Journal of thoracic disease最新文献

{"title":"The synergistic effects of PM_2.5 and high-fat diet on Th1/Th2 balance in model mice with asthma.","authors":"Ruifeng Bai, Bingqian Liu, Tianshui Li, Heng Zhou, Xinyang Yue, Ying Liu, Yining Shan, Zhigang Li, Yongjie Wei, Jun Wu","doi":"10.21037/jtd-24-1139","DOIUrl":"https://doi.org/10.21037/jtd-24-1139","url":null,"abstract":"<p><strong>Background: </strong>Particulate matter, ambient particulate matter with an aerodynamic equivalent diameter ≤2.5 µm (PM_2.5) is closely associated with asthma, and a high-fat diet is also a risk factor for the condition. In many cities in China, exposure to PM_2.5 and consumption of a high-fat diet coexist. The Th1/Th2 balance is the immunological foundation for the onset and progression of asthma, and it is more accurate to describe asthma symptoms in terms of changes in this balance. Therefore, the aim of this study was to investigate the effects of PM_2.5 and high-fat diet the combined effects on Th1/Th2 balance in asthma immune.</p><p><strong>Methods: </strong>Given this background, our study examined the effects of PM_2.5 and high-fat diets on the Th1/Th2 balance and proposed potential molecular mechanisms for asthma development induced by these factors. In this study, male BALB/c mice and ovalbumin (OVA)-sensitized asthma mice subjected to either a normal or high-fat diet were exposed to PM_2.5 or filtered air for one month. We evaluated the effects of PM_2.5 and high-fat diets on asthma using histopathology, enzyme-linked immunosorbent assays, transcriptome sequencing, and quantitative polymerase chain reaction (PCR).</p><p><strong>Results: </strong>We found that PM_2.5 exposure increased the secretion of Th2-related inflammatory mediators, while a high-fat diet increased the secretion of Th1-related inflammatory mediators. However, the combined effects still predominantly favored a Th2 skew. PM_2.5 exposure shifted the Th1/Th2 balance toward Th2, whereas a high-fat diet shifted it toward Th1. The combination of PM_2.5 exposure and a high-fat diet resulted in a less pronounced Th2 polarization compared to PM_2.5 exposure alone.</p><p><strong>Conclusions: </strong>PM_2.5 exposure and short-term high-fat diet both exacerbate asthma but there is an opposite direction of modulation of the Th1/Th2 balance.</p>","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":"17 3","pages":"1502-1511"},"PeriodicalIF":2.1,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11986740/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144031948","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":"Implementation of a robotic-assisted thoracic surgery program for anatomical lung resections, a single surgeon's experience.","authors":"Andreas Westerlind, Maya Landenhed-Smith, Carl-Johan Malm, Göran Dellgren","doi":"10.21037/jtd-24-1182","DOIUrl":"https://doi.org/10.21037/jtd-24-1182","url":null,"abstract":"<p><strong>Background: </strong>Robotic-assisted thoracic surgery (RATS) for pulmonary resections has been reported to be a safe and feasible method with similar outcomes to those of video-assisted thoracic surgery (VATS). In 2021 our department launched a RATS program. The aims of this study are to evaluate the initial results and learning curve of a series of RATS procedures performed by a single surgeon experienced in uniportal video-assisted thoracic surgery (uVATS) during an initial period of access to the robotic platform limited to two cases per week.</p><p><strong>Methods: </strong>A retrospective study including consecutive RATS and uVATS lobectomies performed by a single surgeon from November 2021 to September 2023 at Sahlgrenska University Hospital. Endpoints were days with chest tube (CT), length of stay (LOS) and intraoperative learning curve as reflected in the duration of procedures.</p><p><strong>Results: </strong>A total of 82 RATS and 60 uVATS consecutive lobectomies were included. Preoperative demographics were similar in the RATS and uVATS groups. Preoperative assessment of tumour size from computed tomography scans were larger in the uVATS group than in the RATS group [25 (18.00-39.00) <i>vs.</i> 18 (14.00-28.25) mm, P=0.002], but clinical tumour-node-metastasis (TNM) stage were similar between groups (P=0.23). Days with CT was significantly shorter for RATS than uVATS [1.00 (1.00-1.00) <i>vs</i>. 1.00 (1.00-3.75)]; P=0.01]. LOS in the RATS group was 2 [2.00-3.00] <i>vs.</i> 2 [2.00-5.00] days in the uVATS group (P=0.07). Operation time (OP time) was longer in the RATS group [136.00 (114.50-152.25) <i>vs.