Modification of some markers of inflammation during treatment for acute respiratory exacerbation in cystic fibrosis

An objective approach for monitoring the treatment of acute pulmonary exacerbation in cystic fibrosis was evaluated. Eleven biochemical markers of inflammation (erythrocyte sedimentation rate, neutrophil count, C-reactive protein, alpha-1 antitrypsin, haptoglobin, ceruloplasmin, fibronectin, alpha-1 glycoprotein, alpha-2 macroglobulin, C3, granulocyte elastase and anti-Pseudomonas IgG) were measured in blood serum and plasma from 46 cystic fibrosis patients with chronic Pseudomonas aeruginosa colonization before and after treatment. The overall outcome in each patient was evaluated by means of a pondered sum of clinical, chest X-ray and lung function scores. Biochemical markers were related to the overall clinical improvement: haptoglobin, ceruloplasmin, fibronectin and alpha-1 glycoprotein showed a good sensitivity (64-70%), specificity (60-70%) and positive predictive value (86-89%). Granulocyte elastase showed a similar sensitivity (67%) and positive predictive value (85%) but a lower specificity (33%). The negative predictive value was generally poor (32-39%). Our data suggest that the combined measurement of some markers of inflammation and of conventional clinical parameters, may help in evaluating the efficacy of anti-infective treatment in cystic fibrosis.     

Breast masses: mammographic evaluation

The systematic mammographic evaluation of a breast mass involves independent assessments of its size, location, density, shape, clarity of margins, and interval change from prior examination. Additional fine-detail mammograms should be obtained to facilitate this analysis, especially when an equivocal interpretation is planned. Definitively benign masses (those localized to the skin, of fat density, or of mixed density) will not require more attention. Among the remaining water-density lesions, those that have an even slightly stellate appearance should be considered suspicious for malignancy; virtually all of them will undergo biopsy. Well-circumscribed masses should next be evaluated by aspiration or US examination to establish or exclude the diagnosis of simple benign cyst. Only solid and indeterminate lesions will require further evaluation, with the ultimate decision for biopsy versus mammographic follow-up depending on the probability of malignancy determined by the combination of mammographic and physical findings as well as pertinent data from the medical history.     

Physiology of sucking in the normal term infant using real-time US

Our study of 16 normal term, breast-fed infants documents real-time ultrasound as a technique for evaluating the oral portion of the sucking mechanism in infants. We also describe the mechanics of sucking used by the infants during breast-feeding.     

Cell activation by Toll-like receptors: role of LBP and CD14

Members of the Toll-like receptor (TLR) family have been shown to be important in the activation of cells by a variety of microbial ligands. TLRs are thought to mediate the 'recognition event' that follows an encounter between a mammalian cell and a microbial agent. In the case of the response to bacterial lipopolysaccharide (LPS), it is clear that the ability of these cell surface proteins to initiate the events necessary for activation of cells to produce cytokines is dependent upon 'accessory proteins' such as the pattern recognition protein CD14 and the lipopolysaccharide binding protein (LBP). While the role of these proteins in the LPS-specific response is defined, their role in other TLR responses has not been defined, but it is important in understanding these events and, potentially, in designing new therapeutic strategies. Here we report on the role of these proteins in the response to yeast zymosan. The requirements for this response (which unlike the response to LPS is a response to a particulate antigen) and the role of other serum proteins are defined.