Boiron (France)

<bold>Introduction:</bold> Adolescent Idiopathic Scoliosis (AIS) is a three dimensional spinal and thoracic deformity often resulting in restrictive pulmonary disease and airflow obstruction. The impact of posterior spinal fusion(PSF) on thoracic shape and pulmonary function remains unclear. <bold>Methods:</bold> A prospective AIS cohort was assessed pre- and one year post-PSF using spinal X-rays, pulmonary function tests (PFTs), and spirometry controlled chest CT at in- and expiration. CT-derived parameters included spinal penetration index(SPi), endothoracic hump ratio(EHr), hemithoracic-width ratio(HWr), spinal rotation(RAml) and rib-hump index (RHi). Paired t-tests with Bonferroni correction assessed pre and post-surgery differences, and Spearman’s Rho(rs) analyzed correlation with lung function (FEV1% and FVC%-predicted). <bold>Results:</bold> 60 patients (77% female, mean age 14.9 years) were included. Preoperatively, FEV1% correlated with SPi (rs -0.51 p,0.001) and EHr (rs -0.50 p<0.001) while FVC% correlated with SPi (rs -0.55, p<0.001) and EHr (rs -0.51 p<0.001). Postoperatively, FEV1% improved by 2.2% (p<0.01), while FVC%-pred remained stable. The chest intrusion (SPi and EHr) did not improve significantly, but RAml did improve with 5.5° (p<0.001) as did the RHi with 0,11 (p<0.001). <bold>Discussion:</bold> Corrective surgery significantly improved coronal (HWr) and rotational thoracic deformity (RAml and RHi) and FEV1% in AIS patients. However, chest intrusion parameters (SPi and EHr) which correlated most strongly with PFTs preoperatively did not improve after PSF.

<bold>Background:</bold> Flow limitation occurs in bronchial generations visible on chest CT. Small airway disease and emphysema shift the flow-limiting segment upstream. Bronchial wall thickness metrics like Pi10 correlate with FEV₁ and FEV₁/FVC but do not specifically measure the flow-limiting region. <bold>Aim:</bold> To measure bronchi and bronchus-artery(BA) dimensions in the flow-limiting region and emphysema to identify metrics that correlate with FEV₁ and FEV₁/FVC. <bold>Methods:</bold> CTs (COPDGene substudy, n=1319) were analyzed: LungQ-BA (Thirona, Nijmegen) automatically measures in flow-limiting subsegmental generations 1-6(G1-6): bronchial outer(Bout), inner (Bin), artery(A) diameter, and bronchial wall thickness(Bwt) and computes ratios: Bout/A; Bin/A; Bwt/A and Bwa/Boa (bronchial wall area/bronchial outer area). Emphysema: %<950HU(LAA-950HU). Regression analyses: associations of bronchial metrics and LAA-950HU with FEV₁ and FEV₁/FVC. <bold>Results:</bold> Median(IQR) BA-pairs in G1-6 per CT was 218(92). Adjusted for lung volume and GOLD stage, all ratios correlate well with FEV₁/FVC and FEV1. For wall thickness, Bwa/Boa with LAA-950HU showed the best predictive value. <bold>Conclusion:</bold> Bronchial metrics in the flow-limiting region correlated well with FEV1/FVC and FEV1. Wall thickness, Bwa/Boa, in combination with emphysema resulted in the highest correlations, highlighting the potential of this measurement as a sensitive imaging marker for studies in COPD. <fig><object-id>erj;66/suppl_69/PA6213/F1</object-id><object-id>F1</object-id><object-id>F1</object-id><graphic></graphic></fig>

<bold>Background:</bold> SHIP-CT evaluated the impact of inhaled hypertonic saline(HS) vs isotonic saline(IS) on lung structure in preschool children with CF(pCwCF). PRAGMA-CF scoring and automatic bronchus-artery analysis showed fewer bronchial abnormalities in the HS group compared to IS after 48 weeks. A recently developed AI-algorithm allows for quantification of mucus plugs(MP) on CT. This analysis aimed to assess the effect of inhaled HS on MP in pCwCF. <bold>Methods:</bold> Number, volume, and location of MP throughout the bronchial tree were quantified using a fully automatic algorithm(LungQ, Thirona). It identifies MP that completely obstruct the bronchus with a detectable proximal lumen. Regression analysis was used to evaluate the difference between groups at 48 weeks. <bold>Results:</bold> 113 baseline and 103 48-week CTs among 115 pCwCF(55 HS,60 IS) were analyzed. MPs were detected in 37% and 25% of CTs at baseline and 48 weeks, respectively. In patients with MP, median(IQR) MP count at baseline and at 48 weeks was 1(1.5) and 4(7) for the IS group, and 2(6.5) and 1.5(27.2) for the HS group. At 48 weeks, the IS group showed a higher MP count than the HS group(mean difference 0.75; 95%CI 0.36–1.15; p = 0.0005). <bold>Conclusion:</bold> Inhaled hypertonic saline significantly reduced MP over 48 weeks in preschool children with CF, supporting previous findings of improved structural airway abnormalities in the HS group. <fig><object-id>erj;66/suppl_69/OA3321/F1</object-id><object-id>F1</object-id><object-id>F1</object-id><graphic></graphic></fig>

