Journal of thoracic disease最新文献

Background: Drug-coated balloons (DCBs) are commonly used in small coronary arteries. A recent trial reported similar outcomes between paclitaxel-coated balloons (PCBs) and sirolimus-coated balloons (SCBs) in side branch (SB) stenosis after stenting main branch (MB). This trial investigated whether SCBs and PCBs produce similar effects in de novo bifurcation lesions.

Methods: In this prospective, multicenter, randomized, non-inferiority clinical trial, patients with de novo non-left main coronary bifurcation lesions undergoing provisional stent of SB were randomly assigned in a 1:1 ratio to receive either SCBs or PCBs in SB. The primary efficacy endpoint was the percentage of target lesion stenosis (TLS) in the SB observed on angiogram 9 months after treatment. Secondary endpoints included efficacy and safety endpoints. The former included restenosis of target lesions and the latter included adverse events (AEs) and serious adverse events (SAEs).

Results: During June 2021 and October 2023, a total of 241 patients (SCB 121 vs. PCB 120) were included at 10 centers in China (mean age 63.92±9.48 years; 32% female). At the 9-month follow-up, the difference in the primary efficacy endpoint between the SCB (26.8%±14.4%) and PCB (30.6%±17.1%) groups was -3.8% (95% confidence interval: -7.9% to 0.2%, P<0.05 for non-inferiority margin of 7%). The secondary efficacy endpoints were similar between the two groups, including restenosis of target lesions (7.2% vs. 7.8%, P=0.88), late lumen loss (LLL) (0.21 vs. 0.26 mm, P=0.69), target lesion revascularization (TLR) (0.84% vs. 0.85%, P>0.99), target vessel revascularization (TVR) (0.84% vs. 0.85%, P>0.99), target lesion failure (TLF) (0.84% vs. 0.85%, P>0.99), major adverse cardiac event (MACE) (4.2% vs. 2.0%, P=0.43), and major adverse cardiac and cerebral event (MACCE) (0.84% vs. 1.71%, P=0.62) at 9 months. The secondary safety endpoints were also similar between the groups.

Conclusions: In patients with de novo non-left main coronary bifurcation lesions treated with provisional stenting in the SB, SB dilation with SCB was non-inferior to PCB in terms of percentage of TLS at 9-month follow-up.Trial Registration: This study was registered at the National Research Registration and Filing Information System (https://www.medicalresearch.org.cn/, MR-12-24-007528).

Background: Emerging evidence indicates a possible relation of the platelet-to-lymphocyte ratio (PLR) to clinical outcomes in the coronary artery disease (CAD) population receiving coronary artery bypass grafting (CABG). However, current findings remain inconclusive and inconsistent. Our study examines the prognostic value of PLR in CAD patients undergoing CABG.

Methods: PubMed, Embase, Web of Science, as well as Cochrane Library, were thoroughly retrieved until April 15, 2025. Data for categorical and continuous variables were merged separately using odds ratio (OR), 95% confidence interval (CI), and standardized mean difference (SMD). In addition, the result stability was rated, and possible sources of heterogeneity were identified via sensitivity and subgroup analyses.

Results: Twenty-seven studies were encompassed, comprising nine cohort studies and eighteen case-control studies, with an aggregate sample size of 17,120 patients. Meta-analysis of categorical data revealed that elevated PLR was notably linked to an elevated incidence of postoperative atrial fibrillation (POAF) (OR =1.02, 95% CI: 1.01-1.02; P<0.001), all-cause mortality (ACM) (OR =1.69, 95% CI: 1.04-2.74; P=0.03), and delirium (OR =1.05, 95% CI: 1.03-1.07; P<0.001). Statistically significant relations were noted between PLR and acute kidney injury (AKI) (OR =1.04, 95% CI: 0.97-1.11; P=0.30) or saphenous vein graft disease (SVGD) (OR =1.34, 95% CI: 0.81-2.20; P=0.25). For continuous variables, elevated PLR values were associated with a greater likelihood of POAF, AKI, ACM, and SVGD; however, no significant correlations were found with delirium or other adverse events. Subgroup analyses suggested that the predictive value of PLR for POAF was influenced by study design, patient age, geographic location, and PLR cutoff values, while region and time of PLR measurement affected its prognostic significance for AKI.

Conclusions: An elevated PLR correlated with a potential risk of POAF, AKI, ACM, delirium, and SVGD in the CAD population undergoing CABG. PLR may be a valuable and accessible biomarker for prognostic assessment in this patient population, thereby aiding clinical decision-making in the context of surgical management of CAD.

