Immune regulation in idiopathic bronchiectasis.

Ann N Y Acad Sci. 2012 Dec;1272(1):68-72

Authors: Boyton RJ, Altmann DM

Abstract
Bronchiectasis is a complex pathological endpoint arrived at through a diverse interplay between lung infection and altered immune function. It comprises irreversible, abnormal dilatation of one or more bronchi, with chronic airway inflammation and is associated with recurrent chest infections, airflow obstruction, chronic cough, excessive sputum production, and malaise. Many pathogens are associated with this disease, including chronic bacterial infections, nontuberculous mycobacteria, and aspergillis. However, the etiology is poorly defined. Disease-associated genes indicate a likely contribution to disease mechanism both from innate and adaptive immunity. The role of immune mechanisms is highlighted by the occurrence of bronchiectasis in a subset of patients with rheumatoid arthritis or inflammatory bowel disease as well as diseases of immune dysregulation such as combined variable immune deficiency, transporter associated with antigen processing (TAP) deficiency syndrome, and hyper-IgE syndrome. Recent evidence indicates a possible role of excessive natural killer cell activation in pathogenesis.

PMID: 23231716 [PubMed - in process]

Emerging infectious diseases in 2012: 20 years after the institute of medicine report.

MBio. 2012;3(6)

Authors: Morens DM, Fauci AS

Abstract
ABSTRACT Twenty years ago (1992), a landmark Institute of Medicine report entitled "Emerging Infections: Microbial Threats to Health in the United States" underscored the important but often underappreciated concept of emerging infectious diseases (EIDs). A review of the progress made and setbacks experienced over the past 2 decades suggests that even though many new diseases have emerged, such as SARS (severe acute respiratory syndrome) and the 2009 pandemic influenza, significant advances have occurred in EID control, prevention, and treatment. Among many elements of the increase in the capacity to control EIDs are genomics-associated advances in microbial detection and treatment, improved disease surveillance, and greater awareness of EIDs and the complicated variables that underlie emergence. In looking back over the past 20 years, it is apparent that we are in a time of great change in which both the challenge of EIDs and our responses to them are being transformed. Recent advances support guarded optimism that further breakthroughs lie ahead.

PMID: 23232716 [PubMed - in process]

Transesophageal Bronchoscopic Ultrasound-Guided Fine Needle Aspiration for Diagnosis of Sarcoidosis.

Respiration. 2012 Dec 7;

Authors: Oki M, Saka H, Kitagawa C, Kogure Y, Murata N, Adachi T, Ichihara S, Moritani S

Abstract
Background: Several studies have reported that specimens from mediastinal lesions located adjacent to the esophagus can be sampled using an ultrasound bronchoscope instead of an ultrasound endoscope. Objectives: The aim of this study was to evaluate the diagnostic utility of transesophageal bronchoscopic ultrasound-guided fine needle aspiration using an ultrasound bronchoscope in patients with stage I/II sarcoidosis. Methods: Thirty-three patients suspected of having stage I/II sarcoidosis were included in this prospective study. Needle aspiration through the esophagus using an ultrasound bronchoscope was performed for hilar and/or mediastinal lymph nodes. The final diagnosis of sarcoidosis was based on clinicoradiological compatibility and pathological findings. Results: A total of 62 lymph nodes with a mean shortest diameter of 13.6 mm were examined. Of the 33 patients enrolled, 29 were given a final diagnosis of sarcoidosis. Four of the residual patients had other diseases (1 lung cancer, 1 tuberculosis, 2 non-specific lymphadenitis). Transesophageal bronchoscopic ultrasound-guided fine needle aspiration showed noncaseating epithelioid cell granulomas in 25 of 29 patients (86%; 95% confidence interval 73-100) with the final diagnosis of sarcoidosis. No complications were observed. Conclusions: Transesophageal bronchoscopic ultrasound-guided fine needle aspiration is feasible, safe and accurate for the diagnosis of stage I/II sarcoidosis.

PMID: 23234838 [PubMed - as supplied by publisher]

'Effects of continuous positive airway pressure on blood pressure in hypertensive patients with obstructive sleep apnea: a 3-year follow-up'

J Hypertens. 2012 Dec 11;

Authors: Kasiakogias A, Tsioufis C, Thomopoulos C, Aragiannis D, Alchanatis M, Tousoulis D, Papademetriou V, Floras JS, Stefanadis C

Abstract
OBJECTIVE:: Several studies have reported a small yet significant decrease in blood pressure (BP) with continuous positive airway pressure (CPAP) application in patients with obstructive sleep apnea (OSA). We investigated the long-term efficiency of CPAP in the management of hypertensive patients with OSA on top of conventional antihypertensive medication. METHODS:: We followed 91 nonsleepy patients (aged 54 ± 9 years, 69 men) with essential hypertension and newly diagnosed moderate-to-severe OSA (apnea-hypopnea index, 38 ± 24 events/h on polysomnography) for a mean period of 3.1 years, after switching them to antihypertensive treatment targeting office BP less than 140/90 mmHg (<130/80 mmHg in diabetic patients). Participants were defined as on-CPAP if they adhered to CPAP treatment during the whole follow-up period (N = 41), whereas those that did not follow CPAP therapy served as controls (N = 50). RESULTS:: By the end of follow-up, on-CPAP patients and controls exhibited similar SBP and DBP levels (133 ± 12 versus 133 ± 13 mmHg, 84 ± 9 versus 85 ± 9 mmHg, respectively, P > 0.05 for all), number of patients with controlled hypertension (71 versus 70%, P > 0.05), and number of antihypertensive drugs needed to achieve BP control (2.28 ± 1.09 versus 2.11 ± 0.72, P > 0.05). In a subgroup of patients (N = 34) in whom ambulatory BP monitoring was also performed, 24-h BP levels did not differ between the two groups (125 ± 10/76 ± 7 mmHg versus 123 ± 11/75 ± 10 mmHg, P > 0.05). In multiple regression models, CPAP application was not associated with changes in BP levels. CONCLUSION:: In nonsleepy, hypertensive, OSA patients on conventional antihypertensive treatment, long-term CPAP application is not associated with lower BP levels or a need for less antihypertensive drugs for BP control.

PMID: 23235356 [PubMed - as supplied by publisher]