Journal of thoracic disease最新文献

{"title":"Factors influencing management modifications following fiberoptic bronchoscopy in critically ill ICU patients.","authors":"Chailat Maluangnon, Surat Tongyoo, Preecha Thomrongpairoj, Supparerk Disayabutr","doi":"10.21037/jtd-24-1040","DOIUrl":"https://doi.org/10.21037/jtd-24-1040","url":null,"abstract":"<p><strong>Background: </strong>Fiberoptic bronchoscopy (FOB) has evolved into a crucial diagnostic and therapeutic procedure for respiratory tract conditions over the years. Despite its benefits, this approach poses increased risks to critically ill patients. This study aimed to identify clinical parameters that influence management modifications after FOB in the general intensive care unit (ICU) population, an area not extensively explored.</p><p><strong>Methods: </strong>In this retrospective study, critically ill adults admitted to a medical ICU in Bangkok, Thailand, who underwent FOB between January 2013 and December 2022 were enrolled. Clinical parameters, imaging findings, and indications were analyzed to identify factors associated with modifications in post-bronchoscopic management.</p><p><strong>Results: </strong>A total of 118 patients were reviewed and management modifications occurred in 69 patients (58.5%), in which antibiotic modification (78.3%) was the leading reason. Chronic steroid use and suspected interstitial lung disease were associated with management modifications after FOB, while alveolar infiltration on chest radiography was not. Although management modifications showed a trend toward lower mortality, statistical significance was not reached. Multivariate analysis identified chronic steroid use as the only independent factor [adjusted odds ratio (aOR): 2.26; 95% confidence interval (CI): 1.01-5.06; P=0.048].</p><p><strong>Conclusions: </strong>Among critically ill patients, chronic steroid use was a predictor of management modifications after FOB and is likely to be beneficial.</p>","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11494594/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142502975","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The ratio of lymph node eluate/serum cytokeratin 21-1 is a potential predictor of lymph node metastasis in lung adenocarcinoma.","authors":"Shihao Xu, Tianqi Hu, Chenkang Zhou, Min Wang, Jiachun Jiang, Yumin Wang, Caihong Wang","doi":"10.21037/jtd-24-410","DOIUrl":"https://doi.org/10.21037/jtd-24-410","url":null,"abstract":"<p><strong>Background: </strong>Lymph node metastasis (LNM) plays an important role in prognosis of lung cancer, either in preoperative TNM staging or postoperative disease recurrence or progress. This study aimed to explore the diagnostic performances of biomarkers from lymph node eluate for LNM in lung adenocarcinoma (LUAD).</p><p><strong>Methods: </strong>A prospective analysis was conducted based on lymph node eluate specimens collected via ultrasound-guided lymph node biopsy from 48 LUAD patients with suspected LNM in the neck. According to cytopathological results, the patients were categorized into two groups: one with LNM and the other with non-LNM (NLNM). Carcinoembryonic antigen (CEA), cytokeratin 21-1 fragment (CYFRA21-1), neuron-specific enolase (NSE) and gastrin precursor releasing peptide (ProGRP) in lymph node eluate were detected by immunoassay analyzers, and tumor marker was simultaneously collected in serum of patients.</p><p><strong>Results: </strong>The serum levels of CEA, CYFRA21-1, NSE, and the ratios of CYFRA21-1 and NSE in the lymph node eluate to serum were significantly higher in the LNM group, compared to NLNM group. The areas under curves (AUCs) for CEA, CYFRA21-1, NSE, and ratios of CYFRA21-1 and NSE were 0.79, 0.91, 0.85, 0.93, and 0.89, respectively. The ratio of CYFRA21-1 in lymph node eluate to serum (rCYFRA21-1) performed best in diagnosing, with a sensitivity of 92.3%, a specificity of 92.9%, and an AUC of 0.93.</p><p><strong>Conclusions: </strong>The rCYFRA21-1 to that in the serum might serve as a potential predictor for LNM in LUAD.