Background: Limited evidence exists regarding the role of the routine contrast swallow in determining the safety of initiating oral intake following esophagectomy. Therefore, this study evaluated its clinical relevance in decision-making regarding oral intake.
Methods: A descriptive, observational, single-center study included esophageal cancer patients who underwent esophagectomy with gastric conduit reconstruction between March 2019 and March 2021. Patients were kept nil by mouth until postoperative day (POD) 3 and began oral intake from POD 4 if the contrast swallow was normal. The primary outcome was routine use (POD 2-6) of the contrast swallow and its impact on oral intake decisions. Predictors of an abnormal contrast swallow were explored using logistic regression.
Results: A contrast swallow was routinely performed in 80 of 110 patients (73%), of which 48 (44%) had a normal contrast swallow, while 32 (29%) had an abnormal contrast swallow. Ultimately, in 28 patients (25%), findings of the contrast swallow led to a decision to delay oral intake. All abnormal contrast swallows (n=32) involved aspiration (n=30, 94%) or laryngeal penetration (n=2, 6%). Aspiration occurred alongside delayed gastric conduit emptying in 2 cases, and anastomotic leakage was suspected in 2 others but not confirmed on computed tomography (CT) scan. No statistically independent predictors of an abnormal contrast swallow were identified in multivariable analysis.
Conclusions: Routine contrast swallow following esophagectomy led to withholding oral intake in 25% of cases. Future research should explore a more selective approach in specific patient categories.
Background: Small cell lung cancer (SCLC) is a highly aggressive malignancy with limited therapeutic options. ABHD4, a member of the lipid-metabolizing enzyme family, has been implicated in various cancers, but its precise role and molecular mechanisms in SCLC remain poorly understood. The aim of this study was to investigate the functional impact of ABHD4 on SCLC progression and to explore its potential links with lipid metabolism and the PI3K/AKT/mTOR signaling pathway.
Methods: The study analyzed ABHD4 expression in clinical SCLC specimens and cell lines. Functional characterization was performed using ABHD4 knockdown in xenograft models and cancer cells to assess effects on tumor growth, proliferation, migration, invasion, and apoptosis. Metabolomic profiling was employed to examine lipid metabolism changes. Mechanistic studies focused on the PI3K/AKT/mTOR pathway, and curcumin treatment was used to interrogate ABHD4-associated phenotypes in H69 cells.
Results: ABHD4 was consistently upregulated in SCLC samples compared to normal controls. Its knockdown significantly impaired tumor growth in vivo and reduced cancer cell proliferation, migration, and invasion while promoting apoptosis. Metabolomic analysis confirmed a connection between ABHD4 expression and altered lipid metabolism. Mechanistically, ABHD4 was identified as a key factor associated with the PI3K/AKT/mTOR pathway. Furthermore, curcumin treatment effectively attenuated the oncogenic phenotypes linked to ABHD4 overexpression.
Conclusions: This study demonstrates that ABHD4 contributes to SCLC progression, associates with modulations in lipid metabolism, and is linked to the PI3K/AKT/mTOR signaling pathway. The findings suggest ABHD4 as a potential therapeutic target, with curcumin showing promise in mitigating its oncogenic effects.
Background: Postoperative analgesia is crucial for recovery after thoracic surgery. The neutrophil-to-lymphocyte ratio (NLR) serves as an indicator of systemic inflammatory status. This study aimed to evaluate the impact of different postoperative analgesia modalities on NLR and recovery outcomes in patients undergoing thoracic surgery.
Methods: We retrospectively analyzed data from 1,099 patients who underwent thoracic surgery between January 2020 and July 2024 and received patient-controlled analgesia (PCA). Based on the pain relief method employed, the patients were categorized into two groups: the patient-controlled epidural analgesia (PCEA) group (n=533) and the patient-controlled intravenous analgesia (PCIA) group (n=566). The primary outcome was the NLR at 48 hours postoperatively. Secondary outcomes included postoperative pain scores and recovery parameters.
