Journal of thoracic disease最新文献

Background: Acute lung injury (ALI) is one of the most serious pulmonary complications following lung resection. Despite the known beneficial effects of corticosteroid treatment for postoperative ALI, limited data are available regarding corticosteroid treatment duration. This study aimed to evaluate the beneficial effects of a short-course corticosteroid in patients with postoperative ALI following lung resection surgery for lung cancer.

Methods: This retrospective observational study included 91 patients who were treated with corticosteroids for postoperative ALI among 7,317 patients who underwent lung resection surgery for lung cancer between January 2017 and March 2021. Patients were divided into two groups, short (≤14 days, n=31) and long (≥15 days, n=60) courses, on the basis of corticosteroid treatment duration.

Results: While similar baseline characteristics were observed between the two groups, the short-course group had a higher corticosteroid loading dose than the long-course group; however, the cumulative dose in the first 7 days was not different between the two groups. Overall, in-hospital mortality rates were 3.2% and 26.7% in the short- and long-course groups, respectively (P=0.01). Moreover, the long-course group had higher additional intensive care unit (ICU) admission (32.3% vs. 60.0%, P=0.02) and persistent air leakage (0% vs. 13.3%, P=0.09). In the logistic regression analysis, corticosteroid treatment duration was marginally associated with in-hospital mortality [adjusted odds ratio (OR), 9.03; 95% confidence interval (CI): 0.96-84.9, P=0.054].

Conclusions: Short-course corticosteroid treatment was associated with a lower rate of surgical site complications, additional ICU admission, and in-hospital mortality, which suggests the necessity of efforts for reducing the total duration by weighing the benefits and adverse effects of corticosteroid treatment for postoperative ALI.

Background: Chronic obstructive pulmonary disease (COPD) was a significant public health concern, with smoking being the primary risk factor for its development and progression. The impact of smoking on respiratory rehabilitation efficacy in COPD patients remains an area of interest and investigation. This study aimed to assess the influence of smoking on the efficacy of respiratory rehabilitation in patients with COPD.

Methods: Data of patients with COPD from October 2015 to October 2023 were retrospectively analyzed in this case-control study. The patients who had previously participated in a pulmonary rehabilitation program were excluded. Pulmonary function, exercise capacity, quality of life, and sleep patterns were evaluated before and after rehabilitation.

Results: A total of 40 patients were included and categorized into non-smoking (n=20) and smoking groups (n=20) based on their smoking history. Before rehabilitation, no significant differences were observed between the groups in forced expiratory volume in one second (FEV₁) (P=0.96), forced vital capacity (FVC) (P=0.97), FEV₁/FVC ratio (P=0.73), maximal voluntary ventilation (MVV) (P=0.69), and diffusing capacity of the lung for carbon monoxide (DLCO) (P=0.63). After rehabilitation, FEV₁ (P=0.02), FVC (P=0.009), FEV₁/FVC ratio (P=0.03), MVV (P=0.004), DLCO (P=0.01), these pulmonary functions for non-smokers were much better than the smokers. Similarly, the non-smoking group exhibited significantly greater improvements in 6-minute walk distance (P=0.03), peak oxygen consumption (VO₂) (P=0.01), Borg scale ratings (P=0.02), St. George's Respiratory Questionnaire (SGRQ) scores (P=0.004), and Medical Research Council (MRC) dyspnea scale scores (P=0.005) compared to the smoking group after rehabilitation. The non-smoking patients have more better quality of life compared to the smokers after rehabilitation, which demonstrated by the quality of life scores and Sleep Quality Score, including somatization (P=0.01), emotion management (P=0.009), role play (P=0.008), cognitive function (P=0.04), return to social function (P=0.01), Sleep Quality Score (P=0.02).

Conclusions: Smoking negatively impacts the efficacy of respiratory rehabilitation in COPD patients, leading to poorer pulmonary function, exercise capacity, quality of life, and sleep patterns.

Background: There are insufficient data regarding how to deal with moderate aortic valve (AV) dysfunction during rheumatic mitral valve (MV) surgery. In this study, the clinical outcomes of patients who underwent rheumatic MV surgery with or without concurrent AV procedures were compared.

Methods: A total of 343 patients who underwent rheumatic MV surgery with moderate AV dysfunction were enrolled between January 2015 and August 2022, and a median 40-month follow-up was conducted. The more-than-mild AV dysfunction during follow-up was the primary endpoint event, while all-cause mortality and cardiac reoperation both before discharge and during follow-up encompassed the secondary endpoint events.

