Chest最新文献

{"title":"A 59-Year-Old Man With Fever and Dyspnea During Chemotherapy for Acute Myeloid Leukemia.","authors":"Yijing Li, Shanshan Wei, Jialin Zhu, Weihua Gao, Xihao Hu, Xi Wang","doi":"10.1016/j.chest.2026.01.037","DOIUrl":"https://doi.org/10.1016/j.chest.2026.01.037","url":null,"abstract":"<p><strong>Case presentation: </strong>A 59-year-old man with a history of acute myeloid leukemia complicated by myeloid sarcoma was receiving systemic chemotherapy.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":"170 4","pages":"e117-e122"},"PeriodicalIF":9.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149135202","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":"Natural History, Treatment, Survival, and Causes of Mortality in Patients With Subsolid and Ground-Glass Nodules.","authors":"Justin M Bader, Samantha R Prince, William de Santis, Emma R Kane, Lynn Tanoue, Anna S Bader, Justin D Blasberg, Frank C Detterbeck, Gavitt A Woodard","doi":"10.1016/j.chest.2026.04.053","DOIUrl":"10.1016/j.chest.2026.04.053","url":null,"abstract":"<p><strong>Background: </strong>Subsolid nodules (SSNs) and ground-glass opacities (GGOs) are an increasingly common clinical problem. This unique subtype of lung adenocarcinoma poses a treatment dilemma because many can be safely monitored with radiographic observation alone and require no intervention. Improved understanding of the natural history and outcomes of patients with SSNs is needed to improve clinical decision-making and treatment recommendations.</p><p><strong>Research question: </strong>What is the natural history of growth, likelihood of treatment, and most likely cause of mortality in a comprehensive cohort of patients with SSNs and GGOs identified on chest CT scan?</p><p><strong>Study design and methods: </strong>Natural language processing was used to identify all patients with SSNs on outpatient chest CT scans in 2017 (n = 17,276) in the Yale New Haven Health System. Manual chart review was performed for demographics, nodule size, growth on subsequent CT scan, treatment, pathology, and survival.</p><p><strong>Results: </strong>A cohort of 322 patients were identified with 64% (n = 207) nonsolid nodules (pure GGO) and 36% (n = 115) part-solid nodules. Over 5 years of follow-up, 81% of nonsolid nodules remained nonsolid and 19% developed a new solid component. Within 5 years, 19% (n = 60) underwent treatment, with patients with part-solid nodules being more likely to undergo treatment than those with nonsolid nodules (32% vs 11%, respectively; P < .001). Five-year overall survival was 79.8%, with 98.4% 5-year SSN-related survival. Development of a new, second primary malignancy was common in patients with SSN, who were significantly more likely to die from a secondary primary cancer than their SSN at 5 years (8.43% vs 1.54%, respectively; P < .001).</p><p><strong>Interpretation: </strong>Patients should be reassured regarding the excellent survival associated with SSNs. Our results indicate that most can be safely observed without intervention, particularly nonsolid nodules or pure GGOs. Patients with SSNs were shown to have high rates of developing multiple lung nodules and second primary lung cancer.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":"1326-1336"},"PeriodicalIF":9.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147970749","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":"Amit Chopra, Kurt Hu, David Feller-Kopman, Marc A Judson","doi":"10.1016/j.chest.2026.06.025","DOIUrl":"https://doi.org/10.1016/j.chest.2026.06.025","url":null,"abstract":"","PeriodicalId":9782,"journal":{"name":"Chest","volume":"170 4","pages":"e134-e135"},"PeriodicalIF":9.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149134458","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":"Performance and Utility of the Sybil Deep Learning Model for Lung Cancer Risk Prediction in Asian High- and Low-Risk Populations.","authors":"Yeon Wook Kim, Jeongbin Oh, Jinyong Park, Myeongju Kim, Dong Yeong Kim, Ju Gang Nam, Jong Sun Park, Jae Ho Lee, Choon-Taek Lee","doi":"10.1016/j.chest.2026.05.002","DOIUrl":"10.1016/j.chest.2026.05.002","url":null,"abstract":"<p><strong>Background: </strong>Sybil is a deep learning model designed to predict future lung cancer risk based on a single low-dose chest CT (LDCT) scan, facilitating a precision-based approach to lung cancer screening (LCS).</p><p><strong>Research question: </strong>What are the performance and utility of Sybil in a pragmatic Asian LCS cohort?