{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,3]],"date-time":"2026-11-03T17:13:43Z","timestamp":1793726023289,"version":"4.6.1"},"reference-count":32,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,6,30]],"date-time":"2025-06-30T00:00:00Z","timestamp":1751241600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"},{"start":{"date-parts":[[2025,6,30]],"date-time":"2025-06-30T00:00:00Z","timestamp":1751241600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"}],"funder":[{"name":"2020 Fujian Provincial Department of Finance Special Funds","award":["BPB-2020LFC"],"award-info":[{"award-number":["BPB-2020LFC"]}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["J Cardiothorac Surg"],"DOI":"10.1186\/s13019-025-03480-0","type":"journal-article","created":{"date-parts":[[2025,6,30]],"date-time":"2025-06-30T03:57:20Z","timestamp":1751255840000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Delving into immune modulation: thymectomy in myasthenia gravis"],"prefix":"10.1186","volume":"20","author":[{"given":"Nanlong","family":"Lin","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhongshan","family":"Yang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Weiqiang","family":"Yi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yanxun","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fancai","family":"Lai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,6,30]]},"reference":[{"issue":"26","key":"3480_CR1","doi-asserted-by":"publisher","first-page":"2570","DOI":"10.1056\/NEJMra1602678","volume":"375","author":"NE Gilhus","year":"2016","unstructured":"Gilhus NE. Myasthenia Gravis. N Engl J Med. 2016;375(26):2570\u201381.","journal-title":"N Engl J Med"},{"key":"3480_CR2","doi-asserted-by":"publisher","first-page":"1110499","DOI":"10.3389\/fimmu.2023.1110499","volume":"14","author":"R Huda","year":"2023","unstructured":"Huda R. Inflammation and autoimmune myasthenia Gravis. Front Immunol. 2023;14:1110499.","journal-title":"Front Immunol"},{"issue":"1","key":"3480_CR3","doi-asserted-by":"publisher","first-page":"30","DOI":"10.1038\/s41572-019-0079-y","volume":"5","author":"NE Gilhus","year":"2019","unstructured":"Gilhus NE, Tzartos S, Evoli A, Palace J, Burns TM, Verschuuren J. Myasthenia Gravis. Nat Rev Dis Primers. 2019;5(1):30.","journal-title":"Nat Rev Dis Primers"},{"issue":"1","key":"3480_CR4","doi-asserted-by":"publisher","first-page":"82","DOI":"10.1111\/nyas.13518","volume":"1412","author":"A Evoli","year":"2018","unstructured":"Evoli A, Alboini PE, Damato V, Iorio R, Provenzano C, Bartoccioni E, Marino M. Myasthenia Gravis with antibodies to musk: an update. Ann N Y Acad Sci. 2018;1412(1):82\u20139.","journal-title":"Ann N Y Acad Sci"},{"issue":"1","key":"3480_CR5","doi-asserted-by":"publisher","first-page":"126","DOI":"10.1111\/nyas.13573","volume":"1413","author":"M Yan","year":"2018","unstructured":"Yan M, Xing GL, Xiong WC, Mei L. Agrin and Lrp4 antibodies as new biomarkers of myasthenia Gravis. Ann N Y Acad Sci. 2018;1413(1):126\u201335.","journal-title":"Ann N Y Acad Sci"},{"key":"3480_CR6","doi-asserted-by":"publisher","first-page":"212","DOI":"10.3389\/fimmu.2020.00212","volume":"11","author":"K Lazaridis","year":"2020","unstructured":"Lazaridis K, Tzartos SJ. Autoantibody specificities in myasthenia Gravis; implications for improved diagnostics and therapeutics. Front Immunol. 