Journal of thoracic disease最新文献

{"title":"Impact of airflow stimulation: mild cold airflow is more sensitive to influenza virus infection.","authors":"Weiwei Huang, Chunguang Yang, Xiaohong Zheng, Runfeng Li, Wenlu Wang, Hua Qian, Zifeng Yang","doi":"10.21037/jtd-24-1546","DOIUrl":"10.21037/jtd-24-1546","url":null,"abstract":"<p><strong>Background: </strong>With the popularity of heating, ventilation, and air conditioning (HVAC) and the growth of time that humans spend indoors, people have begun to think more about what kind of indoor air-conditioned environments are beneficial and sustainable for health, especially for preventing respiratory infectious diseases. This study aims to explore the role of airflow in mechanically ventilated environments in modulating airway immune and defense mechanisms.</p><p><strong>Methods: </strong>Based on the self-developed mouse-applicable climate chamber system and the corresponding mouse model, this study investigated the health effects of exposure to thermal environments [(I) 20 ℃, 0 m/s; (II) 20 ℃, 1.5 m/s; and (III) 15 ℃, 1.5 m/s] on influenza-infected mice (female, 6-8 weeks), of which body and organ weight, and survival situation were measured and recorded. Lung histopathologic changes were analyzed by hematoxylin-eosin (H&E) staining. The messenger ribonucleic acid (mRNA) relative expression levels of interleukin-6 (IL-6) and interferon-γ (IFN-γ) in lung tissues were determined by quantitative real-time polymerase chain reaction (qRT-PCR). Lung tissue virus titer measurement was also conducted. We also collected peripheral blood samples for blood cell counts to assess the impact of environmental conditions on systemic inflammation.</p><p><strong>Results: </strong>Prolonged mild exposure to cold airflow inhibited weight gain and significantly increased lung coefficient. The relative mRNA expression of inflammatory factors in lung tissues was elevated considerably and the area occupied proportion of the lung interstitium was significantly increased after cold airflow exposure. However, peripheral blood neutrophil and lymphocyte percentages were not significantly different from those of the control group. While there were remarkable differences in body weight changes, survival situations, lung coefficients, lung tissue viral titers, and peripheral blood neutrophil and lymphocyte percentages for mice with different environmental exposure experiences after viral infection.</p><p><strong>Conclusions: </strong>Our findings suggest that the effects of airflow on health do not exist independently of temperature. Prolonged mild cold airflow in air-conditioned environments may induce respiratory injury and thus exacerbate respiratory virus infection outcomes, suggesting that the effect of airflow in air-conditioned environments should receive due attention in protecting public respiratory health.</p>","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":"17 6","pages":"3643-3657"},"PeriodicalIF":2.1,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12268511/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144675115","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":"Incidence, risk factors, and predictive modeling of pulmonary infection after high-risk surgery for lung cancer: a retrospective case-control study.","authors":"Jiajia Ma, Bei Xue, Zhengmin Zhang, Liping Yao, Xiaoxin Liu","doi":"10.21037/jtd-2024-2276","DOIUrl":"10.21037/jtd-2024-2276","url":null,"abstract":"<p><strong>Background: </strong>The hierarchical operation management system is one of the core medical systems. Graded management based on the degree of surgical risk, difficulty, resource consumption, and ethical risks can help ensure the quality and safety of the surgery. With the progress of medical technology and the continuous development of medical standards, the proportion of lung cancer patients who underwent high-risk surgery was increasing rapidly. The purpose of this study is to explore the incidence, risk factors, and prediction models of pulmonary infection after high-risk surgery for lung cancer based on machine learning algorithms.</p><p><strong>Methods: </strong>This study included individuals who underwent lung cancer high-risk surgery at Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine from January 2021 to December 2023. Five machine learning algorithms including least absolute shrinkage and selection operator (LASSO)-assisted logistic regression (LR), artificial neural network (ANN), support vector machine (SVM), random forest (RF), and eXtreme gradient boosting (XGB) were adopted to explore risk factors and prediction models of pulmonary infection after high-risk surgery for lung cancer.