Current Issue : January - March Volume : 2017 Issue Number : 1 Articles : 6 Articles
Background: Exercise training positively influences exercise tolerance and functional capacity of patients with\nidiopathic pulmonary arterial hypertension (IPAH). However, the underlying mechanisms are unclear. We\nhypothesized that exercise modulates the activated inflammatory state found in IPAH patients.\nMethods: Single cardiopulmonary exercise testing was performed in 16 IPAH patients and 10 healthy subjects.\nPhenotypic characterization of peripheral blood mononuclear cells and circulating cytokines were assessed before,\ndirectly after and 1 h after exercise.\nResults: Before exercise testing, IPAH patients showed elevated Th2 lymphocytes, regulatory T lymphocytes, IL-6,\nand TNF-alpha, whilst Th1/Th17 lymphocytes and IL-4 were reduced. In IPAH patients but not in healthy subject,\nexercise caused an immediate relative decrease of Th17 lymphocytes and a sustained reduction of IL-1-beta and IL-\n6. The higher the decrease of IL-6 the higher was the peak oxygen consumption of IPAH patients.\nConclusions: Exercise seems to be safe from an immune and inflammatory point of view in IPAH patients. Our\nresults demonstrate that exercise does not aggravate the inflammatory state and seems to elicit an immunemodulating\neffect in IPAH patients....
Background: Airflow obstruction, which encompasses several phenotypes, is common among HIV-infected\nindividuals. Obesity and adipose-related inflammation are associated with both COPD (fixed airflow obstruction) and\nasthma (reversible airflow obstruction) in HIV-uninfected persons, but the relationship to airway inflammation and\nairflow obstruction in HIV-infected persons is unknown. The objective of this study was to determine if adiposity\nand adipose-associated inflammation are associated with airway obstruction phenotypes in HIV-infected persons.\nMethods: We performed a cross-sectional analysis of 121 HIV-infected individuals assessed with pulmonary function\ntesting, chest CT scans for measures of airway wall thickness (wall area percent [WA%]) and adipose tissue volumes\n(mediastinal and subcutaneous), as well as HIV- and adipose-related inflammatory markers. Participants were\ndefined as COPD phenotype (post-bronchodilator FEV1/FVC < lower limit of normal) or asthma phenotype (doctordiagnosed\nasthma or bronchodilator response). Pearson correlation coefficients were calculated between adipose\nmeasurements, WA%, and pulmonary function. Multivariable logistic and linear regression models were used to\ndetermine associations of airflow obstruction and airway remodeling (WA%) with adipose measurements and\nparticipant characteristics.\nResults: Twenty-three (19 %) participants were classified as the COPD phenotype and 33 (27 %) were classified as\nthe asthma phenotype. Body mass index (BMI) was similar between those with and without COPD, but higher in\nthose with asthma compared to those without (mean [SD] 30.7 kg/m2 [8.1] vs. 26.5 kg/m2 [5.3], p = 0.008). WA%\ncorrelated with greater BMI (r = 0.55, p < 0.001) and volume of adipose tissue (subcutaneous, r = 0.40; p < 0.001;\nmediastinal, r = 0.25; p = 0.005). Multivariable regression found the COPD phenotype associated with greater age\nand pack-years smoking; the asthma phenotype with younger age, female gender, smoking history, and lower\nadiponectin levels; and greater WA% with greater BMI, younger age, higher soluble CD163, and higher CD4 counts.\nConclusions: Adiposity and adipose-related inflammation are associated with an asthma phenotype, but not a\nCOPD phenotype, of obstructive lung disease in HIV-infected persons. Airway wall thickness is associated with\nadiposity and inflammation. Adipose-related inflammation may play a role in HIV-associated asthma....
Background: Autonomic dysfunction in patients with chronic obstructive pulmonary disease (COPD) may increase\nthe risks of arrhythmia and sudden death. We studied cardiac autonomic function in patients with acute\nexacerbation of COPD (AECOPD).\nMethods: Patients with AECOPD were classified into ventricular tachycardia (VT) and non-VT groups according to\nthe presence or absence of VT. The following parameters derived from 24-h Holter monitoring were compared\nbetween groups: average heart rate, heart rate deceleration capacity (DC), heart rate acceleration capacity (AC),\nstandard deviation of normal RR intervals (SDNN), standard deviation of average RR interval in 5-min segments\n(SDANN), root mean square of standard deviations of differences between adjacent normal RR intervals (rMSSD),\nlow-frequency power (LF), high-frequency power (HF) and LF/HF ratio.\nResults: Seventy patients were included, 22 in the VT group and 48 in the non-VT group. The groups had similar\nclinical characteristics (except for more common amiodarone use in the VT group, P < 0.05) and general ECG\ncharacteristics. DC, SDNN, SDANN and rMSSD were lower and AC higher in the VT group (P < 0.05). In the VT group,\nDC was correlated positively with SDNN (r = 0.716), SDANN (r = 0.595), rMSSD (r = 0.571) and HF (r = 0.486), and\nnegatively with LF (r = -0.518) and LF/HF (r = -0.458) (P < 0.05). AC was correlated negatively with SDNN (r = -0.682),\nSDANN (r = -0.567) and rMSSD (r = -0.548) (P < 0.05).\nConclusions: DC decreased and AC increased in patients with AECOPD and VT, reflecting an imbalance in\nautonomic regulation of the heart that might increase the risk of sudden death....
