Gut dysbiosis and gut-derived metabolites have been linked to pulmonary arterial hypertension. However, associations between specific microbes, and corresponding metabolites, with pulmonary arterial hypertension disease severity is limited.

This was a prospective cohort study of patients with pulmonary arterial hypertension undergoing right heart catheterization, with pulmonary artery blood subject to nuclear magnetic resonance metabolomics, and simultaneous stool sample shotgun metagenomics. Validation of metabolite levels with disease severity was done in an independent cohort of pulmonary arterial hypertension patients with blood samples from right heart catheterization testing.

The presence of Lactobacillus species in the gut microbiome of pulmonary arterial hypertension patients was associated with less severe pulmonary hemodynamics and echocardiographic right ventricular dysfunction. Higher threonine levels were associated with more favorable pulmonary hemodynamic characteristics in both prospective and independent validation cohorts of pulmonary arterial hypertension patients.

Detectable Lactobacillus species in the gut microbiome of pulmonary arterial hypertension patients are associated with more favorable pulmonary hemodynamic and right ventricular characteristics. Circulating gut-derived metabolites may also be involved. Further investigation into the relationship between gut microbial Lactobacillus, circulating metabolites, disease severity, and clinical outcomes in pulmonary arterial hypertension may be warranted.

To evaluate arterio-venous gas parameters-P(ca-v)CO₂ or ΔPCO₂, Ca-vO₂, and P(v-a) CO₂/Ca-vO₂ ratio, and to develop a novel Heart-Lung Coupling (HLC) index defined as (ΔPCO₂/Ca-vO₂)/Cardiac Index to quantify the interaction between ventilatory efficiency and circulatory performance in pulmonary arterial hypertension (PAH).

In this single-center retrospective study, patients with PAH who underwent right heart catheterization between September 2019 and May 2024 were evaluated. After exclusions, 115 patients were included (35 idiopathic PAH [IPAH] and 80 congenital heart disease-associated PAH [CHD-PAH]). Hemodynamics, arteriovenous gas parameters, and functional indices, including 6-min walk distance (6MWD) and NT-proBNP, were analyzed. The HLC was calculated and compared between groups. Association with functional parameters was assessed using Spearman correlation and multivariate linear regression after LASSO selection. Receiver operating characteristic analysis evaluated the ability of HLC to identify impaired exercise capacity (6MWD < 350 m).

ΔPCO₂, Ca-vO₂ and P(v-a) CO₂/Ca-vO₂ ratio were significantly higher in IPAH than CHD-PAH (8.3 vs. 3.5 mmHg, p < 0.001; 4.8 vs. 3.4 mL/dL, p = 0.005; 1.84 vs. 1.11, p < 0.001, respectively). The HLC index was also higher in IPAH (median 0.82 vs. 0.40, p = 0.001). HLC showed modest correlation with 6MWD (r = 0.27, p = 0.04) and NT-proBNP (r = 0.24, p = 0.021). In multivariate regression, HLC remained independently associated with 6MWD (β = 32.86, 95% CI: 5.15-60.57, p = 0.021). Discrimination of impaired exercise capacity was limited (AUC of 0.55).

The HLC index integrates gas exchange and cardiac output to characterize heart-lung interaction in PAH. This novel physiological metric may provide complementary insights into cardiopulmonary coupling and functional limitation.

