How Does Preeclampsia Predispose to Future Cardiovascular Disease?

Pulmonary hypertension (PH) is a progressive lung disease characterized by elevated pressure in the lung vasculature, resulting in right-sided heart failure and premature death. The pathogenesis of PH is complex and multifactorial, involving a dysregulated autonomic nervous system and immune response. Inflammatory mechanisms have been linked to the development and progression of PH; however, these are usually restricted to systemic and/or local lung tissue. Inflammation within the CNS, often referred to as neuroinflammation involves activation of the microglia, the innate immune cells that are found specifically in the brain and spinal cord. Microglial activation results in the release of several cytokines and chemokines that trigger neuroinflammation, and has been implicated in the pathogenesis of several disease conditions such as Alzheimer’s, Parkinson’s, hypertension, atherosclerosis, and metabolic disorders. In this review, we introduce the concept of neuroinflammation in the context of PH, and discuss possible strategies that could be developed for PH therapy based on this concept.     

Does Exposure to Indoor Allergens Contribute to the Development of Asthma and Allergy?

Common indoor allergens include house dust mite, cockroach, animal dander, and certain molds. In genetically susceptible children, exposure to these indoor allergens during the critical postnatal period may lead to sensitization in early childhood. Consistent evidence indicates that children sensitized to common indoor allergens are at several-fold higher risk of asthma and allergy. Due to conflicting evidence from prospective studies, some doubt remains regarding a direct and dose–response relationship between exposure and development of asthma. However, in recent years, evidence has accumulated that exposure to indoor allergen causes asthma and allergy, but this effect may depend on dose and type of allergen as well as the underlying genetic susceptibility of the child.     

Are Complicated Forms of Celiac Disease Cryptic T-Cell Lymphomas?

We assessed the clonality of duodenal mucosal T cells in patientswith celiac disease and controls. Fifteen adult patients were studied.Four patients had a complicated celiac disease, 3 did not respond to agluten-free diet, and 2 had an ulcerative jejunitis (including 1 patient with nonresponsive celiac disease). Seven patients had anuntreated celiac disease responsive to a gluten-free diet. Histologicalexamination of duodenal biopsies of these 11 patients showedbenign-appearing celiac disease without evidence of lymphoma. Fourpatients with nonulcer dyspepsia and normal duodenal biopsies served ascontrols. TCR gene rearrangements were analyzed by multiplexpolymerase chain reaction on DNA extracted from duodenal biopsies.Major clonal rearrangements of the T-cell receptor were found in 4 cases, all with complicated celiac disease. Monoclonality was confirmedby DNA sequencing of the junctional region in 3 cases and byhybridization with clone-specific oligoprobes. Patients with celiacdisease responsive to gluten-free diet had mainly a polyclonal pattern,with 1 of them having an oligoclonal rearrangement. An oligoclonalpattern was also observed in 2 control patients. Three patients withcomplicated celiac disease evolved to T-cell lymphoma with liver (n = 2) or bone marrow (n = 1) invasion. Identical clones were found inthe enteropathic duodenojejunum and peripheral blood in the patientwith large-cell lymphoma with bone marrow invasion. This study suggeststhat complicated celiac disease is a cryptic T-cell lymphoma.     

Malignant melanoma of the lung: is it easy to determine its origin?

Malignant melanoma involving the respiratory tract is nearly always metastatic. True primary tumors are very rare, and only approximately 28 cases have been reported in the literature. Extensive clinical and histopathological examinations are needed to ascertain that the lung is the primary site. We present the case of a 67-year-old man with an apparent primary malignant melanoma of the lung in the right lower lobe. We also review the literature.     

CeliacScore 2.0: Up to date of the Score System for the Diagnosis of Celiac Disease: association with DQ?1*02 and DQ?1*0302 alleles

Introduction: Celiac disease (CD) diagnosis can be improved if a scoring system comprising clinical, nutritional, serological and histopathological elements is applied. DQb1*02 and/ or DQb1*0302 alleles can be expected to be more frequent among subjects with the highest scores. Objectives: To assess the relationship between score assigned to the patient by means of the system developed and alleles associated with CD. Methods: Scores were assigned to 69 patients (Women: 68.1%; Ages ? 60 years: 95.7%) assisted by a multidisciplinary group for management of CD, using an updated version of a previously described score system (CeliacScore 2.0) were correlated with the occurrence of DQb1*02 and/or DQb1*0302 alleles. CD was diagnosed if the assigned score was ? 10. Results: 17.4% of studied patients were diagnosed as CD. DQb1*02 and/or DQb1*0302 alleles were present in 56.5% of our cases. Scores assigned to patient′s were independent of the presence of alleles of interest (c2 = 2.3; p > 0.319). 75.0% of subjects with a score higher than 10 had the alleles of interest. The probability for the presence of DQb1*02 and/or DQb1*0302 alleles was 2.7 in patients with scores ? 10. Conclusions: The described system can be useful in the CD diagnosis. Alleles associated with CD concentrated among those with the highest scores. Scoring system's operating characteristics should be explored in further studies.     

Predictors of entry to the nursing home: Does length of follow-up matter?

This study examined the extent to which predictors of nursing home entry vary in their salience as a function of length of follow-up. Participants were 201 persons attending five senior day care centers. The impact of baseline assessment on nursing home entry was examined at one, two, and three-year follow-up periods. Analysis revealed that MMSE, IADL, physical non-aggressive agitated behavior, and 4 indicators of caregiver burden had significantly changing impacts on time to nursing home entry. Only depressed affect and age remained significant predictors at all three follow-up periods in the multivariate analysis. Physical and verbal aggressive agitation and declining caregiver health were significant predictors in the short term. Socializing and ethnicity became predictors at year three. We have demonstrated that while some predictors of nursing home placement are robust over varying follow-up times, the predictive value of others changes with length of the follow-up period. Length of follow-up needs to be taken into account in clarifying the processes that predict nursing home entry.