Journal of thoracic disease最新文献

Background: While sympathectomy remains the optimal surgical intervention for severe primary palmar hyperhidrosis (PPH), compensatory hyperhidrosis (CH) has emerged as the most significant factor contributing to postoperative patient regret. This retrospective study aimed to identify risk factors and develop a predictive model for moderate-to-severe compensatory hyperhidrosis (msCH) in patients with PPH.

Methods: A total of 1,013 patients were retrieved from the institutional database between 2014 and 2024. Logistic regression modeling was utilized to identify risk factors for msCH. A nomogram for predicting msCH was developed accordingly.

Results: Of the initial cohort, there were 903 patients included in the final analysis, among whom 182 (20.2%) developed msCH. The following factors were identified as independent risk factors for msCH: age >25 years [odds ratio (OR) 3.32, 95% confidence interval (CI): 2.23-4.95, P<0.01], smoking history (OR 6.46, 95% CI: 4.37-9.54, P<0.01), higher body mass index (BMI) (OR 1.68, 95% CI: 1.10-2.56, P=0.02), palmar-axillary hyperhidrosis (OR 2.37, 95% CI: 1.57-3.57, P<0.01), and T3 sympathectomy (OR 3.14, 95% CI: 2.03-4.85, P<0.01). A predictive nomogram for msCH was developed based on these factors. Receiver operating characteristic (ROC) curve analysis demonstrated an area under the curve (AUC) of 0.839, indicating good predictive performance.

Conclusions: Age >25 years, smoking history, higher BMI, palmar-axillary hyperhidrosis, and T3 sympathectomy were independent risk factors for msCH. Based on these factors, a predictive model for msCH was developed and showed high predictive accuracy.

Background and objective: Allergic bronchopulmonary aspergillosis (ABPA) is a hypersensitivity disorder classically associated with asthma or cystic fibrosis (CF). Recent guidelines have broadened the scope of ABPA to include patients with bronchiectasis, even without underlying asthma or CF. Beyond ABPA, other Aspergillus-associated phenotypes, namely Aspergillus sensitization (AS), chronic Aspergillus infection (CAI), and Aspergillus bronchitis, are increasingly recognized as clinically relevant entities in bronchiectasis. This review outlines the immunological, radiological, and clinical characteristics of ABPA in bronchiectasis, describes the prevalence and spectrum of Aspergillus-related airway disease, and presents a contemporary diagnostic and therapeutic framework based on the 2024 International Society for Human and Animal Mycology (ISHAM) ABPA Working Group (AWG) guidelines.

Methods: We searched PubMed since its inception to June 6, 2025. The keywords included "ABPA" OR "allergic bronchopulmonary aspergillosis" OR "bronchiectasis". Inclusion criteria focused on original studies in English involving bronchiectasis and ABPA, published in peer-reviewed journals.

Key content and findings: ABPA, AS, and CAI represent a continuum of fungal airway disease shaped by host immune responses. ABPA affects approximately 4% of bronchiectasis patients and may be both a cause and consequence of bronchiectasis. AS and CAI collectively may affect up to 30% of bronchiectasis patients and are independently associated with worse clinical outcomes, including higher bronchiectasis severity scores and increased exacerbation rates. A. fumigatus-immunoglobulin E (IgE) remains the cornerstone of ABPA screening, with international guidelines advocating routine testing in all bronchiectasis patients at diagnosis. ABPA is diagnosed when AS coexists with supportive immunological and radiological features. Management includes systemic glucocorticoids or triazole antifungals, with inhaled antifungals and biologics reserved for treatment-dependent cases.

Conclusions: ABPA and related Aspergillus-associated endotypes are underrecognized yet modifiable drivers of disease progression in bronchiectasis. Routine screening for Aspergillus-related airway diseases and phenotype-specific management strategies are essential to improving patient outcomes.

Background: Cartridge color selection generally depends on the surgeon's preference, based on the lung parenchyma thickness and location of tumor or presence of underlying lung diseases. We hypothesize that air leaks in pulmonary wedge resection occur due to injury to the visceral pleura around the staple line when the lung expands. Therefore, selecting black cartridge, the one with the largest staple height may be reasonable to avoid occurrence of air leaks. We aimed to clarify the impact of cartridge selection on the occurrence of air leak in pulmonary resection with a stapling device.

Methods: We retrospectively reviewed 145 patients who underwent thoracoscopic pulmonary wedge resection for pulmonary malignant tumors using Tri-Staple™. A black cartridge alone was used in 118 patients, and a purple cartridge (alone or in combination with black or camel cartridge) was used in 27 patients. The presence or absence of air leak from the stapling site was visually observed during an intraoperative water seal test. We also evaluated the leak threshold of the stapled line of the black and purple cartridges with ex vivo porcine lungs (six samples for each cartridge).

Results: Overall, 12 patients (10.1%) in the black cartridge group and eight (29.6%) in the purple cartridge group developed air leaks (P=0.01). Adjustment by the propensity score for patient background indicated that the purple cartridge might be a risk factor for intraoperative air leak (P=0.08). According to the experimental study, the leak threshold of the lungs when excised using black cartridge was significantly higher than that when excised using purple cartridge (80.0±16.7 vs. 49.7±22.8 cmH₂O, P=0.03).

