American journal of respiratory and critical care medicine
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Am. J. Respir. Crit. Care Med. · Sep 2011
Has my patient responded? Interpreting clinical measurements such as the 6-minute-walk test.
To correctly interpret clinical measurements it is necessary to understand the standard deviation and the standard error; the former reflects the range or variability of individuals within a sample and the latter reflects the precision for which the group parameters have been estimated. When evaluating an individual patient, test measurement properties such as repeatability will assist in concluding whether a repeated test, measured to monitor the response to an intervention, has changed beyond its natural variability. Using the “best” test has an inherent bias and ignores the natural test variation, whereas the average of repeated tests is more representative of the true value, making it more discriminative to change. Serial measurements to follow progress will increase a clinician's confidence in the observed effects of treatment.
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Am. J. Respir. Crit. Care Med. · Sep 2011
Elevated eosinophil protein X in urine from healthy neonates precedes development of atopy in the first 6 years of life.
Biomarkers predicting development of atopic disease are needed for targeted preventive measures and to study if disease pathology may be active before onset of symptoms. ⋯ Eosinophil protein X in urine from asymptomatic neonates is a biomarker significantly associated with later development of allergic sensitization, nasal eosinophilia, and eczema during the first 6 years of life. These findings suggest activation of eosinophil granulocytes early in life before development of atopy-related symptoms.
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Am. J. Respir. Crit. Care Med. · Sep 2011
The inflammatory preatherosclerotic remodeling induced by intermittent hypoxia is attenuated by RANTES/CCL5 inhibition.
The highly prevalent obstructive sleep apnea syndrome (OSA) with its main component intermittent hypoxia (IH) is a risk factor for cardiovascular mortality. The poor knowledge of its pathophysiology has limited the development of specific treatments, whereas the gold standard treatment, continuous positive airway pressure, may not fully reverse the chronic consequences of OSA and has limited acceptance in some patients. ⋯ Inflammation is a determinant mechanism for IH-induced preatherosclerotic remodeling involving RANTES/CCL5, a key chemokine in atherogenesis. Characterization of the inflammatory response could allow identifying at-risk patients for complications, and its pharmacologic manipulation may represent a potential complementary treatment of sleep apnea consequences.
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Am. J. Respir. Crit. Care Med. · Sep 2011
Estrogen rescues preexisting severe pulmonary hypertension in rats.
Pulmonary hypertension (PH) is characterized by progressive increase in pulmonary artery pressure leading to right ventricular (RV) hypertrophy, RV failure, and death. Current treatments only temporarily reduce severity of the disease, and an ideal therapy is still lacking. ⋯ Estrogen rescues preexisting severe PH in rats by restoring lung and RV structure and function that are maintained even after removal of estrogen. Estrogen-induced rescue of PH is associated with stimulation of cardiopulmonary neoangiogenesis, suppression of inflammation, fibrosis, and RV hypertrophy. Furthermore, estrogen rescue is likely mediated through estrogen receptor-β.
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Am. J. Respir. Crit. Care Med. · Sep 2011
Short-course chemotherapy with TMC207 and rifapentine in a murine model of latent tuberculosis infection.
Multidrug-resistant and extensively drug-resistant tuberculosis (MDR/XDR-TB) is an emerging global health threat. Proper management of close contacts of infectious patients is increasingly important. However, no evidence-based recommendations for treating latent TB infection (LTBI) after MDR/XDR-TB exposure (DR-LTBI) exist. An ultrashort regimen for LTBI caused by drug-susceptible strains (DS-LTBI) is also desirable. TMC207 has bactericidal and sterilizing activity in animal models of TB and improves the activity of current MDR-TB therapy in patients. ⋯ TMC207 has substantial sterilizing activity and may enable treatment of DR-LTBI in 3-4 months.