Journal of thoracic disease最新文献

Background: Climate change has increased temperature variability, impacting respiratory health. While the data related to its short-term effects on lung function is conflicting, its long-term effects remain even more uncertain. Therefore, this study aimed to evaluate the short-, mid-, and long-term effects of ambient temperature on lung function and respiratory symptoms in a nationally representative population.

Methods: We conducted a cross-sectional analysis of 10,819 participants from the Korean National Health and Nutrition Examination Survey (KNHANES) [2016-2018]. Individualised temperature exposures were estimated using high-resolution atmospheric models. Generalised additive model (GAM) and distributed lag non-linear model (DLNM) were used to assess the short-term (lag days 0-14), mid-term [moving average (MA): 30-180 days], and long-term (MA: 1-5 years) effects on lung function.

Results: Short-term exposure to high temperature (29.7 ℃) was associated with decreased forced expiratory volume in 1 second (FEV₁) [mean: -2.59%; 95% confidence interval (CI): -4.35% to -0.82%] relative to the minimum risk temperature (MRT; 22.0 ℃), with cumulative effects persisting over 14 days [forced vital capacity (FVC) mean: -4.98%, 95% CI: -6.99% to -2.96%; FEV₁ mean: -5.95%, 95% CI: -8.23% to -3.67%]. Long-term temperature exposure was associated with lung function decline, with a 5-year MA decrease in FEV₁ (-3.87%, 95% CI: -6.81% to -0.93%) at 13.7 ℃, relative to the MRT of 10.0 ℃, with a more pronounced effect at upper temperature extremes. Chronic sputum production was associated with long-term heat exposure [1-year, odds ratio (OR): 1.349, 95% CI: 1.173-1.554; 3-year, OR: 1.299, 95% CI: 1.093-1.552; 5-year, OR: 1.189, 95% CI: 1.000-1.423].

Conclusions: Short- and long-term heat exposure were associated with impaired lung function, with more pronounced effects observed at higher temperatures.

Background: Frailty is associated with adverse clinical outcomes and is recognized as an important predictor of prognosis. Yet, practical frailty-based tools to assess the risk of postoperative complications after radical esophagectomy are still inadequate. The aim of this study was to evaluate the predictive performance of the Memorial Sloan Kettering-Frailty Index (MSK-FI) and to establish a more comprehensive model for forecasting postoperative complications in this patient population.

Methods: We retrospectively analyzed 410 patients who underwent radical esophagectomy between 2022 and 2023. Preoperative frailty status of these patients was calculated using MSK-FI. Patients were accordingly classified as frail (MSK-FI ≥2, n=86) or non-frail (MSK-FI <2, n=324). A predictive nomogram was subsequently conducted by incorporating clinical and surgical characteristics.

Results: Compared with the non-frail group, patients in the frail group had significantly higher rates of severe postoperative complications (26.74% vs. 14.20%; P=0.006) and longer hospital stays (11 vs. 10 days, P=0.01). Univariate logistic regression analysis identified age ≥65 years [odds ratio (OR) =2.11, P=0.02], neoadjuvant therapy (OR =1.86, P=0.03), MSK-FI ≥2 (OR =2.21, P=0.008), cervical esophagogastric anastomosis (OR =2.02, P=0.01), and prolonged surgery duration (OR =1.79, P=0.04) as risk factors for severe postoperative complications. These variables were incorporated into multivariable stepwise logistic regression to develop a predictive nomogram model, which demonstrated an area under the curve (AUC) of 0.700 [95% confidence interval (CI): 0.637-0.767].

Conclusions: Preoperative frailty status is associated with an increased risk of adverse perioperative outcomes in patients after radical esophagectomy. The integration of MSK-FI and clinical characteristics in nomogram provides a practical tool for predicting severe postoperative complications.

Background: Accurate preoperative staging is crucial for esophageal cancer treatment decisions. Traditional clinical T staging via imaging falls short of pathological precision. This study aimed to assess computed tomography (CT) radiomics' accuracy in predicting T stage for esophageal squamous cell carcinoma (ESCC) using machine learning and identify key stable features influencing T staging.

