American journal of respiratory and critical care medicine
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Am. J. Respir. Crit. Care Med. · Jul 2014
Increased one-year health care utilization in survivors of severe sepsis.
Hospitalizations for severe sepsis are common, and a growing number of patients survive to hospital discharge. Nonetheless, little is known about survivors' post-discharge healthcare use. ⋯ Healthcare use is markedly elevated after severe sepsis, and post-discharge management may be an opportunity to reduce resource use.
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Am. J. Respir. Crit. Care Med. · Jul 2014
Clinical TrialAn Aberrant Leukotriene A4 Hydrolase-PGP Pathway in the Pathogenesis of Chronic Obstructive Pulmonary Disease.
Chronic neutrophilic inflammation is a hallmark in the pathogenesis of chronic obstructive pulmonary disease (COPD) and persists after cigarette smoking has stopped. Mechanisms involved in this ongoing inflammatory response have not been delineated. ⋯ These results demonstrate a novel pathway of aberrant regulation of PGP/AcPGP, suggesting this inflammatory pathway may be intimately involved in disease progression in the absence of ongoing cigarette smoke exposure. We highlight a mechanism by which acrolein potentiates neutrophilic inflammation through selective inhibition of LTA4H aminopeptidase activity. Clinical trial registered with www.clinicaltrials.gov (NCT 00292552).
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Am. J. Respir. Crit. Care Med. · Jul 2014
Oxygenation Response to PEEP Predicts Mortality in ARDS: A Secondary Analysis of the LOVS and ExPress Trials.
Previous trials of higher positive end-expiratory pressure (PEEP) for acute respiratory distress syndrome (ARDS) failed to demonstrate mortality benefit, possibly because of differences in lung recruitability among patients with ARDS. ⋯ Patients with ARDS who respond to increased PEEP by improved oxygenation have a lower risk of death. The oxygenation response to PEEP might be used to predict whether patients will benefit from higher versus lower PEEP.
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Am. J. Respir. Crit. Care Med. · Jul 2014
Distinct Differences in Gene Expression Patterns in Pulmonary Arteries of COPD and IPF Patients with PH.
The development of pulmonary hypertension (PH) in patients with idiopathic pulmonary fibrosis (IPF) or chronic obstructive pulmonary disease (COPD) is associated with increased morbidity. ⋯ Despite clinical and histologic vascular remodeling in all patients with PH-COPD and PH-IPF, differential gene expression pattern was present in pulmonary artery profiles. Several genes involved in retinol metabolism and ECM receptor interaction enable discrimination of vascular remodeling in PH-IPF or PH-COPD. This suggests that pulmonary arterial remodeling in PH-COPD and PH-IPF is caused by different molecular mechanisms and may require specific therapeutic options.