Hasil untuk "Diseases of the respiratory system"

Viktorija Domrina, Beatričė Linkauskaitė, Liucija Mazaliauskaitė

Background: EGPA is a rare, multi-system, autoimmune disease characterized by vasculitis along with asthma and elevated eosinophils in the blood and tissues, affecting 1 to 3 in 1 million people annually, primarily middle-aged population [1]. It is well known that a large proportion of EGPA patients have had asthma and/or have had or currently have nasal polyps [2]. EGPA is associated with increased mortality compared to the general population. Due to variable clinical presentations, diagnosis is often delayed, leading to various physical deficits and life-threatening conditions. Therefore, it is important to detect and treat the syndrome in a timely manner.   The Case: We present a case of successful diagnosis and treatment Churg-Strauss syndrome, emphasizing the importance of early recognition and intervention. A 56-year-old man with bronchial asthma and a history of sinus surgery presented with rhinitis, cough, low-grade fever, wrist pain and digital paresthesia. Initial imaging revealed sinusitis and right lung infiltrates and treatment for presumed pneumonia was started. During hospitalisation he developed anaemia, respiratory failure, haemoptysis, persistent inflammation and urinary problems. Further evaluation revealed a haemorrhagic rash, eosinophilic leukocytosis, haematuria, proteinuria and positive p-ANCA antibodies. Renal biopsy confirmed focal necrotizing and crescentic glomerulonephritis with eosinophilic infiltration consistent with EGPA. The patient's clinical condition improved rapidly with the introduction of high-dose methylprednisolone pulse therapy.   Conclusion: This case demonstrates the complexity of diagnosing EGPA, which can be diverse and similar to more common diseases such as asthma, sinusitis and pneumonia. A multidisciplinary approach, including histological confirmation, was necessary to establish an accurate diagnosis. Early recognition and prompt initiation of corticosteroid treatment led to favourable short-term outcomes. Given the risk of relapse and chronic organ damage, long-term follow-up and consideration of biological therapy are warranted to improve disease control and prognosis.

Takayuki Yamamoto, Yukihiro Sugimoto, Yu Tsukasa et al.

ABSTRACT An 85‐year‐old man presented with a persistent cough accompanied by sputum production. He was initially treated with antibiotics and expectorants but showed no improvement. Chest computed tomography revealed a dense nodule in the right bronchus intermedius. On detailed history‐taking, he recalled eating mukago—a small edible bulbil of Dioscorea japonica that is occasionally consumed in Japan—shortly before symptom onset. Flexible bronchoscopy identified an oval, hard foreign body lodged in the bronchus, which was successfully removed using biopsy forceps. The extracted object was confirmed to be a mukago. His cough disappeared after removal. Our case highlights the importance of considering foreign body aspiration in elderly patients presenting with unexplained chronic cough, even in the absence of overt choking episodes. Thorough dietary history‐taking, appropriate imaging, and bronchoscopy are essential for timely diagnosis and effective management of foreign body aspiration.

Qian Liu, Qian Liu, Shuzhi Lin et al.

BackgroundMultimorbidity presents a significant global health challenge, particularly among older people in China; however, research on its patterns and dynamic evolution remains limited. This study examines chronic disease co-occurrence and associated risk factors, identifying multimorbidity trends to inform health management and policy.MethodsThis study utilized the latest five-wave national survey data from the China Health and Retirement Longitudinal Study (CHARLS) on 2,798 individuals aged 60 years or older with multimorbidity. Latent class analysis (LCA) identified distinct multimorbidity patterns from 14 self-reported chronic conditions. Longitudinal follow-up data were then used to construct transition frequency matrices, modeling the trajectory and dynamic evolution of multimorbidity among older people in China over time.ResultsUsing LCA, 2,798 participants were classified into four patterns: the multi-system disorder group (10.33%), the gastrointestinal metabolism group (44.07%), the cardiovascular disease group (37.81%), and the respiratory disease group (7.79%). Over five waves, the gastrointestinal metabolism group declined (from 74.70% in 2011 to 44.07% in 2020), while the cardiovascular group increased (from 15.87 to 37.81%). The multi-system and respiratory groups also grew. Transition analysis showed the gastrointestinal metabolism group was the least stable, with many shifting to the cardiovascular group (7.29% from 2013 to 2015, 23.81% from 2015 to 2018, 18.54% from 2018 to 2020).ConclusionThe disease burden among older people is shifting from gastrointestinal metabolism disorders to cardiovascular diseases, with gastrointestinal issues potentially acting as precursors to cardiovascular conditions. Future research should investigate the risk factors influencing transitions between multimorbidity patterns and their underlying mechanisms.

