Thorax最新文献

{"title":"Is NEWS2 the optimal evidence-based surveillance tool for all respiratory patients or does it just represent the beginning of an iterative development process?","authors":"Dominick Shaw, Andrew W Fogarty","doi":"10.1136/thorax-2024-222335","DOIUrl":"10.1136/thorax-2024-222335","url":null,"abstract":"<p><p>Medical practice is built on the foundations of evidence-based medicine. Hence, the more common the clinical intervention, the more comprehensive the evidence on which that intervention should be based. Although the widespread adoption of a national early warning score in the UK has led to improvements in the delivery of care, it should be considered as providing a foundation that can be refined and developed, and there is still a need for critical reflection and evaluation of early warning scores, particularly for individuals with chronic respiratory disease, in order to optimise patient monitoring, predict deterioration and guide intervention.</p>","PeriodicalId":23284,"journal":{"name":"Thorax","volume":" ","pages":"197-201"},"PeriodicalIF":9.0,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143374767","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":"Role of inflammasomes in acute respiratory distress syndrome.","authors":"Luke Flower, Emilio G Vozza, Clare E Bryant, Charlotte Summers","doi":"10.1136/thorax-2024-222596","DOIUrl":"10.1136/thorax-2024-222596","url":null,"abstract":"<p><p>Acute respiratory distress syndrome (ARDS) is present in >10% of all people admitted to critical care and is associated with severe morbidity and mortality. Despite more than half a century since its first description, no efficacious pharmacological therapies have been developed, and little progress has been made in improving clinical outcomes. Neutrophils are the principal drivers of ARDS, with their priming and subsequent aberrant downstream functions, including interleukin (IL) 1β and IL-18 secretion, central to the disease pathogenesis. The dominant pathways through which IL-1β and IL-18 are believed to be elaborated are multimeric protein structures called inflammasomes that consist of sensor proteins, adaptor proteins and an effector enzyme. The inflammasome's initial activation depends on one of a variety of damage-associated (DAMP) or pathogen-associated (PAMP) molecular patterns. However, once activated, a common downstream inflammatory pathway is initiated regardless of the specific DAMP or PAMP involved. Several inflammasomes exist in humans. The nucleotide-binding domain leucine-rich repeat (NLR) family, pyrin domain-containing 3 (NLRP3), inflammasome is the best described in the context of ARDS and is known to be activated in both infective and sterile cases. The NLR family, caspase activation and recruitment domain-containing 4 (NLRC4) and absent in melanoma 2 (AIM2) inflammasomes have also been implicated in various ARDS settings, as have inflammasome-independent pathways. Further work is required to understand human biology as much of our knowledge is extrapolated from rodent experimental models. Experimental lung injury models have demonstrated beneficial responses to inflammasome, IL-1β and IL-18 blockade. However, findings have yet to be successfully translated into humans with ARDS, likely due to an underappreciation of the central role of the neutrophil inflammasome. A thorough understanding of inflammasome pathways is vital for critical care clinicians and researchers and for the development of beneficial therapies. In this review, we describe the central role of the inflammasome in the development of ARDS and its potential for immunomodulation, highlighting key areas for future research.</p>","PeriodicalId":23284,"journal":{"name":"Thorax","volume":" ","pages":"255-263"},"PeriodicalIF":9.0,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12015084/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143068163","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":"Pulmonary rehabilitation: one size does not fit all.","authors":"Narelle S Cox, Anne E Holland","doi":"10.1136/thorax-2024-222680","DOIUrl":"10.1136/thorax-2024-222680","url":null,"abstract":"","PeriodicalId":23284,"journal":{"name":"Thorax","volume":" ","pages":"189-190"},"PeriodicalIF":9.0,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143123589","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":"Incidental finding of leukaemic pulmonary infiltration confirmed by flow