Table of Content

20 June 2026, Volume 7 Issue 3

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Health Care

The impact of staged intervention based on the transtheoretical model on rehabilitation exercise compliance in patients with chronic obstructive pulmonary disease and concomitant frailty

Qiu Quying, Jin Weiwei, Sheng Caijuan

Journal of Tuberculosis and Lung Disease. 2026, 7(3):  284-288.  doi:10.19983/j.issn.2096-8493.20260081

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Objective: To explore the effect of staged intervention based on the transtheoretical model (TTM) on rehabilitation exercise compliance in patients with chronic obstructive pulmonary disease (COPD) complicated with frailty. Methods: A total of 116 patients with COPD complicated with frailty admitted to Qingpu Branch of Zhongshan Hospital Affiliated to Fudan University from January 2023 to August 2023 were enrolled as research subjects. They were divided into the control group and the observation group by the random number table method. One patient in the observation group dropped out due to sudden pneumothorax during hospitalization. Ultimately, 58 cases were included in the control group and 57 cases in the observation group. The control group received routine exercise health education, while the observation group received staged intervention based on the TTM on the basis of routine nursing. After 6 months of intervention, a self-designed rehabilitation exercise compliance scale was adopted to evaluate patients’ compliance, and the differences in compliance between the two groups were compared. Results: After intervention, the full compliance rate of rehabilitation exercise in the observation group was significantly higher than that in the control group (63.16% (36/57) vs. 27.59% (16/58)), while the non-compliance rate was markedly lower (7.02% (4/57) vs. 48.28% (28/58)), with statistically significant differences (χ²=31.256, P<0.001). After intervention, the proportion of patients in the pre-contemplation stage in the observation group (15.80%, 9/57) was obviously lower than that in the control group (60.34%, 35/58); the proportions of patients in the action stage and maintenance stage in the observation group were 52.63% (30/57) and 28.07% (16/57) respectively, which were significantly higher than those in the control group (31.04% (18/58) and 3.45% (2/58)). The differences were statistically significant (Z=-5.405, P<0.001). Conclusion: Staged intervention based on the TTM can significantly improve rehabilitation exercise compliance in patients with COPD complicated by frailty.

Effect of detailed phased nursing based on disease severity grading combined with medical-elderly care integration model on patients with chronic obstructive pulmonary disease complicated with pulmonary heart disease

Lu Haixia, Cao Hong

Journal of Tuberculosis and Lung Disease. 2026, 7(3):  289-293.  doi:10.19983/j.issn.2096-8493.20260090

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Objective: To explore the impact of a detailed phased nursing model based on disease severity grading combined with integrated medical and elderly care on cardiopulmonary function and acute exacerbation risk in community patients with chronic obstructive pulmonary disease (COPD) complicated by cor pulmonale, providing a basis for long-term community nursing management of this elderly patient population. Methods: Sixty patients with COPD and cor pulmonale who were diagnosed through pulmonary function screening of permanent residents in Xiayang Subdistrict Community Health Service Center, Shanghai, from January to December 2024 and included in the community chronic disease management program were selected as study subjects. They were randomly divided into a control group and an observation group (30 cases for each). The control group received routine chronic disease nursing interventions in the community, while the observation group was provided with detailed phased nursing care based on disease severity grading and integrated medical and elderly care. Their post-intervention pulmonary function indicators, cardiac function indicators, and acute exacerbation frequencies within 6 months were compared between the two groups. Results: Before intervention, the control group’s average predicted percentage of forced expiratory volume in one second, forced vital capacity, N-terminal pro-brain natriuretic peptide, and 6-minute walking distance were (47.89±6.72) %, (1.91±0.35) L, (720.14±106.32) pg/ml, and (253.47±39.15) m, respectively, with no statistically significant differences compared to the observation group((48.12±6.58) %, (1.93±0.32) L, (717.36±102.85) pg/ml, and (255.12±38.64) m; t=0.217, P=0.829; t=0.184, P=0.855; t=0.125, P=0.901; t=0.196, P=0.845). After the intervention, the observation group showed an average first-second forced expiratory volume as a percentage of the predicted value of (56.23±7.91) % and an average forced vital capacity of (2.47±0.42) L, both higher than those of the control group ((48.26±6.85) % and (1.94±0.33) L, respectively). The observation group had an average N-terminal pro-brain natriuretic peptide level of (481.95±90.87) pg/ml, lower than the control group’s (715.82±104.96) pg/ml. Their average 6-minute walking distance was (324.85±43.76) m, longer than the control group’s (256.93±38.42) m. Their average number of acute exacerbations was (1.05±0.45), fewer than the control group’s (2.41±0.80). All differences were statistically significant (t=7.632, P<0.001; t=5.196, P<0.001; t=9.380, P<0.001; t=6.305, P<0.001; t=7.938, P<0.001). Conclusion: For community patients with COPD combined with cor pulmonale, the detailed phased nursing model based on disease severity grading combined with a medical-elderly care integration approach can effectively improve cardiopulmonary function and reduce the risk of acute exacerbations, demonstrating practical value for application in grassroots level.

