Longitudinal plasma cytokine concentrations and recurrent wheezing after RSV bronchiolitis.

BACKGROUND: Respiratory syncytial virus (RSV) bronchiolitis in young children has been associated with increased risk for developing recurrent wheezing, but the underlying mechanisms, are not completely defined. We hypothesized that RSV induces a disregulated immune response defined by a distinct cytokine profile in infants at increased risk for developing recurrent wheezing. METHODS: Previously healthy infants less than 12 months of age hospitalized with a first episode of RSV bronchiolitis were enrolled and blood samples and clinical and epidemiological data collected. A group of healthy non-infected controls were enrolled in parallel. Children were followed longitudinally and subsequent blood samples collected in RSV-infected infants at one month and at one year after hospital discharge to measure longitudinal plasma concentrations of IFN-γ, TNF-α, IL-2, IL-4, IL-6, IL-8, IL-10, IL-12, IL-17 and IL1-ß. Risk of post-RSV wheezing was assessed by Poisson modelling. RESULTS: From October 2008 to March 2012 we enrolled 37 infants hospitalized with RSV bronchiolitis and 9 healthy age-matched controls. Within the RSV cohort, 17 (46%) children developed recurrent wheezing within the following 12 months. Plasma cytokine profiles measured during the acute infection were similar in children who developed recurrent wheezing versus those who did not, but lower in healthy controls vs RSV infants who subsequently developed wheezing. At one month and 12 months post-acute RSV infection, infants who developed recurrent wheezing had higher IFN-γ plasma concentrations versus those with no-wheezing (p < 0.05). Moreover, IFN-γ concentrations were identified as independent predictor of post-RSV wheezing. CONCLUSIONS: Children with RSV-associated recurrent wheezing had persistently elevated plasma concentrations of IFN-γ for a year after acute infection, suggesting that this cytokine could be used as a biomarker for risk of recurrent wheezing and possibly plays a role in the pathogenesis of this condition.

Papel de la reserva cognitiva en la recuperación cognitiva de pacientes que han sufrido una adicción grave a sustancias / The role of the cognitive reserve in the cognitive recovery of patients who have suffered a severe addiction to substances

Introducción: La reserva cognitiva resulta ser una variable de pronóstico en la recuperación cognitiva tras un daño cerebral. Pocos estudios han abordado su papel en el estado cognitivo tras un período sostenido de adicción a sustancias. Objetivo: Analizar el papel modulador de la reserva cognitiva sobre la relación entre el tiempo de abstinencia y el estado cognitivo de los pacientes con adicción grave a sustancias. Pacientes y métodos: Se valora a un total de 26 pacientes en recuperación tras una adicción grave a sustancias con un protocolo de evaluación neuropsicológica y cuestionarios de reserva cognitiva. Se emplea el análisis factorial exploratorio para conformar las variables y el análisis de regresión lineal para ver las relaciones predictivas. Resultados: Se obtienen tres factores de funcionamiento cognitivo: integridad de procesamiento, control inhibitorio y memoria verbal, así como un factor global de reserva. En los modelos de regresión, sólo se encuentran relaciones predictivas en un modelo de relación directa entre la abstinencia y la memoria verbal, y en un modelo de relación independiente entre la reserva cognitiva y el tiempo de abstinencia con la memoria verbal, pero no en la relación de modulación, ni en otras relaciones en el resto de los factores. Conclusión: Se debate el papel de la reserva cognitiva como mediadora en el estado cognitivo en los pacientes en período de abstinencia tras una adicción grave a sustancias: muestra una relación con la memoria, pero no una modulación del papel del tiempo de abstinencia sobre ese estado cognitivo

Introduction: Cognitive reserve has been shown to be a prognostic variable in cognitive recovery after brain damage. Few studies have addressed its role in the cognitive status after a sustained period of substance addiction. Aim: To analyse the modulating role of cognitive reserve in the relation between withdrawal time and the cognitive status of patients with severe substance addiction. Patients and methods: A total of 26 patients recovering from severe substance addiction were assessed using a neuropsychological assessment protocol and cognitive reserve questionnaires. Exploratory factor analysis is used to define the variables and linear regression analysis is employed to view the predictive relations. Results: Three cognitive functioning factors are obtained: processing integrity, inhibitory control and verbal memory, as well as an overall reserve factor. In the regression models, predictive relations are found only in a model of a direct relation between withdrawal and verbal memory, and in a model of an independent relation between cognitive reserve and withdrawal time and verbal memory, but not in the modulation relationship or in other relations in the rest of the factors. Conclusion: The article discusses the role of the cognitive reserve as a mediator in the cognitive status of patients in a period of withdrawal after a serious addiction to substances. A relationship with memory is shown, but no modulation of the role of withdrawal time on that cognitive status is detected