Journal of thoracic disease最新文献

{"title":"A retrospective study exploring chronic pulmonary aspergillosis in post-tuberculosis lung disease patients.","authors":"Tamzyn Huisamen, Helen Thomson, Kristin R V Harrington, Nicola Baines, Christelle Ackermann, Stephanie Griffith-Richards, Cara Koffeman, Nevadna Singh, Coenraad F N Koegelenberg, Elizna Maasdorp, Brian W Allwood","doi":"10.21037/jtd-24-1062","DOIUrl":"10.21037/jtd-24-1062","url":null,"abstract":"<p><strong>Background: </strong>Chronic pulmonary aspergillosis (CPA) complicates post-tuberculosis lung disease (PTLD), causing significant morbidity and mortality. Predictors for Aspergillus seropositivity and CPA in a PTLD population remain unclear. The objective of this study was to identify the clinical, radiological, physiological, and biochemical characteristics of patients presenting to an adult PTLD clinical service, who met full criteria for CPA, and to compare them to those who did not, as well as compare those with positive Aspergillus serology to those without.</p><p><strong>Methods: </strong>This retrospective cross-sectional study, performed in a tertiary adult PTLD clinical service in South Africa, investigated the clinical, radiological, physiological and biochemical characteristics of patients who had Aspergillus serology performed and compared those with positive and negative serology, as well as those meeting CPA diagnostic criteria with those who did not.</p><p><strong>Results: </strong>Over a 2-year period, 238 patients were seen in the PTLD clinic, of which 79 had registered Aspergillus immunoglobulin G (IgG) serology testing and computed tomography (CT) chest imaging performed. Twenty-six (32.9%) patients had positive Aspergillus serology and 20 (25.3%) met criteria for CPA. Current radiological definitions for CPA when applied in a blinded fashion, had a sensitivity of 80.8% and a specificity of 58.5% for Aspergillus seropositivity, with a positive predictive value of 48.8%. Having ≥4 episodes of previous pulmonary tuberculosis (PTB) was significantly associated with both Aspergillus seropositivity [odds ratio (OR) =10.9; 95% confidence interval (CI): 2.1-84.9] and CPA diagnosis (OR =15.5; 95% CI: 2.8-125.6). Haemoptysis was significantly more common in those with positive Aspergillus serology (OR =2.7; 95% CI: 1.4-5.2) and in those with CPA (OR =2.7; 95% CI: 1.4-5.4). Total immunoglobulin E (IgE) levels were significantly higher in those with Aspergillus seropositivity (P value =0.006) and in those with CPA (P value =0.03). Other symptoms, spirometric and laboratory findings were similar between groups.</p><p><strong>Conclusions: </strong>Current radiological criteria are not sufficiently specific for the diagnosis of CPA in PTLD populations, necessitating wider use of Aspergillus serology. The significant overlap in clinical syndromes highlights a complicated yet poorly understood relationship between CPA and PTLD, with increased frequency of haemoptysis requiring further research.</p>","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":"17 1","pages":"320-332"},"PeriodicalIF":2.1,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11833582/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143458463","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":"Advanced thymic epithelial tumour resection: vascular resection and reconstruction strategy.","authors":"Akshay J Patel, Eleni Josephides, Rajdeep Bilkhu, Paolo Bosco, Gianluca Lucchese, Andrea Bille","doi":"10.21037/jtd-24-1395","DOIUrl":"10.21037/jtd-24-1395","url":null,"abstract":"<p><strong>Background: </strong>Thymic epithelial tumors (TETs) represent the predominant primary malignancy of the anterior mediastinum, often necessitating complex surgical interventions due to their invasive nature. The prognosis of advanced TET relies significantly on achieving complete resection with microscopically clear margins (R0). This frequently entails resection and reconstruction of major vascular structures like the superior vena cava (SVC) and brachiocephalic veins, and in some cases, extra pleural pneumonectomy (EPP). The aim of the study is to interrogate our series of advanced TET resections.