Effect of lung volume reduction surgery on early function of lung and pulmonary hemodynamics in COPD

Objective To evaluate the effects of lung volume reduction surgery (LVRS) on early lung function and pulmonary hemodynamics in severe chronic obstructive pulmonary disease (COPD). Methods 31 patients with severe COPD underwent LVRS, bilateral LVRS in 11 patients and unilateral in 20 patients. The results of lung function (FEV1, RV, TLC), arterial blood gas analysis (PAO2, PACO2 ) and color Doppler echocardiography (CD,CI,FS,EF,PAP) were analyzed before and 3 month after LVRS in 26 cases. Results FEV1, RV and TLC were improved significantly after surgery ( P 【 0. 01). PaO2 increased (P 【 0. 05 ) and PaCO2, decreased postoperatively (P 【 0. 01). According to the Doppler echocardiography, there were no statistic differences in cardiac functions (CO, CI, FS, EF, and PAP) between pre- and post-operation. The 6-minute-walk-distance in 26 patients was (227 ± 88) m, significantly increased after surgery. Conclusion LVRS is effective in the treatment of patients with severe COPD. 3 months after operation, the

Mid-term effects of lung volume reduction surgery on pulmonary function in patients with chronic obstructive pulmonary disease

Background Now lung volume reduction surgery （LVRS） has become one of the most effective methods for the management of some cases of severe chronic obstructive pulmonary disease （COPD）. We evaluated the mid-term effects of LVRS on pulmonary function in patients with severe COPD. Methods Ten male patients with severe COPD aged 38-70 years underwent LVRS and their pulmonary function was assessed before, 3 months and 3 years after surgery. The spirometric and gas exchange parameters included residual volume, total lung capacity, inspiratory capacity, forced vital capacity, forced expiratory volume in one second, diffusion capacity for CO, and arterial blood gas. A 6-minute walk distance （6MWD） test was performed.Results As to preoperative assessment, most spirometric parameters and 6MWD were significantly improved after 3 months and slightly 3 years after LVRS. Gas exchange parameters were significantly improved 3 months after surgery, but returned to the preoperative levels after 3 years. Conclusions LVRS may significantly improve pulmonary function in patients with severe COPD indicating for LVRS. Mid-term pulmonary function 3 years after surgery can be decreased to the level at 3 months after surgery. Three years after LVRS, lung volume and pulmonary ventilation function can be significantly improved, but the improvement in gas exchange function was not significant.

In situ forming chitosan-based hydrogel as a lung sealant for biological lung volume reduction

Biological lung volume reduction （BLVR） using lung sealant has received more attention recently as a new non-surgical approach to emphysema treatment. Many tissue sealants have been studied but only a few have been proposed for BLVR. In this work, we prepared in situ forming chitosan-based hydrogels （CSG） using covalent cross-linking of chitosan and genipin in the cooperation of ionic interaction between chitosan and sodium orthophosphate hydrate （Na3PO4.12H20） and characterized by Fourier transform infrared spectroscopy, scanning electron microscopy and rheological methods. CSG showed short gelation time （8 min）, high swelling ratio （〉100 %） and non-toxicity （3T3 mouse fibroblast cell viability 〉80 %） under physiological conditions. The application of lung sealant for BLVR was tested in a Chinese dog and evaluated by chest computed tomography. After 3 weeks of the installation of CSG in bronchopulmonary segment, the gel formation was detected at a localized region of bronchi and the local atelectasis occurred. Our findings indicate that this chitosan-based hydrogel is a promising new candidate for use as a lung sealant for BLVR.

