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Thomaz Fleury Curado, Arie Oliven, Luiz U Sennes, Vsevolod Y Polotsky, David Eisele, Alan R Schwartz
Over the past 30 years, hypoglossal nerve stimulation has moved through a development pathway to become a viable treatment modality for patients with obstructive sleep apnea. Initial pilot studies in animals and humans laid the conceptual foundation for this approach, leading to the development of fully implantable stimulating systems for therapeutic purposes. These devices were then demonstrated to be both safe and efficacious in feasibility studies. One such closed-loop stimulating device was found effective in treating a limited spectrum of apneic patients and is currently FDA-approved for this purpose...
September 14, 2018: Chest
Vincent F Capaldi, Thomas J Balkin, Vincent Mysliwiec
Historically, scientific knowledge gaps - including a lack of information regarding the minimum amount of sleep needed to sustain nominally adequate, militarily-relevant performance and nescience of the potential impact of chronic sleep restriction on health and psychological well-being - have hindered decision-making vis-à-vis sleep/alertness management in operational environments. However, against a backdrop of increasing awareness of the importance of sleep for sustaining both performance and health, military researchers are currently (a) developing a comprehensive, individualized sleep/alertness management system to optimize the general effectiveness of military personnel (i...
September 12, 2018: Chest
Scott M Palmer, Laurie Snyder, Jamie L Todd, Benjamin Soule, Rose Christian, Kevin Anstrom, Yi Luo, Robert Gagnon, Glenn Rosen
BACKGROUND: Idiopathic pulmonary fibrosis (IPF) causes irreversible loss of lung function. The lysophosphatidic acid receptor 1 (LPA1 ) pathway is implicated in IPF etiology. Safety and efficacy of BMS-986020, a high-affinity LPA1 antagonist, was assessed versus placebo in a phase 2 study in patients with IPF. METHODS: IM136003 was a phase 2, parallel-arm, multicenter, randomized, double-blind, placebo-controlled trial. Adults with IPF (forced vital capacity [FVC], 45%-90%; diffusing capacity for carbon monoxide, 30%-80%) were randomized to receive placebo, or 600-mg BMS-986020 (QD or BID) for 26 weeks...
September 7, 2018: Chest
Vickram Tejwani, Himanshu Deshwal, Byron Ho, Manisha J Loss, Robin K Avery, Atul C Mehta
No abstract text is available yet for this article.
September 7, 2018: Chest
Philip S Wells, Martin H Prins, Jan Beyer-Westendorf, Anthonie Wa Lensing, Lloyd Haskell, Bennett Levitan, François Laliberté, Veronica Ashton, Yongling Xiao, Dominique Lejeune, Concetta Crivera, Patrick Lefebvre, Qi Zhao, Zhong Yuan, Jeff Schein, Paolo Prandoni
BACKGROUND: Using data from the Reduced-dosed Rivaroxaban in the Long-term Prevention of Recurrent Symptomatic Venous Thromboembolism (EINSTEIN-CHOICE) trial, this study assessed cost impact of continued anticoagulation therapy with rivaroxaban vs. aspirin. METHODS: Total healthcare costs (2016USD) associated with rivaroxaban and aspirin were calculated as the sum of clinical event costs and drug costs from a US managed care perspective. Clinical event costs were calculated by multiplying event rate by cost of care...
September 7, 2018: Chest
Denise Maria Servantes, Shahrokh Javaheri, Ana Claudia Pelissari Kravchychyn, Luciana Julio Storti, Dirceu Rodrigues Almeida, Marco Túlio de Mello, Fátima Dumas Cintra, Sergio Tufik, Lia Bittencourt
BACKGROUND: Exercise and CPAP improve OSA. This study examined the effects of exercise in patients with heart failure (HF) and OSA. METHODS: Patients with HF and OSA were randomized to the following study groups: control, exercise, CPAP, and exercise + CPAP. RESULTS: Sixty-five participants completed the protocol. Comparing baseline vs 3 months, the mean apnea-hypopnea index (AHI) did not change significantly (in events per hour) in the control group, decreased moderately in the exercise group (28 ± 17 to 18 ± 12; P < ...
September 6, 2018: Chest
Krysta S Wolfe, Bhakti K Patel, Erica L MacKenzie, Shewit P Giovanni, Anne S Pohlman, Matthew M Churpek, Jesse B Hall, John P Kress
BACKGROUND: Vasoactive medications are commonly used in the treatment of critically ill patients, but their impact on the development of ICU-acquired weakness is not well described. The objective of this study is to evaluate the relationship between vasoactive medication use and the outcome of ICU-acquired weakness. METHODS: This is a secondary analysis of mechanically ventilated patients (N = 172) enrolled in a randomized clinical trial of early occupational and physical therapy vs conventional therapy, which evaluated the end point of ICU-acquired weakness on hospital discharge...