</p><p><strong>Methods: </strong>We analysed our experience with vascular resection and reconstruction in 14 patients with advanced stage III/IV TET undergoing extensive resection post-neoadjuvant chemotherapy. A comprehensive preoperative evaluation was performed, including computed tomography (CT), positron emission tomography (PET), biopsy, and exercise testing. We describe our surgical approach and the details of our series.</p><p><strong>Results: </strong>From 2015 to 2023, 31 patients underwent surgery for advanced TET at our centre, with major vessel reconstruction performed in 14 cases. This included resection of SVC and innominate veins with subsequent reconstruction using polytetrafluoroethylene (PTFE) grafts. The median operative time was 350 minutes, with a median blood loss of 1,300 mL. Cardiopulmonary bypass (CPB) was required in 2 cases. The rate of R0 resection was 78.6%, with a recurrence rate of 14.3% at a median follow-up of 1,700 days. Postoperative complications occurred in 42.9% of patients, with an in-hospital mortality rate of 7.1%.</p><p><strong>Conclusions: </strong>Multi-disciplinary management, meticulous preoperative planning, and advanced surgical techniques are essential for the successful treatment of advanced TET. Complex vascular resections should be reserved for high-volume centres to optimize outcomes.</p>","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":"17 1","pages":"299-307"},"PeriodicalIF":2.1,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11833585/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143458470","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 outcome of urgent thoracoscopic surgery on complicated parapneumonic infection with short-term preoperative antibiotic usage.","authors":"Younggi Jung, Eunjue Yi, Sungho Lee, Jae Ho Chung","doi":"10.21037/jtd-24-1331","DOIUrl":"10.21037/jtd-24-1331","url":null,"abstract":"<p><strong>Background: </strong>Prompt initiation of antibiotics and drainage of infection source is essential in the management of pleural cavity infection. Although surgical drainage is considered a gold standard of treatment for unresolved parapneumonic infection, optimal timing for surgical intervention is still under debate. Thus, we seek to analyze the clinical outcomes of urgent thoracoscopic surgery for complicated parapneumonic effusion regarding the duration of preoperative antibiotic usage.</p><p><strong>Methods: </strong>Medical records were retrospectively reviewed for patients who received thoracoscopic surgery for complicated parapneumonic effusion or empyema. Patients were grouped according to the preoperative antibiotic durations and compared. Group A consists of the patients with less than 3 days of preoperative antibiotics usage and Group B consists of those with more than 3 days of preoperative antibiotic coverage. Basic demographics, preoperative chest computed tomography (CT) findings, antibiotics usage, duration until surgery and treatment outcomes were evaluated.</p><p><strong>Results: </strong>From February 2008 to November 2018, a total of 180 patients underwent video-assisted thoracoscopic surgery (VATS) for pleural drainage or decortication of lung. Group A patients had higher C-reactive protein value (240 <i>vs</i>. 192 mg/L, P=0.003) and were given significantly shorter duration of total antibiotics (9 <i>vs</i>. 14 days, P<0.001). The median duration of postoperative chest tube indwelling time (5 <i>vs</i>. 5 days, P=0.38), postoperative hospital stays (8 <i>vs</i>. 8 days, P=0.56), operation time (105 <i>vs</i>. 105 min, P=0.88) showed no significant difference between the groups. CT images of Group A patients showed a significantly higher rate of multi-loculation (83 <i>vs</i>. 59, P=0.008) and interlobar effusions (64 <i>vs</i>. 42, P=0.02). There were two postoperative mortalities and four recurrences.</p><p><strong>Conclusions: </strong>Faster and relatively safe and successful clinical outcomes can be achieved with urgent thoracoscopic surgery on patients with complicated parapneumonic effusion despite limited duration of antibiotics coverage.