Chest
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Multicenter Study
Midregional proadrenomedullin as a prognostic tool in community-acquired pneumonia.
Midregional proadrenomedullin (MR-proADM) is a potential prognostic biomarker in patients with community-acquired pneumonia (CAP). Previous work has been hampered by sample size and illness spectrum limits. We sought to describe the pattern of MR-proADM in a broad CAP cohort, confirm its prognostic role, and compare its performance to procalcitonin, a novel biomarker of infection. ⋯ In our multicenter CAP cohort, MR-proADM levels correlate with increasing severity of illness and death. High MR-proADM levels offer additional risk stratification in high-risk CAP patients, but otherwise MR-proADM levels do not alter PSI-based risk assessment in most CAP patients.
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The 3-hydroxy 3-methylglutaryl coenzyme A reductase inhibitors (ie, statins) are widely used for the treatment of patients with hypercholesterolemia and cardiovascular disease. Emerging evidence suggests a beneficial effect of statins on the morbidity and mortality of patients with COPD. The objective of this study was to perform a systematic review of the literature evaluating the effect of statin therapy on outcomes in patients with COPD. ⋯ The current literature collectively suggests that statins may have a beneficial role in the treatment of COPD. However, the majority of published studies have inherent methodological limitations of retrospective studies and population-based analyses. There is a need for prospective interventional trials designed specifically to assess the impact of statins on clinically relevant outcomes in COPD.
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Multicenter Study Clinical Trial
Characteristics of children intubated and mechanically ventilated in 16 PICUs.
When designing multicenter clinical trials, it is important to understand the characteristics of children who have received ventilation in PICUs. ⋯ At least 30% of children in a cross-section of US PICUs are endotracheally intubated, and 25% of those with respiratory failure do not fulfill the radiographic criteria for ALI. Although few patients without an indwelling arterial line require more than modest ventilator support, many may still meet the oxygenation criteria for ALI. These findings will facilitate sample size calculations and help to determine feasibility for future trials on pediatric mechanical ventilation.
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COPD is a highly prevalent disorder that results from the interplay of genetic susceptibility and environmental exposures. Over the past 2 decades, significant technological advances have been made in genetic investigations of complex diseases, yet limited progress has been made in the identification of additional COPD susceptibility genes. ⋯ More refined characterization of the emphysema and airway components of COPD can now be obtained through the systematic use of CT scans. These improved phenotypes can be applied in genome-wide association studies and will likely lead to the discovery of additional susceptibility loci and therapeutic targets.
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In patients with idiopathic pulmonary fibrosis (IPF), our objectives were to identify predictors of abnormal heart rate recovery (HRR) at 1 min after completion of a 6-min walk test (6MWT) [HRR1] and 2 min after completion of a 6MWT (HRR2), and to determine whether abnormal HRR predicts mortality. ⋯ Abnormal HRR after 6MWT predicts mortality in IPF patients. Research is needed to confirm these findings prospectively and to examine the mechanisms of HRR in IPF patients.