CHEST pulmonary最新文献

{"title":"Concordance of a Web-based Lung Cancer Risk Self-Assessment Tool With Nursing Risk Assessment","authors":"Ifeoma Iloghalu MD ,&nbsp;Kirk Graff PhD ,&nbsp;Matthew Warkentin PhD ,&nbsp;Huiming Yang MD ,&nbsp;Alain Tremblay MDCM","doi":"10.1016/j.chpulm.2025.100197","DOIUrl":"10.1016/j.chpulm.2025.100197","url":null,"abstract":"<div><h3>Background</h3><div>The Alberta Lung Cancer Screening Program implemented a web-based risk self-assessment tool using the Prostate, Lung, Colorectal, Ovarian Model 2012 (PLCOm2012) model. To determine the accuracy of individual self-risk assessments, this study compared user online entries with program nurse assessments.</div></div><div><h3>Research Question</h3><div>Is the web-based lung cancer risk self-assessment tool based on the PLCOm2012 model accurate in predicting lung cancer risk among Albertans aged 50 to 74 years when incorporated into an existing lung cancer screening program?</div></div><div><h3>Study Design and Methods</h3><div>This retrospective study used administrative data from the Alberta Lung Cancer Screening Program, which was designed to enroll 3,800 participants from September 2022 to September 2024. All self-referrals from the web tool with a risk score ≥ 1.5% were included up to July 2024. Concordance was assessed between web entries and matched nurse assessments and the impact of discordant lung cancer risks estimated.</div></div><div><h3>Result</h3><div>A total of 384 matched entries were analyzed. The mean age of the participants was 64 ± 6 years, and most were currently smoking (61%). The study revealed high (&gt; 95%) concordance between web entries and nurse assessments; concordance for education, smoking intensity, and smoking duration were slightly lower (90%-92%). Although a discrepancy in at least 1 value was common (32%), this resulted in an eligible participant being re-categorized as ineligible only in 3.7% of cases. Overall, 65% of participants had concordant PLCOm2012 risk scores (within 0.1%). The differences in PLCOm2012 risk between web and nurse entries ranged from – 3% to 2.5%.</div></div><div><h3>Interpretation</h3><div>This study described the feasibility of implementing a web-based lung cancer risk self-assessment tool based on the PLCOm2012 model and found a high concordance of discrete data points between the web entries and nurse entries. However, at least 1 value was discordant in one-third of the participants, and this occasionally affected risk scores. Confirmation of lung cancer risk by a health care provider remains important prior to screening.</div></div>","PeriodicalId":94286,"journal":{"name":"CHEST pulmonary","volume":"3 4","pages":"Article 100197"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145334327","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Comprehensive Approach to Lung Volume Reduction Encompassing Surgical and Endobronchial Treatment of Severe Emphysema","authors":"Wim Janssens MD, PhD ,&nbsp;S. Everaerts MD, PhD ,&nbsp;N. Filipow MD, PhD ,&nbsp;C. Vandervelde MD ,&nbsp;J. Coolen MD, PhD ,&nbsp;H. Geysen PhD ,&nbsp;A. Blondeel PhD ,&nbsp;I. Gyselinck MD, PhD ,&nbsp;D. Stylemans MD ,&nbsp;I. Niesten MD ,&nbsp;F. Janssens MD ,&nbsp;S. Bouneb MD ,&nbsp;A. Neyrinck MD, PhD ,&nbsp;G. Verleden MD, PhD ,&nbsp;D. Van Raemdonck MD, PhD ,&nbsp;C. Dooms MD, PhD ,&nbsp;L. Ceulemans MD, PhD","doi":"10.1016/j.chpulm.2025.100194","DOIUrl":"10.1016/j.chpulm.2025.100194","url":null,"abstract":"<div><h3>Background</h3><div>Randomized controlled trials with lung volume reduction surgery (LVRS) or endobronchial valves (EBVs) have shown clinically significant benefits for specific patients with emphysema.</div></div><div><h3>Research Question</h3><div>What is the impact of a comprehensive lung volume reduction (LVR) program, with both LVRS and EBVs as treatment options, on patient selection and short- and long-term outcomes in real life?