Journal of thoracic disease
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The introduction of immune checkpoint inhibitors have greatly improved clinical outcomes in several cancer types, revolutionizing the management of a wide variety of tumors endowed with poor prognosis. Despite its success, high grade immune related adverse events were observed in patients treated with checkpoint inhibitors. ⋯ In this review we discuss possible mechanisms involved in cardiac toxicity triggered by inhibition of cytotoxic T lymphocyte antigen 4 (CTLA-4) and programmed cell death 1 (PD-1) pathway, the most prominent checkpoint inhibitors available in the clinic. Major cardiovascular events associated with checkpoint inhibitors adds another layer of complexity in cancer therapy and urges for an interdisciplinary approach between oncologists, cardiologists, and immunologist.
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Chronic obstructive pulmonary disease (COPD) and obstructive sleep apnoea (OSA) syndrome are both highly prevalent, affecting at least 10% of the general adult population, and each has been independently associated with an increased risk of cardiovascular disease. The presence of both disorders together, commonly referred to as the overlap syndrome, is also highly prevalent, although various clinical and pathophysiological factors associated with COPD may increase or decrease the likelihood of OSA. Lung hyperinflation reduces the likelihood of obstructive apnoea, whereas right heart failure increases the likelihood as a result of rostral fluid shift causing upper airway narrowing in the supine position while asleep. ⋯ Cardiac sympathetic activity is increased in patients with the overlap syndrome when compared to each disorder alone, but echocardiographic evidence of left ventricular strain is no greater in overlap patients when compared to COPD alone. While survival might be expected to be worse in overlap patients, recent evidence surprisingly indicates that the incremental contribution of lung function to mortality diminishes with increasing severity of OSA. Identification of co-morbid OSA in patients with COPD has practical clinical significance as appropriate positive airway pressure therapy in COPD patients with co-existing OSA is associated with improved morbidity and mortality.
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We previously reported the techniques for total endoscopic atrial septal defect (ASD) repair on hearts arrested with cardioplegia through three small incisions in the chest wall without aid of a surgical robotic system. The optimal results motivated us to use total thoracoscopic technology for ASD on perfused beating hearts. ⋯ Total thoracoscopic closure of ASD without assistance of a surgical robotic system on beating heart is safe and feasible and can be used as a therapeutic option for ASD, and by using the mentioned technique, less injuries are applied to patients.
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In 2013, the Centers for Disease Control and Prevention (CDC) issued the concept of the ventilator-associated events (VAEs) as a quality indicator (QI) in the intensive care unit (ICU). A number of studies have been conducted in the United States and other Western countries to evaluate its practicality. However, information on VAEs in non-Western countries is scarce. The purpose of this preliminary study was to illuminate the incidence and associated mortality rate of VAEs in Japan, as a first step in the effort to determine its practicality. ⋯ The prevalence of VAEs appears low in Japanese ICUs. Nonetheless, mortality was substantially higher in patients who developed VAEs. Although some potential indices of VAEs are suggested to serve as QIs, additional studies to elaborate its practicality would further be required.
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A single long-acting bronchodilator, ultra-long acting muscarinic antagonist (ultra-LAMA) or ultra-long acting β2-agonist (ultra-LABA) is preferred for the initial treatment of patients with chronic obstructive pulmonary disease (COPD); however, there are few head-to-head comparative studies between the two. Here, a meta-analysis of randomized controlled trials was performed to compare the clinical efficacy between ultra-LABA and ultra-LAMA in patients with moderate-to-severe COPD. ⋯ This study suggests that COPD exacerbation occurred less often in patients taking an ultra-LAMA than in those taking an ultra-LABA with similar efficacy of lung function and quality of life.