An assessment of the correlation between robust CT-derived ventilation and pulmonary function test in a cohort with no respiratory symptoms

OBJECTIVE: To evaluate CT-ventilation imaging (CTVI) within a well-characterized, healthy cohort with no respiratory symptoms and examine the correlation between CTVI and concurrent pulmonary function test (PFT). METHODS: CT scans and PFTs from 77 Caucasian participants in the NORM dataset (clinicaltrials.gov NCT00848406) were analyzed. CTVI was generated using the robust Integrated Jacobian Formulation (IJF) method. IJF estimated total lung capacity (TLC) was computed from CTVI. Bias-adjusted Pearson’s correlation between PFT and IJF-based TLC was computed. RESULTS: IJF- and PFT-measured TLC showed a good correlation for both males and females [males: 0.657, 95% CI (0.438–0.797); females: 0.667, 95% CI (0.416–0.817)]. When adjusting for age, height, smoking, and abnormal CT scan, correlation moderated [males: 0.432, 95% CI (0.129–0.655); females: 0.540, 95% CI (0.207–0.753)]. Visual inspection of CTVI revealed participants who had functional defects, despite the fact that all participant had normal high-resolution CT scan. CONCLUSION: In this study, we demonstrate that IJF computed CTVI has good correlation with concurrent PFT in a well-validated patient cohort with no respiratory symptoms. ADVANCES IN KNOWLEDGE: IJF-computed CTVI’s overall numerical robustness and consistency with PFT support its potential as a method for providing spatiotemporal assessment of high and low function areas on volumetric non-contrast CT scan

Factors influencing the total procedure time of CT-guided percutaneous core-needle biopsies of lung nodules: a retrospective analysis

PURPOSEThis study aims to investigate the factors that influence total procedure time when performing computed tomography (CT)-guided percutaneous core-needle lung biopsies.METHODSThis is a cross-sectional study of 673 patients, who underwent a CT-guided percutaneous coreneedle biopsy at a tertiary care center from March 2014 to August 2016. Data on patient, nodule, and procedural factors and outcomes were collected retrospectively. Univariate linear regression and a multivariate stepwise linear regression were utilized for analysis.RESULTSFactors most strongly associated with prolonged procedure duration include 20-gauge needle use when compared with 18-gauge needle use (estimated difference in time=1.19), collecting additional core biopsies (estimated difference in time=1.10), decubitus nodule side up (DNSU; estimated difference in time=1.42), and supine positioning (estimated difference in time=1.16) relative to decubitus nodule side down positioning, and increased nodule distance from the skin surface (estimated difference in time=1.03). Increased nodule length (estimated difference in time=0.93) was associated with reductions in procedure duration. Prolonged procedure time was associated with an increased rate of pneumothorax (odds ratio (OR)=1.02; P < .0001) and decreased rate of pulmonary hemorrhage (OR=0.97; P < .0001).CONCLUSIONThe use of 20-gauge biopsy needle, collecting additional core biopsies, DNSU and supine positioning, smaller nodule size, and increasing nodule distance from the skin surface were associated with increased procedure time for CT-guided core needle biopsies of lung nodules. Prolonged procedure time is associated with a higher rate of pneumothorax and a lower rate of pulmonary hemorrhage

Randomly and Non-Randomly Missing Renal Function Data in the Strong Heart Study: A Comparison of Imputation Methods

