Journal of thoracic disease最新文献

{"title":"The global status and trends of local ablation for lung malignancies: a bibliometric and visualization analysis.","authors":"Yi-Nuo Wei, Ya-Shi Yin, Hou-Fa Ning, Xi-Zhen Wang, Wei-Guang Shao, Peng Dong, Ke-De Yuan, Guang-Zhi Wang","doi":"10.21037/jtd-2025-287","DOIUrl":"10.21037/jtd-2025-287","url":null,"abstract":"<p><strong>Background: </strong>Lung cancer remains the leading cause of cancer-related mortality globally. In recent years, the advent of image-guided percutaneous ablation techniques has led to a gradual increase in the application of local ablation therapy (LAT) for both primary and secondary lung malignancies. Despite this progress, a systematic summary of the research trends and current clinical applications in this field is still lacking. Bibliometric analysis, a powerful statistical and visualization tool, can provide valuable insights into the evolving landscape of this therapeutic modality. This study aimed to examine the utilization of LAT for both primary and metastatic lung cancers, while exploring current research focuses and potential future directions in this field.</p><p><strong>Methods: </strong>By leveraging the Web of Science (WOS) core collection database, this study employed VOSviewer and bibliometrix tools to analyze current research trends and future development directions of LAT for both primary and metastatic lung cancers.</p><p><strong>Results: </strong>The study findings revealed a steady increase in annual publication volume between 2008 and 2023. Research output was predominantly contributed by China, the United States, and Japan. Among institutions, Memorial Sloan Kettering Cancer Center led in publication count, with Shandong University and Okayama University following closely. The <i>Journal of Vascular and Interventional Radiology</i> emerged as the most prominent journal in this research domain. Through keyword analysis, five major research clusters were identified: (I) therapeutic technologies for lung cancer; (II) ablation methodologies for non-small cell lung cancer (NSCLC); (III) interventional approaches and strategies for lung cancer; (IV) ablation techniques for metastatic lung tumors; and (V) innovative technologies in lung cancer treatment.</p><p><strong>Conclusions: </strong>Local ablation combined with other treatments are expected to improve therapeutic effects and become future trend in the treatment of lung malignancies.</p>","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":"17 8","pages":"5417-5428"},"PeriodicalIF":1.9,"publicationDate":"2025-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12433045/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145064798","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lipid metabolism-related genes regulate the immune microenvironment during ex vivo lung perfusion for lung transplants.","authors":"Yuan Zhang, Zhi-Chang Yang, Qian-Hua Zhou, Zhen-Yang Geng, Kai-Jun Huang, Yang Yang, Hao-Xiang Yuan, Pu Shen","doi":"10.21037/jtd-2025-358","DOIUrl":"10.21037/jtd-2025-358","url":null,"abstract":"<p><strong>Background: </strong>Ex vivo lung perfusion (EVLP) serves as a vital platform for donor lung assessment and repair in transplantation. Although lipid metabolism plays a crucial role in pulmonary homeostasis and undergoes alterations during EVLP, the precise regulatory mechanisms linking metabolic changes to immune modulation remain poorly understood. This study aimed to identify key lipid metabolism-related genes governing immune microenvironment remodeling during EVLP and to validate their diagnostic and therapeutic potential.</p><p><strong>Methods: </strong>We analyzed transcriptomic profiles from human donor lungs before and after EVLP using datasets GSE127057 (discovery cohort) and GSE127055 (validation cohort). A comprehensive analytical framework was implemented, incorporating weighted gene co-expression network analysis (WGCNA), protein-protein interaction (PPI) networks, and three machine learning algorithms including least absolute shrinkage and selection operator (LASSO) regression, Random Forest (RF), and eXtreme Gradient Boosting (XGBoost) to identify key lipid metabolism-related genes. Immune cell infiltration patterns were characterized using established computational methods, with subsequent validation in an EVLP model of C57BL/6J wild-type mice.