Journal of thoracic disease最新文献

{"title":"LTB4R inhibits apoptosis and induces radiosensitivity by promoting the PI3K/AKT pathway in esophageal squamous cell carcinoma.","authors":"Yanhui Li, Dehua Ma, Jiawei Liang, Jianlei Yu, Hanxi Zhou, Hao Liu, Ying Zhang, Pengfei Sheng, Minhua Ye, Chunguo Wang, Min Kong, Xuelian Chen, Jianfei Shen","doi":"10.21037/jtd-2026-0819","DOIUrl":"10.21037/jtd-2026-0819","url":null,"abstract":"<p><strong>Background: </strong>Radiotherapy (RT) is a critical treatment modality for esophageal squamous cell carcinoma (ESCC), yet radioresistance poses a major clinical challenge. Prior studies have reported elevated leukotriene B4 receptor (LTB4R) expression in ESCC tissues versus adjacent normal tissues, where it promotes cell proliferation, invasion, and metastasis. However, the correlation between LTB4R expression and ESCC radioresponsiveness remains uninvestigated. This study aimed to clarify LTB4R's role in regulating ESCC cell sensitivity to RT and its underlying molecular mechanisms.</p><p><strong>Methods: </strong><i>In vitro</i>, Cell Counting Kit-8 (CCK-8), colony formation, scratch, and Transwell assays evaluated LTB4R's effects on ESCC cell proliferation, migration, and invasion post-RT. <i>In vivo</i>, subcutaneous xenograft models were established; mice were stratified into RT and non-RT groups, with immunohistochemistry (IHC) and hematoxylin-eosin (HE) staining to assess LTB4R's function. Transcriptome sequencing identified downstream pathways, which were validated via flow cytometry and Western blot.</p><p><strong>Results: </strong>LTB4R knockdown suppressed malignant phenotypes of ESCC cells after RT <i>in vitro</i>. Combined LTB4R inhibition and RT significantly reduced tumor volume <i>in vivo</i>, enhancing therapeutic efficacy. Mechanistically, LTB4R modulated ESCC radiosensitivity by activating the phosphoinositide 3-kinase (PI3K)/protein kinase B (AKT) and apoptotic signaling pathways.</p><p><strong>Conclusions: </strong>LTB4R regulates ESCC radioresponse via the PI3K/AKT-apoptosis axis, and holds potential as a predictive biomarker for RT efficacy in ESCC.</p>","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":"18 7","pages":"745"},"PeriodicalIF":2.3,"publicationDate":"2026-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13460194/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148712844","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 pleural anthracosis severity on the structure and function of subcarinal lymph nodes.","authors":"Xiaodong Zhang, Jie Liu, Jian Sun, Zhan Liu, Hongbo Guo, Weipeng Shao","doi":"10.21037/jtd-2026-1274","DOIUrl":"10.21037/jtd-2026-1274","url":null,"abstract":"<p><strong>Background: </strong>Pleural anthracosis (PA), characterized by the deposition of carbonaceous particles in the subpleural region, is a common pathological finding associated with environmental air pollution, yet its specific impact on regional lymph node (LN) biology remains poorly understood. This study aimed to investigate the structural and functional alterations in subcarinal LNs, correlating these changes with varying degrees of PA.</p><p><strong>Methods: </strong>Based on thoracoscopic imaging, PA was categorized into four grades by three associate chief physicians of thoracic surgery, and the PA area ratio was quantified using ImageJ software. The corresponding subcarinal LNs were analyzed via hematoxylin-eosin (HE), Masson's trichrome, Elastica van Gieson (EVG) staining, and immunohistochemistry for Ki67 (proliferation), CD31 (vascular endothelium), CD68 (macrophages), and D2-40 (lymphatic endothelium).</p><p><strong>Results: </strong>Results demonstrated that increased PA severity was associated with greater accumulation of black particulate matter within the LN capsule and medulla. EVG staining revealed minimal collagen and elastic fiber deposition across most groups, with scant elastic fibers only observed in the highest PA grade (90%). Notably, quantitative analyses of Ki67, CD31, CD68, and D2-40 immunostaining-encompassing positive cell ratio, density, mean optical density, H-score, and Immunoreactive Score (IRS)-all exhibited a consistent non-linear trend, initially increasing and subsequently declining with advancing PA severity.</p><p><strong>Conclusions: </strong>These findings suggest that PA induces significant but complex, non-progressive modulations in LNs microstructure, cellular proliferation, vascularity, macrophage presence, and lymphatic integrity. This study provides novel insights into the pathophysiological interplay between environmental particulate deposition and regional immune tissue remodeling, warranting further investigation into its potential implications for lymphatic function and immune surveillance in the context of pulmonary pathology.