Tag: nevin manimala

J Thorac Dis. 2026 May 31;18(5):512. doi: 10.21037/jtd-2025-1-2719. Epub 2026 Apr 26.

ABSTRACT

BACKGROUND: The optimal timing of thoracic radiotherapy (RT) during concurrent chemoradiotherapy (CCRT) for small cell lung cancer (SCLC) remains controversial. This study aimed to evaluate treatment outcomes, prognostic factors, and the role of prophylactic cranial irradiation (PCI) according to thoracic RT timing in patients with limited-disease (LD) SCLC.

METHODS: A retrospective study was conducted on patients with SCLC diagnosed between 2018 and 2022. Survival outcomes, prognostic factors, treatment outcomes, and adverse events were assessed according to thoracic RT timing (early vs. late) and PCI use.

RESULTS: Among 122 patients diagnosed with LD-SCLC, 99 who received CCRT were included in the analysis, comprising 74 patients in the early thoracic RT (ERT) and 25 in the late thoracic RT (LRT) group. After propensity score matching (PSM) based on RT timing, Kaplan-Meier survival analysis demonstrated that the ERT group had significantly longer median overall survival (OS) (20.0 vs. 12.0 months, P=0.041) and progression-free survival (PFS) (16.0 vs. 8.0 months, P=0.01) than the LRT group, whereas brain metastasis-free survival (BMFS) did not differ significantly (P=0.32). Following PSM according to PCI status, OS and PFS were comparable between groups; however, BMFS was significantly longer in the PCI group (P=0.048). In multivariate Cox analysis, both age and thoracic RT timing remained significant prognostic factors for OS and PFS. No statistically significant differences were observed in treatment response or treatment-related adverse events between groups.

CONCLUSIONS: In patients with LD-SCLC treated with CCRT, ERT was associated with improved survival without a significant increase in treatment-related toxicity. Although PCI did not confer a clear survival benefit, it may reduce the risk of brain metastasis.

PMID:42306720 | PMC:PMC13266864 | DOI:10.21037/jtd-2025-1-2719

J Thorac Dis. 2026 May 31;18(5):467. doi: 10.21037/jtd-2026-0500. Epub 2026 May 27.

ABSTRACT

BACKGROUND: Pulmonary rehabilitation plays a crucial role in lung cancer patients after surgery. In this context, traditional Chinese exercises (TCEs) are being increasingly utilized. However, the existing studies are characterized by small sample sizes, inconsistent interventions, and diverse outcome measures, which result in high heterogeneity and limited clinical applicability. This meta-analysis systematically assessed the impacts of two common TCEs on postoperative lung cancer patients, aiming to provide a basis for evidence-based rehabilitation strategies.

METHODS: A systematic search of nine electronic databases was conducted for randomized controlled trials (RCTs) from inception to November 3, 2025. After independent screening, data extraction, and risk-of-bias assessment, meta-analysis was performed.

RESULTS: Twenty-five RCTs involving 1,834 participants were included. The meta-analysis demonstrated that TCE significantly improved pulmonary function outcomes, including forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), FEV1/FVC ratio, and FEV1% predicted. Additionally, TCE increased the 6-minute walk distance (6MWD) and quality of life (QoL) score. Regarding psychological outcomes, TCE significantly alleviated symptoms of anxiety. TCE showed no statistically significant effect on postoperative fatigue, Borg dyspnea scores and depression in lung cancer patients. Subgroup analyses suggested that timing of intervention initiation and settings may account for the observed heterogeneity in respiratory function outcomes. Furthermore, subgroup showed that Liuzijue was more effective than Baduanjin in improving FEV1/FVC (mean difference: 4.88 vs. 2.71), while Baduanjin was more effective than Liuzijue in alleviating anxiety (mean difference: -7.45 vs. -2.20).

CONCLUSIONS: TCE appears to be a beneficial intervention for enhancing pulmonary function, QoL, and mental health in postoperative lung cancer patients. However, further-quality studies are warranted to confirm the robustness of these findings due to limitations in certain outcome measures.

PMID:42306719 | PMC:PMC13266663 | DOI:10.21037/jtd-2026-0500

J Thorac Dis. 2026 May 31;18(5):490. doi: 10.21037/jtd-2026-1-0358. Epub 2026 May 27.

