Background: Chronic obstructive pulmonary disease (COPD) was a significant public health concern, with smoking being the primary risk factor for its development and progression. The impact of smoking on respiratory rehabilitation efficacy in COPD patients remains an area of interest and investigation. This study aimed to assess the influence of smoking on the efficacy of respiratory rehabilitation in patients with COPD.

Methods: Data of patients with COPD from October 2015 to October 2023 were retrospectively analyzed in this case-control study. The patients who had previously participated in a pulmonary rehabilitation program were excluded. Pulmonary function, exercise capacity, quality of life, and sleep patterns were evaluated before and after rehabilitation.

Results: A total of 40 patients were included and categorized into non-smoking (n=20) and smoking groups (n=20) based on their smoking history. Before rehabilitation, no significant differences were observed between the groups in forced expiratory volume in one second (FEV₁) (P=0.96), forced vital capacity (FVC) (P=0.97), FEV₁/FVC ratio (P=0.73), maximal voluntary ventilation (MVV) (P=0.69), and diffusing capacity of the lung for carbon monoxide (DLCO) (P=0.63). After rehabilitation, FEV₁ (P=0.02), FVC (P=0.009), FEV₁/FVC ratio (P=0.03), MVV (P=0.004), DLCO (P=0.01), these pulmonary functions for non-smokers were much better than the smokers. Similarly, the non-smoking group exhibited significantly greater improvements in 6-minute walk distance (P=0.03), peak oxygen consumption (VO₂) (P=0.01), Borg scale ratings (P=0.02), St. George’s Respiratory Questionnaire (SGRQ) scores (P=0.004), and Medical Research Council (MRC) dyspnea scale scores (P=0.005) compared to the smoking group after rehabilitation. The non-smoking patients have more better quality of life compared to the smokers after rehabilitation, which demonstrated by the quality of life scores and Sleep Quality Score, including somatization (P=0.01), emotion management (P=0.009), role play (P=0.008), cognitive function (P=0.04), return to social function (P=0.01), Sleep Quality Score (P=0.02).

Conclusions: Smoking negatively impacts the efficacy of respiratory rehabilitation in COPD patients, leading to poorer pulmonary function, exercise capacity, quality of life, and sleep patterns.

Background: Over recent decades, findings on the potential correlation between type II diabetes mellitus (T2DM) and the risk of esophageal cancer (EC) have displayed considerable heterogeneity. Furthermore, metformin has emerged as a potentially protective agent against certain site-specific malignancies. This study aims to explore the causal relationship between T2DM, medication treatments (metformin, insulin, gliclazide), and EC risk while addressing the notable variability in previous research findings.

Methods: To elucidate the causal associations between T2DM, medication treatments, and EC, we employed a synergistic methodology that integrates the two-sample Mendelian randomization (MR) approach with meta-analysis. The genome-wide association studies (GWAS) pertaining to each exposure and EC were acquired from a publicly accessible database.

Results: For MR analyses, three out of seven GWAS datasets within the T2DM cohort exhibited statistical significance. Conversely, all MR analyses yielded non-significant results in the medication cohort. Meta-analyses suggested that a genetic predisposition to T2DM correlated with a reduced risk of EC [odds ratio (OR), 0.999612; 95% confidence interval (CI): 0.999468–0.999756; P=0.01; I²=0%]. Moreover, metformin intake was causally linked to a decreased prevalence of EC (OR, 0.988954; 95% CI: 0.979044–0.998963; P=0.03; I²=0%), whereas neither insulin nor gliclazide manifests statistical significance.

Conclusions: Our findings indicate T2DM and metformin are causally associated with diminished risk of EC, while no causal associations exist between insulin, gliclazide, and EC.

Background: Postoperative coagulation dysfunction is one of the common complications after coronary artery bypass grafting (CABG), especially in elderly patients. The aim of this study was to establish a risk prediction model for coagulation disorders in elderly patients after CABG, effectively identify high-risk patients who are prone to coagulation disorders, and strengthen postoperative treatment monitoring for these patients.

Methods: Patients who underwent CABG were retrospectively included between February 2019 and December 2020, and were randomly divided into a derivation set and a validation set at a ratio of 7:3. The disseminated intravascular coagulation (DIC) score of ≥2 was defined as coagulation disorder. The least absolute shrinkage and selection operator (LASSO) regression was used for variable selection and the establishment of a regression model. The confusion matrix and receiver operating characteristic (ROC) curve were used to evaluate the model prediction effect.

