Imágenes diagnósticas en el estudio del compromiso pulmonar de la discinesia ciliar primaria en niños / Chest imaging in study of primary ciliary dyskinesia in children

The diagnosis of primary ciliary dyskinesia (PCD) is complex and requires high clinical suspicion. The findings in the diagnostic images are nonspecific and can be seen in other conditions of the airway. In this review, we will describe the findings of PCD in chest radiography and computed tomography, with emphasis on some of the characteristics that differentiate it from cystic fibrosis and we will review the role of CT in the monitoring of changes of the PCD, since the CT findings correlate very well with the structural changes that occur in the course of PCD, especially bronchiectasis. However, using serial CTs should be decided on a case-by-case basis to avoid unnecessary radiation because they are pediatric patients.

El diagnóstico de la Discinesia ciliar primaria (DCP) es complejo y requiere alta sospecha clínica. Los hallazgos en la imágenes diagnósticas son inespecíficos y se pueden ver en otras afecciones de la vía aérea. En esta revisión describiremos los hallazgos de la DCP en Radiología simple y en Tomografía computada (TC), con énfasis en algunas de las características que permiten diferenciarla de la Fibrosis quística (FQ) y revisaremos el rol de la TC en la monitorización de la DCP ya que los hallazgos en la TC se correlacionan muy bien con los cambios estructurales que ocurren en el curso de la DCP, en especial las bronquiectasias. Sin embargo usar TC seriadas se debe decidir caso por caso para evitar la radiación innecesaria por ser pacientes pediátricos.

Cholesterol Depletion in Cell Membranes of Human Airway Epithelial Cells Suppresses MUC5AC Gene Expression

PURPOSE: If cholesterol in the cell membrane is depleted by treating cells with methyl-beta-cyclodextrin (MbetaCD), the activities of transmembrane receptors are altered in a cell-specific and/or receptor-specific manner. The proinflammatory cytokines, IL-1beta is potent inducers of MUC5AC mRNA and protein synthesis in human airway epithelial cells. Cells activated by IL-1beta showed increased phosphorylation of extracellular signal regulated kinase (ERK) and p38 mitogen-activated protein kinase (MAPK). Thus, we investigated the effects of cholesterol depletion on the expression of MUC5AC in human airway epithelial cells and whether these alterations to MUC5AC expression were related to MAPK activity. MATERIALS AND METHODS: After NCI-H292 cells were pretreated with 1% MbetaCD before adding IL-1beta for 24 hours, MUC5AC mRNA expression was determined by reverse transcription-polymerase chain reaction (RT-PCR) and real time-PCR. Cholesterol depletion by MbetaCD was measured by modified microenzymatic fluorescence assay and filipin staining. The phosphorylation of IL-1 receptor, ERK and p38 MAPK, was analyzed by western blot. RESULTS: Cholesterol in the cell membrane was significantly depleted by treatment with MbetaCD on cells. IL-1beta-induced MUC5AC mRNA expression was decreased by MbetaCD and this decrease occurred IL-1-receptor-specifically. Moreover, we have shown that MbetaCD suppressed the activation of ERK1/2 and p38 MAPK in cells activated with IL-1beta. This result suggests that MbetaCD-mediated suppression of IL-1beta-induced MUC5AC mRNA operated via the ERK- and p38 MAPK-dependent pathway. CONCLUSION: Cholesterol depletion in NCI-H292 cell membrane may be considered an anti-hypersecretory method since it effectively inhibits mucus secretion of respiratory epithelial cells.

[Clinical and phmetric evaluation of gastro-esophageal reflux impact on upper airways in adult]

Gastroesophageal reflux is a frequent and benign affection. It represents an etiopathological entity in otorhinolaryngology; that may occasion a large variety of ENT manifestations. To evaluate clinical and pHmetric impact of gastro esophageal reflux on upper airways in adult. Prospective study about 95 cases diagnosed and treated at the ENT department of military hospital of Tunis. Clinical features, pH metric profiles and therapeutic approach are reported and compared to the literature. The mean age was 37 years old. Sex ratio was 1.16. Pharyngolaryngeal symptoms dominated ENT manifestations [41 cases]. Laryngeal dyspnea, cough and dysphonia were predictive of danger. Positive pH metric rate collated to posterior laryngitis and pharyngitis were respectively 81.2% and 79.1%. Posterior laryngitis, dental erosion and chronic sinusitis, seem to have pejorative significance. Otorhinolaryngologist must think about asymptomatic reflux every time when chronic or recurrent ENT affection remain unexplained after complete clinical investigations. PH monitoring confirms gastroesophageal reflux disease

Comparative Quantitative and Qualitative Attributes of the Surface Respiratory Macrophages in the Domestic Duck and the Rabbit / Atributos Cualitativos, Cuantitativos y Comparativos de los Macrófagos de la Superficie Respiratoria en el Pato Doméstico y el Conejo

