Comparison of surgical outcomes and prognosis between wedge resection and simple Segmentectomy for GGO diameter between 2 cm and 3 cm in non-small cell lung cancer: a multicenter and propensity score matching analysis

Background As segmentectomy had become commonly used for Non-Small Cell Lung Cancer (NSCLC) treatment, which had the advantages of radical operation, however, it remains controversial owing to procedural complexity and risk of increased complications compared with wedge resection. We evaluated operative and postoperative outcomes of simple segmentectomy compared to wedge resection in ground-glass opacity (GGO) diameter between 2 cm and 3 cm NSCLC. Methods We retrospectively reviewed 1600 clinical GGO diameter between 2 cm and 3 cm NSCLC patients who received simple segmentectomy and wedge resection between Jan 2011 and Jan 2015. Participants were matched 1:1 on their propensity score for two groups. Clinic-pathologic, operative, and postoperative results of two groups were compared. Results After using propensity score methods to create a matched cohort of participants with simple segmentectomy group similar to that wedge resection, there were no significant differences detected in tumor size, margin distance, histology, age, sex, preoperative comorbidities and preoperative pulmonary function. Overall complications in simple segmentectomy group were more than wedge resection group (21% vs 3%, p = 0.03). Median operative time (110.6 vs. 71.2 min; p = 0.01) and prolonged air leakage (12% vs. 3%; p = 0.02) was significantly longer in the simple segmentectomy group. There was no difference in recurrence free survival (RFS) and overall survival (OS) of 5-years between simple segmentectomy group and wedge resection group. Postoperative pulmonary function in simple segmentectomy group recovered more slowly than wedge resection group. Conclusion Wedge resection may have comparable efficacy as simple segmentectomy for GGO diameter between 2 cm and 3 cm NSCLC, but lead to less complications, less surgical procedure and faster recovery of pulmonary function.

Cardiopulmonary Function Assessment in Children With Pulmonary Valve Stenosis

ObjectivePulmonary valve (PV) stenosis affects cardiac pulmonary function and exercise performance. A cardiopulmonary exercise test (CPET) combined with a transthoracic echocardiogram (TTE) can measure exercise performance, disease progression, and treatment effects. We assessed the exercise capacity in children with PV stenosis by conducting CPET and TTE.MethodsFrom 2005 to 2021, 84 patients with PV stenosis aged 6–18 years were enrolled; 43 were treated with balloon pulmonary valvuloplasty (BPV) (Group A), and 41 received follow-up care (Group B), and their CPET and pulmonary function test results were compared with 84 healthy, matched individuals (Control). We also conducted TTE to compare the peak pulmonary artery pulse wave velocity and pulmonary valve (PV) area before and after catheterization and follow-up care.ResultsThere were no significant differences among the CPET parameters of the patient groups and controls in anaerobic metabolic equivalent (MET) (group A: 6.44 ± 0.58; group B: 6.28 ± 0.47, control: 6.92 ± 0.39, p = 0.110), peak MET (group A: 9.32 ± 0.74; group B: 9.13 ± 0.63; control: 9.80 ± 0.52, p = 0.263), and heart rate recovery (group A: 28.04 ± 4.70; group B: 26.44 ± 3.43, control:26.10 ± 2.42, p = 0.718). No significant differences were found in the pulmonary functions between the three groups. The pulmonary artery pulse wave velocity significantly decreased after catheterization (3.97 ± 1.50 vs. 1.95 ± 0.94, p < 0.0001), but not after follow-up care (1.67 ± 0.77 vs. 1.75 ± 0.66, p = 0.129). The pulmonary vale area significantly improved in group A (0.89 ± 0.71 vs. 1.16 ± 0.58, p < 0.0001), whereas only insignificant progression of PV stenosis was observed in group B (1.60 ± 0.64 vs. 1.57 ± 0.65, p = 0.110).ConclusionsPatients treated with BPV had a similar exercise capacity with that of patients under follow-up care and the healthy controls. Larger or multi-center studies should be conducted to confirm the physical fitness of pediatric patients with PV stenosis after management.

