Hasil untuk "Diseases of the respiratory system"

Marc Paredes, Domingo Madera, Marta Plana Pes et al.

Mechanical hemostatic agents, such as oxidized cellulose (Willocell©), are frequently used in thoracic surgery. Although considered safe, they can induce granulomatous reactions that mimic tumor recurrence. In this retrospective study, we analyzed patients from the Hospital Universitari de Bellvitge (July 2024–March 2025) who underwent EBUS due to lymphadenopathies with increased SUV on PET-FDG following surgery for lung cancer. Nine patients, who had undergone anatomical lung resections (VATS or RATS), presented with suspicious lymphadenopathies ipsilateral to the surgical site. EBUS-TBNA revealed no malignancy but showed amorphous material compatible with a foreign body reaction attributable to Willocell©. Only one patient was diagnosed with tumor recurrence.This case series underscores the importance of maintaining a broad differential diagnosis when evaluating potential causes of increased metabolic activity on PET/CT scans, as its specificity is limited. EBUS-TBNA proves to be a key tool for achieving an accurate diagnosis in these scenarios. Resumen: Los agentes hemostáticos mecánicos como la celulosa oxidada (Willocell©) se utilizan frecuentemente en cirugía torácica. Aunque son seguros, pueden provocar reacciones granulomatosas que simulan recidiva tumoral. En este estudio retrospectivo, analizamos pacientes del Hospital Universitario de Bellvitge (julio 2024-marzo 2025) que se sometieron a EBUS por linfadenopatías con captación aumentada en PET-FDG tras cirugía por neoplasia pulmonar. Nueve pacientes, operados mediante resección pulmonar anatómica (VATS o RATS), presentaron ganglios linfáticos sospechosos ipsilaterales al sitio quirúrgico. El EBUS-TBNA no mostró malignidad, pero sí material amorfo compatible con reacción a cuerpo extraño atribuible al Willocell©. Solo un caso presentó finalmente recidiva tumoral. Esta serie de casos destaca la importancia de mantener un diagnóstico diferencial amplio ante posibles causas de aumento de la actividad metabólica en la PET/TC siendo el EBUS-TBNA una herramienta clave para un diagnóstico certero.

Nuo Chen⁺, Luojia Dai⁺, Juanjuan Wang et al.

Introduction Youth smoking is a serious public health problem. Nevertheless, a rigorous tobacco-free environment within schools, combined with exemplary tobacco control behavior among school personnel can effectively contribute to reducing adolescent smoking. This study compared the tobacco control environment in Shanghai secondary schools in 2017 and 2021, and explored how the tobacco control environment influenced the tobacco control behaviors of school personnel. Methods Two cross-sectional studies were conducted from October to December 2017 and October to December 2021, using stratified cluster random sampling method, and 2403 and 1761 valid questionnaires were collected, respectively. The chi-squared test was used to test the differences between categorical variables. Binary logistic regression was conducted using survey data from 2021 to explore the influencing factors of staff’s tobacco control behaviors. Results Compared with 2017, the percentages of staff members who were current smokers, had smoked on campus in the past year and were exposed to secondhand smoke (SHS) on campus in the past 7 days in 2021 decreased by 2.95%, 2.30% and 8.91%, respectively. However, the proportion of personnel who knew the school had organized tobacco control education decreased. Furthermore, school personnel who had received tobacco control education and agreed the school should strictly prohibit students from smoking (AOR=1.64; 95% CI: 1.25–2.15) were more likely to inform about the harm of tobacco to students. Those who had participated in tobacco control education activities or tobacco control trainings (AOR=1.87; 95% CI: 1.30–2.69) and believed that the school did not strictly prohibit either students (AOR=0.30; 95% CI: 0.22–0.41) or personnel (AOR=0.46; 95% CI: 0.36–0.59) from smoking were more inclined to stop students from smoking. Conclusions Compared with 2017, the rates of smoking and secondhand smoke exposure among school personnel decreased in 2021, but some schools still lacked comprehensive education on tobacco control behaviors for the staff. Enhancing the health literacy and strengthening tobacco control education among staff were effective strategies to encouraging their active adoption of tobacco control behaviors.

Long Z, Zhu T, Zhou Y et al.

