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  1. Article: Pulmonary amyloidosis as the presenting finding in a patient with multiple myeloma.

    Kronen, Ryan / Ziehr, David R / Kane, Ashley E D / VanderLaan, Paul A / Kholdani, Cyrus A / Hallowell, Robert W

    Respiratory medicine case reports

    2022  Volume 37, Page(s) 101626

    Abstract: We present the case of a 58-year-old man who presented with dyspnea, cough, and weight loss and was ultimately diagnosed with pulmonary amyloidosis and multiple myeloma. Diagnosis was achieved with a lung biopsy which showed AL amyloid deposits involving ...

    Abstract We present the case of a 58-year-old man who presented with dyspnea, cough, and weight loss and was ultimately diagnosed with pulmonary amyloidosis and multiple myeloma. Diagnosis was achieved with a lung biopsy which showed AL amyloid deposits involving the interstitium, vessels, and airway. He was treated with cyclophosphamide, bortezomib, and dexamethasone but died prior to completing treatment. His case is unique for the amyloid deposition found in all three lung compartments with clear pathophysiologic manifestations of each compartment, and the rapid disease progression that led to respiratory failure and death.
    Language English
    Publishing date 2022-03-18
    Publishing country England
    Document type Case Reports
    ZDB-ID 2666110-X
    ISSN 2213-0071
    ISSN 2213-0071
    DOI 10.1016/j.rmcr.2022.101626
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: Metformin and prostate cancer mortality: a meta-analysis.

    Stopsack, Konrad H / Ziehr, David R / Rider, Jennifer R / Giovannucci, Edward L

    Cancer causes & control : CCC

    2016  Volume 27, Issue 1, Page(s) 105–113

    Abstract: Purpose: Observational studies report conflicting results on the association between metformin exposure and prostate cancer outcomes. This meta-analysis summarizes studies reporting overall survival, prostate cancer-specific mortality, and biochemical ... ...

    Abstract Purpose: Observational studies report conflicting results on the association between metformin exposure and prostate cancer outcomes. This meta-analysis summarizes studies reporting overall survival, prostate cancer-specific mortality, and biochemical recurrence.
    Methods: PubMed and Embase were systematically reviewed to identify studies investigating the association between metformin use and clinical endpoints among men with prostate cancer while taking confounding by diabetes diagnosis into account. Pooled risk estimates (hazard ratios, HRs) and 95 % confidence intervals (CIs) were calculated using random-effects models. Sensitivity analyses for quality components and factors for heterogeneity were conducted.
    Results: Of 549 articles identified, nine retrospective cohort studies representing 9,186 patients were included. There was significant heterogeneity between studies, and studies differed in quality. Metformin use was associated with improved overall survival in studies with clear risk window definition (HR 0.88, 95 % CI 0.86-0.90, p < 0.001) and in studies with potential immortal time bias (HR 0.52, 95 % CI 0.41-0.65, p < 0.001). No significant association with prostate cancer-specific mortality was detected (HR 0.76, 95 % CI 0.44-1.31, p = 0.33). Metformin use was associated with a decreased risk of biochemical recurrence (HR 0.79, 95 % CI 0.63-1.00, p = 0.047).
    Conclusions: This meta-analysis suggests a benefit of metformin in men with diabetes and prostate cancer. However, further carefully designed studies are needed to confirm findings and to assess potential generalization to non-diabetic, non-white, and less aggressively treated men with prostate cancer.
    MeSH term(s) Diabetes Mellitus/drug therapy ; Humans ; Male ; Metformin/therapeutic use ; Prostatic Neoplasms/mortality ; Retrospective Studies ; Risk
    Chemical Substances Metformin (9100L32L2N)
    Language English
    Publishing date 2016-01
    Publishing country Netherlands
    Document type Journal Article ; Meta-Analysis
    ZDB-ID 1064022-8
    ISSN 1573-7225 ; 0957-5243
    ISSN (online) 1573-7225
    ISSN 0957-5243
    DOI 10.1007/s10552-015-0687-0
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  3. Article ; Online: E-Cigarette Use, Small Airway Fibrosis, and Constrictive Bronchiolitis.

