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Michael J. Stephen, MD is an associate professor at Thomas Jefferson University in Philadelphia and director of the Adult Cystic Fibrosis Center. Over the past two decades, he has studied advanced end-stage lung diseases and worked with patients at diverse locales, including a Massachusetts prison näytä lisää hospital and a pediatric HIV clinic in Cape Town, South Africa. He lives in New Jersey. näytä vähemmän

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Expanded my awareness of cystic fibrosis. Good information about breathing / lungs / lung transplants.
 
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Elizabeth80 | 2 muuta kirja-arvostelua | Nov 22, 2021 |
Good Information On Facts, But Get A Second Opinion On Recommendations. This is a book about the origins and history of lung medicine, by a doc specializing in lung medicine. And because of that very nature, on facts it is quite remarkable. Stephen details everything from the evolution of the lung to the various ailments of it, focusing the last couple of chapters on Cystic Fibrosis in particular, and does so in a very understandable manner. Ultimately this is a prime example of the Flight Director Principle though, where one should absolutely listen to subject matter experts *on their subjects*... and consider the implications on other systems - particularly in conjunction with experts on those other systems - when this particular subject matter expert makes recommendations that impact other systems. And that is where getting a second opinion will be most useful in this particular tale, as many of Stephen's recommendations outside of lung medicine specifically could very likely be problematic at best. Still, only a single star deduction as largely your mileage is going to vary there based more on how you feel about his particular recommendations in those realms. Truly and enlightening read, and very much recommended.… (lisätietoja)
 
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BookAnonJeff | 2 muuta kirja-arvostelua | Jul 11, 2021 |
Very informative and seemingly comprehensive, but I would have preferred there to be more of a connection between the stories. I'm not sure why some patients were featured, since they weren't obviously connected to the author.

> In inland bodies of fresh water, the temperature can vary widely, as can the amounts of nutrients and minerals. The summer and winter also produce very different living conditions in freshwater environments, which often host very different species depending on the season. By contrast, the ocean environment is exceptionally stable.

> when we hyperventilate at rest without an increase in CO2 production, as can happen during a panic attack. Here one is blowing off too much CO2 and acid, and our pH climbs to dangerous levels, which is why one may be told to breath into a paper bag to inhale the expelled CO2, restoring needed acid to the blood

> if an engineer was designing a breathing machine, the functions of gas exchange and air movement would be separated. Birds have such a system. With each breath they take, air moves into air sacs, which are large, easily distensible organs in which no gas exchange takes place. This air then gets shunted to a separate area for gas exchange, termed air capillaries. There, because there is no need for the gas exchange units to bend when a breath occurs, the distance between the air and the blood vessels is incredibly thin, much less than the one third of a micron in mammals, making the exchange even easier. A final difference is that air movement in the bird lung goes around in a circle, much as blood does, so birds get fresh air with both inspiration and expiration

> Dr. Clements imagined that something within the lung must be lowering surface tension so dramatically as to overcome the effect of size on pressure. He correctly postulated it was a soap-like foam, which exerted a dispersal effect as its molecules became more concentrated and the area became smaller, and lost this effect when the lung expanded and pulled the soap like foam molecules apart. The effect of this soap-like foam lowering surface tension would be more important than lung size in calculating pressure if it was a powerful substance (which it was, and is). John Clements later named this substance surfactant

> If the history of civilization is surveyed in its entirety, no other infectious disease has killed more people than TB, over one billion in the last two hundred years alone.100 And it continues to kill more than one million people worldwide each year.

> The researchers’ conclusion was that seals brought TB to the Americas, picking it up from Africa and then swimming across the Atlantic and spreading it to those who hunted them along the coastline of South America.

> up to 90 percent of residents in certain cities got infected. For a time in nineteenth-century Europe and America, TB accounted for one out of every four deaths. During this two-hundred-year period, TB became known as the “white plague,” due to its slow-acting way of sucking the life, weight, and health out of people, turning a patient from a person into a ghost.

> New York City has historically been on the front line of the TB epidemic in the United States. This was never more true than in the late nineteenth century, when TB was the leading killer in the city, claiming ten thousand lives every year

> In 1900, there were 280 deaths per 100,000 people per year. By 1920, deaths were down to 126 per 100,000, and by 1940 the number was 49, less than 25 percent of the 1900 level. This was all without the use of any antibiotics.

> TB grows slowly. Compared to a typical bacterium such as streptococcus, which divides every thirty minutes, TB’s doubling time is sixteen to twenty hours. Cultures for normal bacteria are usually held for a few days. For tuberculosis, because it grows so slowly, one has to wait eight weeks for a definitive answer on a culture.

> Today, a typical course of treatment for a bacterial pneumonia from streptococcus is five to seven days, usually with a single drug. For tuberculosis, the typical course is six to nine months, with multiple drugs being the standard. Recent attempts at shortening this time to even four months have failed.