2020;11:212.","journal-title":"Front Immunol"},{"key":"3480_CR7","doi-asserted-by":"publisher","first-page":"706244","DOI":"10.3389\/fimmu.2021.706244","volume":"12","author":"M Duah","year":"2021","unstructured":"Duah M, Li L, Shen J, Lan Q, Pan B, Xu K. Thymus degeneration and regeneration. Front Immunol. 2021;12:706244.","journal-title":"Front Immunol"},{"issue":"8","key":"3480_CR8","doi-asserted-by":"publisher","first-page":"2031","DOI":"10.4049\/jimmunol.1900662","volume":"203","author":"DL Owen","year":"2019","unstructured":"Owen DL, Sjaastad LE, Farrar MA. Regulatory T cell development in the Thymus. J Immunol. 2019;203(8):2031\u201341.","journal-title":"J Immunol"},{"issue":"14","key":"3480_CR9","doi-asserted-by":"publisher","first-page":"2542","DOI":"10.1016\/j.cell.2022.05.018","volume":"185","author":"DA Michelson","year":"2022","unstructured":"Michelson DA, Hase K, Kaisho T, Benoist C, Mathis D. Thymic epithelial cells Co-Opt Lineage-Defining transcription factors to eliminate autoreactive T cells. Cell. 2022;185(14):2542\u2013e255818.","journal-title":"Cell"},{"key":"3480_CR10","doi-asserted-by":"crossref","unstructured":"Huang Y, Tan Y, Shi J, Guan YJFN. Patients with myasthenia Gravis with acute onset of dyspnea. Predictors of Progression to Myasthenic Crisis and Prognosis; 2021.","DOI":"10.3389\/fneur.2021.767961"},{"issue":"5","key":"3480_CR11","doi-asserted-by":"publisher","first-page":"416","DOI":"10.1097\/WCO.0000000000001189","volume":"36","author":"J Rath","year":"2023","unstructured":"Rath J, Moser B, Zimprich F. Thymectomy in myasthenia Gravis. Curr Opin Neurol. 2023;36(5):416\u201323.","journal-title":"Curr Opin Neurol"},{"issue":"3","key":"3480_CR12","doi-asserted-by":"publisher","first-page":"114","DOI":"10.1212\/WNL.0000000000011124","volume":"96","author":"P Narayanaswami","year":"2021","unstructured":"Narayanaswami P, Sanders DB, Wolfe G, Benatar M, Cea G, Evoli A, et al. Verschuuren J. International consensus guidance for management of myasthenia Gravis: 2020 update. Neurology. 2021;96(3):114\u201322.","journal-title":"Neurology"},{"issue":"5","key":"3480_CR13","doi-asserted-by":"publisher","first-page":"406","DOI":"10.1056\/NEJMoa2302892","volume":"389","author":"KA Kooshesh","year":"2023","unstructured":"Kooshesh KA, Foy BH, Sykes DB, Gustafsson K, Scadden DT. Health consequences of Thymus removal in adults. N Engl J Med. 2023;389(5):406\u201317.","journal-title":"N Engl J Med"},{"issue":"6","key":"3480_CR14","doi-asserted-by":"publisher","first-page":"511","DOI":"10.1056\/NEJMoa1602489","volume":"375","author":"GI Wolfe","year":"2016","unstructured":"Wolfe GI, Kaminski HJ, Aban IB, Minisman G, Kuo HC, Marx A, et al. Cutter GR. Randomized trial of thymectomy in myasthenia Gravis. N Engl J Med. 2016;375(6):511\u201322.","journal-title":"N Engl J Med"},{"issue":"8","key":"3480_CR15","doi-asserted-by":"publisher","first-page":"e13671","DOI":"10.1111\/acel.13671","volume":"21","author":"Z Liang","year":"2022","unstructured":"Liang Z, Dong X, Zhang Z, Zhang Q, Zhao Y. Age-Related thymic involution: mechanisms and functional impact. Aging Cell. 2022;21(8):e13671.","journal-title":"Aging Cell"},{"issue":"7981","key":"3480_CR16","doi-asserted-by":"publisher","first-page":"164","DOI":"10.1038\/s41586-023-06512-8","volume":"622","author":"T Givony","year":"2023","unstructured":"Givony T, Leshkowitz D, Del Castillo D, Nevo S, Kadouri N, Dassa B, et al. Abramson J. Thymic mimetic cells function beyond Self-Tolerance. Nature. 