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Endoplasmic reticulum stress-MMRN1 positive feedback contributes to cisplatin resistance in small cell lung cancer. 内质网应激- mmrn1正反馈有助于小细胞肺癌顺铂耐药。
IF 2.1 3区 医学 Q3 RESPIRATORY SYSTEM Pub Date : 2024-12-31 Epub Date: 2024-12-28 DOI: 10.21037/jtd-24-1477
Mingxin Liu, Peihong Hu, Bo Tang, Qi Yang, Run Xiang, Yiqiang Liu, Juan Li, Binghuo Wu, Hong Wu, Bo Tian, Chuan Xu, Qiang Li

Background: Small cell lung cancer (SCLC) accounts for 15% of all lung cancers and presents early metastasis and poor prognosis. Chemotherapy with cisplatin (CDDP) remains one of the standards of care in first-line treatment. However, the emergence of acquired resistance to CDDP causes disease progression and cancer recurrence. A comprehensive understanding of the CDDP-resistant mechanisms aids in defining accurate biomarkers and developing potential strategies.

Methods: The liquid chromatograph mass spectrometer (LC-MS/MS) was conducted to analyze the differential exosomal proteins from plasma samples of SCLC patients with non-treatment or resistance to CDDP. The online RNA-seq data with clinicopathological information on SCLC patients were downloaded from the Gene Expression Omnibus (GEO) database for further prognostic analysis. The SCLC cell line model of acquired CDDP resistance was established to investigate the role of platelet protein multimerin-1 (MMRN1) in CDDP resistance.

Results: MMRN1 was increased in CDDP-resistant SCLC patients and cell line models. Reduction of MMRN1 recovered the sensitivity to CDDP while overexpression of MMRN1 conferred CDDP resistance. The CDDP-resistant SCLC cells disseminated resistant to the CDDP-sensitive SCLC cells via the exosomal MMRN1. Additionally, CDDP treatment induces endoplasmic reticulum (ER) stress and subsequent upregulation of MMRN1. Increasing MMRN1 interacted with binding immunoglobulin protein (BiP) in the ER, maintaining the ER stress in SCLC cells.

Conclusions: The present study identified exosomal MMRN1 as a potential biomarker for CDDP resistance in SCLC. MMRN1 sustains ER stress via interaction with BiP and subsequently facilitates CDDP resistance, which might be a promising therapeutic target to overcome CDDP resistance.

背景:小细胞肺癌(Small cell lung cancer, SCLC)占所有肺癌的15%,具有早期转移和预后差的特点。顺铂化疗(CDDP)仍然是一线治疗的护理标准之一。然而,对CDDP获得性耐药的出现会导致疾病进展和癌症复发。全面了解抗cddp机制有助于确定准确的生物标志物和制定潜在的策略。方法:采用液相色谱-质谱联用技术(LC-MS/MS)对CDDP未治疗或耐药的SCLC患者血浆样品进行差异性外泌体蛋白分析。从Gene Expression Omnibus (GEO)数据库下载SCLC患者临床病理信息的在线RNA-seq数据,用于进一步的预后分析。建立SCLC获得性CDDP耐药细胞系模型,探讨血小板蛋白多聚素-1 (MMRN1)在CDDP耐药中的作用。结果:MMRN1在cddp耐药SCLC患者和细胞系模型中升高。MMRN1的减少恢复了对CDDP的敏感性,而MMRN1的过表达使CDDP耐药。耐cddp的SCLC细胞通过外泌体MMRN1向cddp敏感的SCLC细胞播散耐药。此外,CDDP治疗诱导内质网(ER)应激和随后的MMRN1上调。增加MMRN1与内质网中的结合免疫球蛋白(BiP)相互作用,维持SCLC细胞内质网应激。结论:本研究确定外泌体MMRN1是SCLC中CDDP耐药的潜在生物标志物。MMRN1通过与BiP相互作用维持内质网应激,随后促进CDDP耐药,这可能是克服CDDP耐药的一个有希望的治疗靶点。
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引用次数: 0
Investigation of causal associations between cerebral cortical structure and Barrett's esophagus: insights from Mendelian randomization and meta-analysis. 大脑皮质结构与巴雷特食道之间因果关系的调查:来自孟德尔随机化和meta分析的见解。
IF 2.1 3区 医学 Q3 RESPIRATORY SYSTEM Pub Date : 2024-12-31 Epub Date: 2024-12-16 DOI: 10.21037/jtd-24-698
Qiong Liu, Xiaofang Liu, Mengge Gao, Bo Yang, Miaoqing Luo, Biying Yang, Guojun Liang

Background: Barrett's esophagus (BE) is a precancerous condition often associated with esophageal adenocarcinoma, influenced by both genetic and environmental factors. However, there is controversy regarding the causal relationship between cerebral cortical structures and BE, with recent studies suggesting a potential neurobiological component to its multifactorial etiology. This study aims to clarify this relationship by utilizing Mendelian randomization (MR) analysis to investigate the potential causal effects of cortical structure variations on BE risk.

Methods: Comprehensive MR analyses was utilized to examine the potential causal associations between variations in cerebral cortical structure, specifically cortical thickness (TH) and surface area (SA), and the susceptibility to developing BE. Data were obtained from two genome-wide association study (GWAS) repositories. Instrumental variables were chosen using rigorous criteria, and the analysis was enhanced by employing inverse variance weighting and three additional methods, as well as conducting sensitivity analyses to evaluate the reliability of our results. In the validation stage, we used meta-analysis to combine the effect sizes to obtain robust causal relationships.

Results: Initial MR findings indicated significant associations between cortical structural features in several specific regions and BE. The meta-analysis confirmed a consistent negative correlation with BE for increased cortical TH in the supramarginal and pars orbitalis regions, and a positive correlation for increased SA in the middle temporal region. Additional initial positive findings did not maintain significance in the meta-analysis, suggesting the need for cautious interpretation and further validation.