</p>","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":"18 7","pages":"779"},"PeriodicalIF":2.3,"publicationDate":"2026-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13462965/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148720944","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":"Burden of multidrug-resistant and extensively drug-resistant tuberculosis in China, India and Russia: estimates from the GBD 2023 study.","authors":"Jian-Di Li, Zong-Yu Li, Kun-Hua Xiong, Jing-Wen Ling, Guo-Qiang Chen, Huan-Huan Tang, Bei-Bei Huang, Yu-Ting Chen, Gang Chen, Zong Ning, Hui Feng","doi":"10.21037/jtd-2026-0761","DOIUrl":"10.21037/jtd-2026-0761","url":null,"abstract":"<p><strong>Background: </strong>Multidrug-resistant and extensively drug-resistant tuberculosis (MDR-TB/XDR-TB) strains are complicating global tuberculosis (TB) control, with China, India, and Russia bearing the heaviest burdens. This study aimed to map their epidemiological profiles to guide targeted interventions.</p><p><strong>Methods: </strong>Epidemiological data were collected from the Global Burden of Disease Study (GBD) 2023. Joinpoint regression, decomposition, age-period-cohort, and autoregressive integrated moving average (ARIMA) analyses were performed.</p><p><strong>Results: </strong>China, India, and Russia ranked among the top three globally in the absolute number of MDR-TB/XDR-TB cases. Over the past 30 years, China had seen a significant decrease in the age-standardized rate of MDR-TB, contrasting with the rising trends in India and Russia, with epidemiological changes being the main driving factor. China had a significantly negative net drift value for XDR-TB mortality, indicating an overall decline across age groups over time, whereas India and Russia had significantly positive values, indicating an overall increase across age groups. In recent years, the burden of XDR-TB had decreased in China and Russia, while there had been no significant change in India. In all three countries, disease burden was higher in men than women, with significant differences in peak age. Predictions indicate rising XDR-TB prevalence in India and Russia, while China's indicators were expected to stabilize.</p><p><strong>Conclusions: </strong>MDR-TB/XDR-TB's epidemiological characteristics differ significantly among China, India, and Russia, necessitating the development of differentiated prevention and control strategies and strengthened joint efforts.</p>","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":"18 7","pages":"765"},"PeriodicalIF":2.3,"publicationDate":"2026-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13460139/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148712928","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":"Initial experience with the EndoFusion 3D system for noninvasive intraoperative localization of pulmonary nodules.","authors":"Wei Gan, Yi Yu, Wu-Ke Peng, Qi-Lin Huang, Xiao-Yue Peng, Chun-Lin Ye","doi":"10.21037/jtd-2026-0899","DOIUrl":"10.21037/jtd-2026-0899","url":null,"abstract":"<p><strong>Background: </strong>Intraoperative localization of small peripheral pulmonary nodules remains difficult during video-assisted thoracoscopic surgery (VATS), especially for subcentimeter and ground-glass-predominant lesions. Conventional computed tomography (CT) guided localization is effective but invasive and carries radiation exposure and puncture-related risks. This study assessed the feasibility and safety of EndoFusion, a system that projects preoperative three-dimensional (3D) information onto real-time thoracoscopic views to assist localization.</p><p><strong>Methods: </strong>A single-center retrospective study was conducted on patients undergoing VATS sublobar resection with EndoFusion-assisted localization. Preoperative 3D models were generated from thin-slice CT and registered to the pleural surface intraoperatively. Technical success, localization accuracy, perioperative outcomes, and complications were assessed.</p><p><strong>Results: </strong>Fifteen patients with a total of 19 peripheral pulmonary nodules were included. The median nodule size was 8.0 mm and the median pleural depth was 3.0 mm, with most lesions characterized as pure ground-glass nodules (pGGNs) or consolidation-to-tumor ratio (CTR) ≤0.25. All patients successfully underwent VATS resection without conversion, including wedge resection (60.0%), combined wedge and segmentectomy (26.7%), or segmentectomy (13.3%). The median operative time was 75 minutes, and EndoFusion registration was completed in a median of 128 seconds. Intraoperative blood loss was minimal (median 50 mL), and no intraoperative complications occurred. Two patients (13.3%) developed minor postoperative complications, and the median hospital stay was 4 days.</p><p><strong>Conclusions: </strong>EndoFusion provides a feasible, safe, and fully noninvasive intraoperative localization method for VATS. By projecting patient-specific 3D anatomy directly onto the operative field, it enhances precision, reduces cognitive burden, and may serve as an effective alternative to conventional preoperative localization.