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Dual sequential testing for latent tuberculosis infection in BCG-vaccinated contacts: is it worth it? 对接种过bcg的接触者进行潜伏结核感染的双序贯检测:值得吗?
IF 1 1区 医学
Thorax Pub Date : 2025-06-19 DOI: 10.1136/thorax-2025-223594
Cynthia B E Chee, Yee-Tang Wang
{"title":"Dual sequential testing for latent tuberculosis infection in BCG-vaccinated contacts: is it worth it?","authors":"Cynthia B E Chee, Yee-Tang Wang","doi":"10.1136/thorax-2025-223594","DOIUrl":"https://doi.org/10.1136/thorax-2025-223594","url":null,"abstract":"A pillar of the WHO End TB Strategy is targeted latent tuberculosis infection (LTBI) testing to identify persons who would benefit from TB preventive treatment (TPT).1 The WHO recommends the interferon-gamma release assays (IGRAs), tuberculin skin test (TST) or Mycobacterium tuberculosis antigen-based skin tests without preference, for LTBI detection in persons at high risk for recent TB infection or of progression to active disease,2 whereas guidelines from low TB incidence/high income countries preferentially recommend the IGRAs over the TST especially in those who have received BCG vaccination or who are not likely to return for TST reading.3 Both TST and IGRAs have shown similar (although disappointingly low) positive predictive values for progression to TB disease in meta-analyses which included subjects from a variety of settings and population subgroups (eg, contacts, healthcare workers, immunosuppressed persons and migrants).4 5 The IGRAs have several advantages over the TST, namely its superior specificity in BCG-vaccinated persons, a machine readout …","PeriodicalId":23284,"journal":{"name":"Thorax","volume":"12 1","pages":""},"PeriodicalIF":10.0,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144319410","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}
引用次数: 0
Long-term exposure to low-level crystalline silica and risk assessment of silicosis: a cohort study. 长期暴露于低水平结晶二氧化硅和矽肺病风险评估:一项队列研究。
IF 7.7 1区 医学
Thorax Pub Date : 2025-06-16 DOI: 10.1136/thorax-2024-222660
Dongming Wang, Wenzhen Li, Min Zhou, Jixuan Ma, Yanjun Guo, Weihong Chen
{"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":"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/m<sup>3</sup>, 0.10 mg/m<sup>3</sup> and 0.35 mg/m<sup>3</sup>. 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/m<sup>3</sup>, 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/m<sup>3</sup> 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/m<sup>3</sup> 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":"451-456"},"PeriodicalIF":7.7,"publicationDate":"2025-06-16","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}
引用次数: 0
Inflammation in preschool cystic fibrosis is of mixed phenotype, extends beyond the lung and is differentially modified by CFTR modulators. 学龄前囊性纤维化的炎症是混合表型,延伸到肺之外,并被CFTR调节剂不同地修饰。
IF 7.7 1区 医学
Thorax Pub Date : 2025-06-16 DOI: 10.1136/thorax-2024-221634
Shivanthan Shanthikumar, Liam Gubbels, Anson Tsz Chun Wong, Hannah Walker, Sarath C Ranganathan, Melanie R Neeland
{"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":"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":"433-444"},"PeriodicalIF":7.7,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12322466/pdf/","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":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Inhalational exposures associated with risk of interstitial lung disease: a systematic review and meta-analysis. 吸入暴露与间质性肺病风险相关:一项系统回顾和荟萃分析
IF 1 1区 医学
Thorax Pub Date : 2025-06-15 DOI: 10.1136/thorax-2024-222306
Cathryn T Lee,Sheiphali A Gandhi,Seham Elmrayed,Hayley Barnes,Diane Lorenzetti,Margaret L Salisbury,Iain D Stewart,Christopher Barber,Cheryl E Peters,Johanna Feary,Kerri A Johannson
