Thorax最新文献

{"title":"Associations of pulmonary microvascular blood volume with per cent emphysema and CT emphysema subtypes in the community: the MESA Lung study.","authors":"Emilia A Hermann, Amin Motahari, Eric A Hoffman, Yifei Sun, Norrina Allen, Elsa D Angelini, Alain G Bertoni, David A Bluemke, Sarah E Gerard, Junfeng Guo, David W Kaczka, Andrew Laine, Erin Michos, Prashant Nagpal, James S Pankow, Coralynn S Sack, Benjamin Smith, Karen Hinckley Stukovsky, Karol E Watson, Artur Wysoczanski, R Graham Barr","doi":"10.1136/thorax-2024-222002","DOIUrl":"https://doi.org/10.1136/thorax-2024-222002","url":null,"abstract":"<p><strong>Background: </strong>Pulmonary microvasculature alterations are implicated in emphysema pathogenesis, but the association between pulmonary microvascular blood volume (PMBV) and emphysema has not been directly assessed at scale, and prior studies have used non-specific measures of emphysema.</p><p><strong>Methods: </strong>The Multi-Ethnic Study of Atherosclerosis Lung Study invited participants recruited from the community without renal impairment to undergo contrast-enhanced dual-energy CT. Pulmonary blood volume was calculated by material decomposition; PMBV was defined as blood volume in the peripheral 2 cm of the lung. Non-contrast CT was acquired to assess per cent emphysema and novel CT emphysema subtypes, which include the diffuse emphysema subtype and small-airways-related combined bronchitic-apical emphysema subtype. Generalised linear regression models included age, sex, race/ethnicity, body size, smoking, total lung volume and small airway count.</p><p><strong>Results: </strong>Among 495 participants, 53% were never-smokers and the race/ethnic distribution was 35% white, 31% black, 15% Hispanic and 18% Asian. Mean PMBV was 352±120 mL; mean per cent emphysema was 4.95±4.75%. Lower PMBV was associated with greater per cent emphysema (-0.90% per 100 mL PMBV, 95% CI: -1.29 to -0.51). The association was of larger magnitude in participants with 10 or more pack-years smoking and airflow obstruction, but present among participants with no smoking history or airflow limitation, and was specific to the diffuse CT emphysema subtype (-1.48% per 100 mL PMBV, 95% CI: -2.31 to -0.55).</p><p><strong>Conclusion: </strong>In this community-based study, lower PMBV was associated with greater per cent emphysema, including in participants without a smoking history or airflow limitation, and was specific to the diffuse CT emphysema subtype.</p>","PeriodicalId":23284,"journal":{"name":"Thorax","volume":null,"pages":null},"PeriodicalIF":9.0,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142576663","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Imaging in early tuberculosis.","authors":"Robert Wilkinson","doi":"10.1136/thorax-2024-221993","DOIUrl":"https://doi.org/10.1136/thorax-2024-221993","url":null,"abstract":"","PeriodicalId":23284,"journal":{"name":"Thorax","volume":null,"pages":null},"PeriodicalIF":9.0,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142576653","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Journal club","authors":"Anthony W Martinelli","doi":"10.1136/thorax-2024-222463","DOIUrl":"https://doi.org/10.1136/thorax-2024-222463","url":null,"abstract":"The ACCESS trial ( Lancet Respir Med 2024;12(4):294–304) provides new evidence supporting the use of macrolides in community-acquired pneumonia (CAP). In this prospective, double-blind study, Giamarellos-Bourboulis and colleagues randomised patients admitted with CAP and receiving intravenous antibiotics to addition of either oral clarithromycin or placebo for 7 days. Participants from 18 Greek hospitals were enrolled, with CAP defined as consolidation on chest radiograph with compatible auscultatory findings or consolidation on CT, though a pathogen was only identified in 55% of the study population (most commonly Staphylococcus aureus ). Inclusion criteria limited the study to a subset of hospital patients with systemic inflammation, requiring two positive criteria of systemic inflammatory response syndrome, a sequential organ failure assessment (SOFA) score of≥2, and a procalcitonin of≥0.25 ng/mL. The primary outcome was achievement at day 4 of both an ‘early clinical response’ (≥50% decrease in respiratory symptom score) and an ‘early inflammatory response’ (≥30% decrease in SOFA score and/or procalcitonin decrease by≥80% or to<0.25 ng/mL). This endpoint was met in 68% (n=91) of patients treated with clarithromycin, compared with 38% (n=51) in the placebo group (OR 3.40 (95% CI 2.06 to 5.63), p<0.0001). Secondary analyses revealed that clarithromycin significantly reduced the rate of progression to organ dysfunction and recurrent sepsis, and shortened time to hospital …","PeriodicalId":23284,"journal":{"name":"Thorax","volume":null,"pages":null},"PeriodicalIF":10.