Results: The risk factors associated with postoperative coagulation dysfunction, selected by LASSO regression, including patient weight, preoperative baseline estimated glomerular filtration rate (eGFR), B-type natriuretic peptide (BNP), platelet count (PLT), preoperative use of heparin and angiotensin receptor-neprilysin inhibitor (ARNI), as well as intraoperative utilization of epinephrine, norepinephrine, dopamine, cephalosporins, cardiopulmonary bypass (CPB), intra-aortic balloon pump (IABP), extracorporeal membrane oxygenation (ECMO), operation duration, and total intraoperative fluid input. The area under curve (AUC) of the derivation set was 0.818 [95% confidence interval (CI): 0.775−0.862], while the AUC of the validation set was 0.827 (95% CI: 0.755−0.898). The sensitivity and specificity of the model in the derivation set were 80.0% and 70.0%. In the validation set, the sensitivity was 76.6% and the specificity was 81.7%, indicating that the model has good predictive performance.

Conclusions: The LASSO regression model for predicting coagulation disorders after CABG showed a good predictive performance in both the derivation set and the validation set, which is helpful for early identification of high-risk patients with coagulation disorders after CABG.

Background: Acute lung injury (ALI) is one of the most serious pulmonary complications following lung resection. Despite the known beneficial effects of corticosteroid treatment for postoperative ALI, limited data are available regarding corticosteroid treatment duration. This study aimed to evaluate the beneficial effects of a short-course corticosteroid in patients with postoperative ALI following lung resection surgery for lung cancer.

Methods: This retrospective observational study included 91 patients who were treated with corticosteroids for postoperative ALI among 7,317 patients who underwent lung resection surgery for lung cancer between January 2017 and March 2021. Patients were divided into two groups, short (≤14 days, n=31) and long (≥15 days, n=60) courses, on the basis of corticosteroid treatment duration.

Results: While similar baseline characteristics were observed between the two groups, the short-course group had a higher corticosteroid loading dose than the long-course group; however, the cumulative dose in the first 7 days was not different between the two groups. Overall, in-hospital mortality rates were 3.2% and 26.7% in the short- and long-course groups, respectively (P=0.01). Moreover, the long-course group had higher additional intensive care unit (ICU) admission (32.3% vs. 60.0%, P=0.02) and persistent air leakage (0% vs. 13.3%, P=0.09). In the logistic regression analysis, corticosteroid treatment duration was marginally associated with in-hospital mortality [adjusted odds ratio (OR), 9.03; 95% confidence interval (CI): 0.96–84.9, P=0.054].

Conclusions: Short-course corticosteroid treatment was associated with a lower rate of surgical site complications, additional ICU admission, and in-hospital mortality, which suggests the necessity of efforts for reducing the total duration by weighing the benefits and adverse effects of corticosteroid treatment for postoperative ALI.

Background: Esophagectomy following neoadjuvant chemoradiotherapy (nCRT) is a curative treatment for locally advanced esophageal cancer. However, pulmonary complications are the most common postoperative issues and can adversely affect survival. While numerous studies have investigated predictors for these complications and survival, morphomic predictors, derived from body composition measurements on computed tomography scans, have been rarely reported. Our study aims to delineate morphomic predictors for post-esophagectomy pulmonary complications and overall survival.

Methods: We retrospectively analyzed esophageal cancer patients who received nCRT followed by esophagectomy between 2004 and 2016. Preoperative clinical and morphomic variables were collected to evaluate post-esophagectomy pulmonary complications and overall survival. Multivariable logistic regression and Cox’s proportional hazard model were used for analysis.

Results: The study involved 221 esophageal cancer patients who received nCRT followed by surgery. Factors such as increased blood loss (P=0.01), more harvested nodes (P<0.001), advanced pT stage (P=0.01), elevated visceral adipose tissue (VAT) density (P=0.04), and reduced skeletal muscle (SM) area (P=0.01) were linked to pulmonary complications. Additionally, being male (P=0.01), increased blood loss (P<0.001), non-R0 resection margin (P=0.001), advanced pStage (P<0.001), advanced pT stage (P=0.02), and decreased SM density (P=0.045) were associated with poorer overall survival.

Conclusions: Increased VAT density and decreased SM area were associated with pulmonary complications, while decreased SM density was linked to poorer overall survival. Preoperative analytic morphomics aids in predicting both postoperative pulmonary complications and survival.

Background: Whether the preoperative anemia affects the prognosis and the therapeutic choice between coronary artery bypass grafting (CABG) or medical therapy alone in patients with ischemic cardiomyopathy (ICM) remains unclear. We assess the influence of preoperative anemia on long-term outcomes in ICM patients treated with medical therapy alone with or without CABG.

Methods: Patients with preoperative hemoglobin were included from the Surgical Treatment of Ischemic Heart Failure (STICH) trial. The primary outcome was long-term all-cause mortality.

