bluuebunny/crossref_metadata_2025 huggingface dataset:
Bronchoalveolar lavage in allergic granulomatosis and angiitis
Authors: Wallaert B , Gosset P , Prin L , Bart F , Marquette CH , Tonnel AB
Published: November 2022

Pulmonary involvement occurs in approximatively half of patients with allergic granulomatosis and angiitis (AGA). We studied bronchoalveolar cells from six patients with histologically proven AGA and compared our results with those obtained from four patients with chronic eosinophilic pneumonia (CEP), nine nonsmoking patients with bronchial asthma and blood eosinophilia, and 10 healthy nonsmokers. Pulmonary infiltrates were present in 5 out of 6 AGA patients. None of these patients was receiving corticosteroids at the time of entry to the study. Pulmonary function tests were normal in two cases, and demonstrated on obstructive ventilatory disorder with hypoxaemia in four cases. Total cell yield did not differ between AGA patients (22.4 +/- 4.9 x 10(4) cells.ml-1), asthmatics (9.6 +/- 1.7 x 10(4) cells.ml-1) and controls (11.3 +/- 1.5 x 10(4) cells.ml-1), whereas it was dramatically increased in patients with CEP (186.4 +/- 26.3 x 10(4) cells.ml-1). All six AGA patients demonstrated an increased percentage of alveolar eosinophils (mean: 31.1 +/- 9.9%; range 6-66%). In two patients evaluation of alveolar eosinophil subpopulations showed a low percentage (27 and 36%) of hypodense cells, when compared to the high levels (> 80%) found in CEP. No significant correlation could be established between bronchoalveolar (BAL) results and clinical data, pulmonary function abnormalities, or biological results. Sequential evaluation of alveolitis in two AGA patients undergoing corticosteroid therapy demonstrated persistent alveolar eosinophilia, despite disappearance of clinical, radiological and biological abnormalities. Our data demonstrate that eosinophils are present in the alveolar spaces of patients with AGA.(ABSTRACT TRUNCATED AT 250 WORDS)
Protection by N-acetylcysteine against pulmonary endothelial cell damage induced by oxidant injury
Authors: Sala R , Moriggi E , Corvasce G , Morelli D
Published: November 2022

The protective effect of N-acetylcysteine (NAC) against oxidant lung injury was investigated in a model of acute immunological alveolitis in the rat. Intrapulmonary immune complex deposition into rat lungs, induced by intratracheal infusion of immunoglobulin G (IgG) anti-bovine serum albumin (BSA) antibodies and intravenous injection of the antigen, caused lung damage associated with a marked decrease in [14C]5-hydroxytryptamine ([14C]5HT) uptake capacity, taken as a biochemical marker of endothelial cell function. The oral administration of a single dose of NAC (2 mmol.kg-1) 60 min before antigen/antibody (Ag/Ab) treatment was effective in preventing pulmonary endothelial cell [14C]5HT uptake loss induced by immune complex deposition. The mechanisms involved in this lung protective action of NAC were investigated by studying the antioxidant activity of NAC on hypoxanthine/xanthine oxidase-induced lung damage in vitro, and the effectiveness of the drug as lung glutathione (reduced form) (GSH) precursor in diethylmaleate-depleted rats. The results obtained provide further evidence on the ability of NAC to reduce the susceptibility of lung tissue to free radical-induced damage, by potentiating the antioxidant defence systems.
Skin reactivity and eosinophil count in relation to the outcome of childhood asthma
Authors: Roorda RJ , Gerritsen J , van Aalderen WM , Knol K
Published: November 2022

The aim of this study was to determine whether an association can be found between childhood skin reactivity and the outcome of asthma in young adulthood in a group of 406 asthmatic children, of whom 348 (86%) could be followed up in adulthood. A complete data set on skin tests and eosinophil count was available in 259 allergic subjects. They were stratified into three classes, according to initial skin test score in childhood. An increase in skin reactivity was noted from childhood to adulthood, while the differences in skin reactivity between the three classes remained significant. In childhood, a marked difference in total eosinophil count was found between the classes. Towards adulthood, a decrease in eosinophil count was noted, and the differences between the classes were no longer significant. The children with lowest skin reactivity also had the lowest symptom score in childhood. In adulthood, the prevalence of respiratory symptoms in this class was lower than in the other two classes. The prevalence of bronchial responsiveness to histamine was lowest in subjects with the lowest skin test score in childhood. Ventilatory parameters revealed no differences between the three classes. We conclude that although a low skin reactivity in childhood might be associated with a relatively favourable prognosis for asthma symptoms in adulthood, there is only limited evidence to support this hypothesis in our study.
Differences between sniff mouth pressures and static maximal inspiratory mouth pressures
Authors: Heijdra YF , Dekhuijzen PN , van Herwaarden CL , Folgering HT
Published: November 2022

