Function In Lung Cancer Patients Research Articles

Effect of Radiotherapy on the Right Ventricular Function in Lung Cancer Patients.

Anticancer treatment is associated with many side effects, including those involving the cardiovascular system. While many studies are available on the effects of radiotherapy (RT) on the left ventricle (LV), studies are lacking on the early effects of RT on the structure and function of the right ventricle (RV). Our study aims to assess, using modern echocardiographic techniques, the effect of irradiation on RV systolic function in the mid-term follow-up of patients undergoing RT for lung cancer (LC). This single-center, prospective study included consecutive patients with LC who were referred for treatment with definite radiotherapy and chemotherapy (study group) or chemotherapy only (control group). The study included 43 patients with a mean age of 64.9 ± 8.1 years. Cancer treatment-related RV toxicity (CTR-RVT) was found in 17 patients (40%). Early reductions in TAPSE values were observed among patients in the study group (20.3 mm vs. 22.1 mm, p = 0.021). Compared to baseline, there was a significant reduction in RV global longitudinal strain (RV GLS) in the study group immediately after the treatment (-21.1% vs. -18.4%, p = 0.02) and also at 3 months after RT (-21.1% vs. -19.1%, p = 0.021). A significant reduction in the RV FWLS value was also observed at 3 months after the end of the treatment (-23.8% vs. -21.8, p = 0.046). There were no significant changes in the three-dimensional right ventricular ejection fraction (3DRVEF) during the follow-up. We found a correlation (p = 0.003) between the mean dose of radiation to the RV and 3DRVEF when assessed immediately after RT. The mean dose of radiation to the heart correlated with RV free-wall longitudinal strain (RV FWLS) immediately after RT (p = 0.03). RV cardiotoxicity occurs in nearly half of patients treated for lung cancer. TAPSE is an important marker of deterioration of RV function under LC treatment. Compared to 3DRVEF, speckle tracking echocardiography is more useful in revealing deterioration of RV systolic function after radiotherapy.

Neoadjuvant immune checkpoint inhibitor therapy and chemotherapy improve pulmonary ventilation and diffusion function in patients with lung cancer.

To investigate changes of pulmonary ventilation function and diffusion function in lung cancer patients after neoadjuvant immune checkpoint inhibitors (ICIs) therapy combined with chemotherapy treatment. Patients with newly diagnosed lung cancer (Ⅱa-Ⅲb) admitted to Zhejiang Cancer Hospital from October 2021 to July 2022, who received ICIs combined with chemotherapy for more than two courses were enrolled. Patients underwent pulmonary ventilation function and diffusion function assessments before and after treatment. The demographic information, sizes and locations of cancer lesions, doses and duration of ICIs used, pulmonary function results before and after treatment, and the tumor regression were documented. The changes of pulmonary function parameters before and after the treatment were analyzed with paired t test and Wilcoxon rank-sum test. The factors influencing the pulmonary function changes were analyzed by multiple linear Lasso regression and ridge regression. Among the 52 patients, 50 cases were males (96.15%) and 43 cases were squamous carcinoma (82.69%). The medium age of the patients was 67 years. After neoadjuvant therapy, 36 patients (69.23%) showed remission of tumor lesions. After treatment, the parameters of pulmonary ventilation inspiratory vital capacity (IVC) and the area under the expiratory flow-volume curve (AREAex), and the parameter of pulmonary diffusion total lung capacity increased compared with the baseline (all P<0.05). Forced vital capacity (FVC) and forced expiratory volume in first second (FEV1) also showed an increasing trend. Multivariate linear Lasso regression and ridge regression showed that baseline IVC had a significant negative effect on IVC improvement (Beta=－0.435, t=－2.968, P<0.01), baseline TLC had a significant negative effect on the improvement of TLC (Beta=－0.266, t=－2.474, P<0.05), and the remission of obstructive pneumonia favored the improvement of TLC (Beta=0.308, t=2.443, P<0.05). After ICIs neoadjuvant treatment combined with chemotherapy, the lung ventilation and diffusion function can be improved in lung cancer patients, particularly for those with reduced baseline ventilation and diffusion function.

