American journal of respiratory and critical care medicine
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Am. J. Respir. Crit. Care Med. · Dec 2014
ReviewRespiratory Complications of Organophosphorus Nerve Agent and Insecticide Poisoning - Implications for Respiratory and Critical Care.
Organophosphorus (OP) compound poisoning is a major global public health problem. Acute OP insecticide self-poisoning kills over 200,000 people every year, the majority from self-harm in rural Asia. Highly toxic OP nerve agents (e.g., sarin) are a significant current terrorist threat, as shown by attacks in Damascus during 2013. ⋯ However, preclinical and clinical research over the last two decades has indicated a more complex picture of respiratory complications after OP insecticide poisoning, including onset of delayed neuromuscular junction dysfunction during the cholinergic syndrome, aspiration causing pneumonia and acute respiratory distress syndrome, and the involvement of solvents in OP toxicity. The treatment of OP poisoning has not changed over the last 50 years. However, a better understanding of the multiple respiratory complications of OP poisoning offers additional therapeutic opportunities.
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Am. J. Respir. Crit. Care Med. · Dec 2014
Cigarette Smoking Impairs Human Pulmonary Immunity to Mycobacterium tuberculosis.
Cigarette smoking is linked to important aspects of tuberculosis, such as susceptibility to infection, disease reactivation, mortality, transmission, and persistent infectiousness. The mechanistic basis for this remains poorly understood. ⋯ In smokers, the pulmonary compartment has a number of macrophage-specific immune impairments that provide some mechanistic explanations whereby cigarette smoking renders a patient susceptible to tuberculosis infection and disease.
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Am. J. Respir. Crit. Care Med. · Dec 2014
Asbestos Exposure, Pleural Plaques and the Risk of Death from Lung Cancer.
Although asbestos is a well-known lung carcinogen, the pleural plaque-lung cancer link remains controversial. ⋯ Pleural plaques may be an independent risk factor for lung cancer death in asbestos-exposed workers and could be used as an additional criterion in the definition of high-risk populations eligible for CT screening.
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Am. J. Respir. Crit. Care Med. · Dec 2014
Practice GuidelineAn Official American Thoracic Society Clinical Practice Guideline: The Diagnosis of Intensive Care Unit-acquired Weakness in Adults.
Profound muscle weakness during and after critical illness is termed intensive care unit-acquired weakness (ICUAW). ⋯ Research that identifies treatments that benefit patients with ICUAW is necessary to determine whether the benefits of diagnostic testing for ICUAW outweigh its burdens.
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Am. J. Respir. Crit. Care Med. · Dec 2014
IL-33-dependent Type 2 Inflammation During Rhinovirus-induced Asthma Exacerbations In Vivo.
Rhinoviruses are the major cause of asthma exacerbations; however, its underlying mechanisms are poorly understood. We hypothesized that the epithelial cell-derived cytokine IL-33 plays a central role in exacerbation pathogenesis through augmentation of type 2 inflammation. ⋯ IL-33 and type 2 cytokines are induced during a rhinovirus-induced asthma exacerbation in vivo. Virus-induced IL-33 and IL-33-responsive T cells and ILC2s are key mechanistic links between viral infection and exacerbation of asthma. IL-33 inhibition is a novel therapeutic approach for asthma exacerbations.