American journal of respiratory and critical care medicine
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Am. J. Respir. Crit. Care Med. · Nov 2013
Bronchus-Associated Lymphoid Tissue in Pulmonary Hypertension Produces Pathologic Autoantibodies.
Autoimmunity has long been associated with pulmonary hypertension. Bronchus-associated lymphoid tissue plays important roles in antigen sampling and self-tolerance during infection and inflammation. ⋯ Bronchus-associated lymphoid tissue expands in pulmonary hypertension and is autoimmunologically active. Loss of self-tolerance contributes to pulmonary vascular remodeling and pulmonary hypertension. Lymphoid tissue-directed therapies may be beneficial in treating pulmonary hypertension.
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Am. J. Respir. Crit. Care Med. · Nov 2013
ReviewAn Official American Thoracic Society Systematic Review: Influence of Psychosocial Characteristics on Workplace Disability among Workers with Respiratory Impairment.
Psychosocial characteristics likely play an important role in the severity of workplace disability for workers with a respiratory impairment. ⋯ Psychosocial characteristics likely influence workplace disability in workers with respiratory impairments. The impact of targeted therapies is unclear and warrants further study.
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Am. J. Respir. Crit. Care Med. · Nov 2013
ReviewPatient Ventilator Interactions: Implications for Clinical Management.
Assisted/supported modes of mechanical ventilation offer significant advantages over controlled modes in terms of ventilator muscle function/recovery and patient comfort (and sedation needs). However, assisted/supported breaths must interact with patient demands during all three phases of breath delivery: trigger, target, and cycle. Synchronous interactions match ventilator support with patient demands; dyssynchronous interactions do not. ⋯ These include adjustments of the trigger variable, the use of pressure versus fixed flow targeted breaths, and a number of manipulations of the cycle variable. Clinicians need to know how to use these modalities and monitor them properly, especially understanding airway pressure and flow graphics. Future strategies are emerging that have theoretical appeal but they await good clinical outcome studies before they become commonplace.
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Am. J. Respir. Crit. Care Med. · Nov 2013
Distinct Quantitative CT Emphysema Patterns are Associated with Physiology and Function in Smokers.
Emphysema occurs in distinct pathologic patterns, but little is known about the epidemiologic associations of these patterns. Standard quantitative measures of emphysema from computed tomography (CT) do not distinguish between distinct patterns of parenchymal destruction. ⋯ Measures of distinct CT emphysema patterns provide novel information about the relationship between emphysema and key measures of physiology, physical function, and health care use. Measures of mild emphysema in smokers with preserved lung function can be extracted from CT scans and are significantly associated with functional measures.