{"title":"Inhalational exposures associated with risk of interstitial lung disease: a systematic review and meta-analysis.","authors":"Cathryn T Lee,Sheiphali A Gandhi,Seham Elmrayed,Hayley Barnes,Diane Lorenzetti,Margaret L Salisbury,Iain D Stewart,Christopher Barber,Cheryl E Peters,Johanna Feary,Kerri A Johannson","doi":"10.1136/thorax-2024-222306","DOIUrl":"https://doi.org/10.1136/thorax-2024-222306","url":null,"abstract":"RATIONALEInhalational exposures are associated with risk of developing interstitial lung disease (ILD), yet the relationship between specific exposures and ILD is poorly characterised.OBJECTIVEIdentify inhalational exposures associated with ILD and estimate the effects of exposures on ILD risk.METHODSMEDLINE and EMBASE databases were searched from 1990 to 2022 to identify inhalational exposures associated with ILD diagnosis. ILDs where causality is well-established (hypersensitivity pneumonitis, pneumoconiosis) and sarcoidosis were excluded. Two independent reviewers screened abstracts with full-text review and data extraction of eligible studies. Where possible, data were pooled and multilevel meta-analysis was specified using a random effects model. Sources of heterogeneity and risk of bias were assessed.MAIN RESULTS96 studies were included in the systematic review, representing 40 819 116 subjects (295 167 had ILD, 40 523 949 controls). For the meta-analysis, 54 studies were included (40 490 793 subjects: 273 899 ILD, 40 216 894 controls). Exposures associated with significantly increased ILD risk included smoking (OR 1.69, 95% CI 1.47 to 1.94), organic exposures (OR 1.56, 95% CI 1.12 to 2.16), metals (OR 1.52, 95% CI 1.07 to 2.16), dust (OR 1.45, 95% CI 1.20 to 1.76) and asbestos (OR 1.53, 95% CI 1.08 to 2.15). Silica and fumes had positive associations with ILD that trended towards significance.CONCLUSIONSThis systematic review and multilevel meta-analysis is the first to comprehensively assess the effect of inhalational exposures on overall risk of ILD, with multiple putative exposures identified. Future work should investigate novel occupational exposures associated with ILD, characterise the gene-environment interaction and develop preventative strategies.PROSPERO REGISTRATION NUMBERCRD42022292908.","PeriodicalId":23284,"journal":{"name":"Thorax","volume":"13 1","pages":""},"PeriodicalIF":10.0,"publicationDate":"2025-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144295671","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}
引用次数: 0
Harnessing AI in critical care: opportunities, challenges and key steps for success. 在重症监护中利用人工智能:机遇、挑战和成功的关键步骤。
IF 1 1区 医学
Thorax Pub Date : 2025-06-15 DOI: 10.1136/thorax-2024-222125
Alexandre Kalimouttou,Robert D Stevens,Romain Pirracchio
{"title":"Harnessing AI in critical care: opportunities, challenges and key steps for success.","authors":"Alexandre Kalimouttou,Robert D Stevens,Romain Pirracchio","doi":"10.1136/thorax-2024-222125","DOIUrl":"https://doi.org/10.1136/thorax-2024-222125","url":null,"abstract":"BACKGROUNDThe integration of artificial intelligence (AI) into critical care offers significant potential to enhance early diagnosis, predict patient deterioration, personalise treatment and inform clinical decision-making. Despite this promise, AI adoption in the intensive care unit (ICU) faces challenges, as illustrated by the limited number of AI tools which have been approved for clinical use and/or successfully deployed in critical care.METHODSAims of the review are to provide a synthesis of research on AI in critical care; assess approved tools; and consider challenges and opportunities, focusing on the different phases of the AI algorithm lifecycle in the ICU, including data collection, modelling, validation, implementation and post-deployment monitoring. Peer-reviewed publications were searched using terms relevant to AI and critical care spanning the years 2000-2025.RESULTSResearch on AI applications in the ICU is characterised by significant limitations including suboptimal data quality, retrospective analyses and a paucity of prospective validation studies. The few AI algorithms that have received Food and Drug Administration approval for use in the ICU have not gained widespread clinical adoption due, in part, to issues such as lack of user trust, integration challenges, unclear clinical impact or performance drift. Overcoming these barriers will require a structured approach that addresses the key challenges identified in the AI lifecycle, including the integration of real-world data, post-deployment performance monitoring, governance and ethical considerations. A successful implementation pathway should consider realistic goal-setting, greater model explainability, improved workflow integration and active end-user involvement.CONCLUSIONSAdvancing critical care with AI will require special attention to interdisciplinary collaboration, robust validation frameworks and adaptive governance models. The need for rigorous scientific evaluation needs to be balanced with the pressure for rapid deployment. Ensuring transparency, safety and alignment with clinical workflows will be critical to achieving meaningful AI integration in critical care.","PeriodicalId":23284,"journal":{"name":"Thorax","volume":"6 1","pages":""},"PeriodicalIF":10.0,"publicationDate":"2025-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144295672","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}
