bluuebunny/crossref_metadata_2025 huggingface dataset:
Components of respiratory resistance monitored in mechanically ventilated patients
Authors: Babik B. , Peták F. , Asztalos T. , Deák Z.I. , Bogáts G. , Hantos Z.
Published: January 2003

The interrupter technique is commonly adopted to monitor respiratory resistance (Rrs,int) during mechanical ventilation; however,Rrs,intis often interpreted as an index of airway resistance (Raw).

This study compared the values ofRrs,intprovided by a Siemens 940 Lung Mechanics Monitor with total respiratory impedance (Zrs) parameters in 39 patients with normal spirometric parameters, who were undergoing elective coronary bypass surgery.Zrswas determined at the airway opening with pseudorandom oscillations of 0.2–6 Hz at end inspiration.Rawand tissue resistance (Rti) were derived from theZrsdata by model fitting;Rtiand total resistance (Rrs,osc=Raw+Rti) were calculated at the actual respirator frequencies. Lower airway resistance (Rawl) was estimated by measuring tracheal pressure.

Although good agreement was obtained betweenRrs,oscandRrs,int, with a ratio of 1.07±0.19 (mean±sd), they correlated poorly (r2=0.36).Rtiand the equipment component ofRawaccounted for most ofRrs,osc(39.8±11.9 and 43.0±6.9%, respectively), whereas only a small portion belonged toRawl(17.2±6.3%).

It is concluded that respiratory resistance may become very insensitive to changes in lower airway resistance and therefore, inappropriate for following alterations in airway tone during mechanical ventilation, especially in patients with relatively normal respiratory mechanics, where the tissue and equipment resistances represent the vast majority of the total resistance.
Regulation of E-cadherin expression by dexamethasone and tumour necrosis factor-α in nasal epithelium
Authors: Carayol N. , Vachier I. , Campbell A. , Crampette L. , Bousquet J. , Godard P. , Chanez P.
Published: January 2003

Asthma and rhinitis often coexist and share many clinical features. The extent of epithelial alteration in nasal inflammation is controversial. Cell-cell adhesion plays an important role in tissue morphogenesis and homeostasis and is mediated by the cadherin family. In human bronchial epithelial cells the authors have shown that tumour necrosis factor (TNF)-α induced a significant decrease of E-cadherin and β-catenin expression. The addition of dexamethasone inhibited this decrease. The aim of the present study was to investigate the effect of TNF-α and dexamethasone on the regulation of E-cadherin, γ-catenin and β-catenin in human nasal epithelial cells (HNEC).

A primary culture of HNEC, obtained from human nasal turbinates after surgery, was used. The quantitative and qualitative modulation of E-cadherin, γ-catenin and β-catenin expression was assessed by Western blot and immunofluorescence analysis. In order to assess the TNF-α-induced activation of HNEC, interleukin-8 and RANTES (regulated on activation, normal T-cell expressed and secreted) release was assessed by enzyme-linked immunosorbent assay.

The results showed that TNF-α induced, a decrease in γ-catenin and β-catenin expression, but had no effect on E-cadherin expression. Immunofluorescence showed that TNF-α induced cytoplasmic localisation of E-cadherin, γ-catenin and β-catenin. Dexamethasone inhibited the effect of TNF-α and induced a three-fold increase in E-cadherin expression.

These results suggest that the difference in nasal and bronchial epithelial cohesion may be due to the differential effect of tumour necrosis factor-α and dexamethasone on E-cadherin expression.
Diaphragmatic function after intense exercise in congestive heart failure patients
Authors: Kufel T.J. , Pineda L.A. , Junega R.G. , Hathwar R. , Mador M.J.
Published: January 2003

Respiratory muscle strength and endurance is reduced in patients with congestive heart failure, making these patients susceptible to diaphragmatic fatigue during exercise.

In order to determine whether or not contractile fatigue of the diaphragm occurs in patients with congestive heart failure following intense exercise, twitch transdiaphragmatic pressures (twitchPtdi) were measured during unpotentiated and potentiated cervical magnetic stimulation (CMS) of the phrenic nerves before and at intervals after cycle endurance exercise.

Ten patients aged 65.7±6.0 yrs (mean±sd) with an ejection fraction of 31.2±9.8% performed a constant-load symptom-limited exercise test at 60% of their peak work capacity. TwitchPtdiat baseline were 15.9±6.3 cmH2O (unpotentiated CMS) and 28.8±10.7 cmH2O (potentiated CMS) and at 10 min postexercise were 16.4±4.7 cmH2O (unpotentiated CMS) and 27.6±10.1 cmH2O (potentiated CMS). One patient demonstrated a sustained fall in twitchPtdiof ≥15%, considered potentially indicative of diaphragmatic fatigue.

Contractile diaphragmatic fatigue is uncommon in untrained patients with congestive heart failure following high-intensity constant-workload cycle exercise. Therefore, diaphragmatic fatigue is an unlikely cause of exercise-limitation during activities of daily living in heart failure patients.
Hypertonic saline increases tight junction permeability in airway epithelium
Authors: Högman M. , Mörk A-C. , Roomans G.M.
Published: January 2003

Asthmatics are known to react to inhaled hyperosmolar solution. Therefore, the effect of hyperosmolar salt solutions on tight junctions of the airway epithelium was investigated by electron microscopy.

Rat trachea was perfused with different concentrations of sodium chloride (NaCl) and then fixed from the luminal side with glutaraldehyde to which the electron dense tracer lanthanum chloride had been added.

