1,721,096 research outputs found
Telomeropathies: an emerging spectrum of disorders with important implications for patients with interstitial lung disease
No full textGrowing evidence demonstrates that a number of clinical disorders may be related to genetic defects in telomere replication and extension. Overall, these syndromes are referred to as "telomeropathies" or "telomere disorders/syndromes"; they are increasingly being identified. In adulthood, idiopathic pulmonary fibrosis (IPF) is the most common symptom of telomeropathy. IPF is a progressive and fatal disease characterized by scarring of the lungs that thickens the interstitium ultimately leading to irreversible respiratory failure. Starting from this basis, the present review analyzes and discusses the findings of a relevant paper by Gautam George and colleagues from the Division of Pulmonary and Critical Care Medicine at Brigham and Women's Hospital and Harvard Medical School in Boston, MA, recently appeared on the prestigious journal CHEST. In a cohort of patients addressed to lung transplantation, authors were able to demonstrate that subclinical bone marrow and liver abnormalities can be seen in patients with interstitial lung disease (ILD) and short telomeres, in some cases in the absence of clinically significant abnormalities in peripheral blood count and liver function tests. This observation sustains the rationale for further studies aimed to validate telomere length testing as a useful parameter as part of the evaluation for transplant candidacy. A deeper clarification of the complex link between IPF and short telomeres and telomeropathies is required for a new ILD classification, aimed to a fully personalized approach to the disease
Non invasive ventilation in the treatment of obstructive sleep apnea syndrome: Continuous positive airways pressure and more
No full textObstructive sleep apnea syndrome (OSAS) is characterized by repetitive obstruction of the upper airways often resulting in oxygen desaturation and arousal from sleep, excessive sleepiness and other consequences for health with an increase in morbility and mortality. Continuous positive airways pressure (CPAP) is currently considered to be the cornerstone of the therapy for OSAS. CPAP is immediately and consistently effective in relieving sleep apnea and daytime symptoms. CPAP reduces the incidence of accidents on the road, at work or at home, it is likely that CPAP has beneficial effects on daytime hypertension and that it reduces cardiovascular morbidity and mortality in the long term, but this has yet to be demonstrated unequivocally. The pressure should be titrated manually in the sleep laboratory during a full night of polysomnography, to eliminate apneas, hypopneas, snoring and sleep fragmentation, but it is possible use other strategies for titration. AutoCPAP (also called intelligent of self-adjusted CPAP) can be used for titration before switching to constant CPAP machine or can be used for long-term therapy. In the minority of OSAS patients requiring high levels of pressure or exhibiting chronic alveolar hypoventilation, clinical experience suggests that BiPAP could be of interest. Common difficulties associated with CPAP therapy include sense of dryness in the mouth, rhinorrhea, nasal congestion and mask discomfort, claustrophobia ets. Therefore, many patients are unable to or unwilling to comply with the use of CPAP, on this regard the various non-CPAP approaches are developed for the management of OSAS. A weight-reducing diet should be considered an important element not only as a treatment option, but also in the prevention and management of OSAS because obesity comprises airway function by altering pharyngeal size or geometry. Patients with OSAS should abstain from alcohol because it reduces the motor activity of the airway resistance and predispose to occlusion during sleep. Patients who use benzodiazepines, narcotics and barbiturates reported clinically significant upper way obstruction. The role of drug therapy in the treatment of OSAS is not well known. The 2 most extensively used pharmacological agents for treating OSAS have been medroxyprogesterone and the tricyclic antidepressant such us protriptiline. The use of oral appliance for the treatment of snoring and OSAS is relatively new field, with the result that there are many unanswered questions in this regard but it could be a reliable option for treating socially destructive snoring. Surgical management should be direct to the anatomic region involved and have specific goals for clearance at the respective obstruction levels. Presurgical evaluation for appreciation of the type of anatomic abnormality present and the degree of severity of OSAS is very important. However, none of these has been shown to be superior to CPAP. In the clinical practice, only selected patients will benefit from therapies other than CPAP
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Severe uncontrolled asthma with bronchiectasis: a pilot study of an emerging phenotype that responds to mepolizumab