引用次数: 0
Is it truly chronic thromboembolic pulmonary hypertension? A case of pulmonary hypertension with proptosis 它真的是慢性血栓栓塞性肺动脉高压吗?肺动脉高压伴突出1例
IF 1 1区 医学
Thorax Pub Date : 2025-06-15 DOI: 10.1136/thorax-2024-222953
Yuebo Song, Fajiu Li, Wanmu Xie, Ling Zhao, Huan Li, Ziyang Zhu, Chenghong Li, Shuai Zhang, Zhenguo Zhai
{"title":"Is it truly chronic thromboembolic pulmonary hypertension? A case of pulmonary hypertension with proptosis","authors":"Yuebo Song, Fajiu Li, Wanmu Xie, Ling Zhao, Huan Li, Ziyang Zhu, Chenghong Li, Shuai Zhang, Zhenguo Zhai","doi":"10.1136/thorax-2024-222953","DOIUrl":"https://doi.org/10.1136/thorax-2024-222953","url":null,"abstract":"A 42-year-old man presented with an 11-month history of progressive exertional dyspnoea and leg swelling. His 6 min walk distance (6MWD) was 345 m. Three months before admission, blood tests revealed an elevated D-dimer level of 3.56 mg/L (<0.5 mg/L), B-type natriuretic peptide (BNP) level of 860 pg/mL (<100 pg/mL) and creatinine level of 251.70 µmol/L (35–106 μmol/L). No evidence of deep vein thrombosis was found on lower extremity ultrasonography. Echocardiography showed right heart enlargement with a right-to-left ventricular ratio of 2.1, right ventricular hypertrophy (wall thickness, 5.4 mm) and an increased estimated systolic pulmonary artery pressure (PAP) of 65 mmHg. A pulmonary ventilation–perfusion scan identified mismatched perfusion deficits, and CT pulmonary angiography (CTPA) showed filling defects primarily in the left pulmonary arterial trunk. Upon these findings, therapy with the anticoagulant rivaroxaban was immediately initiated. Despite a partial reduction in the D-dimer level to 1.67 mg/L, the patient showed no significant improvement on repeat CTPA (figure 1). One week before admission, a right heart catheterisation confirmed precapillary pulmonary hypertension (PH) with a mean PAP of 39 mmHg, pulmonary artery wedge pressure of 7 mmHg …","PeriodicalId":23284,"journal":{"name":"Thorax","volume":"230 1","pages":""},"PeriodicalIF":10.0,"publicationDate":"2025-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144296121","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}
引用次数: 0
Climate change: shifting boundaries of fungal disease in Europe and beyond 气候变化:欧洲及其他地区真菌疾病的边界不断变化
IF 1 1区 医学
Thorax Pub Date : 2025-06-08 DOI: 10.1136/thorax-2024-222168
Michael Bottery, Sarah Sedik, Ilan Schwartz, Martin Hoenigl, Norman van Rhijn
{"title":"Climate change: shifting boundaries of fungal disease in Europe and beyond","authors":"Michael Bottery, Sarah Sedik, Ilan Schwartz, Martin Hoenigl, Norman van Rhijn","doi":"10.1136/thorax-2024-222168","DOIUrl":"https://doi.org/10.1136/thorax-2024-222168","url":null,"abstract":"Climate change is altering ecosystems worldwide. While shifting environmental conditions are complex, it has been hypothesised that the impact of climate change is directly leading to increases in fungal infections across the globe. Rising temperatures, changing precipitation patterns and extreme weather events are thought to be driving the adaptation of fungal pathogens to new climates, expanding their geographical range and posing a growing threat to human health and agriculture. This review highlights how climate change may impact key pathogens, including Candida auris , Candida orthopsilosis , Cryptococcus deuterogattii and resistant strains of Aspergillus fumigatus , which have emerged as significant public health concerns. Their spread is accelerated by globalisation, urbanisation and the intensifying use of agricultural fungicides, which further increase antifungal resistance. The growing prevalence of resistant strains and emergence of novel fungal pathogens is likely linked to anthropogenic climate change, underscoring the urgent need for action and for more robust data collection.","PeriodicalId":23284,"journal":{"name":"Thorax","volume":"47 1","pages":""},"PeriodicalIF":10.0,"publicationDate":"2025-06-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144238139","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}