ABSTRACT

BACKGROUND: Concomitant mitral valve surgery and coronary artery bypass grafting (CABG) remains the standard treatment for patients with severe mitral valve disease complicated by coronary artery disease. However, this combined procedure is associated with substantial perioperative risk. While off-pump or on-pump beating heart CABG may reduce aortic cross-clamp and cardiopulmonary bypass times compared with conventional on-pump arrested-heart CABG, evidence comparing these surgical strategies in combined mitral valve and CABG surgery remains limited. Therefore, this study aimed to evaluate the short-term outcomes of mitral valve surgery combined with on-pump arrested-heart CABG versus off-pump or on-pump beating heart CABG.

METHODS: A total of 473 patients who underwent concomitant CABG and mitral valve surgery were retrospectively analyzed. Among these patients, 368 patients underwent on-pump arrested-heart CABG (ONCABG group) and 105 patients underwent off-pump or on-pump beating heart CABG (BHCABG group). Covariate balancing propensity score (CBPS) and inverse probability of treatment weighting (IPTW) was utilized to reduce bias. The primary endpoints were in-hospital mortality and major perioperative complications.

RESULTS: After CBPS and IPTW adjustment, the BHCABG group demonstrated significantly shorter aortic cross-clamp times [ratio =0.765; 95% confidence interval (CI): 0.695-0.843; P<0.001] compared with the ONCABG group, lower peak high-sensitivity cardiac troponin I (hsTnI) levels (P=0.01) and serum creatinine levels (P<0.001). Notably, the risk of new-onset stroke was significantly reduced in the BHCABG group [odds ratio (OR) =0.063; 95% CI: 0.008-0.490; P=0.008]. No statistically significant differences were observed in operative time, mechanical ventilation duration, or in-hospital mortality between the two groups.

CONCLUSIONS: In patients undergoing combined mitral valve surgery and surgical coronary revascularization, off-pump revascularization or on-pump beating heart strategy is associated with attenuated myocardial injury, renal injury and a lower risk of postoperative stroke compared with the conventional on-pump technique.

PMID:42306714 | PMC:PMC13266873 | DOI:10.21037/jtd-2026-1-0358

J Thorac Dis. 2026 May 31;18(5):465. doi: 10.21037/jtd-2026-1-0220. Epub 2026 May 27.

ABSTRACT

BACKGROUND: Severity assessment of human immunodeficiency virus (HIV)-associated Pneumocystis jirovecii pneumonia (PJP) is clinically important because arterial blood gas indices are standard but may not fully capture the heterogeneity of lung involvement on chest computed tomography (CT). We aimed to develop and internally validate a CT radiomics model for classifying severity in adults with confirmed HIV-associated PJP.

METHODS: This retrospective single-center study included 96 adult patients with confirmed HIV-associated PJP who underwent chest CT at presentation. Disease severity was classified as mild or moderate-to-severe according to room-air arterial blood gas criteria, with moderate-to-severe disease defined as arterial partial pressure of oxygen (PaO₂) <70 mmHg or an alveolar-arterial oxygen gradient (A-aDO₂) ≥35 mmHg. Clinical variables were retrospectively collected from medical records. Patients were randomly divided into training and test cohorts at a ratio of 7:3. Radiomics features were extracted from the bilateral lung parenchyma. After least absolute shrinkage and selection operator regression, features with non-zero coefficients were included in the final radiomics model. In parallel, a clinical logistic model incorporating serum lactate dehydrogenase, β-D-glucan, and CD4 count was developed in the training cohort and tested in the test cohort. Model performance was assessed using the area under the receiver operating characteristic curve (AUC) with 95% confidence intervals (CIs), calibration analysis, decision curve analysis, and pairwise DeLong test comparisons.

RESULTS: Of the 96 patients, 38 were classified as mild and 58 as moderate-to-severe. Patients with moderate-to-severe disease had a higher frequency of dyspnea, higher levels of inflammatory markers, and lower CD4 count. The final radiomics model included 10 features. In the training cohort, the radiomics model achieved an AUC of 0.92 (95% CI: 0.85-0.97), compared with 0.65 (95% CI: 0.51-0.78) for the clinical logistic model. In the test cohort, the radiomics model showed a numerically higher AUC of 0.89 (95% CI: 0.72-1.00), followed by the clinical logistic model at 0.84 (95% CI: 0.68-0.97). Using their respective classification thresholds, the radiomics model yielded a sensitivity of 0.778 (95% CI: 0.548-0.910) and a specificity of 0.818 (95% CI: 0.523-0.949) in the test cohort, while the clinical logistic model yielded a sensitivity of 0.722 (95% CI: 0.491-0.875) and a specificity of 0.909 (95% CI: 0.623-0.984). Pairwise DeLong tests in the test cohort showed no statistically significant difference between the radiomics model and the clinical logistic model.