Pretreatment Alveolar Nitric Oxide Levels Predict Improvement of Pulmonary Function 1 Year Following Anti-Asthma Treatments in Patients with Inhaled Corticosteroid-Naïve Asthma

<b><i>Introduction:</i></b> Inhaled corticosteroids (ICS) are fundamental agents to subside airway inflammation and improve forced expiratory volume in 1 s (FEV₁) among asthmatics. Alveolar concentrations of nitric oxide (CANO), as well as the classical fraction of exhaled nitric oxide (FeNO50), are associated with the pathophysiology of asthma. However, the association between pretreatment CANO levels and response to anti-asthma treatments, including ICS, remains unknown. <b><i>Methods:</i></b> We retrospectively analyzed 107 patients newly diagnosed with asthma. ICS in combination with long-acting β₂-agonists (ICS/LABA) was initiated. FEV₁ and FeNO levels were evaluated at diagnosis and were followed up at 6 and 12 months after the treatment intervention. CANO levels were estimated using various expiratory flows of FeNO measurements. Factors associated with annual changes in FEV₁ (ΔFEV₁) were analyzed. Patients with a ΔFEV₁ &#x3c;–20 mL were defined as “poor-responders.” <b><i>Results:</i></b> FEV₁, FeNO50, and CANO levels significantly improved by anti-asthma treatments. The average ΔFEV₁ was 85 (176) mL. Eighty-two patients continuously took ICS/LABA treatment. Higher pretreatment CANO levels and continuous use of LABA were independent predictive factors for the improvement of FEV₁ on multivariate analysis. The decline in FeNO50 and CANO levels by the anti-asthma treatments was significantly greater in 81 responders than in 26 poor-responders. CANO, but not FeNO50, levels at 12 months were significantly higher in poor-responders than in responders (<i>p</i> = 0.009). <b><i>Conclusion:</i></b> Levels of CANO, but not FeNO50, predict changes in pulmonary function in ICS-naïve asthmatics. Meanwhile, persistently high levels of CANO may be related to poor responsiveness to treatments assessed by ΔFEV₁.

What Is Most Suitable for Children With Cystic Fibrosis—The Relationship Between Spirometry, Oscillometry, and Multiple Breath Nitrogen Washout

IntroductionIn cystic fibrosis (CF), pathological lung changes begin early in life. The technological progress currently gives many diagnostic possibilities. However, pulmonary function testing in children remains problematic.ObjectivesOur study aimed to correlate the results of impulse oscillometry (IOS) with those of multiple breath nitrogen washout (MBNW) in our pediatric CF population. We also compared those parameters between the groups with and without spirometric features of obturation.MethodsWe collected 150 pulmonary function test sets, including spirometry, IOS, and MBNW in patients with CF aged 12.08 ± 3.85 years [6–18]. The study group was divided into two subgroups: IA (without obturation) and IB (with obturation). We also compared Sacin, Scond, and oscillometry parameters of 20 patients aged 14–18 years who reached the appropriate tidal volume (VT) during MBNW.ResultsStatistical analysis showed a negative correlation between lung clearance index (LCI) and spimoetric parameters. Comparison of subgroups IA (n = 102) and IB (n = 48) indicated a statistically significant difference in LCI (p &lt; 0.001) and FEV1z-score (p &lt; 0.001), FEV1% pred (p &lt; 0.001), MEF25z-score (p &lt; 0.001), MEF50 z-score (p &lt; 0.001), MEF75 z-score (p &lt; 0.001), R5% pred (p &lt; 0.05), and R20% pred (p &lt; 0.01). LCI higher than 7.91 was found in 75.33% of the study group, in subgroup IB—91.67%, and IA−67.6%.ConclusionsLCI derived from MBNW may be a better tool than IOS for assessing pulmonary function in patients with CF, particularly those who cannot perform spirometry.

Airway to Lung Volume Ratio on CT is Associated with Pulmonary Function Transition from Obstructive to Restrictive Pattern in Obesity

Background: Obesity is associated with excessive airway collapse and reduced lung volume; it is unknown whether it affects airway-lung interactions. We sought to compare the airway tree to lung volume ratio, assessed by CT, in obese individuals with and without ventilation disorders.Methods: Participants underwent inspiratory chest CT and pulmonary function. The percentage ratio of the whole airway tree to lung volume, automatically segmented via deep learning, was defined as CT airway volume percent (AWV%). Total airway count (TAC), airway wall area percent (WA%), and other CT indexes were also measured. Results: We evaluated 88 participants including adolescents(age: 14-18, n= 12) and adults (age: 19-25, n= 17; age: 26-35, n= 39; age> 35, n= 20). Obese adolescents had higher forced vital capacity (FVC) (P = 0.001) and lower AWV% (P = 0.008) than obese adults (age >35). Among obese adults, participants with restrictive disorders had larger AWV% (P < 0.001) and those with obstructive disorders showed smaller AWV% (P < 0.001) compared to participants with normal ventilation. AWV% was positively correlated with age and forced expiratory volume in 1 second (FEV1)/FVC and adversely related to FVC (P< 0.05 for all), and in multivariate models, AWV% independently predicted FEV1/FVC (R2 = 0.49, P < 0.001) and FVC (R2 = 0.60, P < 0.001).Conclusion: Transitions in lung function patterns between obese adolescents and adults are associated with airway to lung ratios. The obesity-induced disproportion between the airway tree and lung volume may adversely affect and complicate lung ventilation.

