The role of the epithelial cell in asthma

It is done a review of the intervention of the epithelial bronchial cell in the pathophysiology of asthma. The respiratory epithelium acts as a physical barrier that separates the external environment from the pulmonary internal environment. It controls the intercellular and trans -cellular permeability and this way the accessibility of the inhaled pathogens to the antigen presenting cells involved in the immuno -inflammatory response. Epithelial cells connected by tight junctions contribute to the barrier function of the airways. They express a poliovirus receiver - related protein (PRR), toll like receptors (TLRs) and protease- -activated receptors (PARs), which recognize bacterial agents and allergens. Its dysfunction turns them into important sources of inflammatory mediators. The bidirectional interaction between the epithelium and other bronchial wall elements with inhaled particles originates a structure with its own identity, the designated EMTU - Epithelial Mesenchymal Trophic Unit. These observations support a central role for the epithelial cell in chronic inflammation and in the remodelling of the asthmatic process. Infectious diseases and environmental stress can activate different cell receptors and signalling pathways that induce changes in the cell surface modifying their response to future stimulations, namely to other infectious aggressions. The bronchial epithelium has barrier functions with selective permeability; it has metabolic activity producing cytokines and chemokines stimulating the cell's recruitment and activation, increasing the bronchial reactivity and the remodelling of the airways

Exercise and immunoinflammatory responses

O estudo da relação entre o exercício e a resposta inflamatória e imunológica tem motivado um elevado interesse, desde há vários anos. Existe uma estreita comunicação entre o sistema neuroendócrino e as células imunocompetentes através de mensageiros que vão ter uma intervenção importante nessa resposta. O exercício físico determina em geral uma imunossupressão transitória, precedida de um aumento da componente celular e humoral de intensidade e duração variáveis, dependendo da natureza do exercício e da susceptibilidade específica aos mediadores libertados. Os leucócitos totais, particularmente os neutrófilos e células natural killer mantêm-se elevados no período que se segue ao exercício intenso, enquanto os linfócitos tendem rapidamente a atingir contagens semelhantes ou inferiores aos valores pré-exercício. O exercício intenso pode favorecer um desvio do fenótipo linfocitário Th1 para o fenótipo Th2. As imunoglobulinas, particularmente a IgG, tendem a aumentar transitoriamente. As proteínas de fase aguda e as citocinas, principalmente a IL6 e TNFα, terão intervenções particularmente destacadas neste processo. A prática regular de desporto moderado induz um retorno à estabilidade basal da maioria dos parâmetros, bem como a uma protecção acrescida relativamente a agressores microbianos ambientais. Esta observação está limitada pela dificuldade em distinguir uma actividade moderada continuada de um esforço físico intenso cíclico, sendo contudo certo que os benefícios na saúde atribuídos ao exercício físico moderado estão em larga medida relacionados com as modificações que provocam no sistema inflamatório e imunológico

Surface electromyography and three/four-dimension ultrasound assessment of the pelvic floor in women with severe perineal tear

Hypothesis 3rd and 4th-degree perineal tears extend into or through the anal sphincter complex and may be associated with pelvic floor dysfunction. To date, there is scant knowledge of pelvic floor muscle (PFM) function after severe perineal tears. This study aimed to test the association between measurement with surface electromyography (sEMG) of the PFM and transperineal ultrasound of levator hiatus (LH) dimensions during maximum voluntary contraction (MVC) of the PFM in women with diagnosed 3rd and 4th-degree perineal tears. Study design, materials, and methods This was a cross-sectional study of 16 primi- and multiparous women, mean age 32.9 years (±7.8) with 3rd and 4th-degree perineal tears identified during and corrected after delivery. Both evaluations for each participant were conducted on the same day at the hospital birth clinic, an average of 16.7 months after delivery (range 4 -27). Before the assessments, women answered a questionnaire with sociodemographic and obstetric data, the ICIQ-UI-SF14, and were asked about AI symptoms. The ability to perform a correct PFM contraction was assessed by a physical therapist using vaginal palpation before sEMG and 3/4D transperineal ultrasound evaluation of LH dimensions (anteroposterior and transverse diameters; LH area) at rest and during MVC. sEMG was performed with a portable EMG biofeedback device, Physioplux Clinical, and the Periform intravaginal probe. To reduce crosstalk and ensure isolated contraction of the PFM, bipolar adhesive electrodes were unilaterally placed on the right rectus abdominal muscle and the right hip adductor muscle. Any activation of the gluteal muscles was controlled by visual observation. The 3D/4D transperineal ultrasound was performed with an empty bladder, in the dorsal lithotomy position, using the GE Voluson Expert 8 ultrasound with a 4-8 MHz curved array volume transducer, with an acquisition angle of 85 degrees. LH area, anteroposterior (AP), and transversal (TR) diameters were measured in the plane of minimal hiatal dimensions, defined as the minimal distance between the symphysis pubis and the anterior margin of the central aspect of the puborectalis muscle. Results MVC of the PFM measured through sEMG resulted in a signal amplitude of 23.3 ± 13.9 µV (peak) (range 4-50).info:eu-repo/semantics/publishedVersio

