Journal of thoracic disease最新文献

{"title":"Relapsing polychondritis: tracheobronchial involvement and differential diagnoses.","authors":"Louis Grandière, Hugues Vicaire, Gabriel Pop, Morgane Didier, Olivia Freynet, Marina Alexandre, Dominique Clero, Alexis Mathian, Emmanuel Martinod, Pierre-Yves Brillet, Thomas Gille, Yurdagül Uzunhan","doi":"10.21037/jtd-24-1603","DOIUrl":"10.21037/jtd-24-1603","url":null,"abstract":"<p><p>This review is describing the diagnostic and therapeutic approach to tracheobronchial involvement in relapsing polychondritis (RP), with a focus on differential diagnoses of inflammatory origin. RP is a systemic auto-immune disease that mainly affects cartilage structures, progressing through inflammatory flare-ups between phases of remission and ultimately leading to deformation of the involved cartilages. Besides the damage of auricular or nasal cartilage, tracheobronchial and cardiac involvement are the most severe, and can seriously alter the prognosis. Tracheobronchial lesions are assessed through a multimodal approach. Mapping of tracheal lesions is achieved using dynamic thoracic imaging and flexible bronchoscopy. Measurement of pulmonary function (with new emphasis on pulse oscillometry) is useful to diagnose obstructive ventilatory impairment, and can be used to follow RP patients, after therapeutics implementation. Diagnosis can be difficult in the absence of specific diagnostic tools, especially because there is a large number of differential diagnoses, in particular inflammatory diseases. Nuclear imaging can help with detection of metabolic activity on involved cartilages, leading to sharpen the final diagnosis. The prognosis has improved, thanks to the upgraded interventional bronchoscopy techniques, and the development of immunosuppressant including targeted therapies, such as tumor necrosis factor-α (TNF-α) inhibitors, offering patients several treatment options, in addition to supportive care.</p>","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":"17 1","pages":"461-475"},"PeriodicalIF":2.1,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11833600/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143458579","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 preoperative anemia in ischemic cardiomyopathy with or without coronary artery bypass grafting.","authors":"Yang Huang, Kaizheng Liu, Gang Li, Huawei Wu, Guangguo Fu, Bohao Jian, Jinyu Pan, Tongxin Chu, Yi Zhang, Mengya Liang, Zhuoming Zhou, Zhongkai Wu","doi":"10.21037/jtd-24-1187","DOIUrl":"10.21037/jtd-24-1187","url":null,"abstract":"<p><strong>Background: </strong>Whether the preoperative anemia affects the prognosis and the therapeutic choice between coronary artery bypass grafting (CABG) or medical therapy alone in patients with ischemic cardiomyopathy (ICM) remains unclear. We assess the influence of preoperative anemia on long-term outcomes in ICM patients treated with medical therapy alone with or without CABG.</p><p><strong>Methods: </strong>Patients with preoperative hemoglobin were included from the Surgical Treatment of Ischemic Heart Failure (STICH) trial. The primary outcome was long-term all-cause mortality.</p><p><strong>Results: </strong>A total of 1,209 patients were enrolled, with 320 (26.5%) patients with anemia, and 889 (73.5%) without anemia. The median follow-up time was 9.7 years. Compared with patients without anemia, patients with anemia had a higher risk of all-cause mortality [adjusted hazard ratio (aHR): 1.15; 95% confidence interval (CI): 0.98 to 1.36] and cardiovascular mortality (aHR: 1.26; 95% CI: 1.04 to 1.53). Among patients with anemia, CABG provided a significant survival benefit compared with medical therapy alone (all-cause mortality: aHR: 0.64; 95% CI: 0.48 to 0.85; cardiovascular mortality: aHR: 0.54; 95% CI: 0.39 to 0.76). Though with borderline statistical significance, CABG also provided additional survival benefit among patients without anemia (all-cause mortality: aHR: 0.87; 95% CI: 0.73 to 1.03; cardiovascular mortality: aHR: 0.83; 95% CI: 0.68 to 1.01). Sensitivity analyses based on as-treated principle showed the consistent results.</p><p><strong>Conclusions: </strong>Preoperative anemia is an independent risk factor for mortality in patients with ICM, whereas preoperative anemia does not affect the long-term survival benefits associated with CABG, which might help surgeons in making rational therapeutic decisions during clinical practice.