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L'essentiel de la littérature réçente en Pneumologie

Dans cette rubrique on vous propose une revue de la littérature à travers une sélection d'abstracts d'articles originaux.
On essaiera de vous tenir informé des dernières nouveautés de recherche en matière de Pneumologie. On ne vous fournit que le résumé de l'article et le lien correspondant, pour accéder à l'article en full text vous devez être inscrits à la revue correspondante.
Cliquez ici pour consulter la liste des revues de Pneumologie disponibles en libre accès.

Pediatric pulmonary arterial hypertension: on the eve of growing up Imprimer Envoyer
Lundi, 14 Août 2017 07:24
imagePurpose of review: Current recommendations for diagnosis and treatment of pulmonary arterial hypertension (PAH) during childhood are expert opinion based, because of lacking pediatric data. In recent years, however, important pediatric data have emerged on PAH. Recent findings: PAH in children shows similarities as well as differences compared to adults. Neonates and children know specific clinical presentations and a hemodynamic profile that differs from adults with PAH. Children identified as acute vasodilator responders according to the criteria proposed for adults rather than the pediatric criteria have better outcome when treated with calcium channel blockers. For nonresponders, combination PAH-targeted therapy leads to improved outcome compared to monotherapy. In pediatric PAH, WHO functional class, N-terminal pro-brain natriuretic peptide and tricuspid annular plane systolic excursion were identified as surrogates for survival and therefore qualify to be treatment goals in a goal-oriented treatment strategy. Summary: In order to refine current pediatric treatment guidelines, data on efficacy of specific treatment regiments and strategies are needed. The recently validated composite endpoint of clinical worsening allows for trials that will provide these data. For the first time, evidence-based treatment goals have been identified that will allow for a goal-oriented treatment strategy. Furthermore, various prognostic predictors have been identified that may prove treatment goals in future.
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Microbiome in interstitial lung disease: from pathogenesis to treatment target Imprimer Envoyer
Lundi, 14 Août 2017 07:24
imagePurpose of review: This review summarizes current knowledge of the role of the lung microbiome in interstitial lung disease and poses considerations of the microbiome as a therapeutic target. Recent findings: Although historically considered sterile, bacterial communities have now been well documented in lungs in health and disease. Studies in idiopathic pulmonary fibrosis (IPF) suggest that increased bacterial burden and/or abundance of potentially pathogenic bacteria may drive disease progression, acute exacerbations, and mortality. More recent work has highlighted the interaction between the lung microbiome and the innate immune system in IPF, strengthening the argument for the role of both host and environment interaction in disease pathogenesis. In support of this, studies of interstitial lung diseases other than IPF suggest that it may be the host immune response, which shapes the microbiome in these diseases. Some clinical and mouse model data also suggest that the lung microbiome may represent a therapeutic target, via antibiotic administration, immunization against pathogenic organisms, or treatment directed at gastroesophageal reflux. Summary: Evidence suggests that the lung microbiome may serve as a prognostic biomarker, a therapeutic target, or provide an explanation for disease pathogenesis in IPF.
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Acute exacerbations of interstitial lung disease: lessons from idiopathic pulmonary fibrosis Imprimer Envoyer
Lundi, 14 Août 2017 07:23
imagePurpose of review: The purpose of this review is to provide an update on acute exacerbation of interstitial lung disease (ILD), with a focus on idiopathic pulmonary fibrosis (IPF), in the light of the recently revised definition of acute exacerbation-IPF. Strengths and limitations of the current definition of acute exacerbation-IPF are also discussed. Recent findings: Clinically, acute exacerbation-IPFs are highly relevant events with a mortality rate of approximately 50%. A 2016 working group on acute exacerbation-IPF has suggested the definition be widened to include any acute respiratory worsening with new widespread alveolar abnormality on high-resolution computed tomography of the chest not fully explained by cardiac failure or fluid overload. Management of acute exacerbation-IPF typically includes supportive care, high-dose corticosteroids and broad-spectrum antibiotics, despite the scarcity of data supporting the usefulness of these therapies. The effect of a number of novel therapeutic approaches is currently under investigation. Summary: Acute exacerbation-IPF has recently been redefined. A standardized definition, similar to that of other chronic respiratory diseases, will likely facilitate the performance of highly needed studies in acute exacerbation of both IPF and other ILDs.
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