Arthur Sung, MD, FCCP

All Publications

• Development of a Prognostic Survival Risk Score for Lung Cancer Patients With Type 2 Diabetes Mellitus: A Territory-Wide Retrospective Cohort Study. Cancer medicine Zhong, C. C., Huang, J., Li, Z., Jiang, Y., Yang, Z., Yuan, J., Huang, X., Liu, X., Wang, H., Poon, J., Dou, Q., Sung, A., Wong, M. C. 2026; 15 (9): e72164

  Abstract

  Lung cancer is a leading cause of cancer-related mortality, and its prognosis is often affected by comorbidities such as type 2 diabetes mellitus (T2DM). This study aimed to identify survival risk factors for lung cancer patients with T2DM, evaluate the predictive models, and develop a risk score system for survival prediction.We analyzed data from 5491 lung cancer patients with T2DM from the Hong Kong Hospital Authority Data Collaboration Laboratory (HADCL) (2000-2020). Prognostic factors were evaluated using Cox proportional hazards regression. Four algorithms were used to construct survival analysis models: Cox proportional hazards regression, LASSO Cox regression, survival tree, and random survival forests (RSF). An interpretable risk scoring system was subsequently derived using the selected predictors.Older age at cancer diagnosis, male sex, longer duration between T2DM diagnosis and lung cancer diagnosis (T2DM duration), smoking, alcohol consumption, history of stroke, and higher HbA1c were associated with increased mortality risk, whereas hypertension, coronary heart disease, insulin usage, anti-lipid usage, and anti-diabetic usage were associated with reduced mortality risk. Among the evaluated models, the RSF model demonstrated the best predictive performance, as indicated by the C-index (0.71) and time-dependent AUC (0.883). The developed risk score system included the following criteria: age at cancer diagnosis; T2DM duration; smoking status; HbA1c; HDL-C; serum potassium (K) levels; LDL-C. A score ≥ 75 classified 47.33% of patients as high-risk, with a corresponding five-year survival probability of 5.51%.Among the evaluated models, the RSF model demonstrated the best predictive performance. The developed risk scoring system may support risk stratification and identification of high-risk patient subgroups, potentially facilitating personalized prognostic assessment and clinical management.

  View details for DOI 10.1002/cam4.72164

  View details for PubMedID 42655935

  View details for PubMedCentralID PMC13519287

• Phenotyping EMT and MET cellular states in lung cancer patient liquid biopsies at a personalized level using mass cytometry. Scientific reports Karacosta, L. G., Pancirer, D., Preiss, J. S., Benson, J. A., Trope, W., Shrager, J. B., Sung, A. W., Neal, J. W., Bendall, S. C., Wakelee, H., Plevritis, S. K. 2023; 13 (1): 21781

  Abstract

  Malignant pleural effusions (MPEs) can be utilized as liquid biopsy for phenotyping malignant cells and for precision immunotherapy, yet MPEs are inadequately studied at the single-cell proteomic level. Here we leverage mass cytometry to interrogate immune and epithelial cellular profiles of primary tumors and pleural effusions (PEs) from early and late-stage non-small cell lung cancer (NSCLC) patients, with the goal of assessing epithelial-mesenchymal transition (EMT) and mesenchymal-epithelial transition (MET) states in patient specimens. By using the EMT-MET reference map PHENOSTAMP, we observe a variety of EMT states in cytokeratin positive (CK+) cells, and report for the first time MET-enriched CK+ cells in MPEs. We show that these states may be relevant to disease stage and therapy response. Furthermore, we found that the fraction of CD33+ myeloid cells in PEs was positively correlated to the fraction of CK+ cells. Longitudinal analysis of MPEs drawn 2 months apart from a patient undergoing therapy, revealed that CK+ cells acquired heterogeneous EMT features during treatment. We present this work as a feasibility study that justifies deeper characterization of EMT and MET states in malignant cells found in PEs as a promising clinical platform to better evaluate disease progression and treatment response at a personalized level.

