumin, sodium–globulin ratio (SGR), neutrophil–lymphocyte ratio (NLR), systemic immune inflammation index (SII), hemoglobin–albumin–lymphocyte–platelet score (HALP), and advanced lung cancer index (ALI) were associated with survival. Models were established for multivariate analyses. In the models, NLR, SGR, HALP, immunotherapy, radiotherapy, and Eastern Cooperative Oncology Group (ECOG) performance status showed independent prognostic features (p < 0.001, p = 0.003, p = 0.002, p < 0.001, p = 0.010, and p = 0.025, respectively). In addition, in the subgroup analysis, prognostic indexes (NLR, SGR, and HALP) were found to have a prognostic effect on survival in multiple subgroups. Conclusions Pretreatment NLR, SGR, HALP, immunotherapy, radiotherapy, and ECOG performance status are independent prognostic factors for advanced NSCLC patients. These prognostic factors can be used in clinical practice as easily accessible, simple, and useful tools for clinicians.