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Comorbidities and Mortality in Hypercapnic Obese under Domiciliary Noninvasive Ventilation.

Comorbidities and Mortality in Hypercapnic Obese under Domiciliary Noninvasive Ventilation.

PLoS One. 2013;8(1):e52006

Authors: Borel JC, Burel B, Tamisier R, Dias-Domingos S, Baguet JP, Levy P, Pepin JL

Abstract
BACKGROUND: The higher mortality rate in untreated patients with obesity-associated hypoventilation is a strong rationale for long-term noninvasive ventilation (NIV). The impacts of comorbidities, medications and NIV compliance on survival of these patients remain largely unexplored.
METHODS: Observational cohort of hypercapnic obese patients initiated on NIV between March 2003 and July 2008. Survival curves were estimated by the Kaplan-Meier method. Anthropometric measurements, pulmonary function, blood gases, nocturnal SpO(2) indices, comorbidities, medications, conditions of NIV initiation and NIV compliance were used as covariates. Univariate and multivariate Cox models allowed to assess predictive factors of mortality.
RESULTS: One hundred and seven patients (56% women), in whom NIV was initiated in acute (36%) or chronic conditions, were followed during 43±14 months. The 1, 2, 3 years survival rates were 99%, 94%, and 89%, respectively. In univariate analysis, death was associated with older age (>61 years), low FEV1 (<66% predicted value), male gender, BMI×time, concomitant COPD, NIV initiation in acute condition, use of inhaled corticosteroids, ß-blockers, nonthiazide diuretics, angiotensin-converting enzyme inhibitors and combination of cardiovascular drugs (one diuretic and at least one other cardiovascular agent). In multivariate analysis, combination of cardiovascular agents was the only factor independently associated with higher risk of death (HR = 5.3; 95% CI 1.18; 23.9). Female gender was associated with lower risk of death.
CONCLUSION: Cardiovascular comorbidities represent the main factor predicting mortality in patient with obesity-associated hypoventilation treated by NIV. In this population, NIV should be associated with a combination of treatment modalities to reduce cardiovascular risk.

PMID: 23341888 [PubMed - in process]

Two Panels of Plasma MicroRNAs as Non-Invasive Biomarkers for Prediction of Recurrence in Resectable NSCLC.

Two Panels of Plasma MicroRNAs as Non-Invasive Biomarkers for Prediction of Recurrence in Resectable NSCLC.

PLoS One. 2013;8(1):e54596

Authors: Sanfiorenzo C, Ilie MI, Belaid A, Barlési F, Mouroux J, Marquette CH, Brest P, Hofman P

Abstract
The diagnosis of non-small cell lung carcinoma (NSCLC) at an early stage, as well as better prediction of outcome remains clinically challenging due to the lack of specific and robust non-invasive markers. The discovery of microRNAs (miRNAs), particularly those found in the bloodstream, has opened up new perspectives for tumor diagnosis and prognosis. The aim of our study was to determine whether expression profiles of specific miRNAs in plasma could accurately discriminate between NSCLC patients and controls, and whether they are able to predict the prognosis of resectable NSCLC patients. We therefore evaluated a series of seventeen NSCLC-related miRNAs by quantitative real-time (qRT)-PCR in plasma from 52 patients with I-IIIA stages NSCLC, 10 patients with chronic obstructive pulmonary disease (COPD) and 20-age, sex and smoking status-matched healthy individuals. We identified an eleven-plasma miRNA panel that could distinguish NSCLC patients from healthy subjects (AUC = 0.879). A six-plasma miRNA panel was able to discriminate between NSCLC patients and COPD patients (AUC = 0.944). Furthermore, we identified a three-miRNA plasma signature (high miR-155-5p, high miR-223-3p, and low miR-126-3p) that significantly associated with a higher risk for progression in adenocarcinoma patients. In addition, a three-miRNA plasma panel (high miR-20a-5p, low miR-152-3p, and low miR-199a-5p) significantly predicted survival of squamous cell carcinoma patients. In conclusion, we identified two plasma miRNA expression profiles that may be useful for predicting the outcome of patients with resectable NSCLC.

PMID: 23342174 [PubMed - in process]

Acute Infections and Venous Thromboembolism

Infection is a risk factor for venous thromboembolism (VTE). Rates of acute infections and acute venous thromboembolism (VTE) are both high; therefore, any relationship between infection and VTE has potential major clinical importance. Evidence is emerging of a possible relationship between deep venous thrombosis, pulmonary embolism, and acute infection (Smeeth L et al, Lancet 2006;367:1075-9; and Clayton TS, Int J Epidemiol 2011;40:819-27). Studies to date, however, have not examined the magnitude and duration of the potential increase of VTE risk associated with hospital-acquired or community-acquired infections. The authors examined whether patients with hospital-diagnosed or community-treated infection were at increased risk of VTE. This was a population-based, case-controlled study i...

Tuberculosis screening in immigrants from high prevalence countries: Interview first or chest radiograph first?

Immigration from high tuberculosis (TB) prevalence countries has a substantial impact on the epidemiology of TB in receiving countries with low TB incidence.
Cross‐border migration offers an ideal opportunity for active case finding that will result in a lower case load in the host country and a reduced spread of disease to both the indigenous and migrant populations.
Screening strategies can start "off‐shore", thereby indirectly assisting and empowering public health systems in the source countries, or be performed at ports of entry with or without long term engagement of "on‐shore" facilities and systems to provide either preventive therapy or surveillance for reactivation of latent TB.
The chest radiograph seems to be playing a key role in this process but questions remai...

Procalcitonin in Acute Exacerbations of Interstitial Pneumonia: Another Tool in the Toolbox?

Interstitial lung diseases (sometimes also referred to as interstitial pneumonias, or IPs) comprise a heterogeneous group of diffuse parenchymal lung diseases that are associated with identifiable causes (such as collagen vascular diseases (CVD‐ILD), like rheumatoid arthritis and scleroderma, or chronic hypersensitivity pneumonitis) and unidentified etiologies (idiopathic interstitial pneumonias, IIP, the most common of which is idiopathic pulmonary fibrosis, or IPF). During their slowly progressive decline, many IPF patients may suddenly experience an acute worsening of their disease. In the absence of an identifiable cause such as infection, heart failure, or pulmonary embolism, these sudden deteriorations have been defined as acute exacerbations and are associated with a significantly...

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