Exploration of AI-Assisted On-Board Perfusion Imaging Technique on Patients Undergoing Thoraxradiotherapy

Pulmonary function of lung cancer patients can significantly change along the radiation therapy (RT) course. Scholars have synthesized lung function maps from computed tomography (CT) images. Still, there is lack of study exploring the feasibility of generating lung perfusion information from cone-beam CT (CBCT). Our study aims to fill up this gap in the body of literatures. One-hundred-and-six pairs of planning CT and CBCT images of thoracic cancer patients from XX hospital were collected retrospectively. All CT images were registered to CBCT with a deformable algorithm, and referred as deformed planning CT (dCT). A 2D convolutional neural network (CNN) model built with cycle generative adversarial network (cycle-GAN) was trained to correct CBCT image artifacts and HU value discrepancies. The corrected CBCT was named enhanced CBCT (eCBCT) in this study. All CBCT, eCBCT and dCT images were then input to a pre-trained CT-to-perfusion deep learning (DL) model to synthesize perfusion images (PI), namely PICBCT, PIeCBCT and PIdCT respectively. For model training, 80 image pairs were assigned to the training set while others to the testing set. dCT and PIdCT were respectively regarded as the ground truth in two consecutive models. One extra validation case acquired with SPECT perfusion scan was collected for model performance test. Quantitative evaluation was done between the ground truth and the synthesized images. Peak signal-to-noise ratio (PSNR) and mean absolute error (MAE) were computed to assess efficacy of CBCT enhancement. Correlation (R) and Dice similarity coefficient (DSC) were used to evaluate voxel-wise and function-wise concurrence in CBCT-derived perfusion mapping. In CBCT enhancement, [eCBCT-dCT] pairs demonstrated higher agreement than [CBCT-dCT] pairs. Quantitatively, PSNR and MAE were improved from 21.10±1.60 to 24.08±1.76, and 68.99±13.51 to 47.06±11.31 (p<0.01), respectively. For perfusion translation, higher correlation was demonstrated in both voxel-wise and function-wise evaluation within [PIeCBCT-PIdCT] than [PICBCT-PIdCT]. R correlation increased from 0.84±0.09 to 0.89±0.06 (p<0.01), whereas DSC in high-functional regions increased from 0.77±0.06 to 0.82±0.05 (p<0.01). In the validation case, strong correlation was observed between SPECT perfusion scan and PIeCBCT, with R increasing from 0.57 to 0.65 when compared to PICBCT. We proposed a novel DL framework that synthesized perfusion images from fractionally acquired CBCT. Our framework met the clinical needs in providing real-time lung perfusion maps. It can be used to track the continuously changing pulmonary function status throughout the RT course using routinely scanned CBCT, without additional imaging modalities. The framework can facilitate functionally guided adaptive radiation therapy by providing immediate pulmonary function information.

Changes in pulmonary function in lung cancer patients after segmentectomy or lobectomy: a retrospective, non-intervention, observation study.

Pulmonary segmentectomy (SE) became an increasingly popular method for resection of early-stage lung cancer. This study aims to compare the impact of single SE (SSE), multiple SE (MSE) and lobectomy (LE) on postoperative pulmonary function in patients with NSCLC. Medical records of a total of 1284 patients who underwent LE (n = 493), SSE (n = 558) and MSE (n = 233) at Shanghai Pulmonary Hospital from January 2013 to October, 2020 were retrospectively analysed. Pulmonary function tests (PFTs) were performed preoperatively and 12 months after surgery. SSE was associated with a significantly smaller decline in the PFT values compared to MSE and LE. There was a poor consistency between the observed and expected (O/E) loss of pulmonary function in all study groups (P < 0.05). Both LE and SE resulted in similar O/E ratios of all PFT parameters (P > 0.05). Overall loss of pulmonary function was much greater after LE than after both SSE and MSE. MSE was associated with higher postoperative pulmonary function decline compared to SSE but was still beneficial over LE. Both LE and SE groups had similar PFT loss per segment (P > 0.05).

Prediction of postoperative lung function in lung cancer patients using machine learning models.