</p><p><strong>Results: </strong>Analysis of GSE127057 revealed 656 differentially expressed genes (DEGs) post-EVLP. Through integrative bioinformatics approaches, three lipid metabolism-related hub genes (<i>UGCG</i>, <i>SAMD8</i>, <i>MED26</i>) were identified as consistently upregulated. These genes demonstrated significant positive correlations with resting natural killer (NK) cell populations and negative associations with activated NK cells. The diagnostic potential of these biomarkers was confirmed through receiver operating characteristic (ROC) analysis, achieving an area under curve (AUC) of 0.986 in the discovery cohort (GSE127057) and 0.922 in the independent validation cohort (GSE127055). Experimental validation in murine EVLP models recapitulated the significant upregulation of all three hub genes.</p><p><strong>Conclusions: </strong>This study establishes UGCG, SAMD8, and MED26 as central regulators of lipid metabolism during EVLP, with their expression patterns correlating with NK cell functional states. These findings provide mechanistic insights into metabolic-immune interactions during donor lung preservation and identify potential biomarkers for clinical monitoring and therapeutic targeting.</p>","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":"17 8","pages":"6045-6065"},"PeriodicalIF":1.9,"publicationDate":"2025-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12433055/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145064990","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Chest computed tomography findings do not influence the decision of pneumologists regarding the diagnosis and management of pulmonary long coronavirus disease: a single center retrospective study.","authors":"Stefanie Meiler, Daniel Schmalenberger, Maximilian Malfertheiner, Iris Dvorak, Quirin Strotzer, Christian Stroszczynski, Okka Wilkea Hamer","doi":"10.21037/jtd-2025-433","DOIUrl":"10.21037/jtd-2025-433","url":null,"abstract":"<p><strong>Background: </strong>Pulmonary symptoms are common in long coronavirus disease (COVID), yet the diagnostic value of chest computed tomography (CT) in these patients remains unclear, particularly when physical examination and pulmonary function tests are normal. This study investigates whether chest CT influences the decision of pneumologists regarding the measures taken for diagnostic work-up, the final diagnosis, the confidence in the diagnosis, and the downstream management of patients suspected to suffer from pulmonary long COVID.</p><p><strong>Methods: </strong>All patients presented in a dedicated long COVID outpatient clinic of a secondary care hospital that specializes in lung diseases between April 2020 and August 2021. Inclusion criteria were age ≥18 years, suspicion for long COVID syndrome of pulmonary origin according to the National Institute for Health and Care Excellence (NICE) criteria and availability of a chest CT acquired during work-up. Three pneumologists evaluated the patient's records in two rounds (round 1 without and round 2 with knowledge of CT results). Identical parameters were queried in the two runs: diagnosis of pulmonary long COVID, confidence of the diagnosis on a scale from 0 to 3, need for: bronchoalveolar lavage (BAL), transbronchial biopsy (TBB), cryobiopsy, video-assisted thoracoscopy (VATS), ergospirometry, ventilation/perfusion scintigraphy, follow-up appointment, rehabilitation.</p><p><strong>Results: </strong>Forty-one patients were included (24 male; age 21 to 72 years, mean 55 years). In the first and second round diagnosis of pulmonary long COVID was made in an average of 10 (24%) and 11 (27%) patients (P=0.69). Confidence of diagnosis was 1.9 and 2.6 (P<0.001). No statistical difference was found regarding the frequency of diagnostic measures and downstream management.</p><p><strong>Conclusions: </strong>Chest CT did not influence the diagnostic decision of pneumologists for patients suspected to suffer from pulmonary long COVID. However, the confidence in the diagnosis was improved by chest CT. Still, based on our results chest CT does not routinely have to be included in the work-up of long COVID, when pulmonary function tests and auscultation are normal.