Chinese expert recommendation on transnasal corticosteroid nebulization for the treatment of chronic rhinosinusitis 2021
J Thorac Dis. 2021 Nov;13(11):6217-6229. doi: 10.21037/jtd-21-1142.ABSTRACTCorticosteroids are efficacious in treating chronic rhinosinusitis (CRS), but concerns on the potential side effects remain, especially for long-term usage of systemic corticosteroids. Accumulated evidence shows that transnasal nebulization may be a reasonable solution in balancing both efficacy and safety. However, no consensus or guideline has been formulated on the use of steroid transnasal nebulization in treating CRS. The consensus is achieved through literature review and exchange of Chinese experts in Group of Otorhinolaryngology and Ophthalm...
Source: Journal of Thoracic Disease - January 7, 2022 Category: Respiratory Medicine Authors: Chengshuo Wang Lei Cheng Huabin Li Zheng Liu Hongfei Lou Jianbo Shi Ying Sun Dehui Wang Qintai Yang Hongmeng Yu Changqing Zhao Dongdong Zhu Fengli Cheng Yan Li Bo Liao Meiping Lu Cuida Meng Shen Shen Yueqi Sun Rui Zheng Luo Zhang Source Type: research

Safety and durability of single-stage type I hybrid total aortic arch repair for extensive aortic arch disease: early- and long-term clinical outcomes from a single center and our 10-year of experience
CONCLUSIONS: Single-stage type I hybrid total aortic arch repair has achieved desirable outcomes in our center, which does not increase perioperative risk in the elderly patients, meanwhile, also acquire acceptable durability in the young patients. In conclusion, this surgery is a practical mini-invasive treatment for extensive aortic arch disease with strict and limited indications.PMID:34992803 | PMC:PMC8662513 | DOI:10.21037/jtd-20-3479 (Source: Journal of Thoracic Disease)
Source: Journal of Thoracic Disease - January 7, 2022 Category: Respiratory Medicine Authors: Bowen Zhang Yizhen Wei Yanxiang Liu Hao Lin Shenghua Liang Yaojun Dun Cuntao Yu Xiangyang Qian Hongwei Guo Xiaogang Sun Source Type: research

Application of machine learning approaches to predict the 5-year survival status of patients with esophageal cancer
CONCLUSIONS: The XGBoost model and the complete dataset can be used to construct an accurate prognostic model for patients diagnosed with EC which may be applicable in clinical practice in the future.PMID:34992804 | PMC:PMC8662490 | DOI:10.21037/jtd-21-1107 (Source: Journal of Thoracic Disease)
Source: Journal of Thoracic Disease - January 7, 2022 Category: Respiratory Medicine Authors: Xian Gong Bin Zheng Guobing Xu Hao Chen Chun Chen Source Type: research

Left atrial appendage elimination techniques: stapled excision versus internal suture obliteration
CONCLUSIONS: Stapled excision of the LAA was associated with a lower rate of LAA elimination failure compared to internal suture obliteration. However, care should be taken to prevent staple-related bleeding.PMID:34992805 | PMC:PMC8662504 | DOI:10.21037/jtd-21-1138 (Source: Journal of Thoracic Disease)
Source: Journal of Thoracic Disease - January 7, 2022 Category: Respiratory Medicine Authors: Yoonjin Kang Ho Young Hwang Seohee Joo Ji Hyeon Park Ji Seong Kim Suk Ho Sohn Jae Woong Choi Source Type: research

Minimally invasive esophagectomy learning curves with different types of background experience
CONCLUSIONS: According to this study, learning phase of the individual surgeon determines the outcomes of MIE, not the institutional learning phase.PMID:34992806 | PMC:PMC8662479 | DOI:10.21037/jtd-21-1063 (Source: Journal of Thoracic Disease)
Source: Journal of Thoracic Disease - January 7, 2022 Category: Respiratory Medicine Authors: Olli Helminen Joonas H Kauppila Henna Saviaro Fredrik Yannopoulos Sanna Meril äinen Vesa Koivukangas Heikki Huhta Johanna Mrena Juha Saarnio Eero Sihvo Source Type: research

Sequential or concomitant chemotherapy with hypofractionated radiotherapy for locally advanced non-small cell lung cancer: a meta-analysis of randomized trials
J Thorac Dis. 2021 Nov;13(11):6272-6282. doi: 10.21037/jtd-21-573.ABSTRACTBACKGROUND: For patients with locally advanced non-small cell lung cancer (NSCLC), the standard treatment is concurrent or sequential chemotherapy with radiotherapy. Most treatment schedules use radiotherapy with conventional fractionation; however, the application of hypofractionated radiotherapy (HYPO-RT) regimens is rising. A meta-analysis was performed to assess the efficacy and safety of chemotherapy combined with HYPO-RT and indirectly compare with the outcomes from previous studies employing concomitant conventional radiotherapy (CONV-RT).METH...
Source: Journal of Thoracic Disease - January 7, 2022 Category: Respiratory Medicine Authors: Gustavo Arruda Viani Andre Guimaraes Gouveia Fabio Ynoe Moraes Source Type: research

