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Actinomycosis mimicking metastatic lung malignancy Thorax (IF 10.0) Pub Date : 2024-05-13 Daniel Sims, Anthony Kerry, Kim Billingham
A 66-year-old Nepalese man with a medical history of hypertension presented with a 4-month history of an intermittently productive cough, worsening breathlessness, unintentional weight loss and a progressively enlarging lump on the right anterior chest wall that had become red and warm in the days prior to admission. On examination, he was cachectic, febrile and tachycardic, but the chest was clear
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Definition of diaphragmatic sleep disordered breathing and clinical meaning in Duchenne muscular dystrophy Thorax (IF 10.0) Pub Date : 2024-05-09 Federica Trucco, Matthew Davies, Alberto Andrea Zambon, Deborah Ridout, Francois Abel, Francesco Muntoni
Background Diaphragmatic sleep disordered breathing (dSDB) has been recently identified as sleep dysfunction secondary to diaphragmatic weakness in Duchenne muscular dystrophy (DMD). However, scoring criteria for the identification of dSDB are missing. This study aimed to define and validate dSDB scoring criteria and to evaluate whether dSDB severity correlates with respiratory progression in DMD.
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Impact of age at ivacaftor initiation on pulmonary outcomes among people with cystic fibrosis Thorax (IF 10.0) Pub Date : 2024-05-06 Christian A Merlo, Lisa J McGarry, Teja Thorat, Catherine Nguyen, Maral DerSarkissian, Aruna Muthukumar, Joe Healy, M Alan Brookhart, Jaime L Rubin
Background Ivacaftor (IVA) improves lung function and other extrapulmonary outcomes in people with cystic fibrosis (CF). However, the effect of initiating IVA at earlier versus later ages has not been studied. Methods We conducted an observational cohort study of people in the US CF Foundation Patient Registry aged ≥6 years with ≥1 CF transmembrane conductance regulator–gating mutation to compare the
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Epigenome-wide association study of lung cancer among never smokers in two prospective cohorts in Shanghai, China Thorax (IF 10.0) Pub Date : 2024-05-03 Mohammad L Rahman, Charles E Breeze, Xiao-Ou Shu, Jason Y Y Wong, Batel Blechter, Andres Cardenas, Xuting Wang, Bu-Tian Ji, Wei Hu, Qiuyin Cai, H Dean Hosgood, Gong Yang, Jianxin Shi, Jirong Long, Yu-Tang Gao, Douglas A Bell, Wei Zheng, Nathaniel Rothman, Qing Lan
Background The aetiology of lung cancer among individuals who never smoked remains elusive, despite 15% of lung cancer cases in men and 53% in women worldwide being unrelated to smoking. Epigenetic alterations, particularly DNA methylation (DNAm) changes, have emerged as potential drivers. Yet, few prospective epigenome-wide association studies (EWAS), primarily focusing on peripheral blood DNAm with
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Epigenetic clock as the new hand of time for lung cancer in never smokers Thorax (IF 10.0) Pub Date : 2024-05-03 David C Christiani
Estimates of lung cancer among persons who never smoked are 10%–20% in the USA, translating into 20–40 000 cases annually. Globally, and especially in East Asia, the incidence of lung cancer among non-tobacco users is considerably higher than in the USA, especially in women.1 The causes of lung cancer in lifelong never-smokers are not well understood. Possibilities include exposure to other carcinogens
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Lung function trajectories from school age to adulthood and their relationship with markers of cardiovascular disease risk Thorax (IF 10.0) Pub Date : 2024-05-02 Raquel Granell, Sadia Haider, Matea Deliu, Anhar Ullah, Osama Mahmoud, Sara Fontanella, Lesley Lowe, Angela Simpson, James William Dodd, Seyed Hasan Arshad, Clare S Murray, Graham Roberts, Alun Hughes, Chloe Park, John W Holloway, Adnan Custovic
Rationale Lung function in early adulthood is associated with subsequent adverse health outcomes. Objectives To ascertain whether stable and reproducible lung function trajectories can be derived in different populations and investigate their association with objective measures of cardiovascular structure and function. Methods Using latent profile modelling, we studied three population-based birth
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Incidence, prevalence and mortality of idiopathic pulmonary fibrosis in England from 2008 to 2018: a cohort study Thorax (IF 10.0) Pub Date : 2024-04-30 Rikisha Gupta, Ann Dorothy Morgan, Peter M George, Jennifer K Quint
Background Owing to discrepancies in methodologies and how idiopathic pulmonary fibrosis (IPF) is diagnosed it is challenging to establish a consistent understanding of the disease burden In the UK, over 10 years ago, the incidence and prevalence of IPF were reported as 2.8–8.7 per 100 000 person-years (from 2000 to 2012) and 39 per 100 000 persons (in 2012), respectively. Here, we estimated the incidence
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Epidemiology of idiopathic pulmonary fibrosis: opportunities and hurdles for population-level studies of rare disease Thorax (IF 10.0) Pub Date : 2024-04-30 Daniel-Costin Marinescu, Alyson W Wong