Conclusions: Our clinical and experimental data suggest that selecting black cartridge is better than purple cartridge to avoid occurrence of air leak in pulmonary wedge resection for pulmonary malignant tumors.

Background: Pleural mesothelioma (PM) is an aggressive malignancy that originates on the mesothelial surface of the pleura, peritoneum, pericardium, and tunica vaginalis. Due to the absence of specific clinical symptoms, early-stage diagnosis occurs in fewer than 5% of cases. Comprehensive assessments of the research landscape on PM biomarkers remain scarce. Therefore, this study employs bibliometric methods to systematically analyze research trends and developments in PM biomarkers, delineate the historical and current research landscape, and identify emerging research frontiers.

Methods: We conducted a literature search for studies on PM biomarkers published between January 1, 2002, and December 31, 2024. Bibliometric analysis and data visualization were performed using VOSviewer and CiteSpace based on literature retrieved from the Web of Science Core Collection (WoSCC).

Results: A total of 662 publications on PM biomarkers, spanning from 2002 to 2024, were included in this study. Our findings reveal a substantial increase in global research on PM biomarkers over the past two decades, with annual publications peaking in 2021. The United States leads in publication volume, while the University of Western Australia ranks as the most prolific institution in this domain. Jenette Creaney, Glen Reid, and Harvey I. Pass are among the most influential authors in this field, while Journal of Thoracic Oncology, PLoS One, and Lung Cancer are the leading journals publishing research on this topic. Biomarkers associated with the diagnosis, treatment, and prognosis of PM remain central research foci in the field.

Conclusions: This study represents the first bibliometric visualization of the research landscape on PM biomarkers, delineating key trends and research boundaries while serving as a valuable reference for scholars.

Background: Bronchiectasis is characterized by chronic cough and bronchial dilation. It has evolved from an orphan disease to a common condition, with a long history of research. This study employed bibliometric and visualization analyses to comprehensively examine the research dynamics, hotspots, and development trends in bronchiectasis research.

Methods: Articles on bronchiectasis published between 2005 and 2024 were collected from the Web of Science Core Collection (WoSCC). The co-occurrence and clustering of keywords, co-citations of literature, and cooperation relationships among countries and institutions were analyzed and visualized via R-Bibliometric and VOSviewer.

Results: A total of 127 countries/regions participated in the research on bronchiectasis, with 6,331 articles included in the analysis, published in 1,350 journals. The results showed that the number of research achievements on bronchiectasis had been increasing over the past 20 years. The United States of America was the country with the highest number of publications and citations. The top high-frequency keywords are sorted by frequency of occurrence: "bronchiectasis", "cystic fibrosis", "COPD", "CT", "asthma", "children", "primary ciliary dyskinesia", "exacerbation", "Pseudomonas aeruginosa", and "interstitial lung disease". The co-citation analysis suggested that the co-cited literature primarily focused on the establishment and evolution of the Bronchiectasis Severity Index, as well as the publication of guidelines for bronchiectasis.

Conclusions: Research in the field of bronchiectasis is growing rapidly. The causes of decreased respiratory function might be the focus of subsequent research and the direction of development. This study encapsulates the developmental trajectories in the realm of bronchiectasis research, offering references for ongoing and forthcoming studies relevant to bronchiectasis.

Background: The use of energy devices for the division of cutting planes in sublobectomy remains controversial, especially in terms of postoperative complications. The aim of this study is to evaluate the safety and feasibility of this technique in patients undergoing sublobectomy.

Methods: A cohort of 69 patients who had received sublobectomy was retrospectively enrolled. The cutting planes were dissected by energy devices without a stapler in all the surgeries. An analysis was conducted of the clinical, pathological, and surgical parameters, along with the postoperative course of recovery. Expansion of the residual lung was evaluated 3 and 6 months after surgery.

Results: The average age of the patients was 51.4 years and over three quarters of them were female, non-smokers. All the surgeries were done by uni-portal video-assisted thoracoscopic surgery with the mean operation time being 124.9 minutes and an average blood loss of 25.9 mL. The overall complication rate was 13% (9/69), with prolonged air leak being most common (7.2%, 5/69). The mean time of chest tube drainage and hospital stay after surgery was 3.5 and 3.8 days, respectively. Full remnant lung expansion was obtained in 65.1% (41/63) of the patients at three-month follow-up after surgery. At 6-month follow-up, the rate of full lung expansion of the patients rose to 90.5% (57/63).

Conclusions: It is safe and feasible to divide the cutting plane by energy devices during sublobectomy for selected patients.

Background: Hemoptysis is associated with a variety of respiratory system diseases. Bronchial artery embolization (BAE) is effective for this condition, and preoperative computed tomography angiography (CTA) is helpful for the implementation of BAE. Some non-life-threatening cases have intermittent and recurrent episodes after conservative treatment, and no obvious abnormalities were found during tests and examinations, and they were defined as upper lobe-origin hemoptysis (ULOH), with concerns of embolism. This study aimed to describe the clinical characteristics of a distinct subtype of hemoptysis patients, termed ULOH, as well as the efficacy and outcomes of these patients after BAE.

