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Prognostic value and potential biological function of PMSD11 in lung adenocarcinoma. PMSD11 在肺腺癌中的预后价值和潜在生物功能
IF 2.1 3区 医学 Q3 RESPIRATORY SYSTEM Pub Date : 2024-11-30 Epub Date: 2024-11-29 DOI: 10.21037/jtd-24-1622
Yong Xi, Jing Zeng, Yundong Zhou, Weiyu Shen, Hirokazu Taniguchi, Retnagowri Rajandram, Sivakumar Krishnasamy

Background: The 26S non-ATPase regulatory subunit 11 (PSMD11) is a multiprotein complex that participates in the ATP-dependent degradation of ubiquitinated proteins and is essential to the regulation of embryonic stem cell proteasome activity. PSMD11 has been demonstrated to be a factor contributing to the emergence and progression of cancer cells. However, the prognostic value and potential biological function of PMSD11 in lung adenocarcinoma (LUAD) remains unclear. The aim of this study was to comprehensively investigate the prognostic and biological value of PSMD11 in LUAD.

Methods: We primarily endeavored to comprehensively investigate the prognostic and predictive value of PSMD11 in patients with LUAD. Additionally, we aimed to further clarify the underlying mechanisms of PSMD11 in LUAD tumorigenesis and progression via rigorous bioinformatics analyses, including expression analysis, survival analysis, clinicopathological analysis, immune microenvironment analysis, somatic mutation analysis, drug analysis, and cuproptosis analysis. Subsequently, we examined effect of PSMD11 expression on immune escape in a non-small cell lung cancer (NSCLC) cell-T cell coculture model.

Results: We found that PSMD11 had a significantly higher expression in LUAD tissues than in normal lung tissues. Three clinical characteristics (age, stage, and overall survival event) exhibited significant differences between the PSMD11 high- and low-expression groups. In biological function, PSMD11 appears to exert its tumorigenic effects predominantly in pathways related to DNA replication and membrane-gated channel functions. Notably, we observed that PSMD11 exhibited the strongest positive correlation with T helper 2 cells, gamma-delta T cells, and T regulatory cells and the highest negative correlation with B cells, mast cells, and CD8+ T cells. Furthermore, we found that the expression of cuproptosis genes (DLAT, DLD, and PDHA1) was positively correlated with the expression of PSMD11 (P<0.001).

Conclusions: These results indicate that PSMD11 has the potential to be a novel therapeutic target and sensitive biomarker for patients with LUAD.