Background: Pulmonary rehabilitation improves survival and reduces postoperative complications in patients with lung cancer, highlighting the need for precise assessment of exercise capacity. Conventional tools such as the cardiopulmonary exercise test (CPET) and the 6-minute walk test (6MWT) are valuable but often limited by equipment, time, and patient-related factors, including balance problems, musculoskeletal limitations, and postoperative chest wall pain. The timed up and go test (TUGT) is a simple measure reflecting lower extremity strength, balance, and gait speed, yet its clinical utility has not been established in patients after lung cancer resection. This study aimed to investigate the relationship between the TUGT and established exercise assessments (6MWT and CPET) and to evaluate the potential role of the TUGT as a practical screening tool for pulmonary rehabilitation.

Methods: This retrospective observational study included 62 patients who underwent lung cancer resection between March 2019 and June 2023. Exercise capacity was evaluated using TUGT, 6MWT, and CPET. Receiver operating characteristic (ROC) curve analysis was performed to determine the diagnostic value of TUGT in identifying reduced exercise capacity, defined as 6MWT <525 meters. A subgroup of 35 patients who completed an 8-week pulmonary rehabilitation was additionally analyzed to assess changes in functional performance.

Results: There was a strong negative correlation between TUGT time and 6MWT distance (r=-0.61, P<0.001) and a moderate negative correlation between maximal oxygen consumption (VO₂max) and TUGT time (r=-0.46, P<0.001), where shorter TUGT time indicates better performance. In the ROC curve analysis, a TUGT time of 6.4 seconds identified patients with reduced exercise capacity (6MWT <525 meters), considered at higher risk of poor postoperative outcomes, with 66% sensitivity and 93% specificity. In the rehabilitation subgroup, significant improvements were observed across all three assessments, including a decrease in TUGT time, an increase in 6MWT distance, and an improvement in VO₂max.

Conclusions: TUGT demonstrates significant correlations with both CPET and 6MWT and may serve as a simple, feasible, and clinically valuable screening tool for identifying patients with reduced postoperative exercise capacity. Incorporating TUGT into routine postoperative evaluations may facilitate early detection of reduced functional capacity and guide timely referral for pulmonary rehabilitation.

Background: Medical thoracoscopy (MT) is a minimally invasive procedure used for diagnosing and managing undiagnosed pleural effusions. Argon plasma coagulation (APC) is a non-contact electrosurgical technique widely used in gastrointestinal and bronchoscopic procedures, yet its application in MT remains underreported. This study describes the APC technique during MT for hemostasis and evaluates its safety and feasibility.

Methods: We conducted a retrospective observational study of patients who underwent MT with APC at Mayo Clinic, Jacksonville, FL, between December 1, 2022 and April 4, 2024. Patient demographics, procedural details, and pleural fluid analysis were recorded. Hemostasis was achieved using a rigid APC applicator, with bleeding severity assessed using the Validated Intraoperative Bleeding Scale (VIOPS). Descriptive statistical analyses were performed.

Results: Twenty patients (median age: 72 years) underwent MT with APC, primarily for recurrent pleural effusion (95%). Adhesiolysis was performed in 60% of cases, and pleural biopsies were obtained in 95%. The median pleural fluid volume removed was 642.5 mL. A single bleeding complication (5%) was recorded (VIOPS score ≥2). No cases of air embolism were observed. Histopathology revealed malignancy in 21.1% of biopsies.

Conclusions: MT with APC appears to be a safe and effective technique for achieving hemostasis following pleural biopsy, with a low complication rate. This study provides a foundation for future research on the role of APC in pleuroscopy and its potential advantages over conventional hemostatic techniques.

Background: Chronic obstructive pulmonary disease (COPD) coexisting with bronchiectasis (BE) leads to increased symptom severity, elevated mortality rates, and worsened clinical outcomes. This study aimed to determine the independent risk factors (RFs) associated with COPD combined with BE (COPD-BE), subsequently establishing and validating a nomogram-based clinical prediction model. This model aims to early identify the presence of BE in patients with COPD, so that clinicians can quickly identify COPD-BE patients and formulate targeted management strategies to improve their prognosis and reduce mortality.

Methods: A total of 382 COPD patients were retrospectively enrolled and analyzed. Participants were randomly allocated at a 7:3 proportion into a training group comprising 268 cases and a validation group containing 114 cases. Subsequently, individuals were categorized based on whether BE was present, forming COPD-BE and COPD-alone subgroups. To identify RFs independently associated with COPD-BE, initial univariate logistic regression was performed, followed by least absolute shrinkage and selection operator (LASSO) regression for variable selection, and ultimately multivariable regression modeling. Using factors determined by the multivariate analysis, a predictive nomogram was subsequently developed. Receiver operating characteristic (ROC) analyses were conducted, and corresponding areas under the curve (AUCs) were calculated, to evaluate the predictive accuracy of the model. The nomogram's clinical effectiveness and accuracy were further validated through calibration assessments and decision curve analysis (DCA).

Results: Independent RFs for COPD-BE included female sex, hemoptysis, history of pulmonary tuberculosis, Pseudomonas aeruginosa infection, globulin levels, and mechanical ventilation duration (P<0.05). The predictive model demonstrated good discriminative ability, with an AUC of 0.840 [95% confidence interval (CI): 0.790-0.890] in the training set and 0.829 [95% CI: 0.749-0.909] in the validation set. Calibration analyses showed good agreement between predicted probabilities and actual outcomes (P>0.05). Furthermore, DCA suggested the nomogram has potential clinical utility.

