Journal of thoracic disease最新文献

{"title":"Imaging findings of multislice computed tomography in 21 patients with airway invasive pulmonary aspergillosis.","authors":"Xiaoqiong Ni, Rui Yu, Jinpeng Hou, Yang Ya, Guohua Fan, Zhengrong Chen","doi":"10.21037/jtd-24-843","DOIUrl":"10.21037/jtd-24-843","url":null,"abstract":"<p><strong>Background: </strong>Airway invasive aspergillosis (AWIA) poses a diagnostic challenge due to its nonspecific clinical manifestations. This study aimed to characterize the imaging findings of AWIA and explore the clinical characteristics that facilitate the diagnosis of AWIA.</p><p><strong>Methods: </strong>A retrospective analysis was conducted on 21 patients clinically and pathologically diagnosed with AWIA. All subjects underwent chest multislice computed tomography (MSCT) scans, and their clinical data were collected. The computed tomography (CT) features were evaluated, and 17 patients received the follow-up of MSCT in our hospital.</p><p><strong>Results: </strong>The high-frequency CT signs with an incidence of ≥60% included lobar and segmental bronchial lumen stenosis and wall thickening, patchy peribronchial consolidation, tree-in-bud sign, nodules (>5 mm), bronchioles wall thickening and lumen expansion. The low-frequency signs with an incidence of <40% included trachea or left/right main bronchial wall thickening, lobar and segmental bronchiectasis and wall thickening, ground-glass opacity, cavity, and pleural effusion. The inter-reader agreement for CT features was substantial (kappa =0.78). Additionally, we observed that clinical symptom improvement did not always correspond with immediate improvement in CT imaging findings during the early stages of treatment.</p><p><strong>Conclusions: </strong>The presence of specific high-frequency CT features in patients with underlying risk factors should prompt consideration of AWIA. Early recognition of these CT patterns may facilitate timely diagnosis and treatment, potentially improving patient outcomes.</p>","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":"17 2","pages":"887-897"},"PeriodicalIF":2.1,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11898349/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143625003","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":"Mechanical stress in a solid ellipsoid model of the lung after thoracoscopic surgery for spontaneous pneumothorax.","authors":"Byungho Lee, Chan Beom Park, Anna Lee","doi":"10.21037/jtd-24-1728","DOIUrl":"10.21037/jtd-24-1728","url":null,"abstract":"<p><strong>Background: </strong>Newly formed bullae after video-assisted thoracoscopic surgery (VATS) bullectomy in primary spontaneous pneumothorax (PSP) are an important etiology for recurrence and are associated with mechanical stress along the stapling line. However, the distribution or pattern of stress after VATS bullectomy has not been thoroughly investigated. Our aim was to analyze the stress distribution following lung resection.</p><p><strong>Methods: </strong>Using finite element method analyses in COMSOL Multiphysics software to evaluate the stress distribution along the stapling line, a solid ellipsoidal lung model was constructed. Simulations were subsequently conducted to evaluate changes in stress along the stapling line after VATS bullectomy. Finally, a parametric study investigating the changes in stress based on the difference between the lung resection volume and the degree of lung collapse was conducted.</p><p><strong>Results: </strong>The magnitude of the stress progressively increased with the inflation of the lung, and the highest stresses were observed at both ends and the center of the stapling line. The parametric studies showed that the maximum stress observed was positively correlated with the amount of lung resection (R²=0.961, P<0.001) and negatively correlated with the degree of lung collapse before stapling (R²=0.964, P<0.001). A wrinkling phenomenon was also observed adjacent to the stapling line.</p><p><strong>Conclusions: </strong>The mechanical stress during inflation progressively increased, reaching its peak at both ends and in the center, resulting in uneven wrinkling along the stapling line. Minimal resection with incomplete collapse before stapling could be considered a potential strategy to reduce stress.