Results: Patients were allocated into two groups, including the no treatment (NT) (n=121) and aortic valvuloplasty (AVP) or aortic valve replacement (AVR) groups (n=222). Most of patients (110/121, 90.9%) in the NT group were combined with predominant aortic regurgitation. In the NT and AVP or AVR groups, 27.9% and 8.0% of patients reached the primary endpoint, and 5.0% and 7.3% of patients experienced the secondary endpoint events, respectively. This study confirmed a significantly higher proportion of patients in the NT group who reached the primary endpoint (relative risk, 2.98; 95% confidence interval: 1.61-5.62; P<0.001), after inverse probability treatment weighting.

Conclusions: Concomitant AV surgery significantly improved AV condition during follow-up for patients with moderate AV dysfunction during rheumatic valve surgery. However, it was safe and reasonable to delay surgical treatment of the AV and regular follow-ups for patients with predominant moderate aortic regurgitation.

Background: Single-use flexible bronchoscopes (SUFBs) offer various advantages over reusable bronchoscopes (RBs) including portability and cost-effectiveness, and potentially reduced infection transmission. Our study aimed to review the performance of the Ambu^® aScope™ 5 Broncho suite in Cork University Hospital.

Methods: Following ethical approval, data was collected prospectively on procedures performed with the Ambu^® aScope™ 5 in Cork University Hospital. Data included patient demographics, procedure details (location, indication, SUFB size, procedures, complications), and user satisfaction and demographics.

Results: There were 98 procedures performed with the Ambu^® aScope™ 5, all in the endoscopy suite. There were 42 female patients (42.9%) and 56 male (57.1%). Various sized models were used-2.7/1.2 (n=3), 4.2/2.2 (n=4), 5/2.2 (n=60), 5.6/2.8 (n=31). Infection was the most common indication while others included malignancy, haemoptysis, sarcoidosis, and asthma. The most commonly performed procedure was airway inspection (n=98), while bronchoalveolar lavage (BAL) (n=84), brushings (n=3), endobronchial biopsies (n=5), transbronchial needle aspiration (TBNA) (n=1), and argon plasma coagulation (APC) (n=1) were among others. The average user satisfaction rating (from one to five in ascending order of satisfaction) was 4.8 [5 (n=85), 4 (n=9), 3 (n=1), 2 (n=3), 1 (n=0)]. The most common reason for user dissatisfaction was related to suction (n=3). Conversion from single-use to RB was not required in any case. There were no bronchoscope-related patient complications.

Conclusions: Within this cohort of patients, the Ambu^® aScope™ 5 was both safe and versatile with a high level of user satisfaction.

Background: Although early removal of postoperative chest drains in segmentectomy may be difficult due to the management of air leakage in intersegmental planes, patients can be discharged earlier if it is successfully achieved. In segmentectomy, we evaluated the feasibility of postoperative day (POD) 1 discharge using a minimally invasive approach (MIA) after drain removal on the day of surgery (DOS).

Methods: Ninety patients who underwent segmentectomy via MIA between July 2021 and September 2023 were included in this retrospective study. These patients were divided into those who received drain removal on DOS or after DOS. Clinical characteristics and perioperative outcomes were compared between the two groups. In addition, the factors associated with drain removal on DOS and discharge on POD1 in the patients who received drain removal on DOS were identified.

Results: Drains were removed on DOS in 67 patients (74.4%). Therefore, the 90 patients were divided into those who underwent drain removal on DOS (n=67) or after DOS (n=23). Patients who underwent drain removal on DOS had significantly higher forced expiratory volume in 1 second (FEV1.0) % (P=0.03) and shorter postoperative hospital stay (P<0.001). In multivariate analyses, FEV1.0% was significantly associated with drain removal on DOS (odds ratio: 0.934, 95% confidence interval: 0.880-0.993, P=0.03). Of the 67 patients who underwent drain removal on DOS, 31 (46.3%) were discharged on POD1. Among the variables, surgery performed by the chief surgeon was significantly associated with discharge on POD1 (vs. others, odds ratio: 0.117, 95% confidence interval: 0.019-0.730, P=0.02).

Conclusions: POD1 discharge for segmentectomy using a MIA after drain removal on DOS is considered feasible. However, we still have room for improvement as 53.7% of patients were discharged on POD2 or later despite drain removal on DOS.

Background and objective: Mechanical power (MP) provides an integrated index of the mechanical properties of the respiratory system during mechanical ventilation. Increased levels of MP may identify patients who will do poorly during weaning and extubation. This literature review investigated the use of MP as a predictor of weaning outcomes in intensive care unit (ICU) patients, including a focused comparison of patients with coronavirus disease 19 (COVID-19) infections and patients with other causes of respiratory failure.

Methods: A review of the literature using PubMed, Embase, MEDLINE, and Preprint identified 305 possible studies; after removal of duplicates, 219 studies were screened, and five papers were selected for analysis. A search updated in 2024 identified four additional papers to include in this review.