Long-term outcomes after lung-sparing surgery for epithelial mesothelioma
J Thorac Dis. 2021 Nov;13(11):6283-6293. doi: 10.21037/jtd-21-691.ABSTRACTBACKGROUND: This observational study evaluates retrospectively the long-term outcomes after pleurectomy/decortication for pleural mesothelioma, with and without the resection/reconstruction of diaphragm and pericardium.METHODS: Data from 155 consecutive patients undergoing lung-sparing surgery for epithelial pleural mesothelioma were reviewed. Selection criteria for surgery were cT1-3, cN0-1, good performance status, age 12 months was strongly related to the overall survival (P12 months is predictive of an increased survival when the macroscopic comp...
Source: Journal of Thoracic Disease - January 7, 2022 Category: Respiratory Medicine Authors: Cristiano Breda Simone Furia Giuseppe Lucchini Antonio Zaccaria Enrico Verderi Giuseppe Natale Fabio Lo Giudice Roberta Cavallin Andrea Ferronato Paolo Fontana Source Type: research

Prognostic factors and patients' profile in treated stage I and II lung adenocarcinoma: a Hospital's Cancer Registry-based analysis
CONCLUSIONS: The 5-year OS has significantly improved as long as the 5-year group analysed. Also, the 5-year OS of the patients treated in high complexity hospitals is higher than those treated in PHCCO.PMID:34992809 | PMC:PMC8662506 | DOI:10.21037/jtd-21-1071 (Source: Journal of Thoracic Disease)
Source: Journal of Thoracic Disease - January 7, 2022 Category: Respiratory Medicine Authors: Fernando Conrado Abr ão Stela Verzinhasse Peres Igor Renato Louro Bruno de Abreu Riad Naim Younes Source Type: research

Diagnostic usefulness of bronchoscopy for peripheral pulmonary lesions in patients with idiopathic pulmonary fibrosis
CONCLUSIONS: Bronchoscopy using R-EBUS was safe and showed an acceptable diagnostic yield for PPLs, even in patients with IPF.PMID:34992810 | PMC:PMC8662480 | DOI:10.21037/jtd-21-1067 (Source: Journal of Thoracic Disease)
Source: Journal of Thoracic Disease - January 7, 2022 Category: Respiratory Medicine Authors: Hitomi Nogawa Yuji Matsumoto Midori Tanaka Takaaki Tsuchida Source Type: research

Near-infrared fluorescent imaging with indocyanine green in rabbit and patient specimens of esophageal cancer
CONCLUSIONS: NIR fluorescence imaging can be used to visualize esophageal cancer after systemic injection of ICG. ICG at 2 mg/kg at 12 h is optimal for tumor detection. However, since the clinical trials were conducted in a small number of patients, further studies are needed in larger populations.PMID:34992811 | PMC:PMC8662470 | DOI:10.21037/jtd-21-790 (Source: Journal of Thoracic Disease)
Source: Journal of Thoracic Disease - January 7, 2022 Category: Respiratory Medicine Authors: Jiyun Rho Yu Hua Quan Byeong Hyeon Choi Kook Nam Han Beop-Min Kim Young Ho Choi Hyun Koo Kim Source Type: research

The use of grape juice in the detection of esophageal leaks
CONCLUSIONS: This pilot study demonstrates the effectiveness of using grape juice in detecting esophageal leaks after esophageal operations in patients with tube thoracostomies. Grape juice may be cheaper and potentially less morbid than other studies performed to detect esophageal leaks. Further research is needed to justify the increased use of grape juice in patients who undergo esophageal operations.PMID:34992812 | PMC:PMC8662515 | DOI:10.21037/jtd-21-1185 (Source: Journal of Thoracic Disease)
Source: Journal of Thoracic Disease - January 7, 2022 Category: Respiratory Medicine Authors: Madison J Malfitano Jenny T Bui Rachel M Swier Benjamin E Haithcock Source Type: research

Comparison of stapler and electrocautery for division of the intersegmental plane in lung segmentectomy
J Thorac Dis. 2021 Nov;13(11):6331-6342. doi: 10.21037/jtd-21-1397.ABSTRACTBACKGROUND: We retrospectively compared the use of a stapler and electrocautery for division of the intersegmental plane during pulmonary segmentectomy.METHODS: We enrolled 156 patients who underwent pulmonary segmentectomy in our department between March 2006 and August 2020. The patients were divided into electrocautery (n=62) and stapler (n=94) groups based on the device used to divide the intersegmental plane. Patient characteristics, perioperative outcomes, and ratios of actual (calculated using software) to predicted (calculated by counting th...
Source: Journal of Thoracic Disease - January 7, 2022 Category: Respiratory Medicine Authors: Tomohiro Yazawa Hitoshi Igai Kazuki Numajiri Fumi Ohsawa Natsumi Matsuura Mitsuhiro Kamiyoshihara Source Type: research

