Journal of thoracic disease最新文献

{"title":"Active surveillance for patients with multifocal ground-glass nodules: protocol of a prospective, multi-center, single-arm trial (ECTOP-1021).","authors":"Haoxuan Wu, Penghao Deng, Fangqiu Fu, Yang Zhang, Haiquan Chen","doi":"10.21037/jtd-2024-1956","DOIUrl":"10.21037/jtd-2024-1956","url":null,"abstract":"<p><strong>Background: </strong>For early-stage lung cancers identified as ground-glass opacity (GGO) on thin-section computed tomography (TSCT), the previously proposed concept of the surgical curative time window suggests that surgical resection is deemed appropriate at any point within this timeframe, eliminating the necessity for immediate surgery upon initial detection. However, uncertainties persist regarding the impact of delayed surgery on survival and the optimal timing of surgery within a surveillance context.</p><p><strong>Methods: </strong>The Eastern Cooperative Thoracic Oncology Project-1021 (ECTOP-1021) (ClinicalTrials.gov, NCT06097910) is a prospective, multi-center, single-arm trial designed to evaluate the safety of active surveillance for patients with early-stage multifocal ground-glass nodules (GGNs). Patients with persistent GGNs, characterized by a tumor diameter ≤2 cm, consolidation-to-tumor ratio (CTR) ≤0.25, and the presence of three or more lesions, will be enrolled. Regular TSCT scans will be conducted according to a predefined follow-up schedule, and surgery will be performed when resection criteria are met. The primary endpoint is 5-year overall survival (OS). The study aims to enroll a total of 370 patients from centers and hospitals within the ECTOP study group over a 3-year period.</p><p><strong>Discussion: </strong>The trial will establish the surveillance strategy, involving the avoidance or delay of surgery within the surgical curative time window, as a standard treatment for patients with multifocal GGNs.</p><p><strong>Trial registration: </strong>This trial is officially registered on ClinicalTrials.gov (NCT06097910).</p>","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":"17 4","pages":"2634-2639"},"PeriodicalIF":2.1,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12090158/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144119435","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":"Computed tomography-guided percutaneous biopsy for diagnosing pulmonary nodules: a prospective, multicenter observational study.","authors":"Yun Liu, Ling Zhao, Hua-Long Yu, Wei Zhao, Dong Li, Guo-Dong Li, Hao Wang, Bin Huo, Qi-Ming Huang, Bai-Wu Liang, Rong Ding, Zhe Wang, Chen Liu, Liang-Yu Deng, Jun-Ru Xiong, Xue-Quan Huang, Chuang He","doi":"10.21037/jtd-24-1912","DOIUrl":"10.21037/jtd-24-1912","url":null,"abstract":"<p><strong>Background: </strong>Pulmonary nodules are common radiological findings, and accurate diagnosis is essential for patient management and prognosis. Computed tomography (CT)-guided percutaneous biopsy (CTPB) is a minimally invasive and accessible diagnostic method, but its accuracy requires further evaluation. This study assessed the accuracy of CTPBs for diagnosing pulmonary nodules.</p><p><strong>Methods: </strong>This study involved 591 patients from ten medical centers in China who were prospectively enrolled between April 2021 and April 2022. The primary outcome was the consistency between biopsy pathology results and final clinical diagnosis, while secondary outcomes included the incidence of biopsy-related complications. The data were analyzed via logistic regression and the receiver operating characteristic (ROC) curves.</p><p><strong>Results: </strong>The 591 patients included in this study had an average age of 59.29±11.22 years, and 50.6% were male. The nodules were categorized as pure ground-glass nodules (10.2%), part-solid nodules (32.0%), and solid nodules (57.9%). The diagnostic accuracy of CTPB for pulmonary nodules was 95.10% (specificity: 100%, sensitivity: 92.79%), the positive predictive value was 100%, and the negative predictive value was 86.76%. Multivariate logistic regression revealed that solid nodules (P<0.001), subsolid nodules [consolidation-to-tumor ratio (CTR) >50%, P=0.001], semiautomatic (tru-cut) needles (P=0.02), number of cuts (P=0.01), intermediate (P=0.006) and peripheral nodules (P=0.02) significantly impacted the diagnostic accuracy of lung nodule biopsy. These factors had predictive value in determining the accuracy of pulmonary nodule biopsy diagnosis (area under the ROC curve: 0.812). The incidence of pneumothorax was 13%, and the incidence of high-grade pulmonary hemorrhage was 27.1%, which did not affect the diagnostic accuracy, while other complications, such as hemopneumothorax (3.6%), pleural reaction (0.7%), and air embolism (0.2%), were rare.