Eosinophils contribute to the resolution of lung-allergic responses following repeated allergen challenge.
 |
BACKGROUND: Eosinophils accumulate at the site of allergic inflammation and are critical effector cells in allergic diseases. Recent studies have also suggested a role for eosinophils in the resolution of inflammation.
OBJECTIVE: To determine the role of eosinophils in the resolution phase of the response to repeated allergen challenge.
METHODS: Eosinophil-deficient (PHIL) and wild-type (WT) littermates were sensitized and challenged to ovalbumin (OVA) 7 or 11 times. Airway inflammation, airway hyperresponsiveness (AHR) to inhaled methacholine, bronchoalveolar lavage (BAL) cytokine levels, and lung histology were monitored. Intracellular cytokine levels in BAL leukocytes were analyzed by flow cytometry. Groups of OVA-sensitized PHIL mice received bone marrow from WT or IL-10(-/-) donors 30 days before the OVA challenge.
RESULTS: PHIL and WT mice developed similar levels of AHR and numbers of leukocytes and cytokine levels in BAL fluid after OVA sensitization and 7 airway challenges; no eosinophils were detected in the PHIL mice. Unlike WT mice, sensitized PHIL mice maintained AHR, lung inflammation, and increased levels of IL-4, IL-5, and IL-13 in BAL fluid after 11 challenges whereas IL-10 and TGF-β levels were decreased. Restoration of eosinophil numbers after injection of bone marrow from WT but not IL-10-deficient mice restored levels of IL-10 and TGF-β in BAL fluid as well as suppressed AHR and inflammation. Intracellular staining of BAL leukocytes revealed the capacity of eosinophils to produce IL-10.
CONCLUSIONS: After repeated allergen challenge, eosinophils appeared not essential for the development of AHR and lung inflammation but contributed to the resolution of AHR and inflammation by producing IL-10.
Cost-effectiveness of CPAP treatment related to cardiovascular disease in patients with severe OSAS: the Greek experience
Obstructive sleep apnea syndrome (OSAS) is common in adults, and it is associated with increased morbidity and mortality especially due to cardiovascular disease (CVD), as reported by numerous studies.
Τhe gold standard for the diagnosis of OSAS is polysomnography (PSG) though it has a significant cost. In addition, there are cost issues related to the first-line therapy, namely the use of continuous positive airway pressure (CPAP) devices. Despite the fact that cost concerns should not deter physicians from referring patients for sleep evaluation and sleep physicians from treating them properly, the “cruel” economic rules of modern society always raise questions related to cost-effectiveness.
Several studies from the UK, Canada, and Spain have found that treatment of moderate to severe OSAS with CPAP is cost-effective. OSAS is associated with increased morbidity with consequent increased health-care costs. Thus, prevention of OSAS complications by its early diagnosis and ...
The value of non-invasive ventilation
Non-invasive ventilation (NIV) use has increased markedly over the last 10 years. Children being treated with NIV are now a common sight in most paediatric intensive care units and high dependency units and nearly all tertiary respiratory units will look after a cohort of children who use NIV at home.
Although the published evidence base for use of NIV in acute and chronic respiratory failure is relatively weak, it is now very unlikely that there will be any more randomised controlled trials of this intervention. Effectiveness of NIV will need to be evaluated on each child as it used. It is important to define the purpose of using NIV in each child, and then determine whether it is effective.
Adherence to the Global Initiative for Chronic Obstructive Lung Disease guidelines for management of COPD: A hospital‐ base study
Objectives : To determine the level of adherence to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines, we compared our inpatient management of exacerbations of chronic obstructive pulmonary disease (COPD) to these guidelines.
Method : This cross-sectional descriptive study was conducted from January 2011 to April 2012 in a 360-bed teaching hospital in Shiraz, Iran. We recorded the management data for 96 consecutive patients with COPD exacerbation. SPSS 11.5 software (SPSS Inc., Chicago, IL, USA) was used for all statistical analyses.
Results : The mean (SD) age of our patients was 67.3 (14) years, and more than 75% of them were men. Adherence for starting antibiotics was 84.4%. Most of our patients (82.3%) received oxygen therapy, for a level of adherence to GOLD recommendations of 74%. Nearly 95% received a short-acting bronchodilator and 12.5% received a long-acting bronchodilator. Adherence to the guidelines was 19.8% for oral and 61.4% for inhaled steroids. Adherence to the guidelines was 49% for starting N-acetylcysteine, 77.1% for antitussives and 13.5% for xanthine derivatives (aminophylline and theophylline).The overall adherence to GOLD guidelines was 67.2% at our hospital.
Conclusion : The level of adherence to GOLD guidelines for the management of COPD exacerbation was suboptimal at our teaching hospital. Further improvements in adherence to these guidelines are needed.
Safety of interventional bronchoscopy through complication review at a cancer center
The complication rate with regards to bronchoscopy is comparable to historical controls according to the related literature, and their occurrence appears to be sporadic, not relevant to patient characteristics and mostly related to the bronchoscopy itself rather than the introduction of new techniques. Bronchoscopy remains safe along with technical innovations. However, risk recognition and effective prevention is essential.