Safety of geriatric patients undergoing endobronchial ultrasound-guided transbronchial needle aspiration with deep sedation: a retrospective study.

BACKGROUND: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) can be performed in a wide range, from minimal sedation to general anesthesia. Advanced age increases perioperative risks related to anesthesia and is also associated with many pathological processes that further increase morbidity and mortality. The ideal sedation protocol for EBUS-TBNA has yet to be determined in geriatric patients. Deep sedation (DS) may increase the safety and performance of the procedure. There are limited studies evaluating the effectiveness and safety of EBUS-TBNA under DS in elderly patients. METHODS: 280 patients who underwent EBUS-TBNA under DS were included in this retrospective study. 156 patients aged 65 years and over (Group 1) and 124 patients under 45 (Group 2) were compared. Demographic data, comorbidities, pulmonary function tests (PFTs), hemodynamic measurements, and peripheral oxygen saturation (SpO2) before the procedure were evaluated. In addition, the duration of the EBUS-TBNA procedure, sedation agents and dosages, recovery time, and complications related to the procedure in the 24 h and applied medications and treatments were recorded. RESULTS: There was no difference in body mass index, EBUS-TBNA procedure duration, and recovery time between geriatric and young patients(p > 0.05). The proportion of female patients, pre-anesthesia SpO2, and PFTs were found to be significantly lower in geriatric patients(p < 0.05). ASA classification, frequency of comorbidities, and initial mean arterial pressure were found to be significantly higher in the geriatric group(p < 0.05). The propofol-ketamine combination was the most preferred sedative in both groups. The dose of propofol used in the regimen in which propofol was administered alone was found to be lower in the elderly group (p < 0.05). The increase in the HR was significant in Group 2 in the T4 and T5 periods with respect to T1 when the differences were compared (p < 0.05). As a complication, the frequency of high blood pressure during the procedure was higher in the elderly group (p < 0.05). CONCLUSIONS: The EBUS-TBNA procedure performed under DS was safe in elderly and young patients. Our study showed that the procedure and recovery times were similar in the elderly and young groups. The incidence of temporary high blood pressure during the procedure was higher in the elderly patients. The other complication rates during the procedure were similar in groups. Decreased propofol dose in the regimen using propofol alone has shown us that anesthetists are more sensitive to the administration of sedative agents in geriatric patients, taking into account comorbidities and drug interactions.

What is the yield of EBUS-TBNA for re-evaluation of previously treated non-small-cell lung cancer?

BACKGROUND: Locoregional recurrence in lung cancer still remains an important problem. We aimed to indicate the effectiveness of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) for reevaluation in previously treated nonsmall cell lung cancer (NSCLC). METHODS: : NSCLC patients who underwent EBUS for rebiopsy of suspicious recurrent or progressive lesions between January 2010 and June 2017 were reviewed. Patients were categorized into two groups based on the previous treatment modalities: Group 1 (G1) consisted of patients who had been treated with chemoradiotherapy, and Group 2 (G2) consisted of patients who had undergone radical surgery. RESULTS: Of 115 patients, 100 patients enrolled in the study. Of 26 patients with 35 lymph nodes in G1, malignant cells were identified in thirteen patients (50%). Anthracosis was detected in the remaining. Malignancy was detected in 28 patients (37.8%) in G2. Thirty-threepatients were diagnosed as benign (24 anthracosis; 8 lymphocytes, and 1 granulomatous); 8 were not sampled, and inadequate material was obtained in five. The sensitivity, specificity, negative and positive predictive value, and overall diagnostic accuracy of EBUS-TBNA for rebiopsy in G1 were 84.8%, 100%, 89.1%, 100%, and 93.2%, respectively. These values were all perfect in G2. DISCUSSION: EBUS-TBNA could be preferred as a feasible and efficient procedure for rebiopsy in previously treated NSCLC patients.

Chronic obstructive pulmonary disease phenotypes in Turkey: the COPET study-a national, multicenter cross-sectional observational study.