    Hariri, Lida P / Flashner, Bess M / Kanarek, David J / O'Donnell, Walter J / Soskis, Alyssa / Ziehr, David R / Frank, Angela / Nandy, Sreyankar / Berigei, Sarita R / Sharma, Amita / Mathisen, Douglas / Keyes, Colleen M / Lanuti, Michael / Muniappan, Ashok / Shepard, Jo-Anne O'Malley / Mino-Kenudson, Mari / Ly, Amy / Hung, Yin P / Castelino, Flavia V /
    Ott, Harald C / Medoff, Benjamin D / Christiani, David C

    NEJM evidence

    2022  Volume 1, Issue 6

    Abstract: Background: Vaping, including the use of electronic cigarettes (e-cigarettes), has become increasingly prevalent, yet the associated long-term health risks are largely unknown. Given the prevalence of use, particularly among adolescents early in their ... ...

    Abstract Background: Vaping, including the use of electronic cigarettes (e-cigarettes), has become increasingly prevalent, yet the associated long-term health risks are largely unknown. Given the prevalence of use, particularly among adolescents early in their lifespan, it is vital to understand the potential chronic pathologic sequelae of vaping.
    Methods: We present the cases of four patients with chronic lung disease associated with e-cigarette use characterized by clinical evaluation, with pulmonary function tests (PFTs), chest high-resolution computed tomography (HRCT), endobronchial optical coherence tomography (EB-OCT) imaging, and histopathologic assessment.
    Results: Each patient presented with shortness of breath and chest pain in association with a 3- to 8-year history of e-cigarette use, with mild progressive airway obstruction on PFTs and/or chest HRCT findings demonstrating evidence of air trapping and bronchial wall thickening. EB-OCT imaging performed in two patients showed small airway-centered fibrosis with bronchiolar narrowing and lumen irregularities. The predominant histopathologic feature on surgical lung biopsy was small airway-centered fibrosis, including constrictive bronchiolitis and MUC5AC overexpression in all patients. Patients who ceased vaping had a partial, but not complete, reversal of disease over 1 to 4 years.
    Conclusions: After thorough evaluation for other potential etiologies, vaping was considered to be the most likely common causal etiology for all patients due to the temporal association of symptomatic chronic lung disease with e-cigarette use and partial improvement in symptoms after e-cigarette cessation. In this series, we associate the histopathologic pattern of small airway-centered fibrosis, including constrictive bronchiolitis, with vaping, potentially defining a clinical and pathologic entity associated with e-cigarette use. (Funded in part by the National Institutes of Health.).
    Language English
    Publishing date 2022-05-13
    Publishing country United States
    Document type Journal Article
    ISSN 2766-5526
    ISSN (online) 2766-5526
    DOI 10.1056/evidoa2100051
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  4. Article ; Online: Respiratory Physiology of Prone Positioning With and Without Inhaled Nitric Oxide Across the Coronavirus Disease 2019 Acute Respiratory Distress Syndrome Severity Spectrum.

    Ziehr, David R / Alladina, Jehan / Wolf, Molly E / Brait, Kelsey L / Malhotra, Atul / La Vita, Carolyn / Berra, Lorenzo / Hibbert, Kathryn A / Hardin, C Corey

    Critical care explorations

    2021  Volume 3, Issue 6, Page(s) e0471

    Abstract: Importance: Prone positioning improves clinical outcomes in moderate-to-severe acute respiratory distress syndrome and has been widely adopted for the treatment of patients with acute respiratory distress syndrome due to coronavirus disease 2019. Little ...