</div></div><div><h3>Study Design and Methods</h3><div>This study summarizes the results of a prospective comprehensive LVR program in tertiary care, based on 5-year inclusions and follow-up over 1 to 3 years.</div></div><div><h3>Results</h3><div>A total of 429 cases were discussed at a multidisciplinary emphysema board; of these, 131 (30%) were referred for LVRS, 73 (17%) were referred for EBV, 25 (6%) were referred for lung transplantation, and 200 (47%) were referred for usual care. A total of 38 (52%) of the EBV interventions were followed by a second to fourth intervention, including LVRS in 25 (34%). For LVRS first, 72 (55%) and 37 (38%) of patients had a single 1-stage bilateral or unilateral LVRS procedure, and 22 (17%) had a staged procedure. Clinically significant improvements between baseline and follow-up visits were obtained on all outcome dimensions in all LVRS and EBV groups for most of the visits. Responder rates varied between 50% and 80% at 3 months to 1 year and slowly declined in the second year. Transplant-free survival over 2.5 years, adjusted for age and BODE Index at baseline, was significantly better for the EBV intervention (hazard ratio, 0.14; 95% CI, 0.04-0.44) and borderline significant for LVRS (hazard ratio, 0.7; 95% CI, 0.45-1.2) compared with the nonintervention group.</div></div><div><h3>Interpretation</h3><div>LVR programs should cover both surgical and bronchoscopic interventions to maximize eligibility and to improve outcome and prognosis of highly symptomatic patients with severe emphysema.</div></div>","PeriodicalId":94286,"journal":{"name":"CHEST pulmonary","volume":"3 4","pages":"Article 100194"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145797098","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Contribution of Interstitial Lung Disease to Mortality in Patients With Connective Tissue Diseases","authors":"Atefeh Vaezi MD ,&nbsp;Tracy Ashby DO ,&nbsp;Arvind Balavenkataraman MD ,&nbsp;Nadera Sweiss MD ,&nbsp;Mehdi Mirsaeidi MD","doi":"10.1016/j.chpulm.2025.100157","DOIUrl":"10.1016/j.chpulm.2025.100157","url":null,"abstract":"<div><h3>Background</h3><div>Interstitial lung diseases (ILDs) are common in patients with connective tissue diseases (CTDs), but their role in the mortality of patients with CTDs remains unexplored.</div></div><div><h3>Research Question</h3><div>What proportion of mortality in patients with CTDs is due to ILD?</div></div><div><h3>Study Design and Methods</h3><div>In this retrospective, population-based epidemiologic study, we used the Wide-Ranging Online Data for Epidemiologic Research database and extracted mortality data of all deceased US citizens aged ≥ 15 years, from 1999 to 2019. Age-adjusted mortality rate (AAMR) was calculated by sex, racial group, and state of death. The annual trend was examined using the annual percent change and average annual percent change. We identified the rank of ILD as an underlying cause of death compared with the 15 leading causes of death in patients with CTDs.</div></div><div><h3>Results</h3><div>From 1999 to 2019, CTDs were mentioned in the death certificates of 286,643 US citizens, with 26,406 (7.12%) of them having ILDs simultaneously. The ILD-CTD-related AAMR per 1 million population decreased from 4.26 in 1999 to 3.37 in 2015 and further increased to 4.03 in 2019. The ILD-CTD-related AAMRs during 1999 to 2019 for female individuals and male individuals were 4.53 and 2.80 per 1 million, respectively. In the list of 15 leading causes of mortality, ILD could be ranked as the seventh, 11th, third, fourth, and fourth cause of death in patients with rheumatoid arthritis, systemic lupus erythematosus, polymyositis/dermatomyositis, systemic sclerosis, and Sjögren syndrome, respectively.