Lanthanum penetrated 3±1% of the tight junctions in trachea perfused with 295 mOsm Krebs-Ringer's buffer (KRB). Adding NaCl to the KRB (KRB-NaCl) increased osmolarity of the solution. After perfusion with 589 or 876 mOsm KRB-NaCl, lanthanum was observed in the lateral intercellular spaces in 50±11 and 57±6%, respectively. The effect of hyperosmolarity was reversible and only 6±1% of the tight junctions were penetrated after perfusion with 295 mOsm KRB solution following 589 mOsm KRB-NaCl perfusion. Adding mannitol to the KRB to an osmolarity of 589 mOsm only caused 5±1% of the tight junctions to open, even though osmotic effects were observed.

Opening the tight junctions with hyperosmolar salt solutions may play a role in exercise-induced asthma. It may also open the prospect for increased penetration of inhaled drugs into the interstitium and the circulation.
Occupational and environmental risk factors for respiratory symptoms in rural Beijing, China
Authors: Zhang L-X. , Enarson D.A. , He G-X. , Li B. , Chan-Yeung M.
Published: January 2003

The aim of the present study was to determine the effects of occupational and environmental exposure on respiratory symptoms in adults in rural Beijing, China.

Thirty randomly selected villages in the counties of Shunyi and Tongxian, 50 km north and east, respectively, of the city of Beijing, China, participated in this study. Village doctors interviewed all residents aged ≥15 yrs and completed the International Union Against Tuberculosis and Lung Disease Questionnaire on Bronchial Symptoms translated into Chinese with added questions on smoking and occupational and environmental exposure.

Of the eligible population, 22,528 adults (98%) took part. The prevalence of all respiratory symptoms,i.e.asthma-like symptoms, asthma attacks in the last 12 months, chronic cough and chronic phlegm, was low. Significant determinants for respiratory symptoms were age, sex, smoking and county of residence. A dose-dependent relationship was found between cumulative cigarette consumption and prevalence of respiratory symptoms. After adjusting for these variables, exposure to insecticides and fertilisers significantly increased the risk of most of the respiratory symptoms, whereas exposure to indoor air pollution from domestic fuels did not.

Exposure to chemicals such as insecticides and fertilisers contributed independently to the risk of respiratory symptoms in rural Beijing, China.
Polyethylene flock-associated interstitial lung disease in a Spanish female
Authors: Barroso E. , Ibañez M.D. , Aranda F.I. , Romero S.
Published: January 2003

This case study presents a female aged 54 yrs with a 12 months history of progressive pulmonary impairment after a 7-yr period of occupational exposure to rotary-cut polyethylene. An open lung biopsy revealed the histopathology of follicular bronchiolitis that is viewed as a stereotypical feature for flock worker's lung. It seems to be the first case of plastic flock-associated interstitial lung disease reported outside North America.
Applicability of laser scanning cytometry to study paediatric alveolar macrophages
Authors: Bunn H.J. , Woltmann G. , Grigg J.
Published: January 2003

Laser scanning cytometry (LSC) generates quantitative information on immune receptor expression from cells cytocentrifuged onto a microscope slide. In children, the description of developmental changes in immune receptor expression on alveolar macrophages (AM) has been limited by the small number of cells recovered by bronchoalveolar lavage (BAL). The applicability of LSC to the study of AM from normal children was therefore assessed.

AM were obtained by BAL of normal children following intubation prior to elective surgery. The ability of LSC to identify the cytoplasm of AM was assessed using either: 1) autofluorescence; 2) forward scatter; 3) nuclear staining with propidium iodide; or 4) a fluorescent-labelled monoclonal antibody to CD68, a pan-macrophage antigen.

LSC could only reliably identify individual AM when stained with CD68. The sensitivity for detecting single whole AM using CD68 was 0.97 and the positive predictive value was 0.88, respectively, with excellent repeatability. In addition, a range of immunofluorescence parameters were generated for CD68.

It is concluded that laser scanning cytometry is suited to the study of immune receptor expression from small numbers of paediatric alveolar macrophages, when CD68 is used for cell identification.
Effects of noninvasive ventilation on lung hyperinflation in stable hypercapnic COPD
Authors: Díaz O. , Bégin P. , Torrealba B. , Jover E. , Lisboa C.
Published: January 2003

Two previous uncontrolled studies have suggested that noninvasive mechanical ventilation (NIMV) in patients with hypercapnic chronic obstructive pulmonary disease (COPD) improves arterial blood gas tensions by decreasing lung hyperinflation with the consequent reduction in inspiratory loads and changes in ventilatory pattern. The aim of this randomised placebo-controlled study was to determine whether these mechanisms play a pivotal role in the effects of NIMV on arterial blood gases.

Thirty-six stable hypercapnic COPD patients were randomly allocated to NIMV or sham NIMV. A 2-week run-in period was followed by a 3-week study period, during which ventilation was applied 3 h·day−1, 5 days a week. Arterial blood gases, spirometry, lung volumes, and respiratory mechanics were measured before and after application of NIMV.

Patients submitted to NIMV showed changes (mean (95% confidence interval)) in daytime arterial carbon dioxide tension (Pa,CO2) and arterial oxygen tension of −1.12 (−1.52–−0.73) kPa (−8.4 (−11.4–−5.5) mmHg) and 1.14 (0.70–1.50) kPa (8.6 (5.3–11.9) mmHg), respectively. Total lung capacity, functional residual capacity (FRC) and residual volume were found to be reduced by 10 (7–13), 25 (18–31), and 36 (27–45)% of their predicted value, respectively, whereas forced expiratory volume in one second and forced vital capacity increased by 4 (1.5–6.9) and 9 (5–13)% pred, respectively. Tidal volume (VT) increased by 181 (110–252) mL. All of the above changes were significant compared with sham NIMV. Changes inPa,CO2were significantly related to changes in dynamic intrinsic positive end-expiratory pressure, inspiratory lung impedance,VTand FRC.

