Multidisciplinary Respiratory Medicine最新文献

{"title":"Paradigm shift in medicine and in clinical reasoning method: time has come for a new chest semiotics.","authors":"Gino Soldati, Andrea Smargiassi, Francesco Tursi, Alessandro Zanforlin, Sara Cinquini, Paolo Carlucci, Giampietro Marchetti, Dejan Radovanovic, Riccardo Inchingolo","doi":"10.5826/mrm.2026.1090","DOIUrl":"10.5826/mrm.2026.1090","url":null,"abstract":"<p><strong>Introduction: </strong>Clinical reasoning in medicine is a complex cognitive process that integrates sensory perception, interpretation, and abductive inference to develop diagnostic hypotheses. Despite the rise of artificial intelligence, the patient-clinician encounter remains rooted in semiotics and a probabilistic approach driven by Bayesian updating. In this context, medical knowledge is viewed as context-dependent and subject to continuous revision based on new clinical signs.</p><p><strong>Main body: </strong>This paper identifies bedside ultrasonography as a transformative \"epistemic mediator\" that enhances traditional semiotics by uncovering subtle clinical signs often missed by conventional inspection, palpation, percussion, and auscultation. In managing respiratory diseases, ultrasound provides direct, contextualized data that refines the interpretation of findings such as dullness, altered fremitus, and crackles by linking them to specific anatomical correlates. Based on these principles, the AdET-CHEPHEUS initiative proposes a new paradigm for chest physical examination centered on three pillars: 1) Visual inspection; 2) Auscultation integrated with ultrasound; 3) Palpatory ultrasound evaluation Conclusion: By replacing traditional percussion with more informative and reproducible ultrasound-based methods, this model aligns modern technology with classical clinical epistemology. The integration of ultrasound into bedside reasoning represents a vital evolution in chest semiotics, preserving the human element of the diagnostic process while increasing accuracy.</p>","PeriodicalId":51135,"journal":{"name":"Multidisciplinary Respiratory Medicine","volume":"21 ","pages":"1090"},"PeriodicalIF":2.1,"publicationDate":"2026-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13148802/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147596010","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Semiotics and clinical reasoning: Thoracic ultrasound as an epistemic mediator.","authors":"Lorenzo Magnani","doi":"10.5826/mrm.2026.1099","DOIUrl":"10.5826/mrm.2026.1099","url":null,"abstract":"","PeriodicalId":51135,"journal":{"name":"Multidisciplinary Respiratory Medicine","volume":"21 ","pages":"1099"},"PeriodicalIF":2.1,"publicationDate":"2026-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13148800/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147596044","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Novel mutation (M_angera-E288V) in alpha-1 antitrypsin deficiency.","authors":"Giorgio Lorini, Stefania Ottaviani, Ilaria Giana, Giulia Accordino, Alice Maria Balderacchi, Angelo Guido Corsico, Ilaria Ferrarotti, Davide Piloni","doi":"10.5826/mrm.2026.1053","DOIUrl":"10.5826/mrm.2026.1053","url":null,"abstract":"<p><strong>Background: </strong>Alpha-1 antitrypsin deficiency is an autosomal, codominant disorder caused by mutations of the SERPINA1 gene. Several mutations have been described associated with the development of pulmonary and/or chronic liver diseases. We report a novel mutation Mangera, identified for the first time in an Italian patient originating from the city of Angera (Varese), Italy.</p><p><strong>Case presentation: </strong>This case report describes a 64-year-old Italian male, a lifelong non-smoker, diagnosed with severe alpha-1 antitrypsin deficiency (AATD) as composed heterozygous with S allele and a novel mutation named Mangera. The patient presented with exertional dyspnea and had reduced serum AAT levels (0.54 g/L). Pulmonary function tests indicated mild airway obstruction with preserved diffusion capacity, and chest CT scans revealed early centrilobular emphysema and fibrotic changes. Genetic analysis was performed, finding a previously unreported mutation. Despite the severe AAT deficiency, the patient exhibited no significant clinical, radiological, or functional deterioration. Given the absence of disease progression, augmentation therapy was deferred in favor of ongoing annual monitoring.</p><p><strong>Conclusions: </strong>This case report highlights the necessity of referring patients to specialized centers equipped with the expertise and tools required for precise diagnosis. Furthermore, the identification of the Mangera mutation expands the spectrum of known SERPINA1 variants associated with severe AATD, emphasizing the ongoing need for vigilance and thorough investigation in cases of suspected deficiency.