Idiopathic pulmonary fibrosis (IPF) is a rare condition for which reliable disease trends over time can be difficult to obtain. Understanding the epidemiology of IPF is crucial given its impact on quality of life and productivity of affected individuals and their families,1 as well as substantial costs to the healthcare system.2 The occurrence of IPF over time has likely changed with growing awareness
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Unilateral pleural effusion with pulmonary hypertension in sarcoidosis: do not forget the pulmonary veins! Thorax (IF 10.0) Pub Date : 2024-04-29 Elif Sumeyye Agaoglu, Tom Semple, Athol U Wells, Stephen Wort, Laura C Price
A 64-year-old woman presented with exertional dyspnoea and ankle oedema. She had lung biopsy-confirmed sarcoidosis 6 years previously, having initially responded to prednisolone, with clinical stability for several years. Pulmonary function tests (PFTs) showed forced expiratory volume in 1 s, 2 litres; forced vital capacity, 2.5 litres; and carbon monoxide transfer factor, 4.03 (49.2% predicted). Chest
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Rheumatoid arthritis and idiopathic pulmonary fibrosis: a bidirectional Mendelian randomisation study Thorax (IF 10.0) Pub Date : 2024-04-22 Olivia C Leavy, Leticia Kawano-Dourado, Iain D Stewart, Jennifer K Quint, Joshua J Solomon, Raphael Borie, Bruno Crestani, Louise V Wain, Gisli Jenkins, Philippe Dieudé, Cosetta Minelli
Background A usual interstitial pneumonia (UIP) pattern of lung injury is a key feature of idiopathic pulmonary fibrosis (IPF) and is also observed in up to 40% of individuals with rheumatoid arthritis (RA)-associated interstitial lung disease (RA-ILD). The RA-UIP phenotype could result from either a causal relationship of RA on UIP or vice versa, or from a simple co-occurrence of RA and IPF due to
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Environmental pollutants exposure-derived extracellular vesicles: crucial players in respiratory disorders Thorax (IF 10.0) Pub Date : 2024-04-17 Haoran Shen, Rui Zheng, Mulong Du, David C Christiani
Background Individual exposure to environmental pollutants, as one of the most influential drivers of respiratory disorders, has received considerable attention due to its preventability and controllability. Considering that the extracellular vesicle (EV) was an emerging intercellular communication medium, recent studies have highlighted the crucial role of environmental pollutants derived EVs (EPE-EVs)
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Mildly elevated pulmonary vascular resistance and worsened survival in PH-ILD: an opportunity for earlier diagnosis and intervention? Thorax (IF 10.0) Pub Date : 2024-05-01 Steven J Cassady, Bradley A Maron
Pulmonary hypertension (PH) is a feared complication of interstitial lung disease (ILD) owing to increased risk for hospitalisation and mortality among affected patients. The development of PH in ILD is attributed to several pathobiological mechanisms that often converge to remodel pulmonary arterioles including hypoxic pulmonary vasoconstriction, endothelial dysfunction, inflammation, increased oxidant
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Does ICS treatment increase the risk of pneumonia in asthma? Thorax (IF 10.0) Pub Date : 2024-05-01 Christer Janson
Patients with asthma have an increased risk of being hospitalised for pneumonia. For example, in a study based on the Respiratory Health In Northern Europe data set, Ekbom et al found that adults with asthma had a more than three times higher risk (HR (3.35 (95% CI 1.97 to 5.02)) of hospitalisation for pneumonia than non-asthmatics.1 Kankaanranta et al also found a high incidence of pneumonia in people
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Impacts of sex and gender on severe asthma Thorax (IF 10.0) Pub Date : 2024-05-01 Kimberley C W Wang, John D Blakey
For decades, the unwritten rule for asthma management was ‘Keep it Simple’, with clinicians largely trying to apply a one-size-fits-all stepwise approach to hundreds of millions of people across the globe. More recently, our broader understanding, increasing array of targeted therapies, and relatively stagnant outcomes have led to a greater acknowledgement of the complexity that needs to be addressed
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Unravelling the obesity–asthma connection in childhood and adolescence: does body shape matter? Thorax (IF 10.0) Pub Date : 2024-05-01 Ann D Morgan
Given the concurrent worldwide epidemics of childhood obesity and asthma, it is perhaps not surprising that the two have been inextricably linked in the minds of many. Indeed, there is good evidence to suggest that adiposity in childhood is associated with an increased risk of developing asthma.1 2 Several longitudinal studies conducted in population-based cohorts have demonstrated that childhood obesity
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Use of inhaled corticosteroids and the risk of hospitalisation for pneumonia in children with asthma: a nationwide cohort study Thorax (IF 10.0) Pub Date : 2024-05-01 Karl-Hermann Sielinou Kamgang, Samuel Arthur Rhedin, Catarina Almqvist, Viktor Wintzell
