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Keattiyoat Wattanakit, MD, MPH

Department of Internal Medicine/Cardiology
Cleveland Clinic
Cleveland, Ohio

Over time treatment 99213 buy olanzapine 5mg fast delivery, these stimuli can activate the dopamine system on their own and trigger powerful urges to take the substance symptoms 7 days after iui purchase olanzapine 5 mg. These wanting urges are called incentive salience and they can persist even after the rewarding effects of the substance have diminished medications side effects prescription drugs order olanzapine amex. As a result medicine valium generic olanzapine 5 mg without a prescription, exposure to people, places, or things previously associated with substance use can serve as triggers or cues that promote substance seeking and taking, even in people who are in recovery. Red represents the extended amygdala involved in the Negative Affect/Withdrawal stage. Green represents the prefrontal cortex involved in the Preoccupation/Anticipation stage. However, over time, the neurons stopped fring in response to the drug and instead fred when they were exposed to the neutral stimulus associated with it. This means that the animals associated the stimulus with the substance and, in anticipation of getting the substance, their brains began releasing dopamine, resulting in a strong motivation to seek the drug. For example, dopamine is released in the brains of people addicted to cocaine when they are exposed to cues they have come to associate with cocaine. These fndings help to explain why individuals with substance use disorders who are trying to maintain abstinence are at increased risk of relapse if they continue to have contact with the people they previously used drugs with or the places where they used drugs. Substances Stimulate Areas of the Brain Involved in Habit Formation A second sub-region of the basal ganglia, the dorsal striatum, is involved in another critical component of the binge/intoxication stage: habit formation. The release of dopamine (along with activation of brain opioid systems) and release of glutamate (an excitatory neurotransmitter) can eventually trigger changes in the dorsal striatum. In Summary: the Binge/Intoxication Stage and the Basal Ganglia the reward circuitry of the basal ganglia. As alcohol or substance use progresses, repeated activation of the habit circuitry of the basal ganglia. The involvement of these reward and habit neurocircuits helps explain the intense desire for the substance (craving) and the compulsive substance seeking that occurs when actively or previously addicted individuals are exposed to alcohol and/or drug cues in their surroundings. Withdrawal/Negative Affect Stage: Extended Amygdala the withdrawal/negative affect stage of addiction follows the binge/intoxication stage, and, in turn, sets up future rounds of binge/intoxication. During this stage, a person who has been using alcohol or drugs experiences withdrawal symptoms, which include negative emotions and, sometimes, symptoms of physical illness, when they stop taking the substance. Other studies also show that when an addicted person is given a stimulant, it causes a smaller release of dopamine than when the same dose is given to a person who is not addicted. This is because natural reinforcers also depend upon the same reward system and circuits. This impairment explains why those who develop a substance use disorder often do not derive the same level of satisfaction or pleasure from once-pleasurable activities. This general loss of reward sensitivity may also account for the compulsive escalation of substance use as addicted individuals attempt to regain the pleasurable feelings the reward system once provided. The person who has had a cocaine use disorder has lower levels of the D2 dopamine receptor (depicted in red) in the striatum one month (middle) and four months (right) after stopping cocaine use compared to the non-user. The level of dopamine receptors in the brain of the cocaine user are higher at the 4-month mark (right), but have not returned to the levels observed in the non-user (left). In animal and human studies, when researchers use special chemicals called antagonists to block activation of the stress neurotransmitter systems, it has the effect of reducing substance intake in response to withdrawal and stress. For example, blocking the activation of stress receptors in the brain reduced alcohol consumption in both alcohol-dependent rats and humans with an alcohol use disorder. Recent research also suggests that neuroadaptations in the endogenous cannabinoid system within the extended amygdala contribute to increased stress reactivity and negative emotional states in addiction. As noted previously, this motivation is strengthened through negative reinforcement, because taking the substance relieves the negative feelings associated with withdrawal, at least temporarily. Of course, this process is a vicious cycle: Taking drugs or