</p>","PeriodicalId":51135,"journal":{"name":"Multidisciplinary Respiratory Medicine","volume":"21 ","pages":"1053"},"PeriodicalIF":2.1,"publicationDate":"2026-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13086044/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147367152","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Highlights from the Italian National Congress of Imaging in Pulmonology 2025: fostering implementation of advanced technologies for precision patient-centered care.","authors":"Guido Marchi, Michele Mondoni","doi":"10.5826/mrm.2026.1086","DOIUrl":"10.5826/mrm.2026.1086","url":null,"abstract":"<p><p>The Italian National Congress of Imaging in Pulmonology, held in Milan on November 21st, provided a unique educational platform exploring the evolving role of thoracic imaging in respiratory medicine. Organized by the Italian Respiratory Society (SIP-IRS) Imaging Study Group, the congress brought together over 160 participants, including pulmonologists, radiologists, interventional specialists, and early-career professionals, reflecting the essential role of multidisciplinary collaboration in modern respiratory care. Topics included functional imaging approaches to small airway disease in COPD and asthma, multimodal imaging in lung transplantation, the role of CT angiography for haemoptysis management, and radiomics applications for quantifying emphysema patterns and fibrotic changes. The role of imaging in guiding inhaled and biological therapies was explored, alongside a lively debate on thoracic ultrasound for interstitial lung disease screening. Advanced sessions covered medical thoracoscopy techniques, quantitative ultrasound and artificial intelligence in pleural diseases, shape-sensing robotic-assisted bronchoscopy for peripheral nodules, expanding cryobiopsy applications, and imaging's role in monitoring progressive pulmonary fibrosis therapeutics. A distinctive feature was the first \"Images in Pulmonology\" contest, won by a remarkable case simultaneously depicting lung cancer and new life. This meeting report summarizes key congress highlights and underscores the importance of fostering multidisciplinary collaboration and structured imaging education to bridge the gap between technological capabilities and clinical expertise in respiratory medicine.</p>","PeriodicalId":51135,"journal":{"name":"Multidisciplinary Respiratory Medicine","volume":"21 ","pages":"1086"},"PeriodicalIF":2.1,"publicationDate":"2026-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13086045/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147357585","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Single-Inhaler Triple Therapy (SITT) for COPD: An Italian expert opinion paper on improving clinical outcomes and equity of therapeutic access.","authors":"Andrea Bianco, Salvatore D'Antonio, Francesco Paolo Lombardo, Claudio Micheletto, Stefano Palcic, Gherardo Siscaro, Pietro Pirina","doi":"10.5826/mrm.2026.1070","DOIUrl":"10.5826/mrm.2026.1070","url":null,"abstract":"<p><p>Chronic Obstructive Pulmonary Disease (COPD) is a leading cause of global morbidity and mortality, with significant burden in Italy. Prevalence estimates vary by data source: Health Search data indicate a prevalence of 2.7% among adults, whereas population-based analyses report higher estimates of approximately 5.6%. Triple therapy combining a long-acting muscarinic antagonist (LAMA), a long-acting beta2-agonist (LABA), and an inhaled corticosteroid (ICS) has been shown to improve lung function, reduce exacerbations, and potentially decrease mortality in moderate-to-severe COPD. Fixed-dose Single-Inhaler Triple Therapy (SITT) provides practical advantages over Multiple-Inhaler Triple Therapy (MITT), including improved treatment adherence, fewer inhaler technique errors, and comparable safety. This expert opinion review summarizes evidence from randomized controlled trials and real-world studies supporting the clinical, practical, and economic benefits of SITT. While access to SITT in Italy is influenced by regulatory frameworks, optimizing prescription practices and aligning treatment strategies with clinical evidence could enhance continuity of care and patient outcomes. The paper highlights strategies to improve COPD management, reduce treatment discontinuation, and ensure equitable access to effective therapies.