</p><p><strong>Study design and methods: </strong>We analyzed 21,087 individuals 50 to 80 years of age who underwent LDCT screening between January 2009 and December 2021. Baseline LDCT scans were evaluated using Sybil to calculate the risk of lung cancer diagnosis within 1 to 6 years. Model performance was assessed with the area under the receiver operating characteristic curve (AUROC). Stratified analyses were conducted for individuals with ≥ 20 pack-years (PYs) of smoking history (n = 4,611), individuals who ever smoked with < 20 or unknown PYs (n = 5,378), and individuals who have never smoked (INS) (n = 11,098).</p><p><strong>Results: </strong>Among 21,087 participants, subsolid nodules were more common in INS (9.3%) than in those with ≥ 20 PYs (7.1%) or < 20/unknown PYs (6.7%) (P < .001). A total of 257 participants were diagnosed with lung cancer within 6 years. Sybil achieved AUROCs of 0.86 (95% CI, 0.82-0.89) for 1-year invasive lung cancer predictions and 0.74 (95% CI, 0.70-0.77) for 6-year invasive lung cancer predictions. For INS, AUROCs were 0.86 (95% CI, 0.81-0.91) for 1-year predictions and 0.79 (95% CI, 0.74-0.84) for 6-year predictions. Sybil's short-term performance declined in individuals with LDCT findings of granulomatous sequelae, but long-term performance was maintained. Reduced performance was also observed in individuals with subsolid nodules and those without a detected baseline nodule. Five-year overall survival among lung cancer cases was 92.7% in INS, 75.9% for < 20/unknown PYs, and 68.6% in ≥ 20 PYs (P < .001).</p><p><strong>Interpretation: </strong>Our results show that Sybil demonstrated robust performance in predicting future lung cancer in an Asian screening cohort composed of individuals with diverse risk profiles. The findings highlight the potential to develop personalized LCS strategies using Sybil to address region-specific needs.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":"1311-1325"},"PeriodicalIF":9.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147947794","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":"Recurrent VTE During Anticoagulation: Diagnosis, Systematic Evaluation, and Management.","authors":"Lucía Ordieres-Ortega, Francisco Galeano-Valle, Marina López-Rubio, Rubén Alonso-Beato, Pablo Demelo-Rodríguez","doi":"10.1016/j.chest.2026.05.035","DOIUrl":"10.1016/j.chest.2026.05.035","url":null,"abstract":"<p><p>Recurrent VTE occurring during therapeutic anticoagulation represents a clinically challenging and high-risk condition. Although the incidence of breakthrough events under adequate anticoagulant therapy is relatively low, their occurrence is associated with increased short-term mortality, heightened bleeding risk related to treatment escalation, and long-term morbidity. Accurate diagnosis is critical and should rely on careful comparison with prior imaging studies. Residual thrombosis and early clot propagation are relatively frequent findings during follow-up and may mimic true recurrence, leading to potential misclassification. Management of recurrent VTE during anticoagulation is largely informed by observational studies, guideline recommendations, and expert consensus, as robust randomized trial data are lacking. A structured approach is essential and should begin with confirmation of adherence, appropriate dosing, drug-drug interactions, and possible absorption issues. Targeted evaluation for underlying prothrombotic conditions, including malignancy and antiphospholipid syndrome, is recommended. Low-molecular-weight heparin remains central to acute management, although supporting evidence is limited. Special populations require individualized strategies balancing thrombotic and bleeding risks. Routine use of inferior vena cava filters should be avoided, and intensified anticoagulation should generally be time-limited with planned reassessment. Significant gaps remain in the evidence base. Prospective registries and well-designed randomized trials are needed to refine diagnostic criteria, clarify mechanisms of anticoagulant failure, and define optimal management strategies in this high-risk population.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":"1249-1259"},"PeriodicalIF":9.