Corticosteroid administration reduces the concentration of hyaluronan in bronchoalveolar lavage in a murine model of eosinophilic airway inflammation.

OBJECTIVE: To analyze the effect of corticosteroid administration on the concentration of hyaluronan (HA) in bronchoalveolar lavage (BAL) in a murine model of eosinophilic airway inflammation and to study the mechanisms involved. MATERIALS AND METHODS: Untreated-mice or mice treated with 1 µg/g/day betamethasone (Bm) or 0.25 µg/g/day(-1) budesonide (Bd) were sensitized and challenged with Dermatophagoides pteronyssinus (Dp) or saline (control group). The concentration of HA in BAL was determined by ELISA. In vitro migration assays were performed using a Boyden chamber and the expression of HA synthases (HAS) was analyzed by RT-PCR. RESULTS: We found a significant increase (P < 0.01) in the levels of HA in BAL from Dp-treated mice that was prevented by Bm or Bd. Corticosteroids also inhibited the increase in HAS expression, and the phosphorylation of Akt and ERK in the lungs of challenged mice. Finally, we found that low molecular weight HA induces the chemotaxis of BAL cells in vitro through a mechanism mediated by CD44. CONCLUSION: We conclude that corticosteroids prevent the increase in HA in BAL from Dp-challenged mice. This effect is associated with reduced expression of HAS and reduced phosphorylation of Akt and ERK in the lungs of challenged mice.

Son necesarios los normogramas autóctonos / Normograms are required autochthonous

He leído con sumo interés y un especial agrado el trabajo Comparación de las pruebas de función pulmonar en población adulta sana de la Provincia de Mendoza, Argentina, con valores de referencia internacionales (RAMR 2014;1:10-19). Felicito a los autores por la iniciativa, ya que creo que las ecuaciones locales son absolutamente necesarias. En este sentido, en 1998 publicamos los Valores Espirométricos Normales para la Ciudad de Buenos Aires (Medicina Buenos Aires 1998; 58: 141-6)

Reliability of a 25-item low-stakes multiple-choice assessment of bronchoscopic knowledge.

BACKGROUND: A need for improved patient safety, quality of care, and accountability has prompted the development of competency-based educational processes. Assessment tools related to bronchoscopy training, however, have not yet been developed or validated. PURPOSES: To determine whether 25 multiple-choice questions (MCQs) extracted from the free, Web-based Essential Bronchoscopist (EB) learning guide qualify in their original form as a preliminary pool of questions for a low-stakes assessment of bronchoscopic knowledge. MATERIALS AND METHODS: Twenty-five randomly selected MCQs from among the top 70 question-answer sets of the EB were administered to 40 self-declared novice bronchoscopists (n = 13), experienced bronchoscopists (n = 21), and expert bronchoscopists (n = 6). A difficulty index and a discrimination index (DI) were calculated for each item. Internal consistency reliability was calculated using item-total correlation and Cronbach alpha. Content validity was determined by five independent experts. Ideal test items based on a difficulty index and item-total correlation were administered to a different group of 24 bronchoscopists to prospectively reassess internal consistency reliability. RESULTS: The mean (+/- SD) score for the 40 participants was 16.47 +/- 3.72 (median score, 17; score range, 7 to 22). The mean difficulty index was 0.65 +/- 0.22, and the mean DI was 0.52 +/- 0.28. Item total-correlations ranged from - 0.01 to + 0.71. Test content was unanimously validated. The Cronbach alpha was 0.69. There was no significant correlation between scores and the number of bronchoscopies performed or self-declared expertise. Eleven ideal test MCQs were identified. The internal consistency of these items remained satisfactory (Cronbach alpha = 0.75) when assessed prospectively in a different cohort. CONCLUSION: Reliable and valid MCQs were identified to initiate a preliminary pool of questions for a low-stakes assessment of bronchoscopic knowledge.

