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Time of India
26-05-2025
- Health
- Time of India
Dr Sameer Arbat presents two research papers at ATS 2025 in San Francisco, USA
1 2 Nagpur: Dr Sameer Arbat, a renowned interventional pulmonologist in Central India, added another significant milestone to his career by presenting two original research papers at the prestigious American Thoracic Society (ATS) International Conference 2025 held in San Francisco, USA from May 16 to May 25. Dr Arbat presented two research papers including one on allergy testing and a rare case of airway stenting and removal conducted at One Healthcare. Both research papers were presented in collaboration with Dr Irfan Rahman, associate dean, Rochester University, New York. His research presentations were based on clinical advancements and innovations in interventional pulmonology, reflecting the growing capabilities of Indian medical research on the global stage. Dr Arbat showcased his contributions to cutting-edge pulmonary research on a global platform that draws thousands of clinicians, researchers, and thought leaders from around the world. Recognising his outstanding contributions and potential for international collaboration, Dr Arbat was selected as the Social Media Ambassador for this event by the Asia-Pacific Society of Respirology (APSR) and awarded a Registration Grant of $750 USD. by Taboola by Taboola Sponsored Links Sponsored Links Promoted Links Promoted Links You May Like ¡Desbloquea tus venas y gana años de vida! Beauty Ideas Leer más Undo The grant is awarded to a select few young researchers and clinicians from the Asia-Pacific region who show promise in advancing respiratory medicine. Dr Arbat, currently the president of Media Committee of World Association for Bronchology and Interventional Pulmonology (WABIP) became a member of the Society for Advanced Bronchoscopy (SAB) USA. Commenting on the honour, Dr Arbat said, "It is a privilege to represent India and the Asia-Pacific region at such a prestigious scientific forum. The American Thoracic Society Conference is one of the largest gathering of respiratory clinicians and researchers. Being able to present my work and exchange ideas with some of the best minds in the field is truly inspiring." Dr Arbat's achievements mark yet another proud moment for Nagpur and the Indian pulmonary fraternity, reinforcing the importance of global engagement and innovation in healthcare. Dr Sameer Arbat has performed more than 1,000 interventional pulmonology procedures including EBUS, Cryobiopsy, Rigid Bronchoscopy, Airway Stenting and Thoracoscopy.
Medscape
22-05-2025
- Health
- Medscape
Frailty in the ICU: Many Definitions, No Easy Solutions
SAN FRANCISCO — Frailty is hard to define and hard to distinguish from the effects of illness, injury, and medical interventions, but the frailty of patients in the intensive care unit (ICU) can have profound effects on outcomes, including the risk for mortality. In a scientific symposium on frailty in the ICU, presented during the American Thoracic Society (ATS) 2025 International Conference, researchers outlined both the challenges of assessing frailty in the ICU and the effects of frailty on patients in the ICU and after discharge. 'I think the ICU is a unique rubric to understand the role of frailty, stress, and maladaptive physiologic responses in mediating short- and long-term outcomes,' said Aluko Akini Hope, MD, from Oregon Health Sciences University in Portland, Oregon. Despite some unique challenges in the ICU setting, frailty can be measured using approaches that consider both frailty phenotype and cumulative deficits, Hope said. He defined physical frailty as 'a clinical state in which the patient has reduced functional reserve and increased vulnerability to stressors due to maladaptive changes across multiple physiologic systems.' Although definitions and means of assessing frailty vary, they can be roughly grouped into two main conceptual models. The phenotypic model relies on physical factors such as recent weight loss > 10 lbs, low grip strength, exhaustion, slow gait, and low physical activity. The cumulative health deficit model can be summed up as 'the more individuals have wrong, the more likely they are to be frail,' Hope said. Multiple Assessment Tools Frailty can be assessed with a variety of approaches, including the frailty index, which generates a score calculated by dividing the number of deficits a patient has by the total number of health variables considered. The assessment using this index can be reduced to approximately 30 items with good predictive validity, Hope said. The predictive power of this model relies, however, on clinical documentation in the electronic health record and is subject to residual confounding. In contrast to the frailty index, the Clinical Frailty Scales is based on clinical judgment of experienced clinicians to summarize the overall frailty or fitness level of older patients. The 9-point scale ranks patients from being 'very fit' to terminally ill and is associated with both morbidity and mortality outcomes in ICUs. This scale, widely used in ICUs in Canada for research purposes, has strong