  View details for DOI 10.1038/s41598-023-46458-5

  View details for PubMedID 38065965

  View details for PubMedCentralID 2689101

• Unilateral diaphragmatic paralysis after stereotactic ablative radiotherapy to a lung tumor abutting the course of the phrenic nerve. Practical radiation oncology Eke, I., Guo, H. H., Loo, J. B., Sung, A. W., Diehn, M., Vitzthum, L., Chin, A. L., Gensheimer, M. F. 2023

  Abstract

  We present the case of a woman with metastatic adenoid cystic carcinoma who received stereotactic ablative radiotherapy (SABR) with a total dose of 50 Gy in 4 fractions to two lung metastases and developed symptomatic left phrenic nerve injury 2 years after radiation. The maximum dose to the approximate location of the phrenic nerve was 57.7 Gy which corresponds to a biologically effective dose for late effects (using α/β ratio = 3) of 335.14 Gy. Here, we discuss the case, planning considerations by radiation oncologists and medical physicists, and the multidisciplinary medical management of this patient.

  View details for DOI 10.1016/j.prro.2023.04.010

  View details for PubMedID 37150318

• Genomic Profiling of Bronchoalveolar Lavage Fluid in Lung Cancer. Cancer research Nair, V. S., Hui, A. B., Chabon, J. J., Shahrokh Esfahani, M., Stehr, H., Nabet, B. Y., Zhou, L., Chaudhuri, A. A., Benson, J. A., Ayers, K., Bedi, H., Ramsey, M. C., Van Wert, R., Antic, S., Lui, N. S., Backhus, L. M., Berry, M. F., Sung, A. W., Massion, P. P., Shrager, J. B., Alizadeh, A. A., Diehn, M. 2022

  Abstract

  Genomic profiling of Bronchoalveolar Lavage (BAL) samples may be useful for tumor profiling and diagnosis in the clinic. Here, we compared tumor-derived mutations detected in BAL samples from subjects with non-small cell lung cancer (NSCLC) to those detected in matched plasma samples. CAncer Personalized Profiling by deep Sequencing (CAPP-Seq) was used to genotype DNA purified from BAL, plasma and tumor samples from patients with NSCLC. The characteristics of cell-free DNA (cfDNA) isolated from BAL fluid were first characterized to optimize the technical approach. Somatic mutations identified in tumor were then compared to those identified in BAL and plasma, and the potential of BAL cfDNA analysis to distinguish lung cancer patients from risk-matched controls was explored. In total, 200 biofluid and tumor samples from 38 cases and 21 controls undergoing BAL for lung cancer evaluation were profiled. More tumor variants were identified in BAL cfDNA than plasma cfDNA in all stages (p<0.001) and in stage I-II disease only. Four of 21 controls harbored low levels of cancer-associated driver mutations in BAL cfDNA (mean VAF=0.5%), suggesting the presence of somatic mutations in non-malignant airway cells. Finally, using a Random Forest model with leave-one-out cross validation, an exploratory BAL genomic classifier identified lung cancer with 69% sensitivity and 100% specificity in this cohort and detected more cancers than BAL cytology. Detecting tumor-derived mutations by targeted sequencing of BAL cfDNA is technically feasible and appears to be more sensitive than plasma profiling. Further studies are required to define optimal diagnostic applications and clinical utility.

  View details for DOI 10.1158/0008-5472.CAN-22-0554

  View details for PubMedID 35748739

• The Value of Endobronchial Ultrasound Guided-Fine Needle Aspiration in Research Biobanking Miyakawa-Liu, M., Lundi, L., Padda, S., Leuenberger, D., Sung, A., Ramsey, M., Nair, V., Bedi, H., Ozawa, M. SPRINGERNATURE. 2022: 286-287

  View details for Web of Science ID 000770361800267

• The Value of Endobronchial Ultrasound Guided-Fine Needle Aspiration in Research Biobanking Miyakawa-Liu, M., Lundi, L., Padda, S., Leuenberger, D., Sung, A., Ramsey, M., Nair, V., Bedi, H., Ozawa, M. SPRINGERNATURE. 2022: 286-287