Self-efficacy as a mediator between patient’s rumination on disease and their psychological health-related quality of life in patients with chronic obstructive pulmonary disease

Shen Wei, Zhou Yuting, Jiang Ling

Journal of Tuberculosis and Lung Disease. 2026, 7(3):  294-301.  doi:10.19983/j.issn.2096-8493.20260079

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Objective: To explore the impact of patient’s rumination of disease on their psychological health-related quality of life in patients with chronic obstructive pulmonary disease (COPD), and to examine the mediating role of self-efficacy between these two variables. Methods: A convenience sampling method was used to select 263 COPD patients admitted to Shanghai Second People’s Hospital between June 2023 and October 2025 as study subjects, according to inclusion criteria. A general information questionnaire, the General Self-Efficacy Scale, the Rumination Scale, and the SF-12 Quality of Life Scale were used to conduct a questionnaire survey on all subjects, and the corresponding scores were calculated. Spearman correlation analysis was performed on self-efficacy, rumination on disease, and mental health-related quality of life using SPSS 21.0 software. A structural equation model was constructed using Amos 28.0 software to test the mediating effect of self-efficacy. Results: The average scores for self-efficacy, patient’s rumination on disease, and mental health-related quality of life in COPD patients were (23.42±5.51), (54.65±6.84), and (62.71±8.78), respectively. Spearman correlation analysis showed that self-efficacy was significantly negatively correlated with patient’s rumination on disease (r=-0.798, P<0.001) and significantly positively correlated with mental health-related quality of life (r=0.859, P<0.001); patient’s rumination on disease was significantly negatively correlated with mental health-related quality of life (r=-0.864, P<0.001). The structural equation model fitted well (χ²/dF=2.143, IFI=0.983, TLI=0.976, CFI=0.983, RMSEA=0.066). Mediation analysis showed that self-efficacy partially mediated the relationship between patient’s rumination on disease and quality of life related to mental health (indirect effect (95%CI)=-0.471 (-0.574 to -0.382), P<0.001; direct effect (95%CI)=-0.484 (-0.608 to -0.373), P<0.001; total effect (95%CI)=-0.955 (-1.069 to -0.854), P<0.001), with the mediating effect accounting for 49.32% of the total effect. Conclusion: Patient’s rumination on COPD can indirectly affect their mental health-related quality of life by reducing self-efficacy. Clinical interventions should emphasize on improving patients’ self-efficacy to mitigate the adverse effects of patient’s rumination of COPD on their mental health-related quality of life.

Efficacy of intradermal needle plus wrist-ankle acupuncture for assisting fiberoptic bronchoscopy

Lu Nanjin, Dai Shuiyan, Li Peiwen, Huang Kunlun, Liang Guoming, Liang Weiquan, Chen Shaosen

Journal of Tuberculosis and Lung Disease. 2026, 7(3):  302-307.  doi:10.19983/j.issn.2096-8493.20260095

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Objective: To explore the adjuvant effect of intradermal needle combined with wristankle acupuncture under the concept of preemptive analgesia in patients undergoing fiberoptic bronchoscopy. Methods: A total of 120 patients undergoing fiberoptic bronchoscopy in the Department of Respiratory and Critical Care Medicine, Foshan Second People’s Hospital from January to July 2023 were enrolled. They were randomly divided into treatment group, control group, and sham acupuncture group, with 40 cases in each group. Vital signs, Selfrating Anxiety Scale (SAS) scores, patient comfort (Visual Analogue Scale 1, VAS1), physician satisfaction (Visual Analogue Scale 2, VAS2), and postoperative adverse reactions were compared at four time points: before examination (T1), passing the glottis (T2), 5 minutes after passing the glottis (T3), and after completion of examination (T4). Results: Repeatedmeasures analysis of variance showed significant differences in systolic blood pressure among the three groups (F=4.130, P=0.019). Systolic blood pressure in the treatment group at T3 and T4 ((132.51±15.47) mmHg and (131.20±17.69) mmHg; 1 mmHg=0.133 kPa) was more stable than that in the control group ((135.05±18.57) mmHg and (136.88±19.33) mmHg) and sham group ((141.73±16.82) mmHg and (145.45±21.02) mmHg). Heart rate also differed significantly among groups at all time points (F=3.850, P=0.024). SAS scores decreased significantly in the treatment group after examination (42.61±8.49 vs. 40.95±6.42; t=2.010, P=0.050), but increased markedly in the control and sham groups. VAS1 and VAS2 scores remained stable in the treatment group but decreased significantly in the other two groups. The incidence of adverse reactions in the treatment group was 10.0% (4/40), significantly lower than 42.5% (17/40) in the control group and 32.5% (13/40) in the sham group (χ²=10.917, P=0.004). Conclusion: Intradermal needle combined with wristankle acupuncture can stabilize vital signs, relieve anxiety, improve patient comfort and physician satisfaction, and reduce adverse reactions in patients undergoing fiberoptic bronchoscopy.

Evaluation of the application effect of nurse-led protocol-based weaning in patients with invasive mechanical ventilation in the intensive care unit

Xia Lifang, Fan Zhiwen, Zhang Wei, Jin Weiwei

Journal of Tuberculosis and Lung Disease. 2026, 7(3):  308-313.  doi:10.19983/j.issn.2096-8493.20260082

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Objective: To compare the application effects of a nurse-led protocolized weaning program with conventional weaning program in intensive care unit (ICU) patients receiving invasive mechanical ventilation, and to provide evidence for clinical weaning practice. Methods: A total of 120 patients receiving invasive mechanical ventilation and admitted to the Emergency ICU and Surgical ICU of Qingpu Hospital Affiliated to Fudan University from January to September 2025 were enrolled and divided into an observation group and a control group, with 60 cases in each group. The control group received conventional weaning, while the observation group received a nurse-led protocolized nursing program (including daily weaning screening, 3-minute spontaneous breathing trial, spontaneous breathing trial, physician-nurse collaborative weaning and extubation, and post-extubation nursing management and monitoring). The daily weaning screening rate, mean duration of mechanical ventilation, weaning failure rate, and ICU length of stay were compared between the two groups. Results: The median (Q₁,Q₃) daily weaning screening rate in the observation group was 100.0% (100.0%, 100.0%), which was higher than that in the control group (66.7% (50.0%, 75.0%)). The duration of mechanical ventilation in the observation group was (73.4±24.8) h, shorter than that in the control group ((82.2±23.1) h). The ICU length of stay in the observation group was (4.9±1.4) d, shorter than that in the control group ((5.8±1.6) d). All differences were statistically significant (Z=9.222, P<0.001; t=1.999, P=0.048; t=3.305, P=0.001). The weaning failure rate was 1.7% (1/60) in the observation group and 3.3% (2/60) in the control group, with no statistically significant difference (χ²=0.342, P=0.559). Conclusion: The nurse-led protocolized weaning can shorten the weaning time, mean duration of mechanical ventilation, and ICU length of stay in patients receiving invasive mechanical ventilation, but has no effect on the weaning failure rate. Overall, it has clinical application value.

