Journal of thoracic disease最新文献

Background: Tuberculous pleuritis is the second most common extrapulmonary tuberculosis. Its prompt diagnosis and appropriate management are essential to decrease the morbidity and mortality of affected patients. We aimed to assess whether the serum sestrin 2 and fetuin-A levels can be used to diagnose early pleural involvement in patients with pulmonary tuberculosis.

Methods: We performed a cross-sectional study and enrolled patients with pulmonary tuberculosis between October 2020 and October 2022. Their demographics and clinical characteristics were recorded. The serum sestrin 2 and fetuin-A levels were detected. Early pleural involvement was determined by a chest computed tomography (CT) scan. Patients were assigned into two groups: pleural involvement versus nonpleural involvement. The characteristics of the two groups were compared. Multivariate logistic regression analysis was performed to study the relationships between the serum sestrin 2 and fetuin-A levels with pleural involvement under potential confounders. Receiver operating characteristic (ROC) curve analysis was used to examine the performance of sestrin 2 and fetuin-A determination to diagnose pleural involvement.

Results: We enrolled 136 pulmonary tuberculosis patients, with a mean age of 50.4 (±7.3) years old, including 79 (58.1%) males. There were 89 and 47 patients with or without pleural involvement, respectively. The baseline demographics and clinical characteristics were comparable between the two groups. Compared with the patients without pleural involvement, those with pleural involvement had a higher serum sestrin 2 level but a lower serum fetuin-A level (both P<0.05). Multivariate logistic regression analysis confirmed the association of serum sestrin 2 and fetuin-A levels with pleural involvement. In addition, ROC curve analyses demonstrated that sestrin 2 and fetuin-A alone had a high sensitivity, but the combination of these two measurements had the best performance to detect pleural involvement.

Conclusions: High sestrin 2 and low fetuin-A serum levels can be used to evaluate early pleural involvement in patients with pulmonary tuberculosis.

Background: Postoperative pulmonary complications (PPCs) represent a significant source of morbidity and mortality in surgical patients. Measurement of predicted postoperative forced expiratory volume in the first second (ppo FEV1) may allow for reliable prediction of PPCs and perioperative planning. This study aimed to determine if impaired ppo FEV1 is associated with increased risk of PPCs following oncologic lung resection.

Methods: Patients who underwent elective pulmonary resection at The Ottawa Hospital between 2008 and 2018 were evaluated. The presence and severity of PPCs as defined by the Ottawa Thoracic Morbidity & Mortality system were analyzed. The incidence of PPCs was evaluated based on different ppo FEV1 cut-off values (40%, 50%, and 60%), and a multivariable logistic regression was performed to identify predictors of PPCs.

Results: Of 1,949 included patients, a thoracoscopic approach (64.4%) was most frequently utilized, and lobectomies represented the most common procedure (60.5%). All cut-off ppo FEV1 values of <40% (P<0.001), <50% (P<0.001), and <60% (P=0.004) were associated with more frequent PPCs (13.0%, 11.6%, and 7.6%, respectively), while only ppo FEV1 <50% showed differences in both minor (P<0.001) and major (P=0.005) PPCs. With ppo FEV1 <50%, differences in PPCs were demonstrated specifically in both thoracoscopic (P=0.03) and open (P=0.003) procedures. On multivariable analysis, ppo FEV1 <50% (P=0.03) and need for operative conversion (P<0.001) independently predicted PPCs.

Conclusions: Routine assessment of ppo FEV1 is a practical strategy to identify patients at increased risk of developing PPCs, and can identify candidates for preoperative optimization and postoperative pulmonary support.

Background: There is uncertainty with respect to the baseline tumor markers and clinical outcomes for patients with connective tissue disease-associated interstitial lung disease (CTD-ILD). The study aimed to assess the association between baseline tumor markers and progressive pulmonary fibrosis (PPF) and prognosis.

