Chest tightness variant asthma(CTVA)is an atypical form of asthma with chest tightness as the sole or predominant symptom.The underlying receptors for chest tightness are bronchial C-fibers or rapidly adapting receptors.The nerve impulses are transmitted via the vagus nerve and processed in different regions of the cerebral cortex.Chest tightness is associated with sensory perception,and CTVA patients may have heightened ability to detect subtle changes in lung function,but such sensory perception is unrelated to respiratory muscle activity,lung hyperinflation,or mechanical loading of the respiratory system.Airway inflammation,pulmonary ventilation dysfunction(especially involving small airways),and airway hyperresponsiveness may underlie the sensation of chest tightness.CTVA patients are prone to comorbid anxiety and depression,which share similar central nervous system processing pathways with dyspnea,suggesting a possible neurological basis for the development of CTVA.This article examines the recognition and mechanisms of chest tightness,and explores the pathogenesis of CTVA,focusing on its association with airway inflammation,ventilation dysfunction,airway hyperresponsiveness,and psychosocial factors.

Objectives:To explore the risk factors of blood loss and blood transfusion requirements in limit-ed resection for spinal metastases of lung cancer.Methods:The data of 97 patients who underwent limited resection for spinal metastases of lung cancer in Guangdong Provincial People's Hospital from January 1,2017 to December 31,2022 were continuously collected,including 61 males and 36 females,aged 60.2±10.1 years old.The gender,body mass index(BMI),operative time,number of internal fixation screws,number of decompressed segments,epidermal growth factor receptor(EGFR)mutation,lung cancer pathology,preoperative chemotherapy status,bone metastasis at first diagnosed,location segment of metastasis,type of surgical proce-dure,epidural spinal cord compression(ESCC)classification,preoperative 48-hour international normalized ratio(INR),preoperative 48-hour red blood cell(RBC)count,preoperative 48-hour white blood cell(WBC)count,preoperative 48-hour preoperative platelet count,preoperative 48-hour blood calcium level,the Revised-Tokuhashi prognostic score were collected.Univariate and multivariate linear regression analyses were em-ployed to assess the impact of various factors on intraoperative blood loss,while univariate and multivariate logistic regression analyses were utilized to evaluate the influence of different factors on the transfusion re-quirement.Results:Intraoperative blood loss ranged from 20 to 4800 mL(mean 916±939mL),and 56 patients required intraoperative blood transfusion.Compared to patients without transfusion,those requiring blood trans-fusion had a higher number of pedicle screws implanted,a greater proportion of EGFR mutation,a lower pro-portion of bone metastasis at first diagnosed,a higher proportion of thoracic vertebra metastases,and lower preoperative 48-hour RBC count.Significant factors influencing intraoperative blood loss included operative duration(β=107.1,P=0.026),number of pedicle screws implanted(β=108.3,P=0.023),and EGFR mutation(β=369.7,P=0.048).Significant factors associated with transfusion requirements included the number of pedicle screws implanted[odds ratio(OR)=1.7,95％confidence interval(CI)=1.2-2.3,P=0.001],EGFR mutation(OR=0.1,95％CI=0.0-0.5,P=0.003),bone metastasis at first diagnosed(OR=3.8,95％CI=1.2-11.9,P=0.023),and preop-erative 48-hour RBC count(OR=0.3,95％CI=0.1-0.7,P=0.009).Conclusions:Increased surgical invasiveness and the presence of EGFR mutation were associated with greater intraoperative blood loss and transfusion re-quirements in patients undergoing limited resection for spinal metastases of lung cancer.Additionally,patients with non-bone metastasis at first diagnosed exhibited higher transfusion requirements.