</i> 100 (84.25-120.00) minutes in the uVATS group; P<0.001]. After RATS case number 44 no further reduction in OP time was recorded.</p><p><strong>Conclusions: </strong>RATS is a feasible method for lobectomy and can be efficiently introduced as a standard surgical approach even with limited access to the robotic surgical platform, with a learning curve of approximately 44 cases.</p>","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":"17 3","pages":"1335-1348"},"PeriodicalIF":2.1,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11986765/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144032850","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":"Video-assisted thoracoscopy with two-lung ventilation and CO₂ insufflation in primary spontaneous pneumothorax: propensity score matching comparison.","authors":"Ying Jie Cui, Wen Xue Piao, Yong Chae Jung, Hyun Jin Cho, Min-Woong Kang","doi":"10.21037/jtd-24-1749","DOIUrl":"https://doi.org/10.21037/jtd-24-1749","url":null,"abstract":"<p><strong>Background: </strong>Primary spontaneous pneumothorax (PSP) is commonly treated with video-assisted thoracoscopic surgery (VATS), which traditionally requires one-lung ventilation (OLV) with double-lumen endotracheal intubation to optimize the surgical field. However, OLV may be associated with complications such as airway trauma and postoperative sore throat. In contrast, two-lung ventilation (TLV) with CO₂ insufflation has been proposed as an alternative that may reduce airway-related complications while maintaining adequate visualization. This study assessed the feasibility of VATS with TLV and CO₂ insufflation for PSP compared to the conventional OLV approach.</p><p><strong>Methods: </strong>We retrospectively analyzed 181 patients with PSP treated at our center between July 2020 and December 2023; of these, 134 underwent thoracoscopic bullectomy. Fifty-six patients received VATS with TLV and CO₂ insufflation. Seventy-eight patients underwent OLV via double-lumen endotracheal intubation. Patient data were categorized into groups based on the minimization of bias between those receiving TLV and those receiving OLV, following analysis matched by propensity scores. A comparative analysis across these groups was also conducted, focusing on demographic data and intraoperative and postoperative outcomes.</p><p><strong>Results: </strong>The TLV group demonstrated several advantages, including shorter anesthesia induction time (13.45±5.25 min, P=0.01), shorter total anesthesia time (63.18±14.45 min, P=0.003), fewer days of chest tube drainage (1.41±1.22 days, P=0.04), shorter postoperative hospital stay (2.36±0.88 days, P=0.01), lower wedge resection specimen weight (3.21±2.5 g, P=0.03), fewer instances of postoperative ipsilateral and contralateral recurrence, and lower likelihood of short-term recurrence. No significant differences were found in surgical time (P=0.17), anesthesia recovery time (P=0.48), use of endostaplers (P=0.35), number of wedge resections (P=0.21), and pleurodesis (P=0.73).</p><p><strong>Conclusions: </strong>In appropriately selected patients, TLV appears to be a viable option that does not increase recurrence risk compared to OLV while offering the benefit of a shorter anesthesia duration. Therefore, this method may be suitable for patients with PSP.</p>","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":"17 3","pages":"1217-1227"},"PeriodicalIF":2.1,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11986787/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144002719","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":"Construction and analysis of the invasive prediction model for pulmonary nodules: based on clinical, CT image and DNA methylation characteristics.","authors":"Qingjie Yang, Xiaoyan Sun, Shenghua Lv, Qingtian Li, Linhui Lan, Ningquan Liu, Mingyang Wang, Kaibao Han, Xinhai Feng","doi":"10.21037/jtd-24-1763","DOIUrl":"https://doi.org/10.21037/jtd-24-1763","url":null,"abstract":"<p><strong>Background: </strong>Accurately identifying whether pulmonary nodules are microinvasive adenocarcinoma or invasive carcinoma (MIA or IC) is clinically significant. This study aims to construct a predictive model for this.