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Exercise training in pulmonary arterial hypertension associated with connective tissue diseases.

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Exercise training in pulmonary arterial hypertension associated with connective tissue diseases.

Arthritis Res Ther. 2012 Jun 18;14(3):R148

Authors: Grunig E, Maier F, Ehlken N, Fischer C, Lichtblau M, Blank N, Fiehn C, Stockl F, Prange F, Staehler G, Reichenberger F, Tiede H, Halank M, Seyfarth HJ, Wagner S, Nagel C

Abstract
ABSTRACT: INTRODUCTION: The objective of this prospective study was to assess short- and long-term efficacy of exercise training (ET) as add-on to medical therapy in patients with connective tissue disease-associated pulmonary arterial hypertension (CTD-APAH). METHODS: Patients with invasively confirmed CTD-APAH received ET in-hospital for 3 weeks and continued at home for 12 weeks. Efficacy parameters have been evaluated at baseline and after 15 weeks by blinded-observers. Survival rate has been evaluated in a follow-up period of 2.9+/-1.9 years. RESULTS: Twenty-one consecutive patients were included and assessed at baseline, and after 3 weeks, 14 after 15 weeks. Patients significantly improved the mean distance walked in 6 minutes compared to baseline by 67+/-52 meters after 3 weeks (p<0.001) and by 71+/-35 meters after 15 weeks (p=0.003), scores of quality of life (p<0.05), heart rate at rest, peak oxygen consumption, oxygen saturation and maximal workload. Systolic pulmonary artery pressure and diastolic systemic blood pressure improved significantly after 3 weeks of ET. The 1- and 2-year overall-survival rates were 100%, the 3-year survival 73%. In one patient lung transplantation was performed 6 months after ET. CONCLUSION: ET as add-on to medical therapy is highly effective in patients with CTD-APAH to improve work capacity, quality of life and further prognostic relevant parameters and possibly improves the 1-, 2- and 3-year survival rate. Further randomized controlled studies are needed to confirm these results. Trial registration: NCT00491309 (clinicaltrials.gov).

PMID: 22709477 [PubMed - as supplied by publisher]

Pathogenesis of influenza virus infections: the good, the bad and the ugly.

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Pathogenesis of influenza virus infections: the good, the bad and the ugly.

Curr Opin Virol. 2012 Jun;2(3):276-86

Authors: Kuiken T, Riteau B, Fouchier R, Rimmelzwaan G

Abstract
The clinical outcome of different influenza virus infections ranges from subclinical upper respiratory tract disease to fatal lower respiratory tract disease. An important determinant in the pathogenesis of these diseases is the tissue tropism of the influenza virus. Furthermore, virulence is often correlated with virus replication and is regulated by multiple virus genes. Host defense against virus infection consists of both innate and adaptive immune responses. However, excessive or dysbalanced immune response may result in lung tissue damage, reduced respiratory capacity, and severe disease or even death. By interdisciplinary efforts to better understand the intricate interaction between virus, tissue, and immune response, we may be able to find new ways to improve the outcome of influenza virus infections.

PMID: 22709515 [PubMed - in process]

Oxidative Stress in COPD Patients, Smokers and Non-Smokers Subjects.

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Oxidative Stress in COPD Patients, Smokers and Non-Smokers Subjects.

Respir Care. 2012 Jun 15;

Authors: Tavilani H, Nadi E, Karimi J, Goodarzi MT

Abstract
BACKGROUND: Oxidative stress has been known for having a key role in pathogenesis of many diseases. The aim of this study was to investigate the oxidative stress and also the relationship between antioxidant system statuses and lung function in patients with COPD and smokers and non-smokers subjects. METHODS: Thirty patients with COPD, 30 smokers and 30 healthy non-smokers participated in this study. The investigation included determination of the lung function and the measurements of plasma ceruloplasmin, ferritin, and total antioxidant capacity, also erythrocyte glutathione peroxidase, glutathione reductase, superoxide dismutase and catalase. RESULTS: Plasma ceruloplasmin, ferritin and erythrocyte glutathione peroxidase andglutathione reductase were not significantly different between the studied groups. Patients with COPD and smokers had lower catalase and superoxide dismutase activity (p<0.01) than the non-smoker group. Levels of antioxidant capacity were significantly lower in patients with COPD and smokers than in non-smoker group (p<0.01). Regression analysis revealed no correlations between antioxidant status and spirometric data. CONCLUSIONS: Decreased total antioxidant capacity in plasma of patients with COPD and smokers suggests an increased oxidative stress in this group. However no relationship was found between lung function and antioxidant systems status in COPD patients.