Measurements of static maximal inspiratory mouth pressure (PImax) and dynamic sniff mouth pressure (Psniff) are frequently used to assess inspiratory muscle strength. The aim of the present study was to examine, in 42 healthy subjects, the equivalence of PImax and Psniff, the influence of body posture on PImax and Psniff, and the effects of nasal patency and repeated manoeuvres on Psniff. PImax was significantly higher than Psniff, 11.05 +/- 0.42 versus 8.53 +/- 0.31 kPa. Because of the low agreement between PImax and Psniff, the two measurement methods were not interchangeable. The limits of agreement were 2.56 +/- 3.92 kPa. Sitting PImax was 11.05 +/- 0.42 kPa, and supine PImax was 9.36 +/- 0.41 kPa. Sitting and supine Psniff were 8.53 +/- 0.31 kPa and 7.52 +/- 0.33 kPa, respectively. Psniff performed with one nostril open instead of two, was higher: 9.67 +/- 0.32 kPa left and 9.62 +/- 0.32 kPa right versus 8.53 +/- 0.31 kPa when both nostrils were open. After 20-28 sniff manoeuvres, Psniff fell from 8.43 +/- 0.31 kPa to 7.83 +/- 0.30 kPa, suggesting some mechanism of inspiratory muscle fatigue. We conclude that measurement of sitting PImax yields the highest values for inspiratory muscle strength. The two measurement methods, Psniff and PImax, are not interchangeable. Measurement of Psniff is affected by nasal patency.
Assessment of bronchodilator response in children with asthma. Dutch CNSLD Study Group
Authors: Waalkens HJ , Merkus PJ , van Essen-Zandvliet EE , Brand PL , Gerritsen J , Duiverman EJ , Kerrebijn KF , Knol KK , Quanjer PH
Published: November 2022

The bronchodilator response (BDR) in forced expiratory volume in one second (FEV1) is routinely assessed to estimate the reversibility of airways obstruction. However, there is no consensus on how the BDR should be expressed, and recommendations applying to children are lacking. Similarly, the relationship between BDR and nonspecific bronchial hyperresponsiveness to histamine (BHR) has not been elucidated. These questions were addressed in 116 children, 7-16 yrs of age, with stable asthma after withdrawal of all pulmonary maintenance medication. Inclusion criteria were an initial FEV1 between 55-90% predicted, and/or FEV1/forced vital capacity (FVC) between 50-75%, as well as a fall in FEV1 of 20% or more when challenged with up to 150 micrograms histamine. The change in FEV1 (delta FEV1) 20 min after inhalation of 800 micrograms salbutamol was expressed in four ways: as an absolute difference (delta FEV1(l)), as a percentage of predicted FEV1 (delta FEV1%pred) or initial FEV1 (delta FEV1%init), and as a percentage of the deficit in FEV1 (delta FEV1%(pred-init)). delta FEV1%init and delta FEV1%pred were not related to age and stature of the children; delta FEV1%(pred-init) was related to stature, whilst delta FEV1(l) was related to both age and stature. All indices correlated with initial FEV1. However, this is an artefact introduced by relating change to initial value, rather than to the mean of initial and final value. In fact, BDR, expressed as delta FEV1%pred, was only slightly greater in children with the lowest initial airway calibre (p = 0.08), unlike delta FEV1%init. BDR was weakly related to BHR.(ABSTRACT TRUNCATED AT 250 WORDS)
Cross-tachyphylactic airway response to inhaled bradykinin, kallidin and [desArg9]-bradykinin in asthmatic subjects
Authors: Polosa R , Rajakulasingam K , Prosperini G , Milazzo LV , Santonocito G , Holgate ST
Published: November 2022

Kinins are oligopeptides that may act as mediators in the pathogenesis of bronchial asthma by interacting with specific cell surface receptors designated B1 and B2. When administered by inhalation to asthmatic subjects, bradykinin and kallidin, but not [desArg9]-bradykinin, provoke potent bronchoconstriction, thus suggesting a specific effect compatible with the stimulation of B2 receptors. To characterize further the receptor(s) mediating this bronchospastic response we have carried out cross-tachyphylactic studies with inhaled bradykinin, kallidin, and [desArg9]-bradykinin, administered in a randomized double-blind fashion in a group of 10 asthmatic subjects. Inhalation of bradykinin and kallidin, but not [desArg9]-bradykinin, elicited concentration-related falls in forced expiratory volume in one second (FEV1) in all the subjects studied. The geometric mean provocation concentrations of inhaled agonists reducing FEV1 by 20% of baseline (PC20) were 0.12 and 0.28 mg.ml-1 for bradykinin and kallidin, respectively. When inhaled at concentrations up to 10.62 mg.ml-1, [desArg9]-bradykinin failed to provoke any significant fall in FEV1 from baseline in any of the subjects studied. Following recovery from the second bradykinin challenge, provocation with kallidin revealed a reduced response to this agonist, the PC20 value increasing from 0.28 to 1.23 mg.ml-1. Similarly, once the airways had recovered from the second kallidin challenge, provocation with bradykinin also showed a reduced response, the PC20Bk increasing from 0.12 to 0.94 mg.ml-1. Surprisingly, despite failing to cause bronchoconstriction, repeated exposures with inhaled [desArg9]-bradykinin reduced the airway response to bradykinin, the PC20Bk increasing from 0.12 to 0.41 mg.ml-1.(ABSTRACT TRUNCATED AT 250 WORDS)
Parenchymal emphysema measured by CT lung density correlates with lung function in patients with bullous disease
Authors: Gould GA , Redpath AT , Ryan M , Warren PM , Best JJ , Cameron EJ , MacNee W
Published: November 2022

