Journal of thoracic disease最新文献

Background: Pulmonary embolism (PE) survivors frequently experience persistent dyspnea and diminished quality of life (QoL). Evidence suggests that rehabilitation exercise has a positive impact on QoL, physical fitness, and dyspnea in patients with heart disease and chronic obstructive pulmonary disease. However, the effects of exercise on patients with PE remain ambiguous. The purpose of our study was to systematically evaluate the impact of exercise on physical fitness and QoL in patients with PE.

Methods: PubMed, Medical Literature Analysis and Retrieval System Online (MEDLINE), Excerpta Medica Database (EMBASE), Scopus, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Central Register of Controlled Trials (CENTRAL), and Web of Science (WOS) databases were searched from their inception to May 21, 2024. Two reviewers independently extracted the data and evaluated the methodological quality and risk of bias in the included studies.

Results: Two studies involving 348 participants were included. This meta-analysis showed that exercise did not significantly improve the outcomes of incremental shuttle walk test (ISWT) [mean difference (MD) =60.46; 95% confidence interval (CI): -5.51, 126.42; P=0.07] or the EuroQol-5 Dimensions questionnaire (EQ-5D) (MD =0.02; 95% CI: -0.01, 0.05; P=0.14), and it did not significantly reduce pulmonary embolism quality of life (PEmbQoL) (MD =0.00; 95% CI: -0.04, 0.04; P=0.93).

Conclusions: The potential benefits of exercise programs range from no improvement in ISWT and PEmb-QoL to significant improvements in both. Implementing exercises may be valuable for patients with PE. Future meticulously designed randomized controlled trials are needed to validate these findings.

Background: Short-term and long-term adverse events could occur after general anesthesia (GA) and the specific mechanism driving these effects has not yet been well-characterized. In this study, we aimed to evaluate the global effect of GA on DNA methylation in the cell-free DNA (cfDNA) of surgical lung-nodule patients.

Methods: This large retrospective cohort study enrolled 1,006 surgical lung nodule patients (529 pre-anesthesia, and 477 post-anesthesia). Methylation profiles of the cfDNA isolated from plasma were analyzed by targeted bisulfite sequencing using an enrichment panel covering 12,899 biologically informative methylation regions and 105,844 CpG sites.

Results: By comparing the pre-anesthesia to the post-anesthesia group, a total of 4,562 differentially methylated regions (DMRs) were identified as GA-induced DMRs. Pathway enrichment analysis annotated with cellular processes including pattern specification process, head/heart/bone/tissues development and morphogenesis pathways, cell-adhesion, extra-cellular matrix (ECM) remodeling pathways, and signaling pathways including PI3K-AKT pathway, Ca²⁺ dependent pathway and RAS/extracellular signal-regulated kinase (RAS/ERK) signaling pathway. Prediction models using 20 DMR markers were derived using Random Forest, which could accurately predict biochemical indicators for post-operative abnormal coagulation function including activated-partial-thromboplastin-time [APTT, area under curve (AUC) 0.81], international normalized ratio (INR, AUC 0.87), D-dimer (AUC 0.82), neutrophil (AUC 0.84) and monocyte (AUC 0.79). Low methylation level in one of the top DMR markers, cg02032606 (DLX-4 gene), was found to be associated with worse overall survival in both lung adenocarcinoma and squamous carcinoma patients.

Conclusions: This study demonstrated that GA could result in acute DNA methylation changes, which were associated with tissue damage and repair responses. These GA-induced methylation changes were associated with postoperative coagulation functions and could serve as a promising predictive biomarker for coagulation disorders after surgery.

Background: Intraoperative hypothermia (IOH) has a high incidence in lung transplantation, which is considered to be an important factor affecting perioperative morbidity and mortality. Therefore, it is crucial to prevent IOH during lung transplantation. This study aimed to identify risk factors for IOH in patients receiving lung transplants, and to develop a risk model for predicting IOH.

Methods: We collected data on 160 patients who received lung transplants at The First Affiliated Hospital, Guangzhou Medical University between January 2019 and October 2023. The patients were divided into a hypothermic group (n=106) and non-hypothermic group (n=54) based on whether or not they developed IOH. We built a logistic regression model and used a nomogram to investigate the risk of IOH. The predictive power of the model was evaluated using the receiver operating characteristics (ROC) curve and the calibration curve.