背景:26S非ATP酶调节亚基11(PSMD11)是一种多蛋白复合物,参与泛素化蛋白质的ATP依赖性降解,对胚胎干细胞蛋白酶体活性的调节至关重要。PSMD11 已被证实是导致癌细胞出现和发展的一个因素。然而,PMSD11在肺腺癌(LUAD)中的预后价值和潜在生物功能仍不清楚。本研究旨在全面研究 PSMD11 在 LUAD 中的预后和生物学价值:我们主要致力于全面研究 PSMD11 在 LUAD 患者中的预后和预测价值。此外,我们还旨在通过严格的生物信息学分析,包括表达分析、生存分析、临床病理分析、免疫微环境分析、体细胞突变分析、药物分析和杯突分析,进一步阐明 PSMD11 在 LUAD 肿瘤发生和发展中的潜在机制。随后,我们在非小细胞肺癌(NSCLC)细胞-T细胞共培养模型中研究了PSMD11的表达对免疫逃逸的影响:结果:我们发现 PSMD11 在 LUAD 组织中的表达明显高于正常肺组织。三种临床特征(年龄、分期和总生存事件)在 PSMD11 高表达组和低表达组之间存在显著差异。在生物学功能方面,PSMD11似乎主要在与DNA复制和膜门通道功能相关的通路中发挥致癌作用。值得注意的是,我们观察到 PSMD11 与 T 辅助 2 细胞、γ-δ T 细胞和 T 调节细胞的正相关性最强,而与 B 细胞、肥大细胞和 CD8+ T 细胞的负相关性最高。此外,我们还发现杯突基因(DLAT、DLD 和 PDHA1)的表达与 PSMD11(PConclusions)的表达呈正相关:这些结果表明,PSMD11有可能成为LUAD患者的新型治疗靶点和敏感生物标志物。
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引用次数: 0
Utilizing the ultrasonic shear for internal mammary artery harvesting in minimally invasive coronary artery bypass grafting surgery is worth considering. 在微创冠状动脉旁路移植手术中利用超声波剪切力采集乳内动脉值得考虑。
IF 2.1 3区 医学 Q3 RESPIRATORY SYSTEM Pub Date : 2024-11-30 Epub Date: 2024-11-29 DOI: 10.21037/jtd-24-1226
Yi Hong, Yunpeng Zhu, Yunpeng Ling
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引用次数: 0
Experimental study of the effects of pirfenidone and nintedanib on joint inflammation and pulmonary fibrosis in a rheumatoid arthritis-associated interstitial lung disease mouse model. 类风湿性关节炎相关间质性肺病小鼠模型中吡非尼酮和宁替尼对关节炎症和肺纤维化影响的实验研究。
IF 2.1 3区 医学 Q3 RESPIRATORY SYSTEM Pub Date : 2024-11-30 Epub Date: 2024-11-29 DOI: 10.21037/jtd-24-882
Jia Liu, Lulu Xu, Xiaoling Guan, Jie Zhang
<p><strong>Background: </strong>Rheumatoid arthritis-associated interstitial lung disease (RA-ILD) is a serious pulmonary complication in rheumatoid arthritis (RA) patients, is one of the leading causes of death in RA patients. This study was designed to determine whether pirfenidone and nintedanib can alleviate joint inflammation and pulmonary fibrosis in a mouse model of RA-ILD.</p><p><strong>Methods: </strong>Male DBA/1 mice were injected with bovine type II collagen (bCII) to establish the RA-ILD model. Pirfenidone (20 mg/kg) and nintedanib (60 mg/kg) were administered, and body weight, joint swelling, pathology of the lungs and knees, macrophage polarization in bronchoalveolar lavage fluid (BALF), and the fluorescence intensity of phosphorylated janus kinase 2/phosphorylated signal transducer and activator of transcription 3 (p-Jak2/p-Stat3) in the lungs and knees were determined. Quantitative real-time polymerase chain reaction (qRT-PCR) was used to measure mRNA, and western blotting was conducted to detect the protein. Macrophage line RAW264.7 were divided into the following groups: the RAW264.7, RAW264.7 + IL-4/IL-13 (IL-4/IL-13, 60 ng/mL), RAW264.7 + IL-4/IL-13 + pirfenidone (0.5 and 1.0 mmol/L), RAW264.7 + IL-4/IL-13 + nintedanib (0.1 and 0.5 µmol/L). Mouse primary fibroblast-like synovial (FLS) cells were divided into the following groups: the FLS, FLS + transforming growth factor-β1 (TGF-β1; 10 µg/L), FLS + TGF-β1 + pirfenidone (0.5 and 1.0 mmol/L), FLS + TGF-β1 + nintedanib (0.1 and 0.5 µmol/L) groups. Proteins in each group were detected.</p><p><strong>Results: </strong>The body weights of the mice in the pirfenidone and nintedanib groups were greater than those in the RA-ILD group (P<0.05), the arthritis scores were also significantly lower (P<0.05). The proportion of M2-type macrophages in the BALF of the nintedanib group significantly decreased (P<0.05). Inflammatory cell infiltration in the lung was reduced in the pirfenidone and nintedanib groups; additionally, decreased levels of synovium, collagen, angiogenesis, and bone destruction of the knee joint and a lower synovitis score were observed (P<0.05). Masson staining revealed that collagen deposition in the lungs in the pirfenidone and nintedanib groups was reduced (P<0.05). P-Jak2/p-Stat3 expression in the lungs and knee joints in the pirfenidone and nintedanib groups was low (P<0.001 in the lung and P<0.005 in the knee joint). The mRNA expression of collagen-IV, Stat3, and Jak2 in the lungs was lower in the pirfenidone and nintedanib (P<0.05); the protein expression levels of p-Jak2/Jak2, p-Stat3/Stat3, p-Smad3/Smad3, and TGF-β receptor 2 (TGF-βR2) in the lungs in the pirfenidone and nintedanib groups decreased (P<0.05). P-Jak2/Jak2, p-Stat3/Stat3, TGF-βR2, cluster of differentiation 206 (CD206), and arginase-1 (ARG-1) were lower in the pirfenidone and nintedanib groups of RAW264.7 cells (at all different concentrations, P<0.05). P-JAK2/JAK2, p-Stat3/Stat3, and TGF-βR2 were
背景:类风湿性关节炎相关性间质性肺病(RA-ILD)是类风湿性关节炎(RA)患者的一种严重肺部并发症,也是导致RA患者死亡的主要原因之一。本研究旨在确定吡非尼酮和宁替尼是否能减轻RA-ILD小鼠模型的关节炎症和肺纤维化:雄性 DBA/1 小鼠注射牛 II 型胶原蛋白(bCII)以建立 RA-ILD 模型。方法:给雄性DBA/1小鼠注射牛II型胶原蛋白(bCII),建立RA-ILD模型;给药吡非尼酮(20 mg/kg)和宁替丹尼(60 mg/kg),测定小鼠体重、关节肿胀、肺部和膝关节病理变化、支气管肺泡灌洗液(BALF)中巨噬细胞极化、肺部和膝关节中磷酸化破伤风激酶2/磷酸化转录信号转导子和激活子3(p-Jak2/p-Stat3)的荧光强度。采用实时定量聚合酶链反应(qRT-PCR)测定 mRNA,并进行蛋白印迹检测。将巨噬细胞系 RAW264.7 分成以下几组:RAW264.7、RAW264.7 + IL-4/IL-13(IL-4/IL-13,60 ng/mL)、RAW264.7 + IL-4/IL-13 + pirfenidone(0.5 和 1.0 mmol/L)、RAW264.7 + IL-4/IL-13 + nintedanib(0.1 和 0.5 µmol/L)。将小鼠原代成纤维细胞样滑膜(FLS)细胞分为以下几组:FLS 组、FLS + 转化生长因子-β1(TGF-β1;10 µg/L)组、FLS + TGF-β1 + 吡非尼酮(0.5 和 1.0 mmol/L)组、FLS + TGF-β1 + 宁替尼(0.1 和 0.5 µmol/L)组。检测各组的蛋白质:结果:吡非尼酮组和宁替丹尼组小鼠的体重高于 RA-ILD 组(PConclusions.Pirfenidone 和 nintedanib 组):在RA-ILD小鼠模型中,吡非尼酮和宁替尼不仅能减轻肺纤维化程度,还能缓解关节症状。其作用机制与抑制 TGF-β 信号通路、Jak2/Stat3 信号通路以及巨噬细胞极化为 M2 表型有关。
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引用次数: 0
Surgical outcomes and learning curve of complex versus simple segmentectomy for uniportal video-assisted thoracoscopic surgery: an initial experience of 100 cases of a single experienced surgeon.
IF 2.1 3区 医学 Q3 RESPIRATORY SYSTEM Pub Date : 2024-11-30 Epub Date: 2024-11-14 DOI: 10.21037/jtd-24-1028
Takahiro Homma, Hisashi Saji, Yoshifumi Shimada, Keitaro Tanabe, Koji Kojima, Hideki Marushima, Tomoyuki Miyazawa, Hiroyuki Kimura, Hiroki Sakai, Kanji Otsubo, Takayuki Hatakeyama, Toshihiro Ojima, Tomoshi Tsuchiya, Hitoshi Igai