</p>","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":"17 8","pages":"5654-5662"},"PeriodicalIF":1.9,"publicationDate":"2025-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12433019/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145065011","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Management and survival outcomes of patients with postoperative recurrence of non-small cell lung cancer at isolated ipsilateral hilar or mediastinal lymph node.","authors":"Keiji Yamanashi, Masatsugu Hamaji, Ryo Miyata, Ryo Nakanobo, Masashi Kobayashi, Makoto Sonobe, Masaki Ikeda, Yusuke Muranishi, Tomoya Kono, Hiromi Oda, Hiroya Yamagishi, Yoshito Yamada, Tsuyoshi Shoji, Takehisa Fukada, Hiroshi Date","doi":"10.21037/jtd-2025-809","DOIUrl":"10.21037/jtd-2025-809","url":null,"abstract":"<p><strong>Background: </strong>Current guidelines recommend chemoradiotherapy or chemotherapy alone in cases of prior radiotherapy for mediastinal lymph node (LN) recurrence after surgery for non-small cell lung cancer (NSCLC). However, data on management and outcomes remain limited. This study investigated treatment approaches and survival outcomes in patients with isolated ipsilateral hilar or mediastinal LN recurrence after surgical resection for NSCLC.</p><p><strong>Methods: </strong>A retrospective chart review was conducted using a multi-institutional database to identify consecutive patients with isolated ipsilateral hilar or mediastinal LN recurrence after surgical resection for NSCLC between 2014 and 2016 at 10 institutions. Patient characteristics, recurrence treatment, and post-recurrence survival (PRS) were analyzed.</p><p><strong>Results: </strong>Sixty-seven patients were included, with a median age of 72 years and a median follow-up of 51.5 months. Two- and 5-year PRS rates were 69.2% and 34.2%, respectively. Local radical therapy (LRT) (surgical resection or radiotherapy), chemotherapy, and chemoradiotherapy were administered in 16 (24%), 30 (45%), and 21 (31%) patients, respectively. Among those receiving chemotherapy, cytotoxic drugs, tyrosine kinase inhibitor (TKI), and immune checkpoint inhibitor (ICI) with or without cytotoxic drugs were administered in 12, 11, and 7 patients, respectively. Five-year PRS rates in patients receiving LRT, chemotherapy, and chemoradiotherapy were 32.9%, 12.6%, and 55.0%, respectively.</p><p><strong>Conclusions: </strong>Our data suggest that various treatments are administered for postoperative recurrence at isolated ipsilateral hilar or mediastinal LN, differing from current guideline recommendations, which is associated with acceptable survival outcomes. Multidisciplinary discussions are essential for optimizing management.</p>","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":"17 8","pages":"5524-5533"},"PeriodicalIF":1.9,"publicationDate":"2025-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12433083/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145065018","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Biomarkers for the diagnosis of indeterminate pulmonary nodules: are we there yet?","authors":"Kevin C McGann, Timothy A Khalil, Michael N Kammer, Edwin J Ostrin, Harvey I Pass, Jun-Chieh James Tsay, Leopoldo N Segal, Melissa Potter, Stephen A Deppen, Fabien Maldonado, Eric L Grogan","doi":"10.21037/jtd-2024-2010","DOIUrl":"10.21037/jtd-2024-2010","url":null,"abstract":"<p><p>Indeterminate pulmonary nodules (IPNs), which are nodules that cannot be classified as definitively benign or malignant at the time of detection, are now diagnosed on the order of millions per year. Management of IPNs remains heavily debated, and routine practice ultimately involves some balance of overall clinical risk assessment and additional diagnostic tests or procedures which may generate significant risk, cost, and worry. Biomarkers are biologically based tests or indicators capable of accurately characterizing the physiologic properties of homeostasis and disease that are not otherwise easily evaluated by the clinician. Accurate biomarkers thereby serve as reliable surrogates for biological aberrancy, and importantly for the field of diagnostics, can signal early pathology before it becomes clinically detectable. In the realm of IPNs, biomarker development seeks to address a growing need for noninvasive adjunct tools that can be leveraged clinically to add clarity where diagnostic uncertainty exists. Here, effective diagnostic biomarkers have the potential to hone clinical management, accelerate treatment when indicated, and curb added unnecessary diagnostics. In this review article, the authors highlight the role for biomarkers in the diagnosis of IPNs, outline the methodology for successful biomarker development, and discuss contemporary IPN biomarker research and the remaining challenges and future directions for the field.