Chest最新文献

{"title":"A 23-Year-Old Man With Hemoptysis and Expectoration of a Metal Fragment.","authors":"Kyle R Weinstein, Brandon P Call, Gaston Becherano, Nithya K Iyer, Gary Schwartz","doi":"10.1016/j.chest.2026.04.037","DOIUrl":"https://doi.org/10.1016/j.chest.2026.04.037","url":null,"abstract":"<p><strong>Case presentation: </strong>A 23-year-old man with a medical history significant for juvenile polyposis-hereditary hemorrhagic telangiectasia (SMAD4 and ENG mutation-positive), multiple prior coil embolizations for pulmonary arteriovenous malformations, and recurrent epistaxis refractory to nasal cauterization presented to the emergency department with 1 week of cough and 2 days of hemoptysis.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":"170 4","pages":"e123-e126"},"PeriodicalIF":9.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149135247","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":"Place-Based Inequities in E-Cigarette/Vape and Cannabis Retail Density in Massachusetts: The Role of Child Opportunity and Social Vulnerability.","authors":"Ashley L Saint-Fleur, Diane Story, Marissa Hauptman, Alicia Casey","doi":"10.1016/j.chest.2026.04.026","DOIUrl":"10.1016/j.chest.2026.04.026","url":null,"abstract":"<p><strong>Background: </strong>As the legalized markets for cannabis and electronic nicotine delivery systems (e-cigarettes/vapes) expand, there are growing concerns about increased youth exposure through retail accessibility. However, the extent to which retail placement aligns with structural neighborhood conditions remains unclear.</p><p><strong>Research question: </strong>How do neighborhood-level opportunity and vulnerability, measured through the Child Opportunity Index (COI) and Social Vulnerability Index (SVI), relate to e-cigarette/vape and cannabis retail density in Massachusetts?</p><p><strong>Study design and methods: </strong>Using an ecological cross-sectional design, 5,034 licensed e-cigarette/vape (2022-2024) and 483 licensed cannabis (2024) retail locations in Massachusetts were geocoded to census tracts. Spatial analysis identified hot spots (high-density clusters) and cold spots (low-density clusters). Neighborhood characteristics were captured through the COI and SVI, which encompass a range of demographic, socioeconomic, and household indicators. Descriptive statistics and negative binomial regression models assessed associations between the COI, the SVI, and retail density.</p><p><strong>Results: </strong>Retailers were concentrated in census tracts with lower COI scores across all domains, indicating lower child opportunity, and higher SVI scores, indicating greater social vulnerability, with largest differences observed in socioeconomic status and household composition. Higher levels of the COI were associated with fewer retailers (count ratio, 0.9; 95% CI, 0.89-0.93), whereas higher SVI was associated with more retailers (count ratio, 1.1; 95% CI, 1.06-1.11). However, SVI themes of Housing Type/Transportation and Minority Status/Language showed minimal variation across retail hot and cold spots.</p><p><strong>Interpretation: </strong>E-cigarette/vape and cannabis retailers were disproportionately clustered in areas of high social vulnerability and low child opportunity in Massachusetts. Clustering aligned most closely with measures of socioeconomic disadvantage, rather than housing structure or racial/ethnic composition, diverging from historical tobacco retail patterns. Monitoring retail density may provide valuable insight into evolving industry strategies, state-specific factors, and the role of neighborhood-level policies in shaping exposure risk in vulnerable communities.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":"1299-1310"},"PeriodicalIF":9.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13143344/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147811704","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":"It Is Time to Change the Notion That 4 Hours of Positive Airway Pressure Use at 70% Adherence Is Adequate.","authors":"Chris Y Kim, Dora Zalai, Colin M Shapiro","doi":"10.1016/j.chest.2026.05.030","DOIUrl":"https://doi.org/10.1016/j.chest.2026.05.030","url":null,"abstract":"","PeriodicalId":9782,"journal":{"name":"Chest","volume":"170 4","pages":"1018-1020"},"PeriodicalIF":9.