  View details for Web of Science ID 000770360200266

• Use of home pulse oximetry with daily short message service messages for monitoring outpatients with COVID-19: The patient's experience DIGITAL HEALTH Vaughan, L., Eggert, L. E., Jonas, A., Sung, A., Singer, S. 2021; 7: 20552076211067651

  Abstract

  Studies have shown COVID-19 patients may have a low oxygen saturation (SpO2) independent of visible respiratory distress, a phenomenon termed "silent hypoxia." Silent hypoxia creates uncertainty in the outpatient setting for clinicians and patients alike. In this study, we examined the potential for pulse oximeters in identifying early signs of clinical deterioration. We report descriptive results on COVID-positive patients' experiences with a comprehensive home monitoring tool comprised of home SpO2 measurements with a novel symptom-tracking short message service/text messaging application. Of patients who required hospitalization, 83% sought care as a result of low pulse oximeter readings. Nearly all patients who did not require hospitalization reported that having a pulse oximeter provided them with the confidence to stay at home. Essentially all patients found a home pulse oximeter useful. Keeping COVID-19-positive patients at home reduces the potential for disease spread and prevents unnecessary costs and strain on the healthcare system.

  View details for DOI 10.1177/20552076211067651

  View details for Web of Science ID 000731017000001

  View details for PubMedID 34925873

  View details for PubMedCentralID PMC8679026

• American Association for Bronchology and Interventional Pulmonology (AABIP) Statement on the Use of Bronchoscopy and Respiratory Specimen Collection in Patients With Suspected or Confirmed COVID-19 Infection JOURNAL OF BRONCHOLOGY & INTERVENTIONAL PULMONOLOGY Wahidi, M. M., Lamb, C., Murgu, S., Musani, A., Shojaee, S., Sachdeva, A., Maldonado, F., Mahmood, K., Kinsey, M., Sethi, S., Mahajan, A., Majid, A., Keyes, C., Alraiyes, A. H., Sung, A., Hsia, D., Eapen, G. 2020; 27 (4): E52–E54

  View details for DOI 10.1097/LBR.0000000000000681

  View details for Web of Science ID 000576508300001

  View details for PubMedID 32195687

  View details for PubMedCentralID PMC7141581

• CommNETs/NANETS guidelines for the diagnosis and management of patients with Lung Neuroendocrine Tumors: An international collaborative endorsement and update of the 2015 ENETS expert consensus guidelines. Journal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer Singh, S., Bergsland, E. K., Card, C. M., Hope, T. A., Kunz, P. L., Laidley, D. T., Lawrence, B., Leyden, S., Metz, D. C., Michael, M., Modahl, L. E., Myrehaug, S., Padda, S. K., Pommier, R. F., Ramirez, R. A., Soulen, M., Strosberg, J., Sung, A., Thawer, A., Wei, B., Xu, B., Segelov, E. 2020

  Abstract

  INTRODUCTION: Lung neuroendocrine tumors (LNETs) are uncommon cancers and there is a paucity of randomized evidence to guide practice. As a result, current guidelines from different neuroendocrine tumor societies vary considerably. There is a need to update and harmonise global consensus guidelines. This paper reports best practice guidelines produced by a collaboration between the Commonwealth Neuroendocrine Tumour Research Collaboration (CommNETs) and the North American Neuroendocrine Tumor Society (NANETS).METHODS: We performed a formal endorsement and updating process of the 2015 European Neuroendocrine Tumor Society (ENETS) expert consensus paper on LNET. A systematic review from January 2013 to October 2017 was conducted to procure the most recent evidence. The stepwise endorsement process involved experts from all major subspecialties, as well as patients and advocates. Guided by discussion of the most recent evidence, each statement from ENETS was either endorsed, modified, or removed. New consensus statements were added if appropriate.RESULTS: The search yielded 1,109 new publications of which 230 met the inclusion criteria. Twelve statements were endorsed, 22 statements were modified or updated, one was removed and two were added. Critical answered questions for each topic in LNET were identified.CONCLUSIONS: Through the consensus process, guidelines for the management of patients with local and metastatic NETs have been updated to include both recent evidence and practice changes relating to technological and definitional advances. The guidelines provide clear, evidence-based statements aimed at harmonising the global approach to patients with LNETs, based on the principles of person-centered and LNET-specific care. The importance of LNET-directed research and person-centered care throughout the diagnosis, treatment, and follow-up journey is emphasized along with directions for future collaborative research.