> this kind of rapid lethal progression occurs only in a small minority of patients. But what is strange about TB is that it has the ability to cause a minor initial infection that can be contained, but not completely killed, by the macrophage and then go dormant for years, or even decades. Tuberculosis goes into hiding in some patients, probably deep in the lymph nodes of the chest. It is likely transported to the lymph nodes by the macrophage, which ingest TB but is then unable to completely kill it.

> The disease is raging out of control in many countries. Absolute numbers of cases are staggering in countries like South Africa, where in 2019 the incidence was 520 per 100,000; in the Philippines it was 554. Resistance has also become more of an issue, with multi-drug resistance rampant in countries like Kazakhstan, Ukraine, and Russia.

> Duke’s aggressive advertising paid off. Acquiring money and market share, he bought out four of his competitors and in 1890 merged them into the American Tobacco Company. He also saw potential overseas and formed the British American Tobacco Company to expand into the European market, taking advantage of his one-size-fits-all product, easily recognized and branded as Duke Cigarettes. Duke became extraordinarily rich and in 1924 gave away some of his money to the then-small Trinity College in Durham, North Carolina. In return for his gift of $100 million, the leaders of the college honored Duke by renaming the institution after him.

> Many of the receptors in the VTA are, not surprisingly, acetylcholine receptors, and there are several different types, some called nicotinic acetylcholine receptors because nicotine can also bind there, creating an imposter safety signal. So rather than a high, nicotine creates a sense of well-being that all is good and safe in the world.

> The half-life of nicotine is about two hours, so over the course of a day, smokers are in a constant battle to maintain steady levels. In the morning the brain is more desperate, after eight hours without its fix.

> In an average year, air pollution causes 6.5 million premature deaths, more than 90 percent of them in developing countries. All forms of pollution contribute to one out of every six deaths worldwide; in the most affected countries, this number increases to one out of four deaths

> lower respiratory tract infections are the number one cause of mortality in children under five years of age, accounting for some 570,000 deaths each year.

> In Great Britain, the matter reached a tipping point in December 1952 with the Great Smog of London. For five days, a thick toxic cloud hung in the air, and the city endured a pollution like none of the previous “pea-soupers.”

> Russia still mines about a million tons of asbestos every year, with hundreds of thousands of workers dependent on the asbestos industry for their livelihood. Worldwide, some two million tons are mined every year.

> in August 2018, researchers discovered a pulmonary cell called the ionocyte, which may transform our understanding of how the lung hydrates itself.

> Over half of lung cancer patients present with metastatic disease. One year one’s chest X-ray can be completely clear, and then twelve months later a doctor is explaining that the pain in one’s chest is from a mass in the lung and the cancer may have metastasized to one’s spine and brain

> Kidney transplant recipients enjoy a five- and ten-year survival rate of approximately 80 and 60 percent, while the outcomes for both liver and heart transplants are both about 75 and 57 percent, respectively. Comparatively, the five- and ten-year survival rates for a lung transplant are 55 and 34 percent

> The next big leap forward with protein modulator therapy came in 2019, with the published results of Trikafta, a pill that contains three protein modulators, all working in synergy. The study, published in the New England Journal of Medicine, showed an average increase of 14 percent in lung function, over three times the result seen with Symdeko. Just as important, with its superior efficacy, the drug is powerful enough to work on many of those CF patients with mutations that caused more severe defects in the protein. With FDA approval of Trikafta in October 2019, the percentage of CF patients eligible jumped from 55 percent to almost 95 percent.

> in 2015, amazed everybody in attendance by announcing at the invocation that the estimated average lifespan for a patient born with CF had jumped from forty-one years to forty-seven years in the previous year

> Cystic fibrosis patients make too much mucus, which gets stuck deep in the lungs, providing a fertile breeding ground for bacteria. Infections and lung destruction follow in a mutually reinforcing cycle of dysfunction.

> patients inhale multiple medications every day to break up the mucus. After taking the medicines, they must expectorate the secretions, either with vigorous coughing or with chest physical therapy, in which a parent pounds on the child’s back to agitate the mucus and move it out of the airways. The work is intense and usually requires an hour in the morning and another hour at night, even with the advent of protein modulators

> Given the overall poor outcomes and ubiquity of complications, transplanting lungs is a high-wire act compared to transplanting other organs. Assessing a patient’s likelihood of dying soon from their lung disease versus their ability to live after a transplant was considered impossible. Thus, the original system of getting in line and waiting for new lungs remained until 2005, long after it had been abandoned in liver and kidney transplants

> liver and kidney formulas can be more accurate because their absolute numbers are so much larger that statisticians have more data to work with. Fortunately, the Lung Allocation Score system worked, despite its potential flaws. The number of deaths on the waiting list plummeted in the years after the new system was implemented, from an average of more than four hundred to two hundred per year. Almost as important, there was no big change in one-year mortality, or even five-year mortality

> A CF patient in 1950 could expect to live a few years, while today life expectancy on average is forty-seven years
… (lisätietoja)
 
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breic | 2 muuta kirja-arvostelua | May 25, 2021 |

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1
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35
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#405,584
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½ 3.6
Kirja-arvosteluja
3
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3