Journal of thoracic disease最新文献

Background: The patterns of bronchopulmonary vascular bifurcation within the lung exhibit considerable diversity. To perform safe and accurate anatomical pulmonary resections, an understanding of the anatomy of the pulmonary vessels and bronchi, including variations, is of utmost importance to general thoracic surgeons.

Case description: We performed a 3-dimensional (3D) computed tomography (CT) reconstruction of the pulmonary vessels and bronchi for a 66-year-old female patient. From the 3D reconstruction, we were able to observe clearly that this patient had complex variations in the right pulmonary artery, vein, and bronchus. Not only the bronchi and vessels of the right upper lobe, but also the vessels and bronchi of the middle and lower lobes are also variable. Due to this, we performed video-assisted right upper lobectomy and mediastinal lymph node dissection for her without misjudgment of the pulmonary vessels and bronchi. The patient recovered well and was discharged after 3 days.

Conclusions: We first report a very rare case involving complex variations in the right pulmonary artery, vein, and bronchus in a single patient using 3D reconstruction technology. We hope this article can remind all thoracic surgeons to evaluate the variations of pulmonary blood vessels and bronchi thoroughly and comprehensively before surgery and formulate appropriate surgical plans to ensure the successful implementation of the surgery.

Background: Asthma is a chronic respiratory disease that affects billions of people. Due to its diverse phenotypes and endotypes with distinct pathophysiological mechanisms, significant challenges arise in its clinical diagnosis and treatment. The discovery of potential biomarkers of asthma has significant implications for its clinical classification and precise treatment. The purpose of this study is to identify potential biomarkers for asthma, providing a foundation for its diagnosis and treatment.

Methods: We constructed an ovalbumin (OVA)-sensitized asthmatic mice model and used isobaric Tags for Relative and Absolute Quantitation (iTRAQ) labeling and liquid chromatography-mass spectrometry/mass spectrometry (LC-MS/MS) technology to identify differentially expressed proteins (DEPs) in lung tissues. We then performed enrichment analyses of the DEPs using the Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) databases, and constructed protein-protein interaction (PPI) networks.

Results: We identified 242 DEPs in the asthmatic mice model and showed that heat shock protein family A (Hsp70) member 5 (HSPA5) is a central protein in asthma. Consistent with our bioinformatics analysis, our western blot validation confirmed that the protein levels of arginase 1 (ARG1), chitinase-like protein 3 (CHIL3), chloride channel accessory 1 (CLCA1), and bactericidal/permeability-increasing protein (BPI) fold-containing family B member 1 (BPIFB1) were significantly increased in asthma group compared to the control group. Thus, we found that CLCA1 and BPIFB1 were the most promising potential biomarkers of asthma.

Conclusions: Our iTRAQ analysis and western blot verification of asthmatic mice showed that HSPA5 is a central protein in asthma, and CLCA1 and BPIFB1 are novel potential biomarkers that could play significant roles in the diagnosis and treatment of asthma.

Thoracic outlet syndrome (TOS) is a rare condition resulting from the compression of the brachial plexus and/or the subclavian vessels in the thoracic outlet (TO). Neurogenic TOS (NTOS) is the most common form in up to 95% of the cases, while venous TOS (VTOS) occurs in 3-5% and arterial TOS (ATOS) in 1-2% of the cases. Patients may suffer from the pathologic coexistence of arterio-venous compression in the TO called arterio-venous TOS (AVTOS) with an overlap of clinical symptoms. While imaging studies such as computed tomography (CT)-angiography, magnetic resonance imaging (MRI)-angiography and duplex sonography are helpful to detect the underlying condition in vascular pathologies, electrodiagnostic testing is necessary to distinguish NTOS from other peripheral neuropathies. Subclavian vein (SV)-compression in the TO can result in venous thrombosis, called Paget-Schroetter syndrome (PSS), named after the discoverers of the disease. Besides oral anticoagulation in cases with venous upper extremity thrombosis and multimodal conservative treatment in the management of NTOS, surgical decompression is the current standard of care for TOS. Surgical decompression aims to remove structures compressing the brachial plexus or the subclavian vasculature in the TO. In NTOS, when conservative management has failed, surgical resection of the 1^st or a cervical rib is often combined with scalenectomy and brachial plexus neurolysis. Minimally invasive techniques have replaced traditionally open supra-, infraclavicular or transaxillary approaches with excellent results and minimal morbidity. Video-assisted thoracoscopic surgery (VATS) was described to offer better visualization, shorter length of stay (LOS) and less neurovascular injuries attributable to less traction applied. Robotic-assisted thoracoscopic surgery (RATS) moreover, further improved magnification, angulation of the surgical instruments in narrow anatomical spaces and the comfort for the operating surgeon. Uniportal RATS (uRATS) has lately been applied for 1^st rib resection. The aim of this surgical technique manual is to describe and illustrate a RATS 1^st rib resection with its advantages over traditionally open approaches step by step.