Construction and clinical efficacy evaluation of an early out-of-bed exercise system guided by enhanced recovery after surgery for post-radical resection of lung cancer

Yan Wenhua, Shi Zhiqiang, Chen Liying, Chen Wenjun, Li Wenfang

Journal of Tuberculosis and Lung Disease. 2026, 7(3):  314-322.  doi:10.19983/j.issn.2096-8493.20250168

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Objective: Based on the core concept of enhanced recovery after surgery (ERAS), a standardized early mobilization protocol for patients after radical resection of lung cancer was developed, and its clinical application value was thoroughly evaluated. Methods: Through database retrieval and two rounds of Delphi expert consultation, an early mobilization program for patients after radical resection of lung cancer was developed. According to the inclusion criteria, 170 patients who underwent video-assisted thoracoscopic radical resection of lung cancer in the Affiliated Pulmonary Hospital of Shanxi Medical University (Taiyuan Fourth People’s Hospital) and Shanxi Hospital of Cancer Hospital, Chinese Academy of Medical Sciences from October 2024 to March 2025 were selected as the study cohort. Based on the admission sequence number, the subjects were equally divided into an observation group and a control group (85 cases each) using a random number table. The control group received conventional ERAS diagnosis, treatment, and nursing pathways; the observation group implemented the specific early mobilization program constructed in this study on the basis of ERAS. After excluding 3 patients who withdrew during the implementation, 167 patients were finally included, with 83 cases in the observation group and 84 cases in the control group. The main outcome measures included: time to first out-of-bed activity postoperatively, time to first anal flatus and defecation, rate of out-of-bed activity within 24 hours postoperatively, length of postoperative hospital stay, incidence of activity-related adverse events (AE), comfort status (Kolcaba’s Comfort Scale), pain level (visual analogue scale (VAS)), and emotional state (anxiety (SAS) and depression (SDS) scales). Results: After selecting 12 domain experts to participate in the correspondence consultation, an early mobilization plan was finally established, including 2 first-level items, 7 second-level items, and 23 third-level specific items. After different nursing interventions, the first ambulation time ((16.24±3.12) h), the first exhaust time ((24.51±4.35) h), the first defecation time ((36.72±5.41) h) and the postoperative hospitalization time ((6.21±1.34) d) in the observation group were shorter than those in the control group ((32.57±6.89) h, (41.83±7.62) h, (58.96±9.14) h, (8.75±2.16) d), with statistically significant difference (t=-19.690,-18.011,-19.112,-9.121, all P<0.001). The rate of ambulation within 24 hours postoperatively (96.39% (80/83)) was significantly higher than that in the control group (8.33% (7/84)), and the difference was statistically significant (χ²=129.701, P<0.001). There was no significant difference in the incidence of adverse events between the observation group (0 (0/83)) and the control group (5.95% (5/84))(Fisher’s exact test, P=0.059). The VAS scores on postoperative days 1 to 3 of the observation group (2.23±0.07, 0.97±0.11, 0.47±0.06) were significantly lower than those of the control group (4.14±0.08, 2.78±0.12, 1.33±0.11). The GCQ scores in the observation group (83.08±0.36, 96.21±0.29, 95.97±0.39) were significantly higher than those in the control group (74.54±0.38, 83.33±0.26, 88.65±0.34). All differences were statistically significant (t=-164.249, -101.626,-62.819, 149.104, 302.077, 129.225, all P<0.001). The SAS and SDS scores at discharge in the observation group ((41.38±5.26) and (38.64±3.36) points) were significantly lower than those in the control group ((48.52±6.11) and (48.73±1.75) points), the differences were statistically significant (t=-8.051, -8.447, Ps<0.001). Conclusion: The early mobilization program after radical lung cancer surgery developed in this study significantly accelerates postoperative physiological recovery, improves activity compliance, and does not increase safety risks.but whether it can bring continuous benefits in the long-term after surgery remains to be further verified.

Analysis of the dynamic changes and influencing factors of psychological pain in elderly patients with pulmonary embolism

Chen Peiying, Liu Cuiping, Zheng Lijiao

Journal of Tuberculosis and Lung Disease. 2026, 7(3):  323-328.  doi:10.19983/j.issn.2096-8493.20260056

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Objective: To analyze the developmental trajectory of psychological distress in elderly patients with pulmonary embolism and explore its influencing factors based on a latent variable mixed growth model. Methods: A total of 230 elderly patients with pulmonary embolism admitted to the Affiliated Hospital of Putian University in Fujian Province from June 2023 to April 2025 were selected as the research subjects. General information questionnaires and psychological distress thermometers were used to investigate the patients. A latent variable growth mixed model was constructed for patients’ psychological distress, and logistic regression analysis was employed to analyze the factors influencing psychological distress in elderly patients with pulmonary embolism. Results: According to the results of the latent variable growth mixed model, three latent categories were identified: the persistently high psychological distress group (32 cases, 13.91%), the decreasing psychological distress group (112 cases, 48.70%), and the no psychological distress group (86 cases, 37.39%). Multivariate logistic regression analysis revealed that age, education level, payment type, and monthly income were influencing factors for persistently high psychological distress (OR (95%CI) values were: 1.318 (1.141-1.522), 3.414 (1.018-11.450), 3.250 (1.048-10.075), 3.763 (1.052-13.461), respectively) and decreasing psychological distress (OR (95%CI) values were: 1.120 (1.045-1.199), 2.147 (1.143-4.032), 1.912 (1.037-3.527), 1.913 (1.029-3.555), respectively) in elderly patients with pulmonary embolism. Conclusion: There are three different developmental trajectories of psychological distress in elderly patients with pulmonary embolism. Among them, age, education level, payment type, and monthly income are all influencing factors for patients’ sustained high psychological distress and the decrease in psychological distress.