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149135158","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":"Artificial Intelligence and the Radiographic Aging Clock: Chest Radiography in the Age of Artificial Intelligence, Challenges and Opportunities.","authors":"Sharyn I Katz, Leonid Roshkovan","doi":"10.1016/j.chest.2026.07.5230","DOIUrl":"https://doi.org/10.1016/j.chest.2026.07.5230","url":null,"abstract":"","PeriodicalId":9782,"journal":{"name":"Chest","volume":"170 4","pages":"1001-1003"},"PeriodicalIF":9.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149135196","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":"Comparison of Hemodynamic Responses to Balloon Pulmonary Angioplasty in Chronic Thromboembolic Pulmonary Hypertension in Japan and The Netherlands: A Multicenter Study.","authors":"Satoshi Higuchi, Konstantinos Mantzios, Takatoyo Kiko, Taijyu Satoh, Tamara C Rodenburg, Diederik P Staal, Tetsuya Fukuda, Hideki Ota, Aleid M Breuning, Ryo Takano, Marcel A M Beijk, Rutger J Lely, Jan van Haersma de With, Frank Oosterveer, Esther Nossent, Jurjan Aman, Sanne Boerman, Jan-Peter van Kuijk, Shuhei Sugiyama, Nobuhiro Yaoita, Hiroki Horinouchi, Hiroya Hayashi, Shinya Fujisaki, Frances S de Man, Anton Vonk Noordegraaf, Marco C Post, Lilian J Meijboom, Takeshi Ogo, Harm Jan Bogaard","doi":"10.1016/j.chest.2026.04.029","DOIUrl":"10.1016/j.chest.2026.04.029","url":null,"abstract":"<p><strong>Background: </strong>Mean pulmonary arterial pressure (mPAP) after balloon pulmonary angioplasty (BPA) in patients with chronic thromboembolic pulmonary hypertension (CTEPH) consistently has been lower in Japan compared with non-Japanese cohorts.</p><p><strong>Research question: </strong>What factors are associated with higher mPAP after BPA?</p><p><strong>Study design and methods: </strong>This retrospective multicenter study screened 200 consecutive patients with CTEPH who underwent BPA at 2 centers in The Netherlands and 2 centers in Japan. After excluding patients with prior pulmonary endarterectomy or lacking follow-up hemodynamic data, 138 patients were analyzed. Comorbidities, lesion distribution and morphologic features, PH medication, procedural details, and hemodynamic parameters were compared between the 2 countries' cohorts. Multivariable regression analysis was performed to identify factors associated with high mPAP at follow-up.</p><p><strong>Results: </strong>The proportion of male patients (55% vs 24%), BMI (mean [SD], 26 [4] kg/m² vs 23 [5] kg/m²), the prevalence of atrial fibrillation (9% vs 0%), and smoking rate (43% vs 23%) were higher and diffusing capacity of the lung for carbon monoxide (Dlco) was lower (mean [SD], 69% [15%] vs 79% [19%]) in the cohort from The Netherlands. Proximal lesion distribution and severity on CT imaging were comparable between the 2 countries. The Japanese cohort demonstrated a greater mPAP reduction (-16 mm Hg [40%] vs -10 mm Hg [28%]; P < .01 ), with a lower mPAP at follow-up (mean [SE], 22 [1] mm Hg vs 30 [1] mm Hg; P < .01). Independent factors associated with higher follow-up mPAP included lower Dlco, higher right atrial pressure, higher pulmonary arterial wedge pressure at follow-up, a greater number of BPA sessions, and less frequent use of intermediate-sized balloons.</p><p><strong>Interpretation: </strong>Our results show that higher mPAP after BPA was associated with impaired lung and left-sided heart function and procedural parameters, rather than nationality or lesion distribution. These findings suggest that occult cardiopulmonary comorbidities are important contributors to international differences in BPA outcomes and that differences in procedural practice may play a role.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":"1218-1231"},"PeriodicalIF":9.