</p><p><strong>Results: </strong>A cohort of 2,650 patients were eligible for the study after application of the exclusion criteria, with an overall incidence of postoperative pulmonary infection at 9.66% (256/2,650). LASSO regression screened out eight characteristic variables including daily smoking, history of diabetes, diffusing capacity of the lung for carbon monoxide percentage of predicted (DLCO%Pred), airway resistance percentage of predicted (Raw%Pred), maximum tumor diameter, perioperative oral nutritional supplements (ONS) supplement, postoperative urinary catheter, and pleural adhesion degree. The risk prediction model of postoperative pulmonary infection was constructed using these eight clinical features. The area under the curve (AUC) range of the five models was 0.893-0.936. The XGB model outperformed the others, with an AUC of 0.936 [95% confidence interval (CI): 0.923-0.949]. The LR model had an AUC of 0.927 (95% CI: 0.921-0.939), second only to the XGB model, which was converted into a nomogram for model visualization.</p><p><strong>Conclusions: </strong>The establishment of a risk prediction model based on machine learning can help clinical nursing staff identify high-risk patients for pulmonary infection after lung cancer high-risk surgery. The nomogram is expected to be an effective tool for nursing staff to manage the risk of pulmonary infection after lung cancer high-risk surgery.</p>","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":"17 6","pages":"3702-3715"},"PeriodicalIF":2.1,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12268473/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144675119","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 model for postoperative pulmonary complications after thoracoscopic surgery with machine learning algorithms and SHapley Additive exPlanations.","authors":"Shenyan Wang, Yongqi Lin, Hujuan Shi, Pengcheng Liang, Zihao Luo, Junfeng Kong, Junda Huang, Mingmei Cheng, Baoliang Zhang, Yanzhong Wang, Hongxing Kan, Lizhong Liang, Wanqing Xie","doi":"10.21037/jtd-24-1853","DOIUrl":"10.21037/jtd-24-1853","url":null,"abstract":"<p><strong>Background: </strong>Postoperative pulmonary complications (PPCs) are common and have a negative impact on postoperative morbidity and mortality, with associated medical resource use and cost care plan. Management of preoperative and intraoperative risk factors has been shown to reduce the occurrence of PPCs. Therefore, this study aimed to develop a risk prediction model for PPCs based on explainable machine learning (ML) methods and evaluate its predictive performance in order to enhance the prevention and intervention for PPCs.</p><p><strong>Methods: </strong>In this study, the medical records of 1,629 patients who underwent thoracoscopic surgery were collected from two clinical groups at the Affiliated Hospital of Guangdong Medical University between August 2018 and October 2021. Five categories of data were used as predictors, including patient demographics, medical history and comorbidities, laboratory studies, intraoperative vital signs, and surgical procedure-related data. Seven ML methods, including random forest (RF), adaptive boosting (AdaBoost), extra trees (ET), extreme gradient boosting (XGBoost), gradient boosting decision tree (GBDT), and two ensemble learning methods, including voting classifier (Voting), and stacking-logistic regression (Stacking-LR), were used to predict the occurrence of PPCs in patients undergoing thoracoscopic surgery. The model performance was validated in internal, temporal, and external phases. Additionally, an explainable approach based on ML methods and the SHapely Additive exPlanation (SHAP) algorithm was used for calculating the PPCs risk and generating individual explanations of the model decisions.</p><p><strong>Results: </strong>In the model validation phase, the RF algorithm performed well in all types of validations compared with other ML algorithms. Internal validation from within-center dataset, area under the curve (AUC) =0.82 [95% confidence interval (CI): 0.80-0.84]; temporal validation from within-center dataset, AUC =0.73 (95% CI: 0.71-0.75); external validation from cross-center dataset, AUC =0.76 (95% CI: 0.75-0.77). The model-agnostic explanation was generated by the SHAP analysis that illustrated the significant clinical factors associated with the top 20 risks of PPCs.</p><p><strong>Conclusions: </strong>The risk prediction model for PPCs based on the explainable ML methods is valid and, therefore, can be implemented in clinical settings for identifying high-risk patients for PPCs, providing appropriate clinical advice regarding targeted interventions and improved monitoring to alleviate modifiable risk factors.