</p>","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":"18 7","pages":"757"},"PeriodicalIF":2.3,"publicationDate":"2026-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13460179/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148712998","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":"Surgery compared with medical treatment in patients with type A aortic intramural hematoma: a systematic review and meta-analysis.","authors":"Si-Qi Lyu, Yan-Min Yang, Juan Wang, Yi-Jing Xin, Li-Hui Zheng, Shuang Wu","doi":"10.21037/jtd-2026-1104","DOIUrl":"10.21037/jtd-2026-1104","url":null,"abstract":"<p><strong>Background: </strong>The optimal management strategy for type A aortic intramural hematoma (IMH) remains controversial. In these patients, we conducted a meta-analysis to assess outcomes following early surgery (ES) <i>vs.</i> initial medical treatment (MT).</p><p><strong>Methods: </strong>A systematic search of PubMed, the Cochrane Library, EMBASE, and ClinicalTrials.gov was performed. Studies that compared ES with initial MT for type A IMH were eligible.</p><p><strong>Results: </strong>Across 22 studies of 1,831 participants, the ES group demonstrated a non-significant lower in-hospital mortality [relative risk (RR): 0.74; 95% confidence interval (CI): 0.50-1.10] and significantly reduced all-cause mortality during follow-up (RR: 0.56; 95% CI: 0.37-0.83) compared with the initial MT group. No significant difference was detected in the risk of aortic-related death between the ES group and the initial MT group. Patients receiving initial MT but converted to timely surgery (CS) later had a comparable in-hospital mortality [ES <i>vs.</i> CS: RR (95% CI): 0.85 (0.44-1.64)] and significantly reduced all-cause mortality during follow-up [ES <i>vs.</i> CS: RR (95% CI): 3.80 (1.12-12.84)] compared with the ES group. When excluding patients declining doctor-recommended surgery (DS) from the initial MT group, the risk of in-hospital death was comparable between the ES group and the initial MT-DS group [RR (95% CI): 1.04 (0.49-2.17)].</p><p><strong>Conclusions: </strong>In patients with type A IMH, ES was associated with non-significantly lower in-hospital mortality and remarkably reduced all-cause mortality during follow-up compared with initial MT. Conversion from initial MT to timely surgery yielded non-inferior outcomes compared with ES, suggesting that a \"wait-and-see\" strategy might also lead to acceptable outcomes in selected patients. Further high-quality prospective studies are required to establish the optimal management approach for this population.</p>","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":"18 7","pages":"730"},"PeriodicalIF":2.3,"publicationDate":"2026-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13460205/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148713001","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":"A layered target-release nanoparticle system for normalizing the lung cancer microenvironment and enhancing antitumor effect.","authors":"Linjia Zhu, Xiaoqiang Chen, Dong Chun, Qiuyan Lin, Shaofei Yuan","doi":"10.21037/jtd-2026-1195","DOIUrl":"10.21037/jtd-2026-1195","url":null,"abstract":"<p><strong>Background: </strong>Abnormal tumor vasculature and dense collagen fiber networks contribute to elevated interstitial pressure in solid tumors, compressing blood vessels and impairing the delivery of nanoparticle (NP)-based therapeutics. Promoting normalization of the tumor microenvironment is a promising strategy for enhancing drug penetration. This study aimed to develop a pH-responsive bilayer nanoplatform capable of sequentially delivering a microenvironment modulator and a targeted chemotherapeutic agent for improved efficacy against lung cancer.</p><p><strong>Methods: </strong>We designed a bilayer lipid NP system with an inner core of triptolide (TPL) encapsulated in folic acid-modified chitosan for tumor cell targeting. The outer layer was composed of pH-sensitive dioleoylphosphatidylethanolamine (DOPE) lipids, co-encapsulated ligustrazine (LT), and TPL-loaded nanoparticles (TPL-NPs) to form LT-co-encapsulated TPL-NPs (LT@TPL-NPs). NP characterization, pH-responsive release profiling, and <i>in vitro</i> cellular uptake assays were performed. All animal experiments were conducted following institutional ethical guidelines.</p><p><strong>Results: </strong>In the acidic tumor microenvironment, LT@TPL-NPs triggered the sequential release of LT followed by TPL-NPs. LT promoted the normalization of the tumor microenvironment, characterized by reduced interstitial pressure and enhanced NP penetration depth. The released TPL-NPs, modified with folic acid and carrying a positive surface charge, demonstrated efficient cellular uptake and intracellular drug delivery in lung cancer cell models.