Journal of thoracic disease最新文献

{"title":"A bibliometric analysis of research trends in mediastinitis: a rare, high mortality, and complex infectious disease.","authors":"Fangfang Deng, Ronghui Chen, Shengshan Liu, Guangli Yang, Dandan Zhou, Anyong Yu, Cui Yang, Tianxi Zhang","doi":"10.21037/jtd-2026-1333","DOIUrl":"https://doi.org/10.21037/jtd-2026-1333","url":null,"abstract":"<p><strong>Background: </strong>Mediastinitis is a severe infectious disease with complex etiology and high mortality. Existing research involves multiple disciplines, including thoracic surgery, infectious diseases, and radiology, and the findings are relatively scattered. This study aims to analyze the current state and research hotspots of mediastinitis using bibliometric methods, providing a comprehensive analysis of the development in this field and offering guidance and references for future research in this area.</p><p><strong>Methods: </strong>Publications related to mediastinitis from 2005 to 2024 were retrieved from the Web of Science Core Collection (WoSCC) database. VOSviewer, CiteSpace, and the R package \"bibliometrix\" were used for visual analysis of countries, authors, and keywords in selected literature.</p><p><strong>Results: </strong>A total of 1,510 articles from 64 countries were included in this study. The publication volume in the field of mediastinitis has stabilized in recent years. Major research hubs include the United States, China, Japan, and Europe. <i>Interactive Cardiovascular and Thoracic Surgery</i> is the most productive journal, while <i>Annals of Thoracic Surgery</i> is the most cited in collaborative research. Research contributions come from 7,478 authors, with Ingemansson R being the most prolific contributor. The most common keyword is \"management\". Keyword clustering analysis revealed three main research areas: etiology, treatment, and complications. The keyword emergence results indicate that early studies have focused on complications following thoracic surgery. Recent research has shifted its attention to non-surgical sources of infections, chronic types, and their associated complications.</p><p><strong>Conclusions: </strong>Mediastinitis is a rare and critical condition with complexity, and a single diagnosis and treatment approach is often insufficient to address it. A multidisciplinary collaborative management system is of vital importance for improving the prognosis of such patients. Research on mediastinitis shows a clear regional imbalance, and cross-team and international collaboration should be strengthened to promote the development of a systematic body of research in this field. Non-surgical mediastinitis and chronic mediastinitis, especially when combined with chronic diseases such as diabetes, may become the focus of future research.</p>","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":"18 9","pages":"1016"},"PeriodicalIF":2.3,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13655853/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149182781","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":"Glycyrrhizic acid attenuates sepsis-induced acute lung injury by regulating macrophage M2 polarization via PRKCD.","authors":"Yikun Chen, Yucheng Liu, Jiayi Shen, Kerong Wang, Jun Jiang, Huazhong Cai, Jiangning Yin","doi":"10.21037/jtd-2026-1327","DOIUrl":"https://doi.org/10.21037/jtd-2026-1327","url":null,"abstract":"<p><strong>Background: </strong>Although glycyrrhizic acid (GA) has anti-inflammatory properties and protein kinase C delta (PRKCD) is involved in sepsis, whether GA alleviates sepsis-induced acute lung injury (SI-ALI) by regulating macrophage polarization via PRKCD remains unclear. This study aimed to investigate the protective effects of GA in SI-ALI and explore the underlying molecular mechanisms, with a focus on macrophage polarization mediated by PRKCD.</p><p><strong>Methods: </strong>A cecal ligation and puncture (CLP) model was used to induce sepsis in mice. GA was administered intraperitoneally at different doses for <i>in vivo</i> intervention, and PRKCD overexpression was employed to validate the mechanism. <i>In vitro</i>, an inflammatory model was established by lipopolysaccharide (LPS) stimulation of RAW 264.7 macrophage cells, followed by GA treatment and PRKCD silencing or overexpression. Hematoxylin and eosin (HE) staining, lung wet-to-dry weight (W/D) ratio measurement, immunohistochemistry, flow cytometry, immunofluorescence, Cell Counting Kit-8 (CCK-8) assay, terminal deoxynucleotidyl transferase dUTP nick-end labeling (TUNEL), Western blot, and enzyme-linked immunosorbent assay (ELISA) were used to assess inflammation, PRKCD expression, and macrophage polarization in lung tissues and cells.</p><p><strong>Results: </strong>GA significantly alleviated CLP-induced lung tissue injury and pulmonary edema (W/D ratio: 4.5±0.8 <i>vs.