Clinical study of simultaneous lung volume reduction surgery during resection of pulmonary or esophageal neoplasms

Background If the emphysema lesions are not symmetrical, unilateral lung volume reduction surgery （LVRS） can be carried out on the more severe side. The aim of this research was to evaluate the feasibility and effects of LVRS performed simultaneously with resection of pulmonary and esophageal neoplasms. Methods Forty-five patients with pulmonary neoplasm and 37 patients with esophageal neoplasm were randomly assigned to group A or group B. In group A, LVRS was performed simultaneously on the same side as thoracotomy. In group B, only tumor resection was performed. The nonfunctional lung area was determined by preoperative chest computed tomography and lung ventilation/perfusion scan. The lung volume removed was about 20% to 30% of the lobes on one side. Preoperative and postoperative indexes including pulmonary function testing variables, arterial blood gas analysis variables, dyspnea scale, 6-minute walk distance, etc., were compared between the groups. Results There were no surgical deaths in this study. The postoperative forced vital capacity in 1 second, PaO2, PaCO2, dyspnea scale, and 6-minute walk distance were improved significantly in group A, whereas these indexes did not change or decreased slightly in group B. Conclusions For tumor patients who have associated emphysema, simultaneous LVRS not only increases the chance of receiving surgical therapy, but also improves the postoperative quality of life of the patient. LVRS has expanded the surgical indication for tumor patients.

Short- and long-term outcomes of lung volume reduction surgery

In 1957, Brantigan applied lung volume reduction surgery （LVRS） to the treatment of emphysema. In 1995, Cooper reused this operation and obtained remarkable benefit in patients with chronic obstructive pulmonary disease （COPD）. Although there are still some doubts about the effect of LVRS, in the past 10 years, a lot of clinical information approved that LVRS can give benefit to more than 70% of COPD patients. At present, a series of researches in long-term investigation and function evaluation such as NETT have got elementary affirmative conclusion about some disputative problems.

Spontaneous pneumothorax in a single lung transplant recipient-a blessing in disguise: A case report

BACKGROUND End-stage chronic obstructive pulmonary disease(COPD)is one of the common lung diseases referred for lung transplantation.According to the international society of heart and lung transplantation,30%of all lung transplantations are carried out for COPD alone.When compared to bilateral lung transplant,singlelung transplant(SLT)has similar short-term and medium-term results for COPD.For patients with severe upper lobe predominant emphysema,lung volume reduction surgery is an excellent alternative which results in improvement in functional status and long-term mortality.In 2018,endobronchial valves were approved by the Food and Drug Administration for severe upper lobe predominant emphysema as they demonstrated improvement in lung function,exercise capacity,and quality of life.However,the role of endobronchial valves in native lung emphysema in SLT patients has not been studied.CASE SUMMARY We describe an unusual case of severe emphysema who underwent a successful SLT 15 years ago and had gradual worsening of lung function suggestive of chronic lung allograft dysfunction.However,her lung function improved significantly after a spontaneous pneumothorax of the native lung resulting in auto-deflation of large bullae.CONCLUSION This case highlights the clinical significance of native lung hyperinflation in single lung transplant recipient and how spontaneous decompression due to pneumothorax led to clinical improvement in our patient.

Interventional pulmonology for chronic inflammatory airway diseases

Chronic inflammatory airway diseases,such as chronic bronchitis,chronic obstructive pulmonary disease,emphysema,and bronchial asthma,pose significant healthcare challenges.Interventional treatments offer promise as valuable complements to the optimal medical therapy recommended by the Global Initiative for Chronic Obstructive Lung Disease guideline and the Global Initiative for Asthma guideline.By directly accessing the airways,these minimally invasive procedures enable precise interventions.They encompass a wide range of techniques including bronchial thermoplasty and targeted lung denervation for both chronic obstructive pulmonary disease and severe asthma,bronchoscopic lung volume reduction(including the use of endobronchial valves,coils,and bronchoscopic thermal vapor ablation),airway bypass and peripheral stent placement for emphysema,bronchial rheoplasty and spray cryotherapy for chronic bronchitis,and other emerging methods.These interventional treatments aim to improve patients’symptoms by reducing lung volume,alleviating hyperinflation,eliminating vagal innervation,disrupting hyperplastic goblet cells and thus reducing excessive mucus secretion,and weakening submucosal smooth muscles.This review highlights the potential advantages of interventional treatments for chronic inflammatory airway diseases and discusses relevant techniques tailored to specific disease subtypes.The overall aim is to assist interventional pulmonologists in selecting the most appropriate techniques for individual patients.