Chest
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Investigations using high-resolution CT (HRCT) show that bronchial dilatation (BD) is found in many patients with asthma. However, the pathogenesis and pathophysiologic relevance of BD in asthma are poorly understood. A balance between matrix metalloproteinases (MMPs) and tissue inhibitors of metalloproteinases (TIMPs) may control the remodeling of extracellular matrix, and excess MMPs have been associated with destruction or dilatation of airways in patients with bronchiectasis. ⋯ BD is more prevalent in asthmatic patients than in normal subjects and might be associated with the severity of asthma. Cellular inflammation or possible imbalance between MMP-9 and TIMP-1 was not demonstrated in this study to be related to BD in asthma.
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Heart rate recovery (HRR) after exercise correlates with decreased vagal tone and mortality. Patients with COPD may have altered autonomic tone. We sought to determine the association of HRR with spirometry measures of pulmonary function. ⋯ Abnormalities found on spirometry are associated with abnormal HRR, which may reflect an altered autonomic tone associated with pulmonary dysfunction, either obstructive or restrictive in nature.
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To understand how Medicaid recipients with asthma view their experience with care. ⋯ Asthmatic patients rated the quality of the information that their physicians provide very highly and reported that that they understand how to treat exacerbations. However, they do not take prescribed inhaled steroids on a daily basis. In addition, many asthmatic patients reside in homes where cigarette smoking is present.
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Comparative Study
Contribution of C-reactive protein to the diagnosis and assessment of severity of community-acquired pneumonia.
To assess the usefulness of serum C-reactive protein (CRP) in the diagnosis and treatment approach of patients with community-acquired pneumonia (CAP). ⋯ Serum CRP level is a useful marker for establishing the diagnosis of CAP in adult patients with lower respiratory tract infections. High CRP values are especially high in patients with pneumonias caused by S pneumoniae or L pneumophila. Moreover, high CRP values are suggestive of severity, which may be of value in deciding about the appropriateness of inpatient care.
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The clinical practice of lung transplantation (LT) varies widely among transplant centers. The objective of this study was to determine the practice patterns of North American lung transplant programs in specific areas that are considered controversial by most lung transplant practitioners. ⋯ This survey provides a large, time-sensitive database summarizing the clinical practice of LT in North America. In general, the survey responses demonstrated a remarkable degree of consistency around patient selection criteria, but much greater variance in posttransplant management of lung transplant recipients. These findings may reflect the fact that a published selection criteria guideline exists, but no similar documents have been designed for postoperative management. Hopefully, postoperative areas with widely divergent approaches to management will foster future collaborative studies aimed at identifying the most appropriate practices.