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    Translating Basic Research into Clinical Practice: Vitamin D in Asthma - Mechanisms of Action and Considerations for Clinical Trials.
    Chest 2017 Sep 15. Epub 2017 Sep 15.
    MRC and Asthma UK Centre for Allergic Mechanisms of Asthma, King's College London, Guy's Hospital, London UK, SE1 9RT. Electronic address:
    There is increasing interest in the therapeutic utility of vitamin D in asthma, supported by a significant body of evidence on epidemiological associations between vitamin D insufficiency and worse asthma control. In support of a causal relationship, vitamin D beneficially modulates diverse immunological pathways in heterogeneous asthma endotypes, regulating the actions of lymphocytes, mast cells, antigen-presenting cells and structural cells to dampen excessive inflammatory responses. Allergic asthma is characterised by a failure of immune tolerance, and development of pathological responses to inhaled aeroallergens, and vitamin D has been extensively shown to support immune regulation. Read More

    Surgical Treatment of Obstructive Sleep Apnea on Cardiovascular Outcomes: A Systematic Review.
    Chest 2017 Sep 15. Epub 2017 Sep 15.
    Department of Otolaryngology, Emory University School of Medicine, Atlanta, GA; Department of Neurology, Division of Sleep Medicine, Emory University School of Medicine, Atlanta, GA. Electronic address:
    Background: Obstructive sleep apnea (OSA) is an increasingly prevalent clinical problem with significant effects on quality of life and cardiovascular risk. Surgical therapy represents an important treatment for those unable to use positive airway pressure. This systematic review examines the available cardiovascular risk reduction data for surgical treatment of OSA. Read More

    Commonly used patient-reported outcomes do not improve prediction of COPD exacerbations - a multicenter 4.5 year prospective cohort study.
    Chest 2017 Sep 15. Epub 2017 Sep 15.
    Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland.
    Background: Several cross-sectional and short-term studies suggest that patient-reported outcomes (PROs) may be useful to (help) predict COPD exacerbations but evidence from long-term prospective cohort studies is missing. Our aim was to assess if PROs add to the prediction of exacerbations.

    Methods: 408 primary care COPD patients participated in the multicenter prospective ICE COLD ERIC cohort. Read More

    Extending the Reach of Evidence-Based Medicine: A Proposed Categorization of Lower-Level Evidence.
    Chest 2017 Sep 15. Epub 2017 Sep 15.
    Clinical practice involves making many management decisions for which only limited formal evidence exists. While the methodology of evidence-based medicine has evolved tremendously, there is a need to better characterize lower-level evidence. This should enhance the ability to appropriately weigh the evidence against other considerations, and counter the temptation to think it is more robust than it actually is. Read More

    Methacholine challenge testing: a novel method for measuring PD20.
    Chest 2017 Sep 15. Epub 2017 Sep 15.
    University of Saskatchewan, College of Medicine, Department of Physiology, 107 Wiggins Road, Saskatoon, SK S7N 5E5 Canada; University of Saskatchewan, Department of Medicine, Division of Respirology, Critical Care and Sleep Medicine, 103Hospital Drive, Saskatoon, SK S7N 0W8 Canada.
    Background: New guidelines for methacholine challenge testing recommend reporting the test outcome as dose rather than concentration. Jet nebulizers have historically been used for methacholine challenge testing but much of the weight loss, often (incorrectly) referred to as aerosol output, is actually evaporation. The Wright® nebulizer is well characterized and still widely used, but its availability is unclear and it is non-disposable. Read More

    Clinical practice and infrastructure review of fecal microbiota transplantation for Clostridium difficile infection.
    Chest 2017 Sep 15. Epub 2017 Sep 15.
    Division of Infectious Diseases &; Fecal Microbiota Transplantation Program, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
    A significant proportion of C. difficile infection (CDI) cases recur after completion of antibiotic therapy, and antibiotic cure rates diminish with each recurrence of CDI. Fecal microbiota transplantation (FMT) is an effective therapy for recurrent FMT, which otherwise requires prolonged or indefinite antibiotic treatment. Read More

    A multicenter, randomized trial of a checklist for endotracheal intubation of critically ill adults.
    Chest 2017 Sep 13. Epub 2017 Sep 13.
    Vanderbilt University School of Medicine, Department of Medicine, Division of Allergy, Pulmonary and Critical Care Medicine.
    Background: Hypoxemia and hypotension are common complications during endotracheal intubation of critically ill adults. Verbal performance of a written, pre-intubation checklist may prevent these complications. We compared a written, verbally-performed, pre-intubation checklist to usual care with regard to lowest arterial oxygen saturation or lowest systolic blood pressure experienced by critically ill adults undergoing endotracheal intubation. Read More

