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https://www.readbyqxmd.com/read/27890714/a-randomized-trial-of-the-amikacin-fosfomycin-inhalation-system-for-the-adjunctive-therapy-of-gram-negative-ventilator-associated-pneumonia-iasis-trial
#1
Marin H Kollef, Jean-Damien Ricard, Damien Roux, Bruno Francois, Eleni Ischaki, Zsolt Rozgonyi, Thierry Boulain, Zsolt Ivanyi, Gál János, Denis Garot, Firas Koura, Epaminondas Zakynthinos, George Dimopoulos, Antonio Torres, Wayne Danker, A Bruce Montgomery
BACKGROUND: Clinical failures in ventilator-associated pneumonia (VAP) caused by Gram-negative bacteria are common and associated with substantial morbidity, mortality, and resource utilization. METHODS: We assessed the safety and efficacy of the amikacin fosfomycin inhalation system (AFIS) for the treatment of Gram-negative bacterial VAP in a randomized double-blind, placebo-controlled, parallel group, phase 2 study between May 2013 and March 2016. We compared standard of care in each arm plus 300 mg amikacin/120 mg fosfomycin or placebo (saline), delivered by aerosol twice daily for 10 days (or to extubation if <10 days) via the investigational eFlow Inline System (PARI GmbH, Germany)...
November 24, 2016: Chest
https://www.readbyqxmd.com/read/27890713/allogeneic-human-mesenchymal-stem-cells-in-patients-with-idiopathic-pulmonary-fibrosis-via-intravenous-delivery-aether-a-phase-i-safety-clinical-trial
#2
Marilyn K Glassberg, Julia Minkiewicz, Rebecca L Toonkel, Emmanuelle S Simonet, Gustavo A Rubio, Darcy Difede, Shirin Shafazand, Aisha Khan, Marietsy V Pujol, Vincent F LaRussa, Lisa H Lancaster, Glenn D Rosen, Joel Fishman, Yolanda N Mageto, Adam Mendizabal, Joshua M Hare
BACKGROUND: Despite recent FDA approval of two new drugs for idiopathic pulmonary fibrosis (IPF), curative therapies remain elusive and mortality remains high. Pre-clinical and clinical data support the safety of human mesenchymal stem cells as a potential novel therapy for this fatal condition. The AETHER trial was the first study designed to evaluate the safety of a single infusion of bone marrow-derived mesenchymal stem cells in patients with idiopathic pulmonary fibrosis. METHODS: Nine patients with mild to moderate IPF were sequentially assigned to one of three cohorts and dosed with a single intravenous infusion of 20, 100, or 200 x 10(6) human bone marrow-derived mesenchymal stem cells per infusion from young, unrelated, male donors...
November 24, 2016: Chest
https://www.readbyqxmd.com/read/27890712/quantitative-ct-measures-of-bronchiectasis-in-smokers
#3
Alejandro A Diaz, Thomas P Young, Diego J Maselli, Carlos H Martinez, Ritu Gill, Pietro Nardelli, Wei Wang, Gregory L Kinney, John E Hokanson, George R Washko, Raul San Jose Estepar
BACKGROUND: Bronchiectasis is frequent in smokers with COPD, however there is only limited data on objective assessments of this process. OBJECTIVE: To objectively assess bronchovascular morphology, calculate the ratio of the diameters of bronchial lumen and adjacent artery (BA ratio), and identify those measurements able to discriminate bronchiectasis. METHODS: We collected quantitative computed tomography (QCT) measures of BA ratios, peak wall attenuation, wall thickness (WT), wall area, and wall area percent (WA%) at matched 4(th)-6(th) airway generations in 21 ever smokers with bronchiectasis (cases) and 21 never-smoking controls (control airways)...