In subjects with chronic obstructive pulmonary disease (COPD) computed tomographic (CT) lung density correlates with direct pathological measurements of the size of the distal airspaces, as well as with measurements of airflow limitation and impairment of the diffusing capacity. Thus, CT lung density can be used to quantify emphysema in life. We wanted to assess the use of CT scanning to detect and measure the extent of bullous lung, and to quantify the severity of emphysema in the non-bullous areas of the lungs. In patients with bullous emphysema (21 males and 2 females; aged 31-69 yrs; forced expiratory volume in one second (FEV1) 14-84% predicted; volume corrected diffusing capacity of the lungs for carbon monoxide (DLCO/VA) 17-114% predicted). CT lung density was measured in electromagnetic imaging (EMI) units. The extent of bullous emphysema correlated poorly with all respiratory function measurements. In contrast, the severity of emphysema in the non-bullous parts of the lungs, expressed as either the mean EMI number, or the EMI number of the lowest 5th percentile of the CT lung density histogram, correlated well with measurements of airflow limitation and diffusing capacity. Our findings, thus, suggest that in patients with bullae the major determinant of respiratory function is the severity of the emphysema in non-bullous lung, and that the extent of the bullae has less functional importance.(ABSTRACT TRUNCATED AT 250 WORDS)
Steroid resistant asthma: what is the clinical definition?
Authors: Woolcock AJ
Published: November 2022

Asthma is usually a steroid responsive disease. A few patients respond poorly to these drugs, and others need such high doses to control the disease that side-effects become a serious problem. The term steroid resistant asthma is used for both groups. In some patients, factors may be operating to make the asthma worse and, thus, to increase the requirement for steroids. In order to make a clinical diagnosis of steroid resistant asthma, it is therefore necessary to investigate the factors that could be operating to prevent a "normal" response to steroids. These factors include wrong diagnosis, insufficient steroid reaching the airway mucosa, continuing exposure to sensitizing agents, unrecognized aggravating agents, excessive use of beta-agonist aerosols, and failure to undertake regular management according to a strict management plan. Using a strict clinical definition of steroid resistant asthma leads to better investigation and treatment of individual patients, allows steroids to be stopped when they are not indicated, allows other anti-inflammatory drugs to be used with confidence, and provides a well-defined group of patients for further research relating to the mechanisms of action of steroids.
Pulmonary involvement in human T-cell lymphotropic virus type-I uveitis: T-lymphocytosis and high proviral DNA load in bronchoalveolar lavage fluid
Authors: Sugimoto M , Mita S , Tokunaga M , Yamaguchi K , Cho I , Matsumoto M , Mochizuki M , Araki S , Takatsuki K , Ando M
Published: November 2022

The ocular manifestation of human T-cell lymphotropic virus type I (HTLV-I) infection has been recognized as a new clinical entity termed HTLV-I uveitis. In order to determine whether HTLV-I uveitis is associated with lymphocyte alveolitis, bronchoalveolar lavage (BAL) was carried out in 11 patients with HTLV-I uveitis, five asymptomatic HTLV-I carriers, 11 HTLV-I-negative patients with ocular sarcoidosis, and nine normal control subjects seronegative for HTLV-I. Six of the 11 patients with HTLV-I uveitis showed increased total cell counts, and T-lymphocytosis in BAL fluid. CD4+/CD8+ ratios of T-lymphocytes were decreased in three of these patients, and normal in three other patients. Such abnormalities of the lung were not found in asymptomatic HTLV-I carriers, and in normal control subjects. BAL findings in HTLV-I uveitis differed from those of patients with sarcoidosis in terms of the lymphocytic component. Interestingly, it was found that there was an increase of HTLV-I proviral deoxyribonucleic acid (DNA) load in peripheral blood mononuclear cells (PBMC) from seven patients with HTLV-I uveitis, and in the BAL cells from four patients with pulmonary involvement. These results provide further evidence in terms of HTLV-I tropism for the lung, and suggest that a systemic and local increase of HTLV-I proviral DNA load plays an important role in the pathogenesis of lymphocyte alveolitis in patients with HTLV-I uveitis.
Tracheal size is a determinant of the bronchoconstrictive response to inhaled methacholine
Authors: Bourbeau J , Delfino R , Ernst P
Published: November 2022

We hypothesized that the size of the large airways is a determinant of bronchial responsiveness to inhaled methacholine. This was investigated by measuring the relationship of tracheal size and branching angle to the bronchoconstrictive response to methacholine, in 169 male construction insulators, aged 20-50 yrs, as part of a workforce-based, cross-sectional survey of respiratory health. Bronchial responsiveness was expressed as the concentration of methacholine, inhaled for 2 min of tidal breathing, which provoked a 15% fall in forced expiratory volume in one second (FEV1). Tracheal size was assessed from tracings of standard posteroanterior chest radiographs, at full inspiration. After accounting for the effect of airway calibre (FEV1/forced vital capacity (FVC)), age, height, and pack-years of cigarette smoking, on airways responsiveness, there was a significant association (p < 0.05) between tracheal length, diameter, or surface area and the degree of bronchoconstriction obtained by inhaling methacholine. The increase in airway responsiveness with decreasing tracheal size may reflect increased deposition of methacholine, secondary to smaller cross-sectional area and greater linear velocity of air in the trachea and main bronchi.
Factors contributing to dyspnoea during bronchoconstriction and exercise in asthmatic subjects
Authors: Killian KJ , Summers E , Watson RM , O'Byrne PM , Jones NL , Campbell EJ
Published: November 2022

