Chest最新文献

{"title":"A 24/7 Pilot Remote Emergency Multidisciplinary Discussion for Rapidly Progressive Interstitial Lung Disease: A 2-Year Experience.","authors":"Pierre Bay, Marc Pineton de Chambrun, Yves Allenbach, Jérôme Le Pavec, Clément Picard, Benjamin Zuber, Vincent Bunel, Baptiste Hervier, Alain Meyer, Makoto Miyara, Pierre-Yves Brillet, Samia Boussouar, Christelle Declercq, Yacine Tandjaoui-Lambiotte, Hilario Nunes, Vincent Cottin, Eric Hachulla, Yurdagül Uzunhan","doi":"10.1016/j.chest.2024.07.179","DOIUrl":"10.1016/j.chest.2024.07.179","url":null,"abstract":"","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":"183-187"},"PeriodicalIF":9.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142092458","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":"Marios Rossides, Susanna Kullberg, Elizabeth V Arkema","doi":"10.1016/j.chest.2024.09.024","DOIUrl":"https://doi.org/10.1016/j.chest.2024.09.024","url":null,"abstract":"","PeriodicalId":9782,"journal":{"name":"Chest","volume":"167 1","pages":"e32-e33"},"PeriodicalIF":9.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142964007","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":"Attic of Sorrow.","authors":"Charles A Read","doi":"10.1016/j.chest.2024.08.002","DOIUrl":"https://doi.org/10.1016/j.chest.2024.08.002","url":null,"abstract":"","PeriodicalId":9782,"journal":{"name":"Chest","volume":"167 1","pages":"222-223"},"PeriodicalIF":9.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142964076","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":"Moataz Maher Emara","doi":"10.1016/j.chest.2024.08.023","DOIUrl":"https://doi.org/10.1016/j.chest.2024.08.023","url":null,"abstract":"","PeriodicalId":9782,"journal":{"name":"Chest","volume":"167 1","pages":"e30-e31"},"PeriodicalIF":9.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142964099","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":"Extracellular Vesicle-Encapsulated microRNAs and Respiratory Health Among American Indian Participants in the Strong Heart Study.","authors":"Christina M Eckhardt, Haotian Wu, Gabriela Jackson, Marisa H Sobel, Tessa Bloomquist, Adnan Divjan, Hadler da Silva, Lyle G Best, Shelley Cole, Jason Umans, Ying Zhang, Peter de Hoff, Louise C Laurent, Matthew S Perzanowski, Ke Cheng, Andrea A Baccarelli, Tiffany R Sanchez","doi":"10.1016/j.chest.2024.08.004","DOIUrl":"10.1016/j.chest.2024.08.004","url":null,"abstract":"<p><strong>Background: </strong>American Indian populations have experienced marked disparities in respiratory disease burden. Extracellular vesicle-encapsulated microRNAs (EV-miRNAs) are a novel class of biomarkers that may improve recognition of lung damage in indigenous populations in the United States.</p><p><strong>Research question: </strong>Are plasma EV-miRNAs viable biomarkers of respiratory health in American Indian populations?</p><p><strong>Study design and methods: </strong>The Strong Heart Study is a prospective cohort study that enrolled American Indian patients aged 45 to 74 years. EV-miRNA expression was measured in plasma (1993-1995). Respiratory health outcomes, including prebronchodilator FEV₁, FVC, and respiratory symptom burden, were ascertained in the same study visit. Club cell secretory protein (CC-16), an antiinflammatory pneumoprotein implicated in COPD pathogenesis, was measured in serum. Linear and logistic regression were used for statistical analyses. Biological pathway analyses were used to elucidate gene targets of significant EV-miRNAs.</p><p><strong>Results: </strong>Among 853 American Indian adults, three EV-miRNAs were associated with FEV₁, four EV-miRNAs were associated with FVC, and one EV-miRNA was associated with FEV₁/FVC (P < .05). Increased miR-1294 expression was associated with higher odds of airflow limitation (OR, 1.29; 95% CI, 1.07-1.55), whereas increased expression of miR-1294 (OR, 1.32; 95% CI, 1.07-1.63) and miR-532-5p (OR, 1.57; 95% CI, 1.02-2.40) was associated with higher odds of restriction. Increased miR-451a expression was associated with lower odds of exertional dyspnea (OR, 0.71; 95% CI, 0.59-0.85). Twenty-two EV-miRNAs were associated with serum CC-16 levels (q < 0.05), suggesting that EV-miRNAs may play a role in the pathway linking CC-16 to COPD pathogenesis. A pathway analysis showed key EV-miRNAs targeted biological pathways that modulate inflammation, immunity, and structural integrity in the lungs.