Lancet Respiratory Medicine最新文献

{"title":"Optimising trial design for cardiogenic shock: insights from the sixth Critical Care Clinical Trialists Workshop","authors":"Antoine Kimmoun, Connor O'Brien, Vanessa Blumer, Florian A Wenzl, Janine Pöss, Uwe Zeymer, Jacob E Møller, Nadia Aissaoui, Shashank S Sinha, Alain Combes, Naoki Sato, Alessandro Sionis, Sabri Soussi, Susanna Price, Rhonda E Monroe, Rebecca Mathew, Alexandre Mebazaa","doi":"10.1016/s2213-2600(25)00084-0","DOIUrl":"https://doi.org/10.1016/s2213-2600(25)00084-0","url":null,"abstract":"Despite substantial advancements in the management of cardiogenic shock, mortality rates remain greater than 40%. Trials have shown that increasing survival rates in cardiogenic shock is challenging. Even the most successful trials show 5–15% reductions in mortality, and gains have been restricted to acute myocardial infarction cardiogenic shock, representing approximately 5% of the population with cardiogenic shock. Trials studying pharmacological strategies in all populations with cardiogenic shock have been consistently neutral or negative. The reasons are complex and include heterogeneity in cardiogenic shock phenotypes, timing of patient inclusion, high prevalence of multiorgan failure and cardiac arrest, and unrealistic estimated treatment effects that restrict sample size with sometimes inadequate funding leading to underpowered trials. In June, 2024, international experts from the fields of cardiology, anaesthesiology, critical care medicine, biostatistics, government regulation of trials, and patient advocacy convened at the sixth Critical Care Clinical Trialists Workshop to reflect on how to improve the design of future randomised clinical trials in cardiogenic shock. This Position Paper summarises the results of discussions regarding what an optimal randomised controlled trial on cardiogenic shock should entail in terms of population selection, primary objectives, statistical analysis, and incorporation of the patient's perspective.","PeriodicalId":51307,"journal":{"name":"Lancet Respiratory Medicine","volume":"46 1","pages":""},"PeriodicalIF":76.2,"publicationDate":"2025-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143909867","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":"The rising threat of predatory journals and paper mills in respiratory medicine and research","authors":"Joan B Soriano, Alberto Ruano-Ravina","doi":"10.1016/s2213-2600(25)00117-1","DOIUrl":"https://doi.org/10.1016/s2213-2600(25)00117-1","url":null,"abstract":"No Abstract","PeriodicalId":51307,"journal":{"name":"Lancet Respiratory Medicine","volume":"24 1","pages":""},"PeriodicalIF":76.2,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143901313","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":"Time T—to understand treatment response","authors":"Iwein Gyselinck, Helene Huts, Maarten De Vos, Wim Janssens","doi":"10.1016/s2213-2600(25)00118-3","DOIUrl":"https://doi.org/10.1016/s2213-2600(25)00118-3","url":null,"abstract":"No Abstract","PeriodicalId":51307,"journal":{"name":"Lancet Respiratory Medicine","volume":"130 1","pages":""},"PeriodicalIF":76.2,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143897522","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":"Tracing the threads of air pollution","authors":"Peter Ranscombe","doi":"10.1016/s2213-2600(25)00162-6","DOIUrl":"https://doi.org/10.1016/s2213-2600(25)00162-6","url":null,"abstract":"No Abstract","PeriodicalId":51307,"journal":{"name":"Lancet Respiratory Medicine","volume":"31 1","pages":""},"PeriodicalIF":76.2,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143889346","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":"C-reactive protein-guided treatment in pneumonia: charting a personalised approach – Authors’ reply","authors":"Jim M Smit, Jesse H Krijthe, Gianfranco U Meduri, Pierre-François Dequin, Harin Karunajeewa, Antoni Torres, Marcel J T Reinders, Henrik Endeman, Philip A Van Der Zee","doi":"10.1016/s2213-2600(25)00096-7","DOIUrl":"https://doi.org/10.1016/s2213-2600(25)00096-7","url":null,"abstract":"No Abstract","PeriodicalId":51307,"journal":{"name":"Lancet Respiratory Medicine","volume":"36 1","pages":""},"PeriodicalIF":76.2,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143889360","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":"Defining and subphenotyping ARDS: insights from an international Delphi expert panel","authors":"Prashant Nasa, Lieuwe D Bos, Elisa Estenssoro, Frank M P van Haren, Ary Serpa Neto, Patricia R M Rocco, Arthur S Slutsky, Marcus J Schultz","doi":"10.1016/s2213-2600(25)00115-8","DOIUrl":"https://doi.org/10.1016/s2213-2600(25)00115-8","url":null,"abstract":"Although the definition of acute respiratory distress syndrome (ARDS) has undergone numerous revisions aimed at enhancing its diagnostic accuracy and clinical practicality, the usefulness and precision of these definitions remain matters of ongoing discussion. In this Position Paper, we report on a Delphi study to reach a consensus on the conceptual model of ARDS, specifically identifying its defining components within clinical, research, and educational contexts as well as exploring the potential role of subphenotyping. We did a four-round Delphi study, involving experts in ARDS research and management from a diverse range of geoeconomic regions and professional backgrounds. Consensus was achieved for the conceptual model of ARDS; key components to be included for an ARDS definition in the context of research, education, and patient management; and the need for further research in subphenotyping ARDS. Additionally, we highlight knowledge gaps and research priorities that could guide future investigations in this area. Our study builds on previous non-Delphi-based consensus processes (eg, the new global definition of ARDS and