Current opinion in pulmonary medicine
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Cisplatin-based chemotherapy remains the treatment of choice in advanced nonsmall-cell lung cancer. The development of predictive biomarkers able to identify lung-cancer patients who are most likely to benefit from cisplatin-based chemotherapy would be a powerful tool. Many reports have explored the role of ERCC1 expression in the repair mechanism of cisplatin-induced DNA adducts in cancer cells. ⋯ High ERCC1 expression is predictive of resistance to platinum-based therapy. Thus, there is solid evidence to support ERCC1 as a useful marker of clinical resistance to platinum-based chemotherapy in the adjuvant setting of nonsmall-cell lung cancer. Meanwhile, optimization of methodology and standardization of technical procedures seem necessary before larger prospective studies can address the same question.
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This review describes advances in clinical and microbiological modalities for diagnosis of nosocomial pneumonia and the role of biological markers. ⋯ The diagnostic modality chosen depends on availability, personnel experience, and the patient's clinical status. Recent guidelines support the use of quantitative cultures in an integrated clinical and microbiological algorithm. The decision to adjust antibiotics involves clinical reassessment and interpretation of culture results. Biological markers have a potential role as screening and prognostic tools.
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Invasive fungal infections of the lung have been increasing due to the increase of the population most at risk. This review aims to describe some of the emerging fungal pathogens and their complex management. ⋯ Invasive fungal infections are on the increase and contribute significantly to overall mortality, particularly among transplant recipients. With the lack of well designed controlled clinical studies, physicians will need to draw from previously described cases and in-vitro susceptibility testing to optimize therapy.
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There is growing evidence that genetics plays a role in the development of chronic obstructive pulmonary disease. This review deals with the most recent findings, new methods to detect genetic susceptibility that may be helpful in this field, and how the environment may act on the genetic code of susceptible individuals and chronic obstructive pulmonary disease sufferers. ⋯ Candidate gene studies need to be interpreted with caution because of their lack of reproducibility. Genome-wide association studies may offer the best approach to identifying susceptibility genes in chronic obstructive pulmonary disease. Epigenetics needs to be considered in concert with genetic findings.
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Long-term oxygen treatment is one of the few interventions that improve survival in chronic obstructive pulmonary disease and it is widely used even though published evidence supporting the use of this treatment in chronic obstructive pulmonary disease is scanty. In addition, some studies do not demonstrate a mortality benefit for long-term oxygen treatment in this disease. It is important that long-term oxygen treatment be administered only to those patients who will benefit and in a manner that maximizes its efficacy. New studies are urgently needed to address these questions. ⋯ Future research will address the optimal timing and duration of oxygen therapy during rest, exercise and sleep, ways of identifying chronic obstructive pulmonary disease patients who are most likely to benefit and ways of improving patient compliance, all of which may have a profound effect on clinical practice.