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[The small airways: Normal histology and the main histopathological lesions].

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[The small airways: Normal histology and the main histopathological lesions].

Rev Mal Respir. 2013 Apr;30(4):286-301

Authors: Kambouchner M

Abstract
Lesions of the small airway are observed in a wide variety of pulmonary conditions, most of which are due to infection, tobacco and connective tissue diseases. They are sometimes isolated or, more often, associated with involvement of other pulmonary structures such as the bronchi, the lung parenchyma and the pleura. The pathological spectrum of the bronchiolar response to injury is relatively limited. Thus, the same lesion is observed in various clinical settings. There is no correlation between the severity of the small airway involvement seen by the pathologist and the clinical and functional manifestations of bronchiolitis. The causes of bronchiolitis may be classified on a clinical basis, on aetiology or on histological appearance, yet no single classification appears to be suitable. An integrated clinical, radiological, functional and histological approach is needed. As they are seen by the pathologist microscopically, small airway lesions may be subdivided into three categories: (1) simple nonspecific lesions (bronchiolitis - cellular, follicular, granulomatous, obliterative, constrictive) that are never exclusively related to one clinical picture, (2) or displaying a more specific pattern like the respiratory bronchiolitis of the smoker or the histolgical changes of asthma, (3) bronchiolar lesions in conditions described as "interstitial", predominantly centrilobular, involving the small airways and the lung parenchyma, and visible radiologically. After recalling the normal histological appearances of the bronchioles, this review describes the diversity of the histopathological lesions of the small airways.

PMID: 23664287 [PubMed - in process]

Pulmonary vascular mechanics: Important contributors to the increased right ventricular afterload of pulmonary hypertension.

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Pulmonary vascular mechanics: Important contributors to the increased right ventricular afterload of pulmonary hypertension.

Exp Physiol. 2013 May 10;

Authors: Wang Z, Chesler NC

Abstract
Chronic hypoxia causes pulmonary vasoconstriction and vascular remodeling, which lead to hypoxic pulmonary hypertension (HPH). HPH is associated with living at high altitudes and is a complication of many lung diseases, including chronic obstructive pulmonary disease, cystic fibrosis, and obstructive sleep apnea. Pulmonary vascular changes that occur with HPH include stiffening and narrowing of the pulmonary arteries that appear to involve all vascular cell types and sub-layers of the arterial wall. Right ventricular (RV) changes that occur with HPH include RV hypertrophy and RV fibrosis, often with preserved systolic and diastolic function and ventricular-vascular coupling efficiency. Both vascular stiffening and narrowing are important contributors to RV afterload via increases in oscillatory and steady ventricular work, respectively. The increased blood viscosity that occurs in HPH can be quite dramatic and is another important contributor to RV afterload. However, the viscosity, vascular mechanics and ventricular changes that occur with HPH are all reversible. Furthermore, even with continued hypoxia vascular remodeling does not progress to the obliterative, plexiform lesions that are seen clinically in severe pulmonary hypertension. In animal models, the RV changes appear adaptive, not maladaptive. In summary, HPH-induced vascular mechanical changes affect ventricular function but both are adaptive and reversible, which differentiates HPH from severe pulmonary hypertension. The mechanisms of adaptation and reversibility may provide useful insight into therapeutic targets for the clinical disease state.

PMID: 23666792 [PubMed - as supplied by publisher]

Intima-Media Thickness in Patients With Obstructive Sleep Apnea Without Comorbidities.

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Intima-Media Thickness in Patients With Obstructive Sleep Apnea Without Comorbidities.

