Journal of thoracic disease最新文献

Background: Endoscopic thoracic sympathectomy is a well-known and effective treatment for palmar and axillary primary hyperhidrosis (PHH). Its most frequent drawback and the main complaint among patients who underwent surgery is the appearance of compensatory sweating (CS). To date, no long-term studies using internationally standardized tools have assessed the efficacy and impact of this surgery on patients. In this study we performed a very long-term follow-up of the patients using an internationally validated tool. The aim of this article is to assess the technique as a treatment for hyperhidrosis, focusing on its long-term efficacy, side effects (CS), and patient satisfaction with the procedure.

Methods: A closed cohort study was performed conducting a review of the clinical records to identify 100 consecutive patients who underwent bilateral endoscopic thoracic surgery with a minimum follow-up period of 2 years. Patients with diagnoses other than primary palmar or axillary hyperhidrosis or those for whom follow-up was impossible were excluded. A structured telephone survey, including the International Hyperhidrosis Society "Hyperhidrosis Disease Severity Scale" (HDSS) was conducted for all patients. Data were summarized using median (1^st and 3^rd quartiles) for quantitative variables and relative and absolute frequencies for qualitative variables. To study the likelihood of a patient recommending the surgery, a Bayesian logistic regression model was used reporting results as odds ratio (OR).

Results: A total of 91 patients were included in the follow-up. The median follow-up duration was 10.66 (5.68, 11.98) years. The most affected zone was the hands (29.67%), and the most common sympathectomy levels were R2 and R3 (68.13%). The overall surgical efficacy rate was of 94.50% and CS appeared in 36.26% of the patients, with 75.76% of these cases being mild and severe in only one patient. In total, 97.8% of patients improved their HDSS score after surgery. The OR of recommending the surgery for a lower HDSS index was 0.24 and 0.18 for the apparition of CS. Despite it, 91.21% of patients recommend the surgery, with an overall satisfaction rate of 93.95%.

Conclusions: Endoscopic thoracic sympathectomy is an effective and safe treatment for palmar and axillary PHH, with a relatively low rate of CS which, when present, is typically mild, making it a highly satisfactory treatment option for patients.

Background: Non-tuberculous mycobacterial lung disease may coexist or precede lung cancer, yet a causal link remains unproven. This study aimed to elucidate the causal association between non-tuberculous mycobacteria (NTM) and lung cancer.

Methods: Summary data from genome-wide association studies (GWAS) for NTM, atypical mycobacterial lung infections, and various types of lung cancer were utilized. A two-sample Mendelian randomization (MR) design was applied using the inverse variance weighted (IVW), weighted median, weighted mode, and MR-Egger regression methods. Sensitivity analysis and MR Pleiotropy RESidual Sum and Outlier (MR-PRESSO) were used to detect and correct for horizontal pleiotropy. The leave-one-out analysis was used to evaluate the robustness of the results.

Results: The IVW results showed no significant causal relationships between NTM infection and the risk of lung cancer and between atypical mycobacterial lung infection and the risk of lung cancer. The results of the weighted median, weighted mode, and MR-Egger regression methods aligned with those of the IVW method. Cochran's Q test revealed that heterogeneity significantly influenced the association between NTM pulmonary infections and lung cancer. The MR-PRESSO analysis identified two outlier instrumental variables (IVs); after excluding them, the results remained similar, without causal associations.

Conclusions: The findings of this study do not support a genetically causal relationship between NTM and atypical mycobacterial lung infections with lung cancer.

Background: Serious mental illness (SMI) is associated with increased complications and worse outcomes in a variety of surgical diseases, however, SMI as a risk factor in thoracic surgery patients is incompletely understood. We aimed to investigate if comorbid SMI would impact mortality and morbidity following lung cancer resection.

Methods: We identified 615 patients from the Society of Thoracic Surgery (STS) database at the University of North Carolina - Chapel Hill (January 2013-June 2021) who underwent lung cancer resection for non-small cell lung cancer (NSCLC). Patients identified with comorbid SMI as defined in prior studies were identified and stratified into mood, anxiety, and psychosis disorders. We analyzed the risk-adjusted impact of SMI on composite morbidity and mortality and length of stay (LOS) using multivariable logistic regression and Poisson regression analysis, respectively.

Results: Patients with SMI were younger, more frequently female, and more likely to be a smoker. Among identified patients, 186 (37.1%) had comorbid SMI which were predominantly mood disorders (90.3%). Overall, 116 patients (23.2%) had the primary outcome of composite postoperative mortality or morbidity. Following multivariable risk adjustment, patients with and without SMI did not have significantly different morbidity and mortality [odds ratio (OR) =1.36; 95% confidence interval (CI): 0.86-2.15]. After adjusting for surgery performed and other covariates, LOS was significantly longer among patients with SMI [risk ratio (RR) =1.21; 95% CI: 1.13-1.30].