Results: The postoperative NLR at 48 hours was significantly lower in the PCEA group (4.75) than in the PCIA group (5.90) (P<0.001). The PCEA group also demonstrated superior pain control and faster recovery, including shorter time to chest drain removal and length of hospital stay (LOS).
Conclusions: Compared to intravenous analgesia, epidural analgesia significantly reduces the postoperative NLR.
Background: Superior sulcus tumours (SSTs) are a rare but serious non-small cell lung cancer that requires aggressive multi-modal intervention. Existing literature suggests patient outcomes are adversely affected by diagnosis delay, often from misdiagnosis as a musculoskeletal condition. As such, the aims of this review were to identify the key clinical features of SSTs documented in the literature and differentiate them from commonly misdiagnosed musculoskeletal pathologies.
Methods: In accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for scoping reviews (PRISMA-ScR), a systematic search of electronic databases was conducted for studies of SST patients with descriptions of their signs and symptoms. These findings along with information on any length of diagnostic delay or misdiagnosis were extracted for analysis.
Results: The final review included a sample of 1,328 patients across 31 studies. A total of 111 patients had a misdiagnosis resulting in diagnostic delay. The most common presentation across all SSTs was shoulder pain (60.0%), followed by a history of smoking (27.0%), and arm pain (25.6%). Diagnostic delay was most frequently due to radiographic error by primary contact physicians. For patients who received a misdiagnosis, the most common clinical findings were signs and symptoms of upper limb neuropathy (55.7%), shoulder pain (53.2%) and chest pain (27.9%). Within this subgroup, SSTs were most frequently misdiagnosed as cervical spine radiculopathy, cervical spine osteoarthritis, or glenohumeral osteoarthritis. Additionally, within the misdiagnosis subgroup, key features of SSTs such as Horner's syndrome and history of smoking were less prevalent compared to the larger group.
Conclusions: Explicit testing and differentiation between shoulder and cervical spine pathology are required when examining patients with atraumatic shoulder and/or arm pain to rule out SSTs. Specifically, targeted testing for cervical spine radiculopathy and glenohumeral osteoarthritis can help guide appropriate imaging in the initial stages of assessment. When requested, apical lung imaging should be scrutinized to prevent physicians from missing radiographic signs of SSTs that may lead to diagnostic delay.
Background: Postoperative atrial fibrillation (POAF) is a common complication after coronary artery bypass grafting (CABG), yet reliable preoperative risk markers remain limited. Estimated pulse wave velocity (ePWV), a simple noninvasive indicator of arterial stiffness, may enhance risk stratification; however, its association with POAF has not been fully elucidated. This study aimed to investigate the nonlinear association and potential threshold effect between preoperative ePWV and POAF in patients undergoing CABG.
Methods: This single-center retrospective cohort study included 8,570 patients who underwent CABG between 2021 and 2022 at Beijing Anzhen Hospital. ePWV was calculated using age and mean blood pressure. Logistic regression, restricted cubic spline (RCS) modeling, and two-piecewise linear regression were used to evaluate the association and potential threshold effect between ePWV and POAF. Predictive performance was evaluated using receiver operating characteristic (ROC) analysis.
Results: POAF occurred in 7.9% of patients. Higher ePWV was independently associated with POAF [adjusted odds ratio (OR): 1.15, 95% confidence interval (CI): 1.09-1.21; P<0.001]. A significant nonlinear relationship was observed, with an inflection point at 11.4 m/s. Below this threshold, each 1 m/s increase in ePWV was associated with a 27% higher risk of POAF, whereas no significant association was observed at ePWV values ≥11.4 m/s. The area under the curve (AUC) for ePWV was 0.583, and the optimal cutoff of 9.62 meters per second yielded a negative predictive value of 94.6%.
Conclusions: ePWV shows an independent and nonlinear association with POAF after CABG, with identifiable thresholds that may inform preoperative risk stratification. As a simple and noninvasive measure of arterial stiffness, ePWV may assist in identifying patients at elevated risk of POAF. Validation in multicenter prospective cohorts is warranted to establish its broader clinical utility.