Advanced Maternal Age: Adverse Outcomes of Pregnancy, A Meta-Analysis

INTRODUCTION: The risks of pregnancy in women of advanced maternal age are not consensual amongst studies. The aim of this metaanalysis was to determine whether women of advanced maternal age (≥ 35 years old) had worse obstetrical and perinatal outcomes than non- advanced maternal age women (20 - 34 years old) in singleton, naturally-conceived pregnancies. MATERIAL AND METHODS: We searched PubMed/ MEDLINE, IndexRMP and the Cochrane Database of Systematic Reviews. Ten studies were included according to the following criteria: population of > 1000 nulliparous and/or multiparous women with singleton gestations who did not undergo any type of infertility treatment. Using Review Manager v. 5.3, two meta-analysis were performed: one comparing the outcomes of 20 - 34-year-old vs 35 - 40-year-old women, and another comparing the outcomes of 35 - 40-year-old women vs > 40-year-old women. RESULTS: Women aged 35 - 40 years old were more likely to have > 12 years of education than 20 - 34 years old and > 40 years old women. Advanced maternal age women (35 - 40 and > 40 years old) were more likely to be overweight and having gestational diabetes and gestational hypertension. They were also more likely to undergo induced labour and elective caesarean deliveries. Furthermore, they had worse perinatal outcomes such as preterm delivery, low birthweight babies, higher rates of Neonatal Intensive Care Unit admission and worse Apgar scores. Advanced maternal age women had higher rates of perinatal mortality and stillbirth. DISCUSSION: Most authors present similar results to our study. Although the majority of adverse outcomes can be explained through the physio-pathological changes regarding the female reproductive apparatus that come with aging and its inherent comorbidities, according to the existing literature advanced maternal age can be an independent risk factor per se. In older pregnant women without comorbidities such as gestational hypertension or diabetes there are still worse obstetric and perinatal outcomes, which indicate that advanced maternal age is an independent strong risk factor alone. CONCLUSION: Advanced maternal age women are at a higher risk of adverse obstetrical and perinatal outcomes. In both comparisons, worse outcomes were more prevalent in the older group, suggesting that poorer outcomes are more prevalent with increasing age.info:eu-repo/semantics/publishedVersio

A Standardized Classification for Subdural Hematomas- I

Subdural hematomas are a frequent and highly heterogeneous traumatic disorder, with significant clinical and socioeconomic consequences. In clinical and medicolegal practice, subdural hematomas are classified according to its apparent age, which significantly influences its intrinsic pathogenic behavior, forensic implications, clinical management, and outcome. Although practical, this empirical classification is somewhat arbitrary and scarcely informative, considering the remarkable heterogeneity of this entity. The current research project aims at implementing a comprehensive multifactorial classification of subdural hematomas, allowing a more standardized and coherent assessment and management of this condition. This new method of classification of subdural hematomas takes into account its intrinsic and extrinsic features, using imaging data and histopathological elements, to provide an easily apprehensible and intuitive nomenclature. The proposed classification unifies and organizes all relevant details concerning subdural hematomas, hopefully improving surgical care and forensic systematization

Cellulose-binding domains as a tool for paper recycling

Treatment of secondary paper fibres with cellulose-binding domains allows for improvements of pulp drainability and of paper mechanical properties. The interfacial system fibrewater- fibre, and after drying, fibre-air-fibre, may be affected by the CBD treatment, influencing the pulp and paper technical properties. Inverse Gas Chromatography provides experimental evidence that support this hypothesis