Conclusions: In a 7.5-year period from a single academic institution, patients undergoing lung cancer resection had high rates of SMI. While no difference in composite morbidity and mortality was demonstrated, patients with SMI had significantly longer LOS.

Background: Sometimes, the identification of ground-glass opacities (GGOs), small or deep pulmonary nodules can be difficult also in expert hands. Usually for these lesions pulmonary lobectomy is an overtreatment, so we developed a technique to identify easily these nodules. The objective of this research is to assess the effectiveness and safety of using preoperative cone beam computed tomography (CBCT) to guide the placement of micro-coils in the lung parenchyma near GGO and small lesions. Additionally, the study aims to identify potential factors that could predict coil-assisted failures during uniportal video-assisted thoracic surgery (U-VATS) resections.

Methods: The clinical, radiological, and surgical records of 117 patients who underwent U-VATS resection following CBCT-guided micro-coil localization of GGOs and small deep nodules between January 2017 and February 2023 were retrospectively analyzed. We have placed a micro coil under CBCT guide before the intervention in the 24 hours preceding the intervention. The patient received a pulmonary wedge resection in U-VATS technique and an immediate fresh frozen section to determine the necessity of a pulmonary lobectomy.

Results: One hundred and eight lesions/117 lesions (92.3%) were correctly identified by the coil. The coil placement had only mild complications: perilesional bleeding, pneumothorax requiring pleural drainage (2/117), hypotension (2/117), subcutaneous emphysema (1/117) and 1 case of coil retained in the chest wall. Ninety-seven lesions/117 lesions (82.9%) were malignant. Among these, 74 (76.3%) were lung adenocarcinomas.

Conclusions: Preoperative CBCT-guided micro-coil localization, is a safe and cheap procedure, allows the detection of GGOs, small or deep nodules in U-VATS with low rate of conversion to thoracotomy and few complications, without any use of intraoperatory radiations.

Background: It has been proposed that repeated exposure of bronchial epithelial cells to atmospheric particulate matter (PM) could disrupt airway epithelial integrity and lead to epithelial-to-mesenchymal transition (EMT) and ultimately airway remodeling. The molecular mechanisms underlying PM-related bronchial epithelial EMT have not yet been elucidated. The aim of this research is to clarify the molecular mechanism of EMT upon PM exposure.

Methods: Using an in vivo mouse model of PM-induced airway inflammation and an in vitro model of PM-stimulated bronchial epithelial cells, we clarified the role of haptoglobin (HP) in PM-induced bronchial epithelial EMT. The expression of HP in lung tissues was evaluated by immunohistochemistry (IHC). Western blotting (WB) and immunofluorescence staining were used to analyze EMT-related protein expression and the relevant signaling pathways in the changes in lung tissues and bronchial epithelial cells upon PM exposure. HP small interfering RNA (siRNA) was used to implement the interference of endogenous HP.

Results: In vivo experiments showed elevated HP expression in the bronchial epithelium upon PM exposure. IHC and WB showed that E-cadherin expression was decreased, and vimentin expression was increased in bronchial epithelial cells. Moreover, WB results showed that the phosphorylation levels of signal transducer and activator of transcription 3 (STAT3) and extracellular regulated protein kinases (ERK) were elevated in the lung parenchymal tissue of mice. The results of in vitro molecular mechanism experiments showed that compared with those of the control group, the phosphorylation levels of STAT3 and ERK in the PM group increased progressively with higher concentrations of PM and longer stimulation durations. BEAS-2B cells were pretreated with stattic (STAT3 inhibitor) and/or U0126 (ERK inhibitor), and it was found that either stattic or U0126 inhibited PM-induced reduction of E-cadherin expression and elevation of vimentin expression, and the inhibitory effect was most significant when both inhibitors were pretreated simultaneously. Through transfection of BEAS-2B cells with HP siRNA, WB results showed that HP siRNA partially reversed the PM-induced reduction in E-cadherin expression and elevation of vimentin expression, in addition to the reduction in the phosphorylation levels of the STAT3 and ERK.

Conclusions: HP is an important mediator of PM-induced EMT in bronchial epithelial cells and promotes PM-induced EMT in bronchial epithelial cells through activation of the STAT3 signaling pathway and the ERK signaling pathway. Inhibition of HP expression attenuates PM exposure-induced EMT in bronchial epithelial cells.

Background: Postoperative pneumonia (POP) predicts poor outcomes after lung surgery, especially for patients undergoing sleeve lobectomy. Fiberoptic bronchoscopy (FOB) is frequently used in the treatment of POP for patients receiving sleeve lobectomy. This study aimed to assess the effect of prophylactic FOB on the incidence of POP in these patients.

