Journal of thoracic disease最新文献

Background: In patients with non-small cell lung cancer (NSCLC), postoperative pulmonary complications (PPCs) significantly increase morbidity and healthcare costs. To improve upon models based solely on static variables, this study aimed to develop a preoperative nomogram integrating cardiopulmonary exercise testing (CPET) parameters for predicting PPCs. The primary objective of this study was to develop a nomogram for predicting PPCs in NSCLC patients using preoperative CPET parameters combined with clinical variables, and to validate its discriminatory power and predictive.

Methods: Data, including clinical and CPET results, were collected from patients who underwent CPET before video-assisted thoracic surgery (VATS) at the Department of Thoracic Surgery, Xuzhou Central Hospital between August 2019 and November 2023. Independent risk factors for PPCs were identified through univariate and multivariate stepwise logistic regressions, and a nomogram prediction model was constructed. The model's discriminatory power and accuracy were assessed using the concordance index (C-index), calibration curve, receiver operating characteristic (ROC) curve, and area under the curve (AUC) in the validation cohort.

Results: Data from 607 patients were used to construct the nomogram, which included age, intraoperative blood loss, chronic obstructive pulmonary disease (COPD), peak oxygen uptake (VO₂ peak), and the minute ventilation/carbon dioxide production (VE/VCO₂) slope as predictive factors. The model demonstrated good discrimination and accuracy, with a C-index of 0.790 [95% confidence interval (95% CI): 0.743-0.853]. The calibration plot showed strong agreement between predicted and actual PPC probabilities. The ROC curve confirmed the model's acceptable discrimination ability [area under the curve (AUC): 0.790, 95% CI: 0.605-0.829] in internal validation.

Conclusions: The predictive model for PPCs in patients with NSCLC exhibits strong discrimination and accuracy. It offers valuable support for clinicians in making informed treatment decisions.

Pectus excavatum (PE) is the most common congenital deformity of the anterior chest wall and is increasingly recognized as a clinically relevant condition in adult patients. While minimally invasive repair of pectus excavatum (MIRPE) is well established in pediatric and adolescent populations, early attempts to apply this technique in adults were associated with higher complication rates. These challenges were largely attributed to increased chest wall rigidity, more severe and asymmetric deformities, and greater mechanical forces acting on intrathoracic support bars. Over the past two decades, however, progressive refinements in surgical technique, bar stabilization, and perioperative management have enabled the safe expansion of MIRPE to adult populations. This review summarizes the contemporary literature on MIRPE in adults, focusing on patient selection, technical considerations, perioperative strategies, and reported outcomes. Adult MIRPE presents distinct technical challenges and frequently requires modifications such as routine thoracoscopic guidance, forced sternal elevation, reinforcement of intercostal spaces, use of multiple bars, cross-bar configurations, and enhanced bar fixation techniques to achieve durable correction. These technical adaptations have contributed to reductions in bar displacement, recurrence, and major complications in more recent series. Postoperative pain management remains a critical component of adult repair, and the adoption of multimodal analgesic protocols, including intercostal nerve cryoablation, has been associated with reduced opioid requirements and shorter hospital length of stay. Contemporary reports from experienced, high-volume centers demonstrate consistent improvements in patient-reported quality of life (QoL), symptom burden, and cosmetic satisfaction following adult MIRPE. Improvements in cardiopulmonary function have been described in selected patients, particularly when complete anatomic correction is achieved, although objective physiologic benefits remain variable across studies. Adult MIRPE is technically demanding, and outcomes appear closely linked to surgeon experience and institutional volume. With careful patient selection and modern surgical strategies, MIRPE can be performed safely and effectively in adult patients, including those over 30 years of age. Further prospective studies focused on adult populations are needed to better define long-term outcomes and durability following bar removal.

Background: Pain management is an essential part of enhanced recovery after surgery, facilitating early return to mobility and improving respiratory mechanics. Acute pain management guidelines for patients undergoing video-assisted thoracoscopic surgery (VATS) procedures have been published recently. We assessed compliance of Canadian surgeons with those guidelines.

Methods: A survey was distributed to all currently practicing Canadian thoracic surgeons through the Canadian Association of Thoracic Surgeons (CATS). The survey included questions about demographics, nerve block techniques, and other analgesics. Responses were scored as not, partially, or fully compliant with Procedure Specific Postoperative Pain Management (PROSPECT) guidelines for nerve blocks and other analgesics.

Results: The response rate was 25% (53 surgeons of 213 CATS members). Most surgeons infiltrated the port sites (83%) and placed intercostal nerve blocks (81%). However, only 16 (30%) respondents complied with guidelines on analgesic nerve blocks and 11 (21%) on analgesic medications. Ten (19%) respondents use a thoracic epidural. None of the respondents were in full compliance with the guidelines.