</p>","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11494544/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142502977","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prediction of hemoptysis in patients with anomalous systemic arterial supply to normal basal segments of the lower lobe using a combination of CT features and clinical materials.","authors":"Yi-Fan Zhang, Qiong Zhao, Heshui Shi","doi":"10.21037/jtd-24-738","DOIUrl":"https://doi.org/10.21037/jtd-24-738","url":null,"abstract":"<p><strong>Background: </strong>Anomalous systemic arterial supply to the normal basal segments of the lower lobe (ASALL) is a rare anomaly with a common complication of hemoptysis. To estimate the risk of hemoptysis, this study aims to investigate the value of contrast-enhanced computed tomography (CT) and construct a risk-scoring model based on radiological features and clinical materials of patients with ASALL.</p><p><strong>Methods: </strong>Forty-three eligible individuals (17 women and 26 males), who underwent multiphase contrast-enhanced CT, were included in this study. Hemoptysis was predicted by combined systemic arterial features (C_D-A) and combined demographic and radiological features (C_D-R). Potential hemoptysis predictors were identified using multivariate regression analysis. A receiver operating characteristic (ROC) curve analysis was used to assess the prediction efficiency. The coefficient of regression model was used to build a combined risk scoring (C_RS) model for hemoptysis. The decision curve analysis (DCA) was performed to evaluate the clinical usefulness of the risk-scoring model.</p><p><strong>Results: </strong>Hemoptysis was present in 17 (39.5%) ASALL patients. The areas under the curve (AUCs) for the predicted performance of C_D-A and C_D-R were 0.869 and 0.890, respectively. Independent predictors generated a scoring model using the formula C_RS = 3 × age + 3 × sex + 4 × [ground glass opacity (GGO)] + 3 × (C_D-A >0.522). The prediction performance of this model was displayed with an AUC of 0.939. This scoring model was demonstrated to be significantly preferable to C_D-A (P=0.046) and C_D-R (P=0.02) by the Hanley and McNeil test. The DCA showed that the C_RS model was more beneficial when the threshold probability was between 5% and 92%.</p><p><strong>Conclusions: </strong>The scoring model offers a viable method for evaluating the risk of hemoptysis in patients with ASALL by combining radiological and clinical data.</p>","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11494567/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142503008","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lung field-based severity score (LFSS): a feasible tool to identify COVID-19 patients at high risk of progressing to critical disease.","authors":"Xin'ang Jiang, Jun Hu, Qinling Jiang, Taohu Zhou, Fei Yao, Yi Sun, Qingyang Liu, Chao Zhou, Kang Shi, Xiaoqing Lin, Jie Li, Yueze Li, Qianxi Jin, Wenting Tu, Xiuxiu Zhou, Yun Wang, Xiaoyan Xin, Shiyuan Liu, Li Fan","doi":"10.21037/jtd-24-544","DOIUrl":"https://doi.org/10.21037/jtd-24-544","url":null,"abstract":"<p><strong>Background: </strong>Coronavirus disease 2019 (COVID-19) still poses a threat to people's physical and mental health. We proposed a new semi-quantitative visual classification method for COVID-19, and this study aimed to evaluate the clinical usefulness and feasibility of lung field-based severity score (LFSS).</p><p><strong>Methods: </strong>This retrospective study included 794 COVID-19 patients from two hospitals in China between December 2022 and January 2023. Six lung fields on the axial computed tomography (CT) were defined. LFSS and eighteen clinical characteristics were evaluated. LFSS was based on summing up the parenchymal opacification involving each lung field, which was scored as 0 (0%), 1 (1-24%), 2 (25-49%), 3 (50-74%), or 4 (75-100%), respectively (range of LFSS from 0 to 24). Total pneumonia burden (TPB) was calculated using the U-net model. The correlation between LFSS and TPB was analyzed. After performing logistic regression analysis, an LFSS-based model, clinical-based model and combined model were developed. Receiver operating characteristic curves were used to evaluate and compare the performance of three models.</p><p><strong>Results: </strong>LFSS, age, chronic liver disease, chronic kidney disease, white blood cell, neutrophils, lymphocytes and C-reactive protein differed significantly between the non-critical and critical group (all P<0.05). There was a strong positive correlation of LFSS and TPB (Pearson correlation coefficient =0.767, P<0.001). The area under curves of LFSS-based model, clinical-based model and combined model were 0.799 [95% confidence interval (CI): 0.770-0.827], 0.758 (95% CI: 0.727-0.788), and 0.848 (95% CI: 0.821-0.872), respectively.