Thoracic research and practice最新文献

{"title":"Comment on: Letter to the Editor Regarding CT-based Prediction of Lung Cancer Histology.","authors":"Fani Tsolaki","doi":"10.4274/ThoracResPract.2026.2026-3-5","DOIUrl":"https://doi.org/10.4274/ThoracResPract.2026.2026-3-5","url":null,"abstract":"","PeriodicalId":75221,"journal":{"name":"Thoracic research and practice","volume":"27 3","pages":"195"},"PeriodicalIF":0.6,"publicationDate":"2026-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147876803","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":"Clinical Characteristics of Moderate-to-Severe Obstructive Sleep Apnea: A Cross-sectional Analysis of 12,715 Adults from the TURKAPNE Cohort.","authors":"Baran Balcan, Aylin Pıhtılı, Esen Kıyan, Mehmet Sezai Taşbakan, Özen K Başoğlu, Şenay Aydın, Aykut Çilli, Neşe Dursunoğlu, Nur Aleyna Yetkin, Yüksel Peker","doi":"10.4274/ThoracResPract.2026.2026-1-4","DOIUrl":"10.4274/ThoracResPract.2026.2026-1-4","url":null,"abstract":"<p><strong>Objective: </strong>Obstructive sleep apnea (OSA) is a common sleep-related breathing disorder associated with cardiometabolic morbidity. However, its clinical presentation is heterogeneous, and subjective sleepiness does not consistently reflect disease severity. We aimed to describe the clinical and polysomnographic characteristics of moderate-to-severe OSA and to identify factors independently associated with disease severity in a large nationwide sleep clinic cohort.</p><p><strong>Material and methods: </strong>This cross-sectional study was conducted within the Turkish Sleep Apnea Database cohort and included 12,715 adults with complete baseline clinical and polysomnographic data from 34 sleep centers. Moderate-to-severe OSA was defined as an apnea-hypopnea index (AHI) ≥15 events/h. Demographic and anthropometric variables, sleep-related symptoms, Epworth Sleepiness Scale (ESS) scores, polysomnographic parameters, and comorbidities were analyzed. Independent factors associated with moderate-to-severe OSA were identified using multivariable logistic regression.</p><p><strong>Results: </strong>Overall, 8,393 patients (66.0%) had moderate-to-severe OSA and 4,322 (34.0%) had no or mild OSA (AHI <15 events/h). Patients with moderate-to-severe OSA were older, more frequently male, and had a higher body mass index (BMI) (all P < 0.001). Although excessive daytime sleepiness (ESS ≥11) was more common (25.8% vs. 17.7%, P < 0.001), ESS score was not independently associated with disease severity. Increasing age, male sex, higher BMI, snoring, witnessed apneas, and nocturnal dyspnea remained independent associates of moderate-to-severe OSA.</p><p><strong>Conclusion: </strong>In this large nationwide sleep clinic cohort, objective risk factors and classic nocturnal symptoms were more informative than subjective sleepiness in identifying clinically significant OSA and support a risk-based approach in routine pulmonary practice.</p>","PeriodicalId":75221,"journal":{"name":"Thoracic research and practice","volume":" ","pages":"173-181"},"PeriodicalIF":0.6,"publicationDate":"2026-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147791273","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":"The Impact of the Exposome on Epithelial Barriers: New Approach Methodologies for Translational Research.","authors":"Pelin Saglam-Metiner, Ebru Calkan-Yildirim, Basar Dogan, R Dilara Vaizoglu, Cigdem Elif Celik, Ozlem Goksel, Ozlem Yesil-Celiktas, Levent Pelit, Yasin Kaymaz, Henrik Kløverpris, Douglas S Kwon, Carla F Kim, Petros Koutrakis, Cezmi Akdis, Omer H Yilmaz, Tuncay Goksel","doi":"10.4274/ThoracResPract.2026.2026-1-9","DOIUrl":"10.4274/ThoracResPract.2026.2026-1-9","url":null,"abstract":"<p><p>Environmental exposures experienced throughout life, collectively referred to as the exposome, play a fundamental role in shaping epithelial barrier integrity, repair capacity, and vulnerability to disease. These exposures encompass a broad spectrum of chemical, physical, biological, and lifestyle-related factors. Despite growing recognition of their importance, a key unresolved challenge is understanding how single exposures and, more importantly, complex real-world exposure mixtures jointly disrupt