Journal of thoracic disease最新文献

Background: Delirium is a frequent and serious complication in critically ill patients, particularly those receiving extracorporeal membrane oxygenation (ECMO), and is associated with increased morbidity and mortality. This study aimed to evaluate the association between different sedation drugs and the occurrence of delirium in patients receiving ECMO, as well as to explore other potential risk factors by analyzing baseline characteristics and laboratory findings.

Methods: A retrospective cohort study was conducted on patients receiving ECMO who were monitored for delirium. Baseline characteristics, laboratory findings, and the duration and types of sedative drugs used were analyzed to determine their association with delirium. Logistic regression analysis was performed to evaluate the effect of sedatives on delirium risk.

Results: Of the 51 patients on ECMO (mean age: 56 years; males: 39), 34 developed delirium, while 17 did not. Significant differences were observed in the use of tracheostomy and sedative drug combinations between groups. Logistic regression revealed that midazolam was associated with a significantly higher risk of delirium (odds ratio: 15.39, 95% confidence interval: 2.14-110.70), whereas sufentanil and dexmedetomidine did not show significant associations.

Conclusions: Midazolam use was strongly associated with increased delirium risk in patients on ECMO, whereas sufentanil and dexmedetomidine were not associated with delirium. These findings highlight the importance of sedative management in critically ill patients undergoing ECMO.

Background: The prognostic significance of body composition phenotypes for patients undergoing emergency surgical intervention for acute type A aortic dissection (ATAAD) remains unclear. This study aimed to evaluate the impact of different body composition parameters on postoperative outcomes in ATAAD patients.

Methods: A single-institution retrospective cohort study was conducted on patients who underwent emergency surgery for ATAAD between January 2016 and December 2021. Body composition analysis was performed using preoperative computed tomography (CT) scans, with skeletal muscle area, muscle quality, subcutaneous adipose tissue (SAT) area and visceral adipose tissue area (VAT) quantified at the third lumbar vertebra (L3) level. These parameters were analyzed for their association with early mortality, postoperative complications, and the durations of hospital and intensive care unit (ICU) stays.

Results: Among 755 included patients (mean age 51.2±10.7 years; 84.4% male), sarcopenia and myosteatosis prevalence was 16.6% and 53.8%, respectively. Multivariable analyses identified myosteatosis as an independent predictor of prolonged overall hospital stay [β=3.02 days, 95% confidence interval (CI): 0.871-5.169; P=0.006] and ICU stay (β=1.835 days, 95% CI: 0.35-3.313; P=0.02). No statistically significant associations were observed for sarcopenia, SAT or VAT with any measured clinical outcomes.

Conclusions: In ATAAD patients, body composition was not associated with early mortality or major complications, suggesting that emergency surgery should be considered across different phenotypes. Moreover, myosteatosis was independently associated with prolonged hospitalization and ICU stay, which may aid in postoperative risk stratification.

Background: Statins, widely prescribed for hypercholesterolemia, have demonstrated potential anti-neoplastic properties in preclinical studies. Despite growing interest in their oncologic effects, the role of statin therapy within curative treatment of esophageal cancer remains unexplored. This study aimed to evaluate the impact of statin use on pathologic complete response (pCR) rate, disease-free survival (DFS), and overall survival (OS) in patients undergoing neoadjuvant chemo(radio)therapy followed by esophagectomy.

Methods: All consecutive patients with esophageal or gastroesophageal junction cancer who underwent esophagectomy following neoadjuvant therapy between March 1994 and September 2013 were retrospectively analyzed using a prospectively maintained database. Baseline demographic and clinical variables were compared between statin users and non-users.

Results: A total of 463 patients were included, of whom 90 (19.4%) were statin users at diagnosis. Neoadjuvant chemotherapy (CT) was administered in 88 patients (19%) and chemoradiotherapy (CRT) in 375 patients (81%). pCR (ypT0N0M0) was achieved in 85 patients (18%), with no statistically significant difference between statin users and non-users (22.2% vs. 17.4%, P=0.29). Median DFS (45 vs. 40 months, P=0.25) and OS (44 vs. 42 months, P=0.28) were also not significantly different between the two groups. However, a non-significant trend toward improved DFS was identified in patients with esophageal adenocarcinoma receiving lipophilic statin therapy.

Conclusions: In this cohort, statin use was not associated with improved pathologic response or survival outcomes following neoadjuvant therapy for esophageal cancer. These findings do not support modification or discontinuation of statin therapy in this patient population.

