American journal of respiratory and critical care medicine最新文献

{"title":"Understanding Small Airway Dysfunction in Tobacco-Exposed Adults Using Oscillometry.","authors":"Ram Baalachandran, David A Kaminsky","doi":"10.1164/rccm.202504-0921ED","DOIUrl":"10.1164/rccm.202504-0921ED","url":null,"abstract":"","PeriodicalId":7664,"journal":{"name":"American journal of respiratory and critical care medicine","volume":" ","pages":"1543-1544"},"PeriodicalIF":19.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12432428/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144558822","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":"Erratum: Approach to the Evaluation and Management of Interstitial Lung Abnormalities: An Official American Thoracic Society Clinical Statement.","authors":"","doi":"10.1164/rccm.v211erratum4","DOIUrl":"10.1164/rccm.v211erratum4","url":null,"abstract":"","PeriodicalId":7664,"journal":{"name":"American journal of respiratory and critical care medicine","volume":"211 9","pages":"1727"},"PeriodicalIF":19.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12432423/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144939330","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":"Metabolomic Evidence of Biological Overlap with Heart Failure with Preserved Ejection Fraction in a Subset of Pulmonary Arterial Hypertension.","authors":"Stephen M Black","doi":"10.1164/rccm.202504-0965ED","DOIUrl":"10.1164/rccm.202504-0965ED","url":null,"abstract":"","PeriodicalId":7664,"journal":{"name":"American journal of respiratory and critical care medicine","volume":" ","pages":"1553-1555"},"PeriodicalIF":19.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12432444/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144726529","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":"Treatment of Nicotine Use in Adolescents Under 18 Years of Age: An Official American Thoracic Society Clinical Practice Guideline.","authors":"Sarah E Bauer, Madalina Macrea, Alicia Casey, Elif Dagli, Michelle N Eakin, Harold J Farber, Priscilla Gonzalez, Don Hayes, Shih-Wen Hu, Hasmeena Kathuria, Shandra L Knight, Theo J Moraes, Enid R Neptune, Megan E Piper, Emily H Skeen, Ching-Sui Ueng, Dona Upson, Susan C Walley, Devika R Rao","doi":"10.1164/rccm.202507-1577ST","DOIUrl":"10.1164/rccm.202507-1577ST","url":null,"abstract":"<p><p><b>Background:</b> The rising popularity of electronic cigarettes (e-cigarettes), the nicotine product that is most used by adolescents since 2014, has reversed decades of progress in declining youth tobacco use. E-cigarette use in adolescents is associated with future smoking, and evidence is mounting of an increased association with nicotine dependence. Therapies used to treat nicotine dependence in adults include pharmacotherapy and behavioral interventions. Pediatric guidelines recommend routine screening for any tobacco product use beginning at age 10 years. The goal of this guideline was to develop an evidence-based clinical practice guideline for the treatment of nicotine use in adolescents. <b>Methods:</b> We summarized evidence addressing five PICO (patients, intervention, comparator, and outcome) questions, which were formulated by a multidisciplinary panel of experts and methodologists using the evidence-to-decision framework. The Grading of Recommendations, Assessment, Development, and Evaluation (or, GRADE) approach was used to evaluate the certainty in evidence and generate actionable recommendations, which were voted on by the panel. <b>Results:</b> The panel members considered the strength of the evidence as well as the potential benefits of the treatment modality from a clinical standpoint. The overall quality of the evidence was weak. Recommendations for or against the treatment modality for nicotine use were developed. <b>Conclusions:</b> This expert panel provides evidence-based recommendations for treating nicotine use in adolescents 10 to 18 years of age.</p>","PeriodicalId":7664,"journal":{"name":"American journal of respiratory and critical care medicine","volume":"211 9","pages":"1584-1599"},"PeriodicalIF":19.