Full text linkGiovanna E Carpagnano,1 Giulia Scioscia,1 Donato Lacedonia,1 Giacomo Curradi,2 Maria Pia Foschino Barbaro1 1Department of Medical and Surgical Sciences, Institute of Respiratory Diseases, University of Foggia, Foggia, Italy; 2Medical and Scientific Department, GlaxoSmithKline, Verona, Italy Background: Asthma and bronchiectasis are different conditions that frequently coexist. The prevalence of bronchiectasis rises considerably in subjects with severe asthma (25%–51%).Objective: We evaluated the clinical and biological efficacy of mepolizumab on our pilot population of severe uncontrolled asthmatics with bronchiectasis not related to other pathologies.Patients and methods: Four patients with severe uncontrolled asthma and diagnosed as bronchiectasis were recruited and started biological treatment with mepolizumab. Standard investigations were performed in all four patients at baseline (T0), after 3 months (T1) and after 1 year (T2) of treatment.Results: After 1 year (T2) of therapy with mepolizumab, patients showed a significant increment of asthma control test value (12±1.1 vs 24.5±0.3, P<0.01), a reduction of the number of exacerbations/year (5±0.7 vs 0.75±0.75, P<0.01), an increase of pre-bronchodilator FEV1 (1,680±500 vs 1,860±550 mL, P<0.01) and a reduction of eosinophils in blood (0.75±0.14 vs 0.12±0.02 cells/µL, P<0.01), in the sputum (9.6%±2.1% vs 5.6%±2.7%, P<0.05) and in nasal cytology (++ vs +).Conclusion: The efficacy of mepolizumab in terms of reduction of inflammation and increase of control that we observed in our patients might suggest that targeting the IL-5 in severe eosinophilic asthma with bronchiectasis may be a good therapeutic strategy. Keywords: severe asthma, bronchiectasis, mepolizumab, phenotype
 
Expression profiling of miRNA-145 and miRNA-338 in serum and sputum of patients with COPD, asthma, and asthma–COPD overlap syndrome phenotype
Full text linkDonato Lacedonia,* Grazia Pia Palladino,* Maria Pia Foschino-Barbaro, Giulia Scioscia, Giovanna Elisiana Carpagnano Department of Medical and Surgical Sciences, Institute of Respiratory Diseases, University of Foggia, Foggia, Italy *These authors contributed equally to this work Background and objectives: A new phenotype with overlapping characteristics between asthma and chronic obstructive pulmonary disease (COPD) called asthma–COPD overlap syndrome (ACOS) is emerging among inflammation diseases. To date, there is no agreement on specific criteria to define this syndrome, and the current guidelines are insufficient to classify the analogy and differences between overlap and COPD or asthma phenotypes. It would be necessary to identify new biomarkers able to identify these diseases clearly. Thus, the aim of this study was to identify a serum and supernatant of sputum microRNA (miRNA) expression profile of miRNA-145 and miRNA-338 in patients with asthma (n=13), COPD (n=31), and ACOS (n=8) and controls (n=7). Methods: The expression was evaluated using quantitative real-time polymerase chain reaction (qRT-PCR). For statistical analysis, the ANOVA test, Kruskal–Wallis test, Mann–Whitney U-test, and Spearman’s rank correlation were used. Results: The main finding of this work is that the expression of miRNA-338 is higher in the supernatant of different obstructive diseases than in peripheral blood, while miRNA-145 is higher only in the supernatant of asthma patients. The expression of both selected miRNAs is higher in the supernatant of asthma and COPD patients than in controls. Conclusion: Differences in sputum miRNA expression profile were observed between patients with ACOS and asthma or COPD, which underline the potential role of miRNA as a biomarker that is able to discriminate patients with ACOS, asthma, and COPD. Keywords: asthma–COPD overlap syndrome, ACOS, asthma, chronic obstructive pulmonary disease, miRNA, sputu
Variations on the Author
Full text link“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
Appropriate Similarity Measures for Author Cocitation Analysis
Full text linkWe provide a number of new insights into the methodological discussion about author cocitation analysis. We first argue that the use of the Pearson correlation for measuring the similarity between authors’ cocitation profiles is not very satisfactory. We then discuss what kind of similarity measures may be used as an alternative to the Pearson correlation. We consider three similarity measures in particular. One is the well-known cosine. The other two similarity measures have not been used before in the bibliometric literature. Finally, we show by means of an example that our findings have a high practical relevance.information science;Pearson correlation;cosine;similarity measure;author cocitation analysis
Tocilizumab and liver injury in patients with COVID-19
No full textCurrent mortality rate in patients with COVID-19 disease is about 2%, whereas 5% of patients require admission to the intensive care unit. It is assumed that interleukin (IL)-6 may be involved in the pathogenesis of severe COVID-19 infections; therefore, in the absence of a specific antiviral therapy, some authors have suggested that tocilizumab – a drug used to block the signal transduction pathway of IL-6 – could have beneficial effects in the management of severe COVID-19 disease. However, mild-to-moderate elevation in transaminases and drug-induced liver injury have been observed in patients treated with tocilizumab. We present seven cases of patients with elevated liver enzymes [up to five times the upper limit of normal (ULN)] at baseline who received tocilizumab for life-threatening COVID-19 disease. All patients had no history of liver or pulmonary disease and were admitted for acute hypoxemic respiratory failure, dyspnea and fever due to COVID-19 bilateral pneumonia. IL-6 was available in six patients, and was significantly increased particularly in those with severe impairment of lung function. All patients received tocilizumab (8 mg/kg/day) for two consecutive days because of lack of improvement after hydroxychloroquine, azithromycin and lopinavir/ritonavir treatment. After tocilizumab administration, clinical condition rapidly improved and liver function test normalized within 3 weeks of treatment. Tocilizumab may be effective for the treatment of severe COVID-19 disease, even in patients with elevated liver function tests. Further studies are needed to evaluate the impact of tocilizumab use on liver function tests in patients with pre-existing chronic liver disease
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