CONCLUSIONS: In this small single-center study, the CT radiomics model showed promising discrimination for severity classification in HIV-associated PJP, but these findings are preliminary and require external multicenter validation before clinical use.

PMID:42306699 | PMC:PMC13266726 | DOI:10.21037/jtd-2026-1-0220

J Thorac Dis. 2026 May 31;18(5):464. doi: 10.21037/jtd-2025-1870. Epub 2026 Apr 30.

ABSTRACT

BACKGROUND: Pulmonary nodules and masses (PNMs) are closely associated with lung cancer, for which early and accurate diagnosis is essential. However, current diagnostic methods have inherent limitations and may produce false-positive or false-negative results, thereby complicating clinical decision-making. Diffusion-weighted imaging (DWI) has emerged as a promising tool for distinguishing benign lesions from malignant lesions, although the combined diagnostic value of lesion-to-spinal cord ratio (LSR) and apparent diffusion coefficient (ADC) remains underexplored. This study aimed to evaluate the diagnostic value of LSR and ADC in distinguishing benign PNMs from malignant PNMs.

METHODS: Multi-b-value DWI, commonly used for intravoxel incoherent motion (IVIM) acquisition, was retrospectively performed in patients with PNMs. Lesions were classified based on histopathological findings or clinical follow-up. ADC values were calculated from multi-b-value DWI data using a monoexponential fit, and LSR values were measured from DWI images at selected b-values. Independent-samples t-test was employed to assess statistical differences between the benign and malignant groups. Receiver operating characteristic curve analysis was conducted to determine the optimal cutoff values using the maximal Youden index and to evaluate the diagnostic performance of each parameter.

RESULTS: Among 56 lesions, 34 were benign and 22 were malignant. Malignant lesions exhibited significantly lower ADC values and higher LSR values compared with benign lesions (P<0.05). The area under the curve (AUC) for ADC was generally higher than that for LSR (P<0.05). Among ADC parameters, the maximum ADC value had the highest AUC [0.759, 95% confidence interval (CI): 0.631-0.887], with a sensitivity of 0.636 (95% CI: 0.407-0.828), a specificity of 0.824 (95% CI: 0.655-0.932), and a diagnostic threshold of 1.265×10^-3 mm²/s. Among the LSR parameters, LSR at b=500 s/mm² had the highest AUC (0.682, 95% CI: 0.530-0.834), with a sensitivity of 0.591 and a specificity of 0.794. The combination of ADC and LSR outperformed either parameter alone, achieving an AUC of 0.787 (95% CI: 0.658-0.885), a sensitivity of 0.909 (95% CI: 0.708-0.989), and a specificity of 0.559 (95% CI: 0.379-0.728).

CONCLUSIONS: Both ADC and LSR provide valuable diagnostic information for distinguishing benign PNMs from malignant PNMs. Integrating ADC and LSR further enhances diagnostic accuracy, supporting their combined application as a non-invasive, complementary imaging biomarker in clinical evaluation of PNMs.

PMID:42306682 | PMC:PMC13266818 | DOI:10.21037/jtd-2025-1870

J Thorac Dis. 2026 May 31;18(5):466. doi: 10.21037/jtd-2026-1-0132. Epub 2026 May 27.

ABSTRACT

BACKGROUND: Pectus excavatum (PE) represents the most prevalent congenital deformity of the chest wall, and minimally invasive repair of pectus excavatum (MIRPE) continues to evolve in pursuit of improved correction and reduced morbidity. Both cross-bar (CB) and parallel-bar (PB) configurations are widely adopted, yet comparative data remain limited. This systematic review and meta-analysis evaluated perioperative outcomes and postoperative efficacy of CB versus PB techniques.

METHODS: Following PRISMA 2020 guidelines, PubMed, Embase, and the Cochrane Library were searched through October 24, 2025. Studies directly comparing CB and PB and reporting at least one predefined outcome were eligible. Pooled odds ratios (ORs) and mean differences (MDs) were estimated using a random-effects model based on the DerSimonian-Laird method. Risk of bias was evaluated using Risk of Bias In Non-randomized Studies of Interventions tool (ROBINS-I), and the certainty of evidence was graded according to Grading of Recommendations, Assessment, Development, and Evaluation (GRADE).

