Respiration; international review of thoracic diseases
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Polysomnography (PSG) tests are very complicated and time consuming, despite their clinical benefits in the diagnosis of patients with obstructive sleep apnea hypopnea syndrome (OSAHS). A plasma marker would be desirable to select patients suspected of OSAHS for further PSG studies. We have recently reported that orexin-A concentrations in plasma collected immediately after waking early in the morning were significantly lower in patients with OSAHS than in controls. ⋯ These findings suggest that the orexin-A concentration in plasma obtained even in the daytime may be a useful plasma marker for screening OSAHS.
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Restriction is a typical functional abnormality in interstitial lung disease (ILD) patients, but is not always present, especially in the early stage of the disease. The greater reduction of vital capacity (VC; %pred.) than total lung capacity (TLC; %pred.) is regarded as a typical pattern of lung function disturbances in ILD patients. ⋯ The relative loss of TLC was greater than VC in our large group of patients. Measurement of TLC should be part of functional assessment of ILD patients, irrespective of whether they present or do not present a restrictive pattern in spirometry.
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A decreased forced expiratory volume in 1 s/vital capacity (FEV(1)/VC) ratio is the hallmark of the definition of airway obstruction. We recently suggested that a lung function pattern, we called small airways syndrome (SAOS), has a normal FEV(1)/VC and total lung capacity (TLC) and reflects obstruction of small airways. ⋯ Our results suggest that a normal FEV(1)/VC ratio does not exclude airway obstruction. A decrease of FEV(1), provided TLC is normal, reflects small airway obstruction.
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Editorial Comment Review
Bronchoscopic lung volume reduction: a window for the future?
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Technically challenging professions such as those of the defense and transportation industries increasingly use computer-based simulation and written self-learning instruments for education and to determine competency. A structured learning curriculum does not exist, however, for flexible bronchoscopy, a minimally invasive diagnostic procedure performed on thousands of patients by respiratory specialists, otolaryngologists, anesthesiologists, and surgeons worldwide. ⋯ Trainees concluded that (1) bronchoscopy simulation was realistic, (2) simulator-based practice would help improve technical skills, and (3) a written questionnaire would benefit theoretical knowledge acquisition if designed as a learning instrument. The wide variability noted in this study as well as the lack of a relationship between technical skill, knowledge of bronchoscopy theory, extent of training, and bronchoscopy experience suggest that competency should not be assumed based on years of bronchoscopy training or on an arbitrary number of procedures performed.