</p>","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":"17 6","pages":"3603-3618"},"PeriodicalIF":2.1,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12268710/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144675121","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 the efficacy and clinical prognosis of first-line EGFR-tyrosine kinase inhibitors in non-small cell lung cancer patients based on ΔCt values derived from the super-amplification refractory mutation system (ARMS): a real-world retrospective study.","authors":"Zhuohao Huang, Yanxia Wu, Haiyin Ye, Yongcun Wang, Zhong Huang, Yuting Chen, Zhen Cheng, Xiaobi Huang, Chang Xiao, Jinmei Li, Guanghua Chen, Wenmei Su","doi":"10.21037/jtd-2025-97","DOIUrl":"10.21037/jtd-2025-97","url":null,"abstract":"<p><strong>Background: </strong>Lung cancer, especially non-small cell lung cancer (NSCLC), is a leading cause of cancer mortality. Epidermal growth factor receptor (EGFR) mutations drive NSCLC progression but also sensitize tumors to EGFR-tyrosine kinase inhibitors (TKIs). However, the response rate to targeted therapy is only 70%, and most patients experience disease progression 9 to 14 months after first- or second-generation EGFR-TKI treatment. This study aims to examine the association between super-amplification refractory mutation system (ARMS)-derived ΔCt values [mutant DNA cycle threshold (Ct) value relative to the endogenous reference gene (Ct) value] and EGFR mutation (EGFRm) abundance in predicting the efficacy and prognosis of EGFR-TKIs in NSCLC patients.</p><p><strong>Methods: </strong>The present retrospective research encompassed 139 patients with stage IIIB-IV NSCLC treated with EGFR-TKIs. Patients were categorized based on super-ARMS ΔCt values and Kaplan-Meier, and Cox regression models were used to evaluate the outcomes in survival and independent influencing factors, thus establishing the optimal ΔCt value for EGFR-TKIs response.</p><p><strong>Results: </strong>High mutation abundance, defined by ΔCt ≤3.76, was correlated with increased objective response rate (ORR) (61.2% <i>vs.</i> 36.8%, P=0.003) and longer median progression-free survival (mPFS) (20.9 <i>vs.</i> 15.8 months, log-rank P=0.005) compared to low abundance. The optimal ΔCt cut-off predictive of EGFR-TKIs response was 4.335. Patients with ΔCt ≤4.335 demonstrated superior ORR (64.6% <i>vs.</i> 28.1%, P<0.001) and mPFS (20.9 <i>vs.</i> 13.5 months, log-rank P<0.001) compared to those with ΔCt >4.335. Multivariate Cox analysis identified median ΔCt value group (ΔCt ≤3.76 or ΔCt >3.76), the optimal ΔCt cut-off value group (ΔCt ≤4.335 or ΔCt >4.335), brain metastasis, liver metastasis, EGFRm status, performance status (PS) score, and the generation of EGFR-TKIs as independent predictors of PFS in first-line EGFR-TKIs-treated patients.</p><p><strong>Conclusions: </strong>Stratification based on ΔCt values derived from the super-ARMS system can predict the efficacy and clinical prognosis of first-line EGFR-TKI treatment in NSCLC patients. Additionally, higher mutation abundance may contribute to the superior efficacy and prognosis of EGFR-TKIs in patients with exon 19 deletions compared to those with the 21L858R mutation.</p>","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":"17 6","pages":"3897-3911"},"PeriodicalIF":2.1,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12268672/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144675122","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":"Protocol for robotic-assisted bronchoscopy versus electromagnetic navigation bronchoscopy for the diagnosis of peripheral pulmonary nodules: a randomized trial (ARTICULAtE study).","authors":"Fangfang Xie, Chunxi Zhang, Chun Li, Dan Liu, Yuanlin Song, Michael J Simoff, Jiayuan Sun","doi":"10.21037/jtd-2025-312","DOIUrl":"10.21037/jtd-2025-312","url":null,"abstract":"<p><strong>Background: </strong>Electromagnetic navigation bronchoscopy (ENB) and shape-sensing robotic-assisted bronchoscopy (ssRAB) are the two dominant bronchoscopic technologies for the diagnosis of peripheral pulmonary nodules (PPNs). However, data directly comparing ENB and ssRAB are limited. We designed a randomized controlled trial to compare the diagnostic performance of these two technologies. The primary objective is to evaluate if ssRAB is superior to ENB for the diagnosis of PPNs.</p><p><strong>Methods: </strong>It is a multicenter, open-label, superiority randomized controlled trial. Patients with PPNs suspicious for lung cancer with a long-axis 8 to 30 mm are being approached for enrollment. The first 90 patients are being recruited as lead-in cases to allow the investigators to become familiar with the ssRAB system. A total of 264 patients will be enrolled in the randomized stage. The primary outcome is the diagnostic yield at the 6-month post-procedure follow-up. The secondary outcomes include diagnostic yield using a strict definition, diagnostic sensitivity of malignancies, the incidence of pneumothorax that requires chest tube placement and/or re-hospitalization or extended hospitalization within 1 month post-procedure, and the incidence of intraoperative severe airway bleeding. Enrollment for the study began in 20 March, 2024 and is currently in progress.