Methods: This is a prospective cohort study. Serum levels of nine tumor markers, including carcinoembryonic antigen (CEA) and carbohydrate antigen 125 (CA125), neuron-specific enolase (NSE), squamous cell carcinoma (SCC) antigen, cytokeratin fraction 21-1 (CYFRA21-1), serum ferritin (SF), alpha-fetoprotein (AFP) and carbohydrate antigen 724 (CA724) were collected at baseline in patients with CTD-ILD and healthy controls (HCs). Logistic regression and receiver operating characteristic (ROC) curves were used to assess the strength of baseline tumor markers in identifying PPF in CTD-ILD. Correlation analysis was performed to explore associations between tumor markers and disease severity. The relationship of prognosis and these markers was also evaluated.

Results: There were 224 patients with CTD-ILD and 63 HCs included in the analysis. The serum CEA and CA125 levels were significantly higher in the PPF group than in the non-PPF and HC groups. The area under the ROC curve (AUC) of CEA was 0.64 [95% confidence interval (CI): 0.56-0.72], the highest among the tested tumor markers. For CA125, the AUC was 0.59 (95% CI: 0.51-0.68). Patients were then stratified into low-titre and high-titre groups based on the median levels of CEA or CA125. Compared with the low CEA group, patients in the high CEA group showed a higher risk for PPF [odds ratio (OR): 3.42, 95% CI: 1.74-6.72, P<0.001], while compared with the low CA125 group, patients in the high CA125 group had an OR of 1.96 (95% CI: 1.08-3.55, P=0.03). Elevated CEA concentration remained a significant risk factor of PPF in multivariate analysis, but CA125 did not. Furthermore, elevated CEA levels was also an independent risk factor associated with all-cause mortality and acute exacerbation (AE) in CTD-ILD patients.

Conclusions: Circulating CEA may be associated with pulmonary fibrosis progression and prognosis of CTD-ILD.

Background: The identification of volatile organic compounds (VOCs) in exhaled breath has garnered significant research attention as a means of screening and diagnosing lung cancer in recent decades. However, there is no universally accepted protocol for the collection of breath samples to measure VOCs in the clinical context. The purpose of this study was to summarize the current sampling techniques used to obtain VOCs from exhaled breath specifically in the context of lung cancer screening and diagnosis.

Methods: We searched four major literature databases (PubMed, Embase, Web of Science, and The Cochrane Library) to identify studies published from January 1985 to October 2023. Trials that analyzed endogenous VOCs within exhaled breath to screen or diagnose lung cancer were included. The methods used for exhaled breath collection were divided under the following headings: before collection (patient preparation, environmental preparation, contamination detection), during collection (time of breath collection, type of container, breath fraction selected, the volume and route of breath), and after collection (storage of breath samples, VOCs stability).

Results: A total of 89 studies involving 6,409 individuals diagnosed with lung cancer were selected. The methods used to collect the breath varied substantially among the studies. A separate room was prepared for breath collection in 29 studies, the physiological state of the participants was described in 57 studies, and environmental considerations were reported in 41 studies. Polymer bags, specifically Tedlar bags, were the predominant choice for breath sample collection and were used in 58 out of the 89 studies. Alveolar breath was the most commonly selected breath fraction, which was used in 43 studies. Only 15 studies reported the storage conditions of the breath samples, which ranged from -40 ℃ to room temperature, and the stability of VOCs was recorded in 41 studies.

Conclusions: There is an urgent need for breath collection methods to be standardized to maximize the potential of this diagnostic approach. The summarized exhaled breath collection process proposed in this study based on included studies may serve as a method for future clinical research.

Background: Transthoracic biopsy has proven to be an effective procedure, especially for peripheral lung lesions, in obtaining samples that can definitively diagnose the underlying pathology. Despite its effectiveness, studies have demonstrated that it is associated with complications such as pneumothorax and hemoptysis. This study aims to evaluate the incidence of these complications and identify prognostic factors in patients who underwent a transthoracic biopsy.