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142440243","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Community-based approaches to improve tuberculosis services: observations from preintervention and postintervention surveys in a high TB burden disadvantaged community in India","authors":"Jyothi Bhat, Ravendra Kumar Sharma, Rajiv Yadav, M Muniyandi, Prashant Mishra, Samridhi Nigam, Mercy Aparna Latha Lingala, Vikas Gangadhar Rao","doi":"10.1136/thorax-2024-221446","DOIUrl":"https://doi.org/10.1136/thorax-2024-221446","url":null,"abstract":"An alarmingly high prevalence of tuberculosis (TB) was reported among the Saharia tribe in Madhya Pradesh, India. A community-based intervention study was undertaken to improve TB case finding during 2018–2021. The interventions mainly comprised active case detection through village TB volunteers using advocacy, communication and social mobilisation activities. A preintervention and postintervention survey design was adopted to assess the impact of intervention. The prevalence declined from 1357 (95% CI 1206 to 1527) to 752 (95% CI 646 to 875) per 100 000 population (p<0.001). The study findings highlight the importance of innovative community-based approaches in controlling TB in high burden areas.","PeriodicalId":23284,"journal":{"name":"Thorax","volume":null,"pages":null},"PeriodicalIF":10.0,"publicationDate":"2024-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142490492","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Collagen neoepitopes in sarcoidosis: what do they tell us?","authors":"Daniel A Culver, Pauline Teresa Lukey","doi":"10.1136/thorax-2024-222276","DOIUrl":"https://doi.org/10.1136/thorax-2024-222276","url":null,"abstract":"Fibrosis is scarring due to the replacement of tissue architecture by extracellular matrix (ECM), which consists largely of collagen. Scarring progressively destroys organ structure and thereby impairs function. Accumulation of collagen is thought to be due to an increase in production, a reduction in degradation of collagen or a combination of both.1 If so, we might expect the ratio of production to degradation to increase with increasing fibrosis. Biomarkers of type III and VI collagen production (PRO-C3 and PRO-C6) and degradation (C3M and C6M), called neoepitopes, have been developed to measure these processes.1 In diseases such as idiopathic pulmonary fibrosis, where fibrosis is the dominant pathophysiological feature, neoepitope levels align closely with disease progression.2 Whether these collagen markers are relevant in other diseases has been less well explored. In sarcoidosis, fibrosis in affected organs, especially the lungs and heart, accounts for most of the long-term morbidity and mortality that is directly attributable to sarcoidosis itself (rather than due to attempts to treat the disease). Fibrosis in sarcoidosis is thought to occur in the setting of persistent granulomatous inflammation but is likely modulated by other factors besides duration of disease alone since not all patients with chronic sarcoidosis develop substantial fibrosis. A major clinical challenge is to identify whether the dysfunction of an affected organ is predominantly due to granulomatous inflammation or fibrosis. Thus, a blood marker of sarcoidosis fibrosis would be an extremely helpful clinical tool. Recently, Sand and co-workers3 hypothesised that patients with sarcoidosis may have increased plasma levels of collagen neoepitopes and that …","PeriodicalId":23284,"journal":{"name":"Thorax","volume":null,"pages":null},"PeriodicalIF":10.0,"publicationDate":"2024-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142487508","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Inequalities in care and the burden of wheeze and asthma in young children from diverse socioeconomic and ethnic backgrounds.","authors":"Björn Nordlund","doi":"10.1136/thorax-2024-222111","DOIUrl":"10.1136/thorax-2024-222111","url":null,"abstract":"","PeriodicalId":23284,"journal":{"name":"Thorax","volume":null,"pages":null},"PeriodicalIF":9.0,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141996577","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predicting the risk of pulmonary deterioration in sarcoidosis.","authors":"Elizabeth V Arkema, Pernilla Lindin Darlington, Yvette C Cozier","doi":"10.1136/thorax-2024-222124","DOIUrl":"10.1136/thorax-2024-222124","url":null,"abstract":"","PeriodicalId":23284,"journal":{"name":"Thorax","volume":null,"pages":null},"PeriodicalIF":9.0,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142372958","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Added complexity to genotype–phenotype relationships in primary ciliary dyskinesia: TAS2R38 as a gene modifier","authors":"Katherine Alexandra Despotes, Stephanie D Davis","doi":"10.1136/thorax-2024-222333","DOIUrl":"https://doi.org/10.1136/thorax-2024-222333","url":null,"abstract":"Primary