Thorax最新文献

{"title":"Vasodilator-induced selective pulmonary oedema in sarcoidosis-associated pulmonary hypertension with pulmonary venous stenosis","authors":"Takatoyo Kiko, Akihiro Tsuji, Jin Ueda, Keiko Ohta-Ogo, Takeshi Ogo","doi":"10.1136/thorax-2024-222190","DOIUrl":"https://doi.org/10.1136/thorax-2024-222190","url":null,"abstract":"A 43-year-old woman was diagnosed with sarcoidosis-associated pulmonary hypertension (SAPH) based on transbronchial lymph node and lung biopsy (figure 1A) and right heart catheterisation. Contrast-enhanced CT revealed no signs of pulmonary embolism. Based on the medical history, laboratory examination and imaging modalities, other potential causes of pulmonary hypertension (PH) were excluded. The diffusion capacity of carbon monoxide was 81% of the predicted value; arterial haemoglobin oxygen saturation was 92% on room air. First, she was prescribed prednisolone (15 mg daily) for 6 months, after which a phosphodiesterase type 5 inhibitor (tadalafil; 40 mg daily) was initiated. Despite treatment, her PH persisted, exhibiting a mean pulmonary artery pressure, 39 mm Hg; cardiac index, 1.9 L/min/m2; pulmonary artery wedge pressure, 4 mm Hg; and pulmonary vascular resistance, 13.0 Wood units. Consequently, an endothelin receptor antagonist (macitentan; 10 mg daily), was added to her regimen. After 4 days of macitentan initiation, her shortness of breath worsened with increased body weight, leading to heart failure. Chest radiography (figure 2A) and CT (figure 2B) revealed selective pulmonary oedema. Contrast-enhanced CT showed pulmonary venous stenosis due to sarcoidosis lesions (figure 2C). Pulmonary angiography confirmed severely localised pulmonary venous stenosis and occlusion (figure …","PeriodicalId":23284,"journal":{"name":"Thorax","volume":"30 1","pages":""},"PeriodicalIF":10.0,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143518018","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":"Preserved ratio impaired spirometry (PRISm): prognostic, preventable and treatable?","authors":"Guy G Brusselle, Sebastian G Riemann","doi":"10.1136/thorax-2024-222923","DOIUrl":"https://doi.org/10.1136/thorax-2024-222923","url":null,"abstract":"Spirometry is a crucial lung function test, which is primarily aimed at identifying airway obstruction in subjects with chronic symptoms of shortness of breath or cough. An obstructive pattern is defined as an impaired ratio of forced expiratory volume in 1 s (FEV1) to forced vital capacity (FVC) (ie, FEV1/FVC less than the lower limit of normal (LLN)) (figure 1). It may be caused by asthma and/or chronic obstructive pulmonary disease (COPD) and warrants further testing including bronchodilator responsiveness. Spirometry is essential for diagnosing asthma and COPD, but also for monitoring the course of these highly prevalent chronic airway diseases, including the response to treatment, the level of short-term asthma control and the occurrence of long-term clinical remission. However, there is a second spirometric pattern which is important to discern in clinical practice: preserved ratio impaired spirometry (PRISm), defined as a preserved FEV1/FVC ratio but impaired FEV1 (ie, FEV1 less than 80% predicted). Only recently, PRISm has attracted more attention. Figure 1 The main spirometric patterns encompass an obstructive pattern, a normal spirometry and preserved ratio impaired spirometry (PRISm). BMI, body mass index; COPD, chronic obstructive pulmonary disease; FEV1, forced expiratory volume in 1 s; FVC, forced vital capacity; HDL, high-density lipoprotein; LE8: Life’s Essential 8; LLN, lower limit of normal. PRISm, affecting approximately 6%–18% of the adult general population and elicited by multiple conditions, is associated with …","PeriodicalId":23284,"journal":{"name":"Thorax","volume":"50 1","pages":""},"PeriodicalIF":10.0,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143462610","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":"Natalie McLeod","doi":"10.1136/thorax-2025-223055","DOIUrl":"https://doi.org/10.1136/thorax-2025-223055","url":null,"abstract":"","PeriodicalId":23284,"journal":{"name":"Thorax","volume":"80 3","pages":"188"},"PeriodicalIF":9.0,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143442151","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":"Extracellular vesicles offer enticing opportunities to target and treat lung