Chest最新文献

{"title":"Noninvasive Arterial Pressure Measurements at the Lower Leg: Evaluation of the Influence of Patient Position (Semi-recumbent or Horizontal)-A Prospective Study.","authors":"Karim Lakhal, Alexia Audran, Gurvan Normand, Bertrand Rozec, Thierry Boulain, Jérôme E Dauvergne","doi":"10.1016/j.chest.2024.08.042","DOIUrl":"10.1016/j.chest.2024.08.042","url":null,"abstract":"","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":"490-494"},"PeriodicalIF":9.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142139444","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":"Airways Abnormalities in a Prospective Cohort of Patients With Rheumatoid Arthritis.","authors":"Scott M Matson, Jiwoong Choi, Drayton Rorah, Shamir Khan, Anna Trofimoff, Taewon Kim, David H Lee, Asma Abdolijomoor, Maggie Chen, Imaan Azeem, Linh Ngo, Tami J Bang, Peter Sachs, Kevin D Deane, M Kristen Demoruelle, Mario Castro, Joyce S Lee","doi":"10.1016/j.chest.2024.09.006","DOIUrl":"10.1016/j.chest.2024.09.006","url":null,"abstract":"<p><strong>Background: </strong>Rheumatoid arthritis (RA) affects roughly 1% of the population and commonly involves the lungs. Of lung involvement in RA, interstitial lung disease (ILD) is well known; however, airways disease in RA is relatively understudied.</p><p><strong>Research question: </strong>What are the baseline airways abnormalities in a prospective cohort of patients with RA based on pulmonary function testing (PFT) results, high-resolution CT (HRCT) scans, and computational imaging analysis and are there associations between these abnormalities and respiratory symptoms?</p><p><strong>Study design and methods: </strong>In this single-center study, 188 patients with RA without a clinical diagnosis of ILD underwent HRCT imaging and PFT. Radiologists assessed HRCT scans for airway abnormalities. Computational imaging via VIDA Vision software and in-house quantitative CT imaging analysis was applied to 147 HRCT scans to quantify airway abnormalities.</p><p><strong>Results: </strong>Airways obstruction (FEV₁ to FVC ratio < 0.7) was present in 20.7% of patients and was associated with older age, male sex, and higher smoking rate. Radiologists identified airway abnormalities in 61% of patients: 55% had bronchial wall thickening, 12% had bronchiectasis, and 5% had mosaic attenuation. These airways findings were associated with older age; male sex; lower FEV₁, FVC, and FEV₁ to FVC ratio; and higher rates of rheumatoid factor positivity. Prespecified quantitative CT scan metrics (wall thickening percentage and emphysema percentage) correlated with obstruction in PFT results and more severe respiratory symptoms, including shortness of breath and cough.</p><p><strong>Interpretation: </strong>High rates of airways abnormalities were found in this prospective RA cohort based on three methods of detection. Significant associations were identified between quantitative CT scan measures and respiratory symptoms. Airways disease may be an underrecognized extra-articular manifestation of RA and quantitative CT imaging may be a sensitive method to detect the clinical impact on respiratory symptoms.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":"495-506"},"PeriodicalIF":9.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11867896/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142342561","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":"Decídetexto: Mobile Cessation Support for Latino Adults Who Smoke: A Randomized Clinical Trial.","authors":"Francisco Cartujano-Barrera, Lisa Sanderson Cox, Delwyn Catley, Xueya Cai, Francisco J Diaz, Evelyn Arana-Chicas, Arlette Chávez-Iñiguez, Chinwe Ogedegbe, Kristi D Graves, M Patricia Rivera, Arturo Ponce, Edward F Ellerbeck, Ana Paula Cupertino","doi":"10.1016/j.chest.2024.07.160","DOIUrl":"10.1016/j.chest.2024.07.160","url":null,"abstract":"<p><strong>Background: </strong>Latino adults experience multiple barriers to health care access and treatment that result in tobacco-related disparities. Mobile interventions have the potential to deliver smoking cessation treatment among Latino adults, who show the highest use rates of mobile technologies.</p><p><strong>Research question: </strong>Is Decídetexto, a culturally accommodated mobile health intervention, more effective for smoking cessation compared with standard care among Latinx adults who smoke?</p><p><strong>Study design and methods: </strong>A two-arm parallel group randomized clinical trial was conducted in Kansas, New Jersey, and New York between October 2018 and September 2021. Eligible Latino adults who smoke (n = 457) were randomly assigned to Decídetexto or a standard care group. The primary outcome was biochemically verified 7-day smoking abstinence at week 24. Secondary outcomes included self-reported 7-day smoking abstinence at weeks 12 and 24 and uptake and adherence of nicotine replacement therapy (NRT).