</p><p><strong>Conclusions: </strong>This pH-responsive bilayer nanoplatform enables spatiotemporally controlled release of a microenvironment-modulating agent and a targeted chemotherapeutic, achieving synergistic effects of physical barrier remodeling and tumor cell cytotoxicity. This strategy offers a potential approach to overcoming delivery barriers in solid tumors and should be further evaluated in preclinical models of thoracic malignancy.</p>","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":"18 7","pages":"789"},"PeriodicalIF":2.3,"publicationDate":"2026-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13460222/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148712863","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":"Gastroesophageal reflux disease predicts 6-month readmission in acute exacerbation of chronic obstructive pulmonary disease: development and validation of a nomogram.","authors":"Qiaoyun Zhou, Guangxi Zhu, Peng Zhang, Baolong Qi","doi":"10.21037/jtd-2026-0849","DOIUrl":"10.21037/jtd-2026-0849","url":null,"abstract":"<p><strong>Background: </strong>Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide, and acute exacerbation of COPD (AECOPD) frequently leads to hospitalisation and early readmission. Gastroesophageal reflux disease (GERD) is a common comorbidity in COPD, but its role in predicting post-discharge readmission remains unclear. This study aimed to investigate the impact of GERD on the risk of 6-month readmission in patients with AECOPD and to develop an individualized predictive nomogram model.</p><p><strong>Methods: </strong>A total of 683 patients with AECOPD admitted to the Department of Respiratory Medicine, Anhui No. 2 Provincial People's Hospital, between May 2023 and March 2025 were prospectively enrolled. GERD was assessed using the GERD Questionnaire, with a total score of ≥8 used as the diagnostic cutoff. All patients were followed up for 6 months after discharge. Regression analyses were performed to identify predictors and develop a nomogram, followed by internal validation.</p><p><strong>Results: </strong>Among the 683 enrolled patients, the overall 6-month readmission rate was 29.6% (202/683). Multivariate logistic regression analysis showed that acute exacerbation in previous 1 year [odds ratio (OR) =1.629; 95% confidence interval (CI): 1.035-2.563; P=0.03], GERD (OR =2.553; 95% CI: 1.616-4.033; P<0.001), Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage (OR =1.365; 95% CI: 1.097-1.697; P=0.005), and B-type natriuretic peptide (BNP) (OR =1.008; 95% CI: 1.002-1.014; P=0.006) were independent risk factors for readmission within 6 months after discharge for AECOPD patients, while body mass index (BMI) (OR =0.875; 95% CI: 0.814-0.940; P<0.001) was a protective factor. The model demonstrated moderate discriminative ability, with an area under the curve (AUC) of 0.708 (95% CI: 0.653-0.758) in the training group and 0.731 (95% CI: 0.648-0.784) in the validation group. The calibration curve demonstrated good model fit, and decision curve analysis confirmed that the model had clinical utility within the threshold range of 0.2 to 0.6.</p><p><strong>Conclusions: </strong>A prediction model based on five clinically accessible variables-BMI, acute exacerbation in previous 1 year, GERD, GOLD stage, and BNP-can effectively identify patients at high risk for readmission within 6 months following discharge for AECOPD. This finding suggests that GERD is an important predictor of readmission in AECOPD patients following discharge.</p>","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":"18 7","pages":"729"},"PeriodicalIF":2.3,"publicationDate":"2026-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13460143/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148712943","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":"The combination of pralsetinib and bevacizumab enhances antitumor activity against KIF5B-RET lung cancer via PI3K/AKT pathway.","authors":"Xia Wang, Gaofeng Yuan, Li Cong, Zhen Song, Lili Lin, Zhugen Cao","doi":"10.21037/jtd-2026-1-0012","DOIUrl":"10.21037/jtd-2026-1-0012","url":null,"abstract":"<p><strong>Background: </strong>Although pralsetinib has shown promising efficacy in rearranged during transfection (RET) fusion-positive non-small cell lung cancer (NSCLC), acquired resistance remains a major clinical challenge and requires effective combination strategies. The study aims to explore the antitumor efficacy of the combined treatment of pralsetinib and bevacizumab in RET fusion-positive NSCLC.</p><p><strong>Methods: </strong>Ba/F3 stably expressing KIF5B-RET and subsequent pralsetinib resistant cell line were used for evaluating the antitumor efficacy <i>in vitro</i> and <i>in vivo</i>. The 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay was used to evaluate the proliferative ability of Ba/F3 cell lines. The vascular endothelial growth factor (VEGF) levels in the cell supernatant were detected using the enzyme-linked immunosorbent assay (ELISA) method. Blood vessels in tumor were detected by Immunohistochemical staining.