Chest
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Increased epicardial adipose tissue (EAT) has adverse effects in cardiovascular diseases, independent of body mass index (BMI). Estrogen levels may impact EAT accumulation. Little is known about the predictors and potential impact of EAT in PAH. ⋯ In patients with PAH, high EAT and a greater rate of accumulation of EAT volume were independently associated with worse survival. Higher EAT volume was also associated with lower estrogen levels. The association of EAT volume with survival was independent of BMI and disease severity, suggesting that EAT may be a marker for a unique PAH phenotype. Future research should investigate the role of EAT-modifying therapies in PAH and consider incorporating EAT into PAH risk models.
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At the request of the Statewide Healthcare Coordination Center, the Minnesota Critical Care Working Group (CCWG) and ethics subgroup (EWG), composed of interprofessional leaders from Minnesota's nine largest health systems were asked to plan and coordinate critical care operations during the COVID-19 pandemic, including the 2021 Fall surge. ⋯ CCWG collected and analyzed evidence demonstrating crisis conditions and healthcare professional moral distress during the Fall 2021 COVID-19 surge. However, the group had a limited impact on care processes. This paper analyzes the group's efforts. It includes recommendations for researchers and policy makers.
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Lymphangioleiomyomatosis (LAM) is a rare cystic lung disease affecting women and is characterized by the proliferation of abnormal smooth muscle-like cells within the lungs, kidneys, and lymphatic system. Forced expiratory volume in 1 second (FEV1) and diffusing capacity of the lungs for carbon monoxide (DLCO) are two commonly used markers for evaluating the status of LAM, although the disease may predominantly be associated with changes in only one of these parameters. In this special feature, we trace the historical evolution of DLCO and FEV1 in LAM up to their current uses, beginning with their relationship in early studies with histopathology and imaging. ⋯ The LAM Histology Score (LHS), which measures the involvement of cysts and LAM cells in the lung via biopsy, relates to disease stages and aligns more with DLCO than FEV1. The Cyst Score, calculated from high-resolution computed tomography (HRCT) scans, is a measure of the lung parenchyma occupied by cysts and correlates with disease progression. Large cysts as visualized by HRCT predominantly influence FEV1, whereas smaller cysts, which impact a greater surface area of the lung and may be underestimated, tend to affect DLCO.
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Chronic obstructive pulmonary disease (COPD)-associated expiratory central airway collapse (ECAC) is a frequently overlooked benign airway obstructive disease, with complex causes and unclear pathological and physiological mechanisms. Although interventions such as noninvasive positive pressure ventilation, airway stenting, and tracheobronchoplasty have shown definite efficacy in the treatment of COPD-associated ECAC, the diagnosis and treatment of this disease remain challenging. This article provides a systematic evaluation and outlook of the epidemiology, etiology, pathophysiology, clinical manifestations, diagnosis, treatment of COPD-associated ECAC. ⋯ Although COPD -associated ECAC is attracting considerable attention, its pathophysiological mechanisms, diagnosis, and management are full of challenges. In the future, RCTs on different therapies using patient-centered outcomes, cost-effective analysis on different interventions, and consensus guidelines on COPD-associated ECAC are urgently needed.
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Impaired pulmonary function carries significant risks for lung, cardiovascular, and metabolic disorders. ⋯ This study identifies proteomic signatures of reduced lung function linked to comorbidities, paving the way for improved diagnostics and treatment for lung disease.