American journal of respiratory and critical care medicine
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Am. J. Respir. Crit. Care Med. · Feb 2012
Comparative Study Clinical TrialDiscordance among commercially available diagnostics for latent tuberculosis infection.
There is uncertainty regarding how to interpret discordance between tests for latent tuberculosis infection. ⋯ For most positive results the three tests identified different people, suggesting that in low-prevalence populations most discordant results are caused by false-positives. False-positive tuberculin skin test reactions associated with reactivity to nontuberculous mycobacteria and bacille Calmette-Guérin vaccination may account for a proportion of test discordance observed.
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Am. J. Respir. Crit. Care Med. · Feb 2012
Metabolic syndrome biomarkers predict lung function impairment: a nested case-control study.
Cross-sectional studies demonstrate an association between metabolic syndrome and impaired lung function. ⋯ Abnormal triglycerides and HDL and elevated heart rate and leptin are independent risk factors of greater susceptibility to lung function impairment after September 11, 2001, whereas elevated amylin is protective. Metabolic biomarkers are predictors of lung disease, and may be useful for assessing risk of impaired lung function in response to particulate inhalation.
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Am. J. Respir. Crit. Care Med. · Feb 2012
ReviewDecision making in patients with pulmonary nodules.
Integrating current evidence with fundamental concepts from decision analysis suggests that management of patients with pulmonary nodules should begin with estimating the pretest probability of cancer from the patient's clinical risk factors and computed tomography characteristics. Then, the consequences of treatment should be considered, by comparing the benefits of surgery if the patient has lung cancer with the potential harm if the patient does not have cancer. This analysis determines the "treatment threshold," which is the point around which the decision centers. ⋯ Patient preferences should be considered because the absolute difference in outcome between strategies may be small. The optimal approach to the management of patients with pulmonary nodules is evolving as technologies develop. Areas of uncertainty include quantifying the hazard of delayed diagnosis; determining the optimal duration of follow-up for ground-glass and semisolid opacities; establishing the roles of volumetric imaging, advanced bronchoscopic technologies, and limited surgical resections; and calculating the cost-effectiveness of different strategies.