Conclusions: Our study underscores the gastrointestinal-brain axis hypothesis, identifying cortical structure integrity as a potential modifier of BE risk, highlighting the importance of considering neurobiological factors in its pathogenesis. Understanding these associations could have significant clinical implications, particularly in developing targeted interventions to modify BE risk based on neurological pathways.

背景:Barrett食管(BE)是一种常与食管腺癌相关的癌前病变,受遗传和环境因素的影响。然而,关于大脑皮质结构与BE之间的因果关系存在争议,最近的研究表明其多因素病因可能存在神经生物学成分。本研究旨在通过孟德尔随机化(MR)分析来研究皮层结构变化对BE风险的潜在因果影响,从而阐明这种关系。方法:采用全面的磁共振分析来研究大脑皮质结构(特别是皮质厚度(TH)和表面积(SA))的变化与发生BE的易感性之间的潜在因果关系。数据来自两个全基因组关联研究(GWAS)数据库。工具变量的选择采用了严格的标准,并通过反方差加权和另外三种方法来增强分析,以及进行敏感性分析来评估我们结果的可靠性。在验证阶段,我们使用荟萃分析来结合效应大小以获得可靠的因果关系。结果:最初的MR发现表明几个特定区域的皮质结构特征与BE之间存在显著关联。meta分析证实了边缘上和眶部皮质TH升高与BE呈负相关,而颞中区SA升高与BE呈正相关。其他最初的阳性结果在荟萃分析中没有保持显著性,表明需要谨慎解释和进一步验证。结论:我们的研究强调了胃肠道-脑轴假说,确定皮质结构完整性是BE风险的潜在调节因素,强调了在其发病机制中考虑神经生物学因素的重要性。了解这些关联可能具有重要的临床意义,特别是在制定有针对性的干预措施以改变基于神经通路的BE风险方面。
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引用次数: 0
Combining cardiac and renal biomarkers to establish a clinical early prediction model for cardiac surgery-associated acute kidney injury: a prospective observational study. 结合心脏和肾脏生物标志物建立心脏手术相关急性肾损伤的临床早期预测模型:一项前瞻性观察研究
IF 2.1 3区 医学 Q3 RESPIRATORY SYSTEM Pub Date : 2024-12-31 Epub Date: 2024-12-27 DOI: 10.21037/jtd-24-1185
Jiaxin Li, Jinlin Wu, Liming Lei, Bowen Gu, Han Wang, Yusheng Xu, Chunbo Chen, Miaoxian Fang

Background: Cardiac surgery-associated acute kidney injury (CSA-AKI) is a prevalent complication with poor outcomes, and its early prediction remains a challenging task. Currently available biomarkers for acute kidney injury (AKI) include serum cystatin C (sCysC) and urinary N-acetyl-β-D-glucosaminidase (uNAG). Widely used biomarkers for assessing cardiac function and injury are N-terminal pro B-type natriuretic peptide (NT-proBNP) and cardiac troponin I (cTnI). In light of this, our study aimed to evaluate the effectiveness of these four biomarkers in predicting CSA-AKI.

Methods: This prospective observational study enrolled adult patients who had undergone cardiac surgery. The clinical prediction model for CSA-AKI was developed using the least absolute shrinkage and selection operator (LASSO) regression method. The model's performance was assessed using the area under the curve of the receiver operating characteristic (ROC-AUC), decision curve analysis (DCA), and calibration curves. Furthermore, a separate validation cohort was constructed to externally validate the prediction model. Additionally, a risk nomogram was created to facilitate risk assessment and prediction.

Results: In the modeling cohort consisting of 689 patients and the validation cohort consisting of 313 patients, the total incidence of CSA-AKI was 33.4%. The LASSO regression identified several predictors, including age, history of hypertension, baseline serum creatinine (sCr), coronary artery bypass grafting combined with valve surgery, cardiopulmonary bypass duration, preoperative albumin, hemoglobin, postoperative NT-proBNP, cTnI, sCysC, and uNAG. The constructed clinical prediction model demonstrated robust performance, with a ROC-AUC of 0.830 (0.800-0.860) in the modeling cohort and 0.840 (0.790-0.880) in the validation cohort. Furthermore, both calibration and DCA indicated good model fit and clinical benefit.

Conclusions: This study demonstrates that incorporating the immediately postoperative renal biomarkers, sCysC and uNAG, along with the cardiac biomarkers, NT-proBNP and cTnI, into a clinical early prediction model can significantly enhance the accuracy of predicting CSA-AKI. These findings suggest that a comprehensive approach combining both renal and cardiac biomarkers holds promise for improving the early detection and prediction of CSA-AKI.

