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https://www.readbyqxmd.com/read/29778660/sarcoidosis-diagnostic-score-sds-a-systematic-evaluation-to-enhance-the-diagnosis-of-sarcoidosis
#1
Alexandra N Bickett, Elyse E Lower, Robert P Baughman
BACKGROUND: The diagnosis of sarcoidosis is made by the combination of clinical features and biopsy results. The clinical features of sarcoidosis can be quite variable. We developed a Sarcoidosis Diagnostic Score (SDS) to summarize the clinical features of possible sarcoidosis patients. METHODS: Biopsy confirmed sarcoidosis patients seen during a seven-month time period at the University of Cincinnati Sarcoidosis clinic were prospectively identified. Non-sarcoidosis patients seen at the same clinic were used as controls...
May 17, 2018: Chest
https://www.readbyqxmd.com/read/29778659/sepsis-3-septic-shock-criteria-and-associated-mortality-among-infected-hospitalized-patients-assessed-by-a-rapid-response-team
#2
Shannon M Fernando, Peter M Reardon, Bram Rochwerg, Nathan I Shapiro, Donald M Yealy, Andrew J E Seely, Jeffrey J Perry, Douglas P Barnaby, Kyle Murphy, Peter Tanuseputro, Kwadwo Kyeremanteng
BACKGROUND: Rapid Response Teams (RRTs) respond to deteriorating hospitalized patients, and help determine subsequent management, including Intensive Care Unit (ICU) admission. In such patients with sepsis and septic shock, the Sepsis-3 clinical criteria have a potential role in detection, risk-stratification, and prognostication, though their accuracy in comparison to the Systemic Inflammatory Response Syndrome (SIRS)-based septic shock criteria are unknown. We sought to evaluate prognostic accuracy of the Sepsis-3 criteria for in-hospital mortality among infected hospitalized patients with acute deterioration...
May 17, 2018: Chest
https://www.readbyqxmd.com/read/29778658/marijuana-and-lung-disease
#3
REVIEW
Donald P Tashkin
As marijuana smoking prevalence increases in the U.S. concern regarding its potential risks to lung health has also risen, given the general similarity in the smoke contents between marijuana and tobacco. Most studies have found a significant association between marijuana smoking and chronic bronchitis symptoms after adjustment for tobacco. While reports are mixed regarding associations between marijuana smoking and lung function, none has shown a relationship to decrements in forced expired volume in 1 sec (FEV1) and few have found a relationship to a decreased ratio of FEV1 to forced vital capacity (FVC), possibly related to an association between marijuana and an increased FVC...
May 17, 2018: Chest
https://www.readbyqxmd.com/read/29777655/long-term-outcomes-in-systemic-sclerosis-associated-pulmonary-arterial-hypertension-from-the-pulmonary-hypertension-assessment-and-recognition-of-outcomes-in-scleroderma-registry-pharos
#4
Kathleen D Kolstad, Shufeng Li, Virginia Steen, Lorinda Chung
BACKGROUND: Pulmonary arterial hypertension (PAH) is a leading cause of death in patients with systemic sclerosis (SSc). The purpose of this study was to assess long-term outcomes in patients with SSc-PAH. METHODS: Pulmonary Hypertension Assessment and Recognition of Outcomes in Scleroderma is a prospective registry of SSc patients at high risk for or with incident pulmonary hypertension based on right heart catheterization (RHC). Incident World Health Organization Group I PAH patients were analyzed...
May 16, 2018: Chest
https://www.readbyqxmd.com/read/29763589/%C3%AE-1-antitrypsin-polymerizes-in-alveolar-macrophages-of-smokers-with-and-without-%C3%AE-1-antitrypsin-deficiency
#5
Erica Bazzan, Mariaenrica Tinè, Davide Biondini, Riccardo Benetti, Simonetta Baraldo, Graziella Turato, Stefano Fagiuoli, Aurelio Sonzogni, Chiara Rigobello, Federico Rea, Fiorella Calabrese, Maria Pia Foschino-Barbaro, Elena Miranda, David A Lomas, Marina Saetta, Manuel G Cosio
BACKGROUND: The deficiency of α1 -antitrypsin (AAT) is secondary to misfolding and polymerization of the abnormal Z-AAT in liver cells and is associated with lung emphysema. Alveolar macrophages (AM) produce AAT, however it is not known if Z-AAT can polymerize in AM, further decreasing lung AAT and promoting lung inflammation. AIMS: To investigate if AAT polymerizes in human AM and to study the possible relation between polymerization and degree of lung inflammation...