The purpose of the present study was to identify: 1) whether dyspnoea during bronchoconstriction and exercise is related, in asthmatic subjects; and 2) to what extent baseline pulmonary function and respiratory muscle strength contribute to dyspnoea under both conditions. One hundred and seventy five consecutive subjects, referred with suspected asthma, rated the intensity of dyspnoea (Borg scale 0-10): 1) during the administration of doubling concentrations of methacholine to 32 mg.ml-1 methacholine, or until the baseline forced expiratory volume in one second (FEV1) was reduced by 20%; and 2) during incremental cycle ergometry (100 kpm.min-1 each minute) to maximal capacity. 138/175 subjects achieved a 20% reduction in their baseline FEV1; 18 of the 138 were excluded, 2 children and 16 with complicating pulmonary disorders (diffusing capacity of the lung for carbon monoxide (DLCO) and/or total lung capacity (TLC) < 70% predicted). The remaining 120 out of 175 constituted the study population. Dyspnoea following a 20% reduction in the baseline FEV1 (Dys20%) was linearly interpolated, using the rating of dyspnoea and the FEV1 at the two final concentrations of methacholine. In the 120 asthmatic subjects, the mean intensity of dyspnoea was "moderate" (2.9, SD 1.91; Borg 0-10) and the intensity across subjects was not significantly related to baseline FEV1, vital capacity (VC), FEV1/VC, DLCO, TLC and maximal static inspiratory pressure (MIP), alone or in combination.(ABSTRACT TRUNCATED AT 250 WORDS)
Questionnaire assessments of recent exposure to environmental tobacco smoke in relation to salivary cotinine
Authors: Delfino RJ , Ernst P , Jaakkola MS , Solomon S , Becklake MR
Published: November 2022

The increasing evidence of the ill-health effects of environmental tobacco smoke (ETS) has prompted the search for accurate measures of exposure to ETS. The present study examined whether it was possible to enhance the ability of questionnaire-derived assessments of ETS exposure, to predict salivary cotinine. Salivary samples were obtained from 258 nonsmoking bank employees, who simultaneously answered questions detailing their exposure to second-hand smoke within the last three days. Exposure models were created, to take into account the number of smokers nearby, length of time in their presence, half-life of cotinine in bodily fluids, level of aversion to cigarette smoke and time of year. All models, including the consideration of intensity and duration of exposure combined, explained an equal amount of variance of log cotinine levels (approximately 16%). The weak relationship between questionnaire estimates of ETS exposure and cotinine, found in the present study, suggests that further investigation is needed to improve the assessment of recent ETS exposure.
Pulmonary immune cells in health and disease: dendritic cells and Langerhans' cells
Authors: Hance AJ
Published: November 2022

The activation of T-lymphocytes recognizing specific antigens is a crucial and early event in the development of an immune response, but T-lymphocytes cannot respond to antigens without help of a second cell type called accessory cells or antigen-presenting cells. Studies from several groups have indicated that pulmonary dendritic cells and Langerhans' cells, like their counterparts in other tissues, are potent accessory cells, and suggest that these cells may play an extremely important role in initiating lung immune responses. The purpose of this review is to summarize current information concerning pulmonary dendritic cells and Langerhans' cells, including their origin, distribution in the lung and functional capabilities. The possible role of these cells in certain lung diseases of immune origin will also be discussed.
Sole pulmonary involvement by Langerhans' cell histiocytosis in a child
Authors: Chatkin JM , Bastos JC , Stein RT , Gaiger AM
Published: November 2022

The case of a boy aged 4 yrs and 7 months, with isolated pulmonary involvement by Langerhans' cell histiocytosis is reported. The presentation of the disease was a sudden pneumothorax, with no previous signs of respiratory disease. The case was confirmed by S-100 and MT1 antibody staining, and was treated with pulse steroids and several pleural drainages, until the boy died after a large bilateral pneumothorax.
Long-term oxygen therapy in parenchymal lung diseases: an analysis of survival. The Swedish Society of Chest Medicine
Authors: Strom K , Boman G
Published: November 2022

We have analysed the predictors of survival in patients starting long-term domiciliary oxygen therapy (LTO) for chronic hypoxia caused by parenchymal lung disease. In 240 patients (136 males) LTO was started at a mean age of 70 yrs. Survivors have been followed up for a minimum of 28 months (range 28-57 months). Interstitial fibrosis was the sole cause of hypoxia in 51 patients, and late sequelae of pulmonary tuberculosis in 48 patients. More than one (mixed) disease caused hypoxia in 124 patients. Patients with tuberculosis (TB) started LTO with significantly higher values of arterial carbon dioxide tension (PaCO2) and markedly lower spirometry volumes than patients with interstitial fibrosis. In the total patient group survival was correlated in the univariate analysis to cause(s) of hypoxia, performance status and PaCO2 when breathing air. TB had a relatively good prognosis, whilst interstitial fibrosis implied a poor long-term survival. A PaCO2 of below 5.5 kPa and a poor performance class was associated with increased mortality rates. In TB patients, survival was better when thoracic deformity contributed to hypoxia. In patients with interstitial fibrosis, a forced vital capacity of below 2.1 l was associated with increased mortality. Concomitant chronic obstructive pulmonary disease was associated with better survival than interstitial fibrosis alone. In the multivariate analysis, survival was found correlated to performance status, presence or absence of thoracic deformity and forced expiratory volume in one second (FEV1) and forced vital capacity (FVC).(ABSTRACT TRUNCATED AT 250 WORDS)
Production of acute bronchiolitis in guinea-pigs by human respiratory syncytial virus
Authors: Hegele RG , Robinson PJ , Gonzalez S , Hogg JC
Published: November 2022