    Abstract Importance: Prone positioning improves clinical outcomes in moderate-to-severe acute respiratory distress syndrome and has been widely adopted for the treatment of patients with acute respiratory distress syndrome due to coronavirus disease 2019. Little is known about the effects of prone positioning among patients with less severe acute respiratory distress syndrome, obesity, or those treated with pulmonary vasodilators.
    Objectives: We characterize the change in oxygenation, respiratory system compliance, and dead-space-to-tidal-volume ratio in response to prone positioning in patients with coronavirus disease 2019 acute respiratory distress syndrome with a range of severities. A subset analysis of patients treated with inhaled nitric oxide and subsequent prone positioning explored the influence of pulmonary vasodilation on the physiology of prone positioning.
    Design setting and participants: Retrospective cohort study of all consecutively admitted adult patients with acute respiratory distress syndrome due to coronavirus disease 2019 treated with mechanical ventilation and prone positioning in the ICUs of an academic hospital between March 11, 2020, and May 1, 2020.
    Main outcomes and measures: Respiratory system mechanics and gas exchange during the first episode of prone positioning.
    Results: Among 122 patients, median (interquartile range) age was 60 years (51-71 yr), median body mass index was 31.5 kg/m
    Conclusions and relevance: Prone positioning improves oxygenation across the acute respiratory distress syndrome severity spectrum, irrespective of supine respiratory system compliance, positive end-expiratory pressure, or body mass index. There was a greater relative benefit among patients with more severe disease. Prone positioning confers an additive benefit in oxygenation among patients treated with inhaled nitric oxide.
    Language English
    Publishing date 2021-06-15
    Publishing country United States
    Document type Journal Article
    ISSN 2639-8028
    ISSN (online) 2639-8028
    DOI 10.1097/CCE.0000000000000471
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  5. Article ; Online: Exercise performance in patients with post-acute sequelae of SARS-CoV-2 infection compared to patients with unexplained dyspnea.

    Alba, George A / Ziehr, David R / Rouvina, Jennifer N / Hariri, Lida P / Knipe, Rachel S / Medoff, Benjamin D / Hibbert, Kathryn A / Kowal, Alyssa / Hoenstine, Casey / Ginns, Leo C / Lewis, Gregory D / Hardin, C Corey

    EClinicalMedicine

    2021  Volume 39, Page(s) 101066

    Abstract: Background: Dyspnea and exercise intolerance are commonly reported post-acute sequelae of SARS-CoV-2 infection (PASC), but routine diagnostic testing is often normal. Cardiopulmonary exercise testing (CPET) offers comprehensive assessment of dyspnea to ... ...

    Abstract Background: Dyspnea and exercise intolerance are commonly reported post-acute sequelae of SARS-CoV-2 infection (PASC), but routine diagnostic testing is often normal. Cardiopulmonary exercise testing (CPET) offers comprehensive assessment of dyspnea to characterize pulmonary PASC.
    Methods: We performed a retrospective cohort study of CPET performed on patients reporting dyspnea and/or exercise intolerance following confirmed Covid-19 between August 1, 2020 and March 1, 2021, and compared them to age- and sex-matched patients with unexplained dyspnea referred for CPET at the same center in the pre-Covid-19 era.
    Findings: Compared to matched unexplained dyspnea comparators, PASC patients shared similar medical comorbidities and subjective dyspnea at referral (mMRC score 1.6 ± 0.9 vs. 1.4 ± 0.9,
    Interpretation: Despite prominent dyspnea, physiological abnormalities on CPET were mild across a range of initial Covid-19 severity and similar to matched comparators referred for dyspnea without antecedent SARS-CoV-2.
    Funding: The project was supported by the NHLBI (R01HL131029, R01HL151841, U10HL110337, T32HL116275) and a KL2 award (5KL2TR002542-02) from Harvard Catalyst.
    Language English
    Publishing date 2021-08-28
    Publishing country England
    Document type Journal Article
    ISSN 2589-5370
    ISSN (online) 2589-5370
    DOI 10.1016/j.eclinm.2021.101066
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  6. Article ; Online: Understanding critically ill sepsis patients with normal serum lactate levels: results from U.S. and European ICU cohorts.