</p><p><strong>Methods: </strong>Clinical, computed tomography (CT) image, and peripheral blood methylation data of 294 patients were collected. Based on postoperative pathology, they were divided into invasive (MIA or IC) and non-invasive groups. A quarter of the data was randomly selected as the validation set, and the rest was the training set. Screened significant indicators in training set and divided into three groups: clinical and image features, methylation features, and comprehensive features combining both. Logistic regression analyses were conducted respectively to construct models, and the model effect was verified in the validation set.</p><p><strong>Results: </strong>There were six indicators in the comprehensive model (proportion of solid components, maximum CT value, SH3BP5_338_ CpG 4, PNPLA2_329_CpG 1, PNPLA2_329_CpG 4, and ARHGAP35 476_CpG_5). The area under the curve (AUC) of the training set and the validation set were 0.90 and 0.87, respectively. Prediction accuracies were 82% and 82%, sensitivities were 82% and 80%, specificities were 82% and 84%. The predictive effect of comprehensive model was better than that of the clinical and image feature model and the methylation feature model.</p><p><strong>Conclusions: </strong>The invasiveness predictive model for pulmonary nodules constructed by combining clinical, CT image, and methylation features in this study has a relatively satisfactory effect and is worthy of further exploration and improvement.</p>","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":"17 3","pages":"1349-1363"},"PeriodicalIF":2.1,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11986751/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144031941","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":"Clinical outcomes of caregiver-led indwelling pleural catheter care and drainage at a Singapore tertiary referral hospital.","authors":"Brian Lee Wei Chua, Si Ling Young, Qiao Li Tan, Carrie Kah-Lai Leong, Jane Jing Yi Wong, Ivana Gilcrist Chiew Sian Phua, Wen Ting Lim, Ken Junyang Goh","doi":"10.21037/jtd-24-1734","DOIUrl":"https://doi.org/10.21037/jtd-24-1734","url":null,"abstract":"<p><strong>Background: </strong>Indwelling pleural catheters (IPCs) are an established first-line treatment option for symptomatic malignant pleural effusions (MPEs). However, community nursing support for IPC care and drainage is not available in many healthcare systems. In this study, we sought to evaluate IPC outcomes and complication rates in patients for whom IPC care and home drainage are performed by family members and caregivers.</p><p><strong>Methods: </strong>Patients who underwent IPC insertions between January 2017 to December 2022 were included in this observational cohort study. Caregiver training were provided to all patients and appointed caregivers by pleural specialist nurse. All patients were assessed at regular intervals every 1 to 2 months, until death or IPC removal. Clinical outcomes and adverse events were recorded prospectively.</p><p><strong>Results: </strong>We evaluated 140 patients with a median age of 68 years [interquartile range (IQR): 61-73 years]. MPE was the underlying etiology in 137 patients (97.9%). The most common causes of MPE were lung cancer (42.9%) and breast cancer (22.1%). The median duration of IPC placement was 64 (IQR: 36-120) days. About a third of patients (35.0%) had spontaneous pleurodesis allowing for removal of the IPC, with this occurring at a median of 78 (IQR: 52-144) days. The median length of survival from the time of IPC insertion was 102 (IQR: 41-308) days. IPC related complications occurred in 38 (27.1%) patients. Catheter malfunction, most commonly a non-draining IPC due to catheter blockage, occurred in 27 (19.3%) of patients, and 14 (10.0%) patients developed infective complications. Nine (6.4%) patients required hospitalisation for IPC-related complications. There were no bleeding complications or procedure-related deaths.</p><p><strong>Conclusions: </strong>In healthcare systems without available community nursing services, IPCs remain a valuable treatment option for patients with symptomatic MPEs. Comparable clinical outcomes and safety profiles can be achieved even for patients where IPC care and drainage are primarily led by caregivers or family members, in the presence of appropriate support and caregiver training provided by a pleural service.