Respiratory syncytial virus (RSV) is the most important cause of acute bronchiolitis in young children, and is implicated in the pathogenesis of paediatric asthma. The present studies were designed to develop a model of acute RSV bronchiolitis in young guinea-pigs, that could be used to study the mechanisms of the acute bronchiolitis and its sequelae. Anaesthetized, one month old guinea-pigs received either 4 x 10(3) plaque forming units of Long strain human RSV or uninfected cell culture medium intranasally. Bronchiolar inflammation was assessed 6 days (n = 10 RSV-inoculated; n = 10 controls) and 14 days (n = 10 RSV-inoculated; n = 9 controls) postinoculation using a semiquantitative histological scoring system. Viral replication within the lung was evaluated by culture, and the intrapulmonary distribution of viral antigens was evaluated by immunohistochemistry. The RSV-inoculated group showed histological evidence of acute bronchiolitis 6 days after inoculation, which subsided by Day 14. Replicating virus was cultured from the lungs of 9 out of 10 RSV-inoculated animals on Day 6, and 2 out of 10 animals on Day 14, with no growth from control animals. Viral antigens were identified primarily within airway epithelial cells on Day 6, and within alveolar macrophages on Day 14. Intranasal inoculation of human RSV into guinea-pigs provides a model of acute RSV bronchiolitis that may facilitate the study of both the pathogenesis of acute infection and the possible role of RSV in the subsequent development of nonspecific bronchial hyperresponsiveness in children.
Heterogeneity of type III procollagen N-terminal peptides in BAL fluid from normal and fibrotic lungs
Authors: Harrison NK , McAnulty RJ , Kimpton WG , Fraser  , Laurent TC , Laurent GJ
Published: November 2022

Levels of the N-terminal propeptide of type III collagen (PIIINP) in bronchoalveolar lavage fluid (BALF) are thought to reflect type III collagen production by the lungs, and increased levels have been reported in patients with pulmonary fibrosis. We wanted to know more about the relative proportions of these peptides in normal BALF, whether they altered in pulmonary fibrosis, and whether lymphoid tissue is capable of clearing PIIINPs. In this study, we used a radioimmunoassay which detects the different forms of PIIINP-related antigens with equal specificity, to measure PIIINPs in serum and BALF of patients with cryptogenic fibrosing alveolitis (CFA). To investigate why PIIINP profiles in BALF differed from serum, the absolute concentration and relative proportion of PIIINPs in lymph afferent and efferent to the popliteal lymph node of a sheep were also determined. PIIINP concentrations were significantly greater in serum and BALF of patients with CFA, compared with controls. Gel chromatography indicated that serum antigen distribution, both of patients and controls, contained approximately 20% Col 1-3; the remainder being Col 1. In contrast, BALF contained Col 1-3 and Col 1, together with an antigen of high molecular weight (> 150 kD). The relative proportion of each antigen varied quite widely, but there were no apparent differences between patients and controls. The concentration of PIIINPs in afferent lymph was 295 ng.ml-1 and in efferent lymph was 104 ng.ml-1. Gel chromatography demonstrated that a significant amount of Col 1-3, together with a high molecular weight peptide, had been cleared during passage through the node.(ABSTRACT TRUNCATED AT 250 WORDS)
Voluntary cough suppression as an indication of symptom severity in upper respiratory tract infections
Authors: Hutchings HA , Eccles R , Smith AP , Jawad MS
Published: November 2022

The aim of the present study was to determine whether the ability to suppress cough voluntarily is an index of cough severity in upper respiratory tract infection. Cough was measured by means of a microphone linked to a pen recorder and subjects were instructed to voluntarily suppress cough in order to determine cough suppression time. Subjective scores of symptom severity, mood and psychological parameters were made prior to cough measurements. The baseline frequency of cough showed a distribution towards the higher frequencies, with a median of 2.1 (lower quartile 1.2, upper quartile 3.2) coughs.min-1. The results for cough suppression fell into two distinct groups, one group reaching a breaking point within 12.6 min; and another group which did not cough during the 20 min cough suppression period. In the group of subjects which broke from the cough suppression, there was an inverse relationship between the cough suppression time and the baseline frequency of cough. The median frequency of cough following cough suppression was significantly greater than the baseline median frequency of cough. The subjects who reached a breaking point had a greater baseline frequency of cough and a greater symptom severity score, and they also felt more feeble, clumsy, sad and antagonistic than the group which did not reach a breaking point. The subjects who reached a breaking point had significantly greater scores for the psychology parameter of obsessional symptoms than the group which did not reach a breaking point.(ABSTRACT TRUNCATED AT 250 WORDS)
Airway responsiveness to leukotriene C4 (LTC4), leukotriene E4 (LTE4) and histamine in aspirin-sensitive asthmatic subjects
Authors: Christie PE , Schmitz-Schumann M , Spur BW , Lee TH
Published: November 2022

