Publications by authors named "Justin K Lui"

18 Publications

  • Page 1 of 1

Critical Care of Patients With Cardiopulmonary Complications of Sarcoidosis.

J Intensive Care Med 2021 Feb 22:885066621993041. Epub 2021 Feb 22.

The Pulmonary Center, Boston University School of Medicine, Boston, MA, USA.

Sarcoidosis is a systemic inflammatory disease defined by the presence of aberrant granulomas affecting various organs. Due to its multisystem involvement, care of patients with established sarcoidosis becomes challenging, especially in the intensive care setting. While the lungs are typically involved, extrapulmonary manifestations also occur either concurrently or exclusively within a significant proportion of patients, complicating diagnostic and management decisions. The scope of this review is to focus on what considerations are necessary in the evaluation and management of patients with known sarcoidosis and their associated complications within a cardiopulmonary and critical care perspective.
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http://dx.doi.org/10.1177/0885066621993041DOI Listing
February 2021

Novel Therapeutic Approaches for Pulmonary Manifestations of Systemic Sclerosis.

Am J Respir Crit Care Med 2020 09;202(6):878-880

Section of Pulmonary, Allergy, Sleep and Critical Care Medicine, Boston University School of Medicine, Boston, Massachusetts.

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http://dx.doi.org/10.1164/rccm.202002-0307RRDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7491395PMC
September 2020

Pleural Effusions Following Liver Transplantation: A Single-Center Experience.

J Intensive Care Med 2020 Jun 12:885066620932448. Epub 2020 Jun 12.

Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA.

Introduction: This was a single-center retrospective study to evaluate incidence, prognosis, and risk factors in patients with postoperative pleural effusions, a common pulmonary complication following liver transplantation.

Methods: A retrospective review was performed on 374 liver transplantation cases through a database within the timeframe of January 1, 2009 through December 31, 2015. Demographics, pulmonary and cardiac function testing, laboratory studies, intraoperative transfusion/infusion volumes, postoperative management, and outcomes were analyzed.

Results: In the immediate postoperative period, 189 (50.5%) developed pleural effusions following liver transplantation of which 145 (76.7%) resolved within 3 months. Those who developed pleural effusions demonstrated a lower fibrinogen (149.6 ± 66.3 mg/dL vs 178.4 ± 87.3 mg/dL; = .009), total protein (5.8 ± 1.0 mg/dL vs 6.1 ± 1.2 mg/dL; = .04), and hemoglobin (9.8 ± 1.8 mg/dL vs 10.3 ± 1.9 mg/dL; = .004). There was not a statistically significant difference in 1-year all-cause mortality and in-hospital mortality between liver transplant recipients with and without pleural effusions. Liver transplant recipients who developed pleural effusions had a longer hospital length of stay (16.4 ± 10.9 days vs 14.0 ± 16.5 days; = .1), but the differences were not statistically significant. However, there was a significant difference in tracheostomy rates (11.6% vs 5.4%; = .03) in recipients who developed pleural effusions compared to recipients who did not.

Conclusions: In summary, pleural effusions are common after liver transplantation and are associated with increased morbidity. Pre- and intraoperative risk factors can offer both predictive and prognostic value for post-transplantation pleural effusions. Further prospective studies will be needed to further evaluate the relevance of these findings to limit instances of postoperative pleural effusions.
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http://dx.doi.org/10.1177/0885066620932448DOI Listing
June 2020

Strategies for effective intern orientation.

Clin Teach 2020 12 16;17(6):600-605. Epub 2020 Mar 16.

Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA.

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http://dx.doi.org/10.1111/tct.13151DOI Listing
December 2020

Barriers to End-of-Life Care from Tuberculosis: A Teachable Moment.

Am J Med 2019 09 15;132(9):e701-e702. Epub 2019 Apr 15.

Department of Medicine, Boston University School of Medicine, Boston, MA.

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http://dx.doi.org/10.1016/j.amjmed.2019.03.042DOI Listing
September 2019

Intensive Care of Pulmonary Complications Following Liver Transplantation.

J Intensive Care Med 2018 Nov 18;33(11):595-608. Epub 2018 Mar 18.