alcohol to lessen the symptoms of withdrawal that occur during a period of abstinence actually causes those symptoms to be even worse the next time a person stops taking the substance, making it even harder to maintain abstinence. Together, these phenomena provide a powerful neurochemical basis for the negative emotional state associated with withdrawal. The drive to alleviate these negative feelings negatively reinforces alcohol or drug use and drives compulsive substance taking. Preoccupation/Anticipation Stage: Prefrontal Cortex the preoccupation/anticipation stage of the addiction cycle is the stage in which a person may begin to seek substances again after a period of abstinence. In people with severe substance use disorders, that period of abstinence may be quite short (hours). In this stage, an addicted person becomes preoccupied with using substances again. Executive function is essential for a person to make appropriate choices about whether or not to use a substance and to override often strong urges to use, especially when the person experiences triggers, such as stimuli associated with that substance. People also engage the Go system when they begin behaviors that help them achieve goals. Indeed, research shows that when substance-seeking behavior is triggered by substance-associated environmental cues (incentive salience), activity in the Go circuits of the prefrontal cortex increases dramatically. This increased activity stimulates the nucleus accumbens to release glutamate, the main excitatory neurotransmitter in the brain. This release, in turn, promotes incentive salience, which creates a powerful urge to use the substance in the presence of drug-associated cues. The Go system also engages habit-response systems in the dorsal striatum, and it contributes to the impulsivity associated with substance seeking. Habitual responding can occur automatically and subconsciously, meaning a person may not even be aware that they are engaging in such behaviors. Especially relevant to its role in addiction, this system controls the dorsal striatum and the nucleus accumbens, the areas of the basal ganglia that are involved in the binge/intoxication stage of addiction. As described above, these neurotransmitters are activated during prolonged abstinence during the withdrawal/negative affect stage of addiction. Studies show that lower activity in the Stop component of the prefrontal cortex is associated with increased activity of stress circuitry involving the extended amygdala, and this increased activity drives substance-taking behavior and relapse. These executive function defcits parallel changes in the prefrontal cortex and suggest decreased activity in the Stop system and greater reactivity of the Go system in response to substance-related stimuli. Indeed, a smaller volume of the prefrontal cortex in abstinent, previously addicted individuals predicts a shorter time to relapse. In Summary: the Preoccupation/Anticipation Stage and the Prefrontal Cortex this stage of the addiction cycle is characterized by a disruption of executive function caused by a compromised prefrontal cortex. The activity of the neurotransmitter glutamate is increased, which drives substance use habits associated with craving, and disrupts how dopamine infuences the frontal cortex. Progression through this cycle involves three major regions of the brain: the basal ganglia, the extended amygdala, and the prefrontal cortex, as well as multiple neurotransmitter systems 2. The power of addictive substances to produce positive feelings and relieve negative feelings fuels the development of compulsive use of substances. The combination of increased incentive salience (binge/intoxication stage), decreased reward sensitivity and increased stress sensitivity (withdrawal/negative affect stage), and compromised executive function (preoccupation/ anticipation stage) provides an often overwhelming drive for substance seeking that can be unrelenting. Different Classes of Substances Affect the Brain and Behavior in Different Ways Although the three stages of addiction generally apply to all addictive substances, different substances affect the brain and behavior in different ways during each stage of the addiction cycle. Differences in the pharmacokinetics of various substances determine the duration of their effects on the body and partly account for the differences in their patterns of use. For example, nicotine has a short half-life, which means smokers need to smoke often to maintain the effect. What the body does Additional research is needed to understand how using more to a drug after it has been taken, including than one substance affects the brain and the development and how rapidly the drug is absorbed, broken down, and processed by the body. As use progresses, the opioid must be taken to avoid the severe negative effects that occur during withdrawal. With repeated exposure to opioids, stimuli associated with the pleasant effects of the substances.

