Pub Date : 2026-03-09DOI: 10.1016/j.chest.2026.02.010
Yogen Singh, Manuel Sanchez Luna, Belinda Chan, Almudena Alonso-Ojembarrena, Nadya Yousef, Mahmoud Montasser, Virginie Meau Petit, Iuri Corsini, Pradeep Suryawanshi, Alok Sharma, Anna Milan, Lukas Aichhorn, Simona Vladareanu, Francesco Raimondi, Daniele De Luca
To provide an expert consensus framework for standardizing lung ultrasound training for neonatologists.
为规范新生儿肺部超声培训提供专家共识框架。
{"title":"Expert Consensus Framework for Standardizing Lung Ultrasound Training for Neonatologists issued by ESPNIC Neonatal Critical Care Section and Point-of-care Ultrasound Working Group","authors":"Yogen Singh, Manuel Sanchez Luna, Belinda Chan, Almudena Alonso-Ojembarrena, Nadya Yousef, Mahmoud Montasser, Virginie Meau Petit, Iuri Corsini, Pradeep Suryawanshi, Alok Sharma, Anna Milan, Lukas Aichhorn, Simona Vladareanu, Francesco Raimondi, Daniele De Luca","doi":"10.1016/j.chest.2026.02.010","DOIUrl":"https://doi.org/10.1016/j.chest.2026.02.010","url":null,"abstract":"To provide an expert consensus framework for standardizing lung ultrasound training for neonatologists.","PeriodicalId":9782,"journal":{"name":"Chest","volume":"11 1","pages":""},"PeriodicalIF":9.6,"publicationDate":"2026-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147392589","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}
BACKGROUNDSome evidence suggests that obstructive sleep apnea (OSA) may attenuate myocardial injury and reduce infarct severity during acute coronary syndromes (ACS), potentially through stimulation of coronary collateral circulation (CCC). However, the relationship between OSA and collateral development, and their combined impact on ACS event severity, remains unclear.RESEARCH QUESTIONWhat is the relationship between OSA and coronary collateral development and what is their combined impact on ACS severity?STUDY DESIGN AND METHODSPost-hoc analysis of the ISAACC trial including first-time ACS patients with CCC assessment using the Cohen Rentrop Scale (CRS), where CRS ≥ 2 (CRS 2/3) indicated well-developed collaterals. OSA was diagnosed via respiratory polygraphy performed within 24-72 h of hospitalization. Associations between OSA and CRS 2/3 were evaluated using adjusted logistic regression. Peak creatine kinase (CK), peak cardiac troponin I (cTnI), and left ventricular ejection fraction (LVEF) were analyzed as ACS severity markers.RESULTSOf 185 participants included, 79.5% had OSA. Participants were mainly middle-aged, men, and presented a high comorbidity burden. OSA was associated with greater odds of well-developed collaterals with an adjusted OR (95% CI) of 2.84 (1.24 to 7.19; p = 0.019), with a dose-response increase across OSA severity categories. Among OSA patients, the presence of robust collaterals was associated with significantly lower peak CK and cTnI levels during the ACS episode, but not with improved LVEF.INTERPRETATIONIn first-time ACS patients, OSA was associated with a higher prevalence of well-developed coronary collaterals. Among patients with OSA, robust collateralization was associated with less myocardial injury during ACS, supporting the hypothesis that OSA may promote adaptive vascular remodeling, which warrants further mechanistic investigation.