</p><p><strong>Results: </strong>Participants' mean age was 48.7 (SD, 11.1) years, 45.2% were female, and 50.3% smoked ≥ 10 cigarettes per day. Two hundred twenty-nine participants were assigned to Decídetexto and 228 to standard care. Treating those lost to follow-up as participants who continued smoking, 14.4% of participants in the Decídetexto group were biochemically verified abstinent at week 24 compared with 9.2% in the standard care group (OR, 1.66; 95% CI, 0.93-2.97; P = .09). Treating those lost to follow-up as participants who continued smoking, 34.1% of the participants in the Decídetexto group self-reported smoking abstinence at week 24 compared with 20.6% of participants in the standard care group (OR, 1.99; 95% CI, 1.31-3.03; P < .001). Analyzing only participants who completed the assessment at week 24, 90.6% (174/192) of participants in the Decídetexto group self-reported using NRT for at least 1 day compared with 70.2% (139/198) of participants in standard care (OR, 4.10; 95% CI, 2.31-7.28; P < .01).</p><p><strong>Interpretation: </strong>Among Latino adults who smoke, the Decídetexto intervention was not associated with a statistically significant increase in biochemically verified abstinence at week 24. However, the Decídetexto intervention was associated with a statistically significant increase in self-reported 7-day smoking abstinence at weeks 12 and 24 and uptake of NRT. This randomized clinical trial provides encouragement for the use of Decídetexto for smoking cessation among Latino adults.</p><p><strong>Clinical trial registration: </strong>ClinicalTrials.gov identifier: NCT03586596.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":"619-629"},"PeriodicalIF":9.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11867890/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141970701","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 Metagenomic Next-Generation Sequencing on Clinical Outcomes of Patients With Severe Community-Acquired Pneumonia in the ICU: A Multicenter, Randomized Controlled Trial.","authors":"Xiaojing Wu, Ting Sun, Hangyong He, Lihua Xing, Zhenshun Cheng, Shuang Geng, Dexiang Xu, Hong Luo, Cheng Chen, Mingyan Jiang, Guopeng Hou, Tianshu Zhai, Ying Cai, Yijie Liu, Junlu Li, Lan Ni, Xueying Li, Binbin Qu, Cheng Lei, Yang Wang, Zi Gu, Peng Zhang, Xu Huang, Min Li, Jingen Xia, Lian He, Qingyuan Zhan","doi":"10.1016/j.chest.2024.07.144","DOIUrl":"10.1016/j.chest.2024.07.144","url":null,"abstract":"<p><strong>Background: </strong>Metagenomic next-generation sequencing (mNGS) was previously established as a method that can increase the pathogen identification rate in patients with severe community-acquired pneumonia (SCAP).</p><p><strong>Research question: </strong>What is the impact on clinical outcomes of mNGS of BAL fluid (BALF) in patients with SCAP in the ICU?</p><p><strong>Study design and methods: </strong>A multicenter randomized controlled open-label clinical trial was conducted in 10 ICUs. Patients were randomized in a 1:1 ratio to undergo BALF assessment with conventional microbiological tests (CMTs) only (ie, the CMT group) or BALF assessment with both mNGS and CMTs (ie, the mNGS group). The primary outcome was the time to clinical improvement, defined as the time from randomization to either an improvement of two points on a six-category ordinal scale or discharge from the ICU, whichever occurred first.</p><p><strong>Results: </strong>A total of 349 patients were randomized to treatment between January 1, 2021, and November 18, 2022; 170 were assigned to the CMT group and 179 to the mNGS group. In the intention-to-treat analysis, the time to clinical improvement was better in the mNGS group than in the CMT group (10 days vs 13 days; difference, -2.0 days; 95% CI, -3.0 to 0.0 days). Similar results were obtained in the per-protocol analysis. The proportion of patients with clinical improvement within 14 days was significantly higher in the mNGS group (62.0%) than in the CMT group (46.5%). There was no significant difference in other secondary outcomes.</p><p><strong>Interpretation: </strong>We found that compared with the use of CMTs alone, mNGS combined with CMTs reduced the time to clinical improvement for patients with SCAP.</p><p><strong>Clinical trial registration: </strong>Chinese Clinical Trial Registry, ChiCTR; www.chictr.org.cn/index.html; ChiCTR2000037894.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":"362-373"},"PeriodicalIF":9.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141787280","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":"Post-Pulmonary Embolism Phenotypes Described by Invasive Cardiopulmonary Exercise Testing.","authors":"Michael Insel, Tammer El Aini, Gregory Woodhead, Rebecca Wig, Saad Kubba, Guido Claessen, Erin Howden, Franz Rischard","doi":"10.1016/j.chest.2024.08.040","DOIUrl":"10.1016/j.chest.2024.08.040","url":null,"abstract":"<p><strong>Background: </strong>Post-pulmonary embolism (PE) dyspnea is common. Existing noninvasive studies have demonstrated that post-PE dyspnea is associated with elevations in right ventricular (RV) afterload, dead space ventilation, and deconditioning. We aimed to use invasive cardiopulmonary exercise testing (iCPET) parameters in patients with post-PE dyspnea to identify unique physiologic phenotypes.</p><p><strong>Research question: </strong>Do distinct post-PE dyspnea physiologic phenotypes exist that are described with iCPET?