Chest
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Sleep abnormalities are clearly recognized as a distinct clinical symptom of concern in neurodegenerative disorders. Appropriate management of sleep-related symptoms has a positive impact on quality of life in patients with neurodegenerative disorders. This review provides an overview of mechanisms that are currently being considered that tie sleep with neurodegeneration. ⋯ This provides a clinical strategy for screening patients in the preclinical stages of neurodegenerative disorders to enable therapeutic trials to establish the efficacy of neuroprotective agents to prevent or delay the development of symptoms and functional decline. It is unclear if sleep disturbance directly impacts neurodegenerative processes or is a secondary outcome of neurodegeneration; this is an active area of research. The clinical importance of recognizing and managing sleep changes in neurodegenerative disorders is beyond doubt.
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Because the interrelationships of objectively ascertained sleep-disordered breathing (SDB), postcardiac surgery atrial fibrillation (PCSAF), and obesity remain unclear, we aimed to further investigate the interrelationships in a clinic-based cohort. ⋯ SDB was significantly associated with PCSAF in unadjusted analyses, but not after taking into account obesity; those with both SDB and obesity may represent a vulnerable subgroup to target to reduce PCSAF and its associated morbidity.
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Many people with asthma remain suboptimally controlled despite current treatments. Reasons include comorbidities that could aggravate asthma, including gastroesophageal reflux. We aimed to investigate whether aspiration occurs in patients with asthma and, if so, does it correlate with asthma control? ⋯ This study suggests that the importance of aspiration on current asthma symptom control and exacerbation rate may be overstated. However, this study did not address the role of aspiration and future risk of exacerbation.
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Case Reports
An Elderly Man With Pancreatic Neuroendocrine Tumor and a Cavitary Right Upper Lobe Lung Mass.
An elderly man presented to the ED from a nursing care facility after transient loss of consciousness. Three weeks previously, the patient had been diagnosed with a high-grade pancreatic neuroendocrine tumor (NET) with metastases to the liver after being hospitalized for weakness. A chest radiograph at that time had revealed a right upper lobe mass that was presumed to represent a metastatic lesion (Fig 1); CT of the chest demonstrated similar findings (Fig 2). ⋯ In addition, his medical history was significant for hypertension, diabetes mellitus, and congestive heart failure with systolic dysfunction. He was a former smoker. Prior to his recent illness and hospitalization, he lived at home with his family and was independent in his activities of daily living.
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Cardiac output (Q˙) is a key parameter in the assessment of cardiac function, its measurement being crucial for the diagnosis, treatment, and prognostic evaluation of all heart diseases. Until recently, Q˙ determination at peak exercise has been possible through invasive methods, so that normal values were obtained in studies based on small populations. ⋯ The simultaneous measurement of Q˙ and V˙o2 at peak exercise in a large sample of healthy subjects provided an equation to predict peak Q˙ from peak V˙o2 values.