Extracellular Vesicles from Airway Secretions: New Insights in Lung Diseases.

Lung diseases (LD) are one of the most common causes of death worldwide. Although it is known that chronic airway inflammation and excessive tissue repair are processes associated with LD such as asthma, chronic obstructive pulmonary disease (COPD) or idiopathic pulmonary fibrosis (IPF), their specific pathways remain unclear. Extracellular vesicles (EVs) are heterogeneous nanoscale membrane vesicles with an important role in cell-to-cell communication. EVs are present in general biofluids as plasma or urine but also in secretions of the airway as bronchoalveolar lavage fluid (BALF), induced sputum (IS), nasal lavage (NL) or pharyngeal lavage. Alterations of airway EV cargo could be crucial for understanding LD. Airway EVs have shown a role in the pathogenesis of some LD such as eosinophil increase in asthma, the promotion of lung cancer in vitro models in COPD and as biomarkers to distinguishing IPF in patients with diffuse lung diseases. In addition, they also have a promising future as therapeutics for LD. In this review, we focus on the importance of airway secretions in LD, the pivotal role of EVs from those secretions on their pathophysiology and their potential for biomarker discovery.

[Tetanus in Denmark - a forgotten but dangerous disease].

In this review of tetanus in Denmark, it is discussed, why tetanus cases continue to occur especially in elderly people, although it is a preventable disease. The phenomenon is due to a lack of primary or booster vaccination and waning immunity with age, and immediate diagnosis and treatment are crucial to prevent deadly outcome. In Denmark, booster vaccination is recommended every tenth year. Estimation of immunisation status by medical interview is unreliable, and a future solution may be the use of a tetanus quick test and focus on booster vaccination in a primary care setting.

[Environmental factors and the promotion of participation. The Perspective of medical rehabilitation]. / Umweltfaktoren und Teilhabeförderung. Die Perspektive der medizinischen Rehabilitation.

BACKGROUND: The International Classification of Functioning, Disability and Health (ICF), as well as the main goal of enabling participation, are of fundamental importance for medical rehabilitation. According to the logic of the ICF and its underlying multidimensional model of functioning and disability, the participation of a person can be influenced by modelling environmental factors. OBJECTIVES: This article presents environmental factors as defined by the ICF in the context of medical rehabilitation and aims to answer to what extent environmental factors are already involved in medical rehabilitation and if there are further environmental factors with the potential of being involved in interventions for improvement of participation. MATERIALS AND METHODS: An analysis of documents with relevance to medical rehabilitation was done. Text passages that referred to environmental factors were linked to the environmental factor codes of the ICF. RESULTS AND CONCLUSIONS: The ICF and its underlying model of functioning and disability provide a conceptual framework both for making the current usage of environmental factors apparent and for deriving and developing new intervention approaches with the involvement of environmental factors. The analysis of documents showed that environmental factor codes vary in how well they are represented in these documents. There are environmental factor codes that are barely or not at all represented, but do have potential to contribute to the improvement of participation.

Prognostic power of proadrenomedullin in community-acquired pneumonia is independent of aetiology.

Biomarkers are useful in community-acquired pneumonia (CAP). Recently, midregional (MR) proadrenomedullin (proADM) has been shown to be of potential prognostic use. We sought to determine whether this prognostic role depends on the cause of CAP. We conducted a prospective cohort study of immunocompetent patients with CAP. Pneumonia Severity Index (PSI) and CURB-65 score (confusion (abbreviated mental test score of ≤ 8), urea ≥ 7 mol · L(-1), respiratory rate ≥ 30 breaths · min(-1), blood pressure <90 mmHg systolic or <60 mmHg diastolic, and age ≥ 65 yrs), blood C-reactive protein, procalcitonin, MR-proADM, and microbiological studies were systematically performed. Patients were grouped as bacterial, viral/atypical and mixed CAP, and were followed up at 30, 90 and 180 days, and 1 yr. We recruited 228 CAP patients. Identification of at least one pathogen was achieved in 155 (68%) patients. MR-proADM levels closely correlated with increasing severity scores, and showed an important predictive power for complications and short- and long-term mortality (1 yr). Its addition to PSI and CURB-65 significantly improved their prognostic accuracy. A MR-proADM cut-off of 0.646 nmol · L(-1) identified 92% of patients scored as PSI classes IV and V as high risk. MR-proADM outcome prediction power was not affected by different aetiologies. MR-proADM has high short- and long-term prognostic accuracy, and increases the accuracy of clinical scores. The prognostic value of MR-proADM is not modified by different possible CAP aetiologies.