</p>","PeriodicalId":51135,"journal":{"name":"Multidisciplinary Respiratory Medicine","volume":"21 ","pages":"1070"},"PeriodicalIF":2.1,"publicationDate":"2026-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12971106/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147291810","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pediatric lung ultrasound: Tips and tricks for better scanning and interpretation.","authors":"Anna Maria Musolino, Laura Gori, Monica Tei, Maria Chiara Supino, Carmen D'Amore, Marta Ciofi Degli Atti, Lorenzo Di Sarno, Antonella Amendolea, Alessandro Manganaro, Gino Soldati, Francesco Tursi, Danilo Buonsenso, Cristina De Rose, Renato Cutrera, Marco Cirillo, Paolo Tomà, Caterina Bock, Francesco Esposito, Alberto Villani, Vincenzo Colacino, Annarita Iadecola, Paolo Adamoli, Gian Luca Trobia, Alfina Domenica Coco, Giuseppe Limoli, Rino Agostiniani","doi":"10.5826/mrm.2026.1074","DOIUrl":"10.5826/mrm.2026.1074","url":null,"abstract":"<p><p>In recent decades lung ultrasound (LUS) has emerged as an invaluable bedside imaging tool for the evaluation of respiratory conditions such as pneumonia, bronchiolitis, pneumothorax, and pleural effusion in pediatric age, thanks to the thin chest wall and absence of rib ossification. Despite its growing application, optimizing technique and interpretation remains crucial for reliable diagnostic performance. The present educational paper provides practical tips and tricks to enhance the accuracy, efficiency, and clinical value of LUS in pediatric patients, focusing on probe selection, patient positioning, scanning technique, common artifacts, and interpretation pitfalls.</p>","PeriodicalId":51135,"journal":{"name":"Multidisciplinary Respiratory Medicine","volume":"21 ","pages":"1074"},"PeriodicalIF":2.1,"publicationDate":"2026-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12971107/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146259933","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Timing and predictors of tracheostomy decannulation in COVID-19 and non-COVID-19 ARDS: A real-world study.","authors":"Cinzia Lastoria, Annalisa Carlucci, Francesca Cemmi, Manuela Bergonzi, Abramo Bazza, Roberta Marra, Federica Fioretti, Matteo Vigna, Francesco Tursi, Chiara Mele, Claudia Crimi","doi":"10.5826/mrm.2025.1048","DOIUrl":"10.5826/mrm.2025.1048","url":null,"abstract":"<p><strong>Background: </strong>Tracheostomy is a commonly performed procedure in patients requiring prolonged mechanical ventilation (MV) in Intensive Care Units (ICUs), including COVID-19-related ARDS. However, limited data exist on the timing and predictors of decannulation.</p><p><strong>Aim: </strong>To compare time to decannulation between COVID-19 and non-COVID-19 ARDS patients and to identify predictive factors.</p><p><strong>Methods: </strong>A retrospective study including 96 COVID-19 ARDS and 32 non-COVID-19 ARDS tracheostomized patients admitted to step-down units after ICU stay from March 2020 to May 2021. Clinical, demographic data and comorbidities were analysed as well as predictors for decannulation delay.</p><p><strong>Results: </strong>Timing of decannulation was similar between the two groups. Multivariate analysis identified limb weakness assessed by the Medical Research Council (MRC) scale, duration of steroids therapy, clinical complications, PaO2/FiO2 ratio and smoking history as independent predictors of decannulation timing.</p><p><strong>Conclusions: </strong>COVID-19 did not affect timing of decannulation compared to non-COVID-19 ARDS. ICU-acquired weakness, assessed through the MRC scale, was the strongest predictor of delayed decannulation.</p>","PeriodicalId":51135,"journal":{"name":"Multidisciplinary Respiratory Medicine","volume":"21 ","pages":"1048"},"PeriodicalIF":2.1,"publicationDate":"2026-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12971105/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146182866","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The abstracts of VIII National Congress AdET (Accademia di Ecografia Toracica).","authors":"Various Authors","doi":"10.5826/mrm.2026.1085","DOIUrl":"10.5826/mrm.2026.1085","url":null,"abstract":"<p><p>Pisa, Italy, November 6th-8th Every year, the Accademia di Ecografia Toracia (AdET), an Italian association focused on highlighting the scien-tific relevance of thoracic ultrasound (TUS) in clinical practice, presents the projects of its researchers from across Italy and beyond, in a National Congress where the results from AdET projects are shared and debated. Hereby we report the abstracts of the works submitted for publication.</p>","PeriodicalId":51135,"journal":{"name":"Multidisciplinary Respiratory Medicine","volume":"21 ","pages":"1085"},"PeriodicalIF":1.6,"publicationDate":"2026-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12971104/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146020407","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence and outcomes of SARS-CoV-2 infection in ILD: Post-pandemic study in South Italy.","authors":"Antonio Russo, Luigi Massari, Gaetano Rea, Stefano Sanduzzi Zamparelli, Ludovica Capitelli, Fausto De Michele, Marialuisa Bocchino","doi":"10.5826/mrm.2026.1052","DOIUrl":"10.5826/mrm.2026.1052","url":null,"abstract":"<p><p>This retrospective study assessed the impact of SARS-CoV-2 infection on patients with interstitial