: Surgical resection is the standard treatment for early-stage lung cancer. Since postoperative lung function is related to mortality, predicted postoperative lung function is used to determine the treatment modality. The aim of this study was to evaluate the predictive performance of linear regression and machine learning models. We extracted data from the Clinical Data Warehouse (CDW) and developed 3 sets: set Ⅰ, the linear regression model; set Ⅱ, machine learning models omitting the missing data: and set Ⅲ, machine learning models imputing the missing data. Six machine learning models, the least absolute shrinkage and selection operator (LASSO), ridge regression, ElasticNet, Random Forest, eXtreme gradient boosting (XGBoost), and the light gradient boosting machine (LightGBM) were implemented. The forced expiratory volume in one second (FEV1) measured 6 months after surgery was defined as the outcome. Five-fold cross-validation was performed for hyperparameter tuning of the machine learning models. The dataset was split into training and test datasets at a 70:30 ratio. Implementation was done after dataset splitting in set Ⅲ. Predictive performance was evaluated by R2 and mean squared error (MSE) in the 3 sets. A total of 1,487 patients were included in sets Ⅰ and Ⅲ and 896 patients were included in set Ⅱ. In set Ⅰ, the R2 value was 0.27 and in set Ⅱ, LightGBM was the best model with the highest R2 value of 0.5 and the lowest MSE of 154.95. In set Ⅲ, LightGBM was the best model with the highest R2 value of 0.56 and the lowest MSE of 174.07. The LightGBM model showed the best performance in predicting postoperative lung function.

Assessment of a computed tomography-based radiomics approach for assessing lung function in lung cancer patients

PurposeWe aimed to assess radiomics approaches for estimating three pulmonary function test (PFT) results (forced expiratory volume in one second [FEV1], forced vital capacity [FVC], and the ratio of FEV1 to FVC [FEV1/FVC]) using data extracted from chest computed tomography (CT) images. MethodsThis retrospective study included 85 lung cancer patients (mean age, 75 years ±8; 69 men) who underwent stereotactic body radiotherapy between 2012 and 2020. Their pretreatment chest breath-hold CT and PFT data before radiotherapy were obtained. A total of 107 radiomics features (Shape: 14, Intensity: 18, Texture: 75) were extracted using two methods: extraction of the lung tissue (<-250 HU) (APPROACH 1), and extraction of small blood vessels and lung tissue (APPROACH 2). The PFT results were estimated using the least absolute shrinkage and selection operator regression. Pearson’s correlation coefficients (r) were determined for all PFT results, and the area under the curve (AUC) was calculated for FEV1/FVC (<70 %). Finally, we compared our approaches with the conventional formula (Conventional). ResultsFor the estimated FEV1/FVC, the Pearson’s r were 0.21 (P =.06), 0.69 (P <.01), and 0.73 (P <.01) for Conventional, APPROACH 1, and APPROACH 2, respectively; the AUCs for FEV1/FVC (<70 %) were 0.67 (95 % confidence interval [CI]: 0.55, 0.79), 0.82 (CI: 0.72, 0.91; P =.047) and 0.86 (CI: 0.78, 0.94; P =.01), respectively. ConclusionsThe radiomics approach performed better than the conventional equation and may be useful for assessing lung function based on CT images.

ABCDEF pulmonary rehabilitation program can improve the mid-term lung function of lung cancer patients after thoracoscopic surgery: A randomized controlled study

Background Pulmonary rehabilitation is recommended for most patients with lung diseases. However, some previous studies have shown that pulmonary rehabilitation has no obvious effect on short-term lung function in patients with lung cancer.Objective The purpose of this study was to evaluate the effect of the ABCDEF pulmonary rehabilitation program on lung cancer patients who have undergone surgery.Design This was a randomized controlled trial with repeated measures.Settings The study was conducted in the Cardiothoracic Surgery Department of a 4000-bed comprising training and research hospital from 2019 to 2020.Participants A total of 90 patients who underwent thoracoscopic pneumonectomy were divided into two groups of 45, using a completely randomized model.Methods Patients in the experimental group participated in an ABCDEF program (Acapella positive vibration pressure training, breathing exercise, cycling training, dance in the square, education, and follow-up) after surgery. In contrast, the regular care provided to the control group focused on breathing and expectoration guidance. The study outcomes were the first second (FEV1), forced vital capacity (FVC), FEV1/FVC ratio, 6 min walking distance, Borg score, incidence of postoperative complications, length of indwelling chest tube, and length of postoperative stay. Generalized estimating equation models were used to compare the changes in the outcomes between the groups over time.Results The ABCDEF pulmonary rehabilitation program for patients who underwent thoracoscopic pneumonectomy was found to be more effective in increasing lung function at 3 months after discharge (p<0.05). However, there was no statistically significant difference on the day of discharge (p>0.05). Exercise tolerance was different at both time points (p<0.05). The incidence of postoperative complications in the experimental group was lower than that in the control group (p<0.05). The length of postoperative stay in the experimental group was also shorter (p<0.05), however, the length of the indwelling chest tube was not significantly different between the intervention and control groups (p>0.05).Conclusions This study showed that the ABCDEF pulmonary rehabilitation program could effectively improve mid-term lung function and exercise tolerance in patients after thoracoscopic pneumonectomy, and reduce the incidence of postoperative complications along with the length of postoperative hospital stay.