Key content and findings: These studies demonstrate that higher MP levels are associated with weaning failure in ICU patients and that adjustment of MP for lung-thorax compliance (LTC) improves the prediction of outcomes. One study analyzed outcomes in patients with COVID-19 infections and reported that despite having higher MPs, patients with COVID-19 had lower rates of weaning failures. This result suggests different respiratory mechanics in these patients that could complicate weaning decisions.

Conclusions: In summary, MP can predict weaning outcomes in patients with respiratory failure requiring mechanical ventilation. However, some patients with COVID-19 infection may have unusual respiratory mechanics that may influence these associations.

Background: Camrelizumab combined with chemotherapy has shown significant clinical benefits in the first-line treatment of advanced esophageal squamous cell cancer (ESCC). Despite promising results from randomized trials, there is a need for real-world evidence to understand the broader applicability and long-term outcomes of neoadjuvant treatments in diverse patient populations with ESCC. This study aimed to evaluate the efficacy and safety of neoadjuvant camrelizumab combined with chemotherapy in patients with resectable locally advanced ESCC in a real-world setting.

Methods: We retrospectively reviewed clinical data from 83 patients with locally advanced, potentially resectable ESCC who received neoadjuvant camrelizumab combined with docetaxel, oxaliplatin, and S1 chemotherapy at Xijing Hospital of Digestive Diseases, Fourth Military Medical University from March 2020 to May 2023. Inclusion criteria were based on clinical stage, histological confirmation, and patient tolerance. Baseline clinical characteristics were assessed using standard diagnostic tools. Treatment involved three cycles of camrelizumab combined with chemotherapy, with efficacy and safety evaluated using Response Evaluation Criteria in Solid Tumors (RECIST) criteria. Tumor downstaging, survival outcomes, and safety were assessed.

Results: The median age of patients was 61 years (range, 46-75 years), and tumors were predominantly located in the middle (n=49, 59.04%) and lower (n=23, 27.71%) regions of the esophagus. Most patients were diagnosed at stages III-IV (55.42% and 38.55%, respectively), and all of the patients completed neoadjuvant treatment. Additionally, 24 (28.92%) patients achieved complete response (CR), 40 (48.19%) patients achieved partial response (PR), and 9 (10.84%) patients achieved stable disease (SD). The objective response rate (ORR) was 77.11% (64/83), and the disease control rate (DCR) was 87.95% (73/83). Of the 14 patients who underwent surgery, the R0 resection rate was 100%, and 28.57% (4/14) achieved pathological CR (pCR). The median follow-up time was 31.0 months, and the 3-year overall survival (OS) rate was 56.9%. The incidence of grade ≥3 adverse events was 6.02% (5/83). No deaths occurred.

Conclusions: While our real-world data suggest potential benefits of neoadjuvant camrelizumab plus chemotherapy in locally advanced ESCC, the absence of a control group limits the generalizability of these findings. Further randomized studies are needed to validate these results.

Background and objective: Lung neoplasia is the leading cause of cancer death worldwide, thus, early detection and accuracy in establishing a diagnosis is paramount. As a consequence of decades of basic and translational studies revealing the genetic basis of lung cancer, a paradigm shift has occurred toward a personalized approach to medicine whereby mutational analysis confers an opportunity for safer, and expedient treatment options. In this context, next-generation sequencing (NGS) has emerged as a vital technological advance, and has become increasingly established as a core method for rapidly and effectively identifying actionable mutations in lung cancer. For these reasons, an updated review of the literature across invasive and non-invasive diagnostic modalities in lung cancer is warranted to inform diagnostic approaches and prompt new investigations. The objective of the present review is to provide a focused update on applications of NGS in lung cancer diagnostics, with a special focus on tissue acquisition methodologies and mutational analysis.

Methods: The search strategy included a survey of the current literature from 2005 to 2024 in PubMed, Medline, Scopus, and Google Scholar. Eligible study types included original research, literature reviews (narrative and systematic), and observational studies. which encompassed findings pertinent to the lung cancer diagnostics, mutational analysis and lung cancer treatment overlapping with applications and use of NGS technologies.

Key content and findings: There are extensive and diverse advantages to the use of NGS in lung cancer diagnostics, especially when compared to traditional sequencing techniques including, speed, effectiveness, easy adoption in the context of analysis of samples prepared for lung cancer diagnosis. Advances in cell-free DNA reinforce the firm role of NGS in novel approaches.

Conclusions: NGS implementation is a crucial and beneficial technological leap in lung cancer diagnosis, especially given the environment of novel and established targeted and immune based therapies which require mutational testing. Its numerous benefits such as expedient results and reduced sample requirements will continue to ability optimize lung cancer outcomes by virtue of improved patient safety, reduction of unnecessary procedures, and provision of accurate results.