American journal of respiratory and critical care medicine
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Am. J. Respir. Crit. Care Med. · Aug 2016
Observational StudyGut Microbiota Predict Pulmonary Infiltrates After Allogeneic Hematopoietic Cell Transplantation.
Pulmonary complications (PCs) cause significant morbidity and mortality after allogeneic hematopoietic stem cell transplantation (HCT). Shifts in gut microbiota have been linked to HCT outcomes; however, their effect on PCs is unknown. ⋯ This is the first study to demonstrate prospective changes in gut microbiota associated with PCs after HCT. Postengraftment PCs and γ-proteobacteria domination were predictive of mortality. This suggests an adverse relationship between the graft and lung, which is perhaps mediated by bacterial composition in the gut. Further study is warranted.
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Am. J. Respir. Crit. Care Med. · Aug 2016
Randomized Controlled Trial Multicenter StudyThe Effect of Treatment of Obstructive Sleep Apnea on Glycemic Control in Type 2 Diabetes.
There is uncertainty about the effects of treating obstructive sleep apnea on glycemic control in patients with type 2 diabetes. ⋯ This trial showed no effect of positive airway pressure therapy on glycemic control in patients with relatively well-controlled type 2 diabetes and obstructive sleep apnea. Clinical trial registered with www.clinicaltrials.gov (NCT00509223).
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Am. J. Respir. Crit. Care Med. · Aug 2016
ReviewNecroptosis: a Novel Cell Death Modality and its Potential Relevance for Critical Care Medicine.
Cell death is intertwined with life in development, homeostasis, pathology, and aging. Until recently, apoptosis was the best known form of programmed cell death, whereas necrosis was for a long time considered accidental owing to physicochemical injury. However, identification of crucial signaling and execution molecules, which are highly regulated, revealed that necrosis encompasses several cell death modalities that can be therapeutically targeted. ⋯ We are only beginning to appreciate the role of necroptosis in different pathological conditions, including critical illnesses. In this review, we discuss the molecular mechanisms of necroptosis and analyze the effect of inhibiting necroptosis in experimental models of critical illnesses. In view of the identification of an increasing number of cell death modalities, we also briefly discuss the simultaneous targeting of multiple cell death modalities because, depending on the cell type and cellular conditions, various types of cell death may contribute to the pathology.
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Am. J. Respir. Crit. Care Med. · Aug 2016
ReviewLung-kidney Crosstalk in the Critically Ill Patient.
Discoveries have emerged highlighting the complex nature of the interorgan cross-talk between the kidney and the lung. Vascular rigidity, neurohormonal activation, tissue hypoxia, and abnormal immune cell signaling have been identified as common pathways leading to the development and progression of chronic kidney disease. However, our understanding of the causal relationships between lung injury and kidney injury is not precise. ⋯ Right ventricular dysfunction and congestive states may contribute to alterations of renal perfusion and oxygenation, leading to diuretic resistance and recurrent hospitalization. In patients with concomitant respiratory failure, noninvasive ventilation represents a promising treatment option for the correction of impaired renal microcirculation and endothelial dysfunction. In patients requiring extracorporeal membrane oxygenation, short- and long-term monitoring of kidney function is warranted, as they are at highest risk of developing acute kidney injury and fluid overload.