It was concluded that the beneficial effects of noninvasive mechanical ventilation could be explained by a reduction in lung hyperinflation and inspiratory loads.
Exhaled nitric oxide in specific challenge tests to assess occupational asthma
Authors: Piipari R. , Piirilä P. , Keskinen H. , Tuppurainen M. , Sovijärvi A. , Nordman H.
Published: January 2003

Exhaled nitric oxide (NO) is a marker of eosinophilic inflammation of the airway mucosa accompanying changes in the clinical condition of asthma. Allergen exposure has been associated with delayed elevation of exhaled NO. The aim of this study was to assess the asthmatic airway inflammation with exhaled NO measurements during specific bronchial challenge tests with occupational agents.

Forty patients with suspected occupational asthma were investigated. Specific bronchial challenge tests were performed with forced expiratory volume in one second or peak expiratory flow follow-up, supplemented by exhaled NO measurements before and 24 h after challenge tests.

In active challenges, which induced bronchoconstriction, a significant mean increase of exhaled NO concentration was noted. In patients with a normal or slightly increased (<14.5 parts per billion (ppb)) basal NO level and a late bronchoconstriction, a significant increase in exhaled NO was seen. Patients with a high basal NO level (>14.5 ppb) and a significant bronchoconstriction did not show a significant NO elevation. Challenge tests without bronchoconstriction were not associated with a significant elevation of exhaled NO.

Exhaled nitric oxide measurements can be used to indicate the development of airway inflammation accompanying late asthmatic reaction after bronchial challenge tests in patients with a normal or slightly increased basal nitric oxide concentration.
Copenhagen City Heart Study: longitudinal analysis of ventilatory capacity in diabetic and nondiabetic adults
Authors: Lange P. , Parner J. , Schnohr P. , Jensen G.
Published: January 2003

The natural history of lung function in diabetes is unknown due to the lack of longitudinal observations.

The decline of forced expiratory volume in one second (FEV1) and forced vital capacity (FVC) was studied over 15 yrs in the 17,506 adult participants of The Copenhagen City Heart Study, which included 266 individuals with diabetes.

Multiple linear regression and a mixed-effects model were used, taking into account correlation between repeated measurements and adjusting for relevant confounders. In both sexes, FEV1and FVC were consistently lower in diabetic individuals, compared with healthy individuals, with an average reduction of ∼8% of the predicted value. Longitudinal analyses showed that the decline of FEV1and FVC in diabetic individuals was similar to that observed in nondiabetic subjects.

It was concluded that although diabetic subjects have, on average, a lower forced expiratory volume in one second and forced vital capacity than individuals without diabetes, this deficit seems not to be progressive in the long term. These observations may be of importance with regard to diabetes treatment with inhaled pulmonary insulin, which is likely to become available within a few years.
Vascular endothelial growth factor mRNA and protein expression in airway epithelial cell linesin vitro
Authors: Koyama S. , Sato E. , Tsukadaira A. , Haniuda M. , Numanami H. , Kurai M. , Nagai S. , Izumi T.
Published: January 2003

Vascular endothelial growth factor (VEGF) plays multifunctional roles in vascular permeability, repair and remodelling processes, in addition to the maintenance of vascular structure and function. In the present study, the potential of airway epithelial cell lines, BEAS-2B cells and A549 cells, to release and express VEGF in unstimulated and stimulated conditions was evaluated.

The secretion and expression of VEGF were evaluated by enzyme-linked immunosorbant assay and by reverse transcriptase-polymerase chain reaction. The isoforms of released VEGF were determined by high-performance liquid chromatography.

BEAS-2B cells and A549 cells released VEGF constitutively. Interleukin (IL)-1β and tumour necrosis factor (TNF)-α augmented the release of VEGF in a time- and dose-dependent manner. The released VEGF was 165 amino acid residues in either condition.Pseudomonas aeruginosalipopolysaccharide (LPS), interferon (IFN)-γ, smoke extract (SE), neutrophil elastase (NE), and bradykinin stimulated the release of VEGF. Keracinocyte growth factor (KGF), which reduces vascular permeability, also stimulated both cells to release VEGF. VEGF messenger ribonucleic acid (mRNA) was expressed both time- and dose-dependently at 2 h, and declined after 2 h in response to IL-1β and TNF-α. The expression of VEGF mRNA in airway epithelial cells was also augmented by LPS, IFN-γ, SE, NE, and KGF stimulation.

These data suggest that airway epithelial cells may regulate the maintenance of vascular structure and function, as well as vascular permeability, repair and remodelling processes, in a variety of lung conditions by expressing vascular endothelial growth factor.
The management of childhood asthma in the community
Authors: Maziak W. , von Mutius E. , Beimfohr C. , Hirsch T. , Leupold W. , Keil U. , Weiland S.K.
Published: January 2003

The aim of the present study was to assess the management of children with asthma in the community.

Community-based random samples of children aged 5–7 and 9–11 yrs in Dresden and Munich, Germany, were studied in 1995–1996 using the phase II protocol of the International Study of Asthma and Allergies in Childhood. Detailed information on the use of antiasthma drugs and accessory treatment in the past year was collected by parental questionnaire. A total of 11,094 (response rate 83%) children participated.

