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Sarcoidosis is a Th1/Th17 multisystem disorder: wider implications

Facco et al demonstrated elevated levels of T helper 17 (Th17) cells in the peripheral blood and in the bronchoalveolar lavage of patients with active sarcoidosis; increased expression of interleukin 17 (IL-17) and IL-23R in lung and lymph node specimens was also noted.1 These results suggest a role for the IL-23/Th17 inflammatory axis in the pathogenesis of sarcoidosis. Crohn's disease (CD) is a severe inflammatory bowel disease (IBD). Many components of the IL-23 pathway (IL23R, IL12B, STAT3, JAK2, TYK2) are true IBD susceptibility genes, suggesting a crucial role for this pathway in maintaining intestinal immune homeostasis.2 We recently reported the development of multisystem sarcoidosis in two CD patients who had received maintenance therapy with natalizumab, a selective adhesion mole...

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Oxygen and the airways

The best things carried to excess are wrong (Charles Churchill (satirist) 1731–1764) The use of oxygen for the management of patients with acute breathlessness, irrespective of cause, is well established in medical practice. The perception of benefit, even in the absence of measurement of oxygenation, and concerns over adverse outcomes from severe hypoxaemia have driven the use of high-concentration oxygen therapy over many years with little regard to possible harmful effects. While there have been many advocates for the cautious use of oxygen in chronic obstructive pulmonary disease (COPD) as a result of its propensity to promote hypercarbia, liberal use in asthma appears universal. This approach pervades student teaching through medical texts, even when there is significant respira...

Randomised controlled trial of high concentration versus titrated oxygen therapy in severe exacerbations of asthma

Conclusion High concentration oxygen therapy causes a clinically significant increase in Ptco2 in patients presenting with severe exacerbations of asthma. A titrated oxygen regime is recommended in the treatment of severe asthma, in which oxygen is administered only to patients with hypoxaemia, in a dose that relieves hypoxaemia without causing hyperoxaemia. Clinical trial number ACTRN12607000131459. (Source: Thorax)

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Comprehensive Management of Respiratory Symptoms in Patients with Advanced Lung Cancer.

Patients with advanced lung cancer experience a high symptom burden with great impact upon functional status and quality of life and poor long-term survival.

Respiratory symptoms, like dyspnea, cough, and hemoptysis, are highly prevalent and cause profound distress at the time of diagnosis and as disease progresses.

This review discusses common reversible causes of dyspnea and examines pharmacologic and nonpharmacologic approaches to symptom management of dyspnea, cough, and hemoptysis.

Current surgical treatment of non-small-cell lung cancer.

When considering surgical treatment for non-small-cell lung cancer (NSCLC), a distinction is made between early-stage disease (stages IA/B and IIA/B), locoregionally advanced disease (stages IIIA/B) and metastatic disease (stage IV). Complete surgical resection of NSCLC can provide good long-term outcome.

Surgery is considered the treatment of choice in patients with early-stage NSCLC or patients with T3N1 disease. Surgery for locoregionally advanced disease remains controversial. In specific cases of T4 disease, surgery can provide long-term survival. In patients with stage IIIA-N2 disease, surgery is only offered to patients who have achieved mediastinal downstaging following induction therapy.

Careful preoperative evaluation is clearly important in the staging and selection of patients with NSCLC for surgery.

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