</p>","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":"17 3","pages":"1512-1519"},"PeriodicalIF":2.1,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11986789/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144029675","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 value of fibrosis score and ¹⁸F-FDG by positron emission tomography-computed tomography in lung cancer patients with interstitial lung disease.","authors":"Rui Xu, Lijie Yin, Guangliang Qiang, Liping Fu","doi":"10.21037/jtd-24-1512","DOIUrl":"https://doi.org/10.21037/jtd-24-1512","url":null,"abstract":"<p><strong>Background: </strong>Compared to general population, patients with interstitial lung disease (ILD) shows an increased risk of lung cancer (LC), and higher LC complications. Hence, this study aims to analyze the factors related to the postoperative complications and mortality of patients with malignant lung tumor-and ILD after surgical resection.</p><p><strong>Methods: </strong>This study analyzed the clinical information, surgical conditions, preoperative computed tomography (CT) and positron emission tomography (PET) examination data, as well as postoperative follow-up data of 60 non-small cell LC patients and 60 non-small cell LC patients with interstitial lung disease (LC-ILD). In this study, 120 patients with non-small cell LC were retrospectively reviewed, of which 60 were assigned to LC group and 60 to LC-ILD group. Cohorts were evaluated for differences in clinical data, surgical conditions, preoperative CT/PET examination data, and postoperative follow-up data.</p><p><strong>Results: </strong>The postoperative complications in the LC-ILD group were slightly higher than those in the LC group (P<0.001), and the prognosis of LC patients with ILD was significantly worse than that of those without ILD (P=0.048). The standardized uptake value ratio (SUVR) of noncancerous interstitial pneumonia (IP) area in patients with postoperative complications was higher than that of patients without complications (P=0.005), and it was the risk factor for postoperative complications in LC-ILD group [hazard ratio (HR) 3.384 (1.023-25.441); P=0.02]. Until the end of follow-up, the CT scores of non-survivors were higher than those of survivors (9.30±3.56 <i>vs</i>. 5.52±2.26; P=0.001). Age [HR 3.919 (1.094-7.789); P=0.04], the CT score [HR 2.352 (1.028-4.033); P=0.007], and smoking history [HR 0.354 (0.096-0.643); P=0.03] were the risk factors for mortality.</p><p><strong>Conclusions: </strong>The postoperative complications and mortality of LC-ILD significantly increase. Higher SUVR of noncancerous IP area usually indicates an increase of postoperative complications. Higher CT score and smoking history suggest a poor prognosis. A follow-up longitudinal study is needed to validate the findings.</p>","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":"17 3","pages":"1541-1551"},"PeriodicalIF":2.1,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11986795/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144033191","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":"Comparing erector spinae plane (ESP) and thoracic paravertebral (TPV) block analgesic effect after elective video-assisted thoracic surgery: a randomized, multiple-blinded, non-inferiority trial.","authors":"Roberto Dossi, Miriam Patella, Barbara Barozzi, Gaston Dellaferrera, Adele Tessitore, Isabella Gimigliano, Stefano Cafarotti, Andrea Saporito","doi":"10.21037/jtd-24-1548","DOIUrl":"https://doi.org/10.21037/jtd-24-1548","url":null,"abstract":"<p><strong>Background: </strong>Video-assisted thoracic surgery (VATS) is the gold standard for minimally invasive lung resections. Postoperative pain from VATS can hinder breathing and increase complications. Thoracic epidural analgesia (TEA) is effective but invasive. Less invasive options like thoracic paravertebral (TPV) block and erector spinae plane (ESP) block are being explored. This study compares ESP and TPV in a randomized, non-inferiority trial, focusing on opioid consumption post-VATS.</p><p><strong>Methods: </strong>This single-center, randomized, multiple-blinded, controlled, non-inferiority trial included 50 patients undergoing VATS at the Regional Hospital of Bellinzona and Valli (ORBV). Patients were randomized to receive either an ESP block with local anesthetic and a TPV block with saline (Anest ESP) or an ESP block with saline and a TPV block with local anesthetic (Sham ESP). The primary outcome was the cumulative dose of rescue opioids at 24 and 48 hours postoperatively.</p><p><strong>Results: </strong>Data from 47 patients were analyzed. There was no statistically significant difference in opioid consumption between the Anest ESP and Sham ESP groups at 24 hours (P=0.09) and 48 hours (P=0.12). In a sub-analysis by type of surgery, the NRS values were higher, as postulated, in major surgery. Cardiopulmonary complications and procedural times were low and comparable between groups.