</i> 6.7±0.8 in the Model group, P<0.01) and reduced tumor necrosis factor-alpha (TNF-α) and interleukin-1 beta (IL-1β) levels in bronchoalveolar lavage fluid (BALF; from 211±18 to 82±9 pg/mL and from 162±16 to 52±10 pg/mL, respectively, P<0.001). In LPS-stimulated macrophages, GA enhanced cell viability (CCK-8: 83%±6% <i>vs.</i> 55%±4% in the LPS group, P<0.01), reduced apoptosis (TUNEL-positive cells: 20%±3% <i>vs.</i> 64%±6%, P<0.001), suppressed M1 polarization (CD86: 15%±4% <i>vs.</i> 45%±7%, P<0.01), promoted M2 polarization (CD206: 38%±7% <i>vs.</i> 3%±2%, P<0.01), and decreased pro-inflammatory cytokine secretion. PRKCD expression was upregulated under septic conditions. PRKCD silencing mitigated LPS-induced inflammation and modulated macrophage polarization, whereas PRKCD overexpression partially reversed the protective effects of GA.</p><p><strong>Conclusions: </strong>GA exerts anti-inflammatory and lung-protective effects in SI-ALI, and our findings suggest that these effects are associated with PRKCD inhibition and restoration of macrophage polarization balance. These results identify PRKCD as a candidate target and support further investigation of GA as a potential therapeutic strategy for SI-ALI.</p>","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":"18 9","pages":"1008"},"PeriodicalIF":2.3,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13656050/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149182799","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":"Near-infrared fluorescent clip-guided navigation in robot-assisted thoracoscopic esophagectomy for esophageal cancer: a single-center feasibility study.","authors":"Kohei Kanamori, Kazuo Koyanagi, Miho Yamamoto, Yoshiaki Shoji, Akihito Kazuno, Yamato Ninomiya, Mika Ogimi, Takatoshi Seki, Kohei Tajima, Rie Nakashima, Masaki Mori, Masashi Yoshida","doi":"10.21037/jtd-2026-1290","DOIUrl":"https://doi.org/10.21037/jtd-2026-1290","url":null,"abstract":"<p><strong>Background: </strong>In esophageal cancer surgery, ensuring a sufficient proximal margin without excessive resection is important for oncological safety and minimizing surgical difficulty in anastomosis. In robot-assisted surgery, direct tumor palpation is not possible, and conventional methods such as endoscopic tattooing or intraoperative endoscopy have certain limitations. This study aimed to evaluate the feasibility and clinical utility of a new near-infrared fluorescent clip (Xemex FS marker) for tumor localization during robot-assisted esophagectomy.</p><p><strong>Methods: </strong>This study included 60 consecutive patients with esophageal or esophagogastric junction (EGJ) cancer who underwent robot-assisted esophagectomy using the Xemex FS marker. In addition, 64 historical control patients who underwent robot-assisted esophagectomy without fluorescent clip-guided navigation were included for exploratory comparison of surgical margin outcomes. Two fluorescent clips were placed 1 cm oral to the tumor on the right side of the esophageal wall via endoscopy the day before surgery. The Firefly system of the da Vinci surgical system was used to confirm the clip location and determine the esophageal cutline. Surgical outcomes, complications, and proximal margin outcomes were evaluated.</p><p><strong>Results: </strong>Clip placement was successful in 59 of 60 patients (98.3%), and the fluorescent signal was detected intraoperatively in all 59 patients. No clip-related intraoperative complications were observed. The median proximal margin from the tumor was 52 mm in the fluorescent clip group and 48 mm in the control group, with no significant difference between the groups. Tumor exposure at transection was not observed in the fluorescent clip group, whereas it occurred in two patients in the control group. Intraoperative endoscopy was not required in any case in the fluorescent clip group.</p><p><strong>Conclusions: </strong>Near-infrared fluorescent clip navigation was feasible for intraoperative tumor localization during robot-assisted esophagectomy. This technique may improve surgical precision and simplify intraoperative workflow by eliminating the need for intraoperative endoscopy.