Study on the Benefit of Postoperative Exercise Rehabilitation in Patients with Lung Cancer Complicated with Chronic Obstructive Pulmonary Disease

背景与目的慢性阻塞性肺病（chronic obstructive pulmonary diseases, COPD）影响全世界范围内45%-63%的肺癌患者，合并COPD的肺癌患者心肺功能降低，围术期风险增加，且术后运动耐力和肺功能较常规肺癌患者下降幅度更大。已有研究表明术后运动训练可以改善未经选择的肺癌患者运动耐力，但合并COPD的肺癌患者是否也能从术后运动训练中获益尚不清楚，本研究拟探究术后运动训练对肺癌合并COPD患者运动耐力、日常活动能力和肺功能的影响。方法前瞻性分析2020年8月5日-2021年8月25日于四川大学华西医院肺癌中心行肺切除术治疗的非小细胞肺癌（non-small cell lung cancer, NSCLC）合并COPD患者74例，随机分为运动组和对照组；两组患者术后第1周接受常规术后康复，从第2周开始对照组给予常规护理，运动组在此基础上进行术后运动康复训练，为期2周。术前3天进行基线评估，术后3周进行终点评估。结果两组患者的运动耐力，日常活动能力和肺功能测试结果均从基线到终点有所下降，但在手术和干预方案后，运动组心肺运动试验的最大耗氧量和6分钟步行试验的步行距离均显著优于对照组[(13.09±1.46) mL/kg/min vs (11.89±1.38) mL/kg/min, P=0.033; (297±46) m vs (243±43) m, P=0.041]。运动组平均微信计步数量也显著优于对照组（4, 381±397 vs 3, 478±342, P=0.035）。运动组用力肺活量（forced vital capacity, FVC）和一秒用力呼气容积（forced expiratory volume in one second, FEV1）均优于对照组，但差异未达到统计学显著水平[(1.76±0.19) L vs (1.60±0.28) L, P=0.084; (1.01±0.17) L vs (0.96±0.21) L, P=0.467]。结论术后运动康复训练可以改善肺癌合并COPD患者运动耐力和日常活动能力，促进术后康复。

Accounting for Serial and Parallel Functionality of the Lung May Minimize Post-Radiotherapy Loss of Respiratory Function in Lung Cancer Patients

Functional lung avoidance (FLA) radiotherapy (RT) aims to minimize post-RT respiratory function loss. Current FLA approaches spatially map lung function and preferentially avoid dose to high-functioning lung (HFL). However, current FLA methods do not adequately consider the conducting architecture responsible for gas exchange (airways/vasculature). Previously, we showed that excessive toxicity to airways results in airway collapse, leading to functional loss within downstream lung sub-volumes. We proposed the functionally weighted airway sparing (FWAS) method to spare airways connected to HFL. Here, we propose a novel method that combines both FLA and FWAS to minimize post-RT functional loss.We estimated post-RT decline in regional airflow and ventilation as a combined measure of functional loss. High-res breath-hold CTs (BHCTs) and simulation 4DCTs from seven lung SAbR patients were analyzed retrospectively. Three functional avoidance IMRT strategies were compared to conventional IMRT planning: (i) FLA - a 4DCT-based ventilation map was used to delineate the HFL, defined as the functional regions of the lung above the mean intensity in the map. FLA plans were optimized such that mean dose and V13.5 in HFL were as low as reasonably achievable while meeting clinical dose constraints. (ii) FWAS - a virtual bronchoscopy software was used to autosegment 12 airway generations on the BHCT. Each terminal airway was connected to a lung sub-volume and assigned a functional weight based on the relative ventilation contribution of the sub-volume based on the ventilation map. For non-terminal airways, the weight was calculated in terms of the cumulative ventilation supported by corresponding downstream airways. These weights were used in the optimization along with airway dose constraints, estimated as a function of airway diameter and 5% probability of collapse. (iii) FLA+FWAS - the two strategies were combined to reduce the dose to both HFL and corresponding upstream airways.Overall, FLA+FWAS provided the highest ventilation preservations with an average improvement, compared to conventional plans, of 12%, followed by FWAS (8%), and FLA (3%). In all cases, clinical objectives for planning target volume and organs at risk were met. Generalized estimated equations with identity link and normal distribution and exchangeable correlation matrix showed that all these improvements were statistically significant (P < 0.04).These initial results suggest that it is crucial to consider the serial as well as the parallel nature of the lung, being airway sparing likely more critical to minimize post-RT functional loss.