</p><p><strong>Discussion: </strong>The results of this study will provide evidence to directly compare ssRAB and ENB in terms of diagnostic yield of PPNs and guide the selection of appropriate diagnostic techniques for different nodules.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov identifier: NCT06308120.</p>","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":"17 6","pages":"4339-4348"},"PeriodicalIF":2.1,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12268680/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144675124","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":"Assessment of postoperative outcomes of prescription benzodiazepine use in lung transplant recipients.","authors":"Austin Chang, Taisuke Kaiho, Benjamin Louis Thomae, Yudai Miyashita, Amanda Kamar, Anne O'Boye, Ambalavanan Arunachalam, Chitaru Kurihara","doi":"10.21037/jtd-2025-35","DOIUrl":"10.21037/jtd-2025-35","url":null,"abstract":"<p><strong>Background: </strong>The use of prescribed benzodiazepine (BZD) has been associated with adverse outcomes, including morbidity and mortality, in certain groups of solid organ transplant recipients. However, its impact on outcomes in lung transplant patients has not been well established. This retrospective study explores the survival rates and mortality risk factors in lung transplant recipients with preoperative BZD prescriptions.</p><p><strong>Methods: </strong>This study included an institutional lung transplant database between January 2018 and May 2024. Data were collected on patient characteristics, pretransplant laboratory values, and postoperative outcomes, including rejection and survival. Chi-squared, one-way analysis of variance (ANOVA), Kruskal-Wallis, Kaplan-Meier, and Wilcoxon signed-rank tests were used for analysis.</p><p><strong>Results: </strong>During the study period, 399 patients underwent lung transplantation. BZD use within 30 days prior to lung transplantation was reported in 141 patients (35.3%): 35 of 141 (24.8%) had BZD ≥2 mg (high-BZD) and 106 of 141 (75.2%) had BZD <2 mg (low-BZD). The high-BZD cohort had younger patients [mean: 47.8±13.5 <i>vs.</i> 62.3±9.8 (low-BZD) <i>vs.</i> 59.4±12.1 (no BZD) years, P<0.001], more bilateral lung transplants [94.3% <i>vs.</i> 57.5% (low-BZD) <i>vs.</i> 59.7% (no BZD), P<0.001], and higher lung allocation scores [mean: 79.6±17.6 <i>vs.</i> 55.24±17.9 (low-BZD) <i>vs.</i> 51.6±17.0 (no BZD), P<0.001] than their counterparts. There was no significant difference in one-year survival between the high-BZD cohort and their counterparts [84.9% <i>vs.</i> 88.1% (low-BZD) <i>vs.</i> 88.3% (no BZD), P=0.61]. However, intensive care unit (ICU) stay {median: 15 [interquartile range (IQR), 10-28] <i>vs.</i> 8 (IQR, 5-16, low-BZD) <i>vs.</i> 7 (IQR, 4-14, no BZD) days, P<0.001}, post-transplant ventilator period [median: 4 (IQR, 2-14) <i>vs.</i> 2 (IQR, 1-4, low-BZD) <i>vs.</i> 2 (IQR, 1-3, no BZD) days, P=0.003] and hospital stay [median: 32 (IQR, 17-42) <i>vs.</i> 18 (IQR, 12-32, low-BZD) <i>vs.</i> 16 (IQR, 11-29, no BZD) days, P=0.002] were significantly longer in the high BZD cohort. The incidence of primary graft dysfunction (PGD) in any grade was not significantly higher in the high BZD cohort [hazard ratio (HR) =1.39; 95% confidence interval (CI): 0.68-2.84; P=0.37], but PGD grade 3 was significantly higher in the high BZD cohort (HR =2.73; 95% CI: 1.20-6.22; P=0.02).</p><p><strong>Conclusions: </strong>This study highlights that preoperative BZD ≥2 mg use in lung transplant patients could be attributed to a higher rate of PGD grade 3 and prolonged hospital stay after lung transplantation. Appropriate weaning of BZD may be needed to minimize the risk of prolonged ICU stay and morbidity.</p>","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":"17 6","pages":"3737-3748"},"PeriodicalIF":2.1,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12268595/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144675148","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":"Comparison of diagnostic yield and complication of medical thoracoscopy using Flexible Bronchoscope versus Semi-Rigid Pleuroscope among Hospitalized Patients with Pleural Effusion (FLEXPLEUR): a retrospective observational study.","authors":"Ahmad Razman Shamsuddin, Mas Fazlin Mohamad Jailaini, Azat Azrai Azmel, Mohamed Faisal Abdul Hamid","doi":"10.21037/jtd-2025-135","DOIUrl":"10.21037/jtd-2025-135","url":null,"abstract":"<p><strong>Background: </strong>Pleural effusion is a prevalent issue worldwide presenting with a diagnostic challenge. Medical thoracoscopy (MT) via a semi-rigid pleuroscope (SRP) or rigid thoracoscope is the gold standard for diagnosing the aetiology of pleural effusions when less invasive tests fail. MT using a flexible bronchoscope (FB) could offer a viable alternative. However, there is a lack of comparative studies between MT using a SRP and a FB. We aimed to compare the diagnostic yield and complications of MT using a FB versus a SRP in the Respiratory Unit, Hospital Canselor Tuanku Muhriz, National University of Malaysia.