Journal of thoracic disease最新文献

Background: The hemoglobin glycation index (HGI), which reflects discrepancies between glycosylated hemoglobin (HbA1c) and fasting plasma glucose (FPG), has been linked to poor outcomes across various diseases. This study aims to clarify its prognostic value in patients with community-acquired pneumonia (CAP), a critical concern for clinicians, by evaluating the association between HGI and all-cause mortality in CAP requiring intensive care unit (ICU) monitoring, specifically examining potential non-linear relationships and subgroup-specific effects.

Methods: The Medical Information Mart for Intensive Care IV (MIMIC-IV) database was used for this retrospective cohort analysis. HGI was calculated by linear regression of HbA1c on FPG. Kaplan-Meier and Cox regression analyses were used to evaluate the association between HGI and all-cause mortality. Restricted cubic spline (RCS) and threshold effect analyses examined non-linear relationships, and subgroup analyses explored effect heterogeneity.

Results: The research enrolled a cohort of 1,674 individuals diagnosed with CAP for investigation. The all-cause mortality rates of patients within 30 days and 90 days were 25.08% and 33.92% respectively. We divided the patients into four groups (Q1-Q4) based on quartiles. Cox regression showed that Q3 had the lowest mortality risk at 30 days [hazard ratio (HR) =0.46; 95% confidence interval (CI): 0.29-0.74; P<0.001] and 90 days (HR =0.44; 95% CI: 0.29-0.69; P<0.001), compared to Q1 (the lower HGI). RCS revealed an L-shaped association, with inflection points near -0.32. Subgroup analysis showed a stronger association in elderly patients (P=0.01).

Conclusions: HGI is independently associated with mortality in patients with CAP, with a non-linear L-shaped relationship. Lower HGI levels are associated with a higher risk, and HGI may serve as a valuable marker for early risk stratification, particularly in elderly patients.

Background: N-methyl-D-aspartate receptors (NMDARs) are known to contribute to neurological and neurodegenerative diseases. Meanwhile, glutamate ionotropic receptor N-methyl-D-aspartate-type subunit 2D (GRIN2D), which encodes NMDAR subunit 2D, may play a role in colorectal cancer. The study examined whether GRIN2D is involved in lung cancer.

Methods: Through the use of quantitative reverse-transcription polymerase chain reaction (qRT-PCR), GRIN2D expression was detected in tissue samples and cell lines. EdU staining assay was used to determine the cell proliferation ability, while TUNEL staining assay was used to evaluate apoptosis. The phosphorylation levels of PI3K, AKT, and mTOR were measured via Western blotting; cell viability was evaluated via Cell Counting Kit-8 (CCK-8) assay; and colony formation ability was examined via colony formation assay.

Results: In this study, we demonstrated that lung adenocarcinoma and related cancer cell lines had significantly high levels of GRIN2D expression. GRIN2D promoted cancer cell proliferation while inhibiting apoptosis via the PI3K/mTOR signaling pathway. Esketamine, a GRIN2D inhibitor, and LY294002, a PI3K inhibitor, either alone or in combination, could suppress the tumor growth induced by high GRIN2D levels both in vitro and in vivo.

Conclusions: This study is the first to identify the involvement of GRIN2D in lung cancer and to clarify the underlying mechanism of its effect; the findings further suggest that ketamine in cancer treatment may extend beyond relieving pain and depression.

Background: Chronic obstructive pulmonary disease (COPD) is a major cause of hospitalization and mortality. Outcomes may vary by admitting specialty due to differences in expertise and adherence to evidence-based care. This study assessed whether specialty-led management influences inpatient outcomes for COPD exacerbations after adjusting for selection bias using propensity weighting.

Methods: This retrospective cohort study was conducted for adults aged ≥40 years admitted with COPD exacerbations between January 2017 and March 2025. Patients with asthma, bronchiectasis, or direct intensive care unit (ICU) admissions were excluded. Data were extracted from electronic health records. Propensity scores derived from demographic and clinical covariates [age, gender, body mass index, comorbidities, smoking status, admission saturation of peripheral oxygen (SpO₂), and influenza vaccination status] were used to generate inverse probability of treatment weighting (IPTW) to balance respiratory medicine (RM) and internal medicine (IM) groups. Outcomes included all cause in-hospital mortality, hospital length of stay (LOS), non-invasive ventilation (NIV) and invasive mechanical ventilation (IMV) ventilatory support use, and 30-/90-day readmissions.