Background: Complex segmentectomy for uniportal video-assisted thoracoscopic surgery (VATS) remains controversial due to procedural complexity and the risk of increased complications, unlike multiportal VATS. Demonstrating the perioperative results and proficiency of individual surgeon is believed to influence future dissemination for uniportal VATS. In this study, we aimed to compare the perioperative outcomes and learning curves of complex versus simple segmentectomy for uniportal VATS.

Methods: This retrospective cohort study included all patients who had an elective uniportal VATS segmentectomy between July 2018 and June 2023. We documented our initial experience with 100 consecutive segmentectomy cases. A single board-certified experienced surgeon performed all procedures. The perioperative outcomes of the complex (n=45) and simple (n=55) segmentectomy groups were compared using propensity score matching and the cumulative sum technique.

Results: Using propensity score matching, 29 patients were chosen from each group. There was no statistically significant difference between the two groups in perioperative outcomes. The initial learning curve for simple segmentectomy was completed after 20 cases, while that for complex segmentectomy was completed after 11 cases.

Conclusions: Uniportal VATS complex segmentectomy was safe and comparable to simple segmentectomy in terms of perioperative outcomes and learning curves in an experienced surgeon. Uniportal VATS complex segmentectomy should be considered a viable surgical option.

背景:单孔视频辅助胸腔镜手术(VATS)与多孔 VATS 不同,手术复杂且并发症风险增加,因此单孔 VATS 复杂节段切除术仍存在争议。展示单孔 VATS 的围手术期效果和外科医生的熟练程度被认为会影响单孔 VATS 未来的推广。在本研究中,我们旨在比较单孔 VATS 复杂与简单节段切除术的围手术期结果和学习曲线:这项回顾性队列研究纳入了 2018 年 7 月至 2023 年 6 月间所有接受择期单孔 VATS 段切除术的患者。我们记录了 100 例连续段切除术的初步经验。所有手术均由一名获得董事会认证的经验丰富的外科医生完成。使用倾向得分匹配和累积和技术比较了复杂组(45 例)和简单组(55 例)节段切除术的围手术期结果:结果:采用倾向评分匹配法,每组选择了 29 名患者。两组围手术期结果无明显统计学差异。简单肺段切除术的初始学习曲线在 20 例后完成,而复杂肺段切除术的初始学习曲线在 11 例后完成:结论:单孔 VATS 复杂节段切除术是安全的,在围手术期结果和学习曲线方面,经验丰富的外科医生与简单节段切除术具有可比性。单孔 VATS 复杂节段切除术应被视为一种可行的手术选择。
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引用次数: 0
The TNM classification of lung cancer-a historic perspective. 肺癌 TNM 分类--历史的视角。
IF 2.1 3区 医学 Q3 RESPIRATORY SYSTEM Pub Date : 2024-11-30 Epub Date: 2024-11-18 DOI: 10.21037/jtd-24-1212
Ramón Rami-Porta