September 3, 2018: Chest
Karthik Suresh, Jarushka Naidoo, Cheng Ting Lin, Sonye Danoff
Immune checkpoint inhibitors (ICI) are newer, immunotherapy-based drugs that have been shown to improve survival in advanced non-small cell lung cancer (NSCLC). Unlike traditional chemotherapeutic agents, ICIs work by boosting the body's natural tumor killing response. However, this unique mechanism of action has also led to the recognition of class specific side-effects. Labeled immune related adverse events (irAEs), these toxicities can affect multiple organ systems including the lungs. Immune-mediated lung injury due to ICI use, termed checkpoint inhibitor pneumonitis (CIP), occurs in about 3-5% of patients receiving ICI, though the real world incidence of this entity may be higher, especially now that ICIs are being used in non-clinical trial settings...
September 3, 2018: Chest
Hassan Burhan, Ryan Young, Tara Byrne, Robert Peat, Jennifer Furlong, Susan Renwick, Tristan Elkin, Sandra Oelbaum, Paul P Walker
BACKGROUND: Heroin smoking is associated with deprivation, early onset severe emphysema, premature morbidity and mortality and high use of healthcare; but individuals engage poorly with traditional health services. METHODS: In this cross sectional study we screened a population of heroin smokers prescribed opiate substitution therapy for airway disease with community drug services. We assessed drug exposure, respiratory symptoms, health status and COPD prevalence...
September 3, 2018: Chest
Samira Shojaee, Najib Rahman, Kevin Haas, Ryan Kern, Michael Leise, Mohammed Alnijoumi, Carla Lamb, Adnan Majid, Jason Akulian, Fabien Maldonado, Hans Lee, Marwah Khalid, Todd Stravitz, Le Kang, Alexander Chen
BACKGROUND: The outcome of indwelling pleural catheter (IPC) use in hepatic hydrothorax (HH) is unclear. This study aimed to review the safety and feasibility of IPC in patients with refractory HH. METHODS: A retrospective multicenter study of patients with HH from January 2010 to December 2016 was performed. Inclusion criteria were refractory HH treated with IPC and an underlying diagnosis of cirrhosis. Records were reviewed for patient demographics, operative reports and laboratory values...
August 29, 2018: Chest
Himanshu Deshwal, Sameer K Avasarala, Subha Ghosh, Atul C Mehta
Advanced technologies such as endobronchial ultrasound and electromagnetic navigation have revolutionized the field of bronchoscopy. Its indications as a diagnostic as well as therapeutic tool continue to expand at a rapid pace. This has also led to emergence of a new subspecialty of interventional pulmonology and over forty fellowship training programs. However, with increasing popularity and accessibility there is a high impetus for performing the procedure where it may be of limited value. Based on the literature review and our own experience we came up with the list of conditions where the bronchoscopy is of limited value yet being performed frequently...
August 29, 2018: Chest
Lukas Martin, Matthias Derwall, Sura Al Zoubi, Elisabeth Zechendorf, Daniel A Reuter, Chris Thiemermann, Tobias Schuerholz
Septic cardiomyopathy is a key feature of sepsis-associated cardiovascular failure. Despite the lack of consistent diagnostic criteria, patients typically exhibit ventricular dilatation, reduced ventricular contractility and/or both right and left ventricular dysfunction with a reduced response to volume infusion. Although there is solid evidence that the presence of septic cardiomyopathy is a relevant contributor to organ dysfunction and an important factor in the already-complicated therapeutic management of septic patients, there are still several questions to be asked: Which factors/mechanisms cause a cardiac dysfunction associated with sepsis? How do we diagnose septic cardiomyopathy? How do we treat septic cardiomyopathy? How does septic cardiomyopathy influence the long-term outcome of the patient? Each of these questions is interrelated, and the answers require a profound understanding of the underlying pathophysiology that involves a complex mix of systemic factors and molecular, metabolic, and structural changes of the cardiomyocyte...
August 29, 2018: Chest
Katherine A Young, Daniel F Dilling
The field of lung transplant has made significant advances over the past several decades. Despite these advances, morbidity and mortality remain high when compared with other solid organ transplants. As the field moves forward, the speed by which progress can be made will in part be determined by our ability to overcome several stumbling blocks including: donor shortage, proper selection of candidates, primary graft dysfunction, and chronic lung allograft dysfunction. The advances and developments surrounding these factors will have a significant impact on shaping the field within the coming years...
