Background: Primary spontaneous pneumothorax (PSP) is commonly treated with video-assisted thoracoscopic surgery (VATS), which traditionally requires one-lung ventilation (OLV) with double-lumen endotracheal intubation to optimize the surgical field. However, OLV may be associated with complications such as airway trauma and postoperative sore throat. In contrast, two-lung ventilation (TLV) with CO₂ insufflation has been proposed as an alternative that may reduce airway-related complications while maintaining adequate visualization. This study assessed the feasibility of VATS with TLV and CO₂ insufflation for PSP compared to the conventional OLV approach.

Methods: We retrospectively analyzed 181 patients with PSP treated at our center between July 2020 and December 2023; of these, 134 underwent thoracoscopic bullectomy. Fifty-six patients received VATS with TLV and CO₂ insufflation. Seventy-eight patients underwent OLV via double-lumen endotracheal intubation. Patient data were categorized into groups based on the minimization of bias between those receiving TLV and those receiving OLV, following analysis matched by propensity scores. A comparative analysis across these groups was also conducted, focusing on demographic data and intraoperative and postoperative outcomes.

Results: The TLV group demonstrated several advantages, including shorter anesthesia induction time (13.45±5.25 min, P=0.01), shorter total anesthesia time (63.18±14.45 min, P=0.003), fewer days of chest tube drainage (1.41±1.22 days, P=0.04), shorter postoperative hospital stay (2.36±0.88 days, P=0.01), lower wedge resection specimen weight (3.21±2.5 g, P=0.03), fewer instances of postoperative ipsilateral and contralateral recurrence, and lower likelihood of short-term recurrence. No significant differences were found in surgical time (P=0.17), anesthesia recovery time (P=0.48), use of endostaplers (P=0.35), number of wedge resections (P=0.21), and pleurodesis (P=0.73).

Conclusions: In appropriately selected patients, TLV appears to be a viable option that does not increase recurrence risk compared to OLV while offering the benefit of a shorter anesthesia duration. Therefore, this method may be suitable for patients with PSP.

Keywords: Primary spontaneous pneumothorax (PSP); video-assisted thoracoscopic surgery (VATS); CO₂; single incision

Background: At this stage, the prognostic analysis of heart failure (HF) patients mainly focused on death and 30-day readmission, and fewer studies focused on 90-day readmission. Therefore, this study was to explore the risk factors for 90-day readmission in HF patients.

Methods: Least absolute shrinkage and selection operator (LASSO) regression was used to perform variable screening. Multivariate logistic regression was used to analyze the influencing factors of 90-day readmission of patients with HF. Logistic classification, eXtreme gradient boosting (XGBoost) regression, and random forest were used to rank the influencing factors, and the Wayne diagram extracted the common factors of the top five influencing factors obtained by the three methods. Trend regression analysis and restricted cubic spline analysis were used to analyze the correlation between these factors and the 90-day readmission of patients with HF.

Results: Charlson Comorbidity Index (CCI), red blood cell count (RBC), red cell distribution width (RDW), and age were the main factors influencing the 90-day readmission of patients with HF. With the increase of CCI, the risk of 90-day readmission for patients with HF increased, the same results were found in RDW and age, while with the increase of RBC value, the risk of 90-day readmission decreased. RBC and RDW were linearly correlated with the 90-day readmission of patients with HF, while CCI and age were nonlinearly correlated with the 90-day readmission of patients with HF.

Conclusions: CCI, RBC, RDW, and age were the main factors influencing the 90-day readmission of patients with HF. RBC and RDW were linearly correlated with the 90-day readmission of patients with HF, while CCI and age were nonlinearly correlated with the 90-day readmission of patients with HF.

Keywords: 90-day readmission; heart failure (HF); risk factors

Background: The coexistence of pulmonary tuberculosis (PTB) and pulmonary embolism (PE) is an uncommon clinical condition, and its rarity is associated with a high mortality rate, underscoring the critical importance of early diagnosis. The purpose of this study is to develop and validate a nomogram model for predicting risk of PE in patients with PTB.

Methods: We included 694 patients with PTB in the development cohort and 236 patients in the validation cohort from another center. A prediction model was established based on independent risk factors. The nomogram’s performance was evaluated using the area under the receiver operating characteristic (ROC) curve (AUC), calibration curve analysis, and decision curve analysis (DCA).

Results: D-dimer, age, tumor, chest pain, dyspnea, and surgery were independent risk factors for PTB with PE, and a nomogram model was established to predict PTB with PE. The AUC of the development and validation cohort model was 0.903 and 0.821. The calibration curves for both cohorts showed that the probabilities predicted by the model were very close to the actual probabilities. The DCA also demonstrated that the nomogram model showed significant clinical application value.

Conclusions: The risk factor-related nomogram model identified in this study has a high predictive accuracy and provides a clinical application for assessing the risk of PE in patients with tuberculosis.

Keywords: Pulmonary tuberculosis (PTB); pulmonary embolism (PE); nomogram model; risk factors