Background: Timing of chest tube removal in trauma patients is debatable. This study aimed to assess whether protocolized early thoracostomy tube (TT) removal is associated with better outcomes. The study hypothesis is that early removal of TT is feasible and safe.

Methods: This was a prospective study for clinical assessment of early TT removal initiated 48 hours post-insertion [early (≤3 days) vs. late (>3 days) groups].

Results: One hundred and fifty patients were enrolled, and a total of 174 TTs were inserted. There were 24 patients with bilateral TTs. The median age was 34 years (range, 15–78 years), and 93% were males. Following this protocol, 105 TTs were removed within 3 days post-insertion. There was a slight increase in the number of patients with recurrent pneumothorax in the early removal group compared to the late removal group (P=0.09). The chest Abbreviated Injury Scale, the rates of recurrent hemothorax, hemopneumothorax, and tube dislodgement were comparable among the two groups. The rate of recurrent pneumothorax (22.2% vs. 5.1%; P=0.02) and chest tube re-insertion (11.1% vs. 0.0%; P=0.002) were significant in patients with TT output 150–200 mL (over 24 h) as compared to those with lesser TT output. There was no significant difference in complications and post-TT removal interventions based on the size and anatomical location of TT insertion.

Conclusions: Although there were post-removal events in the early removal group, the rate of post-removal complications and interventions was comparable to that in the late group. Moreover, the laterality of insertion and the tube size were not associated with complications. The TT removal protocol needs validation in larger multicenter studies.

Keywords: Chest trauma; chest tube; thoracostomy; tube removal; hemopneumothorax

Background: Chronic cough (CC) is defined by cough more than 8 weeks. Common causes of CC are upper airway cough syndrome (UACS), asthma, eosinophilic bronchitis (EB), and gastroesophageal reflux diseases (GERD). However, we do not know the characteristics of responding to treatment early. We conducted this study to evaluate the characteristics of the early responder group of CC.

Methods: This study was conducted as multi-center, retrospective observational study. Patients were collected in 15 university hospitals. The severity and quality of life (QOL) of CC were measured by cough numeric rating scale (NRS) and Cough Assessment Test (COAT) scores three times (baseline, 2 weeks, and 4 weeks after treatment). The early responder group was defined by improvement of minimal important difference in both cough NRS and COAT.

Results: Early responder group was more diagnosed as UACS compared to non-early responder group (65.7% vs. 49.2%, P=0.006). They also had higher baseline cough NRS (5.5±1.2 vs. 4.9±1.3, P<0.001). After adjusting confounding factors such as sex, age, cough duration, baseline cough severity and QOL, and diagnoses of UACS, asthma/EB, or GERD, higher cough NRS [odds ratio (OR) 1.44; 95% confidence interval (CI): 1.06–1.97; P=0.02] and diagnosis of UACS (OR 1.76; 95% CI: 1.02–3.02; P=0.04) were associated with being early responder group in the multivariate logistic regression analyses.

Conclusions: We demonstrated the characteristics of early responders of CC treatment. UACS group and higher baseline cough severity group showed earlier response to treatment than other groups.

Keywords: Chronic cough (CC); early responder; upper airway cough syndrome (UACS); cough numeric rating scale (cough NRS); Cough Assessment Test (COAT)

Background: Paravalvular leak (PVL) is a recognized complication following surgical aortic valve replacement (SAVR), with a reported incidence ranging from 1% to 10%. Although some patients with mild PVL remain asymptomatic, others may develop clinically significant complications such as heart failure or hemolysis, underscoring the importance of early detection and timely intervention. While previous research has largely emphasized the risk factors and prognostic implications of PVL, limited literature focuses on the detailed echocardiographic characteristics of both the native aortic valve prior to SAVR and the PVL itself following surgery. Therefore, the objective of this study was to investigate the echocardiographic features of PVL after SAVR—specifically its origin, severity, and correlation with the calcified location of the preprocedural aortic valve.

