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Smoke and Autoimmunity: The fire behind the disease.

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Smoke and Autoimmunity: The fire behind the disease.

Autoimmun Rev. 2016 Jan 6;

Authors: Perricone C, Versini M, Ben-Ami D, Gertel S, Abdulla W, Segel MJ, Ceccarelli F, Conti F, Cantarini L, Bogdanos DP, Antonelli A, Amital H, Valesini G, Shoenfeld Y

Abstract
The association between smoke habit and autoimmunity has been hypothesized long time ago. Smoke has been called to play a pathogenic role since in certain autoimmune disease as it may trigger the development of autoantibodies, and act on pathogenic mechanism possibly related with an imbalance of the immune system. Indeed, it has been proven by epidemiologic studies as well as in animal models the potential burden caused by smoke. For instance, smoke, by provoking oxidative stress, may contribute to lupus disease by dysregulating DNA demethylation, upregulation of immune genes and leading to autoreactivity. Moreover, it can alter the lung microenvironment, facilitating infections, which, in turn, may trigger the development of an autoimmune condition. This, in turn, may result in a dysregulation of the autoimmune system leading to autoimmune phenomena. Not only cigarette smoke, but also air pollution has been called responsible for the development of autoimmunity. These evidences suggest the need for large epidemiological studies in order to further explore the biological plausibility of smoke effect in the pathogenesis of autoimmune diseases.

PMID: 26772647 [PubMed - as supplied by publisher]

Aspergillus tubingensis: a major filamentous fungus found in the airways of patients with lung disease.

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The black Aspergillus group comprises A. niger and 18 other species, which are morphologically indistinguishable. Among this species subset, A. tubingensis, described in less than 30 human cases before 2014, is primarily isolated from ear, nose, and throat samples.

Recently, matrix-assisted laser desorption/ionization time-of-flight mass spectrometry has emerged as a powerful technique to identify microbes in diagnostic settings. We applied this method to identify 1,720 filamentous fungi routinely isolated from clinical samples our laboratory over a two-year study period. Accordingly, we found 85 isolates of A. niger, 58 of A. tubingensis, and six other black Aspergillus (4 A. carbonarius and 2 A. japonicus). A. tubingensis was the fifth most frequent mold isolated in our mycology laboratory, primarily isolated from respiratory samples (40/58 isolates).

In this study, we mainly aimed to describe the clinical pattern of Aspergillus tubingensis.We analyzed the clinical features of the patients in whom A. tubingensis had been isolated from 40 respiratory samples. Thirty patients suffered from cystic fibrosis, chronic obstructive pulmonary disease or other types of chronic respiratory failure. Strikingly, 20 patients were experiencing respiratory acute exacerbation at the time the sample was collected. Antifungal susceptibility testing of 36 A. tubingensis isolates showed lower amphotericin B MICs (P < 10(-4)) and higher itraconazole and voriconazole MICs (P < 10(-4) and P = .0331, respectively) compared with 36 A. niger isolates.

Further studies are required to better establish the role that this fungus plays in human diseases, especially in the context of cystic fibrosis and chronic pulmonary diseases.

Association between Body Mass Index (BMI) and fraction of exhaled nitric oxide (FeNO) levels in the National Health and Nutrition Examination Survey (NHANES) 2007-2010.

PURPOSE: Obesity is characterised by chronic, low-grade systemic inflammation. Elevated FeNO levels reflect airway inflammation in various lung diseases including asthma.
METHODS: This is a cross-sectional analysis of data from NHANES 2007-2010. Participants younger than 20 years old with history of cough/cold symptoms in the past 7 days, smoking, exercise in the previous hour, consumption of nitric oxide rich meats/vegetables, or use of inhaled corticosteroids during the previous 2 days were excluded. BMI (in kg/m(2)) was divided in to 4 categories: underweight (UW) (0-18.5), Normal (N) (≥18.5 to <25), Overweight (OW) (≥25 and <30) and Obese (O) ≥30.

RESULTS: There were a total of 149,629,652 weighted participants: UW (22,235,218), N (45,021,536), OW (5,1670,522) and O (50,199,974); 50.36% were men and 49.63% were women. The mean age increased with BMI category [p<.0001]. Mean FeNO levels (in ppb) increased with increasing BMI category: UW (12.52±1.05) N (16.25±0.64), OW (16.62±0.34), and O (16.78±0.39) [p=0.0035]. FEV1/FVC (%) decreased with increasing BMI category: UW (80.68) compared to N (78.51), OW (77.67) and O (78.72) [p=0.0014]. There is a weak yet statistically significant correlation between FeNO levels and both age, BMI. Multivariate analysis predicting FeNO based on BMI category, adjusting for age, gender, race and airway obstruction found age less than 60 years, male gender, certain races and UW BMI category were associated with statistically significantly lower FeNO levels.

CONCLUSIONS: Older age and male gender are associated with increased FeNO levels. Controlling for age, gender, and race, obese individuals have a statistically significantly higher FENO than underweight individuals.

Establishing a Role for Polysomnography in Hospitalized Children.

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Children with medical complexity have a high prevalence of sleep disorders. However, outpatient polysomnography to evaluate for these conditions may be difficult to perform because of lack of skilled nursing care. The aim of this study was to explore polysomnography indications in hospitalized children and assess its impact on patient care.

METHODS: Data from 85 inpatient polysomnographies of 70 children hospitalized between March and December 2014 were retrospectively collected.

RESULTS: Sixty percent of patients were boys with ages 6.5 ± 6 years. Chronic respiratory failure was present in 33.8%, airway obstruction due to defects of the tracheobronchial tree or craniofacial abnormalities in 54.3%, neurological complications of the perinatal period in 22.9%, genetic syndromes and neurodegenerative disorders in 31.4%, congenital myopathies in 5.7%, metabolic diseases in 4.3% and congenital cyanotic heart defects in 4.3%. Indications for polysomnography included assessment of chronic pulmonary disease (60%), ventilator requirements (41.2%), apnea/desaturation (23.5%), and acute life-threatening events (1.2%). Abnormal results were found in 89.4%. The observed diagnosis was obstructive sleep apnea in 64.7%, signs of chronic lung disease in 34.1%, hypoventilation in 9.4%, periodic breathing in 3.5%, and periodic limb movement of sleep in 4.7%. The following interventions were performed: adjustment of ventilator parameters (45.8%), positive airway pressure initiation (24.7%), otorhinolaryngology referral (30.6%), supraglottoplasty (2.4%), tracheostomy decannulation (2.4%), and tracheostomy placement (3.5%). Nine patients had available follow-up polysomnograms, all showing improvement in sleep variables after adherence to recommended interventions.

CONCLUSIONS: In patients with medical complexity, inpatient polysomnographies give invaluable information to guide immediate medical decision making and should be strongly considered if resources allow this.

Interaction between corticosteroids and muscarinic antagonists in human airways

Conclusions Our study provides for the first time the pharmacological rationale for combining low doses of an ICS plus a LAMA. (Source: Pulmonary Pharmacology and Therapeutics)

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