Developed by Pierre F. Denoix in the mid-20th century as a clinical classification of anatomic tumour extent, the tumour, node, and metastasis (TNM) classification was adopted by the Union for International Cancer Control (UICC) and the American Joint Committee on Cancer (AJCC). The first lung cancer classification was published as a brochure in 1966 by the UICC, and 2 years later, the UICC published the first edition of the TNM Classification of Malignant Tumours, which was followed 9 years later by the first edition of the AJCC Manual for Staging of Cancer. The 2nd to 6th editions of the lung cancer classification were based on a North American database managed by Clifton F. Mountain, who also introduced the pathologic classification for tumours undergoing resection. Most descriptors used today originated in the second edition of the classification. To address the limitation of the North American database being restricted to a single geographic region, Peter Goldstraw proposed the creation of a larger, international database within the International Association for the Study of Lung Cancer (IASLC). The IASLC Staging Project, developed by the members of the IASLC Staging and Prognostic Factors Committee (SPFC) and the statisticians of Cancer Research and Biostatistics (CRAB), has already compiled three databases, which informed the analyses for the 7th, the 8th, and the 9th editions of the lung cancer TNM classification. This classification has stood the test of time and will remain valuable as long as the anatomic extent of lung cancer continues to play a role in therapy and research.

肿瘤、结节和转移(TNM)分类法由皮埃尔-德努瓦(Pierre F. Denoix)于 20 世纪中期提出,作为一种对肿瘤解剖范围进行临床分类的方法,被国际癌症控制联盟(UICC)和美国癌症联合委员会(AJCC)所采用。国际癌症控制联盟(UICC)于 1966 年出版了第一本肺癌分类小册子,2 年后,UICC 出版了第一版《恶性肿瘤 TNM 分类》,9 年后又出版了第一版《AJCC 癌症分期手册》。第 2 版至第 6 版肺癌分类法是基于 Clifton F. Mountain 管理的北美数据库,他还为接受切除的肿瘤引入了病理分类法。目前使用的大多数描述符都源自第二版分类法。为了解决北美数据库仅限于单一地区的局限性,彼得-戈德斯特劳(Peter Goldstraw)提议在国际肺癌研究协会(IASLC)内建立一个更大的国际数据库。IASLC 分期项目由 IASLC 分期和预后因素委员会(SPFC)成员和癌症研究与生物统计学(CRAB)的统计学家共同开发,目前已建立了三个数据库,为第七版、第八版和第九版肺癌 TNM 分类的分析提供了依据。该分类法经受住了时间的考验,只要肺癌的解剖范围继续在治疗和研究中发挥作用,该分类法仍将具有价值。
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引用次数: 0
Localization strategies for deep lung nodule using electromagnetic navigation bronchoscopy and indocyanine green fluorescence: a technical note. 使用电磁导航支气管镜和吲哚青绿荧光的肺深部结节定位策略:技术说明。
IF 2.1 3区 医学 Q3 RESPIRATORY SYSTEM Pub Date : 2024-11-30 Epub Date: 2024-11-29 DOI: 10.21037/jtd-24-1303
Yuan Xu, Hongsheng Liu, Yingzhi Qin, Chao Guo, Shanqing Li, Naixin Liang

Accurate localization of pulmonary nodules is crucial for successful video-assisted thoracoscopic surgery (VATS) resection. Electromagnetic navigation bronchoscopy (ENB) combined with indocyanine green (ICG) fluorescence has emerged as a promising technique for precise pulmonary nodule marking. This study aims to evaluate the efficacy and safety of four ENB-guided ICG marking techniques: direct lesion marking, superficial marking, resection boundary marking, and margin sphere marking. We prospectively enrolled 80 patients with deep lung nodules and evaluated the procedural outcomes, accuracy, complications, and postoperative results of each ENB-guided strategy. The overall success rate of ENB-guided ICG marking was 97.5%, with no significant differences among the four techniques. The superficial marking and resection boundary marking methods achieved 100% fluorescence visibility and superior consistency in marking. The visibility of fluorescence varied among the four marking methods. No severe complications occurred during the ENB procedures, while 1 patient had minor bleeding at the dye injection site. Our study demonstrates that ENB-guided localization using ICG dye and fluorescence thoracoscopy is a safe and effective technique for the preoperative marking of deep lung nodules. Among the four localization strategies investigated, we recommend prioritizing the superficial marking and resection boundary marking methods in clinical practice when feasible, as they provide reliable and precise guidance for the resection of deep lung nodules.