Among children with wheeze in the last year, 36% had used bronchodilators and 19% were on regular anti-inflammatory treatment. The strongest determinant of treatment was a physician's diagnosis of asthma. Forty-seven per cent of the children with current wheeze had not been diagnosed as asthmatics and received hardly any treatment (9% bronchodilators and 2% anti-inflammatory drugs), despite an increased prevalence of severe asthma symptoms, bronchial hyperresponsiveness and atopic sensitisation compared with children without asthma symptoms. The proportion of children regularly using inhaled steroids was small (6%) among current wheezers and reached only 21% among children with diagnosed asthma and >12 wheezing attacks in the last year. Inhaled steroid use was lower in Munich than in Dresden and inversely related to the use of alternative remedies.

Further efforts to improve the diagnosis and treatment of childhood asthma are needed. These should aim to increase awareness of the chronic nature of asthma and the need for treatment according to current guidelines.
Effect of medroxyprogesterone on arterial blood gases, leptin and neuropeptide Y in postmenopausal females
Authors: Saaresranta T. , Irjala K. , Polo O.
Published: January 2003

Natural progesterone, a potent respiratory stimulant, stimulates leptin production in premenopausal females. Leptin and its counterpart neuropeptide Y (NPY) have recently been linked with respiration. The effect of medroxyprogesterone acetate (MPA) on arterial blood gases, serum leptin and NPY was evaluated in this study.

Fourteen postmenopausal females with respiratory impairment, due mostly to chronic obstructive pulmonary disease, were recruited for a randomised, double-blind, placebo-controlled crossover trial. Arterial blood gases, serum leptin and NPY concentrations were measured at baseline and after 14 days of treatment with placebo and MPA, separated by a 6-week washout period.

Thirteen patients completed the trial. The mean±sd carbon dioxide tension in arterial blood (Pa,CO2) was 5.4±0.6 kPa at baseline, and decreased by 0.8±0.3 kPa during treatment with MPA. The oxygen tension in arterial blood (Pa,O2) and pH did not change. At baseline, the mean base excess was 0.6±1.9 mmol·L−1and the mean bicarbonate (HCO3−) concentration was 25.1±1.6 mmol·L−1. With MPA, base excess decreased by 2.2±1.2 mmol·L−1and HCO3−by 1.9±1.0 mmol·L−1from baseline. The mean concentrations of serum leptin (19.8±9.9 µg·L−1at baseline, 19.7±9.8 µg·L−1with MPA) or NPY (94.0±18.3 pmol·L−1at baseline, 85.1±41.2 pmol·L−1with MPA) did not change. However, the reduction inPa,CO2correlated with the reduction of serum leptin concentration.

Medroxyprogesterone acetate effectively decreased the carbon dioxide tension in postmenopausal females with chronic respiratory impairment. The results suggest that a decrease in the carbon dioxide tension of ≥0.9 kPa is necessary for a reduction in serum leptin concentration.
What predicts poor collection of medication among children with asthma? A case-control study
Authors: Irvine L. , Crombie I.K. , Alder E.M. , Neville R.G. , Clark R.A.
Published: January 2003

Compliance with asthma medication is recognised to be a problem. Acquisition of medication is the first step towards compliance. Factors predicting poor collection of prophylactic medication were investigated.

A case/control study was conducted. Cases were children who had had at least two consultations for poorly controlled asthma in 1 yr and collected prescriptions of prophylactic medication irregularly. Controls were children whose prescriptions were collected as instructed.

Levels of knowledge about asthma and asthma medication were high in both groups. Parents of cases were more likely to perceive their child's asthma to be moderate or severe and more likely to report that their child's asthma was not well controlled. They reported more night-time symptoms, exercise symptoms and school absence. Parents of cases were less likely to report that administering inhalers was part of the evening routine. They were less likely to perceive their child's prophylactic medication to be very effective and more reluctant to administer prophylactic medication.

Some parents may decide to undertreat their children, although lack of organised routine may contribute to poor compliance. Parents need guidance on interpreting symptoms and support in establishing routines for the administration of medication.
Infrastructure, funding and follow-up in a programme of noninvasive ventilation
Authors: Leger P. , Laier-Groeneveld G.
Published: January 2003

Originating from centres charged with the care of patients with chronic respiratory insufficiency, noninvasive ventilation (NIV) has been used increasingly in chronic and acute respiratory failure during the last decade. Despite a considerable number of series and randomised studies advocating access to NIV for units that treat acute or chronic ventilatory failure, the number of units and the proportion of total ventilatory support remains poor. This is due to lack of education, as many units treat only a few patients per year. Indication, technique, education, monitoring and home care require special experience and a special environment and there is a wide range throughout Europe. With respect to home care in particular, there are many organisations, which range from totally private to hospital based or run for profit. A concerted action, funded by the European Union, will soon provide valuable information about the practice of home ventilation in Europe based on a European survey.
Organizing pneumonia in textile printing workers: a clinical description
Authors: Romero S , Hernandez L , Gil J , Aranda I , Martin C , Sanchez-Paya J
Published: January 2003

