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Article ; Online: Retreatment of symptomatic chronic bronchitis with bronchial rheoplasty.

Klemm, Theresa / Krimsky, William / Welz, Kelly / Valipour, Arschang

BMJ case reports

2024 Volume 17, Issue 2

Abstract: A man in his early 70s with a long-standing history of chronic bronchitis presented to our department 3 years ago with debilitating chronic cough and excessive sputum production. He had no previous diagnosis of chronic obstructive pulmonary disease and ... ...

Abstract	A man in his early 70s with a long-standing history of chronic bronchitis presented to our department 3 years ago with debilitating chronic cough and excessive sputum production. He had no previous diagnosis of chronic obstructive pulmonary disease and without evidence of severe respiratory tract infections. Due to his symptom burden and impairments in daily activities, the patient was considered to be an appropriate candidate for bronchial rheoplasty, a novel endoscopic treatment for patients with chronic bronchitis. The patient responded well to bilateral treatment but then experienced symptom recurrence roughly 14 months after completing the initial treatment. In the absence of an alternative explanation for the return of these symptoms, he then underwent uneventful retreatment. The patient, again, reported significant symptom improvement and no adverse effects since retreatment. While further studies are necessary to assess the safety and efficacy of retreatment, the findings from this case are encouraging.
MeSH term(s)	Male ; Humans ; Bronchitis, Chronic/drug therapy ; Bronchitis, Chronic/surgery ; Pulmonary Disease, Chronic Obstructive ; Bronchi ; Retreatment ; Chronic Disease ; Bronchitis/complications ; Bronchitis/drug therapy ; Bronchitis/diagnosis
Language	English
Publishing date	2024-02-17
Publishing country	England
Document type	Case Reports ; Journal Article
ISSN	1757-790X
ISSN (online)	1757-790X
DOI	10.1136/bcr-2023-256764
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Article: Pulsed Electric Field (PEF) treatment of progressive non-small cell lung cancer concurrently treated with immune checkpoint blockade: A case report.

Jimenez, Marcelo / Fernandez, Jose M / Krimsky, William S

Respiratory medicine case reports

2024 Volume 49, Page(s) 102018

Abstract: Pulsed Electric Field (PEF) energy was delivered at the time of confirmational biopsy to ablate recurrent NSCLC in the right upper lobe (RUL) of the lung after recurrence while on durvalumab consolidation. The patient tolerated the procedure and ... ...

Abstract	Pulsed Electric Field (PEF) energy was delivered at the time of confirmational biopsy to ablate recurrent NSCLC in the right upper lobe (RUL) of the lung after recurrence while on durvalumab consolidation. The patient tolerated the procedure and exhibited stable disease at 6 and 12 months from time of durvalumab discontinuation and PEF treatment, respectively. This report represents the first use of the Aliya™ PEF system as a minimally invasive modality with potential to re-sensitize disease to immune checkpoint blockade (ICB) upon progression. Clinicaltrialsgov identifier: NCT04773275.
Language	English
Publishing date	2024-03-29
Publishing country	England
Document type	Case Reports
ZDB-ID	2666110-X
ISSN	2213-0071
ISSN	2213-0071
DOI	10.1016/j.rmcr.2024.102018
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Article ; Online: Airway Mucosal Remodeling: Mechanism of Action and Preclinical Data of Pulsed Electric Fields for Chronic Bronchitis and Mucus Hypersecretion.

Krimsky, William / Neal Ii, Robert E / Kim, Victor

Respiration; international review of thoracic diseases

2023 Volume 102, Issue 11, Page(s) 948–960

Abstract: Patients living with chronic bronchitis (CB) suffer from physical limitations and poor quality of life. In general, treatment options that directly address the mucus hypersecretion component of CB are quite limited. Chronic airway inflammation and the ... ...