Total flavonoids of Taraxacum mongolicum inhibit non-small cell lung cancer by regulating immune function

Ethnopharmacological relevanceTaraxacum mongolicum Hand.-Mazz. has been used in lung cancer treatment in Chinese medicine. However, its specific mechanism of action has not yet been reported, and developing pharmaceutical anti-cancer resources is important. Here, we aimed to elucidate the anti-tumor effects of dandelion in vitro and in vivo and assess its effects on immune function in lung cancer patients. Aim of the studyIn the present study, we mainly observed the therapeutic effects of total flavonoids from Taraxacum mongolicum Hand.-Mazz. (TFTM) on non-small cell lung cancer and its influence on the body's immune function. Materials and methodsIn vitro experiments on A549 and H1299 cells were performed using the CCK8 method; the proliferation and migration of cells were observed to investigate the wound healing effects of TFTM, and flow cytometry was used to detect the apoptotic rate of TFTM on lung cancer cells. In vivo experiments were preformed to establish a non-small cell lung cancer mouse model using subcutaneously transplanted Lewis cells, and the body weight and tumor growth of the mice were recorded. Hematoxylin and eosin staining was performed for tumor tissue to assess pathological changes. The thymus, spleen, and lungs were isolated for to calculate organ index. The CD4+, CD8+, and CD4+/CD8+ levels were detected in mouse spleen using flow cytometry, and IL-2, IL-3, IFN-γ, and TNF-α levels were determined in serum using enzyme-linked immunosorbent assay. Expressions of IL-2, IL-3, IFN-γ, and TNF-α were detected using quantitative real-time PCR in tumor tissues, and Ki67 expression was observed by immunofluorescence. ResultsAt 24 h, TFTM (100 and 200 μg/mL) had the best inhibitory effect on the proliferation of A549 and H1299 cells. The cell migration rate significantly reduced (P < 0.01), and the tumor inhibition rate increased (P < 0.01) and promoted apoptosis (P < 0.01). The mouse thymus index significantly increased (P < 0.05) and mouse spleen index reduced (P < 0.05). The CD4+, CD8+, and CD4+/CD8+ levels in Lewis lung cancer mouse model increased, as did the levels of IL-2, IL-3, IFN-γ, and TNF-α in the serum and tumor of mice; Ki67 expression in tumor tissues significantly reduced (P < 0.01). ConclusionTFTM has an inhibitory effect on lung cancer. The mechanism may be that it improves the host's protective immune response by having a milder tumor growth inhibitory effect than cyclophosphamide.

Continuous Serratus Anterior Plane Block Improved Early Pulmonary Function After Lung Cancer Surgical Procedure

