Obstructive sleep apnea(OSA) is associated with metabolic, cardiovascular and neuropsychological disorders, with substantial morbidity and economic costs. OSA has been estimated to affect 4%-11% of the population, dep...Obstructive sleep apnea(OSA) is associated with metabolic, cardiovascular and neuropsychological disorders, with substantial morbidity and economic costs. OSA has been estimated to affect 4%-11% of the population, depending on age. Obesity is a significant risk factor for OSA. Non alcoholic fatty liver disease(NAFLD) has emerged as an integral component of the metabolic syndrome, with insulin resistance as the central pathogenic feature. Estimates based on imaging and autopsy studies suggest that about 20%-30% of adults in the United States and other Western countries have NAFLD. Evidence now suggests that NAFLD is independently correlated to insulin resistance regardless of adiposity. Some authors have suggested that OSA may be another contributor to NAFLD development. In complex diseases, several or many different genes interact with environmental factors in determining disease presence or its phenotype. Individual genes only have a small effect on disease risk and can therefore be very difficult to identify. The genetic and hormonal determinants of OSA and NAFLD have received little attention. A wide variety of intermediate phenotypes and genes are involved in OSA and NAFLD which makes this syndrome genetically complex. Various adipokines, the most important of whichare leptin, adiponectin, tumor necrosis factor-alpha, resistin and interleukin-6, have a key role in NAFLD and OSA. Some studies have suggested that oxidative stress may also contribute to the development of NAFLD and OSA. Lifestyle intervention, insulin sensitizer drugs and bariatric surgery aim to improve metabolic syndrome, OSA and NAFLD but need further investigation.展开更多
AIM To prospectively evaluate the reproducibility of diaphragm thickness measurement by ultrasonography at the bedside by critical care physicians in patients on invasive mechanical ventilation.METHODS In a prospectiv...AIM To prospectively evaluate the reproducibility of diaphragm thickness measurement by ultrasonography at the bedside by critical care physicians in patients on invasive mechanical ventilation.METHODS In a prospective observational study of 64 invasively ventilated patients, diaphragmatic thickness measurement was taken by 2 different observers at the same site. Three measurements were taken by each observer and averaged. The intraobserver and interobserver variability was assessed by estimation of intraclass correlation coefficient. The limits of agreement were plotted as the difference between two observations against the average of the two observations in Bland and Altman analysis.RESULTS The mean diaphragm thickness at the functional residual capacity was 2.29 ± 0.4 mm and the lower limit of the normal, i.e., the 5 th percentile was 1.7 mm(95%CI: 1.6-1.8). The intraclass correlation coefficient for intraobserver variability was 0.986(95%CI: 0.979-0.991)with a P value of < 0.001. The intraclass correlation coefficient for interobserver variability was 0.987(95%CI: 0.949-0.997) with a P value of < 0.001. In Bland and Altman analysis, both intraobserver and interobserver measurements showed high limits of agreement. CONCLUSION Our study demonstrates that the measurement of diaphragm thickness by ultrasound can be accurately performed by critical care physicians with high degree of reproducibility in patients on mechanical ventilation.展开更多
Mucinous adenocarcinoma represents a rare subtype of adenocarcinoma of the lung, which is frequently invasive and has a poorer prognosis. Of its wide range of imaging appearances, air-space consolidation is the most f...Mucinous adenocarcinoma represents a rare subtype of adenocarcinoma of the lung, which is frequently invasive and has a poorer prognosis. Of its wide range of imaging appearances, air-space consolidation is the most frequent pattern while cavitary form has only rarely been reported. Despite imaging advancements, the differentiation of benign and malignant cavitary lung lesions sometimes remains imperfect. We propose "Tambourine" sign on computed tomography to raise the suspicion of mucinous adenocarcinoma in a lung cavity, under appropriate clinical settings. The sign indicates an irregular cavity with undistorted prominent thick walled bronchioles within the wall and draping along thereby resembling the musical instrument "tambourine". Adjacent ground glass and internal septations may also be seen.展开更多
The differential diagnoses of a cavitary lung lesion in renal transplant recipients would include infection, malignancy and less commonly inflammatory diseases. Bacterial infection, Tuberculosis, Nocardiosis, fungal i...The differential diagnoses of a cavitary lung lesion in renal transplant recipients would include infection, malignancy and less commonly inflammatory diseases. Bacterial infection, Tuberculosis, Nocardiosis, fungal infections like Aspergillosis and Cryptococcosis need to be considered in these patients. Pulmonary cryptococcosis usually presents 16-21 mo after transplantation, more frequently in patients who have a high level of cumulative immunosuppression. Here we discuss an interesting patient who never received any induction/anti-rejection therapy but developed both BK virus nephropathy as well as severe pulmonary Cryptococcal infection after remaining stable for 6 years after transplantation. This case highlights the risk of serious opportunistic infections even in apparently low immunologic risk transplant recipients many years after transplantation.展开更多
