American journal of respiratory and critical care medicine
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Am. J. Respir. Crit. Care Med. · Apr 2017
MMP-1 Activation Contributes to Airway Smooth Muscle Growth and Asthma Severity.
Matrix metalloproteinase-1 (MMP-1) and mast cells are present in the airways of people with asthma. ⋯ MMP-1 is activated by mast cell tryptase resulting in a proproliferative extracellular matrix. In asthma, mast cells are associated with airway smooth muscle growth, MMP-1 levels are associated with bronchial hyperresponsiveness, and MMP-1 activation are associated with exacerbation severity. Our findings suggest that airway smooth muscle/mast cell interactions contribute to asthma severity by transiently increasing MMP activation, airway smooth muscle growth, and airway responsiveness.
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Am. J. Respir. Crit. Care Med. · Apr 2017
Randomized Controlled Trial Multicenter StudyFluctuation Analysis of Peak Expiratory Flow and its Association with Treatment Failure in Asthma.
Temporal fluctuations have been demonstrated in lung function and asthma control, but the effect of controller therapy on these fluctuations is unknown. ⋯ We conclude that increased temporal self-similarity (α) of more variable lung function (CVpef) is associated with treatment failure, but the pattern of change in self-similarity leading up to treatment failure is variable across individuals.
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Am. J. Respir. Crit. Care Med. · Apr 2017
Randomized Controlled Trial Multicenter StudyRandomized Trial of Pleural Fluid Drainage Frequency in Patients with Malignant Pleural Effusions-The ASAP Trial.
Patients with malignant pleural effusions have significant dyspnea and shortened life expectancy. Indwelling pleural catheters allow patients to drain pleural fluid at home and can lead to autopleurodesis. The optimal drainage frequency to achieve autopleurodesis and freedom from catheter has not been determined. ⋯ Among patients with malignant pleural effusion, daily drainage of pleural fluid via an indwelling pleural catheter led to a higher rate of autopleurodesis and faster time to liberty from catheter. Clinical trial registered with www.clinicaltrials.gov (NCT 00978939).
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Am. J. Respir. Crit. Care Med. · Apr 2017
ReviewSpontaneous Breathing During Mechanical Ventilation - Risks, Mechanisms & Management.
Spontaneous respiratory effort during mechanical ventilation has long been recognized to improve oxygenation, and because oxygenation is a key management target, such effort may seem beneficial. Also, disuse and loss of peripheral muscle and diaphragm function is increasingly recognized, and thus spontaneous breathing may confer additional advantage. ⋯ Notwithstanding the central place of spontaneous breathing in mechanical ventilation, accumulating evidence indicates that it may cause-or worsen-acute lung injury, especially if acute respiratory distress syndrome is severe and spontaneous effort is vigorous. This Perspective reviews the evidence for this phenomenon, explores mechanisms of injury, and provides suggestions for clinical management and future research.
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Am. J. Respir. Crit. Care Med. · Apr 2017
Multicenter Study Comparative StudyComparison of Echocardiographic Indices Used to Predict Fluid Responsiveness in Ventilated Patients.
Assessment of fluid responsiveness relies on dynamic echocardiographic parameters that have not yet been compared in large cohorts. ⋯ ∆VmaxAo had the best sensitivity and ∆SVC the best specificity in predicting fluid responsiveness. ∆SVC had a greater diagnostic accuracy than ∆IVC and ∆PP, but its measurement requires transesophageal echocardiography.