bluuebunny/crossref_metadata_2025 huggingface dataset:
Effects of erythromycin onPseudomonas aeruginosaadherence to collagen and morphologyin vitro
Authors: Tsang K.W. , Ng P. , Ho P.L. , Chan S. , Tipoe G. , Leung R. , Sun J. , Ho J.C. , Ip M.S. , Lam W.K.
Published: September 2008

The airways of patients with bronchiectasis and cystic fibrosis are often chronically colonised byPseudomonas aeruginosa(PA), which is virtually impossible to eradicate. Low-dose erythromycin (EM), for unknown mechanisms, is efficacious in bronchiectasis and diffuse panbronchiolitis.

In this study, anin vitromodel to investigate PA adherence to human type IV basement collagen was developed by using scanning electron microscopy (SEM). There were significantly less PA bacilli per 20 random SEM fields (4,000×) when PA was cultured in 0.05, 0.5 and 5 µg·mL−1of EM compared with control (absence of EM). Adherence density (20 SEM fields·log−1inocular size) for PA obtained from no EM (56.8±43.16) was significantly higher than that obtained from 0.05, 0.5, and 5 µg·mL−1EM (21.5±17.56, 23.3±16.65, and 21.4±12.65 respectively). By using SEM it was found that PA, when incubated in EM (0.05, 0.5, 5 µg·mL−1) had a significant reduction in its diagonal length, radius, height, volume and surface area.

It is possible, therefore, that these misshapedPseudomonas aeruginosabacilli are more susceptible to host defence mechanisms, while at the same time less adherent to the basement membrane of the airwayin vivo. Therefore, this could help explain the clinical efficacy of low-dose erythromycin therapy on patients withPseudomonas aeruginosainfection.
Tumour necrosis factor family genes in a phenotype of COPD associated with emphysema
Authors: Ferrarotti I. , Zorzetto M. , Beccaria M. , Gilè L.S. , Porta R. , Ambrosino N. , Pignatti P.F. , Cerveri I. , Pozzi E. , Luisetti M.
Published: September 2008

Genetic factors are believed to play a role in the individual susceptibility to chronic obstructive pulmonary disease (COPD). Tumour necrosis factor (TNF) family genes have been widely investigated but inconsistent results may lie either in the genetic heterogeneity of populations or in the poor phenotype definition. A genetic study was performed using a narrower phenotype of COPD.

The authors studied 86 healthy smokers and 63 COPD subjects who were enrolled based on irreversible airflow obstruction (forced expiratory volume in one second/forced vital capacity <70% predicted) and a diffusing capacity for carbon monoxide <50% predicted (moderate-to-severe COPD associated with pulmonary emphysema). The following polymorphisms were investigated: TNF-308, the biallelic polymorphism located in the first intron of the lymphotoxin‐α gene, and exon 1 and exon 6 of the TNF receptor 1 and 2 genes, respectively.

No significant deviations were found concerning the four polymorphisms studied between the two populations.

The authors confirm that the tumour necrosis factor family genes, at least for the polymorphisms investigated, are not major genetic risk factors for chronic obstructive pulmonary disease in Caucasians, either defined in terms of emphysema (this study) or airflow obstruction (previous studies). Nevertheless, the authors would like to emphasise the importance of narrowing the phenotype in the search for genetic risk factors in chronic obstructive pulmonary disease.
Reduced lung function and risk of atrial fibrillation in The Copenhagen City Heart Study
Authors: Buch P. , Friberg J. , Scharling H. , Lange P. , Prescott E.
Published: September 2008

Chronic obstructive pulmonary disease has been associated with a high frequency of arrhythmias. Few studies have analysed the role of reduced lung function in predicting atrial fibrillation (AF). The aim of the present study was to investigate the relationship between forced expiratory volume in one second (FEV1) and risk of first episode of AF in a prospective study.

Data from 13,430 males and females without previous myocardial infarction, who participated in the Copenhagen City Heart Study, were analysed. New AF was assessed at re-examination after 5 yrs and by hospital admission for AF during a period of 13 yrs. Multivariate analyses were used with adjustment for cardiopulmonary risk factors. There were 62 new cases of AF at 5-yr follow-up (0.58%) and 290 cases (2.20%) diagnosed at hospitalisations.

Risk of new AF at re-examination was 1.8-times higher for FEV1between 60–80% of predicted compared with FEV1≥80% after adjustment for sex, age, smoking, blood pressure, diabetes and body mass index. The risk of AF hospitalisation was 1.3-times higher for FEV1between 60–80% and 1.8-times higher for FEV1<60% compared with FEV1≥80%, when additional adjustment was made for education, treatment with diuretics and chest pain at activity.

The authors conclude that reduced lung function is an independent predictor for incident atrial fibrillation.
Procalcitonin as a diagnostic tool in lower respiratory tract infections and tuberculosis
Authors: Polzin A. , Pletz M. , Erbes R. , Raffenberg M. , Mauch H. , Wagner S. , Arndt G. , Lode H.
Published: September 2008

The diagnostic significance of procalcitonin concentrations in lower respiratory tract infections and tuberculosis is not known. A prospective analysis was, therefore, performed in patients with acute exacerbation of chronic bronchitis (AECB), community-acquired pneumonia (CAP), hospital-acquired pneumonia (HAP) and tuberculosis and their procalcitonin levels compared with those of patients with noninfectious lung diseases (controls). In addition, standard inflammatory parameter data were collected.