Methods: This retrospective cohort analysis included adults from Thu Duc City Hospital, a sub-urban hospital who underwent transthoracic biopsy from 2017 to 2022. Complications that were evaluated included pneumothorax and hemoptysis. Separate logistic regression models estimated the association of pneumothorax or hemoptysis and selected baseline patient demographic and clinical characteristics.

Results: Among 221 patients who underwent transthoracic biopsy, 27.6% experienced pneumothorax complications, 19.9% had hemoptysis, and 5.4% had both. No air embolism was recorded. Most of the complications were mild and limited with medical management. Among patients who experienced pneumothorax, 6.6% (4/61) required chest tube drainage. Biopsy in tumors with a distance from chest wall to tumor edge of more than 20 mm and skin to tumor edge of more than 40 mm was associated with a higher risk of pneumothorax complication. Using the area under the receiver operating characteristic (AUROC) curve, a threshold of 23 mm for chest wall to tumor edge and 39.4 mm for skin to tumor edge could help predict pneumothorax with significant sensitivities and specificities.

Conclusions: This retrospective study demonstrated that approximately half of patients undergoing thoracic biopsy experienced complications. It was suggested that pneumothorax could be predicted by measuring the distance from the tumor edge to the chest wall and the skin to have better preoperation preparation and potentially mitigate the issue.

Background: Esophageal squamous cell carcinoma (ESCC) represents a considerable health challenge, primarily due to its poor prognosis and the limited availability of effective therapeutic interventions. Ubiquitination, a vital post-translational modification, is integral to cellular regulation; nonetheless, its role in ESCC has not been thoroughly explored. This study aims to identify ubiquitination-related differentially expressed genes (URDEGs) that possess prognostic significance in the context of ESCC.

Methods: We conducted a comprehensive analysis using The Cancer Genome Atlas ESCC (TCGA-ESCC) dataset, GSE20347, and an in-house ESCC dataset to identify URDEGs. The limma R package was used to determine the intersection of ubiquitination-related genes (URGs) with common differentially expressed genes (Co-DEGs) for differential expression analysis. To evaluate prognostic value, Kaplan-Meier survival analysis was conducted, while functional enrichment was examined using Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) analyses. Validation was performed using real-time quantitative polymerase chain reaction.

Results: Eighty-five URDEGs were identified, with five key genes (BUB1B, CHEK1, DNMT1, IRAK1, and PRKDC) showing significant prognostic value. Analysis revealed that these genes play key roles in essential processes such as the cell cycle and immune response, and their varied expression in ESCC tissues supports their use as targets for therapy.

Conclusions: The results of our study highlight the prognostic significance of URDEGs in ESCC, suggesting that they may serve as useful biomarkers and therapeutic targets. Future research should focus on clinical validation and the development of targeted therapies to improve the outcomes of patients with ESCC.

Background and objective: Farnesoid X receptor (FXR), which is encoded by the NR1H4 gene, is a ligand-activated transcription factor and a member of the nuclear receptor (NR) superfamily. As a receptor for bile acid (BA), FXR has been shown to play a key role in the regulation of BA metabolism, lipid metabolism, and the inflammatory response. This article reviews the roles of FXR in the pathogenesis of various lung diseases, and identifies potential diagnostic indicators or therapeutic targets for these diseases.

Methods: The PubMed and National Center for Biotechnology Information (NCBI) online databases were searched to retrieve relevant articles published from 2000 to 2024.

Key content and findings: FXR was originally found to be expressed in BA-targeted organs, such as the liver and intestine. However, recent studies have shown that FXR is also expressed in "non-classical" BA-targeted organs, such as the lung and blood vessels. FXR is not only involved in the pathophysiology of a series of diseases of the gastrointestinal tract and liver, but is also involved in various lung diseases. Recent evidence suggests that FXR participates in the pathogenesis of lung diseases through multiple mechanisms. In addition, FXR may be a potential therapeutic target for some lung diseases. For example, FXR has been reported to promote the occurrence and development of non-small cell lung cancer (NSCLC) by inducing the expression of programmed death ligand 1 (PD-L1) and subsequently suppressing anti-tumor immunity in the tumor microenvironment.