</div></div><div><h3>Interpretation</h3><div>Our findings underscore the necessity for developing screening protocols and targeted interventions aimed at reducing ILD-related mortality in patients with CTD. This could significantly improve outcomes and quality of life for these patients.</div></div>","PeriodicalId":94286,"journal":{"name":"CHEST pulmonary","volume":"3 4","pages":"Article 100157"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145797099","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cyclical Hemoptysis in a Patient With Right Lower Lobe Opacity","authors":"Shintaro Oyama MD ,&nbsp;Tomonori Makiguchi MD, PhD ,&nbsp;Yasuhito Nunomura MD ,&nbsp;Shunta Mukai MD ,&nbsp;Kengo Tani MD ,&nbsp;Takahiro Sasaki MD ,&nbsp;Daisuke Kimura MD, PhD ,&nbsp;Masamichi Itoga MD, PhD ,&nbsp;Hisashi Tanaka MD, PhD ,&nbsp;Kageaki Taima MD, PhD ,&nbsp;Sadatomo Tasaka MD, PhD, FCCP","doi":"10.1016/j.chpulm.2025.100215","DOIUrl":"10.1016/j.chpulm.2025.100215","url":null,"abstract":"<div><h3>Case Presentation</h3><div>A 33-year-old woman, who had a 6 pack-year smoking history, presented with cyclical hemoptysis for 4 months. Although she was treated for suspected pneumonia due to the opacity in posterior basal segment of the right lower lobe (Fig 1A), her symptom recurred concurrently with menstruation. She had a history of an induced abortion and a spontaneous abortion in her late 20s.</div></div>","PeriodicalId":94286,"journal":{"name":"CHEST pulmonary","volume":"3 4","pages":"Article 100215"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145624050","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Additional Accuracy Gained by Cone Beam CT in Shape-Sensing Robotic Bronchoscopy","authors":"Alberto E. Revelo MD ,&nbsp;Jing Peng PhD ,&nbsp;Jianing Ma PhD ,&nbsp;Michael Woods M.Ed. ,&nbsp;Christian Ghattas MD ,&nbsp;Jasleen Pannu MBBS ,&nbsp;Jeffrey C. Horowitz MD ,&nbsp;Nicholas Pastis MD","doi":"10.1016/j.chpulm.2025.100203","DOIUrl":"10.1016/j.chpulm.2025.100203","url":null,"abstract":"<div><h3>Background</h3><div>Cone beam CT (CBCT) scan provides an intraprocedural 3-dimensional image of the biopsy tool in relation to the lesion, which may enhance the accuracy of robotic-assisted bronchoscopy (RAB) through real-time bronchoscopy adjustments. Our goal is to evaluate the ability to accurately position, in real time, a biopsy needle in the center of a pulmonary nodule using shape-sensing RAB alone vs shape-sensing RAB + CBCT guidance.</div></div><div><h3>Research Question</h3><div>Does the addition of CBCT improve the accuracy of robotic bronchoscopy?</div></div><div><h3>Study Design and Methods</h3><div>A total of 102 nodules were biopsied using shape-sensing RAB and the position of the needle in relation to the center of the nodule identified using a ceiling-mounted CBCT scanner. Repositioning of the RAB after 1 or 2 CBCT adjustments was accomplished using information gathered from the 3-dimensional images and using an updated augmented fluoroscopy target. The primary end point was needle location and distance change of the needle tip in reference to the lesion center using RAB alone vs RAB + CBCT scan. Secondary end points were improvement in radial endobronchial ultrasound image and average number of CBCT spins required to land at the center of the target.</div></div><div><h3>Results</h3><div>Using RAB alone, the needle was placed in the center in 27 nodules (26.5%). The addition of CBCT scan to RAB greatly improved the distance of the needle toward the center of the lesion (mean ± SD, −4.08 ± 4.63 mm) in 46 nodules (61.3%) after 1 CBCT adjustment and (mean ± SD, −4.02 ± 4.21 mm) in an additional 17 nodules (58.6%) after a second CBCT adjustment (<em>P</em> &lt; .001). Radial endobronchial ultrasound image was also improved from eccentric to concentric.