Lung. 2013 May 14;

Authors: Gorzewska A, Specjalski K, Drozdowski J, Kunicka K, Swierblewska E, Bieniaszewski L, Słomiński JM, Jassem E

Abstract
BACKGROUND: Obstructive sleep apnea (OSA) is associated with elevated risk of cardiovascular events. The early stages of vascular complications can be visualized by means of ultrasound. Intima-media thickness (IMT) correlates with the presence of risk factors of cardiovascular diseases such as hypertension, diabetes, tobacco smoking, or hyperlipidemia. However, little is known whether OSA itself may be the cause of IMT thickening. METHODS: The study group was composed of 28 patients (6 women, 22 men; mean age = 53.8 years, mean BMI = 27.1 kg/m(2), mean AHI = 22.4/h) with OSA who had no comorbidities. The control group consisted of 28 healthy subjects (6 women, 22 men; mean age = 53.9 years; mean BMI = 27.5 kg/m(2)). In both groups IMT was assessed in common carotid arteries with the use of ultrasonography. Additionally, in patients with OSA, pulse wave velocity, echocardiography, 24-h automated blood pressure monitoring, clinical signs and symptoms, and blood tests were performed to investigate possible correlations with IMT. RESULTS: Median IMT was 0.41 mm in OSA patients and 0.46 mm in the control group (p = 0.087). Echocardiography revealed left ventricle hypertrophy in 21 %, systolic disorders in 8 %, and diastolic disorders in 57 % of the patients. In a large majority of patients, pulse wave velocity was found to be normal. IMT correlated with age (r = 0.446, p = 0.017), total cholesterol (r = 0.518, p = 0.005), daytime systolic blood pressure (r = 0.422, p = 0.025), pulse pressure 24 h and daytime (r = 0.424, p = 0.027 and r = 0.449, p = 0.019), early mitral flow/atrial mitral flow (E/A) (r = -0.429, p = 0.023), and posterior wall diameter (PWD) (r = 0.417, p = 0.270). CONCLUSION: In a relatively nonobese group of patients, no significant differences were found in the intima-media thickness between OSA patients without concomitant cardiovascular diseases and healthy controls. This may lead to the conclusion that IMT does not reflect increased risk of cardiovascular events in patients with isolated OSA.

PMID: 23670279 [PubMed - as supplied by publisher]

Molecular classification of non-small-cell lung cancer: diagnosis, individualized treatment, and prognosis.

Non-small-cell lung cancer (NSCLC) is the most common cause of premature death among the malignant diseases worldwide. The current staging criteria do not fully capture the complexity of this disease. Molecular biology techniques, particularly gene expression microarrays, proteomics, and next-generation sequencing, have recently been developed to facilitate effectively its molecular classification. The underlying etiology, pathogenesis, therapeutics, and prognosis of NSCLC based on an improved molecular classification scheme may promote individualized treatment and improve clinical outcomes.
This review focuses on the molecular classification of NSCLC based on gene expression microarray technology reported during the past decade, as well as their applications for improving the diagnosis, staging and treatment of NSCLC, including the discovery of prognostic markers or potential therapeutic targets. We highlight some of the recent studies that may refine the identification of NSCLC subtypes using novel techniques such as epigenetics, proteomics, or deep sequencing.

PMID: 23681892 [PubMed - as supplied by publisher]

Mapping the future for pulmonary fibrosis.

Pulmonary fibrosis is the ultimate outcome of various interstitial lung diseases, many of which have a dismal prognosis. Pulmonary fibrosis therefore represents a critical unmet medical need. Progress in research over the last 30 years has been encouraging. This work, which has been funded by governments, charitable trusts, industries and patient groups, has resulted in clinical trials testing novel drugs, giving hope to patients. In late September 2012, representatives from across academics, industry, and funding agencies met at the 17(th) International Colloquium on Airway and Lung Fibrosis Meeting to discuss state-of-the-art knowledge of pulmonary fibrosis.
This manuscript summarizes the outcome of the meeting, highlighting the most relevant results and discoveries. It also attempts to provide a roadmap for future studies. It is hoped that such a roadmap may help all interested parties to generate new research, which will be vital to continued progress. We are encouraged by the commitment expressed by all participants at this meeting and the shared vision of promoting future progress through international collaboration, the pooling of valuable resources, and the involvement of new generation of physicians and scientists.

PMID: 23682111 [PubMed - as supplied by publisher]

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