Chest
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Emerging data suggest that determination of physiologic endotypic traits (eg, loop gain) may enable precision medicine in OSA. ⋯ Endotypic trait analysis using a single standard polysomnography shows acceptable reliability and reproducibility in patients with moderate to severe OSA. The reported MDDs of endotypic traits may facilitate the quantification of relevant changes and may guide future evaluation of interventions in OSA.
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Early detection of lung cancer through management of pulmonary nodules (PNs) may reduce lung cancer mortality. We assessed the relationship between PNs and lung cancer. ⋯ Patients with lung cancer who received a diagnosis after identification of PNs tended to have localized disease. Of all patients with localized disease, almost one-third had PNs that were diagnosed previously, compared with 5% of patients who had undergone LDCT scan screening. PNs represent a relatively common presentation of potentially curable lung cancer.
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Recent guidelines have emphasized actively avoiding fever to improve outcomes in patients who are comatose following resuscitation from cardiac arrest (ie, out-of-hospital cardiac arrest). However, whether targeted temperature management between 32 °C and 36 °C (TTM32-36) can improve neurologic outcome in some patients remains debated. ⋯ TTM32-36 was significantly associated with a better outcome in patients with low and high severity at ICU admission assessed according to the mCAHP score. Further studies are needed to evaluate individualized temperature control following out-of-hospital cardiac arrest.
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CPAP is the first-line therapy for OSA. A high or variable residual apnea-hypopnea index (rAHI) reflects treatment failure and potentially is triggered by exacerbation of cardiovascular comorbidities. Previous studies showed that high rAHI and large rAHI variability are associated with underlying comorbidities, OSA characteristics at diagnosis, and CPAP equipment, including mask type and settings. ⋯ Identifying phenotypic traits and factors associated with high rAHI variability will allow early intervention and the development of personalized follow-up pathways for CPAP treatment.
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A critical need exists to develop remission-inducing therapies for lymphangioleiomyomatosis. ⋯ The addition of resveratrol was safe and well tolerated in patients with lymphangioleiomyomatosis taking sirolimus and was associated with modest improvement in HRQOL. Larger controlled trials of this combination might be warranted to assess definitively the usefulness of resveratrol as an additive therapy in lymphangioleiomyomatosis.