Background The potential association between the use of inhaled corticosteroids (ICS) and the risk of pneumonia among adults is disputed and paediatric-specific evidence is scarce. Aim To assess the potential association between ICS, use and the risk of hospitalisation for pneumonia among children (age 2–17 years) with asthma. Methods This was a cohort study based on nationwide data from routine clinical
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Impact of sex on severe asthma: a cross-sectional retrospective analysis of UK primary and specialist care Thorax (IF 10.0) Pub Date : 2024-05-01 Lola Loewenthal, John Busby, Ronald McDowell, Thomas Brown, Hassan Burhan, Rekha Chaudhuri, Paddy Dennison, James William Dodd, Simon Doe, Shoaib Faruqi, Robin Gore, Elfatih Idris, David Joshua Jackson, Mitesh Patel, Thomas Pantin, Ian Pavord, Paul E Pfeffer, David B Price, Hitasha Rupani, Salman Siddiqui, Liam G Heaney, Andrew Menzies-Gow
Introduction After puberty, females are more likely to develop asthma and in a more severe form than males. The associations between asthma and sex are complex with multiple intrinsic and external factors. Aim To evaluate the sex differences in the characteristics and treatment of patients with severe asthma (SA) in a real-world setting. Methods Demographic, clinical and treatment characteristics for
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Greenhouse gas emissions associated with suboptimal asthma care in the UK: the SABINA healthCARe-Based envirONmental cost of treatment (CARBON) study Thorax (IF 10.0) Pub Date : 2024-05-01 Alexander J K Wilkinson, Ekaterina Maslova, Christer Janson, Vasanth Radhakrishnan, Jennifer K Quint, Nigel Budgen, Trung N Tran, Yang Xu, Andrew Menzies-Gow, John P Bell
Background Poorly controlled asthma is associated with increased morbidity and healthcare resource utilisation (HCRU). Therefore, to quantify the environmental impact of asthma care, this retrospective, cohort, healthCARe-Based envirONmental cost of treatment (CARBON) study estimated greenhouse gas (GHG) emissions in the UK associated with the management of well-controlled versus poorly controlled
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Mild elevation of pulmonary vascular resistance predicts mortality regardless of mean pulmonary artery pressure in mild interstitial lung disease Thorax (IF 10.0) Pub Date : 2024-05-01 Tomonori Sato, Taiki Furukawa, Ryo Teramachi, Jun Fukihara, Yasuhiko Yamano, Toshiki Yokoyama, Toshiaki Matsuda, Kensuke Kataoka, Tomoki Kimura, Koji Sakamoto, Makoto Ishii, Yasuhiro Kondoh
Background Pulmonary hypertension (PH) is defined by elevated mean pulmonary arterial pressure (MPAP), and elevated pulmonary vascular resistance (PVR) reflects pulmonary vascular abnormalities. The clinical significance of non-severe PH in patients with various interstitial lung diseases (ILDs) has not been fully elucidated. We aimed to investigate the clinical significance of MPAP and PVR for mortality
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Prognostic factors for survival in unresectable stage III EGFR mutation-positive lung adenocarcinoma: impact of pre-CCRT PET-CT Thorax (IF 10.0) Pub Date : 2024-05-01 Wei-Chun Lin, Wan-Ming Chen, Ben-Chang Shia, Szu-Yuan Wu
Purpose To assess the survival impact of pre-concurrent chemoradiotherapy (CCRT) staging with positron emission tomography-CT (PET-CT) in patients with unresectable epidermal growth factor receptor (EGFR) mutation-positive adenocarcinoma. Methods Patients with unresectable stage IIIA–IIIC EGFR mutation-positive adenocarcinoma undergoing definitive CCRT were divided into two groups: those who received
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Do pulmonary rehabilitation programmes improve outcomes in patients with COPD posthospital discharge for exacerbation: a systematic review and meta-analysis Thorax (IF 10.0) Pub Date : 2024-05-01 Alex R Jenkins, Chris Burtin, Pat G Camp, Peter Lindenauer, Brian Carlin, Jennifer A Alison, Carolyn Rochester, Anne E Holland
Introduction Previous systematic reviews have provided heterogeneous and differing estimates for the efficacy of pulmonary rehabilitation following exacerbations of chronic obstructive pulmonary disease (COPD). The aim of this review was to examine the efficacy of pulmonary rehabilitation programmes initiated within 3 weeks of hospital discharge following an exacerbation of COPD. Methods An update
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Body composition and respiratory outcomes in children: a population-based prospective cohort study Thorax (IF 10.0) Pub Date : 2024-05-01 Tong Wu, Susana Santos, Hugo G Quezada‐Pinedo, Meike W. Vernooij, Vincent W.V. Jaddoe, Stefan Klein, Liesbeth Duijts, Edwin H.G. Oei
Background Body composition might influence lung function and asthma in children, but its longitudinal relations are unclear. We aimed to identify critical periods for body composition changes during childhood and adolescence in relation to respiratory outcomes in adolescents. Methods In a population-based prospective cohort study, we measured body mass index, fat mass index (FMI), lean mass index
