In this systematic review with meta-analysis, we sought to determine the current strength of evidence for or against digital and traditional chest drainage systems following pulmonary surgery with regards to hard clinical end points and cost-effectiveness. PubMed, EMBASE and Web of Science were searched from their inception to 31 July 2017. The weighted mean difference (WMD) and the risk ratio were used for continuous and dichotomous outcomes, respectively, each with 95% confidence intervals (CIs). The heterogeneity and risk of bias were also assessed. A total of 10 randomized controlled trials enrolling 1268 patients were included in this study. Overall, digital chest drainage reduced the duration of chest tube placement (WMD -0.72 days; 95% CI -1.03 to -0.40; P < 0.001), length of hospital stay (WMD -0.97 days; 95% CI -1.46 to -0.48; P < 0.001), air leak duration (WMD -0.95 days; 95% CI -1.51 to 0.39; P < 0.001), and postoperative cost (WMD -443.16 euros; 95% CI -747.60 to -138.73; P = 0.004). However, the effect differences between the 2 groups were not significant for the duration of a prolonged air leak and the percentage of patients discharged home on a device. The stability of these studies was strong. No publication bias was detected. It may be necessary to use a digital chest drainage system for patients who underwent pulmonary surgery to reduce the duration of chest tube placement, length of hospital stay and air leak duration.

Purpose Detecting gene mutations by two competing biomarkers, circulating tumor cells (CTCs) and ctDNA has gradually paved a new diagnostic avenue for personalized medicine. We performed a comprehensive analysis to compare the diagnostic value of CTCs and ctDNA for gene mutations in lung cancer. Methods Publications were electronically searched in PubMed, Embase, and Web of Science as of July 2018. Pooled sensitivity, specificity, and AUC, each with a 95% CI, were yielded. Subgroup analyses and sensitivity analyses were conducted. Quality assessment of included studies was also performed. Results From 4,283 candidate articles, we identified 47 articles with a total of 7,244 patients for qualitative review and meta-analysis. When detecting EGFR , the CTC and ctDNA groups had pooled sensitivity of 75.4% (95% CI 0.683–0.817) and 67.1% (95% CI 0.647–0.695), respectively. When testing KRAS , pooled sensitivity was 38.7% (95% CI 0.266–0.519) in the CTC group and 65.1% (95% CI 0.558–0.736) in the ctDNA group. The diagnostic performance of ctDNA in testing ALK and BRAF was also evaluated. Heterogeneity among the 47 articles was acceptable. Conclusion ctDNA might be a more promising biomarker with equivalent performance to CTCs when detecting EGFR and its detailed subtypes, and superior diagnostic capacity when testing KRAS and ALK . In addition, the diagnostic performance of ctDNA and CTCs depends on the detection methods greatly, and this warrants further studies to explore more sensitive methods.

Background. Lung transplantations (LTx) have become an effective lifesaving treatment for patients with end-stage lung diseases. While the shortage of lung donor pool and severe posttransplantation complications exaggerate the obstacle of LTx. This meta-analysis aimed to evaluate the efficacy of donation after circulatory death (DCD) in LTx for patients with endstage lung diseases. Methods. PubMed, EmBase, and Web of Science were systematically searched for all relevant studies comparing the efficacy of DCD and conventional donation after brain death (DBD). The relative risk (RR) value as well as the weighted mean difference with a 95% confidence interval (CI) were pooled for dichotomous and continuous outcomes, respectively. The heterogeneity across the included studies was also assessed carefully. Results. Overall, 17 studies with 995 DCD recipients and 38 579 DBD recipients were included. The pooled analysis showed comparable 1-year overall survival between the 2 cohorts (RR 0.89, 95% CI, 0.74-1.07, P = 0.536, I 2 = 0%). The airway anastomotic complications rate in DCD cohort was higher than that in DBD cohorts (RR 2.00; 95% CI, 1.29-3.11, P = 0.002, I 2 = 0%). There was no significant difference between DCD and DBD regarding the occurrence of primary graft dysfunction grade 2/3, bronchiolitis obliterans syndrome, acute transplantation rejection, and length of stay. The stability of the included studies was strong. Conclusions. Evidence of this meta-analysis indicated that the use of lungs from DCD donors could effectively and safely expand the donor pool and therefore alleviate the crisis of organ shortage.

PurposeWhole-body vibrating training (WBVT) is a modality aiming to improve neuromuscular performance of patients with COPD. However, a consensus on the effects of WBVT has not been reached. We aimed to clarify the effects of WBVT on functional exercise capacity, pulmonary function, and quality of life in COPD patients.Patients and methodsPubMed, Web of Science, and EMBASE were searched through April 5, 2018. We calculated the pooled weight mean difference (WMD) using a random-effects model. Quality assessment and publication bias analyses were also performed.ResultsWe included eight randomized control trials involving 365 patients. Compared with control group, WBVT increased 6-minute walking distance (6-MWD) (WMD: 62.14 m; 95% CI: 48.12–76.16; P<0.001), the change of 6-MWD (Δ6-MWD) (WMD: 42.33 m; 95% CI: 15.21–69.45; P=0.002), the change of the time to finish five repeated sit-to-stand tests (WMD: −2.07 seconds; 95% CI: −4.00 to −0.05; P=0.04), and decreased the change of St George’s Respiratory Questionnaire score (WMD: −6.65 points; 95% CI: −10.52 to −2.78; P<0.001). However, no significant difference was found between the two groups regarding forced expired volume in 1 second (FEV1) (% predicated), change of FEV1 (% predicated), sit-to-stand test, 6-MWD (% predicated), change of 6-MWD (% predicated), St George’s Respiratory Questionnaire score, COPD Assessment Test score, and change of COPD Assessment Test score.ConclusionWBVT has beneficial effects on functional exercise capacity for COPD patients.

The addition of suction to simple water-seal made no difference to air leak duration, hospital stay or the occurrence of prolonged air leak following pulmonary surgery. In patients where there is concern about a residual or increasing pneumothorax, the addition of suction may be applied selectively.