</p><p><strong>Conclusions: </strong>In real-world settings, CTPB diagnoses pulmonary nodules with high accuracy. Improving diagnostic accuracy and reducing the incidence of common complications, such as pneumothorax and pulmonary hemorrhage, are crucial for the widespread application of this technique as a diagnostic tool.</p>","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":"17 4","pages":"1876-1887"},"PeriodicalIF":2.1,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12090130/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144119927","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":"Pleural invasion of peripheral cT1 lung cancer by deep learning analysis of thoracoscopic images: a retrospective pilot study.","authors":"Kohei Hashimoto, Calvin Davey, Kenshiro Omura, Satoru Tamagawa, Takafumi Urabe, Junji Ichinose, Yosuke Matsuura, Masayuki Nakao, Sakae Okumura, Hironori Ninomiya, Jun Sese, Mingyon Mun","doi":"10.21037/jtd-24-1510","DOIUrl":"10.21037/jtd-24-1510","url":null,"abstract":"<p><strong>Background: </strong>Sublobar resection for small peripheral non-small cell lung cancer (NSCLC) (≤2 cm) became one of the standard procedures. Retrospective studies demonstrated that pathological pleural invasion (pPL) is associated with a higher risk of local recurrence during sublobar resection. If pPL can be properly assessed intraoperatively, converting to lobectomy may reduce the risk of local recurrence associated with sublobar resection. The study objective was to develop a deep learning algorithm predicting pPL from thoracoscopic images.</p><p><strong>Methods: </strong>Among consecutive patients who underwent radical thoracoscopic surgery for cT1N0M0 NSCLC (TNM 8th) from 5/2020 to 3/2022, 80 patients with pleural surface changes due to tumor (excluding cTis/1mi or peritumoral adhesions) were included. A tumor recognition deep learning model using the ResNet50 architecture was constructed from images and the focus was visualized using gradient-weighted class activation mapping (Grad-CAM). Among images in which a tumor is visible, the presence of pPL was predicted (trained on 64, validated on 16). Predictive ability was compared with the surgeons' intraoperative evaluation using McNemar's test.</p><p><strong>Results: </strong>Among 80 patients (age 69±10 years, 42.5% female, tumor diameter 20±7 mm), pPL was found in 22 patients. Compared to the pPL- group, the pPL+ group was significantly older, with larger solid diameter, more pure solid nodules, and higher SUV max. Among the 422,873 images extracted from all 80 videos, 2,074 images showed tumors, of which 608 images were pPL+. The tumor recognition algorithm had an image-level accuracy of 0.78 and F1 score of 0.60. The pPL model had a patient-level accuracy of 0.69, while the accuracy of thoracic surgeons was 0.75 (P=0.32).</p><p><strong>Conclusions: </strong>Deep learning analysis of thoracoscopic images of lung cancer surgery showed the possibility of prediction of pPL to a comparable degree to surgeons.</p>","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":"17 4","pages":"1991-1999"},"PeriodicalIF":2.1,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12090174/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144120013","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":"Diagnostic accuracy of interleukin 32γ for tuberculous pleural effusion.","authors":"Qi Wang, Li Ma, Kan Zhai, Feng-Shuang Yi, Huan-Zhong Shi, Ming-Ming Shao","doi":"10.21037/jtd-24-1676","DOIUrl":"10.21037/jtd-24-1676","url":null,"abstract":"<p><strong>Background: </strong>Accurate diagnosis of tuberculous pleural effusion (TPE) with biomarkers remains difficult. Interleukin 32gamma (IL-32γ) is a recently discovered proinflammatory cytokines which plays a vital role in the immune response to TPE. This study aimed to assess the diagnostic accuracy of IL-32γ for TPE, especially in different ages of patients.</p><p><strong>Methods: </strong>Patients with a confirmed diagnosis of pleural effusion were systematically recruited from Beijing Chao-Yang Hospital between June 2019 and May 2022. The concentration of IL-32γ and interferon-gamma (IFN-γ) were evaluated in the pleural effusions with different etiology from 188 patients using enzyme-linked immunosorbent assay method. Adenosine deaminase (ADA) was determined by peroxidase method.