Search Results (6,515)

Radon exposure is the second leading cause of lung cancer worldwide, yet monitoring strategies remain limited, expensive, and unevenly applied. Recent advances in the Internet of Things (IoT) offer the potential to change radon surveillance through low-cost, real-time, distributed sensing networks. This review consolidates emerging research on IoT-based radon monitoring, drawing from both primary radon studies and analogous applications in environmental IoT. A search across six major databases and relevant grey literature yielded only five radon-specific IoT studies, underscoring how new this research field is rather than reflecting a shortcoming of the review. To enhance the analysis, we delve into sensor physics, embedded system design, wireless protocols, and calibration techniques, incorporating lessons from established IoT sectors like indoor air quality, industrial safety, and volcanic gas monitoring. This interdisciplinary approach reveals that many technical and logistical challenges, such as calibration drift, power autonomy, connectivity, and scalability, have been addressed in related fields and can be adapted for radon monitoring. By uniting pioneering efforts within the broader context of IoT-enabled environmental sensing, this review provides a reference point and a future roadmap. It outlines key research priorities, including large-scale validation, standardized calibration methods, AI-driven analytics integration, and equitable deployment strategies. Although radon-focused IoT research is still at an early stage, current progress suggests it could make continuous exposure assessment more reliable, affordable, and widely accessible with clear public health benefits. Full article

Immune checkpoint inhibitors (ICIs) improve lung cancer prognosis but are associated with immune-related adverse events, most commonly thyroid dysfunction. While prior studies and guidelines have focused on thyroid dysfunction during ICI therapy, data on hypothyroidism and its monitoring after ICI therapy remain limited. We aimed to investigate hypothyroidism incidence and implementation of thyroid function monitoring after ICI therapy completion in patients with lung cancer. We conducted a retrospective observational study using the DeSC claims database of approximately 12 million individuals in Japan. Patients with lung cancer who received ICI therapy between April 2014 and August 2023 were included; those with a history of thyroid hormone replacement or insufficient follow-up were excluded. Among 6883 eligible patients, 277 (4.0%) developed hypothyroidism requiring hormone replacement post-ICI therapy completion (median onset, 67.0 d). Risk factors included ICI plus bevacizumab therapy and a history of myasthenia gravis, while steroid use for ≥28 d during ICI therapy lowered the risk. Post-ICI therapy completion thyroid monitoring was performed in 73.7% of patients, with test date distribution showing a median of 126.0 d and mode of 21.0 d. Hypothyroidism was frequently found to develop within 2 months post-ICI therapy completion, highlighting the need for continued thyroid monitoring and prospective studies to establish optimal surveillance strategies. Full article

Background: End-stage renal disease (ESRD) affects up to 25% of lung transplant recipients within 10 years. The selection process for kidney transplantation versus dialysis reflects complex clinical decision-making that has not been systematically characterized. Methods: This retrospective observational study analyzed all lung transplant recipients who developed ESRD at our center from 2010 to 2024 (n=32), comparing those receiving kidney transplantation (n = 18) versus those remaining on dialysis (n = 14). We developed an exploratory Clinical Selection Score to retrospectively characterize observed selection patterns and calculated E-values to assess robustness to unmeasured confounding. Results: Kidney transplant recipients were younger (35.7 ± 12.9 vs. 48.4 ± 14.8 years, p = 0.013) with better selection characteristics quantified by our Clinical Selection Score (4.1 ± 0.8 vs. 1.6 ± 1.1 points, p < 0.001). The score showed excellent discrimination (C-statistic 0.82). Living donors were available for 88.9% of transplanted patients versus 0% of dialysis patients. In our selected cohorts, mortality was 22.2% in kidney transplant recipients vs. 78.6% in dialysis patients (p = 0.002), with median survival of 161.6 vs. 126.6 months (p = 0.021). After adjustment for age, kidney transplantation was observed to be associated with 72% lower mortality risk (HR 0.28, 95% CI 0.09–0.89, p = 0.031), though selection bias limits causal interpretation. The E-value of 6.61 suggests robustness to unmeasured confounding. Conclusions: This observational study describes real-world selection patterns and their associated outcomes in lung transplant recipients with ESRD. While carefully selected patients receiving kidney transplantation experienced favorable results, many patients were appropriately managed with dialysis based on medical and non-medical factors. Our analysis provides transparency about selection criteria and outcomes to inform clinical decision-making. Larger multicenter studies are needed to validate these findings and develop prediction tools. Full article

