Journal of thoracic disease最新文献

Background and objective: Myocardial infarction with non-obstructive coronary arteries (MINOCA) represents a unique subset of acute coronary syndromes where significant coronary artery obstruction is absent. Despite its clinical relevance, the role of electrocardiogram (ECG) in the diagnosis of MINOCA remains underexplored, with no specific guidelines established. This review examines the current literature to elucidate potential diagnostic markers and guide clinical management.

Methods: A non-systematic review was conducted using the PubMed database, focusing on literature from 2015 onwards, involving studies that analyze the ECGs of patients with MINOCA. Additional data from two representative MINOCA cases at Kingston Health Sciences Centre were also reviewed to illustrate real-world ECG variability and diagnostic value.

Key content and findings: ST-segment elevations are observed in 5-10.5% of MINOCA cases and studies performed on women found ST-segment depression in 15% of cases, T-wave inversions in 45% of cases, prolonged QTc intervals in 28% of cases and 35% present with a normal initial ECG.

Conclusions: Recognizing these diverse ECG presentations of MINOCA is crucial for tailoring management strategies to the underlying pathology, thereby minimizing both over-treatment and under-treatment. Future studies should prioritize longitudinal tracking of ECG changes and correlations with outcomes to establish standardized diagnostic criteria and improve prognostic stratification. This review highlights the significance of conducting additional research to develop clear ECG guidelines tailored specifically for MINOCA.

Background: The relationship between textbook outcome (TO) and health-related quality of life (QOL) is unclear. Our purpose is to investigate the relationship between achieving TO and survival and postoperative QOL in individuals with esophageal squamous cell carcinoma (ESCC).

Methods: We conducted analyses of consecutive patients with ESCC who underwent minimally invasive McKeown esophagectomy in a single center from April 2019 to December 2020. The patients were grouped into a TO group and a non-TO group. The longitudinal QOL was handled using a linear mixed effect model. The European Organization for Research and Treatment of Cancer (EORTC) questionnaires were used to assess symptoms and QOL.

Results: One hundred and twenty-three patients (33.3%) achieved TO. Postoperative complications and insufficient lymph node dissection were the main reasons that hindered achieving TO. In the EORTC Quality of Life Questionnaire Core-30 (EORTC QLQ-C30) and EORTC Quality of Life Esophagus-specific Questionnaire (EORTC QLQ-S18) scales, compared to the non-TO group, the TO group reported worse social function, more financial impact, less trouble with taste, milder dysphagia and better disease-free survival (DFS) and overall survival (OS).

Conclusions: Patients who could achieve the TO might experience a milder dysphagia symptom, better DFS and OS in the short term after esophagectomy. The postoperative management of the patients who can achieve the TO should be strengthened to improve the postoperative QOL.

Background: Recently, the minimally invasive transcervical esophagectomy (MICE) technique was introduced as a new approach for esophagectomy. The aim of this explorative study was to compare the effects of minimally invasive transthoracic esophagectomy (MIE), the most commonly used esophagectomy technique, versus MICE on postoperative immune function.

Methods: For this explorative cohort study, data regarding 42 F4S PREHAB trial participants (NL8699, International Clinical Trials Registry Platform) were analyzed. Immune function was assessed preoperatively and on postoperative day 1 (POD1) via plasma cytokines [interleukin (IL)-6, tumor necrosis factor (TNF), and IL-10], damage-associated molecular patterns (DAMPs) (S100A8/A9 and S100A12), and the Olink targeted proteomics inflammation panel. Ex vivo cytokine production was measured using whole blood stimulation with Escherichia coli lipopolysaccharides. Circulating C-reactive protein (CRP) concentrations (end of surgery until POD7) were analyzed in the F4S PREHAB cohort, supplemented with additional patients who underwent MICE or MIE in the same hospital.

Results: Concentrations of circulating cytokines and DAMPs, ex vivo cytokine production, and levels of additional inflammatory proteins on POD1 did not differ between groups (MIE, n=21; MICE, n=21). The dynamics of circulating CRP concentrations during the first week after surgery were also similar in the MICE (n=61) and MIE (n=66) groups.