interrater reliability in ICU multidisciplinary teams, Hope commented. The phenotypic approach may be more difficult than other measures to use in a critical care setting because it relies on physical aspects such as ability to rise from a chair, slow walking speed, low physical activity, and exhaustion. These measures all rely on patient or caregiver recall. Performance measures to identify frailty include a sit-to-stand test, balance test, gait speed, and mobility stress testing, which may be appropriate in the post-ICU setting but can be hard to apply in a critical care unit. Impact on Outcomes Lauren Ferrante, MD, MHS, from the Yale School of Medicine in New Haven, Connecticut, noted that although the prevalence of frailty increases with age, from 3.2% in 65- to 70-year-olds to 25.7% in 85- to 89-year-olds in one study, many older adults are not frail, and making assumptions about frailty based only on appearance or immediate circumstances can result in either over- or undertreatment of patients. However, it is identified 'frailty is strongly associated with adverse ICU and hospital outcomes, including mortality,' she said. In addition, frailty 'is associated with worse patient-centered outcomes, including health-related quality-of-life and functional outcomes,' Ferrante said. She summarized findings from the literature on the effects of frailty on outcomes. For example, in a study published this year in the Annals of Intensive Care , investigators looked at the impact of frailty and older age on weaning patients from invasive mechanical ventilation and found that the highest proportion of patients for whom weaning failed was in those patients who were deemed to be frail, and that frailty had more consistent effect on weaning duration and success rates than older age. A separate study from the Canadian Critical Care Trials group, published in Intensive Care Medicine in 2024, found that frail patients were more likely than non-frail patients to experience ICU delirium and had higher in-hospital and 6-month mortality rates. Ferrante and colleagues, Hope and colleagues, and others have also looked at frail patients in longitudinal and cohort studies and found that frailty is associated with post-ICU disabilities and poor functional outcomes. In addition, patients who are frail have a 3.5-fold higher likelihood of new admissions to a nursing home after a critical illness than non-frail patients. And as John Muscedere, MD, Queen's University in Kingston, Ontario, Canada, and colleagues reported in a systematic review and meta-analysis, also presented at ATS 2025 International Conference, compared with non-frail patients, those who were frail had a more than twofold relative risk for in-hospital death, had a more than 2.5-fold relative risk for long-term mortality, and were significantly less likely to be discharged home. 'We should be thinking more about augmenting processes of care for frail ICU across the continuum to post-discharge care,' Ferrante said. She recommend considering automated methods of ascertaining frailty such as the eFrailty Index in the Epic medical record system, which automatically generates a frailty index score from chart data and has the potential to be adapted for use in the ICU. Clinicians should be cautioned, however, not to conflate automated measurements with severity of illness, which could yield false positive results, she emphasized. A Confusing Entity An ICU specialist who attended the session told Medscape Medical News that he wasn't convinced that the research presented during the session fully addressed the problem of frailty in the ICU. 'I really worry when we think about frailty as a construct in the ICU that we end up putting the cart before the horse. It's something that we know when we see it, but it's very difficult to measure, and we're talking about different things. When we say the word 'frailty' we're not always talking about the same thing, and I definitely worry when we think about developing specific interventions, particularly around ICU patients,' said Jeremy Kahn, MD, MS, professor of critical care medicine and health policy and management at the University of Pittsburgh, Pittsburgh. 'If we don't really understand what frailty is then we're going to end up with a lot of negative studies that may be several different diseases that we're conflating as one,' he said. Asked by Medscape Medical News whether the idea of an automated frailty index had merit, he replied that 'it's definitely more objective, but then it does raise the question whether you're measuring something new. We have lots of measures around comorbidities, we have age, which is very predictive, and not to say that frailty isn't a real thing, but if we can't measure it in a way differently from age or comorbidities, we're just using the electronic health record.' In the absence of an accurate objective measure of frailty, clinicians may be measuring things that they already know, such as comorbidities, or may be identifying patient populations that are diverse and may not be amenable to a single intervention, Kahn told Medscape Medical News . Hope, Ferrante, and Kahn reported having no relevant financial disclosures.
