Suppression of heme oxygenase-1 activity reduces airway hyperresponsiveness and inflammation in a mouse model of asthma.

OBJECTIVE: Carbon monoxide (CO) levels in expired gas are higher in patients with bronchial asthma than in healthy individuals. Heme oxygenase-1 (HO-1) is a rate-limiting enzyme that catalyzes the degradation of heme to yield biliverdin, CO and free iron. Thus, HO-1 is implicated in the pathogenesis of bronchial asthma. However, whether HO-1 expression and activity in lung tissue are related to allergic airway inflammation remains unclear. We investigated whether expression of HO-1 is related to allergic airway inflammation in lungs and whether HO-1 could influence airway hyperresponsiveness and eosinophilia in mice sensitized to ovalbumin (OVA). METHODS: C57BL/6 mice immunized with OVA were challenged thrice with an aerosol of OVA every second day for 8 days. HO-1-positive cells were identified by immunostaining in lung tissue, and zinc protoporphyrin (Zn-PP), a competitive inhibitor of HO-1, was administered intraperitoneally to OVA-immunized C57BL/6 mice on day 23 (day before inhalation of OVA) and immediately before inhalation on the subsequent 4 days (total five doses). Mice were analyzed for effects of HO-1 on AHR, inflammatory cell infiltration and cytokine levels in lung tissue. Ethical approval was obtained from the concerned institutional review board. RESULTS: Number of HO-1-positive cells increased in the subepithelium of the bronchi after OVA challenge, and HO-1 localized to alveolar macrophages. Zn-PP clearly inhibited AHR, pulmonary eosinophilia and IL-5 and IL-13 expression in the lung tissue. CONCLUSION: Expression of HO-1 is induced in lung tissue during attacks of allergic bronchial asthma, and its activity likely amplifies and prolongs allergic airway inflammation.

Full mini nutritional assessment and prognosis in elderly patients with pulmonary tuberculosis.

OBJECTIVE: Malnutrition is observed frequently in elderly patients with pulmonary tuberculosis (TB). Full Mini Nutritional Assessment (full MNA) is a useful method of measuring nutrition status for elderly person. The objective of this study is to examine the relationship between full MNA and the mortality of elderly patients with pulmonary TB. METHODS: We evaluated 53 elderly patients with pulmonary TB. The nutrition risk assessment was carried out using full MNA. RESULTS: A receiver operating characteristic (ROC) curve was generated for further analysis of the prognostic value of full MNA score. The area under the curve was 0.856 (95% confidence interval [CI], 0.751-0.961). We used the maximum Youden index to obtain optimal cutoff values for full MNA score for prognostic assessment in elderly patients with pulmonary TB. For predicting the risk of mortality, the optimal cutoff value for full MNA score was 13.75. Based on this cutoff value, the Cox proportional hazard model was applied to assess the ability of full MNA score < 14 to predict the prognosis of elderly patients with pulmonary TB. Multivariate analysis identified age (hazard ratio [HR] = 1.114, 95% CI, 1.018-1.219, p = 0.019) and full MNA score < 14 (HR = 9.038, 95% CI, 1.064-76.768, p = 0.044) to be significant independent prognostic factors for survival. CONCLUSION: Severe malnutrition, as defined by full MNA score < 14, was a predictor of high mortality.

The prognostic significance of nutritional status using malnutrition universal screening tool in patients with pulmonary tuberculosis.

BACKGROUND: Malnutrition is frequently observed in patients with pulmonary tuberculosis (TB). The present study aimed to examine the relationship between nutritional status using Malnutrition Universal Screening Tool (MUST) and the mortality of patients with pulmonary TB. METHODS: Fifty-seven patients with pulmonary TB were analyzed. Nutrition assessment was carried out using MUST. The Cox proportional hazard model was applied to assess the ability of MUST to predict prognosis. Receiver operating characteristic curve analysis was used to assess MUST score as a prognostic indicator in pulmonary TB patients. To obtain optimal cut-off values for MUST score for prognostic assessment in TB patients, we used the maximum Youden Index. RESULTS: For predicting the risk of mortality, the optimal cut-off value for MUST score was 3.5. Univariate and multivariate analyses identified age and MUST score ≥ 4 as significant independent prognostic factors for survival. The patients with MUST score ≤ 3 had a median survival of 481 days (95% CI: 453 to 510) and that for the patients with MUST score ≥ 4 was 304 days (95% CI: 214 to 394); the difference was statistically significant (P = 0.001). CONCLUSION: MUST appears to be a reliable tool for nutritional risk assessment of patients with pulmonary TB. In addition, MUST may be a useful prognostic indicator of survival in patients with pulmonary TB.