PMID: 22710284 [PubMed - as supplied by publisher]

Myofibroblasts in interstitial lung diseases show diverse electron microscopic and invasive features.

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Myofibroblasts in interstitial lung diseases show diverse electron microscopic and invasive features.

Lab Invest. 2012 Jun 18;

Authors: Karvonen HM, Lehtonen ST, Sormunen RT, Harju TH, Lappi-Blanco E, Bloigu RS, Kaarteenaho RL

Abstract
The characteristic features of myofibroblasts in various lung disorders are poorly understood. We have evaluated the ultrastructure and invasive capacities of myofibroblasts cultured from small volumes of diagnostic bronchoalveolar lavage (BAL) fluid samples from patients with different types of lung diseases. Cells were cultured from samples of BAL fluid collected from 51 patients that had undergone bronchoscopy and BAL for diagnostic purposes. The cells were visualized by transmission electron microscopy and immunoelectron microscopy to achieve ultrastructural localization of alpha-smooth muscle actin (α-SMA) and fibronectin. The levels of α-SMA protein and mRNA and fibronectin mRNA were measured by western blot and quantitative real-time reverse transcriptase polymerase chain reaction. The invasive capacities of the cells were evaluated. The cultured cells were either fibroblasts or myofibroblasts. The structure of the fibronexus, and the amounts of intracellular actin, extracellular fibronectin and cell junctions of myofibroblasts varied in different diseases. In electron and immunoelectron microscopy, cells cultured from interstitial lung diseases (ILDs) expressed more actin filaments and α-SMA than normal lung. The invasive capacity of the cells obtained from patients with idiopathic pulmonary fibrosis was higher than that from patients with other type of ILDs. Cells expressing more actin filaments had a higher invasion capacity. It is concluded that electron and immunoelectron microscopic studies of myofibroblasts can reveal differential features in various diseases. An analysis of myofibroblasts cultured from diagnostic BAL fluid samples may represent a new kind of tool for diagnostics and research into lung diseases.Laboratory Investigation advance online publication, 18 June 2012; doi:10.1038/labinvest.2012.95.

PMID: 22710982 [PubMed - as supplied by publisher]

Interventional Pulmonology: Focus on Pulmonary Diagnostics.

Interventional pulmonology (IP) allows comprehensive assessment of patients with benign and malignant airway, lung parenchymal and pleural disease. This relatively new branch of pulmonary medicine utilises advanced diagnostic and therapeutic techniques to treat patients with pulmonary diseases.

Endobronchial ultrasound revolutionized assessment of pulmonary nodules, mediastinal lymphadenopathy and lung cancer staging allowing minimally-invasive, highly accurate assessment of lung parenchymal and mediastinal disease, with both macro- and microscopic tissue characterization including molecular signature analysis. High spatial resolution, new endobronchial imaging techniques including Autofluorescence Bronchoscopy (ABI), Narrow Band Imaging (NBI), Optical Coherence Tomography and confocal microscopy enable detailed evaluation of airways with increasing role in detection and treatment of malignancies arising in central airways. Precision in peripheral lesion localization has been increased through innovative navigational techniques including Navigational Bronchoscopy (NB) and Electromagnetic Navigation (EMN). Pleural diseases can be assessed with the use of non-invasive pleural ultrasonography, with high sensitivity and specificity for malignant disease detection. Medical pleuroscopy is a minimally-invasive technique improving diagnostic safety and precision of pleural disease and pleural effusion assessment.

In this review we discuss the newest advances in diagnostic modalities utilized in IP, indications for their use, their diagnostic accuracy, efficacy, safety and challenges in application of these technologies in assessment of thoracic diseases.

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