肺结节的精确定位对于视频辅助胸腔镜手术(VATS)的成功切除至关重要。电磁导航支气管镜(ENB)结合吲哚青绿(ICG)荧光技术已成为一种很有前途的肺结节精确标记技术。本研究旨在评估四种 ENB 引导的 ICG 标记技术的有效性和安全性:直接病灶标记、表层标记、切除边界标记和边缘球形标记。我们前瞻性地招募了80名肺深部结节患者,评估了每种ENB引导策略的手术效果、准确性、并发症和术后效果。ENB引导下ICG标记的总体成功率为97.5%,四种技术之间无显著差异。表层标记法和切除边界标记法的荧光能见度达到100%,标记的一致性也较好。四种标记方法的荧光可见度各不相同。ENB 过程中未出现严重并发症,但有一名患者的染料注射部位出现轻微出血。我们的研究表明,使用ICG染料和荧光胸腔镜进行ENB引导定位是一种安全有效的术前肺深部结节标记技术。在所研究的四种定位策略中,我们建议在可行的情况下在临床实践中优先考虑表层标记和切除边界标记方法,因为它们能为肺部深部结节的切除提供可靠而精确的指导。
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引用次数: 0
Efficacy and safety of applying oxidized regenerated cellulose sheets to the parietal pleura of open chest wounds in thoracic surgery: a prospective randomized controlled trial protocol. 在胸外科开放性胸部伤口的顶胸膜上应用氧化再生纤维素片的有效性和安全性:前瞻性随机对照试验方案。
IF 2.1 3区 医学 Q3 RESPIRATORY SYSTEM Pub Date : 2024-11-30 Epub Date: 2024-11-29 DOI: 10.21037/jtd-24-1296
Takahiro Ochi, Hidemi Suzuki, Yuki Sata, Takahide Toyoda, Terunaga Inage, Kazuhisa Tanaka, Yuichi Sakairi, Yukiko Matsui, Yuki Shiko, Ichiro Yoshino

Background: According to a large-scale clinical trial in Japan, segmentectomy for small peripheral non-small cell lung cancer has an advantage over lobectomy in terms of overall survival, while it could also increase the incidence of local recurrence. In ipsilateral reoperations, intrathoracic adhesions from a previous surgery increase the risk of lung injury and bleeding, which may result in intraoperative and postoperative complications. The ability of oxidized regenerated cellulose (ORC) sheets to prevent postoperative adhesions has been demonstrated in the abdomen, and the same effect is expected in the thoracic region. The purpose of this study is to provide evidence supporting the application of ORC sheets to the parietal pleura of an open chest wounds to prevent postoperative adhesions in the thoracic region.

Methods: This phase II prospective open-label, randomized, parallel-group study will validate adhesion prevention by applying ORC sheets to the parietal pleura of open chest wounds at the time of surgical closure. In the control group, the chest is closed by the usual procedure without ORC sheets. The primary endpoint is the presence rate of pleural adhesion findings on chest echography performed 4-20 weeks postoperatively. Data analysis will be performed in 2025-2026.

Discussion: This study will provide evidence to the adhesion prevention effect of ORC sheet in the thoracic region, with the aim of establishing a strategy to prevent postoperative intrapleural adhesions.

Trial registration: This trial has been registered on the Japan Registry of Clinical Trials 1032230271 (https://jrct.niph.go.jp/latest-detail/jRCT1032230271).

背景:根据日本的一项大规模临床试验,小周围非小细胞肺癌的分段切除术在总生存率方面比肺叶切除术更有优势,但也可能增加局部复发的发生率。在同侧再手术中,前次手术造成的胸腔内粘连增加了肺损伤和出血的风险,可能导致术中和术后并发症。在腹部手术中,氧化再生纤维素(ORC)薄片已被证实具有防止术后粘连的能力,预计在胸部区域也会产生同样的效果。本研究的目的是提供证据,支持在开胸伤口的顶胸膜上应用氧化再生纤维素片,以预防胸部区域的术后粘连:这项 II 期前瞻性开放标签、随机、平行组研究将验证在手术缝合时将 ORC 片应用于开放性胸部伤口的顶胸膜可预防粘连。在对照组中,胸部闭合采用常规程序,不使用 ORC 片。主要终点是术后 4-20 周进行的胸部回声检查中胸膜粘连的出现率。数据分析将于 2025-2026 年进行:讨论:本研究将为 ORC 片在胸腔区域的粘连预防效果提供证据,目的是建立一种预防术后胸膜内粘连的策略:本试验已在日本临床试验注册中心 1032230271 (https://jrct.niph.go.jp/latest-detail/jRCT1032230271) 注册。
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引用次数: 0
Postoperative day of surgery ambulation improves outcomes following lung resection: a multicenter prospective cohort study. 多中心前瞻性队列研究:术后当天行走可改善肺切除术后的预后。
IF 2.1 3区 医学 Q3 RESPIRATORY SYSTEM Pub Date : 2024-11-30 Epub Date: 2024-11-29 DOI: 10.21037/jtd-24-1183
Christina M Stuart, Adam R Dyas, Nicole M Mott, Kyle E Bata, Michael R Bronsert, Alyson D Kelleher, Katherine O McCabe, Crystal Erickson, Simran K Randhawa, Elizabeth A David, John D Mitchell, Robert A Meguid

Background: The impact of post-surgical same day ambulation in lung resection patients is relatively unstudied. We sought to determine the relationship between day of surgery ambulation and postoperative outcomes after lung resection.

