American journal of respiratory and critical care medicine
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Am. J. Respir. Crit. Care Med. · Jan 2014
Use of Induced Pluripotent Stem Cells To Recapitulate Pulmonary Alveolar Proteinosis Pathogenesis.
In patients with pulmonary alveolar proteinosis (PAP) syndrome, disruption of granulocyte/macrophage colony-stimulating factor (GM-CSF) signaling is associated with pathogenic surfactant accumulation from impaired clearance in alveolar macrophages. ⋯ We used patient-specific iPS cells to accurately reproduce the molecular and cellular defects of alveolar macrophages that drive the pathogenesis of PAP in more than 90% of patients. These results demonstrate the critical role of GM-CSF signaling in surfactant homeostasis and PAP pathogenesis in humans and have therapeutic implications for hPAP.
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Am. J. Respir. Crit. Care Med. · Jan 2014
Multicenter StudyDeterminants of Procedural Pain Intensity in the Intensive Care Unit: The Europain Study.
Intensive care unit (ICU) patients undergo several diagnostic and therapeutic procedures every day. The prevalence, intensity, and risk factors of pain related to these procedures are not well known. ⋯ Knowledge of risk factors for greater procedural pain intensity identified in this study may help clinicians select interventions that are needed to minimize procedural pain. Clinical trial registered with www.clinicaltrials.gov (NCT 01070082).
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Am. J. Respir. Crit. Care Med. · Jan 2014
Humidifier Disinfectant-Associated Children's Interstitial Lung Disease.
Beginning in 2006, epidemics of a fatal lung injury of unknown cause in children were observed in Korea every spring. A recent study demonstrated that this type of children's interstitial lung disease (chILD) is associated with humidifier disinfectant use. ⋯ This study suggests that humidifier disinfectant inhalation causes an idiopathic type of chILD that is characterized by spontaneous air leak, rapid progression, lack of response to treatment, and high mortality. Further safety studies must be performed on common environmental compounds, particularly those that enter the human body by an unusual route.
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Am. J. Respir. Crit. Care Med. · Jan 2014
Multicenter Study Comparative StudyClinical and Epidemiologic Phenotypes of Childhood Asthma.
Clinical and epidemiologic approaches have identified two distinct sets of classifications for asthma and wheeze phenotypes. ⋯ Clinical phenotypes were well supported by LCA analysis. The hypothesis-free LCA phenotypes were a useful reference for comparing clinical phenotypes. Thereby, we identified children with clinically conspicuous but undiagnosed disease. Because of their high area under the curve values, clinical phenotypes such as (recurrent) unremitting wheeze emerged as promising alternative asthma definitions for epidemiologic studies.
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Am. J. Respir. Crit. Care Med. · Jan 2014
Multicenter Study Comparative StudyInterferon-γ Release Assays and Tuberculin Skin Testing for Diagnosis of Latent Tuberculosis Infection in Healthcare Workers in the United States.
IFN-γ release assays (IGRAs) are alternatives to tuberculin skin testing (TST) for diagnosis of latent tuberculosis infection. Limited data suggest IGRAs may not perform well for serial testing of healthcare workers (HCWs). ⋯ Most conversions among HCWs in low TB incidence settings appear to be false positives, and these occurred six to nine times more frequently with IGRAs than TST; repeat testing of apparent converters is warranted.