Conclusions: Female sex, hemoptysis, pulmonary tuberculosis history, Pseudomonas aeruginosa infection, globulin level, and mechanical ventilation duration are independent RFs for COPD-BE. The predictive model developed based on these factors demonstrated good predictive performance in internal validation. Pending further external validation, this nomogram holds promise as a useful tool to aid in the early identification of COPD-BE in clinical practice.

Asbestos exposure continues to be a critical public health concern due to its established link with serious respiratory diseases and malignancies. Despite the attention that asbestos-related disease has received and the litigation that has existed, asbestos-related deaths have increased over time. Public reporting of asbestos levels is essential to inform at-risk populations and facilitate regulatory compliance. Laws and practices regarding measuring of asbestos levels and reporting of these levels vary widely. Each different country has different standards that are applied to reporting. In many countries, legislation that has been passed by governing bodies has affected the amount of asbestos use and the reporting standards. Other countries have depended on community organizations to spread awareness and public pressure regarding standards of reporting. This review summarizes current practices in asbestos monitoring and public reporting, examines the strengths and limitations of existing frameworks, and explores technological and policy innovations aimed at improving transparency and public awareness. Enhancing data accessibility and public engagement remains vital to reducing asbestos-related health risks worldwide. Creating a uniform policy as widely as possible regarding asbestos reporting will empower the public and aid in reducing harm from asbestos-related disease. Future efforts should focus on creating comprehensive reporting policies and facilitating the ease at which the public can access this data.

Background: Accurate prognostic risk stratification for lung adenocarcinoma (LUAD) remains a critical challenge. This study employs single-cell pseudo-time series analysis to identify pseudo-time differential genes (PTDGs) associated with LUAD development and constructs tumor progression-related prognostic risk stratification for patients with LUAD.

Methods: This study conducted quality control for single-cell RNA sequencing (RNA-seq) data firstly. Then, malignant tumor cells of the epithelium were identified using cell-cluster markers and InferCNV. Trajectory analysis with Monocle identified PTDGs, further refined to 2,597 candidate genes. The prognostic signature of PTDGs was constructed by using Cox, least absolute shrinkage and selection operator (LASSO) and random forest (RF) analyses. In addition, multicenter datasets and immunohistochemistry analysis were used to evaluate the expression of the identified PTDGs between the two groups.

Results: The developmental trajectory of the LUAD epithelium was plotted, and 13 PTDGs were identified to be highly associated with the prognosis of LUAD. Based on the prognostic risk score, The Cancer Genome Atlas (TCGA)-LUAD patients were well stratified into low- and high-risk groups. The PTDGs-based risk model demonstrated good performance in the training, internal and external validation datasets, as well as being compared with existing risk score formulas. In addition, multi-center datasets and immunohistochemistry revealed a significant up-regulation of DDIT4, FURIN, PTTG1 and RIPK2 at transcriptional and protein expression levels in LUAD tissues compared to normal tissues.

Conclusions: PTDGs are potential biological markers for prognostic risk stratification of patients with LUAD.

Background and objective: Hyperreactivity (HR) refers to an exaggerated biological response to a given stimulus that is within the normal physiological range, resulting from a lowered activation threshold of the involved system or effector cells. It commonly occurs after surgery, lung transplantation, and coronavirus disease 2019 (COVID-19) infection but lacks a unified concept and systematic understanding. This review aims to elucidate the concept, mechanisms, and disease spectrum of HR as an independent clinical entity, systematically explore its roles in postoperative conditions, lung transplantation, and COVID-19, and develop a biomarker-based hierarchical management framework, thereby providing a new paradigm for its precise recognition and intervention.

Methods: We systematically searched the PubMed, Web of Science, Scopus, and China National Knowledge Infrastructure databases for literature published from January 1, 1968, to November 1, 2025, including reviews, randomized controlled trials, and observational studies, human or animal studies related to HR mechanisms or clinical phenotypes, while excluding non-peer-reviewed materials such as case reports and conference abstracts.

Key content and findings: This study first proposes that HR arises from a four-dimensional imbalance across the nervous, endocrine, immune, and microenvironmental systems, characterized by thoroughness, early onset/persistence, and individual variability. The mechanisms underlying HR in postoperative, transplant-related, and COVID-19 conditions are systematically summarized, and a hierarchical, biomarker-based management framework is developed, highlighting the need for marker validation and trajectory modeling.

Conclusions: HR represents an independent clinical entity that transcends traditional disease boundaries. This review provides a new paradigm for its precise recognition and intervention and is expected to advance the conceptual and practical development of this field. Future research, clinical practice, and policy formulation should be individualized and mechanism-driven.