BACKGROUND: While mortality rates decrease in many chronic diseases, it continues to increase in COPD. This situation has led to the need to develop new approaches such as phenotypes in the management of COPD. We aimed to investigate the distribution, characteristics and treatment preference of COPD phenotypes in Turkey. METHODS: The study was designed as a national, multicenter, observational and cross-sectional. A total of 1141 stable COPD patients were included in the analysis. RESULTS: The phenotype distribution was as follows: 55.7% nonexacerbators (NON-AE), 25.6% frequent exacerbators without chronic bronchitis (AE NON-CB), 13.9% frequent exacerbators with chronic bronchitis (AE-CB), and 4.8% with asthma and COPD overlap (ACO). The FEV1 values were significantly higher in the ACO and NON-AE than in the AE-CB and AE NON-CB (p < 0.001). The symptom scores, ADO (age, dyspnoea and FEV1 ) index and the rates of exacerbations were significantly higher in the AE-CB and AE NON-CB phenotypes than in the ACO and NON-AE phenotypes (p < 0.001). Treatment preference in patients with COPD was statistically different among the phenotypes (p < 0.001). Subgroup analysis was performed in terms of emphysema, chronic bronchitis and ACO phenotypes of 1107 patients who had thoracic computed tomography. A total of 202 patients had more than one phenotypic trait, and 149 patients showed no features of a specific phenotype. DISCUSSION: Most of the phenotype models have tried to classify the patient into a certain phenotype so far. However, we observed that some of the patients with COPD had two or more phenotypes together. Therefore, rather than determining which phenotype the patients are classified in, searching for the phenotypic traits of each patient may enable more effective and individualized treatment.

Evaluation of mortality predictors in hospitalized COVID-19 patients: Retrospective cohort study.

INTRODUCTION: Evaluation of parameters that will predict prognosis in COVID19 disease ensures correct determination of treatment strategy. In this study, it was aimed to determine the clinical, radiological and laboratory parameters affecting mortality and to evaluate the risk factors. MATERIALS AND METHODS: Patients hospitalized with the diagnosis of COVID-19 in September 2020 were included in the study. Clinical features, laboratory parameters, and radiological findings at admission were recorded. The relationship of these parameters with 30-day mortality was evaluated. Statistical analysis was performed with SPSS for Windows 16.0 Package Program. RESULT: Three hundred and sixty patients (female/male, n= 228/132) hospitalized in the specified period were included in the study. 30-day mortality rate was 14.4% in all patients. In multiple logistic regression analysis, age, presence of heart failure, admission oxygen saturation, body temperature higher than 38.2 and high ferritin levels were evaluated as independent risk factors for 30-day mortality. CONCLUSIONS: The relationship between clinical and laboratory markers and mortality is very important for the correct orientation of healthcare services and the correct determination of treatment strategy during the COVID-19 pandemic.

Bronchoscopic procedures during COVID-19 pandemic: Experiences in Turkey.

BACKGROUND: Globally, coronavirus disease-2019 (COVID-19) is a new, highly contagious, and life-threatening virus. We aimed to demonstrate how we proceeded with bronchoscopic procedures without published guidelines at the inception of the pandemic period. MATERIALS AND METHODS: All bronchoscopic procedures applied from the first case seen in Turkey (11 March-15 May) were evaluated retrospectively. Patient data on indications, diagnosis, types of procedures, and the results of COVID-19 tests were recorded. RESULTS: This study included 126 patients; 36 required interventional bronchoscopic techniques (28.6%), 74 required endobronchial ultrasonography (EBUS; 58.7%), and 16 required flexible fiberoptic bronchoscopy (12.7%). All interventional rigid bronchoscopic techniques were performed for emergent indications: malignant airway obstruction (66.7%), tracheal stenosis (25%), and bronchopleural fistula (8.3%). Malignancy was diagnosed in 59 (79.7%), 12 (50%), and 4 (25%) patients who underwent EBUS, interventional procedures, and fibreoptic bronchoscopy, respectively. All personnel wore personal protective equipment and patients wore a surgical mask, cap, and disposable gown. Of the patients, 31 (24.6%) were tested for COVID-19 and all the results were negative. COVID-19 was not detected in any of the patients after a 14-day follow-up period. CONCLUSION: This study was based on our experiences and demonstrated that EBUS and/or bronchoscopy should not be postponed in patients with known or suspected lung cancer.

[Mortality prediction ability of phycians in intensive care units of Turkey (MOPAP)]. / Türkiye'de yogun bakim ünitelerinde hekimin mortaliteyi öngörebilme gücü.