{"title":"OSA is associated with enhanced coronary collateral circulation and reduced myocardial injury during acute coronary syndromes.","authors":"Krish Dodani,Albina Aldomà,Adriano Targa,Manuel Sánchez-de-la-Torre,Alicia Sánchez-de-la-Torre,Lucía Pinilla,Jorge Abad,Olga Mínguez,Lydia Pascual,Dolores Martínez,Rafaela Vaca,Ivan Juez-Garcia,Ferran Barbé,Ivan Benitez","doi":"10.1016/j.chest.2026.02.015","DOIUrl":"https://doi.org/10.1016/j.chest.2026.02.015","url":null,"abstract":"BACKGROUNDSome evidence suggests that obstructive sleep apnea (OSA) may attenuate myocardial injury and reduce infarct severity during acute coronary syndromes (ACS), potentially through stimulation of coronary collateral circulation (CCC). However, the relationship between OSA and collateral development, and their combined impact on ACS event severity, remains unclear.RESEARCH QUESTIONWhat is the relationship between OSA and coronary collateral development and what is their combined impact on ACS severity?STUDY DESIGN AND METHODSPost-hoc analysis of the ISAACC trial including first-time ACS patients with CCC assessment using the Cohen Rentrop Scale (CRS), where CRS ≥ 2 (CRS 2/3) indicated well-developed collaterals. OSA was diagnosed via respiratory polygraphy performed within 24-72 h of hospitalization. Associations between OSA and CRS 2/3 were evaluated using adjusted logistic regression. Peak creatine kinase (CK), peak cardiac troponin I (cTnI), and left ventricular ejection fraction (LVEF) were analyzed as ACS severity markers.RESULTSOf 185 participants included, 79.5% had OSA. Participants were mainly middle-aged, men, and presented a high comorbidity burden. OSA was associated with greater odds of well-developed collaterals with an adjusted OR (95% CI) of 2.84 (1.24 to 7.19; p = 0.019), with a dose-response increase across OSA severity categories. Among OSA patients, the presence of robust collaterals was associated with significantly lower peak CK and cTnI levels during the ACS episode, but not with improved LVEF.INTERPRETATIONIn first-time ACS patients, OSA was associated with a higher prevalence of well-developed coronary collaterals. Among patients with OSA, robust collateralization was associated with less myocardial injury during ACS, supporting the hypothesis that OSA may promote adaptive vascular remodeling, which warrants further mechanistic investigation.","PeriodicalId":9782,"journal":{"name":"Chest","volume":"188 1","pages":""},"PeriodicalIF":9.6,"publicationDate":"2026-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147381186","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}
Pub Date : 2026-03-07DOI: 10.1016/j.chest.2026.02.014
Matthew R Lammi,Sarah L Khan,Youlan Rao,Wei Zhao,Aparna Balasubramanian,Stephen C Mathai
BACKGROUNDN-terminal pro-brain natriuretic peptide (NT-proBNP) is a commonly used biomarker of right heart function in patients with pulmonary hypertension.RESEARCH QUESTIONWhat is the minimal important difference (MID) for NT-proBNP change in patients with pulmonary arterial hypertension (PAH) and pulmonary hypertension related to interstitial lung disease (PH-ILD), and is achievement of the MID associated with improved clinical outcomes?STUDY DESIGN AND METHODSData from two placebo-controlled trials were used to determine the MID for PAH (FREEDOM-EV: oral treprostinil) and PH-ILD (INCREASE: inhaled treprostinil). Distributional-based methods were used to calculate the MID for percent change from baseline in NT-proBNP in the FREEDOM-EV and INCREASE trials at 12 and 16 weeks, respectively. The associations between MID achievement and clinical outcomes were assessed by occurrence of a clinical worsening event in FREEDOM-EV or 6-minute walk distance (6MWD) improvement in INCREASE.RESULTSComplete data were available for 638 participants in FREEDOM-EV and 250 participants in INCREASE. The median MID for NT-proBNP change in the FREEDOM-EV and INCREASE trials was a 48% improvement. Participants with PAH who achieved the MID at 12 weeks were 52% less likely to have a clinical worsening event during long-term follow-up (HR, 0.48; 95% CI, 0.31-0.75, p=0.001). Participants with PH-ILD who achieved the MID at 16 weeks had a relative improvement in 6MWD of 40 meters (95% CI, 14-66 meters, p=0.003) compared with those who did not achieve the MID.INTERPRETATIONThe estimated MID for short-term NT-proBNP improvement in PAH and PH-ILD is remarkably similar at 48%. Achievement of the MID for NT-proBNP change is strongly associated with clinically important outcomes in both PAH and PH-ILD, demonstrating that measuring NT-proBNP change over 12-16 weeks can be informative for prognosis and may be useful for decisions regarding treatment escalation in individuals with PAH and PH-ILD.