Abstract	Patients living with chronic bronchitis (CB) suffer from physical limitations and poor quality of life. In general, treatment options that directly address the mucus hypersecretion component of CB are quite limited. Chronic airway inflammation and the associated hypersecretion and cough that are pathognomonic for CB generally result from long-term exposure to airway irritants such as tobacco use and other environmental insults. This, in turn, results in an increase in the quantity and change in composition of the airway mucosa as a consequence of altered goblet cells, club cells, and submucosal glands. Pulsed electric fields (PEFs) provide a method for eradicating the cellular constituents of tissue with limited impact on the stromal proteins. Preclinical evidence in porcine airways demonstrated that particular PEF waveforms allowed for salutary remodeling of the epithelial and submucosal airway tissue layers and appeared to foster rapid regeneration and recovery of the tissue. Therefore, a therapeutic opportunity might exist whereby the application of a specific form of PEF may result in a reduction of the cellular secretory constituents of the airway while also reducing airway mucosal inflammation. This review discusses the use of such PEF to address the underlying disease processes in CB including challenges around device design, dosing, and appropriate delivery methods. Further, we outline considerations for the transition to human airways along with a brief examination of the initial work treating CB patients, suggesting that the therapy is well tolerated with limited adverse events.
MeSH term(s)	Humans ; Animals ; Swine ; Bronchitis, Chronic/therapy ; Bronchitis, Chronic/metabolism ; Quality of Life ; Mucus/metabolism ; Goblet Cells/metabolism ; Inflammation/metabolism ; Mucous Membrane/metabolism
Language	English
Publishing date	2023-10-31
Publishing country	Switzerland
Document type	Journal Article ; Review
ZDB-ID	206674-9
ISSN	1423-0356 ; 0025-7931
ISSN (online)	1423-0356
ISSN	0025-7931
DOI	10.1159/000534370
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Article ; Online: Absence of Arrhythmogenicity with Biphasic Pulsed Electric Fields Delivered to Porcine Airways.

Meininger, Glenn R / Neal, Robert E / Hunter, David W / Krimsky, William S

Annals of biomedical engineering

2023 Volume 52, Issue 1, Page(s) 1–11

Abstract: Pulsed electric field (PEF) technologies treat many types of tissue. Many systems mandate synchronization to the cardiac cycle to avoid the induction of cardiac arrhythmias. Significant differences between PEF systems make the assessment of cardiac ... ...

Abstract	Pulsed electric field (PEF) technologies treat many types of tissue. Many systems mandate synchronization to the cardiac cycle to avoid the induction of cardiac arrhythmias. Significant differences between PEF systems make the assessment of cardiac safety from one technology to another challenging. A growing body of evidence suggests that shorter duration biphasic pulses obviate the need for cardiac synchronization, even when delivered in a monopolar fashion. This study theoretically evaluates the risk profile of different PEF parameters. It then tests a monopolar, biphasic, microsecond-scale PEF technology for arrhythmogenic potential. PEF applications of increasing likelihood to induce an arrhythmia were delivered. The energy was delivered throughout the cardiac cycle, including both single and multiple packets, and then with concentrated delivery on the t-wave. There were no sustained changes to the electrocardiogram waveform or to the cardiac rhythm, despite delivering energy during the most vulnerable phase of the cardiac cycle, and delivery of multiple packets of PEF energy across the cardiac cycle. Only isolated premature-atrial contractions (PAC) were observed. This study provides evidence that certain varieties of biphasic, monopolar PEF delivery do not require synchronized energy delivery to prevent harmful arrhythmias.
MeSH term(s)	Animals ; Swine ; Electricity ; Arrhythmias, Cardiac ; Electrocardiography
Language	English
Publishing date	2023-04-25
Publishing country	United States
Document type	Journal Article
ZDB-ID	185984-5
ISSN	1573-9686 ; 0191-5649 ; 0090-6964
ISSN (online)	1573-9686
ISSN	0191-5649 ; 0090-6964
DOI	10.1007/s10439-023-03190-5
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Zs.A 1018: Show issues

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Article: Editorial: The Hybrid Operating Room in Modern Thoracic Surgery.