A prospective clinical study was performed with four different groups of patients and a control group that consisted of patients with noninfectious lung diseases. A total of 129 patients were included: 25 with HAP, 26 CAP, 26 AECB, 27 tuberculosis, and 25 controls. C-reactive protein level, blood cell counts and procalcitonin concentration were evaluated on the first day after onset of clinical and inflammatory symptoms prior to treatment.

The median procalcitonin concentrations in HAP, CAP, AECB and tuberculosis were not elevated in relation to the cut-off level of 0.5 ng·mL−1. In the HAP group, in four of five patients who subsequently died, procalcitonin concentrations of >0.5 ng·mL−1were found. In acute lower respiratory infections, such as HAP, CAP and AECB, significantly elevated levels were found in comparison to the control group, but below the usual cut-off level. No differences were observed between tuberculosis and the control group.

Relative to the current cut-off level of 0.5 ng·mL−1, procalcitonin concentration is not a useful parameter for diagnosis of lower respiratory tract infections. However, compared to the control group, there were significantly elevated levels in patients with hospital-acquired pneumonia, community-acquired pneumonia and acute exacerbation of chronic bronchitis below the current cut-off level, which should be further investigated.
Airway inflammation in waste handlers exposed to bioaerosols assessed by induced sputum
Authors: Heldal K.K. , Halstensen A.S. , Thorn J. , Eduard W. , Halstensen T.S.
Published: September 2008

Work-associated lower airway inflammation in waste collectors was examined by induced sputum and correlated with the bioaerosol exposure.

Organic waste collectors (n=25) underwent induced sputum collection and spirometry before work on Monday and the following Thursday. Total cells, cell differentials, interleukin (IL)-8 and eosinophilic cationic protein were determined. Personal full-shift exposure measurements were performed Monday, Tuesday and Wednesday and analysed for total bacteria, fungal spores, endotoxins and β(1–3)-glucans.

The percentage of neutrophils (46–58%) and the IL-8 concentration (1.1–1.4 ng·mL−1) increased from Monday to Thursday. Forced expiratory volume in one second (FEV1) was significantly reduced on Thursday, and the decrease in FEV1/forced vital capacity correlated with the increase in the percentage of neutrophils. The median exposure to endotoxin (range 7–180 EU·m−3) and β(1–3)-glucan (range 5–220 ng·m−3) was correlated with the increase in IL-8.

Bioaerosol exposure during waste collection induced an inflammatory response in the lower airways, characterised by neutrophils and interleukin-8 secretion, that influenced the lung function. The inflammatory response was related to microbial components in the bioaerosol and was more pronounced for endotoxin than β(1–3)-glucan exposure. No associations were found for mould spores or bacteria.
Glucocorticoid receptor-binding characteristics in severe asthma
Authors: Bonnans C. , Chanez P. , Meziane H. , Godard P. , Bousquet J. , Vachier I.
Published: September 2008

The cellular mechanisms associated with severe asthma are still poorly understood. This study investigated the association between glucocorticoid-receptor (GR) alterations and continuous oral glucocorticoid therapy requirement in severe asthma.

GR-binding affinity (Kd) and receptor number (n) in peripheral blood monocytes (PBM) obtained from 10 normal subjects, 10 untreated, intermittent asthmatics and 10severe asthmatics were assessed. Moreover, one ability of dexamethasone to inhibit regulated on activation, T-cells expressed and secreted (RANTES) release by these cellsin vitrowas investigated. GR-binding characteristics were studied in PBM using a3H dexamethasone ligand-binding assay and Scatchard analysis. RANTES release was measured in the supernatant of PBM at 24 h using an enzyme-linked immunosorbent assay.

No significant differences in Kdand n were found between the three groups of patients. Dexamethasonein vitrowas able to inhibit RANTES release (mean±sem), with the same concentration/response curve in intermittent, untreated asthmatics (0.47±0.22versus1.64±0.31 ng·mL−1) and severe asthmatics (1.49±0.64versus2.59±0.77 ng·mL−1).

This study showed that, despite long-term treatment with oral glucocorticoids, there was no evidence of abnormalities in glucocorticoid receptor-binding characteristics in severe asthma, and moreover, it was demonstrated that glucocorticoid receptors were functionalin vitro.
Epidermal growth factor receptor expression in pre-invasive and early invasive bronchial lesions
Authors: Meert A-P. , Verdebout J-M. , Martin B. , Ninane V. , Feoli F. , Sculier J-P.
Published: September 2008

The 1999 World Health Organization/International Association for the Study of Lung Cancer histological classification of preneoplastic bronchial lesions has been shown to be reproducible but little is known about its biological significance. The current study evaluated the correspondence between the morphological changes of the bronchial epithelium and epidermal growth factor receptor (EGF-R) expression.

Thirteen normal bronchial epithelia, 19 hyperplasia, 16 metaplasia, 10 mild dysplasia, one moderate dysplasia, 10 severe dysplasia (SD), 14 carcinomain situ(CIS) and 11 microinvasive tumours were assessed. A global EGF-R score obtained by the sum of the positivity score plus the EGF-R staining intensity score was calculated for each lesion.

A global EGF-R score of >5 was reached only in one metaplasia, in six SD, in six CIS and in six microinvasive tumours. There was no difference in EGF-R expression between normal, hyperplastic and metaplastic epitheliaversusmild dysplasia or between severe dysplasiaversusCIS and microinvasive tumours but there was a statistically significant difference between mildversussevere dysplasia.