Study on the replacement time of humidification solution for one-time respiratory circuit

Yuan Huizhen, Liang Zidong, Kong Xueying, Zhong Kaiting

Journal of Tuberculosis and Lung Disease. 2026, 7(3):  329-332.  doi:10.19983/j.issn.2096-8493.20260028

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Objective: To explore the optimal replacement time of disposable breathing circuit humidification solution in order to reduce the risk of ventilator-associated pneumonia (VAP). Methods: A total of 80 children who underwent mechanical ventilation treatment in the pediatric intensive care unit (PICU) of Dongguan Maternal and Child Health Hospital from January 2023 to August 2024 were selected as research subjects. They were randomly divided into a control group and an observation group, with 40 cases in each group. Both groups were connected to closed humidification devices with disposable breathing circuit and infused sterilized injection water at a constant speed. The control group replaced sterilized injection water every 24 hours, while the observation group replaced it after being used up, with the longest replacement time not exceeding 96 hours. On the 7th day, both groups replaced their ventilator pipelines and humidification tanks routinely. Clinical indicators such as the incidence of VAP, bacterial culture results of different sites (ventilator pipelines, condensate water, humidification solution), ventilator parameters, and mechanical ventilation time were compared between the two groups. Results: The total incidence of VAP in the observation group after treatment was 10.0% (4/40), which was not statistically different from 20.0% (8/40) in the control group (Fisher’s exact probability test, P=0.210); the positive rates of bacterial culture in the observation group for ventilator pipelines, condensate water, and humidification solution were 10.0% (4/40), 7.5% (3/40), and 5.0% (2/40), respectively, which were significantly lower than 50.0% (20/40), 45.0% (18/40), and 40.0% (16/40) in the control group (χ²=15.238, P<0.001; χ²=14.528, P<0.001; χ²=14.050, P<0.001). The average mechanical ventilation time and PICU hospitalization time of the observation group were (8.21±1.90) days and (11.81±2.82) days, respectively, which were not statistically different from (8.51±2.10) days and (12.31±3.01) days in the control group (t=0.662, P=0.510; t=0.773, P=0.442). Conclusion: For children undergoing mechanical ventilation in the PICU, the strategy of replacing disposable breathing circuit humidification solution after being used up does not increase the incidence of VAP and is a safe and effective replacement method.

The application of positive assimilation nursing combined with MDT-ERAS chain nursing in patients undergoing lung cancer surgery

Zheng Lijing

Journal of Tuberculosis and Lung Disease. 2026, 7(3):  333-337.  doi:10.19983/j.issn.2096-8493.20250139

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Objective: To analyze the effect of combining positive assimilation nursing with MDT-ERAS chain nursing on patients undergoing thoracoscopic lung resection for lung cancer. Methods: Eighty patients with lung cancer who underwent single-port thoracoscopic lobectomy at Putian University Affiliated Hospital from January to December 2024 were selected as the observation sample. The patients were randomly assigned to two groups by a coin toss. The control group (40 patients) received MDT-ERAS chain nursing, while the study group (40 patients) received MDT-ERAS chain nursing combined with positive assimilation nursing. After the intervention, the two groups’ HHI scores, rapid recovery compliance rates, rehabilitation indices, and postoperative pulmonary complication rates were compared. Results: The HHI scores in the study group were (12.60±1.13) points, (12.53±0.99) points, and (12.58±1.24) points, respectively, significantly higher than the corresponding scores in the control group ((9.25±1.13) points, (9.18±1.34) points, (10.35±0.86) points, respectively). These differences were statistically significant (t=13.291, 12.747, 9.322; P<0.05). The rapid recovery compliance rate was 97.50% (39/40) in the study group, which was higher than 80.00% (32/40) in the control group, and the difference was statistically significant (χ²=6.135, P=0.013). The time to first ambulation, duration of chest drainage tube placement, total hospital stay, and postoperative pain score in the study group were (6.13±1.32) hours, (22.60±1.50) hours, (12.48±1.54) days, and (2.83±1.13) points, respectively. These values were lower than those in the control group ((11.25±1.19) hours, (27.38±2.07) hours, (18.35±2.09) days, (4.33±1.12) points, respectively), and the differences were statistically significant (t=-18.187, -11.811, -14.306, -5.968, P<0.05). The postoperative pulmonary complication rate was 5.00% (2/40) in the study group and 22.50% (9/40) in the control group, with no statistically significant difference (χ²=3.794, P>0.05). Conclusion: Combining positive assimilation nursing with MDT-ERAS chain nursing in patients undergoing lung cancer surgery improves patients’ hope level and rapid recovery compliance, which helps achieve the goal of safe and rapid recovery.