cytometry of BAL fluid.","authors":"Matthew Wells, Aaron Morjaria, William Cooper, Sophie Otton, Huzaifa I Adamali","doi":"10.1136/thorax-2024-222362","DOIUrl":"10.1136/thorax-2024-222362","url":null,"abstract":"","PeriodicalId":23284,"journal":{"name":"Thorax","volume":" ","pages":"251-252"},"PeriodicalIF":9.0,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143374756","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":"Rare case of bilateral lung nodules.","authors":"Muniza Bai, Naren Chandra V, Anant Mohan, Ashu Seith Bhalla","doi":"10.1136/thorax-2024-222277","DOIUrl":"10.1136/thorax-2024-222277","url":null,"abstract":"","PeriodicalId":23284,"journal":{"name":"Thorax","volume":" ","pages":"253-254"},"PeriodicalIF":9.0,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143442148","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":"Filipa Canedo","doi":"10.1136/thorax-2025-223213","DOIUrl":"https://doi.org/10.1136/thorax-2025-223213","url":null,"abstract":"","PeriodicalId":23284,"journal":{"name":"Thorax","volume":"80 4","pages":"264"},"PeriodicalIF":9.0,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143658686","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":"Availability, cost and affordability of essential medicines for smoking cessation in low-income and middle-income countries: a cross-sectional study.","authors":"Catherine Plum, Marie Stolbrink, Obianuju Ozoh, Shamanthi Jayasooriya, Rebecca Nightingale, Kevin Mortimer, David Halpin","doi":"10.1136/thorax-2024-222391","DOIUrl":"10.1136/thorax-2024-222391","url":null,"abstract":"<p><p>Smoking cessation is more effective when supported by medicines. Data on the availability, cost and affordability of these treatments in low-income and middle-income countries (LMIC) are limited. Cross-sectional data for smoking cessation medications were collected from pharmacies, healthcare facilities and central medicine stores in 60 LMIC (2022-2023). Medications had varying availability, large price ranges and were essentially unaffordable. Enabling access to these medications is important in reducing tobacco consumption and associated disease. Strategies for integrating smoking cessation services into health systems are needed to reach Sustainable Development Goal targets.</p>","PeriodicalId":23284,"journal":{"name":"Thorax","volume":" ","pages":"248-250"},"PeriodicalIF":9.0,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12015041/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143123069","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":"Effect of vitamin A on adult lung function: a triangulation of evidence approach.","authors":"Róisín Mongey, Diana A van der Plaat, Seif O Shaheen, Laura Portas, James Potts, Matthew David Hind, Cosetta Minelli","doi":"10.1136/thorax-2024-222622","DOIUrl":"10.1136/thorax-2024-222622","url":null,"abstract":"<p><strong>Background: </strong>Vitamin A, an essential micronutrient obtained through the diet, plays a crucial role in lung development and contributes to lung regeneration. We aimed to investigate its effect on adult lung function using triangulation of evidence from both observational and genetic data.</p><p><strong>Methods: </strong>Using data on 150 000 individuals from UK Biobank and correcting for measurement error (generalised structural equation modelling), we first investigated the association of dietary vitamin A intake (total vitamin A, carotene and retinol) with lung function (forced vital capacity (FVC), forced expiratory volume in 1 s (FEV₁)/FVC)). We then assessed the causality of these associations using Mendelian randomisation (MR), and we investigated the effects on adult lung function of 39 genes related to vitamin A, and their interaction with vitamin A intake.</p><p><strong>Findings: </strong>Our observational analysis suggests a positive association between carotene intake and FVC only (13.3 mL per 100 µg/day; p=2.9×10^-9), with stronger associations in smokers, but no association of retinol intake with FVC or FEV₁/FVC. The MR similarly shows a beneficial effect of serum beta-carotene on FVC only, with no effect of serum retinol on FVC nor FEV₁/FVC. Nine of the vitamin A-related genes were associated with adult lung function, six of which have not been previously identified in genome-wide studies and three (<i>NCOA2, RDH10, RXRB</i>) in any type of genetic study of lung function. Five genes showed possible gene-vitamin A intake interactions.