69 research outputs found
Circulating Metabolic Profile in Idiopathic Pulmonary Fibrosis: Data from the IPF-PRO Registry
BACKGROUND: The circulating metabolome, reflecting underlying cellular processes and disease biology, has not been fully characterized in patients with idiopathic pulmonary fibrosis (IPF). We evaluated whether circulating levels of metabolites correlate with the presence of IPF, with the severity of IPF, or with the risk of clinically relevant outcomes among patients with IPF.
METHODS: We analyzed enrollment plasma samples from 300 patients with IPF in the IPF-PRO Registry and 100 individuals without known lung disease using a set of targeted metabolomics and clinical analyte modules. Linear regression was used to compare metabolite and clinical analyte levels between patients with IPF and controls and to determine associations between metabolite levels and measures of disease severity in patients with IPF. Unadjusted and adjusted univariable Cox regression models were used to evaluate associations between circulating metabolites and the risk of mortality or disease progression among patients with IPF.
RESULTS: Levels of 64 metabolites and 5 clinical analytes were significantly different between patients with IPF and controls. Among analytes with greatest differences were non-esterified fatty acids, multiple long-chain acylcarnitines, and select ceramides, levels of which were higher among patients with IPF versus controls. Levels of the branched-chain amino acids valine and leucine/isoleucine were inversely correlated with measures of disease severity. After adjusting for clinical factors known to influence outcomes, higher levels of the acylcarnitine C:16-OH/C:14-DC were associated with all-cause mortality, lower levels of the acylcarnitine C16:1-OH/C14:1DC were associated with all-cause mortality, respiratory death, and respiratory death or lung transplant, and higher levels of the sphingomyelin d43:2 were associated with the risk of respiratory death or lung transplantation.
CONCLUSIONS: IPF has a distinct circulating metabolic profile characterized by increased levels of non-esterified fatty acids, long-chain acylcarnitines, and ceramides, which may suggest a more catabolic environment that enhances lipid mobilization and metabolism. We identified select metabolites that were highly correlated with measures of disease severity or the risk of disease progression and that may be developed further as biomarkers.
TRIAL REGISTRATION: ClinicalTrials.gov; No: NCT01915511; URL: www.CLINICALTRIALS: gov
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Perioperative management of obstructive sleep apnea: ready for prime time?
Obstructive sleep apnea (OSA) is associated with increased risks of cardiovascular disease and stroke and with elevated rates of postoperative complications (including cardiac ischemia and respiratory failure) in surgical patients. Additionally, the prevalence of OSA is higher in surgical patients than in the general population. Screening for OSA prior to surgery is recommended to identify patients at risk for postoperative complications. The presence of moderate or severe OSA calls for modified strategies of perioperative anesthesia, pain management, and postoperative monitoring to reduce the chance of OSA-associated complications
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Chapter 21 - Sleep in Women: Gender Differences in Health and Disease
Studies of sleep in women, whether in health or disease, are affected by the distinct hormonal changes that occur throughout a woman's life cycle, including puberty, menses, pregnancy, and menopause. Differences exist not only between the sexes but within cohorts of women as they transition through these biologically determined milestones. Additionally, socioeconomic status, workplace, and familial roles influence observed gender differences. In the NSF 2007 poll, 30% of pregnant women and 42% of post-partum women reported rarely or never getting a good night's sleep, compared to 15% among all women; 25% of perimenopausal women and 30% of postmenopausal women reported getting a good night's sleep only a few nights a month or less. Not surprisingly, given their social and/or familial responsibilities, working mothers (72%) and single working women (68%) were more likely to experience sleep problems like insomnia. These sleep disturbances are not without consequences; in the NSF survey, women who experienced daytime sleepiness were more likely to report high stress (80%), drive drowsy at least once per month (27%), spend less time with friends and family (39%), be too tired for sex (33%), and be late for work (20%). Recently, studies recognize that men and women experience sleep and sleep disorders differently. They differ in the prevalence of certain sleep disorders and may have varying presentations and responses to therapies. This chapter serves to both review the existing literature on gender differences in sleep and highlight the considerable gaps in knowledge
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Review: corticosteroids plus LABAs reduce exacerbations and mortality more than steroids alone in COPD
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When bioterrorism strikes: Diagnosis and management of inhalational anthrax The respiratory agents of bioterrorism
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