INTRODUCTION: Intensive care physicians are increasingly involved in decision making about the prognosis of intensive care unit ICU patients. With this study; we aimed to evaluate the power of clinician foresight at prediction of mortality in patient at triage to intensive care and patient follow-up. MATERIALS AND METHODS: This study was conducted in ICUs located in various geographical regions of Turkey between January 1, 2017-April 30, 2017.The clinical research was planned as observational, multicenter, cross-sectional. RESULT: A total of 1169 intubated patients were followed in 37 different ICU. At the beginning of the follow-up we asked the physician who will follow the patient in the ICU to give a score for the probability of survival of the patients. Scoring included a total of 6 scores from 0 to 5, with the "0" the worst probability "5" being the best. According to this distribution, only 1 (0.9%) of 113 patients who were given 0 points survived. Three (6.1%) of 49 with the best score of 5 died. Survival rates were significantly different in each score group (r: -0.488; p<0.001). After the combined mortality estimation scores based on the clinical observations of the physicians (0 and 1 point score was combined as non-survive, 4 and 5 score was combined as survived) 320 of the 545 patients were estimated to be dead and 225 were predicted survival. Sensitivity and spesifity of scoring system to predict mortality was 91.56% (95% CI: 87.96-94.37), 76.89% (95% CI: 70.82-82.23) respectively. CONCLUSIONS: In this study, we concluded that the physicians who follow the patients in the ICU can predict the poor prognosis at the time of admission and the high mortality rate. The physician's opinion on mortality estimation should be considered in intensive care mortality scoring in addition to other laboratory and clinical parameters.

Excellence in non-small cell lung cancer staging by endobronchial-TBNA: Comparison with PET-CT and surgery.

Objective: To determine the correlation and/or discrepancies between positron emission tomography (PET-CT) findings, endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) and surgery in the staging of non-small cell lung carcinoma. Material and methods: Data were evaluated retrospectively from a prospective interventional endoscopy database. Positive results with EBUS-TBNA was the first end point and all cytology negatives were confirmed with mediastinoscopy/surgery. Results: Four hundred and eighty three patients were included and 1017 lymph nodes (LNs) were sampled in the study. One hundred and twenty eight LNs were excluded (positive with EBUS-TBNA). Four hundred and sixty five LN (52.3%) were found benign with EBUS-TBNA; however, only 15 of these were confirmed to be malignant by surgery (1.7%). The sensitivity, specificity, PPV, NPV and diagnostic accuracy of EBUS-TBNA were 96.5, 100, 100, 96.7 and 98.3%, respectively. The sensitivity, specificity, PPV, NPV and diagnostic accuracy of PET-CT for maximum standardized uptake value (SUVmax) 2.5 were 90.1, 29.2, 55.3, 75.4, 59.2%, respectively. A cut-off SUVmax of 5.2 was detected with 74.8% sensitivity, 84% specificity, 82.0% PPV, 77.5% NPV and 79.5% accuracy (area under the curve (AUC) of 0.818, 95% CI 0.791-0.843, p<.001). Conclusion: EBUS is a reliable, repeatable and safe technique with a high diagnostic accuracy and should be performed quickly to avoid superfluous time loss in the staging of lung cancer. Abbreviations PET-CT F-18 fluorodeoxyglucose positron emission computed tomography NSCLC Non-small cell lung cancer EBUS-TBNA Endobronchial ultrasound-guided transbronchial needle aspiration SUVmax Maximum standardized uptake value LNs Lymph nodes TTF-1 Thyroid transcription factor-1 H&E Hematoxylin and eosin; Med: Mediastinoscopy VATS Video associated thoracic surgery AUC Area under curve OR Odds ratio CI Confidence intervals.

Complications of silicone Y stents placed due to malignant airway stenosis.