Exhaled breath (EB) contains numerous volatile organic compounds (VOCs) that can reflect pathological metabolic processes, making breath analysis a promising non-invasive diagnostic approach. In particular, volatile aldehydes and ketones have been identified as disease biomarkers in EB. Gas sensors are expected to play a crucial role in the diagnosis of numerous diseases at an early stage. Among the various available approaches, sensors stand out as especially attractive tools for diagnosing diseases such as lung cancer (LC) and diabetes, due to their affordability and operational simplicity. There is an urgent need in the field of disease detection for the development of affordable, non-invasive, and user-friendly sensors capable of detecting various biomarkers. Devices of the new generation should also demonstrate high repeatability of measurements and extended operational stability of the employed sensors. Due to these demands, the past few years have seen significant advancements in the development and implementation of electronic noses (ENs), which are composed of an array of sensors for the determination of VOCs present in EB. To meet these requirements, the development and integration of advanced receptor coatings on sensor transducers is essential. These coatings include nanostructured materials, molecularly imprinted polymers, and bioreceptors, which collectively enhance selectivity, sensitivity, and operational stability. However, reliable biomarker detection in point-of-care (PoC) mode remains a significant challenge, constrained by several factors. This review provides a comprehensive and critical evaluation of recent studies demonstrating that the detection of VOCs using gas sensor platforms enables disease detection and can be implemented in PoC mode. Full article

Background: The Macklin effect recently demonstrated a high positive predictive value for barotrauma in the COVID-19 ARDS population. However, there was less evidence available regarding the ARDS population without SARS-CoV-2 infection. We aim to analyze COVID-19 and non-COVID-19 ARDS subjects to assess the sensitivity and specificity of the Macklin effect in predicting the development of barotrauma in both groups. Methods: We retrospectively analyzed subjects with ARDS admitted to our center from January 2018 to November 2022. Experienced radiologists examined the presence of the Macklin effect on chest computed tomography scans. Subjects were then divided into two groups based on the presence or absence of the Macklin effect to assess its predictive power regarding barotrauma. Finally, we analyzed the impact of the Macklin effect and barotrauma on Intensive Care Unit and in-hospital mortality. Results: We analyzed 225 patients; the Macklin effect was observed in 44 subjects. In our cohort, the Macklin effect exhibited a sensitivity of 44.6% and a specificity of 90.6% in predicting barotrauma. After excluding the COVID-19 ARDS cases, the Macklin effect showed a sensitivity of 34.7% and a specificity of 93.6%. Nonetheless, in our population, the presence of the Macklin effect or the occurrence of barotrauma did not lead to increased ICU or in-hospital mortality. Conclusions: Our analysis highlighted that the Macklin effect demonstrates high specificity in predicting barotrauma but a low sensitivity; moreover, the development of barotrauma did not impact mortality, possibly due to the exclusion of mild to moderate ARDS and the inclusion of a significant number of ECMO recipients. Finally, the Macklin effect appears early during ARDS and may serve as an early indicator of lung frailty, potentially becoming an additional criterion for referral to centers for advanced ARDS treatment. Full article