{"title":"The Minimal Important Difference in N-Terminal Pro-Brain Natriuretic Peptide in Pulmonary Hypertension.","authors":"Matthew R Lammi,Sarah L Khan,Youlan Rao,Wei Zhao,Aparna Balasubramanian,Stephen C Mathai","doi":"10.1016/j.chest.2026.02.014","DOIUrl":"https://doi.org/10.1016/j.chest.2026.02.014","url":null,"abstract":"BACKGROUNDN-terminal pro-brain natriuretic peptide (NT-proBNP) is a commonly used biomarker of right heart function in patients with pulmonary hypertension.RESEARCH QUESTIONWhat is the minimal important difference (MID) for NT-proBNP change in patients with pulmonary arterial hypertension (PAH) and pulmonary hypertension related to interstitial lung disease (PH-ILD), and is achievement of the MID associated with improved clinical outcomes?STUDY DESIGN AND METHODSData from two placebo-controlled trials were used to determine the MID for PAH (FREEDOM-EV: oral treprostinil) and PH-ILD (INCREASE: inhaled treprostinil). Distributional-based methods were used to calculate the MID for percent change from baseline in NT-proBNP in the FREEDOM-EV and INCREASE trials at 12 and 16 weeks, respectively. The associations between MID achievement and clinical outcomes were assessed by occurrence of a clinical worsening event in FREEDOM-EV or 6-minute walk distance (6MWD) improvement in INCREASE.RESULTSComplete data were available for 638 participants in FREEDOM-EV and 250 participants in INCREASE. The median MID for NT-proBNP change in the FREEDOM-EV and INCREASE trials was a 48% improvement. Participants with PAH who achieved the MID at 12 weeks were 52% less likely to have a clinical worsening event during long-term follow-up (HR, 0.48; 95% CI, 0.31-0.75, p=0.001). Participants with PH-ILD who achieved the MID at 16 weeks had a relative improvement in 6MWD of 40 meters (95% CI, 14-66 meters, p=0.003) compared with those who did not achieve the MID.INTERPRETATIONThe estimated MID for short-term NT-proBNP improvement in PAH and PH-ILD is remarkably similar at 48%. Achievement of the MID for NT-proBNP change is strongly associated with clinically important outcomes in both PAH and PH-ILD, demonstrating that measuring NT-proBNP change over 12-16 weeks can be informative for prognosis and may be useful for decisions regarding treatment escalation in individuals with PAH and PH-ILD.","PeriodicalId":9782,"journal":{"name":"Chest","volume":"33 1","pages":""},"PeriodicalIF":9.6,"publicationDate":"2026-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147381182","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}
Pub Date : 2026-03-07DOI: 10.1016/j.chest.2026.02.013
Bei Li,Li He,Wei Wu,Min Ji,Wen Zhang,Lina Wang,Tanushree Kochar,Fang Yue,Aijun Zhang,Yijun Ge,Xiaoyan Jin,Yan Zhang,Hongying Ma,Qunli Ding,Fei Tang,Chao Cao
BACKGROUNDIatrogenic bleeding related to endobronchial biopsy could be catastrophic and might lead to fatal outcomes. Although some guidelines and studies recommended the prophylactic use of haemostatic agents, there was still insufficient evidence from clinical studies.RESEARCH QUESTIONIs prophylactic haemostatic treatment effective for controlling bleeding in patients undergoing endobronchial biopsy?STUDY DESIGN AND METHODSIn this multicentre randomised placebo-controlled trial, eligible participants scheduled to undergo endobronchial biopsy were randomly assigned (1:1:1) to the adrenaline group, the ice-cold saline group, or the saline (placebo) group. The primary efficacy outcomes were defined as the Bleeding Severity Scale and the Visual Analogue Scale in the termination of the biopsy.RESULTSA total of 462 participants were randomly assigned to the three groups and assessed for efficacy and safety outcomes. Overall, prophylactic haemostasis did not statistically improve the bleeding condition based on the Bleeding Severity Scale or the Visual Analogue Scale. However, in the subgroup of patients aged <65 years, the incidence of bleeding in the ice-cold saline group showed a decreasing trend compared to the placebo (RR 0.90 [95% CI 0.82-0.99], p=0.04). Besides, our findings demonstrated the safety of prophylactic haemostasis.INTERPRETATIONIn this study, we did not observe any improvement in biopsy-related iatrogenic bleeding with the prophylactic haemostasis. However, we observed a trend toward reduced bleeding with prophylactic haemostasis in the subgroup of patients aged <65 years, which merits further study.CLINICAL TRIAL REGISTRATIONThis study was registered in Chinese Clinical Trial Register (ChiCTR2400089591).