Effect of revascularization on coronary chronic total occlusion in patients undergoing coronary artery bypass grafting
CONCLUSIONS: In patients with CTOs undergoing CABG, the rate of ICR was 20.8%, and it significantly increased the risk of mortality and MACCE. Further studies in a large cohort are needed.PMID:34992814 | PMC:PMC8662467 | DOI:10.21037/jtd-21-681 (Source: Journal of Thoracic Disease)
Source: Journal of Thoracic Disease - January 7, 2022 Category: Respiratory Medicine Authors: Jiyun Lee Yun Seok Kim Hwan Wook Kim Joon Kyu Kang Hyun Song Ju Yong Lim Source Type: research

Minimally invasive surgery in the management of resectable thymoma: a retrospective analysis from the National Cancer Database
J Thorac Dis. 2021 Nov;13(11):6353-6362. doi: 10.21037/jtd-20-2660.ABSTRACTBACKGROUND: Thymomas are relatively uncommon tumors traditionally resected via open sternotomy. Despite the appeal of minimally invasive techniques, concerns persist regarding their oncologic efficacy. We hypothesized that minimally-invasive thymectomies for resectable thymomas are oncologically safe when compared to open thymectomy.METHODS: The National Cancer Database (NCDB) was queried for patients with thymoma undergoing resection as the first mode of treatment between 2010-2015. Patient demographics, tumor characteristics and perioperative outc...
Source: Journal of Thoracic Disease - January 7, 2022 Category: Respiratory Medicine Authors: Hai V Salfity Lava Timsina DuyKhanh P Ceppa Thomas J Birdas Source Type: research

A multimodal protocol utilizing liposomal bupivacaine rib blocks leads to opioid reduction in patients undergoing the Nuss procedure
J Thorac Dis. 2021 Nov;13(11):6363-6372. doi: 10.21037/jtd-21-1314.ABSTRACTBACKGROUND: A major challenge associated with the Nuss procedure for pectus excavatum repair is postoperative pain control. Early Recovery Program (ERP) protocols for the Nuss procedure are becoming common, but there is a paucity of experience using liposomal bupivacaine (LB), a long-acting local anesthetic, for rib blocks in this setting. We investigated whether a protocol utilizing LB rib blocks decreased opioid use after the Nuss procedure while achieving equivalent pain control.METHODS: All adolescent patients undergoing the Nuss procedure at ou...
Source: Journal of Thoracic Disease - January 7, 2022 Category: Respiratory Medicine Authors: Alicia L Eubanks David F Grabski Jessica Pollack Daniel E Levin Eugene McGahren Linda W Martin Jeffrey Gander Source Type: research

Stereotactic body radiation therapy for the treatment of pleural metastases in patients with thymoma: a retrospective review of 22 patients
CONCLUSIONS: Stereotactic body radiation therapy of pleural metastases is feasible and offers a promising local control of diseases. The impact of this treatment on patients' survival is hardly predictable because of the heterogeneous clinical behavior of thymomas.PMID:34992817 | PMC:PMC8662497 | DOI:10.21037/jtd-19-3799 (Source: Journal of Thoracic Disease)
Source: Journal of Thoracic Disease - January 7, 2022 Category: Respiratory Medicine Authors: Giulia Pasquini Claudia Menichelli Gabriella Pastore Franco Casamassima Maria Grazia Fabrini Sabrina Cappelli Simona Valleggi Maurizio Lucchesi Marco Lucchi Roberta Ricciardi Michelangelo Maestri Melania Guida Antonio Chella Iacopo Petrini Source Type: research

Outcome of parapneumonic empyema managed surgically or by fibrinolysis: a multicenter study
CONCLUSIONS: Surgical management of PPE was associated with shorter chest tube and hospital duration and better pleural space control. Prospective randomized studies are mandatory.PMID:34992818 | PMC:PMC8662487 | DOI:10.21037/jtd-21-1083 (Source: Journal of Thoracic Disease)
Source: Journal of Thoracic Disease - January 7, 2022 Category: Respiratory Medicine Authors: Sara Federici Benoit B édat Justine Hayau Michel Gonzalez Frederic Triponez Thorsten Krueger Wolfram Karenovics Jean Y Perentes Source Type: research

Venovenous extracorporeal membrane oxygenation-assisted tracheobronchial surgery: a retrospective analysis and literature review
CONCLUSIONS: VV-ECMO is a safe and feasible ventilation mode when intraoperative oxygen saturation cannot be well maintained during tracheobronchial surgery.PMID:34992819 | PMC:PMC8662471 | DOI:10.21037/jtd-21-1324 (Source: Journal of Thoracic Disease)
Source: Journal of Thoracic Disease - January 7, 2022 Category: Respiratory Medicine Authors: Liang Chen Zhexin Wang Heng Zhao Feng Yao Source Type: research