背景:心脏手术相关急性肾损伤(CSA-AKI)是一种预后不良的常见并发症,其早期预测仍然是一项具有挑战性的任务。目前可用的急性肾损伤(AKI)生物标志物包括血清胱抑素C (sCysC)和尿n -乙酰-β- d -氨基葡萄糖酶(uNAG)。广泛应用于评估心功能和损伤的生物标志物是n端前b型利钠肽(NT-proBNP)和心肌肌钙蛋白I (cTnI)。鉴于此,我们的研究旨在评估这四种生物标志物在预测CSA-AKI中的有效性。方法:这项前瞻性观察性研究纳入了接受过心脏手术的成年患者。采用最小绝对收缩和选择算子(LASSO)回归方法建立CSA-AKI的临床预测模型。使用受试者工作特征曲线下面积(ROC-AUC)、决策曲线分析(DCA)和校准曲线来评估模型的性能。此外,还构建了一个单独的验证队列,对预测模型进行外部验证。此外,还创建了一个风险图,以促进风险评估和预测。结果:在建模队列689例患者和验证队列313例患者中,CSA-AKI总发病率为33.4%。LASSO回归确定了几个预测因素,包括年龄、高血压史、基线血清肌酐(sCr)、冠状动脉旁路移植术联合瓣膜手术、体外循环时间、术前白蛋白、血红蛋白、术后NT-proBNP、cTnI、sCysC和uNAG。构建的临床预测模型表现出稳健的性能,建模队列的ROC-AUC为0.830(0.800-0.860),验证队列的ROC-AUC为0.840(0.790-0.880)。校正和DCA均显示良好的模型拟合和临床效益。结论:本研究表明,将术后即刻肾脏生物标志物sCysC和uNAG,以及心脏生物标志物NT-proBNP和cTnI纳入临床早期预测模型,可显著提高CSA-AKI预测的准确性。这些发现表明,结合肾脏和心脏生物标志物的综合方法有望改善CSA-AKI的早期检测和预测。
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引用次数: 0
The long-term success of cardiovascular surgery in Takayasu arteritis: 48 years of experience in Mexico, beyond forefront techniques. Takayasu动脉炎心血管手术的长期成功:在墨西哥48年的经验,超越前沿技术。
IF 2.1 3区 医学 Q3 RESPIRATORY SYSTEM Pub Date : 2024-12-31 Epub Date: 2024-12-27 DOI: 10.21037/jtd-24-709
María Elena Soto, Victor Gabriel Gómez-Saviñón, Cuauhtémoc Vásquez-Jiménez, Rodolfo Barragán-Garcia, Iván Hernandez-Mejia, Solange Gabriela Koretzky, Verónica Guarner-Lans, Israel Perez-Torres, Humberto Jorge Martínez-Hernández, Valentín Herrera-Alarcón

Background: Takayasu arteritis (TA) affects medium and large caliber arteries causing stenosis, occlusion, or aneurysms. It has great predilection for the aortic arch, subclavian and extracranial arteries. The global prevalence is of 1% to 2% per million inhabitants, which varies by geographical region. The main cause of death in TA of cardiovascular origin and includes ischemic cardiomyopathy and valvular disease. The aim of this study was to evaluate the surgical experience according to the type of surgery in subjects with TA and with and without long-term inflammatory activity.

Methods: This was a retrospective and descriptive, cross-sectional study, between 1969 and 2017. Patients with TA with more than 3 classification criteria according to the American College of Rheumatology were included. The type of surgery was classified as: organ preservation, cardiac, bypass, exclusion, and replacement. Inflammatory activity was evaluated.

Results: A total of 41 patients were included, out of which 31 (76%) were women. The age at diagnosis was 29±10 years. The long-term survival rate according to the surgical procedure was in cardiac surgery of 15 years in 90% of cases, in organ preservation surgery of 35 years in 90%. Bypass, replacement, exclusion and other surgeries had a 100% survival at a follow-up of 48 years.

Conclusions: There are different types of surgical approaches to treat the complexity of each TA patient. The surgical technique well selected by experts in cardiothoracic surgery offers an excellent long-term prognosis. Interventional management successfully resolves some arterial occlusive aspects. It is necessary to evaluate the appropriate use of surgical, interventional, and hybrid management through randomized clinical trials to evaluate their comparison with transparency.

背景:高松动脉炎(Takayasu arteritis, TA)累及中、大口径动脉,引起狭窄、闭塞或动脉瘤。它对主动脉弓、锁骨下动脉和颅外动脉有很大的偏好。全球患病率为每百万居民1%至2%,因地理区域而异。心血管源性TA的主要死亡原因包括缺血性心肌病和瓣膜病。本研究的目的是根据手术类型评估TA患者以及有无长期炎症活动的手术经验。方法:这是一项回顾性和描述性的横断面研究,时间为1969年至2017年。根据美国风湿病学会的分类标准,有3个以上的TA患者被纳入。手术类型分为:器官保存、心脏、旁路、排除和置换。评估炎症活动。结果:共纳入41例患者,其中31例(76%)为女性。诊断年龄29±10岁。根据手术方式的长期生存率,心脏手术15年占90%,器官保存手术35年占90%。在48年的随访中,旁路、置换、排除和其他手术的存活率为100%。结论:不同类型的手术入路可以治疗TA患者的复杂性。由心胸外科专家精心选择的手术技术可提供良好的长期预后。介入治疗成功地解决了一些动脉闭塞问题。有必要通过随机临床试验来评估手术、介入和混合治疗的适当使用,以评估它们与透明度的比较。
{"title":"The long-term success of cardiovascular surgery in Takayasu arteritis: 48 years of experience in Mexico, beyond forefront techniques.","authors":"María Elena Soto, Victor Gabriel Gómez-Saviñón, Cuauhtémoc Vásquez-Jiménez, Rodolfo Barragán-Garcia, Iván Hernandez-Mejia, Solange Gabriela Koretzky, Verónica Guarner-Lans, Israel Perez-Torres, Humberto Jorge Martínez-Hernández, Valentín Herrera-Alarcón","doi":"10.21037/jtd-24-709","DOIUrl":"https://doi.org/10.21037/jtd-24-709","url":null,"abstract":"<p><strong>Background: </strong>Takayasu arteritis (TA) affects medium and large caliber arteries causing stenosis, occlusion, or aneurysms. It has great predilection for the aortic arch, subclavian and extracranial arteries. The global prevalence is of 1% to 2% per million inhabitants, which varies by geographical region. The main cause of death in TA of cardiovascular origin and includes ischemic cardiomyopathy and valvular disease. The aim of this study was to evaluate the surgical experience according to the type of surgery in subjects with TA and with and without long-term inflammatory activity.</p><p><strong>Methods: </strong>This was a retrospective and descriptive, cross-sectional study, between 1969 and 2017. Patients with TA with more than 3 classification criteria according to the American College of Rheumatology were included. The type of surgery was classified as: organ preservation, cardiac, bypass, exclusion, and replacement. Inflammatory activity was evaluated.</p><p><strong>Results: </strong>A total of 41 patients were included, out of which 31 (76%) were women. The age at diagnosis was 29±10 years. The long-term survival rate according to the surgical procedure was in cardiac surgery of 15 years in 90% of cases, in organ preservation surgery of 35 years in 90%. Bypass, replacement, exclusion and other surgeries had a 100% survival at a follow-up of 48 years.</p><p><strong>Conclusions: </strong>There are different types of surgical approaches to treat the complexity of each TA patient. The surgical technique well selected by experts in cardiothoracic surgery offers an excellent long-term prognosis. Interventional management successfully resolves some arterial occlusive aspects. It is necessary to evaluate the appropriate use of surgical, interventional, and hybrid management through randomized clinical trials to evaluate their comparison with transparency.</p>","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":"16 12","pages":"8482-8492"},"PeriodicalIF":2.1,"publicationDate":"2024-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11740032/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143007635","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
Thoracic duct identification using three-dimensional thoracoscope versus indocyanine green fluorescence during minimally invasive esophagectomy: a retrospective cohort study. 微创食管切除术中使用三维胸腔镜与吲哚菁绿荧光鉴别胸导管:一项回顾性队列研究。
IF 2.1 3区 医学 Q3 RESPIRATORY SYSTEM Pub Date : 2024-12-31 Epub Date: 2024-12-18 DOI: 10.21037/jtd-24-947
Saiguang Ji, Fuchen Xing, Hai Zhou, Jian Xu, Chenyan Wang, Hong Liu

