American journal of respiratory and critical care medicine
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Am. J. Respir. Crit. Care Med. · Mar 2009
Randomized Controlled Trial Multicenter StudyA randomized controlled trial of nurse-led care for symptomatic moderate-severe obstructive sleep apnea.
Obstructive sleep apnea (OSA) is a prevalent disease. Often limited clinical resources result in long patient waiting lists. Simpler validated methods of care are needed. ⋯ A simplified nurse-led model of care has demonstrated noninferior results to physician-directed care in the management of symptomatic moderate-severe OSA, while being less costly. Clinical trial registered with http://www.anzctr.org.au (ACTRN012605000064606).
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Am. J. Respir. Crit. Care Med. · Mar 2009
Multicenter StudyFibrinogen genes modify the fibrinogen response to ambient particulate matter.
Ambient particulate matter has been associated with systemic inflammation indicated by blood markers such as fibrinogen, implicated in promoting atherothrombosis. ⋯ The data suggest that susceptibility to ambient particulate matter may be partly genetically determined by polymorphisms that alter early physiological responses such as transcription of fibrinogen. Subjects with variants of these frequent SNPs may have increased risks not only due to constitutionally higher fibrinogen concentrations, but also due to an augmented response to environmental inflammatory stimuli such as ambient particulate matter.
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Am. J. Respir. Crit. Care Med. · Mar 2009
Down-regulation of the notch pathway in human airway epithelium in association with smoking and chronic obstructive pulmonary disease.
The airway epithelium of smokers is subject to a variety of mechanisms of injury with consequent modulation of epithelial regeneration and disordered differentiation. Several signaling pathways, including the Notch pathway, control epithelial differentiation in lung morphogenesis, but little is known about the role of these pathways in adults. ⋯ These observations are consistent with the hypothesis that the Notch pathway likely plays a role in the human adult airway epithelium, with down-regulation of Notch pathway gene expression in association with smoking and COPD.
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Am. J. Respir. Crit. Care Med. · Mar 2009
Antimicrobial stewardship in the intensive care unit: advances and obstacles.
Antimicrobial stewardship involves a multifaceted approach that strives to combat the emergence of resistance, improve clinical outcomes, and control costs by improving antimicrobial use. Therefore, stewardship is of great importance and relevance in the intensive care unit. ⋯ Yet, significant obstacles have prevented the full achievement of stewardship's goals, and approaches to confronting these obstacles should be appreciated. Clinicians should realize that antimicrobials are important therapeutic agents and strive to use them wisely.
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Am. J. Respir. Crit. Care Med. · Mar 2009
Sepsis alters the megakaryocyte-platelet transcriptional axis resulting in granzyme B-mediated lymphotoxicity.
Sepsis-related mortality results in part from immunodeficiency secondary to profound lymphoid apoptosis. The biological mechanisms responsible are not understood. ⋯ Our findings establish a conceptual advance in sepsis: Septic megakaryocytes produce platelets with acutely altered mRNA profiles, and these platelets mediate lymphotoxicity via granzyme B. Given the contribution of lymphoid apoptosis to sepsis-related mortality, modulation of platelet granzyme B becomes an important new target for investigation and therapy.