</p>","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":"17 2","pages":"849-858"},"PeriodicalIF":2.1,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11898334/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143625163","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":"Every cloud has a silver lining: DeepSeek's light through acute respiratory distress syndrome shadows.","authors":"Xinhao Jin, Jing Zhang, Jie Yang, Suibi Yang, Dong Xue, Zhongheng Zhang","doi":"10.21037/jtd-2025-381","DOIUrl":"10.21037/jtd-2025-381","url":null,"abstract":"","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":"17 2","pages":"1109-1113"},"PeriodicalIF":2.1,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11898352/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143625067","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":"Neoadjuvant dual immuno-combination therapy with anti-LAG3 and anti-PD-1 antibodies is feasible and safe for resectable non-small cell lung cancer.","authors":"Naoki Furuya, Takahiro Homma, Hisashi Saji","doi":"10.21037/jtd-24-1789","DOIUrl":"10.21037/jtd-24-1789","url":null,"abstract":"","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":"17 2","pages":"528-530"},"PeriodicalIF":2.1,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11898386/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143625167","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":"Development a predictive nomogram for spontaneous pleurodesis in patients with non-small cell lung cancer and malignant pleural effusion.","authors":"Sihan Tan, Hao Zeng, Qin Huang, Xin Pu, Weimin Li, Jason M Ali, Rahul Nayak, Milind Bhagat, Yalun Li, Panwen Tian","doi":"10.21037/jtd-2025-31","DOIUrl":"10.21037/jtd-2025-31","url":null,"abstract":"<p><strong>Background: </strong>Indwelling pleural catheter (IPC) insertion is associated with fewer subsequent procedures and higher rates of spontaneous pleurodesis (SP) in patients with malignant pleural effusion (MPE). However, long-term pleural drains may cause psychological and physical distress. Additionally, only a portion of patients can benefit from IPC insertion and ultimately have them removed. The nomogram reflects the influence of different factors on outcome visually, enabling clinics to assess the optimal population. Thus, the objective of this study was to develop and validate a novel nomogram to predict successful SP in non-small cell lung cancer (NSCLC) patients with MPE treated with IPC.</p><p><strong>Methods: </strong>We reviewed data on the use of IPC insertion for MPE in patients with NSCLC and allocated them randomly to development (60%) and validation (40%) sets. A static and dynamic nomogram was developed based on multivariate logistic regression to evaluate SP occurrence in the development set. Receiver operating characteristic (ROC) curves, calibration curves, decision curve analysis (DCA), and Nelson-Aalen cumulative risk curves were used to validate the predictive accuracy of the nomogram.</p><p><strong>Results: </strong>In total, 331 patients (development set: n=199; validation set: n=132) were selected for this study. Medical thoracoscopy, septated effusion, and effusion volume were the strongest predictors of SP. Other predictors included gender, systemic treatment, and serum neutrophil-to-lymphocyte ratio. The prediction nomogram was demonstrated good predictive ability in the development and validation sets (area under the curve: 0.745 and 0.720, respectively). The DCA indicated that the model had a certain clinical application value. Nelson-Aalen cumulative risk curves showed that the more favorable group received successful SP than did the less favorable group (P<0.001).</p><p><strong>Conclusions: </strong>We developed an accurate and practicable nomogram for successfully predicting SP. These results may benefit clinicians in optimizing treatment decisions, improving the probability of SP, and relieving the long-term discomfort caused by IPC.</p>","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":"17 2","pages":"1013-1027"},"PeriodicalIF":2.1,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11898402/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143625138","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 subcutaneous tunneled periareolar approach in lung resection performed through uniportal video-assisted thoracic surgery.","authors":"Dong Tian, Jun-Jie Wang, Kai-Yuan Jiang, Jie Li, Lei Wang, Hong-Tao Tang, Long-Qi Chen","doi":"10.21037/jtd-24-1613","DOIUrl":"10.21037/jtd-24-1613","url":null,"abstract":"<p><p>The approach for traditional uniportal video-assisted thoracoscopic surgery (Uni-VATS) is typically located on the lateral chest wall, the resulting pain and visible scars may have a negative psychological impact on patients. We present our preliminary experience with the subcutaneous tunneled periareolar approach (STPA) in lung resection performed through Uni-VATS for treating pulmonary nodules. From December 2023 through to June 2024, five patients underwent this procedure, including three cases of the wedge resection, one case of the lobectomy, and one case of the segmentectomy. The operations were uneventful, with no postoperative infections or deaths reported. Scarring from the STPA was effectively concealed within the naturally darker periareolar skin. Tension-free incision reduced postoperative pain for patients, and the follow-up outcomes were favorable. The STPA for Uni-VATS is a safe and reliable method for resection of pulmonary nodules, we recommend this method for patients with aesthetic concerns and for women without reproductive needs.