It is also very important that walking and stair Rett syndrome 11 climbing should be a regular part of the daily routine to maximize these skills (Van Acker treatment example generic olanzapine 2.5mg online, 1991 treatment trends buy olanzapine paypal, p symptoms anemia discount 2.5mg olanzapine overnight delivery. Physiotherapy is also a treatment that is used to improve difficulties with motor movements including range of motion symptoms 0f ms buy olanzapine, walking and flexibility (Perry, 1991). Horseback riding has also been used to increase balance as well as the emotional well being of the children, but its results have not been scientifically reported (Pizzamiglio et al. Stereotypical hand movements are also a highly recognized feature associated with Rett syndrome. There has not been a great deal of progress in the area of intervention for this trait and it is often questioned whether such interventions are needed. Some research studies (Perry, 1991; Van Acker, 1991) show that hand splinting can be successful in stopping hand wringing and hand to mouth actions while the splints are on the hands. This does seem to help the person be more attentive to their environment at the time, but there seems to be no long term effects because once the splints are removed the behavior is likely to return. It is also reported that very few people are able to endure the use of the arm and hand splints, even for short periods of time. Persons affected with Rett syndrome will likely have to deal with the effects of scoliosis or curvature of the spine. Spinal braces are sometimes used to slow the progression, but this does not always prove to be effective. In critical cases, surgery might be necessary to correct the alignment of the spine, which typically stops any further problems (Perry, 1991). Rett syndrome 12 Medications and dietary control are other interventions that are sometimes used to treat the symptoms of Rett syndrome (Perry, 1991; Pizzamiglio et al. Doctors may prescribe medications to manage seizure activity, improve breathing problems, and reduce sleeping difficulties. Changes in diet have been explored in several studies to improve weight gain and alleviate seizures. This diet is high in fat and calories and low in carbohydrates and also includes various supplements. Educational Interventions It has been noted that even though there are varying degrees of cognitive delays in persons affected with Rett syndrome, most people affected appear to be in the range of moderate to severe mental retardation often around the mental age of eight months (Mount, Hastings et al. Educational assessment must be conducted to determine the individual needs of each person affected with Rett syndrome because there is the possibility of a wide range of abilities (Kerr, 2002). In most cases, children with Rett syndrome will receive special education services to learn or often relearn specific functional, adaptive and cognitive skills (Pizzamiglio et al. Communication systems and augmentative and alternative communication devices are often used to increase communication skills. Some of these systems include eye pointing, communication boards (pictures, facial expression, gestures, and the activation of switches (Van Acker, 1991, p. However, little research has been done to cultivate communication and literacy in girls with this condition (Skotko et al. Some of the research that has been done showed the successful use of switch-activated augmentative communication devices, computers with graphics to make requests and eye pointing with picture communication symbols. Story Rett syndrome 13 book reading was found to facilitate meaningful communication for girls affected with Rett syndrome as well (Skotko et al. Music therapy is also often a common intervention used in Rett syndrome (Kerr, 2002; Perry, 1991; Pizzamiglio et al. It can encourage functional hand use through manipulation of the instruments as well as interaction through the alertness created by the music. It may also facilitate communication and is simply just an enjoyable activity for the child. Occasionally, there is research that supports the effectiveness of a highly individualized and specialized treatment regimen. The individual student that was involved in this study made dramatic progress in several areas. She regained the functional use of her hands, improved communication skills, became more attentive, more coordinated, and overall was in a much better emotional state (Pizzamiglio et al. Discussion Rett syndrome is a complex disorder that has seen much progress in the past few years. The characteristics and symptoms have been described above and it is obvious that Rett syndrome significantly alters the life of the people who are so diagnosed. However, having a greater understanding of what Rett syndrome is, what causes it and what can be done to improve the symptoms can help those affected lead more comfortable and enjoyable lives. The accomplishments made in the determination of a genetic cause