Methods: From April 2019 to March 2024, a total of 31 consecutive ULOH patients who suffered varying episodes of relapse after conservative treatment and then received BAE were included. After the procedure, each case ​underwent respiratory rehabilitation, followed by dual-energy computed tomography (DECT)​to quantitatively assess pulmonary function. Patients' demographics, clinical characteristics, imaging findings, details of BAE, and outcomes were reviewed and summarized.

Results: The median age was 49.0 years old. Twenty-eight patients (90.3%) were male, and 22 (71.0%) cases were heavy smokers. CTA indicated that hemorrhage of alveoli was confined to the upper lobes, and the diameter of all bronchial arteries was no more than 2.0 mm. During bronchial artery angiography, each case showed symmetrical characteristic of systemic-pulmonary shunt (SPS) at bilateral apexes. One month after embolization, chest computed tomography (CT) scan demonstrated complete resolution of the lesion. All patients received 6 months of respiratory rehabilitation after procedures, and the followed integrated analysis of DECT showed structure and function were normal. During a median follow-up period of 24 months, no patient experienced hemoptysis recurrence.

Conclusions: Patients with ULOH presented as normal diameter of bronchial arteries and symmetrical characteristic of SPS at bilateral apexes during angiography. After BAE procedure, these patients could harvest complete recovery in both structure and function.

Background: Although lobectomy is considered the standard surgical treatment for stage I non-small cell lung cancer (NSCLC). Recently, anatomical segmentectomy may represent an acceptable oncologic option for these patients. The study aims to compare perioperative and long-term outcomes between anatomical segmentectomy and lobectomy for stage I NSCLC using propensity score matching (PSM) in a single thoracic surgery centre.

Methods: We retrospectively analyzed 60 patients with stage I NSCLC who underwent pulmonary resection between 2017-2024. After 1:1 PSM, 50 patients (25 per group) were included. All patients underwent radical lymphadenectomy with ≥3 mediastinal stations dissected. Primary endpoints were overall survival (OS) and disease-free survival (DFS). Secondary endpoints included recurrence patterns, perioperative outcomes, and oncological adequacy.

Results: After matching, baseline characteristics were well-balanced except for diffusing capacity for carbon monoxide (DLCO) (74.0% vs. 81.5%, P=0.01). All patients achieved R0 resection with comparable lymph node yields (17.3 vs. 16.8 nodes, P=0.32). Segmentectomy was associated with worse DFS [hazard ratio (HR) 2.06, 95% confidence interval (CI): 1.12-3.80, P=0.02] but similar OS (HR 0.70, 95% CI: 0.12-4.07, P=0.69). Overall mortality was 16% (4 deaths per group). Recurrence occurred in 10% of patients (12% segmentectomy vs. 8% lobectomy, P=0.64); however, given the low number of events (n=5), these comparisons should be interpreted with caution. Median follow-up was 24 months.

Conclusions: Despite higher recurrence risk, anatomical segmentectomy with radical lymphadenectomy achieved equivalent OS to lobectomy for selected stage I NSCLC ≤2 cm. The relatively small sample size (n=50) limits statistical power, and these findings should be considered exploratory and hypothesis-generating. This parenchyma-sparing approach represents a valuable option in experienced centers, preserving pulmonary function while maintaining oncological adequacy. Careful patient selection and meticulous surgical technique remain paramount for optimal outcomes.

Background: Racial and socioeconomic disparities in lung cancer are well documented. Given the benefits of surgery and targeted therapies for early-stage disease, there is a need to increase screening participation of high-risk groups to improve survival. Yet, best practices for ascertaining which groups would benefit are lacking. The aims of this study were to demonstrate an association between zip code and stage at diagnosis of lung cancer as well as an association between zip code and age at diagnosis of lung cancer in Massachusetts patients.

Methods: To identify such populations in Massachusetts, patients diagnosed with lung carcinoma from 2004 to 2020 were identified utilizing the Massachusetts Cancer Registry (n=72,559). Zip code-level demographic information, median household income, and percentage of residents without a high school diploma were obtained from census data. Geospatial analysis using ArcGISPro identified spatial trends in lung cancer incidence and patient characteristics.

Results: Average age at diagnosis was 69.4 (±10.2) years old and the majority were White (95.9%) and female (53.8%). Many patients had distant (47.6%) spread at diagnosis, compared to regional (16.3%) or local disease (36.1%). Median household income and educational attainment were correlated with late-to-early-stage prevalence ratio for lung cancer (P<0.05). Higher proportions of Black residents in a zip code correlated with an increased rate of late-stage lung cancer cases in young patients (≤55 years; P<0.05) and further demonstrated geographic trends toward higher incidence of late-stage disease, lower educational attainment, and lower income.

Conclusions: These results demonstrate the utility of geospatial analysis to detect trends in the incidence of late-stage lung cancer relating to race, age, education, and socioeconomic factors. Importantly, these results can direct location preferences for early intervention efforts including patient/provider education and mobile lung cancer screening clinics, particularly in neighborhoods with lower income and education levels (248/250).