β blockers for adults with chronic obstructive pulmonary disease.
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In a large observational study (doi:10.1136/bmj.f6650), Quint and colleagues show that β blockers started before or during hospital admission after myocardial infarction are associated with substantial survival benefits for adults with chronic obstructive pulmonary disease (COPD). They found an adjusted hazard ratio of 0.59 (95% confidence interval 0.44 to 0.79) in those who were already taking β blockers and 0.50 (0.36 to 0.69) in those who started taking them in hospital.1
Randomised controlled trials have already shown that β blockers reduce mortality after myocardial infarction in the general population,2 and a decade ago two large observational studies suggested that this was also true for people with COPD.3 4Other observational studies have even suggested that β blockers may be beneficial for a wider population of patients with COPD.4 5 A recent meta-analysis of nine cohort studies that comprised nearly 100 000 patients with COPD showed a consistent pattern, with a pooled relative risk of mortality of 0.69 (0.62 to 0.78) with β blockade.6 In one study, β blockade was associated with a reduction …
Illustrative cases on individualizing immunoglobulin therapy in primary immunodeficiency disease.
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To illustrate the need for individualized immunoglobulin therapy in patients with primary immunodeficiency diseases (PIDDs) and review current evidence on how best to identify the biological serum IgG level in patients with antibody-deficient PIDD.
DATA SOURCES: Two case studies from the author's clinical practice are discussed. PubMed and Ovid MEDLINE databases were searched for articles pertaining to serum immunoglobulin levels in patients with PIDD and the relation of trough IgG levels to infection incidence and outcomes.
STUDY SELECTIONS: Articles and case studies were selected for their relevance to the individualization of IgG therapy for patients with PIDD. The case studies support the position that each patient has a specific "biological" serum IgG level associated with decreasing or preventing recurrent infection.
RESULTS: Patients with antibody-deficient PIDD are routinely treated with lifelong immunoglobulin replacement. Although a starting dose has been suggested, the dose of IgG that maintains serum IgG levels that protect against severe or recurrent infection has not been determined. It is likely the serum IgG level required to prevent infection in these patients varies as it does in normal individuals. This biological serum IgG level must be identified for each patient by plotting documented infections vs serum IgG levels over time.
CONCLUSION: Clinical experience and recent evidence suggest that optimal treatment of patients with PIDD involves individualizing IgG treatment to identify the optimal IgG serum levels that are required for each patient to become free of recurrent infection or pneumonia instead of trying to achieve a single optimal serum IgG level for all patients.
Optimizing immunoglobulin treatment for patients with primary immunodeficiency disease to prevent pneumonia and infection incidence: review of the current data.
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An increasing body of evidence suggests that the optimal dose for IgG replacement therapy is the dose that keeps the patient as free from infection as possible by either intravenous or subcutaneous delivery.
OBJECTIVE: To review the current evidence on optimizing IgG therapy in patients with primary immunodeficiency disease (PIDD).
METHODS: Surveys conducted among physicians who treat patients with PIDD indicate that most practitioners follow existing data and guidelines on the use and dosage of immunoglobulin therapy. On the basis of the current guidelines, most use intravenous immunoglobulin (IVIG) therapy at a starting dose of 400 mg/kg every 4 weeks to treat a number of primary PIDDs with humoral immune deficiencies. However, for the optimal treatment of PIDDs, therapy needs to be tailored.
RESULTS: Among the issues is the assessment of IgG trough levels or steady-state levels with subcutaneous immunoglobulin (SCIG) therapy needed to reduce or prevent infection in patients with PIDD. Increasing evidence suggests that optimization of treatment can be based on identifying the dosage of IVIG or SCIG for each patient needed to reduce infection.
CONCLUSION: More studies are needed to better clarify the optimal dose, IgG trough level, or IgG steady-state level necessary to reduce infection and optimize treatment for patients with PIDD treated with IVIG or SCIG.
Diagnosis and management of asthma in the elderly.
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Bronchial asthma is one of the most common chronic diseases worldwide, and by definition not expected to recover with aging. However, the concept that asthma can affect older individuals has been largely denied in the past. In clinical practice, asthma that occurs in the most advanced ages is often diagnosed as COPD, thus leading to undertreatment or improper treatment. The heterogeneity of clinical and functional presentation of geriatric asthma, including the partial loss of reversibility and of the allergic component, contributes to this misconception. A large body of evidence has accumulated demonstrating that the prevalence of asthma in the most advanced ages is similar to that in younger ages. The frequent coexistence of comorbid conditions in older patients compared to younger asthmatics, together with age-associated changes of the human lung, may render the management of asthma a complicated task. The article addresses the main issues related to the diagnosis and treatment of asthma in the geriatric age.
Identifying differentially expressed genes and pathways in two types of non-small cell lung cancer: adenocarcinoma and squamous cell carcinoma.
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Non-small cell lung carcinoma, NSCLC, accounts for 80-85% of lung cancers. NSCLC can be mainly divided into two types: adenocarcinoma (ADC) and squamous cell carcinoma (SCC). The purpose of our study was to identify and differentiate the pathogenesis of ADC and SCC at the molecular level. The gene expression profiles of ADC and SCC were downloaded from Gene Expression Omnibus under accession No. GSE10245. Accordingly, differentially expressed genes (DEGs) were identified by the limma package in R language. In addition, DEGs were functionally analyzed by Gene Ontology and Kyoto Encyclopedia of Genes and Genomes pathway enrichment. A total of 4124 DEGs were identified, including CDK1, CDK2, CDK4, and SKP2. The DEGs were mainly involved in 16 pathways related to cell proliferation, cell signal transduction and metabolism. We conclude that the molecular mechanisms of ADC and SCC are considerably different, and that they are involved in immune response, cell signal transduction, metabolism, cell division, and cell proliferation. Therefore, the two diseases should be treated differently. This study offers new insight into the diagnosis and therapy of these two types of lung cancer.