285 research outputs found
Increased prevalence of low oligomeric state surfactant protein D with restricted lectin activity in bronchoalveolar lavage fluid from preterm infants
No full textBackground: Surfactant protein D (SP-D) is a soluble oligomeric C-type lectin known to protect against lipopolysaccharide and ventilator-induced lung injury in preterm lambs. Here we assess the expression and functional status of SP-D in bronchoalveolar lavage fluid (BALF) from preterm infants at risk of chronic lung disease (CLD) of prematurity and term controls. This is the first systematic evaluation of SP-D function in any clinical cohort.Methods: SP-D was quantified in BALF from 28 ventilated preterm infants and five ventilated term infants. SP-D lectin activity was tested in a zymosan binding assay followed by sodium dodecyl sulfate polyacrylamide gel electrophoresis (SDS-PAGE) and western blot in BALF from the same infants. SP-D lectin activity was also tested towards maltose-agarose and mannan for selected BALF samples.Results: SP-D expression was lower on day 1 in those preterm infants who subsequently developed CLD but increased over the first 5 days of life in term and preterm neonates. The percentage of neonatal SP-D capable of binding zymosan rarely exceeded 50% in any BALF sample and was 3.5 times lower in preterm infants than term infants on day 1 of life. Similar binding defects were observed towards maltose-agarose and mannan. SDS-PAGE analysis revealed that zymosan-bound SP-D was more highly oligomerised (?12-mers) than unbound SP-D, which was composed primarily of trimers and lower oligomeric forms.Conclusions: Substantial and functionally relevant variation in the expression and oligomeric distribution of SP-D exists between preterm and term neonatal lung secretions. This has implications for proposed SP-D replacement therapy in this population
Should asymptomatic congenital cystic adenomatous malformations be removed? The case against
No full textIn this article, we debate the pros and cons for the surgical removal of asymptomatic antenatally diagnosed cystic adenomatous malformations (CCAM). It is often argued that asymptomatic antenatally diagnosed CCAMs should be surgically removed in infancy due to the risk of future malignancy, future risk of infection and other symptoms and of increased risk of surgery after infective episodes. However, the risk of malignancy is often overplayed and the risk may not even be decreased after excision of the CCAM. Furthermore, the risk of future symptoms is uncertain thus surgical removal will subject many infants to unnecessary risk. Medical follow up will decrease the numbers that undergo surgical intervention and newer imaging techniques are likely to decrease the radiation risk. Whichever route of management is followed there is an urgent need to outline the natural history of asymptomatic CCAMs
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