</div></div><div><h3>Interpretation</h3><div>The addition of CBCT scan to RAB was shown to improve the position of a biopsy tool in relation to the center of a pulmonary nodule. To our knowledge, this study is the first to quantify the accuracy achieved using both technologies, which may translate into reliability to perform diagnostic and potentially future therapeutic interventions in guided bronchoscopy.</div></div>","PeriodicalId":94286,"journal":{"name":"CHEST pulmonary","volume":"3 4","pages":"Article 100203"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145747476","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dose-Response Effect of Physical Prehabilitation on Major Cardiac and Cerebrovascular Events and Disability Levels After Cardiac Surgery in Frail Patients","authors":"Anna Lee PhD, MPH ,&nbsp;Derek K.W. Yau PhD, MScMed(PainMgt) ,&nbsp;Gavin M. Joynt MBBCh, FCICM ,&nbsp;Kwok M. Ho PhD, MPH","doi":"10.1016/j.chpulm.2025.100213","DOIUrl":"10.1016/j.chpulm.2025.100213","url":null,"abstract":"<div><h3>Background</h3><div>Prehabilitation enhances patients’ resilience to surgical stress and may improve postoperative outcomes. However, the dose response of prehabilitation on outcomes remains unknown.</div></div><div><h3>Research Question</h3><div>Does a twice-weekly supervised outpatient exercise program before elective cardiac surgery in patients with frailty have dose-response effects on 90-day postoperative major cardiac and cerebrovascular events (MACCEs) and disability levels?</div></div><div><h3>Study Design and Methods</h3><div>This was a post hoc analysis of the PREhabilitation for improving QUality of recovery after ELective cardiac surgery (PREQUEL) trial that compared physical prehabilitation (up to 19 sessions over 10 weeks) with usual care in participants with very mild to moderate frailty. Primary outcomes included the 90-day risk of MACCEs and changes in disability levels measured by the World Health Organization Disability Assessment Schedule 2.0 score. Secondary outcomes were preoperative changes in the 6-minute walk test distance, submaximal metabolic equivalents of tasks, and frailty measures. We used a generalized estimating equation model to examine the association between the dose of prehabilitation and the risk of MACCEs. Causal inference was assessed by dose-response function models while allowing nonlinearity.</div></div><div><h3>Results</h3><div>Of the 143 participants, 135 underwent cardiac surgery. No exercise-induced adverse events occurred in 64 participants during 551 sessions. The dose of prehabilitation was not associated with the risk of MACCEs (16 participants with 24 episodes; adjusted OR/session, 0.98; 95% CI, 0.88-1.09). However, improvements in disability levels, 6-minute walk test distance, and metabolic equivalents of tasks were directly related to the number of consecutive doses of prehabilitation before surgery. Improvements in clinical frailty after exercise training were observed in a few patients after 7 weeks of training.</div></div><div><h3>Interpretation</h3><div>In cardiac patients with frailty, a greater number of consecutive doses of physical prehabilitation had favorable effects on improving preoperative exercise capacity and lowering disability levels at 90 days after surgery.</div></div><div><h3>Clinical Trial Registration</h3><div>Chinese Clinical Trials Registry; No.: ChiCTR1800016098; URL: <span><span>https://www.chictr.org.cn/indexEN.html</span><svg><path></path></svg></span></div></div>","PeriodicalId":94286,"journal":{"name":"CHEST pulmonary","volume":"3 4","pages":"Article 100213"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145747471","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Combined Ultrasound-Guided Thoracentesis, Percutaneous Pleural Biopsy, and Indwelling Pleural Catheter Insertion as the First Intervention in Patients With High Likelihood of Malignant Pleural Effusion","authors":"Michael V. Brown MBBS, FRACP ,&nbsp;Jelena Solujic MBBS, FRACP ,&nbsp;Sarah Yeo MBBS, FRACP ,&nbsp;Julia Kim MN ,&nbsp;Phan Nguyen MBBS, F Thor Soc PhD FRACP ,&nbsp;Arash Badiei MBBS, PhD, FRACP","doi":"10.1016/j.chpulm.2025.100201","DOIUrl":"10.1016/j.chpulm.2025.100201","url":null,"abstract":"<div><h3>Background</h3><div>Malignant pleural effusion (MPE) indicates advanced disease and imposes a significant symptomatic burden to patients. Current guidelines recommend stepwise investigation and management.