Implication of a novel postoperative recovery protocol to increase day 1 discharge rate after anatomic lung resection
J Thorac Dis. 2021 Nov;13(11):6399-6408. doi: 10.21037/jtd-21-965.ABSTRACTBACKGROUND: Chest-tube drainage and prolonged air leak after anatomic lung resection (ALR) continue to drive admission days for most programs employing minimal access techniques. The aim of the study was to evaluate the impact of a novel postoperative recovery protocol with revised chest tube management strategies to target discharge on post-operative day 1 (POD1) after ALR.METHODS: This is a pilot study investigating a novel enhanced recovery protocol which either allowed chest tube removal on POD1 or ambulatory management with indwelling chest tube...
Source: Journal of Thoracic Disease - January 7, 2022 Category: Respiratory Medicine Authors: Severin Schmid Mohamad Kaafarani Gabriele Baldini Alexander Amir Florin Costescu Danielle Shafiepour Jonathan Cools-Lartigue Sara Najmeh Christian Sirois Lorenzo Ferri David Mulder Jonathan Spicer Source Type: research

Resveratrol inhibits cell apoptosis by suppressing long noncoding RNA (lncRNA) XLOC_014869 during lipopolysaccharide-induced acute lung injury in rats
CONCLUSIONS: Res can inhibit the increase of lncRNAs XLOC_014869 caused by LPS stimulation and inhibit lung cell apoptosis. These effects may be due to lncRNA XLOC_014869 mediation of the pro-apoptotic factors (Fos, c-Jun, and Fas-L).PMID:34992821 | PMC:PMC8662516 | DOI:10.21037/jtd-21-1113 (Source: Journal of Thoracic Disease)
Source: Journal of Thoracic Disease - January 7, 2022 Category: Respiratory Medicine Authors: Hongbin Jiang Shanmei Wang Likun Hou Jian-An Huang Bo Su Source Type: research

Succinate dehydrogenase 5 regulates lung cancer metastasis by reprogramming glucose metabolism
CONCLUSIONS: Our findings suggest that SDH5 deficiency activates HIF-1α to promote EMT under high glucose conditions and represents a predictive marker for NSCLC patients with diabetes.PMID:34992822 | PMC:PMC8662473 | DOI:10.21037/jtd-21-1769 (Source: Journal of Thoracic Disease)
Source: Journal of Thoracic Disease - January 7, 2022 Category: Respiratory Medicine Authors: Jie Li Zhan Tuo Yan Zong Jun Liu Source Type: research

Systemic arterial gas embolism (SAGE) as a complication of bronchoscopic lung biopsy: a case report and systematic literature review
DISCUSSION: SAGE is an underrecognized but severe adverse effect of bronchoscopic lung biopsy, which often presents with acute coronary or cerebral ischemia or delayed awakening from sedation. It is important for all physicians who perform bronchoscopic biopsies to be aware of the clinical manifestations and therapeutic management of SAGE in order to mitigate morbidity and mortality among patients undergoing these procedures.PMID:34992823 | PMC:PMC8662492 | DOI:10.21037/jtd-21-717 (Source: Journal of Thoracic Disease)
Source: Journal of Thoracic Disease - January 7, 2022 Category: Respiratory Medicine Authors: Kai E Swenson Brian D Shaller Kevin Duong Harmeet Bedi Source Type: research

The role of long-acting muscarinic antagonist/long-acting β agonist fixed-dose combination treatment for chronic obstructive pulmonary disease in China: a narrative review
CONCLUSIONS: We recommend the adoption of a clinical pathway in China that includes an assessment and management algorithm that considers the clinical characteristics in China and classifies the phenotypic characteristics of COPD according to a suitable system. Based on the current information, we can conclude that LAMA/LABA FDCs are a suitable and economically viable choice to reduce symptoms and improve the quality of life (QoL) of patients.PMID:34992824 | PMC:PMC8662495 | DOI:10.21037/jtd-21-961 (Source: Journal of Thoracic Disease)
Source: Journal of Thoracic Disease - January 7, 2022 Category: Respiratory Medicine Authors: Ji'an Zhou Jing Zhang Min Zhou Jingqing Hang Min Zhang Fengfeng Han Huili Zhu Source Type: research

Neoadjuvant camrelizumab, nab-paclitaxel, and carboplatin in patients with stage IB-IIIA non-small cell lung cancer (NANE-LC): a study protocol of prospective, single-arm, multicenter, phase II study
This study will indicate if our new multiomics artificial intelligence system constitutes a valid strategy for neoadjuvant therapy effect prediction and decision-making assistance in the context of neoadjuvant camrelizumab, nab-paclitaxel, and carboplatin treatment for patients with stage IB-IIIA NSCLC.TRIAL REGISTRATION: This trial has been registered at ClinicalTrials.gov (identification number: NCT04541251).PMID:34992825 | PMC:PMC8662502 | DOI:10.21037/jtd-21-1022 (Source: Journal of Thoracic Disease)
Source: Journal of Thoracic Disease - January 7, 2022 Category: Respiratory Medicine Authors: Haiyu Zhou Lili Lin Tao Qin Wei Ren Yujie Tan Qiong Yang Huixin Xu Xinxin Xie Yongjian Chen Shengbo Liu Xing Li Zhihua Li Hai Hu Yunfang Yu Herui Yao Source Type: research

