Annals of the American Thoracic Society
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Neuroendocrine cell hyperplasia of infancy (NEHI) is a diffuse lung disease which presents in infancy and improves during childhood. Long-term outcomes have not previously been described. In one familial cohort, we have reported that NEHI is associated with a heterozygous variant of NKX2.1/TTF1. ⋯ Although clinical improvement occurs over time, NEHI may result in life-long pulmonary abnormalities in some cases. Further studies are required to better describe the natural history of this disease and would be facilitated by additional delineation of genetic mechanisms to enable improved case identification.
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Multicenter Study
Vitamin D Concentrations and Obstructive Sleep Apnea in a Multicenter Cohort of Older Males.
Seasonal nadirs in 25-hydroxyvitamin D (25[OH]D) concentrations overlap with increased incidence and severity of obstructive sleep apnea (OSA) in winter. We hypothesized that, because lower 25(OH)D concentrations might lead to upper airway muscle dysfunction, low 25(OH)D would be associated with higher apnea-hypopnea index (AHI), a measure of OSA severity. ⋯ Among community-dwelling older men, the association between lower 25(OH)D and sleep apnea was largely explained by confounding by larger body mass index and neck circumference.
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Early rehabilitation in an intensive care unit is associated with improved physical functioning and patient outcomes. However, relatively few data have been reported on physical therapy interventions during continuous renal replacement therapy (CRRT) for patients in intensive care units. ⋯ In this prospective observational study at one adult medical intensive care unit, we found that provision of bedside physical therapy while patients underwent CRRT is feasible, and appears safe.
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Multicenter Study
Validation and Refinement of Chronic Lung Allograft Dysfunction Phenotypes in Bilateral and Single Lung Recipients.
The clinical course of chronic lung allograft dysfunction (CLAD) is heterogeneous. Forced vital capacity (FVC) loss at onset, which may suggest a restrictive phenotype, was associated with worse survival for bilateral lung transplant recipients in one previously published single-center study. ⋯ We independently validated the prognostic significance of FVC loss for bilateral lung recipients and demonstrated that this approach to CLAD classification also confers prognostic information for single lung transplant recipients. Improved understanding of these discrete phenotypes is critical to the development of effective therapies.
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Many patients are diagnosed with small pulmonary nodules for which professional societies recommend subsequent imaging surveillance. Adherence to these guidelines involves many steps from both clinicians and patients but has not been well studied. ⋯ Patients and clinicians often do not adhere to nodule follow-up recommendations. Interventions designed to improve communication quality and decrease distress may also improve patient adherence to nodule follow-up recommendations.