Clinical medicine. Circulatory, respiratory and pulmonary medicine最新文献

BACKGROUND: Pulmonary arterial pressure (PAP) varies considerably in heart failure (HF) despite similar degrees of left ventricular (LV) dysfunction. Bradykinin alters vascular tone and common variations in the kinin B2 receptor (BDKRB2) gene exists. We hypothesized that genetic variation in this receptor would influence PAP in HF. METHODS: 131 HF patients (>1yr history systolic HF), without COPD, not currently smoking, BMI < 40, without atrial fibrillation completed the study which included a blood draw for genotyping and neurohormones (ACE, A-II, Bradykinin, ANP, BNP, and catecholamines), an echocardiogram for cardiac function and systolic PAP (PAPsys). RESULTS: Mean LVEF was 29% ± 12%, NYHA class 2 ± 1, age 56 ± 12 yr, BMI 28 ± 5 kg/m(2). Forty-six patients (35%) were homozygous for the +9 allele, 58 (44%) were heterozygous (+9/-9) and 27 (21%) were homozygous for the -9 allele of the BDKRB2. PAPsys averaged 42 ± 13, 38 ± 12, and 35 ± 11 mmHg for +9/+9, +9/-9 and -9/-9, respectively (p = 0.03). There was a trend towards gene effect for plasma ACE with the highest values in +9/+9 and lowest in -9/-9 patients (9.5 ± 10.7, 7.1 ± 8.7, and 5.4 ± 6.4 U/L, respectively, p = 0.06). There were no differences in plasma bradykinin or A-II, LVEF, or NYHA across genotypes. CONCLUSION: These data suggest the +9/+9 polymorphism of the BDKRB2 receptor influences pulmonary vascular tone in stable HF.

Objective: This paper describes state of the art, scientific publications and ongoing research related to the methods of analysis of respiratory sounds.

Methods and material: Review of the current medical and technological literature using Pubmed and personal experience.

Results: The study includes a description of the various techniques that are being used to collect auscultation sounds, a physical description of known pathologic sounds for which automatic detection tools were developed. Modern tools are based on artificial intelligence and on technics such as artificial neural networks, fuzzy systems, and genetic algorithms…

Conclusion: The next step will consist in finding new markers so as to increase the efficiency of decision aid algorithms and tools.

The inflammatory response is modulated through interactions among the nervous, endocrine, and immune systems. Intercommunication between immune cells and the autonomic nervous system is a growing area of interest. Spatial and temporal information about inflammatory processes is relayed to the central nervous system (CNS) where neuroimmune modulation serves to control the extent and intensity of the inflammation. Over the past few decades, research has revealed various routes by which the nervous system and the immune system communicate. The CNS regulates the immune system via hormonal and neuronal pathways, including the sympathetic and parasympathetic nerves. The immune system signals the CNS through cytokines that act both centrally and peripherally. This review aims to introduce the concept of neuroimmune interaction and discuss its potential clinical application, in an attempt to broaden the awareness of this rapidly evolving area and open up new avenues that may aid in the treatment of inflammatory diseases.

Purpose: The objective of this trial was to compare cisplatin-plus-vinorelbine regimen with cisplatin-plus-gemcitabine regimen in patients with stage IIIB-IV non-small cell lung cancer (NSCLC).

Patients and methods: Chemonaive patients with stage IIIB-IV NSCLC received either vinoelbine 30 mg/m(2) (days 1 and 8) plus cisplatin 80 mg/m(2) (day 1) every 21 days (VC arm) or gemcitabine 1250 mg/m(2) (days 1 and 8) plus cisplatin 80 mg/m(2) (day 1) every 21 days (GC arm).

Results: One hundred thirtyfour patients (67 VC and 67 GC) were included to the study. Overall response rates for the VC arm (31.2%) were not significantly different from that of the GC arm (34.3%). There were no differences in overall survival and one-year survival rates. Median survival and one-year survival rates for the VC and GC groups were 10.6 and 11.5 months, 45% and 46.8%, respectively. Grade 3-4 thrombocytopenia was significantly higher on the GC arm (VC 1.4% v GC 8.9%, p < 0.05), as was febrile neutropenia on the VC arm (VC 8.9% v GC 1.4%, p < 0.05).

Conclusion: VC and GC demonstrated similar efficacy but there were differences in toxicity profiles.

Objective: To evaluate the performance of APR-DRG (All Patient Refined-Diagnosis Related Group) Risk of Mortality (ROM) score as a mortality risk adjustor in the intensive care unit (ICU).