epithelial organization, stem and progenitor cell niches, and immune-epithelial communication across different organs. This review consolidates current evidence on environmentally relevant exposomes that directly affect epithelial barrier function and examines their consequences for tissue architecture, niche stability, and frontline defense mechanisms. We further discuss recent advances in new approach methodologies, including organ-specific epithelial barrier models, organoids, organ-on-a-chips, and interconnected multi-organ platforms. By synthesizing evidence across organ systems, we highlight convergent biological processes, such as oxidative stress, inflammatory signaling, disruption of intercellular junctions, and impaired epithelial survival or regeneration, as shared pathways linking environmental stressors to barrier failure. We hope that this review will help bridge exposure science, epithelial biology, and bioengineered human-based models to define critical knowledge gaps and key translational priorities for the field.</p>","PeriodicalId":75221,"journal":{"name":"Thoracic research and practice","volume":" ","pages":"182-194"},"PeriodicalIF":0.6,"publicationDate":"2026-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147679287","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":"Seasonal Oxidative Stress and Airway Reactivity in Rhinitis: Distinct Patterns in Allergic vs. Non-allergic Individuals.","authors":"Sümeyra Alan Yalım, Ayşe Füsun Kalpaklıoğlu, Ayşe Baççıoğlu","doi":"10.4274/ThoracResPract.2026.2025-10-4","DOIUrl":"10.4274/ThoracResPract.2026.2025-10-4","url":null,"abstract":"<p><strong>Objective: </strong>Rhinitis is a common upper airway disorder, classified as either allergic rhinitis (AR) or non-allergic rhinitis (NAR). While the association between air pollution and AR airway diseases has been well documented, its specific effects on NAR remain poorly understood. This study aimed to evaluate the seasonal impact of air pollution on pulmonary function, oxidative stress biomarkers, and bronchial hyperresponsiveness in patients with AR, patients with NAR, and healthy controls.</p><p><strong>Material and methods: </strong>In this prospective case-control study, 58 participants (23 AR, 22 NAR, 13 controls) were evaluated during periods of low pollution (summer) and high pollution (winter). Assessments included symptom questionnaires, pulmonary function tests, bronchial provocation tests (BPT), serum total antioxidant status (TAS), and total oxidative status.</p><p><strong>Results: </strong>In the high pollution period, the NAR group exhibited significantly lower TAS levels compared to summer (1.51±0.15, 1.60±0.2, <i>P</i> = 0.041), indicating an increased oxidative stress. A significant decrease in post-bronchodilator forced expiratory volume in 1 second (FEV)₁ was also observed in the NAR group, suggesting heightened airway reactivity. The AR group demonstrated a higher frequency of BPT reactivity. Pulmonary function declined across all groups in winter, with the greatest reduction observed in AR patients. Within-group analyses revealed seasonal reductions in both FEV₁ and post-BPT FEV₁ in AR and NAR groups.</p><p><strong>Conclusion: </strong>Seasonal air pollution exerts phenotype-specific effects on oxidative stress and airway reactivity in rhinitis. AR patients exhibited increased bronchial hyperresponsiveness, whereas NAR individuals showed a marked decline in antioxidant capacity. These findings highlight the importance of phenotype-based monitoring and management during periods of high environmental exposure.</p>","PeriodicalId":75221,"journal":{"name":"Thoracic research and practice","volume":" ","pages":"141-147"},"PeriodicalIF":0.6,"publicationDate":"2026-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147583143","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":"Compliance of Aerosol Therapy with Evidence-based Guideline and Cost Incurred in Adult Critically-ill Patients: A Prospective Observational Study.","authors":"Ayushi R Verma, Jignesh Shah, Sulochana Kumari, Asavari L Raut, Steffi Abraham, Ritu Priya, Kinjal K Patil","doi":"10.4274/ThoracResPract.2025.2025-9-8","DOIUrl":"10.4274/ThoracResPract.2025.2025-9-8","url":null,"abstract":"<p><strong>Objective: </strong>Aerosol therapy is widely used in intensive care units (ICUs) for managing respiratory conditions. However, non-adherence to evidence-based guidelines can compromise outcomes and increase healthcare costs. This study evaluated the compliance of aerosol therapy with the \"Indian Guidelines on Nebulization Therapy\" and the cost incurred in critically ill patients.