Miami Herald
21-05-2025
- Health
- Miami Herald
Lung cancer risk in never-smokers predicted by AI tool ‘Sybil'
ST. PAUL, Minn., May 19 (UPI) -- With lung cancer rates among non-smokers rising, especially young East Asian women, a new study released Monday is touting the promise of an artificial intelligence tool to "strongly" predict who's most at risk. Lung cancer has long been associated with smoking. But even as overall rates steadily drop and smoking decreases around the world, a unique population of young East Asians are seeing a 2% annual increase in lung cancer cases -- even though half of them have never smoked. The cause of this remains unknown, but suspicion is centered on genetic mutations developed during a person's lifetime rather than inherited, such as damage to a gene that codes for a protein known as EGFR, which prevents cells from growing too quickly. This genetic damage is believed to be caused by environmental toxins including second-hand smoke and even fumes produced by high-temperature stir-fry cooking in rooms that lack proper ventilation. Globally, more than 50% of women diagnosed with lung cancer are non-smokers, compared to 15% to 20% of men. Meanwhile, an estimated 57% of Asian-American women diagnosed with lung cancer have never smoked, compared to only about 15% of all other women, according to a recent University of California-San Francisco study. Against this backdrop of rising cancer cases among seemingly low-risk women, the potential of AI to accurately predict who may be most suspectable to a surprise lung cancer diagnosis has generated considerable interest around the world. In a paper presented Monday at the American Thoracic Society's medical conference in San Francisco, Dr. Yeon Wook Kim of the Seoul National University Bundang Hospital reported a new AI tool dubbed "Sybil" has proven to be accurate in identifying which "true low-risk individuals" are more likely to develop lung cancer -- all foretold from a single low-dose chest CT scan, or LDCT. Sybil, named after the female seers of ancient Greek mythology, was developed in 2023 by researchers at the Massachusetts Institute of Technology's Abdul Latif Jameel Clinic for Machine Learning in Health, the Mass General Cancer Center and Chang Gung Memorial Hospital in Taiwan. It was trained first by feeding it LDCT images largely absent of any signs of cancer, since early-stage lung cancer occupies only tiny portions of the lung and is invisible to the human eye. Then, researchers gave Sybil hundreds of scans with visible cancerous tumors. In its first run, Sybil was able to deliver "C-indices" of up to 0.81 in predicted future occurrences of lung cancer from analyzing one LDCT. Models achieving predictive C-index scores of over 0.7 are considered "good" and those over 0.8 are "strong." This week's Korean study validated those results. Kim and his colleagues evaluated 21,087 people ages 50 to 80 who underwent self-initiated LDCT screening between January 2009 and December 2021 in a tertiary hospital-affiliated screening center in South Korea. These subjects were followed up until June 2024. Baseline LDCTs were analyzed with Sybil to calculate the risk of lung cancer diagnosis within one to six years. Analyses were performed for individuals with various smoking histories, ranging from more than 20 "pack-years" to never-smokers, who comprised 11,098 of the participants. Among all participants, 257 (including 115 never-smokers) were diagnosed with lung cancer within six years from the baseline LDCT. Sybil achieved a C-index for lung cancer prediction at one year of 0.86 and 6 years of 0.74 for all the participants, while among never-smokers, one-year and six-year C-indices were 0.86 and 0.79, respectively. Kim told UPI the results hold the promise of helping to regularize lung cancer screening in Asia, where those efforts are inconsistent and, due to differing demographics, sometimes are at a "disconnect" with international screening criteria. "Asia bears the highest burden of lung cancer, accounting for over 60% of new cases and related deaths worldwide," he said in emailed comments. "A growing proportion of this burden is observed among individuals who have never smoked, particularly among women. "In Korea, more than 85% of female lung cancer patients are non-smokers. As a result, increasing attention has been given to evaluating the effectiveness of lung cancer screening, or LCS, in traditionally low-risk populations in Asia." Government-led programs and initiatives have expanded to include never-smokers into their LCS efforts, while other efforts varying from international guidelines due to their inclusion of such never-smokers have "gained traction in East Asian countries, including South Korea, Taiwan and China," Kim said. AI tools like Sybil could be used to develop "personalized strategies" for patients who have already undergone LDCT screening, but have not yet had follow-ups, he added, while cautioning that further validation will be needed "to confirm the model's potential for clinical use. "While the need for screening low-risk groups may be justified in certain settings, the lack of evidence from randomized trials limits the development of long-term LCS strategies for these populations." Researchers, meanwhile, are "actively" working on expanding Sybil's uses into other personalized health applications, said Adam Yala, an assistant professor at the UCSF/UC-Berkeley Joint Program in Computational Precision Health and one of the AI model's developers. "One, this is broadly applicable across many different types of cancers," he told UPI. "We've got processes ongoing for breast cancer, and we're also working on prostate and pancreas cancers. "And there's also evidence that from CT scans you could predict sudden deaths from cardiovascular disease. This would provide early detection, giving you a better opportunity for early intervention to provide better outcomes. So it's not uniquely about cancer. ... There's a version of this for cardiovascular health, and there could be other areas of medicine, as well." AI's potential to provide health benefits, Yala added, "is totally untapped. For instance, now we're only looking at a patient's CT scan once, but over time, you could look at multiple CTs. Mammograms, as well. There's a lot of data available there. It's a field at its infancy." Copyright 2025 UPI News Corporation. All Rights Reserved.