</p><p><strong>Methods: </strong>Comparative, retrospective and observational study that reviews the hospital database of patients who underwent MT with either FB or SRP between January 2011 and May 2024.</p><p><strong>Results: </strong>A total of 178 patients were recruited (FB: n=90, SRP: n=88). There was no significant difference in diagnostic yield between FB (91.1%) and SRP (87.5%) (P=0.44). There was no significant difference in complications during the procedure between FB (8.9%) and SRP (4.5%) (P=0.25). However, a higher rate of post-procedure complications with a FB (12.2%) compared to a SRP (1.1%) (P=0.003) was observed. The mean overall complication rate is higher for FB (0.20±0.429) than for SRP (0.06±0.233) (P=0.006).</p><p><strong>Conclusions: </strong>MT using a FB could be a viable alternative for diagnosing pleural diseases in settings with limited resources, especially when conventional methods have failed.</p>","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":"17 6","pages":"3631-3642"},"PeriodicalIF":2.1,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12268826/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144675156","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":"Convalescent plasma therapy for COVID-19 in patients with nasal catheter oxygen therapy.","authors":"Ran Chen, Yingying Zhang, Ying Liu, Dandan Shi, Chuwen Wang, Jinming Ye, Danying Yan, Mingxi Peng, Dingfeng Lv, Guoqing Qian","doi":"10.21037/jtd-2024-1991","DOIUrl":"10.21037/jtd-2024-1991","url":null,"abstract":"<p><strong>Background: </strong>Numerous studies have demonstrated that convalescent plasma therapy reduces mortality in coronavirus disease 2019 (COVID-19) patients. Current guidelines recommend nasal catheter oxygen therapy for most hypoxic patients during the early stages of the illness. However, limited data are available regarding the efficacy of convalescent plasma therapy in patients already receiving oxygen therapy. Given the widespread use of nasal catheter oxygen therapy in hypoxic COVID-19 patients and the increasing evidence supporting the efficacy of convalescent plasma, this study aimed to evaluate the efficacy and safety of convalescent plasma therapy in COVID-19 patients who were receiving early oxygen therapy.</p><p><strong>Methods: </strong>A retrospective study was conducted at the First Affiliated Hospital of Ningbo University, analyzing 112 COVID-19 patients treated with convalescent plasma from December 2022 to July 2023. Data on demographics, laboratory tests, and plasma doses were collected before and after convalescent plasma transfusion, alongside standard care. The primary outcome was 28-day mortality, with laboratory parameters as secondary outcomes.</p><p><strong>Results: </strong>On day 28, the mortality rate was 20% in the convalescent plasma group compared to 44% in the standard-care group (P=0.008). In severe COVID-19 cases, mortality was 34% in the convalescent plasma group versus 59% in the standard-care group (P=0.04). Among patients who received nasal catheter oxygen therapy for 48 hours or longer, mortality was 21% in the convalescent plasma group compared to 42% in the standard-care group (P=0.02).</p><p><strong>Conclusions: </strong>Convalescent plasma therapy administered to COVID-19 patients receiving nasal catheter oxygen therapy significantly reduced mortality at day 28.</p>","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":"17 6","pages":"3532-3546"},"PeriodicalIF":2.1,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12268389/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144675160","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":"Factors influencing the difficulty of video-assisted thoracoscopic anterior mediastinal tumor resection via the subxiphoid approach.","authors":"Zi-Yan Wei, Jin-Cheng Chen, Guang-Hu Lai, Tong-Xin Li, Ya-Lu Shen, Ping He, Tao Wu, Wei Wu","doi":"10.21037/jtd-2024-2291","DOIUrl":"10.21037/jtd-2024-2291","url":null,"abstract":"<p><strong>Background: </strong>Video-assisted thoracoscopic mediastinal tumor resection via the subxiphoid approach (SVATS) is the mainstream surgical method for treating anterior mediastinal tumors. The impact of thoracic and mediastinal size on surgery has long been described only as a subjective feeling, and no related research has been reported. In this study, we retrospectively investigated the preoperative predictive factors affecting SVATS, focusing on the depth of the anterior mediastinum and thoracic morphology (width and depth).