RESULTS: Among the 1,021 patients analyzed, 449 underwent CB repair and 572 PB repair. Operative time [MD 4.79 min; 95% confidence interval (CI): -6.27 to 15.85] and length of hospital stay (MD 0.24 days; 95% CI: -0.39 to 0.88) did not differ significantly between techniques. Rates of pleural effusion [4.6% vs. 1.3%; odds ratio (OR) 3.59; 95% CI: 0.82-15.72] and pneumothorax (2.5% vs. 2.3%; OR 1.08; 95% CI: 0.39-2.97) were comparable between CB and PB. CB was associated with a small but statistically significant improvement in postoperative Haller Index (MD -0.10; 95% CI: -0.17 to -0.03). Sensitivity analyses revealed study-driven heterogeneity for operative time and hospital stay. Overall risk of bias ranged from moderate to serious, with low to very low certainty of evidence across outcomes.

CONCLUSIONS: CB and PB techniques demonstrate equivalent perioperative profiles and complication rates in MIRPE.

PMID:42306667 | PMC:PMC13266845 | DOI:10.21037/jtd-2026-1-0132

J Thorac Dis. 2026 May 31;18(5):521. doi: 10.21037/jtd-2026-1-0386. Epub 2026 May 27.

ABSTRACT

BACKGROUND: Pulmonary resection is an important adjunct to antifungal therapy in selected patients with Aspergillus-related lung disease. However, the impact of surgical margin status on treatment outcomes remains poorly defined. The objective is to compare the impact of surgical margins on treatment response in patients with pulmonary fungal infections, analyzing persistence of symptoms, perpetuation of fungal colonization, and disease recurrence.

METHODS: This retrospective study analyzed patients treated between 2020 and 2024 with inflammatory/infectious pulmonary diseases caused by Aspergillus, undergoing pulmonary resection due to complications or as an adjunct to clinical treatment with curative intent. Patients were divided into two groups: tangential margin (distance to pulmonary margin <0.1 cm) and non-tangential margin (distance >0.1 cm). Patients were followed for one year. Exclusion criteria included incomplete records, loss to follow-up, or pneumonectomy cases.

RESULTS: Nineteen patients were included, of whom four experienced disease recurrence. All recurrence cases occurred in the “tangential margin” group. Tangential margins were strongly associated with symptom persistence, with an odds ratio (OR) of 11.0 [95% confidence interval (CI): 1.30-140.9, P=0.04]. Patients in this group also showed a smaller reduction in Aspergillus serology titers (50%) compared to the “non-tangential margin” group (75%), with statistical significance (P=0.04). The study also examined the correlation between the extent of lung disease and treatment outcomes but found no statistically significant association with recurrence, symptom persistence, or serology titer reductions.

CONCLUSIONS: As lung-sparing surgeries become more prevalent, an adequate surgical margin remains critical to achieving disease-free survival. This study suggests the importance of ensuring sufficient margins in pulmonary resections for fungal infections to optimize therapeutic outcomes. Additional research is needed to confirm our findings.

PMID:42306664 | PMC:PMC13266717 | DOI:10.21037/jtd-2026-1-0386

JTCVS Struct Endovasc. 2024 Dec 10;5:100037. doi: 10.1016/j.xjse.2024.100037. eCollection 2025 Mar.

ABSTRACT

OBJECTIVE: The treatment of complex aortic arch pathologies demands the reconstruction (endovascular or surgical) of 1 or multiple supra-aortic vessels to restore the blood flow of these vessels during thoracic endovascular aortic repair. However, the patency and fate of the endovascular bypass remain unclear. This report compares the midterm outcome of endovascular versus surgical bypass in thoracic endovascular aortic repair.

METHODS: Between 2007 and 2015, 395 patients underwent thoracic endovascular aortic repair at our institution. Only thoracic endovascular aortic repairs landing proximally at landing zones zero, 1, and 2 were included (244/395). We recorded the type of bypass method used (endovascular or surgical) and the number of supra-aortic vessels bypassed.

RESULTS: The median follow-up was 4.1 years. Aortic dissection, thoracic aortic aneurysm, and traumatic aortic injury were the most common indications for thoracic endovascular aortic repair. Endovascular bypass was more commonly used in thoracic endovascular aortic repair landing proximally at zone 1. The 30-day postoperative mortality rate was 11% (25 patients), but it was not different among both methods. Six patients (10.5%) in the endovascular group and 27 patients (16.5%) in the surgical bypass group needed reintervention. The late survival and adverse events were similar. Postoperative stroke occurred in 15 patients (6.8%). Type Ia endoleak was more common after endovascular bypass (17 patients, 36.2%), but this was not statistically significant.

CONCLUSIONS: In our report, with a tailored approach, the endovascular reconstruction of the supra-aortic vessels was not inferior to the surgical approach and had an acceptable patency rate at mid follow-up with a low rate of complications after surgery.

