Journal of thoracic disease最新文献

Background and objective: With the rising detection of peripheral pulmonary lesions (PPLs) and ground-glass opacities (GGOs) owing to widespread lung cancer screening, obtaining high-quality tissue for next-generation sequencing (NGS) has become critical. Conventional forceps biopsy often yields insufficient samples with crush artefacts, whereas ultrathin bronchoscopy (UTB) provides access to the peripheral airways. This narrative review aimed to evaluate the current evidence on the diagnostic utility, safety, and specimen quality of transbronchial cryobiopsy (TBLC) using a 1.1-mm cryoprobe in conjunction with UTB.

Methods: We conducted a comprehensive literature search for articles published between January 1, 2019 and October 31, 2025 using PubMed. We prioritized prospective and retrospective studies as well as case series investigating the clinical utility and safety of the 1.1-mm cryoprobe for PPLs. Single case reports were excluded.

Key content and findings: The 1.1-mm cryoprobe exhibited superior flexibility, allowing access to the distal airways without compromising UTB performance. When integrated with advanced guidance technologies, such as radial endobronchial ultrasound (rEBUS), cone-beam computed tomography (CBCT), and robot-assisted bronchoscopy, cryobiopsy attained superior diagnostic yields compared with forceps biopsy. This advantage was particularly pronounced for GGO-predominant lesions and lesions identified as "adjacent to" on rEBUS, where forceps biopsy frequently fails. Crucially, cryobiopsy retrieved large, crush-free, en bloc tissue samples and preserved the histological architecture, significantly enhancing the success rates of programmed death-ligand 1 (PD-L1) evaluation and NGS. Regarding safety, while hemorrhage is a recognized complication, it is effectively managed using standardized protocols, such as the two-scope method or prophylactic balloon occlusion. Pneumothorax rates were comparable to those of conventional methods.

Conclusions: UTB-guided cryobiopsy represents a paradigm shift in diagnostic bronchoscopy, successfully balancing high diagnostic performance with acceptable safety. Overcoming the limitations of conventional sampling is essential in the era of precision medicine. Ongoing multicenter randomized controlled trials (RCTs) are expected to further cement the position of UTB-guided cryobiopsy as a standard-of-care modality.

Background: Obstructive sleep apnea (OSA) has seen a rising prevalence and is closely linked with various cardiovascular diseases. Fluctuations in blood sugar levels, known as glycemic variability (GV), are linked to negative cardiovascular outcomes. The objective of this research is to explore how fluctuations in blood sugar levels affect the occurrence of atrial fibrillation (AF) and the rate of mortality during hospitalization in individuals with OSA.

Methods: This study conducted a retrospective analysis of patients diagnosed with OSA based on the Medical Information Mart for Intensive Care-IV (MIMIC-IV) database (version 2.2) covering the 2008-2019 period. The relationship between GV and outcomes such as AF and in-hospital mortality was assessed through restricted cubic spline (RCS) models and logistic regression (LR), with AF and in-hospital mortality as the primary endpoints. The differences in the risk of AF and in-hospital mortality across various levels of GV were examined using Kaplan-Meier (K-M) survival analysis. Additionally, subgroup analyses were performed to further explore these correlations.

Results: The research involved 6,189 individuals, with a mean age of 64 years old, 36% of whom were women. Among the cohort, 176 patients (2.8%) died during hospitalization, and 673 patients developed AF in the hospital. The analysis using LR revealed a notable link between the GV index and both the risk of AF and in-hospital mortality among OSA patients. According to the RCS model, there was a clear dose-response relationship, revealing that higher values of the GV index corresponded to a heightened risk of AF and in-hospital mortality. Moreover, analysis using the K-M method showed that there were notable statistical variations in the risks of AF and mortality among OSA patients, stratified by quartiles of the GV index.

Conclusions: Patients with OSA who have an elevated GV index face a significantly higher risk of both AF and mortality during hospitalization, underscoring the importance of developing personalized glycemic management strategies to improve patient outcomes.

Background: Optimal dosing of alteplase for systemic thrombolysis in intermediate-risk pulmonary embolism (PE) remains controversial due to hemorrhagic risk. This retrospective cohort study analyzed data from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database to evaluate dose-dependent efficacy and safety of alteplase in PE patients.