2 Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA.

Chronic liver disease has been associated with pulmonary dysfunction both before and after liver transplantation. Post-liver transplantation pulmonary complications can affect both morbidity and mortality often necessitating intensive care during the immediate postoperative period. The major pulmonary complications include pneumonia, pleural effusions, pulmonary edema, and atelectasis. Poor clinical outcomes have been known to be associated with age, severity of liver dysfunction, and preexisting lung disease as well as perioperative events related to fluid balance, particularly transfusion and fluid volumes. Delineating each and every one of these pulmonary complications and their associated risk factors becomes paramount in guiding specific therapeutic strategies.
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http://dx.doi.org/10.1177/0885066618757410DOI Listing
November 2018

Making the Case for an X + Y Scheduling Model in Preliminary Internal Medicine Residency Training.

J Grad Med Educ 2018 Feb;10(1):112-113

Vice Chair of Graduate Medical Education and Program Director, Internal Medicine Residency Program, Department of Medicine, University of Massachusetts Medical School.

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http://dx.doi.org/10.4300/JGME-D-17-00684.1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5821026PMC
February 2018

The role of heterogeneity in asthma: a structure-to-function perspective.

Clin Transl Med 2017 Dec 3;6(1):29. Epub 2017 Aug 3.

Department of Biomedical Engineering, Boston University, Boston, MA, 02215, USA.

A number of methods have evolved through the years in probing the dysfunction that impacts mechanics and ventilation in asthma. What has been consistently found is the notion of heterogeneity that is not only captured in the frequency dependence of lung mechanics measurements but also rendered on imaging as patchy diffuse areas of ventilation defects. The degree of heterogeneity has been linked to airway hyperresponsiveness, a hallmark feature of asthma. How these heterogeneous constriction patterns lead to functional impairment in asthma have only been recently explored using computational airway tree models. By synthesizing measurements of lung mechanics and advances in imaging, computational airway tree models serve as a powerful engine to accelerate our understanding of the physiologic changes that occur in asthma. This review will be focused on the current state of investigational work on the role of heterogeneity in asthma, specifically exploring the structural and functional relationships.
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http://dx.doi.org/10.1186/s40169-017-0159-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5543015PMC
December 2017

Non-Classic Cystic Fibrosis: The Value in Family History.

Am J Med 2017 Aug 24;130(8):e333-e334. Epub 2017 Mar 24.

Department of Medicine, University of Massachusetts Medical School, Worcester; Division of Pulmonary, Allergy, and Critical Care, University of Massachusetts Medical School, Worcester.

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http://dx.doi.org/10.1016/j.amjmed.2017.02.023DOI Listing
August 2017

Facial Drooping, Aphasia, and an Incidental Lung Mass in a Nonsmoker.

J Intensive Care Med 2017 Mar 26;32(3):228-230. Epub 2016 Oct 26.

1 Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA.

Background: Atrial fibrillation and atrial flutter are atrial tachycardias associated with embolic strokes. To date, there have only been a few reports highlighting the incidence of these atrial tachycardias due to mechanical compression of myocardial structures and the pulmonary vasculature in certain mediastinal masses and cysts.

Case: We present a case of a 75-year-old gentleman who is a nonsmoker with a history of hypertension who presents with an acute embolic stroke due to atrial flutter likely from mechanical compression from an underlying squamous cell carcinoma of the lung.

Conclusion: This case represents, to the best of our knowledge, a rare case of squamous cell carcinoma of the lung in a nonsmoker likely leading to mechanical compression and a resultant atrial tachycardia with an embolic stroke.
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http://dx.doi.org/10.1177/0885066616676044DOI Listing
March 2017

Diagnostic Bedside Ultrasonography for Acute Respiratory Failure and Severe Hypoxemia in the Medical Intensive Care Unit: Basics and Comprehensive Approaches.

J Intensive Care Med 2017 Jul 8;32(6):355-372. Epub 2016 Jul 8.

1 Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA.

