American journal of respiratory and critical care medicine
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Am. J. Respir. Crit. Care Med. · Jul 2014
T regulatory cells and PD-1+ T cells contribute to effector T cell dysfunction in COPD patients.
Previous studies from our laboratory have shown that peripheral blood mononuclear cells (PBMCs) from patients with chronic obstructive pulmonary disease (COPD) prone to exacerbations with nontypeable Haemophilus influenzae have impaired responses to lipoprotein P6. We hypothesized that an underlying immunosuppressive network could be responsible for the defective antibacterial immunity observed in these patients. We evaluated T regulatory cells (Tregs), myeloid-derived suppressor cells (MDSC), and exhausted T effector cells (programmed death 1 [PD-1](+)) in patients with COPD, because these cells are known to play a pivotal role in suppressing immune responses. ⋯ Functionally suppressive Tregs, MDSCs, and exhausted PD-1(+) T cells contribute to effector T-cell dysfunction in COPD.
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Am. J. Respir. Crit. Care Med. · Jul 2014
Increased one-year health care utilization in survivors of severe sepsis.
Hospitalizations for severe sepsis are common, and a growing number of patients survive to hospital discharge. Nonetheless, little is known about survivors' post-discharge healthcare use. ⋯ Healthcare use is markedly elevated after severe sepsis, and post-discharge management may be an opportunity to reduce resource use.
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Am. J. Respir. Crit. Care Med. · Jul 2014
Oxygenation Response to PEEP Predicts Mortality in ARDS: A Secondary Analysis of the LOVS and ExPress Trials.
Previous trials of higher positive end-expiratory pressure (PEEP) for acute respiratory distress syndrome (ARDS) failed to demonstrate mortality benefit, possibly because of differences in lung recruitability among patients with ARDS. ⋯ Patients with ARDS who respond to increased PEEP by improved oxygenation have a lower risk of death. The oxygenation response to PEEP might be used to predict whether patients will benefit from higher versus lower PEEP.
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Am. J. Respir. Crit. Care Med. · Jul 2014
Distinct Differences in Gene Expression Patterns in Pulmonary Arteries of COPD and IPF Patients with PH.
The development of pulmonary hypertension (PH) in patients with idiopathic pulmonary fibrosis (IPF) or chronic obstructive pulmonary disease (COPD) is associated with increased morbidity. ⋯ Despite clinical and histologic vascular remodeling in all patients with PH-COPD and PH-IPF, differential gene expression pattern was present in pulmonary artery profiles. Several genes involved in retinol metabolism and ECM receptor interaction enable discrimination of vascular remodeling in PH-IPF or PH-COPD. This suggests that pulmonary arterial remodeling in PH-COPD and PH-IPF is caused by different molecular mechanisms and may require specific therapeutic options.