We wanted to determine whether the airway response to inhaled leukotriene C4 (LTC4) is similar to inhaled leukotriene E4 (LTE4) in aspirin-sensitive asthma and, therefore, determined airway responsiveness to histamine, LTC4 and LTE4 in seven aspirin-sensitive subjects and 13 control asthmatic subjects, who were tolerant of aspirin. The concentration of inhaled lysine-aspirin which produced a 15% fall in forced expiratory volume in one second (FEV1) (PC15) was determined in aspirin-sensitive asthmatic subjects. The dose of histamine, LTC4 and LTE4 which produced a 35% fall in specific airways conductance (PD35sGaw) was determined by linear interpolation from the log dose response curve. There was no correlation between the PC15 for lysine-aspirin and the airway reactivity to inhaled LTC4 or LTE4. There was no difference in airway response to histamine and LTC4 between any of the groups of asthmatic subjects. There was a rank order of potency LTC4 > LTE4 > histamine in both groups, with LTC4 approximately 1,000 fold more potent than histamine in both groups. Aspirin-sensitive asthmatic subjects were significantly more responsive to LTE4 (p = 0.02) than aspirin-tolerant asthmatic subjects. The relative responsiveness of LTE4 to histamine (PD35 histamine/PD35 LTE4) was significantly greater in aspirin-sensitive asthmatic subjects compared to aspirin-tolerant asthmatic subjects (p = 0.05). There was no difference in relative responsiveness of LTC4 to histamine between aspirin-sensitive or aspirin-tolerant asthmatic subjects. We conclude that the airways of aspirin-sensitive asthmatic subjects demonstrate a selective hyperresponsiveness to LTE4, which is not observed for LTC4.
Lung function in awake healthy infants: the first five days of life
Authors: Lodrup-Carlsen KC , Carlsen KH
Published: November 2022

Our main aim was to determine an appropriate time for lung function measurements in infants, prior to environmental influences upon their respiratory tract. Tidal flow-volume loops, respiratory system compliance (Crs) and resistance (Rrs) (single breath passive occlusion technique) were measured in 24 healthy, awake awake infants, at one hour and on the following four days of life to investigate variability and reproducibility over time. Possible differences in lung function were sought between the 12 vaginally-delivered and 12 Caesarean section-delivered infants. Tidal volumes increased each day, but significantly so only from Day 0 to Day 1. The expiratory flow-time ratios (time to reach peak expiratory flow to total expiratory time (Tme/Te) and tidal expiratory flow at 75% to peak flow (TEF25/PTEF)) and expiratory flow-volume ratio (volume to reach peak expiratory flow to total expiratory volume (Vme/Ve)) were significantly smaller on Day 1 than Day 0, but did not change significantly thereafter. Crs and Rrs were lower on Day 0 than later. Intra-individual variation remained stable for tidal flow-volume parameters throughout the study, but was significantly higher during Day 0 and Day 1 for Crs and Rrs. There were no significant differences related to mode of delivery of the infant. We conclude that, for epidemiological purposes, tidal lung function parameters may be measured from Day 2 to Day 4, and that they are not influenced by mode of delivery of the infant.
Thoracoscopy: present diagnostic and therapeutic indications
Authors: Loddenkemper R , Boutin C
Published: November 2022

Thoracoscopy is increasingly being used for diagnosis and treatment of pleuropulmonary disease. The recent revival was made possible by the tremendous advances in endoscopic technology. The main requirements for diagnostic purposes are rigid telescopes and forceps, and for interventional thoracoscopy scissors, staplers and a video recorder. The procedure can be performed either under local or general anaesthesia, with or without double lumen intubation, after inducing an artificial pneumothorax. At the end of the procedure, a chest tube should always be inserted, even if only for a few minutes until the lung re-expands. Main diagnostic indications are pleural effusions, pneumothorax and diffuse lung disease. Main therapeutic indications are pleurodesis by talcage in effusion and pneumothorax and a variety of diseases of the lung, the pleura and the mediastinum, where thoracotomy may be replaced by video-assisted thoracoscopy. The well-known indications of the past remain a domain of pneumologists, whereas minimal invasive thoracotomy is the task of thoracic surgeons. For some indications no sharp line has to be drawn, provided the facilities and skills are present, including those for the management of complications.
Exogenous lipoid pneumonia complicated by Mycobacterium fortuitum and Aspergillus fumigatus infections
Authors: Jouannic I , Desrues B , Lena H , Quinquenel ML , Donnio PY , Delaval P
Published: November 2022

We report the case of a nonimmunocompromised female patient, who developed exogenous lipoid pneumonia with Mycobacterium fortuitum infection at diagnosis, later followed by Aspergillus fumigatus infection. The association of exogenous lipoid pneumonia with atypical mycobacterial infection is uncommon but well-recognized, but, to our knowledge, association with A. fumigatus infection has not previously been reported.
Grace-AKO: a novel and stable knockoff filter for variable selection incorporating gene network structures
Authors: Tian Peixin , Hu Yiqian , Liu Zhonghua , Zhang Yan Dora
Published: November 2022

Motivation

Variable selection is a common statistical approach to identifying genes associated with clinical outcomes of scientific interest. There are thousands of genes in genomic studies, while only a limited number of individual samples are available. Therefore, it is important to develop a method to identify genes associated with outcomes of interest that can control finite-sample false discovery rate (FDR) in high-dimensional data settings.

Results

This article proposes a novel method named Grace-AKO for graph-constrained estimation (Grace), which incorporates aggregation of multiple knockoffs (AKO) with the network-constrained penalty. Grace-AKO can control FDR in finite-sample settings and improve model stability simultaneously. Simulation studies show that Grace-AKO has better performance in finite-sample FDR control than the original Grace model. We apply Grace-AKO to the prostate cancer data in The Cancer Genome Atlas program by incorporating prostate-specific antigen (PSA) pathways in the Kyoto Encyclopedia of Genes and Genomes as the prior information. Grace-AKO finally identifies 47 candidate genes associated with PSA level, and more than 75% of the detected genes can be validated.
The role of subjective cognitive complaints in self-management among haemodialysis patients: a cross-sectional study
Authors: Chan Frederick H. F. , Newman Stanton , Khan Behram A. , Griva Konstadina
Published: November 2022

Background

Subjective cognitive complaints refer to self-experienced difficulties with everyday cognitive tasks. Although there has been a fair amount of research on cognitive impairments and cognitive complaints in end-stage renal disease, the practical implications of these complaints remain unclear. The current study aims to examine the associations of cognitive complaints with sociodemographic and clinical variables, mood, as well as key patient-reported outcomes, i.e., self-efficacy, self-management skills, and treatment adherence.