November 24, 2016: Chest
https://www.readbyqxmd.com/read/27889361/adult-bronchiectasis-patients-a-first-look-at-the-united-states-bronchiectasis-research-registry
#4
Timothy R Aksamit, Anne E O'Donnell, Alan Barker, Kenneth N Olivier, Kevin L Winthrop, M Leigh Anne Daniels, Margaret Johnson, Edward Eden, David Griffith, Michael Knowles, Mark Metersky, Matthias Salathe, Byron Thomashow, Gregory Tino, Gerard Turino, Betsy Carretta, Charles L Daley
OBJECTIVE: We sought to describe the characteristics of adult bronchiectasis patients enrolled in the United States Bronchiectasis Research Registry (BRR). METHODS: The BRR is a database of non-cystic fibrosis bronchiectasis (NCFB) patients enrolled at 13 sites within the United States. Baseline demographic, spirometric, imaging, microbiologic, and therapeutic data were entered into a central web-based database. Patients were subsequently analyzed by the presence NTM...
November 23, 2016: Chest
https://www.readbyqxmd.com/read/27889360/validation-of-the-exhaled-breath-temperature-measure-reference-values-in-healthy-subjects
#5
Giovanna E Carpagnano, Maria P Foschino-Barbaro, Corrado Crocetta, Donato Lacedonia, Valerio Saliani, Luigi Davide Zoppo, Peter J Barnes
BACKGROUND: Exhaled breath temperature (EBT) is a new non-invasive method for the study of inflammatory respiratory diseases with a potential to reach clinical practice. However, few studies, and mainly derived from small, paediatric populations, are available on the validation of the method and the range of normal values is not well established. The aim of this study was to measure EBT values in an Italian population of 298 (45.2±15.5 yrs, 143 male, FEV1 97.2±5.8%, FVC 98.4±3.9%) selected from 867 adult volunteers, in order to define reference values in healthy subjects and to analyse the influence of individual and external variables on this parameter...
November 23, 2016: Chest
https://www.readbyqxmd.com/read/27884767/eif2ak4-mutations-in-patients-diagnosed-with-pulmonary-arterial-hypertension
#6
D Hunter Best, Kelli L Sumner, Benjamin P Smith, Kristy Damjanovich-Colmenares, Ikue Nakayama, Lynette M Brown, Youna Ha, Eleri Paul, Ashley Morris, Mohamed A Jama, Mark W Dodson, Pinar Bayrak-Toydemir, C Gregory Elliott
BACKGROUND: Differentiating pulmonary veno-occlusive disease (PVOD) and pulmonary capillary hemangiomatosis (PCH) from idiopathic or heritable pulmonary arterial hypertension (IPAH and HPAH) is important clinically. Mutations in eukaryotic translation initiation factor 2 alpha kinase 4 (EIF2AK4) cause heritable PVOD and PCH whereas mutations in other genes cause HPAH. The aim of this study is to describe the frequency of pathogenic EIF2AK4 mutations in patients diagnosed clinically with IPAH or HPAH...
November 21, 2016: Chest
https://www.readbyqxmd.com/read/27884766/mechanisms-of-vascular-dysfunction-in-copd-and-effects-of-a-novel-soluble-epoxide-hydrolase-inhibitor-in-smokers
#7
Lucy Yang, Joseph Cheriyan, David D Gutterman, Ruth J Mayer, Zsuzsanna Ament, Jules L Griffin, Aili L Lazaar, David E Newby, Ruth Tal-Singer, Ian B Wilkinson
BACKGROUND: Smoking and chronic obstructive pulmonary disease (COPD) are risk factors for cardiovascular disease, and the pathogenesis may involve endothelial dysfunction. We tested the hypothesis that endothelium-derived epoxyeicosatrienoic acid (EET)-mediated endothelial function is impaired in patients with COPD, and a novel sEH inhibitor GSK2256294 attenuates EET-mediated endothelial dysfunction in human resistance vessels both in vitro and in vivo. METHODS: Endogenous and stimulated endothelial release of EETs was assessed in 12 COPD patients, 11 overweight smokers, and 2 matched control groups, using forearm plethysmography with intra-arterial infusions of fluconazole, bradykinin, and the combination...