inflammation.","authors":"Sally Yunsun Kim","doi":"10.1136/thorax-2024-222696","DOIUrl":"10.1136/thorax-2024-222696","url":null,"abstract":"","PeriodicalId":23284,"journal":{"name":"Thorax","volume":" ","pages":"127-128"},"PeriodicalIF":9.0,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143123578","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":"Accumulating evidence supports advanced bronchoscopy as a modality of choice for difficult-to-reach peripheral lung nodules, but questions remain.","authors":"Rafael Paez, Fabien Maldonado","doi":"10.1136/thorax-2024-222922","DOIUrl":"10.1136/thorax-2024-222922","url":null,"abstract":"","PeriodicalId":23284,"journal":{"name":"Thorax","volume":" ","pages":"131-132"},"PeriodicalIF":9.0,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143374718","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":"Pneumothorax and antibiotic use: a clue to aetiology of primary spontaneous pneumothorax?","authors":"Rob Hallifax","doi":"10.1136/thorax-2024-222542","DOIUrl":"10.1136/thorax-2024-222542","url":null,"abstract":"","PeriodicalId":23284,"journal":{"name":"Thorax","volume":" ","pages":"129-130"},"PeriodicalIF":9.0,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143410735","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":"Association of fluoroquinolones with the risk of spontaneous pneumothorax: nationwide case-time-control study.","authors":"Anne Bénard-Laribière, Elodie Pambrun, Serge Kouzan, Jean-Luc Faillie, Julien Bezin, Antoine Pariente","doi":"10.1136/thorax-2024-221779","DOIUrl":"10.1136/thorax-2024-221779","url":null,"abstract":"<p><strong>Introduction: </strong>Fluoroquinolones can cause severe collagen-associated adverse effects, potentially impacting the pulmonary connective tissue. We investigated the association between fluoroquinolones and spontaneous pneumothorax.</p><p><strong>Methods: </strong>A case-time-control study was performed using the nationwide French reimbursement healthcare system database (SNDS). Cases were adults ≥18 years admitted for spontaneous pneumothorax between 2017 and 2022. For each case, fluoroquinolone use was compared between the risk period immediately preceding the admission date (days -30 to -1), and three earlier reference periods (days -180 to -151, -150 to -121, -120 to -91), adjusting for time-varying confounders. OR estimates were corrected for potential exposure-trend bias using a reference group without the event (matched on age, sex, chronic obstructive pulmonary disease history, calendar time). Amoxicillin use was studied similarly to control for indication bias.</p><p><strong>Results: </strong>Of the 246 pneumothorax cases exposed to fluoroquinolones (63.8% men; mean age, 43.0±18.4 years), 63 were exposed in the 30-day risk period preceding pneumothorax and 128 in the reference periods. Of the 3316 amoxicillin cases (72.9% men; mean age, 39.4±17.6 years), 1210 were exposed in the 30-day risk period and 1603 in the reference ones. OR adjusted for exposure-trend and covariates was 1.59 (95% CI 1.14 to 2.22) for fluoroquinolones and 2.25 (2.07 to 2.45) for amoxicillin.</p><p><strong>Conclusion: </strong>An increased risk of spontaneous pneumothorax was associated with both fluoroquinolone and amoxicillin use, with an even higher association for amoxicillin. This strongly suggests the role of the underlying infections rather than a causal effect of the individual antibiotics and can be considered reassuring regarding a potential lung connective toxicity of fluoroquinolones.</p>","PeriodicalId":23284,"journal":{"name":"Thorax","volume":" ","pages":"159-166"},"PeriodicalIF":9.0,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11877017/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142406933","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":"Invasive angiolipoma of the mediastinum and lung.","authors":"Ziyin Shang, Yongjie Luo, Xiaoling Kang, Chun Hong, Yuan Si","doi":"10.1136/thorax-2024-222337","DOIUrl":"https://doi.org/10.1136/thorax-2024-222337","url":null,"abstract":"","PeriodicalId":23284,"journal":{"name":"Thorax","volume":" ","pages":""},"PeriodicalIF":9.0,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143410760","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":"Inflammation in preschool cystic fibrosis is of mixed phenotype, extends beyond the lung and is differentially modified by CFTR modulators.","authors":"Shivanthan Shanthikumar, Liam Gubbels, Anson Tsz Chun Wong, Hannah Walker, Sarath C Ranganathan, Melanie R Neeland","doi":"10.1136/thorax-2024-221634","DOIUrl":"https://doi.org/10.1136/thorax-2024-221634","url":null,"abstract":"<p><strong>Background: </strong>Early-life inflammation has long been recognised as a key pathophysiological process in the evolution of cystic fibrosis (CF) lung disease. Despite this, no CF-specific anti-inflammatory treatments have been developed. This is crucial even in the era of highly effective modulator therapy as recent evidence suggests that modulators alter, but may not fully resolve, pulmonary inflammation.