  View details for DOI 10.1016/j.jtho.2020.06.021

  View details for PubMedID 32663527

• COVID-19 Test Correlation Between Nasopharyngeal Swab and Bronchoalveolar Lavage in Asymptomatic Patients. Chest Chang, J. n., Swenson, K. E., Sung, A. n., Bedi, H. n. 2020

  View details for DOI 10.1016/j.chest.2020.11.006

  View details for PubMedID 33217415

• Single-Lumen Endotracheal Tube and Bronchial Blocker for Airway Management During Tracheobronchoplasty for Tracheobronchomalacia: A Case Report. A&A practice Lui, N. S., Guo, H. H., Sung, A. W., Peterson, A., Kulkarni, V. N. 2019

  Abstract

  We present a case of a 69-year-old man who underwent tracheobronchoplasty for tracheobronchomalacia using a single-lumen endotracheal tube and a Y-shaped bronchial blocker for airway management. Tracheobronchoplasty is performed by sewing mesh to plicate the posterior, membranous wall of the distal trachea and main bronchi through a right posterolateral thoracotomy. The goals of airway management include continuous left-lung ventilation and lung protection from aspiration. Ideally, only conventional airway management tools are used. This case demonstrates that a single-lumen endotracheal tube with a bronchial blocker can be a straightforward strategy for airway management during tracheobronchoplasty.

  View details for DOI 10.1213/XAA.0000000000001076

  View details for PubMedID 31385817

• Steroid-Sparing Therapy for Tyrosine Kinase Inhibitor-Induced Pneumonitis. Journal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer Sun, T. Y., Sung, A. W., Neal, J. W. 2019; 14 (4): e75-e77

  View details for DOI 10.1016/j.jtho.2018.11.030

  View details for PubMedID 30922583

• Steroid-Sparing Therapy for Tyrosine Kinase Inhibitor-Induced Pneumonitis JOURNAL OF THORACIC ONCOLOGY Sun, T., Sung, A. W., Neal, J. W. 2019; 14 (4): E75–E77

  View details for DOI 10.1016/j.jtho.2018.11.030

  View details for Web of Science ID 000462167700008

• Predictors of Respiratory Decline Following Stereotactic Ablative Radiotherapy to Multiple Lung Tumors. Clinical lung cancer Moding, E. J., Liang, R. n., Lartey, F. M., Maxim, P. G., Sung, A. n., Diehn, M. n., Loo, B. W., Gensheimer, M. F. 2019

  Abstract

  Stereotactic ablative radiotherapy (SABR) is highly effective at controlling early stage primary lung cancer and lung metastases. Although previous studies have suggested that treating multiple lung tumors with SABR is safe, post-treatment changes in respiratory function have not been analyzed in detail.We retrospectively identified patients with 2 or more primary lung cancers or lung metastases treated with SABR and analyzed clinical outcomes and predictors of toxicity. We defined a composite respiratory decline endpoint to include increased oxygen requirement, increased dyspnea scale, or death from respiratory failure not owing to disease progression.A total of 86 patients treated with SABR to 203 lung tumors were analyzed. A total of 21.8% and 41.8% of patients developed composite respiratory decline at 2 and 4 years, respectively. When accounting for intrathoracic disease progression, 12.7% of patients developed composite respiratory decline at 2 years. Of the patients, 7.9% experienced grade 2 or greater radiation pneumonitis. No patient- or treatment-related factor predicted development of respiratory decline. The median overall survival was 46.9 months, and the median progression-free survival was 14.8 months. The cumulative incidence of local failure was 9.7% at 2 years.Although our results confirm that SABR is an effective treatment modality for patients with multiple lung tumors, we observed a high rate of respiratory decline after treatment, which may be owing to a combination of treatment and disease effects. Future studies may help to determine ways to avoid pulmonary toxicity from SABR.