</p><p><strong>Material and methods: </strong>A prospective observational study was conducted in 307 adult patients across the ICUs of a tertiary care hospital during a six-month study period. Analysis was performed using the chi-square test and the Wilcoxon rank-sum test in RStudio (version 4-4.3, 2024). Multivariate logistic regression identified independent predictors of compliance.</p><p><strong>Results: </strong>Of the 307 ICU patients analyzed, 64.5% were male, with an average age of 57±16 years. Jet nebulizers were used in 91.5% of cases. Bronchodilators (47.13%) and corticosteroids (35%) were widely used classes of drugs. Compliance of drug therapy with evidence-based guidelines varied significantly by duration of ICU stay (<i>P</i> = 0.0062) and by ICU category (<i>P</i> = 0.0005). Drug compliance was higher in critical care and neurology ICUs [odds ratio (OR): 6.500, <i>P</i> = 0.0001; OR: 4.574, <i>P</i> = 0.005]. Administration compliance was significantly associated with the diagnosis category (<i>P</i> = 0.00186) and was higher among patients with non-respiratory diagnoses (OR: 4.96, <i>P</i> =0.0068). Adherence to guidelines for drug therapy significantly lowered costs (<i>P</i> = 0.0103).</p><p><strong>Conclusion: </strong>Targeted interventions, protocol standardization, and staff training are needed to enhance compliance, optimize patient care, and control aerosol-related expenditures. Clinically, these findings highlight that adherence to evidence-based aerosol therapy not only enhances patient outcomes but also reduces ICU expenditure, thereby supporting integration into routine clinical practice.</p>","PeriodicalId":75221,"journal":{"name":"Thoracic research and practice","volume":" ","pages":"155-164"},"PeriodicalIF":0.6,"publicationDate":"2026-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147357995","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":"Cost Analysis of Tuberculosis Disease in the Case of Tuberculosis Control Dispensary.","authors":"Dolunay Özlem Zeybek, Mustafa Zeybek, İskender Çetintürk, Yasemin Aslan, Filiz Özyiğit","doi":"10.4274/ThoracResPract.2026.2025-10-2","DOIUrl":"10.4274/ThoracResPract.2026.2025-10-2","url":null,"abstract":"<p><strong>Objective: </strong>To estimate the direct and indirect costs associated with tuberculosis (TB) prevention, control, and treatment activities conducted at a TB control dispensary in Türkiye and to assess the economic burden of TB at the patient level.</p><p><strong>Material and methods: </strong>Patient-level cost data for individuals treated in 2023 with International Classification of Diseases, 10^th Revision diagnostic codes A15-A19 were analyzed from the perspective of the healthcare provider. Direct medical costs were calculated based on healthcare service utilization using reimbursement prices specified in the Turkish Social Security Institution's Health Implementation Communiqué. Indirect costs were estimated using patient-reported data and included productivity loss, time spent accessing healthcare services, transportation expenses, and other out-of-pocket expenditures. All costs were calculated as the average annual cost per patient.</p><p><strong>Results: </strong>The average annual direct cost per patient was $346.39 (9,271.59◊), with prescribed medications constituting the largest component of direct costs. The average annual indirect cost per patient amounted to $1,087.80 (32,013.50◊), mainly driven by productivity losses and time spent in healthcare facilities. Overall, the average annual cost per TB patient was estimated at $1,434.22 (41,285.09◊), with indirect costs accounting for nearly three-quarters of the total economic burden.