Journal of thoracic disease最新文献

Background: Gustave Roussy Immune Score (GRIm-Score), a new prognostic index based on nutritional and inflammatory status, acts as an adverse prognostic factor in patients diagnosed with esophageal cancer (EC). However, the clinical prognostic significance of the GRIm-Score in these patients after receiving neoadjuvant chemoradiotherapy (nCRT) remains unclear. The aim of the study was to evaluate the prognostic value of GRIm-Score in patients with EC following nCRT.

Methods: A retrospective study was conducted involving 432 patients with EC who had undergone surgical resection. The GRIm-Score of each enrolled patient was calculated on the basis of three key parameters: lactate dehydrogenase (LDH), neutrophil-lymphocyte ratio (NLR), and albumin (ALB). Overall survival (OS) and disease-free survival (DFS) were set as the primary study endpoints, which were analyzed utilizing Cox proportional hazards regression analysis, the Kaplan-Meier method, and propensity score matching (PSM).

Results: The study cohort comprised 359 male patients (83.1%) and 73 female patients (16.9%), with a mean age of 62.1±7.7 years and an age range of 39 to 80 years. Following the implementation of PSM, the matched research cohort was divided into a high GRIm-Score group and a low GRIm-Score group, with 55 patients in each group respectively. Patients with a high GRIm-Score exhibited inferior OS (cohort: P<0.001; PSM: P=0.009) and DFS (cohort: P<0.001; PSM: P=0.01). Before PSM, the GRIm-Score was confirmed as an independent prognostic factor for OS (P=0.02) in multivariate regression analyses, while none of the individual indicators of NLR, LDH, and ALB exhibited such prognostic significance. However, after PSM, the GRIm-Score acted as a powerful independent prognostic factor for both OS (P=0.03) and DFS (P=0.04) in these multivariate analyses. Further subgroup analyses demonstrated that the GRIm-Score could effectively identify pT3-4 stage EC patients with inferior OS or DFS, which suggests that the GRIm-Score plays a complementary role in the clinical decision-making for adjuvant therapy in EC patients.

Conclusions: In patients with EC who underwent nCRT followed by surgical resection, the GRIm-Score was verified as an independent prognostic factor. Additionally, this study constitutes the first investigation to elucidate the prognostic significance of the GRIm-Score in EC patients after receiving nCRT.

Background: Cryptococcosis is an opportunistic fungal infection that increasingly affects non-human immunodeficiency virus (HIV), immunocompetent or mildly immunocompromised individuals. Pulmonary cryptococcosis, in particular, poses diagnostic challenges due to its radiological resemblance to malignant lung lesions and often subtle or absent clinical symptoms. The aim of this study is to characterize the demographic features, clinical presentation, diagnostic pathways, radiological and pathological findings, and treatment patterns among hospitalized patients with histopathologically or molecularly confirmed pulmonary cryptococcosis.

Methods: This retrospective descriptive study included 61 non-HIV patients hospitalized with confirmed pulmonary cryptococcal infection over a 5-year period. Data were extracted from medical records, including demographics, comorbidities, presenting symptoms, imaging features, diagnostic procedures, histopathological and molecular confirmation, laboratory parameters, and treatment details. Pearson correlation and linear regression analyses were used to explore predictors of hospital length of stay.

Results: The cohort comprised predominantly male patients (72.1%) with a mean age of 51.6 years. Most cases (63.3%) were incidentally detected on imaging, while the remainder presented with non-specific respiratory symptoms. Radiological findings frequently included multiple pulmonary nodules (56.4%) and ground-glass opacities (16.4%). Surgical resection was performed in over half of the cases, primarily due to initial suspicion of malignancy. Diagnosis was confirmed through periodic acid-Schiff (PAS) (72.1%) or silver staining (57.4%), and supported by molecular testing in selected cases. Three patients (4.9%) had central nervous system (CNS) involvement confirmed by lumbar puncture and imaging. All patients received fluconazole as first-line antifungal therapy, while those with CNS involvement received a combination of amphotericin B and fluconazole followed by fluconazole maintenance therapy. In multivariate analysis, bilateral pulmonary nodules were associated with shorter hospital stays (β =-5.36, P=0.041), while the presence of cavitary lesions predicted longer hospitalization (β =5.04, P=0.03).

Conclusions: Pulmonary cryptococcosis may mimic malignancy and frequently presents without overt symptoms, contributing to diagnostic delays and surgical interventions. Recognition of its radiological patterns and clinical spectrum in non-HIV patients is essential for timely diagnosis and appropriate antifungal treatment. This study highlights the importance of considering cryptococcosis in the differential diagnosis of pulmonary nodules, even in asymptomatic, immunocompetent individuals.

