pre treatment egfr t790m subclones in lung adenocarcinoma harboring activating mutation of egfr a positive prognostic factor for survival

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Musculoskeletal syndrome treated with global postural re-education in double-redo lung transplantation: a case report with an 8-month follow-up

Postoperative pain and persisting fatigue represent critical concerns for patients receiving lung transplantation. The purpose of this study was to illustrate the trajectory of symptoms in a patient who presented with a posttransplant musculoskeletal syndrome after double redo-lung transplantation and attended therapeutic sessions of global postural re-education during the symptomatic phase. A 32-year-old woman with interstitial lung disease underwent double lung transplantation. At 23 months, functional parameters deteriorated, and the patient was placed on the active list for a second double-lung transplantation. Twenty months after re-transplantation, the patient reported continuous thoracic-lumbar musculoskeletal pain exacerbated by moving or performing the standard motor activities. Lower body flexibility improved during the observation period changed from -10 cm to 0 cm at the Chair Sitand- Reach Test. Leg strength improved as well, and the patient was able to perform more repetitions at the Squat Test, improving from 14 to 39. Pain intensity changed from 7 to 4 on a numerical rating scale. We observed that outcomes strictly related to treatment, with lower body flexibility, pain intensity, and physical function improving over time. As a result global postural re-education proved to be effective in this patient

Effects of high-flow nasal cannula in patients with persistent hypercapnia after an acute COPD exacerbation: A prospective pilot study

Background: Persistent hypercapnia after COPD exacerbation is associated with excess mortality and early rehospitalization. High Flow Nasal cannula (HFNC), may be theoretically an alternative to long-term noninvasive ventilation (NIV), since physiological studies have shown a reduction in PaCO2 level after few hours of treatment. In this clinical study we assessed the acceptability of HFNC and its effectiveness in reducing the level of PaCO2 in patients recovering from an Acute Hypercapnic Respiratory Failure (AHRF) episode. We also hypothesized that the response in CO2 clearance is dependent on baseline level of hypercapnia. Methods: Fifty COPD patients recovering from an acute exacerbation and with persistent hypercapnia, despite having attained a stable pH (i.e. pH > 7,35 and PaCO2 > 45 mmHg on 3 consecutive measurements), were enrolled and treated with HFNC for at least 8 h/day and during the nighttime Results: HFNC was well tolerated with a global tolerance score of 4.0 \ub1 0.9. When patients were separated into groups with or without COPD/OSA overlap syndrome, the "pure" COPD patients showed a statistically significant response in terms of PaCO2 decrease (p = 0.044). In addition, the subset of patients with a lower pH at enrolment were those who responded best in terms of CO2 clearance (score test for trend of odds, p = 0.0038). Conclusions: HFNC is able to significantly decrease the level of PaCO2 after 72 h only in "pure" COPD patients, recovering from AHRF. No effects in terms of CO2 reduction were found in those with overlap syndrome. The present findings will help guide selection of the best target population and allow a sample size calculation for future long-term randomized control trials of HFNC vs NIV

Riociguat treatment in patients with chronic thromboembolic pulmonary hypertension: Final safety data from the EXPERT registry

Objective: The soluble guanylate cyclase stimulator riociguat is approved for the treatment of adult patients with pulmonary arterial hypertension (PAH) and inoperable or persistent/recurrent chronic thromboembolic pulmonary hypertension (CTEPH) following Phase

Noninvasive ventilation in unplanned endotracheal extubation: Just a little help from my friend?

editoria

Diaphragm thickening fraction and inspiratory effort in patients with SARS-COV II pneumonia receiving different non-invasive respiratory supports

The assessment of inspiratory effort in the patient with acute hypoxaemic respiratory failure (AHRF) can be performed invasively by measuring the oesophageal pressure swing (DPes) during the inspiratory act.1 The reduction in DPes after two hours of non-invasive ventilation (NIV) in patients with AHRF is a predictor of NIV success.2 The study of diaphragm thickening fraction (TFdi) is a predictor of NIV failure in patients hospitalised for COPD exacerbation with respiratory acidosi

High flow through nasal cannula in exacerbated COPD patients: a systematic review

Chronic Obstructive Pulmonary Disease (COPD) history is characterized by episodes of exacerbation of varying severity, featured by acute worsening of respiratory symptoms, commonly precipitated by respiratory tract infection. The recent ERS/ATS clinical practice guidelines strongly recommend the application of non invasive ventilation (NIV) for patients with acute respiratory failure (ARF) leading to acute or acute-on-chronic respiratory acidosis (pH 7.35) and not for those patients with acute exacerbation of COPD (AECOPD) and hypercapnia who are not acidotic. In recent years, High-Flow through Nasal Cannula (HFNC) has been introduced in the clinical practice. We designed the present systematic review of the literature to assess all effects of HFNC use reported in exacerbated COPD patients. In this setting, HFNC is able to keep PaCO2 unmodified, while oxygenation slightly deteriorates as opposed to NIV. Furthermore, the work of breathing is reduced with HFNC by a similar extent to NIV, while it increases by 40\u201350% during conventional oxygen therapy (COT). HFNC is also reported to be more comfortable than COT and NIV. Despite these results, little and limited evidence for improved clinical outcomes is currently available