of Rett syndrome has opened the door for the need for even further research such as the specific location of the Rett syndrome 14 mutations as well as why the mutations occur. Continued progress in this area will hopefully lead to an eventual cure for Rett syndrome. It is important that educators and therapists are using research-validated interventions and approaches to treat and improve the symptoms associated with Rett syndrome. There are numerous strategies and techniques that have surfaced in the literature, many of which were mentioned in this paper. However, there is much more research that needs to be conducted to ensure that individuals are getting the most effective treatment possible. It is always a constant battle when you are working with a specific disorder such as Rett syndrome because no matter how much progress you make there is always something more that can be done to improve the quality of life of those affected. We will continue to look ahead to even more effective treatments, early intervention, ways of prevention and in the long run maybe even a cure. Annotation: Rett syndrome: Recent progress and implications for research and clinical practice. Brief report: Autistic behaviors among children with Fragile X or Rett syndrome: Implications for the classification of pervasive developmental disorder. Results: the results revealed that 45% have low back pain while 40% have also neck pain during the 1 year period of work. It is consistent in our study that majority of our participants have low back pain during the last 12 months (32%) and last 7 days (31%). Keywords: Musculoskeletal disorders, Body mass index, Pain, Nordic questionnaire, Occupation, Daily living activity, Obesity, Work, Tasks. This standardized questionnaire was used because any other employees in any other organization. It is defined as weight in kilograms divided by the height in meters square (kg/m). Demographic data was collected such as the age, nationality, gender, marital status, occupation, the age for both male and female. All study subjects that meet the All information collected from the participants are strictly inclusion criteria were given informed consent form. All questionnaires that have been completed were included in Participants with the following previous trauma or injures, the statistical analysis. The demographic data for the study participants were in the age group of 32-36 years old. The least subjects which includes name, age, gender, nationality, marital number was at the age group between 47-51 years old as status, occupation, number of years in the job, weight, height showed in Table 1. Majority of the participants in this Nordic Musculoskeletal Questionnaire was used to assess any study were office worker (51. The results showed that the Nordic questionnaire; one with general questions which (45. The majority of the 52-56 8 (4%) participants that were working in Ahlia University were Bahraini with 69% while only 0. Characteristics % Neck Shoulder Elbow Wrist/hand Upper back Lower back hip knee Ankle/ feet 12 months % 40% 29% 9% 24. Variables Age Gender Nationality Marital status Occupation Number of years in job r 0. Therefore, there is no data with which to directly compare the majority of participants in the present study had low back it. The participants had problems with these areas that the current study revealed no significant correlation between caused them to have trouble while working. Same with Abledu & indicate that majority of the workers have not worked Offei [27], their study has more common on the neck pain continuously within a day unlike listed in other studies in the accounting for 28% while only 23.

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The diference between oedema and lymphoedema is that oedema afects the lymph system daughter medicine discount generic olanzapine uk, whereas lymphoedema is caused by a fault in the lymph system and involves a build-up of lymph rather than just fuid symptoms bipolar disorder best purchase for olanzapine. Since lymph contains other elements including waste products and immune cells medicine 003 olanzapine 5mg low cost, the swelling produced by lymphoedema tends to have a more solid texture to it treatment 5ths disease purchase olanzapine australia. The fuid in oedema, on the other hand, can be displaced by pressure, and so indents, or pits, very easily if a fnger is pressed on the skin. A good example of pitting is the indentation left by pressure from the rim of a sock. This can be tested to some extent by pressing a fngertip frmly on the skin surface for twenty seconds (assuming it is not painful). The surface of the skin can also develop a warty complexion and can start to look like the bark of a tree or elephant hide. There is some evidence to suggest that these deposits can partly be explained by a failure of lymph drainage within the cells of the arterial walls. The lymph system is also important for maintaining a healthy body fuid balance, which means that any