Background: Non-A non-B aortic dissection (NANB-AD) is a rare and heterogeneous subtype involving the aortic arch and descending aorta without ascending aortic involvement, and its optimal management remains controversial, particularly in the setting of different primary entry tear locations. Evidence on the early and long-term outcomes of total arch replacement combined with frozen elephant trunk (TAR with FET) in NANB-AD is still limited. This study aimed to evaluate the early and long-term outcomes of TAR with FET in NANB-AD patients with different primary tear locations.

Methods: We retrospectively collected data from patients with NANB-AD who underwent TAR with FET between 2010 and 2022. Patients were stratified into two groups based on the primary tear location: the arch entry group and the descending entry group. Clinical data were collected and long-term follow-up was conducted through August 2024. Primary outcomes included survival, freedom from aortic reintervention, and quality of life measured by activity of daily living (ADL). Competing risk analysis was conducted to assess postoperative mortality and aorta-related reintervention.

Results: A total of 63 patients with NANB-AD were included, with 31 patients in the arch entry group and 32 patients in the descending entry group. Early outcomes included 2 perioperative deaths (3%) and 2 cases of permanent neurological deficit (3%). After a median follow-up of 4 years, 2 additional all-cause deaths (3%) occurred. Five patients (8%) required aortic-related reinterventions, including 2 thoracic endovascular aortic repairs (TEVARs) and 3 thoracoabdominal aortic replacements. Kaplan-Meier analysis demonstrated comparable long-term survival between groups (P=0.30), and competing risk model analysis showed no significant difference in reintervention rates. Functional assessment revealed that 54 patients (91.5%) were able to resume standard physical activities postoperatively.

Conclusions: TAR with FET represents an effective surgical strategy for NANB-AD with favorable early and long-term outcomes. The anatomical location of the primary tear does not significantly influence surgical efficacy, suggesting that this approach is suitable for NANB-AD regardless of entry tear position.

Background: Degenerative mitral regurgitation (DMR) is a cardiovascular condition marked by progressive degeneration of the mitral valve, leading to complications such as heart failure and atrial fibrillation. Despite advancements, research trends and knowledge gaps remain inadequately addressed. Therefore, this study aimed to perform a comprehensive bibliometric analysis of DMR-related research to identify publication trends, influential contributors, and emerging research themes.

Methods: A bibliometric analysis was conducted on articles related to DMR published from 2004 to 2024, retrieved from the Web of Science Core Collection (WoSCC) database. Data were analyzed using Microsoft Excel, R-bibliometrix, VOSviewer, and CiteSpace to evaluate publication trends, international collaborations, key contributors, and emerging research themes.

Results: A total of 2,349 publications were identified, with an annual growth rate of 4.07%, involving 12,474 contributors from 79 countries. The USA led with 726 publications and 37,386 citations. Leading institutions included Mayo Clinic and Harvard University. The top journals were the Journal of the American College of Cardiology, Circulation, and The Journal of Thoracic and Cardiovascular Surgery. The most influential author was Enriquez-Sarano Maurice, followed by Delling Francesca N. and Pepi Mauro. Keyword analysis identified central themes such as "regurgitation", "surgery", and "echocardiography", with emerging topics like "mitral valve repair" and "transcatheter interventions".

Conclusions: This bibliometric analysis highlights significant advancements in DMR research, particularly in surgical techniques and imaging modalities, and provides a foundation for future studies aimed at improving patient outcomes.

Background: Platinum-based adjuvant chemotherapy improves survival in resectable non-small cell lung cancer (NSCLC), but its benefit in undernourished patients-who are often excluded from clinical trials-remains unclear. Simple, objective indices that identify patients unlikely to benefit from platinum-based regimens could help individualize perioperative treatment. This study aimed to clarify whether preoperative nutritional status, particularly the controlling nutritional status (CONUT) score, predicts the survival benefit of platinum-based adjuvant chemotherapy in resectable pathological stage IIA-IIIA NSCLC.

Methods: We conducted a single-center retrospective cohort study of consecutive patients with pathological stage IIA-IIIA NSCLC who underwent complete lobectomy at Tohoku University Hospital between January 2010 and December 2018. Preoperative nutritional status was evaluated using the C-reactive protein-albumin ratio (CAR), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), prognostic nutritional index (PNI), and CONUT score. Patients were categorized into surgery-only and platinum-based adjuvant chemotherapy groups. Overall survival (OS) was estimated by the Kaplan-Meier method and compared using the log-rank test. Hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated using Cox proportional hazards models stratified by nutritional indices, with particular focus on the CONUT score (low, 0-1; high, ≥2).