lung disease (ILD) at two tertiary centers in Southern Italy between January 2022 and December 2023. The cohort included 282 ILD patients (mean age 69.6 years; 54.9% male), with common diagnoses such as idiopathic pulmonary fibrosis (33.3%) and connective tissue disease-associated ILD (18.7%). SARS-CoV-2 infection occurred in 130 patients (46%), mostly with mild or asymptomatic cases. Pneumonia developed in 18 cases, with 72.2% requiring hospitalization and 5 COVID-19-related deaths. Patients with pneumonia had higher rates of ILD progression (27.7%) and incidental post-infection ILD diagnoses (22.2%) than those with mild infection. Vaccination rates were high, correlating with favorable outcomes in most cases. Importantly, pneumonia cases were often associated with incomplete vaccination or complex comorbidities. Differentiating COVID-19-related lung changes from ILD progression proved challenging, highlighting the importance of specialized radiologic assessment. Excluding COVID-related deaths, mortality rates were similar regardless of infection status, suggesting a degree of resilience among ILD patients. The study concludes that with high vaccine coverage and careful follow-up, most ILD patients had stable outcomes after SARS-CoV-2 infection. However, pneumonia remains a risk factor for adverse outcomes, underscoring the need for long-term, specialized ILD care.</p>","PeriodicalId":51135,"journal":{"name":"Multidisciplinary Respiratory Medicine","volume":"21 ","pages":"1052"},"PeriodicalIF":2.1,"publicationDate":"2026-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12971108/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145999606","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"What do the clinical and respiratory functional assessments of woodworkers in Parakou, West Africa, reveal?","authors":"Serge Ade, Mariano Efio, Josiane Patricia Mapto Foupossia, Ibrahim Mama Cissé, Anthony David Harries","doi":"10.5826/mrm.2025.1057","DOIUrl":"10.5826/mrm.2025.1057","url":null,"abstract":"<p><strong>Background: </strong>The prevalence of chronic respiratory diseases is increasing globally. Apart from smoking, other contributing factors include occupational exposures, of which wood dust is thought to play a role. This study aimed to investigate relationships between respiratory symptoms or lung function measurements and exposure to wood dust.</p><p><strong>Methods: </strong>This was a prospective and comparative cross-sectional study carried out at Parakou, between June and September 2024. Overall, 108 woodworkers (exposed group) and 108 administrative agents from the city hall, the court and five selected banks (control group) were included. Data were collected on upper and lower respiratory symptoms persisting for at least one week in the last 12 months, demographic and occupational-related characteristics, comorbidities, lifestyles, followed by particulate matter  measurements in the workplace and spirometry testing.</p><p><strong>Results: </strong>The mean ages of participants in exposed and control groups were 40±11 and 38±9 years-old, respectively (p=0.163). All were males. Seniority in the profession was longer in the exposed group (18±12 years vs 8±6 years; p<0.001). Workplace ventilation was found inadequate in the exposed group (27% vs 0%; p<0.001). In carpentry, Milicia excelsa (66%) and Afzelia africana (64%) were the types of wood most commonly used. Mean dust levels for PM10, PM2.5 and PM1.0 were 1.4±0.6 mg/m3, 1.2±0.6 mg/m3 and 1.2±0.6 mg/m3, respectively. Cleaning and protection methods for woodworkers included dry sweeping (61%), dust collection devices (7%), personal homemade face-masks (99%), and affiliation to company insurance schemes (12%).No worker had planned check-ups arranged with an occupational physician. Both respiratory symptoms (94% vs 56%; p<0.001) and work-related respiratory symptoms (92% vs 19%; p<0.001) were more common in the exposed versus control group. Exposure to wood dust (aPR=6.8; 95%CI=4.1-11.4; p<0.001) and asthma (aPR=5.4; 95%CI=2.9-10.1; p<0.001) were significantly associated with respiratory symptoms, after adjustment for biomass and passive smoking exposure and length in the profession. The exposed group had a higher prevalence of restrictive disorder suggestive pattern on spirometry than the control group (48% vs 20%; p<0.001).</p><p><strong>Conclusions: </strong>Exposure to wood dust adversely affects respiratory function in woodworkers at Parakou, hence the need to raise awareness among these professionals and identify ways to improve their working conditions.</p>","PeriodicalId":51135,"journal":{"name":"Multidisciplinary Respiratory Medicine","volume":"20 ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12732326/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145806234","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}