Methods: A total of 444 patients with ESCC were retrospectively enrolled. Segmented tumor 3D regions of interest (ROIs) from CT scans were analyzed for radiomics features, with key features selected via Spearman correlation and the least absolute shrinkage and selection operator (LASSO). Five machine learning algorithms including support vector machine (SVM), Gaussian Naive Bayes (NB), random forest (RF), logistic regression (LR), and extreme gradient boosting (XGB) were used to build classification models. Data were randomly divided into a training set (n=355, ~80%) and a testing set (n=89, ~20%). Model performance was evaluated by area under the receiver operating characteristic curve (AUC), accuracy, precision, recall, and F1 score.

Results: A total of 1,223 radiomics features were extracted based on the 3D ROIs of ESCC lesions. Feature selection yielded 14 key features for two-class classification (T1-2 vs. T3-4a) and 18 for three-class classification (T1 vs. T2 vs. T3-4a), with 11 features being consistent across both. Notably, RunEntropy and SurfaceVolumeRatio had high feature coefficients. The best AUC for two-class classification (XGB model) was 0.798 with 95% confidence interval (CI) of 0.701-0.895. The SVM model achieved a mean AUC of 0.740 in three-class classification.

Conclusions: The integration of CT radiomics and machine learning provides a valuable, non-invasive tool for preoperative T staging of ESCC. Specifically, the study demonstrates robust performance in two-class classification and provides preliminary reference for the exploration of three-class classification. Additionally, the features RunEntropy and SurfaceVolumeRatio emerge as key stable radiomic indicators for T staging among resectable ESCC patients.

Background: Multiple primary lung cancers (MPLCs) present unique clinical difficulties because of their genetically diverse independent tumors, requiring genetic testing to distinguish synchronous primaries from intrapulmonary metastases. While circulating tumor DNA (ctDNA) analysis shows potential for detecting molecular residual disease (MRD), tumor heterogeneity hinders its application. Thus, there is an urgent need to develop specific biomarkers and standardize liquid biopsy protocols to improve monitoring and treatment. The aim of this study was to analyze the clinicopathological characteristics of postoperative MRD-positive stage I non-small cell lung cancer (NSCLC) patients, with a focus on the potential utility of ctDNA in detecting MRD and guiding therapeutic decisions.

Methods: Twelve patients with pulmonary nodules were analyzed. Paired tissue and plasma samples underwent genomic profiling via next-generation sequencing (NGS) using validated extraction/library preparation kits, following ethical standards. Rigorous quality controls were implemented to ensure sensitive variant detection.

Results: Both solitary (n=5) and multiple nodules (n=7) carried EGFR and TP53 mutations. Multiple nodules had significantly higher tumor mutational burden and clonal heterogeneity. Patients with positive MRD showed markedly elevated ctDNA levels, with clonal dynamics indicating increased shedding in multifocal disease.

Conclusions: Multifocal lung disease exhibits greater genomic complexity and enhanced ctDNA shedding, supporting its use as a disease-tracking tool. The findings identify actionable signatures for MRD surveillance and guide personalized therapeutic interventions based on observed clonal architectures.

Background: Massive bone or tissue defects caused by trauma, tumors or infections are a frequently occurring clinical problem. Novel biomaterials combined with new technologies offer new treatment options especially regarding reconstruction of bone and tissue. Aim of this study was to establish the stable and biocompatible combination of decellularized human dermis with a stable polymer via three-dimensional (3D) printing.

Methods: Polylactide (PLA) models were 3D-printed onto human acellular dermis (hAD) membranes using FreeCAD (computer-aided design) software for modeling and Ultimaker 2+ for printing. Cytotoxicity was assessed using L929 fibroblast cells in an 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazoliumbromid (MTT) assay analogue to DIN EN ISO 10993-5 guidelines. Laser microtome sectioning was performed to enable histological analysis involving hematoxylin-eosin (HE) staining for tissue morphology assessment. The chorioallantoic membrane (CAM) assay was conducted on fertilized chicken eggs to evaluate cytotoxic effects and vascular ingrowth, by microscopic imaging.

Results: PLA was successfully 3D-printed onto hAD, forming a stable bond. After 72 hours of incubation in PBS, the printed structure remained securely attached. Histological analysis confirmed the integrity of the collagen structure after printing with high temperatures, with only slight compression in the top layer of the hAD. Cytotoxicity testing according to ISO 10993-5 showed no significant reduction in cell viability (83%), thereby demonstrating biocompatibility. The CAM assay demonstrated vascular integration, with vessels forming around and connecting to the hybrid material.