</p>","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":"18 9","pages":"1027"},"PeriodicalIF":2.3,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13655904/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149182834","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":"Monitoring multiple rib fractures using pulmonary electrical impedance tomography technology: correlation analysis of pulmonary ventilation changes.","authors":"Liming Wang, Lingqing Zhou, Picong You, Qiuyi Wang, Zhanqi Zhao, Honggang Xia, Dongbin Wang","doi":"10.21037/jtd-2026-1350","DOIUrl":"https://doi.org/10.21037/jtd-2026-1350","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Multiple rib fractures are a common and severe form of chest trauma, which can lead to pulmonary ventilation disorders. Assessment primarily relies on imaging examinations and conventional pulmonary function tests. Electrical impedance tomography (EIT) technology can detect ventilation dysfunctions that are difficult to identify through conventional means. This study utilizes EIT technology to quantify global and regional pulmonary ventilation inhomogeneity and to analyze the correlation between these ventilation characteristics and various factors associated with multiple rib fractures, thereby providing preliminary support for subsequent of intervention and prognosis assessment of rib fractures in EIT.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A cross-sectional exploratory study was conducted. A total of 115 patients with multiple rib fractures admitted to the Department of Cardiothoracic Surgery at Tianjin Hospital in Tianjin City from October 2020 to May 2023 were selected. EIT examinations were performed 24-72 hours after injury, and trauma and EIT data were collected and organized. Whole chest/lung indicators included: pain score [numerical rating scale (NRS)], total number of rib fractures, total number of displaced rib fractures, number of lung contusion lobes, global inhomogeneity index (GI), ventral-to-dorsal ventilation center (CoV&lt;sub&gt;v-d&lt;/sub&gt;), pendelluft (Ap), inspiration delay time (T&lt;sub&gt;ins-i&lt;/sub&gt;), expiration delay time (T&lt;sub&gt;exp-i&lt;/sub&gt;). Regional chest/lung indicators included: total number of (left lateral + left posterior) displaced rib fractures, total number of (right lateral + right posterior) displaced rib fractures, number of left/right lung contusion lobes, left dorsal lung impedance proportion (TIV&lt;sub&gt;D-L&lt;/sub&gt;%), right dorsal lung impedance proportion (TIV&lt;sub&gt;D-R&lt;/sub&gt;%), left dorsal lung Ap (Ap&lt;sub&gt;D-L&lt;/sub&gt;), and right dorsal lung Ap (Ap&lt;sub&gt;D-R&lt;/sub&gt;). Spearman correlation analysis was used for the data.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The number of lung contusion lobes and EIT global-lung parameters (CoV&lt;sub&gt;v-d&lt;/sub&gt;, Ap, T&lt;sub&gt;exp-i&lt;/sub&gt;) all showed a good correlation with the number of rib fractures (P&lt;0.05), especially with the number of displaced rib fractures (P&lt;0.01). The greater the number of rib fractures, the most severe the pain (P&lt;0.01). Changes in EIT parameters were significantly correlated with the degree of pain (P&lt;0.05/0.01). Multiple rib fractures can exacerbate pulmonary injury in the trauma area (P&lt;0.05/0.01), resulting in a reduction of tidal impedance variation in region of interest percentage (TIV&lt;sub&gt;ROI&lt;/sub&gt;%) (P&lt;0.05/0.01), with Ap in this region being more pronounced than in other regions (P&lt;0.05/0.01). Regional Ap was significantly correlated with the local number of displaced rib fractures (P&lt;0.01).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;EIT can provide dynamic ventilation images for patients with rib fractures, quantifying regional ventilation disorders and ","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":"18 9","pages":"1029"},"PeriodicalIF":2.3,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13655884/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149182908","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":"Efficacy and safety of neoadjuvant targeted therapy in surgically treated patients with ALK-rearranged non-small cell lung cancer.","authors":"Yudong Liu, Li Fang, Zhongjing Jiang, Hao Tang, Yi Gan, Desong Yang","doi":"10.21037/jtd-2026-1625","DOIUrl":"https://doi.org/10.21037/jtd-2026-1625","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Anaplastic lymphoma kinase (ALK) tyrosine kinase inhibitors (TKIs) have demonstrated substantial efficacy in advanced ALK-rearranged non-small cell lung cancer (NSCLC), but evidence for their use in the neoadjuvant setting remains limited. This study aimed to evaluate and compare the efficacy and safety of neoadjuvant ALK-targeted therapy and chemotherapy-based neoadjuvant treatment in surgically treated patients with ALK-rearranged NSCLC.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We retrospectively analyzed the clinical data of 20 patients with ALK-rearranged NSCLC who received neoadjuvant therapy followed by curative-intent surgery at the Department of Thoracic Surgery, Hunan Cancer Hospital, between October 2018 and April 2025. Patients were retrospectively classified into an ALK-TKI group (n=13) and a chemotherapy-based group (n=7) according to the neoadjuvant regimen received. A comparative analysis assessed radiological response, pathological response, postoperative complications, adverse events, and survival outcomes between the 2 groups after neoadjuvant therapy.