ABSTRACT
Asthma is a chronic inflammatory disorder of the airways. Disease presentation varies greatly in terms of cause, development, severity, and response to medication, and thus the condition has been subdivided into a number of asthma phenotypes. There is still an unmet need for the identification of phenotype-specific markers and accompanying molecular tools that facilitate the classification of asthma phenotype. To this end, we utilised a range of molecular tools to characterise a well-defined group of female adults with poorly controlled atopic asthma associated with house dust mite (HDM) allergy, relative to non-asthmatic control subjects. Circulating messenger RNA (mRNA) and microRNA (miRNA) were sequenced and quantified, and a differential expression analysis of the two RNA populations performed to determine how gene expression and regulation varied in the disease state. Further, a number of circulating proteins (IL-4, 5, 10, 13, 17 A, Eotaxin, GM-CSF, IFNy, MCP-1, TARC, TNFα, Total IgE, and Endotoxin) were quantified to determine whether the protein profiles differed significantly dependent on disease state. Finally, we utilised a previously published assessment of the circulating "blood microbiome" performed using 16S rRNA amplification and sequencing. Asthmatic subjects displayed a range of significant alterations to circulating gene expression and regulation, relative to healthy control subjects, that may influence systemic immune activity. Notably, several circulating mRNAs were detected in just the asthma group or just in the control group, and many more were observed to be expressed at significantly different levels in the asthma group compared to the control group. Proteomic analysis revealed increased levels of inflammatory proteins within the serum, and decreased levels of the bacterial endotoxin protein in the asthmatic state. Comparison of blood microbiome composition revealed a significant increase in the Firmicutes phylum with asthma that was associated with a concomitant reduction in the Proteobacteria phylum. This study provides a valuable insight into the systemic changes evident in the HDM-associated asthma, identifies a range of molecules that are present in the circulation in a condition-specific manner (with clear biomarker potential), and highlights a range of hypotheses for further study.
Subject(s)
Asthma/immunology , Hypersensitivity/immunology , Pyroglyphidae/immunology , Adult , Allergens/immunology , Animals , Case-Control Studies , Female , Humans , Immunoglobulin E/immunology , Male , Middle Aged , RNA, Messenger/geneticsSubject(s)
HIV Infections/prevention & control , Health Education , Homosexuality, Male , Peer Group , Follow-Up Studies , Humans , Male , Risk Factors , Sexual BehaviorABSTRACT
The provision of comprehensive care to patients requiring maintenance hemodialysis has developed into a complex multidisciplinary effort involving nurses at all levels. Nephrology nursing has evolved over 15 years into a model of so-called "expanded practice," i.e., one in which technical expertise and broad scientific and professional education are necessary as well as significant commitment to quality of care. This practice includes unusual responsibility for management of many aspects of patient care. Described in this paper are the specific responsibilities expected of nurses in hemodialysis, including the response to clinical problems during dialysis. Also reviewed are the more independent contributions of nurses to home and self-care dialysis. An outline of recommended educational content for nephrology nurses is included.