2023;622(7981):164\u201372.","journal-title":"Nature"},{"key":"3480_CR17","doi-asserted-by":"publisher","first-page":"102115","DOI":"10.1016\/j.arr.2023.102115","volume":"92","author":"J Yang","year":"2023","unstructured":"Yang J, Liu J, Liang J, Li F, Wang W, Chen H, Xie X. Epithelial-Mesenchymal transition in Age-Associated thymic involution: mechanisms and therapeutic implications. Ageing Res Rev. 2023;92:102115.","journal-title":"Ageing Res Rev"},{"key":"3480_CR18","doi-asserted-by":"publisher","first-page":"40","DOI":"10.1016\/j.clim.2017.03.003","volume":"179","author":"S Kohler","year":"2017","unstructured":"Kohler S, Keil TOP, Hoffmann S, Swierzy M, Ismail M, R\u00fcckert JC, et al. Meisel A. Cd4(+) Foxp3(+) T regulatory cell subsets in myasthenia Gravis patients. Clin Immunol. 2017;179:40\u20136.","journal-title":"Clin Immunol"},{"issue":"3","key":"3480_CR19","doi-asserted-by":"publisher","first-page":"284","DOI":"10.1016\/j.clim.2004.04.005","volume":"112","author":"Y Sun","year":"2004","unstructured":"Sun Y, Qiao J, Lu CZ, Zhao CB, Zhu XM, Xiao BG. Increase of Circulating Cd4\u2009+\u2009Cd25\u2009+\u2009T cells in myasthenia Gravis patients with stability and thymectomy. Clin Immunol. 2004;112(3):284\u20139.","journal-title":"Clin Immunol"},{"issue":"1","key":"3480_CR20","doi-asserted-by":"publisher","first-page":"235","DOI":"10.1038\/s41392-023-01471-y","volume":"8","author":"L Sun","year":"2023","unstructured":"Sun L, Su Y, Jiao A, Wang X, Zhang B. T cells in health and disease. Signal Transduct Target Ther. 2023;8(1):235.","journal-title":"Signal Transduct Target Ther"},{"issue":"2","key":"3480_CR21","doi-asserted-by":"publisher","first-page":"103","DOI":"10.1038\/s41577-023-00911-8","volume":"24","author":"KM Ashby","year":"2024","unstructured":"Ashby KM, Hogquist KA. A guide to thymic selection of T cells. Nat Rev Immunol. 2024;24(2):103\u201317.","journal-title":"Nat Rev Immunol"},{"issue":"1","key":"3480_CR22","doi-asserted-by":"publisher","first-page":"60","DOI":"10.1007\/s00018-005-5390-y","volume":"63","author":"MJ Herold","year":"2006","unstructured":"Herold MJ, McPherson KG, Reichardt HM. Glucocorticoids in T cell apoptosis and function. Cell Mol Life Sci. 2006;63(1):60\u201372.","journal-title":"Cell Mol Life Sci"},{"issue":"1","key":"3480_CR23","doi-asserted-by":"publisher","first-page":"72","DOI":"10.1111\/imr.13016","volume":"303","author":"MP Cancro","year":"2021","unstructured":"Cancro MP, Tomayko MM. Memory B cells and plasma cells: the differentiative continuum of humoral immunity. Immunol Rev. 2021;303(1):72\u201382.","journal-title":"Immunol Rev"},{"key":"3480_CR24","doi-asserted-by":"crossref","unstructured":"Cheng Q, Pelz A, Taddeo A, Khodadadi L, Klotsche J, Hoyer BF et al. Radbruch AJEJoI. Selective depletion of plasma cells in vivo based on the specificity of their secreted antibodies. 2020 50(2).","DOI":"10.1002\/eji.201948144"},{"key":"3480_CR25","unstructured":"Su F, Cui-Juan L, Jing P, Hong-Xia Y, Laboratory DOJCM. Mistherapy. Changes of cellular and humoral immune indices in patients with myasthenia Gravis and the effect of glucocorticoid therapy. 2019."},{"key":"3480_CR26","doi-asserted-by":"crossref","unstructured":"Scadding GK, Webster ADB, Ross M, Thomas HC, Havard CWHJN. Humoral immunity before and after thymectomy in myasthenia Gravis. 1979 29(4):502.","DOI":"10.1212\/WNL.29.4.502"},{"key":"3480_CR27","unstructured":"Qiang XZ, Wen WR, Guang JY, Min GU, Ping ZY. Zheng MAJcjon, neurology. Relation of humoral immunity and clinical effects in myasthenia Gravis patients after thymectomy. 2006."