</p><p><strong>Results: </strong>At a threshold value of 181.56 ng/L, IL-32γ demonstrated an area under the curve (AUC) of 0.812 [95% confidence interval (CI): 0.748-0.865], with sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), positive predictive value (PPV), and negative predictive value (NPV) of 70.2%, 86.0%, 5.0, 0.4, 92.0%, and 55.7%, respectively. In elderly patients (aged >65 years), IL-32γ demonstrated an AUC of 0.984 (95% CI: 0.891-1.000). Notably, the diagnostic accuracy of IL-32γ was significantly higher than that of ADA (P=0.03) and IFN-γ (P=0.02). Similarly, the AUCs for IL-32γ combined with ADA (0.981, 95% CI: 0.886-1.000) and IL-32γ combined with IFN-γ (1.000, 95% CI: 0.920-1.000) were significantly higher than those of ADA (P=0.04) or IFN-γ (P=0.01) alone in elderly patients.</p><p><strong>Conclusions: </strong>IL-32γ can be used as a valuable biomarker for identifying patients with TPE, especially in elderly patients aged >65 years.</p>","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":"17 4","pages":"2339-2349"},"PeriodicalIF":2.1,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12090101/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144120074","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 versus late chest tube removal after surgery for primary spontaneous pneumothorax-a systematic review and meta-analysis.","authors":"Quirine C A van Steenwijk, Louisa N Spaans, Jerry Braun, Marcel G W Dijkgraaf, Frank J C van den Broek","doi":"10.21037/jtd-24-1802","DOIUrl":"10.21037/jtd-24-1802","url":null,"abstract":"<p><strong>Background: </strong>The optimal timing of postoperative chest tube removal remains disputable. Traditionally, chest tubes are left in place for several days for adequate pleurodesis and recurrence prevention after surgery for primary spontaneous pneumothorax (PSP). Currently, early tube removal, defined as immediate removal upon cessation of air leakage, is increasingly practiced. This study aimed to evaluate the safety of early chest tube removal in terms of recurrence in these patients.</p><p><strong>Methods: </strong>MEDLINE (PubMed), EMBASE and Cochrane databases were searched until January 2024. Inclusion criteria encompassed patients undergoing pleurodesis through video-assisted thoracoscopic surgery (VATS) for PSP if chest tube management was clearly described to discriminate between early and late tube removal protocols, and recurrence rate with a postoperative follow-up period of at least six months was reported. The primary outcome was recurrence rate, with secondary outcomes including postoperative length of stay (LOS), prolonged air leakage (PAL) and chest tube duration. Subgroup analysis contained type of pleurodesis. The quality of evidence was evaluated with the Grading of Recommendations Assessment, Development and Evaluation method.</p><p><strong>Results: </strong>Thirty-six studies comprising 6,166 patients were included, lacking direct comparative studies on early versus late chest tube removal. Due to loss to follow-up, 6,063 patients were analysed regarding recurrence rate, resulting in 4.49% [95% confidence interval (CI): 3.33-6.03%; I²=65.6%] after late removal and 7.61% (95% CI: 5.44-10.57%; I²=8.2%) after early removal (P=0.02). Among the secondary outcomes only chest tube duration was significantly different between early and late removal [2.50 (95% CI: 2.31-2.71) versus 3.42 (95% CI: 3.08-3.81) days, P<0.001]. Subgroup analysis revealed the most pronounced difference in recurrence following pleurectomy as type of pleurodesis (P=0.003). The quality of evidence was considered low.</p><p><strong>Conclusions: </strong>Although no direct comparative studies were retrieved, the best available evidence suggests that early chest tube removal may be associated with a slightly higher recurrence rate after surgical pleurodesis for pneumothorax. High-quality evidence is needed before implementing early removal.