Safety (Complications and Side Effects).

<p>Safety (Complications and Side Effects).</p

Results of patients (n = 80) with returning visits (n = 160).

<p>Results of patients (n = 80) with returning visits (n = 160).</p

Topical Nasal Anesthesia in Flexible Bronchoscopy – A Cross-Over Comparison between Two Devices

<div><p>Introduction</p><p>Topical airway anesthesia is known to improve tolerance and patient satisfaction during flexible bronchoscopy (FB). Lidocaine is commonly used, delivered as an atomized spray. The current study assesses safety and patient satisfaction for nasal anesthesia of a new atomization device during outpatient bronchoscopy in lung transplant recipients.</p><p>Methods</p><p>Using a prospective, non-blinded, cross-over design, patients enrolled between 01-10-2014 and 24-11-2014 received 2% lidocaine using the standard reusable nasal atomizer (CRNA). Those enrolled between 25-11-2014 and 30-01-2015, received a disposable intranasal mucosal atomization device (DIMAD). After each procedure, the treating physician, their assistant and the patient independently rated side-effects and satisfaction, basing their responses on visual analogue scales (VAS). At their next scheduled bronchoscopy during the study period, patients then received the alternative atomizer. Written consent was obtained prior to the first bronchoscopy, and the study approved by the institutional ethics committee.</p><p>Results</p><p>Of the 252 patients enrolled between 01-10-2014 and 30-01-2015, 80 (32%) received both atomizers. Physicians reported better efficacy (p = 0.001) and fewer side effects (p< = 0.001) for DIMAD in patients exposed to both procedures. Among patients with one visit, physicians and their assistants reported improved efficacy (p = 0.018, p = 0.002) and fewer side effects (p< = 0.001, p = 0.029) for the disposable atomizer, whereas patients reported no difference in efficacy or side effects (p = 0.72 and p = 0.20). No severe adverse events were noted. The cost of the reusable device was 4.08€ per procedure, compared to 3.70€ for the disposable device.</p><p>Discussion</p><p>Topical nasal anesthesia via a disposable intranasal mucosal atomization device (DIMAD) offers comparable safety and patient comfort, compared to conventional reusable nasal atomizers (CRNA) in lung transplant recipients. Procedural costs were reduced by 0.34€ per procedure.</p><p>Trial Registration</p><p>clinicaltrials.gov <a href="https://clinicaltrials.gov/ct2/show/NCT02237651?term=NCT02237651&rank=1" target="_blank">NCT02237651</a></p></div

Flow-chart.

<p>Flow-chart.</p

Results for patients with first visit (Primary Endpoints).

<p>Results for patients with first visit (Primary Endpoints).</p

Results.

<p>Results.</p

Demographics.

<p>Demographics.</p

Atomizer Devices.

<p>Atomizer Devices.</p

Lung anti-pneumococcal immunity is restored in chimeric Mincle KO mice reconstituted with the hematopoietic system of WT mice.

<p>Mincle KO mice received whole body irradiation (8 Gy), followed by transplantation with bone marrow cells (10⁷ cells/mouse i.v.) from either WT mice (WT onto KO, white bars), or Mincle KO mice (KO onto KO, transplantation controls, black bars). Seven weeks later, mice were infected orotracheally with 10⁷ CFU/mouse of type 19F <i>S</i>. <i>pneumoniae</i>. (A-C) Determination of BAL fluid cellular constituents (A, alveolar macrophages; B, alveolar exudate macrophages; C, alveolar recruited neutrophils) under baseline conditions (CL), or in response to infection, as indicated. (D) Analysis of Mincle expression on the cell surface of alveolar recruited neutrophils in bronchoalveolar lavage from <i>S</i>. <i>pneumoniae</i>-infected (24 h) Mincle KO mice reconstituted with WT (solid lines) or Mincle KO bone marrow cells (dashed lines). Grey histogram, isotype-stained negative control. (E,F) Determination of CFU counts in BAL fluids (E) or lung tissue (F), as indicated. (G-K) BAL fluid levels of proinflammatory cytokines TNFα (G), KC (H), IL-1β (I), or anti-inflammatory cytokines IL1ra (J), and IL-10 (K) in WT onto KO mice, or KO onto KO mice, as indicated. The data are shown as mean ± SD of n = 5 mice (A-F) or n = 4 mice (G-K) per time point and treatment group, and are representative of two experiments (Mann-Whitney U test).</p

Characterization of glycolipid Glc-DAG purified from <i>S</i>. <i>pneumoniae</i>.

<p>(A) NFAT-GFP reporter cells (4 x 10⁴ cells/well) were incubated with live <i>S</i>. <i>pneumoniae</i> at MOI 0.2, 2, 20 and 200 for 18 h followed by determination of the percentage of GFP-expressing reporter cells by flow cytometry. (B) FcRγ or Mincle+FcRγ expressing NFAT-GFP reporter cells (4 x 10⁴ cells/well) were incubated with aqueous or C:M fraction of <i>S</i>. <i>pneumoniae</i> lysates for 18 h, followed by determination of GFP-expressing reporter cells by flow cytometry. (C) HPTLC result of HPLC fractionated C:M portion of pneumococcal lysates with putative ligand indicated by an arrow head (copper acetate stain). (D) FcRγ (white bars) or Mincle + FcRγ (black bars) NFAT-GFP reporter cell assay of HPLC fractions obtained from scratched and purified HPTLC bands of <i>S</i>. <i>pneumoniae</i> lysates shown in (C). Experiments were repeated three times with similar results. See also <a href="http://www.plospathogens.org/article/info:doi/10.1371/journal.ppat.1006038#ppat.1006038.s002" target="_blank">S2 Fig</a>. (E-H) Effect of TDM (E), or <i>S</i>. <i>pneumoniae</i>-derived Glc-DAG (F), or synthetic Glc-DAG (C14:0/C14:0, (G), or C18:0/C18:0, (H)) to trigger GFP reporter activation in Mincle/FcRγ (black dots), or FcRγ only (white dots) expressing NFAT-GFP reporter cells.</p