The application effect of health management based on the concept of childlike fun in children with respiratory tract infections

Cai Yijing

Journal of Tuberculosis and Lung Disease. 2026, 7(3):  338-342.  doi:10.19983/j.issn.2096-8493.20260041

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Objective: To explore the application effect of health management based on the concept of childlike fun in children with respiratory tract infections. Methods: A retrospective data collection was conducted on 43 children with respiratory tract infections who underwent routine health management at Putian University Affiliated Hospital from January 2022 to December 2022 as the control group, while another 43 children with respiratory tract infections taking routine management at the Hospital from January 2023 to December 2023 and also received child centered health management were enrolled as the observation group. We then compared their main symptoms’ disappearance time, cooperation level, and quality of life between the two groups of children before and after intervention. Results: After intervention, the average disappearance time of fever ((2.13±0.54) d), cough ((5.11±1.06) d), wheezing ((4.08±0.87) d), and lung rales ((5.09±0.93) d) in the observation group were all significantly shorter than those in the control group ((2.67±0.62) d, (5.94±1.13) d, (4.79±0.93) d, (5.94±0.89) d; t=4.307, 3.513, 3.656, 4.330, all P<0.001). After intervention, the excellent cooperation rate of the observation group (95.35%, 41/43) was significantly higher than that of the control group (79.07%, 34/43; χ²=5.108, P=0.024). After intervention, the observation group’s average living environment score (73.36±6.34), satisfaction score (76.52±6.55), social and psychological function score (75.94±6.06), and physiological and psychological health dimension score (80.58±7.13) assessed by the Quality of Life Scale for Children and Adolescents (QLSCA) were all significantly higher than those in the control group ((70.18±5.97), (72.43±6.31), (71.04±6.32), (75.74±6.09); t=2.395, P=0.019; t=2.949, P=0.004; t=3.670, P<0.001; t=3.385, P=0.001). Conclusion: Applying health management based on the concept of childlike fun in children with respiratory infections can promote their symptom disappearance, improve cooperation, and enhance their quality of life.

Research progress on influencing factors and nursing strategies for early mobilization in postoperative lung cancer patients under the concept of ERAS

Jin Kangqi, Han Xiaoyan, Zhang Yimei, Jin Hongying, Zhao Yan, Li Huiling, Lin Ruijiang, Ma Minjie, Ma Xiaoli

Journal of Tuberculosis and Lung Disease. 2026, 7(3):  343-348.  doi:10.19983/j.issn.2096-8493.20262036

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Based on the concept of enhanced recovery after surgery (ERAS), this paper systematically reviewed the influencing factors and nursing strategies for early mobilization in patients after lung cancer surgery. Influencing factors were analyzed from three dimensions: patient-related factors, treatment-related factors, and social support. Nursing strategies were summarized such as optimizing activity interventions, improving health education, promoting preoperative prehabilitation, implementing precise analgesia management, and innovating nursing care models. The analysis indicated that there were significant interactions among these influencing factors, suggesting that patients should be considered as a complex whole and require comprehensive intervention strategies, providing a reference for academic research and clinical practice regarding early mobilization after lung cancer surgery in China.

Original Article

Burden, attributable risk factors, and projection of tuberculosis in China

Ma Jianjun, Zhang Tiejuan, Yu Shihui, Zhai Qianqian, Yao Laishun, Huang Biao

Journal of Tuberculosis and Lung Disease. 2026, 7(3):  349-355.  doi:10.19983/j.issn.2096-8493.20250213

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Objective: With analyzing the burden and attributable risk factors of tuberculosis (TB) in China from 2000 to 2021, and projecting the disease burden from 2022 to 2035, to provide evidence for the formulation of public health policies. Methods: With data from the Global Burden of Disease Study 2021 (GBD 2021), the TB burden in China was assessed using age-standardized incidence rate (ASIR), age-standardized mortality rate (ASMR), and age-standardized disability-adjusted life-year (DALY) rate (ASDR). We analyzed the impact of gender and age on TB burden, adopted the Joinpoint regression model for the changing trend and conducted the Mann-Kendall trend tests. The Autoregressive Integrated Moving Average (ARIMA) model was applied to project the TB burden from 2022 to 2035, with model performance evaluated using the mean absolute percentage error (MAPE), mean absolute error (MAE), and root mean square error (RMSE). Trends in risk factors attributable to smoking, alcohol use, and high fasting plasma glucose were also analyzed. Results: From 2000 to 2021, China observed a downward trend in ASIR, ASMR, and ASDR for TB. By 2021, the ASIR (36.28 per 100000), ASMR (1.91 per 100000), and ASDR (76.22 per 100000) decreased by 54.16%, 81.46%, and 79.67% respectively compared with the ASIR (79.15 per 100000), ASMR (10.30 per 100000), and ASDR (374.96 per 100000) in 2000. The proportion of TB patients aged 60 and above in China in 2021 (41.77%) increased by 42.80% compared with that in 2000 (29.25%).The male-to-female ratio across age groups showed an increasing annual trend, with the >85 age group contributing the most to the sex disparity in 2021 (19.3%). Projections for 2022—2035 indicated a continuous decline, with ASIR, ASMR, and ASDR estimated to reach 17.38, 0.65, and 14.35 per 100000 by 2035, respectively. Regarding risk factors, the proportion attributable to smoking initially rose and then stabilized, with the proportion attributable to smoking 21% in 2000, 26% in 2014, and 25% in 2021.While the proportion attributable to alcohol use showed a steady and continuous increase, with 12% in 2000 and 18% in 2021.The proportion attributable to high fasting plasma glucose initially increased and then declined, with 8% in 2000, 10% in 2015, and 9% in 2021. Smoking in males accounted for the highest attributable proportion (34%) in 2021. Conclusion: Although the burden of TB in China declined significantly from 2000 to 2021, it remains relatively high among males and the elderly. Given the high contribution of smoking in males and the steady rise in alcohol-attributable burden, public health strategies should prioritize strengthening tobacco control and promoting healthy lifestyles. Targeted prevention and control measures focusing on the elderly and male populations are essential.