文摘Obstructive sleep apnea(OSA) is associated with metabolic, cardiovascular and neuropsychological disorders, with substantial morbidity and economic costs. OSA has been estimated to affect 4%-11% of the population, depending on age. Obesity is a significant risk factor for OSA. Non alcoholic fatty liver disease(NAFLD) has emerged as an integral component of the metabolic syndrome, with insulin resistance as the central pathogenic feature. Estimates based on imaging and autopsy studies suggest that about 20%-30% of adults in the United States and other Western countries have NAFLD. Evidence now suggests that NAFLD is independently correlated to insulin resistance regardless of adiposity. Some authors have suggested that OSA may be another contributor to NAFLD development. In complex diseases, several or many different genes interact with environmental factors in determining disease presence or its phenotype. Individual genes only have a small effect on disease risk and can therefore be very difficult to identify. The genetic and hormonal determinants of OSA and NAFLD have received little attention. A wide variety of intermediate phenotypes and genes are involved in OSA and NAFLD which makes this syndrome genetically complex. Various adipokines, the most important of whichare leptin, adiponectin, tumor necrosis factor-alpha, resistin and interleukin-6, have a key role in NAFLD and OSA. Some studies have suggested that oxidative stress may also contribute to the development of NAFLD and OSA. Lifestyle intervention, insulin sensitizer drugs and bariatric surgery aim to improve metabolic syndrome, OSA and NAFLD but need further investigation.
文摘AIM To prospectively evaluate the reproducibility of diaphragm thickness measurement by ultrasonography at the bedside by critical care physicians in patients on invasive mechanical ventilation.METHODS In a prospective observational study of 64 invasively ventilated patients, diaphragmatic thickness measurement was taken by 2 different observers at the same site. Three measurements were taken by each observer and averaged. The intraobserver and interobserver variability was assessed by estimation of intraclass correlation coefficient. The limits of agreement were plotted as the difference between two observations against the average of the two observations in Bland and Altman analysis.RESULTS The mean diaphragm thickness at the functional residual capacity was 2.29 ± 0.4 mm and the lower limit of the normal, i.e., the 5 th percentile was 1.7 mm(95%CI: 1.6-1.8). The intraclass correlation coefficient for intraobserver variability was 0.986(95%CI: 0.979-0.991)with a P value of < 0.001. The intraclass correlation coefficient for interobserver variability was 0.987(95%CI: 0.949-0.997) with a P value of < 0.001. In Bland and Altman analysis, both intraobserver and interobserver measurements showed high limits of agreement. CONCLUSION Our study demonstrates that the measurement of diaphragm thickness by ultrasound can be accurately performed by critical care physicians with high degree of reproducibility in patients on mechanical ventilation.
文摘Mucinous adenocarcinoma represents a rare subtype of adenocarcinoma of the lung, which is frequently invasive and has a poorer prognosis. Of its wide range of imaging appearances, air-space consolidation is the most frequent pattern while cavitary form has only rarely been reported. Despite imaging advancements, the differentiation of benign and malignant cavitary lung lesions sometimes remains imperfect. We propose "Tambourine" sign on computed tomography to raise the suspicion of mucinous adenocarcinoma in a lung cavity, under appropriate clinical settings. The sign indicates an irregular cavity with undistorted prominent thick walled bronchioles within the wall and draping along thereby resembling the musical instrument "tambourine". Adjacent ground glass and internal septations may also be seen.
文摘The differential diagnoses of a cavitary lung lesion in renal transplant recipients would include infection, malignancy and less commonly inflammatory diseases. Bacterial infection, Tuberculosis, Nocardiosis, fungal infections like Aspergillosis and Cryptococcosis need to be considered in these patients. Pulmonary cryptococcosis usually presents 16-21 mo after transplantation, more frequently in patients who have a high level of cumulative immunosuppression. Here we discuss an interesting patient who never received any induction/anti-rejection therapy but developed both BK virus nephropathy as well as severe pulmonary Cryptococcal infection after remaining stable for 6 years after transplantation. This case highlights the risk of serious opportunistic infections even in apparently low immunologic risk transplant recipients many years after transplantation.