INTRODUCTION: Malignant central airway obstruction around the main carina often requires placement of Y­shaped stents. In this study, we aimed to determine the safety of silicone Y stents placed around the main carina in the malignant airway obstruction by examining the long term complications, emergence times and treatment approaches of complications. MATERIALS AND METHODS: Between May 2012 and July 2015, 47 silicone Y stents were placed in 46 patients with malignant external compression or mixed type stenosis around the main carina. Patient stents were placed via rigid bronchoscopy under total intravenous anesthesia in operating room conditions. RESULT: In the half of the patients (23/46), stents were placed under urgent conditions due to acute respiratory failure. Stents were deployed successfully in all the patients. No procedure related deaths were observed. The median time of survival following stent insertion was 157 days. The total long-term complication rate of silicone Y stents was 28.3%. Mucostasis (8.7%) and migration (2.2%) were observed within the first month after placement of the silicone Y stents (median 18 days), stent-edge granulation tissue development (13.0%) was observed at the earliest one month (median 64, range 34-386 days) and stent-edge tumor tissue development (4.3%) were observed at the earliest 3 months (median 151, range 85-217 days). A total of 7 (15.2%) stents were removed, 2 of which were due to mucostasis and 5 of which were due to granulation tissue development. One patient's stent was replaced with a longer silicone Y stent due to stent-edge tumor tissue development. CONCLUSIONS: The best palliative treatment of malignant tumor stenosis around the main carina is still silicone Y stent placement, but the long-term complication rate can be high. For this group of patients, bronchoscopy to be performed at the first and third months after silicone Y stent placement may provide early detection of stent-edge tissue development.

Comparison of two new techniques for the management of malignant central airway obstruction: argon plasma coagulation with mechanical tumor resection versus cryorecanalization.

BACKGROUND: The development of central airway obstruction during malignant diseases is an important cause of morbidity and mortality. Endobronchial therapies can decrease the patient's symptoms and improve quality of life. Here, we compare airway recanalization methods: argon plasma coagulation with mechanical tumor resection (APC + MTR) and cryorecanalization (CR efficiency, complications, restenosis rate, and time to restenosis) in patients with malignant exophytic endobronchial airway obstruction. METHODS: A total of 89 patients were included who were admitted to our hospital between 2005 and 2012. The data were analyzed retrospectively. Initially, a CR procedure was performed in 52 patients using rigid bronchoscopy under general anesthesia; the APC + MTR procedure was performed in 37 patients with malignant airway obstruction. RESULTS: The airway patency rate with APC + MTR was 97.3% (n = 36) and CR was 80.8% (n = 42). The APC + MTR procedure was more effective than CR for recanalization of malignant endobronchial exophytic airway obstruction. Additionally, the achievement rate of airway patency with APC + MTR was significantly higher in tumors with distal bronchial involvement. There was no statistically significant difference between groups in terms of complications, restenosis rate, and time to restenosis. CONCLUSIONS: The APC + MTR procedure is preferred over CR to introduce and maintain airway patency in patients with malignancy-related endobronchial exophytic airway obstruction.

Mediastinal ectopic thyroid diagnosed by endobronchial ultrasound-guided transbronchial needle aspiration: Report of three cases.

An ectopic thyroid gland results from the abnormal migration of the thyroid in the course of its development. Primary ectopic mediastinal thyroid is very rare and occurs in less than 1% of all goiters that can be surgically excised. Ectopic thyroid tissue has a characteristic sonographic appearance as smooth-bordered, homogeneous, hypoechoic tissue with fine specular echoes. We report 3 cases of mediastinal ectopic thyroid diagnosed by endobronchial ultrasound-guided transbrochial needle aspiration biopsy.

The utility of RDW in discrimination of sarcoidosis and tuberculous lymphadenitis diagnosed by ebus.

INTRODUCTION: Erythrocyte distribution width (RDW) is an important indicator of anisocytosis, which is used in the differential diagnosis of anemia and is easily accessible in the complete blood count results. Increased RDW values in coronary artery diseases, pulmonary hypertension and malignancies were detected in the studies. We aimed to demonstrate the usefulness of blood RDW level for the differential diagnosis of granulomatous lymphadenitis associated with tuberculosis and sarcoidosis in our study. MATERIALS AND METHODS: A total of 331 patients, 229 with sarcoidosis (stage I and stage II) and 102 with TB-LA and 50 healthy control group were included in the study. The biopsies were obtained via EBUS-TBNA from 705 lymph nodes of 331 patients. Of tissue diagnosis was non-erosive granulomatous inflammation patients with tuberculosis negative proved by microbiological tests were accepted as sarcoidosis after other causes of granulomatous disease were excluded. RESULT: Of the sarcoidosis patients, 169 (73.7%) were in stage I, and 60 (26.3%) were in stage II. The mean RDW was 14.31 (± 1.6) in the stage I group, 14.99 (± 2.3) in the stage II group, 14.11 (± 2.0) in the TB-LA group, and 13.89 (± 1.3) in the control group. There was a significant difference between the stage II group and the stage I, TB-LA, and control groups (p< 0.05 for all). There was a significant difference in the C-reactive protein levels between the TB-LA and stage I groups (p< 0.01). The eritrocyte sedimentation rate values were higher in the TB-LA group than in both the stage I and stage II groups (p< 0.05). CONCLUSIONS: This is the first study to demonstrate the diagnostic value of RDW in patients with TB-LA and sarcoidosis (Stage I-II) patients diagnosed by EBUS-TBNA. Higher RDW in stage II sarcoidosis than in stage I, TB-LA and control group is related with parenchymal involvement and indicates active inflammation.