May 12, 2018: Chest
https://www.readbyqxmd.com/read/29758181/development-and-validation-of-web-based-nomograms-to-precisely-predict-conditional-risk-of-site-specific-recurrence-for-patients-with-completely-resected-non-small-cell-lung-cancer-a-multi-institutional-study
#6
Yang Zhang, Difan Zheng, Juntao Xie, Yuan Li, Yiyang Wang, Chenguang Li, Jiaqing Xiang, Yawei Zhang, Hong Hu, Yihua Sun, Haiquan Chen
BACKGROUND: There is currently no consensus regarding the optimal postoperative follow-up strategy for completely resected non-small cell lung cancer (NSCLC) patients. We aimed to develop web-based nomograms to precisely predict site-specific postoperative recurrence of NSCLC patients and to guide individual surveillance strategies including when to follow-up and what diagnostic tests to perform. METHODS: We investigated the pattern of recurrence in a series of 2017 NSCLC (squamous cell carcinoma and non-lepidic invasive adenocarcinoma) patients who underwent complete surgical resection in Fudan University Shanghai Cancer Center (development cohort), and developed web-based clinicopathologic prediction models for conditional risk of site-specific recurrence based on Cox regression...
May 11, 2018: Chest
https://www.readbyqxmd.com/read/29752973/big-data-and-data-science-in-critical-care
#7
REVIEW
L Nelson Sanchez-Pinto, Yuan Luo, Matthew M Churpek
The digitalization of the healthcare system has resulted in a deluge of clinical Big Data and has prompted the rapid growth of data science in medicine. Data science, which is the field of study dedicated to the principled extraction of knowledge from complex data, is particularly relevant in the critical care setting. The availability of large amounts of data in the intensive care unit, the need for better evidence-based care, and the complexity of critical illness makes the use of data science techniques and data-driven research particularly appealing to intensivists...
May 9, 2018: Chest
https://www.readbyqxmd.com/read/29750923/ion-channel-modulators-in-cystic-fibrosis
#8
REVIEW
Martina Gentzsch, Marcus A Mall
Cystic fibrosis (CF) is caused by mutations in the cystic fibrosis transmembrane conductance regulator (CFTR) gene and remains one of the most common life-shortening genetic diseases affecting the lung and other organs. CFTR functions as a cAMP-dependent anion channel that transports chloride and bicarbonate across epithelial surfaces and disruption of these ion transport processes plays a central role in the pathogenesis of CF. These findings provided the rationale for pharmacological modulation of ion transport, either by targeting mutant CFTR or alternative ion channels that can compensate for CFTR dysfunction, as a promising therapeutic approach...
May 8, 2018: Chest
https://www.readbyqxmd.com/read/29750922/legal-aspects-of-sleep-medicine-in-the-21-st-century
#9
REVIEW
Saiprakash B Venkateshiah, Romy Hoque, Nancy A Collop
Multiple manifestations of sleep disorders may interact with the law making it important to increase awareness of such interactions among clinicians. Patients with excessive sleepiness may have civil (and in some states criminal) liability if they fall asleep while driving and cause a motor vehicle accident. Employers may be held vicariously liable due to the actions of sleepy employees. Hence awareness of causes of excessive sleepiness such as sleep deprivation and OSA is increasing among trucking, railroad, and other safety sensitive occupations...
May 8, 2018: Chest
https://www.readbyqxmd.com/read/29730328/poor-subpleural-perfusion-predicts-failure-after-balloon-pulmonary-angioplasty-for-non-operable-chronic-thromboembolic-pulmonary-hypertension
#10
Yu Taniguchi, Philippe Brenot, Xavier Jais, Carlos Garcia, Jason Weatherald, Olivier Planche, Elie Fadel, Marc Humbert, Gérald Simonneau
BACKGROUND: Poor subpleural perfusion (PSP) in the capillary phase of pulmonary angiography predicts worse outcomes after pulmonary endarterectomy in operable chronic thromboembolic pulmonary hypertension (CTEPH). Balloon pulmonary angioplasty (BPA) has emerged for non-operable CTEPH. We assessed the association between PSP and BPA failure. METHOD: Subpleural perfusion was classified as poor (defined as subpleural spaces either not or minimally perfused in all segments) or normal...
