MedWorm: Bronchiolitis

Effect of simvastatin on development of obliterative airway disease: An experimental study

The Journal of Heart and Lung Transplantation — Wed, 01 Feb 2012 05:00:00 +0100

Conclusions: Simvastatin treatment inhibited adaptive T-cell alloimmune activation as depicted by reduced expression of lymphocyte chemokine and pro-inflammatory cytokine mRNA and reduced allograft infiltration by inflammatory cells. Importantly, simvastatin inhibits the development of OAD and this effect is partially mediated by increased nitric oxide activity. These results suggest a role for simvastatin in the prevention of obliterative bronchiolitis. (Source: The Journal of Heart and Lung Transplantation)

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Altered progenitor cell and cytokine profiles in bronchiolitis obliterans syndrome

The Journal of Heart and Lung Transplantation — Wed, 01 Feb 2012 05:00:00 +0100

Conclusions: Overall, altered progenitor cell profiles were found in patients who developed advanced BOS, which may be mediated by alterations in circulating cytokines. Ultimately, measurement of progenitor cell profiles may lead to further insight into the pathogenesis of airflow obstruction after lung transplantation. (Source: The Journal of Heart and Lung Transplantation)

Bronchiolitis obliterans organizing pneumonia due to titanium nanoparticles in paint.

The Annals of Thoracic Surgery — Tue, 31 Jan 2012 04:17:16 +0100

We present a case of a 58-year-old man who experienced Bronchiolitis obliterans organizing pneumonia after a 3-month exposure to polyester powder paint. Mineralogical analysis by transmission electron microscopy of a pulmonary sample and the polyester powder paint he was exposed to showed the presence of titanium dioxide nanoparticles in both. We suggest that exposure to titanium dioxide nanoparticles should be added to the etiology of Bronchiolitis obliterans organizing pneumonia. PMID: 22269741 [PubMed - in process] (Source: The Annals of Thoracic Surgery)

Fatal Paraneoplastic Pemphigus After Removal of Castleman’s Disease in a Child

Pediatric Dermatology — Thu, 26 Jan 2012 05:00:00 +0100

We report herein a 10‐year‐old girl with PNP appearing a few weeks after resection of a recurrent CD. Despite improvement in skin and mucosal lesions with prednisolone and azathioprine, she had severe bronchiolitis obliterans and died from respiratory failure a few months later. (Source: Pediatric Dermatology)

Suppression of bronchiolitis obliterans in allogeneic rat lung transplantation-Effectiveness of everolimus.

Experimental and Toxicologic Pathology — Wed, 25 Jan 2012 05:00:00 +0100

CONCLUSION: The effectiveness of everolimus after rat LTX depended on the grade of inflammation of the allograft before initiation of drug treatment. Only allografts with no or low grade AR benefit from long-term treatment with everolilmus in the prevention of BO after LTX. It could be speculated that conversion to an everolimus-based immunosuppression after LTX might only be successful in patients free of BO. PMID: 22284335 [PubMed - as supplied by publisher] (Source: Experimental and Toxicologic Pathology)

Work of breathing to optimize noninvasive ventilation in bronchiolitis obliterans

Intensive Care Medicine — Tue, 24 Jan 2012 06:42:31 +0100

Content Type Journal ArticleCategory CorrespondencePages 1-3DOI 10.1007/s00134-012-2469-4Authors Lisa Giovannini-Chami, Pediatric Pulmonary Department, Hôpitaux Pédiatriques de Nice CHU-Lenval, 06200 Nice, FranceSonia Khirani, Pediatric Pulmonary Unit, National Reference Center for Rare Lung Diseases, INSERM UMR S-938, AP-HP, Hôpital Armand-Trousseau, Université Pierre et Marie Curie-Paris 6, 28 avenue du Docteur Arnold Netter, 75012 Paris, FranceGuillaume Thouvenin, Pediatric Pulmonary Unit, National Reference Center for Rare Lung Diseases, INSERM UMR S-938, AP-HP, Hôpital Armand-Trousseau, Université Pierre et Marie Curie-Paris 6, 28 avenue du Docteur Arnold Netter, 75012 Paris, FranceAdriana Ramirez, Pediatric Pulmonary Unit, National Reference Center for Rare Lung Diseases, I...

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Improved Survival but Marginal Allograft Function in Patients Treated With Extracorporeal Membrane Oxygenation After Lung Transplantation [ORIGINAL ARTICLES: GENERAL THORACIC]

The Annals of Thoracic Surgery — Tue, 24 Jan 2012 05:00:00 +0100

Conclusions Advances in ECMO technology, particularly VV ECMO, have greatly improved the ability to support patients with severe PGD after lung transplantation. VV ECMO is an important tool in the armamentarium of any lung transplant program to optimize patient outcomes; however, strategies to improve lung allograft function in patients experiencing severe PGD are still needed. (Source: The Annals of Thoracic Surgery)

Bronchiolitis Obliterans Organizing Pneumonia Due to Titanium Nanoparticles in Paint [CASE REPORTS]

The Annals of Thoracic Surgery — Tue, 24 Jan 2012 05:00:00 +0100

[Chest physiotherapy and bronchiolitis in the hospitalised infant. Double-blind clinical trial.]

Anales de Pediatria — Tue, 24 Jan 2012 05:00:00 +0100

CONCLUSIONS: Results show that chest physiotherapy has not been effective in reducing hospital stay or length of oxygentherapy in patients with acute bronchiolitis, but in the positive study of children with respiratory syncytial virus in nasopharyngeal aspirate showed a reduced need hours of oxygen. hours (P=.042). PMID: 22281403 [PubMed - as supplied by publisher] (Source: Anales de Pediatria)

Epinephrine for acute bronchiolitis, but not steroids alone, reduces hospital admissions

Evidence-Based Medicine — Mon, 23 Jan 2012 05:00:00 +0100

This study analysed the available literature (regardless of language) on acute bronchiolitis therapy, including randomised controlled trials involving children below 24 months of age with bronchiolitis. Papers evaluated the effect of salbutamol, terbutaline, epinephrine, ipratropium and/or steroids for their effect on hospital admission rates, hospital length of stay, clinical scores, oxygen saturations, respiratory... (Source: Evidence-Based Medicine)

Analysis of symptoms, clinical signs and oxygen support in patients with bronchiolitis before and after chest physiotherapy during hospitalization

Revista Paulista de Pediatria — Wed, 18 Jan 2012 06:37:28 +0100

OBJETIVO:Avaliar os efeitos da fisioterapia em pacientes pediátricos, internados com bronquiolite. MÉTODOS:O estudo incluiu 29 pacientes menores de um ano, com diagnóstico médico de bronquiolite aguda, sem cardiopatia congênita não corrigida, neuropatia, doença pulmonar de base ou que necessitassem de suporte ventilatório, no período de março a julho de 2009. Foi avaliada, por meio de questionário, a opinião dos pais ou responsáveis acerca das condições clínicas do paciente antes e após a primeira sessão de fisioterapia. Foram realizadas manobras de desobstrução brônquica, como drenagem postural, tapotagem, vibração, aceleração de fluxo expiratório e aspiração nasotraqueal. A avaliação foi realizada diariamente por meio de exame físico antes do atendimento fi...

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[Bronchiolitis obliterans: Outcome in the medium term.]

Anales de Pediatria — Wed, 18 Jan 2012 05:00:00 +0100

CONCLUSIONS: In most cases, fixed air-flow obstruction and lung function stability with low respiratory morbidity were observed. HRCT scan and lung function testing supported the diagnosis. PMID: 22265374 [PubMed - as supplied by publisher] (Source: Anales de Pediatria)

Epidemiology of hospitalization for acute bronchiolitis in children: differences between RSV and non-RSV bronchiolitis

European Journal of Clinical Microbiology and Infectious Diseases — Thu, 12 Jan 2012 16:49:09 +0100

In conclusion, this study supports that RSV bronchiolitis seems to be a more severe disease than that caused by other viruses. Content Type Journal ArticleCategory ArticlePages 1-7DOI 10.1007/s10096-011-1529-yAuthors D. Hervás, Son Dureta University Hospital, Palma de Mallorca, The Balearic Islands, SpainJ. Reina, Son Dureta University Hospital, Palma de Mallorca, The Balearic Islands, SpainA. Yañez, Son Dureta University Hospital, Palma de Mallorca, The Balearic Islands, SpainJ. M. del Valle, Son Dureta University Hospital, Palma de Mallorca, The Balearic Islands, SpainJ. Figuerola, Son Dureta University Hospital, Palma de Mallorca, The Balearic Islands, SpainJ. A. Hervás, Son Dureta University Hospital, Palma de Mallorca, The Balearic Islands, Spain Journal European Jou...

Development of a Non-Heart-Beating Lung Donor Program With «Bithermia Preservation», and Results After One Year of Clinical Experience.

Archivos de Bronconeumologia — Thu, 12 Jan 2012 05:00:00 +0100

Authors: Gámez P, Díaz-Hellín V, Marrón C, Meneses JC, de Pablo A, Martín de Nicolás JL, Abstract The number of lung transplantations that are performed in Spain continues to grow, with 235 transplant recipients 2010. Non-heart-beating donations have contributed to this upward progression. Our Lung Transplant Unit began its activity in October 2008 and during these last three years 97% of the transplant interventions performed have been successful. In order to increase the number of donations, we have developed a non-heart-beating donor program as part of the existing organs program in our hospital. In doing so, the development of a multi-organic preservation method (lung, liver and kidney), which we call «Bithermia Preservation», was necessary. This paper presents this me...

Are there febrile diseases with a risk of sudden death in children?

Archives of Disease in Childhood — Wed, 11 Jan 2012 05:00:00 +0100

Parents' knowledge about the management of fever in children has hardly changed over the past few years in spite of a host of educational interventions aimed at improving awareness of the dangers relating to high fever. Unexpected death in children's febrile diseases is considered to be relatively rare and may mostly occur due to meningitis, bronchiolitis, malaria, acute leukaemia and Kawasaki syndrome. Two rare autosomal recessively inherited diseases can present high fever bouts in the neonatal period, which might represent a serious threat due to their intrinsic risk of unpredictable sudden death: Sohar–Crisponi syndrome (SCS, OMIM 601378) and Stüve–Wiedemann syndrome (SWS, OMIM 601559). SCS is already evident at birth with paroxysmal muscular contractions, resembling n...

Pilot study of vapotherm oxygen delivery in moderately severe bronchiolitis

Archives of Disease in Childhood — Wed, 11 Jan 2012 05:00:00 +0100

Heated humidified high flow nasal cannula (HHHFNC) therapy is becoming increasingly used in preterm infants and there is evidence that it can provide some degree of respiratory support.1 2 We designed a prospective, randomised, open pilot study to assess the safety and feasibility of using HHHFNC therapy in infants with bronchiolitis. We recruited infants with a clinical diagnosis of moderately severe bronchiolitis. Following parental informed consent, infants were randomised to head-box oxygen or the Vapotherm 2000i (Vapotherm Inc, Stevensville, Maryland, USA). Initial vapotherm flow was 4 l/min with 100% oxygen and was increased up to 8 l/min if tolerated. Oxygen concentration was adjusted in both groups to achieve target pulse oximeter oxygen saturation (SpO2) of 92–96%.Vapotherm ...

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What I've learned from Clinical Evidence: Head scratchers

Archives of Disease in Childhood - Education and Practice — Wed, 11 Jan 2012 05:00:00 +0100

Browsing in Clinical Evidence, I noticed six updated reviews and stumbled upon a couple of head scratchers for me. One of them, literally made my head itch. Bronchiolitis review. The holy grail has not been found. I thought we had a moderately good treatment in hypertonic saline when I read a systematic review that included four randomised controlled trials (RCT) and showed that 3% saline reduced mean length of stay by a day, and also improved clinical scores, when compared to 0.9% saline. But this review notes two subsequent RCTs that are not very encouraging. The first RCT included 46 children and there was no difference in hospital admission, oxygen saturation or clinical scores between 3% saline plus epinephrine and 0.9% saline plus epinephrine. The second RCT was larger, included 186 ...

