Konsensuspapier der Deutschen Gesellschaft für Pneumologie und Beatmungsmedizin (DGP) und der Deutschen Gesellschaft für Kardiologie – Herz und Kreislaufforschung (DGK) zur Diagnostik und Therapie der kardialen Sarkoidose

Sarcoidosis is a multisystemic granulomatous disorder which affects the respiratory system in the majority of the cases. Cardiac manifestations are found in less than 10?% of the affected cohorts and show a large heterogeneity based on the ethnic background. Cardiac sarcoidosis is not only found in patients with rhythmogenic heart disease, such as atrial and ventricular fibrillation but also in all phenotypes of cardiomyopathy. The overall morbidity and mortality caused by cardiac sarcoidosis in Germany is unclear and no large prospective international studies have been published on this topic. This consensus paper on diagnostic and therapeutic algorithms for cardiac sarcoidosis is based on a current literature search and forms an expert opinion statement under the auspices of the German Respiratory Society and the German Cardiac Society. The rationale of this statement is to provide algorithms to facilitate clinical decision-making based on the individual case situation.     

Parathyroid Hormone Radioimmunoassay: The Clinical Evaluation of Assays Using Commercially Available Reagents

This paper reports on the diagnostic usefulness of two commercial PTH assay kits and four “in-house” assays using commercially available reagents, studying the same samples from normal controls and different patient groups. The ability of such assays to discriminate proven primary hyperparathyroid (1° HPT) patients from normals varied significantly but without any apparent correlation with assay components. For all assays, performance declined markedly in 1° HPT patient groups with lower serum calcium levels. Patients with PTH secondary to chronic renal disease were well discriminated from normal by all assays. Although immunoassays are useful in many cases of 1° HPT, it is difficult to develop C-terminal or mid-region PTH assays that are uniformly diagnostically useful in the clinical situation where they are of greatest potential use i.e. in cases of mildly hypercalcaemic 1° HPT.     

In vivo kinetics of human natural killer cells: the effects of ageing and acute and chronic viral infection

Human natural killer (NK) cells form a circulating population in a state of dynamic homeostasis. We investigated NK cell homeostasis by labelling dividing cells in vivo using deuterium-enriched glucose in young and elderly healthy subjects and patients with viral infection. Following a 24-hr intravenous infusion of 6,6-D(2)-glucose, CD3(-) CD16(+) NK cells sorted from peripheral blood mononuclear cells (PBMC) by fluorescence-activated cell sorter (FACS) were analysed for DNA deuterium content by gas chromatography mass spectrometry to yield minimum estimates for proliferation rate (p). In healthy young adults (n=5), deuterium enrichment was maximal approximately 10 days after labelling, consistent with postmitotic maturation preceding circulation. The mean (+/- standard deviation) proliferation rate was 4 x 3 +/- 2 x 4%/day (equivalent to a doubling time of 16 days) and the total production rate was 15 +/- (7 x 6) x 10(6) cells/l/day. Labelled cells disappeared from the circulation at a similar rate [6 x 9 +/- 4 x 0%/day; half-life (T((1/2))) < 10 days]. Healthy elderly subjects (n=8) had lower proliferation and production rates (P=2 x 5 +/- 1 x 0%/day and 7 x 3 +/- (3 x 7) x 10(6) cells/l/day, respectively; P=0 x 04). Similar rates were seen in patients chronically infected with human T-cell lymphotropic virus type I (HTLV-I) (P=3 x 2 +/- 1 x 9%/day). In acute infectious mononucleosis (n=5), NK cell numbers were increased but kinetics were unaffected (P=2 x 8 +/- 1 x 0%/day) a mean of 12 days after symptom onset. Human NK cells have a turnover time in blood of about 2 weeks. Proliferation rates appear to fall with ageing, remain unperturbed by chronic HTLV-I infection and normalize rapidly following acute Epstein-Barr virus infection.     

Der Pneumologe wird zur Zeitschrift für Pneumologie

Zeitschrift für Pneumologie -     

Use of parenteral nutrition in treatment of advanced regional enteritis

Eight patients with advanced regional enteritis characterized by multiple areas of involvement, previous surgery (5 of 8), and failure on medical therapy (6 of 8) were placed on total parenteral nutrition for a period of 30 days. In eight of nine courses administered, definite improvement marked by weight gain, diminished pain, decreased diarrhea, and increased serum albumin was found. However, clinical remission was transient in seven of eight successful courses, indicating that parenteral nutrition is not a definitive form of therapy. However, the results suggest that parenteral nutrition may be useful in patients with regional enteritis to a) restore nutrition, b) induce remission, and c) prepare a debilitated patient for surgery. Additional experience is required to determine the efficacy of parenteral nutrition for therapy of fistulae caused by regional enteritis.     