This study demonstrates that epidermal growth factor receptor expression rate changes with the stage of the bronchial lesion, increasing from normal epithelium to carcinomain situand microinvasive tumours with a statistically significant difference between mildversussevere dysplasia.
Minimal important difference of the transition dyspnoea index in a multinational clinical trial
Authors: Witek T.J. , Mahler D.A.
Published: September 2008

Dyspnoea is a primary symptom of chronic obstructive pulmonary disease (COPD). The baseline (BDI) and transition (TDI) dyspnoea indices are commonly used instruments to assess breathlessness and the impact of intervention. Its validity and pattern of response in multinational clinical trials has not been established.

In a retrospective analysis of a cohort of 997 COPD patients who received tiotropium, salmeterol or placebo, in addition to usual care, the validity and pattern of response of the BDI and TDI were examined.

The BDI was significantly correlated with the dyspnoea diary (DD) score and the symptom and activity components of the St. George's respiratory questionnaire (SGRQ), establishing concurrent validity. Furthermore, the TDI was also correlated with the changes in DD, SGRQ symptom and activity scores. Construct validity was established by the association between baseline forced expiratory volume in one second (FEV1) and BDI and ΔFEV1with TDI. Physician's global evaluation (PGE) was significantly associated with BDI as well as ΔPGE with TDI. Significant correlations have also been observed when the cohorts were classified according to native English and native non­English speaking countries. A change in PGE of 1 category (i.e.2 units on an 8‐point scale) was associated with a mean TDI of ∼1 unit (0.9–1.3 mean focal score), lending further support to the clinical significance of this change inherent in the instrument's descriptors. TDI responders (i.e.focal score ≥1 unit) used less supplemental salbutamol, had fewer exacerbations and had significantly improved health status as measured by impacts and total SGRQ scores compared with nonresponders.

In conclusion, the transition dyspnoea index is a valid instrument when used in a multinational clinical trial and the patterns of response confirm a 1‐unit change in the transition dyspnoea index focal score as being clinically important.
Biological markers in nasal secretions
Authors: Riechelmann H. , Deutschle T. , Friemel E. , Gross H-J. , Bachem M.
Published: September 2008

Biological markers in nasal secretions provide valuable information on nasal pathophysiology. However, published data on biomarker concentrations in nasal fluids are remarkably inconsistent, and the bias due to different sampling techniques, has not yet been systematically evaluated.

Concentrations of various protein were repeatedly determined in nasal secretions of 16 healthy volunteers. The proteins were detected by using: 1) α2-macroglobulin as a marker for plasma contamination; 2) lactoferrin as a marker for glandular secretion; 3) lactate dehydrogenase as a marker for tissue injury; and 4) interleukin (IL)-1β, IL-8, tumour necrosis factor-α, and eosinophil cationic protein and tryptase as indicators for tissue inflammation. A total of four different sampling methods, including nasal lavage (NL) and a new polyurethane foam sampler technique (PFST) were employed.

Analyte concentrations in NL were approximately10-times lower than in specimens obtained by PFST. Due to the unpredictable dilution during NL, various analytes were below the detection limit of the high sensitivity assays employed. With PFST, concentrations below the detection limit rarely occurred. The specimens did not significantly differ regarding plasma contamination, glandular secretion or tissue injury.

The considerable variability of reported analyte concentrations in nasal secretions mainly results from different sampling techniques. To collect nasal secretions, samplers are considered superior to nasal lavage techniques.
Alveolar macrophages are the main source for tumour necrosis factor‐α in patients with sarcoidosis
Authors: Fehrenbach H. , Zissel G. , Goldmann T. , Tschernig T. , Vollmer E. , Pabst R. , Müller-Quernheim J.
Published: September 2008

Tumour necrosis factor (TNF)‐α is known to play a major role in the formation of noncaseating granuloma, a hallmark of sarcoidosis. The main cellular sourcein situis still ambiguous.

Serial sections of transbronchial biopsies from 14 patients with and 12 without sarcoidosis were studied, using immunohistochemistry (IHC), for TNF‐α, T‐cells (CD3), macrophages (CD68), and epithelial cells (MNF116). TNF‐α spontaneously released (sr-TNF‐α) by freshly isolated bronchoalveolar lavage cells, isolated from the same patients and cultured without any stimulus over a 24‐h period was measured using an enzyme-linked immunosorbent assay.

IHC revealed colocalisation of TNF‐α with CD68 cells only. Cases with TNF‐α tissue immunoreactivity exhibited higher sr-TNF‐α (1,667±504 pg·mL−1) than cases without tissue immunoreactivity (211±60 pg·mL−1). In an explorative approach, a subgroup of patients could be identified and characterised by the presence of alveolar macrophage aggregates. It was found that sr-TNF‐α was highest in this subgroup (2,700±769 pg·mL−1) compared with patients with normal histology (221±61 pg·mL−1) or with prominent granuloma (460±137 pg·mL−1), whereas in most clinical parameters this subgroup was intermediate.

The findings from this study strongly corroborate the view that alveolar macrophages are the main cellular source for tumour necrosis factor‐α in the initial phase of sarcoidosis. The authors suggest that in these patients, aggregates of alveolar macrophages may represent at least predecessors to granulomas if not granulomasin statu nascendi.
The forced oscillation technique in clinical practice: methodology, recommendations and future developments
Authors: Oostveen E. , MacLeod D. , Lorino H. , Farré R. , Hantos Z. , Desager K. , Marchal F.
Published: September 2008

The forced oscillation technique (FOT) is a noninvasive method with which to measure respiratory mechanics. FOT employs small-amplitude pressure oscillations superimposed on the normal breathing and therefore has the advantage over conventional lung function techniques that it does not require the performance of respiratory manoeuvres.