Coadministration of respiratory syncytial virus (RSV) and seasonal influenza vaccines can increase vaccination uptake. mRNA-1345 (mRESVIA, Moderna, Inc.) is indicated in multiple countries for prevention of RSV-lower respiratory tract disease in adults. This randomized, observer-blind, phase 3 study evaluated safety, tolerability, immunogenicity, and inferred efficacy of mRNA-1345 when coadministered with quadrivalent influenza vaccine-high dose (QIV-HD). Adults ≥65 y (n = 1900) were randomly assigned 1:1 to receive both vaccines coadministered at day 1 or sequentially, 21 d apart. Noninferiority of six co-primary immunogenicity endpoints was assessed up to 21 d post vaccination, comparing coadministered versus sequential vaccination. Immunogenicity was measured by serum-neutralizing antibody responses and seroresponse rates for RSV or seroconversion rate for influenza. Reactogenicity was mild/moderate and there were no safety concerns, related serious adverse events, or deaths. Noninferiority of immune responses against influenza A (H1N1, H3N2) and B (Austria, Phuket) was demonstrated, with geometric mean ratios (GMRs; coadministration vs sequential vaccination) of anti-hemagglutinin titers ranging from 0.868-0.948. All lower bounds of the corresponding 95% CI were >0.667, consistent with the commonly accepted noninferiority margin of 1.5 (i.e. 0.667 = 1/1.5). Noninferiority against RSV-A and RSV-B based on GMR was not demonstrated; GMRs (95% CI) of neutralizing antibody were 0.625 (0.570-0.686) and 0.638 (0.584-0.697) for RSV-A and RSV-B, respectively, with the lower bound of 95% CI < 0.667 for RSV-A and B. Coadminstration is estimated to maintain the efficacy of mRNA-1345 against RSV-lower respiratory tract disease based on a correlate of protection model. These results support coadministration of mRNA-1345 with QIV-HD.Clinical trials registration: ClinicalTrials.gov: NCT06060457.

Background Connective tissue disease-associated interstitial lung disease (CTD-ILD) is a spatially and temporally heterogeneous disease. Determining whether CTD-ILD is in a progressive stage is crucial for guiding clinical management. Purpose To determine whether CTD-ILD is associated with ventilation and perfusion parameters quantified with phase-resolved functional lung (PREFUL) MRI and whether these functional parameters can help predict CTD-ILD progression. Materials and Methods In this prospective study performed from May 2024 to April 2025, healthy participants without pulmonary disease and participants with CTD-ILD underwent baseline PREFUL MRI, chest CT, and pulmonary function tests. Participants with CTD-ILD were followed up for 1 year. Disease progression was defined as meeting at least two of the following criteria: an absolute decline in forced vital capacity of more than 5% predicted or an absolute decline in diffusing capacity of lung for carbon monoxide of more than 10% predicted, CT evidence of disease progression, or worsening respiratory symptoms. Least absolute shrinkage and selection operator regression were applied to identify variables associated with disease progression, and predictive performance was assessed using the area under the receiver operating characteristic curve (AUC). Results A total of 172 participants (mean age, 59 years ± 11.8 [SD]; 143 women) were included. Compared with controls, participants with CTD-ILD demonstrated reduced dynamic ventilation (mean, 0.97 arbitrary units [au] ± 0.02 vs 0.95 au ± 0.05, respectively; P < .001) and lower perfusion (mean, 50.3 mL/min per 100 mL ± 16.2 vs 22.0 mL/min per 100 mL ± 9.2; P < .001). At baseline, compared with stable CTD-ILD, progressive CTD-ILD was associated with a higher perfusion defect (mean, 14.7% ± 6.8 vs 26.5% ± 9.1; P < .001) and lower healthy ventilation and perfusion matches (mean, 75.6% ± 8.9 vs 62.1% ± 10.8; P = .001). The multiparametric PREFUL model achieved the highest predictive performance (AUC, 0.87; 95% CI: 0.78, 0.95) compared with other logistic models (P = .004, P < .001). Conclusion In participants with CTD-ILD, ventilation and perfusion parameters derived from PREFUL MRI characterized distinct pulmonary perfusion phenotypes in CTD-ILD and were associated with disease progression over 1 year. © RSNA, 2026 Supplemental material is available for this article. See also the editorial by Rahsepar and Abtin in this issue.

In psychiatry, tensions have often arisen between biological and social approaches, despite their interconnection. Social psychiatry has evolved alongside changing understandings of mental health and its ties to broader social and geopolitical determinants. Global factors such as economic inequality, migration, and social exclusion are increasingly recognized as key influences on mental health outcomes. Nonetheless, challenges like stigma, lack of access, and resource limitations persist. The Biopsychosocial Model remains central to social psychiatry, offering an integrated framework that considers biological, psychological, and social dimensions. This comprehensive perspective ensures that interventions target not only symptoms but also contextual factors contributing to mental illness. The future of social psychiatry will be shaped by heightened awareness of social determinants, particularly amid global crises like war or COVID-19. Consistent application of the biopsychosocial model in clinical settings is essential. Policy advocacy focused on housing, employment, and inclusive care-alongside cultural sensitivity and the use of digital tools-will be vital. Moreover, enhancing psychiatric education and fostering interdisciplinary collaboration will be key to addressing social determinants across all levels of mental health care.