Methods: This is a single-center retrospective cohort study. Postoperative outcomes of patients who underwent sleeve lobectomy for central lung cancer from August 2005 to August 2020 in the West China Hospital were collected. The included patients were divided into two groups based on whether prophylactic FOB was performed, and the two groups were compared using propensity score matching (PSM).

Results: A total of 314 patients were included in this study. There were 166 patients in the aspirated group and 148 patients in the non-aspirated group. PSM resulted in 133 patients in each group. The aspirated group was associated with a lower incidence of POP (7.5% vs. 17.3%; P=0.03), shorter duration of antibiotic use (5.6±3.3 vs. 6.9±3.9 days; P=0.003), and shorter postoperative hospital stay (9.3±4.8 vs. 10.7±5.5 days; P=0.04).

Conclusions: Prophylactic FOB after sleeve lobectomy was associated with improved postoperative outcomes and might be recommended for patients undergoing sleeve lobectomy.

Background: Obesity is associated with an increased risk of aortic diseases and operative risks. Currently, there are no effective drugs available to prevent the occurrence and progression of aortic aneurysms or dissections. We investigated potential biomarkers and therapeutic targets using a multi-omics approach.

Methods: Clinical data from 237 patients with aortic disease were analyzed based on body mass index (BMI) to explore the relationship between BMI and clinical outcomes. An obesity mouse model was developed by feeding a high fat diet (HFD), and an aortic disease model was established by administering human angiotensin II (AngII) at a dosage of 1,000 ng/min/kg via osmotic minipumps. Through analysis of murine aortic transcriptomics and serum proteomics, we identified potential biomarkers for aortic disease with obesity. Enzyme-linked immunosorbent assay was used to detect these biomarkers in human serum.

Results: This study analyzed a cohort of 237 patients with aortic disease and 72 patients with valvulopathy. Patients with aortic disease exhibited a significantly higher BMI and a lower mean age compared to those with valvulopathy. Among the aortic disease group, elevated BMI was associated with a younger age, increased systolic and diastolic blood pressure, and a higher percentage of neutrophils. Transcriptomic analysis revealed an enrichment of genes related to complement and coagulation cascades, as well as the prion disease pathway. Proteomic analysis showed an enrichment of proteins associated with African trypanosomiasis and the estrogen signaling pathway. By integrating transcriptomic and proteomic profiles, complement component 5 (C5) and apolipoprotein D (apoD) were identified as potential biomarkers for the adverse effects of obesity.

Conclusions: High BMI is associated with an increased risk of aortic disease, particularly aortic dissection. Serum C5 and apoD have been identified as potential biomarkers for evaluating the risk of aortic disease in obese individuals. Further research is necessary to explore the pathophysiological pathways correlated with these biomarkers and their potential clinical applications.

Background: Patients with idiopathic pulmonary fibrosis (IPF) are at risk of lung cancer development. Antifibrotic therapy could slow disease progression of IPF, but there is limited data on its effectiveness on lung cancer. Here, we aimed to investigate lung cancer incidence and the risk of mortality of patients with IPF receiving antifibrotic therapy.

Methods: Data from the Korean National Health Insurance service database between October 2015 and September 2021 were used. The incidence of lung cancer and all-cause mortality in the IPF cohort was analyzed depending on pirfenidone treatment. Those who were diagnosed with lung cancer prior to IPF diagnosis were excluded.

Results: Among the 5,038 patients with IPF who were eligible for the study, pirfenidone was administered to 880 patients. Median follow-up duration was 4,872.8 and 23,612.1 person-years in the groups receiving and not receiving pirfenidone, respectively. The incidence of lung cancer was significantly higher in the pirfenidone group compared to non-users [2.44 vs. 1.56 per 100 person-years; risk ratio 1.56; 95% confidence interval (CI), 1.27-1.92]. However, the risk of mortality did not differ significantly between patients receiving pirfenidone and those who did not. Further analysis was conducted to assess lung cancer development and pirfenidone therapy. Among patients with lung cancer, those treated with pirfenidone demonstrated significantly improved survival compared to those not receiving pirfenidone therapy (log-rank test, P<0.001). Pirfenidone therapy was associated with a protective effect on mortality in IPF patients with lung cancer [hazard ratio, 0.61; 95% CI, 0.43-0.85].

Conclusions: Antifibrotic therapy was associated with improved survival in patients with IPF who develop lung cancer, even though the incidence of lung cancer was higher in those receiving antifibrotic treatment compared to those do not.