引用次数: 0
Towards dynamic risk assessments in lung cancer screening 肺癌筛查中的动态风险评估
IF 1 1区 医学
Thorax Pub Date : 2025-06-08 DOI: 10.1136/thorax-2025-223403
Kevin ten Haaf
{"title":"Towards dynamic risk assessments in lung cancer screening","authors":"Kevin ten Haaf","doi":"10.1136/thorax-2025-223403","DOIUrl":"https://doi.org/10.1136/thorax-2025-223403","url":null,"abstract":"Various lung cancer screening programmes and pilot studies are being implemented worldwide.1 Many of these programmes have identified and screened their first selection of individuals that meet the defined criteria for screening eligibility. Regardless of the chosen criteria, there will always be a group of individuals with risks close to but below the cut-off for eligibility, who may reach the eligibility threshold in future years. Approaches for risk reassessment of these individuals should be efficient in order to limit the costs and potential distress of contacting these individuals.2 Consequently, the study by Kumarasamy et al provides a timely and pragmatic approach for evaluating whether and when to reassess these ‘near-miss’ individuals.3 The study evaluated individuals who were approached for the International Lung Screening Trial from seven sites across Australia, Canada and Hong Kong, but were ineligible due to having a PLCOm2012 risk score of less than 1.51%.4 5 It finds that about 50.3% of these individuals reach this risk score before age 80, while 38.7% and 26.9% would do so before ages 75 and 70, respectively. Overall, of the participants eligible by age 80, 69.0% reached the 1.51% risk score within 10 years …","PeriodicalId":23284,"journal":{"name":"Thorax","volume":"40 1","pages":""},"PeriodicalIF":10.0,"publicationDate":"2025-06-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144238146","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}
引用次数: 0
Associations of interstitial lung disease subtype and CT pattern with lung function and survival 间质性肺疾病亚型和CT表现与肺功能和生存的关系
IF 1 1区 医学
Thorax Pub Date : 2025-06-08 DOI: 10.1136/thorax-2024-222149
John S Kim, Janelle Pugashetti, Shwu-Fan Ma, Yong Huang, Anna J Podolanczuk, David A Lynch, Andrea Oh, Josyf Mychaleckyj, Ani Manichaikul, Stephen Rich, Felix Chua, Traci M Adams, Kevin R Flaherty, Joyce S Lee, Joseph A Lasky, Ganesh Raghu, Susan Murray, Catherine Spino, Fernando J Martinez, Imre Noth, Stephen M Humphries, Ayodeji Adegunsoye, Philip L Molyneaux, Justin M Oldham, Chad A Newton
{"title":"Associations of interstitial lung disease subtype and CT pattern with lung function and survival","authors":"John S Kim, Janelle Pugashetti, Shwu-Fan Ma, Yong Huang, Anna J Podolanczuk, David A Lynch, Andrea Oh, Josyf Mychaleckyj, Ani Manichaikul, Stephen Rich, Felix Chua, Traci M Adams, Kevin R Flaherty, Joyce S Lee, Joseph A Lasky, Ganesh Raghu, Susan Murray, Catherine Spino, Fernando J Martinez, Imre Noth, Stephen M Humphries, Ayodeji Adegunsoye, Philip L Molyneaux, Justin M Oldham, Chad A Newton","doi":"10.1136/thorax-2024-222149","DOIUrl":"https://doi.org/10.1136/thorax-2024-222149","url":null,"abstract":"Background Prior work suggests different interstitial lung diseases (ILDs) that share the radiological usual interstitial pneumonia (UIP) pattern have an overall worse prognosis. However, epidemiological data with longitudinal sampling and replication remains lacking. Methods Data was used from the Pulmonary Fibrosis Foundation Patient Registry (PFF-PR) (n=932) and a meta-cohort of ILD research studies (n=1579). Linear mixed-effects models and Cox proportional hazard models were used to determine forced vital capacity (FVC) slopes and 5-year transplant-free survival, respectively, by ILD diagnosis and UIP radiological pattern. Secondarily, we examined FVC and survival by diagnosis and radiological fibrosis quantified by data-driven texture analysis (DTA) in the PFF-PR. Models were adjusted for age, sex, smoking and antifibrotic and immunosuppression medication use. Results The proportions of idiopathic pulmonary fibrosis (IPF), fibrotic hypersensitivity pneumonitis (FHP) and connective tissue disease (CTD)-ILD