Effect of pulmonary arteriovenous malformations on the mechanical properties of the lungs

Abstract Background Pulmonary arteriovenous malformations (PAVMs) are present in approximately 15–50% individuals with hereditary hemorrhagic telangiectasia (HHT). They may be isolated but more often are multiple. The goal of this study was to evaluate the influence of PAVMs on lung mechanical properties. Methods We reviewed the files of all adult patients (age ≥ 18 years) referred to our Center for evaluation of HHT between 2005 and 2013. The diagnosis of HHT was based on the Curacao criteria and/or the presence of a pathogenic mutation. Exclusion criteria included: chronic cardiac or lung disease (i.e. asthma or COPD), suspicion of pulmonary hypertension on echocardiography, current or past smoking (>10 pack-years), history of thoracic surgery, previous treatment of PAVMs by embolotherapy, lung infection or thromboembolic disease in the past 3 months, pregnancy and obesity (BMI > 30 kg/m2). Chest high resolution CT-scan and pulmonary function tests were performed the same day in all patients as part of our routine work-up. Results One hundred and fifty five patients with HHT were included (age: 44.4 ± 16.7 yrs – mean ± SD -; males: 39%). Eighty eight patients had no PAVM, 45 had 1–3 PAVMS and 22 had at least 4 PAVMs. Thirty eight patients had unilateral PAVMs and 29 bilateral PAVMs. We found no statistical relationship between the number, the size and the laterality of PAVMs and results of lung flows and volumes. Conclusion We found no evidence that PAVMs have a significant influence on lung mechanical properties as measured using routine pulmonary function tests in adult patients with HHT, even in case of numerous, macroscopic or bilateral malformations

How to Tackle the Diagnosis and Treatment in the Diverse Scenarios of Extrapulmonary Sarcoidosis

International audienceExtrapulmonary sarcoidosis occurs in 30-50% of cases of sarcoidosis, most often in association with pulmonary involvement, and virtually any organ can be involved. Its incidence depends according to the organs considered, clinical phenotype, and history of sarcoidosis, but also on epidemiological factors like age, sex, geographic ancestry, and socio-professional factors. The presentation, symptomatology, organ dysfunction, severity, and lethal risk vary from and to patient even at the level of the same organ. The presentation may be specific or not, and its occurrence is at variable times in the history of sarcoidosis from initial to delayed. There ar

Intermittent Hypoxia Increases the Severity of Bleomycin-Induced Lung Injury in Mice

Background. Severe obstructive sleep apnea (OSA) with chronic intermittent hypoxia (IH) is common in idiopathic pulmonary fibrosis (IPF). Here, we evaluated the impact of IH on bleomycin- (BLM-) induced pulmonary fibrosis in mice. Methods. C57BL/6J mice received intratracheal BLM or saline and were exposed to IH (40 cycles/hour; FiO2 nadir: 6%; 8 hours/day) or intermittent air (IA). In the four experimental groups, we evaluated (i) survival; (ii) alveolar inflammation, pulmonary edema, lung oxidative stress, and antioxidant enzymes; (iii) lung cell apoptosis; and (iv) pulmonary fibrosis. Results. Survival at day 21 was lower in the BLM-IH group (p<0.05). Pulmonary fibrosis was more severe at day 21 in BLM-IH mice, as assessed by lung collagen content (p=0.02) and histology. At day 4, BLM-IH mice developed a more severe neutrophilic alveolitis, (p<0.001). Lung oxidative stress was observed, and superoxide dismutase and glutathione peroxidase expression was decreased in BLM-IH mice (p<0.05 versus BLM-IA group). At day 8, pulmonary edema was observed and lung cell apoptosis was increased in the BLM-IH group. Conclusion. These results show that exposure to chronic IH increases mortality, lung inflammation, and lung fibrosis in BLM-treated mice. This study raises the question of the worsening impact of severe OSA in IPF patients

Troubles de l’humeur : quand recourir à la stimulation magnétique transcrânienne ?

International audienc

L'énergie à découvert

L'énergie est devenue une question vitale pour les sociétés, le citoyen, l'humanité tout entière. Sujet scientifique, économique, politique et écologique majeur, elle suscite des débats, parfois violents, sur les choix à faire aujourd'hui et leurs conséquences pour l'avenir des hommes et de la planète. Mais, alors que se tient le grand débat national sur la transition énergétique, comment se forger une opinion objective sans connaître les données scientifiques les plus complètes sur les potentiels et les limites de chaque source d'énergie ? Ce livre les met enfin à la disposition du public. L'énergie, qu'est-ce que c'est ? Quelles sont les grandes lois physiques qui la gouvernent ? Comment la produire, la transporter, la stocker ? Le solaire, la biomasse, l'éolien, l'hydraulique sont-ils des solutions alternatives suffisantes ? Et quelle part leur réserver à l'avenir ? Les nombreux articles de ce livre (près de 130) proposent au citoyen des outils pour se faire une opinion face à ces questions. Physiciens, chimistes, biologistes, géophysiciens, environnementalistes, géographes, économistes, y précisent, chiffres et schémas à l'appui, la place respective des énergies fossiles, du nucléaire et des énergies renouvelables. Au-delà, ils expliquent quelles sont les perspectives offertes par la science sur le mix énergétique, le problème du stockage, l'amélioration de nos usages de l'énergie, ses impacts environnementaux et sanitaires