Background: Accumulating clinical evidence suggests that the monocyte-to-lymphocyte ratio (MLR) may serve as a hematological biomarker with prognostic significance for unfavorable outcomes in cardiovascular diseases, cancers, infections, respiratory ailments, and endocrine disorders. Nonetheless, research examining the prognostic value of MLR in acute respiratory failure (ARF) remains scarce. The present investigation seeks to clarify the prognostic association between MLR and adverse outcomes among critically ill individuals with ARF.
Methods: Critically ill individuals diagnosed with ARF were extracted from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database. Baseline MLR was calculated using complete blood count data obtained within the first 24 hours of intensive care unit (ICU) admission. Patients were stratified into four categories based on MLR quartiles (Q1: MLR ≤0.36, Q2: 0.36< MLR ≤0.68, Q3: 0.68< MLR ≤1.20, Q4: MLR >1.20). The principal endpoint of interest was 28-day all-cause mortality, while extended follow-up endpoints included 90- and 365-day mortality. To characterize the association between MLR values and mortality risk, we applied Cox proportional hazards regression together with restricted cubic spline (RCS). Differences in survival probabilities across quartile categories were further illustrated through Kaplan-Meier analyses. Additionally, we executed a battery of subgroup and sensitivity analyses to validate stability of our results.
Results: In total, 3,889 patients diagnosed with ARF were incorporated into the cohort. The observed all-cause mortality rates were 26.69% at 28 days, 30.21% at 90 days, and 31.70% at 1 year. Multivariate Cox proportional hazards regression analysis demonstrated that increased MLR values were robustly associated with elevated risks of all-cause mortality across all follow-up intervals. RCS analysis revealed a significant nonlinear relationship between MLR levels and the risk of all-cause mortality (P for nonlinearity <0.001). Furthermore, Kaplan-Meier analysis showed significant variations in survival outcomes among MLR quartile groups (log-rank P<0.001). A significant interaction effect between MLR levels and mortality risk was noted solely in the subgroup stratified by ischemic heart disease (IHD) comorbidity status (P for interaction <0.05).
Conclusions: In critically ill individuals with ARF, the MLR exhibited a nonlinear relationship with mortality risk across both short- and long-term mortality risks. Elevated MLR levels remained independently linked to unfavorable clinical outcomes, underscoring its relevance as a prognostic biomarker and its potential role in risk stratification of ARF populations.
Background: Secondary fungal infections significantly affect the outcomes of patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). This study aimed to develop and validate a clinically applicable prediction model for this complication.
Methods: In this retrospective cohort study, we analyzed 225 consecutive patients with AECOPD who were admitted to The Fourth Affiliated Hospital of Soochow University (July 2022-July 2024). Patients were randomly allocated to the training (n=177) and validation (n=48) sets. Through multivariable logistic regression analysis, we identified independent risk factors and constructed a nomogram. Model performance was assessed using the area under the curve (AUC), calibration plots with the Hosmer-Lemeshow test, and decision curve analysis (DCA).
Results: Three independent predictors were identified: the use of systemic glucocorticoids within 3 months before admission [odds ratio (OR) 2.943], admission to the hospital due to disease aggravation within the past year (OR 2.679), and the use of antibiotics for ≥14 days (OR 3.739). The nomogram demonstrated excellent discrimination {AUC 0.82 [95% confidence interval (CI): 0.75-0.88] in the training set; 0.80 (0.65-0.95) in the validation set} and good calibration (Hosmer-Lemeshow P>0.05). DCA confirmed the clinical utility across 10-80% risk thresholds.
Conclusions: This validated nomogram, which incorporates three easily obtainable clinical parameters, provides reliable, individualized risk predictions for secondary pulmonary fungal infections in patients with AECOPD, facilitating early targeted interventions.