impairment could possibly contribute to raised blood pressure. There is also a strong association between lymphoedema and obesity (see Chapter 4) and this associ ation is known to work in both directions: obesity is the biggest risk factor for lymphoedema but lymphoedema can also cause obesity. On other occasions we feel unwell and feverish with aching and headache, which are signs the immune system has had to go into overdrive to fght the infection. However, that area becomes very susceptible to infections, which are difcult to eradicate and can keep coming back. It can cause profound illness with high temperatures and low blood pressure, with the accompanying threat of damage to vital organs. This is one of the reasons skin care is so important in managing lymphoedema (see page 95), although there are other ways the harmful bacteria can enter the body. It remains unprov en but it is more than likely that in some cases, because of the weakened immune system, the infection is never properly eradi cated. Antibiotics used to treat infection are intended to aid your immune system, so if your immune response is impaired, they are not always efective. This would explain why some patients with lymphoedema and recurrent cellulitis fnd that they can bring on an attack just by getting overtired, overstressed or by over-exercising. Attacks can come on without warning, sometimes mild, sometimes severe, with no rhyme or reason as to why one attack might be more debilitating than another. This element of unpredictability can be extremely unsettling and discourages people from making plans for holidays or long-distance travel in case infection strikes. A signifcant proportion of those patients will have lymphoedema, but many may not yet have a diagnosis. He had noticed that his ankles would swell on fights; the longer the fight the worse the swelling. He knew it was fuid because he could make an indentation by pressing his thumb into his shin. The swell ing did not hurt, and if he elevated his legs and wore fight socks on trips, he could just about control it. He thought he had the fu but then realised his right leg was painful, bright red and hot to the touch. After fve days on a drip having intravenous antibiotics and then a further two-week course of antibiotics he made a full recovery. Although he did not feel as ill as he had during the frst attack and did not have to spend time in hospital, he was forced to take three weeks off work. After ten days on a drip he was allowed home on oral antibiotics but remained concerned that the leg still hurt and was red. Returning to work a month later, he almost immediately suffered another attack of cellulitis, the fourth, in the same leg. Multiple, repeat infections have resulted in further damage to lymph vessels and severe staining of the skin. Furthermore, without diagnosing the condition and addressing the underlying lymph drainage problem, the swelling and infection will only get worse: the greater the swell ing the more likely it is that an infection will take hold, and every episode of infection can cause further damage to lymph vessels, so making the lymphoedema worse. Persistent or recurrent swelling in the feet, ankles or legs suggests a lymph problem, and should be checked out. The lymphoedema affected not only both of her legs but also the lower abdomen and external genitalia. The pres sure of the lymph fuid within the skin of the genitals led to small blisters which would then leak lymph, making her feel as if she had wet herself. Not long after developing lymphoedema, she started to suffer from bouts of cellulitis. The severity of the attacks would vary but she frequently had to be admitted to hospi tal to be treated for septicaemia. Her swelling got worse as did the leaking of lymph fuid, and her overall health deteriorated, both physically and psychologically. She was a police offcer but gradually became unable to stay on her feet all day or chase criminals on the street. Sadly she was forced into early retirement on medical grounds from a job she loved at the age of forty-fve. After that, the attacks of cellulitis were not as frequent or severe, but they still did not stop altogether. Her legs remained huge and heavy, making it diffcult to walk any distance or fnd clothes to ft. Despite Sarah receiving excellent care, the vicious cycle of relent less swelling and attacks of infection could not be broken. Because she had one huge leg, and most of the swelling was found to be fat related to the lymphoedema, she was funded to have liposuction to reduce its size. This did not cure her lymphoedema and she still had to wear compression garments night and day to control the remaining fuid, but the relentless recurrent attacks of cellulitis fnally ceased, also ending her fear of them, and her quality of life improved enormously. Cellulitis is possibly the worst side efect of lymphoedema, and we need to better understand what causes such frequent bouts so that we can improve both treatment and prevention.