Conclusions: In this review, we summarized the current knowledge of the roles of FXR in different lung diseases. A better understanding of the roles and mechanisms of FXR in lung diseases will provide new perspectives for the treatment of lung diseases.

Background: Kirschner wires or pins were widely used for osteosynthesis in trauma surgery. Breakage of osteosynthesis material and intra-thoracic migration is a complication that has occasionally been described. We reviewed the literature to study the frequency and pathophysiology of such migrations.

Methods: PubMed and Embase databases were searched for reports of intrathoracic osteosynthesis material migration. Cases were divided according to specific anatomic regions. We studied the time interval between initial operation, types of osteosynthesis material, intactness and trajectory of the material. Operative techniques and the outcome of material retrieval were analyzed.

Results: Of 3,592 potential articles, 102 manuscripts met all inclusion criteria describing 112 individual cases for a total of 124 different migrations. Risk of reporting bias was high. Osteosynthesis material predominately migrated into lung (29.0%), mediastinum (24.2%), major vessels/heart (18.5%), pleural space (9.7%) or spinal canal (13.7%). Migration occurred from four anatomical regions but predominantly the shoulder girdle (73.2%). The migration trajectory was not always predicable. We found that migration was linear in 83.8% (odds ratio 4.8, P=0.002) of reported cases if the origin was the clavicle compared to other regions. Intrapulmonary migrations were associated with a linear trajectory of intact material, while intrapleural migration were associated with non-linear migration of broken material. More than half of all reported migrations (51.8%) occurred later than one year after osteosynthesis, ranging from three days to 360 months. Major open surgery was performed for extraction in 66.9% of cases, video-assisted thoracoscopic surgery (VATS) 14.4% and local shoulder/neck incisions in 12.7%. Intra-thoracic migration was fatal in 4.5%. For osteosynthesis material retrieval from pulmonary parenchyma, VATS was used in only 25% and resulted in shorter hospital stays (T=-1.542, P=0.07), 3.2 days (W=0.890, P=0.47) compared to 6.2 days (W=0.879, P=0.056) for open surgery.

Conclusions: Intrathoracic migration of intact or broken Kirschner wires is not rare and potentially fatal. Migration trajectories and destination are difficult to predict. Systematic long-term radiological follow-up of such osteosynthesis material seems warranted. This review suggests that all intrathoracically migrated osteosynthesis material should be surgically removed. Minimally invasive approaches (VATS) should be considered whenever anatomy and clinical presentation allow this.

Background: Despite the benefits of video-assisted thoracoscopic surgery (VATS), postoperative acute pain and nerve injury are still present and contribute to early persistent and chronic pain. The purpose of this study is to describe the incidence of early persistent pain (EPP) after VATS, which remains unexplored, to enhance patient care and promote awareness among clinicians regarding this clinical condition.

Methods: A single-center prospective cohort study that included consecutive patients undergoing VATS between January 2021 and March 2023. The primary outcome was the incidence of EPP, defined as pain experienced at 3 to 4 weeks follow-up. Secondary outcomes were risk factors associated with EPP, characteristics during physical examination, acute postoperative pain scores, the use of additional analgesia and complications between patients with and without EPP.

Results: Of 117 patients, 16.2% [95% confidence interval (CI): 9-23%] developed EPP. The presence of acute postoperative pain was the only risk factor for EPP. The pain was mostly localized at the utility and ventral incision. Hyperesthesia, hypoesthesia and a positive pinch test were the most common sensory disturbances. Patients with EPP showed significantly higher acute pain scores until postoperative day (POD) 4, more frequently used additional opioids until POD 2, and had comparable complications.

Conclusions: Early persistent postoperative pain is present in 16.2% of patients after VATS. Acute postoperative pain is the strongest risk factor for developing such persistent pain. This underlines that awareness of clinicians for strategies that optimize postoperative pain management is of utmost importance.