American journal of respiratory and critical care medicine
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Am. J. Respir. Crit. Care Med. · May 2015
Historical ArticleHistory of Mechanical Ventilation: From Vesalius to Ventilator-Induced Lung Injury.
Mechanical ventilation is a life-saving therapy that catalyzed the development of modern intensive care units. The origins of modern mechanical ventilation can be traced back about five centuries to the seminal work of Andreas Vesalius. ⋯ One of the great advances in ventilatory support over the past few decades has been the development of lung-protective ventilatory strategies, based on our understanding of the iatrogenic consequences of mechanical ventilation such as ventilator-induced lung injury. These strategies have markedly improved clinical outcomes in patients with respiratory failure.
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Am. J. Respir. Crit. Care Med. · May 2015
Non-invasive Analysis of the Sputum Transcriptome Discriminates Clinical Phenotypes of Asthma.
The airway transcriptome includes genes that contribute to the pathophysiologic heterogeneity seen in individuals with asthma. ⋯ There are common patterns of gene expression in the sputum and blood of children and adults that are associated with near-fatal, severe, and milder asthma.
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Am. J. Respir. Crit. Care Med. · May 2015
Risk Assessment of Tuberculosis in Contacts by Interferon-γ Release Assays (IGRAs). A TBNET Study.
Latent infection with Mycobacterium tuberculosis is defined by a positive IFN-γ release assay (IGRA) result in the absence of active tuberculosis. Only few, mostly monocentric studies have evaluated the role of IGRAs to predict the development of tuberculosis in recent contacts in low-incidence countries of tuberculosis. ⋯ Tuberculosis rarely developed among contacts, and preventive chemotherapy effectively reduced the tuberculosis risk among IGRA-positive contacts. Although the negative predictive value of IGRAs is high, the risk for the development of tuberculosis is poorly predicted by these assays.
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Am. J. Respir. Crit. Care Med. · May 2015
Global Epidemiology of Pediatric Severe Sepsis: the Sepsis PRevalence, OUtcomes, and Therapies Study.
Limited data exist about the international burden of severe sepsis in critically ill children. ⋯ Pediatric severe sepsis remains a burdensome public health problem, with prevalence, morbidity, and mortality rates similar to those reported in critically ill adult populations. International clinical trials targeting children with severe sepsis are warranted.
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Am. J. Respir. Crit. Care Med. · May 2015
The DosR Regulon Modulates Adaptive Immunity and is Essential for M. tuberculosis Persistence.
Hypoxia promotes dormancy by causing physiologic changes to actively replicating Mycobacterium tuberculosis. DosR controls the response of M. tuberculosis to hypoxia. ⋯ Delayed adaptive responses, a hallmark of M. tuberculosis infection, not only lead to persistence but also interfere with the development of effective antituberculosis vaccines. The DosR regulon therefore modulates both the magnitude and the timing of adaptive immune responses in response to hypoxia in vivo, resulting in persistent infection. Hence, DosR regulates key aspects of the M. tuberculosis life cycle and limits lung pathology.