Tuberkuloz ve toraks最新文献

{"title":"Explainable benchmarking of U-Net variants for lung segmentation on chest radiographs.","authors":"Khalid Hani Abushahla, Halil Arslan","doi":"10.5578/tt.2026021210","DOIUrl":"https://doi.org/10.5578/tt.2026021210","url":null,"abstract":"<p><strong>Introduction: </strong>Accurate lung field segmentation in chest radiographs is essential for reliable computer-aided diagnosis of pulmonary diseases. This study aimed to systematically benchmark baseline, lightweight, and attention-based U-Net architectures while integrating explainable artificial intelligence (AI) to evaluate both segmentation performance and anatomical focus.</p><p><strong>Materials and methods: </strong>We conducted a comparative evaluation of three U-Net variants-baseline U-Net, attention U-Net, and shallow U-Net-using the chest X-ray Masks and Labels dataset. All models were trained under identical conditions with five-fold cross-validation and evaluated using accuracy, Intersection over Union (IoU), and Dice coefficient. Gradient-weighted Class Activation Mapping (Grad-CAM) was applied to visualize model attention and assess whether network activations were anatomically localized within lung regions. All architectures were implemented in TensorFlow.</p><p><strong>Result: </strong>U-Net and attention U-Net achieved the highest segmentation performance (Dice ≈ 0.97, IoU ≈ 0.94), with Grad-CAM activations consistently localized to lung fields, indicating reliable anatomical focus. The shallow U-Net showed slightly lower accuracy (Dice= 0.96, IoU= 0.92) but demonstrated faster inference and broader sensitivity to internal parenchymal structures, which may facilitate future disease-focused pulmonary analysis.</p><p><strong>Conclusions: </strong>This study highlights the trade-offs between segmentation accuracy, computational efficiency, and model interpretability across U-Net variants. By combining quantitative benchmarking with explainable AI-based analysis, our results provide performance insights, supporting the development of trustworthy AI tools for chest radiograph analysis.</p>","PeriodicalId":519894,"journal":{"name":"Tuberkuloz ve toraks","volume":"74 2","pages":"84-97"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148341857","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Short-term changes in serum total protein and albumin and clinical outcomes in acute exacerbation of interstitial lung diseases.","authors":"Masahiro Uchiyama, Kunihiko Miyazaki, Saori Hashimoto, Yosuke Maezawa, Gen Ohara, Naomi Kayauchi, Hiroaki Satoh, Ryuichi Hasegawa","doi":"10.5578/tt.2026021273","DOIUrl":"https://doi.org/10.5578/tt.2026021273","url":null,"abstract":"<p><strong>Introduction: </strong>Acute exacerbation (AE) of interstitial lung disease (ILD) is associated with high short-term mortality. Although decreases in serum albumin are frequently observed around AE onset, the clinical significance of shortterm dynamic changes in albumin has not been fully evaluated. We investigated whether changes in serum albumin around AE onset are associated with short-term outcomes.</p><p><strong>Materials and methods: </strong>We conducted retrospective study including patients diagnosed with ILD between May 2015 and June 2025. Among patients who developed AE, laboratory data obtained at AE onset and 1-3 months prior were analyzed. Changes in serum total protein (ΔTP) and albumin (ΔAlb) were calculated. Associations between these changes and 30-day mortality, as well as prognosis factor, were examined. Correlations between albumin levels at AE onset and lactate dehydrogenase (LDH) were also evaluated.</p><p><strong>Result: </strong>In 103 ILD patients, both TP and albumin significantly decreased at AE onset compared with pre-AE levels. Patients who died within 30 days showed a greater decline in albumin than survivors, whereas ΔTP was not associated with mortality. Albumin levels at AE onset were inversely correlated with LDH levels (ρ= -0.381), suggesting an association with acute physiological stress that may partly reflect enhanced protein catabolism. Marked hypoalbuminemia at the time of AE onset was an unfavorable factor.</p><p><strong>Conclusions: </strong>At the onset of AE, there was a rapid and marked decrease in serum albumin levels, which was associated with a poor prognosis. This dynamic change might reflect increased catabolism, but further research is needed to determine its causal relationship.