</p><p><strong>Conclusion: </strong>The findings demonstrate that TB imposes a substantial economic burden on patients, primarily through indirect costs, even when TB-related healthcare services are covered by the social security system. These results underscore the need for TB control strategies that extend beyond medical care and incorporate social protection and economic support mechanisms to reduce productivity losses and financial vulnerability among patients.</p>","PeriodicalId":75221,"journal":{"name":"Thoracic research and practice","volume":" ","pages":"165-172"},"PeriodicalIF":0.6,"publicationDate":"2026-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147505632","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":"Prognostic Significance of Computed Tomography Severity Score for Machine Learning Prediction of Intensive Care Unit Admission in COVID-19 Patients.","authors":"Seyed Salman Zakariaee, Ali Sohrabnejad, Mostafa Shanbehzadeh, Negar Naderi","doi":"10.4274/ThoracResPract.2025.2025-7-13","DOIUrl":"10.4274/ThoracResPract.2025.2025-7-13","url":null,"abstract":"<p><strong>Objective: </strong>The computed tomography-severity score (CT-SS) quantifies the severity of pulmonary involvement and is significantly associated with disease severity, intensive care unit (ICU) admissions, and mortality in coronavirus disease-2019 (COVID-19) patients. There is very limited information on the prognostic value of CT-SS when used in machine learning (ML) models to predict ICU admission in COVID-19 patients. In this study, the prognostic significance of CT-SS in ML model-based prediction of ICU admission among COVID-19 patients was evaluated.</p><p><strong>Material and methods: </strong>In this retrospective study, a hospital-based database from 6,854 COVID-19 patients was reviewed. To evaluate the prognostic significance of CT-SS in predicting ICU admission in patients, seven ML methods were trained separately using the most important features, with and without CT-SS data, and their performances were compared.</p><p><strong>Results: </strong>After applying exclusion criteria, 815 COVID-19 patients remained. Just over half of the patients (54.85%) were male, and the mean age was 57.22±16.76 years. The CT-SS index was the strongest predictor among the parameters examined, and integrating this index into the training dataset enhanced ML model performance. The k-nearest neighbors model with 93.3% accuracy, 97.3% sensitivity, 89.4% specificity, and an area under the curve of approximately 98.8% showed the best performance for predicting ICU admission in COVID-19 patients.</p><p><strong>Conclusion: </strong>The results showed that CT-SS is a key predictor for ML models of ICU admission in COVID-19 patients. The ML models developed using a dataset including CT-SS are efficient risk stratification tools for identifying critical COVID-19 patients, thereby facilitating optimal allocation of limited hospital resources.</p>","PeriodicalId":75221,"journal":{"name":"Thoracic research and practice","volume":" ","pages":"132-140"},"PeriodicalIF":0.6,"publicationDate":"2026-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145971479","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":"Reliability and Validity of the Turkish Version of the Lung Transplant-specific Valued Life Activities Scale.","authors":"Ulaş Ar, Erdal Yekeler, Ebru Çalık, Fatmanur Çelik Başaran, Sinan Türkkan","doi":"10.4274/ThoracResPract.2026.2025-10-5","DOIUrl":"10.4274/ThoracResPract.2026.2025-10-5","url":null,"abstract":"<p><strong>Objective: </strong>The lung transplantation-specific valued life activities (LT-VLA) is a 15-item questionnaire developed to assess limitations in activities of daily living in LT recipients. This study aimed to evaluate the validity and reliability of its Turkish version.</p><p><strong>Material and methods: </strong>Twenty-two LT recipients participated in this single-center cross-sectional study. Test-retest reliability was assessed using intraclass correlation coefficients (ICC), and internal consistency was measured with Cronbach's alpha (α). Criterion validity was examined by comparing LT-VLA scores with the Saint George Respiratory Questionnaire, Short Form-12 (SF-12), London Chest Activity of Daily Living Scale (LCADL), and modified Medical Research Council (mMRC) scale.