5923. Research Into Childhood Obstructive Sleep-Disordered Breathing: A Systematic Review.
作者: Roderick P Venekamp.;Deepak Chandrasekharan.;Francois Abel.;Helen Blackshaw.;Irene A Kreis.;Hannah E R Evans.;Anne G M Schilder.
来源: Chest. 2017年152卷1期51-57页
Despite recent clinical guideline development, the best pathway of care for children with symptoms of obstructive sleep-disordered breathing (oSDB) is still debated. This systematic review aims to map the research in childhood oSDB that has been conducted so far to support further guideline development, identify evidence gaps, and guide future research.
5924. Factors Contributing to Unintentional Leak During CPAP Treatment: A Systematic Review.
作者: Marius Lebret.;Jean-Benoit Martinot.;Nathalie Arnol.;Daniel Zerillo.;Renaud Tamisier.;Jean-Louis Pepin.;Jean-Christian Borel.
来源: Chest. 2017年151卷3期707-719页
CPAP is the first-line treatment for moderate to severe OSA syndrome. Up to 25% of patients with OSA syndrome discontinue CPAP treatment due to side effects. Unintentional leakage and its associated annoying consequences are the most frequently reported adverse effects of CPAP. Successive technological improvements have not succeeded in addressing this issue. A systematic review was conducted (1) to assess the impact of different technological advances on unintentional leaks and (2) to determine if any patient characteristics have already been identified as determinants of unintentional leakage. No CPAP modality was superior to another in reducing unintentional leaks and, surprisingly, oronasal masks were associated with higher unintentional leaks. Nasal obstruction, older age, higher BMI, central fat distribution, and male sex might be associated with an increased risk of unintentional leakage. Such leaks remain an important problem. Further studies are needed to improve the understanding of underlying clinical factors so that patients at risk of unintentional leaks may be identified and individualized solutions applied.
5932. Short-term Effects of Supplemental Oxygen on 6-Min Walk Test Outcomes in Patients With COPD: A Randomized, Placebo-Controlled, Single-blind, Crossover Trial.
作者: Inga Jarosch.;Rainer Gloeckl.;Eva Damm.;Anna-Lena Schwedhelm.;David Buhrow.;Andreas Jerrentrup.;Martijn A Spruit.;Klaus Kenn.
来源: Chest. 2017年151卷4期795-803页
The acute effect of supplemental oxygen during exercise has been shown to differ largely among patients with COPD. It is unknown what factors influence oxygen response.
5934. Maximal Inspiratory Pressure: Does the Choice of Reference Values Actually Matter?
作者: Antenor Rodrigues.;Marianne L Da Silva.;Danilo C Berton.;Gerson Cipriano.;Fabio Pitta.;Denis E O'Donnell.;J Alberto Neder.
来源: Chest. 2017年152卷1期32-39页
Single-point measurements of maximal inspiratory pressure (MIP) are frequently used to suggest muscle weakness in clinical practice. Although there is a large variability in "mean" predicted MIP depending on the chosen reference values, it remains unclear whether those discrepancies actually impact on the prevalence of weakness, that is, MIP below the lower limit of normal.
5935. The Power of Flash Mob Research: Conducting a Nationwide Observational Clinical Study on Capillary Refill Time in a Single Day.
作者: Jelmer Alsma.;Jan L C M van Saase.;Prabath W B Nanayakkara.;W E M Ineke Schouten.;Anique Baten.;Martijn P Bauer.;Frits Holleman.;Jack J M Ligtenberg.;Patricia M Stassen.;Karin H A H Kaasjager.;Harm R Haak.;Frank H Bosch.;Stephanie C E Schuit.; .
来源: Chest. 2017年151卷5期1106-1113页
Capillary refill time (CRT) is a clinical test used to evaluate the circulatory status of patients; various methods are available to assess CRT. Conventional clinical research often demands large numbers of patients, making it costly, labor-intensive, and time-consuming. We studied the interobserver agreement on CRT in a nationwide study by using a novel method of research called flash mob research (FMR).