Methods: This was a prospective cohort study at one healthcare system with six hospitals (1/2019-3/2023). Patients undergoing segmentectomy and lobectomy were targeted for inclusion. Patients who had missing ambulation data were excluded. Patients were divided into two cohorts based on whether or not they ambulated postoperatively on the day of surgery. Postoperative outcomes were compared using chi-square, Fisher's exact, or Mann-Whitney-U tests. Multivariable logistic regression controlling for pertinent perioperative confounders was performed to identify the independent effect of ambulation on complication rates.

Results: Of 1,056 patients included in the analytic cohort, 443 patients (42.0%) ambulated postoperatively on the day of surgery. Patients who ambulated day of surgery had significantly lower rates of morbidity, including respiratory complications, surgical site infection, bleeding, cardiac complications, cardiac arrhythmias, infectious complications, and opioid use, and had shorter length of stay, shorter chest tube duration, and lower total hospital cost. After risk-adjustment, patients who ambulated day of surgery had lower odds of overall morbidity, less opioid consumption, shorter length of stay, and shorter chest tube duration.

Conclusions: Patients who ambulated postoperatively on the day of surgery had better surgical recovery and outcomes after lung resection than those who did not. Day of surgery ambulation is an excellent quality metric and associated with avoidance of postoperative complications.

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引用次数: 0
Impact of lymph node evaluation standard in patients undergoing lung resection for clinical stage IA pulmonary adenocarcinoma and squamous cell carcinoma.
IF 2.1 3区 医学 Q3 RESPIRATORY SYSTEM Pub Date : 2024-11-30 Epub Date: 2024-11-11 DOI: 10.21037/jtd-24-971
Raffaele Rocco, Brandon S Hendriksen, Belisario A Ortiz, K Robert Shen, Stephen D Cassivi, Sahar Saddoughi, Janani S Reisenauer, Dennis A Wigle, Luis F Tapias

Background: The American College of Surgeons Commission on Cancer (CoC) revised operative quality standards recommending resection of lymph nodes from at least one hilar station and three different mediastinal stations in all curative-intent pulmonary resections. This study evaluated the prognostic value and factors associated with adherence to this new CoC standard in patients with resected clinical stage IA non-small cell lung cancer (NSCLC).

Methods: Retrospective review of 654 patients who underwent pulmonary resection for clinical IA NSCLC. The study population was divided into patients that met and did not meet the CoC standard.

Results: The CoC standard was met in only 254 (38.8%) patients. Factors associated with meeting the CoC standard included left-sided resections, open technique, and type of pulmonary resection. CoC standard was met in 51.6% of lobectomies, 29.9% of segmentectomies, and 17.1% of wedge resections (P<0.001). Nodal upstaging was more frequent in patients meeting the CoC standard (21.3% vs. 12.5% when standard not met; P=0.004). Time to recurrence [adjusted hazard ratio (aHR): 0.86, 95% confidence interval (CI): 0.63-1.17, P=0.33] and overall survival (aHR: 0.78, 95% CI: 0.58-1.05, P=0.10) were not different between CoC standard groups. However, patients not meeting the CoC standard and classified as pN0 exhibited an overall survival that resembled that of patients with pN1 disease.

Conclusions: Left-sided resections, open technique and lobectomy were associated with meeting the CoC standard. However, this standard did not have a significant impact on long-term outcomes. Larger studies with longer follow-up are needed to clarify the role of the CoC standard in patients with resected stage IA NSCLC.