The present European Respiratory Society Task Force Report describes the basic principle of the technique and gives guidelines for the application and interpretation of FOT as a routine lung function test in the clinical setting, for both adult and paediatric populations.

FOT data, especially those measured at the lower frequencies, are sensitive to airway obstruction, but do not discriminate between obstructive and restrictive lung disorders. There is no consensus regarding the sensitivity of FOT for bronchodilation testing in adults. Values of respiratory resistance have proved sensitive to bronchodilation in children, although the reported cutoff levels remain to be confirmed in future studies.

Forced oscillation technique is a reliable method in the assessment of bronchial hyperresponsiveness in adults and children. Moreover, in contrast with spirometry where a deep inspiration is needed, forced oscillation technique does not modify the airway smooth muscle tone. Forced oscillation technique has been shown to be as sensitive as spirometry in detecting impairments of lung function due to smoking or exposure to occupational hazards. Together with the minimal requirement for the subject's cooperation, this makes forced oscillation technique an ideal lung function test for epidemiological and field studies. Novel applications of forced oscillation technique in the clinical setting include the monitoring of respiratory mechanics during mechanical ventilation and sleep.
Does interferon‐γ improve pulmonary function in idiopathic pulmonary fibrosis?
Authors: Prasse A. , Müller K-M. , Kurz C. , Hamm H. , Virchow J.C.
Published: September 2008

Idiopathic pulmonary fibrosis (IPF) is a disease with progressive and devastating deterioration of lung function and a fatal prognosis, despite aggressive therapeutic attempts, which, in the majority of cases are futile.

Recently, a preliminary study of long-term treatment with interferon (IFN)‐γ1band low-dose prednisolone in patients with IPF suggested that IFN‐γ1btreatment may improve lung function parameters of patients with IPF. Ever since, specialists in respiratory medicine who treat patients with IPF, are called by patients demanding treatment with IFN‐γ1b. Therefore, the authors here present another prospective investigation of IFN‐γ1bin five patients with IPF.

According to the previously published design, patients received 200 µg IFN‐γ1bsubcutaneously three-times per week and 10 mg prednisolone orally for 12 months. Two patients stopped IFN‐γ1btreatment after 4 months due to side-effects and further lung function deterioration and one patient died 3 months after commencement of therapy. In total, pulmonary function improved in only one patient during IFN‐γ1btreatment, while four patients deteriorated.

To conclude, this small series of idiopathic pulmonary fibrosis cases treated with interferon‐γ1band corticosteroids does not support previous data that this treatment improves pulmonary function or alters the natural course of idiopathic pulmonary fibrosis. Furthermore, in the authors' experience, side-effects of interferon‐γ1btreatment can significantly reduce patients' quality of life.
Induction of type-IIA secretory phospholipase A2 in animal models of acute lung injury
Authors: Attalah H.L. , Wu Y. , Alaoui-El-Azher M. , Thouron F. , Koumanov K. , Wolf C. , Brochard L. , Harf A. , Delclaux C. , Touqui L.
Published: September 2008

The aim of this study was to evaluate the presence of type-II secretory phospholipase A2 (sPLA2-IIA) in alveolar space and its possible role in the destruction of surfactant in three rat models of acute lung injury.

Alveolar instillation of either lipopolysaccaride or livePseudomonas aeruginosaresulted in a significant increase in lung oedema and in a decrease in static compliance of the respiratory system together with alveolar-neutrophil influx as compared with healthy control rats.

The upregulation of messenger ribonucleic acid and sPLA2-IIA by the lung was evident. This was associated with surfactant degradation and a decrease in large:small ratio of surfactant aggregates in bacteria-instilled rats. A negative correlation between compliance and sPLA2-IIA activity in bronchoalveolar lavage fluid was shown. By contrast, during alpha naphthylthiourea-induced injury, neither alveolar-neutrophil influx nor increase in sPLA2-IIA activity was observed.

Additional experiments in rats treated with a specific inhibitor of type-II secretory phospholipase A2 activity (3 acetamine-1-benzyl-2 ethylindolyl-5 oxy; propane phosphonic acid (LY311727)) demonstrated no improvement in physiological parameters despite a biochemical effect, suggesting that its activity is only one of the multiple factors involved in the pathophysiology of lung injury.
Spectral oscillations of RR intervals in sleep apnoea/hypopnoea syndrome patients
Authors: Dingli K. , Assimakopoulos T. , Wraith P.K. , Fietze I. , Witt C. , Douglas N.J.
Published: September 2008

A recent study has shown that daytime heart rate variability is reduced in obstructive sleep apnoea/hypopnoea syndrome (OSAHS) patients. In the present study, the hypothesis was that sympathovagal balance around apnoeas/hypopnoeas and nocturnal autonomic activity are altered in OSAHS patients.

Frequency- and time-domain analyses of RR intervals were performed to monitor sympathovagal activity noninvasively. Fourteen untreated OSAHS patients and seven healthy subjects underwent overnight polysomnography.