Zhiwei Long,1,2,* Tieshi Zhu,3,* Yue Zhou,2,* Zixuan Xiang,2 Qiyuan Zeng,2 Ye Qiu,4 Jieying Hu,1 Yan Wang1 1State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, People’s Republic of China; 2Department of Clinical Medicine, Guangzhou Medical University, Guangzhou, People’s Republic of China; 3Department of Neurology, Zhanjiang Central Hospital, Guangdong Medical University, Zhanjiang, People’s Republic of China; 4Gastroenterology and Respiratory Internal Medicine Department, Guangxi Medical University Cancer Hospital, Nanning, Guangxi, 530021, People’s Republic of China*These authors contributed equally to this workCorrespondence: Yan Wang; Jieying Hu, Email 345406739@qq.com; hujieyingjy@126.comPurpose: The blood urea nitrogen/creatinine ratio (BCR) is an effective marker for disease severity stratification. Its efficacy has been demonstrated under numerous conditions. This study aims to investigate the relationship between BCR and in-hospital mortality in intensive care unit (ICU) patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD).Patients and Methods: Eligible ICU patients with AECOPD from the eICU database were included in the study. Patients were divided into high-BCR and low-BCR groups on the basis of the optimal cutoff value (22.78) of the ROC curve for predicting in-hospital mortality in AECOPD patients. Propensity score matching (PSM) was used to balance the baseline differences between the high-BCR and low-BCR groups. Multivariate logistic regression was used to analyze the relationship between BCR and in-hospital mortality in ICU patients with AECOPD. Decision curve analysis (DCA) was performed to evaluate the clinical efficacy of each model via multivariate logistic regression.Results: A total of 3399 eligible ICU patients with AECOPD were included in the study, with 1559 patients in the high-BCR group and 1840 patients in the low-BCR group. After propensity score matching (PSM), 1174 pairs of patients were successfully matched. The results of the multivariate logistic regression revealed that the in-hospital mortality rate for AECOPD patients in the high-BCR subgroup was significantly greater than that in the low-BCR subgroup in both the unmatched and matched cohorts after adjusting for multiple factors. Additionally, DCA demonstrated that the models used in the multivariate logistic regression had effective clinical utility.Conclusion: The blood urea nitrogen/creatinine ratio (BCR) is an effective predictor of in-hospital mortality in ICU patients with AECOPD. Clinicians can use BCR to identify critically ill ICU patients with AECOPD earlier and implement interventions to improve patient outcomes.Keywords: acute exacerbation of chronic obstructive pulmonary disease, blood urea nitrogen, creatinine, intensive care unit, hospital mortality

Wanhua Wu, Jianing Li, Su Chen et al.

Abstract Recent evidence has increasingly underscored the importance of the neuro-immune axis in mediating allergic airway diseases, such as allergic asthma and allergic rhinitis. The intimate spatial relationship between neurons and immune cells suggests that their interactions play a pivotal role in regulating allergic airway inflammation. Upon direct activation by allergens, neurons and immune cells engage in interactions, during which neurotransmitters and neuropeptides released by neurons modulate immune cell activity. Meanwhile, immune cells release inflammatory mediators such as histamine and cytokines, stimulating neurons and amplifying neuropeptide production, thereby exacerbating allergic inflammation. The dynamic interplay between the nervous and immune systems suggests that targeting the neuro-immune axis in the airway could represent a novel approach to treating allergic airway diseases. This review summarized recent evidence on the nervous system’s regulatory mechanisms in immune responses and identified potential therapeutic targets along the peripheral nerve-immune axis for allergic asthma and allergic rhinitis. The findings will provide novel perspectives on the management of allergic airway diseases in the future.

Meng-Meng Xu, Jia-Ying Kang, Qiu-Yan Wang et al.