Can we prevent recurrences in the endoscopic treatment of endobronchial hamartomas?

INTRODUCTION: Recently, treatment of endobronchial hamartomas with interventional bronchoscopic methods has become possible. Although there are several reports of therapeutic benefits, the protocol of administration varies between centers and high recurrence rates continue to be a problem. In this study, we aimed to show that cryotherapy applied to the root of the bronchial wall after removal of the intraluminal portion of endobronchial hamartoma with interventional bronchoscopic methods can prevent recurrences. MATERIALS AND METHODS: Between 2012-2016, the treatment outcomes and long-term follow-up data of patients with symptomatic endobronchial hamartomas treated by interventional bronchoscopic methods were prospectively recorded. After debulking, cryotherapy was applied to the root of the bronchial wall of all lesions. The data were analyzed retrospectively. RESULT: A total of 21 consecutive patients were studied. Twenty (95.2%) of the patients underwent complete resection and only 1 (4.8%) had incomplete resection with various interventional bronchoscopy techniques. One (4.8%) patient who underwent incomplete resection and ineffective cryotherapy relapsed. The other 20 (95.2%) patients were followed up periodically for an average of 36.0 ± 15.0 months. No recurrence was detected. No complications or deaths related to the procedure were observed. CONCLUSIONS: Debulking of endobronchial hamartomas with interventional bronchoscopic methods is effective and safe. Cryotherapy to the root of the lesion may prevent high recurrence rates.

Rising stars of DPLD survival: FVC and exercise desaturation (a single-center study)

Background/aim: Diffuse parenchymal lung diseases (DPLDs) comprise a broad, heterogeneous group of diseases with common functional characteristics and a common final pathway, usually leading to irreversible fibrosis. We investigated the effects of the physiological and functional parameters and of pulmonary hypertension (PH) on survival in DPLDs. Materials and methods: The study included 158 patients with DPLDs. Patient data were examined retrospectively, and survival status was obtained through phone calls. Results: Patients were divided into five groups according to their diagnosis: idiopathic pulmonary fibrosis (IPF), non-IPF idiopathic interstitial pneumonias, connective tissue diseases, sarcoidosis, and other DPLDs. Median survival was 42.9 months. The significant negative effects of older age, presence of delta saturation (DeltaSat; difference between oxygen saturation at rest and after the 6-min walking test), 6-min walking distance (<350 m), systolic pulmonary artery pressure (sPAP; ≥50 mmHg), and baseline percentage of diffusing capacity of the lungs for carbon monoxide (<80%) with percentage of forced vital capacity (FVC%; <80%) were detected on survival (P < 0.05). A one-unit decrease in FVC% was related to a 6% increase in mortality. Another unique finding indicated that higher DeltaSat (>10%) correlated strongly with sPAP (>50 mmHg) and thus with a worse survival rate. Conclusion: The current study determined that FVC% is important in the prediction of mortality. Moreover, it demonstrated a strong relationship between exercise desaturation and PH.

How many samples would be optimal for endobronchial cryobiopsy?