Introduction: Epidermal growth factor receptor (EGFR) alterations exist in 15–50% of non-small cell lung cancer (NSCLC) diagnoses. Although effective therapeutics have been developed in the form of tyrosine kinase inhibitors (TKI), various mechanisms of resistance lead to treatment failure after exposure to EGFR TKI-based therapy. Of these, histologic transformation (HT) into small cell lung cancer (SCLC) represents approximately 14% of cases. Methods: Within a single institution, we retrospectively reviewed longitudinal data from both tissue and liquid biopsies of patients with histologic transformation after a diagnosis of EGFR-mutant NSCLC. We sought to further characterize the baseline and emergent genomic alterations after HT to SCLC in the context of TKI exposure, along with germline alterations that may contribute to lineage plasticity and outcomes. Results: Fifteen patients were included in our analysis. Of these, EGFR exon 19 deletions were the most frequent (n = 11, 73.3%), followed by L858R (n = 3, 20%) and L861Q (n = 1, 6.7%). The median time for transformation was 17 months (95%CI, 8.9–41.9 months). The median OS of our cohort was 51.6 months (95%CI, 26.3—NE) with a median OS post-transformation of 13.4 months. Recurrent genomic alterations included TP53, Rb1, PIK3CA, and BRAF. Germline testing revealed a pathogenic alteration in FBN1, with a recurrent variant of unknown significance (VUS) in PALLD. Conclusion: Post-transformation somatic mutation testing and germline testing at presentation revealed unique mutational profiles not previously reported in the setting of HT to SCLC. Further investigations are required to determine the optimal treatment and sequencing following HT. Full article

Background/Objectives: This study involved an analysis of clinical data, histological types, genetic predisposition, treatment and outcomes in PPB in children. Patients and methods: We conducted a retrospective review of children treated for PPB at Polish pediatric oncology centers between 2011 and 2024. Results: A total of fifteen children (seven boys, eight girls; median age of 39 months; range: 27–64 months) were included. Type II solid/cystic PPB and type III solid PPB were diagnosed in six and eight children, respectively (one not known). Overall, 93% of patients were diagnosed at up to 4 years of age. Metastatic disease at diagnosis was confirmed in three (20%) patients, localized in bones, bone marrow and lymph nodes. Diagnosis was confirmed via central pathology review in 11 patients (73%). DICER1 pathogenic variants were identified in eight patients. All children presented with respiratory symptoms. The tumor dimensions were >10 cm (n = 7), 5–10 cm (n = 5) and <5 cm (n = 2). No bilateral lung involvement was observed. Tumor biopsy was performed in six children (40%), with subsequent resection (R0) in five patients. Primary resection (R0) was achieved in three patients (20%) with type II (n = 1) or type III (n = 2). In the other six patients, non-radical resection was performed: R1 in four (27%) children (with a tumor rupture in one patient) and R2 (subtotal resection) in two children (13%). All patients received postoperative chemotherapy. Maintenance chemotherapy was given to two patients. No patient received radiotherapy as first-line treatment. Progressive disease occurred in two patients in the CNS and lungs. Relapsed disease appeared in three patients, all with CNS involvement. Conclusions: PPB is a rare, malignant tumor of early childhood with an uncertain prognosis. Despite multimodal treatment, patients remain at risk of progression or CNS relapse. Complete surgical resection remains a key prognostic factor. Full article

Background/Objectives: Cancer remains a leading global cause of death, with breast, lung, colorectal, and prostate cancers being among the most prevalent. The integration of Artificial Intelligence (AI) into cancer imaging research offers opportunities for earlier diagnosis and personalized treatment. However, the effectiveness of AI models depends critically on the quality, standardization, and fairness of the input data. The EU-funded INCISIVE project aimed to create a federated, pan-European repository of imaging and clinical data for cancer cases, with a key objective to develop a robust framework for pre-validating data prior to its use in AI development. Methods: We propose a data validation framework to assess clinical (meta)data and imaging data across five dimensions: completeness, validity, consistency, integrity, and fairness. The framework includes procedures for deduplication, annotation verification, DICOM metadata analysis, and anonymization compliance. Results: The pre-validation process identified key data quality issues, such as missing clinical information, inconsistent formatting, and subgroup imbalances, while also demonstrating the added value of structured data entry and standardized protocols. Conclusions: This structured framework addresses common challenges in curating large-scale, multimodal medical data. By applying this approach, the INCISIVE project ensures data quality, interoperability, and equity, providing a transferable model for future health data repositories supporting AI research in oncology. Full article