背景：与支气管内活检相关的先天性出血可能是灾难性的，并可能导致致命的结果。尽管一些指南和研究建议预防性使用止血剂，但临床研究的证据仍然不足。研究问题：预防性止血治疗对支气管活检患者止血有效吗？研究设计和方法在这项多中心随机安慰剂对照试验中，计划接受支气管内活检的符合条件的参与者被随机分配（1:1:1）到肾上腺素组、冰冷生理盐水组或生理盐水（安慰剂）组。主要疗效结果定义为出血严重程度量表和活检终止时的视觉模拟量表。结果共462名受试者被随机分为三组，并对疗效和安全性结果进行评估。总体而言，根据出血严重程度量表或视觉模拟量表，预防性止血并没有统计学上改善出血状况。然而，在<65岁患者亚组中，与安慰剂组相比，冰冷生理盐水组出血发生率呈下降趋势（RR 0.90 [95% CI 0.82-0.99], p=0.04）。此外，我们的研究结果证明了预防性止血的安全性。在这项研究中，我们没有观察到预防性止血对活检相关的医源性出血有任何改善。然而，我们观察到在年龄<65岁的患者亚组中，预防性止血有减少出血的趋势，这值得进一步研究。临床试验注册本研究已在中国临床试验注册中心注册（ChiCTR2400089591）。
{"title":"Prophylactic haemostatic treatment to control iatrogenic bleeding during endobronchial biopsy (PROTECT study): a multicentre, randomised, single-blind, placebo-controlled study.","authors":"Bei Li,Li He,Wei Wu,Min Ji,Wen Zhang,Lina Wang,Tanushree Kochar,Fang Yue,Aijun Zhang,Yijun Ge,Xiaoyan Jin,Yan Zhang,Hongying Ma,Qunli Ding,Fei Tang,Chao Cao","doi":"10.1016/j.chest.2026.02.013","DOIUrl":"https://doi.org/10.1016/j.chest.2026.02.013","url":null,"abstract":"BACKGROUNDIatrogenic bleeding related to endobronchial biopsy could be catastrophic and might lead to fatal outcomes. Although some guidelines and studies recommended the prophylactic use of haemostatic agents, there was still insufficient evidence from clinical studies.RESEARCH QUESTIONIs prophylactic haemostatic treatment effective for controlling bleeding in patients undergoing endobronchial biopsy?STUDY DESIGN AND METHODSIn this multicentre randomised placebo-controlled trial, eligible participants scheduled to undergo endobronchial biopsy were randomly assigned (1:1:1) to the adrenaline group, the ice-cold saline group, or the saline (placebo) group. The primary efficacy outcomes were defined as the Bleeding Severity Scale and the Visual Analogue Scale in the termination of the biopsy.RESULTSA total of 462 participants were randomly assigned to the three groups and assessed for efficacy and safety outcomes. Overall, prophylactic haemostasis did not statistically improve the bleeding condition based on the Bleeding Severity Scale or the Visual Analogue Scale. However, in the subgroup of patients aged <65 years, the incidence of bleeding in the ice-cold saline group showed a decreasing trend compared to the placebo (RR 0.90 [95% CI 0.82-0.99], p=0.04). Besides, our findings demonstrated the safety of prophylactic haemostasis.INTERPRETATIONIn this study, we did not observe any improvement in biopsy-related iatrogenic bleeding with the prophylactic haemostasis. However, we observed a trend toward reduced bleeding with prophylactic haemostasis in the subgroup of patients aged <65 years, which merits further study.CLINICAL TRIAL REGISTRATIONThis study was registered in Chinese Clinical Trial Register (ChiCTR2400089591).","PeriodicalId":9782,"journal":{"name":"Chest","volume":"76 1","pages":""},"PeriodicalIF":9.6,"publicationDate":"2026-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147381184","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}
Pub Date : 2026-03-07DOI: 10.1016/j.chest.2026.02.008
Omri A Arbiv,Gemma Postill,Yunjoo Im,Byung Woo Jhun,Petros Pechlivanoglou,Sarah K Brode,Ahmed M Bayoumi,Theodore K Marras
BACKGROUNDMycobacterium avium complex-pulmonary disease (MAC-PD) can lead to chronic lung disease, which can necessitate intensive antimicrobial therapy. In patients with mild MAC-PD, there is uncertainty in whether guideline-based antimicrobial treatment should be used as compared to watchful waiting.RESEARCH QUESTIONWhat are the long-term consequences of initiation of antimicrobial treatment compared to watchful waiting in patients with mild MAC-PD?STUDY DESIGN AND METHODSWe simulated a cohort of 70-year-old Canadian individuals with nodular bronchiectatic MAC-PD with a macrolide-susceptible specimen and normal lung function. We used a lifetime model to compare between