The American journal of medicine
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Gastroesophageal reflux (GER) has been associated with a number of interstitial lung diseases, including systemic sclerosis and idiopathic pulmonary fibrosis. Systemic sclerosis results in both pulmonary and esophageal manifestations, and studies have shown a correlation, but no causal relation, between GER and pulmonary fibrosis in this condition. ⋯ Aggressive, long-term therapy of GER and evaluation of its effect on pulmonary disease will allow determination of the real influence of GER on idiopathic pulmonary fibrosis. Additional outcomes-based studies and therapeutic trials are needed to clarify the association between GER and interstitial lung diseases.
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Several reflexes are initiated in the fetus and newborn when hypochloremic or strongly acidic solutions contact the epithelium that surrounds the entrance to the laryngeal airway. These reflexes, known collectively as the laryngeal chemoreflex (LCR), include startle, rapid swallowing, apnea, laryngeal constriction, hypertension, and bradycardia. Many studies have shown that prolonged apnea associated with the LCR may be life threatening and might conceivably be a cause of sudden infant death syndrome. ⋯ The LCR develops in the fetus, in an all-aqueous environment, during a period in which aspiration of amniotic fluid poses a serious threat to life. This and other considerations suggest that the transformation in LCR responses from fetal to adult life can be viewed as functionally appropriate to their primary role in defending the airway from aspiration. The laryngeal "water receptors" that initiate the LCR in infants and adults alike appear to be the primary sensory mechanism for defending the airway from aspiration of liquids.
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Long-term activation of the sympathetic nervous system exerts adverse biologic effects that are mediated through alpha(1), beta(1) and beta(2) receptors and that contribute importantly to the progression of heart failure. As a result, beta blockers are no longer considered to be contraindicated for use in these patients but instead now play a critical role in the successful management of chronic heart failure. ⋯ The database supporting the use of beta blockers is now as persuasive (and arguably more persuasive) than the database supporting the use of ACE inhibitors in heart failure (which comprises about 7,000 patients). Yet, the benefits of beta blockers are seen in patients already receiving ACE inhibitors, suggesting that combined blockade of two neurohormonal systems (renin-angiotensin system and sympathetic nervous system) can produce additive effects.
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The objective of this review was to determine the incidence of adverse events associated with acupuncture. ⋯ Although the incidence of minor adverse events associated with acupuncture may be considerable, serious adverse events are rare. Those responsible for establishing competence in acupuncture should consider how to reduce these risks.
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Beta blockers have repeatedly demonstrated their therapeutic value in the treatment of a variety of diseases; as a result, multiple treatment guidelines advocate the use of beta blockers. Despite these guidelines, the use of beta blockers is remarkably low. ⋯ Recent primary evidence from randomized clinical trials has demonstrated a significant benefit to patients with heart failure when beta-blocker therapy is added to standard therapy. To ensure proper treatment, continuing efforts must be made to provide patients with appropriate therapy that is proven to reduce the risks of mortality and morbidity.