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Type 2 Innate Lymphocytes in Allergic Airway Inflammation.

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CD4(+) T helper-2 (Th2) cells, which produce a unique profile of IL-4, IL-5 and IL-13 pro-inflammatory cytokines, are thought to be central in the orchestration and amplification of allergic asthma. However, a novel non-T/non-B lymphoid cell population, named type 2 innate lymphocytes (ILC2s), that produces high amounts of IL-5 and IL-13 was recently discovered. Unlike Th2 cells, these ILC2s are not antigen-restricted and are activated by epithelial cell-derived cytokines IL-25 and IL-33.

In this review, we will focus on recent studies, mainly involving allergen-based mouse models, that have provided evidence for a significant contribution of ILC2 to allergic airway information.

Ion channels.

Effective therapies for the 10% of patients with 'severe' asthma remain elusive, while other pulmonary diseases such as idiopathic pulmonary fibrosis are currently untreatable.

Many cellular processes rely heavily on signals delivered by changes in the intracellular-free Ca(2+) concentration, in many cases relying on Ca(2+) influx from the extracellular fluid through specific ion channels. This Ca(2+) influx is, to some extent, dependent on the plasma membrane potential, which is controlled by the flow of other ions such as K(+) and Cl(-) through their own channels. Irrespective of the point from where pathophysiological cell function is sustained, all mechanisms are predicted to rely heavily on the activity of the final effector ion channels required for pathological cell function.

Ion channels are therefore highly attractive targets for the treatment of many diverse diseases, including those affecting the lung.

Airway Morphology From High Resolution Computed Tomography in Healthy Subjects and Patients With Moderate Persistent Asthma.

Models of the human respiratory tract developed in the past were based on measurements made on human tracheobronchial airways of healthy subjects. With the exception of a few morphometric characteristics such as the bronchial wall thickness (WT), very little has been published concerning the effects of disease on the tree structure and geometrical features.

In this study, a commercial software package was used to segment the airway tree of seven healthy and six moderately persistent asthmatic patients from high resolution computed tomography images. The process was assessed with regards to the treatment of the images of the asthmatic group. The in vivo results for the bronchial length, diameter, WT, branching, and rotation angles are reported and compared per generation for different lobes. Furthermore, some popular mathematical relationships between these morphometric characteristics were examined in order to verify their validity for both groups.

Our results suggest that, even though some relationships agree very well with previously published data, the compartmentalization of airways into lobes and the presence of disease may significantly affect the tree geometry, while the tree structure and airway connectivity is only slightly affected by the disease. Anat Rec, 2013. © 2013 Wiley Periodicals, Inc.

Sarcoidosis

This issue provides a clinical overview of sarcoidosis focusing on prevention, diagnosis, treatment, practice improvement, and patient information. Readers can complete the accompanying CME quiz for 1.5 credits.

Only ACP members and individual subscribers can access the electronic features of In the Clinic. Non-subscribers who wish to access this issue of In the Clinic can elect "Pay for View."

Subscribers can receive 1.5 category 1 CME credits by completing the CME quiz that accompanies this issue of In the Clinic.

The content of In the Clinic is drawn from the clinical information and education resources of the American College of Physicians (ACP), including PIER (Physicians' Information and Education Resource) and MKSAP (Medical Knowledge and Self Assessment Program). Annals of Internal Medicine editors develop In the Clinic from these primary sources in collaboration with the ACP's Medical Education and Publishing division and with assistance of science writers and physician writers. Editorial consultants from PIER and MKSAP provide expert review of the content. Readers who are interested in these primary resources for more detail can consult www.acponline.org, http://pier.acponline.org, and other resources referenced within each issue of In the Clinic.

Sit-to-stand test predicts 2-year COPD mortality

The sit-to-stand test can predict 2-year mortality in patients with chronic obstructive pulmonary disease, say researchers.

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