Chronic cough is a complex disorder that affects up to 5-10% of the general population. It can be challenging to manage as there are few effective treatments, although several novel antitussives are in clinical development. The endpoints used to assess their efficacy in clinical trials should be optimal; most large clinical trials currently use objective measures as the primary outcome, especially cough frequency. There are strengths in this approach, although taking the view that other measures of chronic cough are less important, including patient-rated cough severity, psychosocial impact and other associated symptoms. Patient-reported outcome measures (PROMs) explore patients' personal experiences of health and disease, and the effects of particular conditions on their lives. Numerous validated PROMs exist for chronic cough, from simple visual analogue scales, to those that focus on cough hypersensitivity and cough-specific quality of life. Medicine regulators in the European Union (EU) and United States of America (USA) encourage the use of PROMs in clinical trials but have voiced concerns over their content validity, clinically meaningful thresholds for change, and discordance with objective measures. There are recent and ongoing studies to address these limitations. This review discusses currently available PROMs used to assess chronic cough and discusses their potential role as primary outcome measures in clinical trials.

Lung cancer is still a leading cause of cancer-related deaths worldwide. Vital to ameliorating patient survival rates are early detection, precise evaluation, and personalized treatments. Recent years have witnessed a profound transformation in the field, marked by intricate diagnostic processes and intricate therapeutic protocols that integrate diverse omics domains, heralding a paradigm shift towards personalized and preventive healthcare. This dynamic landscape has embraced the incorporation of advanced machine learning and deep learning techniques, particularly artificial intelligence (AI), into the realm of precision medicine. These groundbreaking innovations create fertile ground for the development of AI-based models adept at extracting valuable insights to inform clinical decisions, with the potential to quantitatively interpret patient data and impact overall patient outcomes significantly. In this comprehensive narrative review, a synthesis of various studies is presented, with a specific focus on three core areas aimed at providing clinicians with a practical understanding of AI-based technologies' potential applications in the diagnosis and management of non-small cell lung cancer (NSCLC). The emphasis is placed on methods for diagnosing malignancy in lung lesions, approaches to predicting histology and other pathological characteristics, and methods for predicting NSCLC gene mutations. The review culminates in a discussion of current trends and future perspectives within the domain of AI-based models, all directed toward enhancing patient care and outcomes in NSCLC. Furthermore, the review underscores the synthesis of diverse studies, accentuating AI applications in NSCLC diagnosis and management. It concludes with a forward-looking discussion on current trends and future perspectives, highlighting the LANTERN Study as a pioneering force set to elevate patient care and outcomes to unprecedented levels.

Background: Acute lung injury (ALI)/acute respiratory distress syndrome (ARDS) has long posed challenges in clinical practice, lacking established preventive and therapeutic approaches. Lianhua Qingke (LHQK), a patented traditional Chinese medicine (TCM), has been found to have anti-inflammatory effects for ameliorating ALI/ARDS induced by lipopolysaccharide (LPS). This study aimed to investigate the effects and potential mechanisms of LHQK on endothelial protection in LPS-induced ALI/ARDS in vivo and in LPS-induced human pulmonary microvascular endothelial cells (HPMECs) injury in vitro.

Methods: In the animal experiment, we induced an ALI/ARDS model by intratracheal injection of LPS (5 mg/mL). LHQK (3.7 g/kg/d for low dose and 7.4 g/kg/d for high dose) or dexamethasone (DEX) (5 mg/kg/d) was administered to mice 3 days prior to LPS treatment. In the in vitro experiments, HPMECs were pretreated with LHQK at concentrations of 125 and 250 µg/mL for 2 hours before being stimulated with LPS (10 µg/mL). We employed lung function test, measurement of lung index, hematoxylin and eosin (H&E) staining, bronchoalveolar lavage fluid (BALF) cell counts, and inflammatory cytokine levels to assess the therapeutic effect of LHQK. Additionally, the extravasation assay of fluorescein isothiocyanate-dextran (FITC-dextran) dye and the transmembrane electrical resistance (TEER) assay were used to evaluate endothelial barrier. Barrier integrity and relevant protein validation were assessed using immunofluorescence (IF) and Western blot analyses. Furthermore, network pharmacology analysis and cellular level screening were employed to predict and screen the active ingredients of LHQK.

Results: Compared to the LPS group, LHQK significantly improved lung function, mitigated lung pathological injuries, reduced inflammatory cells and inflammatory cytokines [tumor necrosis factor (TNF)-α, interleukin (IL)-1β, and IL-6] levels in BALF, and inhibited the expression of vascular cell adhesion molecule-1 (VCAM-1), attenuated LPS-induced pulmonary oedema and FITC-dextran permeability, and enhanced the expression of vascular endothelial-cadherin (VE-cadherin) and occludin. In vitro, LHQK attenuated LPS-induced HPMECs injury by elevating TEER values and enhancing VE-cadherin and occludin protein levels. Finally, network pharmacology analysis and cellular level validation identified potential active ingredients of LHQK.