guideline-based treatment or observation for patients with MAC-PD, accounting for common adverse events, culture conversion rates, and disease recurrences from prior literature. Our outcomes were quality-adjusted life years (QALYs) and life-years. The primary analysis was a probabilistic Monte Carlo simulation to estimate the mean and 95% uncertainty intervals (UI) for each outcome under treatment and observation, as well as the treatment to observation difference. Additional outcomes included deterministic analysis and one- and two-way deterministic sensitivity analyses.RESULTSIn our primary analysis, the cohort of individuals receiving antimicrobial treatment had mean 15.9 QALYs (95% UI 12.4-19.3) while those under observation had 13.4 QALYs (95% UI 9.0-16.4), with a treatment to observation difference of 2.5 QALYs (95% UI 0.8-4.7). Similarly, those receiving treatment had mean 18.3 life-years (95% UI 19.2-25.5) and those under observation had 15.8 life-years (95% UI 17.3-22.2). The treatment to observation difference was 2.5 years (95% UI 1.0-4.2). Increase in QALYs and life-years was consistent across almost all sensitivity analyses.INTERPRETATIONIn a simulated cohort of individuals with mild MAC-PD, we found that guideline-based treatment consistently yielded improved patient utility and life-expectancy. Our findings can support patients and physicians in deciding on treatment modality.
{"title":"Antimicrobial Treatment of Mild Mycobacterium avium Complex-Pulmonary Disease Predicted to Increase Survival and Quality Adjusted Life Years: A Microsimulation Decision Analysis Model.","authors":"Omri A Arbiv,Gemma Postill,Yunjoo Im,Byung Woo Jhun,Petros Pechlivanoglou,Sarah K Brode,Ahmed M Bayoumi,Theodore K Marras","doi":"10.1016/j.chest.2026.02.008","DOIUrl":"https://doi.org/10.1016/j.chest.2026.02.008","url":null,"abstract":"BACKGROUNDMycobacterium avium complex-pulmonary disease (MAC-PD) can lead to chronic lung disease, which can necessitate intensive antimicrobial therapy. In patients with mild MAC-PD, there is uncertainty in whether guideline-based antimicrobial treatment should be used as compared to watchful waiting.RESEARCH QUESTIONWhat are the long-term consequences of initiation of antimicrobial treatment compared to watchful waiting in patients with mild MAC-PD?STUDY DESIGN AND METHODSWe simulated a cohort of 70-year-old Canadian individuals with nodular bronchiectatic MAC-PD with a macrolide-susceptible specimen and normal lung function. We used a lifetime model to compare between guideline-based treatment or observation for patients with MAC-PD, accounting for common adverse events, culture conversion rates, and disease recurrences from prior literature. Our outcomes were quality-adjusted life years (QALYs) and life-years. The primary analysis was a probabilistic Monte Carlo simulation to estimate the mean and 95% uncertainty intervals (UI) for each outcome under treatment and observation, as well as the treatment to observation difference. Additional outcomes included deterministic analysis and one- and two-way deterministic sensitivity analyses.RESULTSIn our primary analysis, the cohort of individuals receiving antimicrobial treatment had mean 15.9 QALYs (95% UI 12.4-19.3) while those under observation had 13.4 QALYs (95% UI 9.0-16.4), with a treatment to observation difference of 2.5 QALYs (95% UI 0.8-4.7). Similarly, those receiving treatment had mean 18.3 life-years (95% UI 19.2-25.5) and those under observation had 15.8 life-years (95% UI 17.3-22.2). The treatment to observation difference was 2.5 years (95% UI 1.0-4.2). Increase in QALYs and life-years was consistent across almost all sensitivity analyses.INTERPRETATIONIn a simulated cohort of individuals with mild MAC-PD, we found that guideline-based treatment consistently yielded improved patient utility and life-expectancy. Our findings can support patients and physicians in deciding on treatment modality.","PeriodicalId":9782,"journal":{"name":"Chest","volume":"44 1","pages":""},"PeriodicalIF":9.6,"publicationDate":"2026-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147381187","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}