Situs Inversus Totalis: The Association of Kartagener's Syndrome With Diffuse Bronchiolitis and Azoospermia.

Archivos de Bronconeumologia — Wed, 11 Jan 2012 05:00:00 +0100

Authors: Mittal V, Shah A Abstract Kartagener's syndrome (KS) is characterised by bronchiectasis, paranasal sinusitis and situs inversus totalis (SIT). Association of diffuse bronchiolitis (DB) with KS has been documented from Japan only. Fourteen patients with SIT were seen in one unit over 7 years. All patients underwent a similar work up which included high resolution computed-tomography (HRCT) of thorax and CT-paranasal sinuses. Semen analysis was done in 2/3 adult males. Eleven patients (6 males and 5 females) had KS while 3 adult females had SIT alone. HRCT-thorax detected bronchiectasis in 10/11 patients with KS. HRCT-thorax confirmed DB in 6/11 patients with KS. One adult male had total sperm count of 2.5million/ml without sperm motility while the other had no sperms. This ...

Respiratory Syncytial Virus Bronchiolitis [JAMA Patient Page]

JAMA — Tue, 10 Jan 2012 05:00:00 +0100

(Source: JAMA)

An Obligatory Role for Lung Infiltrating B Cells in the Immunopathogenesis of Obliterative Airway Disease Induced by Antibodies to MHC Class I Molecules

American Journal of Transplantation — Tue, 10 Jan 2012 05:00:00 +0100

Using a murine model, we demonstrated that endobronchial administration of antibodies (Abs) to major histocompatibility complex (MHC) class I results in cellular infiltration, epithelial metaplasia, fibrosis and obstruction of the small airways (obliterative airway disease [OAD]) mediated predominantly by Th17 responses to self‐antigens. This resembles bronchiolitis obliterans syndrome developed following human lung transplantation. Since B cells play a crucial role in induction of autoimmune responses, we defined the role of B cells and its antigen presenting properties in induction of OAD in this study. Anti‐MHC class I was administered endobronchially in B−/− and wild‐type mice. In contrast to wild type, B−/− animals did not demonstrate cellular infiltration, epithelial me...

Bronchial and Bronchiolar Fibrosis in Rats Exposed to 2,3-Pentanedione Vapors: Implications for Bronchiolitis Obliterans in Humans.

Toxicologic Pathology — Tue, 03 Jan 2012 05:00:00 +0100

Authors: Morgan DL, Jokinen MP, Price HC, Gwinn WM, Palmer SM, Flake GP Abstract 2,3-Pentanedione (PD) is a component of artificial butter flavorings. The use of PD is increasing since diacetyl, a major butter flavorant, was associated with bronchiolitis obliterans (BO) in workers and has been removed from many products. Because the toxicity of inhaled PD is unknown, these studies were conducted to characterize the toxicity of inhaled PD across a range of concentrations in rodents. Male and female Wistar-Han rats and B6C3F1 mice were exposed to 0, 50, 100, or 200 ppm PD 6 h/d, 5 d/wk for up to 2 wk. Bronchoalveolar lavage fluid (BALF) was collected after 1, 3, 5, and 10 exposures, and histopathology was evaluated after 12 exposures. MCP-1, MCP-3, CRP, FGF-9, fibrinogen, and OSM wer...

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Relationship between Kleine-Levin Syndrome and Upper Respiratory Infection in Taiwan

Sleep — Mon, 02 Jan 2012 13:58:37 +0100

Conclusion:The agent behind URI or its consequence (such as fever) is associated with increased incidence of KLS episodes and may explain periodic symptomatic recurrences.Citation:Huang YS; Guilleminault C; Lin KL Hwang FM; Liu FY; Kung YP. Relationship between Kleine-Levin Syndrome and upper respiratory infection in Taiwan. SLEEP 2012;35(1):123-129. (Source: Sleep)

Late Pulmonary Complications After Allogeneic Hematopoietic Stem Cell Transplantation: Diagnosis, Monitoring, Prevention, and Treatment

Seminars in Hematology — Sun, 01 Jan 2012 05:00:00 +0100

Bronchiolitis obliterans syndrome (BOS) is a life-threatening complication that occurs among recipients of allogeneic lung and hematopoietic stem cell transplantation (allo-HSCT). BOS usually occurs within the first 2 years but may develop as late as 5 years after allo-HSCT. Recent prevalence estimates suggest that BOS is likely underdiagnosed in the clinical setting and that 14% of all long-term survivors with chronic graft-versus-host disease (GVHD) may develop BOS. It is difficult to diagnose and once respiratory symptoms appear, most allo-HSCT recipients show severe airflow obstruction. This may be due, at least in part, to the low sensitivity of standard spirometry in detecting small airways obstruction and lack of formal recommendations for screening for this complication. The progno...

Bronchiolitis Obliterans Organizing Pneumonia after Radiofrequency Ablation of Lung Cancer: Report of Three Cases

Journal of Vascular and Interventional Radiology : JVIR — Sun, 01 Jan 2012 05:00:00 +0100

Abstract: The present report describes three cases of a bronchiolitis obliterans organizing pneumonia (BOOP)–like reactive pneumonitis following radiofrequency (RF) ablation for lung cancer. The incidence of BOOP-like reactive pneumonitis after RF ablation at the authors' institution was estimated to be approximately 0.4% (three of 840 sessions). The patients presented with nonspecific symptoms. Computed tomography images showed consolidation or ground-glass opacity in a peripheral-dominant distribution and/or patchy air-space opacities. The disease was nonresponsive to antibiotic therapy but responded favorably to pulse therapy of steroids. BOOP-like reactive pneumonitis should be recognized as a complication following lung RF ablation. (Source: Journal of Vascular and Interventional R...

Montelukast for bronchiolitis obliterans syndrome after lung transplantation.

Chest — Sun, 01 Jan 2012 05:00:00 +0100

Authors: Simons SO, Reijers MH PMID: 22215841 [PubMed - in process] (Source: Chest)

Risk of acute otitis media in relation to acute bronchiolitis in children

International Journal of Pediatric Otorhinolaryngology — Sun, 01 Jan 2012 05:00:00 +0100

Conclusion: We concluded that bacterial AOM is a complication in most children with acute bronchiolitis. Streptococcus pneumonia and Haemophilus influenza were the commonest organisms isolated from middle ear aspirate. RSV is identified in 56% of acute otitis media with bronchiolitis. (Source: International Journal of Pediatric Otorhinolaryngology)

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Infantile cardiac haemangioma with large pericardial effusion diagnosed during acute bronchiolitis episode

Journal of Paediatrics and Child Health — Sun, 01 Jan 2012 05:00:00 +0100

(Source: Journal of Paediatrics and Child Health)

Human Rhinoviruses in Severe Respiratory Disease in Very Low Birth Weight Infants

PEDIATRICS — Fri, 30 Dec 2011 05:00:00 +0100

Human rhinovirus infections are common in children. Although historically associated with upper respiratory tract illness, rhinoviruses are increasingly recognized for their role in the exacerbation of asthma. Their role in bronchiolitis and severe lung disease in premature infants is unclear. The authors of this study prospectively explore the role of rhinoviruses in premature infants using molecular techniques and identify these agents as the most frequent cause of hospitalization in this population. (Read the full article) (Source: PEDIATRICS)

Use of Palivizumab in Primary Practice

PEDIATRICS — Fri, 30 Dec 2011 05:00:00 +0100

Conclusions: In a primary practice, use of palivizumab outside of the AAP guidelines was frequent and manifested as inadequate indications or inadequate number of doses. The former improved with education and standardization of care (suggesting provider problems), while the latter did not (suggesting system problems). Additional interventions are required. (Source: PEDIATRICS)

Human Rhinoviruses in Severe Respiratory Disease in Very Low Birth Weight Infants

PEDIATRICS — Fri, 30 Dec 2011 05:00:00 +0100

Conclusions: HRV is an important and frequent pathogen associated with severe respiratory infections in VLBW infants. Bronchopulmonary dysplasia and the absence of breastfeeding are risk factors for hospitalization. The results of our study reveal that HRV is the predominant pathogen of respiratory infections in premature infants. (Source: PEDIATRICS)

Wheezing

About.com Ovarian Cancer — Tue, 27 Dec 2011 05:00:00 +0100

is usually described as a high-pitched whistling sound. It can be caused by asthma, bronchiolitis, allergic reactions and other lung problems. (Source: About.com Ovarian Cancer)

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Pathology and virology findings in cases of fatal influenza A H1N1 virus infection in 2009–2010

Histopathology — Sun, 25 Dec 2011 17:27:03 +0100

Conclusions: The pulmonary findings are similar to those described in past pandemics. Secondary fungal and viral infections, which have not been reported previously, were noted. Although the number of cases in this study is small, the findings reinforce the notion that changes in extrapulmonary organs are attributable to multiorgan dysfunction syndrome rather than a viral cytopathic effect, and that there is no transplacental transmission of virus. (Source: Histopathology)

Impact of a bronchiolitis clinical care pathway on treatment and hospital stay

European Journal of Pediatrics — Fri, 23 Dec 2011 06:49:13 +0100

Conclusions. A clinical pathway for the management of acute bronchiolitis can be implemented in the hospital setting and the conservative approach, in particular not prescribing bronchodilators, is not associated with prolonged duration of stay. Content Type Journal ArticleCategory Original ArticlePages 1-6DOI 10.1007/s00431-011-1653-9Authors Claire Walker, Child Health Royal Aberdeen Children’s Hospital, University of Aberdeen, Foresterhill, Aberdeen, AB25 2ZG UKSusan Danby, Child Health Royal Aberdeen Children’s Hospital, University of Aberdeen, Foresterhill, Aberdeen, AB25 2ZG UKSteve Turner, Child Health Royal Aberdeen Children’s Hospital, University of Aberdeen, Foresterhill, Aberdeen, AB25 2ZG UK Journal European Journal of PediatricsOnline ISSN 1432-1076Print I...

[An infrequent complication of RSV acute bronchiolitis in an infant.]

Archives de Pediatrie — Wed, 21 Dec 2011 05:00:00 +0100

We report the case of a 10-month-old girl hospitalized with RSV acute bronchiolitis who developed necrotizing pneumonia with pyopneumothorax due to Panton-Valentine leukocidin-secreting Staphylococcus aureus. The outcome was fortunately favorable with antibiotics and pleural drainage. PMID: 22196532 [PubMed - as supplied by publisher] (Source: Archives de Pediatrie)

The Munich‐LTX‐Score: predictor for survival after lung transplantation

Clinical Transplantation — Tue, 20 Dec 2011 05:00:00 +0100

Conclusion: Within our cohort of patients calculation of the Munich‐LTX‐Score, consisting of donor‐, recipient‐, and post‐transplant characteristics, one yr after LTX allowed to predict long‐term survival of lung transplant recipients. After prospective validation, this score could identify patients who may benefit from intensified surveillance after LTX. (Source: Clinical Transplantation)

Serious Bacterial Infection in Febrile InfantsSerious Bacterial Infection in Febrile Infants

Medscape Today Headlines — Fri, 16 Dec 2011 17:27:54 +0100

A systematic review assesses the risk for occult serious bacterial infection in young febrile infants presenting with clinical bronchiolitis or RSV infection. Medscape Pediatrics (Source: Medscape Today Headlines)

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Lung function early after lung transplantation is correlated with the frequency of regulatory T cells

Surgery Today — Fri, 16 Dec 2011 06:53:20 +0100

Conclusions The frequency of Treg cells was positively correlated with good lung function in the early period after lung transplantation. Content Type Journal ArticleCategory Original ArticlePages 1-9DOI 10.1007/s00595-011-0087-3Authors Tomoyuki Nakagiri, Division of Thoracic and Cardiovascular Surgery, Hannover Medical School, Hannover, GermanyGregor Warnecke, Division of Thoracic and Cardiovascular Surgery, Hannover Medical School, Hannover, GermanyMurat Avsar, Division of Thoracic and Cardiovascular Surgery, Hannover Medical School, Hannover, GermanyStefanie Thissen, Division of Thoracic and Cardiovascular Surgery, Hannover Medical School, Hannover, GermanyBianca Kruse, Division of Thoracic and Cardiovascular Surgery, Hannover Medical School, Hannover, GermanyChristi...