Bedside goal-directed ultrasound is a powerful tool for rapid differential diagnosis and monitoring of cardiopulmonary disease in the critically ill patient population. The bedside intensivist is in a unique position to integrate ultrasound findings with the overall clinical situation. Medically critically ill patients who require urgent bedside diagnostic assessment fall into 2 categories: (1) acute respiratory failure and (2) hemodynamic derangements. The first portion of this review outlines the diagnostic role of bedside ultrasound in the medically critically ill patient population for the diagnosis and treatment of acute respiratory failure, acute respiratory distress, and severe hypoxemia. The second portion will focus on the diagnostic role of ultrasound for the evaluation and treatment of shock states, as well as describe protocolized approaches for evaluation of shock during cardiopulmonary resuscitation. Different respiratory system pathologies that result in acute respiratory failure (such as increased interstitial fluid, alveolar consolidation, pleural effusion) cause characteristic ultrasonographic findings; diaphragmatic assessment may also add information. Intracardiac shunting can cause severe hypoxemia. Protocolized approaches for the evaluation of patients with acute respiratory failure or distress are discussed.
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http://dx.doi.org/10.1177/0885066616658475DOI Listing
July 2017

Linking Ventilation Heterogeneity Quantified via Hyperpolarized 3He MRI to Dynamic Lung Mechanics and Airway Hyperresponsiveness.

PLoS One 2015 16;10(11):e0142738. Epub 2015 Nov 16.

Department of Biomedical Engineering, Boston University, Boston, MA, United States of America.

Advancements in hyperpolarized helium-3 MRI (HP 3He-MRI) have introduced the ability to render and quantify ventilation patterns throughout the anatomic regions of the lung. The goal of this study was to establish how ventilation heterogeneity relates to the dynamic changes in mechanical lung function and airway hyperresponsiveness in asthmatic subjects. In four healthy and nine mild-to-moderate asthmatic subjects, we measured dynamic lung resistance and lung elastance from 0.1 to 8 Hz via a broadband ventilation waveform technique. We quantified ventilation heterogeneity using a recently developed coefficient of variation method from HP 3He-MRI imaging. Dynamic lung mechanics and imaging were performed at baseline, post-challenge, and after a series of five deep inspirations. AHR was measured via the concentration of agonist that elicits a 20% decrease in the subject's forced expiratory volume in one second compared to baseline (PC20) dose. The ventilation coefficient of variation was correlated to low-frequency lung resistance (R = 0.647, P < 0.0001), the difference between high and low frequency lung resistance (R = 0.668, P < 0.0001), and low-frequency lung elastance (R = 0.547, P = 0.0003). In asthmatic subjects with PC20 values <25 mg/mL, the coefficient of variation at baseline exhibited a strong negative trend (R = -0.798, P = 0.02) to PC20 dose. Our findings were consistent with the notion of peripheral rather than central involvement of ventilation heterogeneity. Also, the degree of AHR appears to be dependent on the degree to which baseline airway constriction creates baseline ventilation heterogeneity. HP 3He-MRI imaging may be a powerful predictor of the degree of AHR and in tracking the efficacy of therapy.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0142738PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4646346PMC
June 2016

Interprofessionalism between physicians and nurses: moving forward.

Int J Nurs Stud 2015 Dec 28;52(12):1785-8. Epub 2015 Sep 28.

Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA.

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http://dx.doi.org/10.1016/j.ijnurstu.2015.09.011DOI Listing
December 2015

Occam's Razor and the Diagnosis of Mantle Cell Lymphoma.

Am J Med 2015 Dec 30;128(12):e25-6. Epub 2015 Jul 30.

Department of Medicine, University of Massachusetts Medical School, Worcester; Division of Hematology and Oncology, University of Massachusetts Medical School, Worcester.

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http://dx.doi.org/10.1016/j.amjmed.2015.06.050DOI Listing
December 2015

Body mass index predicts major bleeding risks in patients on warfarin.

J Thromb Thrombolysis 2015 Nov;40(4):494-8

Department of Medicine, University of Massachusetts Medical School, Worcester, MA, 01655, USA.