</p>","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":"17 1","pages":"357-368"},"PeriodicalIF":2.1,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11833586/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143458518","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":"CD276 as a critical independent biomarker and immune checkpoint inhibitor target in epithelioid mesothelioma-TCGA study.","authors":"Yuko Aoki, Ken Arimura, Kenzo Hiroshima, Yasuto Sato, Mitsuko Kondo, Etsuko Tagaya","doi":"10.21037/jtd-24-1598","DOIUrl":"10.21037/jtd-24-1598","url":null,"abstract":"<p><strong>Background: </strong>CD276 is an immune checkpoint, and immune checkpoint inhibitors (ICIs) targeting CD276 have been tested against various cancers. However, the precise role of CD276 in mesothelioma subtypes is unknown. This study aimed to reveal the prognostic significance of CD276 in various cancers and explore CD276 as a target for ICIs in different mesothelioma subtypes.</p><p><strong>Methods: </strong>We evaluated data from The Cancer Genome Atlas (TCGA) database retrospectively. The Wilcoxon rank-sum test was used to assess <i>CD276</i> mRNA expression between cancer tissues and the adjacent normal tissues in the context of various cancers. The study involved 86 patients with mesothelioma. The mean number of patients was set as the cutoff value for comparing <i>CD276</i> mRNA expression. The overall survival (OS) of patients with each mesothelioma subtype was estimated using the Kaplan-Meier method with <i>CD276</i> mRNA expression. The factors affecting the correlation between OS and high/low <i>CD276</i> expression in combination with/without a current existing molecular targets of programmed cell death 1 (PD-1), cytotoxic T-lymphocyte-associated protein 4 (CTLA4), and vascular endothelial growth factor A (VEGFA) were assessed using a multivariate Cox proportional hazards model. The correlation between the mRNA expression of <i>CD276</i> and expression of gene markers of tumor-infiltrating immune cells and those of different pathways was evaluated using Spearman's correlation. The factors affecting correlations of <i>CD276</i> mRNA expression were confirmed using a multivariate linear regression model.</p><p><strong>Results: </strong>Upregulated <i>CD276</i> mRNA expression was associated with a poor prognosis in various cancers, including epithelioid mesothelioma. The multivariate Cox proportional hazards model demonstrated that upregulated <i>CD276</i> mRNA expression indicated the worst prognosis, including the combination of <i>CD276</i> and PD-1, <i>CTLA4</i>, and <i>VEGFA</i>. In addition, using a multivariate linear regression model, <i>CD276</i> mRNA expression was found to correlate with multiple glycolytic pathway mRNAs in epithelioid mesothelioma, especially <i>PKM2</i>.</p><p><strong>Conclusions: </strong>CD276 is an independent prognostic biomarker in patients with epithelioid mesothelioma. It is associated with the glycolytic pathway and may contribute to ATP generation in epithelioid mesothelioma. CD276 inhibitors might contribute to better prognosis in patients with epithelioid mesothelioma.</p>","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":"17 1","pages":"109-120"},"PeriodicalIF":2.1,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11833596/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143458551","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":"Effect of dexmedetomidine on postoperative delirium in patients undergoing type A aortic dissection surgery: a prospective cohort study.","authors":"Yan-Rong Yu, Yi-Lin Wang, Xue-Wen Zhu, Li Li, Dong-Jin Wang, Ya-Peng Wang, Jia-Xin Ye","doi":"10.21037/jtd-24-1219","DOIUrl":"10.21037/jtd-24-1219","url":null,"abstract":"<p><strong>Background: </strong>Postoperative delirium (POD) is a common neurocognitive complication after type A aortic dissection (TAAD), which seriously affects the recovery of patients, and the current intervention timing and treatment methods are still uncertain. This prospective observational cohort study aimed to discuss the effect of dexmedetomidine on POD in patients undergoing TAAD surgery.