</p>","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":"17 2","pages":"1073-1079"},"PeriodicalIF":2.1,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11898403/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143625181","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":"DeepSeek: the \"Watson\" to doctors-from assistance to collaboration.","authors":"Wenhua Liang, Peiling Chen, Xusen Zou, Xu Lu, Shaopeng Liu, Jing Yang, Zheng Li, Wen Zhong, Kang Zhang, Yaoming Liang, Jianxing He, Nanshan Zhong","doi":"10.21037/jtd-2025b-03","DOIUrl":"https://doi.org/10.21037/jtd-2025b-03","url":null,"abstract":"","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":"17 2","pages":"1103-1105"},"PeriodicalIF":2.1,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11898397/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143625190","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":"Identifying lung cancer in Emergency Department patients outside national lung cancer screening guidelines.","authors":"Hao Wang, Radhika Cheeti, Miles Murray, Timothy A Muirheid, Jasmine McDowell, Usha Sambamoorthi","doi":"10.21037/jtd-24-1399","DOIUrl":"10.21037/jtd-24-1399","url":null,"abstract":"<p><strong>Background: </strong>Lung cancer has become the second most common cancer and the leading cause of cancer death in the United States. We aim to determine factors associated with newly diagnosed lung cancer at the Emergency Department (ED) and identify specific patient populations eligible for lung cancer diagnostic screening.</p><p><strong>Methods: </strong>This is a single-center retrospective observational study. We included all patients aged between 50 and 80 years old, who presented to the ED seeking healthcare between January 1, 2019, and December 31, 2023. Patients' socio-demographics, clinical information, and whether they were eligible for lung cancer screening determined by the United States Preventive Services Task Force (USPSTF) guideline were analyzed and compared between patients who had newly diagnosed lung cancer at ED and those without. Factors associated with newly diagnosed lung cancer patients were determined by multivariable logistic regressions with inverse probability weighting (IPW) to account for observed selection bias of lung cancer screening eligibility.</p><p><strong>Results: </strong>Out of 75,516 patients in this study, 18,641 (25%) patients had documented smoking histories. Among these, only 8,051 (10.66%) were eligible for lung cancer screening, while 18,348 patients received lung computer tomography (CT). Among all patients whose CTs were performed, 123 individuals were identified as having been newly diagnosed with lung cancer. Multivariable logistic regressions showed that the adjusted odds ratio (AOR) for eligible lung cancer diagnostic screening was 3.07 [95% confidence interval (CI): 2.08-4.53, P<0.001] without IPW and 3.49 (95% CI: 2.24-5.42, P<0.001) with IPW. Other factors associated with newly diagnosed lung cancer in ED were older age, female, and patients who spoke neither English nor Spanish.</p><p><strong>Conclusions: </strong>To optimize the identification of suitable patients for lung cancer diagnostic screening in the ED, it may be beneficial to modify the eligibility criteria beyond those currently outlined by the USPSTF guidelines. Integrating additional factors such as advanced age, female sex, and a preference for non-English languages could improve the screening's effectiveness by capturing at-risk populations that might otherwise be overlooked.</p>","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":"17 2","pages":"695-706"},"PeriodicalIF":2.1,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11898393/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143625074","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":"Analysis of lymph node metastasis based on consolidation tumor ratio and maximum standardized uptake value in clinical stage IA non-small cell lung cancer.","authors":"In Ha Kim, Yooyoung Chong, Jae Kwang Yun, Sehoon Choi, Hyeong Ryul Kim, Yong-Hee Kim, Dong Kwan Kim, Seung-Il Park, Geun Dong Lee","doi":"10.21037/jtd-24-1780","DOIUrl":"10.21037/jtd-24-1780","url":null,"abstract":"<p><strong>Background: </strong>Sublobar resection has been established as an acceptable treatment for early-stage non-small cell lung cancer (NSCLC). As a result, preoperative prediction of lymph node (LN) metastasis is becoming an important factor in determining surgical strategy. This study aimed to investigate the predictive accuracy of the consolidation tumor ratio (CTR) and the maximum standardized uptake value (maxSUV) of the primary tumor for LN metastasis in patients with clinical stage IA NSCLC.</p><p><strong>Methods: </strong>We performed a retrospective analysis using data from 1,338 patients with clinical stage IA NSCLC who underwent surgery between 2011 and 2019. Receiver operating characteristic (ROC) curves and the area under the curve (AUC) were used to identify the optimal maxSUV and CTR for predicting LN metastasis. Multivariate logistic regression analysis was performed to identify independent predictors of LN metastasis. Survival analyses were performed using Cox proportional hazards models to identify prognostic factors for death and recurrence.