Background: Chylothorax following esophagectomy is a frustrating complication with considerable morbidity. In addition, recognizing the morphological patterns of the thoracic duct (TD) holds great significance. This study was aimed at explore the safety and efficacy of three-dimensional (3D) thoracoscope in comparison with indocyanine green (ICG) fluorescence to identify TD during minimally invasive esophagectomy (MIE) for esophageal cancer.

Methods: A totally 354 esophageal cancer patients undergoing MIE in a single center between January 2019 and August 2023 were retrospectively analyzed, including 179 cases using fluorescent laparoscopy (the ICG group) and 175 cases with 3D laparoscopy (the 3D group). The baseline and perioperative parameters such as operation time and the TD-related complications were compared.

Results: Intraoperative recognition rate of the TD in the ICG group was higher than that of the 3D group (98.9% vs. 96.0%), although without a significant difference. Both groups demonstrated similar operation time, estimated blood loss, chest tube drainage, the incidence of postoperative complications and the length of postoperative hospital stay, with P>0.05, respectively. Meanwhile, the ICG group showed better prevention efficacy of the TD ligation. Furthermore, the incidence of complications was not significantly different between the two groups. ICG-specified side effect was not found in this cohort.

Conclusions: The ICG-guided fluorescent laparoscopy as well as the 3D thoracoscope as a simple and safe method is probably sufficient to identify the TD in real-time, which can serve as a potent tool for preventing TD injuries during MIE.

背景:食道切除术后乳糜胸是一种令人沮丧的并发症,发病率很高。此外,认识胸导管的形态形态也具有重要意义。本研究旨在探讨三维(3D)胸腔镜与吲哚菁绿(ICG)荧光鉴别食管癌微创食管切除术(MIE)中TD的安全性和有效性。方法:回顾性分析2019年1月至2023年8月在同一中心行MIE的食管癌患者354例,其中荧光腹腔镜检查179例(ICG组),3D腹腔镜检查175例(3D组)。比较手术时间、td相关并发症等基线及围手术期参数。结果:ICG组术中对TD的识别率高于3D组(98.9% vs 96.0%),但差异无统计学意义。两组手术时间、预估出血量、胸管引流、术后并发症发生率、术后住院时间相近,P < 0.05。同时,ICG组对TD结扎的预防效果较好。两组患者并发症发生率无明显差异。在该队列中未发现icg指定的副作用。结论:icg引导下的荧光腹腔镜和3D胸腔镜作为一种简单、安全的方法,可能足以实时识别TD,可作为预防MIE中TD损伤的有力工具。
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引用次数: 0
Long-term outcomes of common carotid artery cannulation for elective aortic surgery-a follow-up study. 择期主动脉手术颈总动脉插管的长期疗效——一项随访研究。
IF 2.1 3区 医学 Q3 RESPIRATORY SYSTEM Pub Date : 2024-12-31 Epub Date: 2024-12-28 DOI: 10.21037/jtd-24-735
Kiril Penov, Patrick Kohnle, Matz Andreas Haugen, Dejan Radakovic, Nodir Madrahimov, Khaled Machwart, Khaled Hamouda, Rainer Leyh, Constanze Bening

Background: The selection of the cannulation site for elective aortic surgery is mostly an individual choice based on the surgeon's experience and the surgical strategy. We evaluated the long-term outcomes of right common carotid artery (CCA) cannulation using a side graft to establish unilateral selective antegrade cerebral perfusion (uSACP).

Methods: We reviewed the records of 343 patients who underwent elective ascending aortic or aortic arch surgery between 2013 and 2020. One hundred aortic procedures were performed using the right CCA as the sole arterial cannulation site under moderate hypothermic circulatory arrest (MHCA). Cross-validated least absolute shrinkage and selection operator (LASSO) and stepwise Cox regression were applied to model the effects of cannulation sites on adverse outcomes. Kaplan-Meier analysis compared mortality in the treatment group with that in the general population.