Use of a Soluble Epoxide Hydrolase Inhibitor in Smoke-Induced Chronic Obstructive Pulmonary Disease.

Am J Respir Cell Mol... — Fri, 16 Dec 2011 05:00:00 +0100

Conclusions: This is the first report to demonstrate sEHI exerts significant protective effects following repeated, subacute tobacco smoke-induced lung injury in a rat model of COPD. PMID: 22180869 [PubMed - as supplied by publisher] (Source: Am J Respir Cell Mol...)

Primary airway epithelial cultures from children are highly permissive to respiratory syncytial virus infection

Thorax — Wed, 14 Dec 2011 05:00:00 +0100

Conclusion This is one of the first studies to examine comprehensively the responses to RSV infection in primary AEC cultures from children and shows marked differences from those of a commercially available immortalised human cell line but reassuring similarities to results found in vivo. This suggests that future work investigating responses of AECs to RSV infection should use primary AEC cultures. (Source: Thorax)

Airway IFN-γ Production During RSV Bronchiolitis is Associated with Eosinophilic Inflammation

Lung — Mon, 12 Dec 2011 17:06:23 +0100

Conclusion These results suggest that IFN-γ may play an important role in eosinophilic inflammation in RSV bronchiolitis. Content Type Journal ArticlePages 1-6DOI 10.1007/s00408-011-9349-5Authors Chang Keun Kim, Department of Pediatrics, Asthma and Allergy Center, Inje University Sanggye Paik Hospital, Seoul, KoreaZak Callaway, Department of Pediatrics, Asthma and Allergy Center, Inje University Sanggye Paik Hospital, Seoul, KoreaYoung Yull Koh, Department of Pediatrics, Seoul National University Hospital, Seoul, KoreaSoo-Hee Kim, Department of Pediatrics, Asthma and Allergy Center, Inje University Sanggye Paik Hospital, Seoul, KoreaTakao Fujisawa, Institute for Clinical Research, Mie National Hospital, 357 Osato-kubota, Tsu, Mie 514-0124, Japan Journal LungOnli...

A shift in the collagen V antigenic epitope leads to T helper phenotype switch and immune response to self-antigen leading to chronic lung allograft rejection.

Clinical and Developmental Immunology — Mon, 12 Dec 2011 16:06:20 +0100

In this study, we defined the role for the shift in immunodominant epitopes of Col-V in inducing T helper phenotype switch leading to immunity to Col-V and BOS. Sera and lavage from BOS(+) LTx recipients with antibodies to Col-V were analysed. Two years prior to BOS, patients developed antibodies to both Col-V,α1(V) and α2(V) chains. However, at clinical diagnosis of BOS, antibodies became restricted to α1(V). Further, lung biopsy from BOS(+) patients bound to antibodies to α1(V), indicating that these epitopes are exposed. Fourteen Col-V peptides [pep1-14, pep1-4 specific to α1(V), pep5-8 to α1,2(V) and pep9-14 to α2(V)] which bind to HLA-DR4 and -DR7, demonstrated that prior to BOS, pep 6, 7, 9, 11 and 14 were immunodominant and induced interleukin (IL)-10. However, at BOS, the re...

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Clinical features can help predict which infants with bronchiolitis will need hospital admission

The Journal of Pediatrics — Sat, 10 Dec 2011 19:07:37 +0100

Marlais M, Evans J, Abrahamson E. Clinical predictors of admission in infants with acute bronchiolitis. Arch Dis Child 2011;96:648-52. Among infants presenting to the emergency department with bronchiolitis, what factors predict admission to the hospital? (Source: The Journal of Pediatrics)

Long-term Exposure of Chemokine CXCL10 Causes Bronchiolitis-like Inflammation.

Am J Respir Cell Mol... — Thu, 08 Dec 2011 05:00:00 +0100

In this study, we found that CXCL10 mRNA levels were significantly increased in patients with bronchiolitis obliterans syndrome. We generated transgenic mice expressing a mouse CXCL10 cDNA under control of the rat CC10 promoter. Six-month-old CC10-CXCL10 transgenic mice developed bronchiolitis characterized by airway epithelial hyperplasia as well as peribronchiolar and perivascular lymphocyte infiltration. The airway hyperplasia and T cell inflammation were dependent on the presence of CXCR3. Therefore, long-term exposure of the chemokine CXCL10 in the lung causes bronchiolitis-like inflammation in mice. PMID: 22162905 [PubMed - as supplied by publisher] (Source: Am J Respir Cell Mol...)

CXCR3 Chemokine Ligands During Respiratory Viral Infections Predict Lung Allograft Dysfunction

American Journal of Transplantation — Wed, 07 Dec 2011 05:00:00 +0100

Community‐acquired respiratory viruses (CARV) can accelerate the development of lung allograft dysfunction, but the immunologic mechanisms are poorly understood. The chemokine receptor CXCR3 and its chemokine ligands, CXCL9, CXCL10 and CXCL11 have roles in the immune response to viruses and in the pathogenesis of bronchiolitis obliterans syndrome, the predominant manifestation of chronic lung allograft rejection. We explored the impact of CARV infection on CXCR3/ligand biology and explored the use of CXCR3 chemokines as biomarkers for subsequent lung allograft dysfunction. Seventeen lung transplant recipients with CARV infection had bronchoalveolar lavage fluid (BALF) available for analysis. For comparison, we included 34 BALF specimens (2 for each CARV case) that were negative for infec...

Cumulative Exposure to Gamma Interferon‐Dependent Chemokines CXCL9 and CXCL10 Correlates with Worse Outcome After Lung Transplant

American Journal of Transplantation — Wed, 07 Dec 2011 05:00:00 +0100

Outcomes following lung transplant are suboptimal owing to chronic allograft failure termed bronchiolitis obliterans syndrome (BOS). Prior work in both mice and humans has shown that interferon gamma (IFNG)‐induced chemokines, including CXCL9 and CXCL10, are elevated in patients with established BOS. We hypothesized that patients who ultimately developed BOS would have elevations in these chemokines before losing lung function. We utilized a high throughput multiplex enzyme‐linked immunosorbent assay (ELISA) to measure biomarkers in bronchoalveolar lavage fluid (BALF). We modeled cumulative exposure to seven biomarkers (CXCL9, CXCL10, RANTES, IL1‐RA, IL‐17, MCP1 and IL‐13) by calculating the 1‐year area under the curve (AUC) for each biomarker in the BALF of 40 lung transplant ...

Helium-Oxygen Therapy for Infants With Bronchiolitis: A Randomized Controlled Trial [Article]

Archives of Pediatrics — Mon, 05 Dec 2011 05:00:00 +0100

Conclusion Nebulized racemic epinephrine delivered by helium-oxygen followed by helium-oxygen inhalation therapy delivered by HFNC was associated with a greater degree of clinical improvement compared with that delivered by oxygen among infants with bronchiolitis. Trial Registration clinicaltrials.gov Identifier: NCT00116584 (Source: Archives of Pediatrics)

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A shift in the collagen V antigenic epitope leads to T helper phenotype switch and immune response to self‐antigen leading to chronic lung allograft rejection

Clinical and Experimental Immunology — Sat, 03 Dec 2011 23:52:06 +0100

In this study, we defined the role for the shift in immunodominant epitopes of Col‐V in inducing T helper phenotype switch leading to immunity to Col‐V and BOS. Sera and lavage from BOS+ LTx recipients with antibodies to Col‐V were analysed. Two years prior to BOS, patients developed antibodies to both Col‐V,α1(V) and α2(V) chains. However, at clinical diagnosis of BOS, antibodies became restricted to α1(V). Further, lung biopsy from BOS(+) patients bound to antibodies to α1(V), indicating that these epitopes are exposed. Fourteen Col‐V peptides [pep1–14, pep1–4 specific to α1(V), pep5–8 to α1,2(V) and pep9–14 to α2(V)] which bind to HLA‐DR4 and ‐DR7, demonstrated that prior to BOS, pep 6, 7, 9, 11 and 14 were immunodominant and induced interleukin (IL)‐10. H...

Clinical Predictors of Admission in Infants with Acute Bronchiolitis: Marlais M, Evans J, Abrahamson E. Arch Dis Child 2011;96:648–52.

The Journal of Emergency Medicine — Thu, 01 Dec 2011 05:00:00 +0100

Bronchiolitis is common in infants, and deciding whether or not to admit these patients can be difficult in the emergency department (ED). Researchers at a large, urban academic center in the United Kingdom sought to identify clinical predictors of hospital admission in infants presenting with bronchiolitis and to devise a clinical risk scoring system in this population. The authors retrospectively examined the clinical records of 449 infants that presented with acute bronchitis over a 1-year period. Of these patients, 163 (36%) were admitted to the hospital. A total of 29 potential risk predictors were evaluated, and the most accurate predictors of hospital admission were age, duration of symptoms, heart rate, respiratory rate, and oxygen saturation. Predictors with incomplete data sets o...

Is nebulised hypertonic saline useful as an adjunctive treatment for acute bronchiolitis in infants and children less than 24 months of age?

Journal of Paediatrics and Child Health — Thu, 01 Dec 2011 05:00:00 +0100

(Source: Journal of Paediatrics and Child Health)

Paraneoplastic pemphigus with Castleman's disease and bronchiolitis obliterans

Pediatrics International — Thu, 01 Dec 2011 05:00:00 +0100

(Source: Pediatrics International)

Successful Extracorporeal Life Support for Life-threatening Hypercapnia with Bronchiolitis Obliterans after Allogeneic Hematopoietic Stem Cell Transplantation.

Acta Med Okayama — Thu, 01 Dec 2011 05:00:00 +0100

Authors: Waseda K, Tanimoto Y, Ichiba S, Miyahara N, Murakami T, Ochi N, Terado M, Nagano O, Maeda Y, Kanehiro A, Ujike Y, Tanimoto M Abstract Bronchiolitis obliterans (BO) is a disease with a poor prognosis, and a key factor that limits long-term survival after allogeneic hematopoietic stem cell transplantation (HSCT). We here report a case of a 31-year woman with acute lymphatic leukemia, which was treated by chemotherapy and HSCT, and consequently developed BO 2 years after HSCT. A non-tuberculous mycobacterial infection occurred and showed gradual exacerbation. She started taking anti-mycobacterial drugs, but lost appetite, felt tired and finally lost consciousness one month after beginning medication. Arterial blood gas revealed marked hypercapnia. Using extracorporeal life su...

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It's winter again, and another respiratory season is on us

Modern Medicine Contemporary Pediatrics — Thu, 01 Dec 2011 05:00:00 +0100

Another respiratory virus season is on us. Respiratory syncytial virus hit Baltimore in early November, and our residents are already debating the use of bronchodilators, corticosteroids, and nebulized hypertonic saline to treat infants with bronchiolitis. (Source: Modern Medicine Contemporary Pediatrics)

Life-threatening Cardiac Arrhythmia after a Single Dose of Nebulized Epinephrine in Pediatric Emergency Department

Journal of Tropical Pediatrics — Wed, 30 Nov 2011 05:00:00 +0100

We present a case of critical cardiac arrhythmia developed at the Pediatric Emergency Department in an otherwise healthy infant after receiving 3 mg of l-epinephrine (1:1000) nebulization over a 90 min period for a diagnosis of bronchiolitis. Unstable ventricular tachycardia was found after the nebulization therapy that required chemical cardioversion. Frequent premature ventricular contractions (PVCs) were found initially following the cardiac insult that was controlled with oral amiodarone, and disappeared during follow-up. Although epinephrine inhalation is generally safe, adverse life-threatening events could be unpredictable and may evolve even after a single dose of nebulized epinephrine. (Source: Journal of Tropical Pediatrics)

Spirometrically Significant Acute Rejection Increases the Risk for BOS and Death After Lung Transplantation

American Journal of Transplantation — Mon, 28 Nov 2011 05:00:00 +0100

Acute rejection (AR) is a common complication following lung transplantation and is an established risk factor for bronchiolitis obliterans syndrome (BOS). AR clinical presentation varies considerably and is sometimes associated with an acute decrease in forced expiratory volume in 1 s (FEV1). We hypothesized that lung transplant recipients who experience such spirometrically significant AR (SSAR), as defined by a ≥10% decline in FEV1 relative to the prior pulmonary function test, are subsequently at increased risk for BOS and worse overall survival. In a large single center cohort (n = 339), SSAR occurred in 79 subjects (23%) and significantly increased the risk for BOS (p < 0.0001, HR = 3.2, 95% CI 2.3–4.6) and death (p = 0.0001, HR = 2.3, 95% CI 1.5–3.5). These effects persiste...