</p><p><strong>Conclusions: </strong>The LFSS derived from chest CT may be a potential new tool to help identify COVID-19 patients at high risk of progressing to critical disease.</p>","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11494559/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142502993","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Peripheral immunological characteristics of spontaneous pneumothorax: a Mendelian randomization study.","authors":"Liancheng Ruan, Xiong Ma, Lingxiao Zhu, Lang Su, Silin Wang, Qiang Guo, Bingen Wan, Shengyu Qiu, Yang Zhang, Sheng Hu, Binfeng Zhou, Yiping Wei","doi":"10.21037/jtd-24-798","DOIUrl":"https://doi.org/10.21037/jtd-24-798","url":null,"abstract":"<p><strong>Background: </strong>Spontaneous pneumothorax (SP) is a common pleural disease in adolescents and adults. However, the role of immunological characteristics in the pathogenesis of SP remains unclear. This study aims to clarify the causal associations between circulating immune cells, lymphocyte subgroups, and SP susceptibility.</p><p><strong>Methods: </strong>Employing Mendelian randomization (MR), the causal association between circulating immune blood cells and lymphocyte subgroups on SP susceptibility have been assessed. Reverse MR analysis was used to further explore the causal relationship. The MR analysis ensured the reliability of the study results through the deletion of confounding single nucleotide polymorphisms (SNPs), heterogeneity testing, sensitivity analysis.</p><p><strong>Results: </strong>Seven immune cells and SP risk under stringent and lenient threshold conditions were identified. Eosinophils absolute count (AC) [odds ratio (OR) =1.0014, 95% confidence interval (CI): 1.0001-1.0014, P=0.02], memory B cell %B cell ratio (OR =1.008, 95% CI: 1.0002-1.0015, P=0.01), CD4⁺ T cell AC (OR =1.0014, 95% CI: 1.0003-1.0025, P=0.009), effector memory CD4⁺ T cell %T cell ratio (OR =1.0028, 95% CI: 1.0010-1.0046, P=0.003), and HLA-DR⁺CD8⁺ T cell %T cell ratio (OR =1.0019, 95% CI: 1.0004-1.0035, P=0.01) were identified as risk factors for increased susceptibility to SP. Conversely, CD8dim T cell AC (OR =0.9983, 95% CI: 0.9967-0.9999, P=0.03) and CD8dim natural killer T (NKT) %T cell ratio (OR =0.9982, 95% CI: 0.9965-0.9999, P=0.04) exhibited protective effects on SP. In natural killer (NK) cell subgroups and reverse MR analysis, no significance was found.</p><p><strong>Conclusions: </strong>This study establishes a close causal relationship between immune cells and SP through genetic methods, providing a new perspective for understanding the pathophysiological mechanisms of SP.</p>","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11494576/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142503006","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Short-term outcomes of mild (≥30 ℃) <i>vs</i>. moderate hypothermic circulatory arrest in aortic arch surgery.","authors":"Kai Zhu, Sichong Qian, Xudong Pan, Songbo Dong, Jianrong Li, Lizhong Sun, Sihong Zheng, Wenjian Jiang, Xiaolong Wang, Hongjia Zhang","doi":"10.21037/jtd-24-796","DOIUrl":"https://doi.org/10.21037/jtd-24-796","url":null,"abstract":"<p><strong>Background: </strong>Hypothermia and antegrade cerebral perfusion (ACP) strategies in open aortic arch surgery (AAS) have improved significantly. The significance of the gradual temperature rise to mild hypothermia is quite apparent, however, its safety remains a challenge. Therefore, our objective was to explore the safety and efficacy of mild hypothermic circulatory arrest (Mi-HCA, ≥30 ℃).</p><p><strong>Methods: </strong>This retrospective cohort study enrolled in a total of 372 patients, and was performed at the Beijing Anzhen Hospital between January 2017 and November 2022. Among the 372 patients, 81 received AAS at ≥30 ℃, and the remaining 291 received the same at 22-29.9 ℃. Most acute type A aortic dissection (ATAAD) patients received total arch replacement (TAR) and frozen elephant trunk (FET) operation.