Abstract Background Influenza A viruses (IAV) are extremely common respiratory viruses for the acute exacerbation of chronic obstructive pulmonary disease (AECOPD), in which IAV infection may further evoke abnormal macrophage polarization, amplify cytokine storms. Melatonin exerts potential effects of anti-inflammation and anti-IAV infection, while its effects on IAV infection-induced AECOPD are poorly understood. Methods COPD mice models were established through cigarette smoke exposure for consecutive 24 weeks, evaluated by the detection of lung function. AECOPD mice models were established through the intratracheal atomization of influenza A/H3N2 stocks in COPD mice, and were injected intraperitoneally with melatonin (Mel). Then, The polarization of alveolar macrophages (AMs) was assayed by flow cytometry of bronchoalveolar lavage (BAL) cells. In vitro, the effects of melatonin on macrophage polarization were analyzed in IAV-infected Cigarette smoking extract (CSE)-stimulated Raw264.7 macrophages. Moreover, the roles of the melatonin receptors (MTs) in regulating macrophage polarization and apoptosis were determined using MTs antagonist luzindole. Results The present results demonstrated that IAV/H3N2 infection deteriorated lung function (reduced FEV20,50/FVC), exacerbated lung damages in COPD mice with higher dual polarization of AMs. Melatonin therapy improved airflow limitation and lung damages of AECOPD mice by decreasing IAV nucleoprotein (IAV-NP) protein levels and the M1 polarization of pulmonary macrophages. Furthermore, in CSE-stimulated Raw264.7 cells, IAV infection further promoted the dual polarization of macrophages accompanied with decreased MT1 expression. Melatonin decreased STAT1 phosphorylation, the levels of M1 markers and IAV-NP via MTs reflected by the addition of luzindole. Recombinant IL-1β attenuated the inhibitory effects of melatonin on IAV infection and STAT1-driven M1 polarization, while its converting enzyme inhibitor VX765 potentiated the inhibitory effects of melatonin on them. Moreover, melatonin inhibited IAV infection-induced apoptosis by suppressing IL-1β/STAT1 signaling via MTs. Conclusions These findings suggested that melatonin inhibited IAV infection, improved lung function and lung damages of AECOPD via suppressing IL-1β/STAT1-driven macrophage M1 polarization and apoptosis in a MTs-dependent manner. Melatonin may be considered as a potential therapeutic agent for influenza virus infection-induced AECOPD. Graphical Abstract Schematic mechanisms underlying the regulatory effects of melatonin on macrophage polarization and apoptosis in IAV infection plus cigarette stimulation-induced AECOPD model.

Hiromu Kawano, Keiko Kan‐o, Ayaka Egashira et al.

Abstract A 54‐year‐old woman with no history of lung disease including bronchial asthma developed left bacterial pleural empyema due to the perforation of a lung abscess in the left lower lobe. Chest tube drainage and antibiotics improved the pleural empyema. Two months following discharge from the hospital, she developed a cough and left chest pain. Chest computed tomography revealed high‐attenuation mucus plugs, atelectasis in the left lower lobe, and an increased peripheral blood eosinophil count. Bronchoscopy revealed a mucoid impaction in B8 of the left lower lobe, confirming the presence of Aspergillus fumigatus. A diagnosis of allergic bronchopulmonary aspergillosis was made, and treatment with oral prednisolone was initiated, resulting in the resolution of the mucus plugs and improvement of atelectasis.

Chia‐Wei Chang, Chun‐Han Wu

Key message Congenital anomalies of the large airways are occasionally asymptomatic and are incidentally discovered through radiography, often using computed tomography. Bronchoscopy can aid in the direct visual examination of the large airway abnormalities detected on radiography.

Janette K. Burgess, Martin C. Harmsen

The extracellular matrix (ECM) is the scaffold that provides structure and support to all organs, including the lung; however, it is also much more than this. The ECM provides biochemical and biomechanical cues to cells that reside or transit through this micro-environment, instructing their responses. The ECM structure and composition changes in chronic lung diseases; how such changes impact disease pathogenesis is not as well understood. Cells bind to the ECM through surface receptors, of which the integrin family is one of the most widely recognised. The signals that cells receive from the ECM regulate their attachment, proliferation, differentiation, inflammatory secretory profile and survival. There is extensive evidence documenting changes in the composition and amount of ECM in diseased lung tissues. However, changes in the topographical arrangement, organisation of the structural fibres and stiffness (or viscoelasticity) of the matrix in which cells are embedded have an undervalued but strong impact on cell phenotype. The ECM in diseased lungs also changes in physical and biomechanical ways that drive cellular responses. The characteristics of these environments alter cell behaviour and potentially orchestrate perpetuation of lung diseases. Future therapies should target ECM remodelling as much as the underlying culprit cells.