</div></div><div><h3>Research Question</h3><div>Is it feasible and safe to combine ultrasound (US)-guided pleural biopsy and indwelling pleural catheter (IPC) insertion as the initial diagnostic and therapeutic procedure for patients with high preprocedural probability of MPE?</div></div><div><h3>Study Design and Methods</h3><div>We retrospectively analyzed patients who underwent pleural procedures between March 1, 2021, and September 30, 2022. Sixteen patients with symptomatic unilateral pleural effusion and clinical or radiologic features suggestive of malignancy underwent combined US-guided pleural biopsy and IPC insertion as their first management step. Feasibility was determined by the number of patients requiring repeat diagnostic and therapeutic procedures, and time to diagnosis. Safety was determined by complication rates.</div></div><div><h3>Results</h3><div>Of 258 patients who received 384 pleural procedures, 16 patients (11 male; mean age ± SD, 77 ± 9.5 years) underwent the combined procedure. All patients had high preprocedural probability of MPE as evidenced by appropriate history, a unilateral pleural effusion (93.7%), and pleural nodularity or thickening on CT chest scan or US (87.5%). Mean time to diagnostic procedure was 9.3 days. Malignancy was confirmed in 100% of cases, with mesothelioma being the most common (50%). Pleural fluid cytology was diagnostic in 3 cases (18.8%), whereas 13 US-guided pleural biopsies (81.3%) were diagnostic. Nine patients (56.25%) had their IPC removed because of autopleurodesis or treatment response, with a mean removal time of 55.8 days. At 12 months, 5 patients (31.25%) had a documented complication, with pain and catheter blockage being the most common. One patient (6.25%) developed pleural infection. Over one-half (56.2%) received antineoplastic treatment with their IPC in situ. No patient required a repeat pleural procedure on follow-up.</div></div><div><h3>Interpretation</h3><div>A combined approach of closed, percutaneous US-guided pleural biopsy and IPC insertion as initial pleural intervention was shown to be feasible in patients with high preprocedural probability for MPE with no unexpected safety signals.</div></div>","PeriodicalId":94286,"journal":{"name":"CHEST pulmonary","volume":"3 4","pages":"Article 100201"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145624051","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sarcoidosis and Risk of Nephrolithiasis in US Black Women","authors":"Theresa R. McAllister MS ,&nbsp;Praveen Govender MD ,&nbsp;Jacqueline M. Hicks PhD ,&nbsp;Shaun E.L. Wason MD ,&nbsp;Yvette C. Cozier DSc, MPH","doi":"10.1016/j.chpulm.2025.100193","DOIUrl":"10.1016/j.chpulm.2025.100193","url":null,"abstract":"<div><h3>Background</h3><div>Sarcoidosis is a systemic inflammatory disorder linked to dysregulation of vitamin D metabolism. This state can contribute to abnormalities in calcium metabolism, theoretically increasing the risk of nephrolithiasis (kidney stones). Sarcoidosis and risk factors for nephrolithiasis (type 2 diabetes mellitus and hypertension) are common among US Black women.</div></div><div><h3>Research Question</h3><div>How does sarcoidosis affect the risk of nephrolithiasis in a cohort of US Black women? Does the association change by the number and type of cooccurring metabolic condition?