Conclusions: This explorative study found no differences in postoperative inflammatory status between the two procedures. Limited statistical power and sample size warrant larger trials to further investigate potential differences in postoperative immune response and clinically relevant outcomes.

Background: Subclinical gas-trapping correlates with small-airway dysfunction but is not reliably detected by conventional spirometry. We aimed to develop and internally validate a multivariable biphasic quantitative computed tomography (qCT) model to discriminate a residual volume (RV)-defined gas-trapping phenotype [RV expressed as percent predicted (RV%pred) ≥120%].

Methods: In a single-center cross-sectional cohort (n=71), low-dose inspiratory/expiratory CT and pulmonary function testing were obtained within 1 week. RV was measured by single-breath (SB) gas dilution and RV%pred. Participants were stratified as RV-elevated (≥120%) or RV-normal (<120%); qCT metrics were compared between groups, correlations with RV%pred were examined, and a five-fold cross-validated logistic model was built with calibration and decision-curve analyses.

Results: Twenty-three of 71 (32.4%) met the RV-elevated criterion. Compared with RV-normal, the RV-elevated group showed higher mean lung density ratio (MLD_ex/in) (P=0.005), lower mean lung density difference (MLD_ex-in) (P=0.007), and higher low-attenuation fractions (VI-856, VI-950, VI-910) (P≤0.03); lung volume ratio (LV), volume decrease ratio (VDR), relative volume change (RVC), 15^th percentile lung density (Perc15) were not significant (P>0.05). RV%pred correlated moderately with VI-856, MLD_ex/in, MLD_ex-in (|r|≈0.44-0.49), and weakly with VI-950 (r≈0.25). The qCT model achieved an area under the receiver operating characteristic curve (AUC) =0.862 (training) and 0.788 (internal validation), with good calibration and decision-analytic net benefit; feature contributions were dominated by VI-856, MLD_ex/in, and MLD_ex-in.

Conclusions: Biphasic qCT-especially VI-856, MLD_ex/in, MLD_ex-in-captures a subclinical gas-trapping phenotype aligned with an RV-based operational definition and may aid early risk stratification and monitoring.

Background: Primary spontaneous pneumothorax (PSP) is a condition commonly observed in adolescents, often associated with physical characteristics such as tall stature, low body weight, and a flat thoracic cage. However, the relationship between thoracic morphology and the development of PSP remains unclear. This study aimed to compare thoracic parameters between adolescent PSP patients and healthy controls and to identify potential thoracic risk factors for PSP.

Methods: A retrospective case-control study was conducted, including adolescent males aged 13-19 years who underwent surgery for PSP (PSP group) and age-matched healthy controls. Thoracic parameters were measured using 3D-reconstructed chest computed tomography (CT) scans and included transverse diameter (TD), sagittal diameter (SD), and right/left anteroposterior diameters (RAPD/LAPD). Vertical thoracic length was assessed from chest X-rays. Statistical analyses included Mann-Whitney U tests, Spearman correlation, and predictive modeling to identify significant risk factors.

Results: The PSP group demonstrated significantly lower BMI and distinct thoracic morphology compared to controls. The SD/TD ratio was consistently lower across all thoracic levels in the PSP group, with the most pronounced difference observed at the sternal angle (P<0.001). Furthermore, vertical thoracic length was significantly greater in PSP patients (P<0.001). The predictive model for PSP development was significantly improved by incorporating the SD/TD ratio at the sternal angle (P=0.002) and the RAPD/TD ratio at the xiphisternal angle (P=0.008).

Conclusions: Adolescent PSP patients exhibit a unique thoracic morphology characterized by a flattened and flattened thoracic cage. The SD/TD ratio at the sternal angle and the RAPD/TD ratio at the xiphisternal angle emerged as potential risk factors for PSP development. These findings contribute to a deeper understanding of PSP pathophysiology and may inform future strategies for prevention and screening.

Background: Pulmonary architectural destruction often leads to significant clinical manifestations, including productive cough, recurrent infections, and hemoptysis, which may range from mild to life-threatening. This study aimed to compare perioperative outcomes between patients with non-massive and massive hemoptysis undergoing surgical resection for hemoptysis secondary to inflammatory/infectious lung diseases with pulmonary parenchymal destruction and to evaluate the impact of preoperative bronchial artery embolization (BAE) in those with massive hemoptysis.