Periodic limb movements during sleep: a narrative review
CONCLUSIONS: This review closes with a proposal for greater investigation into the identification of potential, divergent biological pathways. To do so would require prospective, multimodal imaging clinical studies which may delineate differential responses to treatment in restless legs syndrome (RLS) without PLMS and PLMS without RLS. This could pave the way toward important new treatment modalities.PMID:34992826 | PMC:PMC8662505 | DOI:10.21037/jtd-21-1353 (Source: Journal of Thoracic Disease)
Source: Journal of Thoracic Disease - January 7, 2022 Category: Respiratory Medicine Authors: Panagis Drakatos Michelle Olaithe Dhun Verma Katarina Ilic Diana Cash Yaqoot Fatima Sean Higgins Allan H Young K Ray Chaudhuri Joerg Steier Timothy Skinner Romola Bucks Ivana Rosenzweig Source Type: research

A proposal for a postoperative protocol for the early diagnosis of bronchopleural fistula after lung resection surgery
J Thorac Dis. 2021 Nov;13(11):6495-6498. doi: 10.21037/jtd-21-1095.NO ABSTRACTPMID:34992827 | PMC:PMC8662483 | DOI:10.21037/jtd-21-1095 (Source: Journal of Thoracic Disease)
Source: Journal of Thoracic Disease - January 7, 2022 Category: Respiratory Medicine Authors: Luca Bertolaccini Elena Prisciandaro Juliana Guarize Lorenzo Spaggiari Source Type: research

Changes in patterns of extracorporeal cardiopulmonary resuscitation during the COVID-19 pandemic
J Thorac Dis. 2021 Nov;13(11):6499-6501. doi: 10.21037/jtd-21-1434.NO ABSTRACTPMID:34992828 | PMC:PMC8662475 | DOI:10.21037/jtd-21-1434 (Source: Journal of Thoracic Disease)
Source: Journal of Thoracic Disease - January 7, 2022 Category: Respiratory Medicine Authors: Pauline Yeung Ng Shu Fang April Ip Andrew Kei-Yan Ng Wai Ming Chan Wai Ching Sin Chun Wai Ngai Source Type: research

Lung transplantation: a comprehensive journey
J Thorac Dis. 2021 Nov;13(11):6502-6503. doi: 10.21037/jtd-21-1592.NO ABSTRACTPMID:34992829 | PMC:PMC8662489 | DOI:10.21037/jtd-21-1592 (Source: Journal of Thoracic Disease)
Source: Journal of Thoracic Disease - January 7, 2022 Category: Respiratory Medicine Authors: Jonathan D'Cunha Source Type: research

The new allocation era and policy
J Thorac Dis. 2021 Nov;13(11):6504-6513. doi: 10.21037/jtd-2021-17.ABSTRACTSince the Department of Health and Human Services (DHHS) issued the Final Rule in 1998 as a guideline for organ transplantation and allocation policies, the lung allocation system has undergone two major changes. The first change came with the implementation of the lung allocation score (LAS) instead of waiting time as the primary determinant for donor lung allocation. The LAS model helped allocate donor lungs based on medical urgency and likelihood of post-transplant success. The LAS has been successful in prioritizing the sickest candidates and re...
Source: Journal of Thoracic Disease - January 7, 2022 Category: Respiratory Medicine Authors: Luke J Benvenuto Selim M Arcasoy Source Type: research

Current trends in candidate selection, contraindications, and indications for lung transplantation
J Thorac Dis. 2021 Nov;13(11):6514-6527. doi: 10.21037/jtd-2021-09.ABSTRACTLung transplantation is an established treatment option that can improve quality of life and prolong survival for select patients diagnosed with end-stage lung disease. Given the gaps in organ donation and failures to make effective use of available organs, careful selection of candidates for lung transplant remains one of the most important considerations of the transplant community. Toward this end, we briefly reviewed recent trends in pretransplant evaluation, candidate selection, organ allocation, and organ preservation techniques. Since the lat...
Source: Journal of Thoracic Disease - January 7, 2022 Category: Respiratory Medicine Authors: Ashwini Arjuna Michael T Olson Rajat Walia Source Type: research