</p>","PeriodicalId":519894,"journal":{"name":"Tuberkuloz ve toraks","volume":"74 2","pages":"75-83"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148341569","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fractional exhaled nitric oxide and practical points in asthma diagnosis and management.","authors":"Betül Özdel Öztürk, Zeynep Çelebi Sözener, Sevim Bavbek","doi":"10.5578/tt.2026021164","DOIUrl":"https://doi.org/10.5578/tt.2026021164","url":null,"abstract":"<p><strong>Introduction: </strong>Asthma, a multifaceted chronic inflammatory disorder, concerns more than 300 million people worldwide. Recent developments have classified asthma into predominantly Type 2 (T2) high and T2 low categories. Specific biomarkers, more so for T2 inflammation, determine the nature of inflammation. Fractional exhaled nitric oxide (FeNO) has been presented as a reliable and non-invasive biomarker of T2, eosinophilic, airway inflammation. The synthesis of nitric oxide (NO) occurs through three isoforms of nitric oxide synthase (NOS), with inducible NOS being predominantly expressed in inflammatory conditions, particularly in response to cytokines like IL-4 and IL-13. Elevated FeNO levels have been related to disease activity and have guided clinical decisions regarding corticosteroid and biologic therapies. FeNO measurement has been found to be effective in diagnosing asthma and assessing treatment response and adherence. The practicality of FeNO as a prognostic tool for exacerbation risk is highlighted in recent studies. In particular, FeNO measurements may help establish individualized treatment approaches and optimized treatment modalities, including biological treatment based on inflammation profiles. However, despite its advantages, the results of FeNO levels can be faked by many factors, such as genetics, environmental conditions, and concomitant diseases. Considering all of these, it seems helpful to integrate FeNO measurement into clinical practice in comprehensive asthma management with cautious interpretation, thus improving patient outcomes.</p>","PeriodicalId":519894,"journal":{"name":"Tuberkuloz ve toraks","volume":"74 2","pages":"106-120"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148341843","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"High-resolution CT findings of culture-confirmed enterococcal pneumonia: A two-center retrospective study.","authors":"Mustafa Yeşilyurt, Hüseyin Alper Kiziloğlu, Fahri Aydin, Adem Karaman, Ömer Araz, Muhammed Hamidullah Uyanik, Fatih Alper, Metin Akgün","doi":"10.5578/tt.2026021212","DOIUrl":"10.5578/tt.2026021212","url":null,"abstract":"<p><strong>Introduction: </strong>This study aimed to describe the high-resolution computed tomography (HRCT) features of culture-confirmed hospital-acquired pneumonia caused by Enterococcus, an uncommon infection rarely characterized radiologically.</p><p><strong>Materials and methods: </strong>We retrospectively reviewed HRCT scans of adults with microbiologically proven enterococcal pneumonia at two tertiary centers between 2019 and 2024. Patients with other pathogens, pulmonary malignancy, pulmonary edema or hemorrhage, or poor-quality images were excluded. Two thoracic radiologists independently evaluated predefined CT features, with consensus reached in cases of discrepancy. Interobserver agreement was measured using Cohen's kappa (κ).</p><p><strong>Result: </strong>Among 105 patients screened, 20 met the inclusion criteria (12 males, 8 females; mean age 62.9 years). The most common CT findings were groundglass opacities and pleural effusions (each in 70%), followed by consolidation (60%), bronchial wall thickening (60%), and intralobular reticulations (50%). Centrilobular nodules were identified in 45%, interlobular septal thickening in 40%, bronchiectasis in 30%, mediastinal lymphadenopathy in 20%, and empyema in 5%. Abnormalities were usually bilateral with lower-lobe predominance, and mixed features were often observed within the same lobe. On follow-up, 10 (50%) patients improved radiographically, whereas 10 (50%) showed disease progression and died despite treatment. Interobserver agreement was high, ranging from κ= 0.68 to κ= 1.00, indicating substantial to almost perfect concordance across features.</p><p><strong>Conclusions: </strong>Enterococcal pneumonia occurs mainly in older, comorbid, and critically ill patients and is associated with high mortality. HRCT commonly demonstrates ground-glass opacities, consolidation, and pleural effusions. Although pleural effusion appeared more frequent than in other bacterial pneumonias, the imaging findings overall were nonspecific, and microbiological confirmation remains essential for diagnosis.</p>","PeriodicalId":519894,"journal":{"name":"Tuberkuloz ve toraks","volume":"74 2","pages":"98-105"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148341818","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Treatment of severe tracheobronchopathia osteochondroplastica: Application of endobronchial argon plasma coagulation, presentation of three cases and literature review.","authors":"Mehmet Akif Özgül, Demet Turan, Efsun Gonca Uğur Chousein, Gersi Alisha, Güler Özgül, Ekrem Cengiz Seyhan","doi":"10.5578/tt.2026021067","DOIUrl":"10.5578/tt.2026021067","url":null,"abstract":"<p><strong>Introduction: </strong>Tracheobronchopathia osteochondroplastica (TBPO) is a rare condition characterized by the abnormal growth of cartilage within the trachea and main bronchi, leading to airway obstruction. The exact cause of TBPO is unknown, but it is thought to be associated with chronic inflammation of the airways and abnormal cartilage metabolism. Since there is not a standardization, the treatment of the condition depends on disease symptoms, infection status and the severity of the airway obstruction. Here, we aimed to present three cases of severe TBPO successfully managed in our interventional pulmonology unit applying argon plasma coagulation and mechanical debulking with rigid bronchoscopy, as well as the literature review.