May 3, 2018: Chest
https://www.readbyqxmd.com/read/29723514/the-evolutional-history-of-electromagnetic-navigation-bronchoscopy-state-of-the-art
#11
REVIEW
Atul C Mehta, Kristin L Hood, Yehuda Schwarz, Stephen B Solomon
Electromagnetic navigation bronchoscopy (ENB) has come a long way from the early roots of electromagnetic theory. Current ENB devices have the potential to change the way lung cancer is detected and treated. This paper provides an overview of the history, current state, and future of ENB.
April 30, 2018: Chest
https://www.readbyqxmd.com/read/29723513/cardiac-cath-labs-their-origins-and-their-future
#12
James E Dalen, Joseph S Alpert
No abstract text is available yet for this article.
April 30, 2018: Chest
https://www.readbyqxmd.com/read/29705221/early-corticosteroids-for-pneumocystis-pneumonia-in-adults-without-hiv-are-not-associated-with-better-outcome
#13
Patrick M Wieruszewski, Jason N Barreto, Erin Frazee, Craig E Daniels, Pritish K Tosh, Ross A Dierkhising, Kristin C Mara, Andrew H Limper
BACKGROUND: Evidence supporting adjunctive corticosteroids during the treatment of Pneumocystis pneumonia (PcP) in adults without human immunodeficiency virus (HIV) is minimal and controversial. METHODS: This retrospective cohort study included PcP-positive, hospitalized patients without HIV admitted to Mayo Clinic from 2006 to 2016. Change from baseline in the respiratory component of the Sequential Organ Failure Assessment score (SOFAresp ) at day 5 was compared between early (within 48 hours) steroid recipients and non-recipients utilizing multivariable logistic regression and in a propensity-matched analysis...
April 26, 2018: Chest
https://www.readbyqxmd.com/read/29705220/psychometric-validation-of-the-pulmonary-arterial-hypertension-symptoms-and-impact-pah-sympact-%C3%A2-questionnaire-results-of-the-symphony-trial
#14
Kelly M Chin, Mardi Gomberg-Maitland, Richard N Channick, Michael J Cuttica, Aryeh Fischer, Robert P Frantz, Elke Hunsche, Leah Kleinman, John W McConnell, Vallerie V McLaughlin, Chad E Miller, Roham T Zamanian, Michael S Zastrow, David B Badesch
BACKGROUND: Disease-specific patient-reported outcome (PRO) instruments are important in assessing the impact of disease and treatment. PAH-SYMPACT® is the first questionnaire for quantifying pulmonary arterial hypertension (PAH) symptoms and impacts developed following the 2009 FDA PRO guidance; previous qualitative research with PAH patients supported its initial content validity. METHODS: Content finalization and psychometric validation were conducted using data from SYMPHONY, a single-arm, 16-week study with macitentan 10mg in US patients with PAH...
April 26, 2018: Chest
https://www.readbyqxmd.com/read/29705219/multicentric-standardized-flow-cytometry-routine-assessment-of-septic-patient-to-predict-clinical-worsening
#15
Thomas Daix, Estelle Guerin, Elsa Tavernier, Emmanuelle Mercier, Valérie Gissot, Olivier Hérault, Jean-Paul Mira, Florence Dumas, Nicolas Chapuis, Christophe Guitton, Marie C Béné, Jean-Pierre Quenot, Cindy Tissier, Julien Guy, Gaël Piton, Anne Roggy, Grégoire Muller, Éric Legac, Nicolas de Prost, Mehdi Khellaf, Orianne Wagner-Ballon, Rémi Coudroy, Elodie Dindinaud, Fabrice Uhel, Mikaël Roussel, Thomas Lafon, Robin Jeannet, Frédéric Vargas, Catherine Fleureau, Mickaël Roux, Kaoutar Allou, Philippe Vignon, Jean Feuillard, Bruno François
BACKGROUND: In this study, we primarily sought to assess the ability of flow cytometry to predict early clinical deterioration and overall survival in septic patients admitted in the emergency department and intensive care unit. METHODS: Patients admitted for community-acquired acute sepsis from 11 hospital centers were eligible. Early (Day 7) and late (Day 28) deaths were notified. Levels of CD64pos granulocytes, CD16pos monocytes, CD16dim immature granulocytes (IG), T and B lymphocytes were assessed by flow cytometry, using an identical, cross-validated, robust and simple consensus standardized protocol in each center...