Thomas Kurian, A R Paramez, Rohita S Chandra et al.

Background and Objective: Extrapulmonary tuberculosis (EPTB) affects about 25% of patients presenting with Tuberculosis (TB). Tuberculous pleural effusion is the second-most common type of EPTB, after lymph node TB. Although the molecular TB diagnostics have lower turnaround time compared to traditional testing methods, the sensitivity in microscopy negative specimens are low. Higher cost and infrastructure requirements are other disadvantages. Truenat, developed by Mobilio diagnostics and validated by ICMR, is a rapid, polymerase chain reaction (PCR)-based diagnostic test to detect Mycobacterium Tuberculosis (MTB) and also rifampicin resistance. According to the WHO, the accuracy of Truenat is comparable to Xpert PCR. We report our experience in using Truenat for EPTB, specifically, pleural TB. Methods: We retrospectively analyzed data from thoracoscopy over the past 2 years. All data pertaining to the use of Truenat for TB in pleural fluid and thoracoscopic biopsy specimens, histopathology, and mycobacterial cultures were analyzed. Results: We had a total of 114 patients with undiagnosed pleural effusion who underwent thoracoscopy during the study. Forty-five patients (39%) had a diagnosis of TB, among the total 114 patients. The sensitivity of tissue Truenat was 51.11 (95% confidence interval [CI]: 35.77–66.30), tissue culture 37.50% (95% CI: 22.73–54.20), pleural fluid Truenat 20% (95% CI: 8.44–36.94), and fluid culture 14.29% (95% CI: 5.43–28.54). The specificities of all the confirmatory tests were 100% when compared to a reference standard which was taken as a combination of histology and culture as the reference standard with or without acid-fast bacilli in the histology samples. Tissue Truenat was significantly more sensitive than fluid Truenat (P < 0.05). Likewise, tissue culture was more sensitive than fluid culture (P < 0.05). Among all microbiology confirmatory tests performed, Truenat of pleural tissue had the highest yield (51.11). Conclusion: Thoracoscopic pleural biopsy Truenat results in improved sensitivity in cases of EPTB.

Cristián García Bruce, Rodrigo Parra Rojas

Kiyoharu Fukushima, Mari Miki, Yuki Matsumoto et al.

Abstract Background Lung resection in patients with nontuberculous mycobacterial pulmonary disease (NTM-PD) has been reported to be associated with favorable outcomes. However, little is known regarding the risk and prognostic factors for refractory and recurrent cases. We aimed to evaluate the overall impact and benefit of adjuvant lung surgery by comparing NTM-PD patients who underwent adjuvant lung resection with those treated exclusively with antibiotics. We also investigated the efficacy of serum IgA antibody against glycopeptidolipid (GPL) core antigen (GPL core antibody) to monitor disease activity and predict the recurrence of disease after adjuvant lung resection. Methods We retrospectively evaluated the clinical characteristics and surgical outcomes of 35 patients surgically treated for NTM-PD. Furthermore, we compared surgically treated patients and control patients treated exclusively with antibiotics who were matched statistically 1:1 using a propensity score calculated from age, sex, body mass index, and radiologic features of disease. Results In the surgically treated patients, the median age was 58 (interquartile range, 47–65) years and 65.7% were female. Twenty-eight patients had Mycobacterium avium complex. Operations comprised four pneumonectomies, two bilobectomies, one bilobectomy plus segmentectomy, 17 lobectomies, two segmentectomies, and nine lobectomies plus segmentectomies. Postoperative complications occurred in seven patients (20%), there were no operative deaths, and 33 (94.3%) patients achieved negative sputum culture conversion. Refractory and recurrent cases were associated with remnant bronchiectasis, contralateral shadows, and positive acid-fast bacilli staining or culture. Of 28 statistically matched pairs, long-term sustained negative culture conversion was observed in 23 (82.2%) surgical group patients and in 14 (50.0%) non-surgical group patients (0.0438). The mortality rate was lower in the surgical group, but did not reach statistical significance (one in the surgical group and four in the non-surgical group, p = 0.3516). GPL core antibody was correlated with disease activity and recurrence. Conclusions NTM-PD patients who underwent adjuvant lung resection experienced overall favorable outcomes and achieved sputum culture conversion more frequently. Long-term mortality may have been reduced by this procedure, and the level of GPL core antibody was shown to be a good clinical indicator of disease activity after surgery.

