The European respiratory journal : official journal of the European Society for Clinical Respiratory Physiology
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Perfusion scintigraphy is the most frequently used method for the regional assessment of pulmonary function in candidates for pulmonary resection with borderline respiratory function. This method provides two-dimensional images, and it considers all the segments of the pulmonary lobes as having the same volume and function, without considering the spatial overlapping of pulmonary areas with different function. As single-photon emission computed tomography (SPECT) provides tomographic imaging, this could be a more precise method for regional assessment. ⋯ The Pearson's linear correlation coefficient was 0.8840 for FEV1,ppo estimated by PA and 0.8791 for FEV1,ppo estimated by SPECT. The linear correlation coefficient for lobectomy was greater than the coefficient for pneumonectomy using both methods. In conclusion, both methods show good correlation for real postoperative pulmonary function without demonstrating single-photon emission computed tomography superiority over planar acquisition, and both methods were more effective for estimating postoperative predicted forced expiratory volume in one second in lobectomies than in pneumonectomies.
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Comparative Study
Reduced inspiratory flow attenuates IL-8 release and MAPK activation of lung overstretch.
Lung overstretch involves mechanical factors, including large tidal volumes (VT), which induce inflammatory responses. The current authors hypothesised that inspiratory flow contributes to ventilator-induced inflammation. Buffer-perfused rabbit lungs were ventilated for 2 h with 21%, O2+5%, CO2, positive end-expiratory pressure of 2-3 cmH2O and randomly assigned to either: 1) normal VT (6 mL x kg(-1)) at respiratory rate (RR) 30, inspiration:expiration time ratio (I:E) 1:1, low inspiratory flow 6 mL x kg(-1) x s(-1); 2) large VT (12 mL x kg(-1)) at RR 30, I:E 1:1, high inspiratory flow 12 mL x kg(-1) x s(-1) (HRHF); 3) large VT at RR 15, I:E 1:1, low inspiratory flow 6 mL x kg(-1) x s(-1) (LRLF); or 4) large VT at RR 15, I:E 1:2.3, high inspiratory flow 10 mL x kg(-1) x s(-1) (LRHF). ⋯ Changes in TNF-alpha were small. Tissue IL-8 and phospho-ERK1/2 staining was localised primarily to smooth muscle, adventitia and bronchial epithelium within larger bronchioles and arterioles. These results indicate that mild overstretch of perfused lungs during high inspiratory flow enhances inflammatory signalling by cells in lung regions most affected by strong turbulent airflow.
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Comment Letter Comparative Study
Pre- and post-bronchodilator spirometric values and the degree of reversibility in patients with COPD.
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Comparative Study
Patient-physician communication about end-of-life care for patients with severe COPD.
Since patients with chronic obstructive pulmonary disease (COPD) infrequently discuss treatment preferences about end-of-life care with physicians, the goal of the present study was to identify which specific areas of communication about end-of-life care occur between patients with severe COPD and their physicians, and how patients rate the quality of this communication. A total of 115 patients with oxygen-dependent COPD, identified in pulmonary clinics in three hospitals and through an oxygen delivery company, were enrolled in this study. A 17-item quality of communication questionnaire (QOC) was administered to patients, along with other measures, including satisfaction with care. ⋯ In conclusion, this study identifies areas of communication that physicians do not address and areas that patients rate poorly, including talking about prognosis, dying and spirituality. These areas may provide targets for interventions to improve communication about end-of-life care for patients with chronic obstructive pulmonary disease. Future studies should determine the responsiveness of these items to interventions, and the effect such interventions have on patient satisfaction and quality of care.
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The evidence for a genetic component in the aetiology of sarcoidosis includes familial aggregation, associations with genetic polymorphisms, and linkage to the major histocompatibility complex class region on chromosome 6p. Unfortunately, the majority of genetic associations with sarcoidosis have not been consistently replicated. In the present study, using a family-based study design, which controls for population stratification, the authors attempted to replicate previously reported associations between sarcoidosis and three attractive candidate genes studied primarily in case-control samples. ⋯ Further analyses of chronic and acute disease phenotypes failed to reveal any notable associations. Assuming an underlying inheritance model with an additive allelic effect on disease risk, the current study had approximately 80-90% statistical power to detect a 3-fold increased risk associated with the putative risk allele of the polymorphisms under study. The present authors conclude that in African-Americans, the angiotensin converting enzyme, vitamin D receptor, and tumour necrosis factor-alpha genes are not significant risk factors for sarcoidosis susceptibility.