Unilateral Lobe Resection by Video-Assisted Thoracoscopy Leads to the Most Optimal Functional Improvement in Severe Emphysema

Identification of Macrophage Polarization-Related Genes as Biomarkers of Chronic Obstructive Pulmonary Disease Based on Bioinformatics Analyses

Objectives

Chronic obstructive pulmonary disease (COPD) is characterized by lung inflammation and remodeling. Macrophage polarization is associated with inflammation and tissue remodeling, as well as immunity. Therefore, this study attempts to investigate the diagnostic value and regulatory mechanism of macrophage polarization-related genes for COPD by bioinformatics analysis and to provide a new theoretical basis for experimental research.

Methods

The raw gene expression profile dataset (GSE124180) was collected from the Gene Expression Omnibus (GEO) database. Next, a weighted gene coexpression network analysis (WGCNA) was conducted to screen macrophage polarization-related genes. The differentially expressed genes (DEGs) between the COPD and normal samples were generated using DESeq2 v3.11 and overlapped with the macrophage polarization-related genes. Moreover, functional annotations of overlapped genes were conducted by Database for Annotation, Visualization and Integrated Discovery (DAVID) Bioinformatics Resource. The immune-related genes were selected, and their correlation with the differential immune cells was analyzed by Pearson. Finally, receiver operating characteristic (ROC) curves were used to verify the diagnostic value of genes.

Results

A total of 4922 coexpressed genes related to macrophage polarization were overlapped with the 203 DEGs between the COPD and normal samples, obtaining 25 genes related to COPD and macrophage polarization. GEM, S100B, and GZMA of them participated in the immune response, which were considered the candidate biomarkers. GEM and S100B were significantly correlated with marker genes of B cells which had a significant difference between the COPD and normal samples. Moreover, GEM was highly associated with the genes in the PI3K/Akt/GSK3β signaling pathway, regulation of actin cytoskeleton, and calcium signaling pathway based on a Pearson correlation analysis of the candidate genes and the genes in the B cell receptor signaling pathway. PPI network analysis also indicated that GEM might participate in the regulation of the PI3K/Akt/GSK3β signaling pathway. The ROC curve showed that GEM possessed an excellent accuracy in distinguishing COPD from normal samples.

Conclusions

The data provide a transcriptome-based evidence that GEM is related to COPD and macrophage polarization likely contributes to COPD diagnosis. At the same time, it is hoped that in-depth functional mining can provide new ideas for exploring the COPD pathogenesis.

Early and Long-Term Outcomes After Non-Intubated, Non-Resectional Lung Volume Reduction Surgery

Objective: In 2001, the introduction of non-resectional lung volume reduction surgery (LVRS) enabled surgery under non-intubated anaesthesia. This study compares this combined technique to a group of patients with a similar disorder who refused non-intubated anaesthesia. Methods: Between January 2001 and October 2015, 108 patients with severe emphysema underwent non-resectional LVRS under non-intubated anaesthesia. During the same period, another 15 patients scheduled for LVRS refused non-intubated surgery and underwent the same procedure under traditional intubated modality. Respiratory and functional parameters were evaluated. Time to residual volume recurrence and overall survival were analysed with the Kaplan–Meier method. Results: Thirteen cases (12%) required intubation due to tenacious pleuropulmonary adhesions (n=7) or intolerance (n=6). Compared with the intubated group, the non-intubated group were found to have significantly better results in post-operative partial pressure of carbon dioxide in arterial blood (PaCO2) (45±8 versus 52±8 mmHg; p=0.04), global operative time (41±24 versus 72±31 minutes; p=0.01), non-fatal complication rate (13.6% versus 33.3%; p=0.029), and especially postoperative pneumonia rate (3.1% versus 33.3%; p=0.004); patient satisfaction for anaesthesia was also improved in the non-intubated group (3.6±1.2 versus 2.8±1.7; p=0.03). Mean air leakage (5.3±3.5 versus 6.1±4.6 days), hospital stay (6.3±4.8 versus 8.0±6.1 days), and 90 days postoperative mortality rate (1.0% versus 6.6%) were lower, yet not significantly, in the non-intubated cohort. All mean respiratory and symptomatic parameters significantly improved in both groups, with no intergroup significant difference, and persisted for 4 years after surgery. Mean follow-up for the non-intubated group was 78±30 months. Analysis of time to residual volume recurrence and overall survival showed no statistically significant intergroup difference. Conclusion: Non-intubated, non-resectional LVRS presents a 90-day postoperative non-fatal complication rate and patient satisfaction for non-intubated anaesthesia that are significantly better than intubated procedures. The long-term outcomes were similar between both groups.