Methods

A total of 305 haemodialysis patients (mean age = 53.97 years, 42.6% female) completed the Kidney Disease Quality of Life Cognitive Function subscale, a brief measure of cognitive complaints. The recommended cut-off point of 60 was used to identify probable cognitive impairment. Measures of self-efficacy, self-management skills (i.e., symptom coping, health monitoring, health service navigation), treatment adherence, and mood symptoms were also administered. Between-group comparisons and correlational analyses were performed to examine associations of cognitive complaints with sociodemographic, clinical, and health behaviour variables. Mediation analyses were also conducted to investigate the mediating role of self-efficacy on the relationship between cognitive complaints and treatment adherence.

Results

Nearly a quarter (23.0%) of haemodialysis patients reported cognitive complaints indicative of clinical impairments. Risk of probable impairments was higher for patients with hypertension, diabetes, those diagnosed with end-stage renal disease at an older age, and those with shorter time on dialysis. Subjective cognitive complaints (both rates of probable impairments as per cut-off and continuous scores) were significantly associated with lower disease and treatment self-efficacy, poorer self-management skills, lower treatment adherence, as well as higher symptoms of distress. Mediation analysis indicated that treatment self-efficacy mediated the relationship between cognitive complaints and treatment adherence.

Conclusions

The current study demonstrated the clinical characteristics of haemodialysis patients who report cognitive complaints indicative of probable cognitive impairments and showed the associations of these complaints with self-management outcomes. Future studies should adopt more comprehensive measures of cognitive complaints and longitudinal designs to confirm the current findings.
Autoimmune encephalitis after BBIBP-CorV (Sinopharm) COVID-19 vaccination: a case report
Authors: Vences Miguel A. , Araujo-Chumacero Mary M. , Cardenas Edu , Canales Diego , Alvarez Arturo , Barja Ebelin , Albujar Maria Fe , Urrunaga-Pastor Diego
Published: November 2022

Background

Vaccination is an important public health strategy; however, many neurological adverse effects are associated with COVID-19 vaccination, being encephalitis a rare manifestation.

Case presentation

We present the case of a 33-year-old woman who received the first dose of the BBIBP-CorV vaccine against COVID-19 on April 4 and the second dose on April 28, 2021. Three days after receiving the second dose, she experienced a subacute episode of headache, fever, insomnia, and transient episodes of environment disconnection. We obtained negative results for infectious, systemic, and oncological causes. Brain magnetic resonance imaging showed lesions in the bilateral caudate nucleus and nonspecific demyelinating lesions at the supratentorial and infratentorial compartments. The results of the neuronal autoantibodies panel were negative. She had an adequate response to immunoglobulin and methylprednisolone; however, she experienced an early clinical relapse and received a new cycle of immunosuppressive treatment followed by a satisfactory clinical evolution.

Conclusions

We report the first case of severe encephalitis associated with BBIBP-CorV (Sinopharm) vaccination in Latin America. The patient had atypical imaging patterns, with early clinical relapse and a favorable response to corticosteroid therapy.
Formation and evolution of idiopathic lamellar macular hole-a pilot study
Authors: Lee Cheng-Yung , Hsia Yun , Yang Chung-May
Published: November 2022

Background

The developmental pathways and subsequent evolutional processes of idiopathic lamellar macular hole (LMH) were studied with spectrum domain optical coherence tomography (SD-OCT).

Methods

Twenty-seven eyes of 26 patients of idiopathic LMH with pre-LMH SD-OCT available were retrospectively reviewed. Relevant OCT parameters and best-corrected visual acuity (BCVA) were collected and analyzed.

Results

Four types of developmental pathways of idiopathic LMH were noted. Type 1 (5 cases), involved disruption of a foveal cyst from vitreomacular traction. Type 2 (10 cases), demonstrated rupture of parafoveal cysts or schisis mainly from epiretinal membrane (ERM). In type 3 pathway (5 cases), a central intraretinal cyst formed under tight ERM with subsequent cyst roof dehiscence. Type 4 (7 cases), showed gradual loss of foveal tissue without cystic lesions from ERM traction. There was no statistically significant change in BCVA during LMH formations or subsequent evolutional processes in any types of the developmental pathways. Three cases developed epiretinal proliferation (EP) during evolution, which showed tendency of decrease in BCVA. Among the three cases, one later developed the degenerative configuration.

Conclusions

In summary, four types of tractional developmental pathways of idiopathic LMH were identified. BCVA was relatively stable during LMH formation and follow-up. Deterioration of visual acuity were found in cases that developed EP during evolution. Transformation into degenerative configuration might be possible after LMH formation.
Effect of the rho-kinase inhibitor ripasudil in needling with mitomycin C for the failure of filtering bleb after trabeculectomy: a cross-sectional study
Authors: Mizuno Yu , Okada Naoki , Onoe Hiromitsu , Tokumo Kana , Okumichi Hideaki , Hirooka Kazuyuki , Kiuchi Yoshiaki
Published: November 2022

Background

Rho-kinase inhibitors can inhibit fibrosis after glaucoma surgery. This study aimed to evaluate the effect of rho-kinase inhibitor after needling procedure with mitomycin C for the failure of filtering bleb with trabeculectomy.