</p><p><strong>Conclusions: </strong>The study did not demonstrate the non-inferiority of the ESP block compared to the TPV block for postoperative analgesia following VATS. However, both blocks provided effective pain relief with no significant differences in outcomes. The findings suggest that both ESP and TPV blocks are viable alternatives to TEA.</p>","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":"17 3","pages":"1531-1540"},"PeriodicalIF":2.1,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11986791/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144026639","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":"Quantitative CT evaluation of extrapulmonary lesions in chronic obstructive pulmonary disease: a narrative review.","authors":"Chengyu Miao, Shengchuan Feng, Fengyan Wang, Zizheng Chen, Jiaxuan Xu, Xueping Li, Zifei Zhou, Rongchang Chen, Zhenyu Liang","doi":"10.21037/jtd-24-1074","DOIUrl":"https://doi.org/10.21037/jtd-24-1074","url":null,"abstract":"<p><strong>Background and objective: </strong>Chronic obstructive pulmonary disease (COPD) is a significant global health challenge characterized by persistent respiratory symptoms and airflow limitation. Recent advancements in computed tomography (CT) have enhanced our understanding of COPD, particularly in diagnosing extrapulmonary comorbidities. This review aims to summarize the current findings on extrapulmonary manifestations in COPD patients and the role of quantitative computed tomography (QCT) in evaluating these comorbidities.</p><p><strong>Methods: </strong>A comprehensive literature search was conducted using PubMed and Web of Science databases, covering studies from January 1999 to May 2024. Keywords included \"COPD\", \"chronic obstructive pulmonary disease\", \"muscle\", \"adipose tissue\", \"coronary artery calcification\", \"bone density\", \"extrapulmonary manifestations\", and \"Quantitative Computed Tomography\". Inclusion criteria focused on studies involving COPD patients using QCT to identify extrapulmonary manifestations, published in peer-reviewed journals and available in English.</p><p><strong>Key content and findings: </strong>The review highlights significant findings, such as the reduction in muscle mass and bone density and the increase in coronary artery calcification (CAC) in COPD patients, all closely associated with disease severity and prognosis. Key metrics evaluated include mid-thigh muscle cross-sectional area, pectoralis muscle area, erector spinae muscles, and bone density. Advanced CT analysis techniques, including artificial intelligence (AI) and machine learning, are emphasized as crucial for improving assessment accuracy and efficiency. Subcutaneous fat reduction and CAC are identified as critical indicators of mortality and disease progression.</p><p><strong>Conclusions: </strong>Quantitative CT evaluation is vital for understanding and managing extrapulmonary lesions in COPD. Future research should focus on establishing suitable measurement tools and methods and defining critical thresholds for treatment efficacy. The integration of advanced CT techniques and interdisciplinary approaches is essential for enhancing diagnostic accuracy and developing personalized treatment strategies for COPD patients.</p>","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":"17 3","pages":"1736-1745"},"PeriodicalIF":2.1,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11986777/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143975100","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":"Completion lobectomy after thoracoscopic segmentectomy on the left side should be approached with thoracotomy.","authors":"Stefano Bongiolatti, Giovanni Mugnaini, Alberto Salvicchi, Alessandro Gonfiotti, Sara Borgianni, Domenico Viggiano, Luca Voltolini","doi":"10.21037/jtd-24-1431","DOIUrl":"https://doi.org/10.21037/jtd-24-1431","url":null,"abstract":"<p><strong>Background: </strong>Lung segmentectomy is widely used to treat early-stage non-small cell lung cancer (NSCLC), but the risk of local recurrence in the ipsilateral lobe is increased and the surgical treatment of the local recurrence could be a real challenge. The aim of this study is to report our experience in a consecutive series of patients undergoing completion lobectomy (CL) after thoracoscopic segmentectomy.</p><p><strong>Methods: </strong>We retrospectively reviewed all the medical charts of the patients who underwent thoracoscopic segmentectomy for early-stage NSCLC (cIA) between January 2015 and December 2023, focusing on patients who had NSCLC recurrence in the ipsilateral lobe treated with CL.