Results: The incidence rate of IOH was 66.25%. Volume of intraoperative fluid [odds ratio (OR) =1.001, 95% confidence interval (CI): 1.000649 to 1.002, P<0.001] was associated with increased risk of developing IOH during lung transplantation, while extracorporeal membrane oxygenation (ECMO) (OR =0.091, 95% CI: 0.036 to 0.229, P<0.001) and circulating-water mattress (OR =0.389, 95% CI: 0.178 to 0.852, P=0.02) were protective factors against IOH. Compared to normothermic patients, patients with IOH were associated with the occurrence of cardiac arrhythmias, but was no difference in the length of stay (LOS) in the intensive care unit (ICU), acute kidney injury (AKI), postoperative hemorrhage, or 30-day mortality. The Hosmer-Lemeshow test yielded a P value of 0.18. The area under the ROC curve was 0.820, indicating that the model had good diagnostic efficacy. Similarly, evaluation of the nomogram using a calibration curve showed that the model had good accuracy in predicting IOH.

Conclusions: Owing to its strong predictive value, this risk prediction model can be used as a guide in clinical practice for screening individuals at high risk of IOH during lung transplantation.

This paper explores the potential of artificial intelligence (AI) in lung cancer screening programs, particularly in the interpretation of computed tomography (CT) scans. The authors acknowledge the benefits of AI, including faster and potentially more accurate analysis of scans, but also raise concerns about clinician trust, transparency, and the deskilling of radiologists due to decreased scan exposure. The rise of AI in medicine and the introduction of national lung cancer screening programs are both increasing contemporarily and naturally the overlap and interplay between the two in the future is ensured. The paper highlights the importance of human-AI collaboration, emphasizing the need for interpretable models and ongoing validation through clinical trials. The promising results and problems uncovered the current pilot studies is explored. Building trust with patients and clinicians is also crucial, considering factors like disease risk perception and the human element of patient interaction. The authors conclude that while AI offers significant promise, widespread adoption hinges on addressing ethical considerations and ensuring a balanced, synergistic relationship between AI and medical professionals. This report aims to provide a talking point to inspire conversations around, and prepare clinicians for the rapidly approaching frontier that is AI in healthcare.

Background: Deep sternal wound infection (DSWI) is a life-threatening postoperative complication of cardiac surgery. Currently, there are many therapies used to treat patients with DSWI. However, none of these therapies have been shown to be the optimal choice for patients with DSWI. Additionally, these methods may require additional facilities which limit their widespread use. Therefore, we aimed to investigate the effectiveness, safety, and risk factors related to the prognosis of DSWI patients treated with pectoralis major flap transposition (PMFT), a more concise method.

Methods: A retrospective, systemic analysis was conducted of DSWI patients at the Beijing Anzhen Hospital from January 2010 until December 2020. All the patients were diagnosed with DSWI according to the relevant guidelines, and treated with PMFT. The patients were divided into the following two groups based on their prognosis after treatment with PMFT: (I) the wound healing (WH) group; and (II) the delayed wound healing or death (DWHD) group. All the participants were followed up for 1 year.

Results: In total, 9.7% (76/785) of the DSWI patients experienced DWHD in the present study. The all-cause mortality rate was 3.7% (29/785). While 90.3% (709/785) of the patients achieved WH after undergoing PMFT. The multivariate logistic regression model indicated that patients with diabetes mellitus, obesity, a history of smoking, abnormal liver function, anemia, chronic infection, immune disease, hypothermia, a longer gap time, and patients requiring extracorporeal membrane oxygenation (ECMO) assistance, salvage surgery, and secondary cardiac surgery were more likely to experience DWDH.

Conclusions: This study showed PMFT was a safe and effective method for treating DSWI after cardiac surgery. Patients with risk factors, such as those mentioned above, require more attention. Prospective studies should be conducted to explore the relationships among the novel risk factors and DSWI.

Background: There has been increasing adoption of robot-assisted thoracic surgery (RATS) and uniportal video-assisted thoracic surgery (uVATS) for lung resection. We undertook a single-institution retrospective study, comparing these approaches.

Methods: An analysis was performed of patients who underwent lung resection by either uVATS or RATS. Operations were performed between July 1, 2020 and July 1, 2021. Two surgeons [one experienced in RATS, the other experienced in multi-portal VATS (mVATS), with the recent adoption of uVATS] performed all operations. Patients with known or suspected lung cancer or metastases were included. In addition to baseline characteristics, adverse events [as defined in the Society of Thoracic Surgeons (STS) General Thoracic Database], subjective pain scores (scale 1-10), and morphine equivalent dose (MED) requirement were compared for patients who remained in the hospital on post-operative days (POD) 1 to 4. For patients with lung cancer, recurrence rates, overall survival, and recurrence-free survival were evaluated.

