Chest

No abstract text is available yet for this article.

No abstract text is available yet for this article.

BACKGROUND: The development of pulmonary hypertension (PH) during the course of chronic obstructive pulmonary disease (COPD) is a well-known phenomenon, the prevalence depending on the severity of airway obstruction. When mean pulmonary pressure (mPAP) level at rest is >35 mm Hg or >25 mm Hg with low cardiac index, the term severe pulmonary hypertension has been chosen. For these patients, little is known on the underlying histological lesions. Our objective was to describe these lesions...

BACKGROUND: The relationship of poor sleep patterns to the increased risk of obesity has been reported, but the results are variable. This study evaluated the association between objectively measured sleep patterns and obesity in a representative adult population of Hispanic/Latino subjects living in the United States. METHODS: This cross-sectional study was an analysis of a multicenter, community-based cohort of 2,156 participants aged 18 to 64 years from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL)...

BACKGROUND: Metabolic Syndrome (MetSyn) predicted future development of World Trade Center lung injury(WTC-LI) in a subgroup of never smoking, male firefighters. An intra-cohort validation of MetSyn as predictors of WTC-LI is examined in the WTC-exposed cohort that has been longitudinally followed for 16 years. METHODS: PFTs(N=98,221) of WTC-exposed workers(N=9,566) were evaluated. A baseline cohort of firefighters with normal FEV1 prior to 9/11 and had serum drawn prior to site closure on July 24, 2002(N=7,487) was investigated...

BACKGROUND: Diagnosis of primary ciliary dyskinesia (PCD) relies on a combination of tests. High-speed video microscopy analysis (HSVA) is widely used to contribute to the diagnosis. It can be analysed on the day of diagnostic consultation, but the qualitative analyses are subjective. Diagnostic accuracy and reliability of assessing ciliary function have not been robustly evaluated. We aimed to establish the accuracy of HSVA to diagnose PCD compared to combination of tests, and assess the inter-observer reliability of HSVA analysis...

BACKGROUND: The utility of physical examination findings for pulmonary hypertension (PH) is not well established. The purpose of this study was to prospectively evaluate the diagnostic performance of the physical examination for detecting PH. METHODS: Consecutive patients undergoing right heart catheterization (n=116) were examined by an attending physician, medical resident and medical student in a blinded fashion. Sensitivity, specificity, positive and negative likelihood ratios (LR) were calculated for each physical finding...

BACKGROUND: Short sleep may be a risk factor for atrial fibrillation. However, previous investigations have been limited by lack of objective sleep measurement and small sample size. We sought to determine the association between objectively measured sleep duration and atrial fibrillation. METHODS: All 31,079 adult patients undergoing diagnostic polysomnography from 1999-2015 at multiple sites within a large hospital network were identified from electronic medical records...

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Psychiatric disorders are common in patients with advanced respiratory diseases, including COPD and asthma. These comorbid illnesses are often associated with poor compliance to medical treatment, increased disability, heightened healthcare utilization and premature mortality. Seeking to improve patient outcomes, improve patient satisfaction and decrease the cost of care has led to the creation of alternative care and reimbursement models. One of the most mature of these models is the collaborative care model (CoCM)...

BACKGROUND: The RENEW trial demonstrated improvements in quality of life, pulmonary function, and exercise performance after endobronchial coil treatment. The aim of this study was to identify parameters associated with superior clinical outcomes. METHODS: Quantitative computerized analysis by an independent radiology laboratory and a qualitative evaluation by five blinded experts of the baseline thoracic computed tomograms (CT) were performed. Univariate and multivariate logistic regression analyses were performed to elucidate characteristics associated with clinical response...

Obstructive sleep apnea (OSA) occurs in approximately 1% to 5% of children in the United States. Long-term cardiovascular risks associated with OSA in the adult population are well-documented. Although changes in blood pressure regulation occur in children with OSA, the pathways leading to chronic cardiovascular risks of OSA in children are less clear. Risk factors associated with cardiovascular disease in adult populations could carry the same future risk for children. It is imperative to determine whether known mechanisms of cardiovascular diseases in adults are like those that lead to pediatric disease...