BACKGROUND: Cryobiopsy, which provides larger specimens without crush artifact, is a good option for the diagnosis of visible endobronchial tumors. While there are several papers on diagnostic performance, application protocols vary between centers. In this study, we aimed to find the optimal number of cryobiopsies in endobronchial tumors. METHODS: We prospectively involved cases with a visible endobronchial tumor in which conventional diagnostic measures failed and/or a therapeutic interventional bronchoscopy was planned. Endobronchial tumor was visualized, and four cryobiopsies were taken with a dedicated flexible probe. The samples were evaluated by a pathologist who was blinded to the order of the biopsies. The cumulative performances of one to four cryobiopsies were compared, and a complication analysis was conducted. RESULTS: A total of 50 patients were involved. Four cryobiopsies were taken from 49 patients, and a single biopsy was taken from one case. The sensitivities of one, two, three and four biopsies were 82, 93.9, 93.9 and 95.9 %, respectively. The difference in performance of one and two biopsies was significant (p = 0.031), but the third and fourth biopsies were found to be unnecessary (p = 1.0 for second versus third and p = 1.0 for second versus fourth). Bleeding risk increased when ≥3 cryobiopsies were taken (Odds Ratio 2.758). CONCLUSIONS: When the diagnostic benefits and complication rates were considered, two cryobiopsies were found to be optimal for endobronchial tumors. In patients with non-diagnostic conventional bronchoscopy, endobronchial tumors may be diagnosed by cryobiopsy.

A case of relapsing polychondritis mimicking lung cancer.

Relapsing polychondritis (RP) is a rare autoimmune disease, characterized by episodic inflammatory attacks on cartilaginous tissue. Elastic cartilage of the ears and nose, hyaline cartilage of the peripheral joints, vertebral fibrocartilage, tracheobronchial cartilage, and tissues rich in proteoglycan such as those in the eyes, heart, blood vessels, and inner ear are more likely to be affected. A 35-year-old male presented with complaints of hoarseness, tinnitus and dyspnea for 19 years, with a history of several diagnostic and therapeutic interventions for laryngeal and respiratory tract. He was diagnosed to have inflammation of the tracheobronchial cartilage, cardiac valvulopathy and conductive hearing loss after intensive diagnostic studies. He responded well to low-dose steroids in combination with methotrexate. RP is a diagnostically challenging condition and may cause significant morbidities during diagnosis. RP should be considered in differential diagnosis of airway obstruction as a rare condition.

Endobronchial metastasis of mixed germ cell tumors: two cases.

Lung metastases from extrapulmonary malignancies are common however endobronchial metastases (EBM) from nonpulmonary neoplasms are rare. A variety of extrathoracic tumors have a tendency to EBM especially breast, colon, and renal carcinomas are most frequent reported tumors however EBM of germ cell tumors are extremely rare. A 39-year-old and a 27-year-old male patient were admitted to our hospital with hemoptysis and dyspnea at different times. Both of them had a history of left orchiectomy due to mixed germ cell tumor two years and one year ago, respectively. On chest X-Ray and thorax computed tomography, first had a right upper lobe atelectasis and second had right total atelectasis. Fiberoptic bronchoscopy (FOB) performed and a vascularized endobronchial lesion (EBL) which tended to bleed was seen in the orifis of right upper lobe in the first case and right main bronchus was totally obstructed by EBL also in the second. Interventional bronchoscopy was performed via rigid bronchoscopy for biopsy and palliative treatment (argon plasma coagulation and debulking) in both two patients because of tendency to bleeding. A partial aperture was achieved at right upper lobe bronchus in the first case and total atelectasis resolved in the second case. Immunohistochemically, histopathological examinations of both patients biopsies confirmed EBM of mixed germ cell tumors. In conclusion, EBM of the germ cell tumors especially with total or partial atelectasis are extremely rare. We want to present these cases to emphasize the importance of distinguishing EBM from primary lung carcinoma which treatment and survival could be different.

A case of tracheal leiomyoma misdiagnosed as asthma.

Primary benign tumors of trachea are rare. Of them, tracheal leiomyoma, constitutes only 1% of all benign lower respiratory tract tumors. Here, we present a case of tracheal leiomyoma who has been receiving high doses of inhaled corticosteroids and bronchodilators for a year with a misdiagnosis of asthma. As the symptoms did not resolve with an overtreatment, she has been undergone radiologic study to find a possible alternative diagnosis. The chest roentgenogram revealed an opacity in the upper mediastinum. In computed tomography, a lesion has been detected in proximal trachea, arising from the posterior wall and protruding through the lumen and almost obliterating the air column. Rigid bronchoscopy has been performed under general anesthesia due to a high risk of bleeding and the endobronchial lesion, freely moving with respiration, has been removed and cryotherapy was applied to the base of the lesion. Receiving the histopathological diagnosis of leiomyoma, the patient is now on 12th month of the follow-up without any recurrence.

