β2-agonist-induced inhibition of neutrophil chemotaxis is not associated with modification of LFA-1 and Mac-1 expression or with impairment of polymorphonuclear leukocyte antibacterial activity

AbstractPatients with chronic obstructive lung disorders often show increased susceptibility to airway infections. As β2-adrenoceptor agonists, in addition to reversing the contractile response of bronchial smooth muscles, may inhibit a variety of inflammatory and immuno-effector cell functions, it is possible that these drugs interfere with host defence mechanisms.The present study was designed to test in vitro whether fenoterol, a short-acting β2-adrenoceptor agonist, could modify human blood neutrophil recruitment and antimicrobial activity.Pre-exposure to fenoterol significantly reduced neutrophil migration towards the complement component C5a, at concentrations ranging from 10−7m to 10−5m , or towards lipopolysaccharide, at a concentration of 10−5m (P<0·05, each comparison). In contrast, the drug (10−8–10−5m) did not significantly modify the increased expression of lymphocyte function-associated antigen (LFA-1, i.e. CD11a/CD18) the macrophage antigen-1 (Mac-1, i.e. CD11b/CD18) induced by N -formylmethionylleucylphenylalanine (fMLP) (P>0·05, each comparison). Finally, incubation of neutrophils with fenoterol (10−8–10−5m) did not significantly influence phagocytosis or intracellular killing of bacteria (Staphylococcus aureus) or H2O2release induced by tetradecanoyl-phorbol-acetate (P>0·1 for each comparison).These results suggest that short-acting β2-adrenoceptor agonists, such as fenoterol, are able partially to reduce neutrophil recruitment in the airways without interfering with the processes involved in phagocytic activity against bacteria

Identification of optimal assisted aspiration conditions of oocytes for use in porcine in vitro maturation: a re-evaluation of the relationship between the cumulus oocyte complex and oocyte quality

The quality of porcine oocytes for use in IVF is commonly graded according to the number of layers of cumulus cells surrounding the oocyte; together these form the cumulus oocyte complex (COC). At least three compact layers of cumulus cells is regarded as important for efficient IVP. To test this, oocytes were scored according to cumulus investment, with grade A representing COCs with three or more cumulus layers including granulosa cell-cumulus oocyte complexes, grade B those with an intact corona radiata surrounded by another layer of cumulus cells and grades C and D representing COCs with lower cumulus cell investment. These oocytes were then monitored for in vitro maturation (IVM), as assessed by tubulin immunostaining for meiotic progression, the development of a cortical granule ring, and by glutathione levels. Results indicate that grading correlates closely with nuclear maturation and cytoplasmic maturation, suggesting that grading oocytes by cumulus investment is a reliable method to predict IVM success. Importantly, Grade A and B oocytes showed no significant differences in any measure and hence using a cut-off of two or more cumulus cell layers may be optimal. We also determined the effect of assisted aspiration for oocyte retrieval, comparing the effect of needle size and applied pressure on the retrieval rate. These data indicated that both variables affected oocyte recovery rates and the quality of recovered oocytes. In combination, these experiments indicate that grade A and B oocytes have a similar developmental potential and that the recovery of oocytes of these grades is maximised by use of an 18-gauge needle and 50mmHg aspiration pressure

Occurrence of Discussion about Lung Cancer Screening Between Patients and Healthcare Providers in the USA, 2017

Computed tomography lung cancer screening reduces lung cancer mortality. However, screening is underutilized. This study assesses the extent to which providers discuss lung cancer screening with their patients, as a lack of discussion and counseling may serve as a potential cause of low utilization rates. Data from 1667 adults aged 55–80 years sampled in the 2017 Health Information National Trends Survey was utilized. A weighted multivariable logistic regression model was fit with past-year discussion about lung cancer screening with a provider as the outcome. The adjusted odds of discussion were higher for current cigarette smokers compared to non-cigarette smokers (adjusted odds ratio = 3.91; 95% confidence interval [CI], 1.75 to 8.74). Despite higher odds, the absolute prevalence was low with only 18% (95% CI, 11.8 to 24.2%) of current adult smokers reporting a past-year discussion. Knowledge of screening from trusted sources of medical information, such as doctors, can increase screening rates and may ultimately reduce lung cancer mortality

Cost-effectiveness of CT screening in the national lung screening trial

BACKGROUND: The National Lung Screening Trial (NLST) showed that screening with low-dose computed tomography (CT) as compared with chest radiography reduced lung-cancer mortality. We examined the cost-effectiveness of screening with low-dose CT in the NLST. METHODS: We estimated mean life-years, quality-adjusted life-years (QALYs), costs per person, and incremental cost-effectiveness ratios (ICERs) for three alternative strategies: screening with low-dose CT, screening with radiography, and no screening. Estimations of life-years were based on the number of observed deaths that occurred during the trial and the projected survival of persons who were alive at the end of the trial. Quality adjustments were derived from a subgroup of participants who were selected to complete quality-of-life surveys. Costs were based on utilization rates and Medicare reimbursements. We also performed analyses of subgroups defined according to age, sex, smoking history, and risk of lung cancer and performed sensitivity analyses based on several assumptions. RESULTS: As compared with no screening, screening with low-dose CT cost an additional $1,631 per person (95$52,000 per life-year gained (95% CI, 34,000 to 106,000) and $81,000 per QALY gained (95$81,000 per QALY gained, but we also determined that modest changes in our assumptions would greatly alter this figure. The determination of whether screening outside the trial will be cost-effective will depend on how screening is implemented

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

American College of Chest Physicians consensus statement on the use of topical anesthesia, analgesia, and sedation during flexible bronchoscopy in adult patients

10.1378/chest.10-3361Chest14051342-1350CHET