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Julie Erb-Alvarez, Aaron M Wendelboe, Daniel S Chertow
No abstract text is available yet for this article.
September 10, 2019: Chest
Gerald S Supinski, Elizabeth A Schroder, Leigh Ann Callahan
Classically, mitochondria have largely been thought to influence the development of illness by modulating cell metabolism and determining the rate of production of high energy phosphate compounds (e.g. ATP). It is now recognized that this is a simplistic view and that mitochondria play key roles in many other processes, including cell signaling, regulating gene expression, modulating cellular calcium levels and influencing the activation of cell death pathways (e.g. caspase activation). Moreover, these multiple mitochondrial functional characteristics are now known to influence the evolution of cellular and organ function in many disease states, including sepsis, ICU acquired skeletal muscle dysfunction, acute lung injury, acute renal failure, and critical illness related immune function dysregulation...
September 5, 2019: Chest
Donald Westerhausen, Anthony J Perkins, Joshua Conley, Babar A Khan, Mark Farber
BACKGROUND: Admissions to intensive care unit (ICU) related to alcohol, prescription and illicit drugs shown to be widespread and costly. In 1993, study by Baldwin et al. revealed 28% of ICU admissions at Johns Hopkins Hospital related to substance abuse and accrued 39% costs. Since then, healthcare expenditures have increased, and substance abuse treatment admissions have risen. We conducted a study to provide updated data on ICU utilization and costs related to licit and illicit abuse at a large county hospital in Indianapolis, Indiana...
September 5, 2019: Chest
Nicholas G Jendzjowsky, Margaret M Kelly
Airway remodelling is a characteristic feature of asthma and is thought to play an important role in the pathogenesis of airway hyperresponsiveness. Myofibroblasts are key structural cells involved in injury and repair, and there is evidence that dysregulation of their normal function contributes to airway remodeling. Despite the importance of myofibroblasts, a lack of specific cellular markers and inconsistent nomenclature has limited recognition of their key role in airway remodeling. Myofibroblasts are increased several-fold in the airways in asthma, in proportion to the severity of the disease...
August 28, 2019: Chest
Ashley A Hansen, Amy B Athey, Michael J Ross, Michael A Grandner
While the link between sleep, health and performance has been well-documented, research on this link in collegiate student-athletes is still in its infancy. A large body of evidence indicates that collegiate student-athletes are not obtaining enough sleep, but less is known about their sleep quality, patterns and the impact on health and performance. Consequently, short sleep negatively impacts physical and mental health, and several domains of performance (i.e., aerobic, anaerobic, sport-specific, cognitive)...
August 28, 2019: Chest
Amit K Mahajan, Omar Ibrahim, Ricardo Perez, Catherine L Oberg, Adnan Majid, Erik Folch
Central airway obstruction (CAO) is associated with significant morbidity and increased mortality. Bronchoscopic electrosurgical and laser ablative tools have proven to be safe and effective instruments for the treatment of malignant CAO. While therapeutic modalities such as electrocautery, argon plasma coagulation (APC), and laser have been utilized for decades, additional tools including radiofrequency ablation (RFA) catheters continue to be developed for the treatment of CAO. These modalities are considered safe in the hands of experienced operators, though serious complications can occur...
August 28, 2019: Chest
Amit Chopra, Marc A Judson, Peter Doelken, Fabien Maldonado, Najib Rahman, John T Huggins
INTRODUCTION: Both elevated pleural elastance (E-PEL ) and radiographic evidence of incomplete lung expansion following thoracentesis have been used to exclude patients with a malignant pleural effusion (MPE) from undergoing pleurodesis. We report a cohort of MPE patients in which complete drainage was attempted with pleural manometry to determine the frequency of E-PEL and its relationship with the post-thoracentesis radiographic findings. METHODS: We identified 70 consecutive MPE patients who underwent therapeutic pleural drainage with pleural manometery...
