American journal of respiratory and critical care medicine
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Am. J. Respir. Crit. Care Med. · Nov 2015
Clinical and Immunological Factors in Emphysema Progression: 5-year Prospective LES-COPD Study.
Cross-sectional studies of T-cell responses to self-antigens correlate with baseline emphysema severity. ⋯ The rate of emphysema progression quantified by CT scans among ever-smokers was highly variable; clinical factors and biomarkers explained only some of the variability. Aggressive clinical care that targets active smokers with autoreactive T cells and low BMI may temporize progression of emphysema.
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Am. J. Respir. Crit. Care Med. · Nov 2015
Clinical TrialEffects of Aged Stored Autologous Red Blood Cells on Human Endothelial Function.
A major abnormality that characterizes the red cell "storage lesion" is increased hemolysis and reduced red cell lifespan after infusion. Low levels of intravascular hemolysis after transfusion of aged stored red cells disrupt nitric oxide (NO) bioavailabity, via accelerated NO scavenging reaction with cell-free plasma hemoglobin. The degree of intravascular hemolysis post-transfusion and effects on endothelial-dependent vasodilation responses to acetylcholine have not been fully characterized in humans. ⋯ We demonstrate that the transfusion of blood at the limits of Food and Drug Administration-approved storage has a significant effect on the forearm circulation and impairs endothelial function. Clinical trial registered with www.clinicaltrials.gov (NCT 01137656).
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Am. J. Respir. Crit. Care Med. · Nov 2015
Pulmonary Hypertension in Heart Failure: Epidemiology, Right Ventricular Function and Survival.
Patients with pulmonary hypertension due to left heart disease (PH-LHD) and a diastolic pulmonary vascular pressure gradient ≥ 7 mm Hg, representing PH out of proportion to pulmonary arterial wedge pressure, have pulmonary vascular disease and increased mortality. Little information exists on this condition, recently labeled as "combined pre- and post-capillary PH" (Cpc-PH). ⋯ Cpc-PH is rare in chronic heart failure. Right ventricular-pulmonary vascular coupling is poor in Cpc-PH and could be one explanation for dismal outcomes.
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Am. J. Respir. Crit. Care Med. · Nov 2015
Airflow Limitation and Histology-shift in the National Lung Screening Trial: the NLST-ACRIN Cohort Substudy (N=18, 714).
Annual computed tomography (CT) is now widely recommended for lung cancer screening in the United States, although concerns remain regarding the potential harms, including those from overdiagnosis. ⋯ In the CT arm of the NLST-ACRIN (American College of Radiology Imaging Network) cohort, COPD status was associated with a doubling of lung cancer incidence, no apparent overdiagnosis, and a more favorable stage shift.
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Am. J. Respir. Crit. Care Med. · Nov 2015
Recent Trends in the Identification of Incidental Pulmonary Nodules.
Pulmonary nodules are common incidental findings, but information about their incidence in the era of computed tomography (CT) is lacking. ⋯ Incidental pulmonary nodules are an increasingly common consequence of routine medical care, with an incidence that is much greater than recognized previously. More frequent nodule identification has not been accompanied by increases in the diagnosis of cancerous nodules.