背景:美国外科医生学会癌症委员会(CoC)修订了手术质量标准,建议在所有治愈性肺切除术中至少切除一个肺门淋巴结和三个不同纵隔淋巴结。本研究评估了临床IA期非小细胞肺癌(NSCLC)切除术患者的预后价值以及与遵守CoC新标准相关的因素:方法:对654例接受肺切除术的临床IA期非小细胞肺癌患者进行回顾性研究。研究对象分为符合和不符合CoC标准的患者:结果:只有 254 例(38.8%)患者达到了 CoC 标准。符合CoC标准的相关因素包括左侧切除、开放技术和肺切除类型。51.6%的肺叶切除术、29.9%的肺段切除术和17.1%的楔形切除术符合CoC标准(未达标时为12.5%;P=0.004)。CoC标准组之间的复发时间[调整后危险比(aHR):0.86,95% 置信区间(CI):0.63-1.17,P=0.33]和总生存期(aHR:0.78,95% CI:0.58-1.05,P=0.10)没有差异。然而,未达到CoC标准且被归类为pN0的患者的总生存率与pN1患者相似:结论:左侧切除术、开放技术和肺叶切除术与达到CoC标准有关。结论:左侧切除术、开放技术和肺叶切除术与达到CoC标准有关,但该标准对长期预后没有显著影响。要明确CoC标准在切除的IA期NSCLC患者中的作用,还需要进行更大规模、更长时间的随访研究。
{"title":"Impact of lymph node evaluation standard in patients undergoing lung resection for clinical stage IA pulmonary adenocarcinoma and squamous cell carcinoma.","authors":"Raffaele Rocco, Brandon S Hendriksen, Belisario A Ortiz, K Robert Shen, Stephen D Cassivi, Sahar Saddoughi, Janani S Reisenauer, Dennis A Wigle, Luis F Tapias","doi":"10.21037/jtd-24-971","DOIUrl":"10.21037/jtd-24-971","url":null,"abstract":"<p><strong>Background: </strong>The American College of Surgeons Commission on Cancer (CoC) revised operative quality standards recommending resection of lymph nodes from at least one hilar station and three different mediastinal stations in all curative-intent pulmonary resections. This study evaluated the prognostic value and factors associated with adherence to this new CoC standard in patients with resected clinical stage IA non-small cell lung cancer (NSCLC).</p><p><strong>Methods: </strong>Retrospective review of 654 patients who underwent pulmonary resection for clinical IA NSCLC. The study population was divided into patients that met and did not meet the CoC standard.</p><p><strong>Results: </strong>The CoC standard was met in only 254 (38.8%) patients. Factors associated with meeting the CoC standard included left-sided resections, open technique, and type of pulmonary resection. CoC standard was met in 51.6% of lobectomies, 29.9% of segmentectomies, and 17.1% of wedge resections (P<0.001). Nodal upstaging was more frequent in patients meeting the CoC standard (21.3% <i>vs.</i> 12.5% when standard not met; P=0.004). Time to recurrence [adjusted hazard ratio (aHR): 0.86, 95% confidence interval (CI): 0.63-1.17, P=0.33] and overall survival (aHR: 0.78, 95% CI: 0.58-1.05, P=0.10) were not different between CoC standard groups. However, patients not meeting the CoC standard and classified as pN0 exhibited an overall survival that resembled that of patients with pN1 disease.</p><p><strong>Conclusions: </strong>Left-sided resections, open technique and lobectomy were associated with meeting the CoC standard. However, this standard did not have a significant impact on long-term outcomes. Larger studies with longer follow-up are needed to clarify the role of the CoC standard in patients with resected stage IA NSCLC.</p>","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":"16 11","pages":"7663-7674"},"PeriodicalIF":2.1,"publicationDate":"2024-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11635252/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142828778","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Clinical features and survival analysis of non-hypertensive aortic dissection patients post-thoracic endovascular aortic repair: a 10-year retrospective study. 胸腔内血管主动脉修补术后非高血压主动脉夹层患者的临床特征和生存分析:一项为期 10 年的回顾性研究。
IF 2.1 3区 医学 Q3 RESPIRATORY SYSTEM Pub Date : 2024-11-30 Epub Date: 2024-11-29 DOI: 10.21037/jtd-24-318
Shuangshuang Li, Xianfei Liu, Jin Yang, Zilin Lu, Jian Dong, Jia He, Jian Zhou

Background: The clinical characteristics and predictors for aortic adverse events (AAEs) after thoracic endovascular aortic repair (TEVAR) of non-hypertensive aortic dissection (AD) patients remain unclear. This study sought to clarify the clinical features of non-hypertensive AD and its incidence of AAEs after TEVAR.

Methods: Clinical data were collected from the electronic medical records, imaging databases and follow-up. Baseline characteristics were balanced by propensity score matching (PSM). Kaplan-Meier analysis and Cox proportional hazards regression analysis were performed to asses postoperative AAEs and risk factors.

Results: Eight hundred and eighty-eight eligible AD patients who had received TEVAR were included. The proportion of males (72.2% vs. 80.6%, P=0.006) and the mean age of onset (55.17±14.95 vs. 59.08±13.34 years, P=0.001) were lower in the non-hypertension group. Type A dissection still accounted for a higher proportion in the non-hypertensive group than the hypertensive group (38.2% vs. 28.3%, P=0.02) after matching. Non-hypertensive AD showed a lower mean survive time (36.65±2.08 vs. 42.74±1.41 months, P=0.01) with a higher 5-year adverse event ratio (37.4% vs. 29.0%, P=0.05). Hazard ratio (HR) of type A dissection, international normalized ratio (INR), prothrombin time (PT), aortic root diameter (AoRoot) and left ventricular volume associated with AAEs after TEVAR were 3.348 [95% confidence interval (CI): 2.313-4.846], 269.197 (95% CI: 3.46-20,946.462), 0.595 (95% CI: 0.369-0.959), 2.446 (95% CI: 1.542-3.880), 1.008 (95% CI: 1.004-1.012), respectively.