Medscape
21-05-2025
- Health
- Medscape
Sorry Fido, The eNose Can Smell ILD Subtypes Too
SAN FRANCISCO — Dogs trained to sniff out lung disease may need to look for another line of work if an 'electronic nose' sensor in development makes it into widespread clinical practice. In a multicenter cohort study of 589 patients with a diagnosis of interstitial lung disease (ILD) by multidisciplinary team discussion and evidence of pulmonary fibrosis on high-resolution CT, the electronic nose technology, or 'eNose,' distinguished between different ILD subtypes with a high degree of accuracy, reported Bart Formsma, MD, PhD candidate at Erasmus Medical Center in Rotterdam, the Netherlands. 'This external validation study demonstrates that various ILDs can be distinguished with high accuracy using an eNose, and therefore, eNose technology holds potential as an easy point-of-care tool in the diagnosis of ILD, potentially reducing diagnostic delay,' he said in an oral abstract session at the American Thoracic Society (ATS) 2025 International Conference here. Tough Nut to Crack Under the best conditions, ILD is still difficult to diagnose, and diagnostic delay is common, Formsma said. The diagnosis is based on a host of factors, including biopsy results, imaging studies, lung function tests, and bronchoalveolar lavage, and a multidisciplinary team is often required to reach consensus on the ILD type. The eNose mimics olfactory receptor function of the human nose and odor detection of the human brain with a sensor array, but the old schnozz goes one better with software and machine learning capabilities of pattern recognition that can pinpoint abnormalities in volatile organic compounds in exhaled breath. To validate the technology for potential use in the pulmonary clinic, Formsma and colleagues conducted a prospective longitudinal study in five ILD centers in the Netherlands, the United Kingdom, Germany, Australia, and France. The investigators analyzed the ability of the eNose to distinguish between ILD subtypes and to identify individual ILD types. A total of 589 patients were included in the training and validation data sets. Approximately one third of the patients (35%) were women. The median patient age was 70 years, the mean forced vital capacity (FVC) was 80% of the predicted value, and the mean diffusion capacity of carbon monoxide (DLco) was 52% of the predicted value. In both the training and validation sets the technology distinguished between idiopathic pulmonary fibrosis with high degrees of accuracy. The area under the curve of receiver operating characteristics (AUC) was 0.91 (95% CI, 0.88-0.95) in the training set and 0.89 (CI, 0.85-0.94) in the validation set. Similarly, the eNose sniffed out differences between connective tissue disease–associated ILD and other ILD types with an AUC in the training and validation sets, respectively, of 0.89 (CI, 0.84-0.94) and 0.91 (CI, 0.85-0.98). The technology was also extremely good at discriminating unclassifiable ILD (U-ILD), with AUCs of 0.92 (CI, 0.86-0.98) and 0.95 (CI, 0.88-1.00), respectively. The eNose was less adept, however, at distinguishing fibrotic hypersensitivity pneumonitis from other ILD types with a training set AUC of 0.88 (CI, 0.81-0.94) but validation set AUC of 0.75 (CI, 0.61-0.88). No Apparent Confounders In the question and answer, session co-moderator Joyce Lee, MD, from the University of Colorado Anschutz Medical Campus, Aurora, Colorado, asked whether diet or other factors could affect the breath samples collected by the eNose. 'We did a subgroup analysis looking into smoking status, gender, and autoimmune drug or antifibrotic drug use, and they had no big influence on outcomes,' Formsma said. Sergio Harari, MD, from San Giueseppe Hospital in Milan, Italy, asked whether there was good correlation between the sensitivity of the eNose analysis and the severity of disease. Study co-author Catharina Moor, MD, also from Erasmus Medical Center, Rotterdam, the Netherlands, responded, noting that the investigators looked at both FVC and DLco, but could not find any indications of disease severity. She added that in previous analyses the group had evaluated the findings in patients with both severe and less severe disease and also found no significant differences, suggesting that the technology might be useful as a screening tool for early ILD, although that potential application has yet to be studied. The study was funded by an unrestricted grant from Boehringer Ingelheim. All persons cited in this article reported having no conflicts of interest.
