Journal of thoracic disease最新文献

Background: Segmentectomy has been shown to be feasible and to convey outcomes comparable to those of lobectomy in several studies. These can be divided into simple (SS) or complex (CS), depending on the number of intersegmental planes dissected during resection. This study aimed to evaluate the postoperative outcomes of uniportal video-assisted thoracic surgery (u-VATS) in CS and SS.

Methods: We conducted a retrospective study from January 2017 to January 2025, including all patients who underwent anatomical segmentectomy via u-VATS. CS and SS were propensity score-matched with a 1:1 ratio.

Results: A total of 402 consecutive u-VATS segmentectomies were conducted during the studied period. After matching, 302 patients were selected. These included 151 SS and 151 CS. Overall, the median age in our study was 70 (64-75) years, with a predominance of female patients (60%, n=181). When contrasting CS with SS, we observed a larger proportion of patients with prolonged air leak [n=35 (23%) vs. n=12 (8%) P<0.001, effect size (ES) =0.210], which was consistent with a longer duration of thoracic drainage in place [3 (2-5) vs. 2 (2-3) days, P<0.001, ES =0.218] and a longer hospitalization period for the CS group [4 (3-6) vs. 3 (2-5) days, P<0.001, ES =0.088].

Conclusions: While small differences may arise when comparing SS and CS, these do not appear to substantially impact the early postoperative course. Ultimately, the complexity of segmentectomies is often determined by the surgeon's practical experience with each specific segment.

Background: Chronic thromboembolic pulmonary hypertension (CTEPH) is a multifaceted and progressive condition that has experienced substantial advancements in research. This study undertook a bibliometric analysis of the 100 most frequently cited articles pertaining to CTEPH to delineate the most influential contributions within the field. The objective was to elucidate significant research trends, identify critical areas of focus, and inform future research trajectories.

Methods: Relevant literature was selected from the Web of Science core collection. The analysis utilized a combination of advanced bibliometric tools: Microsoft Excel 2019, VOSviewer 1.6.20, CiteSpace 6.3.R1, and R 4.3.3.

Results: The publication timeframe extends from 1973 to 2021, during which a peak citation count of 28,460 was recorded. Germany and the USA emerge as the predominant contributors to the body of published articles. Assistance Publique Hopitaux Paris (APHP) emerged as the leading institution, with a total of 30 publications. This was closely followed by the University of California San Diego and the University of California System, each with 28 articles. These articles were disseminated across 38 distinct journals, with the European Respiratory Journal leading in publication volume. Simonneau, Gerald is identified as the most prolific first author, contributing 12 articles. Keyword analysis reveals that early research on CTEPH primarily focused on foundational concepts and established clinical practices, as evidenced by terms such as "pulmonary thromboendarterectomy" and "management". Recently, there has been a notable and sustained shift towards advanced diagnostic methodologies, with "computed tomography" emerging as a focal point of research.

Conclusions: CTEPH research has demonstrated rapid growth and increasing international collaboration over the past two decades, with evolving priorities from surgical management to holistic, patient-centered, and precision medicine approaches. These findings provide a roadmap for future research directions, emphasizing the need for early detection, individualized therapies, and continued innovation in both diagnostics and treatment.

Background: Pulmonary rehabilitation is increasingly recognized as beneficial for lung cancer patients; however, the global research landscape remains insufficiently characterized. Influential contributors, collaboration patterns, and evolving research hotspots are not yet clearly defined. This study aimed to analyze the global research landscape and identify emerging trends in pulmonary rehabilitation for lung cancer patients through comprehensive bibliometric analysis.

Methods: Literature from 1997 to 2025, comprising 454 articles, was retrieved from the Web of Science Core Collection (WoSCC) database. Bibliometric indicators were calculated using Microsoft Excel, while research networks and trends were visualized using VOSviewer, CiteSpace, and "bibliometrix" package of R.

Results: The field showed steady growth with an 8.94% annual growth rate, featuring 2,780 authors from 1,979 institutions across 44 countries/regions. China (87 articles, 19.16%) and the USA (79 articles, 17.40%) dominated publication output, while Belgium demonstrated exceptional citation impact (197.1 citations per publication). The University of Copenhagen (69 articles), Sichuan University (39 articles), and Université de Rouen Normandie (34 articles) were the most productive institutions. Jones LW emerged as the most influential author with the highest h-index (14). Lung Cancer (17 articles, h-index 15) and Supportive Care in Cancer (16 articles, h-index 12) were the leading journals. Keyword analysis revealed ten distinct research clusters, with recent trends emphasizing guideline development, depression management, and tailored approaches for specific lung cancer subtypes.