</p>","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":"17 1","pages":"198-208"},"PeriodicalIF":2.1,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11833565/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143458601","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":"Retraction: Coronary artery bypass grafting <i>vs.</i> drug-eluting stent implantation: the probabilities of reintervention, transition to severe care-need, nursing home, and death in patients with coronary artery disease within the first three years: evaluations based on health claims data in Germany.","authors":"Daniela Georges, Daniel Kreft, Gabriele Doblhammer","doi":"10.21037/jtd-2024-04","DOIUrl":"10.21037/jtd-2024-04","url":null,"abstract":"<p><p>[This retracts the article DOI: 10.21037/jtd-24-251.].</p>","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":"17 1","pages":"522-523"},"PeriodicalIF":2.1,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11833597/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143458630","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":"Surgical management of stage IE/IIE primary pulmonary lymphomas: a propensity score matching study.","authors":"Jie Cao, Huahang Lin, Zhiyu Peng, Zhaokang Huang, Zetao Liu, Chenglin Guo, Jiandong Mei","doi":"10.21037/jtd-24-1524","DOIUrl":"10.21037/jtd-24-1524","url":null,"abstract":"<p><strong>Background: </strong>Primary pulmonary lymphomas (PPLs) are rare malignancies that are frequently misdiagnosed due to their non-specific symptoms and ambiguous imaging findings. Although chemotherapy and radiation are typically the main treatment options, the role of surgery in managing PPLs remains uncertain. This study aimed to evaluate the impact of surgery on survival outcomes in patients with stage IE/IIE PPLs.</p><p><strong>Methods: </strong>We analyzed 2,693 patients with stage IE/IIE PPLs using Cox regression and Kaplan-Meier analyses to assess overall survival (OS) and cancer-specific survival (CSS). Subgroup analyses were performed based on histological subtypes, including mucosa-associated lymphoid tissue (MALT) lymphoma, diffuse large B-cell lymphoma (DLBCL), other non-Hodgkin's lymphoma (NHL), and Hodgkin's lymphoma (HL). Additionally, we analyzed tumor stage and patient characteristics. Propensity score matching (PSM) was applied to reduce potential biases.</p><p><strong>Results: </strong>Among the patients, 1,013 underwent surgery, while 1,680 did not. After PSM, surgery was associated with significantly improved OS [hazard ratio (HR) =0.75, 95% confidence interval (CI): 0.66-0.86, P<0.001] and CSS (HR =0.66, 95% CI: 0.54-0.81, P<0.001). Notably, surgery significantly improved OS and CSS in patients with stage IE (OS: HR =0.62, 95% CI: 0.46-0.84, P=0.002; CSS: HR =0.57, 95% CI: 0.39-0.84, P=0.005) and stage IIE (OS: HR =0.64, 95% CI: 0.41-0.99, P=0.046; CSS: HR =0.47, 95% CI: 0.27-0.85, P=0.01) DLBCL. However, surgery did not significantly affect OS (P=0.24) or CSS (P=0.83) in patients with HL, stage IE/IIE MALT lymphoma (stage IE: OS, P=0.11; CSS, P=0.34; stage IIE: OS, P=0.40; CSS, P=0.75), or stage IE/IIE other NHL (stage IE: OS, P=0.050; CSS, P=0.46; stage IIE: OS, P=0.22; CSS, P=0.11). Additionally, sublobectomy demonstrated outcomes comparable to lobectomy/pneumonectomy in terms of OS and CSS for both stage IE (OS: HR =0.81, 95% CI: 0.63-1.06, P=0.13; CSS: HR =0.91, 95% CI: 0.58-1.43, P=0.70) and stage IIE (OS: HR =0.66, 95% CI: 0.40-1.09, P=0.10; CSS: HR =0.58, 95% CI: 0.26-1.29, P=0.18) PPLs.</p><p><strong>Conclusions: </strong>Surgery improves oncological outcomes for patients with stage IE/IIE DLBCL but does not provide survival benefits for MALT lymphoma, other NHL, or HL. Sublobectomy may be a viable surgical option when complete resection is achieved.</p>","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":"17 1","pages":"134-149"},"PeriodicalIF":2.1,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11833583/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143458654","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":"Immediate start of durvalumab after chemoradiotherapy in unresectable non-small cell lung cancer UICC stage III: early results from the TORG1937/DATE study.","authors":"Brane Grambozov, Markus Stana, Franz Zehentmayr","doi":"10.21037/jtd-24-1638","DOIUrl":"10.21037/jtd-24-1638","url":null,"abstract":"","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":"17 1","pages":"1-4"},"PeriodicalIF":2.1,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11833581/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143458598","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":"Advancing