Methods: Patients with PE treated with systemic alteplase thrombolysis were stratified into two groups based on a clinically established dose threshold of 50 mg. The primary outcomes included 7-day mortality and changes in hemodynamic and respiratory parameters before and after alteplase administration. Secondary outcomes included the relationship between dose stratification and mortality at the intensive care unit (ICU), hospital, 28-, 60-, and 365-day, using Kaplan-Meier survival curves and Cox proportional hazards regression. Propensity score matching (PSM) was employed to minimize bias.

Results: After PSM, 122 patients were included, with 76 in the low-dose group and 46 in the high-dose group. Both groups showed improvements in heart rate (HR). In the high-dose group, partial thromboplastin time (PTT) and blood urea nitrogen (BUN) were significantly higher than in the low-dose group. The low-dose group had lower 7-day and ICU mortality rates than the high-dose group. Cox regression analysis showed that dose stratification was an independent risk factor for 7-day mortality [hazard ratio (HR): 0.289, 95% confidence interval (CI): 0.072-1.023, P=0.045].

Conclusions: This study suggests that low-dose alteplase (≤50 mg) is associated with a better balance between thrombolytic efficacy and safety.

Background: Esophageal cancer is a highly aggressive malignancy with a poor prognosis, particularly in regions such as Asia and Africa. Although surgery remains the standard treatment for early- to intermediate-stage esophageal cancer, a substantial proportion of patients who are recommended for surgery in real-world practice ultimately do not undergo cancer-directed resection. This study aimed to compare long-term survival outcomes between patients who were recommended for surgery but did not undergo it and those who did undergo surgery using the Surveillance, Epidemiology, and End Results (SEER) database.

Methods: This retrospective cohort study utilized data from the SEER database covering the period 2004 to 2021. A total of 7,106 patients with esophageal cancer were enrolled: 5,138 in the surgical group and 1,968 in the nonsurgical group. Propensity score matching (PSM) was performed to adjust for confounding variables. Kaplan-Meier curves and Cox regression analyses were used to compare overall survival (OS) and cancer-specific survival (CSS) between the two groups.

Results: After PSM, patients who underwent surgery had significantly better median OS and CSS compared with the non-surgery group, across multiple factors including age, year of diagnosis, sex, race, income, and tumor location. Notably, surgery was associated with improved survival outcomes in both male and female patients, as well as those with lower esophageal tumors and those diagnosed later in life. The surgical group consistently demonstrated a higher probability of survival, with a significant benefit in both OS and CSS (P<0.001).

Conclusions: Surgery was associated with superior survival in the overall matched cohort and across most subgroups, although this benefit was not observed in selected stages such as T2 and N2 disease. These findings support the importance of surgical intervention in improving long-term survival outcomes for patients with esophageal cancer and highlight the need for better patient selection and management to reduce the number of patients who do not undergo recommended surgery.

Background: Accurate intraoperative localization of small pulmonary nodules remains challenging. Multimodal optical spectroscopy may provide complementary tissue-level information beyond hemoglobin-dependent contrast. This study evaluated multimodal optical differences between lung cancer and paired normal lung tissues.

Methods: Twelve patients undergoing surgical resection of primary lung cancer were prospectively enrolled. Paired ex vivo specimens were collected from tumor and normal lung parenchyma. Optical attenuation was quantified at a fixed wavelength of 638 nm and expressed as optical density (OD). Autofluorescence emission and Raman spectra were acquired under identical excitation conditions using a fiber-optic probe-based system. Optical features were compared between tumor and normal tissues and explored by histological subtype.

Results: Twenty-four tumor tissues and 24 paired normal lung tissues were analyzed. Tumor tissues exhibited significantly higher optical attenuation at 638 nm than corresponding normal lung tissues in both adenocarcinoma and squamous cell carcinoma, with no significant difference in OD between subtypes. Autofluorescence intensity was consistently lower in tumor tissues than in normal lung tissues, and adenocarcinoma demonstrated higher fluorescence intensity than squamous cell carcinoma. Raman spectroscopy revealed distinct spectral differences between tumor and normal tissues and demonstrated subtype-associated variations, including relatively stronger phenylalanine- and tyrosine-related bands in adenocarcinoma.

