Chest最新文献

{"title":"Where Stores Cluster: Inequities in Cannabis and Electronic Nicotine Delivery Systems Retail Access.","authors":"Meredith Case, Alex Federman, Juan Wisnivesky","doi":"10.1016/j.chest.2026.06.024","DOIUrl":"https://doi.org/10.1016/j.chest.2026.06.024","url":null,"abstract":"","PeriodicalId":9782,"journal":{"name":"Chest","volume":"170 4","pages":"1011-1012"},"PeriodicalIF":9.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149134909","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":"Coughing Up New Insights in Hypersensitivity Pneumonitis.","authors":"Joshua Clark, Nishant Gupta","doi":"10.1016/j.chest.2026.04.030","DOIUrl":"https://doi.org/10.1016/j.chest.2026.04.030","url":null,"abstract":"","PeriodicalId":9782,"journal":{"name":"Chest","volume":"170 4","pages":"990-992"},"PeriodicalIF":9.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149135199","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":"Recent Advances in Identifying Pleural Exudates.","authors":"John E Heffner","doi":"10.1016/j.chest.2026.05.046","DOIUrl":"https://doi.org/10.1016/j.chest.2026.05.046","url":null,"abstract":"","PeriodicalId":9782,"journal":{"name":"Chest","volume":"170 4","pages":"e134"},"PeriodicalIF":9.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149135211","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":"Association of In-Hospital Influenza Vaccination With Reduced 1-Year Mortality in Critically Ill Patients With Chronic Pulmonary Disease: A Real-World Target Trial Emulation.","authors":"Jiadong Feng, Fengchan Xi, Chuanrui Sun, Shanjun Tan, Xiling Wang","doi":"10.1016/j.chest.2026.04.022","DOIUrl":"10.1016/j.chest.2026.04.022","url":null,"abstract":"<p><strong>Background: </strong>Influenza vaccination is recommended widely to reduce the risk of death and serious illness in vulnerable people, but in-hospital influenza vaccination for critically ill patients with chronic pulmonary disease (CPD) remains limited.</p><p><strong>Research question: </strong>Is in-hospital influenza vaccination effective in improving the prognosis of critically ill patients with CPD?</p><p><strong>Study design and methods: </strong>We designed a target trial emulation using critically ill inpatients with CPD from the Medical Information Mart for Intensive Care IV database (2011-2022). Propensity score matching was used to balance baseline characteristics. The primary effectiveness outcome was 1-year mortality, with fever within 7 days after vaccination as an exploratory safety outcome. Associations with mortality were assessed using Cox and accelerated failure time models, whereas readmission or emergency department (ED) visits were assessed using logistic models. Vaccine effectiveness (VE) was estimated as (1 - hazard ratio or OR) × 100, and the number needed to vaccinate (NNV) was derived. Noninferiority for fever was defined as the risk difference (RD) with upper 95% CI of < 5%.</p><p><strong>Results: </strong>Among 7,734 patients, 3,803 patients (49.2%) received the influenza vaccine. Vaccination was associated with reduced 1-year mortality (VE, 12%; 95% CI, 3%-20%), with NNV to prevent 1 death of 30 (95% CI, 18-119). Furthermore, patients who were vaccinated showed 12% (95% CI, 1%-21%) lower 90-day mortality, 13% (95% CI, 3%-22%) reduced readmission risk, and 23% (95% CI, 12%-32%) less rate of ED visits. Noninferiority in fever incidence was demonstrated for the vaccinated group compared with the unvaccinated group according to the prespecified noninferiority criterion (RD, 2.22%; 95% CI, -0.02% to 4.47%).</p><p><strong>Interpretation: </strong>Our results show that in-hospital influenza vaccination is effective for critically ill patients with CPD, supporting its integration into routine inpatient care to improve long-term outcomes.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":"1037-1048"},"PeriodicalIF":9.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147811642","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":"Characterization of CT Imaging-Derived Pulmonary Vascular Abnormalities Associated With Pulmonary Hypertension in Chronic Lung Disease.","authors":"Agustín R Garcia, Iván Vollmer, Isabel Blanco, Rubén San José Estepar, Diego A Rodriguez-Chiaradía, Manuel López-Meseguer, Clara Martin-Ontiyuelo, Pietro Nardelli, Fernanda Hernandez-Gonzalez, Adelaida Bosacoma, Jesús Ribas, Xavier Pomares, Salud Santos, María Molina-Molina, Jacobo Sellares, Farbod N Rahaghi, George Washko, Raúl San José Estepar, Joan A Barberà","doi":"10.1016/j.chest.2026.05.027","DOIUrl":"10.1016/j.chest.2026.05.027","url":null,"abstract":"<p><strong>Background: </strong>Pulmonary vascular remodeling is implicated in the pathophysiologic characteristics of pulmonary hypertension (PH) in chronic lung diseases. CT imaging metrics of pulmonary vessels may provide insight into the impact of vessel morphologic features on PH severity in chronic lung diseases (CLDs).</p><p><strong>Research question: </strong>Are CT imaging-assessed pulmonary vascular abnormalities associated with the presence and severity of PH in COPD and fibrosing interstitial lung disease (ILD), and how are they related to parenchymal damage?</p><p><strong>Study design and methods: </strong>We evaluated 117 patients with CLD (63 patients with COPD and 54 patients with ILD), and 38 patients with idiopathic pulmonary arterial hypertension as a comparator group. Patients with COPD and ILD were stratified according to the presence and severity of PH using right heart catheterization. Pulmonary vessel volumes, stratified in arteries and veins, and the extent of emphysema and fibrosis were assessed by volumetric, noncontrast chest CT scans.