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  1. The Triumvirate

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Bumper Christmas Special

This will be the Last Christmas that this particular Trimuvirate contributes Airwaves. So to save you from tears, we will give you something special. The shops have Christmas items on display and the old familiar hits of previous decades are playing to get shoppers in a festive mood. Nothing old or familiar in December’s Thorax though—quite the reverse. We bring you the new, the innovative and the frankly curious.

What will your daddy do, when he sees your Mama kissin' Santa Claus?

Thus sang Noddy Holder of Slade in 1973 (and very year since). However, kissing under the mistletoe (or indeed anywhere else) may be curtailed this year, at hospital Christmas parties, due to COVID-19 restrictions. In this month’s journal, Ponsford and colleagues describe nosocomial transmission of COVID-19 (see page 1246) in 18 hospitals in Wales (60% of those hospitalised in Wales), during the period 1 March to 1 July 2020. For hospital acquired COVID-19, mortality was higher than for community acquired cases and those infected were older and frailer. The authors describe a 30 day interval between admission and a positive COVID-19 test, suggesting prophylactic or postexposure interventions and enhanced infection control measures may be effective. In a linked commentary (see page 1174), Jemima Collins and colleagues urge us not to let our guard down. So stay on your guard should Santa (or a female elf) suggest some kissing under the mistletoe this festive season!

Fairy tale of ARDS

Fairytale of New York is an enduring favourite of the festive season, though close scrutiny of the lyrics suggests it is an unlikely song for the season of goodwill (‘…you’re a bum, you’re a punk…etc’). The song evokes an image of one of the protagonists: ‘…lying there almost dead on a drip in that bed…’ This is a position in which many of those suffering from adult respiratory distress syndrome (ARDS) find themselves. But is the relationship between ARDS and mortality causal? In this issue of Thorax, (see page 1176) Torres and colleagues report the findings of a systematic review and survival analysis to address this issue. Using a novel causal inference method, the authors estimate the attributable mortality of critically ill septic patients with and without ARDS. After controlling for confounders, they find that ARDS increases the risk of death, in patients with sepsis, by 15%. The authors call for continued funding of ARDS prevention trials. Such trials will undoubtedly require multicentre collaboration. In the words of the song: ‘Can't make it all alone. I've built my dreams around you.’

Curious incidents

If you need a Christmas book suggestion ‘The Curious Incident of the Dog in the Night Time’ is a good read and gives insights into neurodiversity. However, a better way to test your diagnostic skill is to read ‘The curious incident of the cast in the airway’ - this month’s Thorax image (see page 1253).

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Christmas scars

The Serbian rock band Van Gogh wrote this particularly dreamy classic and in this edition of Thorax we provide a veritable hamper of papers to dissipate the scars and merry on your yuletide. Liu et al (see page 1186), McGroder et al (see page 1242), Salehian et al (see page 1250) describe the role of telomeres in various fibrotic diseases and maybe the answer to our holiday excesses is a large dose of senolytic?

Last Christmas

It came to pass that the Triumvirate would have just one last Christmas writing the festive Airwaves. It was a joyous time for the joint Editors-in-Chief and indeed it was a time of reflection of the wise words they had penned over the previous six Christmas seasons. They remembered the Yuletide night time festivities that would have prompted Yet Hong Khor and colleagues (see page 1200) to investigate nocturnal hypoxaemia in interstitial lung disease (ILD). However, rather than gold frankincense and myrrh, this systematic review delivered diagnostic evaluation, management and prognosis of nocturnal hypoxaemia in interstitial lung disease. The pooled data from fifty-three studies with 2590 patients demonstrated that nocturnal hypoxaemia is common, associated with gas transfer impairment and pulmonary hypertension, and is a potential prognostic indicator factor. Although Santa Claus will deliver presents on Christmas night for all those who have been good, perhaps we must now consider a delivery of supplemental oxygen for ILD patients every night. It may make for both a happy Christmas and a happy new year.

The Twelve Days of Christmas

On the first day of Christmas my true love gave to me a partridge nested in a pear tree. On the second day of Christmas my true love gave to me two thousand plus patients who developed drug induced ILD, and a partridge nested in a pear tree. On the fourth day of Christmas my true love gave to me four case-control matches, 2 thousand plus patients with DILD and a partridge nested in a pear tree. On the sixth day of Christmas my true love gave to me six drug categories significantly associated with increased occurrence of DILD, four case–control matches, 2 thousand plus patients with DILD and a partridge nested in a pear tree. On the tenth day of Christmas my true love gave to me the list of 10 drugs categories associated with DILD on univariate analysis, six drug categories significantly associated with increased occurrence of DILD, four case–control matches, 2 thousand plus patients with DILD and a partridge nested in a pear tree. On the twelfth day of Christmas my true love gave to me the only drug class inversely associated with DILD with an OR 0.53 (CI 0.37 to 0.75). If you want to find out what this Christmas number 1 is, you will have take your December copy of Thorax from under the Christmas tree, unwrap it carefully, and go to open the pages of Jo et al (see page 1193). Happy Holidays, everybody.

A brighter 2022

2022 will be much brighter for all as we move further away from the COVID-19 pandemic, we see climate change as a global issue to solve and the Triumvirate step down as Editors-in-Chief after 7 years, with a new Triumvirate waiting in the wings. The next job on the horizon is tobacco control, poverty and air pollution. With this in mind, Amaral and colleagues, on behalf of the BOLD collaborative research group (see page 1236), investigated the global ecological association between chronic airflow obstruction and ambient air pollution (PM2.5) across those countries representing most of the regions defined by the Global Burden of Disease. Although the prevalence of chronic airflow obstruction was not associated with PM2.5, it was associated with smoking and poverty. For a brighter 2022, our focus must be on protecting the planet and the people that live on it.

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Naval Thessa Reyes Camilo C Roa Ma Flordeliza Sanchez Leander P Simpao Ewa Nizankowska Mogilnicka Jakub Frey Rafal Harat Filip Mejza Pawel Nastalek Andrzej Pajak Wojciech Skucha Andrzej Szczeklik Magda Twardowska Cristina Bárbara Fátima Rodrigues Hermínia Dias João Cardoso João Almeida Maria João Matos Paula Simão Moutinho Santos Reis Ferreira M Al Ghobain H Alorainy E El-Hamad M. Al Hajjaj A Hashi R Dela R Fanuncio E Doloriel I Marciano L. 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