Efficacy of dexmedetomidine as an adjunct to ropivacaine in bilateral dual-transversus abdominis plane blocks in patients with ovarian cancer who underwent cytoreductive surgery

Objective We sought to evaluate the postoperative control of pain and recovery in patients with ovarian cancer who underwent cytoreductive surgery by adding dexmedetomidine to ropivacaine in bilateral dual-transversus abdominis plane (Bd-TAP) blocks. Methods We enrolled 90 patients with an American Society of Anesthesiologists physical status I to III undergoing open abdominal cytoreductive surgery in this study. Patients were randomized and assigned into three groups (TAP-R, TAP-DR, or CON) of 30 participants each. All of the patients received standardized general anesthesia, and postoperative Bd-TAP blocks were performed. The TAP-R, TAP-DR, and CON groups received Bd-TAP blocks with 0.3% ropivacaine, 0.3% ropivacaine and 0.5 μg/kg of dexmedetomidine, and 0.9% normal saline, respectively. All of the patients received patient-controlled analgesia (PCA) (formula, 100 μg of sufentanil and 16 mg of ondansetron diluted with normal saline to 100 mL). Flurbiprofen axetil was used as a rescue drug if the visual analog scale (VAS) score was more than four points. The first request time for PCA bolus; the VAS scores at 0, 6, 12, 24, and 48 h after operation; and the cumulative sufentanil consumption within 24 and 48 h, respectively, were compared. Pulmonary function was evaluated preoperatively and at 24 h after the operation. The use of the rescue drug was recorded. Postoperative functional recovery, including time to stand, time to walk, time to return of bowel function, time to readiness for discharge, and postoperative complications, were recorded. Results Median values of the first request time for PCA of the TAP-R group was significantly prolonged compared to that of the CON group (median [interquartile range], 7.3 [6.5–8.0] hours vs. 3.0 [2.3–3.5] hours) (P < .001), while the TAP-DR group has the longest request time among the three groups (median [interquartile range], 13.5 [12.4–14.5] hours) (P < .001). The VAS scores at rest and upon coughing of the TAP-R group in the first 12 h were significantly lower than those of the CON group (P < 0.05), but showed no significant difference compared to those of the TAP-DR group. The VAS scores at rest and upon coughing were lower in the TAP-DR group at each time point compared to those of the CON group (P < .05). The cumulative sufentanil consumption in the TAP-DR group was significantly lower at 48 h (P = .04) after surgery than in the CON group, while there was no significant difference compared to that in the TAP-R group (P > .05). Less rescue analgesic was required by patients in the TAP-DR group than in the CON group (P < .05). Postoperative mean measured forced expiratory volume in 1 s (FEV1) and FEV1/forced vital capacity values in the TAP-DR group were significantly higher than those of the CON group (P = .009), while there was no significant difference compared to those of the TAP-R group (P = .10). There was no significantly difference in postoperative functional recovery between TAP-DR and CON group (P > 0.05). Conclusion TAP blocks can provide effective pain relief up to 12 h postoperatively without a significant improvement in postoperative pulmonary function. The addition of dexmedetomidine to ropivacaine for Bd-TAP block prolonged the first bolus time of PCA when compared to that in the TAP-R group and decreased sufentanil consumption and the need of rescue analgesia relative to in the CON group at 48 h postoperative. The procedure provided better postoperative analgesia and improved postoperative pulmonary function relative to the CON group. Our results indicate that dexmedetomidine as an adjuvant of Bd-TAP can provide effective pain relief up to 48 h.