surgical options in esophageal cancer: key findings from the ROMIO randomized clinical trial.","authors":"Takashi Ofuchi, Keisuke Kosumi, Masaaki Iwatuski","doi":"10.21037/jtd-24-1803","DOIUrl":"10.21037/jtd-24-1803","url":null,"abstract":"","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":"17 1","pages":"5-9"},"PeriodicalIF":2.1,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11833599/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143458472","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 practice guidelines and statements from key professional respiratory societies: the status quo.","authors":"Tong Hieu, Latisha E Witjaksono, Arwel W Jones, Yuxin Jiao, William Soon, Emma Marshall, Victoria Ng, Kirushallini Saravanan, Pulasthi V Wettesinghe, Christopher J Ryerson, Kevin C Wilson, Yet H Khor","doi":"10.21037/jtd-24-1564","DOIUrl":"10.21037/jtd-24-1564","url":null,"abstract":"","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":"17 1","pages":"510-513"},"PeriodicalIF":2.1,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11833568/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143458520","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":"Morphomic predictors for post-esophagectomy pulmonary complications and overall survival.","authors":"Chien-Hung Chiu, Peng Zhang, Jules Lin, Andrew C Chang, Brian E Ross, Binu Enchakalody, Nidhi V Shah, Yun-Hen Liu, Yin-Kai Chao, Stewart C Wang","doi":"10.21037/jtd-24-1227","DOIUrl":"10.21037/jtd-24-1227","url":null,"abstract":"<p><strong>Background: </strong>Esophagectomy following neoadjuvant chemoradiotherapy (nCRT) is a curative treatment for locally advanced esophageal cancer. However, pulmonary complications are the most common postoperative issues and can adversely affect survival. While numerous studies have investigated predictors for these complications and survival, morphomic predictors, derived from body composition measurements on computed tomography scans, have been rarely reported. Our study aims to delineate morphomic predictors for post-esophagectomy pulmonary complications and overall survival.</p><p><strong>Methods: </strong>We retrospectively analyzed esophageal cancer patients who received nCRT followed by esophagectomy between 2004 and 2016. Preoperative clinical and morphomic variables were collected to evaluate post-esophagectomy pulmonary complications and overall survival. Multivariable logistic regression and Cox's proportional hazard model were used for analysis.</p><p><strong>Results: </strong>The study involved 221 esophageal cancer patients who received nCRT followed by surgery. Factors such as increased blood loss (P=0.01), more harvested nodes (P<0.001), advanced pT stage (P=0.01), elevated visceral adipose tissue (VAT) density (P=0.04), and reduced skeletal muscle (SM) area (P=0.01) were linked to pulmonary complications. Additionally, being male (P=0.01), increased blood loss (P<0.001), non-R0 resection margin (P=0.001), advanced pStage (P<0.001), advanced pT stage (P=0.02), and decreased SM density (P=0.045) were associated with poorer overall survival.</p><p><strong>Conclusions: </strong>Increased VAT density and decreased SM area were associated with pulmonary complications, while decreased SM density was linked to poorer overall survival. Preoperative analytic morphomics aids in predicting both postoperative pulmonary complications and survival.</p>","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":"17 1","pages":"209-219"},"PeriodicalIF":2.1,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11833574/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143458553","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":"Gene expression profiles in respiratory settings in rats under extracorporeal membrane oxygenation.","authors":"Shohei Mori, Takashi Ohtsuka, Kohei Hashimoto, Yutaka Fujii, Eriko Harada, Rintaro Shigemori, Daiki Kato, Takamasa Shibazaki, Masayuki Shimoda","doi":"10.21037/jtd-24-1661","DOIUrl":"10.21037/jtd-24-1661","url":null,"abstract":"<p><strong>Background: </strong>Venovenous extracorporeal membrane oxygenation (VV-ECMO) is an effective lung protection strategy that avoids ventilator-induced lung injury. However, appropriate respiratory settings for VV-ECMO are yet to be established. This study aimed to elucidate the effects of ventilation under VV-ECMO using a newly developed rat VV-ECMO model and analyzed gene expression profiles.