One-Year Follow-Up after Endobronchial Valve Treatment in Patients with Emphysema without Collateral Ventilation Treated in the STELVIO Trial

BACKGROUND

One-way endobronchial valve (EBV) treatment has shown safety and efficacy at 6 months after treatment in patients with severe emphysema and confirmed absence of interlobar collateral ventilation. Longer follow-up in this subgroup is not available.

OBJECTIVES

To investigate the efficacy and safety of EBV treatment of the STELVIO cohort at a 1-year follow-up.

METHODS

Emphysema patients who have been treated with EBV in the STELVIO trial were invited for a voluntary 1-year follow-up visit. Both the original treatment group and the control group who crossed over to treatment have been included. Analyses are performed on the patients who attended the 1-year follow-up visit.

RESULTS

Sixty-four patients received EBV treatment. At 1 year, 40 patients (26 female; mean age 59 ± 8 years; FEV1 0.86 ± 0.29 L; RV 4.56 ± 1.00 L; 6MWD 367 ± 78 m; and SGRQ 56 ± 13 points) visited the hospital. Significant improvements (p < 0.001) were found for FEV1 (+17%, 95% CI, 11 to 24), RV (-687 mL, 95% CI, -918 to -456), 6MWD (+61 m, 95% CI, 42 to 80), and SGRQ (-11 points, 95% CI, -17 to -6). Two patients died: 1 after 58 days due to progressive respiratory failure and 1 after 338 days of follow-up due to a myocardial infarction. Seventeen percent of the patients underwent valve replacement and 22% of the initially treated patients had permanent valve removal. In 22% of the patients, pneumothoraces occurred before 6 months, and none occurred between 6 and 12 months.

CONCLUSIONS

EBV treatment results in clinically relevant benefits at 1 year of follow-up. Maintenance bronchoscopies to achieve this are needed. This study supports the use of EBV treatment in carefully selected patients with severe emphysema without collateral ventilation.

Staged bilateral single-port thoracoscopic lung volume reduction surgery: A report of 11 cases

The aim of the present study was to investigate the feasibility and efficacy of staged bilateral single-port thoracoscopic lung volume reduction surgery (LVRS) for patients with chronic obstructive pulmonary emphysema (COPE). Eleven male patients with a mean age of 60.27±12.11 years with bilateral COPE and bullae were admitted to the Department of Thoracic Surgery, Xuzhou Central Hospital from January 2013 to June 2014. The patients underwent staged bilateral single-port thoracoscopic LVRS. The hyperinflated bullae were resected using endoscopic staplers (Endo-GIA), followed by continuous suture and biological glue for reinforcement of the margin. In addition, pulmonary function, blood gas assay, 6-min walk distance (6MWD) and life quality evaluated by a short form 36-item health survey questionnaire (SF-36) were recorded before and after LVRS, respectively. All the patients survived after surgery. The chest tube drainage time was 9.09±1.31 days and postoperative hospital stay was 15.73±2.75 days, with 5 cases of persistent air leakage and 7 cases of pulmonary infection which were finally cured. The patients were followed up for 3 to 12 months, and the pulmonary function, partial pressure of oxygen (pO₂), 6MWD and life quality after unilateral or bilateral LVRS were improved compared to these parameters before surgery. However, there was no significant difference between unilateral and bilateral LVRS in terms of life quality. In conclusion, staged bilateral single-port thoracoscopic LVRS may improve the short-term life quality of patients with COPE.