</p><p><strong>Methods: </strong>Between February 2022 and March 2023, 167 eligible patients aged 18 to 85 years who underwent TAAD surgery participated in this study. The patients were assigned to either the dexmedetomidine or the control group, which did not receive dexmedetomidine treatment. The primary outcome of interest was the incidence of delirium within five days following surgery. Secondary outcomes included intubation duration, length of stay in the intensive care unit (ICU), total postoperative hospital stay, incidence of non-delirium complications, and all-cause mortality within seven days. To account for differences in baseline characteristics between the groups, propensity score matching (PSM) was utilized.</p><p><strong>Results: </strong>Before PSM, the dexmedetomidine group was made up of 120 patients, whereas the control group comprised 47. The occurrence rate of POD increased from 35.0% in the dexmedetomidine group to 42.6% in the control group, but there was no significant difference [odds ratio (OR) 0.73; 95% confidence interval (CI): 0.37-1.45; P=0.36]. After 1:1 PSM, there were 42 patients in each of the dexmedetomidine and control groups. The occurrence of POD was 28.6% and 45.2% in the dexmedetomidine and control groups, respectively, with no statistically significant difference observed (OR 0.48; 95% CI: 0.20-1.20; P=0.12). The dexmedetomidine group showed a shorter ICU hospitalization time and postoperative hospital stay than the control group, but the differences were not statistically significant. Furthermore, the two groups had no statistical differences in other secondary outcomes.</p><p><strong>Conclusions: </strong>Intraoperative dexmedetomidine did not decrease the occurrence rate of POD in TAAD patients. Additionally, no significant differences were observed between the dexmedetomidine and control groups regarding the occurrence of non-delirium complications, intubation time, ICU hospitalization time, and postoperative hospital stay.</p>","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":"17 1","pages":"161-173"},"PeriodicalIF":2.1,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11833563/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143458568","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":"High-resolution computed tomography with 1,024-matrix for artificial intelligence-based computer-aided diagnosis in the evaluation of pulmonary nodules.","authors":"Qinling Jiang, Hongbiao Sun, Qi Chen, Yimin Huang, Qingchu Li, Jingyi Tian, Chao Zheng, Xinsheng Mao, Xin'ang Jiang, Yuxin Cheng, Yunmeng Wang, Xiang Wang, Su Wu, Yi Xiao","doi":"10.21037/jtd-24-1311","DOIUrl":"10.21037/jtd-24-1311","url":null,"abstract":"<p><strong>Background: </strong>Computed tomography (CT) plays an important role in the diagnosis of lung nodules and early screening of lung cancer. The purpose of this study was to compare the efficacy of 1,024×1,024 matrix and 512×512 matrix in an artificial intelligence-based computer-aided diagnosis (AI-CAD) for evaluating lung nodules based on CT images.</p><p><strong>Methods: </strong>This retrospective analysis included 344 patients from two hospitals between January 2020 and November 2023. CT images presenting lung nodules smaller than 30 mm were reconstructed using the 512×512 and 1,024×1,024 matrix. We evaluated image quality and AI-CAD detection of lung nodules. Image quality was subjectively scored using a 5-point Likert method and objectively assessed using image noise and signal-to-noise ratio (SNR). For lung nodules detection, we recorded the accuracy, precision, and recall of AI-CAD for detecting of different types and sizes of lung nodules.</p><p><strong>Results: </strong>The 512×512 matrix's overall image subjective evaluation score was 3.63, whereas the 1,024×1,024 matrix's was 4.18, among 344 individuals with 4,319 lung nodules. The detection accuracy, precision, and recall of 512×512 and 1,024×1,024 for AI-CAD in all lung nodules were 91.63% <i>vs.</i> 98.32%, 95.68% <i>vs.</i> 98.32%, and 95.59% <i>vs.