Conclusions: This bibliometric analysis reveals the evolutionary trajectory in pulmonary rehabilitation for lung cancer patients, highlighting the transition from theoretical exploration to practical clinical application.

Background: Omics, encompassing genomics, transcriptomics, proteomics and metabolomics, plays a pivotal role in elucidating the molecular mechanisms underlying lung cancer and advancing precision oncology. While existing studies have primarily focused on the technical development and clinical efficacy of omics applications in cancer, there remains a notable gap in comprehensive assessments of the global research landscape. At different stages of lung cancer initiation, progression, and metastasis, genomics and transcriptomics predominantly reveal oncogenic alterations and dysregulated signaling networks, whereas proteomics and metabolomics capture functional protein dynamics and metabolic reprogramming that drive tumor growth and metastatic adaptation. Importantly, the integration of multi-omics data enables a systematic understanding of the crosstalk between genetic alterations, transcriptional regulation, protein expression, and metabolic remodeling throughout lung cancer evolution. This bibliometric analysis study aims to systematically evaluate scientific output, research trends and hotspots in omics-related lung cancer research.

Methods: Relevant publications were retrieved from the Web of Science Core Collection (WoSCC) from January 1, 2004 to April 27, 2024. Bibliometric analyses and knowledge domain visualizations were conducted using VOSviewer (v1.6.20), CiteSpace (v6.3), R (v4.3.3), and Origin (2024).

Results: A total of 19,087 publications were included, demonstrating sustained growth over two decades [2004-2024]. China contributed the largest volume of publications, whereas the USA showed higher citation impact and stronger influence in collaboration networks. Keyword co-occurrence and burst analyses illustrated that "expression", "lung cancer", "gene expression", "tumor microenvironment", "mutation" and "immunotherapy" are dominant and emerging themes. These findings indicate a clear shift from single-omics approaches and gene-centric investigations toward integrative multi-omics frameworks, with increasing emphasis on the tumor microenvironment (TME) and immunotherapy. The burst analysis of keywords also highlights the rising prominence of artificial intelligence (AI) and machine learning (ML), which have emerged as rapidly growing methodological backbones in recent years.

Conclusions: Research on omics in lung cancer has rapidly evolved toward integrative, TME-focused and immunotherapy-oriented paradigms, with AI/ML serving as an enabling analytical infrastructure. This study underscores the critical role that omics in facilitating early detection, guiding personalized therapeutic strategies, and improving prognostic accuracy. The findings suggest that enhancing cross-disciplinary collaboration and accelerating the clinical translation of multi-omics data may help overcome current challenges in precision oncology.

Background: Influenza lower respiratory tract infections (LRTIs) impose substantial mortality burden in children under five globally, yet, comprehensive analyses of their long-term spatiotemporal disease burden patterns remain underexplored. The research aimed to estimate the death and disability-adjusted life years (DALYs) caused by influenza LRTIs for children under five in 204 countries and territories over the period 1990 to 2021.

Methods: Epidemiologic data on influenza LRTIs, including death and DALYs, were extracted from the Global Burden of Disease (GBD) 2021 database across global, regional, and national strata.

Results: Globally, influenza LRTIs caused 27,615 [95% uncertainty interval (UI): 20,128-36,852] deaths and 2,460,833 (95% UI: 1,796,287-3,280,725) DALYs in children under five in 2021, representing an 83.46% decline in deaths and 83.47% reduction in DALYs since 1990. Death and DALY rates decreased by 84.41% and 84.43%, respectively, with accelerated declines after 2020. Boys consistently exhibited higher mortality and DALYs across, with the largest gender disparity in neonates aged 0-6 days. The 1-5 months age group remained the most vulnerable, though all age strata showed marked burden reductions compared to 1990. Low socio-demographic index (SDI) regions bore the highest burden in 2021, with death and DALY rates of 9.42 and 837.39 per 100,000, despite experiencing the most substantial percentage reductions. Consistent with this pattern, the socioeconomic inequality analysis revealed a substantial narrowing of absolute disparities [slope index of inequality (SII): -4,703.6 to -581.9] concurrent with a deepening of relative inequality [concentration index (CI): -0.46 to -0.61]. Western Sub-Saharan Africa and South Asia had the highest absolute mortality (10,145 and 9,382 deaths) and DALYs (900,693 and 839,480).