November 21, 2016: Chest
https://www.readbyqxmd.com/read/27884765/efficacy-of-clarithromycin-naproxen-oseltamivir-combination-in-the-treatment-of-patients-hospitalized-for-influenza-a-h3n2-infection-an-open-label-randomized-controlled-phase-2b-3-trial
#8
Ivan Fn Hung, Kelvin Kw To, Jasper Fw Chan, Vincent Cc Cheng, Kevin Sh Liu, Anthony Tam, Tuen-Ching Chan, Anna Jinxia Zhang, Patrick Li, Tin-Lun Wong, Ricky Zhang, Michael Ks Cheung, William Leung, Johnson Yn Lau, Manson Fok, Honglin Chen, Kwok-Hung Chan, Kwok-Yung Yuen
BACKGROUND: Influenza causes excessive hospitalizations and deaths. Single agent treatment with oseltamivir in severe influenza might be insufficient. The study assessed the efficacy and safety of oseltamivir-clarithromycin-naproxen combination for treatment of serious influenza. METHODS: From February to April 2015, we conducted a prospective open-label randomized-controlled trial. Adult patients hospitalized for A(H3N2) influenza were randomly assigned to a 2-day combination of clarithromycin 500mg, naproxen 200mg and oseltamivir 75mg twice daily, followed by 3 days of oseltamivir; or oseltamivir 75mg twice daily without placebos for 5 days as control (1:1)...
November 21, 2016: Chest
https://www.readbyqxmd.com/read/27876592/sirs-qsofa-and-organ-dysfunction-insights-from-a-prospective-database-of-emergency-department-patients-with-infection
#9
Julian M Williams, Jaimi H Greenslade, Juliet V McKenzie, Kevin Chu, Anthony Ft Brown, Jeffrey Lipman
OBJECTIVE: A proposed revision of sepsis definitions has abandoned SIRS, defined organ dysfunction as an increase in total SOFA score of ≥2, and conceived "qSOFA" as a bedside indicator of organ dysfunction. We aimed to (1) determine the prognostic impact of SIRS, (2) compare diagnostic accuracy of SIRS and qSOFA for organ dysfunction, and (3) compare standard (Sepsis-2) and revised (Sepsis-3) definitions for organ dysfunction in emergency department patients with infection. METHODS: Consecutive ED patients admitted with presumed infection were prospectively enrolled over three years...
November 19, 2016: Chest
https://www.readbyqxmd.com/read/27876591/cystic-fibrosis-and-the-nervous-system
#10
REVIEW
Leah R Reznikov
Cystic Fibrosis (CF) is a life-shortening autosomal recessive disorder caused by mutations in the gene encoding the cystic fibrosis transmembrane conductance regulator (CFTR). CFTR is an anion channel that conducts bicarbonate and chloride across cell membranes. While defective anion transport across epithelial cells is accepted as the basic defect in CF, many of the features observed in people with CF and organs affected in CF are modulated by the nervous system. This is of interest because CFTR expression has been reported in both the peripheral and central nervous systems, and it is well known that the transport of anions, such as chloride, greatly modulates neuronal excitability...
November 19, 2016: Chest
https://www.readbyqxmd.com/read/27876590/clinical-prognosis-of-non-massive-central-and-non-central-pulmonary-embolism-a-registry-based-cohort-study
#11
Bobby Gouin, Marc Blondon, David Jiménez, Carmen Fernández-Capitán, Henri Bounameaux, Silvia Soler, Rita Duce, Joan Carles Sahuquillo, Nuria Ruiz-Giménez, Manuel Monreal
BACKGROUND: Whether the localization of non-massive pulmonary embolism (PE) is associated with the short and long-term prognosis of patients remains unknown. Our aim is to characterize associations of non-massive PE localization with risks of recurrent venous thromboembolism (VTE), major bleeding and mortality during and after anticoagulation. METHODS: Among participants of the RIETE registry with an incident symptomatic non-massive PE diagnosed by computerized tomography (CT), we compared risks of recurrent VTE, major bleeding and mortality during and after anticoagulation period between central PE (main pulmonary artery) and non-central PE (more peripheral arteries), using Cox proportional hazard adjusted models...
