American journal of respiratory and critical care medicine
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Am. J. Respir. Crit. Care Med. · Jun 2014
ReviewInvestigating the role of NOD-Like Receptors in Bacterial Lung Infection.
Lower respiratory tract infections (LRTIs) are a persistent and pervasive public health problem worldwide. Pneumonia and other LRTIs will be among the leading causes of death in adults, and pneumonia is the single largest cause of death in children. LRTIs are also an important cause of acute lung injury and acute exacerbations of chronic obstructive pulmonary disease. ⋯ The lung contains NLR-expressing immune cells such as leukocytes and nonimmune cells such as epithelial cells that are in constant and close contact with invading microbes. This pulmonary perspective addresses our current understanding of the structure and function of NLR family members, highlighting advances and gaps in knowledge, with a specific focus on immune responses in the respiratory tract during bacterial infection. Further advances in exploring cellular and molecular responses to bacterial pathogens are critical to develop improved strategies to treat and prevent devastating infectious diseases of the lung.
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Exposure to the undersea environment has unique effects on normal physiology and can result in unique disorders that require an understanding of the effects of pressure and inert gas supersaturation on organ function and knowledge of the appropriate therapies, which can include recompression in a hyperbaric chamber. The effects of Boyle's law result in changes in volume of gas-containing spaces when exposed to the increased pressure underwater. These effects can cause middle ear and sinus injury and lung barotrauma due to lung overexpansion during ascent from depth. ⋯ Usual therapy is recompression in a hyperbaric chamber following well-established protocols. Many recreational diving candidates seek medical clearance for diving, and healthcare providers must be knowledgeable of the environmental exposure and its effects on physiologic function to properly assess individuals for fitness to dive. This review provides a basis for understanding the diving environment and its accompanying disorders and provides a basis for assessment of fitness for diving.
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Am. J. Respir. Crit. Care Med. · Jun 2014
ReviewMonitoring Cystic Fibrosis Lung Disease Using Computed Tomography: Radiation Risk into Perspective.
Computed tomography (CT) is a sensitive technique to monitor structural changes related to cystic fibrosis (CF) lung disease. It detects structural pulmonary abnormalities such as bronchiectasis and trapped air, at an early stage, before they become apparent with other diagnostic tests. Clinical decisions may be influenced by knowledge of these abnormalities. ⋯ We conclude that the risk related to routine usage of CT in clinical care is small. In addition, a life-limiting disease, such as CF, lowers the risk of radiation-induced cancer. Nonetheless, the use of CT should always be justified and the radiation dose should be kept as low as reasonably achievable.
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This review provides an update on asthma in Hispanics, a diverse group tracing their ancestry to countries previously under Spanish rule. A marked variability in the prevalence and morbidity from asthma remains among Hispanic subgroups in the United States and Hispanic America. In the United States, Puerto Ricans and Mexican Americans have high and low burdens of asthma, respectively (the "Hispanic Paradox"). ⋯ In the United States, research studies should focus on risk factors that are known to or may diverge among Hispanic subgroups, including but not limited to epigenetic variation, prematurity, vitamin D level, diet, and stress. Clinical trials of culturally appropriate interventions that address multiple aspects of asthma management in Hispanic subgroups should be prioritized for funding. Ensuring high-quality healthcare for all remains a pillar of eliminating asthma disparities.