Prediction of BOS by the single-breath nitrogen test in double lung transplant recipients

BMC Research Notes — Sat, 26 Nov 2011 05:00:00 +0100

We present a retrospective analysis of 61 consecutive bilateral lung or heart-lung transplant recipients who were followed at regular control visits during a 3 year follow-up. The operating characteristics of the N2-slope to diagnose BOS and potential BOS (BOS 0-p) and to predict BOS were determined based on cut off values of 95% specificity. Results: The sensitivity of the N2-slope to identify BOS was 96%, and BOS 0-p 100%. The predictive ability to predict BOS with a N2-slope >478% of the predicted normal was 56%, and if combined with a coincident FEV1 (Source: BMC Research Notes)

Macrolides: from in vitro anti-inflammatory and immunomodulatory properties to clinical practice in respiratory diseases

European Journal of Clinical Pharmacology — Mon, 21 Nov 2011 18:03:38 +0100

Conclusion This review provides an overview on the properties of macrolides (erythromycin, clarithromycin, roxithromycin, azithromycin), their efficacy in various respiratory diseases and their adverse effects. Content Type Journal ArticleCategory Review ArticlePages 1-25DOI 10.1007/s00228-011-1161-xAuthors P. Zarogoulidis, Pulmonary Department, “G. Papanikolaou” Hospital, Aristotle University of Thessaloniki, Thessaloniki, 57010 GreeceN. Papanas, Second Department of Internal Medicine, Democritus University of Thrace, Alexandroupolis, GreeceI. Kioumis, Pulmonary Department, “G. Papanikolaou” Hospital, Aristotle University of Thessaloniki, Thessaloniki, 57010 GreeceE. Chatzaki, Laboratory of Pharmacology, Medical School, Democritus University of Thrace, Alexa...

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Challenges in lung transplantation.

Swiss Medical Weekly — Sun, 20 Nov 2011 23:12:02 +0100

Authors: Krueger T, Berutto C, Aubert JD Abstract Lung transplantation is an established therapy for end-stage pulmonary disorders in selected patients without significant comorbidities. The particular constraints associated with organ transplantation from deceased donors involve specific allocation rules in order to optimise the medical efficacy of the procedure. Comparison of different policies adopted by national transplant agencies reveals that an optimal and unique allocation system is an elusive goal, and that practical, geographical and logistic parameters must be taken into account. A solution to attenuate the imbalance between the number of lung transplant candidates and the limited availability of organs is to consider marginal donors. In particular, assessment and restor...

[Aetiology of bronchiolitis in hospitalised children in South-East Spain.]

Anales de Pediatria — Fri, 18 Nov 2011 05:00:00 +0100

CONCLUSIONS: Respiratory viruses were detected in most of the children below 18 months-old hospitalised with bronchiolitis, and 36% of them showed a mixed infection. PMID: 22104022 [PubMed - as supplied by publisher] (Source: Anales de Pediatria)

Idiopathic constrictive bronchiolitis with rapidly progressive bronchiectasis and Mycobacterium kansasii infection

Respiratory Medicine CME — Thu, 17 Nov 2011 12:48:12 +0100

We describe a 58-year-old man with no preexisting lung disease who suffered rapid loss of lung function with hyperinflation over months in association with rapidly progressive radiographic bronchiectasis. Airway cultures grew Mycobacterium kansasii, Pseudomonas aeruginosa and Aspergillus fumigatus; lung biopsy showed constrictive bronchiolitis that was clinically idiopathic. His respiratory symptoms and pulmonary function rapidly improved within a week of high-dose corticosteroid therapy. We suggest that a diagnosis of constrictive bronchiolitis should be considered in patients with a combination of new rapidly progressive lung hyperinflation and worsening bronchiectasis. We hypothesize that the bronchiolitis-associated bronchiectasis may occur from a predisposition for secondary infection...

Mesalazine: Bronchiolitis obliterans organising pneumonia: case report

Reactions — Wed, 16 Nov 2011 21:59:42 +0100

(Source: Reactions)

Respiratory syncytial virus immunoprophylaxis in high‐risk infants with heart disease

Journal of Paediatrics and Child Health — Wed, 16 Nov 2011 05:00:00 +0100

Conclusions: Compared with other infants, those with haemodynamically significant cardiac disease have a more complicated course of illness with RSV bronchiolitis. In these infants, palivizumab reduced the number of hospitalisations because of RSV. Cohorting patients for maximal palivizumab use reduced overall cost. To significantly impact on intensive care admissions overall, immunoprophylaxis should be considered at a regional level. (Source: Journal of Paediatrics and Child Health)

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Use of data linkage to investigate the aetiology of acute lower respiratory infection hospitalisations in children

Journal of Paediatrics and Child Health — Mon, 14 Nov 2011 05:00:00 +0100

Conclusions: This is the first report of population‐based data linkage between statewide laboratory data and hospitalisation records and demonstrates proof of principle. RSV continues to be an important pathogen in ALRI. As pathogens were identified across all diagnoses, relying on hospital diagnosis coding alone may not accurately estimate the burden of different categories of ALRI. (Source: Journal of Paediatrics and Child Health)

Pulmonary toxicities from targeted therapies: a review

Targeted Oncology — Thu, 10 Nov 2011 16:53:45 +0100

Abstract Pulmonary toxicity is rarely seen with most commonly used targeted therapies. The endothelial growth factor receptor (EGFR) small-molecule tyrosine kinase inhibitors (TKIs) gefitinib and erlotinib can cause interstitial lung disease (ILD). BCR-ABL tyrosine kinase inhibitors imatinib and dasatinib can cause pleural effusions. Infusion-related bronchospasm is common with the monoclonal antibodies to EGFR cetuximab and panitumumab, and case reports of bronchiolitis and pulmonary fibrosis have been described. Up to one-sixth of patients taking mammalian target of rapamycin (mTOR) inhibitors get a reversible interstitial pneumonitis. Bevacizumab, the monoclonal antibody to vascular endothelial growth factor (VEGF), has been associated with hemoptysis and pulmonary embo...

Ten years of human metapneumovirus research

Journal of Clinical Virology — Thu, 10 Nov 2011 05:00:00 +0100

Abstract: Described for the first time in 2001, human metapneumovirus (hMPV) has become one of the main viral pathogens responsible for acute respiratory tract infections in children but also in the elderly and immuno-compromised patients. The pathogen most closely related to hMPV is human respiratory syncytial virus (hRSV), the most common cause of bronchiolitis and pneumonia in young children. hMPV has been classified into two main viral groups A and B and has a seasonal distribution in temperate countries with most cases occurring in winter and spring. Given the difficulties encountered in culturing hMPV in vitro, diagnosis is generally achieved using real-time polymerase chain reaction.Like other Paramyxoviridae, hMPV has a negative-sense single-stranded RNA genome that includes 8 gene...

Is Prevention the Best Treatment? CMV After Lung Transplantation

American Journal of Transplantation — Wed, 09 Nov 2011 05:00:00 +0100

Cytomegalovirus (CMV) is the most prevalent opportunistic infection that occurs in lung‐transplant recipients. In addition to its direct morbidity, multiple studies have demonstrated that CMV, in particular CMV pneumonia, is associated with an increased risk for chronic graft dysfunction manifested as bronchiolitis obliterans syndrome (BOS) and worse posttransplant survival. Therefore, prevention of CMV remains an important goal to improve long‐term lung‐transplant outcomes. Although centers often employed 3 months of prophylaxis in at‐risk patients after lung transplantation, a significant proportion of patients still developed infection or disease after the discontinuation of prophylaxis, highlighting the need for more effective approaches to CMV prevention. A number of early sin...

Exhaled Nitric Oxide: A Valuable Tool for Early Diagnosis and Phenotyping of Bronchiolitis Obliterans Syndrome

American Journal of Transplantation — Fri, 04 Nov 2011 04:00:00 +0100

(Source: American Journal of Transplantation)

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Exhaled Nitric Oxide in Diagnosis of Bronchiolitis Obliterans Syndrome in Lung Transplant Recipients: Possible Limitations

American Journal of Transplantation — Fri, 04 Nov 2011 04:00:00 +0100

(Source: American Journal of Transplantation)

Cesarean Delivery Linked to Infant BronchiolitisCesarean Delivery Linked to Infant Bronchiolitis

Medscape Today Headlines — Thu, 03 Nov 2011 21:45:46 +0100

A new study links birth by cesarean delivery to an increased risk for hospitalizations resulting from bronchiolitis in children up to 2 years of age. Medscape Medical News (Source: Medscape Today Headlines)

Constrictive Bronchiolitis in Soldiers

New England Journal of Medicine — Wed, 02 Nov 2011 21:00:32 +0100

New England Journal of Medicine, Volume 365, Issue 18, Page 1743-1745, November 2011. (Source: New England Journal of Medicine)

Necrotizing Bronchiolitis in Influenza A of Swine Origin (H1N1).

American Journal of Respiratory and Critical Care Medicine — Tue, 01 Nov 2011 04:00:00 +0100

Authors: Toyoshima M, Chida K, Suda T, Sato M PMID: 22045749 [PubMed - as supplied by publisher] (Source: American Journal of Respiratory and Critical Care Medicine)

Unnecessary Care for Bronchiolitis Decreases With Increasing Inpatient Prevalence of Bronchiolitis

PEDIATRICS — Tue, 01 Nov 2011 04:00:00 +0100

CONCLUSIONS: The frequency with which several types of unnecessary care were delivered to patients with bronchiolitis seemed to decrease with increasing IBP. This finding suggests that an association exists between contextual information and care delivery during the management of acute illness, and it highlights the importance of such information for delivery of high-quality health care. (Source: PEDIATRICS)

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A genetic polymorphism in the CAV1 gene associates with the development of bronchiolitis obliterans syndrome after lung transplantation

Fibrogenesis and Tissue Repair — Tue, 01 Nov 2011 04:00:00 +0100

A genetic polymorphism and a consequential increase in protein serum levels contribute to the development of bronchiolitis obliterans syndrome after lung transplantation. (Source: Fibrogenesis and Tissue Repair)

Geographic Distance Between Donor and Recipient Does Not Influence Outcomes After Lung Transplantation [ORIGINAL ARTICLES: GENERAL THORACIC]

The Annals of Thoracic Surgery — Tue, 01 Nov 2011 04:00:00 +0100

Conclusions With appropriate donor selection, moderately long geographic distance (average ischemic time < 6 hours) between the donor and recipient is not associated with the development of BOS or increased death after lung transplantation. By placing less emphasis on distance, more donors could potentially be used to expand the donor pool. (Source: The Annals of Thoracic Surgery)

The Need for a New Animal Model for Chronic Rejection After Lung Transplantation

Transplantation Proceedings — Tue, 01 Nov 2011 04:00:00 +0100

Abstract: The single most important cause of late mortality after lung transplantation is obliterative bronchiolitis (OB), clinically characterized by a decrease in lung function and morphologically by characteristic changes. Recently, new insights into its pathogenesis have been acquired: risk factors have been identified and the use of azithromycin showed a dichotomy with at least 2 different phenotypes of bronchiolitis obliterans syndrome (BOS). It is clear that a good animal model is indispensable to further dissect and unravel the pathogenesis of BOS. Many animal models have been developed to study BOS but, so far, none of these models truly mimics the human situation. Looking at the definition of BOS, a good animal model implies histological OB lesions, possibility to measure lung fu...

