Annals of translational medicine最新文献

Background and objective: Endobronchial one‑way valves (EBVs) were originally developed for lung volume reduction in severe emphysema. Because EBVs allow unidirectional airflow, they have been used off‑label to manage persistent air leaks (PALs)/bronchopleural fistulas (BPFs), haemoptysis, cavitary tuberculosis (TB), and other complex pulmonary conditions. This review summarises the evidence of endobronchial valve applications beyond emphysema.

Methods: We conducted a narrative review of English‑language literature from January 1, 2000 to August 1, 2025, searching PubMed, Embase, Scopus, and Google Scholar for clinical trials, observational studies, case series, and case reports describing EBV use beyond emphysema. The selection of articles was based on relevance to the topic, with emphasis on clinical outcomes. No formal quantitative synthesis was performed given the narrative scope.

Key content and findings: Across case series, EBV placement achieves cessation or substantial reduction of air leaks in roughly half to 80% of patients with postoperative or spontaneous BPFs, often allowing chest tube removal within days and avoiding reoperation. Reported complications are uncommon and include valve migration, expectoration, transient hypoxaemia, and localized infection. Case reports indicate EBVs can serve as emergency bronchoscopic plugs to control massive haemoptysis when conventional therapy fails. Emerging evidence in multidrug‑resistant TB shows that collapse therapy using EBVs alongside appropriate chemotherapy accelerates sputum culture conversion and cavity closure; in a randomized trial, EBV treatment markedly improved culture conversion and long‑term cure rates compared with chemotherapy alone. EBVs have also been used in critical care settings to isolate injured lungs and facilitate weaning from mechanical ventilation or extracorporeal membrane oxygenation (ECMO).

Conclusions: EBVs have evolved into a versatile tool in pulmonary medicine, extending well beyond emphysema treatment. The literature to date indicates that EBVs can effectively seal PALs, control focal pulmonary haemorrhage, and induce therapeutic lung collapse in cavitary disease-all with a minimally invasive approach. EBVs hold significant promise for improving patient care in challenging scenarios, and further research is warranted.

[This corrects the article DOI: 10.21037/atm-22-5493.].

The development and evaluation of effective therapeutic strategies for intervertebral disc degeneration (IVDD) and their successful incorporation into clinical practice remain challenging, largely due to the absence of an optimal preclinical animal model. While both induced and spontaneous IVDD animal models have provided valuable insights, they also present inherent limitations that restrict their translational applicability. Increasing evidence supports the use of sheep as a highly relevant large animal model, as spontaneous spine disorders in this species closely mirror many features of human IVDD. Sheep exhibit remarkable similarities to humans in terms of disc cellular composition, anatomical configuration, physiological loading, histological architecture, and molecular signaling pathways. These features make the ovine model uniquely positioned to bridge the gap between basic science and clinical translation, fulfilling both scientific and regulatory requirements. In this review, we highlight the shared features of IVDD between sheep and humans and examine both spontaneous and induced ovine models currently used to study disc degeneration. Furthermore, we discuss how the integration of advanced technologies, such as surgical navigation systems can refine the reproducibility and precision of these models. These innovations not only enhance experimental rigor but also strengthen the translational value of the ovine model, advancing our understanding of IVDD pathophysiology, diagnosis, prevention, and treatment. Continued refinement of ovine models will play a critical role in the development of effective therapeutic strategies for managing IVDD in humans.

[This corrects the article DOI: 10.21037/atm-22-922.].

Background: High-risk multidisciplinary team (HRMDT) meetings are increasingly implemented for management of high-risk non-small cell lung cancer (NSCLC) patients. However, the safety of surgery is often still questioned, resulting in treatment being diverted towards a "safer" non-surgical oncological treatment option. This study investigates the post-treatment outcomes, including survival, between propensity matched high-risk patients who, after discussion at the HRMDT, receive either surgery or oncological treatment.

Methods: A retrospective analysis of pre-and post-operative variables between high-risk patients referred to the HRMDT, held fortnightly, from 2019-2023 was conducted. Referral criteria to HRMDT are: poor lung function tests, ≤2 important co-morbidities, performance status (PS) ≤2, age ≥85 years, body mass index ≥40 or ≤16 kg/m². Clinical and demographic data were obtained from local electronic records after hospital's approval. These patients were categorized into 2 propensity-matched groups: surgical (anatomical resection) and oncological treatment. Pre- and post-operative variables were statistically compared between groups.

