Lung Biopsy in ARDS: Is It Worth the Risk?

Progress in the treatment of acute respiratory distress syndrome (ARDS) has been slow, perhaps in part due to the heterogeneity in the biology underlying this syndrome. Open lung biopsy is a feasible approach to define various subcategories of underlying histology. In experienced hands, with careful selection of patients and close attention to details of critical care management, including mechanical ventilator settings, the procedure is safe even in patients with severe disease. However, further work is needed to define which patients, if any, experience a beneficial effect on outcome from this procedure. More research is needed on assessing efficacy of potential therapies within histologically defined subgroups. In the future, various biomarkers may be available to non-invasively classify ARDS patients from the standpoint of responsiveness to various therapies, such as gluco-corticoids

Obstructive sleep apnea and psychomotor vigilance task performance

Background: Obstructive sleep apnea (OSA) is a highly prevalent disorder with considerable morbidity and mortality. Vigilance and attentiveness are often impaired in OSA patients. In occupational medicine settings, subjective reports of sleepiness are notoriously inaccurate, making the identification of objective measures of vigilance potentially important for risk assessments of fitness for duty. In order to evaluate the effects of OSA on attentiveness and vigilance, we conducted a cross-sectional study to examine the association between OSA and psychomotor vigilance task (PVT) performance. Methods: Patients attending sleep clinics for evaluation of possible sleep apnea were recruited. The subjects underwent either a standard overnight laboratory polysomnography or home sleep study. Subjective daytime sleepiness was assessed by Epworth sleepiness scale, and vigilance was tested using a portable device. The participants were asked to respond to the PVT signals using their dominant hand. Each PVT administration lasted 10 minutes, with stimuli signals appearing randomly at variable intervals of 2–10 seconds. Results: Mean age of the participants was 46±15 years, and mean body mass index was 34.3±9.8 kg/m2. Participants with higher Epworth scores had worse PVT performance (P<0.05). In multivariate analyses, age, body mass index, and poor sleep efficiency (measured by Pittsburgh sleep quality index score) were associated with worse PVT performance (P<0.05). In contrast, PVT performance did not differ significantly across categories of apnea hypopnea index severity. Subgroup analysis demonstrated that women had worse performance on all PVT measures (P<0.05). Conclusion: PVT performance can be utilized for risk assessments of sleepiness and may be particularly useful among populations where subjective reports are unreliable

An Environment-Wide Association Study (EWAS) on Type 2 Diabetes Mellitus

Background: Type 2 Diabetes (T2D) and other chronic diseases are caused by a complex combination of many genetic and environmental factors. Few methods are available to comprehensively associate specific physical environmental factors with disease. We conducted a pilot Environmental-Wide Association Study (EWAS), in which epidemiological data are comprehensively and systematically interpreted in a manner analogous to a Genome Wide Association Study (GWAS). Methods and Findings: We performed multiple cross-sectional analyses associating 266 unique environmental factors with clinical status for T2D defined by fasting blood sugar (FBG) concentration $126 mg/dL. We utilized available Centers for Disease Control (CDC) National Health and Nutrition Examination Survey (NHANES) cohorts from years 1999 to 2006. Within cohort sample numbers ranged from 503 to 3,318. Logistic regression models were adjusted for age, sex, body mass index (BMI), ethnicity, and an estimate of socioeconomic status (SES). As in GWAS, multiple comparisons were controlled and significant findings were validated with other cohorts. We discovered significant associations for the pesticide-derivative heptachlor epoxide (adjusted OR in three combined cohorts of 1.7 for a 1 SD change in exposure amount; p,0.001), and the vitamin c-tocopherol (adjusted OR 1.5; p,0.001). Higher concentrations of polychlorinated biphenyls (PCBs) such as PCB170 (adjusted OR 2.2; p,0.001) were also found. Protective factors associated with T2D included b-carotenes (adjusted OR 0.6; p,0.001)

Autoadjusting-CPAP effect on serum Leptin concentrations in Obstructive Sleep Apnoea patients

© 2008 Drummond et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution Licens

Predicting environmental chemical factors associated with disease-related gene expression data

<p>Abstract</p> <p>Background</p> <p>Many common diseases arise from an interaction between environmental and genetic factors. Our knowledge regarding environment and gene interactions is growing, but frameworks to build an association between gene-environment interactions and disease using preexisting, publicly available data has been lacking. Integrating freely-available environment-gene interaction and disease phenotype data would allow hypothesis generation for potential environmental associations to disease.</p> <p>Methods</p> <p>We integrated publicly available disease-specific gene expression microarray data and curated chemical-gene interaction data to systematically predict environmental chemicals associated with disease. We derived chemical-gene signatures for 1,338 chemical/environmental chemicals from the Comparative Toxicogenomics Database (CTD). We associated these chemical-gene signatures with differentially expressed genes from datasets found in the Gene Expression Omnibus (GEO) through an enrichment test.</p> <p>Results</p> <p>We were able to verify our analytic method by accurately identifying chemicals applied to samples and cell lines. Furthermore, we were able to predict known and novel environmental associations with prostate, lung, and breast cancers, such as estradiol and bisphenol A.</p> <p>Conclusions</p> <p>We have developed a scalable and statistical method to identify possible environmental associations with disease using publicly available data and have validated some of the associations in the literature.</p

On the inadequacy of environment impact assessments for projects in Bhagwan Mahavir Wildlife Sanctuary and National Park of Goa, India : a peer review

The Environment Impact Assessment (EIA) is a regulatory framework adopted since 1994 in India to evaluate the impact and mitigation measures of projects, however, even after 25 years of adoption, EIAs continue to be of inferior quality with respect to biodiversity documentation and assessment of impacts and their mitigation measures. This questions the credibility of the exercise, as deficient EIAs are habitually used as a basis for project clearances in ecologically sensitive and irreplaceable regions. The authors reiterate this point by analysing impact assessment documents for three projects: the doubling of the National Highway-4A, doubling of the railway-line from Castlerock to Kulem, and laying of a 400-kV transmission line through the Bhagwan Mahavir Wildlife Sanctuary and National Park in the state of Goa. Two of these projects were recently granted ‘Wildlife Clearance’ during a virtual meeting of the Standing Committee of the National Board of Wildlife (NBWL) without a thorough assessment of the project impacts. Assessment reports for the road and railway expansion were found to be deficient on multiple fronts regarding biodiversity assessment and projected impacts, whereas no impact assessment report was available in the public domain for the 400-kV transmission line project. This paper highlights the biodiversity significance of this protected area complex in the Western Ghats, and highlights the lacunae in biodiversity documentation and inadequacy of mitigation measures in assessment documents for all three diversion projects. The EIA process needs to improve substantially if India is to protect its natural resources and adhere to environmental protection policies and regulations nationally and globally

2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation: executive summary.

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2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation: executive summary.

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