</div></div><div><h3>Study Design and Methods</h3><div>We conducted a cross-sectional analysis using data from the Black Women’s Health Study (BWHS), a study of 59,000 US Black women 21 to 69 years of age in 1995 (baseline). Information on sarcoidosis and covariates was obtained from baseline and biennial follow-up questionnaires through 2005. The 2005 questionnaire ascertained diagnoses of nephrolithiasis. We estimated ORs and 95% CIs using logistic regression adjusting for covariates, including calcium and vitamin D supplementation, alcohol consumption, and metabolic conditions (obesity, type 2 diabetes mellitus, hypertension, and hyperlipidemia). We repeated analyses within strata of number of metabolic conditions.</div></div><div><h3>Results</h3><div>The analytical sample consisted of 43,718 women who completed the 2005 BWHS questionnaire. Between 1995 (baseline) and 2005, a total of 832 women reported sarcoidosis. As of 2005, of the women reporting sarcoidosis, 3.9% reported a history of nephrolithiasis, compared with 1.9% of the nonsarcoidosis participants. Among women with sarcoidosis, compared with those without, the odds of nephrolithiasis were 1.80 (95% CI, 1.25-2.59). The association according to number of metabolic conditions (none, 1-2, and 3-4) was additionally increased for women with 3 to 4 cooccurring conditions: 1.96 (95% CI, 1.09-3.52).</div></div><div><h3>Interpretation</h3><div>Our results indicate that US Black women with sarcoidosis have an increased risk of nephrolithiasis. The findings highlight the importance of monitoring for signs of vitamin D and calcium dysregulation in the management of sarcoidosis, especially among those with cooccurring metabolic conditions.</div></div>","PeriodicalId":94286,"journal":{"name":"CHEST pulmonary","volume":"3 4","pages":"Article 100193"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145693527","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Understanding Inpatient Sleep Studies for Sleep-Disordered Breathing","authors":"Tetyana Kendzerska MD, PhD ,&nbsp;Sachin R. Pendharkar MD, MSc ,&nbsp;Robert Talarico MSc ,&nbsp;Vanessa Luks MD ,&nbsp;George Chandy MD ,&nbsp;Sunita Mulpuru MD, MSc ,&nbsp;Kednapa Thavorn PhD ,&nbsp;Mark I. Boulos MD, MSc ,&nbsp;Michael S.B. Mak MD ,&nbsp;Marcus Povitz MDCM, MSc","doi":"10.1016/j.chpulm.2025.100182","DOIUrl":"10.1016/j.chpulm.2025.100182","url":null,"abstract":"<div><h3>Background</h3><div>The utility of inpatient vs outpatient polysomnography (PSG) for individuals with sleep-disordered breathing is unclear.</div></div><div><h3>Research Question</h3><div>How do patient characteristics and sleep medicine care patterns differ between individuals undergoing inpatient vs outpatient PSG?</div></div><div><h3>Study Design and Methods</h3><div>We conducted a retrospective population-based health administrative database study on all adult Ontarians (Canada) hospitalized and/or who underwent PSG between 2012 and 2018. We compared individuals who underwent PSG: (1) during hospitalization (inpatient PSG), (2) within the first month after discharge (delayed PSG), and (3) were not hospitalized in the last year (outpatient PSG). Outcomes included the following: baseline characteristics at the time of PSG, outpatient follow-up rates, and positive airway pressure claims in the year after PSG.</div></div><div><h3>Results</h3><div>We identified 748 individuals in the inpatient group, 9,310 in the delayed group, and 730,967 in the outpatient PSG group. Compared with delayed or outpatient PSG groups, in unadjusted analyses, individuals in the inpatient PSG group were more likely to be older, previously assessed for sleep-disordered breathing, reside in a low-income neighborhood, and have greater comorbidity burden (standardized differences &gt; 0.10). In adjusted analysis, individuals in the inpatient PSG group were less likely to be seen in the sleep clinic within the first year after PSG than the delayed or outpatient PSG group (hazard ratio [HR], 0.79; 95% CI, 0.71-0.87), with no difference between the delayed and outpatient PSG groups (HR, 1.00; 95% CI, 0.98-1.03). Compared with the delayed or outpatient PSG group, those in the inpatient PSG group were 21% (HR vs delayed group, 0.79; 95% CI, 0.67-0.94) to 53% (HR vs outpatient group, 0.47; 95% CI 0.27-0.82) less likely to initiate CPAP or auto-titrating positive airway pressure, and 2 to 10 times more likely to initiate bilevel positive airway pressure (HR vs outpatient group, 10.03; 95% CI, 7.30-13.77).