Treatment of airway inflammation improves exercise pulmonary gas exchange and performance in asthmatic subjects

BACKGROUND: Asthma is an inflammatory disease of the airways that can lead to impaired arterial blood oxygenation during exercise. OBJECTIVE: We asked whether treatment of airway inflammation in asthmatic subjects would improve arterial blood gases during whole-body exercise. METHODS: By using a double-blind parallel-group design, 19 asthmatic subjects completed treadmill exercise to exhaustion on 2 occasions: (1) before and (2) after 6 weeks' treatment with an inhaled corticosteroid (ICS; n = 9) or placebo (n = 10). RESULTS: The ICS group had improved resting pulmonary function, decreased exercise-induced bronchospasm, and decreased postexercise sputum histamine during the posttreatment study compared with that during the pretreatment study. In the ICS group exercise Pao(2) was significantly increased after treatment (84.8 to 93.8 mm Hg). Increased alveolar ventilation (arterial Pco(2) decreased from 36.9 to 34.1 mm Hg) accounted for 37% of the increased Pao(2) and improved gas exchange efficiency (alveolar-to-arterial Po(2) difference decreased from 22.5 to 16.3 mm Hg) accounted for the remaining 63% of the increased Pao(2) after treatment. In the ICS group exercise time to exhaustion was increased from 9.9 minutes during the pretreatment study to 14.8 minutes during the posttreatment study. CONCLUSION: Treatment of airway inflammation in asthmatic subjects can improve arterial blood oxygenation during exercise by (1) improving airway function, thereby allowing increased alveolar ventilation during exercise, and (2) improving the efficiency of alveolar-to-arterial blood O(2) exchange. CLINICAL IMPLICATIONS: In asthmatic patients ICSs not only attenuate exercise-induced bronchospasm but also improve arterial blood oxygenation during exercise.     

Role of pulsed electromagnetic fields in recalcitrant non-unions

Twenty-nine patients of recalcitrant nonunion of long bones were treated by pulsed electromagnetic fields in an attempt to bring about osteogenesis. The pulse used was rectangular, equal mark space wave in the astable, continuous mode operating at a frequency of 40 Hertz. The success rate was 82.5%. The result was not dependent on the age, sex, time of nonunion or the presence of infection. However, the results were uniformly poor when infection and fracture instability were coexistent in the same patient.     

The potential efficacy of thalidomide in the treatment of recalcitrant alopecia areata

Thalidomide has been used in the treatment of many dermatological disorders. This drug is a potent suppressor of IL-12 production which plays a critical role in the development of cellular immune responses mediated by helper T-cells. It induces a drop in helper T-cell counts and a corresponding, though relatively small, rise in suppressor T-cells. It seems that cellular, not humoral, immune mechanisms are involved in the pathogenesis of alopecia areata. Also, decreased suppressor T-cell numbers in the active disease have been reported. Therefore, it could be postulated that thalidomide, especially in combination with other agents, could be of help in the treatment of resistant cases of alopecia areata.     

哮喘家系的特应质性状遗传学分析

目的 对哮喘家系的特应质性状进行遗传分析.方法 收集哮喘家系,对所有人进行血清IgE的测定、皮肤挑刺试验和支气管激发试验.结果 ①家系内哮喘病人和正常人SPT阳性有显著差异(P<0.05).②血清总IgE增高个体SPT阳性百分数为76%,在正常个体SPT阳性百分数为53%,在两组之间有显著的差异(P<0.05).③父母双方均为SPT阳性其子女SPT的阳性率为85.7%,父亲为SPT阳性而母亲正常其子女SPT的阳性率为81.8%,父亲正常母亲为SFT阳性其子女SPT的阳性率为63.6%,父母中任一方SPT阳性与父母SPT均正常其子女SPT阳性率比较有显著差异(P<0.05).结论 哮喘家系中病人特应质更明显;血清总IgE升高与SPT阳性有相关性.父母双方特应质对其子女特应质的影响最大.     

Scytalidium dimidiatum causing recalcitrant subcutaneous lesions produces melanin

Scytalidium dimidiatum is a pigmented dematiaceous coelomycete that typically causes chronic superficial skin diseases and onychomycosis, as well as deeper infections, such as subcutaneous abscesses, mycetoma, and even fungemia in immunocompromised patients. A second species, Scytalidium hyalinum, has hyaline hyphae and arthroconidia and is considered by some authors to be an albino mutant of S. dimidiatum. This study aimed to confirm the presence of melanin or melanin-like compounds (which have been previously implicated in the virulence of other fungal pathogens) in S. dimidiatum from a patient with multiple subcutaneous nodules. Treatment of the hyphae and arthroconidia with proteolytic enzymes, denaturant, and concentrated hot acid yielded dark particles, which were stable free radicals, consistent with their identification as melanins. Extracted melanin particles from S. dimidiatum cultures were labeled by melanin-binding monoclonal antibodies (MAbs) from Sporothrix schenckii, Aspergillus fumigatus, and Cryptococcus neoformans. Lesional skin from the patient infected with S. dimidiatum contained fungal cells that were labeled by melanin-binding MAbs, and digestion of the tissue yielded dark particles that were also reactive. S. hyalinum was also subjected to the melanin extraction protocol, but no dark particles were yielded.