Background: Lung cancer remains the leading cause of cancer-related deaths worldwide, with non-small cell lung cancer (NSCLC) constituting the majority of cases. Immune checkpoint inhibitors have significantly improved outcomes in advanced NSCLC, particularly for patients with programmed cell death ligand-1 (PD-L1) expression. However, obtaining tissue biopsies for PD-L1 assessment in advanced disease is often challenging. Malignant pleural effusion (MPE), frequently associated with advanced lung adenocarcinoma, offers an accessible alternative source for PD-L1 testing. Nevertheless, the reliability of PD-L1 evaluation in cytological specimens from MPE, especially regarding staining methodologies, requires further validation. This study aimed to assess the impact of PD-L1 single staining versus PD-L1/thyroid transcription factor-1 (TTF-1) dual staining on the concordance of PD-L1 tumor proportion scores between paired histologic and cytologic MPE samples.
Methods: This retrospective study involved 112 lung adenocarcinoma patients, using paired histological and MPE cytological samples for PD-L1 evaluation via immunohistochemical staining. Tumor proportion score measured PD-L1 levels, withTTF-1 marking lung adenocarcinoma cells. The study compared PD-L1 staining across samples and techniques.
Results: This study aimed to evaluate the impact of staining methods on PD-L1 scoring in histological and MPE cytological specimens. The results indicate that the selection of PD-L1 single-stained or PD-L1/TTF-1 dual-stained methodologies within the same sample type did not lead to significant differences in the distribution of PD-L1 tumor proportion scores. However, when evaluating concordance with paired histological specimens, PD-L1/TTF-1 dual staining in MPE cytology samples achieved a significantly higher concordance rate (82.14%) compared to PD-L1 single staining (69.64%), with kappa values increasing from 0.59 to 0.75. Notably, in MPE cytology specimens with low tumor density, PD-L1/TTF-1 dual staining demonstrated a marked advantage over PD-L1 single staining, with the concordance rate of tumor proportion score with histology specimens increasing from 56.86% to 84.31%, with kappa values increasing from 0.47 to 0.78.
Conclusions: The application of PD-L1/TTF-1 dual staining in MPE cytological specimens significantly enhances the consistency of PD-L1 expression within tissue specimens, particularly in advanced lung adenocarcinoma patients. This method provides a reliable, evidence-based medical reference that complements histopathological analysis.
Background: The da Vinci Single-Port (SP) system is a robotic platform designed to facilitate uniportal surgery. This study aimed to evaluate the feasibility and safety of the da Vinci SP system for major pulmonary resections.
Methods: We retrospectively reviewed patients with non-small cell lung cancer who underwent lobectomy or segmentectomy using the da Vinci SP system between August 2023 and June 2025. All procedures were performed through a uniportal subcostal incision. The primary endpoint was procedural feasibility, defined as completion of the planned operation without conversion to an alternative surgical approach or the addition of any supplemental ports. Secondary endpoints included safety and perioperative outcomes.
Results: Nine patients were included: 8 (88.9%) had clinical stage I disease, and 1 (11.1%) with clinical stage IIB received neoadjuvant chemoimmunotherapy. The median age was 55.0 (range, 40.0-70.0) years, and 6 patients (66.7%) were women. Lobectomy was performed in 7 patients (77.8%), and segmentectomy in 2 (22.2%). The median operative and console times were 198.0 (range, 141.0-248.0) min and 151.0 (range, 105.0-190.0) min, respectively. All procedures were completed without conversion, and complete resection was achieved in all cases. The median pathologic tumor size was 20.0 (range, 0.0-40.0) mm. A median of 8.0 lymph node (LN) stations and 22.0 LNs were harvested. No Clavien-Dindo grade ≥ III complications occurred. One patient (11.1%) developed chylothorax, which was managed conservatively. The median durations of chest tube drainage and hospital stay were 3 and 4 days, respectively.
Conclusions: Robot-assisted SP major pulmonary resections via a uniportal subcostal approach appear feasible and safe, demonstrating acceptable short-term postoperative outcomes.
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