BACKGROUNDRespiratory viruses are a primary cause of pneumonia in both children and adults, particularly in cases of severe acute respiratory infection (SARI) requiring hospitalization. Although molecular diagnostic technologies have clearly enhanced detection capacity, the selection process of the sampling site substantially influences diagnostic accuracy.RESEARCH QUESTIONHow do diagnostic yield and concordance for respiratory viruses differ between paired upper and lower respiratory tract samples in patients with SARI?STUDY DESIGNAND METHODS: A multicenter, retrospective study was conducted across nine Italian hospitals. The analysis is based on molecular diagnostic data obtained from paired LRT and URT samples collected between 2014 and 2022 and analyzed using multiplex PCR assays for respiratory virus detection. Viral detection rates, concordance and discordance were compared across sample types and viruses, as were quantification cycle (Cq) values obtained by real-time PCR assay (as a proxy for viral load).RESULTSOf the 346 paired samples, 67.9% were concordant and 32.1% were discordant. A virus was detected in the LRT but not in the URT samples in 21.7% of cases. The most prevalent viruses detected were IAV, RV/EV, and RSV. Median Cq values were significantly lower in LRT samples (24.5 vs. 27.5 in URT; p < 0.001), indicating higher viral loads. In 67.3% of concordant sample pairs, viral loads were higher in the LRT sample, with over a third exceeding a 10-fold (1 Log10) difference.INTERPRETATIONSampling only the URT may miss significant viral infections in SARI patients. Sampling the LRT improves diagnostic sensitivity, particularly in later stages of infection, and should be considered in diagnostic protocols to enhance clinical decision-making.
背景：呼吸道病毒是儿童和成人肺炎的主要原因，特别是在需要住院治疗的严重急性呼吸道感染（SARI）病例中。虽然分子诊断技术明显提高了检测能力，但采样地点的选择过程实质上影响了诊断的准确性。研究问题：急性呼吸道感染患者配对的上呼吸道和下呼吸道样本对呼吸道病毒的诊断率和一致性有何不同？研究设计和方法：在意大利9家医院进行了一项多中心、回顾性研究。该分析基于从2014年至2022年收集的成对LRT和URT样本中获得的分子诊断数据，并使用多重PCR检测呼吸道病毒。比较了不同样品类型和病毒的病毒检出率、一致性和不一致性，以及实时PCR测定获得的定量周期（Cq）值（作为病毒载量的代表）。结果在346个配对样本中，67.9%的样本一致，32.1%的样本不一致。在21.7%的病例中，在上呼吸道样本中检测到病毒，但上呼吸道样本中未检测到病毒。检测到的最常见病毒为IAV、RV/EV和RSV。LRT样本的中位Cq值明显较低（24.5 vs. 27.5; p < 0.001），表明病毒载量较高。在67.3%的一致性样本对中，LRT样本中的病毒载量更高，超过三分之一的差异超过10倍（1 Log10）。解释：仅对上呼吸道进行采样可能会遗漏严重急性呼吸道感染患者的重大病毒感染。下呼吸道取样提高了诊断敏感性，特别是在感染后期，应在诊断方案中考虑，以加强临床决策。
{"title":"Clinical sampling challenges in diagnosing severe respiratory viral infections.","authors":"Antonio Piralla,Cristina Russo,Stefania Ranno,Carla Acciarri,Stefano Menzo,Sara Uceda Renteria,Annapaola Callegaro,Maria Vittoria Francescon,Elisa Vian,Elisa Masi,Elisabetta Pagani,Giulia Piccirilli,Tiziana Lazzarotto,Alessandra Pierangeli,Guido Antonelli,Federica Novazzi,Nicasio Mancini,Fausto Baldanti,Elena Pariani, ","doi":"10.1016/j.chest.2025.12.056","DOIUrl":"https://doi.org/10.1016/j.chest.2025.12.056","url":null,"abstract":"BACKGROUNDRespiratory viruses are a primary cause of pneumonia in both children and adults, particularly in cases of severe acute respiratory infection (SARI) requiring hospitalization. Although molecular diagnostic technologies have clearly enhanced detection capacity, the selection process of the sampling site substantially influences diagnostic accuracy.RESEARCH QUESTIONHow do diagnostic yield and concordance for respiratory viruses differ between paired upper and lower respiratory tract samples in patients with SARI?STUDY DESIGNAND METHODS: A