Low (LF) and total (TF) frequency power increased 2 min around the end of apnoeas/hypopnoeas (LF 229±38 ms2, TF 345±45 ms2) compared with undisturbed sleep (LF 106±18 ms2, TF 203±23 ms2). The increase in high frequency (HF) power was not significant. LF increase was proportionally higher than the HF increase (normalised LF (LFn) 67±1 units, normalised HF (HFn) 33±1 units) compared with undisturbed sleep (LFn 52±2 units, HFn 48±2 units). RR duration did not change around apnoeas/hypopnoeas (RR 904±28 ms). The LF and TF power increase was greater around arousal-inducing (LF 260±45 ms2, TF 390±65 ms2) compared with self-terminating (LF 161±31 ms2, TF 249±40 ms2) apnoeas/hypopnoeas; the LF and LFn increases were significant in both groups compared with undisturbed sleep and HF power differences were nonsignificant. RR intervals were longer around self-terminating apnoeas/hypopnoeas (RR 914±29 ms); the differences were not significant compared with undisturbed sleep. RR interval spectral power was not influenced by the event type. RR duration decreased (912±28 ms) and LF, HF and TF power increased (LF 111±16 ms2, HF 62±6 ms2, TF 173±21 ms2) across patients, compared with healthy controls (RR 1138±91 ms, LF 57±3 ms2, HF 35±3 ms2, TF 91±6 ms2). LFn and HFn did not change significantly.

Sympathetic activity increases around apnoeas/hypopnoeas. The recurrent nocturnal fluctuations of sympathovagal balance and the overall increase of nocturnal autonomic activity may be of importance in the development of cardiovascular disease in sleep apnoea patients.
Decreased haem oxygenase-1 and increased inducible nitric oxide synthase in the lung of severe COPD patients
Authors: Maestrelli P. , Páska C. , Saetta M. , Turato G. , Nowicki Y. , Monti S. , Formichi B. , Miniati M. , Fabbri L.M.
Published: September 2008

Oxidant/antioxidant imbalance is implicated in the pathogenesis of chronic obstructive pulmonary disease (COPD).

The current study examined the expression of antioxidant and pro-oxidant enzymes, haem oxygenases (HO) and inducible nitric oxide synthase (iNOS) respectively, in patients with severe COPD and control smokers without lung function impairment. Immunoreactivity for HO-1, HO-2, iNOS and nitric oxide-derived oxidants expressed as nitrotyrosine (N-Tyr) was quantified in peripheral lung.

HO-1+ alveolar macrophages were decreased in severe COPD compared to control smokers, whereas no difference was observed in iNOS+ macrophages. In contrast, severe patients had significantly higher numbers of iNOS+ cells in alveolar walls. These iNOS+ cells were identified as type 2 pneumocytes and their number was inversely related to HO-1+ macrophages. There were no significant differences in N-Tyr immunostaining between the two groups. However, the rate of protein nitration in lungtissue was directly related to iNOS expression and associated with lower valuesofforced expiratory volume in one second/forced vital capacity. HO-2 was constitutively expressed by type 2 pneumocytes and these cells were increased in severe COPD.

In conclusion, the results suggest that the enzymes involved in the oxidative stressresponse may have a different role in the lung defence and that imbalance betweenhaemoxygenase-1 and inducible nitric oxide synthase may be associated withthe development of severe impairment in chronic obstructive pulmonary disease patients.
Prognostic features of residual pleural thickening in parapneumonic pleural effusions
Authors: Jiménez Castro D. , Díaz G. , Pérez-Rodríguez E. , Light R.W.
Published: September 2008

The objective of the study was the identification of predictive factors for the development of residual pleural thickening (RPT) in patients with parapneumonic effusion.

The design of the prospective study involved investigating patients with parapneumonic pleural effusions diagnosed between March 1991 and December 2000 in the respiratory department of Hospital Ramón y Cajal (Madrid, Spain) which is a 1,500 tertiary-care hospital.

The clinical and radiological characteristics and measurements of microbiological and biochemical variables in the pleural fluid taken from the patients were studied. RPT was defined in a posteroanterior chest radiograph as pleural thickening of ≥10 mm measured at the lateral chest wall at the level of an imaginary line, tangent to the diaphragmatic dome.

A total of 48 of the 348 patients studied (13.79%) were found to have RPT. Among the factors studied, only presence of pus in the pleural space, Fine classes IV and V, temperature ≥38°C and delayed resolution of pleural effusions after diagnosis (>15 days) were independently associated with the risk of RPT.

This study showed that significant residual pleural thickening was not a common complication of parapneumonic pleural effusions. There are certain risk factors for the development of residual pleural thickening. However, this complication was not associated with long-term functional repercussions in the series of patients involved in this study.
Coxiella burnetiipneumonia
Authors: Marrie T.J.
Published: September 2008

This report reviews the pulmonary and extrapulmonary manifestation of infections due toCoxiella burnetii.

Q fever, a zoonosis, is due to infection withC. burnetii. This spore-forming microorganism is a small Gram-negative coccobacillus that is an obligate intracellular parasite. The most common animal reservoirs are goats, cattle, sheep, cats, and occasionally dogs. The organism reaches high concentrations in the placenta of infected animals. Aerosolisation occurs at the time of parturition and infection follows inhalation of this aerosol. There are three distinct clinical syndromes of the acute form of the illness: nonspecific febrile illness, pneumonia, and hepatitis. The chronic form of Q fever is almost always endocarditis, but occasionally it is manifest as hepatitis, osteomyelitis or endovascular infection.

The pneumonic form of the illness can range from very mild-to-severe pneumonia requiring assisted ventilation. Multiple round opacities are a common finding on chest radiography. Treatment with doxycycline or a fluoroquinolone is preferred. Susceptibility to macrolides is variable.

