Chest
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The advances in minimally invasive lung cancer diagnostics of the last decade have transformed patient care but have also raised important concerns about the regulatory processes used to approve new devices and the best way to generate data to support their use. Disruptive technologies, such as robotic bronchoscopy, have been widely adopted by interventional pulmonologists in the absence of robust data demonstrating improved patient outcomes. ⋯ Pragmatic clinical trials, which integrate trial procedures into routine clinical care, represent an appealing alternative approach for generating much-needed data to inform clinical care. In this manuscript we illustrate the advantages and disadvantages of these research paradigms using two recently completed randomized controlled trials in navigational bronchoscopy and highlight the barriers and facilitators to using pragmatic trials to address the gap in comparative effectiveness research: these include the need for increased clarity of research regulations for pragmatic trials, adequate federal and private funding for such research, and alignment of incentives between clinicians, researchers, regulators, and industry.
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The incidence of pulmonary nodules and masses in non-HIV immunocompromised patients has significantly increased due to advancements in hematopoietic stem cell transplantation (HSCT), solid organ transplantation (SOT), and the widespread use of chemotherapy and immunosuppressive therapies. Differentiating between infectious and non-infectious causes is critical for appropriate diagnosis and management, especially as radiological and clinical presentations can be nonspecific. ⋯ Pulmonary nodules and masses in immunocompromised patients represent a diagnostic challenge due to overlapping radiological and clinical presentations. By integrating clinical context, immune status, and imaging findings, clinicians can more accurately diagnose and manage these lesions, improving patient outcomes. This review presents an algorithmic approach for differentiating between various causes of pulmonary nodules and masses in non-HIV immunocompromised individuals, providing a valuable tool for clinical practice.
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We previously identified a panel of sputum DNA methylation that predicts lung ageing and risk for lung cancer. ⋯ We defined a novel dietary pattern for lung epigenetic aging, which linked to lung health measurements. Former smokers, especially those with airway obstruction, may benefit the most from nutritional modification.
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Trastuzumab-emtansine have been recently suspected to be associated with the development of pulmonary arterial hypertension (PAH). ⋯ Our results suggest that more patients exposed to trastuzumab-emtansine developed PH compared to trastuzumab alone. Further assessment of this safety signal and exploration of pathophysiological mechanisms is needed.
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The independent, mediation, interaction, and joint effects of socioeconomic status (SES) and phenotypic frailty on the incidence of chronic obstructive pulmonary disease (COPD) are unclear. ⋯ Low SES and frailty are independent risk factors for COPD, and these two factors also have synergistic interaction in COPD. Frailty partially mediated the association between SES and COPD. Thus, the early identification and reversal of frailty may minimize the risk of COPD, especially in individuals with low SES.