Asthma is a frequent comorbidity in children with sickle cell disease and has been associated with an increased risk of acute complications, particularly vaso-occlusive crises and acute chest syndrome. However, determinants of clinical severity among children with sickle cell disease and confirmed asthma remain poorly characterized, especially in tropical settings. This study aimed to identify factors associated with clinical severity in this population.

We conducted an observational study among children with sickle cell disease followed in French Guiana. The analysis was restricted to children with confirmed asthma. Clinical severity was defined as the occurrence of at least two hospitalizations during the 12 months preceding evaluation for vaso-occlusive crises and/or acute chest syndrome. Factors associated with severity were assessed using univariate and multivariate logistic regression analyses.

A total of 138 children with sickle cell disease and confirmed asthma were included, of whom 102 (73.9%) presented a severe clinical form. In multivariate analysis, no variable was independently associated with clinical severity. However, a trend toward an increased risk of severe disease was observed among children living in rural areas (adjusted OR = 1.94; 95% CI: 0.77-4.86), while a trend toward a protective effect was observed for Strongyloides stercoralis infection (adjusted OR = 0.18; 95% CI: 0.02-1.51). Allergic sensitization, although frequent (64.5%), was not associated with clinical severity after adjustment (adjusted OR = 0.66; 95% CI: 0.31-1.44).

Among children with sickle cell disease and confirmed asthma, more than one third experience severe clinical disease. No independent predictors of severity were identified. Observed trends should be interpreted cautiously and considered exploratory. These findings support a stratified approach to sickle cell-associated asthma to identify high-risk children and prevent avoidable acute complications.

Pulmonary arterial hypertension (PAH) is a rare, progressive condition associated with high morbidity and healthcare resource utilization. This study aimed to estimate the annual direct and indirect costs of PAH in Switzerland, from a societal perspective.

A cross-sectional cost-of-illness study was conducted across six Swiss PAH centres between April and December 2024. Adult patients with confirmed PAH (World Health Organization [WHO] Group 1) were invited to complete a standardized questionnaire on work productivity losses, informal care, and healthcare utilization outside the enrolling centre. Clinical data on hospitalizations, outpatient visits, diagnostics, and treatments at the enrolling centre were extracted from medical records. Disease-specific costs were calculated by multiplying resource use and work losses by Swiss-specific unit costs and extrapolated to one year. Estimates were stratified by WHO functional class (WHO-FC) and ESC/ERS 2022 risk strata.

Among 124 participants aged between 18 and 89 years, the mean disease-specific total annual cost per patient was €138,958. Direct healthcare costs represented 78.5% of this amount (€109,114), driven primarily by pharmacological treatment (65% of total costs). Indirect costs amounted to 21.5% (€29,844). Costs increased with disease severity, ranging from €81,957 in WHO-FC 1 to €166,569 in WHO-FC 4, and from €130,970 in ESC/ERS low risk to €291,728 in ESC/ERS high risk. The total national burden was estimated at €48.5 million annually.

PAH imposes a substantial economic burden in Switzerland, largely due to treatment costs and productivity losses. These findings highlight the need for strategies to reduce disease progression and associated societal costs.

The first COVID-19 epidemic wave hit the East and Ile-de-France regions in France, resulting in overwhelmed intensive care units (ICUs). Alongside helicopters and planes, high-speed trains were used for the first time to mass-evacuate critically ill patients. This study aimed to compare outcomes of patients evacuated by trains and by aircrafts.

This was a multicentre retrospective cohort study. Between 13 March and 10 April 2020, 38 ICUs in France transferred patients with severe COVID-19 to 60 ICUs in unaffected regions and countries. Patients were divided into the train group (n = 130) and the air group (n = 163). The study outcomes included 28-day case-fatality, destination ICU length of stay and post-transfer Sequential Organ Failure Assessment (SOFA) score.