</i> 100% respectively. Solid, part-solid, and nonsolid nodule identification accuracy on 512 and 1,024 matrix were 91.30% <i>vs.</i> 98.34%, 94.63% <i>vs.</i> 98.50%, and 94.71% <i>vs.</i> 97.74%, respectively, and of <6 mm, 6-8 mm, and >8 mm nodules were 90.58% <i>vs.</i> 97.87%, 96.64% <i>vs.</i> 99.04% and 93.68% <i>vs.</i> 99.36%, respectively.</p><p><strong>Conclusions: </strong>The 1,024 matrix performed significantly better than the 512 matrix in terms of overall subjective image quality and lung nodule AI-CAD detection rate.</p>","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":"17 1","pages":"289-298"},"PeriodicalIF":2.1,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11833551/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143458590","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 U-shaped relationship between admission peripheral oxygen saturation and all-cause hospital mortality in acute exacerbation of chronic obstructive pulmonary disease: a retrospective analysis using the MIMIC III database.","authors":"Na Meng, Chunyu Tan, Lindong Yuan, Wenjuan Xu, Pengcheng Wang, Peige Zhao","doi":"10.21037/jtd-24-1404","DOIUrl":"10.21037/jtd-24-1404","url":null,"abstract":"<p><strong>Background: </strong>Chronic obstructive pulmonary disease (COPD) and acute exacerbation of chronic obstructive pulmonary disease (AECOPD) pose global challenges, with oxygen saturation (SpO₂) levels crucial in evaluating mortality. This study explored the correlation between admission SpO₂ levels and all-cause hospital mortality in patients with AECOPD, assessing whether SpO₂ can serve as an independent risk factor for predicting in-hospital mortality in these patients.</p><p><strong>Methods: </strong>This study involved 996 AECOPD patients sourced from the Medical Information Mart for Intensive Care (MIMIC) III database (version 1.3), with 134 fatalities. Patients were categorized into a death group (n=134) and a survival group (n=862). The average admission SpO₂ value was recorded for all 996 AECOPD patients. Subsequently, a generalized additive model (GAM) curve was employed to examine the association between admission SpO₂ levels and all-cause hospital mortality. Following this, Cox regression analysis and survival analysis were conducted to further investigate the link between admission SpO₂ and all-cause hospital mortality.</p><p><strong>Results: </strong>The GAM curve demonstrated a non-linear, U-shaped relationship between admission SpO₂ and all-cause hospital mortality in AECOPD patients. The nadir of all-cause hospital mortality was associated with an SpO₂ of 89.5%. Notably, an SpO₂ of 89.5% served as the optimal cutoff for predicting all-cause hospital mortality. Cox regression analysis identified SpO₂ as a risk factor for all-cause hospital mortality in AECOPD patients. Patients with SpO₂ ≥89.5% exhibited independently lower death risk compared to those with SpO₂ <89.5% (hazard ratio: 0.52; 95% confidence interval: 0.37-0.74; P<0.001).</p><p><strong>Conclusions: </strong>Admission SpO₂ level is an independent risk factor for predicting all-cause hospital mortality in AECOPD patients and can serve as a prognostic indicator. A U-shaped relationship was observed, with an admission SpO₂ level of 89.5% associated with the lowest mortality, suggesting an optimal range for improved prognosis.</p>","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":"17 1","pages":"60-69"},"PeriodicalIF":2.1,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11833588/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143458638","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":"Correlation of blood lipids, glucose, and inflammatory indices with the occurrence and prognosis of lesion complexity in unstable angina, a retrospective cohort study.","authors":"Yingkai Xu, Guiling Ma, Boqia Xie, Jing Zhao, Xingpeng Liu, Jianjun Zhang, Mulei Chen","doi":"10.21037/jtd-2024-2122","DOIUrl":"10.21037/jtd-2024-2122","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;In recent years, novel cardiometabolic biomarkers and related pathogenic genes and their heritability have been examined. However, no multitarget predictive evaluation models exist can identify and predict complex lesions in unstable angina (UA) in the early stages before coronary angiography (CAG) or evaluate the prognosis of patients with UA and complex lesions. In this study, we sought to investigate the correlation between blood lipid, glucose, and inflammatory indices and the occurrence and prognosis of UA with complex lesions, and also the risk factors for major adverse cardiocerebrovascular events (MACCEs).