Ng, Calvin S H / Krimsky, William S / Yasufuku, Kazuhiro

Frontiers in surgery

2021 Volume 8, Page(s) 725897

Language	English
Publishing date	2021-07-23
Publishing country	Switzerland
Document type	Editorial
ZDB-ID	2773823-1
ISSN	2296-875X
ISSN	2296-875X
DOI	10.3389/fsurg.2021.725897
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Article ; Online: Efficiency of Electromagnetic Navigation Bronchoscopy and Virtual Bronchoscopic Navigation.

Qian, Kai / Krimsky, William S / Sarkar, Saiyad A / Deng, Yi

The Annals of thoracic surgery

2020 Volume 109, Issue 6, Page(s) 1731–1740

Abstract: Background: Image-guided bronchoscopy techniques have emerged as a means of improving pulmonary nodule biopsy yield. However comparisons of the diagnostic efficacy of electromagnetic navigation bronchoscopy (ENB) and virtual bronchoscopic navigation ( ... ...

Abstract	Background: Image-guided bronchoscopy techniques have emerged as a means of improving pulmonary nodule biopsy yield. However comparisons of the diagnostic efficacy of electromagnetic navigation bronchoscopy (ENB) and virtual bronchoscopic navigation (VBN) have not reached a consensus. This meta-analysis evaluates the overall diagnostic yield and accuracy of ENB and VBN for pulmonary nodules. Methods: A systematic search was conducted to identify relevant articles. Meta-analysis was used to summarize the sensitivities, specificities, and area under the curve for ENB and VBN. Results: Thirty-two studies (1981 patients with pulmonary nodules) were included in this analysis. The pooled sensitivity, specificity, and area under the curve (95% confidence interval) of ENB were 0.80 (0.73-0.85), 0.81 (0.71-0.88), and 0.87 (0.84-0.90), respectively. Corresponding VBN values were 0.80 (0.76-0.83), 0.65 (0.56-0.73), and 0.81 (0.78-0.85), respectively. Comparison of the 2 techniques revealed that ENB had higher specificity and area under the curve but no difference in sensitivity. Conclusions: Both ENB and VBN are valuable tools in the diagnosis of lung nodules. ENB achieved a higher specificity than VBN in the diagnose of lung nodules, whereas ENB performed better than VBN for pulmonary nodules. These results are due to the real-time positioning function of ENB.
MeSH term(s)	Bronchoscopy/methods ; Electromagnetic Phenomena ; Humans ; Multiple Pulmonary Nodules/pathology ; Sensitivity and Specificity ; User-Computer Interface
Language	English
Publishing date	2020-02-26
Publishing country	Netherlands
Document type	Comparative Study ; Journal Article ; Meta-Analysis ; Research Support, Non-U.S. Gov't
ZDB-ID	211007-6
ISSN	1552-6259 ; 0003-4975
ISSN (online)	1552-6259
ISSN	0003-4975
DOI	10.1016/j.athoracsur.2020.01.019
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Zs.A 252: Show issues

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Article: Airway Microbiota in Patients With Synchronous Multiple Primary Lung Cancer: The Bacterial Topography of the Respiratory Tract.

Qian, Kai / Deng, Yi / Krimsky, William S / Feng, Yong-Geng / Peng, Jun / Tai, Yong-Hang / Peng, Hao / Jiang, Li-Hong

Frontiers in oncology

2022 Volume 12, Page(s) 811279

Abstract: Microbes and microbiota dysbiosis are correlated with the development of lung cancer; however, the airway taxa characteristics and bacterial topography in synchronous multiple primary lung cancer (sMPLC) are not fully understood. The present study aimed ... ...