A3309 P1058 the Development symptoms exhaustion generic olanzapine 7.5mg with amex, Usability and Acceptability of an Online P1045 Problems in Elderly Asthma/B treatment brown recluse spider bite discount olanzapine uk. A3323 the Shifting Over Eight Years: Findings from China National Facilitators: L medications blood donation olanzapine 2.5mg visa. A3311 P1059 Developing a Web-Based Educational Module for Teaching P1047 Disease Severity in Newly Diagnosed Asthma Patients and Inhaler Technique Using a Snowball Qualitative Focus Group Initial Treatment Response Following 12 Weeks Treatment in Approach/M medications you cannot eat grapefruit with purchase 5 mg olanzapine with mastercard. A3325 P1049 Burden of Disease of Severe Uncontrolled Asthma: A P1061 Digital Health Intervention for Asthma: Patient Perception of European Study/A. A3328 the information contained in this program is up to date as of March 9, 2017. A3338 P1065 New Measures of Adherence to Inhaled Therapy in Patients P104 A Case of Intravenous and Subcutaneous Air in a Patient with with Asthma/C. A3342 Centered Outcomes Pilot Survey Conducted at an Inner City Community Teaching Hospital/C. A3344 P1070 Preliminary Psychometric Evaluation of the Asthma Daily Facilitator: M. A3346 P1072 Community Health Worker Case-Detection of Asthma in a P112 Not All Coughs Are Due to Upper Airway Cough Syndrome: An Resource-Poor Community in Nicaragua/M. A3347 P1073 Adherence and Asthma Related Exacerbations Associated P113 Primary Endobronchial Leiomyoma: A Rare Benign Pulmonary with Once Daily Fluticasone Furoate/Vilanterol and Twice Daily Neoplasm/M. A7618 P114 Pancreaticobiliary Adenocarcinoma Presenting as Chronic P1074 Preliminary Evaluation of an Adult Asthma Adherence Cough/M. A7619 P116 A Case Report of Intercostal Hernia: A Rare Cough Induced P1075 the Knowledge of Secondary School Teachers in Urban Spontaneous Lung Herniation/F. A3354 Discussion: 11:15-12:00: authors will be present for individual discussion 12:00-1:00: authors will be present for discussion with assigned facilitators the information contained in this program is up to date as of March 9, 2017. A3355 P135 A Rare Case of Secondary Pulmonary Alveolar Proteinaceous P121 Cough Due to a Cyst: Congenital Abnormalities in Adults/J. A3369 P122 A Case of Spontaneous Pneumothorax Managed P136 Sarcoid-Like Pulmonary Reaction Due to Chronic Lymphocitic Conservatively/G. P123 Traditional Japanese Herbal (Kampo) Medicines Can Control a Kairalla, Sao Paulo, Brazil, p. A3358 P137 Analysis of Sarcoidosis Cases Followed at University of Sao Paulo Medical School of Brazil/L. P140 Severe Hypercalcemia as a Presenting Feature of Sarcoidosis in a Patient on Etanercept Therapy/R. A3374 12:00-1:00: authors will be present for discussion with assigned facilitators P141 Bilateral Lung Masses Due to Necrotizing Sarcoid Facilitator: W. A3375 P125 Extrapulmonary Sarcoidosis Presenting with Diffuse Osteolytic Skeletal Lesions/C. A3360 P143 Spontaneous Resolution of Sarcoidosis with Necrotizing Sarcoid Granulomatosis in a Young Man/L. A3378 P128 Co-Existent Sarcoidosis and Lymphoma: Biological P145 Sarcoidosis: A Unique Case of Esophageal Perforation/D. A3363 P147 Treatment of Cardiac Sarcoidosis with Once Monthly Intravenous Methylprednisolone Infusions/D. A3366 P150 Lymphocytic Pleural Effusion in a Sarcoid Fibrosing P133 Coexisting Sarcoidosis and Multiple Myeloma Presenting as Mediastinitis Patient Treated with Vasodilator Therapy for Acute Leg Weakness and Chest Pain/C. A3384 the information contained in this program is up to date as of March 9, 2017. P897 A Unique Manifestation of Anti-Synthetase Syndrome in an Baldi, Sao Paulo, Brazil, p. Kairalla, Sao P899 Amyopathic Dermatomyositis and Interstitial Lung Disease Paulo, Brazil, p. Area J, Hall B-C (Middle Building, Lower Level) Discussion: 11:15-12:00: authors will be present for