Conclusions: In summary, LHQK can mitigate LPS-induced inflammatory infiltration, pulmonary edema, and pulmonary vascular endothelial barrier dysfunction in the context of ALI/ARDS. This is achieved by decreasing the levels of VCAM-1, and increasing the expression levels of barrier-associated junctions, such as VE-cadherin and occludin. Consequently, LHQK exhibits promising therapeutic potential in preventing the progression of ALI/ARDS.

Background: Pulmonary nodules are an early manifestation of many lung cancers, and patients with diabetes are at high risk for lung cancer. However, there is a lack of epidemiological data on pulmonary nodules in patients with diabetes. This study investigated the prevalence rate of pulmonary nodules in hospitalized patients with diabetes and analyzed its influencing factors, with the aim of generating data to inform the management of pulmonary nodules in patients with diabetes.

Methods: This retrospective study included 1,864 patients with diabetes admitted to the Department of Endocrinology and Metabolism in the North District of Suzhou City Hospital from January 2020 to November 2022. According to the chest computed tomography (CT) examination, the patients were divided into two groups: a no pulmonary nodules group and a pulmonary nodules group. The prevalence rate of pulmonary nodules was calculated, and the number, size, nature, and other imaging characteristics of pulmonary nodules were compared. The pulmonary nodule group was divided into three subgroups according to the following nodule diameters: <5, ≥5 and <10, and ≥10 and ≤30 mm. The clinical data, blood biochemistry, insulin resistance index, and serum tumor marker levels were recorded. A multinomial logistic regression model was used to analyze the influencing factors of pulmonary nodule in diabetic patients.

Results: Among the 1,864 hospitalized patients with diabetes, 1,407 were found to have pulmonary nodules, representing a total prevalence rate of 75.48%. Compared with the pulmonary nodules subgroups, the no pulmonary nodules group had a higher proportion of males, a lower smoking rate, and higher incidence of proteinuria (all P values <0.05). Compared with the group with a nodule diameter ≥5 and <10 mm and that with a nodule diameter ≥10 and ≤30 mm, the no pulmonary nodules group had a lower age, insulin use rate, and homocysteine (Hcy) levels but higher fasting and 2-hour postprandial C-peptide level, low-density lipoprotein cholesterol (LDL-C) level and insulin resistance index [Homeostatic Model Assessment for Insulin Resistance 2 (HOMA2IR)] (all P values <0.05). The usage rate of dipeptidyl peptidase 4 (DPP4) inhibitor in the no pulmonary nodules group was lower than that in the subgroup with a nodule diameter ≥5 and <10 mm (P<0.05). Multinomial logistic regression analysis showed that age, smoking, and use of DPP4 inhibitors were independent risk factors for pulmonary nodules. DPP4 inhibitors increased the risk of nodules ≥5 and <10 mm in size, while older age and smoking increased the risk of nodules ≥5 mm in size (all P values <0.05).

Conclusions: The prevalence of pulmonary nodules in hospitalized patients with diabetes is up to 75.48%. Older age, smoking, and use of DPP4 inhibitors were found to be independent risk factors for pulmonary nodule development in diabetic patients.

Background: Minimally invasive procedures are increasingly implemented in aortic valve replacement (AVR) surgeries to minimize surgical trauma and achieve early patient recovery. We aimed to compare between short- and mid-term outcomes for isolated AVR using the representative minimally invasive approaches of right anterior mini-thoracotomy (RAMT) and partial upper sternotomy [J-sternotomy (JS)].

Methods: Patients (n=832) who had undergone surgical AVR between March 2009 and September 2022 were included. We retrospectively examined and compared data from these two minimally invasive approaches, and performed propensity score matching to account for differences in patient baseline characteristics. Early outcomes and late mortality were compared between the matched groups.

Results: After applying exclusion criteria, the study comprised 315 patients who underwent RAMT and 92 who underwent JS. Patients who underwent JS had more comorbidities, compared with those who underwent RAMT. Propensity score matching of 16 variables yielded similar groups for comparison (n=90). Thirty-day mortality was similar between the two groups (0% vs. 1%, respectively; P>0.99). In the RAMT group, the rate of on-table extubation was significantly higher (P<0.001), whereas the blood transfusion rate was lower and length of stay was shorter, compared with the JS group. The 5-year survival rate was higher in the RAMT group than in the JS group (95.0% vs. 85.6%, respectively; P=0.03).

Conclusions: AVR via RAMT was associated with improved early clinical outcomes, shorter length of stay, and increased survival, compared with JS. Despite the technical challenges associated with RAMT, this procedure can be considered a primary strategy for isolated AVR.