Chest最新文献

{"title":"Response.","authors":"Hasan M Al-Dorzi, Jesna Jose, Yaseen M Arabi","doi":"10.1016/j.chest.2024.11.022","DOIUrl":"https://doi.org/10.1016/j.chest.2024.11.022","url":null,"abstract":"","PeriodicalId":9782,"journal":{"name":"Chest","volume":"167 3","pages":"e99-e101"},"PeriodicalIF":9.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143613720","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 Between Caregiver Strain and Emergency Health Care Resource Utilization in Survivors of Critical Illness.","authors":"Christie Docherty, Martin Shaw, Cheuk Yu Chim, Pamela MacTavish, Helen Devine, Peter O'Brien, Phil Lucie, Lucy Hogg, Laura Strachan, Tara Quasim, Joanne McPeake","doi":"10.1016/j.chest.2024.08.057","DOIUrl":"10.1016/j.chest.2024.08.057","url":null,"abstract":"","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":"768-771"},"PeriodicalIF":9.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11882738/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142379140","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":"Graded Transthoracic Contrast Echocardiography After Pulmonary Arteriovenous Malformation Embolization: Can Chest CT Scan Be Avoided in Patients With a Low-Grade Shunt?","authors":"Josefien Hessels, Sjors Klompmaker, Daniel A F van den Heuvel, Sanne Boerman, Hans-Jurgen Mager, Marco C Post","doi":"10.1016/j.chest.2024.09.029","DOIUrl":"10.1016/j.chest.2024.09.029","url":null,"abstract":"<p><strong>Background: </strong>Pulmonary arteriovenous malformations (PAVMs) are direct connections between the pulmonary artery and vein, creating a right-to-left shunt (RLS). Embolization is indicated to prevent complications. Guidelines recommend follow-up chest CT scans to confirm persistent occlusion and embolization of all treatable PAVMs. Graded transthoracic contrast echocardiography (TTCE) after PAVM embolization may offer a reliable alternative in a subgroup of patients while preventing radiation exposure.</p><p><strong>Research question: </strong>Can TTCE predict the need for additional embolotherapy in the postembolization population as accurately as it does in the treatment-naive population?</p><p><strong>Study design and methods: </strong>Since 2018, follow-up after PAVM embolization at our study institution includes both TTCE and chest CT scan after 6 to 12 months and every 3 to 5 years thereafter. Patients who underwent at least 1 follow-up TTCE and chest CT scan were included. The indication for additional embolotherapy was discussed in a multidisciplinary team meeting. The primary outcome was the indication for additional embolotherapy in each right-to-left shunt (RLS) grade. Additionally, the association between the RLS grade and indication for additional embolotherapy was investigated.</p><p><strong>Results: </strong>A total of 339 patients with 412 embolization procedures were included; median time to follow-up TTCE was 7.5 months. An RLS was present in 399 postembolization TTCEs (97%): RLS grade 1 in 93 patients (23%), grade 2 in 149 patients (36%) and grade 3 in 157 patients (38%). In patients with RLS grades 0 and 1, no treatable PAVMs were found on CT scan. In patients with RLS grades 2 and 3, 22 (15%) and 72 (46%) underwent additional embolization.</p><p><strong>Interpretation: </strong>This study shows chest CT scan might be withheld in patients with RLS grades 0 and 1 after PAVM embolization.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":"842-850"},"PeriodicalIF":9.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142388382","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 52-Year-Old Woman With Shortness of Breath and Left Lower Back Pain.","authors":"Faraz Badar, Harith Al-Ataby, Mohammed Al-Azzawi, Mohamed Omballi","doi":"10.1016/j.chest.2024.09.035","DOIUrl":"10.1016/j.chest.2024.09.035","url":null,"abstract":"<p><strong>Case presentation: </strong>A 52-year-old woman presented to the clinic with progressively worsening shortness of breath associated with intermittent pleuritic left lower back pain for the past 6 months. The patient denied any cough, hemoptysis, fever, chills, or weight loss. She had a history of smoking cigarettes for more than 10 years but quit almost 20 years ago. An outpatient chest radiograph was obtained, and it suggested consolidation of the left lower lobe. The patient was treated empirically with amoxicillin-clavulanate for 2 weeks without improvement.