Abstract	Microbes and microbiota dysbiosis are correlated with the development of lung cancer; however, the airway taxa characteristics and bacterial topography in synchronous multiple primary lung cancer (sMPLC) are not fully understood. The present study aimed to investigate the microbiota taxa distribution and characteristics in the airways of patients with sMPLC and clarify specimen acquisition modalities in these patients. Using the precise positioning of electromagnetic navigation bronchoscopy (ENB), we analyzed the characteristics of the respiratory microbiome, which were collected from different sites and using different sampling methods. Microbiome predictor variables were bacterial DNA burden and bacterial community composition based on 16sRNA. Eight non-smoking patients with sMPLC in the same pulmonary lobe were included in this study. Compared with other sampling methods, bacterial burden and diversity were higher in surface areas sampled by bronchoalveolar lavage (BAL). Bacterial topography data revealed that the segment with sMPLC lesions provided evidence of specific colonizing bacteria in segments with lesions. After taxonomic annotation, we identified 4863 phylotypes belonging to 185 genera and 10 different phyla. The four most abundant specific bacterial community members detected in the airway containing sMPLC lesions were
Language	English
Publishing date	2022-04-12
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2649216-7
ISSN	2234-943X
ISSN	2234-943X
DOI	10.3389/fonc.2022.811279
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Article: Towards an optimization of bronchoscopic approaches to the diagnosis and treatment of the pulmonary nodules: a review.

Krimsky, William S / Pritchett, Michael A / Lau, Kelvin K W

Journal of thoracic disease

2017 Volume 10, Issue Suppl 14, Page(s) S1637–S1644

Abstract: The last several years have seen substantive improvements and innovation with respect to bronchoscopic approaches to the indeterminate pulmonary nodule both diagnostically and therapeutically. Indeed, these advances have only accelerated over the last ... ...

Abstract	The last several years have seen substantive improvements and innovation with respect to bronchoscopic approaches to the indeterminate pulmonary nodule both diagnostically and therapeutically. Indeed, these advances have only accelerated over the last year or two and extend across multiple domains and include improvements in imaging technologies and techniques, approaches and tools to access different areas of the lung, tools to acquire tissue as well as tools and methods to ablate tissue. Needless to say, there are a variety of different approaches in terms of how these issues are being solved along with differing levels of technology and infrastructure commitments necessary to utilize these various tools, with some of these approaches being farther along than others. This article reviews some of these recent advances in the domains of advanced imaging, approaches to accessing various parts of the lung, tools designed to acquire tissue, robotic endoscopy platforms, new approaches to tissue ablation as well as potential additions to these areas that are on the horizon.
Language	English
Publishing date	2017-09-05
Publishing country	China
Document type	Journal Article ; Review
ZDB-ID	2573571-8
ISSN	2077-6624 ; 2072-1439
ISSN (online)	2077-6624
ISSN	2072-1439
DOI	10.21037/jtd.2018.04.38
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Article: Primary malignant melanoma of the lung: a case report of a rare tumor and review of the literature.

Yunce, Muharrem / Selinger, Stephen / Krimsky, William / Harley, Daniel P

Journal of community hospital internal medicine perspectives

2018 Volume 8, Issue 1, Page(s) 29–31

Abstract: Primary malignant melanoma of the lung (PMML) is a rare malignancy that exhibits aggressive behavior and has a very poor prognosis. We are reporting on a case of PMML in an otherwise healthy 22-year-old Caucasian male with no significant past medical ... ...