were the following for PFF-PR (70%, 11%, 19%) and meta-cohort (21%, 32%, 47%). In the PFF-PR, CTD-ILD with UIP CT pattern was associated with slower FVC decline (−34.4 mL/year) compared with IPF (−158.4 mL/year) and longer transplant-free survival (HR 0.50, 95% CI 0.29 to 0.85). This was replicated in the meta cohort for FVC (−53.1 vs −185.9 mL/year, p<0.0001) and survival (HR 0.38, 95% CI 0.27 to 0.53). A similar pattern was seen using DTA to objectively categorise patients into higher and lower radiological fibrosis. Between IPF and FHP-UIP, FVC decline was not significantly different in the PFF-PR (−203.4 vs −158.4 mL/year, p=0.58) and meta-cohort (−124.0 vs −185.9 mL/year, p=0.25). Conclusions Even in the presence of a UIP CT pattern, there may still be differences in lung function over time and survival, particularly for CTD-ILD. Data are available upon reasonable request.","PeriodicalId":23284,"journal":{"name":"Thorax","volume":"10 1","pages":""},"PeriodicalIF":10.0,"publicationDate":"2025-06-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144238147","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}
引用次数: 0
Bacterial multiplex polymerase chain reaction tests for the diagnosis and management of pneumonia: ready for prime time? 细菌多重聚合酶链反应试验用于肺炎的诊断和管理:准备好了吗?
IF 1 1区 医学
Thorax Pub Date : 2025-06-05 DOI: 10.1136/thorax-2024-222297
Lowell Ling, Christopher Koon Chi Lai, Chanu Rhee
{"title":"Bacterial multiplex polymerase chain reaction tests for the diagnosis and management of pneumonia: ready for prime time?","authors":"Lowell Ling, Christopher Koon Chi Lai, Chanu Rhee","doi":"10.1136/thorax-2024-222297","DOIUrl":"https://doi.org/10.1136/thorax-2024-222297","url":null,"abstract":"Background The diagnosis and management of pneumonia is often challenging due to its overlapping clinical presentations with other respiratory illnesses, low pathogen identification rates, and slow turnaround time of conventional bacterial cultures. These factors contribute to both inadequate empiric therapy and overuse of broad-spectrum antibiotics, which can negatively impact outcomes. Recently, multiplex polymerase chain reaction (mPCR) assays capable of rapidly detecting multiple bacterial respiratory pathogens and resistance genes have emerged. However, their clinical utility in pneumonia management remains uncertain. Objective To assess the utility of bacterial mPCR assays in pneumonia diagnosis, their impact on antimicrobial usage, and their effect on patient outcomes. Methods A comprehensive literature review was conducted using MEDLINE to identify observational studies and randomised controlled trials (RCTs) evaluating the accuracy and clinical impact of bacterial mPCR tests for pneumonia. Results Bacterial mPCR assays demonstrate high sensitivity for pathogen detection, rapid turnaround compared to conventional cultures, and the ability to identify many common resistance genes. They may also improve pathogen detection in patients who received empirical antibiotics prior to specimen collection. However, mPCRs do not detect all potential pathogens, cannot reliably differentiate colonisation from infection, and may show discordance between genetic and phenotypic resistance. mPCR panels also generally require lower respiratory tract specimens, limiting their utility since many pneumonia patients cannot produce adequate sputum. Observational studies and RCTs suggest that mPCR may help optimise antibiotic selection, but RCTs have not clearly demonstrated reductions in overall antibiotic use or improved clinical outcomes including mortality. Implementation of mPCR without structured antimicrobial stewardship may limit clinical impact. Conclusions Bacterial mPCR assays offer rapid and sensitive pathogen detection, but their integration into pneumonia management requires careful consideration of clinical context and expert antimicrobial stewardship guidance. Future research should focus on optimising their diagnostic and therapeutic applications, evaluating cost-effectiveness, and assessing patient-centered outcomes.","PeriodicalId":23284,"journal":{"name":"Thorax","volume":"9 1","pages":""},"PeriodicalIF":10.0,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144218933","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}
引用次数: 0
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