Results: Among 135 eligible patients (median age, 70 years; 68.1% male), 68 (50.4%) received platinum-based adjuvant chemotherapy. Depending on the index used, 38.5-62.2% of patients were classified as undernourished; 45.9% had high CONUT scores. In patients with low CONUT scores, adjuvant chemotherapy was associated with significantly improved OS compared with surgery alone (HR 0.318, 95% CI: 0.137-0.737; P=0.008), and platinum-based therapy remained an independent prognostic factor in multivariable analysis (HR 0.065, 95% CI: 0.010-0.423; P=0.004). In contrast, in patients with high CONUT scores, adjuvant chemotherapy did not significantly improve OS (HR 0.539, 95% CI: 0.227-1.277; P=0.16). Other nutritional indices did not clearly discriminate the benefit of adjuvant chemotherapy.

Conclusions: The preoperative CONUT score appears useful for identifying resectable stage IIA-IIIA NSCLC patients who are likely to benefit from platinum-based adjuvant chemotherapy. Patients with low CONUT scores derive substantial survival benefit, whereas those with high CONUT scores appear to gain limited benefit. CONUT-based risk stratification may help individualize perioperative systemic therapy, especially in the era of immune checkpoint inhibitors (ICIs) and molecular targeted agents.

Background: Noncalcified coronary plaque is prone to rupture and may lead to major adverse cardiovascular events (MACEs). The pericoronary fat attenuation index (FAI), derived from coronary computed tomographic angiography (CCTA), is an emerging marker of coronary inflammation. This study aimed to assess the predictive value of the FAI for vulnerable plaque and prognosis in patients with coronary heart disease (CHD).

Methods: We retrospectively enrolled 453 patients with CHD who underwent CCTA and were followed for 3 years. Patients were divided into a MACE group (n=103) and a control group (n=350) based on the occurrence of MACEs. The FAI was measured using artificial intelligence software at the site of the most severe coronary stenosis. Clinical characteristics, coronary plaque burden, and FAI were compared between groups. Multivariate logistic regression identified independent predictors of MACEs, and a nomogram prediction model was developed and validated.

Results: Patients with MACEs had significantly higher age, greater total and noncalcified plaque burden, lower left ventricular ejection fraction (LVEF), higher FAI, and a greater prevalence of the multivessel disease. Independent predictors of MACEs included age ≥80 years [relative risk (RR) 12.39, 95% confident interval (CI): 5.75-26.69], LVEF <50% (RR 8.73, 95% CI: 4.10-18.58), total coronary plaque burden >33.3% (RR 4.27, 95% CI: 2.23-8.18), increased FAI (RR 1.08, 95% CI: 1.05-1.11), and multivessel disease (RR 3.14, 95% CI: 1.67-5.90) with all P<0.001. The nomogram model demonstrated strong predictive performance, with area under the curve (AUC) values of 0.920 and 0.862 in the training and validation sets, respectively. FAI was significantly correlated with noncalcified plaque burden (r=0.234, P<0.001).

Conclusions: FAI is associated with coronary noncalcified plaque burden and is an independent predictor of MACEs in patients with CHD. A prediction model incorporating the FAI demonstrated promising efficacy in identifying high-risk patients, supporting its potential role in personalized risk stratification.

Current surgical planning relies on conventional two-dimensional (2D) imaging, but this is limited by its inability to fully represent three-dimensional (3D) anatomical relationships. This limitation is particularly evident in thoracic surgery, where accurate visualization of the pulmonary bronchovascular anatomy is essential for planning lung resections in a surgical field that has high anatomical variations and dynamic deformation during surgery. Although 3D reconstruction techniques have been explored to address these limitations, their adoption into routine clinical practice has been constrained by reliance on expensive proprietary software and a lack of detailed, efficient, reproducible workflows. Here, we describe a novel, practical imaging-based approach for generating patient-specific 3D reconstructions of pulmonary anatomy from computed tomography (CT) data using 3D Slicer, an open-source platform for imaging segmentation and 3D modelling. A reproducible step-by-step workflow is presented, detailing segmentation of pulmonary arteries, veins, bronchi, tumour localization, and resection margin assessment, together with common pitfalls, troubleshooting strategies, and factors influencing accuracy and efficiency. The workflow is designed to be intuitive and time-feasible, with model generation achievable within routine pre-operative planning timeframes. The process is demonstrated through two representative cases in which 3D reconstruction altered surgical planning by clarifying ambiguous anatomy, enabling precise pulmonary tumour localization and accurate resection. With the use of 3D reconstruction technology, anatomical understanding and operative precision can be enhanced, supporting more informed surgical decision-making and potentially improving patient outcomes.