</p>","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":"17 4","pages":"2194-2205"},"PeriodicalIF":2.1,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12093158/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144120077","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":"Computed tomography-based body composition and systemic inflammation for outcome prediction in patients with resectable esophageal squamous cell carcinoma.","authors":"Rong Wang, Liyang Zhu, Jiqing Hao, Nathawadee Lerttanatum, Xiangxun Chen, Liming Wu, Yichun Wang","doi":"10.21037/jtd-2025-508","DOIUrl":"10.21037/jtd-2025-508","url":null,"abstract":"<p><strong>Background: </strong>Computed tomography (CT) can assess a patient's body composition, thereby reflecting an individual's health status. Currently, there is a scarcity of research on the relationship between body composition and prognosis in patients with esophageal squamous cell carcinoma (ESCC) after esophagectomy. We assessed the independent and combined prognostic value of CT-derived body composition parameters, clinical history, pathologic findings, and inflammatory factors in patients with resected ESCC and established a predictive model.</p><p><strong>Methods: </strong>This retrospective analysis included 142 patients with postoperative ESCC. Sarcopenia was diagnosed by assessing the skeletal muscle index at the third lumbar level of CT components. Survival analysis included the Kaplan-Meier method, and the Cox proportional hazards method was employed for multifactor analysis. The consistency index and calibration curve were used to determine the predictive accuracy and discrimination ability of the nomogram.</p><p><strong>Results: </strong>Sarcopenia prevalence among the 142 patients was 62.0% (88/142). The median overall survival (OS) and the 1-, 3-, and 5-year survival rates of patients with sarcopenia were 54.0 months (95% confidence interval: 37.8-70.2), 79.5%, 59.1%, and 44.5%, respectively. Patients without sarcopenia had a median OS of 93.0 months (95% confidence interval: 70.0-116.0), with 1-, 3-, and 5-year survival rates 90.0%, 73.9%, and 65.1%, respectively (P=0.04 for the comparison of OS between the sarcopenia group and the non-sarcopenia group). In the Cox multivariate model, sarcopenia, smoking, lymphocyte albumin score, and tumor-node-metastasis (TNM) stage significantly correlated with postoperative survival in ESCC. The concordance index of the nomogram and calibration curve indicated good agreement between predicted and observed results.</p><p><strong>Conclusions: </strong>Sarcopenia in ESCC was negatively associated with OS. The combination of sarcopenia, pathological parameters, and inflammatory factors could independently predict the survival of patients undergoing ESCC surgery, demonstrating good prognostic value.</p>","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":"17 4","pages":"2441-2452"},"PeriodicalIF":2.1,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12090184/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144119923","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":"An integrated analysis of scRNA-seq and RNA-seq data revealed metastasis-related regulators as prognostic indicators in lung adenocarcinoma.","authors":"Yang Jiang, Danrong Ye, Yongxin Zhou","doi":"10.21037/jtd-2025-482","DOIUrl":"10.21037/jtd-2025-482","url":null,"abstract":"<p><strong>Background: </strong>The incidence and mortality rates of lung cancer are exceptionally high. Many patients are diagnosed with early stage lung cancer but experience rapid recurrence post-surgery. Many research studies have shown that the unfavorable prognosis of patients may be associated with micro-metastasis in the lymph nodes. Our research aimed to develop a nomogram to predict the prognosis of lung adenocarcinoma (LUAD).</p><p><strong>Methods: </strong>Single-cell RNA sequencing (scRNA-seq) data were analyzed to identify 11 cell clusters. Patterns of incoming and outgoing signals were identified across the entire cell population. A weighted gene co-expression network analysis (WGCNA) was conducted to uncover critical genes in LUAD. The intersecting marker genes were used to construct the prognostic model.</p><p><strong>Results: </strong>scRNA-seq data were analyzed to identify 19 cell clusters. We identified 3,464 marker genes from the scRNA-seq dataset, 1,994 differentially expressed genes from the bulk RNA sequencing (RNA-seq) dataset, and 1,863 genes associated with a key module identified by the WGCNA. After performing the intersection, univariate Cox, and least absolute shrinkage and selection operator analyses, a prognostic model was established based on the expression levels of 13 signature genes. Subsequent functional experiments confirmed the role of selected regulated genes.