American journal of respiratory and critical care medicine
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Am. J. Respir. Crit. Care Med. · Mar 2012
Multicenter Study Comparative Study Clinical TrialA large subgroup of mild-to-moderate asthma is persistently noneosinophilic.
Airway eosinophilia is typical of asthma, and many controller treatments target eosinophilic disease. Asthma is clinically heterogeneous, however, and a subgroup of people with asthma do not have airway eosinophilia. The size of this subgroup is uncertain because prior studies have not examined repeated measures of sputum cytology to determine when people with asthma have intermittent versus persistent sputum eosinophila and when they are persistently noneosinophilic. ⋯ Approximately half of patients with mild-to-moderate asthma have persistently noneosinophilic disease, a disease phenotype that responds poorly to currently available antiinflammatory therapy.
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Am. J. Respir. Crit. Care Med. · Mar 2012
ReviewThe use of nonphysician providers in adult intensive care units.
In the United States there are not currently enough critical care-trained practitioners to provide care to all critically ill patients. With calls for "high-intensity" staffing and 24-hour coverage of our intensive care units, the board-certified intensivists we do have are being stretched ever more thin. Nonphysician providers (physician assistants and nurse practitioners) are being used with increasing frequency in critical care settings to provide care to critically ill patients. In this review, we explore the impact of introducing nonphysician providers into the adult intensive care unit.
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Am. J. Respir. Crit. Care Med. · Mar 2012
Comparative StudyThe clinical and environmental determinants of airway transcriptional profiles in allergic asthma.
Gene expression profiling of airway epithelial and inflammatory cells can be used to identify genes involved in environmental asthma. ⋯ Our results indicate that among individuals with allergic asthma, transcriptional changes in airway epithelia and inflammatory cells are influenced by phenotype as well as environmental exposures.
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Am. J. Respir. Crit. Care Med. · Mar 2012
Comparative StudyDifferentiation and recruitment of IL-22-producing helper T cells stimulated by pleural mesothelial cells in tuberculous pleurisy.
IL-22-producing helper T cells (Th22 cells) have been reported to be involved in tuberculosis infection. However, differentiation and immune regulation of Th22 cells in tuberculous pleural effusion (TPE) remain unknown. ⋯ The overrepresentation of Th22 cells in TPE may be due to pleural cytokines and to PMC-produced chemokines. Our data suggest a collaborative loop between PMCs and Th22 cells in TPE. In particular, PMCs were able to function as antigen-presenting cells to stimulate CD4(+) T-cell proliferation and Th22-cell differentiation.
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Am. J. Respir. Crit. Care Med. · Mar 2012
Comparative StudyDisruption of platelet-derived chemokine heteromers prevents neutrophil extravasation in acute lung injury.
Acute lung injury (ALI) causes high mortality, but its molecular mechanisms and therapeutic options remain ill-defined. Gram-negative bacterial infections are the main cause of ALI, leading to lung neutrophil infiltration, permeability increases, deterioration of gas exchange, and lung damage. Platelets are activated during ALI, but insights into their mechanistic contribution to neutrophil accumulation in the lung are elusive. ⋯ Taken together, our data identify a novel function of platelet-derived chemokine heteromers during ALI and demonstrate means for therapeutic interference.