In April 1992 an outbreak of severe respiratory illness occurred among aerographic textile workers in the area of Alcoi, Autonomous Community of Valencia, Spain. An epidemiological study linked this outbreak to the use of a reformulated aerosolized product, Acramin-FWN. We analyzed clinical, laboratory, and pathological data of the first 14 patients with confirmed organizing pneumonia (OP) secondary to this newly recognized occupational toxicant. The mean age of the patients was 30 yrs. The most common clinical findings were cough (86%), epistaxis (71%), dyspnoea (64%), oppressive chest pain (57%), and crackles (50%). A restrictive functional pattern was evident in 64%. Radiographic findings consisted predominantly of patchy infiltrates in 65% and a micronodular pattern in 35%. Treatment with corticosteroids did not prevent initial progression in 11 of the 14 patients and development of irreversible respiratory failure in five patients. At necropsy, besides features of OP, interstitial fibrosis and diffuse alveolar damage were evident. A low total lung capacity, the presence of crackles at admission, and increases in the alveolar-arterial oxygen difference were predictive of death. The organizing pneumonia caused by the inhalation of Acramin-FWN is characterized by a tendency to evolve into progressive interstitial fibrosis despite the use of corticosteroids. The illness is restricted to the respiratory system and once respiratory failure has developed the prognosis is poor.
Bronchial responsiveness in active steelworkers
Authors: Corhay JL , Bury T , Louis R , Delavignette JP , Kayembe JM , Weber G , Albert A , Radermecker MF
Published: January 2003

Coke-oven workers are exposed to dust and irritant gases. Therefore they are at risk of developing lung diseases including chronic bronchitis. Nonspecific bronchial hyperresponsiveness (BHR) has been advocated as a potential risk factor predisposing to the development of chronic bronchitis. In a previous study, we showed that prevalence of BHR was higher in retired coke-oven workers than in retired blast furnace workers. The present study was carried out to determine the prevalence of BHR in active steelworkers. Thus, 137 coke-oven workers and 150 blast furnace workers underwent clinical examination, a standardized questionnaire for the study of respiratory symptoms, pulmonary function testing and methacholine aerosol challenge. The study demonstrates a higher prevalence and degree of BHR [provocative concentration of methacholine causing a 20% fall in forced expiratory volume in one second (PC20) < or = 8 mg x mL(-1)] in coke-oven workers than in blast furnace workers (31.4 versus 6.7%; p<0.001). Moreover, the frequency of respiratory symptoms and basal bronchial obstruction were greater among coke-oven workers with BHR in nonresponders. The basal maximum expiratory flow from 25-75% of forced vital capacity and the respiratory symptoms were correlated with bronchial responsiveness. The lack of correlation observed between BHR and the intensity of smoking or years spent in coke-oven environment may be explained by the high proportion of smokers, the worker turnover in the steel plant, and the "healthy worker effect". In conclusion, the higher prevalence and degree of bronchial hyperresponsiveness in coke-oven workers suggests that coke-oven pollutants are more intense irritants than those that escape from blast furnaces.
The Po River Delta Respiratory Epidemiological Survey: an analysis of factors related to level of total serum IgE
Authors: Sapigni T , Biavati P , Simoni M , Viegi G , Baldacci S , Carrozzi L , Modena P , Pedreschi M , Vellutini M , Paoletti P
Published: January 2003

The purpose of the present study was to analyse whether sex, age, skin test reactivity, cigarette smoking and occupational exposure were related to the total serum immunoglobulin (Ig)E concentrations (kU x L[-1]), in a general population sample. We studied 1,905 subjects (915 males, 990 females) of a general population sample (n=2,841, 8-73 yrs) participating in the second cross-sectional respiratory epidemiological survey in the rural Po Delta area (near Venice, North Italy). Distribution of total serum IgE concentrations was skewed, thus a log-transformation was performed to obtain a Gaussian shape. Significantly higher values of IgE were found in males compared to females. In general, a peak of IgE concentration was found at 8-14 yrs. IgE values tended to be lower in older than younger adults. Significantly higher serum IgE levels were shown in subjects with a positive skin-prick test index (ST+) than in those with a negative skin-prick test index (ST-). There was a significant relationship of total IgE levels with skin reactivity to pollens and house-dust mites. In both sexes higher values of IgE were found in current smokers than in ex-nonsmokers, regardless of skin-test reactivity. There was no significant difference in IgE values between ex- and nonsmokers. Passive smoking and occupational exposure were significantly related to increased IgE values. Our results confirm that in a general population sample immunoglobulin E concentrations are related not only to skin-prick test reactivity to common aeroallergens, but also to other risk factors for chronic obstructive lung diseases, such as sex, active/ passive smoking and occupational exposure.
Role of leukotriene B4 in bronchial hyperresponsiveness induced by interleukin-8
Authors: Fujimura M , Xiu Q , Tsujiura M , Tachibana H , Myou S , Matsuda T , Matsushima K
Published: January 2003

Repeated intranasal administration of interleukin 8 (IL-8) induces bronchial hyperresponsiveness (BHR) accompanied by lower airway neutrophil accumulation (ANA) in guinea-pigs. Leukotriene B4 (LTB4) is a chemotactic factor for neutrophils. To elucidate whether LTB4 and neutrophil elastase are involved in the IL-8-induced BHR and ANA, the effects of a LTB4 antagonist (ONO-4057) and a neutrophil elastase inhibitor (ONO-5046) on the responses were examined. IL-8 (5 microg x kg[-1]) was administered intranasally to guinea-pigs twice weekly for 3 weeks. One day after the last administration, animals were anaesthetized and artificially ventilated through tracheal cannulae, and lateral pressure at the tracheal cannula (Pao) was measured as an overall index of airway responses to inhaled histamine. ONO-4057 (2 or 20 mg x kg[-1]) or ONO-5046 (30 or 300 mg x kg[-1]) was administered intraperitoneally 24 and 1 h before anaesthesia. ONO-4057, but not ONO-5046, significantly inhibited the IL8-induced BHR and ANA, assessed by bronchoalveolar lavage, in a dose-dependent manner. These findings suggest that interleukin 8 causes bronchial hyperresponsiveness and airway neutrophil accumulation in guinea-pigs in vivo. In part this appears to be due to release of leukotriene B4, whereas it may not be mediated by neutrophil elastase.
Influence of external pH on ciliary beat frequency in human bronchi and bronchioles
Authors: Clary-Meinesz C , Mouroux J , Cosson J , Huitorel P , Blaive B
Published: January 2003