</p>","PeriodicalId":519894,"journal":{"name":"Tuberkuloz ve toraks","volume":"74 2","pages":"121-125"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148341543","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ventilator-associated pneumonia in an intensive care unit: A comparative analysis of clinical and microbiological characteristics of COVID-19 and non-COVID-19 patients.","authors":"Elif Mukime Saricaoğlu, Leyla Ferliçolak, Ezgi Gülten, Güle Çinar, İrem Akdemir, Melike Inan Hekimoğlu, İrem Kar, Neriman Defne Altintaş, Fügen Yörük","doi":"10.5578/tt.2026011187","DOIUrl":"10.5578/tt.2026011187","url":null,"abstract":"<p><strong>Introduction: </strong>The incidence and microbiological characteristics of coronavirus disease-2019 (COVID-19) associated ventilator-associated pneumonia (VAP) remain a clinical concern. The present study investigates the risk factors associated with VAP and compares the clinical and microbiological characteristics between the patients with and without COVID-19.</p><p><strong>Materials and methods: </strong>This retrospective case-control study was conducted in a tertiary intensive care unit (ICU) between March 2020 and February 2023. Patients with COVID-19 were identified through positive SARS-CoV-2 polymerase chain reactionresults, while non-COVID-19 patients served as controls. Demographic characteristics, comorbidities, clinical parameters, and microbiological data were analyzed. Risk factors for VAP were determined using multivariate logistic regression analysis. The Kaplan-Meier method was used to estimate the cumulative probability of VAP.</p><p><strong>Result: </strong>A total of 327 mechanically ventilated patients were enrolled, of whom 154 developed VAP. COVID-19 emerged as an independent predictor of VAP, conferring a 2.47-fold increased risk (p= 0.008). COVID-19 VAP patients had a higher prevalence of acute respiratory distress syndrome (ARDS) (p< 0.001), increased corticosteroid use (p= 0.004) and lower APACHE scores (p< 0.001). Both ICU and hospital case fatality rates were significantly increased in COVID-19 VAP patients. Klebsiella pneumoniae was the predominant pathogen in COVID-19 VAP patients, followed by Acinetobacter baumannii as the second most common pathogen.</p><p><strong>Conclusions: </strong>COVID-19 is a significant risk factor for VAP, with distinct clinical and microbiological characteristics compared to non-COVID-19 VAP. The greater occurrence of ARDS, corticosteroid use, and multidrug-resistant organisms in COVID-19-associated VAP highlights the urgent need for individualized antimicrobial strategies aimed at reducing infection-related morbidity and mortality.</p>","PeriodicalId":519894,"journal":{"name":"Tuberkuloz ve toraks","volume":"74 1","pages":"21-31"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147535309","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hypersensitivity pneumonitis.","authors":"Dildar Duman","doi":"10.5578/tt.2026011170","DOIUrl":"10.5578/tt.2026011170","url":null,"abstract":"","PeriodicalId":519894,"journal":{"name":"Tuberkuloz ve toraks","volume":"74 1","pages":"58-65"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147535331","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Can tuberculosis and non-tuberculosis mycobacteria infections be differentiated radiologically?","authors":"Hatice Arzu Uçar, Mehmet Polatli, Murat Telli","doi":"10.5578/tt.2026011073","DOIUrl":"10.5578/tt.2026011073","url":null,"abstract":"<p><strong>Introduction: </strong>Tuberculosis (TB) and non-tuberculous mycobacteria (NTM) are socioeconomically important infectious diseases. Diagnosis is supported by radiological examinations following the evaluation of clinical symptoms. Definitive diagnosis is made microbiologically or histopathologically. TB and NTM infections progress with different radiological findings such as cavitary and nodular infiltrations. In our study, it was aimed to investigate which criteria are stronger radiological determinants of which disease in microbiologically positive TB and NTM cases.</p><p><strong>Materials and methods: </strong>In our study, 417 cases that were positive for TB and NTM infections in the five-year microbiology laboratory were evaluated. The symptoms, sociodemographic, laboratory and radiological findings of the cases were obtained retrospectively from epicrisis information. Patients with NTM growth were examined according to ATS/IDSA NTM Infection diagnostic criteria.