Results: Overall, 168 patients were analyzed [mean age 72.3±2.2 years, 73 (43.4%) males]. After matching, 63 patients were included in each group. Longer length of stay (LOS; median 5 vs. 4 days, P=0.03), more overall complications (54% vs. 41.3%, P=0.09) and more unplanned admissions (9.5% vs. 0%, P=0.01) to critical care were captured in the surgical versus the oncological group. In-hospital and 30-day mortalities were similar but overall survival and disease-free survival were longer in the surgical group (P<0.001 and P<0.001, respectively). Similarly, the overall and disease-free survival per stage was longer in the surgical group.

Conclusions: Overall survival and disease-free survival were longer in high-risk patients treated with surgery. Similar findings were found per NSCLC stage but LOS was longer while complications and unplanned admissions to critical care were more frequent. Surgery should not be precluded from the treatment of high-risk NSCLC patients, discussed at a HRMDT.

[This corrects the article DOI: 10.21037/atm-22-1459.].

[This corrects the article DOI: 10.21037/atm-20-4485.].

Background: Osteoarthritis (OA) is a degenerative joint disease involving cartilage loss and inflammation. Traditional histological evaluation is limited. Micro-computed tomography (micro-CT) offers non-invasive three-dimensional (3D) joint visualization but lacks detailed cartilage assessment. This study developed and evaluated a novel micro-CT-based scoring system for joint structure in a rat model of mono-iodoacetate (MIA)-induced OA.

Methods: OA was induced in the right knees of 24 Wistar male rats using varying MIA concentrations (0.2, 0.5, 1, 3 mg). After 28 days, knee joints were scanned using micro-CT and segmented into 10 compartments. Degenerative changes in each compartment were scored (0-4), and a total joint score was calculated. Histological evaluation using a modified Mankin score was performed on sagittal sections of the patellar groove. Interobserver reliability and correlations between micro-CT joint scores and Mankin scores were analyzed statistically.

Results: The micro-CT 3D imaging scoring system demonstrated excellent interobserver reliability [interclass correlation coefficient (ICC) >0.75 for most compartments]. Micro-CT joint scores revealed statistically significant differences in joint degeneration between the highest MIA dose group (3 mg) and the lower dose groups (0.2 and 0.5 mg). Notably, micro-CT could differentiate between the 0.2 mg and 1mg groups, which was not fully reflected in histological scores. A strong correlation was found between the total micro-CT joint score and the modified Mankin score (ρ=0.8, P<0.001).

Conclusions: The novel micro-CT-based 3D imaging scoring system provides a reliable method for quantifying gross degenerative changes in rat knee joints in the MIA-induced OA model. While it does not directly assess cartilage, its correlation with histological findings suggests its utility as a complementary tool for evaluating overall joint degeneration.

Background: Magnetic resonance imaging (MRI)-based ex vivo thrombus imaging is an emerging modality for evaluating clot composition and guiding therapy. However, when it comes to sample handling, the effect of formalin fixation on MRI relaxation times (T1, T2, and T2*) of thrombus tissue remains poorly characterized. Formalin fixation is widely used in studies investigating the MRI properties of thrombus tissue; however, fixation alters tissue biochemistry and water dynamics. Understanding these effects is essential for accurately interpreting existing literature and for developing reliable ex vivo imaging biomarkers. This study aims to assess the impact of formalin fixation on human thrombus MRI properties using an ultra-high-resolution ex vivo 9.4 T MRI scanner.

Methods: A total of 19 clot samples from 13 patients undergoing mechanical thrombectomy were evaluated. The samples were imaged fresh, after <6 hours of formalin fixation, and after >24 hours of formalin fixation. T1, T2, and T2* relaxation time maps were created and evaluated over the fixation stages. Linear mixed-effects models were used to assess the effect of fixation stage and biological covariates, including clot age, patient age, and body mass index (BMI).

Results: Formalin fixation induced significant reductions in T1 and T2 relaxation times. T1 decreased from 1,801.6±236.3 ms (fresh) to 1,205.0±491.6 ms (>24 h formalin, P<0.001). T2 declined from 77.6±16.5 ms (fresh) to 44.3±13.8 ms (>24 h formalin). Most T2 reduction occurred within the first 6 hours of fixation. T2* values showed minimal changes across fixation stages. Higher BMI and older clot age were significantly associated with shorter T1 values, while no covariates influenced T2 or T2*.

Conclusions: Formalin fixation substantially alters T1 and T2 relaxation times in thrombus tissue, while T2* remains relatively stable. These findings highlight the necessity of accounting for fixation effects and patient-specific biological factors when designing and interpreting ex vivo thrombus MRI data and developing imaging biomarkers.