Chest
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Practice Guideline
Consensus statements on deployment-related respiratory disease, inclusive of constrictive bronchiolitis: A modified Delphi study.
The diagnosis of constrictive bronchiolitis (CB) in previously deployed individuals, and evaluation of respiratory symptoms more broadly, presents considerable challenges, including using consistent histopathologic criteria and clinical assessments. ⋯ Using a modified Delphi technique, consensus statements provide a clinical approach to possible CB in previously deployed individuals. Use of DRRD provides a broad descriptor encompassing a range of postdeployment respiratory findings. Additional follow-up of individuals with DRRD is needed to assess disease progression and to define other features of its natural history, which could inform physicians better and lead to evolution in this nosology.
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Septic shock is defined by the need for vasopressor agents to correct hypotension and lactic acidosis resulting from infection, with 30%-40% case fatality rates. The care of patients with worsening septic shock involves multiple treatment decisions involving vasopressor choices and adjunctive treatments. In this edition of "How I Do It", we provide a case-based discussion of common clinical decisions regarding choice of first-line vasopressor, BP targets, route of vasopressor delivery, use of secondary vasopressors, and adjunctive medications. We also consider diagnostic approaches, treatment, and monitoring strategies for the patient with worsening shock, as well as approaches to difficult weaning of vasopressors.
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Review Historical Article
The Science of Sleep in Medieval Arabic Medicine: Part 1: Ibn Sīnā's Pneumatic Paradigm.
Modern sleep specialists are taught that, before the twentieth century, sleep was universally classified as a passive phenomenon with minimal to no brain activity. However, these assertions are made on the basis of particular readings and reconstructions of the history of sleep, using Western European medical works and ignoring works composed in other parts of the world. ⋯ Avicenna, d. 1037) onward. Building on the earlier Greek medical tradition, Ibn Sīnā provided a new pneumatic understanding of sleep that allowed him to explain previously recorded phenomena associated with sleep, while providing a way to capture how certain parts of the brain (and body) can even increase their activities during sleep.
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Bronchodilator responsiveness (BDR) in obstructive lung disease varies over time and may be associated with distinct clinical features. ⋯ Demonstration of BDR, even once, describes an obstructive lung disease phenotype with a history of asthma and greater small airways disease. Consistent demonstration of BDR indicated a high risk of lung function decline over time in the entire cohort and was associated with higher risk of progression to COPD in patients with GOLD stage 0 disease.
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Multicenter Study
Diagnosing non-small cell lung cancer by exhaled-breath profiling using an electronic nose: a multicentre validation study.
Despite the potential of exhaled breath analysis of volatile organic compounds to diagnose lung cancer, clinical implementation has not been realized, partly due to the lack of validation studies. ⋯ The Netherlands Trial Register; No.: NL7025; URL: https://trialregister.nl/trial/7025.