</p><p><strong>Results: </strong>Mi-HCA patients exhibited strongly augmented systemic temperature (26.19±1.63 <i>vs</i>. 31.40±0.79 ℃, P<0.01). The surgical, cardiopulmonary bypass (CPB), cross-clamp, circulatory arrest, and ACP durations were drastically diminished among Mi-HCA patients (all P<0.01). Moreover, the major adverse events (MAEs) incidence of Mi-HCA patients was significantly decreased (25.43% <i>vs</i>. 14.81%, P<0.05). Simultaneously, the Mi-HCA strategy also exhibited enhanced protection of blood cells, as well as myocardial and hepatic function. Nevertheless, multivariate logistic regression analysis revealed that Mi-HCA strategy (≥30 ℃) was not a stand-alone risk factor for MAEs following AAS.</p><p><strong>Conclusions: </strong>The short-term outcomes and safety of Mi-HCA, in combination with ACP, in AAS are satisfactory. Additionally, relative to the traditional moderate hypothermic circulatory arrest (MHCA) approach, it can substantially decrease operation duration while improving patient clinical outcomes.</p>","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11494574/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142503052","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early thoracic surgery consultation and location of therapy impact time to esophagectomy.","authors":"Ashley L Deeb, Aaron R Dezube, Antonio Lozano, Anupama Singh, Luis E De Leon, Suden Kucukak, Michael T Jaklitsch, Jon O Wee","doi":"10.21037/jtd-24-316","DOIUrl":"https://doi.org/10.21037/jtd-24-316","url":null,"abstract":"<p><strong>Background: </strong>Neoadjuvant chemoradiation therapy (nCRT) followed by esophagectomy is the standard treatment for resectable, locally advanced esophageal cancer. The ideal timing between neoadjuvant therapy and esophagectomy is unclear. Delayed esophagectomy is associated with worse outcomes. We investigated which factors impacted time to esophagectomy in our patients.</p><p><strong>Methods: </strong>We conducted a retrospective analysis of prospectively collected data of patients with pT0-3N0-2 esophageal cancers who underwent CROSS trimodality therapy from May 2016 to January 2020. Sociodemographic factors, comorbidities, and neoadjuvant factors (location of CRT, treatment toxicity, discontinuation of treatment) were compared between patients who underwent surgery within 60 days and those after 60 days.</p><p><strong>Results: </strong>In total, 197 patients were analyzed of whom 137 underwent esophagectomy within 60 days (early surgery, ES) and 60 were outside that window (delayed surgery, DS). More DS patients had a history of myocardial infarction (MI) or stroke (both 11.67% <i>vs.</i> 3.65%, P=0.05) and required CRT dose reduction (16.67% <i>vs.</i> 6.57%, P=0.04). Fewer DS patients received CRT at Dana-Farber Cancer Institute (DFCI) or a DFCI satellite site (33.33% <i>vs.</i> 58.4%, P=0.01) and saw our surgeons before CRT completion (68.33% <i>vs.</i> 89.78%, P=0.001). CRT at DFCI [odds ratio (OR) 2.63, P=0.01] or a satellite site (OR 3.07, P=0.01) and evaluation by a thoracic surgeon (OR 4.07, P=0.001) shortened time to esophagectomy. History of MI (OR 0.29, P=0.04), stroke (OR 0.29, P=0.04), and CRT dose reduction (OR 0.35, P=0.03) delayed time to esophagectomy.</p><p><strong>Conclusions: </strong>Improving access to multispecialty cancer centers and increasing satellite sites may improve time to esophagectomy.</p>","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11494582/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142502969","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Treatment of chronic obstructive pulmonary disease by traditional Chinese medicine Morin monomer regulated by autophagy.","authors":"Zhen Liu, Yang Zeng, Rui Li, Ying Yan, Sicheng Yi, Kui Zhang","doi":"10.21037/jtd-23-1836","DOIUrl":"https://doi.org/10.21037/jtd-23-1836","url":null,"abstract":"<p><strong>Background: </strong>Chronic obstructive pulmonary disease (COPD) is a frequently occurring disorder. The aim of this study is to explore the mechanism of traditional Chinese medicine Morin monomer in the treatment of COPD via regulating autophagy based on the long non-coding RNA (lncRNA) H19/microRNA (miR)-194-5p/Sirtuin (SIRT)1 signal axis.