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12432397/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144939447","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":"Risk Factors for Patient-Important Upper Gastrointestinal Bleeding.","authors":"Adam M Deane, François Lauzier, Neill K J Adhikari, François Lamontagne, Diane Heels-Ansdell, Lehana Thabane, David Williamson, Salmaan Kanji, Jeffrey F Barletta, Simon Finfer, Yaseen Arabi, Marlies Ostermann, John C Marshall, Nicole L Zytaruk, Miranda Hardie, Naomi E Hammond, Gordon Guyatt, Kyle C White, Karen E A Burns, Joanna C Dionne, Paul J Young, Deborah J Cook","doi":"10.1164/rccm.202411-2245OC","DOIUrl":"10.1164/rccm.202411-2245OC","url":null,"abstract":"<p><p><b>Rationale:</b> Patient-important gastrointestinal bleeding is an endpoint developed by patients and family members; however, risk factors for this outcome are unknown. <b>Objectives:</b> We sought to identify risk factors for patient-important upper gastrointestinal bleeding among invasively ventilated adults. <b>Methods:</b> This preplanned regression analysis of an international trial database evaluated baseline and time-varying risk factors in the preceding 3 days for patient-important upper gastrointestinal bleeding, accounting for illness severity and the competing risk of death. <b>Measurements and Main Results:</b> Patient-important upper gastrointestinal bleeding occurred in the ICU among 131 of 4,821 (2.7%) patients. Baseline APACHE II score-hazard ratio (HR), 1.24 (95% confidence interval [CI] = 1.12, 1.37) per 5-point increase-and the following were associated with greater risk of patient-important bleeding: inotropes or vasopressors (HR, 2.05 [95% CI = 1.35, 3.12]), severe thrombocytopenia (platelet count, <50 × 10⁹/L) (HR, 2.21 [95% CI = 1.24, 3.94]) and platelet inhibitor drugs (HR, 1.69 [95% CI = 1.11, 2.56]). A lower bleeding risk was associated with pantoprazole (HR, 0.36 [95% CI = 0.25, 0.54]) and enteral nutrition (HR, 0.81 [95% CI = 0.68, 0.97]) for every increase of 500 ml/d. There was no interaction between enteral nutrition and pantoprazole (interaction <i>P</i> = 0.94). Allocation to pantoprazole was associated with a lower risk of patient-important upper gastrointestinal bleeding regardless of the volume of enteral nutrition (for 500 ml/d: HR, 0.36 [95% CI = 0.22, 0.58]; for no enteral nutrition: HR, 0.36 [95% CI = 0.18, 0.72]). The association of enteral nutrition and bleeding was similar with pantoprazole (HR, 0.82 [95% CI = 0.63, 1.07]) or without pantoprazole (HR, 0.81 [95% CI = 0.66, 1.00]). <b>Conclusions:</b> Several factors are associated with the risk of patient-important upper gastrointestinal bleeding during invasive ventilation.</p>","PeriodicalId":7664,"journal":{"name":"American journal of respiratory and critical care medicine","volume":" ","pages":"1671-1680"},"PeriodicalIF":19.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12432427/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143965394","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":"Metabolomic Evidence of Biological Overlap with Heart Failure with Preserved Ejection Fraction in a Subset of Pulmonary Arterial Hypertension.","authors":"Yogesh N V Reddy, Aneesh K Asokan, Robert P Frantz, Anna Hemnes, Paul M Hassoun, John Barnard, Evelyn Horn, Jane A Leopold, Franz Rischard, Erika B Rosenzweig, Nicholas S Hill, Serpil C Erzurum, Gerald J Beck, J Emanuel Finet, Gabriele Grunig, Christine L Jellis, Stephen C Mathai, Catherine E Simpson, W H Wilson Tang, K Sreekumaran Nair, Barry A Borlaug","doi":"10.1164/rccm.202501-0034OC","DOIUrl":"10.1164/rccm.202501-0034OC","url":null,"abstract":"<p><p><b>Rationale:</b> A subset of patients with group 1 pulmonary hypertension (PH) have superimposed left heart abnormalities with unclear metabolic implications. <b>Objectives:</b> To compare serum/transpulmonary metabolome between group 1 PH stratified by heart failure with preserved ejection fraction (HFpEF) probability. <b>Methods:</b> Patients with group 1 PH were stratified into low (<25%) and high (⩾75%) HFpEF-ABA (age, body mass index, and atrial fibrillation) probability, with healthy control subjects and subjects with clinical HFpEF used for comparison of venous and transpulmonary metabolomics. <b>Measurements and Main Results:</b> Group 1 PH + high HFpEF probability (<i>n</i> = 131) was associated with a significant increase in 207 metabolites (false discovery rate [FDR] <i>P</i> < 0.05 and fold change >1) (<i>n</i> = 193, <i>t</i> test) and a significant decrease in 231 metabolites (FDR <i>P</i> < 0.05 and fold change <1) (<i>n</i> = 193, <i>t</i> test) compared with group 1 PH + low HFpEF probability (<i>n</i> = 62). Group 1 PH + high HFpEF probability was associated with enhanced tryptophan metabolism with higher downstream kynurenine metabolite concentrations and lower serotonin concentrations (FDR <i>P</i> < 0.002 for all, <i>n</i> = 193, <i>t</i> test). Linoleate (precursor to arachidonic acid and prostaglandins) and arginine and homoarginine (precursors to nitric oxide) were all lower in group 1 PH + high HFpEF probability (FDR <i>P</i> < 0.03 for all, <i>n</i> = 193, <i>t</i> test). Metabolome changes in group 1 PH + high HFpEF probability overlapped with clinical HFpEF (<i>n</i> = 240) but were abnormal relative to control subjects (<i>n</i> = 85) (<i>P</i> < 0.0001 for all, <i>n</i> = 456, <i>t</i> test). There was no evidence of differential transpulmonary uptake/release of most metabolites, suggesting probable nonpulmonary origin (except for serotonin, interaction <i>P</i> = 0.04; and kynurenine, interaction <i>P</i> = 0.03; <i>n</i> = 433, mixed model). <b>Conclusions:</b> Patients with group 1 PH + high HFpEF probability have a unique metabolome characterized by enhanced tryptophan-kynurenine pathway breakdown, deficiency of amino acids (such as glycine and serine), lower serotonin, and decreased prostaglandin and nitric oxide precursors. Despite fulfilling clinical criteria for group 1 PH, these metabolome changes were comparable with clinical HFpEF, supporting biological overlap between these two forms of PH.</p>","PeriodicalId":7664,"journal":{"name":"American journal of respiratory and critical care medicine","volume":" ","pages":"1701-1713"},"PeriodicalIF":19.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12432440/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144281983","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":"Zinc-mediated Inhibition of Soluble Epoxide Hydrolase Promotes Pulmonary Hypertension.","authors":"Daniel Simoes de Jesus, Stanley Buffonge, Giancarlo Abis, Roberto Buccafusca, Reshma Baliga, Helen R Warren, Adrian Hobbs, Clemens Ruppert, Astrid Weiss, Ralph T Schermuly, Philip Eaton, Rebecca L Charles","doi":"10.1164/rccm.202409-1763OC","DOIUrl":"10.1164/rccm.202409-1763OC","url":null,"abstract":"<p><p><b>Rationale:</b> Pulmonary hypertension (PH) and vascular remodeling involve complex molecular mechanisms, with zinc and epoxyeicosatrienoic acids playing key roles. <b>Objectives:</b> We sought to investigate whether zinc-mediated inhibition of soluble epoxide hydrolase contributes to the development of PH and vascular remodeling under hypoxic conditions. <b>Methods:</b> Activity assays measured zinc-mediated soluble epoxide hydrolase inhibition, with mutagenesis and inductively coupled mass spectrometry identifying key cysteines. Pulmonary arteries and human pulmonary artery smooth muscle cells were used to measure vasoconstriction in response to epoxyeicosatrienoic acid, zinc, soluble epoxide hydrolase inhibition, or hypoxia treatment. A C230A knockin mouse was generated to elucidate the mechanism <i>in vivo</i> in acute and chronic hypoxia. Hydrolase expression was assessed in patients with idiopathic pulmonary artery hypertension or chronic obstructive pulmonary disease. Using UK Biobank data, soluble epoxide hydrolase mutations were assessed for a link to increased PH risk. <b>Measurements and Main Results:</b> Zinc inhibited soluble epoxide hydrolase by binding to C232/C230 and C423. C230A mice, resistant to zinc binding, were protected from acute hypoxia-induced soluble epoxide hydrolase inhibition, epoxyeicosatrienoic acid accumulation, and increased pulmonary pressure. C230A mice were also resistant to chronic hypoxia-induced PH and to the associated remodeling and loss of hydrolase expression. Patient lung samples showed decreased soluble epoxide hydrolase expression, echoing our findings with mice. UK Biobank participants with loss-of-function mutations in soluble epoxide hydrolase exhibited a higher risk of developing PH. <b>Conclusions:</b> Loss of soluble epoxide hydrolase activity, whether due to genetics, acute zinc-dependent inhibition, or chronic zinc-dependent loss of hydrolase protein, ultimately results in PH, and targeting this pathway may offer new therapeutic opportunities.