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":"167 3","pages":"e83-e87"},"PeriodicalIF":9.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11937227/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143613635","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":"Rebuttal From Drs Dabbous and Mitchell.","authors":"Helene K Dabbous, Ron B Mitchell","doi":"10.1016/j.chest.2024.10.037","DOIUrl":"https://doi.org/10.1016/j.chest.2024.10.037","url":null,"abstract":"","PeriodicalId":9782,"journal":{"name":"Chest","volume":"167 3","pages":"658-659"},"PeriodicalIF":9.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143613713","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":"Reintroducing the Advanced Practice Respiratory Therapist.","authors":"Kevin O'Neil","doi":"10.1016/j.chest.2024.11.005","DOIUrl":"https://doi.org/10.1016/j.chest.2024.11.005","url":null,"abstract":"","PeriodicalId":9782,"journal":{"name":"Chest","volume":"167 3","pages":"642-644"},"PeriodicalIF":9.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143613715","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":"Factors Associated With VTE in Patients Who Are Critically Ill.","authors":"Guanyu Yang","doi":"10.1016/j.chest.2024.09.045","DOIUrl":"https://doi.org/10.1016/j.chest.2024.09.045","url":null,"abstract":"","PeriodicalId":9782,"journal":{"name":"Chest","volume":"167 3","pages":"e99"},"PeriodicalIF":9.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143613647","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":"Obstructive Lung Disease in Osteogenesis Imperfecta: A Potential Model for Interstitial Lung Disease, COPD, and Asthma.","authors":"Carolyn Jordan Henderson, Burton L Lesnick","doi":"10.1016/j.chest.2024.10.034","DOIUrl":"https://doi.org/10.1016/j.chest.2024.10.034","url":null,"abstract":"","PeriodicalId":9782,"journal":{"name":"Chest","volume":"167 3","pages":"645-646"},"PeriodicalIF":9.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143613649","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":"Identifying Abnormal Exertional Breathlessness in COPD: Comparing Modified Medical Research Council and COPD Assessment Test With Cardiopulmonary Exercise Testing.","authors":"Magnus Ekström, Hayley Lewthwaite, Pei Zhi Li, Jean Bourbeau, Wan C Tan, Dennis Jensen","doi":"10.1016/j.chest.2024.10.027","DOIUrl":"10.1016/j.chest.2024.10.027","url":null,"abstract":"<p><strong>Background: </strong>COPD management is guided by the respiratory symptom burden, assessed using the modified Medical Research Council (mMRC) scale, the COPD Assessment Test (CAT), or both.</p><p><strong>Research question: </strong>What are the abilities of mMRC and CAT to detect abnormally high exertional breathlessness on incremental cardiopulmonary cycle exercise testing (CPET) in people with COPD?</p><p><strong>Study design and methods: </strong>Analysis of people aged ≥ 40 years with FEV₁ to FVC ratio of < 0.70 after bronchodilator administration and ≥ 10 pack-years of smoking from the Canadian Cohort Obstructive Lung Disease study. Abnormal exertional breathlessness was defined as a breathlessness (Borg scale 0-10) intensity rating more than the upper limit of normal at the symptom-limited peak of CPET using normative reference equations.