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148210139","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":"Higher Respiratory Muscle Oxygen Cost of Breathing During Exercise in Heart Failure With Preserved Ejection Fraction.","authors":"Tarin C Phillips, Eric J Bruhn, Gizem Cifci, Barry A Borlaug, Thomas P Olson, Joshua R Smith","doi":"10.1016/j.chest.2026.04.051","DOIUrl":"10.1016/j.chest.2026.04.051","url":null,"abstract":"<p><strong>Background: </strong>Patients with heart failure with preserved ejection fraction (HFpEF) have pulmonary system abnormalities resulting in impaired ventilatory reserve and heightened respiratory muscle work during submaximal exercise.</p><p><strong>Research question: </strong>Do patients with HFpEF have higher respiratory muscle oxygen uptake (V˙o₂) during submaximal exercise than control participants?</p><p><strong>Study design and methods: </strong>Patients with HFpEF (n = 13) and control participants (n = 16) completed 2 visits. The first visit included pulmonary function tests and an incremental exercise test. On the second visit, participants mimicked their exercise breathing patterns across a range of work rates (voluntary hyperpnea) in the absence of exercise to quantify respiratory muscle V˙o₂. Respiratory muscle V˙o₂ was reported during exercise at 40 W and approximately 65% peak work rates.</p><p><strong>Results: </strong>During exercise at 40 W, patients with HFpEF had higher respiratory muscle V˙o₂ expressed as % of whole-body V˙o₂ (control participants, 4.6% of whole-body V˙o₂; interquartile range [IQR], 2.0-5.7 vs HFpEF, 8.3% of whole-body V˙o₂; IQR, 6.1-9.2; P < .01) and mL/kg/min (control participants, 0.53 mL/kg/min; IQR, 0.24-0.68 vs HFpEF, 0.79 mL/kg/min; IQR, 0.69-1.10; P < .01). During exercise at 40 W, respiratory muscle V˙o₂ was related to FVC % predicted (r = -0.64; P = .02) and breathing frequency during exercise (r = 0.70; P = .01) for patients with HFpEF, but not control participants (both r > 0.19; P > .40). During exercise at approximately 65% peak work rate, patients with HFpEF had higher respiratory muscle V˙o₂ expressed as % of whole-body V˙o₂ (control participants, 4.6% of whole-body V˙o₂; IQR, 2.8-6.3 vs HFpEF, 7.2% of whole-body V˙o₂; IQR, 6.0-8.8; P < .01). When accounting for ventilation, patients with HFpEF had higher respiratory muscle V˙o₂ during exercise at 40 W and approximately 65% peak work rates (all P < .03).</p><p><strong>Interpretation: </strong>Our results show that respiratory muscle V˙o₂ is significantly elevated in patients with HFpEF compared with control participants during submaximal exercise.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":"1164-1173"},"PeriodicalIF":9.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13316718/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147947831","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":"Deconstructing Heterogeneity of Pulmonary Hypertension Associated With Chronic Lung Disease with Quantitative Chest CT Data.","authors":"Shelsey W Johnson, Katarina Zeder","doi":"10.1016/j.chest.2026.06.040","DOIUrl":"https://doi.org/10.1016/j.chest.2026.06.040","url":null,"abstract":"","PeriodicalId":9782,"journal":{"name":"Chest","volume":"170 4","pages":"1006-1008"},"PeriodicalIF":9.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149135176","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":"Prognostic Signal or Mechanistic Phenotype.","authors":"Shifei He, Lihao Meng","doi":"10.1016/j.chest.2026.04.057","DOIUrl":"https://doi.org/10.1016/j.chest.2026.04.057","url":null,"abstract":"","PeriodicalId":9782,"journal":{"name":"Chest","volume":"170 4","pages":"e136-e137"},"PeriodicalIF":9.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149135180","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":"Paired Arterial Blood Gas Availability: Defining the Applicability of Oxygenation Findings in Portopulmonary Hypertension.","authors":"Ao Wang, Kehui Li","doi":"10.1016/j.chest.2026.05.021","DOIUrl":"https://doi.org/10.1016/j.chest.2026.05.021","url":null,"abstract":"","PeriodicalId":9782,"journal":{"name":"Chest","volume":"170 4","pages":"e135-e136"},"PeriodicalIF":9.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149135194","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":"Corrigendum to: Rivard R, Mailhot-Larouche A, Borg C, et al. Hypereosinophilia With Pseudomonas aeruginosa Infection in Patients With Asthma on Anti-Inteleukin-5 Biologics. CHEST. 2026;170(1):E1-E4.","authors":"","doi":"10.1016/j.chest.2026.08.022","DOIUrl":"https://doi.org/10.1016/j.chest.2026.08.022","url":null,"abstract":"","PeriodicalId":9782,"journal":{"name":"Chest","volume":"170 4","pages":"1346"},"PeriodicalIF":9.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149135250","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}