</p>","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":"17 8","pages":"6265-6282"},"PeriodicalIF":1.9,"publicationDate":"2025-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12433071/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145065066","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Construction and validation of a risk prediction model for venous thromboembolism post-VATS in simultaneous multicentric primary lung cancers.","authors":"Lili Tang, Kai Wang, Huanzhi Peng, Yuexia He, Li Tang, Quanxing Liu","doi":"10.21037/jtd-2025-558","DOIUrl":"10.21037/jtd-2025-558","url":null,"abstract":"<p><strong>Background: </strong>Synchronous multiple primary lung cancers (sMPLCs) represent 0.8% to 20% of new lung cancer diagnoses. Currently, there is a lack of risk prediction models for venous thromboembolism (VTE) after video-assisted thoracoscopic surgery (VATS) in sMPLC patients. This study seeks to create and validate a VTE risk prediction model tailored for sMPLC patients undergoing VATS.</p><p><strong>Methods: </strong>A retrospective cohort analysis was conducted on patients who underwent lung cancer resection from November 2017 to December 2024 using Hospital Information System (HIS), telephone follow-up, and the Questionnaire Star electronic questionnaire. Categorical variables were analyzed using χ² tests and continuous variables were assessed with <i>t</i>-tests for univariate analysis. Variables with statistical significance from the univariate analysis and the least absolute shrinkage and selection operator (LASSO) regression algorithm were included in the logistic regression analysis to identify risk factors and construct the prediction model. A nomogram was used for the visualization of the model. The discriminative ability and calibration of the model were evaluated using the area under the receiver operating characteristic (ROC) curve and calibration plots, respectively. The clinical utility of the model was assessed using decision curve analysis.</p><p><strong>Results: </strong>The occurrence of VTE post-VATS in patients with sMPLC was associated with age, smoking history, coronary artery disease, cerebrovascular disease, chronic obstructive pulmonary disease (COPD), atherosclerotic plaques in the extremities, surgical method, intraoperative transfusion, Postoperative Caprini score, and the number of primary lesions (P<0.05). The area under the ROC curve was 0.917 [95% confidence interval (CI): 0.894-0.941], with a sensitivity of 0.885 and a specificity of 0.818. The calibration curve demonstrated a good fit between the observed and predicted curves, with a mean absolute error of 0.008. The clinical decision curve analysis indicated that the model offered superior clinical benefits compared to the Caprini score.</p><p><strong>Conclusions: </strong>The prediction model constructed in this study exhibits robust predictive performance, providing a theoretical basis for clinical medical staff to identify high-risk groups of patients with sMPLC who may develop VTE after VATS at an early stage and to facilitate timely interventions.</p>","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":"17 8","pages":"5856-5869"},"PeriodicalIF":1.9,"publicationDate":"2025-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12433111/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145065061","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of inspiratory muscle training in patients with chronic heart failure: a systematic review and meta-analysis of randomized controlled trials.","authors":"Mengxuan Yang, Wei Huang, Zeruxin Luo, Xiu Zhang, Jianhua Su, Pengming Yu","doi":"10.21037/jtd-2025-519","DOIUrl":"10.21037/jtd-2025-519","url":null,"abstract":"<p><strong>Background: </strong>The effect of inspiratory muscle training (IMT) in chronic heart failure (CHF) patients remains unclear now. This study aimed to comprehensively identify the therapeutic effects of IMT among CHF patients based on current evidence of randomized controlled trials (RCTs).</p><p><strong>Methods: </strong>Several databases were searched up to January 2, 2024 for RCTs investigating the clinical application of IMT in CHF patients. Primary outcomes were maximal inspiratory pressure (MIP) and pulmonary function. Secondary outcomes were exercise performance, including the six-minute walk test (6MWT) and Borg dyspnea index, quality of life evaluated by the Minnesota Living with Heart Failure Questionnaire (MLWHF) and N terminal-pro brain natriuretic peptide (NT-proBNP). Statistical analyses were conducted by the RevMan 5.3 software.