BackgroundSerratus anterior plane block (SAPB) has been proven to be an efficient way to control postoperative pain. This study explored whether the use of continuous SAPB in combination with flurbiprofen could improve early pulmonary function in lung cancer patients undergoing video-assisted thoracoscopic surgery (VATS). MethodsFrom July 2019 to April 2020, patients who scheduled for elective lung resection undergoing VATS were randomly allocated to receive patient-controlled SAPB in combination with intravenous flurbiprofen or patient-controlled intravenous analgesia. Postoperative pulmonary function variables, including forced expiratory volume in 1 second, and forced vital capacity were collected before and 24, 48, and 72 hours after Surgical Procedure. Pain intensity was measured at rest and on coughing. Comfort scores during breathing exercises, postoperative pulmonary complications, and adverse events were recorded. ResultsA substantial reduction in lung function was exhibited in both groups after Surgical Procedure (P < .001), but lung function variables in the continuous SAPB group were significantly higher (P < .001) throughout the postoperative period up to 72 hours, regardless of the surgical procedure type. Meanwhile, there were significant differences of pain intensity at rest and on coughing between the groups (P < .001). The incidence of pneumonia, pulmonary atelectasis, hypoxemia, vomiting, and the comfort score in the continuous SAPB group was significantly lower (P < .05). ConclusionsPostoperative acute pain treatment with continuous SAPB in combination with flurbiprofen enhanced pulmonary function and reduced postoperative pulmonary complications in lung cancer patients undergoing VATS.

Negative impact of chemical pleurodesis on postoperative pulmonary function for managing prolonged air leakage after segmentectomy.

Prolonged air leakage (PAL) is the most common postoperative complication after segmentectomy and chemical pleurodesis (CP) is one of the common procedures for managing PAL. However, the impact of CP on postoperative pulmonary function remains unclear. We performed a propensity score matching analysis for postoperative pulmonary function in lung cancer patients who underwent segmentectomy. The percentage of postoperative functional change of forced vital capacity (δFVC) and forced expiratory volume in 1s (δFEV1.0) at postoperative 6 and 12months were compared between patients who were managed for PAL by CP (CP group, n = 21) and those who did not receive CP (non-CP, n = 21). The predicted δFVC and δFEV1.0 after segmentectomy and lobectomy were also assessed to evaluate the loss of preserved lung function. δFVC and δFEV1.0 in the CP group were confirmed by a significantly larger decline in postoperative pulmonary function than that seen in the non-CP group at postoperative 6 and 12months (δFVC at 6months, - 21.1% versus - 5.1%, - 20.8% versus - 6.8% at 12months, δFEV1.0 at 6months, - 19.1% versus - 7.2%, - 19.6% versus - 9.7%, at 12months, p < 0.05 respectively). Both δFVC and δFEV1.0 in the CP group were significantly lower than those predicted after segmentectomy (p < 0.01). They were not statistically different from the values predicted if lobectomy was performed. CP after segmentectomy caused the same amount of loss in pulmonary function that was predicted if lobectomy was performed. The benefit of segmentectomy compared to lobectomy for preservation of pulmonary function is impaired by CP.

Exercise and lung cancer surgery: A systematic review of randomized-controlled trials.

Lung cancer patients undergoing surgery are often left physically deconditioned and/or with functional deficits. Exercise interventions may improve pulmonary and physical function before and after lung resection. We conducted a systematic review of randomized-controlled trials (RCTs) testing the impact of pre-, post-, and combined pre-and-post surgery exercise interventions on physical and pulmonary function in lung cancer patients. Exercise pre-surgery seems to substantially improve physical and pulmonary function, which are factors associated with improved ability to undergo surgery while reducing post-surgery complications. Evidence is inconsistent for post-surgery interventions, reporting no or moderate effects. Results from pre-and-post surgery interventions are limited to one study. In conclusion, pre- and post-surgery exercise interventions, individually, have shown beneficial effects for lung cancer patients undergoing surgery. The impact of interventions combining both pre- and post-surgery exercise programs remains unknown. More evidence is needed on the ideal exercise setting, and timing across the lung cancer care continuum.