A study of correlation of pulmonary function test in patients with metabolic syndrome with different components of metabolic syndrome

Background: The increasing incidence of metabolic syndrome has been on the rise especially in urban population and leading to increased risk of cardiovascular disease (CVD) and diabetes mellitus. It has been associated with impairment of pulmonary functions. However, there is limited data regarding the association with individual components of metabolic syndrome and overall effect on components of pulmonary functions.Methods: This is a cross sectional study consisting of 50 subjects with metabolic syndrome. All the subjects underwent pulmonary function tests and the association between different components of metabolic syndrome and pulmonary function were examined using unpaired t-test and Pearson’s partial correlation coefficient. This data was analysed by using statistical package for the social sciences (SPSS) version 12.0.Results: In females, moderate negative significant correlation was seen between forced vital capacity (FVC) and systolic blood pressure (SBP), diastolic blood pressure (DBP), fasting blood sugar (FBS), triglyceride (TG), waist circumference (WC) and body mass index (BMI) whereas positive weak non-significant correlation was seen between FVC and high density lipoprotein cholesterol (HDLC), while no such relation was found with forced expiratory volume in one second (FEV1). In males, negative, moderate significant correlation was seen between FVC and FBS whereas strong, positive, significant correlation was seen between FVC and WC; between FVC and BMI. Negative, moderate, significant correlation was seen between FEV1 and WC; between FEV1 and BMI.Conclusions: Our study concluded that there was a significant impact of FBS and WC on decreasing FVC on both genders with minimally significant impact of other components of metabolic syndrome on FVC with no effect on FEV1 hence indicating a restrictive pattern of pulmonary function derangement. Hence, further studies with larger sample size is needed to confirm whether there are direct or indirect mechanisms through which insulin resistance could affect pulmonary function.

F-18 FDG PET/CT in Relapsing Polychondritis Patients with Initial Respirotory Symptoms: Imaging Features and Association with Pulmonary Function and Disease Activity

Background: To summarize F-18 fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) imaging features of relapsing polychondritis (RP) and to evaluate the feasibility of imaging parameters in the estimation of pulmonary function and disease activity in a cohort of RP patients with airway involvement.Methods: Thirty RP patients with respiratory symptoms who underwent PET/CT scans before corticosteroid treatment were included. Six patients underwent another post-therapeutic PET/CT scan. Imaging features were described by consensus, and FDG uptake values (SUVmax, PET FDG Burden Score (PETFBS) and PETCTindex) either for global cartilages or for the airway were calculated to correlate with clinical symptoms, pulmonary functional parameters and serological inflammatory markers C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR).Results: Laryngo-tracheo-bronchial involvement was detected by PET/CT for all patients with increased FDG uptake in 28/30 patients. The incidence of positive PET was higher in segments with wall thickening (52.68% vs. 15.48%) but was not associated with calcification or stenosis. A total of 46.7% (14/30) of patients presented with sole respiratory symptoms, while PET/CT revealed additional abnormalities in addition to laryngo-tracheo-bronchia. FDG uptake values negatively correlated with disease duration but not with fever. All FDG uptake values showed a positive correlation with FEV1/FVC, with the highest coefficient for SUVmax in the airway (rs =0.628). CRP and ESR were negatively correlated with PETFBS and PETCTindex but not with SUVmax. The largest Spearman correlation coefficient resulted in PETFBS in the airway (rs =0.67). Re-examination PET/CT in 6 patients revealed partial therapeutic response (n = 4), stable disease (n = 1) and progressive disease (n = 1).Conclusion: PET/CT is a valuable tool for assessing RP with airway involvement, especially for patients who present with sole respiratory symptoms. SUVmax and PETFBS have distinct advantages in the clinical evaluation of RP with respect to pulmonary function and disease activity.

Genome-wide Association Study of Pulmonary Function in Europeans and Africans from the UK Biobank Identifies Distinct Variants

Pulmonary function is an indicator of well-being, and pulmonary pathologies are the third major cause of death worldwide. FEV1, FVC, and PEF are quantitively used to assess pulmonary function. We conducted a genome-wide association analysis of pulmonary function in 383,471 individuals of European and 5,978 African descent represented in the UK Biobank. Here, we report 817 variants in Europeans and 3 in Africans associated (p-values < 5 x 10-8) with three pulmonary function parameters; FEV1, FVC and PEF. In addition to 377 variants in Europeans previously reported to be associated with phenotypes related to pulmonary function, we identified 330 novel loci, including an ISX intergenic variant rs369476290 on chromosome 22 in Africans and a KDM2A intron variant rs12790261 on chromosome 11 in Europeans. Remarkably, we find no shared variants among Africans and Europeans. Enrichment analyses of variants separately for each ancestry background revealed significant enrichment for terms related to pulmonary phenotypes in Europeans but not Africans. Further analysis of studies of pulmonary phenotypes revealed individuals of European background are disproportionally overrepresented in datasets compared to Africans, with the gap widening over the past five years. Our findings offer a better understanding of the different variants that modify pulmonary function in Africans and Europeans, a significant finding for future GWAS studies and medicine.