145 research outputs found
Sputum color as a marker of acute bacterial exacerbations of chronic obstructive pulmonary disease
No full textSummaryWe analyzed 795 sputa from 315 patients (233 males, mean age 69.3±8.8 years, mean number of exacerbations 2.52/patient) with acute exacerbations of moderate-to-severe chronic obstructive pulmonary disease (COPD) (mean steady-state FEV1 42.5±7.8% of predicted). 581/795 sputa were considered adequate. Sputum was analyzed by a quali-quantitative colorimetric scale allowing both color distinction and color degree of intensity. Quantitative culture was then performed (threshold: >106CFU/mL). Samples were distinguished in mucoid (145) and purulent (436) sputa. Absence of bacterial growth was observed in 22% and 5% of mucoid and purulent sputa, respectively. Among mucoid sputa, Gram positive bacterial growth occurred more commonly compared to Gram negative and Pseudomonas aeruginosa/Enterobacteriaceae (56%, 24%, 20%, respectively). In purulent sputa, Gram positives were found in 38% of cases, Gram negatives in 38%, and P. aeruginosa/Enterobacteriaceae in 24%. We evaluated whether functional impairment (FEV1) orientates as to the infectious etiology of exacerbations. Significant differences were observed in the distribution of pathogens. Gram negative and P. aeruginosa/Enterobacteriaceae were isolated more frequently in the sputum when FEV1 was <35%. Our study indicates that purulent sputum is strongly associated with bacterial growth in COPD exacerbations. Deepening sputum color (from yellowish to brownish) was associated with increased yield of Gram negative and P. aeruginosa/Enterobacteriaceae
Elevated Tnf-α and Interleukin-6 levels In breath condensate and serum of patients with Non-Cf bronchiectasis comparison to COPD
No full textIntoduction: Exhaled breath condensate (EBC) allows non invasive studies in airway diseases. In bronchiectasis (Br-ect), chronic airway inflammation is an important feature.
Methods: To evaluate the levels of TNF- and IL-6 in EBC and serum of patients (pts) with Br-ect and to compare to COPD, we studied 19 bronchiectatic, nonsmoker pts (mean age±sd 59 ±15y, 12F), 18 COPD pts, ex-smokers (68±6.2 y, 3F), and 18 non smoker controls (63±6y, 5F). Spirometry was performed and the concentration of the inflammatory markers was determined by enzyme immunoassay (Chayman Chem, USA).
Results: Results on the table are expressed as mean (±SD) TNF – (EBC,pg/ml) TNF- (serum,pg/ml) IL-6 (EBC,pg/ml) IL-6 (serum,pg/ml) FEV1 (%pred) FVC (%pred) FEV1/FVC Bronchiectasis 7.1 (±0.1) 14.7(±3.1) 5.7(±0.3) 18.5(±9.0) 65,1±27 81.5±22 63±11 COPD 7.7 (±0.3) 15.2 (±2.8) 8.1(±0.3) 26.4(±12.9) 56.3±15 75.5±18,2 58.7±8,6 Controls 6.4 (±0.6) 7.2 (±1.1) 4.9(±0.6) 10.6(±3.1) 94±5 98±6 95
Conclusions :In Br-ect the concentration of TNF- and IL-6 in both EBC and serum was significantly higher than in controls and lower than in COPD (p<0.0001). In Br-ect group, no correlation was found between TNF-, IL-6 levels and the lung function parameters. In COPD group a negative correlation was found between IL-6 in EBC and FEV1/FVC (p=0.02, r=-0.5).
In bronchiectasis TNF- and IL-6 may reflect airway inflammation as they are elevated in EBC and serum, compared to healthy controls, but they are lower than in COPD.
In COPD, IL-6 in EBC may be related to the disease severity
Corrigendum: Longitudinal "Real-World" outcomes of pirfenidone in idiopathic pulmonary fibrosis in Greece [Front Med, 4, 213, (2017)] doi: 10.3389/fmed.2017.00213
No full textIn the original article, there was a mistake in Figure 1 as published [x and y axes were mislabeled and *p-value < 0.05 indicating significance was missing]. The corrected Figure 1 appears below. The authors apologize for this error and state that this does not change the scientific conclusions of the article in any way. © 2018 Tzouvelekis, Karampitsakos, Ntolios, Tzilas, Bouros, Markozannes, Malliou, Anagnostopoulos, Granitsas, Steiropoulos, Dimakou, Chrysikos, Koulouris and Bouros
The overlap between bronchiectasis and chronic airway diseases: state of the art and future directions
No full textBronchiectasis is a clinical and radiological diagnosis associated with cough, sputum production and recurrent respiratory infections. The clinical presentation inevitably overlaps with other respiratory disorders such as asthma and chronic obstructive pulmonary disease (COPD). In addition, 4-72% of patients with severe COPD are found to have radiological bronchiectasis on computed tomography, with similar frequencies (20-30%) now being reported in cohorts with severe or uncontrolled asthma. Co-diagnosis of bronchiectasis with another airway disease is associated with increased lung inflammation, frequent exacerbations, worse lung function and higher mortality. In addition, many patients with all three disorders have chronic rhinosinusitis and upper airway disease, resulting in a complex "mixed airway" phenotype.The management of asthma, bronchiectasis, COPD and upper airway diseases has traditionally been outlined in separate guidelines for each individual disorder. Recognition that the majority of patients have one or more overlapping pathologies requires that we re-evaluate how we treat airway disease. The concept of treatable traits promotes a holistic, pathophysiology-based approach to treatment rather than a syndromic approach and may be more appropriate for patients with overlapping features.Here, we review the current clinical definition, diagnosis, management and future directions for the overlap between bronchiectasis and other airway diseases
Airway remodelling in children with asthma.