Conclusions: From 1990 to 2021, the global burden of influenza LRTIs in children under five showed a significant decline, with accelerated progress during the coronavirus disease 2019 (COVID-19) pandemic. However, low SDI regions exhibited the steepest declines yet retained the highest mortality rates, with the burden becoming increasingly concentrated in these areas. These findings highlight the urgent need for equitable vaccine distribution, strengthened neonatal care in high-burden areas, and gender-sensitive health policies to achieve Sustainable Development Goal 3.2 and mitigate preventable child deaths.

Background: Malignant pleural effusions (MPEs) are common in cancer patients and significantly impair physical activity. Although symptom relief is the primary treatment goal, the extent of activity limitation and the effectiveness of interventions remain unclear. We used actigraphy to assess the impact of thoracentesis on activity level. The primary objective was to evaluate the association between physical activity (via ActiGraph), quality of life [Short Form 6-Dimension index (SF-6D) utility score], and dyspnea (Borg scale) at weeks 1 and 2 following thoracentesis.

Methods: We conducted a prospective, observational, single-center study in adults with symptomatic, moderate-to-large MPEs.

Results: Participants wore actigraphy devices for a mean of 17.7 hours daily. Higher average steps in week 2 significantly correlated with higher week 2 SF-6D utility scores. Higher calorie expenditure in week 1 significantly correlated with better week 1 SF-6D utility scores. However, no actigraphy metrics significantly affected SF-6D utility score changes from week 1 to week 2. For Borg, higher average triaxial movement in week 2 was modestly associated with lower dyspnea in week 2. Greater week 1 increases (slopes) in calories, moderate-to-vigorous physical activity (MVPA), and triaxial movement significantly predicted larger Borg scale reduction from week 1 to week 2.

Conclusions: These findings suggest that improvement in SF-6D utility scores is tied to average activity levels (calories in week 1, steps in week 2), whereas dyspnea improvement by Borg scale over time is more strongly related to early gains in week 1 activity. Triaxial movement was also associated with less dyspnea in week 2.

Background: Robotic bronchoscopy (RB) is increasingly used to sample peripheral pulmonary lesions due to its high diagnostic yield and low complication rate. Rapid on-site evaluation (ROSE) is often performed intra-procedurally to provide the proceduralist with qualitative and quantitative feedback on specimen quality. ROSE can be performed on fine needle aspiration (FNA) cytology specimens or via touch imprint cytology (TIC) of pathology specimens. Data about the utility of ROSE in RB is sparse. This study aimed to assess the concordance between ROSE and final cytology and pathology results.

Methods: We retrospectively reviewed all RB cases performed at the Anschutz Medical Campus of the University of Colorado from May 2021 to December 2024.

Results: A total of 156 patients were included in the study. Of these 137 also had ROSE performed and were therefore included in the concordance assessment. The concordance between FNA-ROSE and final cytology was 83%, while the concordance between TIC-ROSE and final pathology was 81%. Overall concordance between ROSE and final cytology and pathology results was 88%, and the Pearson χ²-value was 174 (P<0.001). The concordance between linear EBUS-ROSE and final lymph node cytology was 80.1%. The overall diagnostic yield for RB in our study was 75%.

Conclusions: In our cohort of RB cases, FNA-ROSE and TIC-ROSE demonstrated high concordance with the final cytology and pathology results, respectively. ROSE can enable the proceduralist to make important intra-procedural decisions about the number of lesions that need sampling and the tools and techniques to use.

