American journal of respiratory and critical care medicine
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Am. J. Respir. Crit. Care Med. · Oct 2015
A Molecular Biomarker to Diagnose Community-acquired Pneumonia on Intensive Care Unit Admission.
Community-acquired pneumonia (CAP) accounts for a major proportion of intensive care unit (ICU) admissions for respiratory failure and sepsis. Diagnostic uncertainty complicates case management, which may delay appropriate cause-specific treatment. ⋯ CAP and no-CAP patients presented shared and distinct blood genomic responses. We propose the FAIM3:PLAC8 ratio as a candidate biomarker to assist in the rapid diagnosis of CAP on ICU admission. Clinical trial registered with www.clinicaltrials.gov (NCT 01905033).
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Am. J. Respir. Crit. Care Med. · Oct 2015
Comparative StudySustained Benefit from Ivacaftor Demonstrated by Combining Clinical Trial and CF Patient Registry Data.
In clinical trials, patients with cystic fibrosis and a G551D mutation who received ivacaftor experienced improvements in pulmonary and nutritional outcomes. However, whether these improvements reflect a change in disease trajectory cannot be determined without longer-term analyses with an appropriate comparator population. ⋯ These findings suggest that ivacaftor is a disease-modifying therapy for the treatment of cystic fibrosis.
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Am. J. Respir. Crit. Care Med. · Oct 2015
Practice GuidelineAn Official American Thoracic Society/American College of Chest Physicians Policy Statement: Implementation of Low-Dose Computed Tomography Lung Cancer Screening Programs in Clinical Practice.
Annual low-radiation-dose computed tomography (LDCT) screening for lung cancer has been shown to reduce lung cancer mortality among high-risk individuals and is now recommended by multiple organizations. However, LDCT screening is complex, and implementation requires careful planning to ensure benefits outweigh harms. Little guidance has been provided for sites wishing to develop and implement lung cancer screening programs. ⋯ Following the strategies delineated in this policy statement may help sites to develop comprehensive LDCT screening programs that are safe and effective.
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In aging populations, the commonly used Global Initiative for Chronic Obstructive Lung Disease (GOLD) may misclassify normal spirometry as respiratory impairment (airflow obstruction and restrictive pattern), including the presumption of respiratory disease (chronic obstructive pulmonary disease [COPD]). ⋯ GLI-defined normal spirometry, even when classified as respiratory impairment by GOLD, included adjusted mean values in the normal range for multiple phenotypes. These results suggest that among adults with GLI-defined normal spirometry, GOLD may misclassify normal phenotypes as having respiratory impairment.
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Am. J. Respir. Crit. Care Med. · Oct 2015
Nocturnal Hypoxemia Severity Determines Renin-Angiotensin System Activity in Obstructive Sleep Apnea.
Obstructive sleep apnea (OSA) and nocturnal hypoxemia are associated with chronic kidney disease and up-regulation of the renin-angiotensin system (RAS), which is deleterious to renal function. The extent to which the magnitude of RAS activation is influenced by the severity of nocturnal hypoxemia and comorbid obesity has not been determined. ⋯ The severity of nocturnal hypoxemia influences the magnitude of renal, but not the systemic, RAS activation independently of obesity in patients with OSA.