Conclusions: Epidural analgesia is still commonly used despite the recommendation against their use. Epidurals are not superior to other blocks in terms of effectiveness but have a higher rate of complications. Only 30% offered one of the recommended blocks. The presence of a dedicated block room was associated with offering recommended blocks and overall nerve block compliance. The current survey did not capture barriers to regional anesthesia, or knowledge of the guidelines. While there is improvement compared to a prior survey, there is low overall compliance with pain management guidelines.

Background and objective: Coronavirus disease 2019 (COVID-19) is an infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Since the onset of the pandemic, there has been a continuous rise in cases of both COVID-19 and long COVID. It is acknowledged that long COVID is a multisystem disorder with a wide range of symptoms; its primary symptoms and indicators include fatigue, dyspnea, anosmia, myalgia, cough, and hyposmia. SARS-CoV-2 has continuously evolved since the wild strain first appeared, resulting in numerous genetic variants. These strains exhibit significant differences in terms of pathogenicity and immune evasion. Key scientific questions remain regarding whether and how these variations influence the development and clinical course of long COVID. This review aims to examine associations between SARS-CoV-2 strains and long COVID, synthesize current evidence, identify research gaps, and provide recommendations for subsequent rehabilitation treatments.

Methods: Literature searches were conducted using PubMed, focusing on publications from January 2020 to August 2025. Relevant literature on long COVID and SARS-CoV-2 variants was systematically reviewed and summarized, and included in this review.

Key content and findings: This review highlights the ongoing genetic evolution of SARS-CoV-2 as a key temporal dynamic during the pandemic. Different SARS-CoV-2 variants result in varying severity of long COVID. Anti-inflammatory treatments demonstrate significant efficacy for long COVID patients. COVID-19 vaccination prior to SARS-CoV-2 infection reduces the risk of long COVID, and another successful treatment option for persistent COVID symptoms is physical therapy.

Conclusions: Long COVID remains a significant public health challenge. The relationship between SARS-CoV-2 variants and long COVID requires further elucidation. This condition may cause significant economic and medical burdens in the future. To completely protect the physical and mental health of long COVID patients, it is essential to broaden therapeutic options and create individualized therapy programs. Therefore, understanding the connection between long COVID and SARS-CoV-2 variants is crucial. Based on this knowledge, effective strategies must be designed to empower individuals in proactively addressing and managing long COVID.

Background: Postoperative fever is common after aortic surgery and often leads to concerns about infection. However, fever may also arise from noninfectious inflammatory responses. The aim of this study was to identify the risk factors and implications of noninfectious fever in patients undergoing surgery for acute type A aortic dissection (AD).

Methods: This retrospective analysis examined 636 patients who underwent aortic replacement for acute type A AD between 2003 and 2024. Patients were excluded if they had pre- or postoperative infections. The remaining 545 patients were divided into a "Non-fever" group and a "Noninfectious fever" group. Patient demographics, surgical details, and outcomes were compared. Multivariable logistic regression was performed to identify independent predictors of noninfectious fever.

Results: Patients with noninfectious fever were younger (63.3±14.8 vs. 55.7±16.0 years, P<0.001) and had longer cardiopulmonary bypass (CPB) and operation times (P=0.005 and P=0.04, respectively). In the multivariable analysis, independent risk factors for noninfectious fever were age [odds ratio (OR): 0.973, 95% confidence interval (CI): 0.959-0.988, P<0.001], longer CPB time (OR: 1.008, 95% CI: 1.003-1.012, P=0.002), and complete false lumen thrombosis (OR: 2.169, 95% CI: 1.074-4.007, P=0.01). Noninfectious fever was not associated with increased risk of 30-day mortality (OR: 0.537, 95% CI: 0.222-1.297, P=0.17).

Conclusions: Younger age, longer CPB time, and complete false lumen thrombosis were independent risk factors for noninfectious postoperative fever following type A AD surgery. Recognizing this benign response could help to avoid unnecessary testing and antibiotics, which would improve postoperative care and resource utilization.

Background: Idiopathic pulmonary fibrosis (IPF) is a chronic, progressive, fibrotic interstitial lung disease. Crizotinib is an oral tyrosine kinase inhibitor (TKI), which has been widely used in the treatment of non-small cell lung cancer (NSCLC). Previous studies have demonstrated that crizotinib can inhibit downstream signaling pathways of anaplastic lymphoma kinase (ALK) in lung adenocarcinoma mouse, including pSTAT3, pAKT, and pERK, which also play an important role in the development and progression of pulmonary fibrosis. We conducted this study to investigate the antifibrotic efficacy of crizotinib in pulmonary fibrosis in vivo and in vitro, as well as exploring the potential mechanism further.

Methods: Fibroblasts were stimulated with TGF-β1 and co-treated with crizotinib to evaluate its impact on fibroblast activation markers as well as main related proteins of signal pathways in vitro. Male C57BL/6 mice were administered bleomycin (BLM) established as in vivo model. We assessed lung function, micro-computed tomography (CT), hydroxyproline level, percentage of fibrotic areas and the expression of fibrotic factors to evaluate the effects of crizotinib on pulmonary fibrosis. Western blot was performed to identify our speculated hypothesis.