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Impact of post-COVID-19 condition on health status and activities of daily living: the PRIME post-COVID study Thorax (IF 10.0) Pub Date : 2024-05-01 Maarten Van Herck, Demi M E Pagen, Céline J A van Bilsen, Stephanie Brinkhues, Kevin Konings, Casper D J den Heijer, Suhreta Mujakovic, Henriëtte L G ter Waarbeek, Chris Burtin, Daisy J A Janssen, Christian J P A Hoebe, Martijn A Spruit, Nicole H T M Dukers-Muijrers
Objective To assess health and activities of daily living (ADL) in SARS-CoV-2-positive adults with and without post-COVID-19 condition (PCC) and compare this with negative tested individuals. Furthermore, different PCC case definitions were compared with SARS-CoV-2-negative individuals. Methods All adults tested PCR positive for SARS-CoV-2 at the Public Health Service South Limburg (Netherlands) between
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Serum cytokine biosignatures for identification of tuberculosis among HIV-positive inpatients Thorax (IF 10.0) Pub Date : 2024-05-01 Huihua Zhang, LingHua Li, YanXia Liu, Wei Xiao, RuiYao Xu, MengRu Lu, WenBiao Hao, YuChi Gao, Xiaoping Tang, Youchao Dai
Background Serum cytokines correlate with tuberculosis (TB) progression and are predictors of TB recurrence in people living with HIV. We investigated whether serum cytokine biosignatures could diagnose TB among HIV-positive inpatients. Methods We recruited HIV-positive inpatients with symptoms of TB and measured serum levels of inflammation biomarkers including IL-2, IL-4, IL-6, IL-10, tumour necrosis
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Improved pulmonary function and exercise tolerance despite persistent pulmonary fibrosis over 1 year after severe COVID-19 infection Thorax (IF 10.0) Pub Date : 2024-05-01 Claire F McGroder, Mary M Salvatore, Belinda M D'Souza, Eric A Hoffman, Matthew R Baldwin, Christine Kim Garcia
We conducted a prospective single-centre cohort study of 104 multi-ethnic severe COVID-19 survivors from the first wave of the pandemic 15 months after hospitalisation. Of those who were assessed at 4 and 15 months, improvement of ground glass opacities correlated with worsened fibrotic reticulations. Despite a high prevalence of fibrotic patterns (64%), pulmonary function, grip strength, 6 min walk
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Development of respiratory care guidelines for Duchenne muscular dystrophy in the UK: key recommendations for clinical practice Thorax (IF 10.0) Pub Date : 2024-05-01 Anne-Marie Childs, Catherine Turner, Ronan Astin, Stephen Bianchi, John Bourke, Vicki Cunningham, Lisa Edel, Christopher Edwards, Phillippa Farrant, Jane Heraghty, Meredith James, Charlotte Massey, Ben Messer, Jassi Michel Sodhi, Patrick Brian Murphy, Marianela Schiava, Ajit Thomas, Federica Trucco, Michela Guglieri
Significant inconsistencies in respiratory care provision for Duchenne muscular dystrophy (DMD) are reported across different specialist neuromuscular centres in the UK. The absence of robust clinical evidence and expert consensus is a barrier to the implementation of care recommendations in public healthcare systems as is the need to increase awareness of key aspects of care for those living with
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Journal club Thorax (IF 10.0) Pub Date : 2024-05-01 Beenish Iqbal
Malignant pleural effusion (MPE) is a common problem in advanced malignancies and causes debilitating breathlessness leading to poor quality of life. There are two treatment options available to ‘definitively’ manage MPE which include chest drain with talc pleurodesis and indwelling pleural catheters (IPCs). Although both treatments have been in use for a long time, there has been limited research
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Correction: RAGE-induced ILC2 expansion in acute lung injury due to haemorrhagic shock Thorax (IF 10.0) Pub Date : 2024-05-01 BMJ Publishing Group Ltd and British Thoracic Society
Zhang K, Jin Y, Lai D, et al . RAGE-induced ILC2 expansion in acute lung injury due to haemorrhagic shock. Thorax 2020;75:209–19. In the original version of this article, some H&E images in …
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Toxic metals and lung health: silent poisons? Thorax (IF 10.0) Pub Date : 2024-04-10 Seif O Shaheen
Lady Astor: ‘Sir, if you were my husband , I would put arsenic in your tea!’ Churchill: ‘If I were your husband , I would drink it!’ This apocryphal joke is a reminder that arsenic is a potentially fatal poison. The phrase ‘mad as a hatter’ stems from the historical use of mercury by hatmakers, which could have neurotoxic consequences. Ironically, both these metals were also used therapeutically in
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New path for understanding mucociliary clearance Thorax (IF 10.0) Pub Date : 2024-04-10 Timothy E Corcoran
The mucociliary clearance (MC) system is a vital host defence in the lungs and upper airways. Airway mucus traps inhaled bacteria, viruses, fungi and toxins. Underneath the mucus, airway cilia beat synchronously within a thin, watery periciliary liquid layer, propelling the overlying mucus layer towards the mouth. MC is dependent on ciliary structure and function and the composition and hydration of