Conclusions: The successful 3D printing of PLA onto hAD resulted in a stable hybrid material with preserved structural integrity and good fluid resistance. Histological and cytotoxicity analyses confirmed biocompatibility, while the CAM assay demonstrated vascular integration. These findings suggest that the hAD-PLA composite holds potential for biomedical applications, particularly in tissue engineering.

Background: The Bentall procedure remains the gold standard for treating aortic root pathologies. However, the conventional full sternotomy (FS) approach is associated with sternal complications and prolonged recovery times. The right anterior mini-thoracotomy (RAMT), a minimally invasive alternative, offers reduced trauma and preserves sternal integrity, but its safety and efficacy require further evaluation. This study aims to compare the short-term outcomes of RAMT and FS in Bentall procedures.

Methods: This single-center retrospective study included all patients who underwent Bentall surgery between May 2022 and December 2024. Using a 1:2 matched design to balance baseline characteristics, 16 patients were included in the RAMT group and 32 in the FS group. The primary endpoint was the 30-day incidence of major adverse cardiac and cerebrovascular events (MACCEs). Secondary endpoints included cardiopulmonary bypass time (CPBT), postoperative complications, and short-term follow-up outcomes.

Results: The aortic cross-clamp time was significantly longer in the RAMT group compared to the FS group (146±22.4 vs. 130±27.9 min, P=0.03), though no significant differences were found in CPBT or total operative time. Intraoperative blood loss was significantly lower in the RAMT group (median 300 vs. 500 mL, P=0.002). No significant differences were observed between the two groups in 30-day MACCEs, mechanical ventilation time, postoperative length of stay, total hospitalization expenditures, or incidence of major postoperative complications. Short-term follow-up (median 12 months) showed that all patients, except for one case of prosthetic valve endocarditis (PVE) in the RAMT group, survived with improved cardiac function.

Conclusions: In patients selected according to strict criteria, the RAMT approach for Bentall surgery was associated with longer aortic cross-clamp time but significantly reduced intraoperative blood loss, while demonstrating comparable perioperative safety and short-term efficacy to the conventional FS approach. RAMT is a feasible minimally invasive option, although its long-term outcomes warrant further validation through larger sample sizes and extended follow-up.

Background and objective: Mesothelioma remains lethal, with a growing share linked to non-occupational exposure in community settings. This review synthesizes contemporary epidemiology, mechanisms, exposure sources, diagnosis, treatment and public health strategies.

Methods: This narrative review was conducted to synthesize heterogeneous evidence addressing environmental and para-occupational asbestos exposure and its relationship to malignant mesothelioma. A structured literature search was performed using PubMed/MEDLINE, Embase, and Web of Science databases for articles published through 2025. Terms related exclusively to occupational exposure were deliberately deprioritized. Studies were eligible for inclusion if they met at least one of the following criteria: (I) epidemiological investigations evaluating non-occupational, environmental, or para-occupational asbestos exposure; (II) mechanistic or toxicological studies elucidating fiber pathogenicity relevant to environmental exposure scenarios; (III) investigations of population clusters associated with naturally occurring or construction-related mineral fibers; (IV) studies assessing environmental remediation, surveillance strategies, or public-health interventions; or (V) clinical investigations reporting data stratified by exposure category. Articles focusing exclusively on occupational exposure without environmental relevance were excluded. Case reports without exposure characterization, editorials without primary data, and studies lacking clear methodological description were also excluded.

Key content and findings: Environmental risk arises from naturally occurring asbestos (NOA), legacy building materials, industrial residues and para-occupational transfer into homes. Case mix is shifting toward women, younger patients and peritoneal presentations in geologic or industrial hotspots. Fiber biopersistence drives chronic inflammation, oxidative injury and mesothelial transformation. Systemic therapy now centers on dual checkpoint blockade as a first-line standard, with chemo-immunotherapy and platinum-pemetrexed backbones, and selective use of bevacizumab. Surgery is reserved for candidates in expert centers, favoring lung-sparing pleurectomy and decortication when macroscopic clearance is plausible. Prevention requires total prohibition of new asbestos use, disciplined legacy management, robust enforcement, land-use controls in NOA terrains, and household protections.

Conclusions: Environmental drivers will sustain mesothelioma burden unless exposure pathways are eliminated and legacy sources are controlled. Clinical gains come from immunotherapy, selective surgery and coordinated supportive care, but prevention and earlier detection carry the greatest impact. A unified agenda that couples exposure science with equitable public health action is essential to bend incidence and improve outcomes.