},{"key":"3480_CR28","doi-asserted-by":"crossref","unstructured":"Crawford MP, Sinha S, Renavikar PS, Karandikar NJJTJI. Cd4\u2009+\u2009T-Helper 17 (Th17) Signature Cytokine, Il-17, Mediates Cd4 Resistance to Immune Suppression. 2019 202(1_Supplement):57.11\u201357.11.","DOI":"10.4049\/jimmunol.202.Supp.57.11"},{"key":"3480_CR29","doi-asserted-by":"crossref","unstructured":"Pearson CI, Mcdevitt HOJCTiM. Immunology. Redirecting Th1 and Th2 Responses in Autoimmune Disease. 1999 238(238):79.","DOI":"10.1007\/978-3-662-09709-0_5"},{"key":"3480_CR30","unstructured":"Tomoyuki T, Hazama S et al. Surgery MJAJo. Th2 Subset Dominance among Peripheral Blood T Lymphocytes in Patients with Digestive Cancers. 1999."},{"key":"3480_CR31","doi-asserted-by":"crossref","unstructured":"Burocchi A, Pittoni P, Gorzanelli A, Colombo MP, Piconese SJEJI. Intratumor Ox40 stimulation inhibits Irf1 expression and Il-10 production by Treg cells while enhancing Cd40l expression by effector memory T cells. 2011 41(12):3615\u201326.","DOI":"10.1002\/eji.201141700"},{"key":"3480_CR32","doi-asserted-by":"crossref","unstructured":"Camacho V, Patel S, Matkins V, Turnquist HR, Welner RSJTJI. Bone Marrow Resident Tregs Maintain Stromal Cell Function Via Il-10. 2019 202(1_Supplement):118.14-118.14.","DOI":"10.4049\/jimmunol.202.Supp.118.14"}],"container-title":["Journal of Cardiothoracic Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s13019-025-03480-0.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s13019-025-03480-0\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s13019-025-03480-0.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,6,30]],"date-time":"2025-06-30T03:57:22Z","timestamp":1751255842000},"score":1,"resource":{"primary":{"URL":"https:\/\/cardiothoracicsurgery.biomedcentral.com\/articles\/10.1186\/s13019-025-03480-0"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,6,30]]},"references-count":32,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["3480"],"URL":"https:\/\/doi.org\/10.1186\/s13019-025-03480-0","relation":{},"ISSN":["1749-8090"],"issn-type":[{"value":"1749-8090","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,6,30]]},"assertion":[{"value":"11 July 2024","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"18 May 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"30 June 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"As researchers in the medical field, we are well aware of the importance of clinical research for human health and disease treatment. In order to ensure the scientific and reliable nature of research, and to safeguard the rights and interests of human subjects, we hereby establish the following ethical guidelines: As clinical researchers, we have a responsibility to abide by these ethical standards and contribute to the healthy development of the clinical research field. At the same time, we will continuously revise and improve these guidelines according to the actual situation to adapt to the constantly changing clinical research needs and social values. Medical Research and Clinical Technology Application Branch of the Ethics Committee of the First Affiliated Hospital of Fujian Medical University, passed on January 13, 2022, and the Ethics and Medical Technology Review of\n                      the First Affiliated Hospital of Fujian Medical University [2015] No. 084\u2009\u2212\u20092.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"The authors declare no competing interests.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"277"}}