</p><p><strong>Interpretation: </strong>Circulating EV-miRNAs are novel mechanistic biomarkers of respiratory health and may facilitate the early detection and treatment of lung damage in American Indian populations that have been disproportionately affected by chronic lung diseases.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":"87-97"},"PeriodicalIF":9.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11752130/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141999475","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":"The Responsiveness of Exercise Tests in COPD: A Randomized Controlled Trial.","authors":"Theresa C Harvey-Dunstan, Molly M Baldwin, Ruth Tal-Singer, Matthew Allinder, Michael I Polkey, Alan Hamilton, Matthew Richardson, Sarah A Edwards, Michael C Steiner, Mike D Morgan, Sally J Singh","doi":"10.1016/j.chest.2024.05.051","DOIUrl":"10.1016/j.chest.2024.05.051","url":null,"abstract":"<p><strong>Background: </strong>COPD is characterized by reduced exercise tolerance, and improving physical performance is an important therapeutic goal. A variety of exercise tests are commonly used to assess exercise tolerance, including laboratory and field-based tests. The responsiveness of these various tests to common COPD interventions is yet to be compared, but the results may inform test selection in clinical and research settings.</p><p><strong>Research question: </strong>What exercise test possesses the greatest sensitivity to change from before to after intervention in patients with COPD?</p><p><strong>Study design and methods: </strong>One hundred fifty-four patients with symptomatic COPD were recruited and randomized (2:1:1) to 6 weeks of long-acting muscarinic antagonist, pulmonary rehabilitation (PR), or usual care. Before and after intervention, participants performed an incremental cycle exercise test and constant work rate cycle test (CWRCT), incremental shuttle walk test and endurance shuttle walk test (ESWT), 6-min walk test, and 4-m gait speed test.</p><p><strong>Results: </strong>One hundred three participants (mean ± SD age, 67 ± 8 years; 75 male participants [73%]; FEV₁, 50.6 ± 16.8% predicted) completed the study. Significant improvements in the incremental cycle exercise test, CWRCT, incremental cycle exercise test, ESWT, and 6-min walk test results were observed after PR (P < .05), with the greatest improvements seen in the constant work rate protocols (percentages change: CWRCT, 42%; ESWT, 41%).</p><p><strong>Interpretation: </strong>The ESWT and CWRCT seemed to be the most responsive exercise test protocols to long-acting muscarinic antagonist and PR therapy. The magnitude of change was much greater after a program of rehabilitation compared with bronchodilator therapy.</p><p><strong>Clinical trial registry: </strong>International Standard Randomised Controlled Trial Number (ISRCTN): No. 64759523; URL: https://www.isrctn.com/ISRCTN64759523.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":"98-111"},"PeriodicalIF":9.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11752132/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142035349","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":"BAL Fluid Cellular Analysis and Radiologic Patterns in Patients With Fibrotic Interstitial Lung Disease.","authors":"Amanda Grant-Orser, Michael Asmussen, Daniel-Costin Marinescu, Cameron J Hague, Nestor L Muller, Darra T Murphy, Andrew Churg, Joanne L Wright, Amna Al-Arnawoot, Ana-Maria Bilawich, Patrick Bourgouin, Gerard Cox, Celine Durand, Tracy Elliot, Jennifer Ellis, Jolene H Fisher, Derek Fladeland, Gillian C Goobie, Zachary Guenther, Ehsan Haider, Nathan Hambly, James Huynh, Geoffrey Karjala, Nasreen Khalil, Martin Kolb, Jonathon Leipsic, Stacey