American journal of respiratory and critical care medicine
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Am. J. Respir. Crit. Care Med. · Nov 2013
Clinical TrialDiagnosis and Subtyping of de novo and Relapsed Mediastinal Lymphomas by Endobronchial Ultrasound Needle Aspiration.
The current management of lymphoma requires accurate diagnosis and subtyping of de novo lymphoma and of relapsed or refractory lymphoma in known cases. The role of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in the clinical management of lymphomas is unclear. ⋯ Multimodality evaluation of EBUS-TBNA can be successful in the diagnosis of de novo mediastinal lymphomas and is ideally suited in distinguishing lymphoma relapse from alternative pathologies; it is least sensitive in subtyping Hodgkin lymphoma.
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Am. J. Respir. Crit. Care Med. · Nov 2013
Increased Risk of Pneumonia and Bronchiolitis after Bacterial Colonization of the Airways as Neonates.
The frequency of pneumonia and bronchiolitis exhibits considerable variation in otherwise healthy children, and suspected risk factors explain only a minor proportion of the variation. We hypothesized that alterations in the airway microbiome in early life may be associated with susceptibility to pneumonia and bronchiolitis in young children. ⋯ Neonatal airway colonization with S. pneumoniae, H. influenzae, or M. catarrhalis is associated with increased risk of pneumonia and bronchiolitis in early life independently of asthma. This suggests a role of pathogenic bacterial colonization of the airways in neonates for subsequent susceptibly to pneumonia and bronchiolitis.
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Am. J. Respir. Crit. Care Med. · Nov 2013
Outgrowth of the Bacterial Airway Microbiome following Rhinovirus Exacerbation of Chronic Obstructive Pulmonary Disease.
Rhinovirus infection is followed by significantly increased frequencies of positive, potentially pathogenic sputum cultures in chronic obstructive pulmonary disease (COPD). However, it remains unclear whether these represent de novo infections or an increased load of organisms from the complex microbial communities (microbiome) in the lower airways. ⋯ After rhinovirus infection, there is a rise in bacterial burden and a significant outgrowth of Haemophilus influenzae from the existing microbiota of subjects with COPD. This is not observed in healthy individuals. Our findings suggest that rhinovirus infection in COPD alters the respiratory microbiome and may precipitate secondary bacterial infections.
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Am. J. Respir. Crit. Care Med. · Nov 2013
Practice GuidelineAn Official American Thoracic Society Research Statement: Comparative Effectiveness Research in Pulmonary, Critical Care, and Sleep Medicine.
Comparative effectiveness research (CER) is intended to inform decision making in clinical practice, and is central to patient-centered outcomes research (PCOR). ⋯ CER complements traditional efficacy research by placing greater emphasis on the effects of interventions in practice, and developing evidence to address the needs of the many stakeholders involved in health care decisions. Stakeholder engagement is an important component of CER.
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Am. J. Respir. Crit. Care Med. · Nov 2013
Ambient Carbon Monoxide Associated with Reduced Risk of Hospital Admissions for Respiratory Tract Infections.
Recent experimental and clinical studies suggest that exogenous carbon monoxide (CO) at lower concentrations may have beneficial effects under certain circumstances, whereas population-based epidemiologic studies of environmentally relevant CO exposure generated mixed findings. ⋯ Short-term exposure to ambient CO was associated with decreased risk of hospital admissions for RTI, suggesting some acute protective effects of low ambient CO exposure on respiratory infection.