</p><p><strong>Results: </strong>Fifteen RCTs with 494 cases were included in this meta-analysis. Pooled results demonstrated that IMT significantly increased the MIP [mean difference (MD) =16.36 cmH₂O, 95% confidence interval (CI): 12.26 to 20.46, P<0.001] and VO₂peak (MD =1.66 mL/kg/min, 95% CI: 0.27 to 3.05, P=0.02). Besides, patients receiving the IMT showed increased 6MWT (MD =37.40 m, 95% CI: 16.46 to 58.35, P<0.001) and decreased Borg dyspnea index (MD =-0.63, 95% CI: -0.83 to -0.44, P<0.001), MLWHF (MD =-8.51, 95% CI: -13.60 to -3.42, P=0.001) and NT-proBNP (MD =-81.67 pg/mL, 95% CI: -124.88 to -38.45, P<0.001).</p><p><strong>Conclusions: </strong>IMT plays a role in improving the clinical outcomes including the inspiratory muscle function, exercise performance, quality of life and NT-proBNP among CHF patients.</p>","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":"17 8","pages":"6242-6253"},"PeriodicalIF":1.9,"publicationDate":"2025-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12433052/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145065108","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Treatment needs in mild-to-moderate chronic obstructive pulmonary disease: evidence from longitudinal studies.","authors":"Zihui Wang, Junfeng Lin, Guannan Cai, Weijie Guan, Fan Wu, Zhishan Deng, Yumin Zhou, Nanshan Zhong, Pixin Ran","doi":"10.21037/jtd-2025-323","DOIUrl":"10.21037/jtd-2025-323","url":null,"abstract":"<p><strong>Background: </strong>Mild-to-moderate chronic obstructive pulmonary disease (COPD) requires treatment to delay disease progression, but this need is often overlooked. We aim to identify common clinical indicators that can reflect the risk of disease progression, rapidly informing individualized and early-stage intervention strategies.</p><p><strong>Methods: </strong>Patients in the placebo groups of two clinical trials (NCT01455129 and ChiCTR-IIR-17012604) were included as the discovery and validation cohorts. Patients with severe conditions [i.e., forced expiratory volume in one second (FEV₁) ≤60%, COPD assessment test (CAT) ≥10, or frequent acute exacerbations of COPD (AECOPD) history] at baseline or experienced annualized clinically important deterioration (CID, 60 mL in FEV₁, 2 points in CAT, or frequent AECOPD) during follow-up were considered to have treatment needs. Sankey diagrams were employed to show the relationship between treatment needs at baseline and follow-up. Logistic regression was used to examine the association between baseline indicators and the risk of annualized CID. The incident rate ratio (IRR) was used to assess the efficiency of tiotropium in controlling annualized CID risk.</p><p><strong>Results: </strong>In the discovery cohort, over 50% of patients without severe conditions at baseline experienced annualized CID during follow-up. Continued smoking, smoking pack-years ≥30, and positive bronchodilator response (BDR) were associated with increased risk of annualized CID in both the discovery [odds ratio (OR) =1.96, 1.76, and 2.47, respectively] and validation cohorts (OR =2.82, 3.23, and 3.49, respectively). Tiotropium could reduce the risk of annualized CID [IRR =0.61, 95% confidence interval (CI): 0.51-0.72].</p><p><strong>Conclusions: </strong>In patients with mild-to-moderate COPD, half may experience disease progression and are characterized by continued smoking, a smoking history of ≥30 pack-years, and a positive BDR. These risks of disease progression could be partly decreased with tiotropium inhalation.</p>","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":"17 8","pages":"5480-5491"},"PeriodicalIF":1.9,"publicationDate":"2025-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12433070/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145064973","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of obstructive sleep apnea severity and treatment on COVID-19 vaccine-induced immune responses.","authors":"Lan Chen, Sun Zhang, Zhao Chen, Jinling Cheng, Canjie Chen, Tian Tang, Jingxian Zhao, Jincun Zhao, Nanshan Zhong, Nuofu Zhang, Airu Zhu","doi":"10.21037/jtd-2025-391","DOIUrl":"10.21037/jtd-2025-391","url":null,"abstract":"<p><strong>Background: </strong>Obstructive sleep apnea (OSA) is a common disorder linked to immune dysregulation and increased risk of severe coronavirus disease 2019 (COVID-19) outcomes. While vaccination is essential for preventing infection and severe disease, the impact of OSA on vaccine efficacy remains underexplored. This study examines the effects of OSA on immune responses following the third dose of the inactivated severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccine (CoronaVac or BBIBP-CorV).