Lok, Sarah MacIsaac, Micheal McInnis, Helene Manganas, Veronica Marcoux, John Mayo, Julie Morisset, Ciaran Scallan, Tony Sedlic, Shane Shapera, Kelly Sun, Victoria Tan, Alyson W Wong, Boyang Zheng, Christopher J Ryerson, Kerri A Johannson","doi":"10.1016/j.chest.2024.07.166","DOIUrl":"10.1016/j.chest.2024.07.166","url":null,"abstract":"<p><strong>Background: </strong>BAL cellular analysis is often recommended during the initial diagnostic evaluation of fibrotic interstitial lung disease (ILD). Despite recommendation for its use, between-center heterogeneity exists and supportive data concerning the clinical utility and correlation of BAL findings with radiologic features or patterns remain sparse.</p><p><strong>Research question: </strong>In patients with fibrotic ILD, are BAL findings associated with radiologic features, patterns, and clinical diagnoses?</p><p><strong>Study design and methods: </strong>Patients with fibrotic ILD who underwent BAL for diagnostic evaluation and who were enrolled in the prospective Canadian Registry for Pulmonary Fibrosis were re-reviewed in a standardized multidisciplinary discussion (MDD). BAL was categorized according to guideline-recommended thresholds, and using thresholds of lymphocytosis > 20% and neutrophils > 4.5%. High-resolution CT (HRCT) scans were scored (anonymized to clinical data) for specific features and percentage lung involvement. Radiologists classified HRCT scans according to guideline-defined patterns for idiopathic pulmonary fibrosis and fibrotic hypersensitivity pneumonitis; then, MDD diagnoses were assigned, considering all available data.</p><p><strong>Results: </strong>Bronchoscopy with cellular analysis was performed in 209 of 1,593 patients (13%). Lymphocyte % was weakly negatively correlated with total fibrosis % (r = -0.16, P = .023) but not statistically significantly correlated with ground glass opacity % (r = 0.01, P = .94). A mixed BAL pattern was the most frequent in all radiologic patterns (range, 45%-69%), with a minority classifiable according to BAL guidelines. BAL lymphocytosis appeared with similar frequency across HRCT patterns of fibrotic hypersensitivity pneumonitis (21%) and usual interstitial pneumonia (18%). Only 5% of patients with MDD-based fibrotic hypersensitivity pneumonitis had a guideline-defined isolated lymphocytosis > 15%.</p><p><strong>Interpretation: </strong>BAL cellular analyses did not significantly correlate with radiologic features, guideline patterns, or MDD-based diagnoses. Ground glass opacities are often interpreted to represent pulmonary inflammation, but were not associated with BAL lymphocytosis in this cohort.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":"172-182"},"PeriodicalIF":9.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11752126/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142046370","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":"The Use of a Tailored Decision Aid to Improve Understanding of Lung Cancer Screening in People With HIV.","authors":"Nicholas R Murphy, Kristina Crothers, Madison Snidarich, Jehan Z Budak, Meagan C Brown, Bryan J Weiner, Nicholas Giustini, Tanner Caverly, Katherine Durette, Katie DeCell, Matthew Triplette","doi":"10.1016/j.chest.2024.07.147","DOIUrl":"10.1016/j.chest.2024.07.147","url":null,"abstract":"<p><strong>Background: </strong>People with HIV are at increased risk for lung cancer and multimorbidity, complicating the balance of risks and benefits of lung cancer screening. We previously adapted Decision Precision (screenlc.com) to guide shared decision-making for lung cancer screening in people with HIV.</p><p><strong>Research question: </strong>Does an HIV-adapted and personally tailored decision aid improve shared decision-making regarding lung cancer screening in people with HIV as measured by knowledge, decisional conflict, and acceptability?