Usefulness of the Malnutrition Screening Tool in patients with pulmonary tuberculosis.

OBJECTIVE: To examine the relation between the Malnutrition Screening Tool (MST) and the mortality of patients with pulmonary tuberculosis (TB). METHODS: Fifty-two patients with pulmonary TB were analyzed. Nutritional assessment was carried out using the MST. The MST incorporates three components: presence of weight loss (score 0 or 2), amount of weight lost (score 1-4), and poor food intake or poor appetite (score 0 or 1). A score ≥2 means that the patient is at risk for malnutrition. The Cox proportional hazard model was applied to assess the ability of the MST to predict prognosis. Receiver operating characteristic curve analysis was used to assess the MST score as a prognostic indicator in patients with pulmonary TB. To obtain optimal cutoff values for the MST score for the prognostic assessment in patients with TB, the maximum Youden index was used. RESULTS: For predicting the risk of mortality, the optimal cutoff value for the MST score was 2.5. Univariate and multivariate analyses identified age and a MST score ≥3 as significant independent prognostic factors for survival. The patients with a MST score <3 had a median survival of 453 d and those with a MST score ≥3 had a median survival of 242 d; the difference was statistically significant (P = 0.001). CONCLUSION: The MST appears to be a reliable tool for the nutritional risk assessment of patients with pulmonary TB. This risk assessment tool can play a valuable role in quickly identifying patients at an increased risk of death and providing adequate nutritional support.

Subjective global assessment in patients with pulmonary tuberculosis.

BACKGROUND: Malnutrition is observed frequently in patients with pulmonary tuberculosis (TB). Subjective global assessment (SGA) is a subjective method of measuring nutrition status. Few studies have investigated the prognostic role of SGA in patients with pulmonary TB. METHODS: The authors evaluated 39 patients with pulmonary TB. The SGA classification technique was performed; patients were classified as well nourished (A), moderately malnourished (B), or severely malnourished (C). RESULTS: The mean patient age was 67.7 ± 19.0 years, and the majority of patients were male (64.1% ). Twelve patients (30.1% ) were categorized as SGA class A, 14 patients (35.9% ) as class B, and 13 patients (33.3% ) as class C. The SGA-A group had a median survival of 438 days (95% confidence interval, 366-509), the median survival of the SGA-B group was 344 days (251-436), and the median survival of the SGA-C group was 118 days (37-198); these survival rates were significantly different (P < .001). CONCLUSION: SGA appears to be a useful tool for nutrition assessment of patients with pulmonary TB. In addition, SGA may be a prognostic indicator of survival in patients with pulmonary TB.

The immunomodulatory actions of prostaglandin E2 on allergic airway responses in the rat.

PGE(2) has been reported to inhibit allergen-induced airway responses in sensitized human subjects. The aim of this study was to investigate the mechanism of anti-inflammatory actions of PGE(2) in an animal model of allergic asthma. BN rats were sensitized to OVA using Bordetella pertussis as an adjuvant. One week later, an aerosol of OVA was administered. After a further week, animals were anesthetized with urethan, intubated, and subjected to measurements of pulmonary resistance (R(L)) for a period of 8 h after OVA challenge. PGE(2) (1 and 3 micro g in 100 micro l of saline) was administered by insufflation intratracheally 30 min before OVA challenge. The early response was inhibited by PGE(2) (3 micro g). The late response was inhibited by both PGE(2) (1 and 3 micro g). Bronchoalveolar lavage fluid from OVA-challenged rats showed eosinophilia and an increase in the number of cells expressing IL-4 and IL-5 mRNA. These responses were inhibited by PGE(2). Bronchoalveolar lavage fluid levels of cysteinyl-leukotrienes were elevated after OVA challenge and were reduced after PGE(2) to levels comparable with those of sham challenged animals. We conclude that PGE(2) is a potent anti-inflammatory agent that may act by reducing allergen-induced Th2 cell activation and cysteinyl-leukotriene synthesis in the rat.