</p><p><strong>Methods: </strong>Rats were assigned to three groups of five rats each: spontaneous breathing, conventional-protective ventilation, and ultra-protective ventilation. The conventional protective and ultraprotective ventilation groups received volume-controlled ventilation at a frequency of 60 and 20 beats/min, with tidal volumes of 6 and 3 mL/kg, respectively. VV-ECMO was performed at a pump flow rate of 20-30 mL/kg/min. At 120 min post initiation of VV-ECMO, rats were euthanized, and their lungs were harvested. Changes in gene expression were assessed using microarray analysis.</p><p><strong>Results: </strong>Gene expression profile analyses revealed lowest expression of inflammation/immune promotion, cytotoxicity, and cell proliferation related genes (<i>Defa5</i>, <i>Prg2</i>, <i>Siglec8</i>, <i>Atf3</i>, <i>Rnd1</i>, <i>Ctsg</i>, and <i>Gc</i>), and the highest expression of inflammation/immune suppression related genes (<i>Pp2d1</i>) in the spontaneous breathing group as compared to that in the other two mechanical ventilation groups.</p><p><strong>Conclusions: </strong>The findings of this study demonstrated that spontaneous breathing was the least invasive respiratory setting under VV-ECMO. Further, mechanical ventilation may be associated with lung injury even at low ventilation frequency and tidal volume.</p>","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":"17 1","pages":"31-41"},"PeriodicalIF":2.1,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11833566/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143458578","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":"Learning curve for double micro-portal video-assisted thoracoscopic lobectomy.","authors":"Mingliang Xing, Honggang Liu, Liping Tong, Hongtao Duan, Xiaolong Yan","doi":"10.21037/jtd-24-1000","DOIUrl":"10.21037/jtd-24-1000","url":null,"abstract":"<p><strong>Background: </strong>Video-assisted thoracoscopic surgery (VATS) lobectomy serves as a standard surgical approach for the management of resectable lung cancer. The double micro-portal VATS lobectomy technique, a viable surgical procedure, has gained widespread acceptance in clinical settings within our center. In this study, we present a retrospective analysis of our institutional experience with the double micro-portal VATS lobectomy, including an assessment of the learning curve.</p><p><strong>Methods: </strong>The cumulative sum (CUSUM) analysis method was used to analyze the learning curve of 106 cases of double micro-portal VATS lobectomy for resectable lung cancer, all belonging to the same treatment group within the Department of Thoracic Surgery, the 2nd Affiliated Hospital of Air Force Medical University of Chinese People's Liberation Army, from March 2015 to December 2016. The learning curve was derived through accumulating and fitting the operation time and intraoperative bleeding, enabling a comprehensive comparison and analysis of perioperative data across distinct learning phases.</p><p><strong>Results: </strong>With the gradual increase in the number of operations, the operation time gradually shortened. Through the application of CUSUM analysis, the goodness-of-fit coefficient peaked at R²=0.878, corresponding to the formula y=134.6 + 15.84×n - 0.1397×n² - 0.000215×n³. Notably, a vertex crossing occurred when the number of operations reached 51 cases. Similarly, intraoperative bleeding also exhibited a decreasing trend with the increasing number of operations. The goodness-of-fit coefficient attained its maximum value of R²=0.858 using CUSUM analysis, with the formula expressed as y=-238.89 + 81.87×x - 0.9912×x² + 0.002161×x³. A vertex crossing was achieved when the number of operations reached 49 cases. Based on these findings, 106 surgical patients were categorized into two distinct stages: the learning stage and the proficiency stage, with 51 cases serving as the dividing line. Statistically significant differences were observed in both operation time and intraoperative blood loss (IBL) between these two stages (P<0.05).</p><p><strong>Conclusions: </strong>The learning curve of double micro-portal VATS lobectomy is fitted by CUSUM analysis. When the cumulative number of operation cases reaches 51 cases, the operation can achieve a relatively stable level.</p>","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":"17 1","pages":"379-389"},"PeriodicalIF":2.1,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11833562/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143458400","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}