Journal of thoracic disease最新文献

Background: Airway invasive aspergillosis (AWIA) poses a diagnostic challenge due to its nonspecific clinical manifestations. This study aimed to characterize the imaging findings of AWIA and explore the clinical characteristics that facilitate the diagnosis of AWIA.

Methods: A retrospective analysis was conducted on 21 patients clinically and pathologically diagnosed with AWIA. All subjects underwent chest multislice computed tomography (MSCT) scans, and their clinical data were collected. The computed tomography (CT) features were evaluated, and 17 patients received the follow-up of MSCT in our hospital.

Results: The high-frequency CT signs with an incidence of ≥60% included lobar and segmental bronchial lumen stenosis and wall thickening, patchy peribronchial consolidation, tree-in-bud sign, nodules (>5 mm), bronchioles wall thickening and lumen expansion. The low-frequency signs with an incidence of <40% included trachea or left/right main bronchial wall thickening, lobar and segmental bronchiectasis and wall thickening, ground-glass opacity, cavity, and pleural effusion. The inter-reader agreement for CT features was substantial (kappa =0.78). Additionally, we observed that clinical symptom improvement did not always correspond with immediate improvement in CT imaging findings during the early stages of treatment.

Conclusions: The presence of specific high-frequency CT features in patients with underlying risk factors should prompt consideration of AWIA. Early recognition of these CT patterns may facilitate timely diagnosis and treatment, potentially improving patient outcomes.

Background: Indwelling pleural catheter (IPC) insertion is associated with fewer subsequent procedures and higher rates of spontaneous pleurodesis (SP) in patients with malignant pleural effusion (MPE). However, long-term pleural drains may cause psychological and physical distress. Additionally, only a portion of patients can benefit from IPC insertion and ultimately have them removed. The nomogram reflects the influence of different factors on outcome visually, enabling clinics to assess the optimal population. Thus, the objective of this study was to develop and validate a novel nomogram to predict successful SP in non-small cell lung cancer (NSCLC) patients with MPE treated with IPC.

Methods: We reviewed data on the use of IPC insertion for MPE in patients with NSCLC and allocated them randomly to development (60%) and validation (40%) sets. A static and dynamic nomogram was developed based on multivariate logistic regression to evaluate SP occurrence in the development set. Receiver operating characteristic (ROC) curves, calibration curves, decision curve analysis (DCA), and Nelson-Aalen cumulative risk curves were used to validate the predictive accuracy of the nomogram.

Results: In total, 331 patients (development set: n=199; validation set: n=132) were selected for this study. Medical thoracoscopy, septated effusion, and effusion volume were the strongest predictors of SP. Other predictors included gender, systemic treatment, and serum neutrophil-to-lymphocyte ratio. The prediction nomogram was demonstrated good predictive ability in the development and validation sets (area under the curve: 0.745 and 0.720, respectively). The DCA indicated that the model had a certain clinical application value. Nelson-Aalen cumulative risk curves showed that the more favorable group received successful SP than did the less favorable group (P<0.001).

Conclusions: We developed an accurate and practicable nomogram for successfully predicting SP. These results may benefit clinicians in optimizing treatment decisions, improving the probability of SP, and relieving the long-term discomfort caused by IPC.

Background: Newly formed bullae after video-assisted thoracoscopic surgery (VATS) bullectomy in primary spontaneous pneumothorax (PSP) are an important etiology for recurrence and are associated with mechanical stress along the stapling line. However, the distribution or pattern of stress after VATS bullectomy has not been thoroughly investigated. Our aim was to analyze the stress distribution following lung resection.

Methods: Using finite element method analyses in COMSOL Multiphysics software to evaluate the stress distribution along the stapling line, a solid ellipsoidal lung model was constructed. Simulations were subsequently conducted to evaluate changes in stress along the stapling line after VATS bullectomy. Finally, a parametric study investigating the changes in stress based on the difference between the lung resection volume and the degree of lung collapse was conducted.

Results: The magnitude of the stress progressively increased with the inflation of the lung, and the highest stresses were observed at both ends and the center of the stapling line. The parametric studies showed that the maximum stress observed was positively correlated with the amount of lung resection (R²=0.961, P<0.001) and negatively correlated with the degree of lung collapse before stapling (R²=0.964, P<0.001). A wrinkling phenomenon was also observed adjacent to the stapling line.

Conclusions: The mechanical stress during inflation progressively increased, reaching its peak at both ends and in the center, resulting in uneven wrinkling along the stapling line. Minimal resection with incomplete collapse before stapling could be considered a potential strategy to reduce stress.

The approach for traditional uniportal video-assisted thoracoscopic surgery (Uni-VATS) is typically located on the lateral chest wall, the resulting pain and visible scars may have a negative psychological impact on patients. We present our preliminary experience with the subcutaneous tunneled periareolar approach (STPA) in lung resection performed through Uni-VATS for treating pulmonary nodules. From December 2023 through to June 2024, five patients underwent this procedure, including three cases of the wedge resection, one case of the lobectomy, and one case of the segmentectomy. The operations were uneventful, with no postoperative infections or deaths reported. Scarring from the STPA was effectively concealed within the naturally darker periareolar skin. Tension-free incision reduced postoperative pain for patients, and the follow-up outcomes were favorable. The STPA for Uni-VATS is a safe and reliable method for resection of pulmonary nodules, we recommend this method for patients with aesthetic concerns and for women without reproductive needs.

Background: Cone-beam computed tomography (CBCT)-guided bronchoscopy is increasingly utilized for diagnosing peripheral pulmonary lesions (PPLs). We carried out the meta-analysis for assessing the efficacy and safety of CBCT-guided bronchoscopy for PPLs.