Advanced considerations in organ donors
J Thorac Dis. 2021 Nov;13(11):6528-6535. doi: 10.21037/jtd-2021-08.ABSTRACTThe rising need for lung transplantation over recent years has not paralleled the availability of suitable lung allografts. The number of lung transplantations performed each year in the United States remains limited by an inadequate supply of suitable donors as well as low donor utilization rates. While several methods have been proposed for increasing the donor pool, there is considerable disparity between acceptance and utilization of these practices among transplant centers. In this review article, we explore various approaches for enhancing don...
Source: Journal of Thoracic Disease - January 7, 2022 Category: Respiratory Medicine Authors: Hailey M Shepherd Jason M Gauthier Varun Puri Daniel Kreisel Ruben G Nava Source Type: research

Donation after circulatory death donors in lung transplantation
J Thorac Dis. 2021 Nov;13(11):6536-6549. doi: 10.21037/jtd-2021-13.ABSTRACTTransplantation of any organ into a recipient requires a donor. Lung transplant has a long history of an inadequate number of suitable donors to meet demand, leading to deaths on the waiting list annually since national data was collected, and strict listing criteria. Before the Uniform Determination of Death Act (UDDA), passed in 1980, legally defined brain death in the U.S., all donors for lung transplant came from sudden death victims [uncontrolled Donation after Circulatory Death donors (uDCDs)] in the recipient's hospital emergency department. ...
Source: Journal of Thoracic Disease - January 7, 2022 Category: Respiratory Medicine Authors: Thomas M Egan Benjamin E Haithcock Jason Lobo Gita Mody Robert B Love John Jacob Requard John Espey Mir Hasnain Ali Source Type: research

Anesthetic considerations in lung transplantation: past, present and future
J Thorac Dis. 2021 Nov;13(11):6550-6563. doi: 10.21037/jtd-2021-10.ABSTRACTLung transplantation is a very complex surgical procedure with many implications for the anesthetic care of these patients. Comprehensive preoperative evaluation is an important component of the transplant evaluation as it informs many of the decisions made perioperatively to manage these complex patients effectively and appropriately. These decisions may involve pre-emptive actions like pre-habilitation and nutrition optimization of these patients before they arrive for their transplant procedure. Appropriate airway and ventilation management of th...
Source: Journal of Thoracic Disease - January 7, 2022 Category: Respiratory Medicine Authors: Andrew W Murray Michael L Boisen Ashley Fritz J Ross Renew Archer Kilbourne Martin Source Type: research

Bilateral sequential lung transplantation: technical aspects
J Thorac Dis. 2021 Nov;13(11):6564-6575. doi: 10.21037/jtd-2021-22.ABSTRACTThe surgical technique for lung transplantation has evolved dramatically over the last three decades. Significant improvements in short term outcomes in the early years of lung transplantation were due, in large part, to techniques developed to reduce airway anastomotic complications in single lung transplantation. Following development of the technique of en bloc double lung transplantation, evolution to the bilateral sequential technique further reduced airway complications for double lung transplantation. More recently, some programs have utilize...
Source: Journal of Thoracic Disease - January 7, 2022 Category: Respiratory Medicine Authors: Haytham Elgharably Michael J Javorski Kenneth R McCurry Source Type: research

Intraoperative support during lung transplantation
J Thorac Dis. 2021 Nov;13(11):6576-6586. doi: 10.21037/jtd-21-1166.ABSTRACTThe role of intraoperative mechanical support during lung transplantation (LTx) is essential to provide a safe hemodynamic and ventilatory status during critical intraoperative events. This hemodynamic and ventilatory stability is vital to minimize the odds of suboptimal outcomes, especially considering that, due to the scarcity of donors and the fact that more and more patients with significant comorbidities are being considered for this therapy, a more aggressive approach is often needed by the transplant centers. Hence, the attenuation of any pot...
Source: Journal of Thoracic Disease - January 7, 2022 Category: Respiratory Medicine Authors: Pedro Reck Dos Santos Jonathan D'Cunha Source Type: research

Lung retransplantation in the modern era
J Thorac Dis. 2021 Nov;13(11):6587-6593. doi: 10.21037/jtd-2021-25.ABSTRACTChronic lung allograft dysfunction remains the leading cause of long-term morbidity and mortality for lung transplant recipients. Lung retransplantation currently represents the only therapeutic option for patients for refractory allograft dysfunction. However, debate remains regarding both the efficacy and ethicality of lung retransplantation in light of the shortage of lung allografts. The aim of this review is to discuss the available literature on lung retransplantation in the current era. Through this we hope to provide insight into ideal patie...
Source: Journal of Thoracic Disease - January 7, 2022 Category: Respiratory Medicine Authors: A Justin Rucker Joseph R Nellis Jacob A Klapper Matthew G Hartwig Source Type: research

Living-donor lobar lung transplantation
J Thorac Dis. 2021 Nov;13(11):6594-6601. doi: 10.21037/jtd-2021-07.ABSTRACTLiving-donor lobar lung transplantation (LDLLT) has become an important life-saving option for patients with severe respiratory disorders, since it was developed by a group in the University of Southern California in 1993 and introduced in Japan in 1998 in order to address the current severe shortage of brain-dead donor organs. Although LDLLT candidates were basically limited to critically ill patients who would require hospitalization, the long-term use of steroids, and/or mechanical respiratory support prior to transplantation, LDLLT provided good...
Source: Journal of Thoracic Disease - January 7, 2022 Category: Respiratory Medicine Authors: Daisuke Nakajima Hiroshi Date Source Type: research