In conclusion,Coxiella burnetiipneumonia should be considered when there is a suitable exposure history and when outbreaks of a pneumonic illness are being investigated.
Endothelial cells modulate eosinophil surface markers and mediator release
Authors: Dallaire M-J. , Ferland C. , Pagé N. , Lavigne S. , Davoine F. , Laviolette M.
Published: September 2008

Migration from blood to tissue modulates eosinophil function, possibly through interactions with endothelial cells.

The effects of contact with and migration through endothelial cells on eosinophil expression of surface markers and release of leukotriene C4were evaluated.

A small proportion (2.6%) of eosinophils spontaneously migrated through endothelial cell monolayers. Activation of endothelial cells by interleukin (IL)-4 or IL-1β slightly increased this migration (to 12.4%), which became much greater when a chemoattractant was placed in the lower chamber (84.3%). However, the chemotactic effect was downregulated by pretreating endothelial cells with interferon gamma (IFN-γ; 63.1%). At baseline, 5% of eosinophils expressed CD69; this increased to 30.7% in culture on untreated endothelial cells and to 50.9% on IL-1β-pretreated endothelial cells. This effect was mediated through intercellular adhesion molecule-1/CD11b interaction. Eosinophil migration through endothelial cells further increased CD69 expression to 63.9% and also increased CD35 expression from 83.3 to 91.3%. Upon stimulation, eosinophils that had migrated through endothelial cells produced more leukotriene C4than control cells (872.4 and 103.9 pg·mL−1, respectively). Endothelial cell pretreatment with IL-4 or IL-1β further increased leukotriene C4release (1,789.1 and 2,895.1 pg·mL−1, respectively), whereas pretreatment with IFN-γ decreased it (293.7 pg·mL−1).

These data show thatin vitrointeractions with endothelial cells upregulate eosinophil membrane receptor expression and mediator release and that these effects are differently modulated by T-helper cell type 1 and 2 cytokines. These eosinophil modulations may play an important role in asthma pathogenesis.
Predicting sleep apnoea syndrome from heart period: a time-frequency wavelet analysis
Authors: Roche F. , Pichot V. , Sforza E. , Court-Fortune I. , Duverney D. , Costes F. , Garet M. , Barthélémy J-C.
Published: September 2008

Heart rate fluctuations are a typical finding during obstructive sleep apnoea, characterised by bradycardia during the apnoeic phase and tachycardia at the restoration of ventilation. In this study, a time-frequency domain analysis of the nocturnal heart rate variability (HRV) was evaluated as the single diagnostic marker for obstructive sleep apnoea syndrome (OSAS).

The predictive accuracy of time-frequency HRV variables (wavelet (Wv) decomposition parameters from level 2 (Wv2) to level 256 (Wv256)) obtained from nocturnal electrocardiogram Holter monitoring were analysed in 147 consecutive patients aged 53.8±11.2 yrs referred for possible OSAS.

OSAS was diagnosed in 66 patients (44.9%) according to an apnoea/hypopnoea index ≥10. Using receiver-operating characteristic curves analysis, the most powerful predictor variable was Wv32 (W 0.758, p<0.0001), followed by Wv16 (W 0.729, p<0.0001) and Wv64 (W 0.700, p<0.0001). Classification and Regression Trees methodology generated a decision tree for OSAS prediction including all levels of Wv coefficients, from Wv2 to Wv256 with a sensitivity reaching 92.4% and a specificity of 90.1% (percentage of agreement 91.2%) with this nonparametric analysis.

Time-frequency parameters calculated using wavelet transform and extracted from the nocturnal heart period analysis appeared as powerful tools for obstructive sleep apnoea syndrome diagnosis.
Pulmonary echinococcosis
Authors: Morar R. , Feldman C.
Published: September 2008

Echinococcosis or hydatid disease is caused by larvae of the tapewormEchinococcus. Four species are recognised and the vast majority of infestations in humans are caused byE. granulosus.E. granulosuscauses cystic echinococcosis, which has a worldwide distribution. Humans are exposed less frequently toE. multilocularis, which causes alveolar echinococcosis.E. vogeliandE. oligarthrusare rare species and cause polycystic echinococcosis.

In cystic echinococcosis, humans are an accidental host and are usually infected by handling an infected dog. The liver and lungs are the most frequently involved organs. Pulmonary disease appears to be more common in younger individuals. Although most patients are asymptomatic, some may occasionally expectorate the contents of the cyst or develop symptoms related to compression of the surrounding structures. Other symptoms of hydatid disease can result from the release of antigenic material and secondary immunological reactions that develop from cyst rupture. The cysts are characteristically seen as solitary or multiple circumscribed or oval masses on imaging. Detection of antibody directed against specific echinococcal antigens is found in only approximately half of patients with pulmonary cysts. Surgical excision of the cyst is the treatment of choice whenever feasible.
Reduced eosinophil apoptosis in induced sputum correlates with asthma severity
Authors: Duncan C.J.A. , Lawrie A. , Blaylock M.G. , Douglas J.G. , Walsh G.M.
Published: September 2008

This study was carried out to investigate the relationship between induced sputum eosinophil apoptosis and clinical severity score, airway obstruction and symptom scores in patients with chronic stable asthma.

Altogether, 41 chronic stable asthmatic subjects of varying severity defined by Aas score and 17 control subjects underwent spirometry, symptom questionnaire and successful sputum induction. Sputum was processed and cytospins prepared for light microscopy to determine normal and apoptotic eosinophils.