Results: There were 128 (50 uVATS and 78 RATS) patients. Although uVATS patients were older (70 versus 65 years; P=0.01), there was no difference in baseline forced expiratory volume in the first second (FEV₁)%, diffusing capacity for carbon monoxide (DLCO)%, body mass index, and American Society of Anesthesiologists (ASA) scores. Mean procedure times and adverse event rates were similar. Four major complications occurred (all unanticipated return to the operating room). The 30- and 90-day mortality was zero. RATS was associated with shorter hospital stay (2.6 versus 4 days; P=0.02) and improved lymph node (15.3 versus 9.9; P=0.003) dissection. MED requirement was significantly reduced on POD 2-4 after uVATS, on both univariate and multivariate analysis. Ninety-four patients (uVATS; n=38, RATS; n=56) had primary lung cancer. Median follow-up was 15.6 months for these patients. Recurrence occurred in 4/34 (11.8%) uVATS and 7/56 (12.5%) RATS patients (P=0.77). There were no differences in overall survival or time to recurrence.

Conclusions: UVATS and RATS lung resections were associated with similar post-operative adverse event rates. Lymph node dissection and length of stay were improved with RATS. Oncological outcomes were similar. UVATS was associated with lower morphine requirement. Prospective studies will help further clarify the differences between these approaches.

Background: Systemic lymph node dissection (LND) is the standard procedure for operable invasive non-small cell lung cancer (NSCLC), for radical cure and lymph node (LN) staging. However, its necessity is controversial in early-stage patients without LN metastasis, as evidence shows it could not improve prognosis and may cause surgical complications.

Methods: We initiated a prospective, multi-center, single-arm, phase III trial to confirm the non-inferior survival rate of surgery sparing the lower mediastinal LND in apical cT1N0M0 invasive NSCLC with consolidation-tumor ratio (CTR) >0.5 at high-resolution computed tomography (CT) scan. We plan to enroll a total of 634 patients with invasive NSCLC with predominantly non-lepidic subtype confirmed by intraoperative frozen pathology, who will receive radical lung cancer surgery but waiver lower mediastinal LND. The primary endpoint is recurrence-free survival (RFS), the secondary endpoints are overall survival (OS) rate of these patients, metastatic distribution of LNs in different histological subtypes of NSCLC, and consistency between frozen and paraffin pathology reports in determining the tumor invasiveness.

Discussion: The results of this study will validate the necessity of LND in the lower mediastinum in the patients with early-stage NSCLC located in the apical segment with CTR >0.5 at CT scan.

Trial registration: ClinicalTrials.gov Identifier NCT06031246.

Background and objective: Lung cancer continues to be the leading cause of cancer-related deaths globally. Non-small cell lung cancer (NSCLC) accounts for approximately 85% of lung cancer cases. Although targeted therapies and immune checkpoint inhibitors have improved clinical outcomes for NSCLC patients, primary and acquired resistance remain significant obstacles to effective treatment. This review aims to elucidate the molecular mechanisms of NSCLC resistance and explore the potential of nanotechnology-based drug delivery systems in overcoming these resistance barriers.

Methods: The research team conducted a comprehensive literature search in PubMed, Cochrane Library, Google Scholar, Embase, Web of Science, China National Knowledge Internet (CNKI), and Wanfang Database, covering the period from January 1st, 2007 to January 1st, 2024.

Key content and findings: This review summarizes the molecular mechanisms of NSCLC resistance, including target alterations, bypass signaling pathways, phenotypic transformations, and immunosuppressive mechanisms. It discusses the use of nanotechnology-based drug delivery systems (such as polymeric nanoparticles, liposomes, dendrimers, and inorganic nanoparticles) to overcome various resistance barriers. Additionally, it highlights the role of nanotechnology-based immunotherapeutic strategies in modulating tumor immunity. The review also explores methods for rationally designing combination nanomedicine strategies to address resistance issues at multiple levels, thereby enhancing the effectiveness of NSCLC treatment.

Conclusions: A deep understanding of the mechanisms of NSCLC resistance and the innovative application of nanotechnology-based delivery strategies are crucial for improving patient survival. Rationally designing combination nanomedicine strategies that target multiple resistance mechanisms simultaneously holds promise for overcoming NSCLC resistance and enhancing treatment effectiveness. Further research is needed to investigate the clinical translation of emerging nanotechnologies, providing more effective treatment strategies for NSCLC patients.