Objectives:To explore the risk factors of blood loss and blood transfusion requirements in limit-ed resection for spinal metastases of lung cancer.Methods:The data of 97 patients who underwent limited resection for spinal metastases of lung cancer in Guangdong Provincial People's Hospital from January 1,2017 to December 31,2022 were continuously collected,including 61 males and 36 females,aged 60.2±10.1 years old.The gender,body mass index(BMI),operative time,number of internal fixation screws,number of decompressed segments,epidermal growth factor receptor(EGFR)mutation,lung cancer pathology,preoperative chemotherapy status,bone metastasis at first diagnosed,location segment of metastasis,type of surgical proce-dure,epidural spinal cord compression(ESCC)classification,preoperative 48-hour international normalized ratio(INR),preoperative 48-hour red blood cell(RBC)count,preoperative 48-hour white blood cell(WBC)count,preoperative 48-hour preoperative platelet count,preoperative 48-hour blood calcium level,the Revised-Tokuhashi prognostic score were collected.Univariate and multivariate linear regression analyses were em-ployed to assess the impact of various factors on intraoperative blood loss,while univariate and multivariate logistic regression analyses were utilized to evaluate the influence of different factors on the transfusion re-quirement.Results:Intraoperative blood loss ranged from 20 to 4800 mL(mean 916±939mL),and 56 patients required intraoperative blood transfusion.Compared to patients without transfusion,those requiring blood trans-fusion had a higher number of pedicle screws implanted,a greater proportion of EGFR mutation,a lower pro-portion of bone metastasis at first diagnosed,a higher proportion of thoracic vertebra metastases,and lower preoperative 48-hour RBC count.Significant factors influencing intraoperative blood loss included operative duration(β=107.1,P=0.026),number of pedicle screws implanted(β=108.3,P=0.023),and EGFR mutation(β=369.7,P=0.048).Significant factors associated with transfusion requirements included the number of pedicle screws implanted[odds ratio(OR)=1.7,95％confidence interval(CI)=1.2-2.3,P=0.001],EGFR mutation(OR=0.1,95％CI=0.0-0.5,P=0.003),bone metastasis at first diagnosed(OR=3.8,95％CI=1.2-11.9,P=0.023),and preop-erative 48-hour RBC count(OR=0.3,95％CI=0.1-0.7,P=0.009).Conclusions:Increased surgical invasiveness and the presence of EGFR mutation were associated with greater intraoperative blood loss and transfusion re-quirements in patients undergoing limited resection for spinal metastases of lung cancer.Additionally,patients with non-bone metastasis at first diagnosed exhibited higher transfusion requirements.

Objective:To analyze the prognostic factors and evaluate the accuracy of existing survival prediction models in patients with lung cancer-derived spinal metastases who have undergone open surgery.Methods:According to the inclusion criteria, the data of 76 patients with spinal metastasis of lung cancer who underwent open surgery in the department of Orthopedics in Guangdong Provincial People's Hospital were collected from January 2019 to November 2021. The relationship between the number of bone metastasis, pathological type, visceral metastasis, epidermal growth factor receptor mutation, serum alkaline phosphatase (ALP), hemoglobin (Hb), Frankel grade and postoperative survival time in 76 cases was analyzed by Cox logical regression analysis and Kaplan-Meier method to determine the potential prognostic factors. The accuracy of Tomita score, Tokuhashi revised score, Katagiri New score, New England Spinal Metastasis Score score (NESMS) and Skeletal Oncology Research Group (SORG) machine learning algorithm in predicting postoperative survival time was verified by drawing receiver operating characteristic (ROC) curve.Results:The median follow-up time of the patients was 18.0 months (2.3-36.0 months). The median survival time was 12.6 months [95% CI (10.8, 14.4)]. The survival rates at 6 and 12 months after operation were 71.6% and 52.0%, respectively. Multivariate regression analysis showed that ALP [ HR=0.23, 95% CI (0.11, 0.48), P<0.001], Hb [ HR=4.48, 95% CI (2.07, 9.70), P< 0.001] and EGFR mutation [ HR=2.22, 95% CI (1.04, 4.76), P=0.040] were independent predictors of prognosis. The accuracy of Tomita score, Tokuhashi revised score (2005), Katagiri New score and NESMS score in predicting 1-year mortality was 58.7%, 65.7%, 70.5% and 65% respectively, and the accuracy in predicting 6-month mortality was 63.7%, 62.2%, 61.2% and 56.8% respectively. The accuracy of SORG machine learning algorithm in predicting 1-year and 90 d mortality was 81.1%, 67.5%, respectively. Conclusion:No EGFR mutation, ALP>164 U/L and Hb≤125 g/L were risk factors affecting the survival of patients with spinal metastasis of lung cancer. SORG machine learning algorithm has good accuracy in predicting the postoperative survival rate of patients with lung cancer spinal metastasis.