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Pulmonary artery-pulmonary artery collaterals in chronic thromboembolic pulmonary hypertension Thorax (IF 10.0) Pub Date : 2024-04-10 Sugang Gong, Huiting Li, Lan Wang
A 66-year-old woman was diagnosed with chronic thromboembolic pulmonary hypertension (CTEPH), with selective angiography revealing direct collaterals between the A9 and A10 pulmonary artery branches (figure 1A, figure 2 and figure 3A; online supplemental Video 1 and online supplemental Video 2). Balloon pulmonary angioplasty (BPA) of A9 revealed pronounced stenosis and lumen irregularities. Peripheral
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Heteroresistance in tuberculosis: are we missing drug-resistant bacteria hiding in plain sight? Thorax (IF 10.0) Pub Date : 2024-04-10 Mirae Park, Giovanni Satta, Pranabashis Haldar
Tuberculosis (TB) caused by Mycobacterium tuberculosis (MTB) remains the dominant cause of death from a bacterial infectious disease.1 Sustained global efforts to meet the ambitious elimination targets of WHO’s END-TB strategy have had a limited impact so far. This reflects the complex and multifaceted challenge posed, with multidrug resistant (MDR)-TB representing a significant and growing problem
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Extensive airway remodelling in severe COPD imparts resiliency to environmental stressors Thorax (IF 10.0) Pub Date : 2024-04-04 Moumita Ghosh, Eszter K Vladar
Chronic obstructive pulmonary disease (COPD) is a highly prevalent chronic lung disease that is expected to become the third most common cause of death globally by 2030.1 It is characterised by extensive, detrimental structural and functional changes termed ‘remodelling’ in the airway epithelium in response to noxious inhaled contaminants. Cigarette smoke is traditionally considered the chief culprit
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MAC attack: MSCs and macrophages join forces against chronic lung infection Thorax (IF 10.0) Pub Date : 2024-04-04 Hazel Dunbar, Ian James Hawthorne, Karen English
Mesenchymal stromal cells (MSCs) possess several characteristics that make them attractive as a potential adjunct therapy for acute and chronic infectious diseases. MSCs are well known for their impressive immunomodulatory,1 2 pro-repair effects1 3 and clinical safety profile,4 5 however, the efficacy of MSCs in controlling bacterial infections, at least directly, remains unclear.6 Mycobacterium avium
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Unravelling the neutrophil enigma: a new insight into RSV-induced bronchiolitis in infants Thorax (IF 10.0) Pub Date : 2024-04-04 Frances Susanna Grudzinska, Aaron Scott
In this issue of Thorax , Robinson et al describe a novel in vitro model of respiratory syncytial virus (RSV) infection to assess neonatal and adult neutrophil responses.1 The focus was on observing neutrophil migration across RSV-infected differentiated human nasal airway epithelial cells (AECs) in a basolateral to apical direction—mimicking the progression to the airway lumen. RSV is a leading cause
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Ablation for lung cancer: hot or cold intervention Thorax (IF 10.0) Pub Date : 2024-04-04 Pallav L Shah
Over the past two decades, there has been a notable shift in the natural history and epidemiology of lung cancer. Previously there was a greater preponderance of central lung tumours with a squamous cell pathology, over time there appears to be a shift towards more peripheral lung tumours which more commonly have an adenocarcinoma cell type. The rate of squamous cell lung cancer in men in 2000 was
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To progress or not to progress: new insights into the evolution of pleuropulmonary blastomas come from studying lung cysts in adolescents and adults with DICER1-related tumour predisposition Thorax (IF 10.0) Pub Date : 2024-03-28 Eric Santoni-Rugiu
Almost all cases of pleuropulmonary blastoma (PPB), the most common lung malignancy in childhood, are related to biallelic pathogenic variants in DICER1, a gene encoding an RNase III involved in the biogenesis of micro-RNAs, organogenesis and tumor suppression.1 2 Over 70% of patients with PPB are affected by the pleiotropic DICER1 -related tumour susceptibility syndrome caused by heterozygous germline
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Clinical implications of airway obstruction with normal or low FEV1 in childhood and adolescence Thorax (IF 10.0) Pub Date : 2024-03-21 Hans Jacob Lohne Koefoed, Gang Wang, Ulrike Gehring, Sandra Ekstrom, Inger Kull, Roel Vermeulen, Jolanda M A Boer, Anna Bergstrom, Gerard H Koppelman, Erik Melén, Judith M Vonk, Jenny Hallberg
Background Airway obstruction is defined by spirometry as a low forced expiratory volume in 1 s (FEV1) to forced vital capacity (FVC) ratio. This impaired ratio may originate from a low FEV1 (classic) or a normal FEV1 in combination with a large FVC (dysanaptic). The clinical implications of dysanaptic obstruction during childhood and adolescence in the general population remain unclear. Aims To investigate