Background: Combined pulmonary fibrosis and emphysema (CPFE) patients generally have a poorer prognosis compared to those with either pulmonary fibrosis or chronic obstructive pulmonary disease (COPD)/emphysema alone, as demonstrated by several studies. Our study aimed to identify undiagnosed CPFE cases within a lung transplantation cohort initially diagnosed with interstitial lung fibrosis or COPD/emphysema. It was hypothesized that the patient cohort might contain overlooked CPFE cases, and CPFE patients would exhibit a higher incidence of pre-transplant pulmonary hypertension and post-transplant chronic lung allograft dysfunction (CLAD).

Methods: This is a single-center, retrospective cohort study conducted at the University Hospital of Zurich, Switzerland. Expert review of pre-transplant computed tomography (CT) scans by a thoracic radiologist aimed to identify undiagnosed CPFE cases. Diagnostic criteria followed established guidelines, requiring both emphysema and pulmonary fibrosis on CT imaging. A total of 133 consecutive adult bilateral lung transplantations were performed for patients with interstitial lung disease, emphysema, or both (January 1, 2013, to December 31, 2021). A total of 113 patients could be analyzed, 20 patients were excluded because of missing data. The study analyzed pulmonary function tests, pre-transplant pulmonary hypertension screening, and CLAD staging in CPFE and non-CPFE patients. Primary outcome was the incidence of CPFE among lung transplantation candidates initially diagnosed with interstitial lung fibrosis or COPD/emphysema. Secondary outcomes were comparison of pulmonary function, diffusing capacity, invasively measured pulmonary hypertension, and CLAD stages between CPFE and non-CPFE patients.

Results: Based on pre-transplant CT scans, out of 113 patients, 12 (10.6%) were reclassified as previously undiagnosed CPFE, 49 (43.4%) as non-CPFE fibrosis, and 50 (44.2%) as non-CPFE emphysema. A solitary patient (0.9%) was classified as having both fibrosis and emphysema but did not meet the criteria of CPFE. One additional patient (n=1, 0.9%) exhibited a tree-in-bud pattern. Prior to the radiological review, none of the patients had been classified as CPFE and had instead received a radiological diagnosis of COPD, emphysema, sarcoidosis, interstitial pulmonary fibrosis (IPF) or hypersensitivity pneumonitis (HP).

Conclusions: The study confirmed undiagnosed CPFE cases in 12 (10.6%) in the lung transplantation cohort, suggesting potential underdiagnosis or misclassification. Objective analysis revealed similarities in lung function, diffusing capacity, pulmonary hypertension and CLAD between CPFE and non-CPFE groups. Further exploration is warranted to understand CPFE's diagnostic nuances and clinical implications in lung transplantation.

Background and objective: Family-centered care (FCC) is a mutually beneficial healthcare approach focusing on collaborative planning, delivery, and evaluation involving healthcare providers, patients, and families. The FCC approach, despite its widespread application in diverse medical contexts, encounters significant barriers in its integration into clinical practice, particularly in the management of novel coronavirus pneumonia (NCP). This review aims to explore the current state of research on and factors influencing the family-centered clinical model of care, and to reveal the challenges and coping strategies encountered by this model in NCP-like health crises. This review also aims to provide recommendations on how to transform the family-centered clinical care model to effectively respond to declared health emergencies.

Methods: We searched six databases for relevant published literature up to August 30, 2024. In addition, reference lists of all selected publications were used to identify additional eligible studies. One researcher independently selected the literature and the results were checked by a senior researcher; these results were presented and discussed among the researchers to resolve differences and reach consensus.

Key content and findings: Seventy-three articles published from January 01, 1900 to August 30, 2024 met the inclusion criteria. The literature included the conceptual and historical development of FCC in care, areas of application of FCC, assessment and measurement tools for FCC, economic benefits of FCC, gaps in clinical implementation, impact of NCP on FCC, and coping strategies to promote FCC.

Conclusions: The evolution of the FCC marks a transition from the authoritarian approach of traditional healthcare to a more humane, collaborative model. The emergence of the NCP model for prevention and control during the coronavirus disease 2019 (COVID-19) epidemic posed a significant challenge to the implementation and development of the FCC. The integration of telehealth models with FCC is seen as the future of FCC.