</p><p><strong>Methods: </strong>In this study, we used clinical microbiology data, high-dimensional flow cytometry and multiplex immunoassays to compare pulmonary (bronchoalveolar lavage (BAL)) and systemic immunity in 70 preschool children with CF and a total of 32 age-matched preschool controls.</p><p><strong>Results: </strong>We show that inflammation in the early-life CF lung is characterised by innate cell infiltration (neutrophils: 31.31 vs 1.8% of BAL in CF compared with controls, FDRp=0.0001; eosinophils: 0.55 vs 0.06%, FDRp=0.001, and monocytes: 1.91 vs 0.45%, FDRp=0.004) and widespread upregulation of both traditional and type 2 inflammatory soluble signatures (40 analytes significantly elevated in BAL of CF compared with controls, all FDRp<0.1). Key targetable features of this response included pulmonary interleukin (IL)-8 and IL-13 which were most significantly associated with neutrophilic and eosinophilic infiltration, respectively (IL-8 and neutrophils; Spearman rho=0.68, FDRp=0.002: IL-13 and eosinophils; Spearman rho=0.75, FDRp=0.01). Signatures of type 2 inflammation, as identified by REACTOME pathway analysis, including IL-4, IL-13 and FGF-2, were highly elevated in both the lungs and circulation in early CF. When exploring the efficacy of Cystic Fibrosis Transmembrane Conductance Regulator modulators to resolve pulmonary and systemic inflammation in early life, we showed that different classes of modulators have varying effects on inflammation, with ivacaftor showing a more significant effect in the lungs and circulation than lumacaftor/ivacaftor. Finally, we showed that CF children with pathogen colonisation had similar levels of pulmonary inflammation as CF children without pathogen colonisation (no significant differences), and that inflammation was evident during infancy even without evidence of colonisation (as observed by significant increases in levels of SDF-1alpha, M-CSF, IL-2, IL-9, IL-12p40, IL-17, MCP-1 and LIGHT/TNFSF14, all FDRp<0.1), highlighting a role for intrinsic dysregulation of inflammation that begins in early life.</p><p><strong>Conclusions: </strong>We provide a rationale for targeted anti-inflammatory intervention in early-life CF.</p>","PeriodicalId":23284,"journal":{"name":"Thorax","volume":" ","pages":""},"PeriodicalIF":9.0,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143392010","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":"Adult asthma hospitalisations decreased markedly in Finland and Sweden between 2006 and 2022.","authors":"Juho E Kivistö, Jennifer L P Protudjer, Sandra Ekstrom, Jussi Karjalainen, Heini Huhtala, Lauri Lehtimäki, Inger Kull","doi":"10.1136/thorax-2024-222417","DOIUrl":"https://doi.org/10.1136/thorax-2024-222417","url":null,"abstract":"<p><p>A decreasing trend in asthma hospitalisations among Finnish and Swedish children has been reported. However, possible changes in asthma hospitalisations among adults are incompletely characterised. We aimed to investigate the incidence of adult asthma hospitalisations in Finland and Sweden from 2006 to 2022 using Finland's National Hospital Discharge Register and Sweden's National Patient Register. During the study period, the incidence of asthma hospitalisations decreased by 65.8% in Finland (from 84.9 to 29.0 per 100 000 person-years) and by 52.5% in Sweden (from 31.4 to 14.9 per 100 000 person-years). The incidences of asthma hospitalisations were distinctly higher in Finland compared with Sweden at the start of the study period but approached parity among both sexes.</p>","PeriodicalId":23284,"journal":{"name":"Thorax","volume":" ","pages":""},"PeriodicalIF":9.0,"publicationDate":"2025-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143374726","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}