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Patients with UA who underwent percutaneous coronary intervention (PCI) at Chaoyang Hospital between March 2019 and December 2020 were included. Patients with UA who underwent PCI were divided into complex lesion group and noncomplex lesion group according to the CAG results. The blood lipid and glucose levels, inflammatory indices, Synergy between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery (SYNTAX) scores, and clinical outcome events after 3 years follow-up from both groups were calculated.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 523 patients were included, with 248 and 275 patients in the complex and noncomplex lesion groups, respectively. There were no significant differences between the two groups in terms of sex, age, medical history, or demographic characteristics. After 3 years of follow-up, compared with the noncomplex lesion group, the complex lesion group had a higher incidence of target vessel revascularization (TVR) (8.1% &lt;i&gt;vs.&lt;/i&gt; 4.0%; P=0.049) and MACCEs (11.7% &lt;i&gt;vs.&lt;/i&gt; 5.8%; P=0.02). High remnant lipoprotein cholesterol (RLP-C) level, high small dense low-density lipoprotein cholesterol (sLDL-C) level, high lipoprotein (a) [Lp(a)] level, high high-sensitivity C-reactive protein (hs-CRP) level, low lymphocyte level, low albumin level, and low hs-CRP:albumin ratio (CAR) were found to be risk factors for the occurrence of UA with complex lesions. High RLP-C level, high sLDL-C level, high Lp(a) level, and high neutrophil:lymphocyte ratio (NLR) were independent risk factors for MACCEs in the complex lesion group, from which a new prediction model was created. The area under the curve (AUC) of the new model for predicting MACCEs events after 3 years of follow-up [AUC =0.935; 95% confidence interval (CI): 0.881-0.989] in the complex lesion group was higher than that of the SYNTAX score (AUC =0.671; 95% CI: 0.584-0.757) (P&lt;0.001).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Blood lipid and glucose levels and inflammatory indices may be associated with the occurrence of UA with complex lesions. The new model for UA with complex lesions constructed using high RLP-C level, high sLDL-C level, high Lp(a) level, and high NLR level had a stronger ability to predicts MACCEs during follow-up than did the SYNTAX score. Our findings could enhance early det","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":"17 1","pages":"413-428"},"PeriodicalIF":2.1,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11833552/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143458525","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":"Aortic arch-clamping technique without open distal anastomosis for extended ascending aortic aneurysms.","authors":"Bo Jia, Chengnan Li, Cheng Luo, Yongliang Zhong, Yipeng Ge, Zhiyu Qiao, Haiou Hu, Junming Zhu, Lizhong Sun","doi":"10.21037/jtd-24-1133","DOIUrl":"10.21037/jtd-24-1133","url":null,"abstract":"<p><strong>Background: </strong>The open anastomosis technique is a classic procedure for treating extended ascending aortic aneurysms, but hypothermic circulatory arrest is unavoidable, which increases the risk of organ injury. The aortic arch-clamping (AAC) technique is an alternative treatment. This study aimed to evaluate the efficacy of the AAC technique in patients with ascending aortic aneurysms extending to the proximal arch.