Chest
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Individuals with OSA have elevated levels of inflammatory markers, but no prospective study has examined the role of inflammation in the development of OSA. ⋯ Higher CRP was prospectively associated with increased OSA risk, particularly among younger individuals, underweight/normal-weight individuals, or premenopausal women. The differential associations by OSA phenotype/endotype suggest possible mechanisms through which inflammation operates to modulate OSA risk. Given our reliance on a single CRP level measured a decade before OSA assessment, future studies with repeated CRP measurements are warranted to confirm these prospective associations.
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Observational Study
Development and Prospective Validation of a Deep Learning Algorithm for Predicting Need for Mechanical Ventilation.
Objective and early identification of hospitalized patients, and particularly those with novel coronavirus disease 2019 (COVID-19), who may require mechanical ventilation (MV) may aid in delivering timely treatment. ⋯ A transparent deep learning algorithm improves on traditional clinical criteria to predict the need for MV in hospitalized patients, including in those with COVID-19. Such an algorithm may help clinicians to optimize timing of tracheal intubation, to allocate resources and staff better, and to improve patient care.
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Multicenter Study
Clinical significance of interstitial lung disease and its acute exacerbation in microscopic polyangiitis.
Presence of interstitial lung disease (ILD) is thought to be associated with mortality in microscopic polyangiitis (MPA); however, evidence on MPA-ILD remains lacking. Acute exacerbation (AE) refers to rapidly progressive, fatal respiratory deterioration that may develop in patients with various ILDs. No study has investigated the clinical significance of AE in MPA-ILD. ⋯ MPA-ILD represented a distinct phenotype with poor prognosis. Lower %FVC was an independent prognostic factor. Patients with lower %FVC had a risk of developing AE, which was a strong prognostic determinant. The specific management for MPA-ILD and AE should be established.
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Observational Study
Epidemiology, Risk Factors and Outcomes of Diffuse Alveolar Hemorrhage after Hematopoietic Stem Cell Transplantation.
Diffuse alveolar hemorrhage (DAH) is an uncommon complication of hematopoietic stem cell transplantation (HCT) that carries high morbidity and mortality. Limited contemporary data are available regarding the incidence, outcomes, and risk factors for DAH. ⋯ The mortality of DAH after HCT remains high, and DAH can occur long after transplantation. Later development of DAH (>30 days after HCT), need for invasive mechanical ventilation, thrombocytopenia, and elevated INR are all associated with worse outcomes.
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A 44-year-old woman with a history of renal cell carcinoma and thyroid cancer was referred to our institution for evaluation of cystic lung disease. She was an active smoker with a 15-pack-year of tobacco use. Two years before her presentation, she underwent a left nephrectomy for renal cell carcinoma, clear cell type. ⋯ There was no family history of pneumothorax. She complained of mild shortness of breath with exertion and occasional nonproductive cough. As part of her oncologic work up, she underwent a chest CT scan of the lungs (Fig 1).