We gratefully acknowledge Rachel Schaperow, MedStar Health Research Institute, for editing the manuscript.Disclaimer: The opinions expressed in this paper are those of the authors and do not necessarily reflect the views of the Indian Health Service.Kidney and cardiovascular disease are widespread among populations with high prevalence of diabetes, such as American Indians participating in the Strong Heart Study (SHS). Studying these conditions simultaneously in longitudinal studies is challenging, because the morbidity and mortality associated with these diseases result in missing data, and these data are likely not missing at random. When such data are merely excluded, study findings may be compromised. In this article, a subset of 2264 participants with complete renal function data from Strong Heart Exams 1 (1989–1991), 2 (1993–1995), and 3 (1998–1999) was used to examine the performance of five methods used to impute missing data: listwise deletion, mean of serial measures, adjacent value, multiple imputation, and pattern-mixture. Three missing at random models and one non-missing at random model were used to compare the performance of the imputation techniques on randomly and non-randomly missing data. The pattern-mixture method was found to perform best for imputing renal function data that were not missing at random. Determining whether data are missing at random or not can help in choosing the imputation method that will provide the most accurate results.Yeshttp://www.plosone.org/static/editorial#pee

The association of reactive mediastinal and hilar lymphadenopathies with congestive heart failure.

Mediastinal and hilar lymphadenopathy (MHLD) is a common reason for referral to bronchoscopy to assess for malignant, infectious and granulomatous inflammatory etiologies. The rise of Endobronchial ultrasound guided trans-bronchial needle aspiration (EBUS/TBNA) as an accurate, safe and coast effective modality have led to its widespread use in pulmonary medicine. Several etiologies have been reported to be associated with reactive MHLD, such as chronic obstructive pulmonary disease (COPD), pulmonary hypertension, interstitial lung disease and chronic kidney disease. Congestive heart failure (CHF) is considered one of the most common causes of reactive MHLD. The association between CT scan findings and MHLD in CHF is still not well understood. METHODS:We retrospectively reviewed all the patients who underwent EBUS-TBNA bronchoscopy at our tertiary referral center between January 2010 and December 2015. They were screened initially by computed tomography (CT) chest findings. We included patients with pure MHLD with or without CT findings suggestive of CHF. Patients with lung nodules and/or masses, mediastinal mass, parenchymal lung disease suggestive of granulomatous or infectious etiology and extrathoracic lymphadenopathy were excluded. Patients with history of malignancy within 5 years and/or active malignancy were also excluded. We collected clinical, radiological and pathological data, as well as follow up data after 1 year. We used clinical and echocardiographic criteria to diagnose CHF. Reactive lymphadenopathy was defined as EBUS/TBNA samples showing lymph node tissue with no other pathology and 1 year follow up revealing no alternative diagnosis. RESULTS: Out of 1,778 patients who underwent EBUS TBNA bronchoscopy, 46 patients had either pure MHLD (11 patients) and/or lung parenchymal abnormalities compatible with CHF (35 patients) seen in CT scan. There were 24 patients with clinical CHF of whom 21 (Sensitivity = 87.5%, Lr+ = 9.7) had reactive MHLD. Of the 22 patients without CHF, only 2 cases (9.1%) had reactive disease (Odds ratio = 70, P value \u3c0.0001). None of the 23 patients with “reactive” MHLD was diagnosed with any alternative diagnosis after 1 year. CONCLUSION: There was a strong association between clinical diagnosis of CHF and a diagnosis of reactive MHLD. Diagnosis of malignancy has a negative correlation with CT findings compatible with pure MHLD with or without findings suggestive of CHF. Prospective studies performed on CHF patients could provide better understanding of the phenomenon of reactive MHLD and may minimize the number of invasive procedures patients might undergo. (Table Presented)

Arab West Report 2009, Weeks 02-52: Investigative Reporting into Muslim-Christian Relations and Monastic Life

This dataset contains the Arab-West Report special reports that were published in 2009. This dataset mainly contains the writings of Cornelis Hulsman, Drs., among other authors on topics related to Muslim- Christian relations and interfaith dialogue Notably, this dataset contains certain reports related to the Christian faith in Egypt, Monastic life and Coptic Traditions. Some of the articles addressed Muslim-Christian incidents and sectarian tensions that took place in 2009 in Upper Egypt. Articles also address the situation of civil society organizations in Egypt. Additionally, reports document field visits by the Arab-West Report interns and interviews conducted with intellectuals and clergymen. Furthermore, it contained commentary on published material from other sources (reviews / critique of articles)