Chest

BACKGROUND: Both the incidence of lung cancer and the prevalence of metabolic syndrome (MetS) have been increasing worldwide. The relationship between MetS and lung cancer remains controversial. RESEARCH QUESTION: Is the risk of lung cancer associated with MetS and its components? STUDY DESIGN AND METHODS: Multivariable Cox regression models were used to estimate the hazard ratio (HR) of MetS-related variables on lung cancer risk, both overall and by histological subtype, in UK Biobank...

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BACKGROUND: In immunocompromised patients with acute respiratory failure (ARF), the clinical significance of respiratory virus detection in the nasopharynx remains uncertain. RESEARCH QUESTION: Is viral detection in nasopharyngeal swabs associated with causes and outcomes of ARF in immunocompromised patients? STUDY DESIGN AND METHODS: Preplanned post hoc analysis of a randomized controlled trial enrolling immunocompromised patients admitted to 32 ICUs for ARF between May 2016, and December 2017...

No abstract text is available yet for this article.

BACKGROUND: The American Joint Committee on Cancer (AJCC) 8th Edition TNM staging manual for non-small-cell lung cancer (NSCLC) M1a descriptors include tumors presenting with malignant pleural or pericardial effusion ("M1a-Effusion"), pleural or pericardial nodule(s) ("M1a-Pleural"), or separate tumor nodule(s) in a contralateral lobe ("M1a-Contralateral"). RESEARCH QUESTION: Is M1a NSCLC presenting with malignant pleural or pericardial effusion associated with worse survival compared to other types of M1a NSCLC? METHODS: Patients with cT1-4, N0-3, M1a NSCLC (satisfying a single M1a descriptor of "M1a-Effusion", "M1a-Pleural", or "M1a-Contralateral"), according to AJCC 8th edition staging criteria, in the National Cancer Database from 2010-2015 were included...

BACKGROUND: Acute chest syndrome (ACS) is a life-threatening complication of sickle-cell disease (SCD). Although respiratory pathogens are frequently detected in children with ACS, their respective role in triggering the disease is still unclear. We hypothesized that ACS incidence followed the unprecedented population-level changes in respiratory pathogens dynamics following the COVID-19-related non-pharmaceutical interventions (NPIs). RESEARCH QUESTION: What is the respective role of respiratory pathogens in ACS epidemiology? STUDY DESIGN: AND METHODS...

BACKGROUND: Idiopathic subglottic stenosis (iSGS) is a recurrent, chronic disease defined by fibro-inflammatory narrowing of the subglottic airway. A key challenge in treatment is monitoring disease progression, which may be debilitating and unpredictable in timing. RESEARCH QUESTION: Can the SGS-6 Questionnaire be validated as a novel QOL instrument to proactively monitor breathing, disease progression and disease severity in patients with idiopathic subglottic stenosis? STUDY DESIGN AND METHODS: Panel data from 51 patients with iSGS were collected from January 2012 through June 2022, representing 1,684 patient encounters including routine office visits and treatment encounters...

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BACKGROUND: Clinical practice guidelines separately describe radiologic patterns of usual interstitial pneumonia (UIP) and fibrotic hypersensitivity pneumonitis (fHP), without direction on whether or how to apply these approaches concurrently within a single patient. RESEARCH QUESTION: How can we integrate guideline-defined radiologic patterns to diagnose interstitial lung disease (ILD) and what are the pitfalls associated with described patterns that require re-assessment in future guidelines? STUDY DESIGN AND METHODS: Patients from the Canadian Registry for Pulmonary Fibrosis underwent detailed re-evaluation in standardized multidisciplinary discussion...

BACKGROUND: Waterpipe tobacco smoking (WPS) is popular among young adults globally and exposes users to toxicants. RESEARCH QUESTION: Is WPS associated with impaired measures of arterial function and does WPS acutely impair these measures in young adults? STUDY DESIGN AND METHODS: We assessed heart rate (HR), brachial and aortic blood pressure (BP), HR-adjusted augmentation index (AI), and carotid-femoral pulse wave velocity (CFPWV) in 62 waterpipe smokers and 34 never-smokers recruited from the community (mean age 22...