Yuri Gardinazzi, Roger Gonzaléz March, Suprabhath Kalahasti et al.

Comorbidity networks, which capture disease-disease co-occurrence usually based on electronic health records, reveal structured patterns in how diseases cluster and progress across individuals. However, how these networks evolve across different age groups and how this evolution relates to properties like disease prevalence and mortality remains understudied. To address these issues, we used publicly available comorbidity networks extracted from a comprehensive dataset of 45 million Austrian hospital stays from 1997 to 2014, covering 8.9 million patients. These networks grow and become denser with age. We identified groups of diseases that exhibit similar patterns of structural centrality throughout the lifespan, revealing three dominant age-related components with peaks in early childhood, midlife, and late life. To uncover the drivers of this structural change, we examined the relationship between prevalence and degree. This allowed us to identify conditions that were disproportionately connected to other diseases. Using betweenness centrality in combination with mortality data, we further identified high-mortality bridging diseases. Several diseases show high connectivity relative to their prevalence, such as iron deficiency anemia (D50) in children, nicotine dependence (F17), and lipoprotein metabolism disorders (E78) in adults. We also highlight structurally central diseases with high mortality that emerge at different life stages, including cancers (C group), liver cirrhosis (K74), subarachnoid hemorrhage (I60), and chronic kidney disease (N18). These findings underscore the importance of targeting age-specific, network-central conditions with high mortality for prevention and integrated care.

Siqi Ouyang, Xi Xu, Lei Li

This paper presents CMU's submission to the IWSLT 2025 Simultaneous Speech Translation (SST) task for translating unsegmented English speech into Chinese and German text in a streaming manner. Our end-to-end speech-to-text system integrates a chunkwise causal Wav2Vec 2.0 speech encoder, an adapter, and the Qwen2.5-7B-Instruct as the decoder. We use a two-stage simultaneous training procedure on robust speech segments curated from LibriSpeech, CommonVoice, and VoxPopuli datasets, utilizing standard cross-entropy loss. Our model supports adjustable latency through a configurable latency multiplier. Experimental results demonstrate that our system achieves 44.3 BLEU for English-to-Chinese and 25.1 BLEU for English-to-German translations on the ACL60/60 development set, with computation-aware latencies of 2.7 seconds and 2.3 seconds, and theoretical latencies of 2.2 and 1.7 seconds, respectively.

John Wu, Adam Cross, Jimeng Sun

Rare diseases affect 1 in 10 Americans, yet standard ICD coding systems fail to capture these conditions in electronic health records (EHR), leaving crucial information buried in clinical notes. Current approaches struggle with medical abbreviations, miss implicit disease mentions, raise privacy concerns with cloud processing, and lack clinical reasoning abilities. We present Rare Disease Mining Agents (RDMA), a framework that mirrors how medical experts identify rare disease patterns in EHR. RDMA connects scattered clinical observations that together suggest specific rare conditions. By handling clinical abbreviations, recognizing implicit disease patterns, and applying contextual reasoning locally on standard hardware, RDMA reduces privacy risks while improving F1 performance by upwards of 30\% and decreasing inferences costs 10-fold. This approach helps clinicians avoid the privacy risk of using cloud services while accessing key rare disease information from EHR systems, supporting earlier diagnosis for rare disease patients. Available at https://github.com/jhnwu3/RDMA.

Deze Li, Huiwen Zheng, Xiaotong Wang et al.

Yiheng Huang, Jiahao Zhang, Xiaofeng Wang et al.

Gene delivery therapy has emerged as a popular approach for the treatment of various diseases. However, it still poses the challenges of accumulation in target sites and reducing off-target effects. Aerosol gene delivery for the treatment of pulmonary diseases has the advantages of high lung accumulation, specific targeting and fewer systemic side effects. However, the key challenge is selecting the appropriate formulation for aerosol gene delivery that can overcome physiological barriers. There are numerous existing gene carriers under study, including viral vectors and non-viral vectors. With the development of biomaterials, more biocompatible substances have applied gene delivery via inhalation. Furthermore, many types of genes can be delivered through aerosol inhalation, such as DNA, mRNA, siRNA and CRISPR/Cas9. Aerosol delivery of different types of genes has proven to be efficient in the treatment of many diseases such as SARS-CoV-2, cystic fibrosis and lung cancer. In this paper, we provide a comprehensive review of the ongoing research on aerosol gene delivery therapy, including the basic respiratory system, different types of gene carriers, different types of carried genes and clinical applications.