Pharmacokinetics, Pharmacodynamics, and Comparative Bioavailability of Single, Oral 2-mg Doses of Dexamethasone Liquid and Tablet Formulations: A Randomized, Controlled, Crossover Study in Healthy Adult Volunteers.

Clinical Therapeutics — Mon, 31 Oct 2011 04:00:00 +0100

CONCLUSIONS: This single-dose study suggests that the test and reference products met the EMA regulatory criteria to assume bioequivalence in these fasting healthy male and female volunteers. German Register of Clinical Trials registration number: DRKS00000785. PMID: 22047811 [PubMed - as supplied by publisher] (Source: Clinical Therapeutics)

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Role of Oxidants in Interstitial Lung Diseases: Pneumoconioses, Constrictive Bronchiolitis, and Chronic Tropical Pulmonary Eosinophilia

Clinical and Developmental Immunology — Sun, 30 Oct 2011 22:52:59 +0100

Oxidants such as superoxide anion, hydrogen peroxide, and myeloperoxidase from activated inflammatory cells in the lower respiratory tract contribute to inflammation and injury. Etiologic agents include inorganic particulates such as asbestos, silica, or coal mine dust or mixtures of inorganic dust and combustion materials found in World Trade Center dust and smoke. These etiologic agents are phagocytosed by alveolar macrophages or bronchial epithelial cells and release chemotactic factors that recruit inflammatory cells to the lung. Chemotactic factors attract and activate neutrophils, eosinophils, mast cells, and lymphocytes and further activate macrophages to release more oxidants. Inorganic dusts target alveolar macrophages, World Trade Center dust targets bronchial epithelial cells, a...

Nebulized Hypertonic-Saline vs Epinephrine for Bronchiolitis Proof-of-Concept Study by Cumulative Sum (CUSUM) Analysis.

Indian Pediatrics — Sun, 30 Oct 2011 04:00:00 +0100

CONCLUSIONS: The software we developed allows for drawing of control lines to monitor study drug performance. Hypertonic-saline performed as well or better than nebulized epinephrine in bronchiolitis. PMID: 22080619 [PubMed - as supplied by publisher] (Source: Indian Pediatrics)

Gemcitabine: Bronchiolitis obliterans organising pneumonia: case report

Reactions — Sat, 22 Oct 2011 05:54:13 +0100

(Source: Reactions)

Erratum to: Chest physiotherapy using passive expiratory techniques does not reduce bronchiolitis severity: a randomised controlled trial

European Journal of Pediatrics — Thu, 20 Oct 2011 05:56:20 +0100

Content Type Journal ArticleCategory ErratumPages 1-1DOI 10.1007/s00431-011-1601-8Authors Isabelle Rochat, Pediatric Pulmonology Unit, Children’s Hospital, University Hospitals, Geneva, SwitzerlandPatricia Leis, Pediatric Physiotherapy, Children’s Hospital, University Hospitals, Geneva, SwitzerlandMarie Bouchardy, Pediatric Physiotherapy, Children’s Hospital, University Hospitals, Geneva, SwitzerlandChristine Oberli, Pediatric Physiotherapy, Children’s Hospital, University Hospitals, Geneva, SwitzerlandHendrika Sourial, Pediatric Physiotherapy, Children’s Hospital, University Hospitals, Geneva, SwitzerlandMargrit Friedli-Burri, Pediatric Physiotherapy, Children’s Hospital, University Hospitals, Geneva, SwitzerlandThomas Perneger, Division of Clinical Epidemiology, Universit...

Bronchiolitis care gets better as local incidence rises

Modern Medicine — Thu, 20 Oct 2011 04:00:00 +0100

NEW YORK (Reuters Health) - As the number of patients in the hospital with bronchiolitis goes up, their odds of receiving unnecessary care goes down, according to a new report. (Source: Modern Medicine)

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Respiratory support by neurally adjusted ventilatory assist (NAVA) in severe RSV-related bronchiolitis: a case series report

BMC Pediatrics - Latest articles — Thu, 20 Oct 2011 04:00:00 +0100

Conclusions: Our findings highlight the feasibility and benefit of NAVA in children with severe RSV-related bronchiolitis. NAVA provides a less aggressive ventilation requiring lower inspiratory pressures with good results for oxygenation and more comfort for the children. (Source: BMC Pediatrics - Latest articles)

Molecular epidemiological study of human rhinovirus species ABCs from patients with acute respiratory illnesses in Japan.

Journal of Medical Microbiology — Thu, 20 Oct 2011 04:00:00 +0100

Authors: Arakawa M, Okamoto-Nakagawa R, Toda S, Tsukagoshi H, Kobayashi M, Ryo A, Mizuta K, Hasegawa S, Hirano R, Wakiguchi H, Kudo K, Tanaka R, Morita Y, Noda M, Kozawa K, Ichiyama T, Shirabe K, Kimura H Abstract Recent studies suggest that human rhinovirus species A, B, and C (HRV-ABCs) may be associated with both the common cold and severe acute respiratory illnesses (ARI) such as bronchiolitis, wheezy bronchiolitis, and pneumonia. However, the state and molecular epidemiology of these viruses in Japan is not fully understood. We detected the genomes of HRV-ABCs from Japanese patients (92 cases, 0-36 years old, 3.5 ± 5.0 years; mean ± SD) with various ARI including upper respiratory infection (URI), bronchiolitis, wheezy bronchiolitis, croup, and pneumonia between January and ...

Post-Measles Bronchiolitis Obliterans in a 3-y-old Girl

Indian Journal of Pediatrics — Wed, 19 Oct 2011 15:50:29 +0100

Content Type Journal ArticleCategory Scientific Letter to the EditorPages 1-2DOI 10.1007/s12098-011-0583-xAuthors Mandeep Walia, Department of Pediatrics, Chacha Nehru Bal Chikitsalaya, Maulana Azad Medical College, Delhi, IndiaVishnu Goyal, Department of Pediatrics, Chacha Nehru Bal Chikitsalaya, Maulana Azad Medical College, Delhi, IndiaPankaj Jain, Department of Radiology, Sri Anandpur Charitable Trust Diagnostic Centre, Delhi, India Journal Indian Journal of PediatricsOnline ISSN 0973-7693Print ISSN 0019-5456 (Source: Indian Journal of Pediatrics)

Month-by-Month Age Analysis of the Risk for Serious Bacterial Infections in Febrile Infants With Bronchiolitis

Clinical Pediatrics — Tue, 18 Oct 2011 04:00:00 +0100

Conclusion. The risk of SBI among febrile infants with bronchiolitis is significantly lower compared with febrile infants without bronchiolitis, but only after the neonatal period in which the risk for urinary tract infection was relatively high (9.7%). (Source: Clinical Pediatrics)

Optimal level of nasal continuous positive airway pressure in severe viral bronchiolitis

Intensive Care Medicine — Wed, 12 Oct 2011 16:33:24 +0100

Conclusion In infants with hypercapnic respiratory failure due to acute viral bronchiolitis, an nCPAP level of 7 cmH2O is associated with the greatest unloading of the respiratory muscles and improvement of breathing pattern, as well as a favourable short-term clinical outcome. Content Type Journal ArticleCategory Pediatric OriginalPages 1-6DOI 10.1007/s00134-011-2372-4Authors Sandrine Essouri, AP-HP, Pediatric Intensive Care Unit, Kremlin-Bicêtre Hospital, 78 rue du Général Leclerc, 94270 Le Kremlin-Bicêtre, FrancePhilippe Durand, AP-HP, Pediatric Intensive Care Unit, Kremlin-Bicêtre Hospital, 78 rue du Général Leclerc, 94270 Le Kremlin-Bicêtre, FranceLaurent Chevret, AP-HP, Pediatric Intensive Care Unit, Kremlin-Bicêtre Hospital, 78 rue du Général L...

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Paediatric Interstitial Lung Disease: Classification and Definitions

Paediatric Respiratory Reviews — Wed, 12 Oct 2011 04:00:00 +0100

Summary: Classifications of interstitial (diffuse) lung disease in adults and children have undergone significant revision in recent years, with advances in our understanding of new entities and the biology and prognostic significance of certain histologic patterns. The contributions of the European Respiratory Society Task Force on Interstitial Lung Disease in Children and the North American Children's Interstitial Lung Disease Group are reviewed, and a clinicopathologic classification of paediatric diffuse lung disease is summarized. Clinical characteristics and histologic definitions are also presented for selected entities within this classification, specifically, acinar dysgenesis, congenital alveolar dysplasia, alveolar capillary dysplasia with misalignment of pulmonary veins, abnorm...

Clinical Assessment of Occupational Asthma and its Differential Diagnosis

Immunology and Allergy Clinics of North America — Sat, 08 Oct 2011 22:50:06 +0100

Occupational asthma (OA) is defined as asthma caused by sources and conditions attributable to a particular occupational environment and not to stimuli encountered outside the workplace. Two types of OA are distinguished based on their appearance after a latency period or not. The most frequent type appears after a latency period leading to sensitization; the clinical assessment of this type of OA is the topic of this review. The differential diagnosis of OA is also reviewed, including work-exacerbated asthma, eosinophilic bronchitis, hyperventilation syndrome, vocal cord dysfunction, bronchiolitis, and other causes of dyspnea or cough. (Source: Immunology and Allergy Clinics of North America)

Bayesian Probit Regression Model for the Diagnosis of Pulmonary Fibrosis: Proof-of-Principle.

BMC Medical Genomics — Wed, 05 Oct 2011 04:00:00 +0100

Conclusions: This study represents the first use of BPR on whole lung tissue; previously, BPR was primarily used to develop predictive models for cancer. This also represents the first report of an independently validated IPF gene expression signature. In summary, BPR is a promising tool for the development of gene expression signatures from non-neoplastic lung tissue. In the future, BPR might be used to develop definitive diagnostic gene signatures for IPF, prognostic gene signatures for IPF or gene signatures for other non-neoplastic lung disorders such as bronchiolitis obliterans. (Source: BMC Medical Genomics)

NOVAVAX Reports Positive Results From Phase I Trial of Respiratory Syncytial Virus Vaccine Candidate

Medical News (via PRIMEZONE) — Mon, 03 Oct 2011 12:00:00 +0100

ROCKVILLE, Md., Oct. 3, 2011 (GLOBE NEWSWIRE) -- Novavax, Inc. (Nasdaq:NVAX) today announced positive top-line results from a Phase I clinical study of its respiratory syncytial virus (RSV) fusion (F) recombinant nanoparticle vaccine candidate. In a paper titled "Recombinant RSV F nanoparticle vaccine for respiratory disease: antigen characterization, preclinical efficacy and clinical evaluation," Gregory M. Glenn, M.D., Senior Vice President and Chief Medical Officer of Novavax, is presenting safety, immunogenicity and tolerability findings from this study in a poster and oral presentation today and tomorrow, respectively, at the 5th Vaccine and ISV Annual Global Conference in Seattle. In the United States, RSV is the most common cause of bronchiolitis and pneumonia in children under 1 ye...

Occult Serious Bacterial Infection in Infants Younger Than 60 to 90 Days With Bronchiolitis: A Systematic Review [Review Article]

Archives of Pediatrics — Mon, 03 Oct 2011 04:00:00 +0100

Conclusions A screening approach to culturing for serious bacterial infections in febrile infants presenting with bronchiolitis or respiratory syncytial virus infection is very low yield. The rate of urine cultures positive for bacteria remains significant, though asymptomatic bacteriuria may confound these results. (Source: Archives of Pediatrics)

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[Thoracic congenital ectopic right kidney with diaphragmatic hernia: A rare developmental anomaly].