Analysis of trends and forecasting of reported pulmonary tuberculosis incidence in Liangping District, Chongqing from 2011—2025 based on Joinpoint regression and time series models

Liao Ying, Chen Xi, Chen Gong, Chen Jing, Zhao Jing, He Gaoqin, You Maolin, Tu Longcheng

Journal of Tuberculosis and Lung Disease. 2026, 7(3):  356-362.  doi:10.19983/j.issn.2096-8493.20260015

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Objective: To analyze the long-term trends of pulmonary tuberculosis (PTB) incidence in Liangping District, Chongqing from 2011—2025, and to compare the predictive performance of different time series models, thereby providing a scientific basis for precision prevention and control in the context of establishing a “tuberculosis-free district”. Methods: Annual and monthly reported PTB incidence data and demographic data in Liangping District from 2011 to 2025 were collected from the “Infectious Disease Surveillance” subsystem of the “China Disease Prevention and Control Information System”. Joinpoint regression was applied to analyze the long-term trend of annual reported incidence, and the annual percent change (APC), monthly percent change (MPC), and their 95% confidence intervals (CI) were calculated. Using monthly reported PTB incidence data from 2011 to 2023 as the training set, and R 4.5.2 software to automatically select optimal models, three models were constructed: seasonal autoregressive integrated moving average (SARIMA), error-trend-seasonal (ETS), and log-transformed SARIMA. The data from 2024 to 2025 were used as the test set to evaluate the predictive performance of the models. The optimal model was selected based on the root mean squared error (RMSE) and mean absolute percentage error (MAPE), and was then used to forecast the monthly reported PTB incidence for 2026—2027. Results: From 2011 to 2025, a total of 5151 PTB cases were reported in Liangping District, with an annual average reported incidence of 51.21/100000 (5151/10059411) and a monthly average reported incidence of 4.26/100000 (5151/120848683). The annual reported incidence decreased from 80.44/100000 (553/687498) in 2011 to 34.26/100000 (214/624635) in 2025. Joinpoint regression showed an overall downward trend in the annual reported incidence of PTB in Liangping District (APC=-6.14%, 95%CI: -6.85% to -5.42%, t=-17.998, P<0.001). Using R 4.5.2 software, the three optimal models were automatically established and selected from the training set: SARIMA(5,1,1)(2,0,0)_[12], ETS(A,Ad,A), and log-transformed SARIMA(0,1,1)(2,0,0)_[12]. Based on the RMSE and MAPE calculated on the test set, the SARIMA(5,1,1)(2,0,0)_[12] mode exhibited the best predictive performance, with RMSE=0.798 and MAPE=27.016%. The testing and forecasting results of this model indicated that the monthly reported PTB incidence in Liangping District from 2024 to 2027 showed a slowly decreasing trend (MPC=-1.11%, 95%CI: -1.57% to -0.66%, t=-4.916, P<0.001). Conclusion: From 2011 to 2025, the reported incidence of PTB in Liangping District showed a downward trend, indicating remarkable achievements in prevention and control. The SARIMA(5,1,1)(2,0,0)_[12] model demonstrates good short-term predictive capability for monthly PTB incidence in this area, and suggests that more proactive intervention strategies are needed in subsequent prevention and control efforts in Liangping District. This provides solid methodological support for dynamic surveillance and early warning in the creation of a “tuberculosis-free district”.

Epidemiological characteristics and trend of tuberculosis in Nanchuan District, Chongqing, 2004—2024

Zhang Ya, Yu Ya, Wang Qingya, Sun Jian, Li Yingya

Journal of Tuberculosis and Lung Disease. 2026, 7(3):  363-370.  doi:10.19983/j.issn.2096-8493.20250208

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Objective: To analyze the trend of tuberculosis (TB) epidemic in Nanchuan District, Chongqing, and to provide evidence for developing targeted prevention and control strategies. Methods: Data on active TB cases reported in Nanchuan District from 2004 to 2024 was collected. The epidemiological distribution characteristics were retrospectively analyzed using descriptive methods, and the temporal trend in incidence was assessed by Joinpoint regression analysis. Results: From 2004 to 2024, a total of 10452 pulmonary tuberculosis cases were reported in Nanchuan District, with 47 deaths. The average annual notification incidence and mortality rates were 85.94/100000 (10452/12162419) and 0.39/100000 (47/12162419), respectively. The notification incidence peaked in spring (25.32/100000, 3079/12162419), was higher in males (113.58/100000, 7000/6163263), and was predominantly observed among individuals aged 35-39 years (8.64%, 903/10452), farmers (66.93%, 6996/10452), and residents of central townships/subdistricts (43.25%, 4520/10452). Joinpoint regression analysis indicated an overall declining trend in the average annual notification incidence over the past 21 years (AAPC=―5.62%, t=―12.05, P<0.001), with the most pronounced decline observed in winter (AAPC=―9.11%, t=―2.78, P=0.006). Regarding case composition, the proportion of patients in all age groups above 65 years (65-69, 70-74, 75-79, 80-84, and ≥85 years), as well as homemakers/unemployed patients, showed an increasing trend (AAPC values were 4.71%, 5.57%, 9.90%, 9.41%, 11.91%, 8.78%, t values were 6.78, 7.20, 10.38, 5.50, 4.78, 12.12, all P<0.001). The proportion of retirees also increased significantly from 2011 to 2024 (APC=11.81%, t=4.74, P<0.001). Conclusion: The overall tuberculosis epidemic in Nanchuan District showed a downward trend. However, prevention and control of tuberculosis should be continuously strengthened among males, farmers, and people aged 65 years and older, as well as during spring and the period around the Spring Festival.