Results: The mean patient age was 65.9±9.5 years (81% male). The mean MHCA temperature was 27.1±5.1 ℃, and the average uSACP duration was 13.6±7.7 minutes. The early mortality and stroke rates were 1% and 4%, respectively. After a median of 5.4 follow-up years, seven patients suffered stroke, with 92% survival at 6 years, similar to an age- and gender-matched general population (log-rank P=0.50). Multivariable analysis revealed that age at surgery was the only significant predictor of late stroke or death [hazard ratio (HR) =1.083; P=0.01; c-index 0.683). Control Doppler ultrasound examination after a median of 2.3 years found no evidence of injury or dissection of the right CCA.

Conclusions: Cannulation of the right carotid artery is a safe, feasible, and practical adjunct technique for proximal aortic surgery that generates comparable short- and long-term results. Careful patient selection and techniques are essential to minimize risk.

背景:择期主动脉手术插管部位的选择大多是基于外科医生的经验和手术策略的个人选择。我们评估了右颈总动脉(CCA)插管使用侧移植物建立单侧选择性顺行脑灌注(uSACP)的长期结果。方法:我们回顾了2013年至2020年间343例接受择期升主动脉或主动脉弓手术的患者的记录。在中度低温循环停止(MHCA)下,使用右侧CCA作为唯一动脉插管部位进行了100次主动脉手术。交叉验证的最小绝对收缩和选择算子(LASSO)和逐步Cox回归应用于模拟插管部位对不良结局的影响。Kaplan-Meier分析比较了治疗组和普通人群的死亡率。结果:患者平均年龄65.9±9.5岁,男性占81%。MHCA平均温度为27.1±5.1℃,uSACP平均持续时间为13.6±7.7 min。早期死亡率和中风率分别为1%和4%。在平均5.4年的随访后,7名患者发生中风,6年生存率为92%,与年龄和性别匹配的普通人群相似(log-rank P=0.50)。多变量分析显示,手术年龄是晚期卒中或死亡的唯一显著预测因素[危险比(HR) =1.083;P = 0.01;c指数0.683)。中位2.3年后的控制多普勒超声检查未发现右侧CCA损伤或剥离的证据。结论:右颈动脉插管是主动脉近端手术中一种安全、可行、实用的辅助技术,可产生相当的短期和长期效果。谨慎的患者选择和技术是将风险降到最低的必要条件。
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引用次数: 0
Non-infectious pulmonary complications after haematopoietic progenitor transplantation: a diagnostic approach. 造血祖细胞移植后的非感染性肺部并发症:一种诊断方法。
IF 2.1 3区 医学 Q3 RESPIRATORY SYSTEM Pub Date : 2024-12-31 Epub Date: 2024-12-20 DOI: 10.21037/jtd-24-1063
Ana Casal, Vanessa Riveiro, Juan Suárez-Antelo, Lucía Ferreiro, Nuria Rodríguez-Núñez, María E Toubes, Luis Valdés

Haematopoietic stem cell transplantation (HCT) is an established treatment for a wide variety of haematological diseases, both malignant and non-malignant. Infectious and non-infectious post-HCT pulmonary complications are a major cause of morbidity and mortality, with non-infectious complications becoming more prominent in recent decades as prophylaxis has led to a decrease in infectious complications. Globally, these complications can be divided into three phases (neutropenic, early and late phase) depending on their time of onset in relation to the graft. There is a growing awareness that the assessment of the patient undergoing HCT should start before the transplantation itself. It is known that total body irradiation dose, the source of HCT, myeloablative regimens or lower baseline lung function are key risk factors in the development of pulmonary complications. In general, the treatment of these entities consists of administration of corticosteroids with variable response, which highlights the need to better understand the underlying biology in order to have new drugs with more directed targets to improve the prognosis of post-HCT non-infectious pulmonary complications. In view of the limited therapeutic response mentioned above, preventive measures for patients undergoing HCT, such as conditioning of less ablative regimens or pre-selection of high-risk cases, are of paramount importance in order to mitigate the severity of these devastating pulmonary complications.

造血干细胞移植(HCT)是一种广泛的治疗各种血液系统疾病,包括恶性和非恶性。hct后的传染性和非传染性肺部并发症是发病率和死亡率的主要原因,近几十年来,随着预防导致传染性并发症的减少,非传染性并发症变得更加突出。在全球范围内,这些并发症可分为三个阶段(中性粒细胞减少,早期和晚期),这取决于它们与移植物有关的发病时间。越来越多的人意识到,对接受HCT的患者的评估应该在移植之前开始。众所周知,全身辐照剂量、HCT来源、清髓方案或较低的基线肺功能是肺部并发症发生的关键危险因素。一般来说,这些实体的治疗包括给药不同反应的皮质类固醇,这突出了需要更好地了解潜在的生物学,以便有更有针对性的新药来改善hct后非感染性肺部并发症的预后。鉴于上述有限的治疗反应,对接受HCT的患者采取预防措施,如调整较少消融方案或预先选择高风险病例,对于减轻这些破坏性肺部并发症的严重程度至关重要。
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引用次数: 0
Current landscape of immunotherapy in esophageal cancer: a literature review. 食管癌免疫治疗的现状:文献综述。
IF 2.1 3区 医学 Q3 RESPIRATORY SYSTEM Pub Date : 2024-12-31 Epub Date: 2024-12-20 DOI: 10.21037/jtd-24-1145
Mohamad M Moughnyeh, Mary Green, Binit Katuwal, Zane T Hammoud

Background and objective: Esophageal cancer has witnessed a significant shift in its epidemiology within the United States. Adenocarcinoma of the esophagus is now the fastest-growing solid malignancy, surpassing esophageal squamous cell carcinoma (ESCC) in frequency. There has been a concentrated effort to establish new therapies for dealing with this malignancy including immunotherapy in conjunction with surgery and radiotherapy. Our objective is to provide a comprehensive review of the current therapeutic strategies for esophageal cancer, with a particular focus on the emerging role of immunotherapy in combination with surgery and radiotherapy, and its impact on treatment outcomes.