Business Insider
21-05-2025
- Health
- Business Insider
PureTech Health presents deupirfenidone data at ATS conference
PureTech Health (PRTC) delivered a late-breaking, oral presentation at the 2025 American Thoracic Society international conference in San Francisco. The presentation provided further insights into the Phase 2b ELEVATE IPF trial of deupirfenidone, highlighting the strength and durability of deupirfenidone's treatment effect through at least 52 weeks while maintaining favorable tolerability in patients living with idiopathic pulmonary fibrosis. Data presented from PureTech's global Phase 2b randomized, double-blind, active- and placebo-controlled, dose-ranging ELEVATE IPF trial demonstrated the potential for deupirfenidone to offer a differentiated treatment option for patients with IPF. In the trial, patients treated with deupirfenidone 825 mg three times a day experienced a slower rate of lung function decline, as measured by Forced Vital Capacity, at 26 weeks versus those who were treated with placebo. This statistically significant difference represents a robust treatment effect versus placebo of 80.9% for deupirfenidone 825 mg TID as a monotherapy. This result compares favorably against the rate of decline in FVC observed in the trial among patients treated with pirfenidone 801 mg TID versus placebo, which was consistent with previously reported pirfenidone clinical trial data and represents a treatment effect of 54.1%. Taken together, these results indicate that the treatment effect with deupirfenidone 825 mg TID was approximately 50% greater than that of pirfenidone 801 mg TID, based on their respective reductions in lung function decline versus placebo. In addition to these findings, deupirfenidone 825 mg TID also demonstrated a statistically significant benefit in delaying time to IPF progression4 compared to placebo, further supporting the clinical relevance of the treatment effect. Importantly, the rate of FVC decline observed over 26 weeks with deupirfenidone 825 mg TID was similar to the expected natural decline in lung function in healthy older adults. Furthermore, preliminary data from the ongoing open-label extension study suggest that this treatment effect is durable out to at least 52 weeks. As of May 9, a total of 101 patients had received at least 52 weeks of treatment with deupirfenidone. Those in the deupirfenidone 825 mg TID arm experienced a decline in FVC of -32.8 mL over the 52-week period, which is similar to the expected natural decline in lung function in healthy older adults over one year. These new data provide additional support for the durability of the treatment effect observed with this dose and reinforce its potential to stabilize lung function decline over time, while maintaining favorable safety and tolerability. Additional details from the ongoing OLE are expected to be shared in a future scientific forum. These results are further supported by preliminary pharmacokinetic data, which underscore the differentiated profile of deupirfenidone. Compared to pirfenidone 801 mg TID, deupirfenidone 825 mg TID resulted in an approximately 50% increase in drug exposure. Notably, the dramatically increased drug exposure did not result in an increase in tolerability challenges, suggesting that the deuterated structure of deupirfenidone may overcome the dose-limiting adverse events associated with pirfenidone. PureTech believes these PK results are consistent with the enhanced efficacy and favorable tolerability seen with deupirfenidone 825 mg TID in the trial. Deupirfenidone was well tolerated at both doses studied. Safety analyses included identification of the 16 most common treatment-emergent adverse events, defined as occurring in more than 5% of participants in at least one treatment group, and characterized the arm with the highest relative incidence of each of these 16 TEAEs. The pirfenidone 801 mg treatment group had the highest relative incidence for 9 of these TEAEs, followed by deupirfenidone 825 mg (5), placebo (2), and deupirfenidone 550 mg. PureTech is targeting a meeting with the U.S. Food and Drug Administration by the end of the third quarter of 2025 to discuss the results of the Phase 2b trial and align on a potential registrational pathway, with the goal of initiating a Phase 3 trial by the end of 2025. PureTech anticipates providing further guidance later this year following the finalization of the trial design and FDA interactions.