Goose astrovirus (GAstV) infection has emerged as a prevalent cause of urate deposition and viral gout in major goose farming across China, leading to high mortality and substantial economic losses. However, the molecular mechanisms linking GAstV to gout pathogenesis remain elusive. Here, a total of 10 five-day-old Jiangnan white goslings were selected, and tissue damage and kidney gene expression profiles were investigated. The results showed multi-organ damage in GAstV-infected gosling, including kidney, liver, spleen, and lung. Also, 342 differentially expressed genes were identified in infected kidney tissues after 10 days post-infection using transcriptomic sequencing, including 185 upregulated and 157 downregulated genes. In addition, gene set enrichment analysis revealed significant positive correlations between GAstV infection and bile acid metabolism and fatty acid metabolism pathways. Notably, bile acid metabolism was implicated in uric acid regulation and gout progression. Protein–protein interaction network analysis identified AGXT as a central hub gene within the bile acid metabolic pathway, with key upregulated interactors including PIPOX, ALDH1A1, and CAT. AGXT, a critical enzyme in glyoxylate detoxification, directly modulates uric acid biosynthesis. Our findings propose that GAstV-induced activation of bile acid metabolism, particularly AGXT upregulation, drives hyperuricemia and subsequent gout pathology. This study elucidates a novel mechanism of GAstV-associated metabolic dysregulation and provides actionable genetic targets for antiviral breeding strategies in waterfowl. Full article

Background: Uncontrolled asthma remains a significant clinical challenge, often linked to impaired lung function and increased diaphragmatic workload. Recent studies have shown promising results using a triple inhaled therapy comprising beclomethasone dipropionate/formoterol fumarate/glycopyrronium (BDP/FF/G). This study assessed the real-world efficacy of BDP/FF/G on lung function and diaphragmatic workload in patients with uncontrolled asthma. Methods: A prospective observational study enrolled 21 adult patients diagnosed with uncontrolled asthma despite high-dose ICS/LABA therapy. Patients underwent lung function tests and right diaphragmatic ultrasound assessments at baseline and after three months of treatment with BDP/FF/G (172/5/9 mcg, administered as two inhalations every 12 h). Results: After three months, significant improvements were observed in FEV₁ (from 57.75 ± 12.30% to 75.10 ± 18.94%, p < 0.001) and FEF_25–75 (from 47.80 ± 19.23% to 75.10 ± 36.06%, p < 0.001). Additionally, during the same period, we recorded significant reductions in residual volume (from 130.10 ± 28.20% to 92.55 ± 21.18%, p < 0.001) and total airway resistance (R_tot) (from 164.60 ± 83.21% to 140.70 ± 83.25%, p < 0.05). The mean asthma control test (ACT) score increased by 5.6 points (p < 0.001), surpassing the established minimal clinically important difference (MCID) of 3 points and raising the cohort mean above the well-controlled threshold. The right diaphragmatic workload was significantly decreased, as shown by a reduction in thickening fraction (TF) (from 63.86 ± 17.67% to 40.29 ± 16.65%, p < 0.01). Correlation analysis indicated significant associations between diaphragmatic function and some lung function parameters (FEV₁, FEF_25–75, and R_tot). Conclusions: In this real-world pilot, triple BDP/FF/G was linked to improvements in airflow, hyperinflation, symptoms, and a reduction in diaphragmatic thickening fraction, indicating potential physiological benefit. Due to the small sample size, single-centre design, and 3-month follow-up, these results should be viewed as hypothesis-generating and need to be confirmed in larger, controlled, multicentre studies with longer follow-up. Full article