Analysis of factors affecting the delay in diagnosis of pulmonary tuberculosis patients in Haidian District, Beijing, 2015—2024

Li Jie, Liu Xi, Hua Weiyu, Zhang Ying

Journal of Tuberculosis and Lung Disease. 2026, 7(3):  371-376.  doi:10.19983/j.issn.2096-8493.20250172

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Objective: To investigate the situation of diagnostic delay among pulmonary tuberculosis (PTB) patients in Haidian District from 2015 to 2024 and analyze the influencing factors, to provide evidences for tuberculosis prevention and control strategies in Haidian District. Methods: The data of PTB patients with current residential address in Haidian District reported from 2015 to 2024 were exported from the case management module in the Surveillance Report Management System of the China Information System for Disease Prevention and Control. The influencing factors of diagnostic delay were analyzed by using the χ² test, Kaplan-Meier method, log-rank test, and multivariate logistic regression. Results: A total of 7769 PTB patients with current residence in Haidian District were reported from 2015 to 2024. The median diagnostic delay was 20 (6, 45) d, which decreased from 20 d in 2015 to 18 d in 2024. There were 3085 patients with diagnostic delay, with the rate of 39.71% (3085/7769). The delay rate decreased from 40.80% in 2015 to 36.50% in 2024 (${\chi }_{trend}^{2}$=23.518, P<0.01). Compared with workers, household duties/unemployed individuals (OR=1.322,95%CI:1.072-1.629) had a higher risk of diagnostic delay. Compared with patients without bacteriological results, bacteriologically negative (OR=1.192,95%CI:1.056-1.346) was risk factor for diagnostic delay. Compared with the period 2015—2017, patients diagnosed during the period 2021—2024 had a lower risk of delay (OR=0.783,95%CI:0.697-0.878). Conclusion: The diagnostic delay among PTB patients in Haidian District showed a decreasing trend from 2015 to 2024. Bacteriologically negative, household duties/unemployment were identified as the main risk factors for diagnostic delay.

A questionnaire survey and analysis on the cognition status quo of tuberculosis infection prevention and control among clinical support personnel in a tertiary grade A general hospital

Yuan Lirong, Gong Yuhong, Shang Linping, Pan Wei, Gong Qiaoqiao, Yang Guixia, Li Shuhua

Journal of Tuberculosis and Lung Disease. 2026, 7(3):  377-384.  doi:10.19983/j.issn.2096-8493.20250179

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Objective: To understand the level of awareness of tuberculosis infection control among clinical support staff in a tertiary grade A general hospital, and to provide a reference for conducting tuberculosis control training and establishing a tuberculosis infection control system for clinical support staff. Methods: Using a convenience sampling method, 200 clinical support staff members (including medical auxiliary staff, cleaning staff, and nursing aides) from a tertiary general hospital were selected as the research subjects from June to July 2025. A self-designed questionnaire on tuberculosis infection control awareness among clinical support staff in tertiary general hospitals was used for the survey. Results: A total of 200 questionnaires were distributed, with 154 valid responses, resulting in a valid response rate of 77.0%. The scores of basic disease knowledge were (7.86±1.52) for medical auxiliary staff, (6.83±1.33) for cleaning staff, and (6.45±1.54) for nursing aides. Regarding environmental control, only the difference in awareness of medical institution architectural design was statistically significant (χ²=7.308, P=0.041), with nursing aides having a lower correct rate (90.9%, 30/33) compared with medical auxiliary staff (93.2%, 41/44) and cleaning staff (98.7%, 76/77). In terms of respiratory protection, medical auxiliary staff, cleaning staff, and nursing aides performed differently in all dimensions, including core principles (correct rates: 97.7% (43/44), 79.2% (61/77), and 75.8% (25/33); χ²=18.964, P<0.001), mask selection requirements (correct rates: 95.5% (42/44), 75.3% (58/77), and 69.7% (23/33); χ²=16.247, P=0.001), mask wearing procedures (correct rates: 93.2% (41/44), 70.1% (54/77), and 60.6% (20/33); χ²=15.783, P<0.001), fit testing (correct rates: 90.9% (40/44), 66.2% (51/77), and 54.5% (18/33); χ²=17.092, P<0.001), standard mask wearing in high-risk areas (correct rates: 88.6% (39/44), 51.9% (40/77), and 51.5% (17/33); χ²=35.628, P<0.001), auxiliary protective measures (correct rates: 93.2% (41/44), 72.7% (56/77), and 66.7% (22/33); χ²=12.845, P=0.002), specialized respiratory protection training (correct rates: 86.4% (38/44), 71.4% (55/77), and 57.6% (19/33); χ²=8.972, P=0.011) standardized disposal of protective masks (correct rates: 100.0% (44/44), 72.7% (56/77), and 87.9% (29/33); χ²=16.893, P=0.006), mask replacement requirements (correct rates: 95.4% (42/44), 74.0% (57/77), and 72.7% (24/33); χ²=14.536, P<0.001), and standardized removal of masks (correct rates of 97.7% (43/44), 77.9% (60/77), and 78.8% (26/33); χ²=17.241, P=0.001). Conclusion: The awareness of tuberculosis infection control among clinical support staff in hospitals needs to be improved urgently. Managers need to implement precise intervention measures from multiple dimensions and levels, establish a complete tuberculosis infection control system, improve the awareness level of clinical support staff, standardize control behaviors, and effectively control tuberculosis infection.

Cost-effectiveness analysis of tracheal stent implantation types for central airway stenosis

Huang Tongtong, Wang Yonggang, Xin Ying, Tang Chao, Lan Kuixu, Xu Tao

Journal of Tuberculosis and Lung Disease. 2026, 7(3):  385-390.  doi:10.19983/j.issn.2096-8493.20260050