5936. Percent Emphysema and Daily Motor Activity Levels in the General Population: Multi-Ethnic Study of Atherosclerosis.
作者: Christian M Lo Cascio.;Mirja Quante.;Eric A Hoffman.;Alain G Bertoni.;Carrie P Aaron.;Joseph E Schwartz.;Mark V Avdalovic.;Vincent S Fan.;Gina S Lovasi.;Steven M Kawut.;John H M Austin.;Susan Redline.;R Graham Barr.
来源: Chest. 2017年151卷5期1039-1050页
COPD is associated with reduced physical capacity. However, it is unclear whether pulmonary emphysema, which can occur without COPD, is associated with reduced physical activity in daily life, particularly among people without COPD and never smokers. We hypothesized that greater percentage of emphysema-like lung on CT scan is associated with reduced physical activity assessed by actigraphy and self-report.
5937. Hydrocortisone, Vitamin C, and Thiamine for the Treatment of Severe Sepsis and Septic Shock: A Retrospective Before-After Study.
作者: Paul E Marik.;Vikramjit Khangoora.;Racquel Rivera.;Michael H Hooper.;John Catravas.
来源: Chest. 2017年151卷6期1229-1238页
The global burden of sepsis is estimated as 15 to 19 million cases annually, with a mortality rate approaching 60% in low-income countries.
5938. A Man in His 20s With Diffuse Lung Opacities and Acute Respiratory Failure After Hookah Smoking.
A man in his 20s with no medical history presented with 2 days of progressively worsening shortness of breath accompanied by subjective fevers, chills, body aches, decreased appetite, night sweats, and cough producing nonbloody sputum. He denied childhood lung diseases, allergies, or a family history of lung disease. He did not smoke cigarettes but had smoked hookah in Saudi Arabia before moving to the United States 1 month before presentation and had restarted 2 days before the start of symptoms. He denied travel outside of the northeastern United States. He did not take medications, use illicit drugs, or engage in high-risk behavior.
5939. A Woman in Her 60s With Fever and Altered Mental Status in a Psychiatric Hospital.
A woman in her 60s with a history of hepatitis C with cirrhosis and major depressive disorder with psychotic features was admitted to the inpatient psychiatric unit for suicidal ideation. She was initially treated with a combination of sertraline and paliperidone. The paliperidone was subsequently changed to risperidone and ultimately to olanzapine. She developed worsening mental status and was then treated for catatonia with benzodiazepines. Over 2 days, her mental status continued to worsen and she developed fever and tachycardia. She was transferred to the ICU and endotracheally intubated for inability to protect her airway. She was started on lactulose via orogastric tube but showed no improvement in her mental status after 2 days despite having two or three bowel movements per day.
5940. A 48-Year-Old Man With Leukopenia, Jaundice, and Skin Rash After Lung Transplantation.
作者: Ali Ataya.;Abhishek Biswas.;Satish Chandrashekaran.;Juan C Salgado.;Steven S Goldstein.;Amir M Emtiazjoo.
来源: Chest. 2016年150卷6期e167-e170页
A 48-year-old African-American male subject presented with progressive fatigue, jaundice, and new-onset leukopenia 12 weeks after undergoing bilateral lung transplantation for advanced pulmonary sarcoidosis. His transplant surgery and immediate posttransplantation course were uneventful. Induction immunosuppression included methylprednisolone 500 mg intraoperatively and basiliximab (anti-IL-2 monoclonal antibody) on days 0 and 4 after transplantation. His maintenance immunosuppression posttransplantation was prednisone 20 mg daily, tacrolimus with target tacrolimus levels 10 to 15 ng/mL, and mycophenolate mofetil 750 mg twice daily. Both the donor and recipient were seropositive for cytomegalovirus and Epstein-Barr virus. Infectious disease prophylaxis consisted of valganciclovir, trimethoprim/sulfamethoxazole, and voriconazole. Results of the surveillance bronchoscopy conducted after the lung transplant were negative for acute cellular rejection or infection at 4 and 12 weeks' posttransplantation. Findings on spirometry had continuously improved since transplantation.
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