Circulating tumor cells (CTCs) are crucial biomarkers for lung cancer metastasis and recurrence, garnering significant clinical attention. Despite this, efficient and cost-effective detection methods remain scarce. Consequently, there is an urgent demand for the development of highly sensitive CTC detection technologies to enhance lung cancer diagnosis and treatment. This study utilized microspheres and A549 cells to model CTCs, assessing the impact of acoustic field forces on cell viability and proliferation and confirming capture efficiency. Subsequently, CTCs from the peripheral blood of patients with lung cancer were captured and identified using fluorescence in situ hybridization, and the results were compared to the immunomagnetic bead method to evaluate the differences between the techniques. Finally, epidermal growth factor receptor (EGFR) mutation analysis was conducted on CTC-positive samples. The findings showed that acoustic microfluidic technology effectively captures microspheres, A549 cells, and CTCs without compromising cell viability or proliferation. Moreover, EGFR mutation analysis successfully identified mutation types in four samples, establishing a basis for personalized targeted therapy. In conclusion, acoustic microfluidic technology preserves cell viability while efficiently capturing CTCs. When integrated with EGFR mutation analysis, it provides robust support for the precise diagnosis and treatment of lung cancer as well as personalized drug therapy. Full article

Acute lung injury (ALI) is a severe pulmonary disorder characterized by the disruption of the alveolar–capillary barrier, leading to impaired oxygenation and pulmonary edema. Current pharmacological interventions primarily involve the use of steroid drugs, oxygen radical scavengers, and bronchodilators. However, the therapeutic efficacy of these interventions remains inconsistent. Canthin-6-ones, a class of tryptophan-derived alkaloids, exhibit anti-inflammatory, antioxidant, and immunomodulatory properties. In this study, we synthesized a novel Canthin-6-one derivative, namely HCX3, and evaluated its potential beneficial effects and underlying mechanisms on ALI. Prior to the experimental study, network pharmacology analysis revealed that HCX3 may exert anti-inflammatory effects in the context of ALI through the regulation of multiple signaling pathways, including the NF-κB pathways. To validate these findings, Lipopolysaccharide (LPS) was employed to stimulate RAW 264.7 macrophages and bone marrow-derived macrophages (BMDMs) to construct cellular models of inflammatory response associated with ALI. Our data demonstrated that exposure to HCX3 significantly inhibited the transcription and the secretion of multiple pro-inflammatory mediators, including IL-1β, IL-6, and TNF-α, in a dose-dependent manner. Additionally, HCX3 reduced LPS-induced phosphorylation levels of p65 and IκB-α in macrophages, indicating an inhibitory effect of the compound on the activation of NF-κB signaling pathway. Collectively, our data suggest that HCX3 exhibits significant anti-inflammatory effects by inhibiting NF-κB-related signaling pathways, providing new insights for ALI treatment. Full article

Background and Objectives: The objectives of this review were as follows: to measure changes in renal biomarker levels before, immediately after, and 24 h post-marathon; to identify promising biomarkers for the diagnosis of acute kidney injury; and to describe the temporal patterns of biomarker dynamics in relation to the marathon. Materials and Methods: Studies of marathon runners reporting AKI-related biomarkers were included. Four databases (PubMed, EMBASE, Web of Science, and LILACS) were searched. Data on study design, participant characteristics, and biomarker values (pre-, post-, and 24 h post-race) were extracted, and a random effects meta-analysis was performed. Risk of bias was assessed with the National Heart, Lung, and Blood Institute pre–post tool. Results: The study showed significant increases in most biomarkers immediately after the marathon compared to baseline values. The largest increases were observed in Tissue Inhibitor of Metalloproteinases-2* Insulin-like Growth Factor Binding Protein-7 (TIMP-2*IGFBP), copeptin, urinary Liver-type Fatty Acid Binding Protein (L-FABP), urinary Monocyte Chemoattractant Protein-1 (MCP-1), IGFBP-7, urinary Chitinase 3-like Protein 1 (YKL-40), and TIMP-2, suggesting that these biomarkers are promising candidates for future research. Several patterns of biomarker evolution were observed: some increased without decreasing even at 24 h after the marathon; others increased post-marathon and decreased at 24 h while remaining above baseline; some increased after the marathon and then fell below baseline at 24 h. Conclusions: Marathon running causes significant increases in kidney injury biomarkers, with different patterns of evolution. Full article