</p><p><strong>Methods: </strong>A total of 97 severe OSA participants with apnea-hypopnea index (AHI) >30 events/hour, and 88 healthy donors (HDs) were enrolled. Among the OSA participants, 43 individuals without symptomatic treatment before and during follow-up were designated as the untreated OSA group, while 41 participants receiving positive airway pressure (PAP) prior to the third COVID-19 vaccine dose were categorized as the treated OSA group. Full-night polysomnography (PSG) was performed to assess OSA severity. Neutralizing antibody (nAb) levels and cellular immune responses were analyzed at multiple time points following booster vaccination.</p><p><strong>Results: </strong>Immune responses in untreated OSA participants were inversely associated with disease severity. Specifically, untreated OSA participants with AHI >50 events/hour exhibited significantly reduced nAb titers, antibody-secreting cell (ASC) frequencies, and circulating T follicular helper (cTfh) cells, indicating impaired immune recall responses. In contrast, PAP-treated OSA participants demonstrated improved humoral responses, notably at peak immune response stages.</p><p><strong>Conclusions: </strong>These findings highlight a severity-dependent impairment of vaccine-induced immune responses in untreated OSA participants, with evidence that PAP treatment may enhance vaccine efficacy. This study emphasizes the need to consider OSA severity and treatment when optimizing vaccination strategies for this population.</p>","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":"17 8","pages":"5610-5625"},"PeriodicalIF":1.9,"publicationDate":"2025-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12433113/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145064963","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between electrolyte supplementation and cardiac injury in long COVID-19.","authors":"Xida Li, Yonghua Chen, Shuo Sun, Haojian Dong, Jianfang Luo","doi":"10.21037/jtd-2025-689","DOIUrl":"10.21037/jtd-2025-689","url":null,"abstract":"<p><strong>Background: </strong>Cardiac injury is a common complication of long coronavirus disease 2019 (COVID-19), affecting heart function and quality of life. This study aimed to investigate the association between electrolyte supplementation and cardiac injury in long COVID-19.</p><p><strong>Methods: </strong>This retrospective study was conducted at Guangdong Provincial People's Hospital Zhuhai Hospital (Zhuhai Golden Bay Hospital), utilizing data from patients with cardiac injury related to long COVID-19 who were admitted and managed between January 2021 and January 2023. The patients were grouped according to electrolyte supplementation (supplementation group) or no supplementation (control group). The outcomes included heart rate variability (HRV) parameters, the Minnesota Heart Failure Quality of Life questionnaire, and numerical rating scale (NRS) assessments of quality of life.</p><p><strong>Results: </strong>A total of 144 patients with cardiac injury related to long COVID-19 were included in the analysis (supplementation group, n=72; control group, n=72). After adjusting for age, sex, creatinine, total cholesterol, and low-density lipoprotein, multivariable linear regression analysis indicated a significant association between supplementation and increased levels of potassium [β=1.3, 95% confidence interval (CI): 1.1-1.5, P=0.001] and magnesium (β=0.18, 95% CI: 0.07-0.29, P=0.001), as well as improvements in HRV parameters, including standard deviation of normal-to-normal RR intervals over 24 hours, root mean square of successive differences, and high-frequency domain indices/low-frequency domain indices (all P<0.05). Additionally, supplementation correlated with a reduced frequency of premature contractions (β=-5.61, 95% CI: -7.50 to -3.72, P=0.01), lower Minnesota scores (β=-6.7, 95% CI: -9.1 to -4.3, P=0.001), and decreased NRS scores (β=-7.2, 95% CI: -6.5 to -7.9, P=0.02).</p><p><strong>Conclusions: </strong>Electrolyte supplementation may be beneficial in managing cardiac injury associated with long COVID-19. Further research is needed to clarify the role of electrolytes in cardiac injury related to long COVID-19 and to explore management strategies that incorporate electrolyte supplementation.</p>","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":"17 8","pages":"5993-6003"},"PeriodicalIF":1.9,"publicationDate":"2025-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12433138/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145064970","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}