Background. Obstructive sleep apnea syndrome (OSAS) is associated with systemic inflammation and increased risk of\ncardiovascular and chronic kidney disease. Cystatin C (Cyst C) is a novel biomarker of both latent renal damage and cardiovascular\ndisease. Aim of the study was to measure serum levels of Cyst C, as well as IL-8 and CRP, in otherwise healthy OSAS patients.\nMethods. 84 individuals examined with polysomnography for OSAS symptoms without known comorbidities were prospectively\nrecruited. Results. According to apnea hypopnea index (AHI) subjects were divided in two groups: OSAS group (AHI > 5/hour,\n...
Background: The structural changes of the respiratory system related to ageing determine lung function decline in\nhealthy subjects after 25 years of age. An annual reduction of 25 ml in Forced Expiratory Volume in 1 s (FEV1) is\nexpected. We aimed to describe the longitudinal lung function variation of subjects with severe asthma receiving\nappropriate treatment.\nMethods: Consecutive patients enrolled in a Brazilian reference clinic between 2003 and 2006 were invited to\nparticipate. The study participants were followed up for a median of 8 years, and were evaluated with spirometry in\nthree distinct occasions (V0, V1 and V8), at least. At V0, upon enrollment, subjects with previous severe untreated\nasthma were evaluated by a specialist, had their health resource utilization in the last 12 months recorded, and\nperformed spirometry. In V1, 1 year after V0, under proper management, subjects repeated the procedures and\nanswered the Asthma Control Questionnaire (ACQ) and the Asthma Quality of Life Questionnaire (AQLQ). In the last\nstudy visit (V8), 7 years after V1, all patients underwent a pre and post-broncodilator (postBD) spirometry, skin prick\ntest for aeroallergens, answered the ACQ and the AQLQ and had another interview with the specialist.\nResults: Two hundred thirty-four subjects were followed up between V0 and V8. A comparison between\nspirometries of V1 and V8, after the initial improvement has supposedly reached a plateau, shows that the FEV1\nand FVC declined significantly both in absolute and percent of predicted values. FEV1postBD did not change\nsignificantly between V0 and V1, but declined by âË?â??27.1 (âË?â??51.1ââ?¬â??1.4) ml/yr between V1 and V8.\nConclusions: Currently available treatment with a combination of inhaled corticosteroids and LABA may not be\nsufficient to prevent lung function decline in subjects with severe asthma...
Introduction. Endobronchial ultrasound (EBUS) is a procedure that provides access to the mediastinal staging; however, EBUS\ncannot be used to stage all of the nodes in the mediastinum. In these cases, endoscopic ultrasound (EUS) is used for complete\nstaging. Objective. To provide a synthesis of the evidence on the diagnostic performance of EBUS + EUS in patients undergoing\nmediastinal staging. Methods. Systematic review and meta-analysis to evaluate the diagnostic yield of EBUS + EUS compared with\nsurgical staging. Two researchers performed the literature search, quality assessments, data extractions, and analyses.We produced\na meta-analysis including sensitivity, specificity, and likelihood ratio analysis. Results. Twelve primary studies (1515 patients) were\nincluded; two were randomized controlled trials (RCTs) and ten were prospective trials. The pooled sensitivity for combined EBUS\n+ EUS was 87% (CI 84ââ?¬â??89%) and the specificity was 99% (CI 98ââ?¬â??100%). For EBUS + EUS performed with a single bronchoscope\ngroup, the sensitivity improved to 88% (CI 83.1ââ?¬â??91.4%) and specificity improved to 100% (CI 99-100%). Conclusion. EBUS + EUS\nis a highly accurate and safe procedure. The combined procedure should be considered in selected patients with lymphadenopathy\nnoted at stations that are not traditionally accessible with conventional EBUS....
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