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147834257","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":"Anti-C5a Antibody STSA-1002 for Patients With ARDS Due to Viral Pneumonia: A Phase 1b/2, Multicenter, Randomized, Double-Anonymized, Placebo-Controlled Trial.","authors":"Yeming Wang, Xiaobo Huang, Zhenshun Cheng, Ziyi Chu, Haibo Li, Yongmei Zhang, Mingyan Jiang, Xin Gan, Lei Li, Xiuzhi Yang, Zhiqiang Zhang, Lijun Suo, Yuping Li, Xu Huang, Xiaoqian Wang, Song Yun, Xianglong Xiang, Zhong Li, Bin Cao","doi":"10.1016/j.chest.2026.04.052","DOIUrl":"10.1016/j.chest.2026.04.052","url":null,"abstract":"<p><strong>Background: </strong>ARDS constitutes a major cause of mortality, with limited therapeutic options.</p><p><strong>Research question: </strong>Is STSA-1002, an anti-C5a monoclonal antibody, safe and clinically beneficial in ARDS caused by viral pneumonia?</p><p><strong>Study design and methods: </strong>This was a phase 1b/2, multicenter, double-anonymizzed, placebo-controlled trial. Participants aged between 18 and 85 years with ARDS caused by viral pneumonia and Pao₂/Fio₂ ≤ 200 mm Hg were included. Patients were randomly assigned (1:1:1) to receive STSA-1002 1,350 mg, STSA-1002 750 mg, or placebo. The STSA-1002 or matched placebo was administered to participants on days 1, 3, and 7, with an optional additional dose on day 14 ± 1 at the physician's discretion. The primary end point was time to clinical improvement. Clinical improvement was defined as either blood oxygen saturation/Fio₂ > 235 mm Hg or Pao₂/Fio₂ > 200 mm Hg, maintained for at least 48 hours, whichever occurred first, within 28 days.</p><p><strong>Results: </strong>Between December 9, 2023, and March 20, 2025, a total of 49 patients were enrolled and randomized to treatment. Among the 47 patients who received study medication, 17 received STSA-1002 1,350 mg, 15 received STSA-1002 750 mg, and 15 received placebo. The time to clinical improvement was 6.0 days in the STSA 1002 1,350 mg group, 8.4 days in the STSA 1002 750 mg group, and 7.4 days in the control group. A subdistribution hazard ratio of 1.55 (95% CI, 0.68-3.55) was reported for the STSA-1002 1,350 mg group and 1.04 (95% CI, 0.46-2.38) for the STSA-1002 750 mg group according to a competing risk model, both compared with the control group. Following adjustment for baseline Pao₂/Fio₂, the subdistribution hazard ratio was 1.22 (95% CI, 0.52-2.86) and 1.13 (95% CI, 0.47-2.75), respectively. The 28-day all-cause mortality was 5.88% (1 of 17), 26.67% (4 of 15), and 40% (6 of 15). STSA-1002 was well tolerated.</p><p><strong>Interpretation: </strong>STSA-1002 exhibited a favorable safety profile and potential efficacy. These findings warrant confirmation in a phase 3 trial.</p><p><strong>Clinical trial registration: </strong>ClinicalTrials.gov; No.: NCT06038916; URL: www.</p><p><strong>Clinicaltrials: </strong>gov.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":"1092-1104"},"PeriodicalIF":9.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147959794","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":"Nodular Fasciitis of the Lung: A Novel Entity.","authors":"Hardeep Singh Kalsi, Rimsha Khan, Kofi Nimako, Reena Khiroya, David Lawrence, Neal Navani, Ricky Thakrar","doi":"10.1016/j.chest.2026.02.051","DOIUrl":"https://doi.org/10.1016/j.chest.2026.02.051","url":null,"abstract":"<p><p>Pulmonary tumors in young individuals may differ in their causes from older individuals, with a more broad and potentially benign process in the differential diagnosis. Inflammatory myofibroblastic tumors (IMTs) are well described in the literature, and here, we describe a rare previously unreported case of nodular fasciitis of the bronchial tree, initially mimicking a typical IMT, and which spontaneously regressed, avoiding the need for potentially life-altering surgery for the patient. This case highlights the importance of careful evaluation of pseudotumors of the lung and specialist multidisciplinary team assessment.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":"170 4","pages":"e113-e116"},"PeriodicalIF":9.