November 19, 2016: Chest
https://www.readbyqxmd.com/read/27876589/usa-hospitalizations-for-malignant-pleural-effusions-data-from-the-2012-national-inpatient-sample
#12
Niloofar Taghizadeh, Marc Fortin, Alain Tremblay
BACKGROUND: Malignant pleural effusions (MPE) are a common complication of advanced malignancy, but little is known regarding their prevalence and overall burden on a population level. METHODS: We conducted a retrospective analysis of MPE associated hospitalizations using the Healthcare Cost and Utilization Project-Nationwide Inpatient Sample, Agency for Healthcare Research and Quality (HCUP-NIS 2012). Cases were included if MPE was coded as a primary or secondary diagnosis or if an unspecified pleural effusion was coded in addition to a diagnosis of cancer with either of these being the primary diagnosis...
November 19, 2016: Chest
https://www.readbyqxmd.com/read/27865877/cough-in-the-athlete-chest-guideline-and-expert-panel-report
#13
Louis-Philippe Boulet, Julie Turmel, Richard S Irwin
BACKGROUND: Cough is a common symptom experienced by athletes, particularly after exercise. We performed a systematic review to assess in this population: 1) the main etiologies of acute and recurrent cough, either exercise-induced or not; 2) how it is assessed; and 3) how cough is treated in this population. From the systematic review, suggestions for management were developed. METHOD: ology: This review was done according to the CHEST methodological guidelines and GRADE framework up to April 2015...
November 16, 2016: Chest
https://www.readbyqxmd.com/read/27865876/interstitial-lung-disease-in-the-elderly
#14
Karen C Patterson, Rupal J Shah, Mary K Porteous, Jason D Christie, Carly D'Errico, Matthew Chadwick, Matthew Triano, Charuhas Deshpande, Milton D Rossman, Leslie A Litzky, Maryl E Kreider, Wallace T Miller
BACKGROUND: Despite the relationship of idiopathic pulmonary fibrosis (IPF) with advancing age, little is known about the epidemiology of interstitial lung diseases (ILD) in the elderly. Here we describe the diagnoses, clinical characteristics, and outcomes of patients who were elderly at the time of ILD diagnosis. METHODS: Among subjects from a prospective cohort study of ILD, elderly was defined as age > 70. Diagnoses were derived from a multi-disciplinary review...
November 16, 2016: Chest
https://www.readbyqxmd.com/read/27845052/the-management-of-benign-pleural-effusions-using-indwelling-pleural-catheters-a-systematic-review-and-meta-analysis
#15
Monali Patil, Samjot Singh Dhillon, Kristopher Attwood, Marwan Saoud, Abdul H Alraiyes, Kassem Harris
INTRODUCTION: Indwelling pleural catheter (IPC), which was initially introduced for the management of recurrent malignant effusions, could be a valuable management option for recurrent benign pleural effusions (BPE) in place of chemical pleurodesis. The purpose of this study is to analyze the efficacy and safety of IPC in the management of refractory non-malignant effusions. METHODS: We conducted a systematic review and meta-analysis on the published literature...
November 11, 2016: Chest
https://www.readbyqxmd.com/read/27818334/neuromuscular-blockade-in-the-21-st-century-management-of-the-critically-ill-patient
#16
REVIEW
Julian deBacker, Nicholas Hart, Eddy Fan
Neuromuscular blockings agents (NMBAs) have a controversial role in the ventilatory and medical management of critical illness. The clinical concern surrounding NMBA-induced complications stems from evidence presented in the 2002 clinical practice guidelines, but new evidence from subsequent randomized trials and studies provides a more optimistic outlook about the application of NMBAs in the intensive care unit (ICU). Furthermore, changes in the delivery of critical care such as protocolized care pathways, minimizing or interrupting sedation, increased monitoring techniques, and overall improvements in reducing immobility have created a modern, 21st century ICU environment whereby NMBAs may be administered safely...
