American journal of respiratory and critical care medicine
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Am. J. Respir. Crit. Care Med. · Jan 2017
Resonance as the Mechanism of Daytime Periodic Breathing in Patients with Heart Failure.
In patients with chronic heart failure, daytime oscillatory breathing at rest is associated with a high risk of mortality. Experimental evidence, including exaggerated ventilatory responses to CO2 and prolonged circulation time, implicates the ventilatory control system and suggests feedback instability (loop gain > 1) is responsible. However, daytime oscillatory patterns often appear remarkably irregular versus classic instability (Cheyne-Stokes respiration), suggesting our mechanistic understanding is limited. ⋯ Our study elucidates the mechanism underlying daytime ventilatory oscillations in heart failure and provides a means to measure and interpret these oscillations to reveal the underlying chemoreflex hypersensitivity and reduced stability that foretells mortality in this population.
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Am. J. Respir. Crit. Care Med. · Jan 2017
Gene Expression Profiling in Blood Provides Reproducible Molecular Insights into Asthma Control.
Maintaining optimal symptom control remains the primary objective of asthma treatment. Better understanding of the biologic underpinnings of asthma control may lead to the development of improved clinical and pharmaceutical approaches. ⋯ Together, these results demonstrate the existence of specific, reproducible transcriptomic components in blood that vary with degree of asthma control and implicate a novel biologic target (TREM-1).
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Am. J. Respir. Crit. Care Med. · Jan 2017
Observational StudyEvaluation of the Global Lung Initiative 2012 Reference Values for Spirometry in African Children.
Despite the high burden of respiratory disease, no spirometry reference values for African children are available. ⋯ The results of this study support the use of GLI-2012 reference values for schoolchildren in sub-Saharan Africa. Malnutrition affects body growth, leading to a proportionately smaller FEV1 and FVC without respiratory impairment, as shown by the normal FEV1/FVC ratio.
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Am. J. Respir. Crit. Care Med. · Jan 2017
Lung Function in African Infants in the Drakenstein Child Health Study: Impact of Lower Respiratory Tract Illness.
Lower respiratory tract illness is a major cause of childhood morbidity and mortality. It is unknown whether infants are predisposed to illness because of impaired lung function or whether respiratory illness reduces lung function. ⋯ Early life lower respiratory tract illness impairs lung function at 1 year, independent of baseline lung function. Preventing early life lower respiratory tract illness is important to optimize lung function and promote respiratory health in childhood.
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Am. J. Respir. Crit. Care Med. · Jan 2017
Experiences and Expressions of Spirituality At the End of Life in the Intensive Care Unit.
The austere setting of the intensive care unit (ICU) can suppress expressions of spirituality. ⋯ Family members and clinicians consider spirituality an important dimension of end-of-life care. The Three Wishes Project invites and supports the expression of myriad forms of spirituality during the dying process in the ICU.