Nidhi Prabhakar, Kim Vaiphei, Vikarn Vishwajeet et al.

Primary pleural liposarcoma (PPL) is a rare malignant tumor of the pleura. The diagnosis of PPL may be suspected on chest imaging based on radiologic features such as large pleural mass showing areas of fat with or without calcification. Herein, we present the case of a 32-year-old male whose contrast-enhanced computed tomography scan of the chest revealed a large, heterogeneous, hypodense, right pleural-based mass with small areas of fat and calcification within it. An ultrasound-guided biopsy was performed, which confirmed the diagnosis of a myxoid variant of pleural liposarcoma.

Jan-Alexander Schwab, Hendrik Wolf, Jörg Schnitker et al.

Abstract Introduction Intra-seasonal start of treatment with the SQ® grass sublingual immunotherapy(SLIT) tablet (GRAZAX®, ALK, Denmark) has been previously demonstrated to be well-tolerated. The objective of our study was to investigate the tolerability of intra-seasonal start of treatment comparing patients treated by allergists and general practitioners experienced in treatment of allergy (GPs). Methods In a non-interventional, open-label, observational study, data on intra-seasonal start with the SQ® grass SLIT tablet were recorded in patients treated by allergists and GPs in Germany. Adverse events (AEs) were recorded by the physicians at first administration and during the 1–3-month observation period. The tablets taken and any AEs were recorded by the patients in diaries for the first 14 days. Results Treatment with the SQ® grass SLIT tablet was started in 198 patients, and in 179 intra-seasonal (allergists: 140, GPs: 39) and 19 post-seasonal; average treatment period was 47 days. AEs related to intra-seasonal start were reported in 43.6% of patients; no relevant differences between allergists and GPs were observed. In the subgroup of GPs, patients were younger (p = 0.0191), had more frequently asthma (p = 0.0043), more patients used symptomatic medication in the previous pollen season (p = 0.0198) and were more frequently treated for other diseases (p = 0.0467). In the allergists subgroup, more diagnostic allergy tests were applied (p < 0.0001) with less anti-allergic premedication at first administration (p = 0.0026). Conclusion The intra-seasonal start of treatment with the SQ® grass SLIT tablet in patients routinely treated by allergists or GPs with experience in treatment of allergy was well-tolerated, although patient characteristics were different with respect to age, frequency of asthma and concomitant allergies, use of symptomatic medication in the previous grass pollen season and concomitant treatment of other diseases. The safety profile from a previous placebo-controlled clinical trial and data from a previous real-life study on intra-seasonal start performed by allergists were confirmed.

Nicolini A, Grecchi B, Ferrari-Bravo M et al.

Antonello Nicolini,1 Bruna Grecchi,2 Maura Ferrari-Bravo,3 Cornelius Barlascini4 1Respiratory Diseases Unit, Hospital of Sestri Levante, Sestri Levante, Italy; 2Rehabilitation Unit, ASL4 Chiavarese, Chiavari, Italy; 3Statistics Unit, ASL4 Chiavarese, Chiavari, Italy; 4Health Medicine Unit, Hospital of Sestri Levante, Sestri Levante, Italy Purpose: Chest physiotherapy is an important tool in the treatment of COPD. Intrapulmonary percussive ventilation (IPV) and high-frequency chest wall oscillation (HFCWO) are techniques designed to create a global percussion of the lung which removes secretions and probably clears the peripheral bronchial tree. We tested the hypothesis that adding IPV or HFCWO to the best pharmacological therapy (PT) may provide additional clinical benefit over chest physiotherapy in patients with severe COPD. Methods: Sixty patients were randomized into three groups (20 patients in each group): IPV group (treated with PT and IPV), PT group with (treated with PT and HFCWO), and control group (treated with PT alone). Primary outcome measures included results on the dyspnea scale (modified Medical Research Council) and Breathlessness, Cough, and Sputum scale (BCSS), as well as an evaluation of daily life activity (COPD Assessment Test [CAT]). Secondary outcome measures were pulmonary function testing, arterial blood gas analysis, and hematological examinations. Moreover, sputum cell counts were performed at the beginning and at the end of the study. Results: Patients in both the IPV group and the HFCWO group showed a significant improvement in the tests of dyspnea and daily life activity evaluations (modified Medical Research Council scale, BCSS, and CAT) compared to the control group, as well as in pulmonary function tests (forced vital capacity, forced expiratory volume in 1 second, forced expiratory volume in 1&nbsp;second/forced vital capacity%, total lung capacity, residual volume, diffusing lung capacity monoxide, maximal inspiratory pressure, maximal expiratory pressure) and arterial blood gas values. However, in the group comparison analysis for the same variables between IPV group and HFCWO group, we observed a significant improvement in the IPV group maximal inspiratory pressure, maximal expiratory pressure, BCSS, and CAT. Similar results were observed in changes of sputum cytology with reduction of inflammatory cells (neutrophils and macrophages). Conclusion: The two techniques improved daily life activities and lung function in patients with severe COPD. IPV demonstrated a significantly greater effectiveness in improving some pulmonary function tests linked to the small bronchial airways obstruction and respiratory muscle strength and scores on health status assessment scales (BCSS and CAT) as well as a reduction of sputum inflammatory cells compared with HFCWO. Keywords: severe COPD, intrapulmonary percussive ventilation, high-frequency chest wall oscillation, daily life activity