Background: Upper respiratory infections (URIs) impose a substantial global disease burden; however, the evolving epidemiological landscape, specifically for adolescents and young adults (aged 10-24 years), remains obscured by aggregate analyses. Given that this demographic represents a critical phase for human capital development, understanding the long-term trends of URIs is vital for optimizing resource allocation and intervention strategies. This study aimed to quantify the global, regional, and national burden of URIs in this pivotal group from 1990 to 2021 and project trends to 2035, informing targeted public health policies.

Methods: Data were derived from the Global Burden of Disease (GBD) Study 2021. Annual incidence, mortality, and disability-adjusted life years (DALYs) were analyzed across three age subgroups (10-14, 15-19, and 20-24 years). Temporal trends in age-standardized incidence rate (ASIR), age-standardized mortality rate (ASMR), and age-standardized DALYs rate (ASDR) were evaluated using estimated annual percentage changes (EAPC). The average annual percent change (AAPC) summarized the overall trend. A Bayesian age-period-cohort (BAPC) model was employed to forecast disease burden through 2035. Analyses were stratified by sex, region, and socio-demographic index (SDI).

Results: From 1990 to 2021, global ASIR declined slightly (EAPC =-0.16%), while ASMR (-1.69%) and ASDR (-0.26%) showed more substantial reductions. The 10-14 years age group consistently had the highest incidence and DALYs burden, with the slowest mortality decline (EAPC =-1.34%), whereas the 20-24 years age group demonstrated the most rapid improvement. Males experienced steeper mortality reductions (-2.25%) than females (-1.11%). Contrasting global improvements, the high-middle SDI region exhibited a significant upward trend in ASIR (EAPC =0.02%), and increases were also observed in the Caribbean and parts of sub-Saharan Africa. Projections indicate a continued decline in rates but a paradoxical rise in absolute case numbers among older adolescents (15-24 years) by 2035.

Conclusions: While the global mortality and DALYs burden of URIs in adolescents and young adults has improved, incidence remains persistently high, particularly in the 10-14 years age group and high-middle SDI regions. The projected rise in case numbers among older cohorts suggests emerging challenges, potentially linked to immunity gaps. Future strategies must prioritize targeted interventions in high-burden demographics and environmental pollution mitigation.

Background: Extracorporeal membrane oxygenation (ECMO) has emerged as a promising rescue strategy for patients with refractory cardiogenic shock (CS). However, comprehensive and quantitative insights into the global research landscape of ECMO in CS remain limited. This study aimed to address this gap by systematically mapping the global research landscape of ECMO in CS through bibliometric analysis and knowledge visualization.

Methods: A narrative synthesis was used to provide concise summaries of the key findings, highlighting emerging research frontiers and thematic shifts over time. Publications related to ECMO management in CS from 1990 to 2024 were retrieved from the Web of Science Core Collection. CiteSpace and VOSviewer were used to analyze publication patterns, co-authorship networks, keyword clustering, and citation metrics. High-impact authors, institutions, countries, and emerging research frontiers were identified.

Results: A total of 701 publications involving 4,433 authors from 1,105 institutions across 55 countries were analyzed. The United States led in both publication volume and citations, followed by Germany and China. Four major thematic clusters were identified: postcardiotomy shock, cardiac arrest, extracorporeal cardiopulmonary resuscitation (ECPR), acute myocardial infarction (AMI)-related mechanical circulatory support, and ECMO bridging to transplantation. Over time, research emphasis has shifted from general survival and mortality to protocol-driven care, predictive modeling, and long-term outcomes.

Conclusions: ECMO for CS is a rapidly expanding field, with bibliometric patterns suggesting increasing research consolidation and thematic diversification. Bibliometric analysis revealed a centralized and collaborative academic ecosystem with evolving themes suggestive of a shift toward precision support, multidisciplinary management, and clinical guideline development. These insights provide a roadmap for future research and health policy planning.

Background: The widespread use of chest computed tomography (CT) has substantially increased the detection of ground-glass nodules (GGNs). This often causes significant patient anxiety. While most GGNs are slow-growing, misinformation or incomplete guidance on social media can worsen "scan anxiety". This may lead to demands for unnecessary overtreatment or result in poor adherence to surveillance protocols. This study evaluated the content, quality, and reliability of GGN-related short videos on TikTok and Bilibili to determine their utility for patient education.

Methods: We searched both platforms using the keyword "ground-glass nodules" ("GGNs") between September 30-October 8, 2025. We analyzed the top 130 videos per platform. We classified uploaders as professionals (surgeons, radiologists, internists including traditional Chinese medicine physicians) or patients. Content was coded for etiology, imaging, diagnosis, treatment, and follow-up. Video quality and reliability were assessed using the Global Quality Score (GQS, 1-5) and modified DISCERN (mDISCERN). Two physicians rated all videos independently, with adjudication by a senior clinician. Nonparametric tests and Spearman correlations were applied (two-sided P<0.05).