</p><p><strong>Result: </strong>There was a male sex predominance in both groups, and mean age was similar between the groups. The TB group was observed to present with more systemic symptoms, while the NTM group presented with more pulmonary symptoms. In radiological evaluation, the most common findings in both groups were nodules, consolidation, cavitation, and lymphadenopathy. The appearance of a tree in bud was also a common radiological finding in the TB group. When the two groups were compared, the presence of emphysema and atelectasis was significantly higher in the NTM group.</p><p><strong>Conclusions: </strong>In the diagnosis of TB and NTM infections, after taking a detailed anamnesis, care should be taken especially in terms of NTM infections in patients with radiological parenchymal damage.</p>","PeriodicalId":519894,"journal":{"name":"Tuberkuloz ve toraks","volume":"74 1","pages":"1-8"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147535319","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hyalinizing clear cell carcinoma of the lung: A rare case with long-term follow-up.","authors":"İclal Ocak, Furkan Ufuk, Aliya Husain","doi":"10.5578/tt.2026011035","DOIUrl":"10.5578/tt.2026011035","url":null,"abstract":"<p><strong>Introduction: </strong>Primary salivary gland-type lung cancers are extremely rare, accounting for less than 1% of all lung tumors. Hyalinizing clear cell carcinoma (HCCC) of the lung, an even rarer subtype, presents diagnostic challenges due to its similarity to other endobronchial lesions, such as carcinoid tumors or mucoepidermoid carcinoma. Here, we aimed to present a case of a 53-yearold male non-smoker who presented with recurrent respiratory symptoms. Initial chest X-ray showed consolidation, and subsequent computed tomography (CT) revealed a left lower lobe endobronchial nodule with postobstructive pneumonia. Positron emission tomography-CT imaging demonstrated mild F-18 fluorodeoxyglucose uptake, and bronchoscopy with biopsy led to the diagnosis of HCCC. The patient underwent a left lower lobectomy, and histopathological analysis confirmed the diagnosis. The fiveyear follow-up was unremarkable, with no signs of recurrence. This case underscores the importance of considering HCCC in the differential diagnosis of endobronchial lesions, particularly in non-smokers.</p>","PeriodicalId":519894,"journal":{"name":"Tuberkuloz ve toraks","volume":"74 1","pages":"66-70"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147535276","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between metabolic activity and molecular alterations in lung adenocarcinoma: Insights from 18F-FDG PET/CT.","authors":"Nilüfer Yiğit, Hilal Argüner, Sevin Başer, Hande Şenol, Gamze Gököz, Ümit Aydoğmuş, Ferda Bir, Aziz Gültekin","doi":"10.5578/tt.2026011208","DOIUrl":"10.5578/tt.2026011208","url":null,"abstract":"<p><strong>Introduction: </strong>Lung adenocarcinoma is a heterogeneous malignancy characterized by diverse molecular profiles that influence prognosis and treatment response. Identifying noninvasive imaging biomarkers capable of predicting genetic alterations may support early diagnosis and facilitate personalized therapeutic strategies.</p><p><strong>Materials and methods: </strong>In this retrospective study, 225 patients with lung adenocarcinoma who underwent baseline 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) imaging and molecular mutation testing were evaluated. Tumor metabolic activity was quantified using the maximum standardized uptake value (SUVmax) of the primary lesion. The relationship between SUVmax and molecular alterations, including epidermal growth factor receptor (EGFR), anaplastic lymphoma kinase (ALK), ROS proto-oncogene 1 receptor tyrosine kinase (ROS1), Kirsten rat sarcoma viral oncogene homolog mutations, and programmed deathligand 1 (PD-L1) expression, was analyzed.</p><p><strong>Result: </strong>EGFR mutation-positive tumors demonstrated significantly lower SUVmax values compared with mutation-negative tumors. In contrast, PD-L1- positive tumors were associated with higher SUVmax values. No significant correlation was identified between SUVmax and ALK or ROS1 alterations.</p><p><strong>Conclusions: </strong>Tumor metabolic activity measured by PET/CT may reflect specific molecular characteristics of lung adenocarcinoma. PET/CT-derived metabolic parameters, particularly when integrated with artificial intelligence and radiomics, could serve as non-invasive predictors of molecular alterations and help guide individualized treatment strategies. Prospective multicenter studies are warranted to validate these findings and confirm their clinical applicability.</p>","PeriodicalId":519894,"journal":{"name":"Tuberkuloz ve toraks","volume":"74 1","pages":"32-42"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147535194","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}