Background: Compensatory hyperhidrosis (CH) remains the most prevalent postoperative adverse event following endoscopic thoracic sympathectomy (ETS) for primary hyperhidrosis (PH). Current predictive models lack reliability in estimating CH severity. This study introduces a novel predictive framework utilizing rough set theory to establish decision rules for CH stratification.

Methods: In this single‑center retrospective cohort study, clinical data from 225 PH patients undergoing ETS were analyzed, including 37 predictive indicators. These variables were subjected to correlation analysis, regression analysis, and rough set analysis with CH severity.

Results: There were 93.3% (210/225) of patients exhibiting CH following ETS, with 33.3% classified as grade III CH, and no grade IV CH was noted. Body mass index (BMI), the level of sympathectomy, and the temperature difference of the right hand after surgery and before anaesthesia were shown to be significantly correlated with CH on correlation analysis. However, no valid regression model was established with significant correlations involving indicators for further regression analysis. By switching to rough set analysis, four predictive rules for grade III CH were derived: (I) BMI >22 kg/m² + initial onset age of PH >11 years, 84% accuracy; (II) BMI 19.5-22 kg/m² + surgical age >28.5 years, 82% accuracy; (III) BMI 18.5-19.4 kg/m² + postoperative right-hand temperature >36.6 ℃, 77% accuracy; (IV) BMI <18.5 kg/m² + postoperative right-hand temperature <37.0 ℃ + initial PH onset age <10 years, 71% accuracy.

Conclusions: Rough set analysis provides a promising approach for exploring the patterns of CH severity following ETS in patients with PH, and thus which merits further investigation through multicenter, large-sample studies. The four preliminary decision rules for predicting grade III CH derived from rough set analysis show potential clinical relevance but remain tentative, as their utility requires validation in prospective cohorts prior to widespread clinical application.

Background: Neoadjuvant chemo-immunotherapy improves overall survival in resectable stage II-III non-small cell lung cancer (NSCLC). Post-induction re-staging remains challenging and typically relies on contrast-enhanced computed tomography (CT). We assessed the predictive value of ¹⁸F-fluorodeoxyglucose (¹⁸F-FDG) positron emission tomography/computed tomography (PET/CT) for tumor pathologic response and patient survival after induction therapy.

Methods: We analyzed all stage II-III, node-positive NSCLC patients from a collected database [2017-2023] who received neoadjuvant chemo-immunotherapy followed by surgery, with pre- and post-induction cancer assessment by ¹⁸F-FDG PET/CT. We identified 37 patients and determined their demographic characteristics, initial tumor burden, surgical outcomes, pathologic response and overall survival. We then correlated cancer pathologic response and patient overall survival with the mean and max standard uptake value change (ΔSUV) of the primary tumor and lymph nodes between the pre- and post-induction ¹⁸F-FDG PET/CTs using receiver operating characteristic (ROC) and Kaplan-Meier analyses, respectively.

Results: Seventeen women and 20 men (mean age 64±7 years) had mostly stage III adenocarcinomas. Open lobectomies (59%) were the most common procedures. Ninety-two percent of resections were R0. Major pathologic response (MPR) and pathologic complete response (pCR) occurred in 51% and 30% of patients, respectively. Mean/max tumor ΔSUV predicted pCR [area under the curve (AUC) =0.8135, P=0.004/AUC =0.8086, P=0.005] but mean/max lymph node ΔSUV predicted pCR better (AUC =0.9044, P<0.001/AUC =0.8990, P<0.001). A 70% decrease in lymph node ΔSUVmax between pre- and post-induction PET/CT predicted pCR with a sensitivity of 88% and a specificity of 78% and correlated with patient overall survival.

Conclusions: Significant decrease in lymph node ΔSUVmax on PET/CT after neoadjuvant chemo-immunotherapy strongly predict pCR and overall survival. Further prospective validation is required.