</div></div><div><h3>Interpretation</h3><div>Our results indicate that individuals undergoing inpatient PSG represent a unique smaller subgroup with greater comorbidity and social disadvantage, whereas the delayed PSG group may represent an optimal model of care, informing directions for future prospective studies.</div></div>","PeriodicalId":94286,"journal":{"name":"CHEST pulmonary","volume":"3 4","pages":"Article 100182"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145747271","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incidence and Clinical Associations With Phenotypic Drift From Pulmonary Arterial Hypertension to Combined Precapillary and Postcapillary Pulmonary Hypertension","authors":"Kevin T. Schwalbach MD ,&nbsp;Jeffrey Annis PhD ,&nbsp;Jonah David Garry MD ,&nbsp;Hui Nian PhD ,&nbsp;Evan L. Brittain MD ,&nbsp;Anna R. Hemnes MD","doi":"10.1016/j.chpulm.2025.100206","DOIUrl":"10.1016/j.chpulm.2025.100206","url":null,"abstract":"<div><h3>Background</h3><div>Pulmonary hypertension (PH) diagnosis relies on hemodynamic measurements from right heart catheterization (RHC). Pulmonary arterial hypertension (PAH) (group 1) is differentiated from group 2 PH (due to left-sided heart disease) by pulmonary capillary wedge pressure (PCWP), with group 2 requiring PCWP &gt; 15 mm Hg. Contemporary PAH cohorts are older with more cardiovascular comorbidities compared with early descriptions, making it harder to distinguish between PAH and group 2 PH. It is unclear whether hemodynamic shifts between PH classifications occur over time or how these shifts impact outcomes.</div></div><div><h3>Research Question</h3><div>How frequently do patients with PAH develop combined precapillary and postcapillary PH (CpcPH), marked by elevated PCWP on follow-up RHC? What baseline characteristics are associated with this change, and does it affect outcomes?</div></div><div><h3>Study Design and Methods</h3><div>This retrospective cohort analysis at a single academic institution examined demographic, clinical, and RHC data from diagnostic and most recent RHCs. The primary outcome was the incidence of phenotypic drift from PAH to CpcPH. Secondary objectives included identifying clinical features associated with phenotypic drift and its impact on all-cause mortality and hospitalizations.</div></div><div><h3>Results</h3><div>Of 257 patients with PAH, 58 (22.6%; 95% CI, 17.6%-28.2%) experienced phenotypic drift, whereas 199 (77.4%; 95% CI, 72%-83%) retained PAH hemodynamics. Those with drift were more likely to be Black (29.3% vs 14.1%), have atrial fibrillation (12.1% vs 3.5%), have diabetes (22.4% vs 10.5%), and have higher BMI (30.2 vs 28.1 kg/m²). Baseline hemodynamics and echocardiographic features were similar between cohorts. There was no significant difference in survival or time to hospitalization between drift and nondrift groups.</div></div><div><h3>Interpretation</h3><div>Our results indicate that phenotypic drift from PAH to CpcPH is common and associated with features of metabolic syndrome and atrial fibrillation, but not predicted by baseline RHC or imaging features. Phenotypic drift was now shown to affect survival or hospitalization outcomes and should not routinely influence initial PAH treatment decisions.</div></div>","PeriodicalId":94286,"journal":{"name":"CHEST pulmonary","volume":"3 4","pages":"Article 100206"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145747482","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}