Transforming growth factor-beta1 increases airway wound repair via MMP-2 upregulation: a new pathway for epithelial wound repair?

In vivo, transforming growth factor (TGF)-beta1 and matrix metalloproteinases (MMPs) present at the site of airway injury are thought to contribute to epithelial wound repair. As TGF-beta1 can modulate MMP expression and MMPs play an important role in wound repair, we hypothesized that TGF-beta1 may enhance airway epithelial repair via MMPs secreted by epithelial cells. We evaluated the in vitro influence of TGF-beta1 on wound repair in human airway epithelial cells cultured under conditions allowing differentiation. The results showed that TGF-beta1 accelerated in vitro airway wound repair, whereas MMP inhibitors prevented this acceleration. In parallel, we examined the effect of TGF-beta1 on the expression of MMP-2 and MMP-9. TGF-beta1 induced a dramatic increase of MMP-2 expression with an increased steady-state level of MMP-2 mRNA, contrasting with a slight increase in MMP-9 expression. To confirm the role of MMP-2, we subsequently evaluated the effect of MMP-2 on in vitro airway wound repair and demonstrated that the addition of MMP-2 reproduced the acceleration of wound repair induced by TGF-beta1. These results strongly suggest that TGF-beta1 increases in vitro airway wound repair via MMP-2 upregulation. It also raises the issue of a different in vivo biological role of MMP-2 and MMP-9 depending on the cytokine microenvironment.

[Analysis of nasal and exhaled nitric oxide concentration in nasal polyposis]. / Analyse des concentrations nasales et dans l'air expiré du monoxyde d'azote (NO) dans la polypose naso-sinusienne.

UNLABELLED: Nitric oxide (NO) is implicated in the pathophysiology of inflammatory airway diseases. It has been identified as a potential marker of airway inflammation. OBJECTIVE: The purpose of the study was to assess the concentrations of nasal NO in upper and lower airways in nasal polyposis patients. PATIENTS: 18 nasal polyposis patients (14 men, 4 women) and 21 control subjects (7 men, 14 women), all non asthmatic non smokers, without respiratory infections were prospectively studied. METHODS: They included nasal obstruction scoring, nasal endoscopic grading, allergy testing, nasal cytology, flow-volume spirometry and measurement of nasal (NNO) and exhaled NO (ENO) concentrations. NO was measured by a chemiluminescence NO Analyser (Sievers 280). NNO was analysed by aspiration with a constant flow of 3 l/mn. ENO was analysed during a slow expiration (50 ml/s) against a constant resistance of 10 cm H2O. RESULTS: NNO was significantly (p<0,001) decreased in NP group (596.4 +/- 102.06 ppb) compared to control group (2 251.6 +/- 288.6 ppb). ENO was significantly (p<0.05) increased in NP group (45.4 +/- 14.1 ppb) compared to control group (11.2 +/- 1.16 ppb). NNO and ENO were not significantly different between atopic and non-atopic NP patients. NNO concentrations was inversely correlated with the values of nasal endoscopic grading. No correlation was found between NNO concentrations and respectively nasal obstruction scoring and eosinophil count in nasal mucosa. CONCLUSION: Further studies are necessary to understand the pathophysiology of decreasing NNO and increasing ENO in nasal polyposis. In particular, ENO could be consider as a biologic marker of lower airway inflammation in nasal polyposis.

[Analysis of eosinophilia and ECP levels in blood and nasal secretions of 119 nasal polyposis patients]. / Analyse des taux d'éosinophiles et d'ECP dans le sang et les sécrétions nasales chez 119 patients atteints de polypose naso-sinusienne.

OBJECTIVE: The aim of this prospective study was to determine eosinophilia and ECP (Eosinophilic Cationic Protein) levels in blood and in nasal secretions of patients with nasal polyposis (NP). PATIENTS: 119 patients with NP were prospectively studied. The control group included 25 patients. METHODS: They included: questionnaire about asthma and intolerance to aspirin; nasal endosopic grading; nasal symptoms scoring; allergy testing; measurements of serum and nasal values of eosinophilia expressed as a percentage; measurements of serum and nasal values of ECP expressed in ng/ml; the Spearman correlation test, the T series and Khideux tests were used in the statistical analysis. RESULTS: In NP group, 66 were asthmatic (As) and 53 non asthmatics (NAs), 40 were atopic (ATo), and 79 were non atopic (NAto). Values of nasal eosinophilia and nasal ECP in NP patients were significantly higher (respectively 40.7+/-35.6% and 22.8+/-48.0 ng/ml) than the control group (respectively 3.0+/-14% and 2.1+/-3.6 ng/ml). Nasal and serum eosinophilia values in asthmatic patients (As) (respectively 47+/-36% and 7.6+/-6.3%) were significantly higher (p<0.05) than in non asthmatic patients (NAs) (respectively 32.6+/-33.8% and 4.6+/-3.1%). No difference was found in nasal and serum ECP values between asthmatic and non asthmatic patients. Nasal eosinophilia values were significantly correlated (p=0.02) with nasal scoring in NP patients. No correlation was found between nasal ECP and serum ECP values and clinical scoring. CONCLUSION: Nasal eosinophilia and nasal ECP values are significantly increased in NP. Nasal eosinophilia seems to be a relevant biological marker of clinical severity (association with asthma and a high clinical score) in NP patients. By contrast, nasal ECP cannot be consider as a marker of clinical severity.