Age and comorbidity did not differ between groups. Although patients spent more time (+2 hours) and travelled further (+250 km) in the train group than in the air group, the median post-transfer SOFA score was lower in the train group (6 vs 7; p = 0.03). The 28-day mortality rates were not different (train/air unadjusted incidence risk ratio: 0.96; p = 0.94). The ICU stay duration was shorter (-6 days) in the train group, but this difference was reduced after adjusting for clinical events, such as nosocomial infections.

High-speed train was a safe vehicle for remote transfer of critically ill patients. The selection of healthier patients and the better physiological and care conditions during the evacuation may explain the shorter ICU stays of patients transferred by trains.

Accurate tools for patient stratification by likely outcome are needed to support complex decision-making and improve acute non-invasive ventilation (NIV) delivery.

To evaluate the potential of an emerging NIV outcomes (NIVO) score tool to predict in-hospital mortality to aid its validation in a real-world UK hospital population of ward-based NIV for acute exacerbations of chronic obstructive pulmonary disease (AECOPD).

This was a retrospective observational cohort study of all consecutive patient admissions with AECOPD managed with NIV for acute hypercapnic respiratory failure at a teaching hospital.

Clinical parameters were collected as part of an ongoing quality improvement project. Patients were grouped based on their survival status at hospital discharge. First admission of each patient was included in the analysis. NIV failure, defined as NIV withdrawal or intubation requirement due to clinical deterioration on NIV, along with in-hospital mortality, was modelled using logistic regression.

There were 249 unique patient AECOPD admissions with ward-based NIV. Across first admissions, NIV failure rate was 37.3%, in-hospital mortality 26.5%, and 1-year mortality 47.0%. NIVO score was significantly associated with both NIV failure and in-hospital mortality, with odds ratios (95% Confidence intervals) of 1.33 (1.13-1.58, p < 0.001) and 1.52 (1.26-1.86), p < 0.001, respectively. A progressive increase in in-hospital mortality was observed with increasing NIVO scores (p < 0.0001).

This study demonstrates that the NIVO score shows promise as a predictive tool for in-hospital mortality in patients with AECOPD receiving ward-based NIV. Furthermore, it suggests that NIVO may be able to support decision-making for enhanced NIV delivery in new clinical pathways to address the growing burden of chronic obstructive pulmonary disease exacerbations.

BackgroundThe role of corticosteroids in the management of severe community-acquired pneumonia (CAP) in children remains controversial, with limited pediatric evidence. Recent studies have suggested that the effect of corticosteroids varies among subgroups, particularly according to cardiovascular status. The present study thus evaluated the effect of corticosteroids on in-hospital mortality in children with severe CAP and described subgroup differences by concomitant organ failure, age, and the microbial diagnosis.MethodsThis retrospective cohort study used a national inpatient database in Japan to identify children under 20 years old admitted with pneumonia between July 2010 and March 2022 who received ventilatory support within the first 2 days of admission. We performed one-to-one nearest-neighbor propensity score matching to compare children who received corticosteroids within 2 days of admission and continued for ≥3 days (steroid group) with those who did not (non-steroid group). The primary outcome was in-hospital mortality, assessed in matched pairs with subgroup analyses.ResultsOf the 11,427 children with severe CAP, propensity score matching yielded 3,081 matched pairs. In-hospital mortality was 1.6% in the steroid group and 1.7% in the non-steroid group (odds ratio, 0.94; 95% confidence interval [CI]: 0.68-1.31; p = 0.72). Among 359 children with cardiovascular compromise, corticosteroid use was associated with a reduced in-hospital mortality (odds ratio: 0.47; 95% CI: 0.26-0.87), whereas among 5,803 children without cardiovascular compromise, it was not (odds ratio: 1.64; 95% CI: 0.99-2.74). Other subgroup analyses showed no significant differences between the groups.ConclusionsCorticosteroid use did not significantly affect in-hospital mortality in children with severe CAP except in those with cardiovascular compromise. These findings suggest caution in the routine use of corticosteroids in this pediatric cohort, especially in those without cardiovascular compromise.