    Sauer, Christopher M / Gómez, Josep / Botella, Manuel Ruiz / Ziehr, David R / Oldham, William M / Gavidia, Giovana / Rodríguez, Alejandro / Elbers, Paul / Girbes, Armand / Bodi, Maria / Celi, Leo Anthony

    Scientific reports

    2021  Volume 11, Issue 1, Page(s) 20076

    Abstract: While serum lactate level is a predictor of poor clinical outcomes among critically ill patients with sepsis, many have normal serum lactate. A better understanding of this discordance may help differentiate sepsis phenotypes and offer clues to sepsis ... ...

    Abstract While serum lactate level is a predictor of poor clinical outcomes among critically ill patients with sepsis, many have normal serum lactate. A better understanding of this discordance may help differentiate sepsis phenotypes and offer clues to sepsis pathophysiology. Three intensive care unit datasets were utilized. Adult sepsis patients in the highest quartile of illness severity scores were identified. Logistic regression, random forests, and partial least square models were built for each data set. Features differentiating patients with normal/high serum lactate on day 1 were reported. To exclude that differences between the groups were due to potential confounding by pre-resuscitation hyperlactatemia, the analyses were repeated for day 2. Of 4861 patients included, 47% had normal lactate levels. Patients with normal serum lactate levels had lower 28-day mortality rates than those with high lactate levels (17% versus 40%) despite comparable physiologic phenotypes. While performance varied between datasets, logistic regression consistently performed best (area under the receiver operator curve 87-99%). The variables most strongly associated with normal serum lactate were serum bicarbonate, chloride, and pulmonary disease, while serum sodium, AST and liver disease were associated with high serum lactate. Future studies should confirm these findings and establish the underlying pathophysiological mechanisms, thus disentangling association and causation.
    MeSH term(s) Aged ; Critical Illness ; Europe/epidemiology ; Female ; Hospital Mortality/trends ; Humans ; Hyperlactatemia/physiopathology ; Intensive Care Units/statistics & numerical data ; Lactic Acid/blood ; Male ; Prognosis ; Retrospective Studies ; Sepsis/blood ; Sepsis/epidemiology ; Sepsis/pathology ; Severity of Illness Index ; Survival Rate ; United States/epidemiology
    Chemical Substances Lactic Acid (33X04XA5AT)
    Language English
    Publishing date 2021-10-08
    Publishing country England
    Document type Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
    ZDB-ID 2615211-3
    ISSN 2045-2322 ; 2045-2322
    ISSN (online) 2045-2322
    ISSN 2045-2322
    DOI 10.1038/s41598-021-99581-6
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  7. Article ; Online: Phase II and Biomarker Study of Cabozantinib in Metastatic Triple-Negative Breast Cancer Patients.

    Tolaney, Sara M / Ziehr, David R / Guo, Hao / Ng, Mei R / Barry, William T / Higgins, Michaela J / Isakoff, Steven J / Brock, Jane E / Ivanova, Elena V / Paweletz, Cloud P / Demeo, Michelle K / Ramaiya, Nikhil H / Overmoyer, Beth A / Jain, Rakesh K / Winer, Eric P / Duda, Dan G

    The oncologist

    2021  Volume 26, Issue 8, Page(s) e1483

    Language English
    Publishing date 2021-05-12
    Publishing country United States
    Document type Published Erratum
    ZDB-ID 1409038-7
    ISSN 1549-490X ; 1083-7159
    ISSN (online) 1549-490X
    ISSN 1083-7159
    DOI 10.1002/onco.13809
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    Zs.A 4845: Show issues Location:
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  8. Article ; Online: Reply to Epelbaum: Standards and Stereotypes in COVID-19.

