American journal of respiratory and critical care medicine
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Am. J. Respir. Crit. Care Med. · Dec 2016
Randomized Controlled TrialUpper-airway Collapsibility and Loop Gain Predict the Response to Oral Appliance Therapy in Obstructive Sleep Apnea Patients.
Oral appliances (OAs) are commonly used as an alternative treatment to continuous positive airway pressure for patients with obstructive sleep apnea (OSA). However, OAs have variable success at reducing the apnea-hypopnea index (AHI), and predicting responders is challenging. Understanding this variability may lie with the recognition that OSA is a multifactorial disorder and that OAs may affect more than just upper-airway anatomy/collapsibility. ⋯ Our findings suggest that OA therapy improves the upper-airway collapsibility under passive and active conditions. Importantly, a greater response to therapy occurred in those patients with a mild anatomic compromise and a lower loop gain.
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Am. J. Respir. Crit. Care Med. · Dec 2016
Randomized Controlled TrialAngiotensin-Converting Enzyme Inhibition as an Adjunct to Pulmonary Rehabilitation in COPD.
Epidemiological studies in older individuals have found an association between the use of angiotensin-converting enzyme (ACE) inhibition (ACE-I) therapy and preserved locomotor muscle mass, strength, and walking speed. ACE-I therapy might therefore have a role in the context of pulmonary rehabilitation (PR). ⋯ Use of the ACE inhibitor enalapril, together with a program of PR, in patients without an established indication for ACE-I, reduced the peak work rate response to exercise training in patients with chronic obstructive pulmonary disease.
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Am. J. Respir. Crit. Care Med. · Dec 2016
Intra-tumoral Immune Cell Densities are Associated with Lung Adenocarcinoma Gene Alterations.
Tumor-infiltrating immune cells affect lung cancer outcome. However, the factors that influence the composition and function of the tumor immune environment remain poorly defined and need investigation, particularly in the era of immunotherapy. ⋯ Intratumoral immune cell densities (mDCs, CD8+ T cells, neutrophils, macrophages) were significantly associated with molecular alterations in adenocarcinoma underlying the interactions between cancer cells and their microenvironment.
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Am. J. Respir. Crit. Care Med. · Dec 2016
Multicenter Study Comparative StudyComparative Analysis of the Host Response to Community-acquired and Hospital-acquired Pneumonia in Critically Ill Patients.
Preclinical studies suggest that hospitalized patients are susceptible to infections caused by nosocomial respiratory pathogens at least in part because of immune suppression caused by the condition for which they were admitted. ⋯ Patients with HAP and CAP present with a largely similar host response at ICU admission.
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Am. J. Respir. Crit. Care Med. · Dec 2016
Multicenter Study Observational StudyAsthma-like Features and Clinical Course of COPD: An Analysis From the Hokkaido COPD Cohort Study.
Some patients with chronic obstructive pulmonary disease (COPD) have asthma-like features, such as significant bronchodilator reversibility, blood eosinophilia, and/or atopy, even if they are not clinically diagnosed as having asthma. However, the clinical significance of asthma-like features overlapping with COPD remains unclear. ⋯ The presence of asthma-like features was associated with better clinical course in patients with COPD receiving appropriate treatment.