Methods: A retrospective analysis was conducted on patients treated between 2019 and 2024. Patients were categorized into two groups based on hemoptysis severity. A subgroup analysis was performed among those with massive hemoptysis, comparing outcomes between patients who underwent preoperative BAE and those who did not. All patients were followed up for 1 year. Exclusion criteria included incomplete records and loss to follow-up.

Results: Fifty-one patients were included (mean age 42 years, 57% female). Non-massive hemoptysis was observed in 32 patients: 19 presented with massive hemoptysis. Among the latter, 8 underwent preoperative BAE. Massive hemoptysis was associated with increased need for transfusion (P=0.046) and prolonged intensive care unit (ICU) stay (P=0.02). In the embolization subgroup, patients without BAE had significantly longer pleural drainage (P=0.01), greater intraoperative blood loss (P=0.050), longer ICU stay (P=0.02), and higher transfusion rates (P=0.03).

Conclusions: Massive hemoptysis is associated with greater perioperative morbidity. Preoperative BAE appears to be a beneficial and safe adjunct, improving surgical outcomes by reducing bleeding, transfusion needs, and ICU length of stay.

Background: Although targeted and immune-based therapies are now recommended for early-stage non-small cell lung cancer (NSCLC), data on biomarker prevalence in Latin America (LATAM) remain limited. The aim of the descriptive, observational, real-world, EARLY-EGFR (NCT04742192) study was to determine the frequency of EGFR-mutated (EGFRm) in patients with resected stage I-III NSCLC across Asia, Middle East and Africa and LATAM.

Methods: The LATAM subset prospectively enrolled patients with surgically resected stage IA-IIIB [American Joint Committee on Cancer (AJCC) 8th edition] non-squamous NSCLC from March 2021 to October 2022. Primary endpoint was EGFRm prevalence and secondary endpoints were EGFRm subtypes, clinico-demographics and treatment patterns. Associations were analyzed by Fisher's exact test with Monte Carlo.

Results: Of 80 patients (mean ± standard deviation age of 66.5±9.7 years) enrolled, 67.5% were females and 57.5% were never smokers. Most patients had pathological stage (PS) stage I (66.3%) NSCLC, with 85.0% patients having pN0; all patients had adenocarcinoma. Most patients (61.3%) had right lung involvement. More than one-third of patients (39.5%; 30/76) had EGFRm with similar rates in males and females (39.1% vs. 39.6%). Exon-19 deletions (36.7%) and 21-L858R (30.0%) accounted for two-thirds of mutations. Four of 11 (36.4%) patients with EGFRm were found to be programmed death ligand-1 (PD-L1) positive. EGFRm rate in never smokers was significantly higher than in current and former smokers (51.2% vs. 24.2%, P=0.02). A total of 76.3% underwent only surgical resection. Of 44 PS IB-IIIB patients, 40.9% were prescribed systemic adjuvant therapy (AT), mostly platinum-based chemotherapy. Per logistic regression, age ≥60 years had increased odds of EGFRm, while smokers had decreased odds of EGFRm (both P<0.05).

Conclusions: The LATAM subset shows an EGFRm prevalence of 39.5%. Despite American Society of Clinical Oncology guidelines recommending AT in PS IB-IIIB, only about 32% received it. Our results are important for guiding EGFR testing and informing treatment strategies in LATAM with recent and upcoming approvals of targeted and immunotherapy.

Background: Cryobiopsy provides a large amount of specimen with minimal crush artifact, but carries the risk of serious complications such as severe bleeding or pneumothorax. Transbronchial 1.1 mm ultrathin cryobiopsy can be performed through a guide sheath, potentially enabling repeated biopsies from the same location and reducing bleeding complications. This study retrospectively assessed the safety and efficacy of ultrathin cryobiopsy with a 1.1 mm cryoprobe, which can pass through a large guide sheath under radial endobronchial ultrasound (R-EBUS) guidance.