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Prevalence of lung cysts in adolescents and adults with a germline DICER1 pathogenic/likely pathogenic variant: a report from the National Institutes of Health and International Pleuropulmonary Blastoma/DICER1 Registry Thorax (IF 10.0) Pub Date : 2024-03-20 Alexander T Nelson, Lauren M Vasta, Dave Watson, Jung Kim, Anne K Harris, Ana F Best, Laura A Harney, Ann G Carr, Nicole Frederickson, Louis P Dehner, Christian P Kratz, Kelly N Hagedorn, William A Mize, Alexander Ling, Yoav H Messinger, D Ashley Hill, Kris Ann P Schultz, Douglas R Stewart
Background Pleuropulmonary blastoma (PPB), the hallmark tumour associated with DICER1 -related tumour predisposition, is characterised by an age-related progression from a cystic lesion (type I) to a high-grade sarcoma with mixed cystic and solid features (type II) or purely solid lesion (type III). Not all cystic PPBs progress; type Ir (regressed), hypothesised to represent regressed or non-progressed
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Human mesenchymal stromal cells inhibit Mycobacterium avium replication in clinically relevant models of lung infection Thorax (IF 10.0) Pub Date : 2024-03-20 Timothy D Shaw, Anna D Krasnodembskaya, Gunnar N Schroeder, Declan F Doherty, Johnatas Dutra Silva, Shikha M Tandel, Yue Su, David Butler, Rebecca J Ingram, Cecilia M O'Kane
Introduction Novel therapeutic strategies are urgently needed for Mycobacterium avium complex pulmonary disease (MAC-PD). Human mesenchymal stromal cells (MSCs) can directly inhibit MAC growth, but their effect on intracellular bacilli is unknown. We investigated the ability of human MSCs to reduce bacterial replication and inflammation in MAC-infected macrophages and in a murine model of MAC-PD. Methods
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Testosterone and lung function: bigger lungs, slower decline or some combination of both? Thorax (IF 10.0) Pub Date : 2024-03-20 Stephen Milne
In healthy adults, 70%–80% of our vital capacity can be exhaled in a single second when measured by spirometry. This is made possible by the combination of a highly elastic lung, a low-resistance airway tree and recruitable respiratory muscles. Reduced spirometric values do not necessarily indicate disease, however, since forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC) and the ratio
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Distinct trajectories of lung function from childhood to mid-adulthood Thorax (IF 10.0) Pub Date : 2024-03-18 Xian Zhang, Andrew R Gray, Robert J Hancox
Rationale Life course trajectories of lung function development and decline influence the risk for lung disease but are poorly documented. Objective To document lung function trajectories from childhood to mid-adult life. Methods We modelled forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC) and FEV1/FVC at ages 9, 11, 13, 15, 18, 21, 26, 32, 38 and 45 years from a population-based
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Role of blood flow restriction strength training in chronic obstructive pulmonary disease Thorax (IF 10.0) Pub Date : 2024-04-01 Ioannis Vogiatzis
Blood flow restriction (BFR) training is a method partially restricting arterial inflow and fully restricting venous outflow in working musculature during exercise.1 The method uses a pneumatic tourniquet system and involves applying an external pressure, typically using a tourniquet cuff, to the most proximal region of the upper and/or lower limbs. When the cuff is inflated, there is gradual mechanical
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Type-2 inflammation: a key treatable trait associated with lung function decline in chronic airways disease Thorax (IF 10.0) Pub Date : 2024-04-01 Nayia Petousi, Ian D Pavord, Brian Daniel Kent
The chronic airways diseases, asthma and Chronic Obstructive Pulmonary Disease (COPD), are highly prevalent conditions causing significant morbidity and mortality worldwide. Both are acknowledged to be heterogeneous with respect to clinical presentation, prognosis and driving mechanisms.1 Type-2 airway inflammation is arguably the most important and treatable underlying mechanism to identify,1 as it
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Decoding pulmonary nodules: can machine learning enhance malignancy risk stratification? Thorax (IF 10.0) Pub Date : 2024-04-01 Colin Jacobs
Randomised controlled trials, with the National Lung Screening Trial and Dutch-Belgian NELSON trial being the two largest, have demonstrated that lung cancer screening of high-risk individuals using low-dose CT reduces lung cancer mortality compared with no screening or screening with chest X-ray. Fuelled by the positive results of these landmark trials, low-dose CT-based lung cancer screening of high-risk
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Use of inhaled treprostinil in patients with interstitial lung disease and pulmonary hypertension: to boldly go where no other pulmonary vasodilator has gone before? Thorax (IF 10.0) Pub Date : 2024-04-01 Lucilla Piccari, Stephen John Wort