</p><p><strong>Conclusions: </strong>Through the integration of scRNA-seq data and bulk RNA-seq data, we developed an innovative model to predict the prognosis of patients. The risk score was found to be a significant independent predictor and clinical-pathological features of LUAD.</p>","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":"17 4","pages":"2473-2491"},"PeriodicalIF":2.1,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12090110/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144119941","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":"Midterm outcomes of concomitant ascending aorta replacement with rapid deployment aortic valve replacement.","authors":"Sangil Yun, Kyung Hwan Kim, Suk Ho Sohn, Yongwoo Chung, Yoonjin Kang, Ji Seong Kim, Jae Woong Choi","doi":"10.21037/jtd-24-1739","DOIUrl":"10.21037/jtd-24-1739","url":null,"abstract":"<p><strong>Background: </strong>Aortic valve replacement (AVR) frequently accompanies concomitant ascending aorta replacement. This study was conducted to evaluate the early and midterm outcomes of patients who underwent AVR with rapid-deployment valve (RDAVR) and concomitant ascending aorta replacement compared to those who underwent isolated RDAVR.</p><p><strong>Methods: </strong>From June 2016 to June 2023, 130 patients who underwent RDAVR with concomitant ascending aorta replacement (Ao-AVR group) and 108 patients who underwent isolated RDAVR (Iso-AVR group) were enrolled in this study. Early and midterm outcomes were compared between the groups. Multivariate analysis was performed to identify the risk factors associated with all-cause mortality.</p><p><strong>Results: </strong>Ao-AVR group was younger and less morbid than Iso-AVR group. Bicuspid aortic valvulopathy was the main etiology in Ao-AVR group (71.5%), whereas degenerative calcific valvulopathy was the main etiology in Iso-AVR group (55.6%). Cardiopulmonary bypass time and aortic cross-clamp time were 21 and 28 minutes longer, respectively, in Ao-AVR group. Operative mortality was 0.0% in Ao-AVR group, and their early clinical outcomes were comparable to those of Iso-AVR group, except for the occurrence of postoperative atrial fibrillation (46.9% <i>vs.</i> 34.3%, P=0.048). Multivariate analysis demonstrated that age, chronic obstructive pulmonary disease, and emergency operation were the significant risk factors associated with midterm all-cause mortality, whereas concomitant ascending aorta replacement was not a risk factor.</p><p><strong>Conclusions: </strong>Concomitant ascending aorta replacement during RDAVR demonstrated excellent early and midterm outcomes, comparable to isolated RDAVR.</p>","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":"17 4","pages":"2078-2090"},"PeriodicalIF":2.1,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12090124/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144119988","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":"Nalmefene effectively relieves thoracic epidural opioid-induced pruritus without affecting analgesia: a randomized controlled clinical trial.","authors":"Guiting Li, Huan Yan, Weishan Li, Ailun Li, Yiqi Zhu, Jiapeng Huang, Jing Cang, Fang Fang","doi":"10.21037/jtd-24-1455","DOIUrl":"10.21037/jtd-24-1455","url":null,"abstract":"<p><strong>Background: </strong>Pruritus is a prominent side effect of neuraxial opioids. Pruritus is an unpleasant sensation that leads to scratching and discomfort. This trial was aimed to study nalmefene's efficacy for treating epidural opioid-induced pruritus and its effect on postoperative patient-controlled epidural analgesia (PCEA).</p><p><strong>Methods: </strong>We recruited 166 patients who developed postoperative pruritus due to epidural opioid analgesia. Patients were randomized to the nalmefene group or control group and received either 0.5 µg/kg nalmefene or the equivalent volume of saline to evaluate nalmefene's efficacy for treating epidural opioid-induced pruritus and its effect on postoperative PCEA. The primary outcome was the complete relief rate of pruritus within 24 hours after the treatment. Secondary outcomes included postoperative pain scores, other PCEA-related adverse events, itch scores, and the time of itching relief.</p><p><strong>Results: </strong>A total of 160 patients were included in the final analysis. The complete pruritus relief rate in the nalmefene group was significantly higher than that in the control group within 24 hours after the treatment (68 of 80; 85% <i>vs.