Irene Possenti, Marco Scala, Magda Rognoni et al.

Introduction Tobacco-related diseases have a substantial economic impact in terms of medical expenses, loss of productivity, and premature death. Tobacco use is estimated to be responsible for more than 90000 deaths each year in Italy. We aimed to evaluate the annual direct economic impact on the National Health System of hospitalizations attributable to tobacco smoking in Italy. Methods We analyzed data from all the hospitalizations of patients aged ≥30 years that occurred in Italy for 12 selected tobacco-related diseases, during 2018. These diseases included oropharyngeal cancer, esophageal cancer, gastric cancer, lung cancer, pancreatic cancer, bladder cancer, laryngeal cancer, ischemic heart disease, stroke, diseases of arteries, arterioles, and capillaries, pneumonia and influenza, and chronic obstructive pulmonary disease. We obtained information on 984322 hospital discharge records, including each hospitalization's direct costs. Using relative risk estimates from the scientific literature, we computed the population attributable fraction for various tobacco-related diseases to estimate the economic impact attributable to tobacco smoking. Results One-third of all hospitalizations occurred in 2018 in Italy among people aged ≥30 years for 12 tobacco-related diseases were found to be attributable to smoking, accounting for a total cost of €1.64 billion. Among the diseases considered, those with the highest expenditures attributable to tobacco smoking were ischemic heart disease, cerebrovascular disease, and lung cancer, accounting for €556 million, €290 million, and €229 million, respectively. Conclusions Tobacco has a substantial economic impact in Italy, accounting for around 6% of the total cost of hospitalizations in 2018. This figure is expected to be largely underestimated due to several conservative assumptions adopted in the statistical analyses. It is imperative to prioritize comprehensive tobacco control measures to counteract the huge healthcare costs due to tobacco smoking.

Wan Li, Wei Li, Moheng Rong et al.

CT image-guided thermal ablation is widely used for lung cancer treatment; however, follow-up data indicate that physicians' subjective assessments of intraoperative images often overestimate the ablation effect, potentially leading to incomplete treatment. To address these challenges, we developed \textit{Respiratory Differencing}, a novel intraoperative CT image assistance system aimed at improving ablation evaluation. The system first segments tumor regions in preoperative CT images and then employs a multi-stage registration process to align these images with corresponding intraoperative or postoperative images, compensating for respiratory deformations and treatment-induced changes. This system provides two key outputs to help physicians evaluate intraoperative ablation. First, differential images are generated by subtracting the registered preoperative images from the intraoperative ones, allowing direct visualization and quantitative comparison of pre- and post-treatment differences. These differential images enable physicians to assess the relative positions of the tumor and ablation zones, even when the tumor is no longer visible in post-ablation images, thus improving the subjective evaluation of ablation effectiveness. Second, the system provides a quantitative metric that measures the discrepancies between the tumor area and the treatment zone, offering a numerical assessment of the overall efficacy of ablation.This pioneering system compensates for complex lung deformations and integrates pre- and intra-operative imaging data, enhancing quality control in cancer ablation treatments. A follow-up study involving 35 clinical cases demonstrated that our system significantly outperforms traditional subjective assessments in identifying under-ablation cases during or immediately after treatment, highlighting its potential to improve clinical decision-making and patient outcomes.

Denis G. Rancourt, Joseph Hickey

A parameter $ψ$ was recently defined and introduced into the epidemiological modelling scientific literature, and is being accepted. The said parameter was used to argue that there was a disproportionate risk of infection incurred by vaccinated persons due to contacts with unvaccinated persons during the declared COVID-19 pandemic. Opposing published results show that, in general, there is virtually never a disproportionate risk to the vaccinated from the unvaccinated during a respiratory pandemic. Here, we show that the newly introduced vaccinology parameter $ψ$ is incorrectly defined and that the conclusions of disproportionate risk are not valid. Specifically, we prove that the originating authors Fisman et al. (2022, 2024) incorrectly defined and applied the parameter $ψ$. Their application would imply that the said risk increases with increasing segregation from the unvaccinated (up to complete segregation), increases with increasing vaccination coverage (up to complete coverage) and increases with increasing vaccine efficacy (up to perfect vaccine efficacy), which is impossible. Use of the erroneous parameter $ψ$ has the potential to encourage unnecessarily aggressive public health policies and interventions.