</p><p><strong>Results: </strong>Among the 896 patients who underwent lobectomy with systematic LN dissection, 9.8% (88 patients) were found to have LN metastasis. The ROC curve for CTR revealed an AUC of 0.689 [95% confidence interval (CI): 0.646-0.732, P<0.001], while the ROC curve for maxSUV yielded an AUC of 0.748 (95% CI: 0.705-0.791, P<0.001) for predicting LN metastasis. In pure solid mass (CTR =1) with maxSUV exceeding 5.0, LN metastasis was observed in 13.8% of tumor 0-2 cm and 25.7% of tumor 2.1-3 cm. Multivariate analysis identified CTR >0.5 (HR =1.741, 95% CI: 1.122-2.701, P=0.01) and maxSUV >5.0 (HR =2.004, 95% CI: 1.421-2.825, P<0.001) as independent prognostic factors for disease-free survival.</p><p><strong>Conclusions: </strong>In clinical stage IA NSCLC, LN metastasis can be predicted using CTR and maxSUV of the primary mass. It is crucial not to underestimate the rate of LN metastasis when determining the surgical extent.</p>","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":"17 2","pages":"944-958"},"PeriodicalIF":2.1,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11898382/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143625110","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":"Impact of spontaneous ventilation with intubation on perioperative results in uniportal VATS lobectomy compared to general anaesthesia using a double-lumen tube.","authors":"József Furák, Péter Zsoldos, Judit Lantos, Júlia Lantos, Ferenc Rárosi, Evelin Szűcs, Csongor Fabó, Gabriella Kecskés","doi":"10.21037/jtd-24-1396","DOIUrl":"10.21037/jtd-24-1396","url":null,"abstract":"<p><strong>Background: </strong>Minimally invasive thoracic surgery is the most frequently used approach for lung resection to minimize surgical stress on the patient. To further reduce invasiveness, the non-intubated spontaneous ventilation method is applied on the anesthesia side. However, due to the unsafe airway associated with this procedure, this method is not widely adopted. This study analyzes the surgical results of our method, which involves spontaneous ventilation with double lumen tube intubation and uniportal video-assisted thoracic surgery (VATS) lung lobectomies.</p><p><strong>Methods: </strong>Between 2015 and 2023, 302 patients underwent uniportal VATS lobectomy in two different periods, depending on the type of anesthesia. Between 2015 and 2019, traditional relaxation, double lumen tube intubation, and general anesthesia (GA) with mechanical one-lung ventilation were used for lobectomies in 210 patients (93 males, 117 females, mean age 64.3 years) (GA-VATS group). Between 2021 and 2023, 92 cases (44 males, 48 females, mean age 66.3 years) underwent lobectomy with spontaneous ventilation after a short relaxation period, double lumen intubation, and vagus nerve blockade (SVI-VATS group). Perioperative data from 66 patients in each group were analyzed after 1:1 sample propensity score matching (caliper 0.1).</p><p><strong>Results: </strong>Respecting all patients, in the GA-VATS and SVI-VATS groups, the mortality and morbidity rates were 1 (0.47%) and 0 (0%), and 52 (24.7%) (P=0.050) and 19 (20.6%) (P=0.32), respectively. The rate of grade IIIB complications was 13 (6.1%) in the GA-VATS group and 0 (0%) in the SVI-VATS group (P=0.01). The length of surgery was 91.1 <i>vs.</i> 86.4 min (P=0.10), duration of chest drainage was 4.64±4.58 <i>vs.</i> 3.39±3.39 days (P=0.02), the rate of permanent air leak was 43 (20.4%) <i>vs.</i> 8 (8.7%) (P=0.001), reoperation rate was 11 (5.2%) <i>vs.</i> 0 (0%) (P=0.02), and the number of removed mediastinal lymph nodes was 12.7 <i>vs.</i> 12.7 (P=0.97) in the GA-VATS and SVI-VATS groups, respectively. After propensity score-matched analysis, there were no cases of mortality in either group. Morbidity rates were 19 (28.8%) and 15 (22.7%) (P=0.55), length of surgery was 99 <i>vs.</i> 86.7 min (P=0.003), duration of chest drainage was 5.1 <i>vs.</i> 3.8 days (P=0.02), the rate of permanent air leak was 15 (22.7%) <i>vs.</i> 8 (12.1%) (P=0.10), and the reoperation rate was 5 (7.57%) <i>vs.</i> 0 (0%) (P=0.058) in the GA-VATS and SVI-VATS groups, respectively.</p><p><strong>Conclusions: </strong>SVI-VATS lobectomy resulted in fewer complications, particularly those requiring correction under anesthesia (IIIb) and a shorter postoperative period than GA-VATS. The number of removed mediastinal lymph nodes was similar between the groups.</p>","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":"17 2","pages":"774-783"},"PeriodicalIF":2.1,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11898360/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143625141","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}