Spondyloarthritis (SpA) is characterized by inflammatory back pain. Magnetic resonance imaging (MRI) was the earlier gold standard technique for detecting early inflammatory change. We reassessed the diagnostic utility of sacroiliac joint/sacrum (SIS) ratios of single-photon emission computed tomography/computed tomography (SPECT/CT) for identifying sacroiliitis. We aimed to investigate of SPECT/CT in diagnosing SpA using a rheumatologist’s visual scoring of SIS ratios assessment. We conducted a single-center, medical records review study of patients with lower back pain who underwent bone SPECT/CT from August 2016 to April 2020. We employed semiquantitative visual bone scoring methods of SIS ratio. The uptake of each sacroiliac joint was compared to that of the sacrum (0–2). A score of 2 for the sacroiliac joint of either side was considered diagnostic of sacroiliitis. Of the 443 patients assessed, 40 had axial SpA (axSpA), 24 being radiographic axSpA and 16 being nonradiographic axSpA. The sensitivity, specificity, and positive and negative predictive values of SIS ratio of SPECT/CT for axSpA were 87.5%, 56.5%, 16.6%, and 97.8%, respectively. In receiver operating curve analysis, MRI better diagnosed axSpA than did SIS ratio of SPECT/CT. Although the diagnostic utility of SIS ratio of SPECT/CT was inferior to MRI, visual scoring of SPECT/CT affords high sensitivity and negative predictive value in axSpA. When MRI is inappropriate for certain patients, SIS ratio of SPECT/CT is an alternative tool for identifying axSpA in real practice.

Background: Chronic airway diseases, such as asthma and chronic obstructive pulmonary disease (COPD), are increasingly being treated with inhaled corticosteroid (ICS). However, ICSs carry potential infection risks, particularly nontuberculous mycobacteria (NTM). This study investigated the association between ICS use and NTM infection risk using national insurance data, particularly for individuals with chronic airway diseases.Methods: We conducted a nationwide population-based study using data from the National Health Insurance Service-National Sample Cohort in South Korea from 2002 to 2019. The cohort included 57,553 patients diagnosed with COPD or asthma. To assess the risk of NTM infection, we used Cox proportional hazards models and propensity score-based inverse probability of treatment weighting (IPTW) to ensure a balanced analysis of covariates.Results: Of the 57,553 patients (mean age 56.0 years, 43.2% male), 16.5% used ICS and 83.5% did not. We identified 63 NTM infection cases, including nine among ICS users and 54 among non-users. Before and after IPTW, ICS use was associated with a higher risk of NTM infection (adjusted hazard ratio [HR], 4.01; 95% confidence interval [CI], 1.48 to 15.58). Higher risks were significant for patients ≥65 years (adjusted HR, 6.40; 95% CI, 1.28 to 31.94), females (adjusted HR, 10.91; 95% CI, 2.24 to 53.20), never-smokers (adjusted HR, 6.31; 95% CI, 1.49 to 26.64), systemic steroid users (adjusted HR, 50.19; 95% CI, 8.07 to 312.19), and those with higher comorbidity scores (adjusted HR, 6.64; 95% CI, 1.19 to 37.03).Conclusion: ICS use in patients with chronic airway diseases might increase the risk of NTM infection, particularly in older females, never-smokers, and systemic steroid users.

Background: Climate change has increased temperature variability, impacting respiratory health. While the data related to its short-term effects on lung function is conflicting, its long-term effects remain even more uncertain. Therefore, this study aimed to evaluate the short-, mid-, and long-term effects of ambient temperature on lung function and respiratory symptoms in a nationally representative population. Methods: We conducted a cross-sectional analysis of 10,819 participants from the Korean National Health and Nutrition Examination Survey (KNHANES) [2016–2018]. Individualised temperature exposures were estimated using high-resolution atmospheric models. Generalised additive model (GAM) and distributed lag non-linear model (DLNM) were used to assess the short-term (lag days 0–14), mid-term [moving average (MA): 30–180 days], and long-term (MA: 1–5 years) effects on lung function. Results: Short-term exposure to high temperature (29.7 ℃) was associated with decreased forced expiratory volume in 1 second (FEV₁) [mean: −2.59%; 95% confidence interval (CI): −4.35% to −0.82%] relative to the minimum risk temperature (MRT; 22.0 ℃), with cumulative effects persisting over 14 days [forced vital capacity (FVC) mean: −4.98%, 95% CI: −6.99% to −2.96%; FEV₁ mean: −5.95%, 95% CI: −8.23% to −3.67%]. Long-term temperature exposure was associated with lung function decline, with a 5-year MA decrease in FEV₁ (−3.87%, 95% CI: −6.81% to −0.93%) at 13.7 ℃, relative to the MRT of 10.0 ℃, with a more pronounced effect at upper temperature extremes. Chronic sputum production was associated with long-term heat exposure [1-year, odds ratio (OR): 1.349, 95% CI: 1.173–1.554; 3-year, OR: 1.299, 95% CI: 1.093–1.552; 5-year, OR: 1.189, 95% CI: 1.000–1.423]. Conclusions: Short- and long-term heat exposure were associated with impaired lung function, with more pronounced effects observed at higher temperatures.

Background: Hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP) are common among critically ill patients, leading to increased morbidity and mortality rates. Conventional culture-based diagnostics require 48–72 hours, which delays pathogen identification and prolongs the use of broad-spectrum antibiotics. Multiplex polymerase chain reaction (mPCR) enables the rapid detection of pathogens and resistance genes, but its effects on real-world antibiotic decision-making remain unclear.Methods: This retrospective study included patients in the intensive care unit who were diagnosed with HAP or VAP at a tertiary medical center between July 2023 and June 2024. All patients underwent both mPCR and respiratory culture. The primary outcome was the time to the first antibiotic modification based on mPCR or respiratory culture. The secondary outcome was the rate of antibiotic de-escalation from carbapenem or teicoplanin/vancomycin based on mPCR findings.Results: In total, 75 patients were included (median age, 68 years; 61.3% male). mPCR identified bacterial pathogens in 45.3% cases, with a median turnaround time of 281 minutes. The median time to antibiotic modification was 5.8 hours for mPCR versus 122.32 hours for culture (P<0.01). Despite negative mPCR results for gram-negative bacilli, carbapenem therapy was discontinued in only 1 of 24 cases (4.2%). Among 39 patients with negative results for Staphylococcus aureus, vancomycin or teicoplanin was discontinued in only 3 cases (7.7%).Conclusions: mPCR provided faster pathogen identification and earlier antibiotic modifications than conventional respiratory culture. However, antibiotic discontinuation remained uncommon despite negative mPCR results, highlighting challenges in real-world antimicrobial stewardship.

A harmonized respiratory–gut microbiome cohort framework for idiopathic pulmonary fibrosis