Talha Burki

Yagya Raj Pandeya, Samin Karki, Ishan Dangol et al.

We have developed a comprehensive computer system to assist farmers who practice traditional farming methods and have limited access to agricultural experts for addressing crop diseases. Our system utilizes artificial intelligence (AI) to identify and provide remedies for vegetable diseases. To ensure ease of use, we have created a mobile application that offers a user-friendly interface, allowing farmers to inquire about vegetable diseases and receive suitable solutions in their local language. The developed system can be utilized by any farmer with a basic understanding of a smartphone. Specifically, we have designed an AI-enabled mobile application for identifying and suggesting remedies for vegetable diseases, focusing on tomato diseases to benefit the local farming community in Nepal. Our system employs state-of-the-art object detection methodology, namely You Only Look Once (YOLO), to detect tomato diseases. The detected information is then relayed to the mobile application, which provides remedy suggestions guided by domain experts. In order to train our system effectively, we curated a dataset consisting of ten classes of tomato diseases. We utilized various data augmentation methods to address overfitting and trained a YOLOv5 object detector. The proposed method achieved a mean average precision of 0.76 and offers an efficient mobile interface for interacting with the AI system. While our system is currently in the development phase, we are actively working towards enhancing its robustness and real-time usability by accumulating more training samples.

T. Konuma, J. Kanda, N. Uchida et al.

The impact of conditioning intensity on different donor groups has been unclear in allogeneic transplantation. The objective of this study was to clarify the effect of conditioning intensity on disease‐free survival (DFS), relapse, non‐relapse mortality (NRM), neutrophil engraftment, and graft‐versus‐host disease for each donor type. We retrospectively evaluated the effect of conditioning intensity on transplant outcomes for patients with acute leukemia or myelodysplastic syndrome aged between 16 and 60 years in Japan using the transplant conditioning intensity (TCI) scoring system. A total of 8526 patients who received first allogeneic transplantation from 6/6 antigen‐matched sibling donor (MSD, n = 2768), 8/8 allele‐matched unrelated donor (MUD, n = 2357), and unrelated single‐cord blood (UCB, n = 3401) were eligible for the analyses. Compared to conditioning with TCI score 4.0, which was corresponds to conventional myeloablative conditioning, including cyclophosphamide with total body irradiation 12 Gy or busulfan 12.8 mg, and was considered as the reference group in the multivariate analyses, intensified conditioning with TCI score ≥4.5 improved DFS (hazard ratio [HR],0.81, P < 0.001) and relapse rate (HR, 0.70, P < 0.001) but only after UCB transplants and not MSD and MUD transplants. In contrast, NRM was higher after intensified conditioning with TCI score ≥4.5 for MSD (HR, 1.39, P = 0.008) and MUD (HR, 1.47, P = 0.002) transplants but not UCB transplants (HR, 1.12, P = 0.240). Neutrophil engraftment was also significantly higher after intensified conditioning with TCI score ≥4.5 but only for UCB transplants (HR, 1.24, P < 0.001), whereas it was significantly lower after reduced‐intensity conditioning with TCI score ≤3.5 for MSD transplants only (HR, 0.82, P < 0.001). These data demonstrated that an intensified conditioning regimen improved survival and engraftment rate only after a UCB transplants. Therefore, TCI scoring system could enable the optimization of conditioning intensity according to donor type, particularly in terms of survival and engraftment.

Jessie R. Chung, Sara S. Kim, Edward A. Belongia et al.

Abstract Background Individuals in contact with persons with COVID‐19 are at high risk of developing COVID‐19; protection offered by COVID‐19 vaccines in the context of known exposure is poorly understood. Methods Symptomatic outpatients aged ≥12 years reporting acute onset of COVID‐19‐like illness and tested for SARS‐CoV‐2 between February 1 and September 30, 2021 were enrolled. Participants were stratified by self‐report of having known contact with a COVID‐19 case in the 14 days prior to illness onset. Vaccine effectiveness was evaluated using the test‐negative study design and multivariable logistic regression. Results Among 2229 participants, 283/451 (63%) of those reporting contact and 331/1778 (19%) without known contact tested SARS‐CoV‐2‐positive. Adjusted vaccine effectiveness was 71% (95% confidence interval [CI], 49%–83%) among fully vaccinated participants reporting a known contact versus 80% (95% CI, 72%–86%) among those with no known contact ( p ‐value for interaction = 0.2). Conclusions This study contributes to growing evidence of the benefits of vaccinations in preventing COVID‐19 and support vaccination recommendations and the importance of efforts to increase vaccination coverage.