</p><p><strong>Results: </strong>We included 318 people with COPD (40% female) with a mean (SD) age of 66.5 (9.3) years and FEV₁ of 79.5% predicted (19.0% predicted); 26% showed abnormally low exercise capacity (peak oxygen uptake less than the lower limit of normal). Abnormally high exertional breathlessness was present in 24%, including 9% and 11% of people with mMRC score of 0 and CAT score of < 10, respectively. An mMRC score of ≥ 2 and CAT score of ≥ 10 was most specific (95%) to detect abnormal exertional breathlessness, but showed low sensitivity of only 12%. Accuracy for all scale cutoffs or combinations was < 65%. Compared with people with true-negatives findings, people with abnormal exertional breathlessness but low mMRC score, low CAT scores (false-negatives findings), or both showed worse self-reported and physiologic outcomes during CPET, were more likely to have physician-diagnosed COPD, but were not more likely to be taking any respiratory medication (37% vs 30%; mean difference, 6.1%; 95% CI, -7.2 to 19.4; P= .36).</p><p><strong>Interpretation: </strong>In COPD, mMRC and CAT showed low concordance with CPET and failed to identify many people with abnormally high exertional breathlessness.</p><p><strong>Clinical trial registry: </strong>ClinicalTrials.gov; No.: NCT00920348; URL: www.</p><p><strong>Clinicaltrials: </strong>gov.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":"697-711"},"PeriodicalIF":9.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11882773/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142567357","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":"Changes in Lung Function and Mortality Risk in Patients With Idiopathic Pulmonary Fibrosis.","authors":"Justin M Oldham, Megan L Neely, Daniel M Wojdyla, Mridu Gulati, Peide Li, Divya C Patel, Scott M Palmer, Jamie L Todd","doi":"10.1016/j.chest.2025.02.018","DOIUrl":"10.1016/j.chest.2025.02.018","url":null,"abstract":"<p><strong>Background: </strong>Idiopathic pulmonary fibrosis (IPF) is a progressive fibrosing interstitial lung disease associated with lung function decline and high mortality.</p><p><strong>Research question: </strong>What are the associations between thresholds of lung function decline and the risk of mortality in patients with IPF?</p><p><strong>Study design and methods: </strong>The Idiopathic Pulmonary Fibrosis-Prospective Outcomes Registry enrolled patients with IPF that was diagnosed or confirmed at the enrolling center within the prior 6 months. Associations between time to first decline in FVC or diffusing capacity of the lungs for carbon monoxide (Dlco) of ≥ 2% predicted, ≥ 5% predicted, and ≥ 10% predicted (and ≥ 15% predicted for Dlco) and risk of subsequent death or lung transplant was assessed using Cox proportional hazards models with a time-dependent covariate. Models were unadjusted or adjusted for FVC and Dlco % predicted, age, sex, smoking status, BMI, antifibrotic treatment (yes or no), and oxygen use at enrollment.</p><p><strong>Results: </strong>Among 1,001 patients, median follow-up time was 38.4 months. Significant associations were observed between all thresholds of decline in FVC and Dlco % predicted and the risk of death or lung transplant in unadjusted and adjusted analyses. In adjusted analyses, absolute declines in FVC of ≥ 2% predicted, ≥ 5% predicted, and ≥ 10% predicted were associated with 1.8-fold, 2.3-fold, and 2.7-fold increases in the risk of subsequent death or lung transplant, whereas absolute declines in Dlco of ≥ 2% predicted, ≥ 5% predicted, ≥ 10% predicted, and ≥ 15% predicted were associated with 2.0-fold, 1.4-fold, 1.5-fold, and 1.9-fold increases in the risk of subsequent death or lung transplantation, respectively. For Dlco, but not FVC, the increase in risk generally was greater for patients meeting a threshold based on a relative rather than an absolute decline.</p><p><strong>Interpretation: </strong>Even small declines in FVC and Dlco % predicted inform prognosis in patients with IPF.</p><p><strong>Clinical trial registry: </strong>ClinicalTrials.gov; No.: NCT01915511; URL: www.</p><p><strong>Clinicaltrials: </strong>gov.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":""},"PeriodicalIF":9.5,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143531341","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}