</p><p><strong>Results: </strong>In this study, we demonstrated that the anti-angiogenic agent bevacizumab combined with pralsetinib can increase the sensitivity of Ba/F3 cells harboring KIF5B-RET fusion to pralsetinib through the phosphatidylinositol 3-kinase/protein kinase B (PI3K/AKT) pathway. Through ELISA, we observed that the levels of VEGF were elevated when the cell line developed drug resistance. Furthermore, <i>in vivo</i> experiment showed that combination therapy reduced microvessel density, decreased tumor volume, and significantly inhibited the PI3K/AKT pathway.</p><p><strong>Conclusions: </strong>Collectively, our results suggest that the combination of pralsetinib and bevacizumab is a promising approach for treating RET fusion-positive NSCLC.</p>","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":"18 7","pages":"720"},"PeriodicalIF":2.3,"publicationDate":"2026-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13460060/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148713029","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":"Refining the framework of cardiac prehabilitation: insights from the PREQUEL trial and beyond.","authors":"Derek King Wai Yau, Henry Man Kin Wong, Anna Lee","doi":"10.21037/jtd-2026-1383","DOIUrl":"10.21037/jtd-2026-1383","url":null,"abstract":"","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":"18 7","pages":"818"},"PeriodicalIF":2.3,"publicationDate":"2026-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13460210/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148713065","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":"Development and preliminary internal validation of a prediction model incorporating cardiac troponin I (cTnI), N-terminal pro-B-type natriuretic peptide (NT-proBNP), and thyroid function for no-reflow during percutaneous coronary intervention in patients with acute coronary syndrome.","authors":"Yuanyuan Wang, Jianfei Wang, Haipeng Zhang, Yang Cao","doi":"10.21037/jtd-2026-1485","DOIUrl":"10.21037/jtd-2026-1485","url":null,"abstract":"<p><strong>Background: </strong>Coronary artery disease is a leading global cause of death, and acute coronary syndrome (ACS) is its most critical acute form. Percutaneous coronary intervention (PCI) is the standard reperfusion treatment for this condition, but no‑reflow occurs in 30-40% of emergency PCI cases, and this phenomenon is associated with higher mortality and poor prognosis. Coagulation, cardiac, and thyroid function markers, reflecting thrombus burden, myocardial injury, and vascular dysfunction, are closely correlated with no‑reflow, but single biomarkers have limited predictive value. This study aimed to screen independent no-reflow risk factors, build and validate a multivariate model for clinical risk assessment and prevention in ACS patients.</p><p><strong>Methods: </strong>This single‑center retrospective study enrolled a total of 136 patients with ACS admitted to The Second Hospital of Tianjin Medical University in 2024 as the development cohort. Patients were divided into a normal blood flow group (110 cases) and a no-reflow group (26 cases). Preoperative levels of D-dimer, fibrin monomer (FM), von Willebrand factor (VWF), N-terminal pro-B-type natriuretic peptide (NT-proBNP), cardiac troponin I (cTnI) and thyroid function indices were measured. We analyzed intergroup differences and constructed a multivariate logistic regression model to screen independent risk factors for no-reflow. Receiver operating characteristic (ROC) curves were used to evaluate the predictive performance of both individual indicators and the established model, while bootstrap resampling combined with calibration analysis was adopted for internal validation.</p><p><strong>Results: </strong>The proportion of hypertension and the levels of D-dimer, FM, VWF, cTnI, and NT-proBNP were higher in the no-reflow group compared with the normal reflow group (P<0.05), while FT3 concentration was lower (P<0.05). Multivariate logistic regression showed that high levels of D-dimer, FM, VWF, cTnI, and NT-proBNP, along with a low level of FT3, were independent risk factors for no-reflow (P<0.05). ROC curve analysis indicated that the prediction model (incorporating all six independent risk factors) had a diagnostic value for no-reflow. Individual indicators also demonstrated good predictive performance.</p><p><strong>Conclusions: </strong>The preliminary prediction model based on preoperative D-dimer, FM, VWF, cTnI, NT-proBNP, and FT3 levels shows promising predictive performance for no‑reflow, but these findings are exploratory. It should not yet be considered a definitive clinical tool, but may inform future risk‑stratification research.</p>","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":"18 7","pages":"793"},"PeriodicalIF":2.3,"publicationDate":"2026-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13459938/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148712877","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}