</p><p><strong>Results: </strong>Patients with COPD exhibited greater vascular and lung volumes (LVs) than those with ILD, although they showed lower small-vessel volume when adjusted for LV. In both diseases, severe PH was associated with a reduced volume of small arteries normalized to total arterial volume (TAV; blood volume in arteries < 5 mm² in cross-section [BV5art] to TAV ratio) and was more pronounced in patients with COPD, who also showed larger central vessel volumes. In COPD, the extent of emphysema did not correlate with either hemodynamic impairment or small-vessel volume. In contrast, in ILD, the extent of fibrosis was unrelated to hemodynamic impairment, but was corelated inversely with the volume of small arteries and veins.</p><p><strong>Interpretation: </strong>Our results show that COPD and fibrosing ILD exhibit marked differences in pulmonary vessel morphologic features and their relationship with parenchymal remodeling, suggesting distinct mechanisms underlying PH development. In lung disease, the BV5art to TAV ratio seems to be a sensitive marker of hemodynamically confirmed severe PH, particularly in COPD, reflecting intravascular volume redistribution resulting from peripheral vessel remodeling.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":"1232-1248"},"PeriodicalIF":9.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148053038","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":"Unstable Reference and Unblinded Comparison Undermine Artificial Intelligence Echocardiography in Pulmonary Hypertension.","authors":"Ping Xu, Xiao-Long Li, Xian-Qiang Wang","doi":"10.1016/j.chest.2026.04.058","DOIUrl":"https://doi.org/10.1016/j.chest.2026.04.058","url":null,"abstract":"","PeriodicalId":9782,"journal":{"name":"Chest","volume":"170 4","pages":"e138-e139"},"PeriodicalIF":9.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149134699","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":"Female Sex and Cough Severity in Hypersensitivity Pneumonitis: Frequency or Perception?","authors":"Xinyue Wang, Xinyi Xu, Lu Xiao","doi":"10.1016/j.chest.2026.05.043","DOIUrl":"https://doi.org/10.1016/j.chest.2026.05.043","url":null,"abstract":"","PeriodicalId":9782,"journal":{"name":"Chest","volume":"170 4","pages":"e133"},"PeriodicalIF":9.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149135189","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":"Characterizing the Clinical and Economic Impact of Invasive Mold Infection After Lung Transplantation.","authors":"Jonathan Huggins","doi":"10.1016/j.chest.2026.05.038","DOIUrl":"https://doi.org/10.1016/j.chest.2026.05.038","url":null,"abstract":"","PeriodicalId":9782,"journal":{"name":"Chest","volume":"170 4","pages":"993-995"},"PeriodicalIF":9.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149135213","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":"Managing a Critically Ill Patient With Pulmonary Arterial Hypertension.","authors":"Roxana Sulica, Teresa De Marco, Jean M Elwing, Sonia Bartolome, Namita Sood","doi":"10.1016/j.chest.2026.05.018","DOIUrl":"10.1016/j.chest.2026.05.018","url":null,"abstract":"<p><p>Management of critically ill patients with pulmonary hypertension presents significant clinical challenges. Regardless of the underlying etiology or chronicity of pulmonary hypertension, superimposed acute illness can precipitate decompensated right ventricular failure (RVF) and death. Hospitalization, particularly in the ICU, is associated with high mortality, with RVF serving as the direct or indirect cause in most cases. In this article, we will focus on the management of acute decompensated RVF in patients with known pulmonary arterial hypertension (PAH). ICU management of the patient with PAH with RVF centers on the recognition and treatment of potentially reversible precipitants for decompensation and supportive strategies to optimize right ventricular (RV) function. Key goals include maintaining adequate oxygenation and tissue perfusion, correcting electrolyte and other metabolic abnormalities, optimizing fluid balance and RV preload, enhancing RV contractility, and reducing RV afterload. Continuous monitoring of cardiac function is essential, as is identifying and treating potential complications (eg, arrhythmia, acute kidney injury). When RVF persists despite maximal medical therapy, extracorporeal life support may be considered as a bridge to recovery or transplantation. In patients with advanced disease, multidisciplinary discussions aligned with patient and family preferences should guide the goals of care. Integration of palliative care specialists to manage symptoms and support caregivers remains a critical component of comprehensive ICU management for patients with PAH.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":"1260-1271"},"PeriodicalIF":9.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148004598","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":"Targeting C5a, a Good Thing Gone Bad in Viral ARDS.","authors":"Martin Witzenrath","doi":"10.1016/j.chest.2026.06.014","DOIUrl":"https://doi.org/10.1016/j.chest.2026.06.014","url":null,"abstract":"","PeriodicalId":9782,"journal":{"name":"Chest","volume":"170 4","pages":"987-989"},"PeriodicalIF":9.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149134554","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}