November 3, 2016: Chest
https://www.readbyqxmd.com/read/27818333/pulmonary-hypertension-care-center-network-improving-care-and-outcomes-in-ph
#17
Sandeep Sahay, Lana Melendres-Groves, Leena Pawar, Hector R Cajigas
Pulmonary Hypertension (PH) is a chronic, progressive, life threatening disease that requires multidisciplinary expert care. To facilitate this expert, multidisciplinary care, the PH association established a network of pulmonary hypertension care centers (PHCC) with special expertise in pulmonary hypertension (PH), particularly pulmonary arterial hypertension (PAH), to raise the overall quality of care and outcomes in patients with this life-threatening disease across the United States (US). Since the inception of PHCC in September 2014, till date thirty-five centers have been accredited in the US...
November 3, 2016: Chest
https://www.readbyqxmd.com/read/27818332/accuracy-of-lung-ultrasound-in-the-diagnosis-of-pneumonia-in-adults-systematic-review-and-meta-analysis
#18
Ana M Llamas-Álvarez, Eva M Tenza-Lozano, Jaime Latour-Pérez
BACKGROUND: Some studies suggest that lung ultrasound could be useful for diagnosing pneumonia; moreover, it has a more favorable safety profile and lower cost than chest X-ray (CXR) and computed tomography (CT). The aim of this study is to assess the accuracy of bedside lung ultrasound for diagnosing pneumonia in adults through a systematic review and meta-analysis. METHODS: We searched MEDLINE, Scopus, The Cochrane Library, Web of Science, DARE, HTA Database, Google Scholar, LILACS, ClinicalTrials...
November 3, 2016: Chest
https://www.readbyqxmd.com/read/27818331/liberation-from-mechanical-ventilation-an-official-american-college-of-chest-physicians-american-thoracic-society-clinical-practice-guideline-inspiratory-pressure-augmentation-during-spontaneous-breathing-trials-protocols-minimizing-sedation-and-non-invasive
#19
Daniel R Ouellette, Sheena Patel, Timothy D Girard, Peter E Morris, Gregory A Schmidt, Jonathon D Truwit, Waleed Al-Hazzani, Suzanne M Burns, Scott K Epstein, Andres Esteban, Eddy Fan, Miguel Ferrer, Gilles L Fraser, Michelle Gong, Catherine L Hough, Sangeeta Mehta, Rahul Nanchal, Amy J Pawlik, William Schweickert, Curtis N Sessler, Thomas Strøm, John P Kress
BACKGROUND: An update of evidence-based guidelines concerning liberation from mechanical ventilation is needed as new evidence has become available. The American College of Chest Physicians (CHEST) and the American Thoracic Society (ATS) have collaborated to provide recommendations to clinicians concerning ventilator liberation. METHODS: Comprehensive evidence syntheses, including meta-analyses, were performed to summarize all available evidence relevant to the guideline panel's questions...
November 3, 2016: Chest
https://www.readbyqxmd.com/read/27818330/alive-in-the-airways-live-endobronchial-foreign-bodies
#20
REVIEW
Syed Rizwan Ali, Atul C Mehta
Aspiration of a foreign body into the lower airways is a common occurrence and can cause significant morbidity and mortality in humans. Most foreign bodies of the tracheobronchial tree are inanimate. However, medical literature includes reports of live foreign bodies in the airways. Fish, leeches and roundworms are the most common live foreign bodies of the lower airways. Fishermen are more prone to experience a live-fish aspiration while substandard conditions may expose individuals to leech and roundworm infestations...
November 3, 2016: Chest
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