Archives de Pediatrie — Sat, 01 Oct 2011 04:00:00 +0100

We report the case of a female infant admitted for mild respiratory distress at birth in relation with maternofetal infection in whom a right posterior opacity on chest x-ray was diagnosed as intrathoracic kidney by sonography and chest CT scan. Diaphragmatic hernia could not be confirmed at this stage. At 2 months, the presence of air blebs on chest x-ray performed for viral bronchiolitis confirmed an associated right Bochdalek hernia. The infant, although asymptomatic, underwent surgery. The intrathoracic kidney was reduced into the abdominal cavity at the time of surgery. The postoperative course was uneventful and renal function was normal. PMID: 21865018 [PubMed - in process] (Source: Archives de Pediatrie)

The protective role of laparoscopic antireflux surgery against aspiration of pepsin after lung transplantation

Surgery — Sat, 01 Oct 2011 04:00:00 +0100

Conclusion: This study compared pepsin in the BALF from lung transplant patients with and without LARS. Our data show that: (1) the detection of pepsin in the BALF proves aspiration because it is not present in healthy volunteers, and (2) LARS appears effective as a measure to prevent the aspiration of gastroesophageal refluxate in the lung transplant population. We believe that these findings provide a mechanism for those studies suggesting that LARS may prevent nonallogenic injury to the transplanted lungs from aspiration of gastroesophageal contents. (Source: Surgery)

Could you spot the symptoms of Bronchiolitis?

Gurgle — Sat, 01 Oct 2011 03:15:18 +0100

How much do you know about Bronchiolitis? Despite the fact that a third of babies will have had bronchiolitis by the time of their first birthday, research has found that many parents still know very little about the condition. (Source: Gurgle)

Clusters of acute respiratory illness associated with human enterovirus 68 --- Asia, europe, and United States, 2008--2010.

MMWR Morb Mortal Wkl... — Fri, 30 Sep 2011 04:00:00 +0100

This report highlights HEV68 as an increasingly recognized cause of respiratory illness. Clinicians should be aware of HEV68 as one of many causes of viral respiratory disease and should report clusters of unexplained respiratory illness to the appropriate public health agency. PMID: 21956405 [PubMed - in process] (Source: MMWR Morb Mortal Wkl...)

Pulse Oximetry in Pediatric Practice

PEDIATRICS — Fri, 30 Sep 2011 04:00:00 +0100

The introduction of pulse oximetry in clinical practice has allowed for simple, noninvasive, and reasonably accurate estimation of arterial oxygen saturation. Pulse oximetry is routinely used in the emergency department, the pediatric ward, and in pediatric intensive and perioperative care. However, clinically relevant principles and inherent limitations of the method are not always well understood by health care professionals caring for children. The calculation of the percentage of arterial oxyhemoglobin is based on the distinct characteristics of light absorption in the red and infrared spectra by oxygenated versus deoxygenated hemoglobin and takes advantage of the variation in light absorption caused by the pulsatility of arterial blood. Computation of oxygen saturation is achieved wit...

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Infant Swimming in Chlorinated Pools and the Risks of Bronchiolitis, Asthma and Allergy

PEDIATRICS — Fri, 30 Sep 2011 04:00:00 +0100

(Source: PEDIATRICS)

Causal Direction Between Respiratory Syncytial Virus Bronchiolitis and Asthma Studied in Monozygotic Twins

PEDIATRICS — Fri, 30 Sep 2011 04:00:00 +0100

(Source: PEDIATRICS)

NCS 613, a potent and specific PDE4 inhibitor, displays anti-inflammatory effects on human lung tissues

AJP: Lung Cellular and Molecular Physiology — Thu, 29 Sep 2011 04:00:00 +0100

In conclusion, specific PDE4 inhibitors, such as NCS 613, may represent an alternative and isoform-specific approach toward reducing human lung inflammation and airway overreactivity. (Source: AJP: Lung Cellular and Molecular Physiology)

Rhinovirus Infection Tied to Wheezing in ChildrenRhinovirus Infection Tied to Wheezing in Children

Medscape Pediatrics Headlines — Wed, 28 Sep 2011 23:04:10 +0100

Rhinovirus infection and a family history of asthma are major risk factors for wheezing after acute bronchiolitis, researchers reported online August 18th in the European Respiratory Journal. Reuters Health Information (Source: Medscape Pediatrics Headlines)

Rhinovirus infection tied to wheezing in children

Modern Medicine — Tue, 27 Sep 2011 04:00:00 +0100

NEW YORK (Reuters Health) - Rhinovirus infection and a family history of asthma are major risk factors for wheezing after acute bronchiolitis, researchers reported online August 18th in the European Respiratory Journal. (Source: Modern Medicine)

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Successful treatment of a paraneoplastic pemphigus in a teenager using plasmapheresis, corticosteroids and tumour resection

Clinical And Experimental Dermatology — Sat, 24 Sep 2011 14:04:28 +0100

We report a 16‐year‐old girl with the typical findings of PNP associated with Castleman’s tumour. She was treated with tumour resection in combination with plasmapheresis and corticosteroids. Fifteen months after the operation, the patient had recovered without the development of BO. (Source: Clinical And Experimental Dermatology)

Neurally triggered breaths reduce trigger delay and improve ventilator response times in ventilated infants with bronchiolitis

Intensive Care Medicine — Fri, 23 Sep 2011 05:55:01 +0100

Conclusion Neurally triggered breaths reduce trigger delay, improve ventilator response times, and may decrease work of breathing in children with bronchiolitis. Further analysis is required to determine if neurally triggered breaths will improve patient–ventilator synchrony. Content Type Journal ArticleCategory Pediatric OriginalPages 1-7DOI 10.1007/s00134-011-2352-8Authors Katherine C. Clement, Division of Pediatric Critical Care Medicine, Department of Anesthesiology, University of North Carolina at Chapel Hill, 214 MacNider, CB 7221, Chapel Hill, NC 27599-7221, USATracy L. Thurman, Division of Critical Care, Department of Pediatrics, University of Arkansas for Medical Sciences, 3 Children’s Way, Slot 512-12, Little Rock, AR 72202, USAShirley J. Holt, Arkansa...

Prostaglandin E2 as an Inhibitory Modulator of Fibrogenesis in Human Lung Allografts.

American Journal of Respiratory and Critical Care Medicine — Thu, 22 Sep 2011 04:00:00 +0100

CONCLUSIONS: These data identify the PGE2 axis as an important autocrine/paracrine brake on fibrotic differentiation of LR-MSCs, a failure of which is associated with BOS. PMID: 21940790 [PubMed - as supplied by publisher] (Source: American Journal of Respiratory and Critical Care Medicine)

Follicular bronchiolitis and lymphocytic interstitial pneumonia in a Japanese man

Diagnostic Pathology — Wed, 21 Sep 2011 04:00:00 +0100

A 44-year-old Japanese man consulted to our hospital because of cough andsputum. Chest-XP and CT revealed diffuse reticular opacities in both lungs.A transbronchial lung biopsy (TBLB) showed a moderate infiltration oflymphocytes in the alveolar septae. He was diagnosed as interstitial pneumonia,and treated by drugs. One year later, his condition deteriolated, and a large openbiopsy was performed. It showed a diffuse severe infiltration of lymphocytes in thealveolar walls and a few epithelioid granulomas. No bronchiolitis was seen.Immunohistochemical study denied lymphocyte monoclonality, and he wasdiagnosed as lymphocytic interstitial pneumonia (LIP). He was treated by steroid.Six months later, TBLB showed peribronchial lymphocyte infiltration. A large openbiopsy also revealed a severe lym...

Longitudinal lung function declines among california flavoring manufacturing workers

American Journal of Industrial Medicine — Mon, 19 Sep 2011 15:44:08 +0100

ConclusionsSpirometric surveillance of flavoring workers can identify individual workers with an abnormal FEV1decline for preventive intervention, even when the FEV1 itself remains within the normal range. Good quality spirometry and classification of abnormal with relative longitudinal limit of decline minimize misclassification of possible work‐related health effects. Am. J. Ind. Med. © 2011 Wiley‐Liss, Inc. (Source: American Journal of Industrial Medicine)

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Antireflux Surgery Preserves Lung Function in Patients With Gastroesophageal Reflux Disease and End-stage Lung Disease Before and After Lung Transplantation [Paper]

Archives of Surgery — Mon, 19 Sep 2011 04:00:00 +0100

Conclusions There should be a low threshold for performing objective esophageal testing including esophageal impedance because GERD may be occult and ARS may improve or prolong allograft and native lung function. (Source: Archives of Surgery)

Chest physiotherapy using passive expiratory techniques does not reduce bronchiolitis severity: a randomised controlled trial

European Journal of Pediatrics — Fri, 16 Sep 2011 16:42:43 +0100

In conclusion, this study shows the absence of effectiveness of CP using passive expiratory techniques in infants hospitalised for bronchiolitis. It seems justified to recommend against the routine use of CP in these patients. Content Type Journal ArticleCategory Original PaperPages 1-6DOI 10.1007/s00431-011-1562-yAuthors Isabelle Rochat, Pediatric Pulmonology Unit, Children’s Hospital, University Hospitals, Geneva, SwitzerlandPatricia Leis, Pediatric Physiotherapy, Children’s Hospital, University Hospitals, Geneva, SwitzerlandMarie Bouchardy, Pediatric Physiotherapy, Children’s Hospital, University Hospitals, Geneva, SwitzerlandChristine Oberli, Pediatric Physiotherapy, Children’s Hospital, University Hospitals, Geneva, SwitzerlandHendrika Sourial, Pediatric Physiotherapy...

Autoantibody formation in human and rat studies of chronic rejection and primary graft dysfunction.

Seminars in Immunology — Fri, 16 Sep 2011 04:00:00 +0100

Authors: Wilkes DS Abstract Lung transplantation is considered a definitive treatment for many lung diseases. However, rejection and other pathologic entities are major causes of morbidity and mortality for lung transplant recipients. Primary graft dysfunction (PGD) and obliterative bronchiolitis (OB) are the leading causes of early and late mortality, respectively. While the immune basis of PGD has not been clearly defined, evidence is emerging about roles for autoantibodies in this process. Similarly, the pathogenesis of OB has been linked recently to autoimmunity. This review will highlight the current understanding of autoantibodies in PGD and OB post lung transplantation. PMID: 21925897 [PubMed - as supplied by publisher] (Source: Seminars in Immunology)

Effectiveness of palivizumab prophylaxis in infants and children in Florida

Pharmacoepidemiology and Drug Safety — Thu, 15 Sep 2011 04:00:00 +0100

ConclusionIn this community‐based study, palivizumab was associated with a reduction in severe RSV infections of a magnitude comparable to the lower clinical trial efficacy estimates. Protection appears to extend beyond the currently recommended monthly dosing schedule. Copyright © 2011 John Wiley & Sons, Ltd. (Source: Pharmacoepidemiology and Drug Safety)

Corticosteroids in Respiratory Diseases in Children.

American Journal of Respiratory and Critical Care Medicine — Thu, 15 Sep 2011 04:00:00 +0100

Authors: de Benedictis FM, Bush A Abstract We review recent advances in the use of corticosteroids in pediatric lung disease. They are frequently used, either systemically or by inhalation. Their mechanisms of action in pulmonary diseases are ill defined. Corticosteroids exert direct inhibitory effects on many inflammatory cells through genomic mechanisms. There is a time lag before clinical response, and the wash out of effects is also prolonged. Prompt relief in some conditions such as croup may be related to airway mucosal vasoconstriction through a nongenomic mechanism. Corticosteroids have proven beneficial roles in asthma, croup, allergic bronchopulmonary aspergillosis and subglottic hemangioma. In some conditions, such as bronchiolitis, cystic fibrosis and bronchopulmonary d...