Results: Among 6,277 admissions (51.2% RM, 48.8% IM), IPTW achieved covariate balance in 1,034 COPD patients, comprising 516 RM and 518 IM. RM-led care was associated with lower in-hospital mortality [7.9% vs. 18.0%; odds ratio (OR), 0.38; 95% confidence interval (CI): 0.23-0.62; P=0.001] and shorter LOS (8.0±11.3 vs. 10.4±12.2 days; P=0.001). IM patients required more NIV (26.4% vs. 6.6%; OR, 4.08; P=0.001) and IMV (29.0% vs. 7.2%; OR, 4.49; P=0.001), while 30- and 90-day readmission rates were comparable.

Conclusions: After propensity weighting, RM-led inpatient care remained associated with lower mortality and shorter LOS despite less ventilatory support use. These findings reinforce the benefit of specialty-driven management and support integration of respiratory expertise into general medical workflows to improve inpatient COPD outcomes.

Background: Endotracheal intubation (EI) with mechanical ventilation has been the long-standing standard of care for general anesthesia of heart transplantation. The aim of this study is to evaluate the feasibility and recovery impact of a non‑intubated anesthesia (NIA) strategy using a supraglottic airway.

Methods: This study involved a single-center retrospective cohort (February 2023-August 2025). Recipients who were managed with NIA were compared with those receiving conventional EI. Primary outcomes were time to oral intake and time to first mobilization; secondary outcomes included estimated blood loss, intraoperative variables, vasoactive requirements, and intensive care unit length of stay.

Results: Seventeen recipients were included in the analysis (NIA, n=8; EI, n=9). NIA was associated with earlier oral intake [3.8 (3.5-5.0) vs. 27 (22-65) h; P=0.001], earlier mobilization [1.5 (1.3-2.0) vs. 4.0 (4.0-7.0) days; P=0.001], and lower estimated blood loss [375 (300-450) vs. 800 (500-1,000) mL; P=0.02]. Cardiopulmonary bypass, cross‑clamp, operation, and cold ischemia times trended shorter with NIA, but the differences were not statistically significant. No statistically significant differences were observed in intraoperative vasoactive-inotropic score or intraoperative vasoactive-inotropic dose. One planned NIA case converted to EI.

Conclusions: In selected recipients, non‑intubated general anesthesia heart transplantation with a supraglottic airway is feasible and associated with accelerated recovery. Prospective evaluations are warranted.

Background: Virtual-assisted lung mapping (VAL-MAP) using indigo carmine is widely used to localize small pulmonary nodules during sublobar lung resection. However, the visibility of markings remains suboptimal. We developed a novel dual-staining technique (VAL-MAP DS) that combines indigo carmine and indocyanine green (ICG) to enhance marking visibility. This study aimed to prospectively evaluate the efficacy and safety of VAL-MAP DS.

Methods: This single-arm prospective cohort study included patients who underwent sublobar resection of pulmonary nodules at a single tertiary center. Preoperative VAL-MAP DS was performed using bronchoscopic dye injection with both indigo carmine and ICG. The primary endpoint was the success rate of marking detection, defined as intraoperative visibility of either indigo carmine or ICG. Secondary endpoints included the successful resection rate, bronchoscopy-related adverse events, and postoperative complications.

Results: A total of 158 markings were performed for 51 nodules in 48 patients. The overall marking success rate was 98.1% [155/158; 95% confidence interval (CI): 94.6-99.6%] and significantly exceeded the threshold of 90% based on historical data of conventional VAL-MAP using indigo carmine alone. The successful resection rate was 94.1% (48/51; 95% CI: 83.8-98.8%). Bronchoscopy-related adverse events and postoperative complications occurred in 4.2% and 6.3%, respectively.

Conclusions: VAL-MAP DS may enhance intraoperative marking visibility with minimal procedural risk. This dual-staining approach enables more accurate sublobar resections and may reduce the number of markings required per lesion.

Background: Endobronchial ultrasound transbronchial needle aspiration (EBUS-TBNA) is a diagnostic technique for assessing intrathoracic lymph nodes and masses. EBUS-TBNA skill is most commonly acquired through training in interventional pulmonology (IP) or thoracic surgery, but there is no consensus on what constitutes appropriate training. Kingston Health Sciences Centre (KHSC) is a Canadian tertiary care academic institution without a formal IP training program that introduced EBUS in 2014. We seek to describe the attainment of EBUS skill by assessing diagnostic performance and to describe acquisition of skill at this non-IP center.

Methods: Retrospective analysis of EBUS-TBNA procedures at KHSC since 2014 was conducted. We reviewed the first 70 EBUS procedures performed by each of 4 pulmonologists without prior EBUS training between 2014 and 2019 (n=280). Collected data included patient characteristics, indication for EBUS, number, size, and sites of sampled lymph nodes, and diagnostic yield based on pathology reports. Descriptive statistics were used to assess performance and skill acquisition.