Conclusions: Non-hypertensive patients presented a higher proportion of female and type A classification, and a younger mean age of TEVAR treatment. Preoperative indicators including Stanford classification, PT, activated partial thromboplastin time (APTT), AoRoot and left ventricular volume were major risk factors for adverse events after TEVAR, which deserve to be further explored and evaluated for its predictive value for better management of AD.

背景:非高血压主动脉夹层(AD)患者胸腔内血管主动脉修补术(TEVAR)后主动脉不良事件(AAEs)的临床特征和预测因素仍不清楚。本研究旨在明确非高血压主动脉夹层的临床特征及其在 TEVAR 术后 AAE 的发生率:从电子病历、影像数据库和随访中收集临床数据。通过倾向评分匹配(PSM)平衡基线特征。对术后AAEs和风险因素进行Kaplan-Meier分析和Cox比例危险回归分析:结果:共纳入了88名符合条件的接受过TEVAR的AD患者。非高血压组的男性比例(72.2% vs. 80.6%,P=0.006)和平均发病年龄(55.17±14.95 vs. 59.08±13.34岁,P=0.001)均较低。匹配后,非高血压组 A 型夹层所占比例仍高于高血压组(38.2% 对 28.3%,P=0.02)。非高血压 AD 平均存活时间较短(36.65±2.08 个月 vs. 42.74±1.41个月,P=0.01),5年不良事件比率较高(37.4% vs. 29.0%,P=0.05)。TEVAR后与AAEs相关的A型夹层、国际标准化比值(INR)、凝血酶原时间(PT)、主动脉根部直径(AoRoot)和左心室容积的危险比(HR)分别为3.348[95%置信区间(CI):2.313-4.846]、269.197(95% CI:3.46-20,946.462)、0.595(95% CI:0.369-0.959)、2.446(95% CI:1.542-3.880)、1.008(95% CI:1.004-1.012):结论:非高血压患者中女性和A型分类的比例更高,TEVAR治疗的平均年龄更小。术前指标包括斯坦福分级、PT、活化部分凝血活酶时间(APTT)、AoRoot和左心室容积是TEVAR术后不良事件的主要风险因素,值得进一步探讨和评估其预测价值,以便更好地管理AD。
{"title":"Clinical features and survival analysis of non-hypertensive aortic dissection patients post-thoracic endovascular aortic repair: a 10-year retrospective study.","authors":"Shuangshuang Li, Xianfei Liu, Jin Yang, Zilin Lu, Jian Dong, Jia He, Jian Zhou","doi":"10.21037/jtd-24-318","DOIUrl":"10.21037/jtd-24-318","url":null,"abstract":"<p><strong>Background: </strong>The clinical characteristics and predictors for aortic adverse events (AAEs) after thoracic endovascular aortic repair (TEVAR) of non-hypertensive aortic dissection (AD) patients remain unclear. This study sought to clarify the clinical features of non-hypertensive AD and its incidence of AAEs after TEVAR.</p><p><strong>Methods: </strong>Clinical data were collected from the electronic medical records, imaging databases and follow-up. Baseline characteristics were balanced by propensity score matching (PSM). Kaplan-Meier analysis and Cox proportional hazards regression analysis were performed to asses postoperative AAEs and risk factors.</p><p><strong>Results: </strong>Eight hundred and eighty-eight eligible AD patients who had received TEVAR were included. The proportion of males (72.2% <i>vs.</i> 80.6%, P=0.006) and the mean age of onset (55.17±14.95 <i>vs.</i> 59.08±13.34 years, P=0.001) were lower in the non-hypertension group. Type A dissection still accounted for a higher proportion in the non-hypertensive group than the hypertensive group (38.2% <i>vs.</i> 28.3%, P=0.02) after matching. Non-hypertensive AD showed a lower mean survive time (36.65±2.08 <i>vs.</i> 42.74±1.41 months, P=0.01) with a higher 5-year adverse event ratio (37.4% <i>vs.</i> 29.0%, P=0.05). Hazard ratio (HR) of type A dissection, international normalized ratio (INR), prothrombin time (PT), aortic root diameter (AoRoot) and left ventricular volume associated with AAEs after TEVAR were 3.348 [95% confidence interval (CI): 2.313-4.846], 269.197 (95% CI: 3.46-20,946.462), 0.595 (95% CI: 0.369-0.959), 2.446 (95% CI: 1.542-3.880), 1.008 (95% CI: 1.004-1.012), respectively.</p><p><strong>Conclusions: </strong>Non-hypertensive patients presented a higher proportion of female and type A classification, and a younger mean age of TEVAR treatment. Preoperative indicators including Stanford classification, PT, activated partial thromboplastin time (APTT), AoRoot and left ventricular volume were major risk factors for adverse events after TEVAR, which deserve to be further explored and evaluated for its predictive value for better management of AD.</p>","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":"16 11","pages":"7397-7407"},"PeriodicalIF":2.1,"publicationDate":"2024-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11635238/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142829014","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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Journal of thoracic disease
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