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Local interleukin-10 production during respiratory syncytial virus bronchiolitis is associated with post-bronchiolitis wheeze

BioMed Central — Mon, 12 Sep 2011 04:00:00 +0100

Conclusion: The relationship between high local IL-10 levels during the initial RSV infection and physician diagnosed PBW provides further evidence of the importance of the IL-10 response during RSV bronchiolitis. (Source: BioMed Central)

Infection with multiple viruses is not associated with increased disease severity in children with bronchiolitis

Pediatric Pulmonology — Wed, 07 Sep 2011 04:00:00 +0100

ConclusionDisease severity in children with bronchiolitis is not associated with infection by multiple viruses. We conclude that other factors, such as age, contribute to disease severity to a larger extent. Pediatr Pulmonol. © 2011 Wiley‐Liss, Inc. (Source: Pediatric Pulmonology)

Clinical predictors of nasal continuous positive airway pressure requirement in acute bronchiolitis

Pediatric Pulmonology — Wed, 07 Sep 2011 04:00:00 +0100

ConclusionWe have identified clinical variables that were predictive of nCPAP requirement in infants admitted to our unit with bronchiolitis, oxygen requirement in the ED being the strongest single predictor. This is the first such study in the UK, and we hope it may be a starting point for further work that may provide an evidence base to aid clinicians in predicting the use of nCPAP in infants with bronchiolitis. Pediatr Pulmonol. © 2011 Wiley‐Liss, Inc. (Source: Pediatric Pulmonology)

What Causes Coughs?

PediatricEducation.org — Mon, 05 Sep 2011 00:22:52 +0100

Discussion “A cough is a voluntary or involuntary explosive expiration. After a deep inspiration, the glottis is closed and the expiratory muscles contract, compressing the lung and raising intrapulmonary pressure above the atmospheric pressure. The glottis then opens, and gas is expelled at a rapid rate.” Acute coughs are commonly due to upper respiratory tract diseases in children of all ages – often because of post-nasal rhinorrhea. Chronic coughs may be more difficult to determine the cause of and may require more investigation, consultation, and/or empiric trials of medication including radiographic imaging of chest or sinuses, spirotometry, sweat chloride, methacholine challenge, bronchoscopy, gastroscopy, immunodeficiency testing, etc. Children with congenital abn...

Air pollution and admissions for acute lower respiratory infections in young children of Ho Chi Minh City

Air Quality, Atmosphere and Health — Fri, 02 Sep 2011 05:51:39 +0100

This study assessed the effects of exposure to air pollution on hospitalization for acute lower respiratory infection (ALRI) among children under 5 years of age in Ho Chi Minh City (HCMC) from 2003 to 2005. Case-crossover analyses with time-stratified selection of control periods were conducted using daily admissions for pneumonia and bronchiolitis and daily, citywide averages of PM10, NO2, SO2, and O3 (8-h maximum average) estimated from the local air quality monitoring network. Increased concentrations of NO2 and SO2 were associated with increased admissions in the dry season (November to April), with excess risks of 8.50% (95%CI 0.80–16.79) and 5.85% (95%CI 0.44–11.55), respectively. PM10 could also be associated with increased admissions in the dry season, but high correla...

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A Retrospective 12-Month Study of Conversion to Everolimus in Lung Transplant Recipients

Transplantation Proceedings — Thu, 01 Sep 2011 04:00:00 +0100

Conclusions: BOS and RI were the main indications for conversion to everolimus among lung recipients. Conversion to everolimus improved renal function among patients converted because of RI. The present results were inconclusive regarding effects of everolimus on BOS. (Source: Transplantation Proceedings)

The Induction of IgM and IgG Antibodies against HLA or MICA after Lung Transplantation

Advances in Pharmacological Sciences — Mon, 29 Aug 2011 14:10:15 +0100

This study investigates the relationship between IgM and IgG antibodies against HLA and MICA after lung transplantation. Serum was collected from 49 patients once prior to transplantation and monthly for up to 1 year after lung transplantation was analyzed by Luminex to detect IgM and IgG antibodies against HLA and MICA. The presence of either IgM or IgG HLA and/or MICA antibodies prior to or after transplantation was not related to survival, gender, primary disease, or the development of BOS. Additionally, the production of IgG alloantibodies was not preceded by an increase in levels of IgM, and IgM levels were not followed by an increase in IgG. Under current immune suppressive regimen, although the presence of IgM antibodies does not correlate with BOS after LTx, IgM high Ig...

Comparison of serum KL-6 versus bronchoalveolar lavage neutrophilia for the diagnosis of bronchiolitis obliterans in lung transplantation

The Journal of Heart and Lung Transplantation — Mon, 29 Aug 2011 04:00:00 +0100

Conclusions: Serum KL-6 levels are increased and correlate with the decline from baseline in FEV1 in lung transplant recipients. The diagnostic accuracy of serum KL-6 level is better than that of BALF neutrophilia for detecting BOS. (Source: The Journal of Heart and Lung Transplantation)

Bronchiolitis obliterans after allo-SCT: clinical criteria and treatment options

Bone Marrow Transplantation — Sun, 28 Aug 2011 23:00:00 +0100

Authors: H H Uhlving, F Buchvald, C J Heilmann, K G Nielsen, M Gormsen & K G Müller (Source: Bone Marrow Transplantation)

Bronchiolitis obliterans in children: A ghostly journey to the origin.

Allergologia et Immunopathologia — Wed, 24 Aug 2011 23:00:00 +0100

Authors: De Baets F PMID: 21872382 [PubMed - as supplied by publisher] (Source: Allergologia et Immunopathologia)

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How to Recondition Ex Vivo Initially Rejected Donor Lungs for Clinical Transplantation: Clinical Experience from Lund University Hospital

Infectious Diseases in Obstetrics and Gynecology — Wed, 24 Aug 2011 19:34:03 +0100

A major problem in clinical lung transplantation is the shortage of donor lungs. Only about 20% of donor lungs are accepted for transplantation. We have recently reported the results of the first six double lung transplantations performed with donor lungs reconditioned ex vivo that had been deemed unsuitable for transplantation by the Scandiatransplant, Eurotransplant, and UK Transplant organizations because the arterial oxygen pressure was less than 40 kPa. The three-month survival of patients undergoing transplant with these lungs was 100%. One patient died due to sepsis after 95 days, and one due to rejection after 9 months. Four recipients are still alive and well 24 months after transplantation, with no signs of bronchiolitis obliterans syndrome. The donor lungs were re...

European Surveillance of Antimicrobial Consumption (ESAC): disease-specific quality indicators for outpatient antibiotic prescribing

Quality and Safety in Health Care — Sun, 21 Aug 2011 23:00:00 +0100

Conclusion All proposed disease-specific quality indicators for outpatient antibiotic prescribing have face validity and are potentially applicable. They could be used to better describe antibiotic use and assess the quality of antibiotic prescribing patterns in ambulatory care. (Source: Quality and Safety in Health Care)

[Thoracic congenital ectopic right kidney with diaphragmatic hernia: A rare developmental anomaly.]

Archives de Pediatrie — Sun, 21 Aug 2011 23:00:00 +0100

Human Metapneumovirus

Seminars in Respiratory and Critical Care Medicine — Thu, 18 Aug 2011 23:00:00 +0100

Semin Respir Crit Care Med 2011; 32: 447-453DOI: 10.1055/s-0031-1283284ABSTRACTHuman metapneumovirus (hMPV) is a common pathogen that can cause both upper and lower respiratory tract infections, particularly in children, elderly adults, and immunocompromised hosts. Since its initial identification in 2001, hMPV has been isolated from individuals with acute respiratory tract infections (ARTIs) in virtually every continent. Serological studies indicate that it has caused human infection since 1958 or earlier. The epidemiology and clinical manifestations of hMPV are similar to those of the human respiratory syncytial virus (hRSV). HMPV has a seasonal variation: it circulates in late winter to early spring in temperate climates; late spring and summer in tropical regions. In young children, sy...

The evolving spectrum of pulmonary disease in responders to the World Trade Center tragedy

American Journal of Industrial Medicine — Wed, 17 Aug 2011 13:59:27 +0100

AbstractOn September 11, 2001, events at the World Trade Center (WTC) exposed residents of New York City to WTC dust and products of combustion and pyrolysis. The majority of WTC‐exposed fire department rescue workers experienced a substantial decline in airflow over the first 12 months post‐9/11, in addition to the normal age‐related decline that affected all responders, followed by a persistent plateau in pulmonary function in the 6 years thereafter. The spectrum of the resulting pulmonary diseases consists of chronic inflammation, characterized by airflow obstruction, and expressing itself in different ways in large and small airways. These conditions include irritant induced asthma, non‐specific chronic bronchitis, aggravated pre‐existing obstructive lung disease (asthma or C...

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Highlights from this issue

Thorax — Tue, 16 Aug 2011 23:00:00 +0100

Hot topic: ‘always, all I need is the air that I breathe to be healthy’ Pollution is clearly not a good thing under any circumstances, and if you have lung disease it is even worse. We have come a long way from the ‘London Particular’ of Bleak House, but there is a long way to go yet. Bronchiolitis Obliterans Syndrome (BOS) is the scourge of lung transplant recipients, and the commonest cause of late mortality. In this issue of the Journal, the Leuven lung transplant group modelled exposure to air traffic pollution and found that living near to a major road was an independent risk factor for BOS and death after transplantation, and also associated with greater BAL neutrophilia and IL-6 and plasma CRP levels. As was also discussed in the accompanying editorial, this ...

Every breath you take

Thorax — Tue, 16 Aug 2011 23:00:00 +0100

To paraphrase the ubiquitous warning applied to the perverse products of the tobacco industry, ‘breathing may be dangerous to your health’, in particular if you are a lung transplant recipient. This is especially true if you live near a major road in a region with high levels of traffic-related air pollution. Alone among solid organ transplants, the lung allograft is exposed to the ambient environment with every breath. Some environments are toxic, some more so, and the paper by Nawrot et al in Thorax (see page 748) presents a compelling argument that traffic air pollution is a strong component of the toxic environmental risk which has measurable and deleterious effects on pulmonary allograft function and recipient survival, accounting for 28% of deaths.1 Specifically, this lan...

The impact of traffic air pollution on bronchiolitis obliterans syndrome and mortality after lung transplantation

Thorax — Tue, 16 Aug 2011 23:00:00 +0100

Conclusion Traffic-related air pollution appears to constitute a serious risk of BOS and mortality after lung transplantation. (Source: Thorax)

Confirmation of an association between single nucleotide polymorphisms in the VDR gene with respiratory syncytial virus related disease in South African Children

Journal of Medical Virology — Thu, 11 Aug 2011 18:52:13 +0100

AbstractRespiratory syncytial virus is a leading cause of lower respiratory tract infection in infants. Disease severity has been linked to host immune responses and polymorphisms in genes associated with innate immunity. A large‐scale genetics study of single nucleotide polymorphisms (SNPs) in children in the Netherlands identified SNPs in the vitamin D receptor (VDR) and JUN genes which have a strong association with an increased risk of developing bronchiolitis following the first respiratory syncytial virus (RSV) infection. The Toll‐like receptor 4 (TLR4) gene has two SNPs which have been associated previously with RSV disease severity in various populations. The aim of this study was to determine if these SNPs may be associated with RSV disease in African children in South Africa....