Results: A total of 237 videos were included (TikTok, n=125; Bilibili, n=112). Content analysis revealed significant information gaps: while 92.83% of videos discussed treatment options (often emphasizing surgery), only 16.88% explained GGN etiology, and systematic guidance on risk stratification was frequently lacking. Professionally produced videos (surgeons/radiologists) scored significantly higher than patient-generated content. Although Bilibili had higher median GQS scores (3.00 vs. 2.00, P<0.001) than TikTok, the overall reliability (mDISCERN) across both platforms was modest, with no significant difference. Engagement metrics (likes/shares) did not correlate with medical quality.

Conclusions: Current short-video algorithms prioritize engagement over clinical accuracy, resulting in fragmented health information that may distort patients' risk perception of GGNs. While professionals produce higher-quality content, the overall reliability remains suboptimal. Clinicians must be aware of these online information deficits to proactively address patient anxiety and correct misconceptions during consultations, ensuring adherence to evidence-based surveillance pathways.

Background: Recurrent hiatal hernia remains a challenging clinical problem. Failure rates after primary repair can be as high as 59%. Symptomatic patients often require reoperation. Although minimally invasive laparoscopic surgery is the standard approach, the reported outcomes of robot-assisted redo hiatal hernia repair performed without mesh reinforcement remains limited. This study reports the safety and efficacy of robot-assisted laparoscopic redo repair without mesh.

Methods: We conducted a retrospective cohort study of consecutive adult patients who underwent elective robot-assisted laparoscopic redo hiatal hernia repair across a multicentered health system from April 2016 to March 2025. Baseline demographics, comorbidities, preoperative testing, operative findings, repair technique, postoperative complications, and follow-up outcomes were collected through chart review. Primary efficacy outcomes were radiographic and symptomatic recurrences. Statistical analyses were conducted using Chi-squared for categorical variables and t-test for continuous variables.

Results: Fifty-two patients were included in the final analysis. Mean age was 63±9.7 years, 60% were women, and the mean body mass index (BMI) was 30±5 kg/m² at the time of reoperation. Most common preoperative symptoms were reflux (83%) and dysphagia (46%). The most common intraoperative finding was crural repair breakdown (73%). All procedures were completed robotically without mesh and without any conversions or intraoperative complications. The mean operative time was 224±55.1 min. The median length of stay was 2 days with interquartile range of 1 day. At a mean follow-up of 29.3±20.8 months, 88% reported improvement of symptoms, 13% completely discontinued antacid therapy, radiographic or endoscopic recurrence was observed in 38% and symptomatic recurrence in 27% with average time of discovery at 17.3±12.3 months. Only 4% required additional reoperation.

Conclusions: Robot-assisted laparoscopic redo hiatal hernia repair without mesh is safe and demonstrates favorable short-term outcomes. Further comparative prospective studies are needed to clarify long term durability relative to conventional laparoscopy and mesh usage.

Background and objective: Chest wall reconstruction (CWR) remains a surgical challenge for both thoracic and plastic surgeons owing to the physiologic and anatomic complexity of the region. Successful reconstruction re-establish chest wall integrity, obliterate dead space, preserve pulmonary function, and ensure robust soft tissue coverage. This narrative review discusses modern principles of CWR, including advances in biomaterials and surgical techniques, with an emphasis on the role of thoracoplastic collaboration.

Methods: A literature search was performed on PubMed for MeSH terms and keywords pertinent to CWR. Randomized controlled trials, retrospective studies, systematic reviews and case studies published from November 5, 1995 through November 5, 2025 were eligible for inclusion.

Key content and findings: New biomaterials have popularized hybrid and mesh-based approaches to skeletal fixation that preserve respiratory function and protect native tissue from implanted materials. Virtual surgical planning (VSP) and three-dimensional (3D) technology is increasingly used for operative planning and fabricating custom prostheses. While local pedicled flaps remain a mainstay of soft tissue reconstruction, advances in microsurgical tissue transfer have allowed for reconstruction of increasingly large and complex defects. Employing a thoracoplastic approach to CWR is vital to successfully reconstructing complex defects.

Conclusions: CWR remains an area of active innovation, and reconstructive approach varies widely by anatomic region, defect characteristics, and surgeon preference. The rise of new biomaterials and 3D printing holds immense promise for custom reconstructive approaches. Formalized thoracoplastic collaboration throughout the perioperative period is crucial to leveraging the expertise of both thoracic and plastic surgeons, particularly in highly complex cases.