Predicting the Need for Advanced Respiratory Support in COVID-19 Patients During the Initial Pandemic Phase: A Retrospective Analysis.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), led to high morbidity and mortality rates worldwide. It is known that some patients, initially hospitalized in general wards, deteriorate over time and require advanced respiratory support (ARS). This study aimed to identify key risk factors predicting the need for ARS in patients during the pandemic's early months. METHODOLOGY: In this retrospective study, we included patients admitted within the first three months of the pandemic who were diagnosed with COVID-19 via reverse transcription polymerase chain reaction (RT-PCR). The patients who required ARS or invasive mechanical ventilation at admission were excluded. Data on demographics, comorbidities, symptoms, vital signs, and laboratory parameters were collected. Statistical analyses, including multivariate logistic regression and receiver operating characteristic (ROC) curve analysis, were performed to identify independent predictors of ARS and determine the cut-off point. RESULTS: Among 162 patients, 32.1% required ARS. Key differences between ARS and non-ARS groups included age, body mass index (BMI), coronary artery disease prevalence, neutrophil count, C-reactive protein (CRP), ferritin, D-dimer, troponin T levels, neutrophil-to-lymphocyte ratio (NLR), systemic immune-inflammation response index (SIRI), and symptom-to-admission time. Multivariate analysis revealed that age, elevated CRP levels, elevated ferritin levels, and SIRI were significant predictors for ARS. The ROC curve for SIRI showed an area under the curve (AUC) of 0.785, with a cut-off value of 1.915. CONCLUSIONS: Age, CRP levels, ferritin levels, and SIRI are crucial predictors of the need for ARS in COVID-19 patients. The early identification of high-risk patients is essential for timely interventions and resource optimization, particularly during the early stages of pandemics. These insights may assist in optimizing strategies for future respiratory health crisis management.

When to Consider Invasive Lymph Node Staging in Non-Small-Cell Lung Cancer? A Novel Scoring System Utilising Metabolic Parameters in 18F-FDG PET/CT.

OBJECTIVE: The maximum standardised uptake value (SUVmax) is a widely utilised metric in positron emission tomography/computed tomography for clinically staging non-small-cell lung cancer (NSCLC), yet the reliability of SUVmax remains controversial. We herein aimed to assess the effectiveness of semi-quantitative parameters, encompassing size, SUVmax, metabolic tumour volume (MTV), total lesion glycolysis (TLG) and heterogeneity factor (HF), in evaluating both primary tumours and lymph nodes (LNs) on positron emission tomography/computed tomography. A novel scoring system was devised to appraise the role of semi-quantitative parameters and visually evaluate LNs for nodal staging. MATERIALS AND METHODS: Patients with pathological NSCLC, diagnosed between 2014 and 2019 and clinically staged I-III, were enrolled in the study. Patient demographics, including age, sex, tumour location, diameter, tumour-node-metastasis stage, as well as SUVmax, MTV, TLG and HF parameters of primary tumours and LNs, were documented. RESULTS: The analysis comprised 319 patients and 963 LNs. Patients had a mean age of 61.62 years, with 91.5% being male. Adenocarcinoma exhibited a histological association with LN metastasis (P=0.043). The study findings revealed that tumour size, SUVmax, MTV, TLG and HF did not significantly affect the detection of LN metastasis. Conversely, non-squamous cell carcinoma, LNs exhibiting higher FDG levels than the liver, LN size, SUVmax, MTV and TLG were identified as risk factors (P<0.0001). The identified cut-off values were 1.05cm for LN size, 4.055 for SUVmax, 1.805cm3 for MTV and 5.485 for TLG. The scoring system incorporated these parameters, and visual assessment indicated that a score of ≥3 increased the risk of metastasis by 14.33 times. CONCLUSION: We devised a novel scoring system and demonstrated that LNs with a score of ≥3 in patients with NSCLC have a high likelihood of metastasis. This innovative scoring system can serve as a valuable tool to mitigate excessive and extreme measures in the assessment of invasive pathological staging.