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149135184","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":"OSA and Hypertension: What If Titration Finally Matters?","authors":"Wojciech Trzepizur","doi":"10.1016/j.chest.2026.05.011","DOIUrl":"https://doi.org/10.1016/j.chest.2026.05.011","url":null,"abstract":"","PeriodicalId":9782,"journal":{"name":"Chest","volume":"170 4","pages":"1009-1010"},"PeriodicalIF":9.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149135182","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":"Associations of Mucus Plug With Prognosis in COPD: A Systematic Review and Meta-Analysis.","authors":"Jiaqi Pu, Shijia Hong, Jian-Qing He","doi":"10.1016/j.chest.2026.04.038","DOIUrl":"10.1016/j.chest.2026.04.038","url":null,"abstract":"<p><strong>Background: </strong>Radiologically defined mucus plugs in COPD have not been systematically evaluated for prognosis, constraining their use in clinical risk stratification.</p><p><strong>Research question: </strong>In adults with COPD, is the burden of radiologically defined mucus plugs associated with increased risks of mortality, exacerbations, lung function decline, and impaired quality of life?</p><p><strong>Study design and methods: </strong>A systematic review and meta-analysis (PROSPERO: CRD420251228960) was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed, EMBASE, Cochrane Central Register of Controlled Trials, and Web of Science were comprehensively searched from inception to November 11, 2025. Observational studies involving adults with COPD that reported data on mortality, exacerbations, lung function, or quality of life were included. Pooled hazard ratios (HRs) were generated by using random-effects meta-analysis. Prespecified subgroup analyses were stratified according to plug severity (low-grade [score 1-2] vs high-grade [score ≥ 3]) and exacerbation type.</p><p><strong>Results: </strong>Seven studies involving 15,702 patients were included. Compared with patients without mucus plugs, those with low-grade plugs had a 14% higher risk of all-cause mortality (HR, 1.14; 95% CI, 1.03-1.26), which further increased to 48% in the high-grade group, although this estimate did not reach statistical significance (HR, 1.48; 95% CI, 0.86-2.54; P = .16). Similarly, the risk of exacerbations exhibited a graded increase, for both moderate to severe (low-grade: HR, 1.07 [95% CI, 1.05-1.09]; high-grade: HR, 1.15 [95% CI, 1.08-1.23]) and severe (low-grade: HR, 1.11 [95% CI, 1.00-1.22]; high-grade: HR, 1.41 [95% CI, 1.04-1.91]) events. Narrative synthesis confirmed associations with worse lung function and quality of life.</p><p><strong>Interpretation: </strong>This first meta-analysis found a consistent graded association between CT-defined mucus plug burden and poor clinical outcomes in COPD, supporting its role as a clinically relevant prognostic marker for risk stratification. These findings support integrating CT-based plug assessment into clinical practice for risk stratification and highlight the need for targeted mucus-directed therapies.</p><p><strong>Clinical trial registration: </strong>PROSPERO; No.: CRD420251228960; URL: https://www.crd.york.ac.uk/prospero.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":"1074-1084"},"PeriodicalIF":9.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147834326","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":"Hemodynamic Profile and Clinical Outcomes of Low- and High-Cardiometabolic Phenotypes in COPD: A Cluster Analysis.","authors":"Esteban Kosak Lopez, Jose M Martinez-Manzano, Andrew Geller, Raul Leguizamon, Justin Lam, Thitiphan Srikulmontri, Michael Vera Ricaurte, Maria Siqueira Tavares de Melo, Thomas Stavola, John Malin, Enrique Pacheco, Zurab Azmaiparashvili, Kevin Bryan Lo","doi":"10.1016/j.chest.2026.04.046","DOIUrl":"10.1016/j.chest.2026.04.046","url":null,"abstract":"","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":"1085-1091"},"PeriodicalIF":9.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147926999","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}