Chest
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Review Meta Analysis
Effect of statins on chronic obstructive pulmonary disease: a meta-analysis of randomized controlled trials.
Much controversy persists regarding the place of statin drugs in the treatment of patients with COPD. This systematic review and meta-analysis sought to determine the clinical efficacy of statin therapy in COPD. ⋯ The findings from this systematic review suggest a role for statin drugs in patients with COPD and coexisting CVD, evidence of increased systemic inflammation, or hyperlipidemia with respect to improving exercise tolerance and pulmonary function. These findings need to be confirmed by RCTs specifically designed to test this hypothesis and identify appropriate patients for statin use.
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Review Meta Analysis
Diaphragm and lung ultrasound to predict weaning outcome: systematic review and meta-analysis.
Deciding the optimal timing for extubation in patients who are mechanically ventilated can be challenging, and traditional weaning predictor tools are not very accurate. The aim of this systematic review and meta-analysis was to assess the accuracy of lung and diaphragm ultrasound for predicting weaning outcomes in critically ill adults. ⋯ Lung and diaphragm ultrasound can help predict weaning outcome, but its accuracy may vary depending on the patient subpopulation.
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Multicenter Study Clinical Trial
Totally Implantable Intravenous Treprostinil Therapy in Pulmonary Hypertension: Assessment of the Implantation Procedure.
Prostacyclins improve symptoms and survival in pulmonary arterial hypertension (PAH). In response to risks associated with external delivery systems, an implantable IV infusion system was developed. A multicenter, prospective, single-arm, clinical trial (DelIVery for PAH) was conducted to evaluate this system for treprostinil in PAH. This analysis describes the findings related to the implant procedure. ⋯ The procedure for inserting a fully implantable system for treprostinil was successfully performed, with few complications.
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Multicenter Study
Impact of Timing of Lobectomy on Survival for Clinical Stage IA Lung Squamous Cell Carcinoma.
Because the relationship between the timing of surgery following diagnosis of lung cancer and survival has not been precisely described, guidelines on what constitutes a clinically meaningful delay of resection of early-stage lung cancer do not exist. This study tested the hypothesis that increasing the time between diagnosis and lobectomy for stage IA squamous cell carcinoma (SCC) would be associated with worse survival. ⋯ Longer intervals between diagnosis of early-stage lung SCC and surgery are associated with worse survival. Although factors other than the timing of treatment may contribute to this finding, these results suggest that efforts to minimize delays beyond those needed to perform a complete preoperative evaluation may improve survival.
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Asthma and COPD are prevalent chronic inflammatory airway diseases that are responsible for a large global disease burden. Both diseases are complex and heterogeneous, and they are increasingly recognized as overlapping syndromes that may share similar pathophysiologic mechanisms and treatable traits. Eosinophilic airway inflammation is considered the most influential treatable trait of chronic airway disease, and over the last decade, several monoclonal antibodies and small molecule therapies have been developed to target this trait. ⋯ This heterogeneity in treatment response is probably related to different molecular pathways or endotypes leading to eosinophilic airway inflammation, including adaptive immune pathways mediated by T helper 2 cells and innate immune pathways mediated by innate lymphoid cells. The relative contribution of these pathways in asthma and COPD is not yet clarified, and there are currently no reliable biomarkers that represent the various pathways. Therefore, there is an urgent need for easily measurable and reproducible biomarkers that are linked to underlying pathophysiologic disease mechanisms and can predict and monitor responses to novel biologic agents.