American journal of respiratory and critical care medicine
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Am. J. Respir. Crit. Care Med. · Oct 2014
Observational StudyAsymptomatic HIV-infected Individuals on Antiretroviral Therapy Exhibit Impaired Lung CD4(+) T Cell Responses to Mycobacteria.
HIV-infected persons on antiretroviral therapy (ART) remain at higher risk of pulmonary tuberculosis (TB) than HIV-uninfected individuals. This increased susceptibility may be caused by impairment of alveolar macrophage (AM) function and/or mycobacteria-specific alveolar CD4(+) T-cell responses observed in HIV-infected ART-naive adults. ⋯ AM and mycobacteria-specific alveolar CD4(+) T-cell responses in HIV-infected adults on ART for less than 4 years are impaired and may partly explain the high risk of TB in HIV-infected individuals on ART. Strategies to augment ART to improve lung immune cell function and reduce the high incidence of TB in HIV-infected adults who initiate ART should be investigated.
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Am. J. Respir. Crit. Care Med. · Oct 2014
Randomized Controlled TrialSmooth Muscle in the Maintenance of Increased Airway Resistance Elicited by Methacholine in Humans.
Airway narrowing is maintained for a prolonged period after acute bronchoconstriction in humans in the absence of deep inspirations (DIs). ⋯ The maintenance of airway narrowing despite MCh clearance in humans is attributed to an intrinsic ability of ASM to maintain shortening during a progressive decrease of contractile stimulation.
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Am. J. Respir. Crit. Care Med. · Oct 2014
The Role of Bacteria in the Pathogenesis and Progression of Idiopathic Pulmonary Fibrosis.
Idiopathic pulmonary fibrosis (IPF) is a progressive lung disease of unknown cause that leads to respiratory failure and death within 5 years of diagnosis. Overt respiratory infection and immunosuppression carry a high morbidity and mortality, and polymorphisms in genes related to epithelial integrity and host defense predispose to IPF. ⋯ IPF is characterized by an increased bacterial burden in BAL that predicts decline in lung function and death. Trials of antimicrobial therapy are needed to determine if microbial burden is pathogenic in the disease.
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Am. J. Respir. Crit. Care Med. · Oct 2014
Enhanced Upper-airway Muscle Responsiveness is a Distinct Feature of Overweight/Obese Individuals Without Sleep Apnea.
Body habitus is a major determinant of obstructive sleep apnea (OSA). However, many individuals do not have OSA despite being overweight/obese (body mass index > 25 kg/m(2)) for reasons that are not fully elucidated. ⋯ Overweight/obese individuals without apnea have a moderately compromised upper-airway structure that is mitigated by highly responsive upper-airway dilator muscles to avoid OSA. Elucidating the mechanisms underlying enhanced muscle responses in this population may provide clues for novel OSA interventions.
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Am. J. Respir. Crit. Care Med. · Oct 2014
Seeking Worldwide Professional Consensus on the Principles of End-of-life Care for the Critically Ill: The Welpicus Study.
Great differences in end-of-life practices in treating the critically ill around the world warrant agreement regarding the major ethical principles. This analysis determines the extent of worldwide consensus for end-of-life practices, delineates where there is and is not consensus, and analyzes reasons for lack of consensus. Critical care societies worldwide were invited to participate. ⋯ Consensus was obtained for 77 of 81 (95%) statements. Worldwide consensus could be developed for the majority of definitions and statements about end-of-life practices. Statements achieving consensus provide standards of practice for end-of-life care; statements without consensus identify important areas for future research.