</p><p><strong>Methods: </strong>From January 2015 to February 2022, 230 patients with ascending aneurysms extending to the proximal arch underwent surgical intervention. Based on the type of distal ascending aorta surgery, the patients were divided into the AAC group (n=117 cases) and the open distal anastomosis (ODA) group (n=113 cases). The prognosis of 67 matched pairs was compared after 1:1 propensity score matching (PSM).</p><p><strong>Results: </strong>After PSM, the baseline data were similar between the AAC and ODA groups. In the AAC group, the cardiopulmonary bypass duration was significantly lower (median 120 <i>vs</i>. 156 min, P<0.001). The incidences of acute kidney injury (AKI), transient neurological dysfunction, and ventilation time >24 h increased significantly in the ODA group (32.8% <i>vs</i>. 7.5%, P=0.001; 9% <i>vs</i>. 0%, P=0.04; 19.4% <i>vs</i>. 6%, P=0.04, respectively). Multivariable logistic regression analysis showed that the AAC approach was an independent protective factor for composite adverse events [odds ratio (OR): 0.05, 95% confidence interval (CI): 0.01-0.39, P=0.005], ventilation time >24 h (OR: 0.33, 95% CI: 0.12-0.92, P=0.03), and AKI (OR: 0.21, 95% CI: 0.08-0.54, P=0.001). There was no significant difference in midterm mortality (3.0% <i>vs</i>. 4.5%, P=0.44) or reintervention rates (3.0% <i>vs</i>. 3.0%, P=0.91) between the two groups.</p><p><strong>Conclusions: </strong>Considering its short- and mid-term efficacy, the AAC technique is an alternative technique for extended ascending aneurysms.</p>","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":"17 1","pages":"308-319"},"PeriodicalIF":2.1,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11833549/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143458419","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":"<i>PLCXD3-ALK</i>, a novel <i>ALK</i> rearrangement in lung squamous cell carcinoma and its clinical responses to ALK inhibitors.","authors":"Kaidi Chen, Xiuqiong Chen, Xinyue Wang, Bing Yan, Aiqin Liu, Youhui Wang, Jing Zhou, Qianhui Wei, Yi Pan, Richeng Jiang","doi":"10.21037/jtd-24-1428","DOIUrl":"10.21037/jtd-24-1428","url":null,"abstract":"<p><strong>Background: </strong>Lung cancer is the leading cause of cancer-related death worldwide, of which anaplastic lymphoma kinase fusion positive (<i>ALK</i> ⁺) non-small cell lung cancer (NSCLC) accounts for 3-7. Here, we identified a new fusion gene <i>PLCXD3-ALK</i> (P1, A19) from a patient with advanced lung squamous cell carcinoma (LUSC) by next-generation sequencing (NGS). We aimed to evaluate its oncogenic potential by performing functional studies <i>in vitro</i> and tumorigenicity <i>in vivo</i> of this fusion protein.</p><p><strong>Methods: </strong>We performed functional experiments in NIH-3T3 cells with stable expression of <i>PLCXD3-ALK</i> including soft agar colony formation assay, cell proliferation and viability assays, and transwell assay. The activation of downstream pathways and the response to ALK inhibitors crizotinib and alectinib were demonstrated by western blotting (WB). In addition, we further evaluated the tumorigenicity of the <i>PLCXD3-ALK</i> mutants in nude mice.</p><p><strong>Results: </strong>Similar to <i>EML4-ALK</i>, the <i>PLCXD3-ALK</i> fusion promoted proliferation and the capacity for non-anchorage-dependent growth of NIH-3T3 cells. We demonstrated that <i>PLCXD3-ALK</i> can activate ALK self-phosphorylation and downstream pathways, which could be inhibited by the addition of ALK inhibitors. Moreover, we observed that this gene could provoke oncogenic transformation in nude mice. Meanwhile, the patient was monitored for disease progression with computed tomography (CT) scanning during treatment with alectinib, and a benefit was observed.</p><p><strong>Conclusions: </strong>We identified and functionally validated <i>PLCXD3-ALK</i> as a novel rare fusion in NSCLC that has not been previously reported. It can serve as a meaningful therapeutic target for ALK inhibitors of <i>ALK</i> ⁺ NSCLC.</p>","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":"17 1","pages":"93-108"},"PeriodicalIF":2.1,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11833567/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143458460","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}