Concomitant type I thyroplasty and thoracic operations for lung cancer: preventing respiratory complications associated with vagus or recurrent laryngeal nerve injury.

OBJECTIVES: We sought to prevent postoperative swallowing disorder, aspiration, and sputum retention in cases of recurrent laryngeal or vagus nerve section occurring during lung cancer resection. METHODS: In 14 of 25 consecutive patients, type I thyroplasty and thoracic operations were performed during the same period of anesthesia. All patients had a preoperative laryngeal computed tomographic scan providing us with indispensable measurements for vocal fold medialization under general anesthesia (ie, without intraoperative phonatory control). Nine remaining patients had a type I thyroplasty delayed from thoracic operations because of intraoperative doubt about laryngeal innervation injury, and 2 did not need a laryngeal operation. Main postoperative records consisted of swallowing ability, respiratory complications, and quality of voice. RESULTS: No swallowing disorder, aspiration, or sputum retention occurred in cases of concomitant laryngeal and thoracic operations. Of these 14 patients, a single case (7%) of major complication (vocal fold overmedialization) occurred and required an early and successful revision thyroplasty; one case of cervical hematoma that did not require surgical drainage was considered a minor complication (7%). Twelve (86%) patients who underwent the concomitant association of both operations were fully satisfied with their quality of voice. CONCLUSIONS: Type I thyroplasty and thoracic operation can be advantageously associated in case of injury to laryngeal motor innervation to prevent postoperative swallowing disability and dramatic respiratory complications.

[Nasal soluble levels of ICAM-1 in allergic rhinitis]. / Taux d'ICAM-1 soluble nasal dans les rhinites allergiques.

UNLABELLED: Adhesion molecules, such as intercellular adhesion molecule-1 (ICAM-1), play an important role in the development of the inflammatory allergic response in the nose. ICAM-1 expression on nasal epithelial cells during allergic reaction is regarded as a major hallmark of allergic inflammation. OBJECTIVE: The aim of the study was to evaluate the levels of soluble ICAM-1 (sICAM-1) in nasal epithelial lining fluid (ELF) in patients with allergic rhinitis. PATIENTS: Seventeen patients with perennial allergic rhinitis (age: 34,6 +/- 14,6) were screened and the results were compared with those from 11 seasonal allergic rhinitis patients (age: 25.9 +/- 7.4) and 10 non-allergic patients. METHODS: The study was performed outside the pollen season. The scores of subjective symptoms were estimated by two differents methods. First, on the basis of a visual analog scale for the symptoms including nasal obstruction, rhinorrhea, sneezing and pruritus. This score was called "Autoscore" (fullmark =40 points). Second, on the basis of a four mark scale for each symptom defined (0 =no symptom, 1 =mild, 2 =moderate, 3 =severe). This score was called "Heteroscore" (fullmark =12 points). Specimens of nasal mucosa were collected by brushing the surface of nasal cavity. Levels of sICAM-1 and sECP (soluble Eosinophilic cationic protein) were measured by specific enzyme-linked immunosorbent assay. RESULTS: The levels of sICAM-1 in ELF were significantly higher (p <0.01) in patients with perennial rhinitis compared to patients with seasonal rhinitis outside the pollen season and to non allergic patients. Levels of sICAM-1 in patients with perennial allergic rhinitis were correlated with levels of sECP (p <0.003) and with the four mark scale scores (p <0. 03) but did not correlate with the visual analog scale scores. CONCLUSIONS: sICAM-1 increased in nasal secretions during natural perennial rhinitis and could be considered as a representative hallmark for clinical severity and follow-up evaluation in perennial allergic rhinitis.

[Treatment of fractures of the orbital floor: reconstruction using Teflon sheets. Analysis of the results after 5 years]. / Le traitement des fractures du plancher de l'orbite: réfection par lame de Téflon. Analyse des résultats sur 5 ans.

We report our experience with fractures of the orbital floor over the past five years, reporting 80 cases. Different anatomic and clinical forms were defined, particularly trap-door fractures. After a clinical and computed tomography study, we recommend treatment with Teflon implants. Results obtained were analyzed and compared with other series in the literature.

[Parapharyngeal tumors. Apropos of 6 cases]. / Les tumeurs parapharyngées. A propos de 6 cas.

We conducted a retrospective study of six patients presenting a parapharyngeal tumor and an analysis of data of the literature and recall classification of these tumors and their anatomo-clinics characters, therapeutic and diagnostic problems highlighting. These tumors are rare and have various origins, their treatment is almost always surgical by cervical approach which can be undertaken only after a rigorous exploration, systematically associating computed tomography scan and magnetic resonance imaging. Transoral resection is strongly advised against as it is potentially harmful.