Ciliated respiratory epithelial cells have to tolerate variations in local pH caused by the respiratory cycle and potential ventilation-perfusion mismatches. We showed previously that peripheral bronchiolar cilia beat at a lower frequency than bronchial cilia, and have now investigated whether they show differences in tolerance to changes in pH. Using the image analysis system applied in the previous study, we compared variations in the ciliary beat frequencies (CBF) of bronchi and bronchioles sampled from human lung resections at various pH in vitro. Application of nonparametric tests (the variance of samples was not similar) indicated that CBF was not significantly modified when pH was varied between 7.5 and 10.5 for bronchi, and between 5.5 and 10.5 for bronchioles. Reversible and significantly lower CBF were observed below pH 7.0 for bronchi and below pH 5.0 for bronchioles. Extreme pH values such as 11.0 or 3.0 were lethal within a few minutes. Thus, respiratory ciliary beating is able to tolerate external pH variations between 3.5 and 10.5 without permanent impairment. In addition we found that alkaline pH values are more favourable than acidic ones and that bronchiolar ciliated cells are more tolerant to acidic pH than bronchial cells.
Prevalence of bronchial hyperresponsiveness to 4.5% saline and its relation to asthma and allergy symptoms in Austrian children
Authors: Riedler J , Gamper A , Eder W , Oberfeld G
Published: January 2003

The prevalence of asthma in school children has been reported to have increased, with wide variations between countries. To allow comparison of prevalence data, objective markers of asthma should be measured. Therefore, we assessed the prevalence of bronchial hyperresponsiveness (BHR) to hypertonic saline and its relation to asthma and allergy symptoms in 507 Austrian school children, aged 12-15 yrs in a cross-sectional, community based survey. These children were selected from 3,371 children who had answered a self-administered written questionnaire on asthma, hay fever, eczema and environmental factors. The prevalence of BHR to hypertonic saline was 14% and the majority (70%) of the children had mild BHR. The prevalence of wheeze in the last 12 months was 12% and of a diagnostic label of asthma was 6%. Fifty three per cent of the children with symptoms in the last 12 months and a diagnostic label of asthma had BHR, and 33% of those with symptoms in the last 12 months regardless of a diagnostic label of asthma showed a positive response to hypertonic saline. Atopic dermatitis, a diagnostic label of asthma, night cough apart from colds, wheeze in the past 12 months (but not "former wheeze") and male gender were significantly associated with increased response to 4.5% saline in the final logistic regression model. These results show that the prevalence of asthma symptoms in the last 12 months and the prevalence of bronchial hyperresponsiveness to hypertonic saline are twice that of a diagnosis of asthma and that asthma might be underdiagnosed in the present population. The response to hypertonic saline is most strongly associated with current asthma and allergy symptoms. A combination of a "diagnostic label of asthma" and "asthma symptoms in the last 12 months" might best reflect "current asthma" in epidemiological studies in this population.
Catalase, myeloperoxidase and hydrogen peroxide in cystic fibrosis
Authors: Worlitzsch D , Herberth G , Ulrich M , Doring G
Published: January 2003

An oxidant-antioxidant imbalance with damaging consequences for the bronchial epithelium has been hypothesized in the airways of patients with cystic fibrosis (CF). It is based on the assumption that neutrophils entering the lumen of the infected airways undergo activation and release toxic oxygen metabolites and myeloperoxidase (MPO), an enzyme which transforms hydrogen peroxide (H2O2) into highly toxic oxygen metabolites. Our aims were to substantiate this hypothesis. H2O2 levels were measured in breath condensates of 63 CF patients and 51 normal subjects. In CF sputum samples, activities and concentrations of MPO and catalase (CAT) were determined. MPO/H2O2-mediated cytotoxicity of CF sputum was measured in cell culture assays. H2O2 levels were similar in CF patients and normal subjects (mean +/-SD) 0.97 +/- 0.69 versus 1.11+/-0.78 microM; p=0.427). Concentrations and activities of CAT (0.31+/-0.18 microM; 105+/-69 units) and MPO (5.93+/-4.8 microM; 87.8+/-75 units) were detectable in 38 CF sputa. Addition of H2O2 to in vitro cells preincubated with CF sputum did not induce cytotoxicity even when CAT was removed from sputum. Sputum MPO together with H2O2 did not inactivate alpha-proteinase inhibitor. Preincubation of MPO with sulphated glycoconjugates or deoxyribonucleic acid (DNA) totally inhibited its cytotoxic effect. In conclusion, catalase, sulphated glycoconjugates and deoxyribonucleic acid may prevent myeolperoxidase-mediated oxygen radical generation in cystic fibrosis sputum.
Integrin dependent migration of lung cancer cells to extracellular matrix components
Authors: Bredin CG , Sundqvist KG , Hauzenberger D , Klominek J
Published: January 2003