</p><p><strong>Results: </strong>Among the 263 segmentectomies performed, 13 patients (4.9%) experienced local recurrence in the ipsilateral remaining lobe, of whom 9 (3.4%) underwent CL, including 5 in the left upper lobe, with a median interval of 31 months between procedures. All patients underwent CL through thoracotomy with the need of central isolation in 5/9 (55.5%); rupture of the pulmonary artery occurred two patients and vascular sleeve resection was necessary in one. No postoperative deaths were observed, complications occurred in 5/9 patients with major complications, defined as Clavien-Dindo grade >3b, in 2/9 (22.2%) patients. Median hospital stay was 11 days. At the end of follow-up 2 patients had distant recurrence 12 median months after the CL.</p><p><strong>Conclusions: </strong>CL in the left side could be considered a challenging procedure also after minimally invasive segmentectomy and we consider safe to perform CL with thoracotomy due to a scar tissue formation between the bronco-vascular structures leading the need for extensive hilar dissection and central isolation of the pulmonary artery.</p>","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":"17 3","pages":"1561-1569"},"PeriodicalIF":2.1,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11986786/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144010798","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":"Comparative efficacy and safety of inhaled antibiotics in managing chronic <i>Pseudomonas aeruginosa</i> infection in patients with cystic fibrosis and bronchiectasis: a systematic review and network meta-analysis.","authors":"Yifan Chen, Xiao Meng, Jiaxin Zhu, Shengxiao Lai, Zixuan Liu, Zhizhou Dou, Yaozhou Wu, Li Wei","doi":"10.21037/jtd-24-1525","DOIUrl":"https://doi.org/10.21037/jtd-24-1525","url":null,"abstract":"<p><strong>Background: </strong>An expanding array of inhaled antibiotic therapies can be effective for the treatment of chronic <i>Pseudomonas aeruginosa</i> (<i>P. aeruginosa</i>) infection in patients with cystic fibrosis (CF) and non-CF bronchiectasis (NCFB). Nonetheless, there is a paucity of direct studies comparing the curative effects of these regimens. This network meta-analysis (NMA) aimed to assess the efficacy and safety of different inhaled antibiotic therapies for the relative short-term (4 weeks) and long-term (≥4 months) management of chronic <i>P. aeruginosa</i> infection in patients with CF and NCFB, respectively.</p><p><strong>Methods: </strong>We searched PubMed, Web of Science, Embase, and Cochrane Library database as at 25^th February, 2024. Randomized controlled trials (RCTs) involving inhaled antibiotic therapies for treatment of CF or NCFB were thoroughly screened. We conducted this NMA within a Bayesian framework. The surface under the cumulative ranking curve (SUCRA) was calculated to estimate relative effects of interventions per outcome.</p><p><strong>Results: </strong>A total of 39 RCTs were included, involving 18 inhaled antibiotic treatment regimens and 7,486 participants. The primary outcomes assessed were microbiological efficacy and tolerability. According to SUCRA results, for patients with CF, tobramycin inhalation powder (TIP) had the best profile regarding microbiological efficacy at both short-term and long-term follow-up (SUCRA, 94.5%; 90.5%). Colistin for inhalation (SUCRA, 84.0%) and tobramycin inhalation solution (TIS; SUCRA, 75.7%) had the best tolerability profile at short-term and long-term follow-up, respectively. For patients with NCFB, TIP (SUCRA, 84.2%) and gentamicin injectable solution (GM) for inhalation (SUCRA, 92.2%) had the best profile regarding microbiological efficacy at short-term and long-term follow-up, respectively. Ciprofloxacin inhalation powder had the best tolerability profile at both short-term and long-term follow-up (SUCRA, 66.4%; 85.6%).</p><p><strong>Conclusions: </strong>The present study suggests that inhalation of TIS and GM are deemed exhibiting favorable profile across various outcomes for treating chronic <i>P. aeruginosa</i> infection in patients with CF and NCFB, respectively. Further large-scale and higher-quality studies are needed to support the conclusion.</p>","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":"17 3","pages":"1424-1443"},"PeriodicalIF":2.1,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11986750/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144015552","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}