American journal of respiratory and critical care medicine
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Am. J. Respir. Crit. Care Med. · Oct 2013
Defining Phenotypic Causes of Obstructive Sleep Apnea: Identification of Novel Therapeutic Targets.
The pathophysiologic causes of obstructive sleep apnea (OSA) likely vary among patients but have not been well characterized. ⋯ This study confirms that OSA is a heterogeneous disorder. Although Pcrit-anatomy is an important determinant, abnormalities in nonanatomic traits are also present in most patients with OSA.
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Previous studies of chronic obstructive pulmonary disease (COPD) have suggested that genetic factors play an important role in the development of disease. However, single-nucleotide polymorphisms that are associated with COPD in genome-wide association studies have been shown to account for only a small percentage of the genetic variance in phenotypes of COPD, such as spirometry and imaging variables. These phenotypes are highly predictive of disease, and family studies have shown that spirometric phenotypes are heritable. ⋯ This study suggests that a large portion of the genetic risk of COPD is yet to be discovered and gives rationale for additional genetic studies of COPD. The estimates of coheritability (genetic covariance) for pairs of the phenotypes suggest considerable overlap of causal genetic loci.
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Am. J. Respir. Crit. Care Med. · Oct 2013
Clinical TrialImplementation of an Evidence-based Extubation Readiness Bundle in 499 Brain-Injured Patients - a Before-After Evaluation of a Quality Improvement Project.
Mechanical ventilation is associated with morbidity in patients with brain injury. ⋯ The implementation of an evidence-based extubation readiness bundle was associated with a reduction in the duration of ventilation in patients with brain injury.
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Am. J. Respir. Crit. Care Med. · Oct 2013
Practice GuidelineAn official american thoracic society/european respiratory society statement: key concepts and advances in pulmonary rehabilitation.
Pulmonary rehabilitation is recognized as a core component of the management of individuals with chronic respiratory disease. Since the 2006 American Thoracic Society (ATS)/European Respiratory Society (ERS) Statement on Pulmonary Rehabilitation, there has been considerable growth in our knowledge of its efficacy and scope. ⋯ The considerable growth in the science and application of pulmonary rehabilitation since 2006 adds further support for its efficacy in a wide range of individuals with chronic respiratory disease.
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Am. J. Respir. Crit. Care Med. · Oct 2013
Autotaxinproduction of Lysophosphatidic Acid Mediates Allergic Asthmatic Inflammation.
Bioactive lipid mediators, derived from membrane lipid precursors, are released into the airway and airspace where they bind high-affinity cognate receptors and may mediate asthma pathogenesis. Lysophosphatidic acid (LPA), a bioactive lipid mediator generated by the enzymatic activity of extracellular autotaxin (ATX), binds LPA receptors, resulting in an array of biological actions on cell proliferation, migration, survival, differentiation, and motility, and therefore could mediate asthma pathogenesis. ⋯ The ATX-LPA pathway plays a critical role in the pathogenesis of asthma. These preclinical data indicate that targeting the ATX-LPA pathway could be an effective antiasthma treatment strategy.