<bold>Rationale:</bold> Bronchial wall thickening and mucus plugs (MP) can play a role in progressive airflow obstruction in COPD. <bold>Aims:</bold> to identify bronchial markers and MP in COPD patients that predict loss of FEV₁/FVC over a 10-year period. <bold>Methods:</bold> A subset of 280 COPDGene subjects. Groups: based on GOLD-stage at baseline and 10-year follow-up, matched by age, gender and high-risk subtype. Controls: GOLD 0 remaining in GOLD 0 (n=38) and GOLD 2 remaining in GOLD 2 (n=43). Progressors: GOLD 0-2 or PRISm progressing to GOLD 3 or 4 (n=199). LungQ (Thirona, Netherlands) was used to compute bronchus-artery (BA) ratios of the inner and outer bronchus diameter and wall thickness ratios against the adjacent artery (B_in/A, B_out/A, B_wt/A), and between the bronchial wall area and outer area (B_wa/B_oa), showing median (IQR) across segmental generations 1-6. The % of subjects with ≥1 detected MP was noted. <bold>Results:</bold> Baseline: GOLD 0 group had lower B_wt/A, and B_wa/B_oa than the other groups. Between GOLD 2 control and progressor groups there were only insignificant differences. MP prevalence was highest in the progressor group. Longitudinally, the progressors declined in B_in/A from 0.91(0.21) to 0.83(0.22), and in number of BA-pairs measured from 260.7(73.2) to 198.5(67.2) and increased in B_wt/A from 0.25(0.08) to 0.28(0.08), and in B_wa/B_oa from 0.38(0.11) to 0.44(0.12). MP prevalence increased from 27% to 50%, while it remained stable in the control group <bold>Conclusions:</bold> Baseline airway dimensions and MP differed between GOLD 0 and GOLD 2, but not between GOLD 2 progressors and non-progressors. COPD progression was associated with an increase in wall thickness, decrease in bronchial inner diameter and more mucus plugs.

This manuscript signals a new era in the integration of artificial intelligence with software engineering, placing machines at the pinnacle of coding capability. We present a formalized, iterative methodology proving that AI can fully replace human programmers in all aspects of code creation and refinement. Our approach, combining large language models with formal verification, test-driven development, and incremental architectural guidance, achieves a 38.6% improvement over the current top performer's 48.33% accuracy on the SWE-bench benchmark. This surpasses previously assumed limits, signaling the end of human-exclusive coding and the rise of autonomous AI-driven software innovation. More than a technical advance, our work challenges centuries-old assumptions about human creativity. We provide robust evidence of AI superiority, demonstrating tangible gains in practical engineering contexts and laying the foundation for a future in which computational creativity outpaces human ingenuity.

Standards of treatment for limited-stage small-cell lung cancer (SCLC) include chemoradiotherapy. The place of the surgery in this indication is still debated. The objective of this study was to evaluate the overall survival (OS) in patients who underwent surgery for an SCLC undiagnosed before resection in the University Hospital of Nancy, France. Secondarily, the impact of surgery on recurrence-free survival (RFS) was analyzed. All the patients who underwent lung resection in the Department of Thoracic Surgery, from 1991 to 2018, and a diagnosis of SCLC after surgery were included. OS and RFS were analyzed according to the resection type, postoperative staging, and lymph node extension. Sixty-one patients were included. The median OS was higher in patients with lobectomy than those with pneumonectomy (26 [8.4-208.7] vs. 12 [3.4-27.6] months, P < 0.001) in stage I compared to other stages (58 [8.4-208.7] vs. 17 [3.4-83.5] months, P = 0.002), and N0-1 than N2 (25 [3.6-208.7] vs. 15 [3.4-83.5] months, P = 0.01). RFS was also significantly higher after lobectomy than after pneumonectomy (17 [1.6-184.9] vs. 8 [0.5-17.6], P < 0.001), stage I than stages II-III (35 [5-184.9] vs. 11 [0.5-42.4], P < 0.001) and N0-1 compared to N2 (25 [1.6-184.9] vs. 9 [0.5-16.5] months, P = 0.006). In multivariate analysis, the only independent factor influencing the OS was the pneumonectomy (hazard ratios = 3.19; 95% confidence interval [1.46-6.98], P = 0.004). Surgical resection of stage I SCLC may lead to better OS and RFS. N1 patients should not automatically be excluded from surgery. Lobectomy with regional lymph node resection is the preferable choice of surgery.