Is endemic political corruption hampering provision of ART and PMTCT in developing countries?

Introduction

Leadership is a key factor in the success of HIV prevention and treatment. Positive HIV-related outcomes are also affected by funding levels for HIV, health sector resources, disease burden and the socio-economic environment. Leadership on HIV as well as these other factors are affected by the quality of political governance of the country, which may be an overarching factor that influences the making of effective responses to the HIV epidemic.

Aim

The aim of the study was to investigate the association between quality of political governance, on one hand, and coverage of antiretroviral therapy (ART) and prevention of mother-to-child transmission (PMTCT), on the other, in low- to middle-income countries.

Methods

This investigation was carried out through a global review, online data sourcing and statistical analyses. We collected data on health burden and resources, the socio-economic environment, HIV prevalence, ART and PMTCT coverage and indicators of political governance. Outcome variables were coverage of ART (from 2004) and PMTCT (from 2007) to 2009 as a percentage of persons needing it. Potential predictors of treatment coverage were fitted with a baseline multilevel model for univariable and multivariable analyses.

Results

Countries with higher levels of political voice and accountability, more political stability and better control of corruption have higher levels of ART coverage but not PMTCT coverage. Control of corruption (in standard deviation units) had a strong association with ART (AOR=1.82, p=0.002) and PMTCT (AOR=1.97, p=0.01) coverage. Indicators of economic development were not significant when control of corruption was included in the multivariable regression model. Many countries in all income groups had high ART but not PMTCT coverage (e.g. Mexico, Brazil and Romania in the upper-middle-income group; Papua New Guinea and Philippines in the lower-middle-income group; and Cambodia, Laos and Comoros in the low-income group). Very few low-income countries (notably, Haiti and Kenya) had high PMTCT coverage.

Conclusions

Our research found a significant relationship between quality of political governance and treatment coverage. Measures and policies for improving the quality of political governance should be considered as a part of HIV programme implementation to more effectively improve the welfare of people living with HIV, particularly mothers living with HIV and their babies.     

Transient Absorption of Inhaled Vapors into a Multilayer Mucus–Tissue–Blood System

Previous studies have approximated the absorption of vapors into the walls of the respiratory tract as a steady state process. However, non-dimensional analysis indicates that the absorption of vapors in the conducting airways is time-dependent over the timescale of a breathing cycle. The objective of this study was to evaluate the mass transport of sample chemical species through a simple multilayer system composed of mucus, tissue, and blood components on a transient basis. Individual multilayer models were considered that represent the wall dimensions of the nasal extrathoracic (ET₂), bronchial (BB), and bronchiolar (bb) airways. Sample vapors considered were acetaldehyde and benzene, which are highly soluble and moderately soluble in mucus, respectively. To determine absorption, mass transport was calculated based on an existing analytical steady state solution, a new analytical transient solution, and a numerical transient solution. Results indicated that concentrations within the mucus and tissue layers were highly time dependent in the ET₂ and BB regions and moderately time dependent in the bb airways over the timescale of an inhalation cycle, which is approximately 1–2 s. Fluxes of vapors into the tissue and blood varied with time for approximately 6–8 s in the BB region and 0.6–0.8 s in the bb model. The associated transient blood uptake of acetaldehyde and benzene in the upper ET₂ and BB regions varied from steady state values by a factor of approximately 30 after 1 s. Under similar conditions, transient uptake in the bb model varied from steady state conditions by a factor of approximately 1.3. Surprisingly, inclusion of chemical reactions in the mucus and tissue modified the transient uptake predictions only for very large values of reaction rate coefficients (K > 100 min⁻¹). In summary, transient effects significantly impact the absorption of vapors into the walls of the upper respiratory tract (ET₂ and BB regions) and may largely diminish the effects of chemical reactions over the timescale of an inhalation cycle. Furthermore, the transient analytical solution that was developed provides the basis for an improved boundary condition in future CFD simulations of air-phase transport and wall absorption.