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Objective: To compare the cost-effectiveness of tracheal stents made of different materials in the treatment of central airway stenosis. Methods: A retrospective analysis was conducted. A total of 77 patients who underwent tracheal stent implantation for central airway stenosis at The Affiliated Hospital of Qingdao University (including Shinan, Laoshan, West Coast and Pingdu campuses) from March 2022 to March 2025 were enrolled as study subjects. Based on the stent material, the subjects were divided into the temporary stent group (uncovered metal stents, 44 cases) and the long-term stent group (covered metal stents and silicone stents, 33 cases). The cost indicator was the total inpatient and outpatient expenses incurred from tracheal stent implantation and related bronchoscopic follow-ups within 1 year after surgery. The effectiveness indicator was the degree of improvement in dyspnea symptoms. The average cost-effectiveness ratio (CER) was calculated. Multiple linear regression model was used to adjust for baseline differences between groups. One-way sensitivity analysis and probabilistic sensitivity analysis were performed to evaluate the robustness of the results. Results: The mean total costs of the temporary stent group and the long-term stent group were 41009.17 yuan and 69114.86 yuan, respectively. The mean degrees of dyspnea improvement were 1.84 grades and 2.36 grades, respectively, with corresponding CER of 22276.59 and 29240.90. Cost composition analysis showed that the consumables cost, drug cost and general medical service fee in the long-term stent group (median (interquartile range): 17803.36 (15548.68, 22274.72) yuan, 7030.51 (3457.31, 16860.39) yuan, 5323.00 (1823.33, 9825.30) yuan, respectively) were significantly higher than those in the temporary stent group (median (interquartile range): 5158.43 (3349.65, 7402.15) yuan, 3712.29 (1378.60, 7163.31) yuan, 2735.50 (796.75, 4904.61) yuan, respectively), with statistically significant differences (consumables cost: Z=-6.361, P<0.001; drug cost: Z=-2.645, P=0.008; general medical service fee: Z=-2.275, P=0.023). The numbers of repeated interventional treatments due to complications in the temporary stent group and the long-term stent group were 262 and 191, respectively. Among them, outpatient treatments accounted for 64.5% (169/262) and 65.4% (125/191), and inpatient treatments accounted for 35.5% (93/262) and 34.6% (66/191), respectively, with no statistically significant difference (χ²=0.043, P=0.836). Multiple regression analysis showed that stent type (mean total medical cost within 1 year: β (95%CI)=23412.43 (2142.10-44682.76) yuan, P=0.031; mean dyspnea improvement: β (95%CI)=0.88 (0.58-1.17) grades, P<0.001) was an independent influencing factor for both cost and effectiveness. Sensitivity analysis verified the robustness of the results. Conclusion: Temporary stents have better short-term cost-effectiveness than long-term stents in the treatment of central airway stenosis.

Discriminative value of quantitative CT combined with the neutrophil-to-lymphocyte ratio for pulmonary function grading in chronic obstructive pulmonary disease

Zhou Liyou, Yao Qi, Yang Wenxiang, Zhang Yakang, Zhao Hong

Journal of Tuberculosis and Lung Disease. 2026, 7(3):  391-397.  doi:10.19983/j.issn.2096-8493.20250205

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Objective: To investigate the discriminative value of quantitative computed tomography (QCT) parameters combined with the peripheral blood neutrophil-to-lymphocyte ratio (NLR) for pulmonary function grading in patients with chronic obstructive pulmonary disease (COPD). Methods: A total of 535 patients with COPD admitted to Guoyang County People’s Hospital between January 2022 and April 2024 were retrospectively enrolled. General clinical data, laboratory parameters obtained within 24 hours of admission (including white blood cell count, neutrophil count, lymphocyte count, and the calculated NLR), and QCT parameters were collected, including total lung volume, emphysema volume, and the percentage of low attenuation area (LAA%). Pulmonary function grading (GOLD 1-2 vs. GOLD 3-4) was defined as the dependent variable. Univariable analysis and multivariable logistic regression modeling were performed. Model performance was evaluated using receiver operating characteristic curves (ROC), calibration curves, and decision curve analysis (DCA) in terms of discrimination, calibration, and clinical net benefit. Results: Univariable ROC analysis showed that emphysema volume had the highest discriminative performance for pulmonary function grading (AUC=0.740), followed by LAA% (AUC=0.717), total lung volume (AUC=0.679), NLR (AUC=0.637), and albumin (AUC=0.565). The final combined model (total lung volume+LAA%+NLR+albumin) achieved an AUC of 0.765, which was higher than that of any single indicator. Multivariable logistic regression analysis demonstrated that total lung volume, LAA%, and NLR were independently associated with an increased risk of severe grading, whereas albumin was associated with a decreased risk (all P<0.05). Specifically, the adjusted odds ratios (aORs) were 1.053 per 100 ml increase in total lung volume (95%CI: 1.033-1.072, P<0.001), 1.092 per 1% increase in LAA% (95%CI: 1.062-1.123, P<0.001), 1.060 per 1-unit increase in NLR (95%CI: 1.014-1.109, P=0.011), and 0.935 per 1 g/L increase in albumin (95%CI: 0.882-0.990, P=0.022). Bootstrap internal validation indicated good model calibration (mean absolute error≈0.019), and decision curve analysis showed that the combined model provided higher clinical net benefits within the threshold probability range of 0.05 to 0.30. Conclusion: QCT parameters combined with NLR demonstrate moderate discriminative ability in distinguishing GOLD 3-4 from GOLD 1-2 COPD patients, with good calibration and potential clinical applicability after internal validation, providing a reference for risk stratification and clinical decision-making in COPD patients.

Review Articles

Advances in the diagnosis and treatment of tuberculous bronchopleural fistula

Yu Guiping, Wang Tianyu, Lu Zhimeng, Song Yanzheng

Journal of Tuberculosis and Lung Disease. 2026, 7(3):  398-403.  doi:10.19983/j.issn.2096-8493.20260027

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Tuberculous bronchopleural fistula (BPF) is a severe complication arising from tuberculosis. Its occurrence is closely related to the progression of tuberculosis, treatment efficacy, and the patient’s own immune status. Due to the frequent coexistence of severe infections and the lengthy and challenging treatment period, BPF poses significant challenges to clinical treatment. In recent years, with the rapid development of imaging technology, interventional medicine, and material science, the diagnostic and treatment strategies for BPF are undergoing profound changes. This article introduces the epidemiology and clinical characteristics of BPF, further explores its diagnostic and treatment progress, and provides a systematic reference for clinical decision-making.