August 29, 2018: Chest
Anna R Hemnes, Alexander R Opotowsky, Tufik R Assad, Meng Xu, Laura N Doss, Eric Farber-Eger, Quinn S Wells, Evan L Brittain
BACKGROUND: The measurements used to define pulmonary hypertension (PH) etiology, pulmonary arterial wedge pressure (PAWP) and left ventricular end-diastolic pressure (LVEDP), vary in clinical practice. We aimed to identify clinical features associated with measurement discrepancy between PAWP and LVEDP in patients with PH. METHODS: We extracted clinical data and invasive hemodynamics from consecutive patients undergoing concurrent right and left heart catheterization at Vanderbilt between 1998-2014...
August 24, 2018: Chest
Anthony M Lamattina, Angelo Taveira-Dasilva, Hilary J Goldberg, Shefali Bagwe, Ye Cui, Ivan O Rosas, Joel Moss, Elizabeth P Henske, Souheil El-Chemaly
RATIONALE: We have previously conducted the Sirolimus and Autophagy Inhibition in LAM (SAIL) trial, a phase I dose escalation study of the combination of sirolimus and hydroxychloroquine in patients with lymphangioeliomyomatosis (LAM). The goal of the present study was to analyze sera from the SAIL trial to identify novel biomarkers that could shed light into disease pathogenesis and response to therapy. METHODS: We used the DiscoveryMAP® platform from Rules Based Medicine to simultaneously measure 279 analytes in sera collected at each visit from subjects enrolled in the SAIL trial...
August 22, 2018: Chest
Nichole T Tanner, Lonny Yarmus, Alexander Chen, Jessica Wang Memoli, Hiren J Mehta, Nicholas J Pastis, Hans Lee, Michael A Jantz, Paul J Nietert, Gerard A Silvestri
BACKGROUND: New technology has resulted in bronchoscopy being increasingly used for diagnosing pulmonary lesions. Reported yield from these procedures varies widely with few randomized clinical trials. This study compares the diagnostic yield of a thin bronchoscope and radial endobronchial ultrasound (R-EBUS) to standard bronchoscopy with fluoroscopy (SB-F) in lung lesions. METHODS: Patients presenting for diagnostic bronchoscopic evaluation at five centers were randomized to undergo SB-F or R-EBUS with thin bronchoscope (TB-EBUS)...
August 22, 2018: Chest
Basil J Petrof
The diaphragm is the primary muscle of inspiration. Its capacity to respond to the load imposed by pulmonary disease is a major determining factor both in the onset of ventilatory failure and in the ability to successfully separate patients from ventilator support. It has recently been established that a very large proportion of critically ill patients exhibit major weakness of the diaphragm, which is associated with poor clinical outcomes. The two greatest risk factors for the development of diaphragm weakness in critical illness are the use of mechanical ventilation and the presence of sepsis...
August 22, 2018: Chest
Gregory Y H Lip, Amitava Banerjee, Giuseppe Boriani, Chern En Chiang, Ramiz Fargo, Ben Freedman, Deirdre A Lane, Christian T Ruff, Mintu Turakhia, David Werring, Sheena Patel, Lisa Moores
BACKGROUND: The risk of stroke is heterogeneous across different groups of patients with atrial fibrillation (AF), being dependent on the presence of various stroke risk factors. We provide recommendations for antithrombotic treatment based on net clinical benefit for patients with AF at varying levels of stroke risk and in a number of common clinical scenarios. METHODS: Systematic literature reviews were conducted to identify relevant articles published from the last formal search perfomed for the Antithrombotic and Thrombolytic Therapy: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (9th Edition)...
August 21, 2018: Chest
Carole Scheifer, Clémence Bor, Marie-Pierre Debray, Noémie Chanson, Marie-Paule Chauveheid, Bruno Gombert, Thomas Papo, Karim Sacré
A 27-year-old Lebanese man was admitted to our department for multiple pulmonary lesions. The patient had reported persistent fever, cough, shortness of breath, and weight loss since his return from Lebanon 6 weeks earlier. He had been diagnosed with a severe form of Behçet disease 4 years ago, for which the ongoing treatment was a corticosteroid therapy associated with methotrexate and infliximab.
August 17, 2018: Chest
David Bédard Méthot, Évelyne Leblanc, Yves Lacasse
BACKGROUND: The relationship between gastroesophageal reflux disease (GERD) and idiopathic pulmonary fibrosis (IPF) is controversial. Current guidelines recommend that clinicians use regular antacid treatment, while two recent meta-analyses of antacid therapy in IPF were inconclusive. The objective of this study was to examine the evidence regarding the association between GERD and IPF through a systematic review and a meta-analysis, with special reference to the methodologic quality of the observational studies...
August 16, 2018: Chest
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