Platelet function in lung cancer patients undergoing lobectomy

A growing interest concerns arterial thromboembolic disease in cancer patients. As platelets may be key players in this process, investigation of platelet aggregation in cancer patients is of importance. We aimed to investigate platelet aggregation in patients with lung cancer prior to surgery and during video-assisted thoracoscopic surgery (VATS) lobectomy compared with lobectomy performed through a thoracotomy. We included 93 patients (VATS + low molecular weight heparin (LMWH), n = 32; VATS no LMWH, n = 31; thoracotomy + LMWH, n = 30). Data obtained from 121 healthy individuals were used for comparison prior to surgery. Platelet aggregation was analysed by impedance aggregometry using adenosine diphosphate 6.5 μM (ADPtest) and collagen 3.2 μg/mL (COLtest) as agonists. Prior to surgery, platelet aggregation was significantly increased in both VATS-patients (ADPtest, p < .0001; COLtest, p = .0002) and patients undergoing thoracotomy (ADPtest, p < .0001; COLtest, p < .0001) compared with healthy individuals. Platelet aggregation did not differ between VATS-patients and thoracotomy patients prior to surgery (p-values >.11). At the first postoperative day, VATS-patients demonstrated significantly higher collagen-induced platelet aggregation than preoperatively (p = .001), but the increase in platelet aggregation did not differ significantly between VATS and thoracotomy patients (p-values ≥.24). At the second postoperative day, platelet aggregation was significantly reduced in thoracotomy patients compared with the preoperative level (ADPtest, p = .002; COLtest, p = .05). In conclusion, platelet aggregation was significantly increased in patients with primary lung cancer prior to surgery compared with healthy individuals. At the first postoperative day, platelet aggregation was significantly higher than the preoperative level in VATS-patients; however, this increase did not differ between patient groups.

Chemotherapy-induced functional changes of the default mode network in patients with lung cancer.

Previous studies have demonstrated that cognitive impairment is associated with neurophysiological changes in lung cancer following chemotherapy. This study aimed to investigate the intrinsic functional connectivity (FC) pattern within the default mode network (DMN) and its associations with cognitive impairment in patients with lung cancer revealed by resting-state functional magnetic resonance imaging (fMRI). Resting-state fMRI scans were acquired from 21 post-chemotherapy and 27 non-chemotherapy lung cancer patients and 30 healthy controls. All groups were age, gender and education-matched. The posterior cingulate cortex (PCC) was chosen as the seed region to detect the FC patterns and then determine whether these changes were related with specific cognitive performance. Compared with non-chemotherapy lung cancer patients, chemotherapy patients revealed decreased FC between the PCC and the right anterior cingulate cortex (ACC), left inferior parietal lobule (IPL), and left medial prefrontal cortex (mPFC), as well as increased FC with the left postcentral gyrus (PoCG). Relative to healthy controls, post-chemotherapy patients exhibited reduced FC between the PCC and the left ACC and left temporal lobe, as well as increased FC with the right PoCG. Moreover, the decreased FC of the PCC to bilateral ACC in post-chemotherapy patients was positively associated with reduced MoCA scores (left: r = 0.529, p =0.029; right: r = 0.577, p =0.015). The current study mainly demonstrated reduced resting-state FC pattern within the DMN regions that was linked with impaired cognitive function in lung cancer patients after chemotherapy. These findings illustrated the potential role of the DMN in lung cancer patients that will provide novel insight into the underlying neuropathological mechanisms in chemotherapy-induced cognitive impairment.

Effects of interventions with mindfulness-breathing-stretching components on physiological and mental function of lung cancer patients: a mata-analysis

Effects of interventions with mindfulness-breathing-stretching components on physiological and mental function of lung cancer patients: a mata-analysis

Effect of A High Intensive Preoperative Rehabilitation on the Perioperative Complications in Patients with Chronic Obstructive Pulmonary Disease Eligible for Lung Cancer Surgery

背景与目的慢性阻塞性肺病(chronic obstructive pulmonary diseases, COPD)降低患者心肺功能，可导致患者围手术期风险增加。本研究拟探讨术前短期高强度肺康复训练对肺癌合并COPD患者肺功能及术后并发症的影响。方法分析2016年6月-2016年12月101例肺癌合并COPD患者的临床资料，其中肺康复训练组43例，常规治疗组58例，比较两组患者肺功能、术后肺部并发症、住院时间等指标，同时比较肺康复训练组训练前后肺功能相关指标。结果两组患者术前一般资料及肺功能无显著差异，康复训练组住院时间更长[(17.23±4.18) d vs (14.41±4.03) d]，但术后住院时间与常规治疗组无显著差异[(8.93±3.78) d vs (9.62±3.98) d]，两组患者术后肺部感染[8例(18.6%) vs 17例(29.3%)]、肺不张[1例(2.3%) vs 1例(1.7%)]、呼吸衰竭[1例(2.3%) vs 2例(3.4%)]等无显著差异。肺康复训练组训练前后FEV1[(2.06±0.45) L vs (2.15±0.45) L, P < 0.001]、PEF[(4.32±0.90) L/s vs (5.15±1.05) L/s, P < 0.001]、PCO2[(42.42±2.79) mmHg vs (41.58±2.98) mmHg, P=0.009]改善明显，按亚组分析，康复训练后中-重度COPD亚组FEV1[(0.16±0.05) L (8.6%) vs (0.06±0.05) L (2.8%)]增加值较轻度COPD亚组更明显。结论术前短期肺康复训练可改善肺癌合并COPD患者肺功能，其中中-重度COPD患者肺功能改善更明显。