</p><p><strong>Methods: </strong>We studied 133 patients with mediastinal tumors. All had video thoracoscopic surgery through a subxiphoid approach by skilled senior doctors. Patients were divided into the difficult group and the common group according to whether the operation time exceeded the median value. We gathered their clinical data, computed tomography (CT) scans, and postoperative outcomes. We measured the distance from the sternum to the aorta, from the sternum to the spine, and the maximum transverse diameter of the thoracic cavity at the carina level on CT scans, representing the anterior mediastinal depth, thoracic cavity depth, and thoracic cavity width, respectively.</p><p><strong>Results: </strong>All the patients were discharged alive, and the average maximum diameter of the mediastinal tumor was 27.1 cm (interquartile range, 21.70-37.35 cm). There were no significant differences in age, sex, body mass index (BMI), preoperative cardiopulmonary comorbidities, postoperative complications, intensive care unit (ICU) stay, or postoperative hospital stay between the two groups (all P>0.05). Univariate regression analysis revealed that age, thoracic cavity depth, thoracic cavity width, and the ratio of thoracic cavity depth to width were associated with surgical difficulty (P=0.02, P=0.046, P=0.03, P=0.002). Multivariate regression analysis revealed that the independent predictive factors for difficult SVATS did not include the depth of the anterior mediastinum, but rather the depth of the thoracic cavity (P=0.006) and the width of the thoracic cavity (P=0.003).</p><p><strong>Conclusions: </strong>Thoracic morphology (width and depth), rather than the depth of the anterior mediastinum, is a predictive factor for the difficulty of SVATS.</p>","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":"17 6","pages":"3568-3576"},"PeriodicalIF":2.1,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12268755/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144675181","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":"Lobectomy versus sub-lobar resection for special type non-small cell lung cancer ≤2 cm.","authors":"Yang Pan, Xuanhong Jin, Feng Li, Yan Zhang, Zhourong Liu, Liang Shi, Junnan Ru, Yuqi Lin, Zixuan Fei, Leilei Wu, Jian Zeng","doi":"10.21037/jtd-2025-178","DOIUrl":"10.21037/jtd-2025-178","url":null,"abstract":"<p><strong>Background: </strong>Recent randomized trials have shown no significant difference in survival outcomes between lobectomy and sub-lobar resection for non-small cell lung cancer (NSCLC) ≤2 cm. However, these studies predominantly included common subtypes, such as adenocarcinoma and squamous cell carcinoma, with limited data on special type NSCLC (ST-NSCLC). This study aimed to address this gap by comparing overall survival (OS) outcomes between lobectomy and sub-lobar resection in patients with ST-NSCLC ≤2 cm.</p><p><strong>Methods: </strong>We analyzed Surveillance, Epidemiology, and End Results (SEER) database data (2000-2021) for clinical T1a-bN0M0 ST-NSCLC, including large cell carcinoma (LCC), large cell neuroendocrine carcinoma (LCNEC), adenosquamous carcinoma (ASC), malignant carcinoid (MC), and sarcomatoid carcinoma (SC). Patients undergoing lobectomy or sub-lobar resection were propensity score-matched to control baseline differences. OS was assessed using Kaplan-Meier methods and log-rank tests.</p><p><strong>Results: </strong>Of 6,517 patients (4,019 lobectomy, 2,498 sub-lobar resection), post-propensity score matching analysis showed lobectomy was associated with significantly better OS in LCC, LCNEC, ASC, and SC compared to sub-lobar resection. For MC, no OS difference was observed between approaches. In MC subgroup analysis, lobectomy was linked to longer OS in patients aged ≥60 years, white patients, and those without radiation or chemotherapy.</p><p><strong>Conclusions: </strong>In early-stage ST-NSCLC ≤2 cm, lobectomy is associated with better survival outcomes than sub-lobar resection for LCC, LCNEC, ASC, and SC, highlighting the role of tumor histology in surgical decisions. For MC, sub-lobar resection appears comparable to lobectomy. Prospective studies are needed to confirm these findings.</p>","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":"17 6","pages":"3797-3808"},"PeriodicalIF":2.1,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12268714/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144675203","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}