PMID:42306644 | PMC:PMC13244688 | DOI:10.1016/j.xjse.2024.100037

JTCVS Struct Endovasc. 2024 Dec 24;5:100041. doi: 10.1016/j.xjse.2024.100041. eCollection 2025 Mar.

ABSTRACT

OBJECTIVE: Hypoattenuated leaflet thickening (HALT) is a computed tomography (CT) finding after transcatheter aortic valve replacement (TAVR) that is indicative of bioprosthetic valvular thrombosis. There are currently no standardized or validated methods for predicting HALT, which can cause bioprosthetic valve dysfunction and has been associated with adverse patient outcomes. The objective was to develop a novel fast-response, artificial intelligence, and machine learning (ML)-driven computational pipeline to predict HALT using preprocedural CT scans.

METHODS: The pipeline consisted of (1) pre-TAVR CT reconstruction and reduced order modeling simulations to automatically predict postprocedural geometric parameters, (2) a landmark-guided automated left ventricle segmentation method to predict hemodynamic parameters, and (3) statistical and ML analyses to develop HALT predictive metrics.

RESULTS: Pre- and postprocedural scans from 45 patients (21 with HALT, 24 without) were used as inputs for the pipeline. We identified statistically significant relationships between HALT and peak systolic blood velocity (P < .01) and peak systolic blood flow through the bioprosthetic valve (P < .01), left ventricular ejection time (P < .01), ejection volume (P < .05), and right coronary height (P < .05). ML-yielded metrics related to circulation in the neosinuses correlated strongly with HALT occurrence (P < .001) along with the greatest accuracy of 84.40% and area under receiver operating characteristic curve of 0.87.

CONCLUSIONS: A computational pipeline using pre-procedural CT scans as inputs that outputs post-TAVR geometric and hemodynamic measurements was developed to assess metrics with the potential to predict the risk of HALT. Such a tool may help guide decision-making and understanding of prevention of postprocedural thrombosis.

PMID:42306643 | PMC:PMC13244794 | DOI:10.1016/j.xjse.2024.100041

Front Neurol. 2026 Jun 1;17:1840684. doi: 10.3389/fneur.2026.1840684. eCollection 2026.

ABSTRACT

BACKGROUND: Gait disorder and cognitive dysfunction are the most common symptoms in patients with cerebral small vessel disease (CSVD), significantly impacting patients’ quality of life. Currently, there remains a lack of effective treatment for gait disorder and cognitive dysfunction of CSVD. In this randomized, single-blind, sham-controlled study, we conducted high-dose accelerated intermittent theta burst stimulation (aiTBS) in 36 patients with CSVD to investigate the efficacy and safety of high-dose aiTBS targeting the primary motor cortex (M1 area) for treating various symptoms of CSVD, particularly gait and cognitive function.

METHODS: The patients were randomly assigned to two groups of real (n = 19) or sham (n = 17) aiTBS targeting the primary motor cortex. Both groups received 14 consecutive sessions of real-aiTBS or sham-aiTBS. Primary outcome was the change of 3-meter Timed Up and Go (3mTUG) duration, assessed at baseline (T0) and immediately post-intervention (T1), with follow-up evaluations at 4 weeks after intervention (T2). Secondary outcomes included changes in the Tinetti Performance-Oriented Mobility Assessment (Tinetti) score, the Chinese version of the Mini-Mental State Examination (CMMS) score, the Montreal Cognitive Assessment (MoCA) score, three-dimensional gait analysis, and multidimensional function scale scores after intervention.

RESULTS: Compared to the sham-aiTBS group, the real-aiTBS group exhibited significantly greater improvements in multidimensional gait, cognitive, affective and autonomic nervous function assessments. At the 4-week follow-up, time effects were statistically significant for the 3mTUG duration, Tinetti, CMMS, and MoCA scores. The real-aiTBS group exhibited more pronounced group-by-time interaction effects for the 3mTUG duration, Tinetti, and CMMS scores, while no statistically significant differences from the sham-aiTBS group were observed for the MoCA score. The aiTBS intervention response is correlated to the CSVD neuroimaging features, including periventricular white matter hyperintensity, enlarged perivascular space, cortical atrophy, lacune and total CSVD burden score.

CONCLUSION: The aiTBS holds promise as a valuable therapeutic approach for CSVD. High-dose aiTBS targeting the M1 area improved clinical symptoms such as gait and cognitive disorder in patients with CSVD. The therapeutic response to aiTBS in CSVD patients is related to the CSVD neuroimaging phenotypes.

PMID:42306624 | PMC:PMC13265494 | DOI:10.3389/fneur.2026.1840684