Results: A total of 1,209 patients were enrolled, with 320 (26.5%) patients with anemia, and 889 (73.5%) without anemia. The median follow-up time was 9.7 years. Compared with patients without anemia, patients with anemia had a higher risk of all-cause mortality [adjusted hazard ratio (aHR): 1.15; 95% confidence interval (CI): 0.98 to 1.36] and cardiovascular mortality (aHR: 1.26; 95% CI: 1.04 to 1.53). Among patients with anemia, CABG provided a significant survival benefit compared with medical therapy alone (all-cause mortality: aHR: 0.64; 95% CI: 0.48 to 0.85; cardiovascular mortality: aHR: 0.54; 95% CI: 0.39 to 0.76). Though with borderline statistical significance, CABG also provided additional survival benefit among patients without anemia (all-cause mortality: aHR: 0.87; 95% CI: 0.73 to 1.03; cardiovascular mortality: aHR: 0.83; 95% CI: 0.68 to 1.01). Sensitivity analyses based on as-treated principle showed the consistent results.

Conclusions: Preoperative anemia is an independent risk factor for mortality in patients with ICM, whereas preoperative anemia does not affect the long-term survival benefits associated with CABG, which might help surgeons in making rational therapeutic decisions during clinical practice.

Background: There are insufficient data regarding how to deal with moderate aortic valve (AV) dysfunction during rheumatic mitral valve (MV) surgery. In this study, the clinical outcomes of patients who underwent rheumatic MV surgery with or without concurrent AV procedures were compared.

Methods: A total of 343 patients who underwent rheumatic MV surgery with moderate AV dysfunction were enrolled between January 2015 and August 2022, and a median 40-month follow-up was conducted. The more-than-mild AV dysfunction during follow-up was the primary endpoint event, while all-cause mortality and cardiac reoperation both before discharge and during follow-up encompassed the secondary endpoint events.

Results: Patients were allocated into two groups, including the no treatment (NT) (n=121) and aortic valvuloplasty (AVP) or aortic valve replacement (AVR) groups (n=222). Most of patients (110/121, 90.9%) in the NT group were combined with predominant aortic regurgitation. In the NT and AVP or AVR groups, 27.9% and 8.0% of patients reached the primary endpoint, and 5.0% and 7.3% of patients experienced the secondary endpoint events, respectively. This study confirmed a significantly higher proportion of patients in the NT group who reached the primary endpoint (relative risk, 2.98; 95% confidence interval: 1.61–5.62; P<0.001), after inverse probability treatment weighting.

Conclusions: Concomitant AV surgery significantly improved AV condition during follow-up for patients with moderate AV dysfunction during rheumatic valve surgery. However, it was safe and reasonable to delay surgical treatment of the AV and regular follow-ups for patients with predominant moderate aortic regurgitation.

Background: Tuberculosis infection (TBI) is a major challenge to global public health. Early detection and treatment of TBI are crucial in preventing tuberculosis (TB). Although inflammation is closely linked to the pathogenesis of TBI, the neutrophil-to-lymphocyte ratio (NLR), as a new inflammatory marker, has been less studied with TBI risk. This study was based on the National Health and Nutrition Examination Survey (NHANES) database. We utilized a cross-sectional research method to explore the association between NLR and the risk of adult TBI, aiming to fill the blank in the studying relationship between NLR and TBI risk. Our findings may contribute to providing new biomarkers for the diagnosis and treatment of TBI.

Methods: In this cross-sectional research, data from the NHANES database for the periods 1999–2000 and 2011–2012 were pooled for the study, with TBI as the dependent variable and NLR as the independent variable. A total of 2,433 participants were enrolled, including 391 TBI patients and 2,042 non-TBI patients. The inclusion criteria included information from complete blood testing and TBI status assessment. We evaluated demographic characteristics and clinical factors such as body mass index (BMI), smoking, drinking, NLR, and TBI risk. We employed weighted logistic regression to set up a relationship model between NLR and TBI and dissected the association between them through stratified analysis and subgroup analysis with confounding factors adjusted. We also utilized restricted cubic spline (RCS) and Kaplan-Meier (K-M) survival curves to investigate the nonlinear relationship between NLR and TBI, as well as their relationship with survival rates.

Results: A total of 2,433 samples were included in this project, with 391 TBI patients and 2,042 non-TBI patients. In the multivariable weighted logistic regression model, an obvious negative association was observed between NLR and TBI risk [odds ratio (OR) <1, P<0.05], and it was substantially influenced by diabetes (P for interaction =0.049). The negative association between NLR and TBI risk was particularly remarkable (P<0.05) in male and hypertensive patients. The RCS curve indicated a potential linear relationship between NLR and TBI risk (P-non-linear =0.9561), with NLR >1.899, OR <1, being a protective factor. The K-M survival curve revealed an obvious linkage between high NLR (>2.328) and increased death risk in TBI patients.

Conclusions: NLR is remarkably negatively linked with TBI risk. Patients with excessively high NLR have worse outcomes.

Keywords: Neutrophil-to-lymphocyte ratio (NLR); tuberculosis infection (TBI); hypertension; cross-sectional study; National Health and Nutrition Examination Survey (NHANES)