</p><p><strong>Study design and methods: </strong>Patients were enrolled at the time of acute PE and through our pulmonary hypertension (PH) and dyspnea clinic. iCPET was performed if high suspicion existed for PH or if unexplained dyspnea was present. A hierarchical cluster analysis was performed to identify dyspnea phenotypes. iCPET parameters assessing pulmonary hemodynamics, ventilation, and peripheral oxygen use then were compared within and across each cluster and with iCPET control participants against peak oxygen consumed per minute.</p><p><strong>Results: </strong>One hundred seventy-three patients were enrolled. Sixty-seven patients underwent iCPET. All patients showed reductions in peak oxygen consumed per minute and peak cardiac index relative to control participants. Three clusters were identified. Cluster 1 was defined by having elevated RV afterload and impaired ventilatory efficiency. Cluster 2 was defined by elevated RV afterload with reductions in respiratory mechanics. Cluster 3 was defined by mild derangement in RV afterload with mild reductions in peak cardiac output.</p><p><strong>Interpretation: </strong>In this study, iCPET revealed significant heterogeneity in post-PE dyspnea. Three phenotypes were characterized by differences in RV afterload: ventilatory efficiency, respiratory mechanics, and peripheral oxygen use.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":"585-597"},"PeriodicalIF":9.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142139445","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":"Perspectives of Clinicians on the Value of the Get to Know Me Board in the ICU.","authors":"Sumera R Ahmad, Lori Rhudy, Amelia K Barwise, Mahmut C Ozkan, Ognjen Gajic, Lioudmila V Karnatovskaia","doi":"10.1016/j.chest.2024.10.016","DOIUrl":"10.1016/j.chest.2024.10.016","url":null,"abstract":"<p><strong>Background: </strong>Critical illness can render patients at heightened risk of anonymity, loss of dignity, and dehumanization. Because dehumanization results in significant patient distress, it is imperative to find ways to humanize care in the ICU. A Get to Know Me board (GTKMB) is a personal patient profile designed to bring the patient from anonymity; however, its widespread adoption has been challenging.</p><p><strong>Research question: </strong>Identify perspectives of ICU clinicians on the value of the GTKMB in caring for patients in the ICU.</p><p><strong>Study design and methods: </strong>This qualitative study used focus groups conducted via videoconference. We recruited stakeholders from multiprofessional teams across different ICU settings at a large US quaternary care center. Thematic content analysis approach was performed to identify key themes and concepts.</p><p><strong>Results: </strong>We interviewed 38 participants in six focus groups including 10 nurses, seven physicians, six advanced practice providers, five rehabilitation therapists, a respiratory therapist, and a social worker. Themes highlighted the role of the GTKMB in multiple domains including humanizing care of the critically ill, fostering communication, connecting with families, and guiding and facilitating care processes. Several subthemes were identified for each category.</p><p><strong>Interpretation: </strong>The GTKMB was considered important in fostering humanized caring in the ICU by diverse members of an interprofessional ICU team, helping to facilitate communication, establish family connection, and guide care.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":"561-570"},"PeriodicalIF":9.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142459133","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":"Ensifentrine for COPD: Identifying the Patients Who Benefit.","authors":"Rajat Suri, Sanjay Ramakrishnan","doi":"10.1016/j.chest.2024.08.034","DOIUrl":"https://doi.org/10.1016/j.chest.2024.08.034","url":null,"abstract":"","PeriodicalId":9782,"journal":{"name":"Chest","volume":"167 2","pages":"305-306"},"PeriodicalIF":9.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143405294","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":"Is the Global Lung Function Initiative Race-Neutral Spirometry Reference Equation Ready for Clinical Use Around the World?","authors":"Naoya Tanabe","doi":"10.1016/j.chest.2024.10.001","DOIUrl":"https://doi.org/10.1016/j.chest.2024.10.001","url":null,"abstract":"","PeriodicalId":9782,"journal":{"name":"Chest","volume":"167 2","pages":"303-304"},"PeriodicalIF":9.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143405965","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":"Metagenomic Sequencing for Personalized Treatment in Pneumonia: Does Better Detection Lead to Better Outcomes?","authors":"Benjamin G Wu, Matt S Zinter","doi":"10.1016/j.chest.2024.08.031","DOIUrl":"https://doi.org/10.1016/j.chest.2024.08.031","url":null,"abstract":"","PeriodicalId":9782,"journal":{"name":"Chest","volume":"167 2","pages":"300-302"},"PeriodicalIF":9.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143405968","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":"Response.","authors":"Christopher D Barrett, Peter K Moore, Michael B Yaffe","doi":"10.1016/j.chest.2024.10.009","DOIUrl":"https://doi.org/10.1016/j.chest.2024.10.009","url":null,"abstract":"","PeriodicalId":9782,"journal":{"name":"Chest","volume":"167 2","pages":"e64-e65"},"PeriodicalIF":9.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143405971","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}