</p><p><strong>Study design and methods: </strong>This was a single-arm pilot trial of the decision aid in 40 participants with HIV eligible for lung cancer screening. The decision aid included personalized screening recommendations and HIV-specific, 5-year risk estimates of lung cancer and all-cause mortality. Participants reviewed the decision aid at shared decision-making visits and completed previsit and postvisit surveys with measures of knowledge about lung cancer screening, acceptability, and decisional conflict.</p><p><strong>Results: </strong>The 40 enrolled participants were a median age of 62 years, 60% currently smoked, and they had median 5-year risks of lung cancer and all-cause mortality of 2.0% (IQR, 1.4%-3.3%) and 4.1% (IQR, 3.3%-7.9%), respectively. Personalized recommendations included \"Encourage Screening\" for 53% of participants and \"Preference Sensitive\" recommendations for the remainder. Participants showed improvement in two validated knowledge measures with relative improvement of 60% (P < 0.001) on the 12-question lung cancer screening knowledge test and 27% (P < .001) on the seven-question lung cancer screening knowledge score, with significant improvement on questions regarding false-positive and false-negative findings, incidental findings, lung cancer-specific mortality benefit, and the possible harms of screening. Participants reported low scores on the decisional conflict scale (median score, 0; interquartile range, 0-5) and high acceptability. Ninety percent of patients ultimately underwent screening within 1 month of the visit.</p><p><strong>Interpretation: </strong>In our study, this HIV-adapted and personally tailored decision aid improved participants' knowledge of risks, benefits, and characteristics of screening with low decisional conflict and high acceptability. Our results indicate that this decision aid can enable high-quality shared decision-making in this high-risk population.</p><p><strong>Clinical trial registration: </strong>ClinicalTrials.gov; No.: NCT04682301; URL: www.</p><p><strong>Clinicaltrials: </strong>gov.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":"259-269"},"PeriodicalIF":9.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11752131/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141859177","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":"Misclassification of Pulmonary Hypertension With Current Hemodynamic Criteria.","authors":"Maya Guglin, Kartik Munshi, Elizabeth Volz, Mosi Bennett, Terrie Ann Benjamin, Kunjan Bhatt, Arvind Bhimaraj, Timothy Fendler, Marat Fudim, Ashrith Guha, James Thomas Heywood, Orvar Jonsson, Liviu Klein, Patrick McCann, Evan Muse, Monique Robinson, Andrew J Sauer, Hirak Shah, Jacob Abraham","doi":"10.1016/j.chest.2024.05.053","DOIUrl":"10.1016/j.chest.2024.05.053","url":null,"abstract":"","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":"241-244"},"PeriodicalIF":9.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142104746","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":"A 75-Year-Old Man With Supine Hypotension.","authors":"Andres Leonardo Mora Carpio, Madelyn Renzetti, Martin Mutonga, Mark D Siegel","doi":"10.1016/j.chest.2024.06.3816","DOIUrl":"https://doi.org/10.1016/j.chest.2024.06.3816","url":null,"abstract":"<p><strong>Case presentation: </strong>A 75-year-old patient with autosomal dominant polycystic kidney disease (ADPKD) and hypertension was admitted to the hospital with abdominal pain secondary to a choledochal cyst resulting in biliary dilation. His hospital course was complicated by pneumonia, encephalopathy, and lower gastrointestinal bleeding (LGIB) that initially did not lead to hemodynamic compromise. To further evaluate the LGIB, a colonoscopy was performed, during which he experienced significant hypotension after being placed in the supine position and given anesthesia. The hypotension required treatment with vasoactive medications, termination of the colonoscopy, and transfer to the medical ICU for invasive hemodynamic monitoring and treatment.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":"167 1","pages":"e9-e12"},"PeriodicalIF":9.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142964073","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}