BACKGROUND: Hemoptysis is a major cause of morbidity and mortality in patients with cystic fibrosis (CF). Antifibrinolytic agents have demonstrated efficacy in a broad range of bleeding disorders and conditions. We examine use of antifibrinolytic agents to manage hemoptysis in CF. We developed a clinical treatment pathway for inpatient and outpatient use, and report on rates of admission for bleeding before and after implementation. METHODS: All adult CF patients treated with systemic antifibrinolytic agents over a 54-month period according to the treatment pathway were analyzed...

BACKGROUND: The impact of antibiotic timing on sepsis outcomes remains controversial due to conflicting results in prior studies. This study investigated the association of door-to-antibiotic time with long-term mortality in emergency department (ED) patients with sepsis. METHODS: This retrospective cohort study included non-trauma adult ED patients with clinical sepsis admitted to four hospitals from 2013 to 2017. Only patients' first eligible encounter was included...

Flexible bronchoscopy has evolved over the last few decades allowing the chest physicians to use advanced high definition scopes to inspect the airways and perform various sampling techniques. While the techniques of basic bronchoscopic sampling have not changed dramatically, documentation requirements, coding and billing have become more complex and require a better understanding on the part of the proceduralists and practice administrators. Areas in need of attention include learning about the multiple endoscopy rule, appropriate use of modifiers, and recent changes to the Current Procedural Terminology (CPT) codes associated work relative value units (wRVU) for moderate sedation and therapeutic aspiration of secretions...

BACKGROUND: Guidelines recommend empirical vancomycin or linezolid for suspected pneumonia patients at-risk for methicillin-resistant Staphylococcus aureus (MRSA). Unneeded vancomycin or linezolid use may unnecessarily alter host flora and expose patients to toxicity. We therefore sought to determine if rapid testing for MRSA in bronchoalveolar lavage (BAL) can safely decrease use of vancomycin or linezolid for suspected MRSA pneumonia. METHODS: Operating characteristics of the assay were initially validated against culture on residual BAL...

BACKGROUND: Pulmonary edema may complicate the use of pulmonary arterial hypertension (PAH) targeted therapies. We aimed to determine the proportion of patients who develop pulmonary edema after initiation of parenteral prostacyclin therapy, to identify its risk factors, and to assess its implications on hospital length of stay and mortality. METHODS: A retrospective cohort study of PAH patients at the initiation of parenteral prostacyclin between 1997 and 2015 enrolled in the Cleveland Clinic PAH registry...

BACKGROUND: Malignant airway obstruction (MAO) occurs in 30% of patients with advanced stage lung cancer leading to debilitating dyspnea, cough and hemoptysis. Other than recanalization of the airways, these patients lack long-lasting palliative therapy. The goal of this study was to determine the safety and feasibility of local injection of paclitaxel into the airway wall with a novel microinjection catheter. METHODS: In this multicentered prospective trial, 23 patients with non-small cell lung cancer (NSCLC) and MAO from July 2014 through June 2016 were enrolled to undergo rigid bronchoscopy with recanalization, followed by injection of 1...

BACKGROUND: Pulmonary arterial hypertension is a progressive, fatal disease. Published treatment guidelines recommend treatment escalation based on regular patient assessment with the goal of achieving or maintaining low-risk status. Various strategies are available to determine risk status. This analysis describes an update of the REVEAL risk calculator (REVEAL 2.0) and compares it with recently published ESC/ERS guidelines-derived risk assessment strategies. METHODS: A subpopulation from the U...

BACKGROUND: Procalcitonin (PCT)-guided antibiotic discontinuation appears to decrease antibiotic use in critically ill patients, but its impact on survival remains less certain. METHODS: We searched PubMed, EMBASE, Scopus, Web of Science, and CENTRAL for RCTs of PCT-guided antibiotic discontinuation in critically ill adults reporting survival or antibiotic duration. Searches were conducted without language restrictions from inception to 07/23/2018. Two reviewers independently conducted all review stages; another adjudicated differences...