    A 62-Year-Old Woman With Wheezing, Respiratory Failure, and an Abnormal CT Scan.
    Chest 2017 Sep;152(3):e73-e76
    Department of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL.
    Case Presentation: A previously healthy 62-year-old woman was transferred to the ICU from the medical ward with acute bronchospastic respiratory failure requiring intubation and mechanical ventilation. Four weeks before, the patient was vacationing in Arizona and acquired a mildly productive cough as well as mild dyspnea. She presented to an urgent care facility and was diagnosed with community-acquired pneumonia. Read More

    Pulmonary Nodules in an Adolescent Female Presented With Abdominal Pain, Fatigue, and Weight Loss.
    Chest 2017 Sep;152(3):e69-e72
    Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Albany Medical College, Albany, NY.
    Case Presentation: A 14-year-old girl initially presented to a pediatric gastroenterology office with a 1-month history of right upper quadrant abdominal pain, which radiated to the right shoulder and back. Her pain was worse after heavy meals and with deep breaths. She reported anorexia, fatigue, dyspnea while playing soccer, and a 5-pound weight loss. Read More

    Bronchiectasis Complicating Lung Volume Reduction Coil Treatment.
    Chest 2017 Sep;152(3):e57-e60
    Service de Pneumologie B, Hôpital Bichat, Assistance Publique Hôpitaux de Paris, Université Paris 7, INSERM UMR1152, Paris, France. Electronic address:
    Endoscopic lung volume reduction has emerged over the past several years as a promising technique to improve the respiratory functional status of patients with advanced emphysema. Nevertheless, the procedure may be associated with various complications; among them, the development of bronchiectasis related to the coils has not yet been described. We report the case of a patient with emphysema who developed localized bronchiectasis at the site of coil insertion several months after lung volume reduction coil treatment. Read More

    IV Immunoglobulin for Autoimmune Heparin-Induced Thrombocytopenia.
    Chest 2017 Sep;152(3):453-455
    Department of Medicine (Division of Hematology and Thromboembolism), Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada; Department of Pathology and Molecular Medicine, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada; McMaster Centre for Transfusion Research, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada. Electronic address:

    Diaphragm Dysfunction in Critical Illness.
    Chest 2017 Sep 5. Epub 2017 Sep 5.
    University of Kentucky, Lexington, KY, Division of Pulmonary, Critical Care and Sleep Medicine. Electronic address:
    The diaphragm is the major muscle of inspiration and its function is critical for optimal respiration. Diaphragmatic failure has long been recognized as a major contributor to death in a variety of systemic neuromuscular disorders. More recently, it is increasingly apparent that diaphragm dysfunction is present in a high percentage of critically ill patients, and is associated with increased morbidity and mortality. Read More

    Advances in Audio-Based Systems to Monitor Patient Adherence and Inhaler Drug Delivery.
    Chest 2017 Sep 5. Epub 2017 Sep 5.
    Trinity Centre for Bioengineering, Trinity College Dublin, The University of Dublin, Dublin, Ireland; School of Engineering, Trinity College Dublin, The University of Dublin, Dublin, Ireland; School of Medicine, Trinity College Dublin, The University of Dublin, Dublin, Ireland.
    Hundreds of millions of people suffer from asthma and chronic obstructive pulmonary disease (COPD) worldwide. Current medications to control these chronic respiratory diseases can be administered using inhaler devices, such as the pressurized metered dose inhaler (pMDI) and dry powder inhaler (DPI). Providing that they are used as prescribed, inhalers can improve patients' clinical outcomes and quality of life. Read More

    Ethnicity in pulmonary arterial hypertension: possibilities for novel phenotypes in the age of personalized medicine.
    Chest 2017 Sep 5. Epub 2017 Sep 5.
    Weill Cornell Medical College, Institute of Academic Medicine, Houston Methodist Hospital; Houston, Texas. Electronic address:
    In the last decade and a half, the introduction of new therapeutics has revolutionized the management of pulmonary arterial hypertension (PAH). These new treatment options have improved the quality of life and survival in PAH. With an armamentarium of options available, the identification of unique phenotypes can help practitioners choose tailored treatment regimens. Read More

    Asthma Outcomes and Management During Pregnancy.
    Chest 2017 Aug 31. Epub 2017 Aug 31.
    University of Chicago, Section of Pulmonary and Critical Care Medicine.
    Asthma during pregnancy poses a common, increasingly prevalent threat to the health of women and their children. We review recent insights gained from the epidemiology of asthma during pregnancy, demonstrating the many short and long-term risks to mother and fetus incurred by poorly controlled maternal asthma. We further discuss emerging evidence that active asthma management during pregnancy can positively influence and perhaps completely mitigate these poor outcomes. Read More

    Hemodynamic assessment of septic shock patients using transpulmonary thermodilution and critical care echocardiography. A comparative study.
    Chest 2017 Aug 30. Epub 2017 Aug 30.
    Medical-surgical Intensive Care Unit, Teaching hospital of Toulouse, Toulouse, France.
    Background: To assess the agreement between transpulmonary thermodilution (TPT) and critical care echocardiography (CCE) in ventilated septic shock patients.

