Radiological findings of unilateral tuberculous lung destruction

Predictive value of gradient boosting decision trees for postoperative atelectasis complications in patients with pulmonary destruction

OBJECTIVE

To explore the application value of a gradient boosting decision tree (GBDT) in predicting postoperative atelectasis in patients with destroyed lungs.

METHODS

A total of 170 patients with damaged lungs who underwent surgical treatment in Chest Hospital of Guangxi Zhuang Autonomous Region from January 2021 to May 2023 were retrospectively selected. The patients were divided into a training set (n = 119) and a validation set (n = 51). Both GBDT algorithm model and Logistic regression model for predicting postoperative atelectasis in patients were constructed. The receiver operating characteristic (ROC) curve, calibration curve and decision curve were used to evaluate the prediction efficiency of the model.

RESULTS

The GBDT model indicated that the relative importance scores of the four influencing factors were operation time (51.037), intraoperative blood loss (38.657), presence of lung function (9.126) and sputum obstruction (1.180). Multivariate Logistic regression analysis revealed that operation duration and sputum obstruction were significant predictors of postoperative atelectasis among patients with destroyed lungs within the training set (P = 0.048, P = 0.002). The ROC curve analysis showed that the area under the curve (AUC) for GBDT and Logistic model in the training set was 0.795 and 0.763, and their AUCs in the validation set were 0.776 and 0.811. The GBDT model's predictions closely matched the ideal curve, showing a higher net benefit than the reference line.

CONCLUSIONS

GBDT model is suitable for predicting the incidence of complications in small samples.

Analysis of clinical characteristics of different types of lung function impaiement in TDL patients

AIM

The clinical characteristics associated with pulmonary function decline in patients with Tuberculosis-destroyed lung (TDL) remain uncertain. We categorize them based on the pattern of pulmonary function impairment, distinguishing between restrictive spirometric pattern (RSP) and obstructive spirometric pattern (OSP). We aim to compare the severity of these patterns with the clinical characteristics of TDL patients and analyze their correlation.

METHOD

We conducted a retrospective analysis on the clinical data of TDL patients who underwent consecutive pulmonary function tests (PFT) from November 2002 to February 2023. We used the lower limit formula for normal values based on the 2012 Global Lung Function Initiative. We compared the clinical characteristics of RSP patients with those of OSP patients. The characteristics of RSP patients were analyzed using the tertiles of forced vital capacity percentage predicted (FVC% pred) decline based on PFT measurements, and the characteristics of OSP patients were analyzed using the tertiles of forced expiratory volume in 1 s percentage predicted (FEV1% pred) decline.

RESULT

Among the RSP patients, those in the Tertile1 group (with lower FVC% pred) were more likely to have a higher of body mass index (BMI), spinal deformities, and C-reactive protein (CRP) compared to the other two groups (P for trend < 0.001, 0.027, and 0.013, respectively). Among OSP patients, those in the Tertile1 group (with lower FEV1% pred) showed an increasing trend in cough symptoms and contralateral lung infection compared to the Tertile 2-3 group (P for trend 0.036 and 0.009, respectively).

CONCLUSION

For TDL patients, we observed that Patients with high BMI, a higher proportion of spinal scoliosis, and abnormal elevation of CRP levels were more likely to have reduced FVC. Patients with decreased FEV1% pred have more frequent cough symptoms and a higher proportion of lung infections on the affected side.

Post-tubercular Unilateral Lung Destruction: A Complicated Case

Pulmonary tuberculosis is associated with long-term complications that affect both the respiratory and cardiovascular systems. We present the case of a 65-year-old male patient who presented with chief complaints of productive cough and breathlessness for the last four years. Further radiological investigations revealed a left-sided destroyed lung with left lung collapse and deviation of the mediastinum towards the left side. The patient responded well to treatment with broad-spectrum antimicrobial drugs and mucolytics.

Paleopathology of the Ychsma: Evidence of respiratory disease during the Late Intermediate Period (AD 1000-1476) at the Central Coastal site of Pachacamac, Peru

OBJECTIVE

To investigate evidence for maxillary sinusitis and pulmonary inflammation in archaeological skeletons dating to the Late Intermediate Period (AD 1000-1476) at the site of Pachacamac, Peru.

MATERIALS

Thirty-nine individuals (male, female, and unknown sex; 16+ years age-at-death) were analyzed for inflammatory periosteal reaction (IPR) on the visceral (inner) surfaces of the ribs, and 16 individuals were analyzed for evidence of maxillary sinusitis.

METHODS

All individuals were macroscopically examined for bony changes in the maxillary sinuses and new bone formation on the ribs according to pre-established criteria.

RESULTS

Some 33.3% (13/39) of individuals had IPR on the ribs and 93.8% (15/16) had bony changes in the maxillary sinuses.

CONCLUSIONS

Respiratory disease was likely prevalent in people buried at Pachacamac during the Late Intermediate Period. A number of factors may have increased the risk of developing respiratory disease, including exposure to poor air quality and increased crowding and social mixing, resulting from pilgrimage to this important ritual center.

SIGNIFICANCE

This paper represents one of the first systematic analyses of evidence for respiratory disease in Peruvian and South American human skeletal remains, demonstrating the suitability of the region for further study.

LIMITATIONS

A limited sample was available for analysis. Additionally, the site's skeletal preservation was excellent, meaning the sample available for assessment of maxillary sinusitis was smaller, being limited to individuals with post-mortem breakage.

FURTHER RESEARCH

The results of this study should stimulate further much needed systematic investigation of evidence for respiratory disease in other Peruvian and South American populations.