Prediction of postoperative lung function in lung cancer patients using perfusion scintigraphy.

Predicting postoperative lung function is critical in lung cancer patients. Perfusion scintigraphy has been used to estimate postoperative function after lung resection. To evaluate the usefulness of the posterior oblique method in relation to other conventional processing methods for predicting postoperative lung function using lung perfusion scintigraphy. Fifty-five patients with non-small-cell lung cancer who underwent lobectomy were enrolled. Forced expiratory volume in 1 s (FEV1) values were obtained from preoperative and postoperative pulmonary function tests. After performing lung perfusion scintigraphy, predicted FEV1 values were calculated using the segment, conventional, posterior, and posterior oblique methods. Postoperative FEV1 values were compared with predicted FEV1 values. The mean value of the preoperative FEV1 was 2.29 L and that of the postoperative FEV1 was 1.89 L. The mean values of the predicted postoperative FEV1 values for the segment, conventional, posterior, and posterior oblique were 1.83 L, 1.94 L, 1.88 L, and 1.89 L, respectively. Between the observed and predicted FEV1 values, there was a strong correlation without significant difference except for conventional method. Bland-Altman analysis showed that segment and posterior methods underestimated the FEV1, whereas conventional and posterior oblique methods overestimated the FEV1. Predictions with each processing method of lung perfusion scintigraphy showed nearly similar results to the actual postoperative lung function. The posterior oblique method of lung perfusion scintigraphy showed a very small difference to such an extent as to be equal to the observed FEV1, implying that this method may be applied for predicting postoperative lung function in lung cancer patients.

Pro-inflammatory, chemotactic, and anti-inflammatory cytokine responses associate with HPA, but not SNS, function in lung cancer patients

Disrupted cortisol rhythms are associated with earlier mortality across a number of cancer types; however, immune mechanisms by which circadian disruption may accelerate tumor progression have not been adequately defined in humans. Using blood samples from 62 lung cancer patients, PBMC were incubated with stimulators of acquired and innate immunity (PHA, LPS), and cytokines were measured. Serum DHEA, diurnal salivary cortisol, and overnight urinary catecholamines were collected. Hypothesized associations between stimulated analytes (pro-inflammatory: IL-1β, IL-6, TNF-α, IL-17; chemotactic: eotaxin; anti-inflammatory: IL-10; Type 1/TH1: IFN-γ; Type 2/TH2: IL-13, IL-5) and endocrine disruption (HPA axis: DHEA, cortisol; SNS: epinephrine, norepinephrine) were examined using linear regressions. Increased release of eotaxin in unstimulated control (p = 0.030) and LPS (p = 0.025) was associated with dysregulated diurnal cortisol, while increased release of IL-10 stimulated in LPS (p = 0.018) was associated with higher mean cortisol secretion. When adjusting for unstimulated controls, an increased release of IL-6 stimulated in PHA (p = 0.021) and IL-10 stimulated in LPS (p = 0.019), was associated with higher mean cortisol secretion. Response to an immune challenge was associated with HPA axis disruption, but not markers of SNS function. These findings suggest immune mechanisms may partly explain the prognostic significance of HPA axis dysregulation in patients with lung cancer.

Correlational Study of the Level of Cognitive Function in Lung Cancer Patients With Brain Metastases to the Characteristics of the Intracranial Lesions and Whole Brain Radiation Therapy

Correlational Study of the Level of Cognitive Function in Lung Cancer Patients With Brain Metastases to the Characteristics of the Intracranial Lesions and Whole Brain Radiation Therapy