Detection and genetic diversity of human metapneumovirus in hospitalized children with acute respiratory infections in India

Journal of Medical Virology — Thu, 11 Aug 2011 18:52:09 +0100

This study demonstrates that hMPV is an important contributor to acute respiratory infection in children in India, resulting in both outpatient visits and hospitalizations. J. Med. Virol. 83:1799–1810, 2011. © 2011 Wiley‐Liss, Inc. (Source: Journal of Medical Virology)

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Lack of accuracy of ventilatory indexes in predicting extubation success in children submitted to mechanical ventilation

Revista Brasileira de Terapia Intensiva — Thu, 11 Aug 2011 16:16:46 +0100

CONCLUSION: The indexes for predicting extubation success in children submitted to mechanical ventilation are not accurate; they vary widely depending on age, main disease and other clinical aspects. New formulas including clinical variables should be developed for better prediction of extubation success in children submitted to mechanical ventilation (Source: Revista Brasileira de Terapia Intensiva)

Increased protein-energy intake promotes anabolism in critically ill infants with viral bronchiolitis: a double-blind randomised controlled trial

Archives of Disease in Childhood — Wed, 10 Aug 2011 23:00:00 +0100

Conclusions Increasing protein and energy intakes promotes protein anabolism in critically ill infants in the first days after admission. Since this is an important target of nutritional support, increased protein and energy intakes should be preferred above standard intakes in these infants. Dutch Trial Register number: NTR 515. (Source: Archives of Disease in Childhood)

Late presentation of a diaphragmatic hernia

Archives of Disease in Childhood — Wed, 10 Aug 2011 23:00:00 +0100

Our male patient was born at 27 weeks gestation requiring ventilation for respiratory distress syndrome. At 4 weeks of age, necrotising enterocolitis was suspected and abdominal imaging suggested small bowel obstruction, which settled with conservative management. At 8 months of age, he had a partial right upper and middle lobe collapse during respiratory syncytial virus bronchiolitis. He also had mild constipation. Chest radiographs during recurrent presentations with chest infections persistently revealed an indeterminate anomaly in the right cardiophrenic angle for which he was awaiting tertiary respiratory review. This infant presented to our team at 16 months of age with a further episode of cough and wheeze. An anteroposterior chest radiograph (figure 1) revealed a ring-shaped opacit...

Update on living-donor lobar lung transplantation.

Current Opinion in Organ Transplantation — Tue, 09 Aug 2011 23:00:00 +0100

This article will review the current status of LDLLT. RECENT FINDINGS: As of 2011, LDLLT has been performed in approximately 400 patients worldwide. The use of LDLLT has decreased in the USA because of the recent change by the Organ Procurement and Transplantation Network to an urgency/benefit allocation system for cadaveric donor lungs. During the past several years, reports on LDLLT have been most exclusively from Japan where the average waiting time for a cadaveric lung is more than 2 years. LDLLT has been performed various lung diseases including bronchiolitis obliterans following hematopoietic stem cell transplantation. Successful LDLLTs have been reported for patients receiving oversized as well as undersized grafts. The 5-year survival after LDLLT was 74.6% in the 2008 official repo...

CD4(+)Foxp3(+)regulatory T cells induced by TGF-β, IL-2 and all-trans retinoic acid attenuate obliterative bronchiolitis in rat trachea transplantation.

International Immunopharmacology — Tue, 09 Aug 2011 23:00:00 +0100

In this study we investigated the role of Tregs in protecting OB in rat. We show that the combination of TGF-β, Interleukin (IL)-2, and all-trans retinoic acid (atRA) could induce naïve rat CD4(+)CD25(-) T cells to differentiate into CD4(+)CD25(+)Foxp3(+) T cells in vitro, and they acquired suppressive function. In a rat orthotopic tracheal transplantation OB model, the adoptive transfer of the induced Tregs reduced symptoms of airway obliteration and fibrication of grafts when compared with adoptive transfer of control cells without suppressive property. Moreover, recipients treated with the induced Tregs secreted high level of immunosuppressive cytokine TGF-β and IL-10, and low level of pro-inflammatory cytokines IL-17, IFN-γ, IL-6, and MCP-1, and had fewer effector T cells including...

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Overweight does not increase asthma risk but may decrease allergy risk at school age after infantile bronchiolitis

Acta Paediatrica — Sun, 07 Aug 2011 23:00:00 +0100

Conclusion: Previous or current overweight does not increase asthma or allergy risk but current obesity may decrease allergy risk at school age after bronchiolitis in infancy. (Source: Acta Paediatrica)

Fatal bronchiolitis obliterans complicating Stevens-Johnson syndrome following treatment with nimesulide: a case report.

Annals of Tropical Paediatrics — Sun, 07 Aug 2011 12:15:04 +0100

Authors: Dogra S, Suri D, Saini AG, Rawat A, Sodhi KS Nimesulide is a frequently used non-steroidal anti-inflammatory drug with analgesic and antipyretic effects in children. In view of fatal adverse drug reactions, however, its safety has been questioned. A 5-year-old boy developed Stevens-Johnson syndrome following use of nimesulide which was later complicated by rapidly progressive fatal bronchiolitis obliterans. PMID: 21781423 [PubMed - in process] (Source: Annals of Tropical Paediatrics)

IL10 family member genes IL19 and IL20 are associated with recurrent wheeze after respiratory syncytial virus bronchiolitis.

Pediatric Research — Mon, 01 Aug 2011 23:00:00 +0100

Authors: Ermers MJ, Janssen R, Onland-Moret NC, Hodemaekers HM, Rovers M, Houben ML, Kimpen JL, Bont LJ Mechanisms underlying the increased risk of recurrent wheeze following respiratory syncytial virus lower respiratory tract infection (RSV LRTI) are unclear. Specifically, information about genetic determinants of recurrent wheeze following RSV LRTI is limited. We performed a candidate gene association study to identify genetic determinants of recurrent wheeze following RSV LRTI. We investigated 346 single nucleotide polymorphisms (SNPs) in 220 candidate genes in 166 Dutch infants hospitalized for RSV LRTI. Logistic regression analysis was used to study associations between genotypes- and haplotypes and recurrent wheeze following RSV LRTI. We found associations with recurrent wheeze f...

A Randomized Controlled Trial of Propranolol for Infantile Hemangiomas

PEDIATRICS — Sun, 31 Jul 2011 23:00:00 +0100

CONCLUSION: Propranolol hydrochloride administered orally at 2 mg/kg per day reduced the volume, color, and elevation of focal and segmental IH in infants younger than 6 months and children up to 5 years of age. (Source: PEDIATRICS)

Circulating fibrocytes correlate with bronchiolitis obliterans syndrome development after lung transplantation: a novel clinical biomarker.

The Annals of Thoracic Surgery — Sun, 31 Jul 2011 23:00:00 +0100

Authors: Lapar DJ, Burdick MD, Emaminia A, Harris DA, Strieter BA, Liu L, Robbins M, Kron IL, Strieter RM, Lau CL Development of bronchiolitis obliterans syndrome (BOS) after lung transplantation confers increased patient morbidity and mortality. Fibrocytes are circulating bone marrow-derived mesenchymal cell progenitors that influence tissue repair and fibrosis. Fibrocytes have been implicated in chronic pulmonary inflammatory processes. We investigated the correlation of circulating fibrocyte number with BOS development in lung transplant patients. PMID: 21801908 [PubMed - in process] (Source: The Annals of Thoracic Surgery)

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A human-mouse chimeric model of obliterative bronchiolitis after lung transplantation.

The American Journal of Pathology — Sun, 31 Jul 2011 23:00:00 +0100

Authors: Xue J, Zhu X, George MP, Myerburg MM, Stoner MW, Pilewski JW, Duncan SR Obliterative bronchiolitis is a frequent, morbid, and usually refractory complication of lung transplantation. Mechanistic study of obliterative bronchiolitis would be aided by development of a relevant model that uses human immune effector cells and airway targets. Our objective was to develop a murine chimera model that mimics obliterative bronchiolitis of lung allograft recipients in human airways in vivo. Human peripheral blood mononuclear cells were adoptively transferred to immunodeficient mice lacking activity of T, B, and NK cells, with and without concurrent transplantations of human small airways dissected from allogeneic cadaveric lungs. Chimerism with human T cells occurred in the majority of r...

Bronchiolitis obliterans syndrome: the final frontier for lung transplantation.

Chest — Sun, 31 Jul 2011 23:00:00 +0100

This article highlights the body of developing research illustrating the mechanisms by which BOS is mediated, including alloimmune reactivity, the emerging roles of humoral and autoimmunity, activation of innate immune cells, and response to nonimmune-related allograft insults, such as infection and aspiration. In addition, we underscore emerging clinical implications and promising future translational research directions that have the potential to advance our knowledge and improve patient outcomes. PMID: 21813529 [PubMed - in process] (Source: Chest)

Pneumonia in the first 2 years of life, and asthma in preschool‐age children

Pediatrics International — Sun, 31 Jul 2011 23:00:00 +0100

Conclusions: Radiologically confirmed pneumonia in the first 2 years of life may be associated with asthma or asthma‐like symptoms in pre‐school children. (Source: Pediatrics International)

LDH Levels May Predict Bronchiolitis Severity

Pediatric News — Sun, 31 Jul 2011 23:00:00 +0100

Major Finding: For the entire 0- to 8,400-U/mL range, higher LDH values were associated with a lower rate of admission for 24 hours or longer. (Source: Pediatric News)

Single-lung transplantation: does side matter? [Original articles]

European Journal of Cardio-Thoracic Surgery — Thu, 28 Jul 2011 23:00:00 +0100

Conclusion: The preferred side for SLTx differed between fibrotic versus emphysema recipients. Transplant side does not influence recipient survival, freedom from BOS, complications, or pulmonary function after SLTx. Besides surgical considerations in the recipient, offer of a donor lung opposite to the preferred side should not be a reason to postpone the transplantation until a better-matched donor is found. (Source: European Journal of Cardio-Thoracic Surgery)

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Circulating Fibrocytes Correlate With Bronchiolitis Obliterans Syndrome Development After Lung Transplantation: A Novel Clinical Biomarker [ORIGINAL ARTICLES: GENERAL THORACIC]

The Annals of Thoracic Surgery — Wed, 27 Jul 2011 23:00:00 +0100

Conclusions Increased circulating fibrocyte levels correlate with the development of BOS after lung transplantation and positively correlate with advancing BOS stage. Quantification of circulating fibrocytes could serve as a novel biomarker and possible therapeutic target for BOS development in lung transplant patients. (Source: The Annals of Thoracic Surgery)

Lung Size Mismatch in Bilateral Lung Transplantation Is Associated With Allograft Function and Bronchiolitis Obliterans Syndrome.

Chest — Wed, 27 Jul 2011 23:00:00 +0100

CONCLUSIONS: A pTLC-ratio >1.0, suggestive of an oversized allograft, is associated with higher expiratory airflow capacity and a less frequent occurrence of BOS. PMID: 21799025 [PubMed - as supplied by publisher] (Source: Chest)

Thin-section Computed Tomography findings before and after azithromycin treatment of neutrophilic reversible lung allograft dysfunction

European Radiology — Wed, 27 Jul 2011 05:49:34 +0100

Conclusions Within BOS patients those with NRAD differ from azithromycin non-responders by more centrilobular abnormalities on CT before azithromycin and improvement in bronchus dilatation, consolidation and air trapping during treatment. Content Type Journal ArticlePages 1-9DOI 10.1007/s00330-011-2224-1Authors Pim A. de Jong, Department of Radiology, Katholieke Universiteit Leuven, Leuven, BelgiumRobin Vos, Lung Transplantation Unit, Katholieke Universiteit Leuven, Leuven, BelgiumGeert M. Verleden, Lung Transplantation Unit, Katholieke Universiteit Leuven, Leuven, BelgiumBart M. Vanaudenaerde, Lung Transplantation Unit, Katholieke Universiteit Leuven, Leuven, BelgiumJohny A. Verschakelen, Department of Radiology, Katholieke Universiteit Leuven, Leuven, Belgium ...

Cytomegalovirus Replication Within the Lung Allograft Is Associated With Bronchiolitis Obliterans Syndrome

American Journal of Transplantation — Tue, 26 Jul 2011 23:00:00 +0100

Early studies reported cytomegalovirus (CMV) pneumonitis as a risk factor for development of bronchiolitis obliterans syndrome (BOS) following lung transplantation. While improvements in antiviral prophylaxis have resulted in a decreased incidence of CMV pneumonitis, molecular diagnostic techniques allow diagnosis of subclinical CMV replication in the allograft. We hypothesized that this subclinical CMV replication was associated with development of BOS. We retrospectively evaluated 192 lung transplant recipients (LTR) from a single center between 2001 and 2009. Quantitative (PCR) analysis of CMV viral load and histological evidence of CMV pneumonitis and acute cellular rejection was determined on 1749 bronchoalveolar lavage (BAL) specimens and 1536 transbronchial biopsies. CMV was detecte...