Pulmonary hypertension (PH) is a feared complication in patients with any chronic lung disease,1 but those with lung fibrosis have an especially poor mortality and the morbidity burden is very high.2 3 Up to very recently, there has been an almost nihilistic attitude towards these patients, since the lack of treatment options restricted the indication of a definitive diagnosis through right heart catheterisation
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Blood eosinophils take centre stage in predicting the response to sublingual immunotherapy (SLIT): a familiar twist Thorax (IF 10.0) Pub Date : 2024-04-01 Carlos Andrés Celis-Preciado, Philippe Lachapelle, Simon Couillard
Sublingual immunotherapy (SLIT) represents a safer, more comfortable and more convenient allergen immunotherapy than its subcutaneous counterpart. There is an increasing body of evidence showing that SLIT for house dust mites (HDM), grass, ragweed and/or tree pollen improves allergic symptoms and asthma control.1 It is unclear whether SLIT consistently reduces the occurrence of asthma attacks.1–3 Published
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Post-pandemic tuberculosis incidence: potential success of active case finding? Thorax (IF 10.0) Pub Date : 2024-04-01 Catherine M Stein
Until 2020, tuberculosis (TB) was annually the number one infectious killer disease globally. When the COVID-19 pandemic started in 2020, TB took the number two seat in this said ranking, but a very close second.1 TB epidemiologists around the world became very concerned about what might happen with global TB burden in the wake of the pandemic, fearing that lockdowns of health systems and stay-at-home
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Survival analysis from the INCREASE study in PH-ILD: evaluating the impact of treatment crossover on overall mortality Thorax (IF 10.0) Pub Date : 2024-04-01 Steven D Nathan, Shilpa Johri, Joanna M Joly, Christopher S King, Amresh Raina, Colleen A McEvoy, Dasom Lee, Eric Shen, Peter Smith, Chunqin Deng, Aaron B Waxman
Objective A post-hoc analysis of the INCREASE trial and its open-label extension (OLE) was performed to evaluate whether inhaled treprostinil has a long-term survival benefit in patients with pulmonary hypertension associated with interstitial lung disease (PH-ILD). Methods Two different models of survival were employed; the inverse probability of censoring weighting (IPCW) and the rank-preserving
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Radiomics analysis to predict pulmonary nodule malignancy using machine learning approaches Thorax (IF 10.0) Pub Date : 2024-04-01 Matthew T Warkentin, Hamad Al-Sawaihey, Stephen Lam, Geoffrey Liu, Brenda Diergaarde, Jian-Min Yuan, David O Wilson, Sukhinder Atkar-Khattra, Benjamin Grant, Yonathan Brhane, Elham Khodayari-Moez, Kiera R Murison, Martin C Tammemagi, Kieran R Campbell, Rayjean J Hung
Background Low-dose CT screening can reduce lung cancer-related mortality. However, most screen-detected pulmonary abnormalities do not develop into cancer and it often remains challenging to identify malignant nodules, particularly among indeterminate nodules. We aimed to develop and assess prediction models based on radiological features to discriminate between benign and malignant pulmonary lesions
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Protective effect of height on long-term survival of resectable lung cancer: a new feature of the lung cancer paradox Thorax (IF 10.0) Pub Date : 2024-04-01 Elisa Daffré, Raphaël Porcher, Antonio Iannelli, Mathilde Prieto, Laurent Brouchet, Pierre Emmanuel Falcoz, Françoise Le Pimpec Barthes, Pierre Benoit Pages, Pascal Alexandre Thomas, Marcel Dahan, Marco Alifano
Introduction Unlike most malignancies, higher body mass index (BMI) is associated with a reduced risk of lung cancer and improved prognosis after surgery. However, it remains controversial whether height, one of determinants of BMI, is associated with survival independently of BMI and other confounders. Methods We extracted data on all consecutive patients with resectable non-small cell lung cancer
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Decline in prevalence of tuberculosis following an intensive case finding campaign and the COVID-19 pandemic in an urban Ugandan community Thorax (IF 10.0) Pub Date : 2024-04-01 Emily A Kendall, Peter J Kitonsa, Annet Nalutaaya, Katherine O Robsky, Kamoga Caleb Erisa, James Mukiibi, Adithya Cattamanchi, Midori Kato-Maeda, Achilles Katamba, David Dowdy
Background Systematic screening is a potential tool for reducing the prevalence of tuberculosis (TB) and counteracting COVID-19-related disruptions in care. Repeated community-wide screening can also measure changes in the prevalence of TB over time. Methods We conducted serial, cross-sectional TB case finding campaigns in one community in Kampala, Uganda, in 2019 and 2021. Both campaigns sought sputum
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Genetic and T2 biomarkers linked to the efficacy of HDM sublingual immunotherapy in asthma Thorax (IF 10.0) Pub Date : 2024-04-01 Ilka Hoof, Klaus Bønnelykke, Thomas Stranzl, Stephanie Brand, Xingnan Li, Mohamed H Shamji, Deborah A Meyers, Eric D Bateman, Eugene Bleecker, Peter Sejer Andersen
