American journal of respiratory and critical care medicine
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Am. J. Respir. Crit. Care Med. · Feb 2014
Deficiency of MDA5 Results in Exacerbated Chronic Post-Viral Lung Inflammation.
Respiratory viral infections can result in the establishment of chronic lung diseases. Understanding the early innate immune mechanisms that participate in the development of chronic postviral lung disease may reveal new targets for therapeutic intervention. The intracellular viral sensor protein melanoma differentiation-associated protein 5 (MDA5) sustains the acute immune response to Sendai virus, a mouse pathogen that causes chronic lung inflammation, but its role in the development of postviral chronic lung disease is unknown. ⋯ MDA5 modulates the development of chronic lung inflammation by regulating the early inflammatory response in the lung.
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Am. J. Respir. Crit. Care Med. · Feb 2014
Multicenter Study Clinical TrialDiagnostic Accuracy of Intracellular Mycobacterium tuberculosis Detection for Tuberculous Meningitis.
Early diagnosis and treatment of tuberculous meningitis saves lives, but current laboratory diagnostic tests lack sensitivity. ⋯ Enhanced bacterial detection by simple modification of the Ziehl-Neelsen stain and an ESAT-6 intracellular stain improve the laboratory diagnosis of tuberculous meningitis.
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Am. J. Respir. Crit. Care Med. · Feb 2014
Estimates of the Need for Palliative Care Consultation across United States ICUs Using a Trigger-based Model.
Use of triggers for palliative care consultation has been advocated in intensive care units (ICUs) to ensure appropriate specialist involvement for patients at high risk of unmet palliative care needs. The volume of patients meeting these triggers, and thus the potential workload for providers, is unknown. ⋯ Approximately one in seven ICU admissions met triggers for palliative care consultation using a single set of triggers, with an upper estimate of one in five patients using multiple sets of triggers; these estimates were consistent across different types of ICUs and individual units. These results may inform staffing requirements for providers to ensure delivery of specialized palliative care to ICU patients nationally.
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Am. J. Respir. Crit. Care Med. · Feb 2014
Clarification of the Risk of COPD in Alpha-1 Antitrypsin Deficiency PiMZ Heterozygotes.
Severe α1-antitrypsin deficiency (typically PiZZ homozygosity) is associated with a significantly increased risk of airflow obstruction and emphysema but the risk of chronic obstructive pulmonary disease (COPD) in PiMZ heterozygotes remains uncertain. ⋯ These results indicate that PiMZ heterozygotes have significantly more airflow obstruction and COPD than PiMM individuals and cigarette smoke exposure exerts a significant modifier effect.