Background: Uniportal video-thoracoscopic lobectomy has improved postoperative outcomes in lung cancer patients. Thus, thoracic surgeons are increasingly required to learn this new approach. Methods: We evaluate the path of a single surgeon switching from triportal video-thoracoscopic lobectomy to the uniportal, using the cumulative sum (CUSUM) analysis, in a single center to assess the learning curve, enrolling 107 uniportal video-thoracoscopic lobectomies consecutively performed. CUSUM analysis detected how many uniportal video-thoracoscopies occur to obtain changes in mean operation time, among all procedures consecutively performed. CUSUM analysis identified the cut-off at the 67th procedure; this value was used to divide all patients into two groups: group A (first 67 patients, early phase) and group B (40 patients, experienced phase). Then, we analyze the perioperative outcomes between the two groups. Results: Gender characteristics of the two groups were statistically similar. Median operative time decreased significantly after the early phase [188 min (IQR: 151–236) vs. 170.5 (IQR: 134–202) (p-value = 0.02)], respectively. Similarly, during the second phase, the conversions rate decreased: [10 (15%) (group A) vs. 1 (2%) (group B) (p-value = 0.04)], as did the postoperative complications [28 cases (42%) vs. 9 cases (22%) (p-value = 0.04)] and the length of stay [6 days (IQR 5–9.5) vs. 5 days (IQR 4–8) (p-value = 0.04)], giving evidence of skills acquired in the second phase. Conclusions: CUSUM analysis identified 67 uniportal lobectomies, after which operative time, conversion rate, and perioperative complications significantly decreased; the moving average analysis further supports a progressive reduction in operative time. Despite prior multiportal video-thoracoscopic experience, switching to uniportal video-thoracoscopy requires a distinct learning process. Full article

Background: Dupilumab, a monoclonal antibody targeting the IL-4/IL-13 receptor, has shown significant efficacy in improving asthma control and reducing exacerbations in patients with severe eosinophilic asthma. However, there is a lack of knowledge about real-world data on clinical remission rates and their predictors. Objective: This study aimed to evaluate clinical outcomes, remission rates, and predictive factors of remission in a real-life cohort of patients with severe eosinophilic asthma treated with dupilumab. Methods: We conducted a retrospective, bicentric, observational study including 52 patients with severe eosinophilic asthma treated with dupilumab. Clinical, functional, and biomarkers were assessed at baseline, 6 months, and 12 months. Statistical analyses included logistic regression to identify independent predictors of clinical remission. Results: After 12 months of treatment, 48.2% of patients achieved clinical remission. Dupilumab significantly improved asthma control and lung function (including FVC and FEF_25–75), reduced exacerbation rates, and maintenance therapy. High blood eosinophil levels (>490 cells/µL), high FeNO levels (>25 ppb), a history of CRSwNP, and better baseline FEV1 were associated with asthma remission. Conversely, obesity (BMI > 30) and related comorbidities (such as GERD, OSAS, and hypertension) and bronchiectasis were associated with a lower likelihood of remission. Multivariate analysis confirmed higher baseline FEV1 (OR 2.94; IC 1.13–7.6), positive history of CRSwNP (OR 8.03; IC 1.41–45.5), and higher baseline blood eosinophils (OR 1.003 IC 1.001–1.006) as independent predictors of clinical remission. Conclusions: These results are in line with the known effectiveness of dupilumab in severe eosinophilic asthma and identified a history of CRSwNP, higher baseline FEV1, and elevated blood eosinophils as key predictors of clinical remission. These findings may contribute to a more personalized approach to treatment selection, emphasizing the importance of comorbidity assessment together with type 2 inflammation biomarkers. Further prospective studies are needed to validate these results. Full article