< em > Ex vivo < /em > lung perfusion
J Thorac Dis. 2021 Nov;13(11):6602-6617. doi: 10.21037/jtd-2021-23.ABSTRACTLung transplantation is a life-saving treatment for patients with end stage lung disease. The imbalance between lung graft supply and recipients has been a serious issue and barrier to successful lung transplantation. Ex vivo lung perfusion is a strategy wherein lungs are perfused and ventilated outside of the body. This technology has emerged as a safe preservation method that also enables the reassessment and reconditioning of marginal lung grafts. Ex vivo lung perfusion has successfully expanded the donor pool and led to greater lung transplant a...
Source: Journal of Thoracic Disease - January 7, 2022 Category: Respiratory Medicine Authors: Tatsuaki Watanabe Marcelo Cypel Shaf Keshavjee Source Type: research

Primary graft dysfunction: what we know
J Thorac Dis. 2021 Nov;13(11):6618-6627. doi: 10.21037/jtd-2021-18.ABSTRACTMany advances in lung transplant have occurred over the last few decades in the understanding of primary graft dysfunction (PGD) though effective prevention and treatment remain elusive. This review will cover prior understanding of PGD, recent findings, and directions for future research. A consensus statement updating the definition of PGD in 2016 highlights the growing complexity of lung transplant perioperative care taking into account the increasing use of high flow oxygen delivery and pulmonary vasodilators in the current era. PGD, particularl...
Source: Journal of Thoracic Disease - January 7, 2022 Category: Respiratory Medicine Authors: Emily Clausen Edward Cantu Source Type: research

Review: immunosuppression for the lung transplant patient
J Thorac Dis. 2021 Nov;13(11):6628-6644. doi: 10.21037/jtd-2021-11.ABSTRACTLung transplantation (LTx) has evolved significantly since its inception and the improvement in LTx outcomes over the last three decades has predominantly been driven by advances in immunosuppression management. Despite the lack of new classes of immunosuppression medications, immunosuppressive strategies have evolved significantly from a universal method to a more targeted approach, reflecting a greater understanding of the need for individualized therapy and careful consideration of all factors that are influenced by immunosuppression choice. This...
Source: Journal of Thoracic Disease - January 7, 2022 Category: Respiratory Medicine Authors: Sakhee Kotecha Steven Ivulich Gregory Snell Source Type: research

Management of chronic rejection after lung transplantation
J Thorac Dis. 2021 Nov;13(11):6645-6653. doi: 10.21037/jtd-2021-19.ABSTRACTOutcomes after lung transplantation are limited by chronic lung allograft dysfunction (CLAD). The incidence of CLAD is high, and its clinical course tends to be progressive over time, culminating in graft failure and death. Indeed, CLAD is the leading cause of death beyond the first year after lung transplantation. Therapy for CLAD has been limited by a lack of high-quality studies to guide management. In this review, we will discuss the diagnosis of CLAD in light of the recent changes to definitions and will discuss the current clinical evidence av...
Source: Journal of Thoracic Disease - January 7, 2022 Category: Respiratory Medicine Authors: Bahaa Bedair Ramsey R Hachem Source Type: research

Bacterial infections in lung transplantation
J Thorac Dis. 2021 Nov;13(11):6654-6672. doi: 10.21037/jtd-2021-12.ABSTRACTLung transplantation has lower survival rates compared to other than other solid organ transplants (SOT) due to higher rates of infection and rejection-related complications, and bacterial infections (BI) are the most frequent infectious complications. Excess morbidity and mortality are not only a direct consequence of these BI, but so are subsequent loss of allograft tolerance, rejection, and chronic lung allograft dysfunction due to bronchiolitis obliterans syndrome (BOS). A wide variety of pathogens can cause infections in lung transplant recipie...
Source: Journal of Thoracic Disease - January 7, 2022 Category: Respiratory Medicine Authors: Margaret McCort Erica MacKenzie Kenneth Pursell David Pitrak Source Type: research

Viral infections in lung transplantation
In conclusion, the appropriate management of viral complications after transplantation remain an essential step to continue improving survival and quality of life of lung transplant recipients.PMID:34992844 | PMC:PMC8662465 | DOI:10.21037/jtd-2021-24 (Source: Journal of Thoracic Disease)
Source: Journal of Thoracic Disease - January 7, 2022 Category: Respiratory Medicine Authors: Aline Munting Oriol Manuel Source Type: research