Results: In vitro studies showed that crizotinib reduced the gene and protein expression levels of the fibronectin (Fn), Collagen 1 (Col-1) and α-smooth muscle actin (α-SMA), as well as exerting potential anti-fibrotic effects by inhibiting the activation and migration of fibroblasts. Additionally, the results of the in vivo studies demonstrated that crizotinib could improve lung dysfunction, pulmonary fibrosis lesions, area of full ventilation in CT, and the expression of fibrotic-associated factors in lung tissues of BLM-mice. Additionally, crizotinib inhibited the PI3K/AKT/mTOR, STAT3 and ERK signaling pathways, which play vital roles during pulmonary fibrosis.

Conclusions: Through suppressing fibroblast proliferation and activation, crizotinib could alleviate pulmonary fibrosis in BLM induced mice. Crizotinib could inhibit the PI3K/AKT/mTOR, STAT3 and ERK signaling pathways. Crizotinib might be an emerging medication choice for patients with IPF.

Background: Incidental pulmonary nodules (IPNs) are frequently identified in computed tomography (CT) scans performed for unrelated clinical indications. While most are benign, some harbor malignancy, necessitating proper evaluation. This study assesses the prevalence, characteristics, and malignancy predictors of IPNs.

Methods: A retrospective review of CT scans conducted between January 2015 and December 2022 at a single institution was performed. From 16,433 CT reports, 749 cases of pulmonary nodules were identified, of which 219 met inclusion criteria. Of 219 incidental nodules identified, 103 (47%) had follow-up CT imaging and comprised the analytic cohort for outcome assessment. Demographic and clinical data, including smoking history and nodule characteristics, were analyzed. Malignancy was confirmed through histopathological examination. Statistical analyses included descriptive comparisons and penalized logistic regression to account for low event rates.

Results: The study involved 219 patients with an equal sex distribution. The median nodule count was 5 per patient, with a median size of 5 mm. Most nodules were in the right upper lobe. Malignancy was detected in 5 of 103 patients with follow-up imaging (4.85%), which is significantly higher compared with national registry data of the general population. While malignant nodules exhibited slightly larger median sizes (6.5 mm), they did not significantly differ from benign ones in terms of size distribution or lobar location (P>0.05). Patients above 50 years old showed a significantly higher number of nodules (P=0.002).

Conclusions: A significant proportion of IPNs in this cohort demonstrated malignancy risk, highlighting important gaps in follow-up and documentation in routine clinical practice. These findings highlight the need for structured, risk-based follow-up protocols to ensure timely evaluation while avoiding unnecessary interventions.

Background: Combined pulmonary fibrosis and emphysema (CPFE) is associated with high mortality, poor prognosis, and a substantial societal burden. This study aimed to identify and summarize prognostic factors in patients with CPFE through a systematic review and meta-analysis, with the goal of informing clinical management and treatment strategies.

Methods: A systematic search was conducted in PubMed, Web of Science, the Cochrane Library, and Embase from database inception to August 15, 2025, to identify studies investigating prognostic factors in patients with CPFE. The quality of the included studies was assessed using the Newcastle-Ottawa Scale (NOS). Hazard ratio (HR) with 95% confidence interval (CI) was used to determine prognostic factors for CPFE.

Results: This study included 14 studies involving 1,874 patients. A meta-analysis of 10 studies, comprising 1,471 patients, demonstrated that age (HR =1.03; 95% CI: 1.02, 1.05; P<0.001), smoking history (HR =1.63; 95% CI: 1.04, 2.55; P=0.03), lung cancer (HR =5.00; 95% CI: 3.01, 8.31; P<0.001), diffusing capacity of the lung for carbon monoxide (DLCO) (HR =0.96; 95% CI: 0.94, 0.98; P<0.001), percent predicted DLCO (DLCO%pred) (HR =0.97; 95% CI: 0.95, 1.00; P=0.04), an annual increase in composite physiologic index (CPI) (≥5 points) (HR =8.43; 95% CI: 1.46, 48.72; P=0.02), and usual interstitial pneumonia (UIP) pattern on high-resolution computed tomography (HRCT) (HR =1.89; 95% CI: 1.10, 3.25; P=0.02) were prognostic factors for mortality in patients with CPFE. Lung cancer (HR =3.47; 95% CI: 1.74, 6.90; P<0.001) was identified as a prognostic factor for acute exacerbation (AE) in CPFE patients.

Conclusions: Age, smoking history, DLCO, DLCO%pred, lung cancer, an annual increase in CPI(≥5points), and UIP pattern on HRCT may be prognostic factors for mortality in patients with CPFE. Lung cancer may be a prognostic factor for AE in CPFE patients. However, due to the limited number and quality of the included studies, these conclusions need to be validated by further research.