ciliary dyskinesia (PCD), an inherited motile ciliopathy, is characterised by recurrent upper and lower respiratory tract infections, organ laterality defects, subfertility and neonatal respiratory distress due to impaired ciliary function.1 Over 50 PCD disease-causing genes have been identified that impact the structure and function of the cilia (figure 1, originally in Despotes et al 1). Significant clinical heterogeneity is associated with PCD, in part driven by genotype; genotype–phenotype relationships are an emerging area of great importance within this rare disease.2–4 However, clinical heterogeneity has also been reported among patients with the same genetic variants,3 suggesting that genetic modifiers may play an important role in disease manifestations. In their Thorax paper, Pifferi and colleagues have helped uncover our incomplete understanding of this heterogeneity by evaluating the impact of TAS2R38 polymorphisms within specific PCD genotypes. The authors specifically explored the impact of these polymorphisms on Pseudomonas aeruginosa (PA) infections, lung function and nasal nitric oxide (nNO) levels.5 Figure 1 : The location and function of the 54 currently known disease-causing genes implicated in PCD, originally published in Despotes et al (1). Panel A: Respiratory Epithelial Cell. * DNAH9 and DNAH11 are represented twice (panel A and panel C) as these genes are important in ODA structure at different locations along the axoneme length, as demonstrated in panel A. Panel B: Cilium and Intraflageller Transport. Panel C: Axoneme (in cross-section). The outer doublet A and B microtubules are labeled. The cross-section of the axoneme shows the “9 + …","PeriodicalId":23284,"journal":{"name":"Thorax","volume":null,"pages":null},"PeriodicalIF":10.0,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142444248","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pulmonary sarcoidosis: differences in lung function change over time.","authors":"Michelle Sharp, Kevin J Psoter, Ali M Mustafa, Edward S Chen, Nancy W Lin, Stephen C Mathai, Nisha A Gilotra, Michelle N Eakin, Robert A Wise, David R Moller, Meredith C McCormack","doi":"10.1136/thorax-2023-221309","DOIUrl":"10.1136/thorax-2023-221309","url":null,"abstract":"<p><strong>Introduction: </strong>Given the heterogeneity of sarcoidosis, predicting disease course of patients remains a challenge. Our aim was to determine whether the 3-year change in pulmonary function differed between pulmonary function phenotypes and whether there were differential longitudinal changes by race and sex.</p><p><strong>Methods: </strong>We identified individuals seen between 2005 and 2015 with a confirmed diagnosis of sarcoidosis who had at least two pulmonary function test measurements within 3 years of entry into the cohort. For each individual, spirometry, diffusion capacity, Charlson Comorbidity Index, sarcoidosis organ involvement, diagnosis duration, tobacco use, race, sex, age and medications were recorded. We compared changes in pulmonary function by type of pulmonary function phenotype and for demographic groups.</p><p><strong>Results: </strong>Of 291 individuals, 59% (173) were female and 54% (156) were black. Individuals with restrictive pulmonary function phenotype had significantly greater 3-year rate of decline of FVC% (forced vital capacity) predicted and FEV₁% (forced expiratory volume in 1 s) predicted course when compared with normal phenotype. We identified a subset of individuals in the cohort, highest decliners, who had a median 3-year FVC decline of 156 mL. Black individuals had worse pulmonary function at entry into the cohort measured by FVC% predicted, FEV₁% predicted and diffusing capacity for carbon monoxide % predicted compared with white individuals. Black individuals' pulmonary function remained stable or declined over time, whereas white individuals' pulmonary function improved over time. There were no sex differences in rate of change in any pulmonary function parameters.</p><p><strong>Summary: </strong>We found significant differences in 3-year change in pulmonary function among pulmonary function phenotypes and races, but no difference between sexes.</p>","PeriodicalId":23284,"journal":{"name":"Thorax","volume":null,"pages":null},"PeriodicalIF":9.0,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11483203/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141437519","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perivascular epithelioid cell neoplasm of lung.","authors":"Hong Yang, Binglin Lai","doi":"10.1136/thorax-2023-221143","DOIUrl":"10.1136/thorax-2023-221143","url":null,"abstract":"","PeriodicalId":23284,"journal":{"name":"Thorax","volume":null,"pages":null},"PeriodicalIF":9.0,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141749141","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}