Methods: An extensive search in several databases was conducted to identify relevant articles. We evaluated the quality of studies with the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool. The pooled diagnostic yield (DY) and adverse event rate with the 95% confidence interval (CI) were computed. Subgroup analyses were performed according to additional use of navigation, use of radial endobronchial ultrasound (rEBUS), use of fixed or mobile CBCT, whether computed tomography (CT) spin was performed before biopsy to affirm tool-in-lesion, use of rapid onsite cytologic examination (ROSE), strictness of the definition of DY, and study design. Further analysis was performed to explore the association between odds of diagnosis with CBCT guided bronchoscopy and PPLs characteristics (>20 vs. ≤20 mm, non-upper lobe vs. upper lobe, with bronchus sign vs. without bronchus sign, and solid vs. non-solid) as well as sampling methods (forceps vs. fine needle aspiration, forceps vs. cryoprobe sampling). The pooled odds ratio (OR) and 95% CI were calculated. The significance level was set at 0.05. All analyses were performed by using meta package in R version 4.3.2.

Results: We included 23 studies involving 1,769 patients and 1,863 PPLs in the meta-analysis. The overall pooled DY of CBCT-guided bronchoscopy was 80.2% (95% CI: 76.0-84.1%). Subgroup analysis showed that the DY was highest when CBCT was used with robotic-assisted navigation bronchoscopy (pooled DY 87.5%; 95% CI: 81.5-92.4%), the DY was 78.9% (95% CI: 70.8-85.9%) when CBCT was used alone without other navigation techniques. Lesion size >20 mm, presence of bronchus sign and solid lesions were associated with significant increase in the odds of diagnosis with CBCT-guided bronchoscopy. Pooled adverse event rate was 2.3% (95% CI: 1.2-3.6%).

Conclusions: CBCT-guided bronchoscopy is a safe technique with high DY in diagnosing PPLs.

Background: Chronic thromboembolic pulmonary hypertension (CTEPH), a progressive disease, can lead to decompensation of the right half of the heart and death. Studies on CTEPH have increased in number over the last two decades. This study aimed to perform a bibliometric analysis of the global scientific output on CTEPH in the last 24 years to identify research trends and hot topics.

Methods: We searched the Web of Science Core Collection (WoSCC) Science Citation Index Expanded (Science Citation Index Expanded and Social Sciences Citation Index) for literature on CTEPH published from January 1, 2000 to January 31, 2024, and recorded their information. The Bibliometrix software package was used for bibliometric indicator analysis, and VOSviewer and CiteSpace were used to visualize trends and hotspots of CTEPH research.

Results: Overall, 2,264 publications were included in the bibliometric analysis. The number of annual publications increased drastically from 14 in 2000 to 199 in 2023. The number of publications on CTEPH has increased over the last two decades, with 24.4% (n=553) of the publications published in top academic journals. The United States ranked first in publications and had the best CTEPH-investigating institutions; it also had the highest level of international cooperation. Distinctively, 7 of the top 10 institutions and 7 of the top 10 researchers in the field were from Europe with the most influential scientists. A relatively high percentage of the publications were published in top-rank academic journals, especially in respirology and cardiology journals. Pulmonary endarterectomy (PEA) was the main therapy during the first decade, while balloon pulmonary angioplasty (BPA) and pulmonary arterial hypertension (PAH)-targeted medicine have recently gained interest. Dual-energy computed tomography (DECT), right ventricular function, and the role of pulmonary endothelium in microvasculopathy have become the focus of CTEPH research.

Conclusions: The number of publications on CTEPH has increased over the last two decades, and CTEPH has become a significant topic in both respirology and cardiology. Our results indicate that future research in this field will continue to focus on elucidating the pathophysiological mechanisms underlying this disorder, improving diagnostic accuracy, and developing novel imaging techniques. The integration of existing therapeutic modalities and the elucidation of right ventricular dysfunction are key areas of research.

Background: Lung cancer has become the second most common cancer and the leading cause of cancer death in the United States. We aim to determine factors associated with newly diagnosed lung cancer at the Emergency Department (ED) and identify specific patient populations eligible for lung cancer diagnostic screening.

Methods: This is a single-center retrospective observational study. We included all patients aged between 50 and 80 years old, who presented to the ED seeking healthcare between January 1, 2019, and December 31, 2023. Patients' socio-demographics, clinical information, and whether they were eligible for lung cancer screening determined by the United States Preventive Services Task Force (USPSTF) guideline were analyzed and compared between patients who had newly diagnosed lung cancer at ED and those without. Factors associated with newly diagnosed lung cancer patients were determined by multivariable logistic regressions with inverse probability weighting (IPW) to account for observed selection bias of lung cancer screening eligibility.

Results: Out of 75,516 patients in this study, 18,641 (25%) patients had documented smoking histories. Among these, only 8,051 (10.66%) were eligible for lung cancer screening, while 18,348 patients received lung computer tomography (CT). Among all patients whose CTs were performed, 123 individuals were identified as having been newly diagnosed with lung cancer. Multivariable logistic regressions showed that the adjusted odds ratio (AOR) for eligible lung cancer diagnostic screening was 3.07 [95% confidence interval (CI): 2.08-4.53, P<0.001] without IPW and 3.49 (95% CI: 2.24-5.42, P<0.001) with IPW. Other factors associated with newly diagnosed lung cancer in ED were older age, female, and patients who spoke neither English nor Spanish.

Conclusions: To optimize the identification of suitable patients for lung cancer diagnostic screening in the ED, it may be beneficial to modify the eligibility criteria beyond those currently outlined by the USPSTF guidelines. Integrating additional factors such as advanced age, female sex, and a preference for non-English languages could improve the screening's effectiveness by capturing at-risk populations that might otherwise be overlooked.