American journal of respiratory and critical care medicine
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Am. J. Respir. Crit. Care Med. · Oct 2020
WITHDRAWN: Proposal for Initiative of Evidence-based Treatment of COVID-19 Patients with Worsening Hypoxia.
Ahead of Print article withdrawn by publisher.
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Am. J. Respir. Crit. Care Med. · Oct 2020
Age Associated B Cells Appear in Patients with Granulomatous Lung Diseases.
Rationale: A subpopulation of B cells (age-associated B cells [ABCs]) is increased in mice and humans with infections or autoimmune diseases. Because depletion of these cells might be valuable in patients with certain lung diseases, the goal was to find out if ABC-like cells were at elevated levels in such patients. Objectives: To measure ABC-like cell percentages in patients with lung granulomatous diseases. ⋯ Treatment of patients with sarcoidosis led to reduced percentages of ABC-like cells in blood. Conclusions: Increased levels of ABC-like cells in patients with sarcoidosis may be useful in diagnosis. The increase in percentage of ABC-like cells in patients with lung granulomatous diseases and decrease in treated patients suggests that depletion of these cells may be valuable.
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Am. J. Respir. Crit. Care Med. · Oct 2020
Whole Genome Sequencing Identifies Novel Functional Loci Associated with Lung Function in Puerto Rican Youth.
Rationale: Puerto Ricans have the highest childhood asthma prevalence in the United States (23.6%); however, the etiology is uncertain. Objectives: In this study, we sought to uncover the genetic architecture of lung function in Puerto Rican youth with and without asthma who were recruited from the island (n = 836). Methods: We used admixture-mapping and whole-genome sequencing data to discover genomic regions associated with lung function. ⋯ The region-based association tests identified four suggestive windows that harbored candidate rare variants associated with lung function. Conclusions: We identified common and rare genetic variants that may play a critical role in lung function among Puerto Rican youth. We independently validated an inflammatory pathway that could potentially be used to develop more targeted treatments and interventions for patients with asthma.
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Mechanical ventilation can cause acute diaphragm atrophy and injury, and this is associated with poor clinical outcomes. Although the importance and impact of lung-protective ventilation is widely appreciated and well established, the concept of diaphragm-protective ventilation has recently emerged as a potential complementary therapeutic strategy. This Perspective, developed from discussions at a meeting of international experts convened by PLUG (the Pleural Pressure Working Group) of the European Society of Intensive Care Medicine, outlines a conceptual framework for an integrated lung- and diaphragm-protective approach to mechanical ventilation on the basis of growing evidence about mechanisms of injury. ⋯ Adjunctive interventions, including extracorporeal life support techniques, phrenic nerve stimulation, and clinical decision-support systems, may also play an important role in selected patients in the future. Evaluating the clinical impact of this new paradigm will be challenging, owing to the complexity of the intervention. The concept of lung- and diaphragm-protective ventilation presents a new opportunity to potentially improve clinical outcomes for critically ill patients.