August 28, 2019: Chest
David De la Rosa Carrillo, Casilda Olveira Fuster, Marta García-Clemente, Rosa Ma Girón Moreno, Rosa Nieto Royo, Annie Navarro Rolon, Concepción Prados Sánchez, Oriol Sibila, Miguel-Ángel Martínez-García
BACKGROUND: Health-related Quality of Life (QoL) is one of the most important endpoints in bronchiectasis (BE). However, the majority of HRQoL questionnaires are time-consuming or not validated in BE. The COPD Assessment Test (CAT) in an easy-to-use questionnaire. The objective of this study was to perform a complete validation of CAT in BE. METHODS: Observational, multicenter, prospective study in BE patients. Psychometric properties of CAT were measured: internal consistency (Cronbach´s α), repeatability (test-retest; intra-class correlation coefficient [ICC]), discriminant validity (correlation with severity scores), convergent validity (correlation with some validated QoL questionnaire and other clinical variables of interest), longitudinal validity (measuring before and after each exacerbation during follow-up to determine the sensitivity to change and responsiveness), predictive validity to future exacerbations, and finally minimum clinically important difference (MCID)...
August 22, 2019: Chest
Todd C Crawford, Peter J Leary, Charles Fraser, Alejandro Suarez-Pierre, J Trent Magruder, William A Baumgartner, Kenton J Zehr, Glenn J Whitman, S Carolina Masri, Farooq Sheikh, Teresa De Marco, Bradley A Maron, Kavita Sharma, Nisha A Gilotra, Stuart D Russell, Brian A Houston, Bhavadharini Ramu, Ryan J Tedford
BACKGROUND: At the recent 6th World Symposium on Pulmonary Hypertension (PH), the definition of PH was redefined to include lower pulmonary artery pressures in the setting of an elevated pulmonary vascular resistance (PVR). However, the relevance of this change to subjects with PH due to left heart disease as well as the pre-operative assessment of heart transplant (HT) recipients is unknown. METHODS: The UNOS database was queried to identify adult recipients who underwent primary HT from 1996-2015...
August 22, 2019: Chest
Guirong Wang, Shuqi Wang, Xinting Yang, Qing Sun, Guanglu Jiang, Mailing Huang, Fengmin Huo, Yifeng Ma, Xiaoyou Chen, Hairong Huang
BACKGROUND: The Xpert MTB/RIF (Xpert) assay has greatly improved the diagnosis of tuberculosis (TB) and identification of resistance to rifampicin (RIF). However, sensitivity of Xpert remains poor for pleural fluid detection. This study evaluated the performance of the novel next-generation Xpert MTB/RIF Ultra (Xpert Ultra) in comparison to Xpert for pleural TB diagnosis. METHODS: Pleural TB suspects were enrolled consecutively in four hospitals and pleural fluids were subjected to smear, culture and Xpert...
August 19, 2019: Chest
Heng-Jia Liu, Vera P Krymskaya, Elizabeth P Henske
Pulmonary lymphangioleiomyomatosis (LAM) is a rare genetic multisystem disease characterized by the nodular proliferation of smooth muscle-like LAM cells, progressive cystic changes of the lung, lymphatic abnormalities and renal angiomyolipomas (AMLs). LAM can arise sporadically or in women with the autosomal dominant disorder, tuberous sclerosis complex (TSC), in which hamartomatous tumors of brain, heart, skin, kidney and lung are found. LAM and TSC are caused by mutations in the Tuberous Sclerosis Complex 1 (TSC1) or TSC2 tumor suppressor genes leading to elevated mTORC1 activity...
August 19, 2019: Chest
Élie Azoulay, Nathalie de Castro, François Barbier
The development of combination antiretroviral therapies (cART) in the mid-nineties has dramatically modified the clinical presentation of critically ill HIV-infected patients. Most of cART-treated patients ageing with controlled HIV replication are nowadays admitted to the intensive care unit (ICU) for non-AIDS-related events, mostly bacterial pneumonia and exacerbation of comorbidities, variably impacted by chronic HIV infection - e.g., chronic obstructive pulmonary disease, cardiovascular diseases, or solid neoplasms...
August 14, 2019: Chest
Ning Wang, Kerrie Mengersen, Shilu Tong, Michael Kimlin, Maigeng Zhou, Lijun Wang, Wenbiao Hu
BACKGROUND: The study aimed to identify changing spatial and temporal trends of lung cancer mortality rates (LCMRs) among subpopulations in China (ie., region, age, and sex). METHODS: Data on LCMRs from 2006 to 2015 were extracted from the Chinese National Death Surveillance. Joinpoint regression and seasonal decomposition were used to assess the temporal trends. Geographic information system and spatial kriging interpolation were used to examine the spatial trends...