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The baseline characteristics of the 2 groups were comparable without statistically significant differences. Among the 13 patients in the ALK-TKI group, 9 achieved partial response (PR) and 4 had stable disease (SD), resulting in an objective response rate (ORR) of 69.2%. Among the 7 patients in the chemotherapy-based group, 3 achieved PR and 4 had SD, resulting in an ORR of 42.9% (P=0.35). Six patients (46.2%) in the ALK-TKI group and one patient (14.3%) in the chemotherapy-based group achieved major pathological response (MPR) (P=0.32). Four patients (30.8%) in the ALK-TKI group and one patient (14.3%) in the chemotherapy-based group achieved pathological complete response (pCR) (P=0.61). The proportion of patients with ypN0 disease was significantly higher in the ALK-TKI group than in the chemotherapy-based group (11/13 vs. 3/7, P=0.043), and the extent of pathological nodal downstaging was also greater in the ALK-TKI group (P=0.008). There were no significant differences between the 2 groups in the incidence of adverse events, grade ≥3 adverse events, postoperative complications, surgical approach, operative time, blood loss, thoracic drainage duration, or postoperative hospital stay. Kaplan-Meier analyses showed nonsignificant numerical trends toward improved overall survival and recurrence-free survival in the ALK-TKI group. However, these findings were based on a small number of recurrence and death events and should be interpreted with caution.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Neoadjuvant ALK-TKI therapy showed numerically higher radiological and pathological response rates and a significantly higher ypN0 rate and greater pathological nodal downstaging relative to the baseline clinical nodal stage compared with chemotherapy-based neoadjuvant therapy. No statistically significant differences in the observed safety or ","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":"18 9","pages":"1043"},"PeriodicalIF":2.3,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13655808/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149182608","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 predictive model for adverse events in left heart failure patients based on cardiopulmonary ultrasound parameters and clinical predictors.","authors":"Yanfen Zhong, Ji Wu, Hongyu Zheng","doi":"10.21037/jtd-2026-2226","DOIUrl":"https://doi.org/10.21037/jtd-2026-2226","url":null,"abstract":"<p><strong>Background: </strong>Left heart failure (LHF) is the most common in clinical setting and is more likely to experience adverse cardiovascular events. This study aims to establish a predictive nomogram of adverse events based on cardiopulmonary ultrasound (CPUS) parameters and clinical predictors for LHF patients. And the predictive performance of the nomogram was assessed.</p><p><strong>Methods: </strong>Potential risk factors associated with the occurrence of adverse events in LHF were analyzed using one-way analysis of variance (ANOVA) or univariate logistic regression. A multivariate logistic regression model was subsequently constructed, and the results were visualized with a nomogram. Then the predictive ability and clinical application value of the nomogram were verified by the concordance index (C-index), calibration curve and decision curve.</p><p><strong>Results: </strong>A total of 329 heart failure patients including 278 males and 51 females, with an average age of (53.62±15.85) years were enrolled in this study. Independent influencing factors of adverse events were identified through multivariate logistic regression. Finally, four indicators were included, namely, systolic pulmonary artery pressure (sPAP) [odds ratio (OR) =15.53, 95% confidence interval (CI): 1.53-157.19, P=0.02], left atrial transverse diameter (LAD) (OR =1.190, 95% CI: 1.031-1.373, P=0.02), E/e' ratio of left ventricle (LV-E/e') (OR =1.241, 95% CI: 1.101-1.399, P<0.001), and the number of B lines (OR =1.591, 95% CI: 1.123-2.254, P=0.009). The C-index of the nomogram model for predicting the risk of adverse events in LHF patients were 0.888 (95% CI: 0.826-0.950). Furthermore, the calibration curve demonstrated great consistency between the predicted probabilities and the observed outcomes, and the decision curve analysis confirmed the important clinical advantage of the model in LHF patients.</p><p><strong>Conclusions: </strong>CPUS may provide valuable prognostic information in patients with LHF. The constructed prediction model for adverse events, incorporating CPUS parameters including sPAP, LAD, LV-E/e', and number of B lines, demonstrated favorable discriminative ability and accuracy within the study cohort.