Background: Left ventricular assist device (LVAD) has been widely used as an alternative treatment for heart failure, however, aortic regurgitation is a common complication in patients with LVAD support. And the O-A angle (the angle between LVAD outflow graft and the aorta) is considered as a vital factor associated with the function of aortic valve. To date, the biomechanical effect of the O-A angle on the aortic valve remains largely unknown. The aim of this study was to evaluate the O-A angle how to influence the aortic valve biomechanical properties.

Methods: The current study employed a novel fluid-structure interaction (FSI) model that integrates the Lattice Boltzmann method (LBM) and the finite element method (FEM) to investigate the biomechanical effect of the O-A angle on the aortic valve under LVAD support. The biomechanical status of the aortic valve was evaluated at three different O-A angles (45, 90 and 135 degrees) and. four indicators, including stress distribution, the mean stress, the axial hemodynamic force (AHF) and the wall shear stress (WSS) distribution were evaluated at three timepoints (28, 133, and 266 ms).

Results: The results showed that the stress and the high-stress region on the aortic leaflets increased as the O-A angle increased and as the difference between the left ventricular pressure (LVP) and aortic pressure (AP) increased. And the aortic insufficiency was observed at the 28 ms (systolic phase) in the 135-degree O-A angle. During the systolic phase, significant fluctuation in the mean stress was observed when the O-A angle was 90 or 135 degrees. During the diastolic phase, the mean stress increased in the three O-A angle conditions when the difference between the LVP and AP increased. Regarding to the AHF, an obvious fluctuation was observed during the systolic phase (0-100 ms) in the 135-degree O-A angle. During the diastolic phase, the AHF increased in the three O-A angle conditions when the difference between the LVP and AP increased. For the WSS distribution evaluation, the WSS was increased when the O-A angle increased. At 28 ms (the systolic phase), a high WSS was located on the free edge of the leaflets, and the deformed leaflets were observed in the 135-degree O-A angle. And at 133 ms (the rapid diastolic phase), a high WSS was observed at the free edge of the leaflets when the O-A angles were 45 or 90 degrees, and at both free edge and belly of the leaflets in the 135-degree O-A angle.

Conclusions: The O-A angle is closely associated with the biomechanical status of the aortic valve under LVAD support. A large O-A angle caused high stress and WSS on the aortic leaflets, as well as broad stress and WSS distribution, thus leading to deformed leaflets and retrograde flow. Therefore, optimization of the O-A angle will favor to maintain aortic valve function.

Background: Acute type A aortic dissection (ATAAD) requires emergency surgery, but the choice of primary surgery remains controversial. It is believed that simple ascending aorta replacement may lead to higher postoperative survival rate, while the Sun procedure [frozen elephant trunk (FET) + total arch replacement (TAR)] performed in the first stage may obtain better long-term results. The study aimed to compare the outcome of ATAAD patients who underwent the Sun procedure with those without TAR + FET.

Methods: Data of 452 patients with ATAAD admitted to Beijing Anzhen Hospital for surgical treatment from August 1, 2020, to August 16, 2022, were collected and analyzed. Patients with the Sun procedure (n=344) were compared to those without the Sun procedure (n=108). The two groups of patients were matched using propensity score matching (PSM), and the risk factors of poor prognosis were analyzed.

Results: The average postoperative follow-up period was 976±414 days, and the loss of follow-up rate was 0. The postoperative 30-day mortality rates were 12.56% and 5.38% in the Sun procedure group and the non-Sun procedure group after PSM matching, respectively (P=0.06). Multivariate logistic regression analysis showed that postoperative cardiogenic shock, postoperative cerebral malperfusion syndrome (MPS), postoperative spinal MPS, and need for continuous renal replacement therapy (CRRT) were independent risk factors for postoperative 30-day death. The 3-year survival rates were 85.02% and 91.40% in the Sun procedure group and the non-Sun procedure group after PSM matching, respectively (P=0.12). According to multivariate cox regression analysis, the independent risk factors associated with postoperative midterm death were consistent with those associated with 30-day postoperative death that pointed out by logistic regression. The incidence of spinal MPS after the Sun procedure was higher than that in the non-Sun procedure group (P=0.003). At 3-year follow-up, the probability of no distal aortic events (DAEs) was 97.17% and 91.59%, in the Sun procedure group and non-Sun procedure group, respectively, representing a significant difference (P=0.02). Multivariate Cox regression showed that Marfan syndrome and non-Sun procedure were risk factors for DAEs. Fine-Gray analysis also produced results similar to multifactor cox regression analysis, that Marfan syndrome and non-Sun procedure were risk factors for DAEs.

Conclusions: There was no significant difference in postoperative mortality between the Sun procedure group and the non-Sun procedure group. The incidence of spinal MPS in the Sun procedure group was higher than that in the non-Sun procedure group, while the incidence of DAEs in the Sun procedure group was lower than that in non-Sun procedure group.