recent society-based guidelines) by using a rigorous Delphi method that ensured panellist anonymity and used clear quantitative criteria to mitigate potential peer pressure and group conformity. The findings underscore the need to refine the ARDS definition to better account for the heterogeneity of clinical presentations and underlying pathophysiology, and to improve diagnostic precision, including the use of subphenotyping where appropriate.","PeriodicalId":51307,"journal":{"name":"Lancet Respiratory Medicine","volume":"9 1","pages":""},"PeriodicalIF":76.2,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143889347","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":"C-reactive protein-guided treatment in pneumonia: charting a personalised approach","authors":"Shota Yamamoto, Ryosuke Imai, Takayuki Niitsu","doi":"10.1016/s2213-2600(25)00095-5","DOIUrl":"https://doi.org/10.1016/s2213-2600(25)00095-5","url":null,"abstract":"No Abstract","PeriodicalId":51307,"journal":{"name":"Lancet Respiratory Medicine","volume":"67 1","pages":""},"PeriodicalIF":76.2,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143889348","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":"Common and rare variants and survival in idiopathic pulmonary fibrosis","authors":"Effrosyni D Manali, Caroline Kannengiesser, Spyros A Papiris","doi":"10.1016/s2213-2600(25)00116-x","DOIUrl":"https://doi.org/10.1016/s2213-2600(25)00116-x","url":null,"abstract":"No Abstract","PeriodicalId":51307,"journal":{"name":"Lancet Respiratory Medicine","volume":"221 1","pages":""},"PeriodicalIF":76.2,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143884460","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 variants and survival of patients with idiopathic pulmonary fibrosis: analysis of a multicentre, observational cohort study with independent validation","authors":"Aitana Alonso-González, David Jáspez, José M Lorenzo-Salazar, Shwu-Fan Ma, Emma Strickland, Josyf Mychaleckyj, John S Kim, Yong Huang, Ayodeji Adegunsoye, Justin M Oldham, Iain Stewart, Philip L Molyneaux, Toby M Maher, Louise V Wain, Richard J Allen, R Gisli Jenkins, Jonathan A Kropski, Brian Yaspan, Timothy S Blackwell, David Zhang, Carlos Flores","doi":"10.1016/s2213-2600(25)00045-1","DOIUrl":"https://doi.org/10.1016/s2213-2600(25)00045-1","url":null,"abstract":"<h3>Background</h3>Rare pathogenic variants in telomere-related genes are associated with poorer clinical outcomes in idiopathic pulmonary fibrosis (IPF). We aimed to assess whether rare qualifying variants in monogenic adult-onset pulmonary fibrosis genes are associated with IPF survival. Using polygenic risk scores (PRS), we also evaluated the influence of common IPF risk variants in patients carrying the qualifying variants.<h3>Methods</h3>We identified qualifying variants in telomere and non-telomere genes using whole-genome sequences from individuals clinically diagnosed with IPF and enrolled in the Pulmonary Fibrosis Foundation Patient Registry (PFFPR), a large multicentre, observational cohort study (March 29, 2016 to June 15, 2018, n=888). We also derived a PRS for IPF (PRS-IPF) from known common sentinel IPF variants. The primary outcome was the association between qualifying variants and survival. The secondary outcome was the association between qualifying variants and PRS-IPF. We used logistic regression models adjusted for sex, age at diagnosis, and principal components of genetic heterogeneity to examine the mutual relationship of qualifying variants and PRS-IPF. The association between qualifying variants and PRS-IPF with survival was tested using Cox proportional hazard models adjusted for baseline confounders. Validation of the results was sought in data from an independent multicentre, prospective, observational cohort study of IPF in the UK (PROFILE, May 17, 2010 to Sept 5, 2017, n=472), and results were meta-analysed under a fixed-effects model.<h3>Findings</h3>We included 888 patients from PFFPR and 472 from PROFILE, totalling 1360 participants. In the PFFPR, carriers of qualifying variants in monogenic adult-onset pulmonary fibrosis genes were associated with lower PRS-IPF (odds ratio 1·79 [95% CI 1·15–2·81]; p=0·010) and shorter survival (hazard ratio 1·53 [1·12–2·10]; p=7·33 × 10^–3). Individuals with the lowest PRS-IPF also had worse survival (1·61 [1·25–2·07]; p=1·87 × 10^–4). These findings were validated in PROFILE and the meta-analysis of the results showed a consistent direction of effect across both cohorts.<h3>Interpretation</h3>We found non-additive effects between qualifying variants and common risk variants in IPF survival, suggesting distinct disease subtypes and raising the possibility of using PRS to guide sequencing prioritisation. Assessing the carrier status for qualifying variants and modelling PRS-IPF promises to further contribute to predicting disease progression among patients with IPF.<h3>Funding</h3>Instituto de Salud Carlos III; Instituto Tecnológico y de Eenergías Renovables; Cabildo Insular de Tenerife; Fundación DISA; National Heart, Lung, and Blood Institute of the US National Institutes of Health; and UK Medical Research Council.","PeriodicalId":51307,"journal":{"name":"Lancet Respiratory Medicine","volume":"1 1","pages":""},"PeriodicalIF":76.2,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143884469","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":"US judge halts Trump's clawback of public health funds","authors":"Bryant Furlow","doi":"10.1016/s2213-2600(25)00136-5","DOIUrl":"https://doi.org/10.1016/s2213-2600(25)00136-5","url":null,"abstract":"No Abstract","PeriodicalId":51307,"journal":{"name":"Lancet Respiratory Medicine","volume":"7 1","pages":""},"PeriodicalIF":76.2,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143872655","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}