Design: Retrospective analysis of hospital mortality.

Setting: Medical ICU in a university hospital located in metropolitan New York.

Patients: 1213 patients admitted between February 2004 and March 2006.

Main results: Mortality rate correlated significantly with increasing APR-DRG ROM scores (p < 0.0001). Multiple logistic regression analysis demonstrated that, after adjusting for patient age and disease group, APR-DRG ROM was significantly associated with mortality risk in patients, with a one unit increase in APR-DRG ROM associated with a 3-fold increase in mortality.

Conclusions: APR-DRG ROM correlates closely with ICU mortality. Already available for many hospitalized patients around the world, it may provide a readily available means for severity-adjustment when physiologic scoring is not available.

It is common knowledge that asbestos exposure causes asbestos-related diseases such as asbestosis, lung cancer and malignant mesothelioma (MM) not only in people who have handled asbestos in the work environment, but also in residents living near factories that handle asbestos. These facts have been an enormous medical and social problem in Japan since the summer of 2005. We focused on the immunological effects of asbestos and silica on the human immune system. In this brief review, we present immunological changes in patients with MM and outline their experimental detection. For example, there is over-expression of bcl-2 in CD4+ peripheral T-cells, high plasma concentrations of interleukin (IL)-10 and transforming growth factor (TGF)-ß, and multiple over-representation of T cell receptor (TcR)-Vß in peripheral CD3+ T-cells found in MM patients. We also detail an experimental long-term exposure T-cell model. Analysis of the immunological effects of asbestos may help our understanding of the biological effects of asbestos.

Background: The respiratory exchange ratio (RER) indirectly shows the muscle's oxidative capacity to get energy. Sedentarism, exercise and physically active lifestyles modify it. For that reason, this study evaluates the associations between RER during sub-maximum exercise and other well established fitness indicators (body fat, maximum heart rate, maximum O(2) uptake, workload, and lactate threshold), in physically active trained and untrained men.

Methods: The RER, O(2) uptake and blood lactate were measured in eight endurance trained and eight untrained men (age, 22.9 ± 4.5 vs. 21.9 ± 2.8 years; body mass, 67.1 ± 5.4 vs. 72.2 ± 7.7 kg; body fat, 10.6 ± 2.4% vs. 16.6 ± 3.8% and maximum O(2) uptake, 68.9 ± 6.3 vs. 51.6 ± 5.8 ml•kg(-1)•min(-1)), during maximum exercise test and during three different sub-maximum exercises at fixed workload: below, within or above the lactate threshold.

Results: Endurance trained men presented higher O(2) uptake, lower blood lactate concentrations and lower RER values than those in untrained men at the three similar relative workloads. Even though with these differences in RER, a strong association (p < 0.05) of RER during sub-maximum exercise with the other well established fitness indicators was observed, and both maximum O(2) uptake and lactate threshold determined more than 57% of its variance (p < 0.05).

Conclusions: These data demonstrate that RER measurement under sub-maximum exercise conditions was well correlated with other established physical fitness indicators, despite training condition. Furthermore, the results suggest that RER could help obtain an easy approach of fitness status under low exercise intensity and could be utilized in subjects with reduced exercise tolerance.

BACKGROUND: Bronchial Thermoplasty, a procedure that applies thermal energy to the airway wall has been shown to impair the ability of airway to contract in response to methacholine chloride (Mch). The technique has been advocated as an alternative treatment for asthma that may permanently limit airway narrowing. In previous experimental studies in dogs and humans, it was shown that those airways treated with bronchial thermoplasty had significant impairment of Mch responsiveness. METHODS: In the present study, we investigated the ability of canine airways to close completely with very high concentrations of Mch after bronchial thermoplasty. Bronchial thermoplasty was performed on dogs using the Alair System, comprising a low power RF controller and a basket catheter with four electrodes. A local atomization of Mch agonist was delivered directly to the epithelium of the same airway locations with repeated challenges. Airway size was measured with computed tomography, and closure was considered to occur in any airway where the lumen fell below the resolution of the scanner (< 1 mm). RESULTS: Our results show that, while treated airways still have the capacity to close at very high doses of Mch, this ability is seriously impaired after treatment, requiring much higher doses. CONCLUSIONS: Bronchial thermoplasty as currently applied seems to simply shift the entire dose response curve toward increasing airway size. Thus, this procedure simply serves to minimize the ability of airways to narrow under any level of stimulation.