Analysis and applications of respiratory surface EMG: report of a round table meeting.

Surface electromyography (sEMG) can be used to measure the electrical activity of the respiratory muscles. The possible applications of sEMG span from patients suffering from acute respiratory failure to patients receiving chronic home mechanical ventilation, to evaluate muscle function, titrate ventilatory support and guide treatment. However, sEMG is mainly used as a monitoring tool for research and its use in clinical practice is still limited-in part due to a lack of standardization and transparent reporting. During this round table meeting, recommendations on data acquisition, processing, interpretation, and potential clinical applications of respiratory sEMG were discussed. This paper informs the clinical researcher interested in respiratory muscle monitoring about the current state of the art on sEMG, knowledge gaps and potential future applications for patients with respiratory failure.

Importance of basophils in eosinophilic asthma: the murine counterpart.

Several experimental studies in mice showed that basophils participate in the initiation of Th2 adaptive immune response, in addition to the effector phase. However, the role of basophils in allergic airway inflammation is less clear. The aim of this experiment was to assess the importance of basophils in recruiting inflammatory cells and, in particular, eosinophils in a murine model of asthma induced by Aspergillus fumigatus allergens. Additionally, bronchial reactivity was evaluated. Basophil depletion resulted in a reduction of inflammatory cells in the airways and eosinophil recruitment was significantly impaired. Also bronchial reactivity seemed to be impaired in basophil-depleted mice, but the result was not statistically significant. According to these preliminary data, basophils seem to influence the local eosinophilic response of allergic asthma.

EMERGING AND FUTURE THERAPIES FOR ALLERGIC RHINITIS.

Allergic rhinitis (AR) is one of the most common diseases and represents a global health problem, currently affecting up to 30% of the general population, with a continuously increasing prevalence and significant comorbidities and complications. To date, the mainstay of current treatment strategies of AR includes allergen avoidance, pharmacotherapy and allergen-specific immunotherapy, as defined by Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines for both adults and children. The aim of this review is to provide an update on all emerging and future therapeutic options for the treatment of AR.

Mild hyponatremia is a common finding in children evaluated at the emergency department and it is significantly related to plasma C-reactive protein value.

AIM: During infectious diseases, mild hyponatremia is supposed to derive from a transient secretion of vasopressin mediated by non--osmotic stimuli. This study provides data supporting that mild hyponatremia during acute illnesses is related to the systemic inflammatory condition. METHODS: I retrospectively analyzed 328 consecutive children (aged 3 months to 17 years) who received blood tests at the pediatric emergency department in 2 months' period. RESULTS: hyponatremia was found in 98 patients, most of them being mildly hyponatremic. A significant trend towards lower levels of plasmatic sodium, paralleling the increase of C--reactive protein, was showed. CONCLUSION: A significant relationship between plasmatic sodium levels and C--reactive protein was found, apart from the underlying disease.

Basophils are rapidly mobilized following initial aeroallergen encounter in naïve mice and provide a priming source of IL-4 in adaptive immune responses.

Chronic aeroallergen inhalation elicits the expansion of IL-4-producing Th2 cells and the production of IgE antibodies. In sensitized subjects, who have established IgE and Th2 responses, re-exposure to allergen leads to rapid recruitment of basophils, which are thought to be important effectors of late phase allergic reactions. Several investigations of responses to parasites and injected antigens have identified an additional role for basophils as innate immune effectors during initial antigen encounter in immunologically naïve hosts. These cells constitutively express IL-4 and promote Th2 polarized adaptive responses to such antigens. Their early recruitment and modulation of cellular immune responses to natural inhaled allergens in the airways has been scarcely investigated. In this study, basophils were enumerated in lung tissue, blood and spleen from BALB/c mice in the first days after inhalation of an aqueous extract of the allergen, Aspergillus fumigatus (Af). Af inhalation induced rapid increases in basophil numbers in the lung, blood and spleen. This was Rag-1-, MyD88- and IL-3-independent. The basophils expressed abundant IL-4. Their depletion during Af sensitization resulted in an attenuated induction of both IL-4 producing Th lymphocytes and specific IgE and IgG1 responses to an inhaled protein antigen, ovalbumin, which was co-administered. Our results suggest that basophils are rapidly recruited to the airways of naïve mice following initial fungal allergen exposure, produce IL-4 and influence the development of the adaptive immune response.

Rhinosinusitis and asthma.

Chronic rhinosinusitis and asthma are not simply localized disease processes, but part of a systemic inflammatory disease affecting the respiratory tract. There is a correlation between severity of asthma and the clinical and imaging features of rhinosinusitis. It is very important to understand that in patients with chronic sinus disease, both upper and lower airways need to be evaluated and treated and that in patients with moderate or severe asthma, the sinus area should always be investigated, regardless of the presence or not of nasal symptoms. Nasal endoscopy may be considered a feasible and correct approach in asthmatic children to investigate rhinosinusal or adenoid infections, even if they do not present with any clinical sign. Thus, it becomes more and more important to perform a simple, easy and safe nasal endoscopy, in order to have a better chance to treat asthmatic children correctly by identifying a subclinical or an occult rhinosinusal infection.