Since tumour progression is dependent on the ability of malignant cells to interact with the extracellular matrix (ECM), we have investigated the significance of beta1 and beta3 integrins for migration of lung cancer cells to components of the ECM. In an in vitro hapto- and chemotactic assay system, five cell lines representing the major types of lung cancer were examined: adenocarcinoma (WART); squamous cell carcinoma (U-1752); small cell lung cancer (SCLC) (U-1906, 054 A) and large cell lung cancer (LCLC) (U-1810). Flow cytometric analyses were performed to characterize their integrin expression. U-1906, 054 A, WART and U-1752 all expressed beta1 integrins whereas U-1810 did not. However, U-1810 and U-1752 expressed beta3 integrins. All cell lines except U-1810 and U-1752 showed hapto- and chemotactic motility to fibronectin, laminin and type IV collagen and this motility was beta1 integrin-dependent except in the case of U-1810. However, the hapto- and chemotactic responses differed markedly between the separate cell lines and there was no distinct pattern to separate non-small cell lung cancer (NSCLC) from SCLC. No or very little migration was seen in control experiments with bovine serum albumin (BSA) or serum-free medium alone, indicating that the migration of the lung cancer cells require adhesion molecules, soluble or substratum bound. We have found the involvement of beta1 integrins in lung cancer cell migration in vitro towards fibronectin, laminin and type IV collagen except in the case of U-1810. The U-1810 cell line clearly differed from the rest of the cell lines by lacking expression of beta1 integrins.
Partitioning of the elastic work of inspiration in patients with COPD during exercise
Authors: Sliwinski P , Kaminski D , Zielinski J , Yan S
Published: January 2003

During exercise, dynamic hyperinflation-induced intrinsic positive end-expiratory pressure (PEEPi) and decreased dynamic lung compliance (CL,dyn) of patients with chronic obstructive pulmonary disease (COPD) increase the elastic work of inspiration (Wi) more than would be predicted from the increase in tidal volume (VT). This contributes significantly to their exertional breathlessness. In 10 stable patients with COPD, the dynamic Wi was measured during incremental bicycle exercise to exhaustion. The total Wi was then partitioned into the portion required to overcome PEEPi (Wi,PEEPi) and nonPEEPi elastic load (Wi,nonPEEPi). The latter is used to overcome the increase in the total respiratory system elastance during inflation. From resting breathing to peak exercise, Wi more than doubled (p<0.001). This increase was largely due to Wi,PEEPi, which significantly rose from 1.7+/-0.3 to 5.3+/-0.8 L x cm H2O(-1) (p<0.001). In comparison, Wi,nonPEEPi increased from only 3.0+/-0.4 to 5.1+/-0.5 L x cm H2O(-1) (p<0.01). Consequently, Wi,PEEPi as a fraction of total Wi increased from 35.5+/-5.6 to 51.0+/-3.3% (p<0.02). In addition, the measured Wi,nonPEEPi at peak exercise, when expressed as a percentage of its value during resting breathing, was 25% more than that predicted from the increase in VT alone. Assuming a constant chest wall compliance, this can be attributed to the exercise-induced decrease in CL,dyn, which was 0.27+/-0.04 and 0.17+/-0.02 L x cm H2O(-1) (p<0.01), respectively, during resting breathing and peak exercise. In conclusion, the dynamic hyperinflation-induced intrinsic positive end-expiratory pressure is more important than the increase in tidal volume in raising the work of inspiration during exercise in patients with chronic obstructive pulmonary disease; the decrease in dynamic lung compliance plays a definite but less important role.
Long-term treatment of alpha1-antitrypsin deficiency-related pulmonary emphysema with human alpha1-antitrypsin. Wissenschaftliche Arbeitsgemeinschaft zur Therapie von Lungenerkrankungen (WATL)-alpha1-AT-study group
Authors: Wencker M , Banik N , Buhl R , Seidel R , Konietzko N
Published: January 2003

Alpha1-antitrypsin (alpha1-AT) deficiency is a genetic disorder characterized by low serum levels of alpha1-AT and a high risk of pulmonary emphysema at a young age. The resulting surplus of proteases, mainly of neutrophil elastase, can be balanced by i.v. augmentation with alpha1-AT. However, it is not clear if affected patients benefit from long-term augmentation therapy and no long-term safety data are available. We examined 443 patients with severe alpha1-AT deficiency and pulmonary emphysema receiving weekly i.v. infusions of 60 mg x kg body weight(-1) alpha1-AT in addition to their regular medication. The progression of the disease was assessed by repeated lung function measurements, particularly the decline in forced expiratory volume in one second (deltaFEV1). Four hundred and forty three patients with alpha1-AT deficiency tolerated augmentation therapy well with few adverse reactions. The deltaFEV1 in 287 patients with available follow-up data was 57.1+/-31.1 mL x yr(-1). Stratified for baseline FEV1, the decline was 35.6+/-21.3 mL in the 108 patients with an initial FEV1 <30% and 64.0+/-26.4 mL in the 164 with FEV1 30-65% of predicted normal (p=0.0008). The remaining 15 patients had an initial FEV1 >65% pred. Long-term treatment with i.v. alpha1-antitrypsin in patients with severe alpha1-antitrypsin deficiency is feasible and safe. The decline in forced expiratory volume in one second is related to the initial forced expiratory volume in one second as in alpha1-antitrypsin deficient patients not receiving augmentation therapy.
Normative data on snoring: a comparison between younger and older adults
Authors: Stoohs RA , Blum HC , Haselhorst M , Duchna HW , Guilleminault C , Dement WC
Published: January 2003