individual discussion Viewing: Posters will be on display for entire session. A3396 the information contained in this program is up to date as of March 9, 2017. A3415 P931 Pleuroparenchymal Fibroelastosis with Primary Effusion P916 Therapeutic Dilemma in a Patient with a History of Recurrent Lymphoma Like Lymphoma in an Autopsy Case/T. Wingerup, P933 Bronchocentric Granulomatosis in a Previolusly Healthy Varnamo, Sweden, p. A3419 P936 Metastatic Prostate Cancer Masquerading as Interstitial Lung Disease/M. A3420 P937 Constrictive Bronchiolitis Presenting with a Miliary Pattern in a P921 Successful Single Lung Transplantation for Hermansky-Pudlak Patient with Hypersensitivity Pneumonitis/W. A3421 P938 Pulmonary Alveolar Microlithiasis Caused By Two Homozygous Mutations/A. A3423 P941 Spontaneus Improvement of Pulmonary Alveolar Proteinosis P924 Lung Transplantation for a Chinese Young Man with Idiopathic in a High Altitude Resident After Descent to Sea Level/P. A3424 P942 Acute on Chronic Respiratory Failure as a Result of Pulmonary P925 Diffuse Pulmonary Meningotheliomatosis: A Scary, Yet Benign Alveolar Proteinosis/G. A3425 the information contained in this program is up to date as of March 9, 2017. Bendstrup, Aarhus, Successfully with Azathioprine; a Novel Therapy Reported on Denmark, p. A3444 P957 Should Fibrosing Variant of Organizing Pneumonia Stay as in Unclassifiable Idiopathic Interstitial Pneumonias P945 Acute Eosinophilic Pneumonia and Tracheitis Following (Workshop Summary of a Japanese Multicenter Study)/Y. A3447 P958 Clinical Characteristics of Patients with Advanced Idiopathic Pulmonary Fibrosis/J. A3448 P959 Usefulness of Surgical Lung Biopsy in the Diagnosis of P949 Organizing Pneumonia Secondary to Hiatal Hernia/R. Enghelmayer, Buenos Aires, Argentina, Discussion: 11:15-12:00: authors will be present for individual discussion p. A3460 12:00-1:00: authors will be present for discussion with assigned facilitators P962 Low Predictive Value of High-Resolution Computed Facilitators: C. A3454 the information contained in this program is up to date as of March 9, 2017. A3478 P967 Utility of Transthoracic Lung Ultrasound in Assessing Pulmonary Sarcoidosis/A. P970 Outcomes of Newly Proposed Classification of Acute Discussion: 11:15-12:00: authors will be present for individual discussion Respiratory Deterioration in Idiopathic Pulmonary Fibrosis/Y. A3479 P971 Benefits from a Program for Early Interstitial Lung Diseases P1546 A Case of Recurrent Chylothorax in Renal Cell Carcinoma/M. A3481 P972 Association of the Thoracic Adiposity Measured by Computed P1548 Pattern Recognition Pitfall: A Case of Bilateral Tomography with Lung Function/Y. A3483 Patients with Idiopathic Pulmonary Fibrosis and Combined Pulmonary Fibrosis and Emphysema/F. A3484 P974 Clinical Characterization of Interstitial Lung Disease Patients: P1551 Chylothorax in the Setting of Cirrhosis An Unusual Report from a Single Center Longitudinal Database/C. A3473 P1552 A Case of Chylothorax Resulting from Necrotizing P975 Design and Rationale of the Japanese Idiopathic Interstitial Pancreatitis/F. A3475 P1556 Chylothorax Caused by Cirrhosis: A Common Cause of P977 Improved Systemic Bioavailability of Cromolyn Sodium Using Transudative Chylothorax/M. A3491 the information contained in this program is up to date as of March 9, 2017. A3492 P1576 Hyperreactio Luteinalis: A Rare Case of Isolated Refractory Pleural Effusion in Pregnancy/B. A3493 P1577 Air Hunger A Case Report of Spontaneous Asymptomatic P1560 Urinothorax: A Case of a Right-Sided Pleural Effusion with a Pneumothorax and Pneumomediastinum in Male with Severe Contralateral Left-Sided Ureteral Stricture/R. A3495 P1579 Azygous Lobe Contributing to Recurrent Pneumothorax P1562 Recurrent Unexplained Pleural Effusion in Young Female A3499 P1583 Thoracic Endometriosis Presenting as Catamenial P1566 An Uncanny Connection!