Results: The number of EBUS-TBNA procedures increased from 5.3/month in 2014 to 18.3/month in 2019 and 25.5/month in 2023. In the 1^st quartile of skill acquisition (n=17 EBUS per pulmonologist), mean diagnostic yield was 76.5% (range, 70.6-82.4%) compared with 93.4% in the 4^th quartile (n=19 EBUS per pulmonologist; range, 89.5-94.7%). Complications such as persistent hypoxemia and bleeding were rare, occurring in 1 (0.4%) and 2 (0.7%) cases, respectively.

Conclusions: Non-IP trained pulmonologists were able to safely acquire EBUS-TBNA skill at a Canadian academic tertiary care center with a diagnostic accuracy comparable with those reported in literature, within their first 70 cases.

Background: Third-generation epidermal growth factor receptor (EGFR)-tyrosine kinase inhibitors (TKIs) are the standard first-line therapy for advanced EGFR-mutant non-small cell lung cancer (NSCLC). However, disease progression remains inevitable, particularly in the oligometastatic setting. We hypothesized that local radiotherapy (RT) could alter the disease course by eradicating resistant clones. Therefore, this study aimed to evaluate the efficacy of RT combined with a third-generation EGFR-TKI as first-line therapy for advanced oligometastatic NSCLC.

Methods: We retrospectively analyzed EGFR-mutant advanced oligometastatic NSCLC patients treated with third-generation EGFR-TKI at Zhejiang Cancer Hospital. Patients were stratified into TKI only group and TKI + RT group. Efficacy and safety were compared across groups.

Results: From March 2021 to September 2023, a total of 260 patients were enrolled, including 143 received TKI only group and 117 received TKI + RT group. With the median follow-up of 26.2 months, the median progression-free survival (PFS) was 20.6 and 26.0 months (P=0.18), and the median overall survival (OS) was 45.5 and 52.2 months (P=0.98) for TKI only and TKI + RT group respectively. For the subgroup of delivered biologically effective dose with an α/β ratio of 10 Gy (BED₁₀), BED₁₀ ≥50 Gy group achieved significantly better median PFS than the TKI only group (32.1 vs. 20.6 months; P=0.02), while BED₁₀ <50 Gy group showed no significant improvement compared with TKI only group (22.1 vs. 20.6 months, P=0.61). The median OS had no significant differences for BED₁₀ ≥50 Gy vs. TKI only (P=0.26) and BED₁₀ <50 Gy vs. TKI only (P=0.72). The median PFS in patients with brain metastases was significantly improved with RT (BED₁₀ ≥50 Gy) (37.9 vs. 17.3 months, P=0.02). Multivariate analysis identified female, N0-2 stage, non-smoking, 1-2 metastatic lesions, and RT (BED₁₀ ≥50 Gy) as independent favorable prognostic factors for PFS. Subgroup analysis confirmed significantly improved PFS in patients with brain metastases. RT-related adverse events (AEs) (radiation pneumonitis, esophagitis, and cerebral edema) were all grade ≤2.

Conclusions: RT (BED₁₀ ≥50 Gy) combined with third-generation EGFR-TKI therapy improved PFS with favorable safety in EGFR-mutant advanced oligometastatic NSCLC.

Background: Lung transplantation is a critical intervention for patients with irreversible, end-stage lung diseases. Postoperative infection is a common complication of lung transplantation, significantly affecting the survival of patients. Thus, a greater understanding of the spectrum of pathogens and the possible factors related to postoperative infections will aid in the prevention and treatment of postoperative infections. This study examined the distribution and drug resistance of pathogens causing surgical site infections in lung transplant patients, as well as seasonal variations.

Methods: The data of 204 lung transplant patients at Shanghai Pulmonary Hospital from 2016 to 2022, including data on the pathogenic type and drug resistance at the surgical site, were collected and analyzed. Seasonal effects on infection and drug resistance rates were assessed through univariate and multivariable analyses.

Results: Acinetobacter baumannii (26.5%) and Klebsiella pneumoniae (23.6%) were predominant in the 499 bacterial pathogens identified. Acinetobacter baumannii infection rates were seasonally higher in summer and fall (P=0.045), and multidrug-resistant Klebsiella pneumoniae peaked in these seasons (P=0.02). The multifactor analysis confirmed the seasonal pattern for Acinetobacter baumannii (P=0.03, β=0.7). There were no seasonal differences in infection or drug resistance among the other pathogens.

Conclusions: Post-transplant infections by Acinetobacter baumannii and multidrug-resistant Klebsiella pneumoniae are more prevalent in summer and fall due to temperature influences; however, no seasonal variations in other pathogens were observed.