Fungal infections in lung transplantation
J Thorac Dis. 2021 Nov;13(11):6695-6707. doi: 10.21037/jtd-2021-26.ABSTRACTLung transplant is a potential life-saving procedure for chronic lung diseases. Lung transplant recipients (LTRs) are at the greatest risk for invasive fungal infections (IFIs) among solid organ transplant (SOT) recipients because the allograft is directly exposed to fungi in the environment, airway and lung host defenses are impaired, and immunosuppressive regimens are particularly intense. IFIs occur within a year of transplant in 3-19% of LTRs, and they are associated with high mortality, prolonged hospital stays, and excess healthcare costs. The...
Source: Journal of Thoracic Disease - January 7, 2022 Category: Respiratory Medicine Authors: Palash Samanta Cornelius J Clancy M Hong Nguyen Source Type: research

Lung transplantation for pulmonary hypertension
J Thorac Dis. 2021 Nov;13(11):6708-6716. doi: 10.21037/jtd-2021-20.ABSTRACTFrom its identification as a distinct disease entity, understanding and management of pulmonary hypertension has continuously evolved. Diagnostic and therapeutic interventions have greatly improved the prognostic implications of this devastating disease, previously rapidly and uniformly fatal to one chronically managed by multi-disciplinary teams. Improved diagnostic algorithms and active research into biochemical signatures of pulmonary hypertension (PH) have led to earlier diagnosis of PH. Medical therapy has moved from upfront use of continuous i...
Source: Journal of Thoracic Disease - January 7, 2022 Category: Respiratory Medicine Authors: Ann Hwalek Justin P Rosenheck Bryan A Whitson Source Type: research

Airway complications in lung transplantation
J Thorac Dis. 2021 Nov;13(11):6717-6724. doi: 10.21037/jtd-20-2696.ABSTRACTAirway complications (ACs) after lung transplantation remain an important source of morbidity and mortality despite significant advances in the surgical technics, leading to increased cost, and decrease quality of life. The incidences of ACs after lung transplantation range from 2% to 33%, even though most transplant centers have reported rates in the range of 7% to 8%. However, the reported rate of ACs has been inconsistent as a result of a lack of standardized airway definitions and grading protocols before the recent 2018 International Society fo...
Source: Journal of Thoracic Disease - January 7, 2022 Category: Respiratory Medicine Authors: Maria M Crespo Source Type: research

Approaching the sensitized lung patient: risk assessment for donor acceptance
We describe here our approach to evaluate sensitized lung transplant candidates. By employing state-of-the-art technologies to assess histocompatibility and determine physiological properties of circulating HLA antibodies, we can provide our Clinical Team a better risk assessment for lung transplant candidates and facilitate a "road map" to transplant. The cases presented in this paper illustrate the "individualized steps" taken to determine calculated panel reactive antibodies (cPRA), titer and complement-fixing properties of each HLA antibody present in circulation. When a donor is considered, we can ...
Source: Journal of Thoracic Disease - January 7, 2022 Category: Respiratory Medicine Authors: Massimo Mangiola Marilyn Marrari Qingyong Xu Pablo G Sanchez Adriana Zeevi Source Type: research

The role of palliative care in lung transplantation
J Thorac Dis. 2021 Nov;13(11):6737-6746. doi: 10.21037/jtd-2021-27.ABSTRACTLung transplantation confers meaningful benefit for patients by extending life and improving quality of life. Palliative care is a medical specialty that likewise aims to improve the quality of life of patients enduring serious illness and their caregivers. Yet, while transplant candidates and recipients face serious illness they rarely receive palliative care, even at end of life. While limited palliative care utilization is likely multifactorial, one key reason is a limited understanding of the specialty of palliative care and evidence for palliat...
Source: Journal of Thoracic Disease - January 7, 2022 Category: Respiratory Medicine Authors: Eric Nolley Matt Morrell Source Type: research

Critical care considerations in the post-operative period for the lung transplant patient
J Thorac Dis. 2021 Nov;13(11):6747-6753. doi: 10.21037/jtd-21-1441.ABSTRACTThe post-operative management of a lung transplant recipient can be complex. Several factors including medical comorbidities, severity of illness at the time of transplant and intra-operative events can affect graft function and overall survival. During the immediate post-operative period, it becomes essential for early recognition of disease-specific sequelae as they can impact the patient's outcome and quality of life. This often necessitates a multidisciplinary team of pulmonologists, surgeons, medical sub-specialists as well as skilled nurses an...
Source: Journal of Thoracic Disease - January 7, 2022 Category: Respiratory Medicine Authors: Josna Padiyar Source Type: research

Erratum to internal fixation of the proximal tracheal self-expandable metallic stent (SEMS): migration prevention in high risk patients
J Thorac Dis. 2021 Nov;13(11):6754. doi: 10.21037/jtd-2021-40.ABSTRACT[This corrects the article DOI: 10.21037/jtd-20-642.].PMID:34992851 | PMC:PMC8662493 | DOI:10.21037/jtd-2021-40 (Source: Journal of Thoracic Disease)
Source: Journal of Thoracic Disease - January 7, 2022 Category: Respiratory Medicine Authors: Editorial Office Source Type: research