Methods: A thorough search was done using keywords of "esophageal cancer", "immunotherapy in esophageal cancer", and "immunotherapy" in PubMed, MEDLINE, and Google Scholar databases. All studies that were identified in this search were analyzed for relevance and content.

Key content and findings: A total of 1,555 studies were identified which were checked for relevance and content. Fifteen articles were reviewed which focused on esophageal cancer and the immunotherapy directed towards this condition. This review article summarizes the most recent and available evidence on immunotherapy directed towards the treatment of esophageal cancer.

Conclusions: Esophageal cancer treatment is undergoing a paradigm shift with the advent of immunotherapy, particularly programmed cell death protein 1 (PD-1)/programmed death-ligand 1 (PD-L1) inhibitors. These therapies hold promise for both second-line and first-line settings, with evolving biomarkers guiding treatment decisions. Combination strategies and personalized approaches are actively investigated to overcome resistance mechanisms and enhance treatment outcomes in this challenging cancer type.

背景和目的:食管癌的流行病学在美国发生了重大变化。食管腺癌是目前增长最快的实体恶性肿瘤,其发病率超过了食管鳞状细胞癌(ESCC)。人们一直在努力建立新的治疗方法来治疗这种恶性肿瘤,包括结合手术和放疗的免疫治疗。我们的目标是全面回顾食管癌目前的治疗策略,特别关注免疫治疗联合手术和放疗的新作用,及其对治疗结果的影响。方法:在PubMed、MEDLINE、谷歌Scholar数据库中以“食管癌”、“食管癌免疫治疗”、“免疫治疗”为关键词进行全面检索。在此搜索中确定的所有研究都进行了相关性和内容分析。主要内容和发现:共确定了1555项研究,对其相关性和内容进行了检查。本文回顾了15篇关于食管癌和针对食管癌的免疫治疗的文章。本文综述了食管癌免疫治疗的最新和现有证据。结论:随着免疫疗法的出现,尤其是程序性细胞死亡蛋白1 (PD-1)/程序性死亡配体1 (PD-L1)抑制剂的出现,食管癌的治疗正在经历范式转变。这些疗法对二线和一线环境都有希望,不断发展的生物标志物指导治疗决策。联合策略和个性化方法正在积极研究,以克服耐药机制,提高这种具有挑战性的癌症类型的治疗效果。
{"title":"Current landscape of immunotherapy in esophageal cancer: a literature review.","authors":"Mohamad M Moughnyeh, Mary Green, Binit Katuwal, Zane T Hammoud","doi":"10.21037/jtd-24-1145","DOIUrl":"10.21037/jtd-24-1145","url":null,"abstract":"<p><strong>Background and objective: </strong>Esophageal cancer has witnessed a significant shift in its epidemiology within the United States. Adenocarcinoma of the esophagus is now the fastest-growing solid malignancy, surpassing esophageal squamous cell carcinoma (ESCC) in frequency. There has been a concentrated effort to establish new therapies for dealing with this malignancy including immunotherapy in conjunction with surgery and radiotherapy. Our objective is to provide a comprehensive review of the current therapeutic strategies for esophageal cancer, with a particular focus on the emerging role of immunotherapy in combination with surgery and radiotherapy, and its impact on treatment outcomes.</p><p><strong>Methods: </strong>A thorough search was done using keywords of \"esophageal cancer\", \"immunotherapy in esophageal cancer\", and \"immunotherapy\" in PubMed, MEDLINE, and Google Scholar databases. All studies that were identified in this search were analyzed for relevance and content.</p><p><strong>Key content and findings: </strong>A total of 1,555 studies were identified which were checked for relevance and content. Fifteen articles were reviewed which focused on esophageal cancer and the immunotherapy directed towards this condition. This review article summarizes the most recent and available evidence on immunotherapy directed towards the treatment of esophageal cancer.</p><p><strong>Conclusions: </strong>Esophageal cancer treatment is undergoing a paradigm shift with the advent of immunotherapy, particularly programmed cell death protein 1 (PD-1)/programmed death-ligand 1 (PD-L1) inhibitors. These therapies hold promise for both second-line and first-line settings, with evolving biomarkers guiding treatment decisions. Combination strategies and personalized approaches are actively investigated to overcome resistance mechanisms and enhance treatment outcomes in this challenging cancer type.</p>","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":"16 12","pages":"8807-8814"},"PeriodicalIF":2.1,"publicationDate":"2024-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11740023/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143007474","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
Use of a novel claw-suture technique for localization of solitary pulmonary nodules: retrospective study and experience from one center. 使用一种新的爪缝技术定位孤立性肺结节:回顾性研究和来自一个中心的经验。
IF 2.1 3区 医学 Q3 RESPIRATORY SYSTEM Pub Date : 2024-12-31 Epub Date: 2024-12-28 DOI: 10.21037/jtd-24-1876
Lijie Wang, Jinxian He, Liang Zhang, Chengcheng Chen, Jimmy T Efird, Alberto Salvicchi, Ramsy Abdelghani, Biao Chen, Weiyu Shen

Background: Video-assisted thoracoscopic surgery (VATS) is more effective for diagnosing and treating solitary pulmonary nodules (SPNs). It is sometimes difficult to localize through use of minimally invasive techniques. We evaluated the feasibility, effectiveness, and safety of a novel localization method for SPNs. Here, we describe our technical process, perioperative results, and accumulated experience over the years.

Methods: Between February 2018 and April 2023, a retrospective study of a novel claw-suture localization technique was conducted in a single center. A total of 490 patients participating in the localization of preoperative SPNs were enrolled. An anchor claw device with four hooks and three-colored sutures was used for localizing nodules under computed tomography (CT). We then evaluated the localization process and the outcomes of the operative procedure (success rate, safety, feasibility, and patient comfort).

