Chest
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The goal of asthma management is to achieve disease control; however, despite the availability of effective and safe medications, for many patients asthma remains uncontrolled. One reason for this is the fear of long-term side effects from the regular use of inhaled corticosteroids (ICSs). Adverse effects of poorly controlled asthma (for example, obesity, pneumonia, and risks to the fetus) can be perceived as side effects of ICSs. ⋯ Lastly, the risks of uncontrolled asthma during pregnancy are substantially greater than the risks of recommended asthma medications. Treatments to maintain asthma control are the best approach to optimize maternal and fetal health in the pregnancies of women with asthma. The maintenance of asthma control has significant advantages to patients and greatly outweighs the potential risks of treatment side effects.
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Randomized Controlled Trial
Benefits of neuromuscular electrical stimulation prior to endurance training in patients with cystic fibrosis and severe pulmonary dysfunction.
We investigated the effect of neuromuscular electrical stimulation (NMES) training prior to endurance training in patients with cystic fibrosis (CF) and severe pulmonary obstruction. ⋯ NMES training performed prior to endurance training is useful for strengthening peripheral muscles, which in turn may augment gains in body weight and quality of life, further reductions in ventilation requirements during exercise, and retard insulin resistance in patients with CF with severe pulmonary obstruction.
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Multicenter Study
Perception by family members and ICU staff of the quality of dying and death in the ICU: a prospective multicenter study in The Netherlands.
Admission to the ICU is a major event in a patient’s life and also for family members. We tried to elucidate how family members and ICU caregivers experience the dying process of their patients. ⋯ Quality of dying and death is generally perceived to be good by family members and caregivers of patients who die in Dutch ICUs. There is a need for modification of the QODD questionnaire for the European ICU population.
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T helper 17 (Th17) cytokines are now widely believed to be critical for the regulation of various chronic immune diseases. Investigations have revealed a significant role for IL-17 cytokines in regulating inflammation and modulating lung and airway structural cells in asthma and COPD. In this review, our current understanding of the role of Th17-associated cytokines in airway diseases is summarized. Therapeutic approaches targeting IL-17 during asthma and COPD are also discussed.
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Vaccination is the primary strategy for prevention and control of influenza. The surface hemagglutinin (HA) protein of the influenza virus contains two structural elements (head and stalk) that differ in their potential utility as vaccine targets. The head of the HA protein is the primary target of antibodies that confer protective immunity to influenza viruses. ⋯ The use of systems vaccinology has allowed for the generation of gene expression signatures that represent key transcriptional differences between asymptomatic and symptomatic host responses to influenza infection. Additionally, the use of systems vaccinology tools have resulted in the identification of novel surrogate gene markers that are predictors of the magnitude of host responses to vaccines, which is critical to both vaccine development and public health. Identifying associations between variations in vaccine immune responses and gene polymorphisms is critical in the development of universal influenza vaccines.