Mild asthmatic subjects had a significantly lower percentage sputum eosinophils and a significantly higher eosinophil apoptotic ratio (AR) than moderate or chronic severe asthmatics. Severe asthmatic subjects had a significantly greater age, duration of asthma and sputum eosinophil count·mL−1than mild asthmatic subjects. Asthmatic subjects' symptom scores, severity scores and age inversely correlated with AR and the percentage of sputum eosinophils. Baseline forced expiratory volume in one second inversely correlated with percentage sputum eosinophils and positively correlated with AR.

The study demonstrates a relationship between reduced sputum eosinophil apoptosis and increased clinical severity of chronic stable asthma, providing additional evidence that eosinophil apoptosis may be important in the resolution of eosinophilic airway inflammation in asthma.
Evaluation of bronchoalveolar cells in pulmonary paracoccidioidomycosis
Authors: Fornazim M.C. , Balthazar A. , Quagliato R. , Mamoni R.L. , Garcia C. , Blotta M.H.S.L.
Published: September 2008

To investigate the local immune response, the cellular infiltrate and cytokine levels were analysed in bronchoalveolar lavage (BAL) from patients with pulmonary paracoccidioidomycosis. The group consisted of 19 patients aged 34–65 yrs. The diagnosis was confirmed by demonstration of the fungus in the sputum or BAL fluid and by serological tests.

Cytospin preparations showed an increased number of lymphocytes and neutrophils in BAL. A higher number of CD8+ lymphocytes were observed in BAL compared with peripheral blood. Alveolar macrophages (AM) expressed approximately three-fold more major histocompatibility class II, intercellular adhesion molecule-1 and B7-2 molecules on their surfaces than their circulating counterparts, indicating that they had differentiated into activated macrophages inside the lungs.

Cultured AM produced higher levels of interleukin (IL)‐6, tumour necrosis factor (TNF)‐α and macrophage inflammatory protein (MIP)‐1α than peripheral blood monocytes. BAL fluid contained low but detectable amounts of IL‐6, TNF‐α and MIP‐1α, and specific antibodies toParacoccidioides brasiliensis, mainly of the immunoglobulin G2isotype.

As macrophage inflammatory protein‐1α was shown to selectively attract CD8+ T‐cells and this population was elevated in bronchoalveolar lavage, the data suggest that, besides macrophages, CD8+ T‐cells may have an important role in the pathogenesis of pulmonary paracoccidioidomycosis.
Adrenal suppression from high-dose inhaled fluticasone propionate in children with asthma: Fig. 1.—
Authors: Sim D. , Griffiths A. , Armstrong D. , Clarke C. , Rodda C. , Freezer N.
Published: September 2008

This cross-sectional study was designed to examine the prevalence of adrenocortical suppression in children with asthma treated with high-dose inhaled fluticasone propionate (FP).

Children and adolescents (n=50) with asthma, treated with inhaled FP at a dose of ≥1,000 mg a day for ≥6 months, were enrolled. Early morning serum cortisol was performed. Subjects with a serum cortisol of <400 nmol·L−1had a tetracosactrin stimulation test.

Fifty subjects of mean age 13.1 yrs were treated with a mean dose of 924.7 µg·m−2·day−1FP for a mean duration of 2 yrs. Of the 50 subjects, 36 (72%) had serum cortisol levels of <400 nmol·L−1and underwent tetracosactrin stimulation test. Of these, 6 (17%) demonstrated a less than two-fold increase in serum cortisol from baseline and peak cortisol level of ≤550 nmol·L−1at 30 or 60 min poststimulation. There was a significant negative correlation between the dose of FP·m−2and stimulated peak cortisol level.

Biochemical evidence of adrenocortical insufficiency was demonstrated in 12% of the subjects, indicating that high-dose fluticasone propionate use may be associated with dose-dependent adrenocortical suppression.
A short daytime test using correlation dimension for respiratory movement in OSAHS
Authors: Miyata M. , Burioka N. , Sako T. , Suyama H. , Fukuoka Y. , Tomita K. , Higami S. , Shimizu E.
Published: September 2008

In order to examine the pathology in patients with obstructive sleep apnoea/hypopnoea syndrome (OSAHS), the nonlinear properties of respiratory movement and breath-to-breath variations during resting wakefulness with eyes closed was investigated.

Recording of the respiratory movement using inductive plethysmography was performed on 14 patients with OSAHS and 13 control subjects for 2 h in the supine position during daytime. To calculate the correlation dimension (D2) for respiratory movement, an algorithm proposed by Grassberger and Procaccia was applied. The indices of breath-to-breath variations were estimated. To calculate D2 and breath-to-breath variations, two different segments were selected (200 s each).

The value of D2 for respiratory movement in patients with OSAHS was significantly greater than that in control subjects. In the case of ≥2.0 of D2 for respiratory movement, the sensitivity and specificity of detecting the presence of OSAHS was 85.7% and 76.9%, respectively. On the basis of breath-to-breath variations, only the coefficient of variation of expiratory time for respiratory movement in patients with OSAHS was significantly greater than that in the control subjects.

In conclusion, the measurements of correlation dimensions for respiratory movement with a brief period during wakefulness may be a useful index for identifying patients with obstructive sleep apnoea/hypopnoea syndrome.
Characterisation of pleural inflammation occurring after primary spontaneous pneumothorax
Authors: De Smedt A. , Vanderlinden E. , Demanet C. , De Waele M. , Goossens A. , Noppen M.
Published: September 2008

The aim of this study was to examine the inflammatory reaction occurring in the pleural space of patients suffering from primary spontaneous pneumothorax (PSP) using pleural lavage, which was performed in patients with PSP and in healthy control subjects (essential hyperhidrosis patients undergoing thoracoscopy for sympathicolysis treatment). Cellular and solute composition of lavage fluid, peripheral blood and parietal pleural biopsies were analysed.