Results: A total of 510 SPNs were localized before surgery, and the median size of the nodules was 0.70 cm (range, 0.4-2.0 cm). Additionally, 97.1% of these nodules (495 of 510) were localized successfully without dislodgment or device fracture. Types of failures included not meeting the target value of the distance between the claw and lesion (n=12, 2.4%) and displacement of the device (n=3, 0.6%). Pneumothorax (n=63, 12.4%), parenchymal hemorrhage (n=46, 9.0%), and hemothorax (n=1, 0.2%) were the most common complications that did not require further medical treatment. Pleural reactions were reported in 2 patients (0.4%). A notable correlation was also found between the depth of the pulmonary nodules and the incidence of parenchymal hemorrhage (P<0.001). The median length for the entire process was 12 minutes (7-25 minutes). No patients reported significant pain during the localization process, and the device was retrieved with a 100% survival rate after VATS resection.

Conclusions: This method of claw-suture localization is safe, effective, and feasible and can be used to localize SPNs that are challenging to locate before operation.

背景:视频胸腔镜手术(VATS)是诊断和治疗孤立性肺结节(SPNs)更有效的方法。有时很难通过微创技术来定位。我们评估了一种新的spn定位方法的可行性、有效性和安全性。在这里,我们描述了我们的技术过程,围手术期结果,以及多年来积累的经验。方法:2018年2月至2023年4月,在单中心对一种新型爪线定位技术进行回顾性研究。共纳入490例参与术前spn定位的患者。采用锚爪式四钩三色缝线装置在CT下定位结节。然后我们评估了定位过程和手术过程的结果(成功率、安全性、可行性和患者舒适度)。结果:术前定位spn 510例,结节中位大小0.70 cm(范围0.4 ~ 2.0 cm)。此外,97.1%的结节(510例中的495例)成功定位,无脱位或器械骨折。失效类型包括爪距病灶距离(n=12, 2.4%)和装置位移(n=3, 0.6%)未达到目标值。气胸(n=63, 12.4%)、实质出血(n=46, 9.0%)和血胸(n=1, 0.2%)是最常见的不需要进一步治疗的并发症。2例患者出现胸膜反应(0.4%)。肺结节的深度与实质出血的发生率也有显著的相关性(p)。结论:该方法安全、有效、可行,可用于术前定位困难的spn。
{"title":"Use of a novel claw-suture technique for localization of solitary pulmonary nodules: retrospective study and experience from one center.","authors":"Lijie Wang, Jinxian He, Liang Zhang, Chengcheng Chen, Jimmy T Efird, Alberto Salvicchi, Ramsy Abdelghani, Biao Chen, Weiyu Shen","doi":"10.21037/jtd-24-1876","DOIUrl":"https://doi.org/10.21037/jtd-24-1876","url":null,"abstract":"<p><strong>Background: </strong>Video-assisted thoracoscopic surgery (VATS) is more effective for diagnosing and treating solitary pulmonary nodules (SPNs). It is sometimes difficult to localize through use of minimally invasive techniques. We evaluated the feasibility, effectiveness, and safety of a novel localization method for SPNs. Here, we describe our technical process, perioperative results, and accumulated experience over the years.</p><p><strong>Methods: </strong>Between February 2018 and April 2023, a retrospective study of a novel claw-suture localization technique was conducted in a single center. A total of 490 patients participating in the localization of preoperative SPNs were enrolled. An anchor claw device with four hooks and three-colored sutures was used for localizing nodules under computed tomography (CT). We then evaluated the localization process and the outcomes of the operative procedure (success rate, safety, feasibility, and patient comfort).</p><p><strong>Results: </strong>A total of 510 SPNs were localized before surgery, and the median size of the nodules was 0.70 cm (range, 0.4-2.0 cm). Additionally, 97.1% of these nodules (495 of 510) were localized successfully without dislodgment or device fracture. Types of failures included not meeting the target value of the distance between the claw and lesion (n=12, 2.4%) and displacement of the device (n=3, 0.6%). Pneumothorax (n=63, 12.4%), parenchymal hemorrhage (n=46, 9.0%), and hemothorax (n=1, 0.2%) were the most common complications that did not require further medical treatment. Pleural reactions were reported in 2 patients (0.4%). A notable correlation was also found between the depth of the pulmonary nodules and the incidence of parenchymal hemorrhage (P<0.001). The median length for the entire process was 12 minutes (7-25 minutes). No patients reported significant pain during the localization process, and the device was retrieved with a 100% survival rate after VATS resection.</p><p><strong>Conclusions: </strong>This method of claw-suture localization is safe, effective, and feasible and can be used to localize SPNs that are challenging to locate before operation.</p>","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":"16 12","pages":"8699-8708"},"PeriodicalIF":2.1,"publicationDate":"2024-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11740076/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143007551","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
Mortality-related risk factors of idiopathic pulmonary fibrosis: a systematic review and meta-analysis. 特发性肺纤维化的死亡率相关危险因素:系统回顾和荟萃分析
IF 2.1 3区 医学 Q3 RESPIRATORY SYSTEM Pub Date : 2024-12-31 Epub Date: 2024-12-20 DOI: 10.21037/jtd-23-1908
Xuege Sun, Siyuan Lei, Hulei Zhao, Luhan Guo, Yuan Wang

Background: Idiopathic pulmonary fibrosis (IPF) has high mortality and poor prognosis, which brings enormous burdens to families and society. We conducted this meta-analysis to analyze and summarize the risk factors associated with mortality in IPF, hoping to provide reference for clinical prevention and treatment of IPF.

Methods: We conducted a comprehensive search of PubMed, Cochrane Library, Embase, and Web of Science from inception to August 10, 2023, to include cohort studies on mortality in patients with IPF. Two researchers independently screened the studies and extracted data. The Newcastle-Ottawa Scale (NOS) was used to assess the methodological quality of studies. Hazard ratios (HRs) and 95% confidence intervals (CIs) were reported to identify risk factors for mortality in IPF. In addition, we also carried out sensitivity analysis, Begg's and Egger's tests to evaluate the heterogeneity and publication bias.