    Methods: Ventilated patients in sinus rhythm requiring advanced hemodynamic assessment for septic shock were included in this prospective multicenter descriptive study. Patients were assessed successively using TPT and CCE in random order. Read More

    Tracheobronchopathy from Inhaled Corticosteroids.
    Chest 2017 Aug 31. Epub 2017 Aug 31.
    Respiratory Institute, Cleveland Clinic, Cleveland, OH. Electronic address:
    Inhaled corticosteroids (ICSs) have become the mainstay of asthma control. They are also recommended as an add-on therapy to long-acting beta agonists and anticholinergics in moderate to severe COPD with recurrent exacerbations. Ultimately this clinical practice has led to the widespread use of ICSs, which are supported by a more favorable side effect profile than that of systemic steroids. Read More

    Quality Gaps and Comparative Effectiveness of Management Strategies For Recurrent Malignant Pleural Effusions.
    Chest 2017 Aug 29. Epub 2017 Aug 29.
    Department of Health Services Research, MD Anderson Cancer Center, Houston Texas.
    Background: Guidelines for recurrent malignant pleural effusions (MPE) recommend definitive procedures, such as indwelling pleural catheters (IPC) or pleurodesis, over repeat thoracentesis. We hypothesized that many patients have multiple thoracenteses rather than definitive procedures and that this results in more procedures and complications.

    Methods: Retrospective cohort study using SEER-Medicare data from 2007-2011. Read More

    Diaphragm and lung ultrasound to predict weaning outcome: systematic review and meta-analysis.
    Chest 2017 Aug 29. Epub 2017 Aug 29.
    Intensive Care Unit, Elche General University Hospital, Elche, Spain; Department of Clinical Medicine, Miguel Hernández University, Sant Joan d'Alacant, Spain.
    Background: Deciding the optimal timing for extubation in mechanically ventilated patients can be challenging, and traditional weaning predictor tools are not very accurate. The aim of this systematic review and meta-analysis is to assess the accuracy of lung and diaphragm ultrasound for predicting weaning outcomes in critically ill adults.

    Methods: We searched MEDLINE, the Cochrane Library, Web of Science, Scopus, LILACS, Teseo, Tesis Doctorales en Red, and OpenGrey, and we reviewed the bibliographies of relevant studies. Read More

    Pulmonary Arterial Hypertension Associated With Systemic Lupus Erythematosus: Results From the French Pulmonary Hypertension Registry.
    Chest 2017 Aug 26. Epub 2017 Aug 26.
    Université Paris-Sud, Faculté de Médecine, Université Paris-Saclay, Le Kremlin-Bicêtre; AP-HP, Centre de reference de l'Hypertension Pulmonaire, Service de Pneumologie, DHU Thorax Innovation, Hôpital Bicêtre, Le Kremlin-Bicêtre; INSERM UMR_S999, LabEx LERMIT, Centre Chirurgical Marie-Lannelongue, Le Plessis-Robinson, France.
    Background: Pulmonary arterial hypertension (PAH) is a rare complication of systemic lupus erythematosus (SLE).

    Methods: We identified all patients with SLE and PAH (SLE-PAH) who were enrolled in the French Pulmonary Hypertension Registry with a diagnosis confirmed by right heart catheterization (RHC). A control group of 101 patients with SLE without known PAH was selected from SLE expert centers participating in the Pulmonary Hypertension Registry. Read More

    Effect of Statins on COPD: A Meta-Analysis of Randomized Controlled Trials.
    Chest 2017 Aug 25. Epub 2017 Aug 25.
    Department of Respiratory Disease, Xinqiao Hospital, Chongqing, China. Electronic address:
    Background: Much controversy persists regarding the place of statin drugs in the treatment of patients with COPD. This systematic review and meta-analysis sought to determine the clinical efficacy of statin therapy in COPD.

    Methods: We searched MEDLINE, EMBASE, the Cochrane Database, and PubMed for relevant clinical studies. Read More

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