</i> 51 of 80; 63.7%, P=0.002). The median Visual Analog Scale (VAS) pain score, the incidence of other PCEA-related adverse events, and itch scores showed no difference. The Kaplan-Meier curves showed that intravenous nalmefene reduced the median [interquartile range (IQR)] time of itching relief from 15.62 (7.59-23.65) to 1.5 (0.84-2.16) hours (P<0.001). The multivariable analysis indicated that female patients without allergic history were associated with more complete relief of itching.</p><p><strong>Conclusions: </strong>A single dose of intravenous nalmefene could relieve postoperative pruritus from epidural opioids without affecting analgesic effects.</p><p><strong>Trial registration: </strong>The study was retrospectively registered in the Chinese Clinical Trial Registry (ChiCTR2000039596) on November 2, 2020.</p>","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":"17 4","pages":"2028-2037"},"PeriodicalIF":2.1,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12090119/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144120035","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":"North American expert consensus on the clinical role of ex vivo lung perfusion (EVLP) with acellular perfusate.","authors":"Matthew Bacchetta, Christian A Bermudez, Ankit Bharat, A Whitney Brown, Marie M Budev, Marcelo Cypel, Caitlin T Demarest, Daniel F Dilling, Bartley P Griffith, John C Haney, Shaf Keshavjee, Zachary N Kon, Tiago N Machuca, Jorge M Mallea, Si M Pham, Thomas K Waddell, Bryan A Whitson, Kenneth R McCurry","doi":"10.21037/jtd-2024-2069","DOIUrl":"10.21037/jtd-2024-2069","url":null,"abstract":"<p><strong>Background: </strong>Ex vivo lung perfusion (EVLP) of donor lungs not otherwise acceptable for transplantation can provide outcomes similar to standard-criteria lung transplantation and has been reported to increase transplant volume by approximately 20% in some transplant centers. Evidence to support decisions about use of EVLP is limited, so expert opinion can be a useful decision aid. This study developed expert consensus recommendations for EVLP with acellular perfusate using a modified Delphi method.</p><p><strong>Methods: </strong>A panel of 18 physicians with expertise in lung transplantation and EVLP who practice in North America completed three surveys on EVLP: Survey 1 used open-ended questions; Survey 2 used primarily Likert-scale questions; and Survey 3 repeated Survey 2 while providing panelists with the Survey 2 results. A follow-up meeting after Survey 3 probed open questions.</p><p><strong>Results: </strong>The primary goal for EVLP is expanding the number of donor lungs available for transplant. Lungs that are acceptable after EVLP are equivalent to lungs that met standard criteria initially. Lungs with unclear or marginal quality should be placed on EVLP for evaluation, including lungs received from third party organizations with incomplete or concerning information. Decisions on whether to put lungs on EVLP require nuanced clinical judgement and should consider compliance and deflation, the ratio of PaO2 to fraction of inspired oxygen (P/F ratio), peak inspiratory pressure (PIP), edema on imaging, and bronchoscopy, with additional parameters considered as appropriate if lung quality is unclear. EVLP lungs are appropriate for transplant if all relevant parameters are acceptable and may be appropriate if some parameters are borderline depending on clinical judgment. Decisions about transplanting EVLP lungs should consider radiography, delta PO2, overall movement, STEEN Solution™ loss, bronchoscopy, peak airway pressure, and palpation, along with other parameters as appropriate. Key open areas for research include evidence-based criteria for lung selection and assessment, the role of biomarkers, and enhanced techniques and perfusion solutions. In addition, the role of EVLP is unclear in lungs with pulmonary emboli and lungs procured with normothermic regional perfusion (NRP), as is the maximal duration of cold ischemia time (CIT).</p><p><strong>Conclusions: </strong>Decisions about EVLP require nuanced consideration of numerous parameters. Expert opinion from this study may help optimize use of EVLP.</p>","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":"17 4","pages":"1832-1843"},"PeriodicalIF":2.1,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12090176/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144120042","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}