April 26, 2018: Chest
https://www.readbyqxmd.com/read/29705218/acute-tetrahydrobiopterin-improves-endothelial-function-in-patients-with-copd
#16
Paula Rodriguez-Miguelez, Justin Gregg, Nichole Seigler, Leon Bass, Jeffrey Thomas, Jennifer S Pollock, Jennifer C Sullivan, Thomas A Dillard, Ryan A Harris
BACKGROUND: Cardiovascular diseases represent a hallmark characteristic in chronic obstructive pulmonary disease (COPD), and endothelial dysfunction has been observed in these patients. Tetrahydrobiopterin (BH4 ) is an essential cofactor for nitric oxide (NO) synthesis and a regulator of endothelial function. This study sought to test the hypothesis that a single dose of BH4 would improve endothelial function in patients with COPD via an increase in NO bioavailability. METHODS: 17 patients with COPD completed a randomized, double blind, placebo-controlled, crossover trial with an acute dose of either BH4 (Kuvan® , BioMarin Pharmaceuticals) or placebo (PLC)...
April 26, 2018: Chest
https://www.readbyqxmd.com/read/29705217/lower-glucose-target-is-associated-with-improved-30-day-mortality-in-cardiac-and-cardiothoracic-patients
#17
Andrew M Hersh, Eliotte L Hirshberg, Emily L Wilson, James F Orme, Alan H Morris, Michael J Lanspa
BACKGROUND: Practice guidelines recommend against Intensive Insulin Therapy (IIT) in critically ill patients based on trials that had high rates of severe hypoglycemia. Intermountain Healthcare uses a computerized intravenous insulin protocol (eProtocol-insulin) that allows choice of blood glucose (BG) targets (80-110 mg/dl versus 90-140 mg/dl), and has low rates of severe hypoglycemia. We sought to study the effects of BG target on mortality in adult patients in cardiac intensive care units (ICUs) that have very low rates of severe hypoglycemia...
April 26, 2018: Chest
https://www.readbyqxmd.com/read/29704475/chronic-cough-related-to-acute-viral-bronchiolitis-in-children-chest-expert-panel-report
#18
Anne B Chang, John J Oppenheimer, Bruce K Rubin, Miles Weinberger, Richard S Irwin
BACKGROUND: Acute bronchiolitis is common in young children and some children develop chronic cough after their bronchiolitis. We thus undertook systematic reviews based on key questions (KQs) using the PICO format. The KQs were: Among children with chronic cough (>4 weeks) after acute viral bronchiolitis, how effective are the following interventions in improving the resolution of cough?: (1) Antibiotics. If so what type and for how long? (2) Asthma medications (inhaled steroids, beta2 agonist, montelukast) and; (3) Inhaled osmotic agents like hypertonic saline? METHODS: We used the CHEST expert cough panel's protocol and the American College of Chest Physicians (CHEST) methodological guidelines and GRADE framework...
April 25, 2018: Chest
https://www.readbyqxmd.com/read/29698721/fixed-but-not-autoadjusting-positive-airway-pressure-attenuates-the-time-dependent-decline-in-glomerular-filtration-rate-in-patients-with-obstructive-sleep-apnea
#19
Oreste Marrone, Fabio Cibella, Jean-Louis Pépin, Ludger Grote, Johan Verbraecken, Tarja Saaresranta, John A Kvamme, Ozen K Basoglu, Carolina Lombardi, Walter T McNicholas, Jan Hedner, Maria R Bonsignore
BACKGROUND: The impact of treating obstructive sleep apnea (OSA) on renal function decline is controversial. Previous studies usually included small samples and did not consider specific effects of different continuous positive airway pressure (CPAP) modalities. The aim of this study was to evaluate the respective influence of fixed and auto-adjusting CPAP modes on estimated glomerular filtration rate (eGFR) in a large sample of patients derived from the prospective European Sleep Apnea Database (ESADA) cohort...
April 23, 2018: Chest
https://www.readbyqxmd.com/read/29698720/comparison-of-two-lidocaine-administration-techniques-on-perceived-pain-from-bedside-procedures-a-randomized-clinical-trial
#20
Bhakti K Patel, Blair N Wendlandt, Krysta S Wolfe, Shruti B Patel, Elizabeth Doman, Anne S Pohlman, Jesse B Hall, John P Kress
BACKGROUND: Lidocaine is used to alleviate procedural pain, but paradoxically increases pain during injection. Pain perception can be modulated by non-noxious stimuli such as temperature or touch according to the gate control theory of pain. We postulated that lidocaine dripped onto the skin prior to injection would cool or touch the skin surface to reduce pain perception from the procedure. METHODS: We conducted a randomized clinical trial of patients referred to the procedure service from February 2011 thru March 2015...
April 23, 2018: Chest
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