PSP lavage fluid showed an increase in all differentiated leucocytes, but most strikingly eosinophils and neutrophils. In the blood of patients with PSP, the total number of leucocytes and the absolute number of eosinophils, neutrophils and monocytes were also significantly increased. The time in which air was present in the pleural space was positively correlated with the increase of eosinophils in lavage fluid, parietal pleura and blood. Eosinophilic cationic protein was elevated after PSP and strongly correlated with the absolute number of lavage eosinophils. Chemo and cytokine analysis in lavage fluid showed differences in concentrations of interleukin (IL)‐5, IL‐6, IL‐8, IL‐12p40, tumour necrosis factor‐α and RANTES, but not of eotaxin. Surprisingly, high levels of lipopolysaccharide binding protein were also measured.

Primary spontaneous pnumothorax is associated with a substantial pleural inflammatory reaction. The authors hypothesise that mechanical stretch factors, lipopolysaccharide binding protein/lipopolysaccharide complexes or other environmental components trigger pleural inflammation after primary spontaneous pnumothorax.
Lung function 5 yrs after allogeneic bone marrow transplantation conditioned with busulphan and cyclophosphamide
Authors: Lund M.B. , Brinch L. , Kongerud J. , Boe J.
Published: September 2008

Long-term data on lung function after bone marrow transplantation (BMT) are inconclusive. Previously, a persistent reduction in gas transfer 1 yr after allogeneic BMT with busulphan and cyclophosphamide conditioning was reported by the current authors. In the present study this reduction was examined to see if it was permanent, transient or progressive.

Prospectively, 43 consecutive adult patients with malignant blood disorders undertook lung function measurements prior to BMT, at 3 month intervals during the 1st yr after BMT and finally after 5 yrs.

Mean baseline lung function values were >90% predicted. Within the 1st yr after BMT a transient decline in lung volumes and a persistent reduction in gas transfer were observed. After 5 yrs, baseline values were restored for all variables, except in four patients who developed obliterative bronchiolitis. Acute leukaemia and smoking were independently associated with gas transfer reductions at baseline and during the 1st yr after BMT.

Allogeneic bone marrow transplantation with busulphan and cyclophosphamide conditioning was associated with a reduction in gas transfer 1 yr after bone marrow transplantation but baseline values were usually restored after 5 yrs. Since recovery may be gradual and slow, an observation period >1 yr is required before drawing conclusions concerning the development of a permanent reduction in lung function after allogeneic bone marrow transplantation conditioned with busulphan and cyclophosphamide.
Wrist-actigraphic estimation of sleep time under nCPAP treatment in sleep apnoea patients
Authors: Gagnadoux F. , Nguyen X.L. , Rakotonanahary D. , Vidal S. , Fleury B.
Published: September 2008

The aim of this study was to correlate daily use of nasal continuous positive airway pressure (nCPAP) with total sleep time (TST) evaluated by home actigraphy.

Actigraphy was validated by comparing TST determined by actigraphy (aTST) and polysomnography (pTST) in 24 untreated patients with suspected sleep apnoea. The % sleep time spent under nCPAP was estimated on 3 consecutive days in 28 patients receiving long-term nCPAP, by comparing machine-use periods with sleep periods identified by home actigraphy.

The mean difference between pTST and aTST was 2.5 min. The correlation coefficient between aTST and pTST was 0.90. Daily use of nCPAP over the 3 study days was 388±114 min. nCPAP was used 41–100% (82±17% (mean±sd)) of sleep time detected by actigraphy. Some patients used nCPAP during nonsleep periods.

In conclusion, comparison of nasal continuous positive airway pressure use with sleep time estimated by home actigraphy shows marked individual differences in the % sleep time under nasal continuous positive airway pressure. These results suggest that actigraphic estimation of sleep time under nasal continuous positive airway pressure could provide a better index than simple daily use of the device to evaluate the impact of treatment in sleep apnoea.
Spontaneous pneumomediastinum in patients with severe acute respiratory syndrome
Authors: Chu C.M. , Leung Y.Y. , Hui J.Y.H. , Hung I.F.N. , Chan V.L. , Leung W.S. , Law K.I. , Chan C.S. , Chan K.S. , Yuen K.Y.
Published: September 2008

Spontaneous pneumomediastinum (SP) unrelated to assisted ventilation is a newly recognised complication of severe acute respiratory syndrome (SARS). The objective of the present study was to examine the incidence, risk factors and the outcomes of SP in a cohort of SARS victims from a community outbreak.

Data were retrieved from a prospectively collected database of virologically confirmed SARS patients. One hundred and twelve cases were analysable, with 13 patients developing SP (11.6%) at a mean±sd of 19.6±4.6 days from symptom onset.

Peak lactate dehydrogenase level was associated with the development of SP. SP was associated with increased intubation and a trend towards death. Drainage was required in five cases. For patients who survived, the SP and/or the associated pneumothoraces took a median of 28 days (interquartile range: 15–45 days) to resolve completely.

In conclusion, spontaneous pneumomediastinum appeared to be a frequent complication of severe acute respiratory syndrome. Further research is needed to investigate its pathogenesis.