</p>","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":"18 9","pages":"1022"},"PeriodicalIF":2.3,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13655837/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149182750","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":"Incidental pulmonary nodules detected on computed tomography pulmonary angiography: prevalence and malignancy outcomes from a Thai tertiary-care center.","authors":"Korkate Taikerd, Thitiwat Sriprasart","doi":"10.21037/jtd-2026-1524","DOIUrl":"https://doi.org/10.21037/jtd-2026-1524","url":null,"abstract":"<p><strong>Background: </strong>Computed tomography pulmonary angiography (CTPA) is widely used for diagnosing pulmonary embolism (PE) and frequently reveals incidental pulmonary nodules. However, data regarding the prevalence and malignant outcomes of incidental pulmonary nodules, particularly among patients with PE, remain limited in Thailand. This study aimed to investigate the prevalence of incidental pulmonary nodules detected on CTPA and to evaluate malignancy outcomes, particularly in patients with concurrent PE.</p><p><strong>Methods: </strong>This retrospective cohort study included patients aged ≥18 years who underwent CTPA at King Chulalongkorn Memorial Hospital between January 2017 and December 2018. Patients with active lung cancer or known pulmonary metastases were excluded. Clinical characteristics, CTPA findings, and follow-up data were reviewed. Pulmonary nodules were followed until a definitive diagnosis was established, until May 2024, or for a minimum of 2 years in the absence of interval growth.</p><p><strong>Results: </strong>A total of 376 patients were included in the analysis. Incidental pulmonary nodules were identified in 129 patients (34.3%), while PE was diagnosed in 110 patients (29.3%). The prevalence of incidental pulmonary nodules did not differ significantly between the PE-positive and PE-negative groups (29.1% <i>vs.</i> 36.5%; P=0.17). Category-specific analyses demonstrated that patients with PE had a higher proportion of pulmonary nodules >8 mm (21.9% <i>vs.</i> 9.3%) and malignant outcomes (18.8% <i>vs.</i> 3.1%) than those without PE. Relative risks (RRs) with corresponding 95% confidence intervals (CIs) are reported in the Results section. Among the 9 patients ultimately diagnosed with malignancy, most received a definitive diagnosis within 6 months following CTPA.</p><p><strong>Conclusions: </strong>The prevalence of incidental pulmonary nodules detected on CTPA were common and occurred more frequently than previously reported in several international studies. Patients with concurrent PE were more likely to have pulmonary nodules >8 mm and malignant outcomes than patients without PE. These findings suggest that incidental pulmonary nodules detected in patients with concomitant PE may identify a subgroup warranting careful clinical follow-up. Because of the retrospective design and limited number of malignant outcomes, larger prospective studies are required before changes to current surveillance strategies can be recommended.</p>","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":"18 9","pages":"1015"},"PeriodicalIF":2.3,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13655883/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149182867","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":"ZKSCAN3 mitigates lipopolysaccharide-induced acute lung injury by restraining excessive autophagy via activation of the mTOR pathway.","authors":"Lei Zhang, Xinyu Yang, Yiwei Li, Xueshan Bu","doi":"10.21037/jtd-2026-1611","DOIUrl":"https://doi.org/10.21037/jtd-2026-1611","url":null,"abstract":"<p><strong>Background: </strong>Acute lung injury (ALI) is a critical condition marked by dysregulated inflammation and autophagic imbalance. Zinc-finger with KRAB and SCAN domains 3 (ZKSCAN3) is a master transcriptional repressor of autophagy, yet its role in ALI pathogenesis remains unclear. The aim of this study is to elucidate the functional role and underlying mechanisms of ZKSCAN3 in ALI.</p><p><strong>Methods: </strong>ALI was induced in C57BL/6 mice and A549 alveolar epithelial cells by lipopolysaccharide (LPS). ZKSCAN3 was overexpressed using plasmid transfection to evaluate its therapeutic potential. Lung injury was assessed by histopathology, wet-to-dry ratio (W/D ratio), and inflammatory cytokine levels [tumor necrosis factor-alpha (TNF-α), interleukin (IL)-1β, IL-6]. Autophagic activity was evaluated via transmission electron microscopy(TEM), immunofluorescence, and western blotting for LC3-II, Beclin-1, and P62. The involvement of the mTOR pathway was investigated by examining the phosphorylation status of mTOR.