No full textIn questo abstract vengono descritti alcuni aspetti istologici della mucosa bronchiale di bambini asmatici, prelievi ottenuti con biopsia della mucosa fatta per via endoscopic
Public T cell receptor ?-chains are not advantaged during positive selection
No full textStudies of human and murine T cells have shown that public TCR beta-chain rearrangements can dominate the Ag-specific and naive repertoires of distinct individuals. We show that mouse T cells responding to the minor histocompatibility Ag HYD(b)Smcy share an invariant V beta 8.2-J beta 2.3 TCR gene rearrangement. The dominance of this rearrangement shows that it successfully negotiated thymic selection and was highly favored during clonal expansion in all animals examined. We hypothesized that such beta-chains are advantaged during thymic and/or peripheral selection and, as a result, may be over-represented in the naive repertoire. A sequencing study was undertaken to examine the diversity of V beta 8.2-J beta 2.3 CDR3 loops from naive T cell repertoires of multiple mice. Public TCR beta-chain sequences were identified across different repertoires and MHC haplotypes. To determine whether such public beta-chains are advantaged during thymic selection, individual chains were followed through T cell development in a series of novel bone marrow competition chimeras. We demonstrate that beta-chains were positively selected with similar efficiency regardless of CDR3 loop sequence. Therefore, the establishment and maintenance of public beta-chains in the periphery is predominantly controlled by post-thymic events through modification of the primary, thymus-derived TCR repertoire
A rare case of primary intrapulmonary neurilemmoma diagnosed in a 43-year-old asymptomatic man with a well-defined intrapulmonary mass
No full textNeurilemmoma (NL), also termed schwannoma, presents as a well-circumscribed and encapsulated mass in the human body and is almost always solitary. CT scan of a patient with NL shows a round, ovoid, or lobulated well-demarcated solid mass of soft tissue density. Primary intrathoracic neurogenic tumors location varies. However, the development of such tumors is by far more common in the costovertebral angle of the posterior mediastinum. Here, we report a rare case of a 43-year-old patient, never smoker and previously healthy, who presented with a mass adjacent to the right pulmonary hilum. This was an incidental finding on a chest X-ray after annual checkup at his workplace. The diagnosis was primary intrapulmonary NL. Primary intrapulmonary NL is an extremely rare tumor. However, based on the above, chest CT findings of a well-defined solid mass in an asymptomatic patient should raise the suspicion of NL, irrespective of the tumor localization. © 2018 Chrysikos, Kaponi, Triantafillidou, Karampitsakos, Tzouvelekis, Anyfanti, Marossis, Konstantinou, Tringidou, Bouros and Dimakou
Clinical phenotypes in adult patients with bronchiectasis
No full textBronchiectasis is a heterogeneous disease. This study aimed at identifying discrete groups of patients with different clinical and biological characteristics and long-term outcomes.This was a secondary analysis of five European databases of prospectively enrolled adult outpatients with bronchiectasis. Principal component and cluster analyses were performed using demographics, comorbidities, and clinical, radiological, functional and microbiological variables collected during the stable state. Exacerbations, hospitalisations and mortality during a 3-year follow-up were recorded. Clusters were externally validated in an independent cohort of patients with bronchiectasis, also investigating inflammatory markers in sputum.Among 1145 patients (median age 66 years; 40% male), four clusters were identified driven by the presence of chronic infection with Pseudomonas aeruginosa or other pathogens and daily sputum: “Pseudomonas” (16%), “Other chronic infection” (24%), “Daily sputum” (33%) and “Dry bronchiectasis” (27%). Patients in the four clusters showed significant differences in terms of quality of life, exacerbations, hospitalisations and mortality during follow-up. In the validation cohort, free neutrophil elastase activity, myeloperoxidase activity and interleukin-1β levels in sputum were significantly different among the clusters.Identification of four clinical phenotypes in bronchiectasis could favour focused treatments in future interventional studies designed to alter the natural history of the disease
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