Methods: This retrospective cohort study, conducted at a single academic institution, investigated all SAVR procedures performed from June 2010 to October 2022. PVL was identified using intraoperative transesophageal echocardiography (TEE) and transthoracic echocardiography (TTE) within 1 year postoperatively. The echocardiographic characteristics of PVL after SAVR, including its origin and severity, as well as its correlation to the calcified location of the preprocedural aortic valve, were investigated along with the incidence.

Results: Of the total 948 SAVR cases, PVL was identified in 77 (8.1%) intra- and/or postoperatively. Ten of the 77 cases were excluded from the analysis due to missing stored echocardiographic images, resulting in 67 PVL cases being investigated. The origin of PVL was identified in 62 cases on a short-axis (SAX) view of the aortic valve, with the most common site being the mid-portion of right coronary cusp (RCC) of the native aortic valve position in 22 cases (35.5%), followed by the non-coronary cusp (NCC) and the left coronary cusp (LCC), each in 12 cases (19.4%). Calcification of the preprocedural native aortic valve, ranging from mild to severe, was observed in 38 cases (56.7%). Among these 38 cases with a calcified native valve, the location of PVL was identified in 36 cases, showing a significant correlation between the location of calcification and the position of PVL (r=0.74, P<0.001). Of the 67 PVL cases detected intraoperatively and/or postoperatively, severity was mild in 58 cases (86.6%) and moderate in 9 cases (13.4%), with no severe cases.

Conclusions: PVL following SAVR was observed in 8.1% of cases either intraoperatively or within the first year postoperatively. The majority of PVL cases were mild in severity. The most common site of PVL was the mid-portion of the RCC at the native aortic valve position. A significant correlation was found between the location of calcification in the preoperative native valve and the site of PVL.

Keywords: Paravalvular leak (PVL); aortic valve replacement; echocardiography; cardiac surgery

Background: Chronic obstructive pulmonary disease (COPD) is a long-term respiratory condition defined by ongoing respiratory symptoms and restricted airflow, resulting in high rates of morbidity, mortality, and disability for this condition. Due to the incomplete understanding of its pathogenesis, no permanent curative measures or specific drugs are available. In recent years, a multitude of research has highlighted the substantial influence of oxidative stress on the development of COPD; however, there has been a deficiency in bibliometric analyses focusing on research trends and hotspots in the field. Therefore, our study aimed at presenting the emerging trends and hotspots related to COPD and oxidative stress.

Methods: Publications concerning oxidative stress in COPD were obtained from the Web of Science Core Collection database, covering the period from 2010 to 2024. On July 25, 2024, all relevant data were downloaded, followed by a process of data screening and analysis.

Results: The analysis incorporated 1,308 articles and 440 reviews, involving contributions from 1,034 researchers affiliated with 512 institutions across 64 countries published in a total of 548 journals. Through a series of analyses using five visualization tools, we identified the top 5 most productive countries, institutions, journals, and highly co-cited journals in the field from 2010 to 2024. We also identified 12 citation clusters, 10 influential authors, co-cited authors and articles, and 11 keyword clusters, established the top 20 keywords, and observed the evolution of reference and keyword bursts.

Conclusions: This study is the first to quantitatively capture the progress of oxidative stress in the field of COPD research, and the results show a marked upward trend in recent years in terms of research on COPD and oxidative stress. Developing novel effective antioxidants is becoming the future direction for COPD treatment. Besides antioxidant therapy, exposure (to air pollution), cigarette smoke, and mitochondrial dysfunction emerged as prominent research hotspots. This extensive bibliometric study offers significant insights into the exploration of oxidative stress in publications related to COPD with the purpose to support and enhance future scientific research for investigators in the field.

Keywords: Oxidative stress; chronic obstructive pulmonary disease (COPD); bibliometric analysis; CiteSpace; VOSviewer

A new study in Engineering introduces an integrated model. It assesses flood risks to people’s life and property in the lower Yellow River under different floodplain management modes. The research validates the model with real-world events and provides insights for floodplain management.