In mammals, surface respiratory macrophages (SM) are known to play a foremost role in protecting the respiratory system by providing first line of defense through engulfing pathogens and particulate matter respired with air. It has been reported that the pulmonary cellular defense system of domestic birds is inadequate. In particular, low number of SM and even lack of the cells in a healthy avian respiratory system have been associated with susceptibility of domestic birds to respiratory diseases. In an endeavor to resolve the existing controversy, the quantitative and qualitative attributes of the surface respiratory macrophages of the domestic duck and of the domestic rabbit were compared under similar experimental conditions. Quantitatively, the rabbit SM were on average approximately fourteen times more than the duck SM. The SM were found to have comparable diameters measuring about 12 µm in the duck and 13 µm in the rabbit. Similarly, the duck and the rabbit SM were structurally similar. Typically, they were round granular cells possessing filopodial extensions and variable electron dense bodies in the cytoplasm. The phagocytic capacity measured using polystyrene particles revealed that the duck SM had a higher phagocytic capacity than the rabbit SM. The volume density of the engulfed polystyrene particles, i.e. the volume of the particles per unit volume of the cell was estimated at 20 percent in the duck and 9 percent in the rabbit. These results suggest that the comparatively low numbers of SM in domestic birds may contribute to susceptibility of the birds to diseases. However, given the high phagocytic capacity of the avian SM, susceptibility of the domestic birds may not be due to dearth of the SM alone but some other factor (s) such as persistent exposure of the birds to particulate matter which is known to reduce robustness of the SM may be involved.

En los mamíferos, los macrófagos de la superficie respiratoria (SM) son conocidos por jugar el papel más importante en la protección del sistema respiratorio, proporcionando la primera línea de defensa en contra de agentes patógenos y envolviendo las partículas de aire respirado. Se ha informado que el sistema de defensa celular pulmonar de las aves domésticas es insuficiente. En particular, el bajo número de SM, e incluso las células del sistema respiratorio de las aves domésticas, en un ambiente sano, se ha asociado con susceptibilidad a enfermedades respiratorias. En un esfuerzo para resolver la controversia existente, los atributos cuantitativos y cualitativos de los macrófagos de la superficie respiratoria del pato doméstico y el conejo doméstico fueron comparados en las mismas condiciones experimentales. Cuantitativamente, los SM del conejo fueron en promedio aproximadamente catorce veces más que los SM en el pato. Los SM se encontraron con un diámetro comparable, al medir alrededor de 12 micras en el pato y 13 micras en el conejo. Del mismo modo, en el pato y el conejo los SM eran estructuralmente similares. Por lo general, correspondieron a células granulares con extensiones filopodiales y organismos electrodensos variables en el citoplasma. La capacidad fagocítica medida utilizando partículas de poliestireno reveló que los SM del pato tenían una mayor capacidad fagocítica que el conejo. La densidad de volumen de las partículas de poliestireno envueltas, es decir, el volumen de las partículas por unidad de volumen se estimó en 20 por ciento en el pato y 9 por ciento en el conejo. Estos resultados sugieren que el número comparativamente bajo de los SM en las aves domésticas puede contribuir a su susceptibilidad a enfermedades. Sin embargo, dada la alta capacidad fagocítica de los SM aviares, la susceptibilidad de las aves domésticas no puede deberse solamente a la escasez de SM, sino a algunos otros factores pueden estar involucrados, como la exposición persistente de las aves a partículas, las cuales se sabe reducen la robustez de los SM.

Effects of glucocorticoid on IL-13-induced Muc5ac expression in airways of mice / 华中科技大学学报（医学）（英德文版）

To study the effects of glucocorticoid on the IL-13-induced Muc5ac expression in airways of mice, and investigate its role in mucus secretion of airways, 24 pathogen-free BALB/c mice were randomly divided into 3 groups. IL-13 group received an nasal instillation of 100 microg of recombinant murine IL-13 solution on days 1, 3 and 5. In dexamethasone group, dexamethasone (0.5 mg/kg) was administered intraperitoneally 24 h before and 1 h before the first instillation of IL-13 and on 4 consecutive days (day 0 to day 5, 6 consecutive days in total), while control group was not treated with IL-13 or dexamethasone. Bronchoalveolar lavage fluid (BALF) was collected and eosinophils were counted, and expression of Muc5ac mRNA and protein in lungs were detected by reverse transcription-polymerase chain reaction (RT-PCR) technology and immunohistochemical assay respectively. Our results showed that the number of mice, with positve Muc5ac protein expression, expression of Muc5ac mRNA and eosinophils in BALF after IL-13 treatment were all significantly higher than that of control group (all P<0.01). Despite eosinophils reduced (P<0.01), the number of mice with positive Muc5ac protein expression, expression of Muc5ac mRNA afterdexamethasone treatment didn't decreas significantly as compared with that of IL-13 group. It is concluded that IL-13 can up-regulate the expression of Muc5ac mRNA and protein, which may play a pivotal role in the mucus overproduction of airways. Dexamethasone can suppress IL-13-induced eosinophilic infiltration in lung but can't inhibit the mucus overproduction.

Drug uptake from the airways and lungs.

This paper reviews the mechanisms and physiological processes that act when drugs or chemicals are administered into the lower airways and lungs. Administration is usually by aerosol. Agents can be given, for example, either to treat pulmonary diseases such as asthma, or the test for airways' responsiveness or other functions, or as a means of access of a drug to the systemic circulation. The first barrier to absorption is the airway surface liquid, including mucus. The thickness of this layer will determine the concentration of the drug in solution, and therefore its rate of entry into the tissue. The agent must then penetrate the airway epithelium, the strongest barrier for hydrophilic agents. Agents must then diffuse through the epithelial basement membrane and the interstitium. Finally, the agent may be taken up into the mucosal vasculature, and changes in blood flow will influence its uptake and distribution. If the drug is to reach a target organ, such as airway smooth muscle or glands, these barriers have first to be traversed.