Advances in molecular oncology have identified a range of rare but actionable oncogenic alterations in non-small cell lung cancer (NSCLC), such as EGFR exon 20 insertions, MET exon 14 skipping, RET, ROS1, and NTRK fusions, along with BRAF V600E, KRAS G12C, and HER2 mutations. While these alterations collectively account for approximately 20% of NSCLC, evidence guiding perioperative treatment in this population remains limited. This review synthesizes current knowledge and ongoing research regarding neoadjuvant and adjuvant strategies for resectable NSCLC harboring rare mutations. We highlight the clinical efficacy of targeted therapies in advanced stage and explore their potential utility in perioperative settings. Preliminary data suggest that molecular subtype-specific approaches may optimize outcomes, particularly as traditional chemoimmunotherapy appears less effective in several of these genotypes due to immune-cold tumor microenvironment. Moreover, we discuss the evolving role of circulating tumor DNA and minimal residual disease as biomarkers for perioperative treatment guidance. There are several challenges including the lack of randomized perioperative trials, heterogeneity in pathological response assessment, and uncertainty regarding the reliability of surrogate endpoints. With the increasing integration of next-generation sequencing into the standard diagnostic workup of early-stage NSCLC, biomarker-directed perioperative strategies supported by prospective clinical trials enriched for specific genotypes are critical to achieving sustained clinical outcomes in these patient subgroups with rare targetable alterations.

Background and objective: Pleural adhesion is a significant risk factor that can lead to a poor prognosis in thoracic surgery. The extent of these adhesions directly affects the selection of preoperative surgical approaches, the progress of the intraoperative surgical process, and the occurrence of serious postoperative complications. Accurate preoperative judgment of pleural adhesions and their severity is of great significance for formulating perioperative treatment plans and achieving precision medicine. This article focuses on summarizing and synthesizing various imaging methods for preoperative prediction of pleural adhesions and discusses the challenges and prospects facing future research. The aim is to improve preoperative diagnostic accuracy and risk stratification, thereby enhancing surgical safety and efficacy.

Methods: A comprehensive, non-systematic review of the latest literature was carried out in order to investigate the progress of predicting pleural adhesions. PubMed database was being examined, and the last run was on December 17^th 2025.

Key content and findings: This article reviews the definition, classification, and clinical significance of pleural adhesions, and summarizes the latest research progress of imaging prediction of pleural adhesions in the past 10 years. It was found that ultrasound, chest X-ray, computed tomography (CT), and ¹⁸F-fluorodeoxyglucose (¹⁸F-FDG) positron emission tomography (PET)/CT can all effectively predict the pleural adhesion status before the operation.

Conclusions: Pleural adhesions influence the survival prognosis of patients with thoracic surgery. Effective preoperative prediction of the state of pleural adhesions can help to improve the preoperative surgical plan formulation and reduce the occurrence of postoperative complications. Ultrasound, chest X-ray, CT, and ¹⁸F-FDG PET/CT have their advantages and disadvantages in predicting pleural adhesions, and artificial intelligence (AI) may be the direction of future research.

Background: Numerous studies have examined sex and gender differences in chronic obstructive pulmonary disease (COPD), highlighting their roles in disease susceptibility, hormonal regulation, and inflammation. However, research often conflates sex and gender, and gaps remain in tailored therapies and genetic mechanisms. This study, therefore, employs bibliometric analysis to map the evolution and landscape of this research field.

Methods: The authors systematically retrieved literature from the Web of Science Core Collection database, focusing on publications addressing gender differences in COPD between January 1, 2015, and March 4, 2025. The search strategy used the following Boolean query: [TS= ("COPD" OR "Chronic Obstructive Pulmonary Disease") AND ("gender" OR "male" OR "female") NOT ("animal model" OR "cell culture")], adhering to Web of Science Core Collection search syntax rules that ignore case sensitivity but require logical operator capitalisation. Subsequently, bibliometric analyses were performed using CiteSpace 6.3.R1 and VOSviewer 1.6.20.

Results: The search identified 493 publications, and the annual output showed a steady rise. De Miguel-Díez J was the most productive author, and CIBER was the leading institution. High-frequency keywords included COPD, respiratory system, gender differences, and prevalence. Recent focus shifted to gender differences and COPD comorbidities.

Conclusions: Investigations into sex and gender-specific COPD manifestations have grown in recent years, engaging a growing scientific community. This work systematically synthesises pivotal research trajectories and novel mechanistic insights into gender-differentiated COPD pathology. Future therapeutic strategies for COPD may target the role of sex hormones in pulmonary pathophysiology. The comprehensive summary provides an informative theoretical foundation for researchers and clinical providers and is key to future research tools in this field.