</p><p><strong>Methods: </strong>The COPD rat model was constructed, and the lung tissues were collected. The pathological analysis was performed using hematoxylin-eosin (HE), Masson, and periodic acid-Schiff (PAS) staining. Autophagosomes were observed using transmission electron microscope. <i>LncRNA H19</i>, <i>miR-194-5p</i>, <i>SIRT1</i> genes in the rat lung tissues were detected using reverse transcription-quantitative real-time polymerase chain reaction (RT-qPCR). The autophagy-related proteins including SIRT1, mammalian/mechanistic target of rapamycin (mTOR), phosphorylated (p)-mTOR, microtubule-associated protein light chain 3 (LC3), Beclin-1, autophagy-related (ATG)7, and p62 in each group were detected using Western blot.</p><p><strong>Results: </strong>The rats in the control group had normal lung structure. Alveolar enlargement and destruction could be found in the rat lung tissues in the model group, accompanied with obvious infiltration of inflammatory cells, thickened bronchial walls, enlarged alveolar septum, collagen fibers deposition, and goblet cells proliferation. In comparison with the model group, Morin treatment relieved the lung injuries, which was optimized in the moderate- and high-dose groups. The number of autophagosomes in the lung tissues of the model rats was dramatically increased compared with the normal rats. However, the number of autophagosomes in each Morin treatment group was obviously less than that in the model group. <i>LncRNA H19</i> and <i>SIRT1</i> expression was significantly increased in the model group, and <i>miR-194-5p</i> was significantly decreased (P<0.05). Morin and 3-methyladenine (3-MA) could obviously reduce the <i>lncRNA H19</i> and <i>SIRT1</i> expression, and increase the <i>miR-194-5p</i> expression (P<0.05). Relative to control rats, ATG7, Beclin-1, LC3II/I and SIRT1 levels in the model group increased obviously, while the expression of p62, and p-mTOR/mTOR decreased (P<0.05). Morin treatment reduced the expression of ATG7, Beclin-1, SIRT1, LC3II/I significantly, and increased the p-mTOR/mTOR and p62 expression (P<0.05).</p><p><strong>Conclusions: </strong>Morin decreased <i>lncRNA H19</i> expression, resulting in upregulation of <i>miR-194-5p</i> expression, downregulation of <i>SIRT1</i> expression, and increased of p-mTOR/mTOR expression. Furthermore, cell autophagy was inhibited, contributing to the COPD treatment.</p>","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11494543/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142502981","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of the nonstapling bullectomy by manual suturing for young men with primary spontaneous pneumothorax.","authors":"Kosuke Suzuki, Akihiko Kitami, Shinsaku Komiyama, Momoka Okada, Shinnosuke Takamiya, Shinichi Ohashi, Shugo Uematsu","doi":"10.21037/jtd-24-693","DOIUrl":"https://doi.org/10.21037/jtd-24-693","url":null,"abstract":"<p><strong>Background: </strong>Currently, surgery for primary spontaneous pneumothorax (PSP) is performed by bullectomy using a stapler with complete video-assisted thoracic surgery (cVATS). However, the postoperative recurrence rate (RR) of PSP is high in young men. The factors of postoperative PSP recurrence are the formation of postoperative bulla neogenesis (POBN) around the staple line, pleural injury caused by forceps for VATS, and bulla overlooked with a thoracoscope. We attempted nonstapling bullectomy with one-port-one-window (1p-1w) by using hybrid VATS (hVATS) to reduce postoperative RR. This study aimed to evaluate nonstapling bullectomy by manual suturing for young male patients with PSP compared with bullectomy by cVATS.</p><p><strong>Methods: </strong>From January 2012 to December 2022, we retrospectively reviewed the medical records of 259 male patients aged ≤25 years who underwent initial surgery for PSP and compared them between two groups, with staple use (S+) or by manual suturing without staple use (S-). RR, operative time, blood loss, and postoperative hospitalization period were examined in both groups.</p><p><strong>Results: </strong>The median operative time was 81 and 63 min in the S- and S+ groups, respectively (P<0.001), with the S- group tending to be statistically significantly longer. The mean intraoperative blood loss was 1.61 and 2.11 mL in the S- and S+ groups, respectively (P=0.003). The median postoperative hospitalization period was 4 days in both groups (P=0.32). Recurrences occurred in 8 (7.1%) and 14 patients (12.2%) in the S- and S+ groups, respectively [odds ratio (OR) =0.55; 95% confidence interval (CI): 0.22-1.37; P=0.19]. In patients aged <20 years, 5 (6.6%) and 10 (14.1%) patients had a recurrence in the S- and S+ groups, respectively (OR =0.42; 95% CI: 0.13-1.32; P=0.13).