Chest
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Surfactant proteins play a key role in alveolar stability. We examined whether single nucleotide polymorphisms (SNPs) related to the surfactant protein genes are associated with severe influenza. ⋯ SFTPB polymorphism is associated with severe influenza. The role of SFTPB in influenza warrants further studies.
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Passive smoking, or environmental tobacco smoke (ETS), is a risk factor for lung cancer, cardiovascular disease, and childhood asthma, but a relationship with COPD has not been fully established. Our aim was to study ETS as a risk factor for COPD in never smokers. ⋯ In this population-based sample of never smokers, ETS was independently associated with COPD. The association was stronger for ETS in multiple settings. ETS in multiple settings was, after age, the strongest risk factor for COPD and comparable to personal smoking of up to 14 cigarettes/d in comparable materials. The findings strongly advocate measures against smoking in public places.
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Debate remains regarding whether the systemic inflammatory response syndrome (SIRS) identifies patients with clinically important inflammation. Defining criteria may be disproportionately sensitive and lack specificity. We investigated the incidence and evolution of SIRS in a homogenous population (following cardiac surgery) over 7 days to establish the relationship between SIRS and outcome, modeling alternative permutations of the criteria to increase their discriminatory power for mortality, length of stay, and organ dysfunction. ⋯ The concept of SIRS remains valid following cardiac surgery. With suitable modification, its specificity can be improved significantly. We propose that meeting two or more defining criteria for 6 h could be used to define better populations with more difficult clinical courses following cardiac surgery. This group may merit a different clinical approach.
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Practice Guideline
An official american thoracic society/american college of chest physicians policy statement: the choosing wisely top five list in adult pulmonary medicine.
The American Board of Internal Medicine Foundation's Choosing Wisely campaign aims to curb health-care costs and improve patient care by soliciting lists from medical societies of the top five tests or treatments in their specialty that are used too frequently and inappropriately. The American Thoracic Society (ATS) and American College of Chest Physicians created a joint task force, which produced a top five list for adult pulmonary medicine. Our top five recommendations, which were approved by the executive committees of the ATS and American College of Chest Physicians and published by Choosing Wisely in October 2013, are as follows: (1) Do not perform CT scan surveillance for evaluation of indeterminate pulmonary nodules at more frequent intervals or for a longer period of time than recommended by established guidelines; (2) do not routinely offer pharmacologic treatment with advanced vasoactive agents approved only for the management of pulmonary arterial hypertension to patients with pulmonary hypertension resulting from left heart disease or hypoxemic lung diseases (groups II or III pulmonary hypertension); (3) for patients recently discharged on supplemental home oxygen following hospitalization for an acute illness, do not renew the prescription without assessing the patient for ongoing hypoxemia; (4) do not perform chest CT angiography to evaluate for possible pulmonary embolism in patients with a low clinical probability and negative results of a highly sensitive D-dimer assay; (5) do not perform CT scan screening for lung cancer among patients at low risk for lung cancer. We hope pulmonologists will use these recommendations to stimulate frank discussions with patients about when these tests and treatments are indicated--and when they are not.
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Case Reports
Small Airway-Centered Granulomatosis Caused by Long-term Exposure to Polytetrafluoroethylene.
To date, there have been no reports of chronic pulmonary granulomatosis associated with exposure to polytetrafluoroethylene (PTFE). Here, we report three cases of small airway-centered granulomatous lesions in workers employed at facilities that apply coatings to pans and other utensils. The workers were repeatedly exposed to PTFE particles that were probably generated by the drying process when PTFE coatings are dried in a convection oven at high temperatures (380-420 °C). ⋯ Analysis of the spectrum extracted from the position of the foreign particles enabled precise identification of the foreign bodies as PTFE. Fourier transform infrared revealed that all of the lung tissue samples had bands at 1,202 to 1,148 cm(-1) and 1,202 to 1,146 cm(-1), which are characteristic of the asymmetric and symmetric stretching vibrations of the C-F bonds of PTFE. These cases suggest that recurrent inhalational exposure to PTFE particles causes chronic pulmonary granulomatosis.