Conclusions: Ex vivo multimodal optical analysis revealed reproducible tumor-associated differences in optical attenuation, autofluorescence, and Raman spectral features between lung cancer and normal lung tissues. These findings represent tissue-level optical signatures rather than hemoglobin-free intrinsic absorption and support the potential role of multimodal optical spectroscopy as a complementary approach spectroscopic guidance during lung cancer surgery.

Background: Pulmonary cavities (PC) are known to be more prevalent among multidrug-resistant pulmonary tuberculosis (MDR)/extensively drug-resistant tuberculosis (XDR) patients than among drug-sensitive tuberculosis (DS) patients. This study aims to clarify how the interaction between Mycobacterium tuberculosis aggressiveness and tuberculosis history causes the PC prevalence and pattern differences between DS patients and MDR/XDR patients.

Methods: Eastern European patient data were from the NIAID TB (National Institute of Allergy & Infectious Diseases Tuberculosis) Portals Program registered before January 2019. Chinese patients were from Shenzhen, China, treated between April 2017 and February 2019. There were in total 244 DS cases (222 new patients and 22 previously treated patients), 344 MDR cases (188 new patients and 156 previously treated patients), and 155 XDR cases (36 new patients and 119 previously treated patients). The first chest computed tomography (CT) images were analysed. PC were counted only for those with a lumen diameter >5 mm. Multiple cavities in a single consolidation were counted as one cavity. Calcified lesions in the lungs, as a sign of chronicity, were also recorded.

Results: In new patients, there was no difference in lung lesion calcification prevalence among DS (13.5%), MDR (14.4%), and XDR (13.9%). In previously treated patients, lung calcification prevalence was 36.4% for DS, 44.9% for MDR, and 45.4% for XDR. For new patients, the PC prevalence was higher for MDR cases than for DS cases (41% vs. around 25%). For treated patients, PC prevalence increased to 36.4% for DS cases, to 57% for MDX cases, and to 71.4% for XDR cases. For new patients, the mean PC number for positive cases was DS: 1.66, MDR: 2.79, XDR: 2.69. For treated cases, the mean PC number for positive cases was DS: 2.13, MDR: 2.58, XDR: 2.47. For new patients, the mean PC diameter (in mm) for positive cases was DS: 15.4, MDR: 16.9, XDR: 17.5. For treated cases, the mean PC diameter (in mm) for positive cases was DS: 19.0, MDR: 20.8, XDR: 25.6. The number of lung fields with PC lesion was higher for MDR cases than for DS cases. PC number ≥2 had a specificity of around 92.3% for new patients, and around 81.0% for previously treated patients, suggesting the diagnosis of MDR/XDR.

Conclusions: MDR/XDR patients exhibit significantly higher PC prevalence and more extensive pulmonary involvement compared to DS patients, which are not totally determined by the length of disease history. Compared with literature reports, the prevalence of PC and the PC number per positive case were comparatively low in this study. Taking all results together, PC number ≥3 offers reasonable specificity for suggesting the diagnosis of MDR, though the sensitivity would be low.

Background: End-stage respiratory diseases has become a major global health challenge, and lung transplantation (LTX) has emerged as the only currently viable therapeutic option and gained momentum in the last four decades. This study aimed to scientifically visualize the knowledge structure of the LTX research field based on highly cited documents through bibliometric analysis, while integrating current research hotspots to provide valuable insights.

Methods: Research searches and data collection were obtained from Web of Science Core Collection. Calculations and visualizations were performed through Microsoft Excel, VOSviewer, CiteSpace, and Bibliometrix R-package.

Results: From 1980 to November 1, 2024, we identified the top 500 highly cited documents in the field of LTX. Our findings showed that USA, University of Toronto, Keshavjee S, and Journal of Heart and Lung Transplantation were the top country, institution, author and journal with the highest number of publications, while Yousem SA and Journal of Heart and Lung Transplantation were the top cited scholar and journal. The high frequency keywords were "bronchiolitis obliterans syndrome", "transplant recipients", and "rejection". In addition, "pulmonary fibrosis", "ischemia-reperfusion injury", "primary graft dysfunction", and "ex vivo lung perfusion" are worthy of attention.

Conclusions: Our study provided detailed lists of the most highly cited documents in the field of LTX, and comprehensively and visually summarized the knowledge structure of LTX field and gave valuable insights. It aims to inspire subsequent research from macro perspectives and inform the rational allocation of resources and identification of sources of collaboration.