  View details for DOI 10.1016/j.cllc.2019.05.015

  View details for PubMedID 31377143

• First Human Use of a New Robotic-Assisted Fiber Optic Sensing Navigation System for Small Peripheral Pulmonary Nodules. Respiration; international review of thoracic diseases Fielding, D. I., Bashirzadeh, F. n., Son, J. H., Todman, M. n., Chin, A. n., Tan, L. n., Steinke, K. n., Windsor, M. N., Sung, A. W. 2019: 1–9

  Abstract

  We tested a new, investigational robotic-assisted bronchoscope system with a remotely controlled catheter to access small peripheral bronchi with real-time driving under live visualization and distal tip articulation of the catheter. The unique catheter remains stationary once located at the biopsy position.The primary objectives of this study were to evaluate the safety and feasibility of a new shape-sensing robotic bronchoscope system to bronchoscopically approach and facilitate the sampling of small peripheral pulmonary nodules of 1-3 cm. Secondary objectives included evaluating procedural characteristics and early performance trends associated with the use of the new robotic bronchoscope system.Subjects were enrolled according to study eligibility criteria at a single center. Navigation pathways were semi-automatically created using pre-procedure CT scans. Simultaneous (real-time) viewing of actual and virtual bronchi was used real time during navigation to the displayed target. An endobronchial ultrasound mini-probe was used to confirm lesion location. Flexible 19- to 23-G needles specifically designed to accommodate tight bend radii in transbronchial needle aspiration were used along with conventional biopsy tools. Enrolled subjects completed follow-up visits up to 6 months after the procedure.The study included 29 subjects with a mean lesion size of 12.2 ± 4.2, 12.3 ± 3.3, and 11.7 ± 4.1 mm in the axial, coronal, and sagittal planes, respectively. The CT bronchus sign was absent in 41.4% of cases. In 96.6% of cases, the target was reached, and samples were obtained. No device-related adverse events and no instances of pneumothorax or excessive bleeding were observed during the procedure. Early performance trends demonstrated an overall diagnostic yield of 79.3% and a diagnostic yield for malignancy of 88%.This new robotic-assisted bronchoscope system safely navigated to very small peripheral airways under continuous visualization, and through maintenance of a static position, it provides a unique sampling capability for the biopsy of small solitary pulmonary nodules.

  View details for DOI 10.1159/000498951

  View details for PubMedID 31352444

• A Multicenter Randomized Controlled Trial of Zephyr Endobronchial Valve Treatment in Heterogeneous Emphysema (LIBERATE) AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE Criner, G. J., Sue, R., Wright, S., Dransfield, M., Rivas-Perez, H., Wiese, T., Sciurba, F. C., Shah, P. L., Wahidi, M. M., de Oliveira, H., Morrissey, B., Cardoso, P. F. G., Hays, S., Majid, A., Pastis, N., Kopas, L., Vollenweider, M., McFadden, P., Machuzak, M., Hsia, D. W., Sung, A., Jarad, N., Kornaszewska, M., Hazelrigg, S., Krishna, G., Armstrong, B., Shargill, N. S., Slebos, D., LIBERATE Study Grp 2018; 198 (9): 1151–64