</p><p><strong>Results: </strong>ZKSCAN3 expression was significantly downregulated in both LPS-induced lung tissues and A549 cells. Overexpression of ZKSCAN3 markedly alleviated LPS-induced pulmonary edema, alveolar damage, and the surge of pro-inflammatory cytokines. Mechanistically, ZKSCAN3 overexpression suppressed excessive autophagic flux, as evidenced by a decreased LC3-II/LC3-I ratio and Beclin-1 expression, and increased accumulation of P62. Furthermore, this protective effect was associated with a notable increase in mTOR phosphorylation, indicating reactivation of the mTOR-autophagy inhibitory axis.</p><p><strong>Conclusions: </strong>Our findings reveal that downregulation of ZKSCAN3 contributes to the pathogenesis of LPS-induced ALI. Restoration of ZKSCAN3 exerts a protective effect by reining in excessive autophagy, through activation of the mTOR signaling pathway. This positions the ZKSCAN3-mTOR axis as a potential therapeutic target for ALI.</p>","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":"18 9","pages":"1050"},"PeriodicalIF":2.3,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13656046/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149182734","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":"Building a bridge over troubled waters during salvage esophageal reconstruction.","authors":"Ian G Christie, Evan T Alicuben, Ryan M Levy","doi":"10.21037/jtd-2026-1703","DOIUrl":"https://doi.org/10.21037/jtd-2026-1703","url":null,"abstract":"","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":"18 9","pages":"1072"},"PeriodicalIF":2.3,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13656042/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149182740","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":"Procedural efficiency, diagnostic yield, and safety of a novel positioning grid combined with a non-coplanar puncture-angle guide for CT-guided percutaneous transthoracic lung biopsy: a retrospective contemporaneous-control study.","authors":"Ke Xu, Jiayi Chen, Sijia Deng, Aijun Jiang, Liantao Li","doi":"10.21037/jtd-2026-1712","DOIUrl":"10.21037/jtd-2026-1712","url":null,"abstract":"<p><strong>Background: </strong>Computed tomography (CT)-guided percutaneous transthoracic lung biopsy is an important method for obtaining pathological diagnoses of pulmonary lesions. However, conventional manual localization and needle advancement are operator dependent, and technically difficult lesions may require repeated angle adjustments and CT acquisitions. The aim of this study was to evaluate the procedural efficiency, diagnostic performance, and safety of a novel positioning grid combined with a non-coplanar puncture-angle guide.</p><p><strong>Methods: </strong>This single-center, retrospective, nonrandomized contemporaneous-control study included 287 patients who underwent CT-guided percutaneous transthoracic lung biopsy between August 2023 and November 2024. The device group comprised 146 patients treated using the novel positioning grid and angle guide, whereas 141 controls underwent biopsy using a conventional positioning grid without the angle guide. Procedure time, number of CT acquisitions, diagnostic yield, and complications were compared. Multivariable binary logistic regression was used to identify factors associated with pneumothorax.</p><p><strong>Results: </strong>Procedure time was shorter in the device group than in the control group (7.47±2.69 <i>vs.</i> 24.87±7.70 min, P<0.001), and the number of CT acquisitions was lower (4.63±1.08 <i>vs.</i> 6.05±1.99, P<0.001). Diagnostic yield was 98.63% <i>vs.</i> 94.33% (P=0.057). Pneumothorax and hemoptysis were less frequent in the device group (7.53% <i>vs.</i> 26.95% and 1.37% <i>vs.</i> 16.31%, respectively; both P<0.001), whereas perineedle-tract hemorrhage was similar (36.99% <i>vs.</i> 33.33%, P=0.52). In multivariable analysis, device-group membership was independently associated with lower odds of pneumothorax [adjusted odds ratio (aOR) =0.19; 95% confidence interval (CI): 0.09-0.40; P<0.001], whereas emphysema or pulmonary bullae were associated with higher odds (aOR =2.41; 95% CI: 1.14-5.09; P=0.02).</p><p><strong>Conclusions: </strong>Use of the novel positioning grid combined with a non-coplanar puncture-angle guide was associated with shorter procedure time, fewer CT acquisitions, and lower rates of pneumothorax and hemoptysis while maintaining a high diagnostic yield. Prospective multi-operator studies are warranted because the present study was nonrandomized and the groups were treated by different operators.</p>","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":"18 9","pages":"1037"},"PeriodicalIF":2.3,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13655806/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149167832","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}