</p><p><strong>Results: </strong>Cronbach's α values for the mean difficulty, activities affected, and activities unable subscales were 0.945, 0.906, and 0.934, respectively. ICC values ranged from 0.828 to 0.897. The mean difficulty score showed a moderate correlation with LCADL self-care (r = 0.543, <i>P</i> = 0.009) and SF-12 physical (r = -0.532, <i>P</i> = 0.011). The activities affected subscale was correlated with SF-12 physical (r = -0.587, <i>P</i> = 0.004) and with mMRC (r = 0.563, <i>P</i> = 0.006).</p><p><strong>Conclusion: </strong>The Turkish version of the LT-VLA is a reliable and valid tool for assessing activity limitations in LT recipients. It will be a useful and feasible tool for rehabilitation professionals to assess activity limitations in LT recipients undergoing pulmonary rehabilitation.</p>","PeriodicalId":75221,"journal":{"name":"Thoracic research and practice","volume":" ","pages":"148-154"},"PeriodicalIF":0.6,"publicationDate":"2026-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147505696","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":"Response to: Letter to the Editor Regarding CT-based Prediction of Lung Cancer Histology.","authors":"Fadlan Adima Adrianta, Dini Rachma Erawati, Suryanti Dwi Pratiwi, Nanik Setijowati","doi":"10.4274/ThoracResPract.2026.2026-3-10","DOIUrl":"https://doi.org/10.4274/ThoracResPract.2026.2026-3-10","url":null,"abstract":"","PeriodicalId":75221,"journal":{"name":"Thoracic research and practice","volume":"27 3","pages":"196-197"},"PeriodicalIF":0.6,"publicationDate":"2026-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147876772","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":"Comparison of AI-based Chatbot Performance in Analyzing Clinical Scenarios versus Medical Residents: A Novel Approach in Chest Diseases Education.","authors":"Mehmet Hakan Bilgin, Hamit Hakan Alp","doi":"10.4274/ThoracResPract.2026.2026-1-2","DOIUrl":"https://doi.org/10.4274/ThoracResPract.2026.2026-1-2","url":null,"abstract":"<p><strong>Objective: </strong>Rapid advancements in artificial intelligence (AI) technologies offer new opportunities in medical education. The aim of this study is to compare the performance of large language models, specifically ChatGPT-4 and Gemini, in analyzing clinical scenarios with that of chest diseases research assistants (residents), and to evaluate their potential roles in medical education.</p><p><strong>Material and methods: </strong>This cross-sectional, comparative study included 28 resident physicians working in the department of chest diseases at a tertiary-care university hospital. Four clinical scenarios involving diagnoses of massive pulmonary embolism, chronic obstructive pulmonary disease, asthma, and severe pneumonia/sepsis were presented to both participants and AI models (ChatGPT-4 and Gemini). Responses were scored by blinded experts based on current guidelines (Global Initiative for Chronic Obstructive Lung Disease, Global Initiative for Asthma, American Thoracic Society).</p><p><strong>Results: </strong>AI models achieved significantly higher scores than residents, particularly on structured questions requiring theoretical knowledge, classification skills, and the listing of contraindications (<i>P</i> < 0.05). However, it was observed that residents achieved success levels similar to those of AI models in situations requiring emergency intervention (e.g., shock management) through practical, results-oriented approaches. While AI models provided a broader spectrum in differential diagnosis, residents preferred \"telegraphic\" and practice-oriented responses.</p><p><strong>Conclusion: </strong>ChatGPT and Gemini have significant potential as clinical decision-support systems and educational assistants. However, rather than replacing human factors in clinical reasoning and emergency management, they should be positioned as complementary tools that accelerate physicians' access to theoretical knowledge.</p>","PeriodicalId":75221,"journal":{"name":"Thoracic research and practice","volume":" ","pages":""},"PeriodicalIF":0.6,"publicationDate":"2026-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147679310","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}