</p><p><strong>Conclusions: </strong>Compared with stapling bullectomy, nonstapling bullectomy with small thoracotomy for young male patients with PSP had lesser RR. This procedure is beneficial in reducing postoperative recurrence and is one of the surgical choices for young male patients with PSP.</p>","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11494564/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142502974","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predicting non-small cell lung cancer lymph node metastasis: integrating ctDNA mutation/methylation profiling with positron emission tomography-computed tomography (PET-CT) scan: protocol for a prospective clinical trial (LUNon-invasive Study).","authors":"Haitang Yang, Xiaoran Gu, Zhexin Wang, Gang Liu, Yongliang Niu, Xufeng Pan, Feng Yao","doi":"10.21037/jtd-24-1033","DOIUrl":"https://doi.org/10.21037/jtd-24-1033","url":null,"abstract":"<p><strong>Background: </strong>Non-small cell lung cancer (NSCLC) accounts for approximately 85% of lung cancer cases and remains a leading cause of cancer-related death. Lymph node metastasis (LNM) significantly affects recurrence, survival rates, and treatment options. While lymph node sampling is standard for surgically removing operable NSCLC, it can lead to complications. Positron emission tomography-computed tomography (PET-CT) helps assess preoperative LNM despite false positive or negative rates. Additionally, circulating tumor DNA (ctDNA) detects minimal residual disease with high sensitivity and specificity. Whether ctDNA can predict LNM in operable NSCLC remains uncertain. Our goal is to develop a precise model for predicting NSCLC LNM using non-invasive ctDNA/methylation profiling combined with PET-CT imaging.</p><p><strong>Methods: </strong>This is a prospective study conducted in three stages. We will enroll patients with clinical stage I-IIIB [8th tumor, node, metastasis (TNM) staging] NSCLC requiring lobectomy plus lymph node sampling/dissection. The distribution of clinical stages in the enrolled population is as follows: clinical stage cN0 (n=100) and cN1/cN2 (n=100). During Stage 1, we will establish LNMs-specific ctDNA methylation signatures and compare negative predictive value (NPV) rates of LNMs using preoperative blood ctDNA somatic mutation/methylation alone or combined with PET-CT across different groups. For Stage 2, we will compare detection rates between ctDNA somatic mutation/methylation profiles alone or combined with PET-CT and traditional mediastinoscopy/endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA). As for Stage 3, ctDNA-free interval (CFI) and disease-free survival between systematic lymph node presence and absence in patients will be compared with preoperative negative ctDNA profiling and/or PET-CT. In Stage 3, patients will be followed up for 5 years to collect recurrence and survival data. Post-surgery follow-up ctDNA tests will be conducted every 3 months for the first 2 years, every 6 months for years 3-4, and annually in year five. Demographics and baseline data will be summarized with mean, standard deviation, median, max, and min values. Tests will include <i>t</i>-tests, Welch/Behren-Fisher test, and Wilcoxon rank-sum test for continuous variables. Categorical data will be presented as counts/percentages and compared using χ² test or Fisher's exact test.</p><p><strong>Discussion: </strong>By utilizing preoperative ctDNA/methylation profiling in conjunction with PET-CT, this study is expected to yield substantial evidence for accurately predicting LNM before surgery. This will help inform surgeons in selecting the appropriate intraoperative lymph node dissection strategy for operable NSCLC patients.</p><p><strong>Trial registration: </strong>This study is registered on www.clinicaltrials.gov (NCT06358222).</p>","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11494533/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142503007","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}