Snoring is a common sleep-related behaviour. Increased body mass index (BMI), cranio-facial anatomical features, and older age have been linked to the occurrence of snoring. While mostly middle-aged populations have been studied for the occurrence of snoring and sleep-related breathing abnormality, this study was designed to assess the subjective report of snoring and the objective measurement of snoring at the two extremes of human age. The study design called for measurement of snoring in two age groups (college students; n=155 and older subjects; mean age 64.1 yrs n=134) with a mean age difference of 45 yrs. Snoring was assessed with a validated recording device. A validated questionnaire was used to subjectively assess snoring and obtain relevant sleep-related information. Students and older subjects differed in the self-report of snoring. While 83% of students reported "never" or "rarely" snoring only 35% of older subjects fell into these categories. Measurement of snoring during sleep revealed that students spent more time during sleep with continuous snoring than older subjects. In older subjects, a reduction in continuous snoring was accompanied by an increase in apnoeic snoring. Subjective snoring frequency correlated with continuous snoring in students only. A positive family history of snoring increased the odds ratio for self-reported snoring but not for recorded snoring. It has been shown that snoring frequency can vary depending on age and that the congruency between perceived snoring frequency and recorded snoring is influenced by the age of an individual.
Exhaled single-breath nitric oxide measurements are reproducible, repeatable and reflect levels of nitric oxide found in the lower airways
Authors: Gabbay E , Fisher AJ , Small T , Leonard AJ , Corris PA
Published: January 2003

Measurement of exhaled nitric oxide (NO) may allow noninvasive assessment of inflammatory disease in the lung. We determined immediate and day-to-day reproducibility of single-breath NO measurements at different points on the exhaled test, and whether levels recorded reflect levels of NO in the lower airways. Using a rapid chemiluminescence analyser, 55 healthy control subjects performed three sequential tests on each of two days. NO levels were compared at the level corresponding with: 1) the time the mouth pressure fell below 4 cmH2O (MP); 2) the plateau of end-exhaled CO2 (CO2); and 3) the NO plateau (NOp). NO levels were measured directly from the lower airways of 15 lung transplant recipients and compared with NO levels from a single-breath test performed in the same cohort. For measurements performed at MP, CO2 and NOp, the mean +/- SD differences between the two closest levels performed on the same day were 0.11+/-0.18, 0.095+/-0.16 and 0.094+/-0.13 parts per billion (ppb), respectively, and between days were 0.18+/-0.76, 0.19+/-0.78 and 0.17+/-0.8 ppb, respectively. End-expiratory levels recorded at the mouth from a single-breath test and in the lower airways were highly correlated (mouth versus trachea r2=0.95, p<0.0001, mouth versus bronchus r2=0.92, p<0.0001). Single-breath exhaled nitric oxide levels are a simple, reproducible and valid measure of nitric oxide production from the lower respiratory tract.
Current opinion of muco-active drug research: strategies and problems
Authors: Miyata T , Kai H , Isohama Y , Takahama K
Published: January 2003

In general, mucoactive drugs are classified into several groups. However, since many drugs have overlapping effects, it is difficult to classify the drugs into groups based on their major actions. It has been reported that many mucoactive drugs have antioxidant effects. It is reasonable to suggest that an anti-inflammatory property is crucial to demonstrate effectiveness in a clinical context. From this point of view, we have evaluated several mucoactive drugs over two decades. Of these, we will consider the following drugs with anti-inflammatory properties: sodium aceneuramate; glucocorticoids; traditional Chinese medicines; and new cysteine derivatives. On the basis of these findings, we believe that the efforts to seek for compatible actions between glucocorticoids and oriental medicines may provide new opportunities for development of ideal mucoactive drugs with specified actions, i.e. suppression of gene expression.
Early-onset phenytoin toxicity mimicking a renopulmonary syndrome
Authors: Polman AJ , van der Werf TS , Tiebosch AT , Zijlstra JG
Published: January 2003

Phenytoin is a commonly used anti-epileptic drug. Adverse reactions including fever, skin reactions and lymphadenopathy are well known but atypical reactions can also occur. A patient is described with a lag time of only 4 days between onset of phenytoin and the development of a syndrome with acute lung injury and renal failure. The symptoms mimicked a renopulmonary syndrome, and resolved completely after cessation of phenytoin and addition of steroids.
The balance of the annual heating and cooling demand within the London urban heat island
Authors: Watkins R , Palmer J , Kolokotroni M , Littlefair P
Published: January 2003

In London, the urban heat island increases the average and peak air temperatures which in turn affect the demand for heating and cooling. To assess this, the simultaneous hourly air temperature in London has been measured continuously for a year at 80 locations, on a radial grid covering an area of 500 square miles. These have shown that central areas of London are significantly warmer than the surrounding areas (2 K warmer over the year). The measured data have been used as input to a thermal simulation model to assess the heating and cooling load of a standard air-conditioned office building positioned at different locations within the heat island. It is found that the urban cooling load is up to 25% higher over the year, and the annual heating load is reduced by 22%. Minimum CO2 is emitted at a rural location. The net rate of increase of CO2 with temperature is found to be 2.8%/K.
The carbon intensity of electricity: how many kgC per kWhe?
Authors: Hitchin E R , Pout C H
Published: January 2003

While it is relatively easy to describe how a change in electricity demand causes a change in carbon emissions from a system of grid-supplied power, it is by no means easy to quantify this. The following have all been used to determine the carbon emissions from changes in electricity demand:

• the system-average carbon intensity (that is, the ratio between all carbon emitted to all power distributed);

• the carbon intensity of the typical marginal plant; and

• the carbon intensity of new plant built or avoided.

All of these are valid in certain circumstances, but in others can give misleading results. This paper brings together existing information and new results of modeling a limited number of situations to propose, pro tem, a working set of figures for England and Wales, together with recommendation for their application. Further modelling and analysis is proposed to refine thesefigures.