No abstract text is available yet for this article.

No abstract text is available yet for this article.

BACKGROUND: The 2022 European pulmonary hypertension (PH) guidelines incorporate cardiac magnetic resonance (CMR) imaging metrics in the risk stratification of pulmonary arterial hypertension (PAH) patients. Thresholds to identify patients at estimated 1-year mortality risks of <5%, 5-20% and >20% are introduced. However, these cut-off values are mostly single center based and require external validation. RESEARCH QUESTIONS: What are the discriminative prognostic properties of the current cardiac magnetic resonance thresholds in risk stratifying pulmonary arterial hypertension patients? METHODS: We analyzed data from incident, treatment naïve PAH patients from the Amsterdam University Medical Centres, VUmc, the Netherlands...

BACKGROUND: Recently, the Rome proposal updated the definition of exacerbation of COPD (ECOPD). However, such severity grade has not yet demonstrated intermediate-term clinical relevance. RESEARCH QUESTION: What is the association between the Rome severity classification and short-term and intermediate-term clinical outcomes? STUDY DESIGN AND METHODS: We retrospectively grouped hospitalized patients with ECOPD according to the Rome severity classification (ie, mild, moderate, severe)...

No abstract text is available yet for this article.

BACKGROUND: Race-specific spirometry reference equations are used globally to interpret lung function for clinical, research, and social purposes, but inclusion of race is under scrutiny. RESEARCH QUESTION: Does including self-identified race in spirometric reference equation formation improve the ability of predicted FEV1 values to explain quantitative chest CT abnormalities, dyspnea or GOLD classification? STUDY DESIGN AND METHODS: Using data from healthy never-smoking adults in both the National Health and Nutrition Survey (NHANES, 2007-12) and COPD Genetic Epidemiology study (COPDGene) cohorts, we generated race-neutral, race-free and race-specific prediction equations for FEV1...

BACKGROUND: Chronic obstructive pulmonary disease (COPD) was found to associate with frailty. However, there is inadequate longitudinal evidence for associations of COPD with frailty progression. Furthermore, recent studies revealed a new phenotype of lung function impairment: preserved ratio impaired spirometry (PRISm). Associations of PRISm and its transitions with frailty progression are unclear. RESEARCH QUESTION: What are the associations of PRISm, transitions of PRISm, and COPD with frailty progression? STUDY DESIGN AND METHODS: To analyze the associations of PRISm and COPD with frailty progression, 5,901 subjects were included from the English Longitudinal Study of Ageing...

BACKGROUND: Moderate to vigorous physical activity (MVPA) in patients with COPD affects their overall health outcomes, including symptom relief and improved quality of life. However, the magnitude of the effect of MVPA initiation on real-world clinical outcomes has not been well investigated. RESEARCH QUESTION: How does MVPA initiation affect mortality and severe exacerbation rates in patients who have not engaged in MVPA prior to COPD diagnosis? STUDY DESIGN AND METHODS: This study included patients with COPD aged ≥ 40 years who were not performing MVPA prior to COPD diagnosis and had at least one health screening visit prior to and following their COPD diagnosis between January 1, 2010, and December 31, 2018...

BACKGROUND: With recent prioritization of equity in pediatric health outcomes, there has been a shift to examine neighborhood-level healthcare disparities within pediatric populations, specifically in the context of critical illness. RESEARCH QUESTION: Is there an association between individual indicators of neighborhood-level disadvantage and incidence of pediatric intensive care unit (PICU) admission? STUDY DESIGN: An ecological study, at the census tract-level, of pediatric patients admitted to a PICU in a large urban tertiary pediatric hospital...

TOPIC IMPORTANCE: This review will discuss the rationale for vasopressin utilization, summarize the results of clinical trials evaluating vasopressin, and focus on the timing of vasopressin initiation in order to provide clinicians guidance for optimal adjunctive vasopressin initiation in patients with septic shock. REVIEW FINDINGS: Patients with septic shock require vasoactive agents to restore adequate tissue perfusion. After norepinephrine, vasopressin is the suggested second-line adjunctive agent in patients with persistent inadequate mean arterial pressure...