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pubmed: 1073-449X



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Fifty Years of Research in ARDS. Cell Based Therapy for ARDS: Biology and Potential Therapeutic Value.

Fifty Years of Research in ARDS. Cell Based Therapy for ARDS: Biology and Potential Therapeutic Value.

Am J Respir Crit Care Med. 2017 Mar 17;:

Authors: Laffey JG, Matthay MA

Abstract
Based on several pre-clinical studies, cell-based therapy has emerged as a potential new therapeutic for ARDS. Of the various cell-based therapy options, mesenchymal stromal cells (MSCs) from bone marrow, adipose tissue and umbilical cord have the most experimental data to support their potential efficacy for lung injury from both infectious and non-infectious causes. Mechanistically, MSCs exert their beneficial effects by release of paracrine factors, microvesicles, and transfer of mitochondria, all of which have anti-inflammatory and pro-resolving effects on injured lung endothelium and alveolar epithelium, including enhancing the resolution of pulmonary edema by upregulating sodium-dependent alveolar fluid clearance. MSCs also have anti-microbial effects mediated by release of anti-microbial factors and by upregulating monocyte/macrophage phagocytosis. Phase 2a clinical trials to establish safety in ARDS are in progress, and two phase 1 trials did not report any serious adverse events. Several issues need further study including: determining the optimal methods for large scale production; reconstitution of cryopreserved cells for clinical use; defining cell potency assays; and determining the therapeutic potential of conditioned media derived from MSCs. Since ARDS is a heterogeneous syndrome, targeting MSCs to ARDS patients with a more hyper-inflammatory endotype may further enhance their potential for efficacy.

PMID: 28306336 [PubMed - as supplied by publisher]




Fifty Years of Research in ARDS. Respiratory Mechanics in Acute Respiratory Distress Syndrome.

Fifty Years of Research in ARDS. Respiratory Mechanics in Acute Respiratory Distress Syndrome.

Am J Respir Crit Care Med. 2017 Mar 17;:

Authors: Henderson WR, Chen L, Amato MB, Brochard LJ

Abstract
Acute respiratory distress syndrome is a multifactorial lung injury that continues to be associated with high levels of morbidity and mortality. Mechanical ventilation, while lifesaving, is associated with new iatrogenic injury. Current best practice involves the use of small tidal volumes, low plateau and driving pressures, and high levels of positive end expiratory pressure. Collectively, these interventions are termed "lung protective ventilation". Recent investigations suggest that individualized measurements of pulmonary mechanical variables rather than population based ventilation prescriptions may be used to set the ventilator with the potential to improve outcomes beyond those achieved with standard lung protective ventilation. This review outlines the measurement and application of clinically applicable pulmonary mechanical concepts such as plateau pressures, driving pressure, transpulmonary pressures, stress index and measurement of strain. In addition, the concept the "baby lung" and the utility of dynamic in addition to static measures of pulmonary mechanical variables are discussed.

PMID: 28306327 [PubMed - as supplied by publisher]




Classification of Airflow Limitation Based on Z-score Underestimates Mortality in Patients with Chronic Obstructive Pulmonary Disease.

Classification of Airflow Limitation Based on Z-score Underestimates Mortality in Patients with Chronic Obstructive Pulmonary Disease.

Am J Respir Crit Care Med. 2017 Mar 17;:

Authors: Tejero E, Prats E, Casitas R, Galera R, Pardo P, Gavilán A, Martínez-Cerón E, Cubillos-Zapata C, Del Peso L, García-Río F

Abstract
RATIONALE: Global Lung Function Initiative recommends reporting lung function measures as z-score, and a classification of airflow limitation (AL) based on this parameter has recently been proposed.
OBJECTIVE: To evaluate the prognostic capacity of the AL classifications based on z-score or percentage predicted in patients with chronic obstructive pulmonary disease (COPD).
METHODS: A cohort of 2614 COPD patients recruited outside the hospital setting was examined after 57±13 months of follow-up, totalling 10,322 person-years. All-cause mortality was analysed, evaluating the predictive capacity of several AL staging systems.
MEASUREMENTS AND MAIN RESULTS: Based on GOLD guidelines, 461 patients (17.6%) had mild, 1452 (55.5%) moderate, 590 (22.6%) severe, and 111 (4.2%) very severe AL. According to z-score classification, 66.3% of patients remained with the same severity, while 23.7% worsened and 10.0% improved. Unlike other staging systems, patients with severe AL according to z-score had higher mortality than those with very severe AL (increase of risk by 5.2 and 3.9 times compared with mild AL, respectively). The predictive capacity for 5-year survival was slightly higher for FEV1 expressed as percentage of predicted than as z-score (areas under the curves: 0.714-0.760 versus 0.649-0.708, respectively). A severity-dependent relationship between AL grades by z-score and mortality was only detected in patients under the age of 60.
CONCLUSIONS: In COPD patients, the AL classification based on z-score predicts worse mortality than those based on percentage of predicted. It is possible that the z-score underestimates AL severity in patients over 60 years of age with severe functional impairment. .

PMID: 28306326 [PubMed - as supplied by publisher]




Diffuse Subcutaneous Emphysema Following Tracheal Perforation.

Diffuse Subcutaneous Emphysema Following Tracheal Perforation.

Am J Respir Crit Care Med. 2017 Mar 17;:

Authors: Keenan A, Browne W, Bhargava M

PMID: 28306325 [PubMed - as supplied by publisher]




Recommended Reading from Rutgers Robert Wood Johnson Medical School Pulmonary and Critical Care Medicine Fellows.

Recommended Reading from Rutgers Robert Wood Johnson Medical School Pulmonary and Critical Care Medicine Fellows.

Am J Respir Crit Care Med. 2017 Mar 17;:

Authors: Hussain S, Jagpal S, Baig SH, Len EK, Agarwal P

PMID: 28306322 [PubMed - as supplied by publisher]




Eosinophilia, Frequent Exacerbations, and Steroid Response in Chronic Obstructive Pulmonary Disease.

Eosinophilia, Frequent Exacerbations, and Steroid Response in Chronic Obstructive Pulmonary Disease.

Am J Respir Crit Care Med. 2017 Mar 17;:

Authors: Calverley PM, Tetzlaff K, Vogelmeier C, Fabbri LM, Magnussen H, Wouters EF, Mezzanotte W, Disse B, Finnigan H, Asijee G, Hallmann C, Watz H

PMID: 28306321 [PubMed - as supplied by publisher]