</p>","PeriodicalId":7664,"journal":{"name":"American journal of respiratory and critical care medicine","volume":" ","pages":"1689-1700"},"PeriodicalIF":19.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12499926/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144281987","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":"September Highlight.","authors":"","doi":"10.1164/rccm.v211i9xli","DOIUrl":"https://doi.org/10.1164/rccm.v211i9xli","url":null,"abstract":"","PeriodicalId":7664,"journal":{"name":"American journal of respiratory and critical care medicine","volume":"211 9","pages":"xli-xliv"},"PeriodicalIF":19.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144939426","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":"Robotic versus Electromagnetic Bronchoscopy for Peripheral Pulmonary Lesions: A Randomized Trial (RELIANT).","authors":"Rafael Paez, Robert J Lentz, Jennifer D Duke, Justin K Siemann, Cristina Salmon, Greta J Dahlberg, Ankush P Ratwani, Jonathan D Casey, Heidi Chen, Sheau-Chiann Chen, Samira Shojaee, Otis B Rickman, Cheryl L Gatto, Todd W Rice, Fabien Maldonado","doi":"10.1164/rccm.202409-1846OC","DOIUrl":"10.1164/rccm.202409-1846OC","url":null,"abstract":"<p><p><b>Rationale:</b> Robotic-assisted bronchoscopy has emerged as an alternative to electromagnetic navigational bronchoscopy for patients undergoing bronchoscopic biopsy of a peripheral pulmonary lesion. Although both platforms are routinely used in clinical practice, comparative effectiveness data are lacking. <b>Objectives:</b> We sought to compare the effectiveness of robotic-assisted and electromagnetic navigational bronchoscopy for the evaluation of peripheral pulmonary lesions. <b>Methods:</b> In an investigator-initiated, single-center, cluster-randomized noninferiority trial, we assigned patients undergoing diagnostic bronchoscopy for evaluation of a peripheral pulmonary lesion to either robotic-assisted or electromagnetic navigational bronchoscopy. The cluster randomization unit was the operating room in which patients were scheduled. The primary outcome was the diagnostic yield of the procedure, defined as the proportion of cases yielding lesional tissue. Secondary and safety outcomes included procedure duration and complications. <b>Measurements and Main Results:</b> Among the 411 patients included in the modified intention-to-treat analysis, lesional tissue was obtained in 158 of 203 (77.8%) patients in the robotic-assisted group and 157 of 208 (75.5%) patients in the electromagnetic group; the <i>P</i> value for noninferiority was 0.007. The median duration of bronchoscopy was 37 minutes in the robotic-assisted group and 32 minutes in the electromagnetic group (difference, 5 min; 95% confidence interval = 2.0-7.7). Pneumothorax occurred in 4 patients in the robotic-assisted group and 6 patients in the electromagnetic group. <b>Conclusions:</b> In patients undergoing bronchoscopy for the evaluation of a peripheral pulmonary lesion, the diagnostic yield of robotic-assisted bronchoscopy was not inferior to that of electromagnetic navigation bronchoscopy. Clinical trial registered with www.clinicaltrials.gov (NCT05705544).</p>","PeriodicalId":7664,"journal":{"name":"American journal of respiratory and critical care medicine","volume":" ","pages":"1644-1651"},"PeriodicalIF":19.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12432399/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144214679","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":"An Alarming Loss of Pulmonary Rehabilitation Programs: Example from the U.S. Veterans Administration.","authors":"Marilyn L Moy, Linda Nici","doi":"10.1164/rccm.202502-0394VP","DOIUrl":"10.1164/rccm.202502-0394VP","url":null,"abstract":"","PeriodicalId":7664,"journal":{"name":"American journal of respiratory and critical care medicine","volume":" ","pages":"1559-1561"},"PeriodicalIF":19.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12432441/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144281980","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}