Methods: This retrospective observational study evaluated 1.1 mm ultrathin cryobiopsy through a guide sheath (GS-UTCB) for peripheral pulmonary lesions (PPLs), including solitary lesions, pulmonary infiltration, and ground-glass opacity. We compared bronchoscopic parameters between GS-UTCB and conventional endobronchial ultrasound with a guide sheath (EBUS-GS) procedures. In the GS-UTCB group, we analyzed the diagnostic yield of both the 1.1 mm cryoprobe and standard forceps biopsy. Additionally, tissue area and crush artifacts were evaluated for each device.

Results: Between January 2022 and May 2023, 109 patients underwent bronchoscopy; 13 patients received GS-UTCB and 34 received EBUS-GS. The procedure time of the GS-UTCB group was significantly longer than that of the EBUS-GS group (P=0.04). Mild bleeding was significantly more frequent with GS-UTCB group, but there was no significant difference in moderate bleeding. There were no severe or life-threatening complications. In the GS-UTCB group, the diagnostic yield reached 92.3% in total, with 1.1 mm cryoprobe biopsy achieving 84.6% and standard forceps biopsy achieving 69.2%. Tissue area from 1.1 mm cryoprobe specimens was significantly larger than standard forceps (P<0.001), with minimal crush artifacts.

Conclusions: GS-UTCB represents a safe and effective method for sampling of various types of PPLs, demonstrating the potential to complement conventional forceps biopsy with superior tissue quality and diagnostic capability.

Background: Esophageal squamous cell carcinoma (ESCC) is a common malignant tumor with high disease burden and poor prognosis. Lymph node (LN) metastasis (LNM) is a key prognostic factor for ESCC patients, particularly left gastric artery lymph nodes (No. 7) metastasis. No. 7 LNs dissection is essential for preventing residual tumor and recurrence. However, research on No. 7 LNM in ESCC remains limited. This study aimed to evaluate the independent prognostic role of No. 7 LNM in ESCC and characterize its LNM patterns by comparing isolated No. 7 LNM with No. 7 LNM combined with LNM at other sites.

Methods: This study retrospectively analyzed clinical data from 144 patients with thoracic ESCC who had undergone radical esophagectomy and dissection of No. 7, recurrent laryngeal nerve (RLN, No. 106rec), subcarinal (No. 107), and main bronchial (No. 109) LNs at the Cancer Hospital of the Chinese Academy of Medical Sciences from 2019 to 2021. Postoperative follow-up included routine examinations every 3 months for the first 2 years. Lost-to-follow-up cases underwent standard right-censoring, with these data included in the final analysis. Patients were stratified into the No. 7-positive group (No. 7 LN+) and the No. 7-negative group (No. 7 LN-) based on postoperative pathological detection of No. 7 LNM. Kaplan-Meier survival analysis was used to assess the overall survival (OS) and disease-free survival (DFS) in patients with ESCC, and the Cox proportional hazards regression model was applied to identify the independent risk factors associated with OS and DFS.

Results: Among 144 patients with thoracic ESCC, 75 had lower thoracic tumors, 124 received neoadjuvant therapy, and 115 had pathological stage N0-N1 disease. This study analyzed the association between No. 7 LNM and prognosis in these patients. Kaplan-Meier curves showed significantly poorer OS (P=0.007) and DFS (P=0.009) in the No. 7 LN+ group than the No. 7 LN- group. Multivariate Cox regression identified No. 7 LNM as an independent factor influencing the OS (P=0.03) and DFS (P=0.04) of patients with ESCC. Subgroup analysis of patients with No. 7 LNM revealed no significant differences in OS (P=0.33) or DFS (P=0.37) between patients with ESCC with and without 106rec LNM. However, patients with concurrent 107 LNM or 109 LNM had significantly poorer OS (P=0.02) and DFS (P=0.03) compared with those without such metastases. Furthermore, lower-thoracic ESCC patients in the No. 7 LN+ group had significantly poorer OS (P=0.04) and DFS (P=0.04) than the No. 7 LN- group. Sensitivity analysis of patients who received neoadjuvant therapy confirmed the results were robust.

Conclusions: Our study confirms that No. 7 LNM is an indicator of poor prognosis in patients with thoracic ESCC. Standardized dissection of No. 7 LNs is critical during radical esophagectomy for thoracic ESCC.