  Abstract

  This is the first multicenter randomized controlled trial to evaluate the effectiveness and safety of Zephyr Endobronchial Valve (EBV) in patients with little to no collateral ventilation out to 12 months.To evaluate the effectiveness and safety of Zephyr EBV in heterogeneous emphysema with little to no collateral ventilation in the treated lobe.Subjects were enrolled with a 2:1 randomization (EBV/standard of care [SoC]) at 24 sites. Primary outcome at 12 months was the ΔEBV-SoC of subjects with a post-bronchodilator FEV1 improvement from baseline of greater than or equal to 15%. Secondary endpoints included absolute changes in post-bronchodilator FEV1, 6-minute-walk distance, and St. George's Respiratory Questionnaire scores.A total of 190 subjects (128 EBV and 62 SoC) were randomized. At 12 months, 47.7% EBV and 16.8% SoC subjects had a ΔFEV1 greater than or equal to 15% (P < 0.001). ΔEBV-SoC at 12 months was statistically and clinically significant: for FEV1, 0.106 L (P < 0.001); 6-minute-walk distance, +39.31 m (P = 0.002); and St. George's Respiratory Questionnaire, -7.05 points (P = 0.004). Significant ΔEBV-SoC were also observed in hyperinflation (residual volume, -522 ml; P < 0.001), modified Medical Research Council Dyspnea Scale (-0.8 points; P < 0.001), and the BODE (body mass index, airflow obstruction, dyspnea, and exercise capacity) index (-1.2 points). Pneumothorax was the most common serious adverse event in the treatment period (procedure to 45 d), in 34/128 (26.6%) of EBV subjects. Four deaths occurred in the EBV group during this phase, and one each in the EBV and SoC groups between 46 days and 12 months.Zephyr EBV provides clinically meaningful benefits in lung function, exercise tolerance, dyspnea, and quality of life out to at least 12 months, with an acceptable safety profile in patients with little or no collateral ventilation in the target lobe. Clinical trial registered with www.clinicaltrials.gov (NCT 01796392).

  View details for PubMedID 29787288

• Twelve-month positive outcomes of Zephyr endobronchial valves in severe emphysema patients: LIBERATE trial Slebos, D., Wright, S., Sue, R., Dransfield, M., Rivas-Perez, H., Wiese, T., Sciurba, F., Shah, P., Wahidi, M., De Oliviera, H., Morrissey, B., Cardoso, P., Hays, S., Majid, A., Pastis, N., Kopas, L., Vollenweider, M., Mcfadden, P. M., Machuzak, M., Hsia, D., Sung, A., Jarad, N., Kornaszewska, M., Hazelrigg, S., Krishna, G., Ten Hacken, N., Shargill, N., Criner, G. EUROPEAN RESPIRATORY SOC JOURNALS LTD. 2018

  View details for DOI 10.1183/13993003.congress-2018.OA4932

  View details for Web of Science ID 000455567100399

• Improving Quality of Dynamic Airway Computed Tomography Using an Expiratory Airflow Indicator Device. Journal of thoracic imaging Hahn, L. D., Sung, A. W., Shafiq, M. n., Guo, H. H. 2018

  Abstract

  Dynamic computed tomography (CT) of the airways is increasingly used to evaluate patients with suspected expiratory central airway collapse, but current protocols are susceptible to inadequate exhalation caused by variable patient compliance with breathing instructions during the expiratory phase. We developed and tested a low-cost single-use expiratory airflow indicator device that was designed to improve study quality by providing a visual indicator to both patient and operator when adequate expiratory flow was attained.A total of 56 patients undergoing dynamic airway CT were evaluated, 35 of whom were scanned before introduction of the indicator device (control group), with the rest comprising the intervention group. Lung volumes and tracheal cross-sectional areas on inspiratory/expiratory phases were computed using automated lung segmentation and quantitative software analysis. Inadequate exhalation was defined as absolute volume change of <500 mL during the expiratory phase.Fewer patients in the intervention group demonstrated inadequate exhalation. The average change in volume was higher in the intervention group (P=0.004), whereas the average minimum tracheal cross-sectional area was lower (P=0.01).The described expiratory airflow indicator device can be used to ensure adequate exhalation during the expiratory phase of dynamic airway CT. A higher frequency of adequate exhalation may improve reliability and sensitivity of dynamic airway CT for diagnosis of expiratory central airway collapse.