multicenter, retrospective study was conducted across nine Italian hospitals. The analysis is based on molecular diagnostic data obtained from paired LRT and URT samples collected between 2014 and 2022 and analyzed using multiplex PCR assays for respiratory virus detection. Viral detection rates, concordance and discordance were compared across sample types and viruses, as were quantification cycle (Cq) values obtained by real-time PCR assay (as a proxy for viral load).RESULTSOf the 346 paired samples, 67.9% were concordant and 32.1% were discordant. A virus was detected in the LRT but not in the URT samples in 21.7% of cases. The most prevalent viruses detected were IAV, RV/EV, and RSV. Median Cq values were significantly lower in LRT samples (24.5 vs. 27.5 in URT; p < 0.001), indicating higher viral loads. In 67.3% of concordant sample pairs, viral loads were higher in the LRT sample, with over a third exceeding a 10-fold (1 Log10) difference.INTERPRETATIONSampling only the URT may miss significant viral infections in SARI patients. Sampling the LRT improves diagnostic sensitivity, particularly in later stages of infection, and should be considered in diagnostic protocols to enhance clinical decision-making.","PeriodicalId":9782,"journal":{"name":"Chest","volume":"58 1","pages":""},"PeriodicalIF":9.6,"publicationDate":"2026-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147374120","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}
Pub Date : 2026-03-06DOI: 10.1016/j.chest.2025.12.057
Winceslaus Katagira,Mark W Orme,Richard Kasiita,Jesse A Matheson,Matthew Richardson,Andy Barton,Jalia Nanyonga,Michael C Steiner,Bruce Kirenga,Sally J Singh
Background Post-tuberculosis lung disease (PTLD) causes significant disability in TB survivors. Pulmonary rehabilitation (PR) may offer effective disease management but lacks high-quality evidence in this underrepresented population.RESEARCH QUESTIONCompared to usual care, does a 6-week PR programme improve exercise capacity and health-related quality of life (HRQoL) cost-effectively in adults living with post-TB lung disease?STUDY DESIGN AND METHODSWe conducted a single-center randomised controlled trial with blinded outcome assessments, comparing PR vs usual care (UC) for adults with PTLD in Kampala, Uganda. Participants were randomised (1:1) to receive either PR or UC, with assessments at 6-weeks post-intervention. The primary outcome was change in exercise capacity measured by the Incremental Shuttle Walk Test (ISWT). Secondary outcomes included HRQoL, respiratory symptoms, psychological well-being and cost-benefit analysis. A generalized linear mixed model (GLMM) was used for the primary efficacy analysis (intention-to-treat) and a difference-in-differences analysis for secondary outcomes (modified intention-to-treat).RESULTSBetween November 2020 and September 2022, 178 adults with PTLD were assessed for eligibility and 114 randomised, Mean±SD age was 43.3±15.2 years and 65 (57%) were male. The post-intervention improvement in mean ISWT in the PR group was significantly greater than in UC by 54.36m (95%CI 17.22 to 91.51; p=0.004). We also observed significant improvements in HRQoL in PR greater than UC; (CAT score [-3.6 (95%CI -6.7 to -0.39); p=0.015] and CCQ total [-0.37 (95%CI -0.68 to -0.06); p=0.004]). The EQ-VAS and QALYs marginally improved in the PR vs UC (3.98 [95%CI -2.05 to 10.02]; p=0.191) and 0.02 [95%CI -0.02 to 0.05], p=0.334), respectively. The average cost of PR was US$6,468/QALY gained, equating to US$20,000/QALY gained after adjusting for purchasing power (below NICE's cost-effectiveness threshold).INTERPRETATIONIn adults with PTLD, a 6-week PR programme elicited clinically and statistically significant improvements in exercise capacity and HRQoL compared with UC and was cost-effective.