Results: Eighteen studies comprising 8,408 patients were included. The meta-analysis suggested that age (HR =1.03; 95% CI: 1.01, 1.04; P<0.001), forced vital capacity (FVC) (HR =0.97; 95% CI: 0.96, 0.99; P=0.005), FVC to predicted value ratio (FVC% pred) (HR =0.98; 95% CI: 0.97, 0.99; P<0.001), diffusing capacity of the lungs for carbon monoxide to predicted value ratio (DLCO% pred) (HR =0.98; 95% CI: 0.97, 0.99; P<0.001), gender-age-physiology (GAP) index (HR =1.70; 95% CI: 1.20, 2.40; P=0.003), and lung cancer (HR =2.75, 95% CI: 1.23, 6.15; P=0.01) were mortality-related risk factors in patients with IPF. Whereas, gender, smoking, body mass index (BMI), diffusing capacity of the lungs for carbon monoxide (DLCO), C-reactive protein (CRP), 6-minute walking distance (6MWD), pulmonary hypertension, gastroesophageal reflux, and cardiovascular disease were not statistically associated with death.

Conclusions: Age, FVC, FVC% pred, DLCO% pred, GAP index, and lung cancer have been identified as potential risk factors for mortality in patients with IPF. Due to the limited number and quality of included studies, the conclusions need to be verified by further studies.

背景:特发性肺纤维化(Idiopathic pulmonary fibrosis, IPF)病死率高,预后差,给家庭和社会带来巨大负担。我们进行本荟萃分析,分析总结IPF中与死亡率相关的危险因素,希望为IPF的临床防治提供参考。方法:我们对PubMed、Cochrane Library、Embase和Web of Science进行了全面的检索,从成立到2023年8月10日,包括IPF患者死亡率的队列研究。两名研究人员独立筛选研究并提取数据。纽卡斯尔-渥太华量表(NOS)用于评估研究的方法学质量。报告了危险比(hr)和95%置信区间(ci)来确定IPF死亡的危险因素。此外,我们还进行了敏感性分析、Begg’s和Egger’s检验来评估异质性和发表偏倚。结果:纳入18项研究,共8408例患者。meta分析显示,年龄(HR =1.03;95% ci: 1.01, 1.04;P0.001),肺部一氧化碳弥散量与预测值比(DLCO% pred) (HR =0.98;95% ci: 0.97, 0.99;PCO)、c反应蛋白(CRP)、6分钟步行距离(6MWD)、肺动脉高压、胃食管反流和心血管疾病与死亡无统计学相关性。结论:年龄、FVC、FVC% pred、DLCO% pred、GAP指数和肺癌是IPF患者死亡的潜在危险因素。由于纳入的研究数量和质量有限,结论需要进一步的研究来验证。
{"title":"Mortality-related risk factors of idiopathic pulmonary fibrosis: a systematic review and meta-analysis.","authors":"Xuege Sun, Siyuan Lei, Hulei Zhao, Luhan Guo, Yuan Wang","doi":"10.21037/jtd-23-1908","DOIUrl":"https://doi.org/10.21037/jtd-23-1908","url":null,"abstract":"<p><strong>Background: </strong>Idiopathic pulmonary fibrosis (IPF) has high mortality and poor prognosis, which brings enormous burdens to families and society. We conducted this meta-analysis to analyze and summarize the risk factors associated with mortality in IPF, hoping to provide reference for clinical prevention and treatment of IPF.</p><p><strong>Methods: </strong>We conducted a comprehensive search of PubMed, Cochrane Library, Embase, and Web of Science from inception to August 10, 2023, to include cohort studies on mortality in patients with IPF. Two researchers independently screened the studies and extracted data. The Newcastle-Ottawa Scale (NOS) was used to assess the methodological quality of studies. Hazard ratios (HRs) and 95% confidence intervals (CIs) were reported to identify risk factors for mortality in IPF. In addition, we also carried out sensitivity analysis, Begg's and Egger's tests to evaluate the heterogeneity and publication bias.</p><p><strong>Results: </strong>Eighteen studies comprising 8,408 patients were included. The meta-analysis suggested that age (HR =1.03; 95% CI: 1.01, 1.04; P<0.001), forced vital capacity (FVC) (HR =0.97; 95% CI: 0.96, 0.99; P=0.005), FVC to predicted value ratio (FVC% pred) (HR =0.98; 95% CI: 0.97, 0.99; P<i><</i>0.001), diffusing capacity of the lungs for carbon monoxide to predicted value ratio (DL<sub>CO</sub>% pred) (HR =0.98; 95% CI: 0.97, 0.99; P<0.001), gender-age-physiology (GAP) index (HR =1.70; 95% CI: 1.20, 2.40; P=0.003), and lung cancer (HR =2.75, 95% CI: 1.23, 6.15; P=0.01) were mortality-related risk factors in patients with IPF. Whereas, gender, smoking, body mass index (BMI), diffusing capacity of the lungs for carbon monoxide (DL<sub>CO</sub>), C-reactive protein (CRP), 6-minute walking distance (6MWD), pulmonary hypertension, gastroesophageal reflux, and cardiovascular disease were not statistically associated with death.</p><p><strong>Conclusions: </strong>Age, FVC, FVC% pred, DL<sub>CO</sub>% pred, GAP index, and lung cancer have been identified as potential risk factors for mortality in patients with IPF. Due to the limited number and quality of included studies, the conclusions need to be verified by further studies.</p>","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":"16 12","pages":"8338-8349"},"PeriodicalIF":2.1,"publicationDate":"2024-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11740034/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143007723","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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