  View details for PubMedID 29470258

• Airway Anatomy for the Bronchoscopist INTRODUCTION TO BRONCHOSCOPY, 2ND EDITION Hill, S., Kumaran, R., Sung, A., Ernst, A. edited by Ernst, A., Herth, F. J. 2017: 45–54

  View details for Web of Science ID 000444765200004

• Tracheal Diverticulum Following Paratracheal Hypofractionated Radiotherapy in the Setting of Prior and Subsequent Bevacizumab. Cure¯us Chaudhuri, A. A., Chen, J. J., Carter, J. N., Binkley, M. S., Kumar, K. A., Dudley, S. A., Sung, A. W., Loo, B. W. 2016; 8 (4)

  Abstract

  We present the case of a 63-year-old woman with limited metastatic colorectal cancer to the lungs and liver treated with FOLFIRI-bevacizumab, followed by consolidative hypofractionated radiotherapy to right paratracheal metastatic lymphadenopathy. We treated the right paratracheal site with 60 Gy in 15 fractions (70 Gy equivalent dose in 2 Gy fractions). The patient tolerated the treatment well, and six months later started a five-month course of FOLFIRI-bevacizumab for new metastatic disease. She presented to our clinic six months after completing this, complaining of productive cough with scant hemoptysis, and was found to have localized tracheal wall breakdown and diverticulum in the region of prior high-dose radiation therapy, threatening to progress to catastrophic tracheovascular fistula. This was successfully repaired surgically after a lack of response to conservative measures. We urge caution in treating patients with vascular endothelial growth factor (VEGF) inhibitors in the setting of hypofractionated radiotherapy involving the mucosa of tubular organs, even when these treatments are separated by months. Though data is limited as to the impact of sequence, this may be particularly an issue when VEGF inhibitors follow prior radiotherapy.

  View details for DOI 10.7759/cureus.578

  View details for PubMedID 27226939

• Quantitative Emphysema Score as a Predictor of Morbidity in Transthoracic Needle Aspiration Biopsy Gonzales, N., Wang, D., Holty, J., Kuschner, W., Raffy, P., Laeseke, P., Shah, R., Sung, A., Van Wert, R. AMER COLL CHEST PHYSICIANS. 2015

  View details for DOI 10.1378/chest.2280739

  View details for Web of Science ID 000367163100042

• Interventional Pulmonologist Perspective: Treatment of Malignant Pleural Effusion CURRENT TREATMENT OPTIONS IN ONCOLOGY Sweatt, A. J., Sung, A. 2014; 15 (4): 625-643

  Abstract

  The management of known malignant pleural effusions focuses around the initial thoracentesis and subsequent objective and subjective findings. A completely reexpanded lung after fluid removal and with symptomatic improvement predicts successful pleurodesis. Pleurodesis method depends on center expertise as well as patient preference. Medical thoracoscopy does not require the operating room setting and is performed on the spontaneously breathing patient with similar success rate to surgical thoracoscopy in the appropriately selected patients. However, it is not widely available. Talc insufflation is preferred for even distribution of sprayed particles to pleural surfaces. Most often, patients can be discharged home within 24 to 48 hours after continuous chest tube suction. Indwelling pleural catheter has become popular given the ease of insertion and patient centered home drainage. Coordinated care with good patient and family education and support is paramount to maximizing the beneficial potential of the catheter. Complications are minimal, and catheters are easily removed if patients can no longer benefit from drainage, or if pleurodesis has occurred. In the setting of trapped lung as a result of visceral pleura encasement from tumor, indwelling catheter can still be useful if the patient improves with thoracentesis. However, if no subjective improvement is seen after thoracentesis for trapped lung, then no procedure is recommended and other modes of palliation should be sought.