Citoquinas inflamatorias del lavado broncoalveolar en pacientes con enfermedades pulmonares intersticiales difusas: Utilidad en estudios de investigación / Inflammatory Cytokines in the Bronchoalveolar Lavage from Patients withDiffuse Interstitial Lung Diseases: Useful Research Studies

Las Enfermedades Pulmonares Intersticiales Difusas (EPID) se caracterizan por inflamación y fibrosis. El rol del lavado broncoalveolar (LBA) en el diagnóstico delas EPID, ha sido recientemente revalorizado. El objetivo de este trabajo fue evaluar los niveles de citoquinas inflamatorias del LBA asociado a las EPID. Recolectamos LBA de 28 pacientes con EPID y 15 sujetos con pulmones sanos. Realizamos el recuento total de células del LBA y determinamos los niveles de citoquinas por ELISA. Encontramos un incremento significativo en el número total de células y en los niveles de IL-6 en el LBA de los pacientes con Neumonía Intersticial no Específica (NINE), Neumonitis por Hipersensibilidad (NH) y Sarcoidosis en comparación con el grupo control. También, observamos un significativo incremento de IL-8 en el LBA de los pacientes con Fibrosis Pulmonar Idiopática /Neumonía Intersticial Usual (FPI/NIU) comparados con el grupo control. No encontramos relación entre los niveles de citoquinas y los parámetros de función pulmonar. El LBA podría jugar un importante rol para entender los procesos inflamatorios asociados a las EPID. Cuando el LBA es utilizado en conjunto con la información clínica completa, el recuento diferencial y el patrón inflamatorio; este podría contribuir con la evaluación diagnóstica. Sin embargo, el procesamiento del LBA y el análisis de este fluido son críticos para poder aprovechar dicha información. En este estudio, evaluamos la utilización del LBA como una herramienta para comprender los patrones inflamatorios asociados con las EPID.

Interstitial Lung Diseases (ILD) are characterized by inflammation and fibrosis. The role of bronchoalveolar lavage (BAL) in the diagnosis of ILD, has been recently revalued. The aim of this work was to evaluate BAL´s inflammatory cytokines associated with ILD. We collected BAL from 28 patients with ILD and15 control subjects with healthy lungs. We counted the whole BAL cell number and determined cytokines levels by ELISA. We found a significant increase in the whole BAL cell count and IL-6 levels in patients with fibrotic non-specific interstitial pneumonia (NSPI), hypersensitivity pneumonitis (HP) and sarcoidosis in comparison with the control group. We also observed a significant increase of IL-8 in BAL from usual interstitial pneumonia/idiopathic pulmonary fibrosis (UIP/IPF) in comparison with the control group. We didn´t find relationship between cytokines levels and lung function parameters. BAL could play an important role to understand the inflammatory process associated with ILD. When BAL is used together with complete clinical information, BAL cell differential count and inflammatory patterns could contribute to the diagnostic evaluation. BAL processing and analysis of this fluid are critically important for providing useful information. In this study we evaluated the use of BAL as a research tool to understand inflammatory patterns associated with ILD.

Valores espirometricos normales para la ciudad de Buenos Aires / Normograms of spirometric values for the city of Buenos Aires

Debido a la diferencia existente entre las distintas tablas de valores teóricos espirométricos de la literatura, decidimos realizar la de la Ciudad de Buenos Aires y Gran Buenos Aires. Se realizó espirometría forzada, siguiendo las recomendaciones de la American Thoracic Society, a 237 personas (105 de sexo femenino y 132 de sexo masculino) de entre 18 y 86 años, y entre 144 y 194 centímetros de altura. Se les midió Capacidad Vital Forzada (FVC), Volumen Espiratorio Forzado en el primer segundo (FEV1), y Flujo Espiratorio Forzado entre el 25 y el 75 por ciento de la FVC(FEF25-75) en espirómetros previamente calibrados mediante el Simulador de Espirometría por Descompresión Explosiva. Se realizó Regresión Múltiple de los valores obtenidos de Función Pulmonar (FP) con la edad y la altura para cada sexo. Considerando la FP de distribución normal, se determinó el Límite Inferior Normal (LIN) calculando el intervalo de confianza a una cola con un nivel de confianza del 95 por ciento, y se consideró como LIN un porcentaje variable para cada parámetro, a cada edad, y a cada altura, eliminando así el concepto de valor porcentual fijo, utilizado ampliamente en nuestro medio.