Heba M. Atef, Ali A. Okab, Gehan F. Al mehy et al.

Background: Despite the fact that Light’s criteria remain the gold standard approach in differentiating exudates from transudates, several fluid markers have been introduced for establishing the cause of pleural effusion to differentiate types of pleural exudate. Aim: The aim of this study was to explore means of discriminating between malignant and non malignant pleural effusions. Methods: The study conducted on 45 patients (28-males and 17 females) with pleural effusions of different etiologies. They were classified according to their final diagnosis into four groups: Group I: 10 cases (6 males and 4 females) with tuberculous pleural effusions. Group II: 15 cases (8 males and 7 females) with malignant pleural effusions. Group III: 10 cases (7 males and 3 females) with para-pneumonic effusion. Group IV: 10 cases (7 males and 3 females) with transudative pleural effusions included as a control group. The complete biochemical analysis of pleural fluid, pleural fluid culture, and pathological examination of pleural fluid and tissue was performed. Moreover, quantitative measurement of TNF-α in serum and pleural fluid using ELISA was performed. Results: Levels of TNF-α were significantly higher in the pleural fluid of exudative nature compared to transudative type. There was a significant increase in pleural fluid TNF-α level in non malignant effusions (tuberculous and parapneumonic) compared with malignant effusion. Also there was a significant increase in pleural fluid TNF-α level in tuberculous effusion versus malignant effusion. These results indicate that TNF-α may be considered a sensitive marker in differentiation between malignant and non malignant pleural effusions. Conclusion: Pleural fluid level of TNF-α can be used in differentiating malignant from non malignant effusion. Also levels of TNF-α in the serum and pleural fluid could be useful as a complementary marker in the differential diagnosis of two most common types of exudates (tuberculous and malignant).

Hou G, Yin Y, Han D et al.