Methods

This retrospective single-center study examined the effects of rho-kinase inhibitor after the needling procedure. We included 27 eyes of 27 patients with glaucoma who underwent needling procedure using mitomycin C and were subsequently treated with ripasudil—a rho-associated protein kinase inhibitor (ripasudil group)—or without ripasudil (control group). The ripasudil and control groups were compared in terms of intraocular pressure (IOP) and the number of antiglaucoma medications. Success at 12 months after the needling procedure was defined as a > 20% decrease in IOP from the preoperative period without surgical reintervention.

Results

At 12 months after the needling procedure, the mean IOP decreased from 16.9 ± 4.5 to 12.6 ± 1.1 mmHg in the control group and from 16.0 ± 5.3 to 12.2 ± 1.2 mmHg in the ripasudil group (p = 0.77). The 12-month success rates were 60.00% and 56.25% in the control and ripasudil groups (p = 0.98), respectively. In the preoperative period, the numbers of antiglaucoma drugs were 0.27 ± 0.46 and 0.92 ± 0.91 in the control and ripasudil groups (p = 0.022), respectively, and at 12 months after the needling procedure, they were 1.07 ± 1.44 and 0.73 ± 1.10 (p = 0.52), respectively.

Conclusions

Treatment with ripasudil (a rho-associated protein kinase inhibitor) after the needling procedure with mitomycin C did not show better results than treatment with the mitomycin C needling procedure alone at 12 months after the procedure.
Assessing anxiety among adolescents in Hong Kong: psychometric properties and validity of the Generalised Anxiety Disorder-7 (GAD-7) in an epidemiological community sample
Authors: Ip Hang , Suen Yi Nam , Hui Christy Lai Ming , Wong Stephanie Ming Yin , Chan Sherry Kit Wa , Lee Edwin Ho Ming , Wong Michael Tak Hing , Chen Eric Yu Hai
Published: November 2022

Background

The development of a valid and simple-to-use self-administered tool in Asian adolescents for clinical screening and intervention remains limited. The present study assessed the psychometric characteristics and validity of the Generalised Anxiety Disorder Scale-7 (GAD-7) among adolescents in Hong Kong.

Methods

Epidemiological data from 3,261 Hong Kong adolescents aged 15 - 24 years were analysed for the construct validity, criterion validity, concurrent validity, and Rasch Model. All analyses were age- and gender-weighted according to the distributions of Hong Kong’s general population.

Results

The GAD-7 showed high internal consistency and strong fit to the one-factor structure. The best cut-off value was set at 7 or more. Regression models found that the total scores of the scale were positively associated with symptoms of depression and hypomania, schizotypal personality and alcohol dependence. Rasch model analysis found that the separation index was 2.18 and 16.51 for the respondents and items, respectively and all residual pairs had small correlation coefficients (i.e., < 0.3).

Conclusions

All psychometric findings presented in this study support the use of the GAD-7 as a legitimate measure of anxiety severity. A cut-off score of 7 should indicate a potential diagnosable condition in Asian adolescents, which requires our attention but should not be used as a formal diagnostic screening tool. The findings revealed the local dependence of the items of the GAD-7 and that the scale can separate respondents into at least two groups and items into numerous groups according to the separation index.
Relevant vs non-relevant subspecialist for patients hospitalised in internal medicine at a local hospital: which is better? A retrospective cohort study
Authors: Berg Øyvind , Hurtig Ulf , Steinsbekk Aslak
Published: November 2022

Background

Studies of the treatment of patients in-hospital with a specific diagnosis show that physicians with a subspecialisation relevant to this diagnosis can provide a better quality of care. However, studies including patients with a range of diagnoses show a more negligible effect of being attended by a relevant subspecialist. This project aimed to study a more extensive set of patients and diagnoses in an environment where the subspecialist present could be controlled. Thus, this study investigated whether being attended by a physician with a subspeciality relevant to the patient’s primary diagnosis was prospectively associated with readmission, in-hospital mortality, or length of stay compared to a physician with a subspeciality not relevant to the patient’s primary diagnosis.

Methods

We have conducted a retrospective register-based study of 11,059 hospital admissions across 9 years at a local hospital in south-eastern Norway, where it was possible to identify the physician attending the patients at the beginning of the stay. The outcomes studied were emergency readmissions to the same ward within 30 days, any in-hospital mortality and the total length of stay. The patients admitted were matched with the consultant(s) responsible for their treatment. Then, the admissions were divided into two groups according to their primary diagnosis. Was their diagnosis within the subspeciality of the attending consultant (relevant subspecialist) or not (non-relevant subspecialist). The two groups were then compared using bivariable and multivariable models adjusted for patient characteristics, comorbidities, diagnostic group and physician sex.

Results

A relevant subspecialist was present during the first 3 days in 8058 (73%) of the 11,059 patient cases. Patients attended to by a relevant subspecialist had an odds ratio (OR) of 0.91 (95% confidence interval 0.76 to 1.09) for being readmitted and 0.71 (0.48 to 1.04) for dying in the hospital and had a length of stay that was 0.18 (− 0.07 to 0.42) days longer than for those attended to by a non-relevant subspecialist.

Conclusions

This study found that patients attended by a relevant subspecialist did not have a significantly different outcome to those attended by a non-relevant subspecialist.