    Ziehr, David R / Alladina, Jehan / Petri, Camille R / Maley, Jason H / Moskowitz, Ari / Medoff, Benjamin D / Hibbert, Kathryn A / Thompson, B Taylor / Hardin, C Corey

    American journal of respiratory and critical care medicine

    2020  Volume 202, Issue 3, Page(s) 470–471

    MeSH term(s) Betacoronavirus ; COVID-19 ; Coronavirus Infections ; Humans ; Pandemics ; Pneumonia, Viral ; Reference Standards ; SARS-CoV-2
    Keywords covid19
    Language English
    Publishing date 2020-06-02
    Publishing country United States
    Document type Letter ; Comment
    ZDB-ID 1180953-x
    ISSN 1535-4970 ; 0003-0805 ; 1073-449X
    ISSN (online) 1535-4970
    ISSN 0003-0805 ; 1073-449X
    DOI 10.1164/rccm.202005-1944LE
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  9. Article ; Online: Reply to Yaroshetskiy

    Ziehr, David R / Alladina, Jehan / Petri, Camille R / Maley, Jason H / Moskowitz, Ari / Medoff, Benjamin D / Hibbert, Kathryn A / Thompson, B Taylor / Hardin, C Corey

    American journal of respiratory and critical care medicine

    2020  Volume 202, Issue 10, Page(s) 1481–1482

    MeSH term(s) Betacoronavirus ; COVID-19 ; Cohort Studies ; Coronavirus Infections ; Humans ; Intubation, Intratracheal ; Pandemics ; Pneumonia, Viral ; Respiration, Artificial ; Respiratory Distress Syndrome/therapy ; SARS-CoV-2
    Keywords covid19
    Language English
    Publishing date 2020-08-18
    Publishing country United States
    Document type Letter ; Comment
    ZDB-ID 1180953-x
    ISSN 1535-4970 ; 0003-0805 ; 1073-449X
    ISSN (online) 1535-4970
    ISSN 0003-0805 ; 1073-449X
    DOI 10.1164/rccm.202007-2972LE
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  10. Article ; Online: Respiratory Pathophysiology of Mechanically Ventilated Patients with COVID-19: A Cohort Study.

    Ziehr, David R / Alladina, Jehan / Petri, Camille R / Maley, Jason H / Moskowitz, Ari / Medoff, Benjamin D / Hibbert, Kathryn A / Thompson, B Taylor / Hardin, C Corey

    American journal of respiratory and critical care medicine

    2020  Volume 201, Issue 12, Page(s) 1560–1564

    MeSH term(s) Administration, Inhalation ; Adult ; Aged ; Aged, 80 and over ; Betacoronavirus ; COVID-19 ; Comorbidity ; Coronavirus Infections/epidemiology ; Coronavirus Infections/physiopathology ; Coronavirus Infections/therapy ; Diabetes Mellitus/epidemiology ; Extracorporeal Membrane Oxygenation ; Female ; Fluid Therapy ; Humans ; Hypertension/epidemiology ; Lung Diseases/epidemiology ; Male ; Middle Aged ; Pandemics ; Patient Positioning/methods ; Pneumonia, Viral/epidemiology ; Pneumonia, Viral/physiopathology ; Pneumonia, Viral/therapy ; Positive-Pressure Respiration ; Prone Position ; Pulmonary Gas Exchange/physiology ; Renal Insufficiency/epidemiology ; Renal Insufficiency/therapy ; Renal Replacement Therapy ; Respiration, Artificial/methods ; Respiratory Distress Syndrome/epidemiology ; Respiratory Distress Syndrome/physiopathology ; Respiratory Distress Syndrome/therapy ; Respiratory Insufficiency/epidemiology ; Respiratory Insufficiency/physiopathology ; Respiratory Insufficiency/therapy ; Respiratory Mechanics/physiology ; SARS-CoV-2 ; Smoking/epidemiology ; Vasoconstrictor Agents/therapeutic use ; Vasodilator Agents/therapeutic use ; Young Adult
    Chemical Substances Vasoconstrictor Agents ; Vasodilator Agents
    Keywords covid19
    Language English
    Publishing date 2020-04-28
    Publishing country United States
    Document type Letter
    ZDB-ID 1180953-x
    ISSN 1535-4970 ; 0003-0805 ; 1073-449X
    ISSN (online) 1535-4970
    ISSN 0003-0805 ; 1073-449X
    DOI 10.1164/rccm.202004-1163LE
    Database MEDical Literature Analysis and Retrieval System OnLINE

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