  View details for DOI 10.1007/s11864-014-0312-6

  View details for Web of Science ID 000344532800009

• Interventional pulmonologist perspective: treatment of malignant pleural effusion. Current treatment options in oncology Sweatt, A. J., Sung, A. 2014; 15 (4): 625-643

  Abstract

  The management of known malignant pleural effusions focuses around the initial thoracentesis and subsequent objective and subjective findings. A completely reexpanded lung after fluid removal and with symptomatic improvement predicts successful pleurodesis. Pleurodesis method depends on center expertise as well as patient preference. Medical thoracoscopy does not require the operating room setting and is performed on the spontaneously breathing patient with similar success rate to surgical thoracoscopy in the appropriately selected patients. However, it is not widely available. Talc insufflation is preferred for even distribution of sprayed particles to pleural surfaces. Most often, patients can be discharged home within 24 to 48 hours after continuous chest tube suction. Indwelling pleural catheter has become popular given the ease of insertion and patient centered home drainage. Coordinated care with good patient and family education and support is paramount to maximizing the beneficial potential of the catheter. Complications are minimal, and catheters are easily removed if patients can no longer benefit from drainage, or if pleurodesis has occurred. In the setting of trapped lung as a result of visceral pleura encasement from tumor, indwelling catheter can still be useful if the patient improves with thoracentesis. However, if no subjective improvement is seen after thoracentesis for trapped lung, then no procedure is recommended and other modes of palliation should be sought.

  View details for DOI 10.1007/s11864-014-0312-6

  View details for PubMedID 25240411

• Interventional pulmonology approaches in the diagnosis and treatment of early stage non small cell lung cancer TRANSLATIONAL LUNG CANCER RESEARCH Tofts, R., Lee, P. M. J., Sung, A. 2013; 2 (5): 316–31

  Abstract

  Lung cancer management is complex and requires a multi-disciplinary approach to provide comprehensive care. Interventional pulmonology (IP) is an evolving field that utilizes minimally invasive modalities for the initial diagnosis and staging of suspected lung cancers. Endobronchial ultrasound guided sampling of mediastinal lymph nodes for staging and detection of driver mutations is instrumental for prognosis and treatment of early and later stage lung cancers. Advances in navigational bronchoscopy allow for histological sampling of suspicious peripheral lesions with minimal complication rates, as well as assisting with fiducial marker placements for stereotactic radiation therapy. Furthermore, IP can also offer palliation for inoperable cancers and those with late stage diseases. As the trend towards early lung cancer detection with low dose computed tomography is developing, it is paramount for the pulmonary physician with expertise in lung nodule management, minimally invasive sampling and staging to integrate into the paradigm of multi-specialty care.

  View details for DOI 10.3978/j.issn.2218-6751.2013.10.11

  View details for Web of Science ID 000218799300002

  View details for PubMedID 25806251

  View details for PubMedCentralID PMC4367731

• Simvastatin enhances bone morphogenetic protein receptor type II expression BIOCHEMICAL AND BIOPHYSICAL RESEARCH COMMUNICATIONS Hu, H., Sung, A., Zhao, G. H., Shi, L. F., Qiu, D. M., Nishmura, T., Kao, P. N. 2006; 339 (1): 59-64

  Abstract

  Statins confer therapeutic benefits in systemic and pulmonary vascular diseases. Bone morphogenetic protein (BMP) receptors serve essential signaling functions in cardiovascular development and skeletal morphogenesis. Mutations in BMP receptor type II (BMPR2) are associated with human familial and idiopathic pulmonary arterial hypertension, and pathologic neointimal proliferation of vascular endothelial and smooth muscle cells within small pulmonary arteries. In severe experimental pulmonary hypertension, simvastatin reversed disease and conferred a 100% survival advantage. Here, modulation of BMPR2 gene expression by simvastatin is characterized in human embryonic kidney (HEK) 293T, pulmonary artery smooth muscle, and lung microvascular endothelial cells (HLMVECs). A 1.4kb BMPR2 promoter containing Egr-1 binding sites confers reporter gene activation in 293T cells which is partially inhibited by simvastatin. Simvastatin enhances steady-state BMPR2 mRNA and protein expression in HLMVEC, through posttranscriptional mRNA stabilization. Simvastatin induction of BMPR2 expression may improve BMP-BMPR2 signaling thereby enhancing endothelial differentiation and function.

  View details for DOI 10.1016/j.bbrc.2005.10.187

  View details for PubMedID 16297860