{"title":"Clinical and cost-effectiveness of pulmonary rehabilitation for people with post-tuberculosis lung disease in Uganda: a randomised controlled trial.","authors":"Winceslaus Katagira,Mark W Orme,Richard Kasiita,Jesse A Matheson,Matthew Richardson,Andy Barton,Jalia Nanyonga,Michael C Steiner,Bruce Kirenga,Sally J Singh","doi":"10.1016/j.chest.2025.12.057","DOIUrl":"https://doi.org/10.1016/j.chest.2025.12.057","url":null,"abstract":"Background Post-tuberculosis lung disease (PTLD) causes significant disability in TB survivors. Pulmonary rehabilitation (PR) may offer effective disease management but lacks high-quality evidence in this underrepresented population.RESEARCH QUESTIONCompared to usual care, does a 6-week PR programme improve exercise capacity and health-related quality of life (HRQoL) cost-effectively in adults living with post-TB lung disease?STUDY DESIGN AND METHODSWe conducted a single-center randomised controlled trial with blinded outcome assessments, comparing PR vs usual care (UC) for adults with PTLD in Kampala, Uganda. Participants were randomised (1:1) to receive either PR or UC, with assessments at 6-weeks post-intervention. The primary outcome was change in exercise capacity measured by the Incremental Shuttle Walk Test (ISWT). Secondary outcomes included HRQoL, respiratory symptoms, psychological well-being and cost-benefit analysis. A generalized linear mixed model (GLMM) was used for the primary efficacy analysis (intention-to-treat) and a difference-in-differences analysis for secondary outcomes (modified intention-to-treat).RESULTSBetween November 2020 and September 2022, 178 adults with PTLD were assessed for eligibility and 114 randomised, Mean±SD age was 43.3±15.2 years and 65 (57%) were male. The post-intervention improvement in mean ISWT in the PR group was significantly greater than in UC by 54.36m (95%CI 17.22 to 91.51; p=0.004). We also observed significant improvements in HRQoL in PR greater than UC; (CAT score [-3.6 (95%CI -6.7 to -0.39); p=0.015] and CCQ total [-0.37 (95%CI -0.68 to -0.06); p=0.004]). The EQ-VAS and QALYs marginally improved in the PR vs UC (3.98 [95%CI -2.05 to 10.02]; p=0.191) and 0.02 [95%CI -0.02 to 0.05], p=0.334), respectively. The average cost of PR was US$6,468/QALY gained, equating to US$20,000/QALY gained after adjusting for purchasing power (below NICE's cost-effectiveness threshold).INTERPRETATIONIn adults with PTLD, a 6-week PR programme elicited clinically and statistically significant improvements in exercise capacity and HRQoL compared with UC and was cost-effective.","PeriodicalId":9782,"journal":{"name":"Chest","volume":"56 1","pages":""},"PeriodicalIF":9.6,"publicationDate":"2026-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147374126","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}
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