Background Hypersensitivity to house dust mite (HDM) allergens is a common cause of allergic asthma symptoms and can be effectively treated with allergy immunotherapy (AIT). Objective To investigate whether genetic and type 2 (T2) inflammatory biomarkers correlate with disease severity in subjects with allergic asthma, and whether this can be modified by AIT. Methods MITRA ([NCT01433523][1]) was a
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Low-load blood flow restriction strength training in patients with COPD: a randomised single-blind pilot study Thorax (IF 10.0) Pub Date : 2024-04-01 Dario Kohlbrenner, Manuel Kuhn, Anastasios Manettas, Céline Aregger, Matthias Peterer, Nicola Greco, Noriane A Sievi, Christian Clarenbach
Objective The objective of this study is to compare the effectiveness of lower limb low-load blood flow restriction training (LL-BFRT) with high-load strength training (HL-ST) as part of an outpatient pulmonary rehabilitation programme on leg strength in patients with chronic obstructive pulmonary disease (COPD). Methods Participants were randomised to LL-BFRT or HL-ST (24 sessions). LL-BFRT was done
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Type-2 inflammation and lung function decline in chronic airway disease in the general population Thorax (IF 10.0) Pub Date : 2024-04-01 Yunus Çolak, Shoaib Afzal, Jacob Louis Marott, Jørgen Vestbo, Børge Grønne Nordestgaard, Peter Lange
Background It is unclear if type-2 inflammation is associated with accelerated lung function decline in individuals with asthma and chronic obstructive pulmonary disease (COPD). We tested the hypothesis that type-2 inflammation indicated by elevated blood eosinophils (BE) and fraction of exhaled nitric oxide (FeNO) is associated with accelerated lung function decline in the general population. Methods
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Airway smooth muscle and long-term clinical efficacy following bronchial thermoplasty in severe asthma Thorax (IF 10.0) Pub Date : 2024-04-01 Pieta C Wijsman, Annika W M Goorsenberg, Julia N S d’Hooghe, Nick H T ten Hacken, Joris J T H Roelofs, Thais Mauad, Els J M Weersink, Pallav Shah, Jouke T Annema, Peter I Bonta
The mechanism of action of bronchial thermoplasty (BT) treatment for patients with severe asthma is incompletely understood. This study investigated the 2.5-year impact of BT on airway smooth muscle (ASM) mass and clinical parameters by paired data analysis in 22 patients. Our findings demonstrate the persistence of ASM mass reduction of >50% after 2.5 years. Furthermore, sustained improvement in asthma
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Remote vision-based digital patient monitoring of pulse and respiratory rates in acute medical wards Thorax (IF 10.0) Pub Date : 2024-04-01 Adam Lewis, Bindia Venugopal, Varsha Gandhi, Oliver Gibson, Laura Swanton, Malcolm Green, Jordan Bowen, Michael I Polkey
Remote Vision-Based digital Patient Monitoring (VBPM) of pulse (PR) and respiratory rate (RR) was set up in six single rooms in an acute medical and an orthopaedic ward. We compared 102 PR and 154 RR VBPM measurements (from 27 patients) with paired routine nurse measurements. VBPM measurements of RR were validated by reviewing video footage. Nurse measurements of RR were often 16–18 breaths/minute
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Diagnosis of cystic lung diseases: a position statement from the UK Cystic Lung Disease Rare Disease Collaborative Network Thorax (IF 10.0) Pub Date : 2024-04-01 Simon R Johnson, Dominick E Shaw, Michael Avoseh, Irshad Soomro, Kate S Pointon, Maria Kokosi, Andrew G Nicholson, Sujal R Desai, Peter M George
Background Rare cystic lung diseases are increasingly recognised due the wider application of CT scanning making cystic lung disease management a growing part of respiratory care. Cystic lung diseases tend to have extrapulmonary features that can both be diagnostic but also require surveillance and treatment in their own right. As some of these diseases now have specific treatments, making a precise
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Not all wheeze is asthma Thorax (IF 10.0) Pub Date : 2024-04-01 Kher Lik Ng, John Park, Elizabeth Belcher, Alastair J Moore
A 41-year-old man previously diagnosed with asthma presented with an influenza-like illness and breathlessness. He was treated for moderate-to-severe COVID-19 and exacerbation of asthma. CT pulmonary angiography (CTPA) revealed asymmetrical peribronchovascular ground-glass infiltrates consistent with COVID-19 and right main bronchial wall thickening with high-density material thought to be consistent
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Well-differentiated papillary mesothelial tumour: a rare finding on the pleura Thorax (IF 10.0) Pub Date : 2024-04-01 Lysann Rostock, Olaf Holotiuk, Till Ploenes
A 72-year-old woman presented to the emergency department with a history of non-specific intermittent abdominal pain. The patient experienced two episodes of diffuse continuous pain a few hours apart. Pain occurred in all four quadrants, and she felt constriction in the umbilical region. The first episode lasted approximately 2 hours. The second episode lasted more than 6 hours. Thereafter, the patient