Despite the lack of an optimum dosing strategy in obese patients, warfarin remains the most commonly used anticoagulant. Body mass index (BMI) >30 has been linked to increased time to obtain a therapeutic international normalized ratio on initiation of warfarin as well as higher maintenance dose. Despite higher dosage requirements, few studies have examined the relationship between warfarin and bleeding events in obese individuals. We examined the performance of BMI in predicting the incidence of bleeding at an anticoagulation clinic (ACC) over a 1 year period. Eight hundred and sixty-three patients followed in the ACC over a 1 year period were evaluated for bleeds in relation to BMI [defined as weight (kg)/height (m(2))]. Seventy-one of the 863 patients had a bleeding event (8.2 %); mean age 69.5 years and 44 % females. BMI categories were normal weight (21 %), overweight (38 %), obese class I (21 %), II (9 %), and III (11.3 %), respectively. Prevalence of major and minor bleeding events were 4.4 and 3.8 %, respectively. In univariate analyses, hazard ratio (HR) for major bleeding risks increases with higher obesity categories (HR 1.3, 1.85, and 1.93 for classes I, II, III, respectively). In multivariable adjusted model obesity classes II and III significantly increased the risk of major bleeds (HR 1.84, p < 0.001). Bleeding risk is higher in obese compared to normal weight individuals who are on warfarin. These results suggests that BMI plays a role in bleeding events in patients on warfarin.
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http://dx.doi.org/10.1007/s11239-015-1226-2DOI Listing
November 2015

The diagnostic utility of tumor markers: a teachable moment.

Am J Med 2015 May 3;128(5):e9-10. Epub 2015 Jan 3.

Department of Medicine, University of Massachusetts Medical School, Worcester; Division of Infectious Disease, University of Massachusetts Medical School, Worcester.

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http://dx.doi.org/10.1016/j.amjmed.2014.10.063DOI Listing
May 2015

Acute inflammatory demyelinating polyradiculopathy in Legionella pneumonia.

Muscle Nerve 2014 Nov 24;50(5):868-9. Epub 2014 Sep 24.

Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts; Milford Regional Medical Center, Milford, Massachusetts.

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http://dx.doi.org/10.1002/mus.24341DOI Listing
November 2014

Legionella pneumophila cases in a community hospital: A 12-month retrospective review.

SAGE Open Med 2014 10;2:2050312114554673. Epub 2014 Oct 10.

Milford Regional Medical Center, Milford, MA, USA.

Background: Legionella pneumonia has long been recognized as an important cause of community-acquired pneumonia associated with significant morbidity and mortality; however, the description of the incidence of this disease is restricted to sporadic cases in the literature. With the advent of an inexpensive and rapid urine antigen test, routine testing has become more common. We report findings of a retrospective review of 266 patients who were admitted with a clinical diagnosis of community-acquired pneumonia over a 12-month period and were tested for Legionella pneumophila serogroup 1, reporting the prevalence and determinants of Legionella infection.

Methods: Chart reviews of 266 patients admitted for community-acquired pneumonia and who underwent urine antigen testing for Legionella pneumophila during a 1-year time period were conducted, looking at demographic information as well as clinical and laboratory presentation, reporting on the prevalence and determinants of urine antigen positivity using multivariate logistic regression analysis.

Results: Legionella pneumophila serogroup 1 was found in 2.3% of cases of community-acquired pneumonia. We also found that altered mental status, diarrhea, history of lung disease, and alcohol intake were significantly associated with pneumonia associated with Legionella. The presence of these four factors had a low sensitivity in predicting Legionella infection (33%); however, they had a positive predictive value of 98%, with a specificity of 100. All the Legionella-infected patients in our study required admission to the intensive care unit, and one of them developed Guillain-Barré syndrome, which to our knowledge represents the only reported case of this syndrome related to Legionella infection in an adult in the English scientific literature.

Conclusion: Legionella pneumophila serogroup 1 is a common cause of sporadic cases of community-acquired pneumonia associated with a high morbidity and protean manifestations. Clinical features have a poor sensitivity in identifying cases, and routine urine antigen testing in patients with suggestive clinical symptoms appears to be a rational approach in the evaluation of community-acquired pneumonia.
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http://dx.doi.org/10.1177/2050312114554673DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4607230PMC
January 2016