August 14, 2019: Chest
Stuart L Cohen, Jason J Wang, Nicholas Chan, William O'Connell, Rakesh Shah, Pina Sanelli, Suhail Raoof
BACKGROUND: Effective dose (ED) is used to understand radiation-related cancer risk of CT scans. Currently, ED for low-dose computed tomography (LDCT) lung cancer screening (LCS) is estimated by multiplying the CT reported dose length product (DLP) by a DLP-to-ED conversion factor (k-factor) for general chest CT which does not account for gender. The purpose of this study is to calculate gender-specific k-factors for LDCT LCS. METHODS: This retrospective study evaluates consecutive LCS patients across a large health system from 2016-2017...
August 14, 2019: Chest
Jorrit B A Welling, Karin Klooster, Jorine E Hartman, Huib A M Kerstjens, Ina Franz, Michel M R F Struys, Anthony R Absalom, Dirk-Jan Slebos, Clemens R M Barends
BACKGROUND: Absence of interlobar collateral ventilation is key to successful endobronchial valve treatment in patients with severe emphysema and can be functionally assessed using the Chartis® measurement. Chartis has been validated during spontaneous breathing, undergoing procedural sedation (PS), but can also be performed under general anesthesia (GA). Performing Chartis under PS is often challenging because of coughing, mucus secretion and difficulties in maintaining an adequate level of sedation...
August 14, 2019: Chest
Jaclyn Smith, David Allman, Huda Badri, Robert Miller, Julie Morris, Imran Satia, Andrew Wood, Michael Trower
BACKGROUND: Substance P and the neurokinin-1 (NK-1) receptor are implicated in chronic refractory cough (CRC) pathophysiology. We assessed the efficacy and safety of orvepitant, a brain-penetrant NK-1 antagonist, in an open-label study in CRC patients. METHODS: Thirteen patients with daytime cough frequency >3 to <250 coughs/hour took orvepitant 30 mg once daily for 4 weeks. Objective cough frequency was measured over 24 hours at Baseline and Weeks 1, 4, and 8...
August 14, 2019: Chest
Atul C Mehta, Lawrence F Muscarella
Several recent cases associating cleaned and high-level disinfected duodenoscopes with outbreaks of carbapenem-resistant Enterobacteriaceae (CRE) and related multidrug-resistant organisms (MDROs) may cause bronchoscopists, pulmonologists and other stakeholders to inquire about the adequacy of today's practices for reprocessing flexible bronchoscopes. The primary objectives of this study were to address these questions and investigate the risk of reprocessed bronchoscopes transmitting infections of CRE and related MDROs...
August 14, 2019: Chest
Carli J Lehr, Eugene H Blackstone, Kenneth R McCurry, Lucy Thuita, Wayne M Tsuang, Maryam Valapour
BACKGROUND: Age has been implicated as a factor in the plateau of long-term survival after lung transplant. METHODS: We used data from the Scientific Registry of Transplant Recipients to identify all recipients of lung transplant aged ≥ 18 years of age between January 1, 2006 and February 19, 2015. 14,253 patients were included in the analysis. Survival was estimated using a non-proportional hazard model and random-survival forest methodology was used to examine risk-factors for death...
August 13, 2019: Chest
Daniel Rooney, Simon Herkenrath, Christina Priegnitz, Matthias Putzke, Marcel Treml, Jürgen Wenzel, Daniel Aeschbach, Winfried Randerath
BACKGROUND: Air travel is physically demanding and since obesity is rising physicians increasingly need to assess whether such patients can fly safely. OBJECTIVE: Our aim was to compare the diagnostic accuracy of two routinely used exercise tests, 50 meter (50mWT) and six minutes (6MWT) of walking, and hypoxic challenge testing (HCT) in obese individuals. We further explored the diagnostic potential of perceived dyspnoea as measured with the Borg scale, since this is often recorded subsequent to walking tests...
August 13, 2019: Chest
Stacey-Ann Whittaker Brown, Maria Padilla, Grace Mhango, Charles Powell, Mary Salvatore, Claudia Henschke, David Yankelevitz, Keith Sigel, Juan P de-Torres, Juan Wisnivesky
BACKGROUND: Some interstitial lung diseases are associated with lung cancer. However, it is unclear whether asymptomatic interstitial lung abnormalities convey an independent risk. OBJECTIVES: To assess whether interstitial lung abnormalities are associated with an increased risk of lung cancer. METHODS: We analyzed data from all participants in the National Lung Cancer Trial (NSLT) except for subjects with pre-existing interstitial lung disease or prevalent lung cancers...
August 9, 2019: Chest
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