Santhiya Karuppieh, Sri Renukadevi Balusamy, Sumathi Sundaravadivelu et al.

Pei‐ling Bao, Ke‐lan Deng, An‐long Yuan et al.

Abstract Introduction Renal impairment is a common complication in coronavirus disease 2019 (COVID‐19), although its prognostic significance remains unknown. Objectives This study determines the impact of early renal impairment on the clinical outcome of COVID‐19. Methods Patients diagnosed with COVID‐19 and hospitalized in Xiaogan Central Hospital from 20 January to 29 February 2020 were retrospectively included and grouped into two cohorts (cohort with normal renal function and cohort with renal insufficiency) based on the renal function detected on admission. Records of clinical manifestation, laboratory findings and clinical outcome were collected and compared between these two cohorts. Results A total 543 COVID‐19 patients were included. Among these patients, 70 patients developed early renal impairment, with an incidence of 12.89%. A significantly higher white blood cell (WBC) count, C‐reactive protein (CRP), erythrocyte sedimentation rate (ESR), serum creatine (Cr), blood urine nitrogen (BUN) and brain natriuretic peptide (BNP) and a significantly lower blood platelet (PLT), lymphocyte count, prealbumin and albumin (ALB) were detected in the cohort with renal insufficiency (P < 0.05). Patients with early renal impairment were also associated with higher incidences of haematuria/proteinuria, higher incidences of mortality and prolonged hospitalization duration. The independent risk factors for in‐hospital death included age >65 years old, complication of diabetes, renal impairment on admission (Cr > 73 μmol/L and eGFR < 60 ml/min 1.73 m2), WBC > 9.5 × 109/L and ALB < 35 g/L. Conclusion Early renal impairment is associated with higher risk of in‐hospital death for patients with COVID‐19. Risk stratification according to renal function can better guide the clinical management of COVID‐19.

Razieh Sangsari, Maryam Saeedi, Marzieh Maddah et al.

Abstract Mechanical ventilation is a lifesaving treatment used to treat critical neonatal patients. It facilitates gas exchange, oxygenation, and CO2 removal. Despite advances in non-invasive ventilatory support methods in neonates, invasive ventilation (i.e., ventilation via an endotracheal tube) is still a standard treatment in NICUs. This ventilation approach may cause injury despite its advantages, especially in preterm neonates. Therefore, it is recommended that neonatologists consider weaning neonates from invasive mechanical ventilation as soon as possible. This review examines the steps required for the neonate's appropriate weaning and safe extubation from mechanical ventilation.

Jorge Rodríguez Delgado, Margarito Morales Cruz, Christopher López Hernández et al.

Uterine neoplasm metastases to heart is infrequent, especially from uterine cancer, although it is possible because leiomyosarcoma is very invasive. We present a case of a 33 years old woman with 9 months evolution of this neoplasm.  By cardiac and brain symptomatology, this patient was diagnosed with cardiac and brain tumors in imaging studies. The patient underwent tumors resection by cardiac surgery and stereotaxic procedure and subsequent chemo and radiotherapy, without neurological and cardiac symptoms in her evolution.

Leila S. Otten, Berber Piet, Michel M. van den Heuvel et al.

Background The risk for thromboembolisms in nonsmall cell lung cancer (NSCLC) patients is increased and often requires treatment or prophylaxis with direct oral anticoagulants (DOACs). Small-molecule inhibitors (SMIs) to treat NSCLC may cause relevant drug–drug interactions (DDIs) with DOACs. Guidance on how to combine these drugs is lacking, leaving patients at risk of clotting or bleeding. Here, we give practical recommendations to manage these DDIs. Methods For all DOACs and SMIs approved in Europe and the USA up to December 2021, a literature review was executed and reviews by the US Food and Drug Administration and European Medicines Agency were analysed for information on DDIs. A DDI potency classification for DOACs was composed and brought together with DDI characteristics of each SMI, resulting in recommendations for each combination. Results Half of the combinations result in relevant DDIs, requiring an intervention to prevent ineffective or toxic treatment with DOACs. These actions include dose adjustments, separation of administration or switching between anticoagulant therapies. Combinations of SMIs with edoxaban never cause relevant DDIs, compared to more than half of combinations with other DOACs and even increasing to almost all combinations with rivaroxaban. Conclusions Combinations of SMIs and DOACs often result in relevant DDIs that can be prevented by adjusting the DOAC dosage, separation of administration or switching between anticoagulants.