Elevated neopterin levels in non-allergic asthma

Neopterin is synthesized by human monocyte-derived macrophages upon stimulation with interferon-gamma (IFN-gamma). Measurement of neopterin concentration is useful to monitor cell-mediated (Th1-type) immune activation. In this study, we aimed to analyze the behaviour of neopterin in long lasting asthma considering its role as a marker of the Th1 environment and to establish the distinction between patients belonging either to the allergic or the non-allergic population, particularly in the elderly where asthma is often under diagnosed. Therefore we evaluated allergic parameters such as skin prick tests, IgE and hemogram (eosinophils count), and we compared our findings with neopterin values found in an age-matched control population. A group of individuals older than 65 was selected. It included 64 asthmatic patients (mean age 72+/-5 years) and 41 healthy individuals (mean age 79+/-7 years). In our study population, 42 patients presented positive skin tests, mainly to house dust mites. All patients were clinically stable and presented an average percentage of predicted forced expiratory volume in the first second (FEV1) of 73.6+/-25.3 and predicted median expiratory flow percentage (MEF50) of 38.8+/-26.7. Blood cell counts showed statistically different mean values of eosinophils between allergic and non-allergic controls (5.42+/-4.7% versus 2.8+/-2.8%; p2.1ng/ml) presented lower mean IgE values (IgE</=336.58IU) than those with lower neopterin values (</=2.1ng/ml) who presented mean IgE values of 402.70IU. Our initial findings may lead to a better understanding of the immunoinflammatory pathways in asthma. Further studies will probably show that serum neopterin could became a useful marker for asthma classification including in elderly patients with long lasting disease

Substance P in Long-Lasting Asthma: Immunoinflammatory pathways

Background: Substance P (SP) was described at the beginning of the 20th Century, and its biological action was recognized to have implications in neurogenic inflammation and constriction of smooth muscles. The changes associated with inflammatory chronicity can compromise organ function reversibility. The role of neuromechanisms in the pathology of the disease has been investigated in order to achieve better diagnosis and therapeutic approaches. The stimulation of human cells, such as macrophages and polymorphonuclear cells by SP leads to their activation and to the release of reactive oxygen species (ROS) by these cells. Consequently, a continuous inflammatory disability is observed, mainly if a decrease in antioxidant defence occurs. SP is a substrate for dipeptidyl peptidase IV (DPPIV), which is a multifunctional molecule with enzymatic and proinflammatory activities. CD26 is considered an activation T cell marker. The aim of the present study was to analyse if serum SP values in long-lasting asthma patients were related to lung function parameters. It was also decided to analyze the relationship of SP with superoxide dismutase (SOD) and total antioxidant activity in serum (TAS), as well as its association to CD26/DPPIV values considering their immunological and inflammatory properties. Methods/Data base: A group of individuals older than 65 years, including 64 asthmatic patients (mean age 72±5 years) and 41 healthy individuals (mean age 79±7years) was selected. Both subgroups were submitted to clinical observation, to skin prick tests (SPT) and to SP, TAS, SOD, and DPPIV determinations. T cell CD26 typing was also performed. Lung function tests were done on all patients. Results: Among the patients studied, 42 had positive skin tests, mainly to house dust mites. Asthmatic patients showed a significant increase in SP values (116.2±138.9 vs 39.5±17.9 pg/ml) when compared to controls and a significant decrease in TAS levels (.85±.13 vs .91±.10 mM) and in SOD levels (588.1±156.l vs 822.9±179.5 U/gHb). All patients were clinically stable and presented an average percentage of predict forced expiratory volume in the first second (FEV1) of 73.6±25.3 and median expiratory flow percentage of predict (MEF50) of 38.8±26.7. DPPIV values were significantly increased in asthmatics compared to controls (69.7±15.2 vs 58.6±14.3 U/L). The CD26 expression was only slightly increased in asthmatic patients (41.9±10.2 vs 39.4±11.4). Conclusion: These results confirm the role of SP in asthma and give a contribution for a better knowledge of the immunoinflammatory pathway associated with this chronic disorder. A final goal for these studies would be to achieve a better therapeutic approach in order to improve the outcome of asthmatic patients