Abstract	Primary malignant melanoma of the lung (PMML) is a rare malignancy that exhibits aggressive behavior and has a very poor prognosis. We are reporting on a case of PMML in an otherwise healthy 22-year-old Caucasian male with no significant past medical history and an unremarkable family history. The patient initially presented with a 2-month history of a cough and an unexplained 22-lb weight loss. His initial chest X-ray demonstrated opacification of the right lower lobe (RLL) of his lung and a subsequent computerized tomography scan (CT scan) of his lung revealed a large mass occupying most of his RLL (Figure 1). The patient subsequently underwent a bronchoscopy with endobronchial ultrasound. Biopsies revealed a poorly differentiated carcinoma. A positron emission tomography with low dose CT scan was performed per protocol and revealed an intensely hypermetabolic tumor with no evidence for lymphatic disease or extra-thoracic spread. The patient underwent a surgical exploration and a right lower lobectomy with a thoracic lymphadenectomy. The pathology including immunohistochemical stains demonstrated a malignant melanoma with no lymph node involvement. A physical examination including ophthalmic, mucosal, and skin examinations revealed no evidence for an extra-thoracic site of the disease. The patient had negative margins for resection and did not receive any adjuvant therapy and is alive and well with no evidence for recurrence 3 years after the resection.
Language	English
Publishing date	2018-02-06
Publishing country	United States
Document type	Case Reports
ZDB-ID	2616884-4
ISSN	2000-9666
ISSN	2000-9666
DOI	10.1080/20009666.2018.1424485
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Article: Biopsy of peripheral lung nodules utilizing cone beam computer tomography with and without trans bronchial access tool: a retrospective analysis.

Sobieszczyk, Michal Jan / Yuan, Zhuhui / Li, Wei / Krimsky, William

Journal of thoracic disease

2018 Volume 10, Issue 10, Page(s) 5953–5959

Abstract: Background: Currently there are several techniques for endoscopic diagnosis of parenchymal lung abnormalities. Electromagnetic navigation with or without endobronchial ultrasound for diagnosis of the above has been well described. Bronchoscopic Trans ... ...

Abstract	Background: Currently there are several techniques for endoscopic diagnosis of parenchymal lung abnormalities. Electromagnetic navigation with or without endobronchial ultrasound for diagnosis of the above has been well described. Bronchoscopic Trans Bronchial Access Tool is a novel endoscopic technique that creates a virtual pathway to the lesion and is less limited by location of the airway. The CrossCountryTM Transbronchial Access Tool (CovidienTM, Plymouth, MN, USA) is a Food and Drug Administration (FDA) approved off airway device that utilizes a catheter equipped guide sheath for a trans-parenchymal approach to a distal lesion. Cone beam computer tomography (CBCT) is a real-time onsite extrathoracic navigational modality used in the bronchoscopy suite that allows for an open working channel. All three of the above modalities can have reasonable diagnostic yields when used independently. While utilizing the above tools we frequently found ourselves in situations where one technique was not enough, prompting the use of a combination of modalities to obtain the most efficient and accurate diagnosis. We are reporting the feasibility and safety of utilizing these three modalities in conjunction with one another. Methods: Patients with peripheral pulmonary nodules on chest computed tomography underwent a navigation bronchoscopy under general anesthesia. CBCT and radial ultrasound was used in every case to confirm navigation to the target lesion. Lesions without definitive airways leading to them were accessed with the transbronchial access tool (TBAT). Results: Electromagnetic bronchoscopy using CBCT and radial US was performed on 22 patients from April 2016 to September 2016. The TBAT tool was used in 7 patients. The overall diagnostic yield was 77.2% (17 of 22). Diagnostic yield of with use TBAT was 100% (7 of 7). There were no complications. Average case length was 79.95 (range, 50-124) minutes and average fluoroscopy time was 10.39 (1-21.7) minutes. Conclusions: TBAT is a useful and safe tool when accessing peripheral pulmonary nodules and is used in conjunctions with electromagnetic navigation and CBCT.
Keywords	covid19
Language	English
Publishing date	2018-06-25
Publishing country	China
Document type	Journal Article
ZDB-ID	2573571-8
ISSN	2077-6624 ; 2072-1439
ISSN (online)	2077-6624
ISSN	2072-1439
DOI	10.21037/jtd.2018.09.16
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