</p><p><strong>Interpretation: </strong>Our triangulation study provides convincing evidence for a causal effect of vitamin A, carotene in particular, on adult lung function, suggesting a beneficial effect of a carotene-rich diet on adult lung health.</p>","PeriodicalId":23284,"journal":{"name":"Thorax","volume":" ","pages":"236-244"},"PeriodicalIF":9.0,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143410752","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":"Long-term exposure to low-level crystalline silica and risk assessment of silicosis: a cohort study.","authors":"Dongming Wang, Wenzhen Li, Min Zhou, Jixuan Ma, Yanjun Guo, Weihong Chen","doi":"10.1136/thorax-2024-222660","DOIUrl":"https://doi.org/10.1136/thorax-2024-222660","url":null,"abstract":"<p><strong>Background: </strong>High-level exposure to crystalline silica dust is the key factor in silicosis. Long-term exposure to low-level silica dust, for example, lower than that in occupational exposure limits, still needs to be studied for their risk of silicosis.</p><p><strong>Methods: </strong>A total of 30 697 workers were included from a cohort in China. Low-level silica dust exposure was defined as those having a lifetime mean silica dust concentration equal to or under permissible exposure limits, including 0.05 mg/m³, 0.10 mg/m³ and 0.35 mg/m³. Cumulative respirable silica dust exposure (CDE) for individual workers was assessed by linking a job-exposure matrix to personal work history.</p><p><strong>Results: </strong>Among those with average exposure level equal to or lower than 0.05 mg/m³, compared with the lowest quartile CDE (Q1), the HRs of silicosis were 1.32 (95% CI 0.82 to 2.10) for Q2, 1.87 (95% CI 1.22 to 2.88) for Q3 and 2.00 (95% CI 1.30 to 3.09) for Q4. Among those exposed to 0.10 mg/m³ or less exposure level, compared with Q1, the HRs were 2.52 (95% CI 1.88 to 3.38) for Q2, 4.08 (95% CI 3.09 to 5.39) for Q3 and 4.02 (95% CI 3.04 to 5.32) for Q4. Among those exposed to 0.35 mg/m³ or less exposure level, compared with Q1, the HRs were 2.80 (95% CI 2.38 to 3.28) for Q2, 5.76 (95% CI 4.93 to 6.73) for Q3 and 7.14 (95% CI 6.07 to 8.40) for Q4, respectively. Stratified analysis showed that the results and trends did not change with facilities and smoking status.</p><p><strong>Conclusion: </strong>Long-term exposure to low-level silica dust is still associated with a higher risk of silicosis. Control measurements and personal protective equipment should be emphasised to protect the health of workers.</p>","PeriodicalId":23284,"journal":{"name":"Thorax","volume":" ","pages":""},"PeriodicalIF":9.0,"publicationDate":"2025-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143639831","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 microvascular blood volume and emphysema: in vivo link shown in the MESA cohort","authors":"Georgina Bailey, Carole A Ridge","doi":"10.1136/thorax-2025-223133","DOIUrl":"https://doi.org/10.1136/thorax-2025-223133","url":null,"abstract":"While the pulmonary microvasculature is thought to be one of the causative factors in emphysema pathogenesis, there is little in vivo evidence in the general population to confirm this. Hermann and colleagues have investigated this link by quantifying the microvascular blood volume using dual-energy computed tomography (DECT) in a diverse, community-based cohort of older adults with and without emphysema.1 Their findings reveal that lower pulmonary microvascular blood volume (PMBV) is linked to emphysema severity, specifically in those with the diffuse emphysema subtype. This association persisted even in participants without a history of smoking or evidence of airflow limitation on spirometry. DECT allows characterisation of materials by measuring attenuation values at two different X-ray energy levels.2 After the administration of iodinated intravenous contrast, DECT can be used to create iodine maps of the lungs at the voxel level, equivalent to pulmonary perfusion, and allows calculation of perfused PMBV.3 In the current study, PMBV is defined as the blood volume in the peripheral 2 cm of lung tissue excluding the area adjacent to the mediastinum, which was selected automatically in order to assess the regions of lung proven …","PeriodicalId":23284,"journal":{"name":"Thorax","volume":"26 1","pages":""},"PeriodicalIF":10.0,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143618421","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}