Gang Hou, Yan Yin, Dan Han, Qiu-yue Wang, Jian Kang Department of Respiratory Medicine, the First Hospital of China Medical University, Shenyang, People&rsquo;s Republic of China Objective: We investigated how rosiglitazone attenuated cigarette smoke (CS)-induced emphysema in a rat model. In particular, we focused on its possible effects on the imbalance between metalloprotease (MMP) and anti-MMP activity, mitogen-activated protein kinase (MAPK) phosphorylation, and nuclear factor kappa-light-chain-enhancer of activated B cell (NF&kappa;B) signaling pathway over-activation.Methods: A total of 36 Wistar rats were divided into three groups (n=12 each): animals were exposed to CS for 12 weeks in the absence (the CS group) or presence of 30 mg/kg rosiglitazone (the rosiglitazone-CS [RCS] group); a control group was treated with the rosiglitazone vehicle only, without any CS exposure. Histopathology of lung tissue in all groups was evaluated to grade severity of the disease. Expression levels of peroxisome proliferator-activated receptor &gamma; (PPAR&gamma;), MMP2, and MMP9 in lung tissue were determined and compared using Western blotting and immunohistochemistry. Activation of MAPKs, NF&kappa;B, and the nuclear factor of kappa light polypeptide gene enhancer in B-cell inhibitor, alpha (I&kappa;B&alpha;) phosphorylation in lung tissue was examined by Western blotting.Results: Emphysema-related pathology, based on inter-alveolar wall distance and alveolar density, was less severe in the RCS group than in the CS group. Compared with the CS group, levels of PPAR&gamma; were higher in the RCS group, and levels of MMP2 and MMP9 proteins were lower in the RCS rats. Levels of activated MAPKs and NF&kappa;B were also lower, while the I&kappa;B&alpha;phosphorylation was increased in the lung tissue of RCS rats.Conclusion: Our findings suggest that oral administration of rosiglitazone attenuates the metalloprotease activity induced by CS, and the underlying mechanism might involve the activation of signaling pathways dependent on MAPKs or NF&kappa;B. Our results further suggest that PPAR&gamma; contributes to the pathogenesis of emphysema as well as airway inflammation induced by CS. Keywords: emphysema, chronic obstructive pulmonary disease, matrix metalloprotease9, matrix metalloprotease2, PPAR, NF&kappa;B

M Reza Maleki-Yazdi, Suzanne M Kelly, Sy S Lam et al.

INTRODUCTION: No recent Canadian studies with physician- and spirometry-confirmed diagnosis of chronic obstructive pulmonary disease (COPD) that assessed the burden of COPD have been published.

Santo Augusto, Puech-Leão Pedro, Krutman Mariana

<p>Abstract</p> <p>Background</p> <p>Aortic aneurysm and dissection are important causes of death in older people. Ruptured aneurysms show catastrophic fatality rates reaching near 80%. Few population-based mortality studies have been published in the world and none in Brazil. The objective of the present study was to use multiple-cause-of-death methodology in the analysis of mortality trends related to aortic aneurysm and dissection in the state of Sao Paulo, between 1985 and 2009.</p> <p>Methods</p> <p>We analyzed mortality data from the Sao Paulo State Data Analysis System, selecting all death certificates on which aortic aneurysm and dissection were listed as a cause-of-death. The variables sex, age, season of the year, and underlying, associated or total mentions of causes of death were studied using standardized mortality rates, proportions and historical trends. Statistical analyses were performed by chi-square goodness-of-fit and H Kruskal-Wallis tests, and variance analysis. The joinpoint regression model was used to evaluate changes in age-standardized rates trends. A p value less than 0.05 was regarded as significant.</p> <p>Results</p> <p>Over a 25-year period, there were 42,615 deaths related to aortic aneurysm and dissection, of which 36,088 (84.7%) were identified as underlying cause and 6,527 (15.3%) as an associated cause-of-death. Dissection and ruptured aneurysms were considered as an underlying cause of death in 93% of the deaths. For the entire period, a significant increased trend of age-standardized death rates was observed in men and women, while certain non-significant decreases occurred from 1996/2004 until 2009. Abdominal aortic aneurysms and aortic dissections prevailed among men and aortic dissections and aortic aneurysms of unspecified site among women. In 1985 and 2009 death rates ratios of men to women were respectively 2.86 and 2.19, corresponding to a difference decrease between rates of 23.4%. For aortic dissection, ruptured and non-ruptured aneurysms, the overall mean ages at death were, respectively, 63.2, 68.4 and 71.6 years; while, as the underlying cause, the main associated causes of death were as follows: hemorrhages (in 43.8%/40.5%/13.9%); hypertensive diseases (in 49.2%/22.43%/24.5%) and atherosclerosis (in 14.8%/25.5%/15.3%); and, as associated causes, their principal overall underlying causes of death were diseases of the circulatory (55.7%), and respiratory (13.8%) systems and neoplasms (7.8%). A significant seasonal variation, with highest frequency in winter, occurred in deaths identified as underlying cause for aortic dissection, ruptured and non-ruptured aneurysms.</p> <p>Conclusions</p> <p>This study introduces the methodology of multiple-causes-of-death to enhance epidemiologic knowledge of aortic aneurysm and dissection in São Paulo, Brazil. The results presented confer light to the importance of mortality statistics and the need for epidemiologic studies to understand unique trends in our own population.</p>