American journal of respiratory and critical care medicine
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Am. J. Respir. Crit. Care Med. · Aug 2015
Mycobacteria-specific Cytokine Responses Detect TB Infection and Distinguish Latent from Active TB.
Current immunodiagnostic tests for tuberculosis (TB), including the tuberculin skin test and IFN-γ release assay (IGRA), have significant limitations, which include their inability to distinguish between latent TB infection (LTBI) and active TB, a distinction critical for clinical management. ⋯ We identified several mycobacteria-specific cytokine biomarkers with the potential to be exploited for immunodiagnosis. Incorporation of these biomarkers into future immunodiagnostic assays for TB could result in substantial gains in sensitivity and allow the distinction between LTBI and active TB based on a blood test alone.
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Am. J. Respir. Crit. Care Med. · Aug 2015
Randomized Controlled Trial Multicenter Study Comparative StudyUltrathin Bronchoscopy with Multimodal Devices for Peripheral Pulmonary Lesions: A Randomized Trial.
The combination of an ultrathin bronchoscope, navigational technology, and endobronchial ultrasound (EBUS) seems to combine the best of mutual abilities for evaluating peripheral pulmonary lesions, but ultrathin bronchoscopes that allow the use of EBUS have not been developed so far. ⋯ The diagnostic yield of the UTB method is higher than that of the TB-GS method. Clinical trial registered with www.umin.ac.jp/ctr/ (UMIN 000003177).
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Am. J. Respir. Crit. Care Med. · Aug 2015
Institutional Tuberculosis Transmission: Controlled Trial of Upper Room Ultraviolet Air Disinfection - A Basis for New Dosing Guidelines.
Transmission is driving the global tuberculosis epidemic, especially in congregate settings. Worldwide, natural ventilation is the most common means of air disinfection, but it is inherently unreliable and of limited use in cold climates. Upper room germicidal ultraviolet (UV) air disinfection with air mixing has been shown to be highly effective, but improved evidence-based dosing guidelines are needed. ⋯ Upper room germicidal UV air disinfection with air mixing was highly effective in reducing tuberculosis transmission under hospital conditions. These data support using either a total fixture output (rather than electrical or UV lamp wattage) of 15-20 mW/m(3) total room volume, or an average whole-room UV irradiance (fluence rate) of 5-7 μW/cm(2), calculated by a lighting computer-assisted design program modified for UV use.
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Am. J. Respir. Crit. Care Med. · Aug 2015
An Official American Thoracic Society Research Statement: A Research Framework for Pulmonary Nodule Evaluation and Management.
Pulmonary nodules are frequently detected during diagnostic chest imaging and as a result of lung cancer screening. Current guidelines for their evaluation are largely based on low-quality evidence, and patients and clinicians could benefit from more research in this area. ⋯ This statement may help researchers to develop impactful and innovative research projects and enable funders to better judge research proposals. We hope that it will accelerate the pace and increase the efficiency of discovery to improve the quality of care for patients with pulmonary nodules.